电子心理健康方法对医院员工工作功能的影响：一项群组随机对照试验。
Effect of an E-mental health approach to workers' health surveillance versus control group on work functioning of hospital employees: a cluster-RCT.
机构信息
Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
出版信息
PLoS One. 2013 Sep 12;8(9):e72546. doi: 10.1371/journal.pone.0072546. eCollection 2013.
OBJECTIVE
To evaluate an e-mental health (EMH) approach to workers' health surveillance (WHS) targeting work functioning (WF) and mental health (MH) of healthcare professionals in a randomised controlled trial.
METHODS
Nurses and allied health professionals (N = 1140) were cluster-randomised at ward level to the intervention (IG) or control group (CG). The intervention consisted of two parts: (a) online screening and personalised feedback on impaired WF and MH, followed by (b) a tailored offer of self-help EMH interventions. CG received none of these parts. Primary outcome was impaired WF (Nurses Work Functioning Questionnaire), assessed at baseline and after three and six months. Analyses were performed in the positively screened subgroup (i) and in all participants (ii).
RESULTS
Participation rate at baseline was 32% (NIG = 178; NCG = 188). Eighty-two percent screened positive for at least mild impairments in WF and/or MH (NIG = 139; NCG = 161). All IG-participants (N = 178) received part (a) of the intervention, nine participants (all positively screened, 6%) followed an EMH intervention to at least some extent. Regarding the subgroup of positively screened participants (i), both IG and CG improved over time regarding WF (non-significant between-group difference). After six months, 36% of positively screened IG-participants (18/50) had a relevant WF improvement compared to baseline, versus 28% (32/115) of positively screened CG-participants (non-significant difference). In the complete sample (ii), IG and CG improved over time but IG further improved between three and six months while CG did not (significant interaction effect).
CONCLUSIONS
In our study with a full compliance rate of 6% and substantial drop-out leading to a small and underpowered sample, we could not demonstrate that an EMH-approach to WHS is more effective to improve WF and MH than a control group. The effect found in the complete sample of participants is not easily interpreted. Reported results may be useful for future meta-analytic work.
TRIAL REGISTRATION
Dutch Trial Register NTR2786.
目的
在一项随机对照试验中，评估一种电子心理健康（EMH）方法对医疗保健专业人员的工作功能（WF）和心理健康（MH）进行工人健康监测（WHS），以评估其效果。
方法
以病房为单位对护士和辅助医疗专业人员（N=1140）进行聚类随机分组，分为干预组（IG）和对照组（CG）。干预包括两部分：（a）在线筛选和对 WF 和 MH 受损的个性化反馈，随后（b）提供量身定制的自我帮助 EMH 干预。CG 不接受这些部分。主要结局是 WF 受损（护士工作功能问卷），在基线和 3 个月和 6 个月时进行评估。在（i）积极筛查亚组和（ii）所有参与者中进行分析。
结果
基线时的参与率为 32%（NIG=178；NCG=188）。82%的人 WF 和/或 MH 至少有轻度受损（NIG=139；NCG=161）。所有 IG 参与者（N=178）都接受了干预的第（a）部分，9 名参与者（所有阳性筛查者，6%）或多或少地接受了 EMH 干预。对于阳性筛查参与者的亚组（i），IG 和 CG 随着时间的推移在 WF 方面都有所改善（组间无显著性差异）。6 个月后，与基线相比，IG 阳性筛查参与者中有 36%（50 人中有 18 人）WF 有明显改善，而 CG 阳性筛查参与者中有 28%（115 人中有 32 人）（差异无统计学意义）。在完整样本（ii）中，IG 和 CG 随着时间的推移而改善，但 IG 在 3 个月至 6 个月之间进一步改善，而 CG 则没有（有显著的交互效应）。
结论
在我们的研究中，完全依从率为 6%，大量参与者中途退出导致样本量小且无统计学效力，我们无法证明 EMH 方法对 WHS 改善 WF 和 MH 比对照组更有效。在完整样本中发现的效果不易解释。报告的结果可能对未来的荟萃分析工作有用。
试验注册
荷兰试验注册中心 NTR2786。
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