Web-based occupational stress prevention in German micro- and small-sized enterprises - process evaluation results of an implementation study.

BACKGROUND: Structural and behavioral interventions to manage work-related stress are effective in employees. Nonetheless, they have been implemented insufficiently, particularly in micro- and small-sized enterprises (MSE). Main barriers include a lack of knowledge and limited resources, which could potentially be overcome with simplified web-based alternatives for occupational stress prevention. However, there is a lack of implementation research about web-based prevention in realistic settings of MSE. OBJECTIVE: The aim of this study is to evaluate the implementation process and success of an integrated web-based platform for occupational stress prevention ("System P") and to identify potential barriers for its uptake and use in MSE in Germany. METHODS: This study with a mixed-methods approach investigates eight process-related outcomes in a quantitative part I (adoption, reach, penetration, fidelity/dose, costs, acceptability) and a qualitative part II (acceptability, appropriateness and feasibility). Part I has a pre-post design with two measurements (6 months apart) with 98 individual participants and part II consists of 12 semi-structured interviews with managers and intercorporate stakeholders. RESULTS: Part I revealed shortcomings in the implementation process. Adoption/Reach: Despite extensive marketing efforts, less than 1% of the contacted MSE responded to the offer of System P. A total of 40 MSE registered, 24 of which, characterized by good psychosocial safety climate, adopted System P. Penetration: Within these 24 MSE, 15% of the employees used the system. Fidelity/Dose: 11 MSE started a psychosocial risk-assessment (PRA), and no MSE finished it. The stress-management training (SMT) was started by 25 users and completed by 8. COSTS: The use of System P was free of charge, but the time required to engage with was an indirect cost. Part II added insights on the perception of the web-based intervention: Acceptance of System P by users and stakeholders was good and it was assessed as appropriate for MSE. Results for feasibility were mixed. CONCLUSIONS: Although System P was generally perceived as useful and appropriate, only a small number of contacted MSE implemented it as intended. Prior experience and sensitivity for occupational (stress) prevention were mentioned as key facilitators, while (perceived) indirect costs were a key barrier. Enabling MSE to independently manage stress prevention online did not result in successful implementation. Increasing external support could be a solution. ⁺ FULL PROJECT NAME: "PragmatiKK - Pragmatische Lösungen für die Implementation von Maßnahmen zur Stressprävention in Kleinst- und Kleinbetrieben" (= Pragmatic solutions for the implementation of stress prevention interventions in micro and small-sized enterprises). TRIAL REGISTRATION: German Register of Clinical Studies (DRKS) DRKS00026154, date of registration 2021-09-16.

[The Relationship of Work Stress and Somatic Symptoms Among Early Childhood Professionals During the COVID-19 Pandemic]. / Der Zusammenhang von gesundheitskritischen Arbeitsbelastungen und somatischen Symptomen bei frühpädagogischen Fachkräften in der Kindertagesbetreuung während der COVID-19-Pandemie.

The COVID-19 pandemic has changed the world of work. Due to additional occupational health and safety measures early childhood professionals were faced with an increased workload, which may lead to an increased risk for their individual health. The aim of this cross-sectional study was to obtain updated prevalences of psychosocial work stress (effort-reward imbalance, ERI), overcommitment as well as somatic symptoms and their association during the COVID-19 pandemic. Early childhood professionals from a large city in North Rhine-Westphalia (N=1009) participated in the survey between June 2020 and May 2021. The Effort-Reward Imbalance at work questionnaire (16 items version) was used to assess work stress, and the Patient Health Questionnaire (PHQ-15) was used to assess somatic symptoms. A multiple logistic regression tested the association between work stress and somatic health. In total, 72.3% of the sample showed an effort-reward imbalance, 25.0% showed a high overcommitment. The overall prevalence of somatization at a moderate to high level was 45.2%. Effort-reward imbalance and high overcommitment increased the odds of severe symptom presence by a factor of 4.12 and 5.20, respectively. This study shows the high number of effort-reward imbalances, the high overcommitment and the above-average prevalence of somatic complaints among early childhood professionals during the COVID-19 pandemic. In view of these high prevalences and their relationships, there is still a strong need for action and research to reduce work-related stress in this occupational group as well as to investigate the persistence of and the management of somatic symptoms in order to develop long-term preventive measures.

Facilitating stress prevention in micro and small-sized enterprises: protocol for a mixed method study to evaluate the effectiveness and implementation process of targeted web-based interventions.

BACKGROUND: Workplace-related stress is a major risk factor for mental and physical health problems and related sickness absence and productivity loss. Despite evidence regarding the effectiveness of different workplace-based interventions, the implementation of stress prevention interventions is rare, especially in micro and small-sized enterprises (MSE) with fewer than 50 employees. The joint research project "PragmatiKK"+ aims to identify and address the specific barriers to the implementation of stress prevention interventions in MSE. This study protocol describes a mixed method study design to evaluate the effectiveness of adapted stress prevention interventions and the implementation process via an integrated web-based platform ("System P") specifically targeted at MSE. METHODS: First, we develop a web-based intervention, which accounts for the specific working conditions in MSE and addresses stress prevention at a structural and behavioral level. Second, we use common methods of implementation research to perform an effect and process evaluation. We analyze the effectiveness of the web-based stress prevention interventions by comparing depressive symptoms at baseline and follow-up (after 6 months and 12 months). Indicators for a successful implementation process include acceptability, adoption, feasibility, reach, dose, and fidelity, which we will measure with quantitative web-based questionnaires and qualitative interviews. We will also analyze the accumulated usage data from the web-based platform. DISCUSSION: Collecting data on the implementation process and the effectiveness of a web-based intervention will help to identify and overcome common barriers to stress prevention in MSE. This can improve the mental health of employees in MSE, which constitute more than 90% of all enterprises in Germany. + Full Project Name: "PragmatiKK - Pragmatische Lösungen für die Implementation von Maßnahmen zur Stressprävention in Kleinst- und Kleinbetrieben "(= Pragmatic solutions for the implementation of stress prevention interventions in micro and small-sized enterprises). TRIAL REGISTRATION: German Register of Clinical Studies (DRKS): DRKS00026154 , date of registration: 2021-09-16.

Description and application of a method to quantify criterion-related cut-off values for questionnaire-based psychosocial risk assessment.

PURPOSE: The psychosocial risk assessment is a systematic intervention process for organizations that aims at improving psychosocial working conditions as well as employee health. Based on a screening of working conditions, interventions to reduce risk factors are implemented and evaluated. What is missing for most screening instruments however are cut-off values to categorize working conditions into uncritical vs. critical, whereas the latter indicates an elevated risk for illness. To estimate and evaluate cut-off values, two studies were conducted using the receiver operating characteristic (ROC) analysis. METHODS: In Study 1, a sample of 229 participants answered an online survey on depression (PHQ) and psychosocial working conditions using a questionnaire (DYNAMIK) that covers five factors important to workers' health: workload, boundary permeability, participation, leader support, and usability. Using the ROC analysis, criterion-related cut-off values were generated to predict depressive symptoms. In Study 2, these cut-off values were used to classify working conditions in the two categories of 'critical' and 'uncritical' in an independent sample (N = 295). It was tested for differences in the results of the two groups concerning the direct criterion of depressive symptoms and the indirect criterion of effort-reward imbalance. RESULTS: In Study 1, cut-off values differed between the five scales and showed different values for sensitivity and specificity. In Study 2, participants exposed to critical working conditions reported more depressive symptoms as well as an effort-reward imbalance. CONCLUSIONS: Cut-off values are useful to identify working conditions as either critical or uncritical. This knowledge is important when deciding which working conditions should be optimized within the context of psychosocial risk assessment.

Barriers and drivers of psychosocial risk assessments in German micro and small-sized enterprises: a qualitative study with owners and managers.

BACKGROUND: The negative effect of unfavorable working conditions and long-term work stress on health has been demonstrated in previous research. To address these challenges, systematic approaches such as psychosocial risk assessments (PRA) have been developed in many countries worldwide. Despite legal obligations, psychosocial risk assessments are rarely carried out in micro and small-sized enterprises (MSE). Even though those enterprises constitute a large proportion of the general workforce, this area remains largely untouched by research. In order to enable starting points for a greater dissemination in organizational practice, the present study explores barriers and drivers of psychosocial risk assessments in micro and small-sized enterprises. METHODS: A total of 18 owners and managers from 15 micro and small-sized enterprises in North-Rhine Westphalia, Germany, were interviewed. The interviews were audio-recorded, transcribed, and analyzed. A qualitative approach was applied: Content analysis was used to analyze the data, using deductive as well as inductive coding techniques. RESULTS: The following barriers emerged from the interviews: Negative PRA image, stigmatization of mental health, lacking acceptance of employees, fear of excessive authority interference, ignorance of PRA, not understanding the necessity, inappropriate approach, and limited resources. The identified drivers were: Easy access to PRA material, external support from experts, renaming the term "workplace risk assessment", understanding content and benefit of PRA, simplify and revise PRA process, and noticeable consequences of PRA execution and non-execution. The results are comparable with those in larger companies. They emphasize the importance of mental health education, improving the process of psychosocial risk assessments, and the ongoing support in overcoming limited financial as well as human resources. CONCLUSIONS: To improve implementation of PRA in organizational practice, a simplification of the process is proposed, accompanied by information campaigns and an improvement in the health literacy of owners and managers of MSE. In view of the results, the full revision of the PRA approach should also be considered.

Athlete Characteristics and Team Competitive Performance as Moderators for the Relationship Between Coach Transformational Leadership and Athlete Performance.

The goal of this study is to examine the effects of coaches' transformational leadership on player performance. To advance existing research, we examine (a) effects on individual and team performance and (b) consider joint moderating effects of players' win orientation and teams' competitive performance on the leadership- individual performance link. In a three-source sample from German handball teams, we collected data on 336 players and 30 coaches and teams. Results showed positive main effects of transformational leadership's facet of articulating a vision (AV) on team and individual performance and negative main effects of providing an appropriate model (PAM) on team performance. With regard to moderating effects, AV increased and PAM decreased individual performance when both moderators were low, and intellectual stimulation had a positive effect when both were high. This study expands insights into the potential and limitation of transformational leadership with a strong focus on the role of situational contingencies.

The Mediating Role of Fear of COVID-19 in the Association between COVID-19-Related Work Stressors and Subjective Well-being: Path Analysis by Cross-sectional Evidence in the Child Care Sector across Three Samples.

OBJECTIVE: COVID-19 has changed work conditions and instilled fear. However, research overlooked the contributing factors to fear of COVID-19 and its impact on well-being. We addressed this research gap and focused on the essential workforce of child care. METHODS: Three samples of early childhood professionals (ECPs) ( NT1 = 423, NT2 = 142, NT3 = 584) were gathered in Germany between June 2020 and May 2021. We tested via path analysis whether (1) fear of COVID-19 relates to well-being, (2) COVID-19-related work stressors relate to fear of COVID-19, and (3) fear of COVID-19 mediates the relationship of work stressors and well-being. RESULTS: Findings of N T1 and N T3 lent support, while results of N T2 differed. CONCLUSIONS: This study underlines the importance of adapting the work conditions during pandemics to reduce the fear of infection and thus preserve ECPs' well-being.

Improving Well-Being and Fostering Health-Oriented Leadership among Leaders in Small and Medium-Sized Enterprises (SMEs): A Systematic Review.

Leaders of small and medium-sized enterprises (SMEs) are often confronted with specific burdens, which frequently result in increased levels of stress. Leadership behaviour, in turn, has a significant impact on employees' health and performance. Using the Population, Intervention, Comparison, Outcome (PICO) method, we conducted a systematic literature search covering publications from 2002 to 2023 using PubMed, PsycInfo and Business Source Premier on stress-reducing and well-being-improving interventions for SME leaders. The Effective Public Health Practice Project (EPHPP) Quality Assessment Tool was used to assess the methodological quality and risk of bias of the included studies regarding selection bias, study design, confounders, blinding, data collection, withdrawal and drop-out. Of the 3150 identified publications, 6 were included after screening. The studies varied in content (cognitive behavioural therapy [CBT]-based, psychoeducation, and mixed interventions) and approach (individual- and organisation-centred). Not all of the examined interventions provided significant outcomes. However, CBT-based and individualised approaches showed a positive trend in reducing SME leaders' psychosocial stress and improving their well-being. Despite the limited data, it can be concluded that such interventions are beneficial for leaders and their specific needs. Future research should focus on tailored approaches, derived from well-founded theories and integrative interventions addressing SME leaders.

The Impact of the Implementation of Preventive Measures Due to COVID-19 on Work Design and Early Childhood Professionals' Well-Being-A Qualitative Study.

The reopening of child-care programs during COVID-19 demanded comprehensive preventive measures. Research to date has overlooked this reopening process as well as early childhood professionals' (ECPs) implementation efforts and resulting changes in their work practices and well-being. As a result, this study sought insights into (1) the practical implementation of measures, (2) perceptions and evaluations of measures, (3) changes in work characteristics, and (4) its impact on well-being. Qualitative interviews were conducted with German child-care managers (N = 27) between June and August 2020. The semi-structured interviews were audio-recorded, transcribed, and content-analyzed using MAXQDA. ECPs, through a combination of high effort and engagement, ensured the feasibility of most preventive measures. This included practices which were perceived to be unreasonable or ones which were stricter than practices required for the public. This exacerbated the critical work characteristics (e.g., high workload, overtime, and multitasking) from pre-pandemic scenarios and led to new work demands (e.g., changes in work content and social interactions). ECPs maintained intensive work demands and consequently suffered from broad strain outcomes (e.g., worry, exhaustion, anger, fear of infection, and reduced psychological sense of community). This study highlights the adverse psychosocial work environment of ECPs despite the necessity of ensuring health and safety at work.

Presentation of a participatory approach to develop preventive measures to reduce COVID-19 transmission in child care.

BACKGROUND: It can be suspected that work in child care facilities is associated with an elevated exposure risk towards SARS-CoV-2 infections. It is still unclear under which conditions employees in those facilities can safely pursue their work. Preventive workplace-related measures to reduce transmission dynamics in this work environment need to be developed. These measures need to build on a solid scientific foundation and be ready for practical use at the same time. Therefore, the aim of the study is to present a participatory approach to identify, minimize, and eliminate workplace-specific COVID-19 transmission within child care. The approach presented combines quantitative as well as qualitative elements and includes a screening of critical workplace conditions and the development of preventive measures to foster a safe workplace design. METHODS: First, 428 employees of different child care facilities in a large German city reported their subjective risk of infection, fear of infection, and support received by the employer. Second, the participants commented in detail about high risk conditions during work. Third, employees provided suggestions for preventive measures. We conducted a qualitative analysis of free text answers to evaluate which aspects are perceived as critical from an employee perspective. RESULTS: Participants provided valuable and practicable ideas on how to design and improve preventive measures to reduce COVID-19 transmission in child care dealing with structural conditions, the interaction with the parents, the implementation of preventive measures and recommendations for policy makers. CONCLUSIONS: These new insights help to organize pandemic risk management in order to align theoretical based measures with the practical realization. We encourage researchers to adapt the approach presented to other work areas in order to foster participation of employees in work design to reduce COVID-19 transmission.

A three-wave longitudinal study on the relation between commuting strain and somatic symptoms in university students: exploring the role of learning-family conflicts.

BACKGROUND: We examine the role of learning-family conflicts for the relation between commuting strain and health in a sample of medical university students. The first goal of the study was to investigate the mediating role of learning-family conflicts. The second goal was to extend the temporal view on relations between study variables. Therefore, we differentiated long-term systematic change among variables over a period of two-years from a dynamic perspective with repeated commuting events on the individual level of analyses. METHODS: We applied a multilevel research design and collected survey data from 128 medical students on three points in time (N = 339 measurement points). Participants informed about commuting strain, learning-family conflicts, somatic symptoms, as well as commuting distance and time. RESULTS: Bayesian multilevel analyses showed that results differed with regard to level of analysis: while learning-family conflicts mediated the relation between commuting strain and somatic symptoms on a systematic aggregation-level perspective of analysis (indirect effect estimatebetween = 0.13, SE = .05, 95% CI [0.05; ∞), Evidence Ratio = 250.57), this was not the case on the dynamic event perspective (indirect effect estimatewithin = 0.00, SE = 0.00, 95% CI [- 0.01; ∞), Evidence Ratio = 0.84). CONCLUSIONS: We demonstrated that learning-family conflicts explain why commuting may have unfavorable effects on health for medical students. We also showed that it is the long-term commuting experience that is related to health complaints and not the single commuting event. This means that short-term deviations from general levels of commuting strain do not cause somatic symptoms, but general high levels of commuting strain do instead.

Development and Validation of a Questionnaire to Measure Psychosocial Work Stressors in Modern Working Environments.

OBJECTIVE: The rapid development of technology is changing working conditions of many employees. With this, appropriate measurement instruments to capture work-related psychosocial risks to create healthy working conditions are becoming more and more important. Therefore, we developed and validated a questionnaire to assess stressors in work settings which are characterized by a high degree of digitization. METHOD: The validation was based on two independent studies with data collected in four subsamples. All participants were asked about their working conditions and health-related topics using online questionnaires. RESULTS: The resulting 16-item questionnaire consists of five scales: work load, boundary permeability, participation, leader support, and usability. CONCLUSIONS: The results show that the five identified stressors showed acceptable to good values with regard to reliability (internal consistencies, test-retest reliabilities, and interrater agreement) as well as (convergent and concurrent) validity.