Acceptance of an Internet-Based Team Development Tool Aimed at Improving Work-Related Well-being in Nurses: Cross-sectional Study.

BACKGROUND: Workplace health interventions can produce beneficial health- and business-related outcomes. However, such interventions have traditionally focused on lifestyle behaviors of individuals, mostly not considering the role of working conditions. The wecoach intervention is an internet-based tool that combines both a digital and a participatory team development approach aimed at addressing critical job demands and resources as key aspects of health-promoting working conditions. Nursing staff are particularly affected by challenging working conditions and could potentially benefit greatly. Understanding the acceptance of novel workplace health promotion approaches is a critical precursor to their successful implementation and use. OBJECTIVE: This study aims to examine the factors influencing the acceptance of a digitally supported team development tool among nurse managers. METHODS: A sample of 32 nurse managers from 3 German-speaking countries tested wecoach and completed our online questionnaire. Hypotheses were based on the unified theory of acceptance and use of technology (UTAUT) and the organizational health development (OHD) model and were tested using multiple regression analyses. RESULTS: Our analyses found that merely capacities on the team level (CapTeam) significantly contributed to the acceptance of wecoach, although only after the other variables were excluded in the stepwise multiple regression analysis. The UTAUT predictors were unable to add significant variance explanation beyond that, and their inclusion masked the contribution of CapTeam. CONCLUSIONS: For the acceptance of a digitally supported participatory tool, the fit with the team, its culture, and its motivation are of critical importance, while aspects proposed by traditional acceptance models, such as the UTAUT, may not be applicable.

Is the health-awareness of leaders related to the working conditions, engagement, and exhaustion in their teams? A multi-level mediation study.

BACKGROUND: Research shows that leaders influence the health and well-being of employees, by being either a buffer or major source of employee's work stressors. Various leadership behaviors and their relation to employee outcomes have been examined. Yet, a satisfactory explanation of how leaders' behavior influences health has not been found. A new line of research investigates the construct of "health-oriented leadership", that is, the health awareness of leaders towards themselves ("self-care") and towards their employees ("staff-care"). It is hypothesized that this health-orientation has a direct effect on both leader's and employees' health, as well as an indirect effect mediated by their working conditions. METHODS: Data were derived from four company research projects, that involved employee and leader surveys on work, health, and well-being. The sample consisted of 50 teams, with 191 leaders and 604 team members. To test the relation between a leader's self-care and his/her engagement, exhaustion, as well as staff-care, multiple regression analyses and mediation analyses were conducted. The relation between a leader's staff-care, the team's job resources and demands, and the individual employee outcomes engagement and exhaustion were tested with multilevel analyses. RESULTS: Regression analysis showed that the stronger a leader's health-orientation towards him/-herself ("self-care"), the stronger was the health-orientation towards his/her employees ("staff-care"). A leader's self-care was also associated with higher work engagement and lower exhaustion and this relation was mediated by his/her job resources and demands, respectively. Multilevel analysis showed that a leader's staff-care was associated with employee work engagement and exhaustion, and that this relation was mediated by team-level job resources and demands, respectively. CONCLUSIONS: The health-orientation of leaders relates to their own as well as their teams' engagement and exhaustion, which is partly mediated by job demands and resources. Thus the construct of health-orientation may prove worthy of further exploration. For practical conclusions, this study provides support for researching not different leadership styles with very specific facets, but a general orientation towards health, which can be implemented into coaching and consulting sessions for organizations.

Development of a Generic Workshop Appraisal Scale (WASC) for Organizational Health Interventions and Evaluation.

This study presents the development of a generic workshop appraisal scale (WASC) for the evaluation of organizational health interventions. Based on the session evaluation questionnaire (SEQ) by Stiles (1980), we developed a short, generic 10-item scale with pairs of adjectives, covering five facets: comprehensibility, relevance, novelty, activation, and valence. Our study is based on N = 499 employees from four organizations who participated in 41 workshops and filled out an evaluation questionnaire on-site. The questionnaire contained the newly developed WASC, as well as items capturing satisfaction with the developed output and outcome expectancies. Results from confirmative factor analysis confirmed the hypothesized five-factor structure of the WASC. The factor structure was found to be nearly invariant across the four organizations, a result that needs to be replicated in larger samples. Analysis of intra-class correlations indicated that 25% of the variance in workshop appraisal can be explained at workshop level. Hereby, perceived relevance and novelty exhibited lower amounts of shared variance, indicating that corresponding workshop appraisals are influenced more by individual factors and less by group dynamics. Furthermore, results from mediation analysis revealed that participants' workshop appraisals were significantly related to their outcome expectancies, and that this relationship was mediated by output satisfaction. Again, the facets showed differential effects: Relevance and comprehensibility seem to contribute most to the total effect on outcome expectancy, followed by activation, whereas valence and especially novelty play a minor role. Taken together, participants' workshop appraisals - together with output satisfaction and outcome expectancy - may be helpful for monitoring the implementation process and allow for corrective action if necessary.

The Key Job Demands and Resources of Nursing Staff: An Integrative Review of Reviews.

The aim of our review is to identify the key job resources and demands of nursing staff by integrating findings from previously published reviews along the lines of the JD-R model. Understanding these is highly relevant given the ever-increasing pressure in nursing work and the challenges of healthcare organizations in recruiting qualified staff. It is also an important step toward developing targeted workplace interventions. A comprehensive search of the literature identified 14 quantitative and qualitative reviews that were included in our integrative review of reviews. Thematic analysis identified three key job demands and six key job resources of nursing staff, namely work overload, lack of formal rewards, work-life interference, supervisor support, fair and authentic management, transformational leadership, interpersonal relations, autonomy and professional resources. Our results corroborate findings from previous reviews, expand the relevance and generalizability by considering a broader range of relevant health-related and motivational outcomes, and highlight the importance of leadership practices in nursing.

A Digital Tool to Build the Capacity of Leaders to Improve Working Conditions Related to Psychological Health and Well-Being in Teams: Intervention Approach, Prototype, and Evaluation Design of the Web-Application "wecoach".

The "wecoach" is a web-application that builds the capacities of team leaders to improve working conditions that are positively related to the psychological health and well-being of their team members. The web-application works through an automated, rule-based chat enhanced by machine learning. This so-called conversational agent guides the team leader through a systematic project cycle, providing a mind map of work and health, training materials, self-assessments, and online tools to conduct team surveys and workshops, as well as self-evaluation of progress and effectiveness. In this paper, we present the development process of this web-application, which resulted in (1) a comprehensive intervention approach, (2) the prototype, and (3) the implementation of an evaluation design for a multi-level, randomized controlled trial.

"Resources-Demands Ratio": Translating the JD-R-Model for company stakeholders.

OBJECTIVES: Practitioners and organizational leaders are calling for practical ways to explain and monitor factors that affect workplace health and productivity. This article builds on the well-established Job Demands-Resources (JD-R) model and proposes an empirically tested ratio that aggregates indicators of job resources and demands. In this study, we calculate a ratio of generalizable job resources and demands derived from the JD-R model and then translate the ratio into the language of company stakeholders. METHODS: We calculated a ratio based on measures applied in a large stress management intervention study (n = 2983) and report the findings from cross-sectional analysis with health and productivity outcomes from same-source and separate-source data. RESULTS: Findings showed a strong and unambiguous increase in health and productivity measures with each step of increase in the ratio. Loss in explained variance due to aggregation of two factors into a single ratio is small for measures which are known to be predicted by both factors simultaneously. CONCLUSIONS: A translation and visualization of the ratio that is accessible to practitioners and organizational leaders is presented and its use in companies discussed.

The relationship between resourceful working conditions, work-related and general sense of coherence.

Sense of coherence (SoC) has been identified as an important health resource and is associated with various health-related outcomes, especially perceived health and mental health. SoC has also been found to be relevant in the work context. Our study examined whether job resources, such as autonomy or social support, can contribute to the development of SoC. We also examined the role of the setting-specific work-related sense of coherence (Work-SoC) as well as reciprocal relationships between the three variables. Participants (941) from Germany, Switzerland and Austria completed our questionnaires at three waves of data collection. Structural equation modeling was used to identify the best fitting model and interpret the relationships between variables. Our first hypothesis that job resources predict Work-SoC and that Work-SoC predicts SoC was confirmed. We also found support for our second hypothesis that SoC predicts Work-SoC and that Work-SoC predicts job resources. The indirect effects through Work-SoC were only marginally significant in both directions. Our findings illustrate complex and multidirectional relationships between the variables. Job resources seem to contribute to the strengthening of Work-SoC, which seems to set in motion a gain cycle of improved job resources, which again contribute to a higher Work-SoC. Over time, this might contribute to strengthening general SoC. However, our findings showed that SoC was highly stable over the observed 3-month interval, limiting the effect any other variable could exert on it. Future research should further examine the mechanisms and timeframes over which a setting-specific SoC contributes to the development of overall SoC.

Individual and group-level job resources and their relationships with individual work engagement.

OBJECTIVES: This study adds a multilevel perspective to the well-researched individual-level relationship between job resources and work engagement. In addition, we explored whether individual job resources cluster within work groups because of a shared psychosocial environment and investigated whether a resource-rich psychosocial work group environment is beneficial for employee engagement over and above the beneficial effect of individual job resources and independent of their variability within groups. METHODS: Data of 1,219 employees nested in 103 work groups were obtained from a baseline employee survey of a large stress management intervention project implemented in six medium and large-sized organizations in diverse sectors. A variety of important job resources were assessed and grouped to an overall job resource factor with three subfactors (manager behavior, peer behavior, and task-related resources). Data were analyzed using multilevel random coefficient modeling. RESULTS: The results indicated that job resources cluster within work groups and can be aggregated to a group-level job resources construct. However, a resource-rich environment, indicated by high group-level job resources, did not additionally benefit employee work engagement but on the contrary, was negatively related to it. CONCLUSIONS: On the basis of this unexpected result, replication studies are encouraged and suggestions for future studies on possible underlying within-group processes are discussed. The study supports the presumed value of integrating work group as a relevant psychosocial environment into the motivational process and indicates a need to further investigate emergent processes involved in aggregation procedures across levels.

Sense of coherence and the motivational process of the job-demands-resources model.

This longitudinal study systematically examines the various roles played by the personal resource "sense of coherence" (SoC) in the motivational process described by the job-demands-resources model. SoC captures the extent to which people perceive their life as comprehensible, manageable and meaningful, and there is evidence of its influence in many health-related outcomes. The first aim here was to establish whether a resourceful working environment builds up SoC and whether SoC leads to work engagement. A second aim was to test reverse relationships: how work engagement leads to SoC and how SoC in turn relates to job resources. A third aim was to assess whether SoC boosts the relationship between job resources and work engagement. The study utilized a 3-wave, 3-month panel design, involving 940 employees working in a broad range of occupations and economic sectors. The results of longitudinal structural equation modeling show that job resources predict SoC and SoC predicts work engagement, suggesting a mediating role of SoC. In addition, SoC predicts job resources, suggesting reciprocal relationships between job resources and SoC. No boosting effect of SoC was found. Overall, the present findings support the view that providing employees with a resourceful working environment will help to build their SoC. The effects of SoC on perceptual, appraisal, and behavioral processes may in turn lead to enhanced job resources and positive outcomes such as greater work engagement.

The experience of work-life balance across family-life stages in Switzerland: a cross-sectional questionnaire-based study.

BACKGROUND: The division of paid and unpaid labor in families continues to be highly gendered with men doing more paid work and women doing more unpaid care work. This is especially true for life stages with young children. Our study investigates the subjective experience of demands in the work and the private domain and the experience of work-life balance across family-life stages as a consequence of this gendered division of labor. METHODS: We used data from a survey study on work-life issues and health in four large companies in Switzerland (N = 3664). RESULTS: In line with our hypotheses, subjective work and private demands were predicted by an interaction of family-life stages and gender. Specifically, during the primary child-rearing family-life stages, women experience more private demands than men while men experience more work demands, regardless of level of employment. Furthermore, women who work part time experience more work-life balance than women who work full time and more than men who work part or full time during the primary child-rearing family-life stages. CONCLUSIONS: Results are discussed in terms of a gendered work-life experience across the life course and the need for part-time work for both genders. Finally, conclusions are drawn concerning our results' implications for public health considerations.

The Context, Process, and Outcome Evaluation Model for Organisational Health Interventions.

To facilitate evaluation of complex, organisational health interventions (OHIs), this paper aims at developing a context, process, and outcome (CPO) evaluation model. It builds on previous model developments in the field and advances them by clearly defining and relating generic evaluation categories for OHIs. Context is defined as the underlying frame that influences and is influenced by an OHI. It is further differentiated into the omnibus and discrete contexts. Process is differentiated into the implementation process, as the time-limited enactment of the original intervention plan, and the change process of individual and collective dynamics triggered by the implementation process. These processes lead to proximate, intermediate, and distal outcomes, as all results of the change process that are meaningful for various stakeholders. Research questions that might guide the evaluation of an OHI according to the CPO categories and a list of concrete themes/indicators and methods/sources applied within the evaluation of an OHI project at a hospital in Switzerland illustrate the model's applicability in structuring evaluations of complex OHIs. In conclusion, the model supplies a common language and a shared mental model for improving communication between researchers and company members and will improve the comparability and aggregation of evaluation study results.

Towards a Job Demands-Resources Health Model: Empirical Testing with Generalizable Indicators of Job Demands, Job Resources, and Comprehensive Health Outcomes.

Studies using the Job Demands-Resources (JD-R) model commonly have a heterogeneous focus concerning the variables they investigate-selective job demands and resources as well as burnout and work engagement. The present study applies the rationale of the JD-R model to expand the relevant outcomes of job demands and job resources by linking the JD-R model to the logic of a generic health development framework predicting more broadly positive and negative health. The resulting JD-R health model was operationalized and tested with a generalizable set of job characteristics and positive and negative health outcomes among a heterogeneous sample of 2,159 employees. Applying a theory-driven and a data-driven approach, measures which were generally relevant for all employees were selected. Results from structural equation modeling indicated that the model fitted the data. Multiple group analyses indicated invariance across six organizations, gender, job positions, and three times of measurement. Initial evidence was found for the validity of an expanded JD-R health model. Thereby this study contributes to the current research on job characteristics and health by combining the core idea of the JD-R model with the broader concepts of salutogenic and pathogenic health development processes as well as both positive and negative health outcomes.

Process and outcome evaluation of an organizational-level stress management intervention in Switzerland.

This field study evaluates the process and outcome of an organizational-level stress management intervention (SMI) in eight companies, taking into account the lessons learned from previous evaluation research. It utilizes the RE-AIM evaluation framework to capture the Reach and Adoption of the intervention in the companies, the appraisal of the Implementation process and the project's Effectiveness and Maintenance with a range of qualitative and quantitative methods. It applies an adapted research design in the context of a field study involving entire organizations, retrospectively assigning study participants to comparison groups. The results of a longitudinal analysis (n = 1400) showed that the SMI had a positive impact on the participants' job demands and resources, when controlled for baseline levels. Qualitative data analysis revealed that the companies had built capacities for ongoing health promotion and showed what issues must be borne in mind when implementing such projects. The study also showed that participation in such interventions alone does not suffice to achieve the desired impact, but that the individual participants' appraisal of the intervention and the collective involvement of the teams must be further researched to fully understand how change occurs.

Socioeconomic status, working conditions and self-rated health in Switzerland: explaining the gradient in men and women.

OBJECTIVES: Epidemiological research has confirmed the association between socioeconomic status (SES) and health, but only a few studies considered working conditions in this relationship. This study examined the contribution of physical and psychosocial working conditions in explaining the social gradient in self-rated health. METHODS: A representative sample of 10 101 employees, 5003 women and 5098 men, from the Swiss national health survey 2002 was used. SES was assessed according to the EGP-scheme. Working conditions included exposure to physical disturbances, physical strain, job insecurity, monotonous work and handling simultaneous tasks. For data analysis logistic regression analyses were performed. RESULTS: Data show a social gradient for self-rated health (SRH) as well as for physical and psychosocial working conditions. Logistic regression analysis controlling for age, gender and level of employment showed both physical and psychosocial working conditions to be significant predictors of SRH. Physical and psychosocial working conditions such as physical disturbances from work environment, physical strains in doing the job, monotony at work, job insecurity etc. could explain most of the social gradient of SRH in men and women. CONCLUSION: The study confirmed the relevance of modifiable physical and psychosocial working conditions for reducing social inequality in health. Gender differences need to be considered in epidemiological and intervention studies.