Computer‐based versus in‐person interventions for preventing and reducing stress in workers New

Abstract

Background

Chronic exposure to stress has been linked to several negative physiological and psychological health outcomes. Among employees, stress and its associated effects can also result in productivity losses and higher healthcare costs. In‐person (face‐to‐face) and computer‐based (web‐ and mobile‐based) stress management interventions have been shown to be effective in reducing stress in employees compared to no intervention. However, it is unclear if one form of intervention delivery is more effective than the other. It is conceivable that computer‐based interventions are more accessible, convenient, and cost‐effective.

Objectives

To compare the effects of computer‐based interventions versus in‐person interventions for preventing and reducing stress in workers.

Search methods

We searched CENTRAL, MEDLINE, PubMed, Embase, PsycINFO, NIOSHTIC, NIOSHTIC‐2, HSELINE, CISDOC, and two trials registers up to February 2017.

Selection criteria

We included randomised controlled studies that compared the effectiveness of a computer‐based stress management intervention (using any technique) with a face‐to‐face intervention that had the same content. We included studies that measured stress or burnout as an outcome, and used workers from any occupation as participants.

Data collection and analysis

Three authors independently screened and selected 75 unique studies for full‐text review from 3431 unique reports identified from the search. We excluded 73 studies based on full‐text assessment. We included two studies. Two review authors independently extracted stress outcome data from the two included studies. We contacted study authors to gather additional data. We used standardised mean differences (SMDs) with 95% confidence intervals (CIs) to report study results. We did not perform meta‐analyses due to variability in the primary outcome and considerable statistical heterogeneity. We used the GRADE approach to rate the quality of the evidence.

Main results

Two studies met the inclusion criteria, including a total of 159 participants in the included arms of the studies (67 participants completed computer‐based interventions; 92 participants completed in‐person interventions). Workers were primarily white, Caucasian, middle‐aged, and college‐educated. Both studies delivered education about stress, its causes, and strategies to reduce stress (e.g. relaxation or mindfulness) via a computer in the computer‐based arm, and via small group sessions in the in‐person arm. Both studies measured stress using different scales at short‐term follow‐up only (less than one month). Due to considerable heterogeneity in the results, we could not pool the data, and we analysed the results of the studies separately. The SMD of stress levels in the computer‐based intervention group was 0.81 standard deviations higher (95% CI 0.21 to 1.41) than the in‐person group in one study, and 0.35 standard deviations lower (95% CI ‐0.76 to 0.05) than the in‐person group in another study. We judged both studies as having a high risk of bias.

Authors' conclusions

We found very low‐quality evidence with conflicting results, when comparing the effectiveness of computer‐based stress management interventions with in‐person stress management interventions in employees. We could include only two studies with small sample sizes. We have very little confidence in the effect estimates. It is very likely that future studies will change these conclusions.

Author(s)

Anootnara Talkul Kuster, Therese K Dalsbø, Bao Yen Luong Thanh, Arnav Agarwal, Quentin V Durand‐Moreau, Ingvild Kirkehei

Abstract

Plain language summary

Computer‐based versus in‐person stress management programmes for workers 

What is the aim of this review? 

We wanted to find out if stress management programmes at work had a different effect if they were given via a computer, compared to being given in person. We collected and analysed all relevant studies to answer this question. We found two studies that studied the effect of the delivery method on stress reduction in workers.

Key messages 

The effects of the delivery method on stress reduction were unclear. More research should be conducted to directly compare equivalent stress management programmes delivered via a computer and in‐person. Any future studies will likely affect the conclusions of this review.

What was studied in the review?  - Many employers wish to reduce stress in their employees and are willing to invest in stress management programmes. It has been shown that workplace stress management programmes can reduce stress in employees, either when delivered by a computer or mobile device, or by a live person. However, it is unclear if the delivery method itself impacts how effective the programme is. Therefore, we evaluated the effect of the intervention delivery method (computer or in person) to reduce stress in workers.

What are the results of the review? 

We found two studies, involving 159 employees, that looked at stress levels in workers after completing stress management programmes on a computer, compared to workers receiving that same programme content from a live person. Both studies taught participants, individually or in small groups, how to recognise and reduce stress, but had conflicting results.

How up to date is this review? 

We searched for studies that had been published up to February 2017.

Author(s)

Anootnara Talkul Kuster, Therese K Dalsbø, Bao Yen Luong Thanh, Arnav Agarwal, Quentin V Durand‐Moreau, Ingvild Kirkehei

Reviewer's Conclusions

Authors' conclusions 

Implications for practice 

We found very low‐quality evidence with conflicting results of the effectiveness of computer‐based stress management interventions compared to in‐person stress management interventions in employees. We could only include two studies with small sample sizes. We have very little confidence in the effect estimates. It is very likely that future studies will change these conclusions. The true effect may likely be substantially different from the estimate of effect.

Implications for research 

More research is needed that directly compares computer‐based and face‐to‐face stress management programmes, so that the impact of the delivery method can be better understood. The research should randomise employees into equivalent computer‐based and face‐to‐face interventions, as well as a control group. However, future studies must be cognisant of the risk from attrition in computer‐based interventions. In particular, efforts must be made to address attrition, and to account for differences between intervention arms from dropouts (e.g. by using an intention‐to‐treat approach). Adherence in computer‐based health interventions is often around 50% (Kelders 2012; Ludden 2015). Therefore, efforts to monitor adherence (e.g. logging online activity or measuring frequency of practice) are also critical, since adherence seems to be a significant factor in determining outcomes. In addition, researchers should be aware of, and measure possible differences, in characteristics of employees between groups, in particular their ability and propensity to use technology.

Assuming a difference in standard deviations between the two groups of two and a standard deviation of six on the commonly‐used Perceived Stress Scale, at 80% statistical power and with a 95% significance level, the required minimum sample size to detect a meaningful difference would be 141 participants in each study arm. Assuming 50% attrition, we recommend recruiting and allocating at least 300 participants for each intervention arm to avoid future studies from being underpowered.

Furthermore, while research has examined the impact of support systems (both technical and clinical) among computer‐based systems, it has not compared them with in‐person delivery methods. The level of support may be a critical factor associated with adherence, and thus we recommend that future research that compares computer‐based and in‐person stress management interventions in employees also varies the level of support (e.g. completely self‐guided versus self‐guided with online support group). Creating this gradation of human support in separate study arms may provide insight on the direction of the effect size.

Get full text at The Cochrane Library

Computer‐based versus in‐person interventions for preventing and reducing stress in workers New is a sample topic from the Cochrane Abstracts.

To view other topics, please or .

Evidence Central is an integrated web and mobile solution that helps clinicians quickly answer etiology, diagnosis, treatment, and prognosis questions using the latest evidence-based research. .