Workplace Mental Health Interventions in India: A Rapid Systematic Scoping Review.

The mental health initiatives at the workplace are growing in numbers over the past few years. Public and private sectors continue to explore avenues to navigate and adapt initiatives to promote employee's mental wellbeing. However, such initiatives in the Indian context are not thoroughly studied. We attempted to review existing literature on workplace mental health interventions in the Indian context. The scoping review was conducted following the standard process as recommended by the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for scoping reviews. We searched in the databases such as PubMed, Google Scholar and Scopus. Scientific literature including gray literature of the past decade was searched to synthesize evidence on types of mental health interventions and their unique features. Of the 1,311 records, 30 records that met the inclusion criteria were included for the final review. The review highlights evidence on stress and mental health problems faced by the working population and various strategies adopted by organizations to address mental health problems. However, very few interventions were accompanied by comprehensive needs assessment, impact evaluation and workplace policy initiatives. Most interventions were curative-provisioning counseling services, limiting the scope of mental health promotion activities. Addressing mental health wellbeing comprehensively and aligning an organization's policies are crucial. Research on employee mental health, its risk factors, and cost-effectiveness analysis of workplace mental health interventions in the Indian context need to be prioritized.

Obesity Prevention Worksite Wellness Interventions for Health Care Workers: A Narrative Review.

Background: Health care workers face elevated risk of obesity due to their unique work requirements. The purpose of this systematic review was to present a narrative summary of the characteristics and effectiveness of worksite wellness programs focusing on preventing obesity among health care workers. Method: The databases Medline, CINAHL, Embase, PsycINFO, and PubMed were searched. Experimental and quasi-experimental studies published in English (between 2000 and 2018) that (a) were worksite interventions, (b) had intervention directed toward health care employees, and (c) reported weight-related outcomes were included. We excluded commercial weight loss studies. Two coders extracted data on the following: purpose, key study characteristics, design, type and dosage of intervention, outcome measure(s), attrition rate, and risk of bias. Results: Of the 51 studies included in this review, the majority (75%, n = 38) targeted diet and physical activity behaviors. The majority reported improved weight outcomes in favor of the intervention. Overall, moderate- to high-intensity behavioral strategies, using any mode of intervention delivery (phone, face-to-face, or Internet), delivered by a trained professional were effective in improving weight-related outcomes. Environmental strategies were effective in improving healthier habits. Self-directed strategies worked better for motivated employees. Discussion: Multicomponent interventions offered in health care settings may be successful in improving employee weight. Across study designs, several gaps in the reporting of intervention design, dosage, fidelity, and system-level outcomes were found. Conclusion/Applying research to practice: Occupational health professionals should continue to be creative in developing multicomponent interventions (combining behavioral/educational, environmental, and organizational support) and use evidence guidance frameworks/tools to design an intervention and report dosage outcomes.

Pilot evaluation of HEAL - A natural experiment to promote obesity prevention behaviors among low-income pregnant women.

Instituting interventions during the prenatal period is optimal for early obesity prevention in the child. Healthy Eating Active Living (HEAL) is a six-week, multi-component program to promote breastfeeding, healthy dietary habits, cooking skills and physical activity among Medicaid-eligible pregnant-women in Texas. HEAL is integrated into the healthcare system and offered as a standard-of-care for eligible patients. METHODS: Preliminary evaluation of this natural experiment conducted from March 2015 through October 2016 informs the initial feasibility, acceptability and effects of the program on participant diet, home nutrition environment, physical activity, and breastfeeding self-efficacy and intentions measured using self-report surveys. Analysis of covariance (ANCOVA) was conducted to evaluate pre- and post-intervention changes, controlling for participants' ethnicity, age, and income level. Interaction effects of session attendance on the outcomes were further assessed. RESULTS: Of the 329 women who enrolled in HEAL, 210 women completed the pre-post assessment (64% retention rate). Pre-to-post intervention, there were significant increases in availability and intake of fruits and vegetables, self-efficacy towards consuming more fruits and vegetables, and cooking frequency and skills (p < 0.05), and decreased frequency of eating heat and serve foods (p < 0.05). Significant improvements in physical activity, duration of breastfeeding, perceived benefits and intentions to breastfeed were also observed (p < 0.05). Higher attendance of HEAL sessions was associated with better outcomes. Process evaluation demonstrated 95% fidelity of program implementation. CONCLUSION: HEAL operationalizes clinic-community linkages and shows promise in improving behaviors during pregnancy. Future research warrants the use of a stringent study design with a control group to determine program efficacy.

A Public Health Opportunity Found in Food Waste.

A food waste problem coexists with food insecurity and obesity. Brighter Bites, a school-based food cooperative program, successfully channels primarily donated produce to low-income communities and provides nutrition education, creating an increased demand for and intake of fruits and vegetables. We present the framework used in Brighter Bites and results of operationalizing this framework during 3 years of implementation in Houston, Texas. Results demonstrated that, during 2013 through 2016, more than 12,500 families enrolled in Brighter Bites for 16 weeks in the school year. More than 90% of the produce was donated. Each week, families received on average 54 to 61 servings of fresh produce with the average cost of produce being $2.53 per family per week. Of those parents who completed the process surveys, more than 80% reported the produce to be effective in improving their children's diet. Brighter Bites demonstrates a successful model to address food waste and improve dietary habits of underserved families.

Are Hospital Workers Healthy?: A Study of Cardiometabolic, Behavioral, and Psychosocial Factors Associated With Obesity Among Hospital Workers.

OBJECTIVE: This study evaluated the cardiometabolic, behavioral, and psychosocial factors associated with weight status among hospital employees. METHODS: A total of n = 924 employees across the six hospitals in Texas participated in this cross-sectional study, 2012 to 2013. Association between weight status and waist circumference, blood pressure, biomarkers, diet, physical activity, sedentary behaviors, and psychosocial factors was assessed. RESULTS: About 78.1% of employees were overweight/obese. Obese participants (body mass index [BMI] ≥30.0 kg/m) had higher consumption of potatoes, fats, sugary beverages, and spent more time watching television, playing computer games, and sitting than those having normal weight. Being obese was positively associated with blood pressure, blood glucose, low-density lipoprotein, and negatively associated with high-density lipoprotein. Finally, 78.8% of workers were dissatisfied with their worksite wellness with dissatisfaction being higher among obese employees. Being overweight (BMI 25.0 to 29.9 kg/m) was positively associated with blood pressure, but not other variables. CONCLUSION: Understanding the risk profile of hospital workers is critical to developing effective interventions.

An evidence-based conceptual framework of healthy cooking.

Eating out of the home has been positively associated with body weight, obesity, and poor diet quality. While cooking at home has declined steadily over the last several decades, the benefits of home cooking have gained attention in recent years and many healthy cooking projects have emerged around the United States. The purpose of this study was to develop an evidence-based conceptual framework of healthy cooking behavior in relation to chronic disease prevention. A systematic review of the literature was undertaken using broad search terms. Studies analyzing the impact of cooking behaviors across a range of disciplines were included. Experts in the field reviewed the resulting constructs in a small focus group. The model was developed from the extant literature on the subject with 59 studies informing 5 individual constructs (frequency, techniques and methods, minimal usage, flavoring, and ingredient additions/replacements), further defined by a series of individual behaviors. Face validity of these constructs was supported by the focus group. A validated conceptual model is a significant step toward better understanding the relationship between cooking, disease and disease prevention and may serve as a base for future assessment tools and curricula.

Using a Community-Engaged Approach to Develop a Bilingual Survey about Psychosocial Stressors among Individuals of Mexican Origin.

Hypertension is on the rise among Hispanics and is highest among those of Mexican origin. Recent studies have found a positive association between air pollution and blood pressure and hypertension. Moreover, a link between hypertension and adverse socioeconomic conditions is well established. However, less is known about psychosocial stressors, although their impact on coronary heart disease has been shown. To address this gap in the literature, community perspectives of the health consequences of environmental exposures and psychosocial stressors experienced among the Mexican-origin population in Houston, Texas were obtained through participation in focus groups, the establishment of a Neighborhood Council of Advisors (NCA), and the testing of a pilot questionnaire. Taken together, the findings from the community were used to develop a culturally sensitive, bilingual questionnaire for an investigation of the combined effects of environmental and psychosocial stressors on hypertension among individuals of Mexican origin.

An urgent need to understand and address the safety and well-being of hospital "sitters".

BACKGROUND: Hospital sitters provide continuous observation of patients at risk of harming themselves or others. Little is known about sitters' occupational safety and well-being, including experiences with patient/visitor-perpetrated violence (type II). METHODS: Data from surveys, focus groups, individual interviews at six U.S. hospitals were used to characterize the prevalence of and circumstance surrounding type II violence against sitters, as well as broader issues related to sitter use. RESULTS: Sitter respondents had a high 12-month prevalence of physical assault, physical threat, and verbal abuse compared to other workers in the hospital setting. Sitters and other staff indicated the need for clarification of sitters' roles regarding patient care and sitter well-being (e.g., calling for assistance, taking lunch/restroom breaks), training of sitters in personal safety and de-escalation, methods to communicate patient/visitor behaviors, and unit-level support. CONCLUSIONS: The burden of type II violence against hospital sitters is concerning. Policies surrounding sitters' roles and violence prevention training are urgently needed.

Physical assault, physical threat, and verbal abuse perpetrated against hospital workers by patients or visitors in six U.S. hospitals.

BACKGROUND: An elevated risk of patient/visitor perpetrated violence (type II) against hospital nurses and physicians have been reported, while little is known about type II violence among other hospital workers, and circumstances surrounding these events. METHODS: Hospital workers (n = 11,000) in different geographic areas were invited to participate in an anonymous survey. RESULTS: Twelve-month prevalence of type II violence was 39%; 2,098 of 5,385 workers experienced 1,180 physical assaults, 2,260 physical threats, and 5,576 incidents of verbal abuse. Direct care providers were at significant risk, as well as some workers that do not provide direct care. Perpetrator circumstances attributed to violent events included altered mental status, behavioral issues, pain/medication withdrawal, dissatisfaction with care. Fear for safety was common among worker victims (38%). Only 19% of events were reported into official reporting systems. CONCLUSIONS: This pervasive occupational safety issue is of great concern and likely extends to patients for whom these workers care for.

A conceptual framework for organizational readiness to implement nutrition and physical activity programs in early childhood education settings.

Across multiple sectors, organizational readiness predicts the success of program implementation. However, the factors influencing readiness of early childhood education (ECE) organizations for implementation of new nutrition and physical activity programs is poorly understood. This study presents a new conceptual framework to measure organizational readiness to implement nutrition and physical activity programs in ECE centers serving children aged 0 to 5 years. The framework was validated for consensus on relevance and generalizability by conducting focus groups; the participants were managers (16 directors and 2 assistant directors) of ECE centers. The framework theorizes that it is necessary to have "collective readiness," which takes into account such factors as resources, organizational operations, work culture, and the collective attitudes, motivation, beliefs, and intentions of ECE staff. Results of the focus groups demonstrated consensus on the relevance of proposed constructs across ECE settings. Including readiness measures during program planning and evaluation could inform implementation of ECE programs targeting nutrition and physical activity behaviors.

Maternal health situation in India: a case study.

Since the beginning of the Safe Motherhood Initiative, India has accounted for at least a quarter of maternal deaths reported globally. India's goal is to lower maternal mortality to less than 100 per 100,000 livebirths but that is still far away despite its programmatic efforts and rapid economic progress over the past two decades. Geographical vastness and sociocultural diversity mean that maternal mortality varies across the states, and uniform implementation of health-sector reforms is not possible. The case study analyzes the trends in maternal mortality nationally, the maternal healthcare-delivery system at different levels, and the implementation of national maternal health programmes, including recent innovative strategies. It identifies the causes for limited success in improving maternal health and suggests measures to rectify them. It recommends better reporting of maternal deaths and implementation of evidence-based, focused strategies along with effective monitoring for rapid progress. It also stresses the need for regulation of the private sector and encourages further public-private partnerships and policies, along with a strong political will and improved management capacity for improving maternal health.

Maternal health in Gujarat, India: a case study.

Gujarat state of India has come a long way in improving the health indicators since independence, but progress in reducing maternal mortality has been slow and largely unmeasured or documented. This case study identified several challenges for reducing the maternal mortality ratio, including lack of the managerial capacity, shortage of skilled human resources, non-availability of blood in rural areas, and infrastructural and supply bottlenecks. The Gujarat Government has taken several initiatives to improve maternal health services, such as partnership with private obstetricians to provide delivery care to poor women, a relatively-short training of medical officers and nurses to provide emergency obstetric care (EmOC), and an improved emergency transport system. However, several challenges still remain. Recommendations are made for expanding the management capacity for maternal health, operationalization of health facilities, and ensuring EmOC on 24/7 (24 hours a day, seven days a week) basis by posting nurse-midwives and trained medical officers for skilled care, ensuring availability of blood, and improving the registration and auditing of all maternal deaths. However, all these interventions can only take place if there are substantially-increased political will and social awareness.