Using intervention mapping to develop evidence-based toolkits that support workers on long-term sick leave and their managers.

BACKGROUND: Managing long-term sickness absence is challenging in countries where employers and managers have the main responsibility to provide return to work support, particularly for workers with poor mental health. Whilst long-term sick leave and return to work frameworks and guidance exist for employers, there are currently no structured return to work protocols for employers or for their workers encompassing best practice strategies to support a positive and timely return to work outcome. PURPOSE: To utilise the intervention mapping (IM) protocol as a framework to develop return to work toolkits that are underpinned by relevant behaviour change theory targeting mental health to promote a positive return to work experiensce for workers on long-term sick leave. METHODS: This paper provides a worked example of intervention mapping (IM) to develop an intervention through a six-step process to combine theory and evidence in the development of two toolkits - one designed for managers and one to be used by workers on long-term sick leave. As part of this process, collaborative planning techniques were used to develop the intervention. A planning group was set up, through which researchers would work alongside employer, worker, and mental health professional representatives to develop the toolkits. Additionally, feedback on the toolkits were sought from the target populations of workers and managers and from wider employer stakeholders (e.g., human resource specialists). The implementation and evaluation of the toolkits as a workplace intervention were also planned. RESULTS: Two toolkits were designed following the six steps of intervention mapping. Feedback from the planning group (n = 5; psychologist, psychiatrist, person with previous experience of poor mental health, employer and charity worker) and participants (n = 14; employers = 3, wellbeing director = 1; human resources = 2, managers = 2, employees with previous experience of poor mental health = 5) target populations indicated that the toolkits were acceptable and much needed. CONCLUSIONS: Using IM allowed the development of an evidence-based practical intervention, whilst incorporating the views of all the impacted stakeholder groups. The feasibility and acceptability of the toolkits and their supporting intervention components, implementation process and methods of assessment will be evaluated in a feasibility pilot randomised controlled trial.

Developing Self-Compassion in Healthcare Professionals Utilising a Brief Online Intervention: A Randomised Waitlist Control Trial.

(1) Background: The level of stress experienced by staff in the healthcare sector is highly prevalent and well documented. Self-compassion may support the health and wellbeing of individuals and enable them to stay well at work. This study aimed to understand whether a brief, online, self-guided, novel intervention improved the health and wellbeing of healthcare professionals. (2) Methods: In a parallel randomised controlled trial, a volunteer sample of healthcare professionals were assigned to an intervention group (n = 110) or a waitlist control group (n = 80). Measures of self-compassion, mental wellbeing, stress and burnout were collected by an online questionnaire at baseline, post-programme and, for the intervention group, at follow-up. (3) Results: This intervention appeared to be effective in increasing self-compassion and mental health and decreasing stress and burnout. Significant group effects and significant time × group interactions for overall self-compassion [F (2, 183) = 32.72, p < 0.001; effect size ηp2 = 0.226], mental wellbeing [F (2, 212) = 17.46, p < 0.001; effect size ηp2 = 0.135], perceived stress [F (2, 205) = 5.42, p = 0.006; effect size ηp2 = 0.46], personal burnout [F (2, 224) = 7.57, p = 0.001; effect size ηp2 = 0.063] and work burnout [F (2, 208) = 7.39, p = 0.001; effect size ηp2 = 0.062] were found. (4) Conclusions: This study shows promise that an affordable and scalable intervention can be effective for busy healthcare professionals operating in a significantly challenging environment.

Manager-Team (Dis)agreement on Stress-Preventive Behaviours: Relationship with Psychosocial Work Environment and Employees' Well-Being.

The "Management Competencies to Prevent and Reduce Stress at Work" (MCPARS) approach focuses on identifying the stress-preventive managers' competencies able to optimise the employees' well-being through the management of the psychosocial work environment. Considering leadership as contextualised in complex social dynamics, the self-other agreement (SOA) investigation of the MCPARS may enhance previous findings, as it allows for exploring the manager-team perceptions' (dis)agreement and its potential implications. However, no studies have tested the MCPARS using the SOA and multisource data. Grounded in Yammarino and Atwater's SOA reference theory, we conducted an in-depth investigation on the MCPARS's theoretical framework by examining the implications of manager-team (dis)agreement, regarding managers' competencies, on employees' psychosocial environment (H1-H2) and affective well-being (H3). Data from 36 managers and 475 employees were analysed by performing several polynomial regressions, response surface, and mediation analyses. The results reveal a significant relationship between SOA on MCPARS and employees' perceptions of the psychosocial environment (H1). Employees report better perceptions when supervised by in-agreement good or under-estimator managers, while lower ratings occur under over-estimator or in-agreement poor managers (H2). Moreover, the psychosocial environment significantly mediated the relationship between SOA on MCPARS and employees' well-being (H3). The MCPARS theoretical model's soundness is supported, and its implications are discussed.

Work fatigue during COVID-19 lockdown teleworking: the role of psychosocial, environmental, and social working conditions.

Background: During national lockdowns in response to the COVID-19 pandemic, previously office-based workers who transitioned to home-based teleworking faced additional demands (e.g., childcare, inadequate homeworking spaces) likely resulting in poor work privacy fit. Previous office research suggests poor work privacy fit is associated with lower wellbeing and higher work fatigue. Emerging evidence suggests a relationship between childcare duties during pandemic teleworking and work fatigue. In addition to psychosocial working conditions (job demand, job control, and job change management), which are acknowledged predictors of work fatigue, this poses a significant threat to occupational health during pandemic teleworking. However, the relative effects of aspects of the psychosocial environment (job demands and resources), the home office environment (including privacy fit), and the social environment (childcare) on work fatigue as well as their interactions are under-explored. Objective: This study examined the relationships between the psychosocial, environmental, and social working conditions of teleworking during the first COVID-19 lockdown and work fatigue. Specifically, the study examined teleworkers' physical work environment (e.g., if and how home office space is shared, crowding, and noise perceptions) as predictors of privacy fit and the relationship between privacy fit, childcare, psychosocial working conditions (job demand, job control, and job change management), and work fatigue. Work privacy fit was hypothesized to mediate the relationship between childcare and work fatigue. Methods: An online cross-sectional survey was conducted with teleworkers (n = 300) during the first COVID-19 lockdown in April and May 2020; most participants were in Germany, Switzerland, and the United Kingdom. Results: Path analysis was used to examine the hypothesized relationships. Privacy fit was lower for those reporting greater levels of noise in home-working spaces and those feeling crowded at home. Work fatigue was lower amongst those with greater privacy fit and higher amongst those with high levels of job demand. An indirect relationship was observed between childcare and work fatigue with privacy fit mediating this relationship. Conclusion: The influence of privacy fit has so far been largely neglected in research on teleworking, especially during the pandemic. However, its contribution to workers' wellbeing should be acknowledged in occupational health strategies.

Digital Training Program for Line Managers (Managing Minds at Work): Protocol for a Feasibility Pilot Cluster Randomized Controlled Trial.

BACKGROUND: Mental health problems affect 1 in 6 workers annually and are one of the leading causes of sickness absence, with stress, anxiety, and depression being responsible for half of all working days lost in the United Kingdom. Primary interventions with a preventative focus are widely acknowledged as the priority for workplace mental health interventions. Line managers hold a primary role in preventing poor mental health within the workplace and, therefore, need to be equipped with the skills and knowledge to effectively carry out this role. However, most previous intervention studies have directly focused on increasing line managers' understanding and awareness of mental health rather than giving them the skills and competencies to take a proactive preventative approach in how they manage and design work. The Managing Minds at Work (MMW) digital training intervention was collaboratively designed to address this gap. The intervention aims to increase line managers' knowledge and confidence in preventing work-related stress and promoting mental health at work. It consists of 5 modules providing evidence-based interactive content on looking after your mental health, designing and managing work to promote mental well-being, management competencies that prevent work-related stress, developing a psychologically safe workplace, and having conversations about mental health at work. OBJECTIVE: The primary aim of this study is to pilot and feasibility test MMW, a digital training intervention for line managers. METHODS: We use a cluster randomized controlled trial design consisting of 2 arms, the intervention arm and a 3-month waitlist control, in this multicenter feasibility pilot study. Line managers in the intervention arm will complete a baseline questionnaire at screening, immediately post intervention (approximately 6 weeks after baseline), and at 3- and 6-month follow-ups. Line managers in the control arm will complete an initial baseline questionnaire, repeated after 3 months on the waitlist. They will then be granted access to the MMW intervention, following which they will complete the questionnaire post intervention. The direct reports of the line managers in both arms of the trial will also be invited to take part by completing questionnaires at baseline and follow-up. As a feasibility pilot study, a formal sample size is not required. A minimum of 8 clusters (randomized into 2 groups of 4) will be sought to inform a future trial from work organizations of different types and sectors. RESULTS: Recruitment for the study closed in January 2022. Overall, 24 organizations and 224 line managers have been recruited. Data analysis was finished in August 2023. CONCLUSIONS: The results from this feasibility study will provide insight into the usability and acceptability of the MMW intervention and its potential for improving line manager outcomes and those of their direct reports. These results will inform the development of subsequent trials. TRIAL REGISTRATION: ClinicalTrials.gov NCT05154019; https://clinicaltrials.gov/study/NCT05154019. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/48758.

Returning employees back to work: developing a measure for Supervisors to Support Return to Work (SSRW).

INTRODUCTION: Evidence suggests that supervisors' behaviors have a strong influence on employees' health and well-being outcomes. Few have examined the specific behaviors associated with managing an employee back to work following long-term sick leave. This study describes the development of a behavior measure for Supervisors to Support Return to Work (SSRW) using qualitative and quantitative research methods. METHODS: Qualitative data were collected between 2008 and 2010 from a UK population of organisational stakeholders (N = 142), line managers (N = 20) and employees (N = 26). Data from these samples were used to develop a 42 item questionnaire and to validate it using a further sample of line managers (N = 186) and employees (N = 359). RESULTS: Based on a factor structure and reliability results, four scales emerged. The measure demonstrated good internal reliability, construct and concurrent validity. Longitudinal data analyses demonstrated test-retest reliability and promising predictive validity. CONCLUSIONS: This is a potentially valuable tool in research and in organisational settings, both during long-term sick leave and after employees have returned to work.

Helping cancer survivors return to work: what providers tell us about the challenges in assisting cancer patients with work questions.

INTRODUCTION: Cancer patients and survivors report receiving little work-related advice from healthcare providers about how to manage their work during treatment or when to return after completing primary treatment. This study explores the extent to which health professionals involved with colorectal cancer patients address work matters during active treatment. METHODS: Eighteen health professionals from oncology, occupational health and general practice were interviewed. Interviews were transcribed verbatim and analysed using thematic analysis. RESULTS: Health professionals provide conflicting and limited information to patients regarding ability to work during treatment, or when to return to work thereafter. Lack of knowledge about impacts of treatment and symptoms on work ability and sustainability, particularly in relation to different occupations and work tasks resulted in providers offering minimal guidance to patients. Current practices relied on providers' previous experiences with employed patients, rather than a sound evidence-base. CONCLUSIONS: The type of work-related information given to patients by providers is not systematic. It is necessary to develop a better knowledge base about the impacts of cancer and its treatment on work ability, sustainability and return to work that would help providers to offer more tailored advice to patients, consistently. Therefore, it is appropriate to recommend that formal training for providers is necessary. Enhancing the quality of information and training for health professionals to provide better work-related support to patients during the early stages of treatment could enable individuals to manage their work more effectively and facilitate a successful transition from patient to survivor.

Future Teleworking Inclinations Post-COVID-19: Examining the Role of Teleworking Conditions and Perceived Productivity.

Organisations have implemented intensive home-based teleworking in response to global COVID-19 lockdowns and other pandemic-related restrictions. Financial pressures are driving organisations to continue intensive teleworking after the pandemic. Understanding employees' teleworking inclinations post COVID-19, and how these inclinations are influenced by different factors, is important to ensure any future, more permanent changes to teleworking policies are sustainable for both employees and organisations. This study, therefore, investigated the relationships between the context of home-based teleworking during the pandemic (pandemic-teleworking conditions), productivity perceptions during home-based teleworking, and employees' future teleworking inclinations (FTI) beyond the pandemic. Specifically, the study examined whether pandemic-teleworking conditions related to the job, and the physical and social environments at home, influenced employees' FTI, and if perceptions of improved or reduced productivity mediated these relationships. Data were collected during April and May 2020 with a cross-sectional online survey of teleworkers (n = 184) in Germany, Switzerland, the United Kingdom, and other countries during the first COVID-19 lockdowns. Reported FTI were mixed. Most participants (61%) reported wanting to telework more post-pandemic compared to before the pandemic; however, 18% wanted to telework less. Hierarchical multiple regression analysis revealed that some teleworking conditions (job demands and work privacy fit) were positively associated with FTI. Other teleworking conditions (specifically, job change, job control, home office adequacy, and childcare) were not associated with FTI. Perceived changes in productivity mediated the relationship between work privacy fit and FTI. Findings highlight the role of work privacy fit and job demands in influencing pandemic productivity perceptions and teleworking inclinations post-pandemic. Results raise questions about the suitability and sustainability of home-based teleworking for all staff. As organisations plan to increase the proportion of teleworking post-pandemic, this study suggests there is a need to support employees who perceived their productivity to be poor while home-working during the pandemic.

Protocol for a feasibility randomised controlled study of a multicomponent intervention to promote a sustainable return to work of workers on long-term sick leave - PROWORK: PROmoting a Sustainable and Healthy Return to WORK.

BACKGROUND: The cost of sickness absence has major social, psychological and financial implications for individuals and organisations. Return-to-work (RTW) interventions that support good quality communication and contact with the workplace can reduce the length of sickness absence by between 15 and 30 days. However, initiatives promoting a sustainable return to work for workers with poor mental health on long-term sickness absence across small, medium and large enterprises (SMEs and LEs) are limited. This paper describes the protocol of a pilot randomised controlled trial (RCT) to test the feasibility of implementing a RTW intervention across SMEs and LEs across all sectors. METHODS AND DESIGN: A two-arm feasibility RCT with a 4-month intervention will be conducted in SMEs and LE enterprises from the Midlands region, UK. At least 8 organisations (4 controls and interventions), and at least 60 workers and/or managers, will be recruited and randomised into the intervention and control group (30 interventions, 30 controls). Workers on long-term sickness absence (LTSA) (between 8 and 50 days) and managers with a worker on LTSA will be eligible to participate. The intervention is a behavioural change programme, including a managers and workers RTW toolkit, focused on supporting sickness absence and RTW through the provision of knowledge, problem-solving, action planning, goal setting and positive communication that leads to a sustainable RTW. Organisations assigned to the control group will continue with their usual practice. Measurements of mental health, RTW, work outcomes, quality-of-life, workplace support and communication and other demographic data will be taken at baseline, 2 months and 4 months. Feasibility will be assessed based on recruitment, retention, attrition, completion of measures and intervention compliance for which specific process and research outcomes have been established. A process evaluation will explore the experiences and acceptability of the intervention components and evaluation measures. Exploratory economic evaluation will be conducted to further inform a definitive trial. DISCUSSION: This is a novel intervention using a worker-manager approach to promote a sustainable return to work of workers on long-term sick leave due to poor mental wellbeing. If this intervention is shown to be feasible, the outcomes will inform a larger scale randomised control trial. TRIAL REGISTRATION: ISRCTN90032009 (retrospectively registered, date registered 15th December 2020).

Evaluation of a natural workspace intervention with active design features on movement, interaction and health.

BACKGROUND: There is increasing focus on designing workspaces that promote less sitting, more movement and interaction to improve physical and mental health. OBJECTIVE: This study evaluates a natural intervention of a new workplace with active design features and its relocation to a greener and open space. METHODS: An ecological model was used to understand how organisations implement change. Pre and post survey data from 221 matched cases of workers and accelerometery data (n = 50) were analysed. RESULTS: Results show a decrease in occupational sitting (-20.65 mins/workday, p = 0.001) and an increase in workplace walking (+5.61 mins/workday, p = 0.001) using survey data, and accelerometery data (occupational sitting time: -31.0 mins/workday, p = 0.035, standing time: +22.0 mins/workday, p = 0.022, stepping time: +11.0 mins/workday, p = 0.001). Improvements in interaction, musculoskeletal pain and mental health were reported. CONCLUSIONS: Application of the ecological model shows that the organisation understands how to target the built environment and social/cultural environment but not how to target behaviour change at the individual level.

Women's perceptions of chemotherapy-induced cognitive side affects on work ability: a focus group study.

AIMS AND OBJECTIVES: To investigate women's awareness of chemotherapy-induced cognitive changes, their perception of cognitive limitations in carrying out daily tasks and subsequent return to work decisions and perceptions of work ability. BACKGROUND: Evidence suggests that women diagnosed with breast cancer experience cognitive changes as a consequence of chemotherapy treatment. Although these changes tend to be subtle deficits in memory, concentration and the ability to organise information, there has been no published research identifying how they can impact patient's ability to work and subsequent employment decisions. DESIGN: This was a qualitative study. METHOD: Data were collected from breast cancer survivors using semi-structured interviews with two focus groups (n = 6, n = 7). Interviews were transcribed verbatim and analysed using template analysis. RESULTS: Data were categorised into four main themes: (1) awareness of cognitive changes during and following chemotherapy, (2) cognitive ability and confidence in return to work, (3) impact of cognitive changes on work ability and (4) information on the cognitive side effects of chemotherapy. CONCLUSIONS: The views and experiences of breast cancer survivors towards returning to work and subsequent work ability were affected by chemotherapy-induced cognitive impairment. More specifically the appraisal of returning to work and ability to manage work were influenced by three interrelated factors: (1) actual cognitive ability following chemotherapy, (2) awareness of cognitive failures by the women and their families and (3) the subsequent impact on their confidence in carrying out daily tasks including work tasks. RELEVANCE TO CLINICAL PRACTICE: More information and support is needed to help patients with cancer to manage chemotherapy-induced cognitive impairments in home and workplace. Nurses are increasingly asked about the impact of cancer and its treatment on work and are therefore well positioned to offer this advice. Subsequently, nurses require additional knowledge and guidance to provide this information and support.

The influence of employer support on employee management of chronic health conditions at work.

INTRODUCTION: This study examined the relationship between employer support, self-efficacy and self-management of chronic illness at work. METHOD: 772 employees reporting musculoskeletal pain (n = 230), arthritis and rheumatism (n = 132), asthma (n = 129), depression and anxiety (n = 121), heart disease (n = 80) and diabetes(n = 80) completed a questionnaire distributed across four large organizations. A modified version of the Self-Efficacy to Manage Symptoms Scale and the Self-Management Behaviors Scale were used. Support from line manager and occupational health were assessed. RESULTS: Structural equation modelling analyses revealed that line managers support was directly related to employees' self-management of symptoms and medication at work. All three self-efficacy measures (beliefs about the ability to make adjustments,take medication and manage symptoms at work) partially mediated the relationship between line manager support and the use of medication at work. Self-efficacy beliefs in taking medication and making work adjustments also partially mediated the relationship between line manager support and self-management of symptoms at work. In contrast, there were no direct relationship between occupational health support and two self-management behaviors. Self-efficacy beliefs about making adjustments at work fully mediated the relationship between support from occupational health and self-management behaviors. CONCLUSIONS: Employer support in developing both symptom-related and work-related self-efficacy for medication adherence and symptom management is important for those working with a chronic illness.

The importance of transformational leadership style for the well-being of employees working with older people.

AIM: This paper is a report of a study to explore the relationships between transformational leadership, followers' perceived working conditions and employee well-being and job satisfaction. BACKGROUND: There is some evidence that transformational leadership style is linked to employee job satisfaction and well-being. However, it is not clear whether this is due to (i) a direct relationship between leadership and job satisfaction and well-being outcomes or (ii) whether followers' perceived working conditions mediate this relationship. METHODS: A cross-sectional design was applied to data from a questionnaire study of 447 staff caring for older people in Denmark. Data were collected in 2005. A theory-driven model of the relationships between leadership, working conditions, job satisfaction and well-being was tested using structural equation modelling. RESULTS: The transformational leadership style was closely associated with followers' working conditions, namely involvement, influence and meaningfulness. Involvement was associated with job satisfaction and meaningfulness was associated with well-being. However, working conditions were closely correlated with each other, and thus the mediating mechanisms may operate through several different working conditions. A direct path between leadership behaviour and employee well-being was also found. CONCLUSION: Considering working conditions in the absence of studying leadership behaviour (or vice versa) may reveal an incomplete picture of the impact of work and work relationships on well-being. Work re-design interventions focused on influence may benefit from the consideration of training managers to exert transformational leadership behaviours.

Sickness absence management: encouraging attendance or 'risk-taking' presenteeism in employees with chronic illness?

PURPOSE: To investigate the organizational perspectives on the effectiveness of their attendance management policies for chronically ill employees. METHODS: A mixed-method approach was employed involving questionnaire survey with employees and in-depth interviews with key stakeholders of the organizational policies. RESULTS: Participants reported that attendance management polices and the point at which systems were triggered, posed problems for employees managing chronic illness. These systems presented risk to health: employees were more likely to turn up for work despite feeling unwell (presenteeism) to avoid a disciplinary situation but absence-related support was only provided once illness progressed to long-term sick leave. Attendance management polices also raised ethical concerns for 'forced' illness disclosure and immense pressures on line managers to manage attendance. CONCLUSIONS: Participants felt their current attendance management polices were unfavourable toward those managing a chronic illness. The policies heavily focused on attendance despite illness and on providing return to work support following long-term sick leave. Drawing on the results, the authors conclude that attendance management should promote job retention rather than merely prevent absence per se. They outline areas of improvement in the attendance management of employees with chronic illness.

Return-to-work guidance and support for colorectal cancer patients: a feasibility study.

BACKGROUND: Many cancer patients and survivors experience impairments in their ability to work as a result of diagnosis and treatment. Although the literature demonstrates favorable return-to-work rates, there is a lack of intervention studies that have sought to enhance reemployment and return-to-work outcomes. OBJECTIVE: The purpose of this study was to test the feasibility of an intervention designed to offer brief tailored information on work ability during treatment to colorectal cancer patients. METHODS: Thirteen employed colorectal cancer patients were recruited to test the feasibility of the intervention. Participants were provided with an educational leaflet and a face-to-face return-to-work consultation. This included advice and guidance on managing symptoms at work, communication with employer, and information on work ability during and after treatment. This was tailored according to work type (manual/nonmanual). RESULTS: Most participants found key aspects of the intervention useful. In particular, information and advice on the impact of treatment upon work ability were considered most valuable. Although levels of work ability and well-being did not change during the intervention, there were trends of improvement in the data. CONCLUSIONS: This study demonstrated that the content of this intervention could aid return to work. IMPLICATIONS FOR PRACTICE: Most participants felt that specialist cancer nurses and consultants were best placed to deliver return-to-work interventions. Although cancer nurses provide patients with a significant amount of information at diagnosis and treatment, our findings suggest that raising employment matters early on could help identify the most suitable time to deliver a return-to-work intervention.

Cognitive intervention for breast cancer patients undergoing adjuvant chemotherapy: a needs analysis.

BACKGROUND: Evidence suggests women with breast cancer who had received chemotherapy experienced cognitive problems. Although these are largely subtle deficits, they can negatively impact a patient's quality of life, ability to work, and subsequent employment decisions. OBJECTIVE: The present study explored what healthcare information and support are available to help women understand the effects of chemotherapy on daily functioning at home and at work. It also explored what information and support they would find useful as interventions. METHODS: Qualitative interviews were carried out with 31 patients attending a breast cancer clinic 4 months after treatment completion (phase 1) and with 5 oncology health professionals (phase 2). Fifteen women who took part in the interviews completed a short questionnaire on suitable interventions (phase 3). RESULTS: Participants reported problems with fatigue, low mood, memory, and attention. Problems with remembering tasks at work were most common. Participants requested more information and support on cognitive difficulties. Oncology health professionals discussed the need for information and support for patients on managing cognitive problems. From the findings, 4 interventions and delivery modes were identified and validated. These were information and activities on cognitive strategies, help with emotional distress associated with cognitive difficulties, and advice for families and employers. CONCLUSION: Despite mixed evidence for cognitive problems associated with chemotherapy, there is a need for an intervention, and this may be related to managing emotional distress associated with perceived cognitive problems. IMPLICATIONS FOR PRACTICE: Nurses should include potential cognitive problems when providing information to patients.

Using a competency-based approach to identify the management behaviours required to manage workplace stress in nursing: a critical incident study.

AIM: To identify the specific management behaviours associated with the effective management of stress in nursing; and to build a stress management competency framework that can be integrated and compared with nurse management frameworks. BACKGROUND: Workplace stress is a significant problem in healthcare, especially within nursing. While there is a reasonable consensus regarding the sources of stress and its impact on health and well-being, little is known about the specific line manager behaviours that are associated with the effective and ineffective management of stress. METHOD: Semi-structured interviews using critical incident technique were conducted with 41 employees working within 5 National Health Service (NHS) trusts within the United Kingdom. Data were transcribed and analysed using content analysis. FINDINGS: 19 competencies (or sets of behaviour) were identified in the management of stress in employees. The 3 most frequently reported competencies: managing workload and resources, individual consideration and participative approach, are discussed in detail with illustrative quotes. CONCLUSIONS: Managers are vital in the reduction and management of stress at work. Importantly, the 2 of the 3 dominant competencies, managing workload and resources and individual consideration, do not feature in the UK's NHS Knowledge and Skills Framework, suggesting there are important skills gaps with regard to managing workplace stress. The implications of this approach for training and development, performance appraisal and assessment are discussed. Interventions to support managers develop effective behaviours are required to help reduce and manage stress at work.

The mediating effects of team and self-efficacy on the relationship between transformational leadership, and job satisfaction and psychological well-being in healthcare professionals: a cross-sectional questionnaire survey.

BACKGROUND: The importance of transformational leadership for the health and well-being of staff in the healthcare sector is increasingly acknowledged, however, there is less knowledge about the mechanisms that may explain the links between transformational leaders and employee health and well-being. OBJECTIVES: To examine two possible psychological mechanisms that link transformational leadership behaviours to employee job satisfaction and well-being. DESIGN: Cross-sectional study design. SETTINGS: The study took place in two elderly care centers in large Danish local government. Staff were predominantly healthcare assistants but also nurses and other healthcare-related professions participated in the study. PARTICIPANTS: 274 elderly care employees completed the questionnaire. Surveys were sent to all employees working at the centers. 91% were female, the average age was 45 years. METHODS: A questionnaire was distributed to all members of staff in the elderly care centers and where employees were asked to rate their line manager's leadership style and were asked to evaluate their own level of self-efficacy as well as the level of efficacy in their team (team efficacy) and their job satisfaction and psychological well-being. RESULTS: Both team and self-efficacy were found to act as mediators, however, their effects differed. Self-efficacy was found to fully mediate the relationship between transformational leadership and well-being and team efficacy was found to partially mediate the relationship between transformational leadership and job satisfaction and fully mediate the relationship between transformational leadership and well-being. CONCLUSIONS: Within the pressurised environment faced by employees in the healthcare sector today transformational leaders may help ensure employees' job satisfaction and psychological well-being. They do so through the establishment of a sense of being in control as individuals but also as being part of a competent group.

Self-management of health-behaviors among older and younger workers with chronic illness.

OBJECTIVE: To examine the self-management of health behaviors carried out by older (aged 50-69 years) and younger workers (aged 20-49 years) with a chronic illness. METHODS: Questionnaire data was collected from 759 employees with a diagnosed chronic illness. Four categories of self-managing health behaviors were examined: using prescribed medication, monitoring and responding to symptoms, managing an appropriate diet and exercising. RESULTS: The majority of participants (56-97%) reported being advised to carry out health behaviors at home and at work. Controlling for confounding factors, medication use was associated with younger and older workers. Managing an appropriate diet was associated with younger workers with asthma, musculoskeletal pain or diabetes. Exercising was associated with younger workers with asthma and with older workers with heart disease, arthritis and rheumatism or diabetes. CONCLUSIONS: The findings indicate that there are differences in diet and exercise activities among younger and older workers. PRACTICE IMPLICATIONS: To increase self-management in health behaviors at work, improved communication and understanding between the different health professions and the patient/employee is required so that different tailored approaches can be effectively targeted both by age and within the context of the working environment, to those managing asthma, heart disease, diabetes and arthritis and rheumatism.

Work factors related to psychological and health-related distress among employees with chronic illnesses.

OBJECTIVE: This study examined specific psychosocial factors associated with psychological and health-related distress amongst employees reporting different chronic illnesses. METHODS: The sample consisted of 1029 employees managing either musculoskeletal pain (n=324), arthritis and rheumatism (n=192), asthma (n=174), depression and anxiety (n=152), heart disease (n=96) or diabetes (n=91). Information on psychological distress, work limitations, illness management, disclosure, absence, presenteeism, support and demographic factors were obtained through self-administered questionnaires. RESULTS: Both low psychological well-being and high health-related distress were associated with an increase in work limitations (beta=0.20, SE=.03; and beta=0.19, SE=.01, respectively), poorer management of illness symptoms at work (beta=-0.17, SE=.12; and beta=-0.13, SE=.02), high presentieesm (beta=0.19, SE=.25; and beta=0.14, SE=.05) and low workplace support (beta=-0.05, SE=.22; and beta=-0.12, SE=.05). Health-related distress was additionally associated with disclosure of illness at work (beta=0.18, SE=.08) and long-term sickness absence (beta=0.10, SE=.06). CONCLUSIONS: To enable individuals to effectively manage both their illness and their work without serious repercussions, it is important for both healthcare professionals and employers alike, to improve the well-being of workers with chronic illness by supporting and facilitating their efforts to over-come health-related limitations at work.