Reducing nurses' stress: A randomized controlled trial of a web-based stress management program for nurses.

BACKGROUND: Nursing is a notoriously high-stress occupation - emotionally taxing and physically draining, with a high incidence of burnout. In addition to the damaging effects of stress on nurses' health and well being, stress is also a major contributor to attrition and widespread shortages in the nursing profession. Although there exist promising in-person interventions for addressing the problem of stress among nurses, the experience of our group across multiple projects in hospitals has indicated that the schedules and workloads of nurses can pose problems for implementing in-person interventions, and that web-based interventions might be ideally suited to addressing the high levels of stress among nurses. PURPOSE: The purpose of this study was to evaluate the effectiveness of the web-based BREATHE: Stress Management for Nurses program. METHODS: The randomized controlled trial was conducted with 104 nurses in five hospitals in Virginia and one hospital in New York. The primary outcome measure was perceived nursing-related stress. Secondary measures included symptoms of distress, coping, work limitations, job satisfaction, use of substances to relieve stress, alcohol consumption, and understanding depression and anxiety. RESULTS: Program group participants experienced significantly greater reductions than the control group on the full Nursing Stress Scale, and six of the seven subscales. No other significant results were found. Moderator analysis found that nurses with greater experience benefitted more. CONCLUSION: Using a web-based program holds tremendous promise for providing nurses with the tools they need to address nursing related stress.

A Web-based health promotion program for older workers: randomized controlled trial.

BACKGROUND: Recent evidence supports the efficacy of programs that promote improvements in the health practices of workers 50 years and older who are at higher risk for chronic diseases than younger workers are. Internet-based programs that promote healthy practices have also shown promise and, therefore, should be especially appropriate for workers aged 50 years and older. OBJECTIVE: The purpose of the research was to evaluate the effectiveness of HealthyPast50, a fully automated Web-based health promotion program based on social cognitive theory and aimed specifically at workers 50 years and older. METHODS: The randomized controlled trial was conducted across multiple US offices of a large global information technology company. The sample included 278 employees aged 50 to 68 who were recruited online and randomly assigned to the Web-based HealthyPast50 program or to a wait-list control condition. Self-report measures of diet, physical activity, stress, and tobacco use were collected online before and 3 months after the program group was given access to the program. Use data included number of log-ins and number of pages accessed. The primary analysis was multiple linear regression, following intent-to-treat principles with multiple imputation using the Markov chain Monte Carlo (MCMC) approach for nonmonotone missing data. Potential moderators from demographic characteristics and program dosage effects were assessed using multiple linear regression models. Additional analyses were conducted on complete (nonimputed) cases, excluding program participants who used the program for less than 30 minutes. RESULTS: Retention rates were good for both groups: 80.4% (111/138) for the program group and 94.3% (132/140) for the control group. Program group participants spent a mean of 102.26 minutes in the program (SD 148.32), logged in a mean of 4.33 times (SD 4.28), and viewed a mean of 11.04 pages (SD 20.08). In the analysis of the imputed dataset, the program group performed significantly better than the control group on diet behavioral change self-efficacy (estimated adjusted difference [Δ]=0.16, P=.048), planning healthy eating (Δ=0.17, P=.03), and mild exercise (Δ=1.03, P=.01). Moderator and dosage analyses of the dataset found no significant program effects. Analyses of the nonimputed dataset comparing program users with controls found additional significant program effects on eating practices (Δ=0.09, P=.03), exercise self-efficacy (Δ=0.12, P=.03), exercise planning (Δ=0.18, P=.03), and aging beliefs (Δ=0.17, P=.01). Moderator analysis of this dataset also found significant moderator effects of gender on multiple measures of exercise. CONCLUSIONS: A Web-based health promotion program showed promise for making a significant contribution to the short-term dietary and exercise practices of older working adults. Gender effects suggest that the program effects on exercise are due mainly to improvements among women.

Heart healthy online: an innovative approach to risk reduction in the workplace.

OBJECTIVES: To examine whether a Web-based cardiovascular health promotion program was associated with changes in self-reported behaviors, attitudes, and biometric indicators in a population of working adults. METHODS: Employees (n = 210) were recruited and randomized into either an Internet-based or control condition. Participants completed pre- and postintervention self-report assessments on diet, exercise, smoking, and mental health. Pre- and postintervention biometric screenings were also obtained on blood pressure, heart rate, weight, and hip/waist circumference. RESULTS: The intervention was associated with significant improvements in dietary attitudes (P = 0.003; F = 8.83), dietary intentions (P = 0.031; F = 4.72), dietary self-efficacy (P = 0.015; F = 5.97), exercise self-efficacy (P = 0.002; F = 9.51), exercise habits (P = 0.016; F = 5.94), and coping with stress (P = 0.003; F = 8.85) and depression (P = 0.036; F = 4.46). CONCLUSIONS: The program showed promise for promoting cardiovascular risk reduction behaviors. These results are consistent with similar Web-based interventions.

Test of a web-based program to improve adherence to HIV medications.

We evaluated the effectiveness of a web-based version of the Life-Steps intervention combined with modules for stress reduction and mood management, designed to improve medication adherence among HIV infected individuals. 168 HIV+ adults were randomized into either the Life-Steps program or a waitlist control condition. All participants completed a baseline assessment and provided a 2-week electronic pill (MEMS) cap baseline reading. Follow up data collection was conducted at 3, 6 and 9 months. Patients in the web-based Life-Steps condition had significantly higher antiretroviral medication adherence rates than patients in the control group over the nine-month period as measured by the MEMS cap. In addition, analysis of viral load data indicated that the program also resulted in a significant decrease in viral load. These findings indicate that a web-based Life-Steps program can be a useful and implementable tool for helping patients living with HIV maintain medication adherence.

Evaluation of two web-based alcohol interventions in the U.S. military.

OBJECTIVE: The U.S. military has traditionally had high rates of alcohol misuse and alcohol-related problems, necessitating effective treatment programs that minimize participant burden. Web-based interventions have shown promise as efficient treatment options for college students and adults but have not been widely evaluated in the military. This study evaluated the efficacy of two web-based alcohol interventions originally created for civilians and then adapted for U.S. military personnel. METHOD: Two web-based alcohol interventions, Alcohol Savvy and Drinker's Check-Up, were adapted for use among military populations. The interventions were evaluated using a convenience sample of 3,070 active-duty military personnel at eight installations. Following a baseline survey, participants were assigned to one of three treatment conditions: (a) Alcohol Savvy, (b) Drinker's Check-Up, or (c) control (no program participation). Follow-up surveys were completed by 1,072 participants 1 month following baseline and by 532 participants 6 months following baseline. RESULTS: At 1-month follow-up, participants who completed the Drinker's Check-Up intervention had significant reductions in multiple measures of alcohol use relative to controls. Positive outcomes were found for average number of drinks consumed per occasion, frequent heavy episodic drinker status, and estimated peak blood alcohol concentration. These reductions in alcohol use at the 1-month follow-up were maintained at the 6-month follow-up. There were no statistically significant changes in alcohol use for participants who completed Alcohol Savvy. CONCLUSIONS: This study expands the literature on the effectiveness of web-based treatment for alcohol misuse. Findings indicate that web-based programs (Drinker's Check-Up in particular) can significantly decrease several indicators of alcohol use in U.S. military personnel.

Preventing prescription drug misuse: field test of the SmartRx Web program.

Purpose of the project was to test a Web-based program designed to prevent prescription drug misuse. Study sample consisted of 346 working women randomized into either an experimental or wait-list control condition. Analysis of covariance and logistic regression were used to compare responses. Women receiving the intervention had greater knowledge of drug facts and greater self-efficacy in medication adherence and ability to manage problems with medications compared with controls. Women receiving the intervention also had reduced symptoms reported on the CAGE for prescription medications. Findings suggest that multimedia Web-based programs can be a beneficial addition to substance misuse prevention services. The study's limitations are noted.

A web-based mental health program: reaching parents at work.

OBJECTIVE: The purpose of the project was to test a web-based program providing working parents with the knowledge and skills necessary for prevention and early intervention of mental health problems in youth. METHOD: Study sample consisted of 99 parents who were randomized into either an experimental (program use) or waitlist control condition. Analysis of covariance and paired t-tests were used to compare response outcomes for the two groups. RESULTS: Parents receiving the intervention had greater knowledge of youth mental health issues and greater self-efficacy in handling these issues compared to controls. CONCLUSIONS: Findings suggest that referring parents to a multimedia web-based program can improve parents' knowledge of children's' mental health and their confidence in addressing mental health issues. Web-based programs can be offered to individuals in multiple settings, including the workplace, thereby reaching large numbers of parents.

A web-based approach to managing stress and mood disorders in the workforce.

OBJECTIVE: To evaluate the effectiveness of a web-based multimedia health promotion program for the workplace, designed to help reduce stress and to prevent depression, anxiety, and substance abuse. METHODS: Using a randomized controlled trial design, 309 working adults were randomly assigned to the web-based condition or to a wait-list control condition. All participants were assessed on multiple self-reported outcomes at pretest and posttest. RESULTS: Relative to controls, the web-based group reduced their stress, increased their knowledge of depression and anxiety, developed more positive attitudes toward treatment, and adopted a more healthy approach to alcohol consumption. CONCLUSIONS: We found that a brief and easily adaptable web-based stress management program can simultaneously reduce worker stress and address stigmatized behavioral health problems by embedding this prevention material into a more positive stress management framework.

A field test of a web-based workplace health promotion program to improve dietary practices, reduce stress, and increase physical activity: randomized controlled trial.

BACKGROUND: Most work sites engage in some form of health promotion programming designed to improve worker health and reduce health care costs. Although these programs have typically been delivered through combinations of seminars and print materials, workplace health promotion programs are increasingly being delivered through the Internet. OBJECTIVE: The purpose of this research was to evaluate the effectiveness of a Web-based multimedia health promotion program for the workplace, designed to improve dietary practices, reduce stress, and increase physical activity. METHODS: Using a randomized controlled trial design with pretest-posttest comparisons within each group, 419 employees of a human resources company were randomly assigned to the Web-based condition or to a condition that provided print materials on the same topics. All subjects were assessed at pretest and posttest through an online questionnaire containing multiple measures of health behavior and attitudes. The test period was 3 months. Questionnaire data were analyzed mainly by analysis of covariance and t tests. RESULTS: Retention rates were good for both groups-85% for the Web-based group and 87% for the print group. Subjects using the Web-based program performed significantly better than the print group on Attitudes Toward a Healthful Diet (F(1,415) = 7.104, P = .008) and Dietary Stage of Change (F(1,408) = 6.487, P = .01), but there were no significant group differences on the five other dietary measures. Both groups also showed improvement from pretest to posttest on most dietary measures, as indicated by significant t tests. Within the Web-based group, dosage analyses showed significant effects of the number of times the subject accessed the program on measures of Dietary Self-Efficacy (F(2,203) = 5.270, P = .003), Attitudes Toward a Healthful Diet (F(2,204) = 2.585, P = .045), and Dietary Stage of Change (F(2,200) = 4.627, P = .005). No significant differences were found between the two groups on measures of stress or physical activity, although t tests of pretest-posttest changes indicated that both groups improved on several of these measures. The Web-based group gave significantly higher ratings to the program materials than the print group on all health topics and in their overall evaluation (F(1,410) = 9.808, P = .002). CONCLUSIONS: The Web-based program was more effective than print materials in producing improvements in the areas of diet and nutrition but was not more effective in reducing stress or increasing physical activity. The higher ratings given to the Web-based program suggest that workers preferred it to the print materials. Both groups showed numerous pretest-posttest improvements in all health topics, although such improvements might be attributable in part to a Hawthorne effect. Results suggest that a multimedia Web-based program can be a promising means of delivering health promotion material to the workforce, particularly in the area of diet and nutrition.

A field test of a Web-based substance abuse prevention training program for health promotion professionals.

PURPOSE: To evaluate a multimedia substance abuse prevention (SAP) training program for health promotion (HP) practitioners designed to provide opportunities for behavioral modeling and skills building and to motivate and build confidence in ability to integrate SAP into HP offerings. METHODS: Using a posttest only design, 192 practitioners were randomly assigned to receive web-based (experimental group) or print-based (control group) training. Feelings about ability to conduct effective SAP programming, reactions to training materials, and knowledge about substance abuse and how to implement SAP were assessed. The experimental group also rated specific aspects of the web training. RESULTS: The experimental group gave high evaluation ratings, scored significantly higher on self-efficacy items, and gave significantly higher ratings on 12 of 15 reaction items. CONCLUSION: Web-based training was more engaging, understandable, user-friendly, useful, comprehensive, and motivating than print-based training; it is believed to be more effective in helping to integrate substance abuse prevention; and it will serve as a continuous resource.

Workplace health promotion and utilization of health services: follow-up data findings.

This article reports findings from a workplace substance abuse prevention program designed to investigate best practices. The study sought to assess the effects of the worksite wellness program and employee assistance program (EAP) on healthcare utilization and costs, identify predictors of outpatient costs and visits, and assess the effect of the intervention on health attitudes, behaviors, and behavioral health-related costs and visits. Results indicated that visits to the EAP increased as did overall healthcare visits, that utilization of healthcare services and costs were higher in the population receiving substance abuse prevention intervention, and that employees in the substance abuse prevention intervention reported lower heavy drinking and binge drinking. Data suggest that substance abuse prevention may result in higher healthcare costs and utilization in the short term, but a reduction in health risk behaviors such as heavy drinking may result in lower healthcare costs and utilization in the long term.

A field evaluation of five on-site drug-testing devices.

A field study was performed at two police agencies to evaluate the utility and accuracy of five on-site urine analysis drug-testing devices when used to test driving under the influence (DUI) arrestees. The devices evaluated were AccuSign, Rapid Drug Screen, TesTcup-5, TesTstik, and Triage. Standard workplace screening cut-off concentrations were used and samples were tested for marijuana, cocaine and metabolites, amphetamine(s), opiates, and PCP (except opiates 300 ng/mL). Four-hundred arrestees were recruited at each site, informed consent was obtained, and urine specimens were collected from each subject for analysis. Police officers conducted the testing with one device, and trained technicians performed testing with the other four devices. The device used by the officers was rotated. All positive and 5% of the negative samples were confirmed in a laboratory using mass spectrometry. Laboratory cut-off concentrations were 4 ng/mL for carboxy-THC; 50 ng/mL for benzoylecgonine; 100 ng/mL for amphetamines; 50 ng/mL for opiates; and 5 ng/mL for PCP. Approximately one-third (36%) of the subjects tested positive for at least one drug. No randomly selected sample, that tested negative on the devices, tested positive at the laboratory. Based on 800 specimens, the false-negative rate for each device was < 1% for all drug classes. A false positive was defined as testing positive with the device, but the specimen did not contain detectable drug, given the study reporting criteria. For marijuana, benzoylecgonine, and opiates, all devices had < or = 0.25% false-positive rates. For PCP, the false-positive rates were all < or = 1.5%. For amphetamine(s), the false-positive rates were all < or = 1.75%. These rates were adjusted because study confirmation batteries included methylenedioxyamphetamine, methylenedioxymethamphetamine (MDMA), additional over-the-counter sympathomimetic amines, hydromorphone, and hydrocodone. Without the expanded confirmation battery, false-positive rates approached 4% (Triage) for amphetamines and were > or = 2.25% for opiates. Fifty to 90% of the positive amphetamine(s) samples contained MDMA. A similar percentage of the opiate-positive samples contained hydromorphone or hydrocodone. When additional drugs were included in the confirmation testing, it was concluded that the on-site urine analysis drug-testing results were useful in DUI investigations.

Substance use in the construction industry: a comparison of assessment methods.

Most users of illicit drugs are employed adults, with substance use rates especially high in the construction industry. In an effort to shed light on the nature and extent of drug use among construction industry workers, and to compare drug use assessment methods, substance use among construction workers, 60% of whom were apprentices, across six sites was assessed by questionnaire, urinalysis, and hair analysis. Nearly 17% of the participants reported current drug use, although drug use differed dramatically by site. Drug use rates also differed by respondent characteristics, participation rates, and assessment method. The strengths and weaknesses of each assessment method are discussed, along with the rationale for combining methods.

Utilization and cost of behavioral health services: employee characteristics and workplace health promotion.

The study sought to (1) model demographic and employment-related influences on behavioral health care utilization and cost; (2) model behavioral health care utilization and cost influences on general health care cost, job performance, and earnings; and (3) assess workplace-based health promotion's impact on these factors. Behavioral health care utilization was more common in employees who were female, over age 30, with below-median earnings, or with above-median general (non-behavioral) health care costs. Among employees utilizing behavioral health care, related costs were higher for employees with below-median earnings. Employees utilizing behavioral health care had higher general health care costs and received lower performance ratings than other employees. Health promotion participants were compared with a nonparticipant random sample matched on gender, age, and pre-intervention behavioral health care utilization. Among employees without pre-intervention behavioral health care, participants and nonparticipants did not differ in post-intervention utilization. Among employees utilizing behavioral health care adjusting for pre-intervention costs, participants had higher short-term post-intervention behavioral health care costs than nonparticipants.