REducing Stress and Improving professionaLs' vItality Using innovativE iNtervenTions

1. Introduction and rationale Hospital employees are under a lot of pressure due to a large physical and emotional workload and time constraints (1). This may lead to exhaustion, psychological or physical distress and eventually burnout. Maslach et al. (2) have defined three dimensions of burnout: exhaustion, cynicism/depersonalization and sense of inefficacy/low personal accomplishment. Burnout among health care professionals has been an under-recognized and under-reported problem. There is increasing data about burnout and mental vitality among health care workers; up to half of hospital employees are experiencing symptoms of burnout (3-7). Psychological problems among health care workers can cause decreased job satisfaction, decreased efficiency and productivity, absenteeism, abandonment of the medical profession and even poor quality of care and impaired patient safety (4,8-11). Several interventions have been developed to promote well-being and reduce psychological problems among health care workers, including coaching programs and mindfulness and cognitive-behavioral therapy-based interventions (12,13). Although effective, these programs are usually expensive and time-consuming. To increase availability (and to reduce costs) of mental support for healthcare professionals, Your World has been developed. Your World is designed to improve employees' well-being and resilience by implementing new habits according to the 'Healthy Mind Platter' (HMP) (14). Contrary to most existing interventions, Your World is inexpensive and time-efficient, taking only a couple of minutes a day. The healthy mind platter consists of seven neuro-cognitive activities or 'ingredients' that are important for stress reduction: physical time (exercise), sleep time, focus time (planning moments for work or hobbies without interruptions), time in (self-reflection), down time (moments without scheduled tasks), play time (playing and humor) and connecting time (social interaction or time spent with nature). In the Your World app, an eighth dimension was added: earth time, which is related to nature connectedness and pro-environmental behavior. Through weekly challenges (trying out a new habit) and encouraging messages, the app motivates the users to implement new HMP activities into their daily life, in order to improve mental well-being. The investigators hypothesize that Your World will improve resilience and mental vitality and reduce stress among health care employees. Eventually, this will reduce negative psychological outcomes like burnout and its practical consequences (absenteeism, dropout).
2. Objective(s) Main objective

• Does Your World reduce stress among hospital employees as measured by the PSS-10? Secondary objectives
• Does Your World reduce stress among hospital employees as measured by hair cortisol levels?
• Does Your World improve vitality among hospital employees as measured by the Vita-16?
• Which factors (e.g. age, gender, job and department) influence stress and vitality of hospital employees?
• What is the relation between different measurements (i.e. PSS-10, vita-16, vitality scores, mood scores and hair cortisol) of stress and vitality?
• Which factors (e.g. stress, vitality, age, gender, job) influence the use of the Your World app?

1. Study type 3.1 Study type: Prospective randomized controlled trial
2. Methods

4.1 Methods In total, 500 participants will be randomized to the intervention or the control group. Participants in the intervention group will undergo a vitality session and receive a code needed to download and use the Your World app. The control group will not participate in vitality sessions, but they will receive access to the control app. In both groups, hair samples and stress / vitality questionnaires will be collected at baseline and after 3 months. Questionnaires will be collected again after 6 months.

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