A Technology-Assisted Telephone Intervention for Work-Related Stress Management: Pilot Randomized Controlled Trial

Abstract

Background Stress management interventions combining technology with human involvement have the potential to improve the cost-effectiveness of solely human-delivered interventions, but few randomized controlled trials exist for assessing the cost-effectiveness of technology-assisted human interventions. Objective The aim of this study was to investigate whether a technology-assisted telephone intervention for stress management is feasible for increasing mental well-being or decreasing the time use of coaches (as an approximation of intervention cost) while maintaining participants’ adherence and satisfaction compared with traditional telephone coaching. Methods A 2-arm, pilot randomized controlled trial of 9 months for stress management (4-month intensive and 5-month maintenance phases) was conducted. Participants were recruited on the web through a regional occupational health care provider and randomized equally to a research (technology-assisted telephone intervention) and a control (traditional telephone intervention) group. The coaching methodology was based on habit formation, motivational interviewing, and the transtheoretical model. For the research group, technology supported both coaches and participants in identifying behavior change targets, setting the initial coaching plan, monitoring progress, and communication. The pilot outcome was intervention feasibility, measured primarily by self-assessed mental well-being (WorkOptimum index) and self-reported time use of coaches and secondarily by participants’ adherence and satisfaction. Results A total of 49 eligible participants were randomized to the research (n=24) and control (n=25) groups. Most participants were middle-aged (mean 46.26, SD 9.74 years) and female (47/49, 96%). Mental well-being improved significantly in both groups (WorkOptimum from “at risk” to “good” Â>0.85; P<.001), and no between-group differences were observed in the end (Â=0.56, 95% CI 0.37-0.74; P=.56). The total time use of coaches did not differ significantly between the groups (366.0 vs 343.0 minutes, Â=0.60, 95% CI 0.33-0.85; P=.48). Regarding adherence, the dropout rate was 13% (3/24) and 24% (6/25), and the mean adherence rate to coaching calls was 92% and 86% for the research and control groups, respectively; the frequency of performing coaching tasks was similar for both groups after both phases; and the diligence in performing the tasks during the intensive phase was better for the research group (5.0 vs 4.0, Â=0.58, 95% CI 0.51-0.65; P=.03), but no difference was observed during the maintenance phase. Satisfaction was higher in the research group during the intensive phase (5.0 vs 4.0, Â=0.66, 95% CI 0.58-0.73; P<.001) but not during the maintenance phase. Conclusions The technology-assisted telephone intervention is feasible with some modifications, as it had similar preliminary effectiveness as the traditional telephone intervention, and the participants had better satisfaction with and similar or better adherence to the intervention, but it did not reduce the time use of coaches. The technology should be improved to provide more digested information for action planning and templates for messaging. Trial Registration ClinicalTrials.gov NCT02445950; https://www.clinicaltrials.gov/ct2/show/study/NCT02445950

A Comprehensive User Modeling Framework and a Recommender System for Personalizing Well-Being Related Behavior Change Interventions: Development and Evaluation

“…As continuous monitoring of behavior was not implemented as part of With-Me HRS, we were not able to evaluate participants' actual adherence to the recommendations. Nevertheless, some indications of adherence may be inferred from the results of the related pilot RCT [62], which describes the outcomes of the healthcoaching intervention, which utilized With-Me HRS as a technological component. According to the results, participants' self-reported diligence in performing the selected coaching tasks at the beginning of the intervention was slightly better in the group receiving (visible) recommendations compared to the participants who were not provided the opportunity to examine the recommendations (group with hidden recommendations).…”

“…Together, these modules formed a digital healthcoaching system. The content of the stress management program and the functionalities of the overall coaching system are described in [62]. In this study, we focus on the implementation of the HRS module of the coaching system.…”

“…The validity and usefulness of With-Me HRS were studied as a secondary objective of a pilot randomized controlled trial (RCT) [62], where technology-assisted and traditional telephone coaching for occupational stress management were compared in terms of intervention effectiveness and the time use of health coaches. The study was approved by the Ethics Committee of Human Sciences at the University of Oulu, Finland.…”

“…Three health coaches were involved in the study, each with an equal number of participants from both groups. Further details regarding the participants and the study design are presented in [62].…”

“…FIGURE 2. The architecture of With-Me HRS and its connections to the other modules of the overall digital health-coaching system that was utilized in the occupational stress management program described in[62].…”