User engagement with organizational mHealth stress management intervention - A mixed methods study.

Mobile health (mHealth) demonstrates great promise for providing effective and accessible interventions within an organizational context. Compared with traditional workplace interventions, mHealth solutions may be significantly more scalable and easier to standardize. However, inadequate user engagement is a major challenge with mHealth solutions that can negatively impact the potential benefits of an intervention. More research is needed to better understand how to ensure sufficient engagement, which is essential for designing and implementing effective interventions. To address this issue, this study employed a mixed methods approach to investigate what factors influence user engagement with an organizational mHealth intervention. Quantitative data were collected using surveys (n = 1267), and semi-structured interviews were conducted with a subset of participants (n = 17). Primary findings indicate that short and consistent interactions as well as user intention are key drivers of engagement. These results may inform future development of interventions to increase engagement and effectiveness.

Translation and Validation of the Swedish Version of the Tilburg Frailty Indicator.

The Tilburg Frailty Indicator (TFI) is a questionnaire with 15 questions designed for screening for frailty in community-dwelling older people. TFI has a multidimensional approach to frailty, including physical, psychological, and social dimensions. The aim of this study was to translate TFI into Swedish and study its psychometric properties in community-dwelling older people with multimorbidity. A cross-sectional study of individuals 75 years and older, with ≥3 diagnoses of the ICD-10 and ≥3 visits to the Emergency Department in the past 18 months. International guidelines for back-translation were followed. Psychometric properties of the TFI were examined by determining the reliability (inter-item correlations, internal consistency, test-retest) and validity (concurrent, construct, structural). A total of 315 participants (57.8% women) were included, and the mean age was 83.3 years. The reliability coefficient KR-20 was 0.69 for the total sum. A total of 39 individuals were re-tested, and the weighted kappa was 0.7. TFI correlated moderately with other frailty measures. The individual items correlated with alternative measures mostly as expected. In the confirmatory factor analysis (CFA), a three-factor model fitted the data better than a one-factor model. We found evidence for adequate reliability and validity of the Swedish TFI and potential for improvements.

Parental responses and catastrophizing in online cognitive behavioral therapy for pediatric functional abdominal pain: A mediation analysis of a randomized controlled trial.

Objective: To test if decreased parental protective behaviors, monitoring behaviors, and parental catastrophizing mediate relief of gastrointestinal symptoms in children 8-12 years with functional abdominal pain disorders (FAPDs). The study uses secondary data analyses of a randomized controlled trial in which exposure-based online cognitive behavioral therapy (ICBT) was found superior to treatment as usual in decreasing gastrointestinal symptoms. Methods: The ICBT included 10 weekly modules for children and 10 weekly modules for parents. Treatment as usual consisted of any medication, dietary adjustments, and healthcare visits that the participants engaged in during 10 weeks. All measures were self-assessed online by parents. Biweekly assessments of the Adult Responses to Children's Symptoms (ARCS), Protect and Monitor subscales, and the Pain Catastrophizing Scale, parental version (PCS-P) were included in univariate and multivariate growth models to test their mediating effect on the child's gastrointestinal symptoms assessed with the Pediatric Quality of Life Gastrointestinal Symptoms Scale (PedsQL). Results: A total of 90 dyads of children with FAPDs and their parents were included in the study, of which 46 were randomized to ICBT and 44 to treatment as usual. The PCS-P was found to mediate change in the PedsQL ab = 0.639 (95% CI 0.020-2.331), while the ARCS Monitor ab = 0.472 (95% CI -1.002 to 2.547), and Protect ab = -0.151 (95% CI -1.455 to 0.674) were not mediators of change. Conclusions: To target parental catastrophizing in ICBT for pediatric FAPDs is potentially important to reduce abdominal symptoms in children.

Study Engagement and Burnout of the PhD Candidates in Medicine: A Person-Centered Approach.

This study focused on exploring individual variations in doctoral candidates' well-being, in terms of experienced research engagement and burnout by using a person-centered approach. In addition, the associations between well-being profiles and gender, country of origin, study status (full-time or part-time), research group status and drop-out intentions were explored. The participants were 692 PhD candidates in the field of medicine. Latent profile analysis was employed to identify the well-being profiles. Four distinct profiles were identified: high engagement-low burnout, high engagement-moderate burnout, moderate engagement-moderate burnout, and moderate engagement-high burnout. Working in a clinical unit or hospital and working in a research group seemed to be related to increased engagement and reduced risk for suffering burnout, while the intentions to quit one's doctoral studies were more frequently reported in profiles with moderate levels of engagement. The findings imply that although a significant number of PhD candidates in medicine had an increased risk for developing burnout, for most of the PhD candidates research education is an engaging experience.

The Rapid Implementation of a Psychological Support Model for Frontline Healthcare Workers During the COVID-19 Pandemic: A Case Study and Process Evaluation.

The COVID-19 pandemic highlighted the need for psychological support initiatives directed toward frontline healthcare workers, which can be rapidly and sustainably implemented during an infectious disease outbreak. The current case study presents a comprehensive model of psychological support that was implemented at an intensive care unit (ICU) during the first wave of the COVID-19 pandemic. The psychological support model aimed at promoting a resilient stress reaction among frontline staff by protecting physical, social, and psychological resources. The initiatives, targeting different groups of workers, included education and training, peer support, psychologist-supervised and unsupervised group sessions, on-boarding for transferred staff, manager support, and individual sessions for workers experiencing strong stress reactions. The results of the process evaluation of this rapid implementation suggest that peer support initiatives as well as daily group sessions were the most appreciated forms of psychological support. Psychologists involved in organizing and providing the support highlighted several aspects of a successful implementation of the support model: offering support during work hours (preferably after shift), positive attitude of line managers that framed support initiatives as a team effort, and involvement of experienced psychologists able to quickly adjust the content of the support according to the current needs. The study also identified two main problems of the current implementation: the lack of efficient planning due to the use of volunteer work and the need for more structural resources on the organizational level to ensure long-term sustainability of the support model and its implementation among all groups of healthcare staff. The current case study highlights the importance of establishing permanent structural resources and routines for psychological support integrated in clinical practice by healthcare organizations to improve both rapid and sustainable response to future crises.

Psychosocial working conditions of shiftworking nurses: A long-term latent transition analysis.

AIM: This study aimed to identify profiles of working conditions to which nurses were exposed to over time and investigate how changes in working conditions relate to shiftworking and health. BACKGROUND: Previous studies rarely addressed the issue of working conditions development over long periods and the effects of such development on nurses' health. METHODS: Data from a national cohort of nurses in Sweden (N = 2936) were analysed using a person-centred analytical approach-latent profile and latent transition analysis. RESULTS: Nurses report better psychosocial working conditions as they progress into mid-career. Shiftworking nurses experience poorer working conditions than their dayworking counterparts and tend to move from shiftwork to daywork as they progress into mid-career. In mid-career, nurses in work environments characterized by low autonomy and support tend to report poorer health outcomes. CONCLUSION: Current analyses suggest that shiftworking nurses are particularly in need of interventions that address poor work environments. Not only do they experience more negative psychosocial working conditions than their dayworking counterparts, but they do so while having to contend with demanding schedules. IMPLICATIONS FOR NURSING MANAGEMENT: The findings highlight that organisational interventions should target different aspects of the work environment for nurses in diverse stages of their careers.

Intensive longitudinal study of newly graduated nurses' quick returns and self-rated stress.

OBJECTIVE: Little is known about the relationship between quick returns (QR) - shift combinations that result in inter-shift rest periods <11 hours) and stress. The current study examined whether variations in the frequency of QR, both between and within individuals, were associated with changes in self-rated stress. METHODS: A questionnaire was sent weekly to newly graduated nurses during the first 12 weeks of work. Stress was measured with four items from the Stress-Energy Questionnaire on a scale from 1 "not at all" to 5 "very much" [mean 2.65, standard deviation (SD) 1.08]. Shifts worked in the past week were reported and QR were identified by evening-morning shift combinations (mean 0.98, SD 0.90 per week). In total, 350 persons were included in the analysis (3556 observations). Data were analyzed with a multilevel residual dynamic structural equation model (RDSEM) using Bayesian estimation procedures. RESULTS: There was no between-person effect of QR on stress averaged across measurement occasions (0.181, 95% CI -0.060-0.415). However, there was a small within-person effect of QR (0.031, 95% CI 0.001-0.062), meaning that more QR during a given week, compared to that person's average, was associated with an increase in their level of stress during that week. CONCLUSIONS: Nurses were likely to report increased stress during weeks in which they worked more QR. Intervention studies are needed to determine whether the relationship is causal.

Comparing Depressive Symptoms, Emotional Exhaustion, and Sleep Disturbances in Self-Employed and Employed Workers: Application of Approximate Bayesian Measurement Invariance.

Studies investigating differences in mental health problems between self-employed and employed workers have provided contradictory results. Many of the studies utilized scales validated for employed workers, without collecting validity evidence for making comparisons with self-employed. The aim of this study was (1) to collect validity evidence for three different scales assessing depressive symptoms, emotional exhaustion, and sleep disturbances for employed workers, and combinators; and (2) to test if these groups differed. We first conducted approximate measurement invariance analysis and found that all scales were invariant at the scalar level. Self-employed workers had least mental health problems and employed workers had most, but differences were small. Though we found the scales invariant, we do not find them optimal for comparison of means. To be more precise in describing differences between groups, we recommend using clinical cut-offs or scales developed with the specific purpose of assessing mental health problems at work.

Virtual patients designed for training against medical error: Exploring the impact of decision-making on learner motivation.

OBJECTIVES: Medical error is a significant cause of patient harms in clinical practice, but education and training are recognised as having a key role in minimising their incidence. The use of virtual patient (VP) activities targeting training in medical error allows learners to practice patient management in a safe environment. The inclusion of branched decision-making elements in the activities has the potential to drive additional generative cognitive processing and improved learning outcomes, but the increased cognitive load on learning risks negatively affecting learner motivation. The aim of this study is to better understand the impact that the inclusion of decision-making and inducing errors within the VP activities has on learner motivation. METHODS: Using a repeated study design, over a period of six weeks we provided undergraduate medical students at six institutions in three countries with a series of six VPs written around errors in paediatric practice. Participants were divided into two groups and received either linearly structured VPs or ones that incorporated branched decision-making elements. Having completed all the VPs, each participant was asked to complete a survey designed to assess their motivation and learning strategies. RESULTS: Our analysis showed that in general, there was no significant difference in learner motivation between those receiving the linear VPs and those who received branched decision-making VPs. The same results were generally reflected across all six institutions. CONCLUSIONS: The findings demonstrated that the inclusion of decision-making elements did not make a significant difference to undergraduate medical students' motivation, perceived self-efficacy or adopted learning strategies. The length of the intervention was sufficient for learners to overcome any increased cognitive load associated with branched decision-making elements being included in VPs. Further work is required to establish any immediate impact within periods shorter than the length of our study or upon achieved learning outcomes.

Psychosocial working conditions among high-skilled workers: A latent transition analysis.

Theories of psychosocial working conditions assume an interaction of different work environment characteristics. Most studies detail various aspects of such interactions, while fewer investigate the comprehensive patterns of interrelated variables. This exploratory study distinguishes patterns of psychosocial working conditions, describes their characteristics, and investigates their change over 6 years. The working conditions of 1,744 high-skilled workers in Sweden, of a representative sample of the working population, were empirically classified into 4 distinct patterns: (a) the Supporting pattern with a very low workload, very low time pressure, medium learning opportunities, high creativity requirements, and very high autonomy; (b) the Constraining pattern with a very low workload, very low time pressure, low learning opportunities, medium creativity requirements, and very low autonomy; (c) the Demanding pattern with a high workload, high time pressure, medium learning opportunities, high creativity requirements, and very low autonomy; and (d) the Challenging pattern with a high workload, high time pressure, very high learning opportunities, very high creativity requirements, and very high autonomy. Importantly, these patterns were associated with significant differences in worker well-being. From an individual perspective, working conditions most often changed from patterns with a high workload and time pressure to patterns with lower levels of these demands. Over time, the prevalence of the Constraining pattern increased while that of the Challenging pattern decreased. To conclude, a person-centered approach broadens the understanding of the complex interplay between psychosocial working conditions and their longitudinal change, which can improve the tailoring of occupational health interventions. (PsycINFO Database Record

[Psychometric properties of the Polish version of the brief version of Kutcher Adolescent Depression Scale - assessment of depression among students]. / Wlasciwosci psychometryczne polskiej wersji skróconej Skali Depresji Kutchera dla Mlodziezy (Kutcher Adolescent Depression Scale) - pomiar depresji w grupie studentów.

AIM: Depressive disorders, which remain one of the most common and recurrent mood disorders worldwide, presently affect up to 15% of the population under age 25. Adolescent depression is related to a number of adverse phenomena such as scholastic/academic failure, juvenile delinquency, illicit substance abuse or suicide. Studies show that students are at a high risk of developing this disorder but depression in this population is often misdiagnosed and undertreated. Consequently, it is important to develop reliable diagnostic tools to evaluate symptoms of depression in students. Kutcher Adolescent Depression Scale (brief version) is a commonly used screening test used to identify young people at risk for depression, which consists of six items related to its main symptoms. The aim of the study was to adapt and test reliability and content validity of the Polish version of six - item Kutcher's KADS based on analysis of students using confirmatory factor analysis. MATERIAL AND METHODS: A total of 1,589 student aged 18-24 anonymously answered a questionnaire on the risk of depression (KADS) and a demographics survey. RESULTS: Confirmatory factor analysis showed the good fit of model to empirical data: SB χ² (15) = 968.688, p < .001, RMSEA = .053, CFI = .958, SRMR = .029. Factor loading ranged from .40 to .80. CONCLUSIONS: Validation of Polish version of KADS in a group of students aged 18-24 years has shown its high reliability and content validity. Further studies should be focused on the assessment of the questionnaire criterion validity.

Measuring hedonia and eudaimonia as motives for activities: cross-national investigation through traditional and Bayesian structural equation modeling.

Two major goals of this paper were, first to examine the cross-cultural consistency of the factor structure of the Hedonic and Eudaimonic Motives for Activities (HEMA) scale, and second to illustrate the advantages of using Bayesian estimation for such an examination. Bayesian estimation allows for more flexibility in model specification by making it possible to replace exact zero constraints (e.g., no cross-loadings) with approximate zero constraints (e.g., small cross-loadings). The stability of the constructs measured by the HEMA scale was tested across two national samples (Polish and North American) using both traditional and Bayesian estimation. First, a three-factor model (with hedonic pleasure, hedonic comfort and eudaimonic factors) was confirmed in both samples. Second, a model representing the metric invariance was tested. A traditional approach with maximum likelihood estimation reported a misfit of the model, leading to the acceptance of only a partial metric invariance structure. Bayesian estimation-that allowed for small and sample specific cross-loadings-endorsed the metric invariance model. The scalar invariance was not supported, therefore the comparison between latent factor means was not possible. Both traditional and Bayesian procedures revealed a similar latent factor correlation pattern within each of the national groups. The results suggest that the connection between hedonic and eudaimonic motives depends on which of the two hedonic dimensions is considered. In both groups the association between the eudaimonic factor and the hedonic comfort factor was weaker than the correlation between the hedonic pleasure factor and the eudaimonic factor. In summary, this paper explained the cross-national stability of the three-factor structure of the HEMA scale. In addition, it showed that the Bayesian approach is more informative than the traditional one, because it allows for more flexibility in model specification.