Efficacy and cost-effectiveness of minimal guided and unguided internet-based mobile supported stress-management in employees with occupational stress: a three-armed randomised controlled trial

Abstract

BackgroundInternet- and mobile based stress-management interventions (iSMI) may be an effective means to address the negative consequences of occupational stress. However, available results from randomised controlled trials are conflicting. Moreover, it is yet not clear whether guided or unguided self-help iSMI provide better value for money. Internet-based mental health interventions without guidance are often much less effective than interventions including at least some guidance from a professional. However, direct comparisons in randomised controlled trials are scarce and, to the best of our knowledge, the comparative (cost)-effectiveness of guided vs. unguided iSMI has not yet been studied. Hence, this study investigates the acceptability and (cost-) effectiveness of minimal guided and unguided iSMI in employees with heightened levels of perceived stress.MethodsA three-armed randomised controlled trial (RCT) will be conducted to compare a minimal guided and unguided iSMI with a waiting list control condition (WLC). Both active conditions are based on the same iSMI, i.e. GET.ON Stress, and differ only with regard to the guidance format. Employees with heightened levels of perceived stress (PSS ≥ 22) will be randomised to one of three conditions. Primary outcome will be comparative changes in perceived stress (PSS). Secondary outcomes include changes in self-reported depression, work-engagement, presenteeism and absenteeism. Moreover, a cost-effectiveness analysis will be conducted from a societal perspective, including both direct medical costs and costs related to productivity losses. In addition, a cost-benefit analysis will be conducted from the employer’s perspective. Incremental net-benefit regression analyses will address the question if there are any baseline factors (i.e. subgroups of employees) associated with particularly favorable cost-effectiveness when the experimental intervention is offered. Assessments take place at baseline, 7 weeks post-treatment and 6 months after randomisation.DiscussionOnline-based (guided) self-help interventions could be an acceptable, effective and economically sustainable approach to offer evidence-based intervention alternatives to reduce the negative consequences associated with work-related stress. This study evaluates the (cost-) effectiveness of two versions of an iSMI, minimal guided and unguided iSMI. Thus, the present study will further enhance the evidence-base for iSMI and provide valuable information about the optimal balance between outcome and economic costs.Trial registrationGerman Clinical Trial Registration (DRKS): DRKS00005687.

Internet- and mobile-based stress management for employees with adherence-focused guidance: efficacy and mechanism of change

“…However, RCT that compare adherence-focused guidance format with regular content feedbacks are needed to support such an assumption and to determine whether or not adherence-focused guidance formats can result in equivalent outcomes as more intensive contentfocused guidance formats. However, even if a less intensive guidance format should yield lower effects in direct comparisons, their potential on a population level might still be higher as such interventions have a greater reach and more participants can be treated for the same costs (28,59). On the other hand, it may very well be the case that employees are less willing to participate in an intervention if no regular content feedback is provided, which would result in lower overall effects in the target population (60,61).…”

“…Participants were supported by an e-coach applying an adherence-focused guidance concept. For a detailed description see (28). The purpose of the guidance was to support participants to adhere to the treatment modules whilst keeping it to a minimum in order to minimize costs.…”

“…One way to enhance the cost-efficacy of these interventions is to use the cost-intensive guidance component exclusively to foster adherence to the self-help intervention and not to provide detailed feedback on the exercises participants complete (28,29). In such an adherence-focused guidance concept, participants are supported in the regular completion of the intervention sessions (ie, e-mail reminders); however, feedback is only provided upon request of the participant.…”

Efficacy of an internet-based problem-solving training for teachers: results of a randomized controlled trial

“…At work, people often must cope with difficult situations and solve problems while also addressing the challenging emotions that arise in those situations. Because deficits in the ability to adaptively cope with difficult emotions are related to various mental health problems (64), the use of effective emotion-regulation techniques (65) in low-threshold internet-based stressmanagement training appears promising (66,67).…”

Employees� Perspectives on the Facilitators and Barriers to Engaging With Digital Mental Health Interventions in the Workplace: Qualitative Study (Preprint)

“…In line with other minimal guided interventions (see [57]) the ecoach provided adherence support (login reminders) and feedback on request. Interviewees were divided by their experience of the e-coach and by how pro-active they wanted the coaching to be.…”