%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e20445 %T Effects of Smartphone-Based Stress Management on Improving Work Engagement Among Nurses in Vietnam: Secondary Analysis of a Three-Arm Randomized Controlled Trial %A Sasaki,Natsu %A Imamura,Kotaro %A Tran,Thuy Thi Thu %A Nguyen,Huong Thanh %A Kuribayashi,Kazuto %A Sakuraya,Asuka %A Bui,Thu Minh %A Nguyen,Quynh Thuy %A Nguyen,Nga Thi %A Nguyen,Giang Thi Huong %A Zhang,Melvyn Weibin %A Minas,Harry %A Sekiya,Yuki %A Watanabe,Kazuhiro %A Tsutsumi,Akizumi %A Shimazu,Akihito %A Kawakami,Norito %+ Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, , Japan, 81 3 5841 3522, nkawakami@m.u-tokyo.ac.jp %K stress management %K mental health %K occupational health %K digital health %K workplace %K LMICs %K South-East Asia %K health care professionals %D 2021 %7 23.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Work engagement is important for employee well-being and work performance. However, no intervention study has investigated the effect of an eMental Health intervention on work engagement among workers in low- and middle-income countries (LMICs). Objective: The aim of the study was to examine the effects of a newly developed smartphone-based stress management program (ABC Stress Management) on improving work engagement among hospital nurses in Vietnam, an LMIC. Methods: Full-time registered nurses (n=949) were randomly assigned to one of 2 intervention groups or a control group. The intervention groups were a 6-week, 6-lesson program offering basic cognitive behavioral therapy (CBT-based stress management skills), provided in either free-choice (program A) or fixed order (program B). Work engagement was assessed at baseline and 3-month and 7-month follow-ups in each of the 3 groups. Results: The scores of work engagement in both intervention groups improved from baseline to 3-month follow-up, and then decreased at the 7-month follow-up, while the score steadily increased from baseline to 7-month follow-up in the control group. Program B showed a significant intervention effect on improving work engagement at the 3-month follow-up (P=.049) with a small effect size (Cohen d= 0.16; 95% CI 0.001 to 0.43]). Program A showed nonsignificant trend (d=0.13; 95% CI –0.014 to 0.41; P=.07) toward improved engagement at 3 months. Neither program achieved effectiveness at the 7-month follow-up. Conclusions: The study demonstrated that a fixed order (program B) delivery of a smartphone-based stress management program was effective in improving work engagement in nurses in Vietnam. However, the effect was small and only temporary. Further improvement of this program is required to achieve a greater effect size and more sustained, longer lasting impact on work engagement. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000033139; tinyurl.com/55gxo253 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-025138 %M 33620328 %R 10.2196/20445 %U https://www.jmir.org/2021/2/e20445 %U https://doi.org/10.2196/20445 %U http://www.ncbi.nlm.nih.gov/pubmed/33620328 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e24392 %T Prospective Associations Between Fixed-Term Contract Positions and Mental Illness Rates in Denmark’s General Workforce: Protocol for a Cohort Study %A Hannerz,Harald %A Burr,Hermann %A Soll-Johanning,Helle %A Nielsen,Martin Lindhardt %A Garde,Anne Helene %A Flyvholm,Mari-Ann %+ The National Research Center for the Working Environment, Lersø Parkallé 105, Copenhagen, 2100, Denmark, 45 39165460 ext 39165460, hha@nrcwe.dk %K cohort study %K fixed-term employment %K fixed term contract %K unemployment %K psychotropic drugs %K psychiatric hospital treatment %D 2021 %7 5.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: In 2018, 14% of employees in the European Union had fixed-term contracts. Fixed-term contract positions are often less secure than permanent contract positions. Perceived job insecurity has been associated with increased rates of mental ill health. However, the association between fixed-term contract positions and mental ill health is uncertain. A recent review concluded that the quality of most existing studies is low and that the results of the few studies with high quality are contradictory. Objective: This study aims to estimate the incidence rate ratios (RRs) of psychotropic drug use and psychiatric hospital treatment. These ratios will be considered, first, in relation to the contrast fixed-term versus permanent contract and, second, to fixed-term contract versus unemployment. Methods: Interview data with baseline information on employment status from the Danish Labor Force Surveys in the years 2001-2013 will be linked to data from national registers. Participants will be followed up for up to 5 years after the interview. Poisson regression will be used to estimate incidence RRs for psychiatric hospital treatment for mood, anxiety, or stress-related disorders and redeemed prescriptions for psychotropic drugs, as a function of employment status at baseline. The following contrasts will be considered: full-time temporary employment versus full-time permanent employment and temporary employment (regardless of weekly working hours) versus unemployment. The analyses will be controlled for a series of possible confounders. People who have received sickness benefits, have received social security cash benefits, have redeemed a prescription for psychotropic drugs, or have received psychiatric hospital treatment for a mental disorder sometime during a 1-year period preceding baseline will be excluded from the study. The study will include approximately 134,000 participants (13,000 unemployed, 106,000 with permanent contracts, and 15,000 with fixed-term contracts). We expect to find approximately 16,400 incident cases of redeemed prescriptions of psychotropic drugs and 2150 incident cases of psychiatric hospital treatment for mood, anxiety, or stress-related disorders. Results: We expect the analyses to be completed by the end of 2021 and the results to be published in mid-2022. Conclusions: The statistical power of the study will be large enough to test the hypothesis of a prospective association between fixed-term contract positions and mental illness in the general workforce of Denmark. International Registered Report Identifier (IRRID): DERR1-10.2196/24392 %M 33325837 %R 10.2196/24392 %U https://www.researchprotocols.org/2021/2/e24392 %U https://doi.org/10.2196/24392 %U http://www.ncbi.nlm.nih.gov/pubmed/33325837 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 11 %P e23623 %T The Associations of Electronic Health Record Usability and User Age With Stress and Cognitive Failures Among Finnish Registered Nurses: Cross-Sectional Study %A Kaihlanen,Anu-Marja %A Gluschkoff,Kia %A Hyppönen,Hannele %A Kaipio,Johanna %A Puttonen,Sampsa %A Vehko,Tuulikki %A Saranto,Kaija %A Karhe,Liisa %A Heponiemi,Tarja %+ Finnish Institute for Health and Welfare, P.O. Box 30, Helsinki, FI-00271, Finland, 358 295246033, anu.kaihlanen@thl.fi %K electronic health records %K usability %K stress %K cognitive failure %K nurse %D 2020 %7 18.11.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Electronic health records (EHRs) are expected to provide many clinical and organizational benefits. Simultaneously, the end users may face unintended consequences, such as stress and increased cognitive workload, due to poor EHR usability. However, whether the effects of usability depend on end user characteristics, such as career stage or age, remains poorly understood. Objective: The objective of this study was to examine the associations of EHR usability and user age with stress related to information systems and cognitive failures among registered nurses. Methods: A cross-sectional survey design was employed in Finland in 2017. A total of 3383 registered nurses responded to the nationwide electronic survey. Multiple linear regression was used to examine the associations of EHR usability (eg, how easily information can be found and a patient’s care can be documented) and user age with stress related to information systems and cognitive failures. Interaction effects of EHR usability and age were also tested. Models were adjusted for gender and employment sector. Results: Poor EHR usability was associated with higher levels of stress related to information systems (β=.38; P<.001). The strength of the association did not depend on user age. Poor EHR usability was also associated with higher levels of cognitive failures (β=.28; P<.001). There was a significant interaction effect between age and EHR usability for cognitive failures (β=.04; P<.001). Young nurses who found the EHR difficult to use reported the most cognitive failures. Conclusions: Information system stress due to poor EHR usability afflicts younger and older nurses alike. However, younger nurses starting their careers may be more cognitively burdened if they find EHR systems difficult to use compared to older nurses. Adequate support in using the EHRs may be particularly important to young registered nurses, who have a lot to learn and adopt in their early years of practice. %M 33206050 %R 10.2196/23623 %U http://medinform.jmir.org/2020/11/e23623/ %U https://doi.org/10.2196/23623 %U http://www.ncbi.nlm.nih.gov/pubmed/33206050 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 9 %N 4 %P e16376 %T Leveraging Walking Performance to Understand Work Fatigue Among Young Adults: Mixed-Methods Study %A Yan,Xinghui %A Rau,Pei-Luen Patrick %A Zhong,Runting %+ Department of Industrial Engineering, Shunde Building, Tsinghua University, Beijing, 100084, China, 86 010 6277 6664, rpl@tsinghua.edu.cn %K work fatigue %K fatigability %K walking performance %K 6MWT %K mobile health %D 2020 %7 13.11.2020 %9 Original Paper %J Interact J Med Res %G English %X Background: Work fatigue negatively impacts personal health in the long term. Prior research has indicated the possibility of leveraging both walking parameters and perceptual measures to assess a person’s fatigue status. However, an effective and ubiquitous approach to assessing work fatigue in young adults remains unexplored. Objective: The goals of this paper were to (1) explore how walking rhythms and multiple streams of data, including reaction time, self-reports, and an activity diary, reflect work-induced fatigue in the lab setting; (2) identify the relationship between objective performance and subjective perception in indicating fatigue status and fatigability; and (3) propose a mobile-based assessment for work-induced fatigue that uses multiple measurements. Methods: We conducted a 2-day in-lab study to measure participants’ fatigue status using multiple measurements, including the stair climb test (SCT), the 6-minute walk test (6MWT), and the reaction time test. Both the SCT and the 6MWT were conducted at different points in time and under 2 conditions (measurement time, including prior to and after work, and pace, including normal and fast). Participants reported their fatigue perception through questionnaires completed before conducting walking tests and in an activity diary recorded over a week. Walking performance data were collected by a smartphone with a built-in 3-axis accelerometer. To examine the effect of fatigability on walking performance, we first clustered participants into 2 groups based on their reported mental fatigue level in the entry surveys and then compared their walking performance using a generalized linear model (GLM). The reaction time was examined using a 2-way repeated-measures GLM. We conducted semistructured interviews to understand participants’ fatigue perception after each day’s walking tests. Results: All participants (N=26; mean age 24.68 years) were divided into 2 groups—the fatigue-sensitive group (11/26, 42%) and the fatigue-nonsensitive group (15/26, 58%)—based on their mental subscores from 3 entry surveys: Fatigue Scale-14, Three-Dimensional Work Fatigue Inventory, and Fatigue Self-Assessment Scale (FSAS). The fatigue-sensitive group reported a significantly higher FSAS score in the before-work setting (t50=–3.361; P=.001). The fatigue-sensitive group covered fewer steps than the fatigue-nonsensitive group (β1=–0.099; SE 0.019; t1=–5.323; P<.001) and had a higher step-to-step time variability in the 6MWT (β1=9.61 × 10–4; t1=2.329; P=.02). No strong correlation between subjective and objective measurements was observed in the study. Conclusions: Walking parameters, including step counts and step-to-step time variability, and some selected scales (eg, FSAS) were found to reflect participants’ work-induced fatigue. Overall, our work suggests the opportunity of employing mobile-based walking measurements to indicate work fatigue among young adults. %M 33185557 %R 10.2196/16376 %U http://www.i-jmr.org/2020/4/e16376/ %U https://doi.org/10.2196/16376 %U http://www.ncbi.nlm.nih.gov/pubmed/33185557 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e18067 %T Effectiveness of a Smartphone App (BioBase) for Reducing Anxiety and Increasing Mental Well-Being: Pilot Feasibility and Acceptability Study %A Kawadler,Jamie M %A Hemmings,Nicola Rose %A Ponzo,Sonia %A Morelli,Davide %A Bird,Geoffrey %A Plans,David %+ Huma Therapeutics Limited, 13th Floor Millbank Tower, 21-24 Millbank, , London, , United Kingdom, 44 7527016574, jamie@biobeats.com %K health and well-being %K health promotion %K organizational and leadership support %K workplace %D 2020 %7 10.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of workplace-related stress and anxiety is high, resulting in stress-related physical and mental illness. Digital self-guided interventions aimed at key areas of workplace design may be able to provide remote anxiolytic effects. Objective: The aim of this feasibility study is to assess changes in anxiety and mental well-being after use of the BioBase programme, a mobile phone platform for psycho-educational modules, tools, and real-time feedback of physiological data. Methods: A 4-week observational study was carried out in 55 healthy adults who were screened for stress with the Depression Anxiety Stress Scale (DASS) Stress subscale. Participants completed anxiety (6-item State-Trait Anxiety Inventory [STAI]) and mental well-being (Warwick-Edinburgh Mental Well-being Scale [WEMWBS]) questionnaires at baseline and at 4 weeks. Feedback questionnaires were administered after 4 weeks. Results: After 4 weeks of using the programme and controlling for any effect of being paid to take part in the study, STAI significantly decreased (baseline mean 45.52 [SD 13.2]; 4-week mean 39.82 [SD 11.2]; t54=–3.51; P<.001; CI –8.88 to –2.52; Cohen d=0.96) and WEMWBS significantly increased (baseline mean 48.12 [SD 6.4]; 4-week mean 50.4 [SD 6.9]; t53=2.41; P=.019; CI 0.44-4.23; Cohen d=0.66). Further, higher baseline stress was significantly associated with a greater decrease in STAI (t53=–3.41; P=.001; CI –8.10 to –2.10; R2=0.180) and a greater increase in WEMWBS (t52=2.41; P=.019; CI 0.38-4.11, R2=0.101). On feedback, participants found the programme easy to use/navigate, with the content being acceptable and relevant to workplace-related stressors; 70% (21/30) of participants would recommend the programme to a friend. Conclusions: The BioBase programme is a potentially effective intervention in decreasing anxiety and increasing mental well-being, with larger changes in those with higher baseline levels of stress. %M 32969341 %R 10.2196/18067 %U https://formative.jmir.org/2020/11/e18067 %U https://doi.org/10.2196/18067 %U http://www.ncbi.nlm.nih.gov/pubmed/32969341 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e19412 %T Exploring the Effects of a Brief Biofeedback Breathing Session Delivered Through the BioBase App in Facilitating Employee Stress Recovery: Randomized Experimental Study %A Chelidoni,Olga %A Plans,David %A Ponzo,Sonia %A Morelli,Davide %A Cropley,Mark %+ Faculty of Health and Medical Sciences, School of Psychology, University of Surrey, Stag Hill, Guildford, GU2 7XH, United Kingdom, 44 01483686928, mark.cropley@surrey.ac.uk %K breathing %K biofeedback %K smartphone %K heart rate variability %K recovery %K mindfulness %K stress %K mobile phone %D 2020 %7 15.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Recovery from stress is a predictive factor for cardiovascular health, and heart rate variability (HRV) is suggested to be an index of how well people physiologically recover from stress. Biofeedback and mindfulness interventions that include guided breathing have been shown to be effective in increasing HRV and facilitating stress recovery. Objective: This study aims to assess the effectiveness of a brief app-based breathing intervention (BioBase) in enhancing physiological recovery among employees who were induced to cognitive and emotional stress. Methods: In total, we recruited 75 full-time employees. Interbeat (RR) intervals were recorded continuously for 5 min at baseline and during cognitive and emotional stress induction. The session ended with a 5-min recovery period during which participants were randomly allocated into 3 conditions: app-based breathing (BioBase), mindfulness body scan, or control. Subjective tension was assessed at the end of each period. Results: Subjective tension significantly increased following stress induction. HRV significantly decreased following the stress period. In the recovery phase, the root mean square of successive RR interval differences (P=.002), the percentage of successive RR intervals that differed by >50 ms (P=.008), and high frequency (P=.01) were significantly higher in the BioBase breathing condition than in the mindfulness body scan and the control groups. Conclusions: Biofeedback breathing interventions digitally delivered through a commercially available app can be effective in facilitating stress recovery among employees. These findings contribute to the mobile health literature on the beneficial effects of brief app-based breathing interventions on employees’ cardiovascular health. %M 33055072 %R 10.2196/19412 %U http://mhealth.jmir.org/2020/10/e19412/ %U https://doi.org/10.2196/19412 %U http://www.ncbi.nlm.nih.gov/pubmed/33055072 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e17835 %T Evaluation of an Occupational Exercise Training Program for Firefighters: Mixed Methods Pilot Study %A Leary,Miriam %A Thomas,James %A Hayes,Ryan %A Sherlock,Lori %+ Division of Exercise Physiology, Department of Human Performance and Applied Exercise Science, West Virginia University, 8324 HSC South, PO Box 9227, Morgantown, WV, 26505, United States, 1 3045811755, miriam.leary@hsc.wvu.edu %K firefighters %K exercise %K mixed methods %K qualitative %K clinical %K performance %D 2020 %7 21.9.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Occupational exercise training programs can improve overall health and fitness in firefighters, but evidence beyond clinical and performance outcomes is needed before fire departments invest in and successfully adopt health promotion programs. Objective: This mixed methods pilot study sought to pair clinical and performance outcomes with participants’ qualitative feedback (eg, participants’ enjoyment, lifestyle behavior changes, and team structure) with the goal of informing recommendations for future programs. Methods: Professional firefighters participated in a 14-week occupational exercise training program with assessments conducted pre- and posttraining. Clinical outcomes included weight, BMI, body fat percentage, resting heart rate, systolic blood pressure, and diastolic blood pressure. Performance outcomes included the sharpened Romberg balance test, 1-repetition maximum leg press and bench press, graded exercise test (estimated VO2max), knee range of motion, shoulder flexibility, and hamstring flexibility. Self-administered surveys (Short Form-36, International Physical Activity Questionnaire, Barriers Self-Efficacy Scale, and Barriers to Being Active Quiz) were completed. In 3 private focus groups of 3 to 4 participants, firefighters' experiences in the training program and their health behaviors were explored. Results: Male firefighters (n=14; age: mean 36.4, SD 2.6 years) completed 20 training sessions. There were no significant changes to weight (P=.20), BMI (P=.15), body fat percentage (P=.16), systolic blood pressure (P=.12), estimated VO2max (P=.34), balance (P=.24), knee range of motion (left: P=.35; right: P=.31), or hamstring flexibility (P=.14). There was a significant decrease in diastolic blood pressure (P=.04) and significant increases in shoulder flexibility (P<.001) and leg press 1-repetition maximum volume (P=.04). Participants reported improvements in overall health, endurance, flexibility, and mood as well as improvements to team environment and health behaviors around the station; however, there was a decline in overcoming barriers to physical activity. Conclusions: A 14-week program of exercise training in firefighters elicited improvements in clinical, performance, and self-reported physical activity outcomes. This occupational exercise training program for firefighters increased time spent exercising, improved team building, and led to physical and mental health benefits. Results from this pilot study set a broad, informed, and meaningful foundation for future efforts to increase firefighter participation in occupational fitness programs. %M 32955453 %R 10.2196/17835 %U http://formative.jmir.org/2020/9/e17835/ %U https://doi.org/10.2196/17835 %U http://www.ncbi.nlm.nih.gov/pubmed/32955453 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e11543 %T Motivation Predicts Change in Nurses’ Physical Activity Levels During a Web-Based Worksite Intervention: Results From a Randomized Trial %A Brunet,Jennifer %A Tulloch,Heather E %A Wolfe Phillips,Emily %A Reid,Robert D %A Pipe,Andrew L %A Reed,Jennifer L %+ Faculty of Health Sciences, University of Ottawa, Montpetit Hall 339, 125 University Private, Ottawa, ON, K1N 6N5, Canada, 1 613 562 5800 ext 3068, jennifer.brunet@uottawa.ca %K physical activity %K motivation %K wearable technology %K nurses %D 2020 %7 11.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Low physical activity levels can negatively affect the health of nurses. Given the low physical activity levels reported by nurses, there is a clear need for brief and economical interventions designed to increase physical activity levels in this population. We developed a web-based intervention that used motivational strategies to increase nurses’ physical activity levels. The intervention provided the nurses with feedback from an activity monitor coupled with a web-based individual, friend, or team physical activity challenge. Objective: In this parallel-group randomized trial, we examine whether nurses’ motivation at baseline predicted changes in objectively measured physical activity levels during the 6-week intervention. Methods: The participants were 76 nurses (n=74, 97% female; mean age 46, SD 11 years) randomly assigned to 1 of 3 physical activity challenge conditions: (1) individual, (2) friend, or (3) team. The nurses completed a web-based questionnaire designed to assess motivational regulations for physical activity levels before the intervention and wore a Tractivity activity monitor before and during the 6-week intervention. We analyzed data using multilevel modeling for repeated measures. Results: The nurses’ physical activity levels increased (linear estimate=10.30, SE 3.15; P=.001), but the rate of change decreased over time (quadratic estimate=−2.06, SE 0.52; P<.001). External and identified regulations (ß=−2.08 to 11.55; P=.02 to .04), but not intrinsic and introjected regulations (ß=−.91 to 6.29; P=.06 to .36), predicted changes in the nurses’ physical activity levels. Conclusions: Our findings provide evidence that an intervention that incorporates self-monitoring and physical activity challenges can be generally effective in increasing nurses’ physical activity levels in the short term. They also suggest that drawing solely on organismic integration theory to predict changes in physical activity levels among the nurses participating in web-based worksite interventions may have been insufficient. Future research should examine additional personal (eg, self-efficacy) and occupational factors (eg, shift length and shift type) that influence physical activity levels to identify potential targets for intervention among nurses. Trial Registration: ClinicalTrials.gov NCT04524572; https://clinicaltrials.gov/ct2/show/NCT04524572 %M 32915158 %R 10.2196/11543 %U http://www.jmir.org/2020/9/e11543/ %U https://doi.org/10.2196/11543 %U http://www.ncbi.nlm.nih.gov/pubmed/32915158 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 9 %P e18051 %T Work2Prevent, an Employment Intervention Program as HIV Prevention for Young Men Who Have Sex With Men and Transgender Youth of Color (Phase 3): Protocol for a Single-Arm Community-Based Trial to Assess Feasibility and Acceptability in a Real-World Setting %A Hill,Brandon J %A Motley,Darnell N %A Rosentel,Kris %A VandeVusse,Alicia %A Garofalo,Robert %A Kuhns,Lisa M %A Kipke,Michele D %A Reisner,Sari %A Rupp,Betty %A West Goolsby,Rachel %A McCumber,Micah %A Renshaw,Laura %A Schneider,John A %+ Planned Parenthood Great Plains, 4401 W 109th St #100, Overland Park, KS, 66211, United States, 1 913 345 4624, brandon.hill@ppgreatplains.org %K HIV/AIDS %K youth %K young men who have sex with men %K YMSM %K young transgender women %K YTW %K gender nonconforming youth %K LGBTQ %K unemployment %K homelessness %K sex work %D 2020 %7 11.9.2020 %9 Original Paper %J JMIR Res Protoc %G English %X Background: In the United States, young cisgender men who have sex with men (YMSM), young transgender women (YTW), and gender nonconforming (GNC) youth face elevated rates of HIV infection. However, racial and ethnic disparities in adolescent HIV infection cannot be attributed to individual-level factors alone and are situated within larger social and structural contexts that marginalize and predispose sexual and gender minority youth of color to HIV. Addressing broader ecological factors that drive transmission requires interventions that focus on the distal drivers of HIV infection, including violence exposure, housing, food insecurity, educational attainment, and employment. Given the ways that economic instability may make YMSM, YTW, and GNC youth of color vulnerable to HIV exposure, this study focuses on employment as an HIV prevention intervention. More specifically, the intervention, called Work2Prevent (W2P), targets economic stability through job readiness and employment as a means of preventing behaviors and factors associated with adolescent and young adult HIV, such as transactional sex work and homelessness. The intervention was adapted from iFOUR, an evidence-based employment program for HIV-positive adults in phase 1 of this study, and pilot tested in a university-based setting in phase 2. Objective: This paper aims to describe the protocol for the community-based test phase of W2P. The purpose of this phase was to pilot test a tailored, theoretically informed employment intervention program among YMSM, YTW, and GNC youth of color within a lesbian, gay, bisexual, transgender, and queer (LGBTQ) community setting. Methods: The employment intervention was pilot tested using a single-arm pretest-posttest trial design implemented among a sample of vulnerable YMSM, YTW, and GNC youth of color using services within a community-based LGBTQ center. Assessments will examine intervention feasibility, acceptability, and preliminary estimates of efficacy. Results: Phase 3 of W2P research activities began in May 2019 and was completed in December 2019. Overall, 41 participants were enrolled in the community-based pilot. Conclusions: This study will assess intervention feasibility and acceptability in the target populations and determine preliminary efficacy of the intervention to increase employment and reduce vulnerability to HIV when implemented in a community-based setting serving LGBTQ youth of color. Testing the intervention in a community setting is an opportunity to evaluate how recruitment, retention, and other outcomes are impacted by delivery in a venue akin to where this intervention could eventually be used by nonresearchers. If W2P demonstrates feasibility and acceptability, a larger multisite trial implemented in multiple community settings serving YMSM, YTW, and GNC youth of color is planned. Trial Registration: ClinicalTrials.gov NCT03313310; https://clinicaltrials.gov/ct2/show/NCT03313310 International Registered Report Identifier (IRRID): DERR1-10.2196/18051 %M 32915162 %R 10.2196/18051 %U https://www.researchprotocols.org/2020/9/e18051 %U https://doi.org/10.2196/18051 %U http://www.ncbi.nlm.nih.gov/pubmed/32915162 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e18253 %T Relationship Between Chronic Stress and Heart Rate Over Time Modulated by Gender in a Cohort of Office Workers: Cross-Sectional Study Using Wearable Technologies %A van Kraaij,Alex Wilhelmus Jacobus %A Schiavone,Giuseppina %A Lutin,Erika %A Claes,Stephan %A Van Hoof,Chris %+ OnePlanet Research Center, imec-the Netherlands, Bronland 10, Wageningen, 6708 WH, Netherlands, 31 404020400, alex.vankraaij@imec.nl %K chronic stress %K heart rate %K circadian rhythm %K gender %K age %K wearable device %D 2020 %7 9.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic stress is increasing in prevalence and is associated with several physical and mental disorders. Although it is proven that acute stress changes physiology, much less is known about the relationship between physiology and long-term stress. Continuous measurement of vital signs in daily life and chronic stress detection algorithms could serve this purpose. For this, it is paramount to model the effects of chronic stress on human physiology and include other cofounders, such as demographics, enabling the enrichment of a population-wide approach with individual variations. Objective: The main objectives of this study were to investigate the effect of chronic stress on heart rate (HR) over time while correcting for weekdays versus weekends and to test a possible modulation effect by gender and age in a healthy cohort. Methods: Throughout 2016 and 2017, healthy employees of technology companies were asked to participate in a 5-day observation stress study. They were required to wear two wearables, of which one included an electrocardiogram sensor. The derived HR was averaged per hour and served as an output for a mixed design model including a trigonometric fit over time with four harmonics (periods of 24, 12, 8, and 6 hours), gender, age, whether it was a workday or weekend day, and a chronic stress score derived from the Perceived Stress Scale (PSS) as predictors. Results: The study included 328 subjects, of which 142 were female and 186 were male participants, with a mean age of 38.9 (SD 10.2) years and a mean PSS score of 13.7 (SD 6.0). As main effects, gender (χ21=24.02, P<.001); the hour of the day (χ21=73.22, P<.001); the circadian harmonic (χ22=284.4, P<.001); and the harmonic over 12 hours (χ22=242.1, P<.001), over 8 hours (χ22=23.78, P<.001), and over 6 hours (χ22=82.96, P<.001) had a significant effect on HR. Two three-way interaction effects were found. The interaction of age, whether it was a workday or weekend day, and the circadian harmonic over time were significantly correlated with HR (χ22=7.13, P=.03), as well as the interaction of gender, PSS score, and the circadian harmonic over time (χ22=7.59, P=.02). Conclusions: The results show a relationship between HR and the three-way interaction of chronic stress, gender, and the circadian harmonic. The modulation by gender might be related to evolution-based energy utilization strategies, as suggested in related literature studies. More research, including daily cortisol assessment, longer recordings, and a wider population, should be performed to confirm this interpretation. This would enable the development of more complete and personalized models of chronic stress. %M 32902392 %R 10.2196/18253 %U http://www.jmir.org/2020/9/e18253/ %U https://doi.org/10.2196/18253 %U http://www.ncbi.nlm.nih.gov/pubmed/32902392 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19500 %T Adherence of Female Health Care Workers to the Use a Web-Based Tool for Improving and Modifying Lifestyle: Prospective Target Group Pilot Study %A Jukic,Tomislav %A Ihan,Alojz %A Petek Šter,Marija %A Strojnik,Vojko %A Stubljar,David %A Starc,Andrej %+ Institute of Microbiology and Immunology, Ljubljana, Slovenia, 386 40842593, d.stubljar@gmail.com %K mHealth %K eHealth %K health care workers %K occupational stress %K burnout %K adherence %K web-based tool %D 2020 %7 14.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Health care professionals are exposed to the psychological and physiological effects of stress, which is a well-known risk factor for various mental and physical health problems. Objective: The aims of this study were to assess the adherence of female health care workers to use a web-based tool for improving and modifying lifestyle and to identify the potential factors influencing their adherence. Methods: A prospective, observational study was performed. A total of 80 female health care workers (physicians and gradated nurses) from 2 university medical centers and female members of a family medicine society participated. Participants completed a questionnaire that inquired about their basic demographic data and physical fitness. Physical fitness was assessed by the Rockport Fitness Walking Test. Adherence to a web-based application (24@life) was followed for 3 months and the number of log-ins into the application was counted. Results: The study was conducted from March to October 2019. Significantly high workload has been detected in all groups (P<.05), except in the general practitioner with normal workload group. The graduated nurse working in the surgery room group showed chronic stress with elevated S-cortisol levels (>690 nmol/L); activated cellular immune system with elevated concentrations of lymphocytes (reference 1.1-2.5 × 109 cells/L), CD3 cells (reference 0.7-1.9 × 109 cells/L), CD8 cells (reference 0.2-0.7 × 109 cells/L), and HLA-DR/CD3 cells (reference 0.04-0.2 × 109 cells/L); and the worst quality of sleep (mean 2.8 [SD 1.2]). Only 32 of 80 participants (40%) were adherent to the web-based application. Participants most frequently viewed web pages on areas of physical activity (497 times) and nutrition (332 times). No factors or participant’s characteristics such as weight (odds ratio [OR] 1.026, 95% CI 0.977-1.078), BMI (OR 0.993, 95% CI 0.834-1.184), age (OR 0.970, 95% CI 0.910-1.034), or stress level (OR 0.997, 95% CI 0.995-1.000) were identified to affect the adherence rates. Conclusions: Female health care workers exposed to high workload did not find the web-based application useful for improving and modifying their lifestyle. Therefore, other strategies that might help health care workers facing stress and improve their lifestyle should be identified. %M 32687475 %R 10.2196/19500 %U https://www.jmir.org/2020/8/e19500 %U https://doi.org/10.2196/19500 %U http://www.ncbi.nlm.nih.gov/pubmed/32687475 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19222 %T Topic Modeling of Social Networking Service Data on Occupational Accidents in Korea: Latent Dirichlet Allocation Analysis %A Min,Kyoung-Bok %A Song,Sung-Hee %A Min,Jin-Young %+ Institute of Health and Environment, Seoul National University School of Public Health, Gwanak-ro 1, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 8802759, yaemin00@snu.ac.kr %K topic modeling %K occupational accident %K social media %K knowledge %K workplace %K accident %K model %K analysis %K safety %D 2020 %7 13.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In most industrialized societies, regulations, inspections, insurance, and legal options are established to support workers who suffer injury, disease, or death in relation to their work; in practice, these resources are imperfect or even unavailable due to workplace or employer obstruction. Thus, limitations exist to identify unmet needs in occupational safety and health information. Objective: The aim of this study was to explore hidden issues related to occupational accidents by examining social network services (SNS) data using topic modeling. Methods: Based on the results of a Google search for the phrases occupational accident, industrial accident and occupational diseases, a total of 145 websites were selected. From among these websites, we collected 15,244 documents on queries related to occupational accidents between 2002 and 2018. To transform unstructured text into structure data, natural language processing of the Korean language was conducted. We performed the latent Dirichlet allocation (LDA) as a topic model using a Python library. A time-series linear regression analysis was also conducted to identify yearly trends for the given documents. Results: The results of the LDA model showed 14 topics with 3 themes: workers’ compensation benefits (Theme 1), illicit agreements with the employer (Theme 2), and fatal and non-fatal injuries and vulnerable workers (Theme 3). Theme 1 represented the largest cluster (52.2%) of the collected documents and included keywords related to workers’ compensation (ie, company, occupational injury, insurance, accident, approval, and compensation) and keywords describing specific compensation benefits such as medical expense benefits, temporary incapacity benefits, and disability benefits. In the yearly trend, Theme 1 gradually decreased; however, other themes showed an overall increasing pattern. Certain queries (ie, musculoskeletal system, critical care, and foreign workers) showed no significant variation in the number of queries. Conclusions: We conducted LDA analysis of SNS data of occupational accident–related queries and discovered that the primary concerns of workers posting about occupational injuries and diseases were workers’ compensation benefits, fatal and non-fatal injuries, vulnerable workers, and illicit agreements with employers. While traditional systems focus mainly on quantitative monitoring of occupational accidents, qualitative aspects formulated by topic modeling from unstructured SNS queries may be valuable to address inequalities and improve occupational health and safety. %M 32663156 %R 10.2196/19222 %U http://www.jmir.org/2020/8/e19222/ %U https://doi.org/10.2196/19222 %U http://www.ncbi.nlm.nih.gov/pubmed/32663156 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 8 %P e17145 %T Effectiveness of Combining Organizational Alcohol Policy and Skills Training for Managers to Reduce Hazardous Alcohol Consumption in Swedish Workplaces: Study Protocol for a Cluster Randomized Study %A Elling,Devy Lysandra %A Wilson,Martina %A Carlbring,Per %A Wennberg,Peter %A Sundqvist,Kristina %+ Department of Public Health Sciences, Stockholm University, Sveavagen 160, Stockholm, SE-106 91, Sweden, 46 8 16 20 00, devy.elling@su.se %K alcohol prevention %K health promotion %K workplace intervention %K hazardous alcohol use %K alcohol use %K intervention %K workplace %D 2020 %7 12.8.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: High alcohol consumption poses risks to individual health and society. Previous alcohol interventions have mainly focused on high-risk consumers or young adults in school-based settings. Since the majority of the adult population is in the workforce, the workplace can be considered a favorable arena for implementing interventions. Objective: This protocol describes a project aimed at increasing knowledge of the effectiveness of combining the implementation of an organizational alcohol policy with skills training for managers as a workplace alcohol prevention program, by evaluating the intervention and exploring managers’ perceptions of the intervention. Methods: Organizations with at least 100 employees were invited to take part in the project. A total of 11 organizations (744 managers and 11,761 employees) were included in the project. Data are collected through self-administered online surveys at baseline, 12 months, and 24 months. The primary outcome is managers’ inclination to initiate an early alcohol intervention (eg, by initiating a dialogue) when concern regarding employees’ hazardous alcohol consumption arises. The secondary outcomes of interest are managers’ and employees’ organizational alcohol policy knowledge and changes in alcohol consumption, as measured using the Alcohol Use Disorder Identification Test (AUDIT) score. A linear mixed-model framework will be used to model variability on different levels. Primary analysis will follow an intention-to-treat approach. Additionally, managers’ responses from semistructured interviews will be analyzed using thematic analysis to explore managers’ experiences regarding the prevention program. Results: This study is ongoing. The overall study start was on January 2018, and the study is planned to end in December 2020. Baseline and 12-month follow-up measurements have been collected. Conclusions: This project is designed to evaluate the effectiveness of an alcohol prevention program regarding higher inclination to initiate early alcohol interventions after policy implementation and skills training among managers, compared to the usual practices in the workplace. The results from this study can contribute to increased knowledge about alcohol interventions and future prevention programs in the workplace. Trial Registration: ISRCTN17250048; http://www.isrctn.com/ISRCTN17250048 International Registered Report Identifier (IRRID): DERR1-10.2196/17145 %M 32784185 %R 10.2196/17145 %U https://www.researchprotocols.org/2020/8/e17145 %U https://doi.org/10.2196/17145 %U http://www.ncbi.nlm.nih.gov/pubmed/32784185 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e16422 %T Occupation Coding of Job Titles: Iterative Development of an Automated Coding Algorithm for the Canadian National Occupation Classification (ACA-NOC) %A Bao,Hongchang %A Baker,Christopher J O %A Adisesh,Anil %+ Department of Computer Science, Faculty of Science, Applied Science and Engineering, University of New Brunswick, 100 Tucker Park Rd, Saint John, NB, E2K5E2, Canada, 1 (506) 648 2302, bakerc@unb.ca %K occupation coding %K automated coding %K occupational health %K job title %D 2020 %7 5.8.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: In many research studies, the identification of social determinants is an important activity, in particular, information about occupations is frequently added to existing patient data. Such information is usually solicited during interviews with open-ended questions such as “What is your job?” and “What industry sector do you work in?” Before being able to use this information for further analysis, the responses need to be categorized using a coding system, such as the Canadian National Occupational Classification (NOC). Manual coding is the usual method, which is a time-consuming and error-prone activity, suitable for automation. Objective: This study aims to facilitate automated coding by introducing a rigorous algorithm that will be able to identify the NOC (2016) codes using only job title and industry information as input. Using manually coded data sets, we sought to benchmark and iteratively improve the performance of the algorithm. Methods: We developed the ACA-NOC algorithm based on the NOC (2016), which allowed users to match NOC codes with job and industry titles. We employed several different search strategies in the ACA-NOC algorithm to find the best match, including exact search, minor exact search, like search, near (same order) search, near (different order) search, any search, and weak match search. In addition, a filtering step based on the hierarchical structure of the NOC data was applied to the algorithm to select the best matching codes. Results: The ACA-NOC was applied to over 500 manually coded job and industry titles. The accuracy rate at the four-digit NOC code level was 58.7% (332/566) and improved when broader job categories were considered (65.0% at the three-digit NOC code level, 72.3% at the two-digit NOC code level, and 81.6% at the one-digit NOC code level). Conclusions: The ACA-NOC is a rigorous algorithm for automatically coding the Canadian NOC system and has been evaluated using real-world data. It allows researchers to code moderate-sized data sets with occupation in a timely and cost-efficient manner such that further analytics are possible. Initial assessments indicate that it has state-of-the-art performance and is readily extensible upon further benchmarking on larger data sets. %M 32755893 %R 10.2196/16422 %U https://formative.jmir.org/2020/8/e16422 %U https://doi.org/10.2196/16422 %U http://www.ncbi.nlm.nih.gov/pubmed/32755893 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e15338 %T Monitoring Occupational Sitting, Standing, and Stepping in Office Employees With the W@W-App and the MetaWearC Sensor: Validation Study %A Bort-Roig,Judit %A Chirveches-Pérez,Emilia %A Garcia-Cuyàs,Francesc %A Dowd,Kieran P %A Puig-Ribera,Anna %+ Sport and Physical Activity Research Group, Centre for Health and Social Care Research, University of Vic-Central University of Catalonia, Miquel Martí i Pol, 1, Vic, 08500, Spain, 34 938863342, annam.puig@uvic.cat %K validity %K self-monitoring %K sedentary behavior %K physical activity %K smartphone %K mobile phone %K device-based measure %D 2020 %7 4.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Replacing occupational sitting time with active tasks has several proposed health benefits for office employees. Mobile phones and motion sensors can provide objective information in real time on occupational sitting behavior. However, the validity and feasibility of using mobile health (mHealth) devices to quantify and modify occupational sedentary time is unclear. Objective: The aim of this study is to validate the new Walk@Work-Application (W@W-App)—including an external motion sensor (MetaWearC) attached to the thigh—for measuring occupational sitting, standing, and stepping in free-living conditions against the activPAL3M, the current gold-standard, device-based measure for postural behaviors. Methods: In total, 20 office workers (16 [80%] females; mean age 39.5, SD 8.1 years) downloaded the W@W-App to their mobile phones, wore a MetaWearC sensor attached to their thigh using a tailored band, and wore the activPAL3M for 3-8 consecutive working hours. Differences between both measures were examined using paired-samples t tests and Wilcoxon signed-rank tests. Agreement between measures was examined using concordance correlation coefficients (CCCs), 95% CIs, Bland-Altman plots (mean bias, 95% limits of agreement [LoA]), and equivalence testing techniques. Results: The median recording time for the W@W-App+MetaWearC and the activPAL3M was 237.5 (SD 132.8) minutes and 240.0 (SD 127.5) minutes, respectively (P<.001). No significant differences between sitting (P=.53), standing (P=.12), and stepping times (P=.61) were identified. The CCC identified substantial agreement between both measures for sitting (CCC=0.98, 95% CI 0.96-0.99), moderate agreement for standing (CCC=0.93, 95% CI 0.81-0.97), and poor agreement for stepping (CCC=0.74, 95% CI 0.47-0.88). Bland-Altman plots indicated that sitting time (mean bias –1.66 minutes, 95% LoA –30.37 to 20.05) and standing time (mean bias –4.85 minutes, 95% LoA –31.31 to 21.62) were underreported. For stepping time, a positive mean bias of 1.15 minutes (95% LoA –15.11 to 17.41) was identified. Equivalence testing demonstrated that the estimates obtained from the W@W-App+MetaWearC and the activPAL3M were considered equivalent for all variables excluding stepping time. Conclusions: The W@W-App+MetaWearC is a low-cost tool with acceptable levels of accuracy that can objectively quantify occupational sitting, standing, stationary, and upright times in real time. Due to the availability of real-time feedback for users, this tool can positively influence occupational sitting behaviors in future interventions. Trial Registration: ClinicalTrials.gov NCT04092738; https://clinicaltrials.gov/ct2/show/NCT04092738 %M 32459625 %R 10.2196/15338 %U https://mhealth.jmir.org/2020/8/e15338 %U https://doi.org/10.2196/15338 %U http://www.ncbi.nlm.nih.gov/pubmed/32459625 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17857 %T An App for Classifying Personal Mental Illness at Workplace Using Fit Statistics and Convolutional Neural Networks: Survey-Based Quantitative Study %A Yan,Yu-Hua %A Chien,Tsair-Wei %A Yeh,Yu-Tsen %A Chou,Willy %A Hsing,Shu-Chen %+ Respiratory Therapy Unit, Chi Mei Medical Center, No 901, Chung Hwa Road, Yung Kung Dist, Tainan, 710, Taiwan, 886 +886937399106, rtlisa1965@gmail.com %K respiratory therapist %K ELMI app %K Rasch analysis %K convolutional neural network %K mental health %K mobile phone %D 2020 %7 31.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mental illness (MI) is common among those who work in health care settings. Whether MI is related to employees’ mental status at work is yet to be determined. An MI app is developed and proposed to help employees assess their mental status in the hope of detecting MI at an earlier stage. Objective: This study aims to build a model using convolutional neural networks (CNNs) and fit statistics based on 2 aspects of measures and outfit mean square errors for the automatic detection and classification of personal MI at the workplace using the emotional labor and mental health (ELMH) questionnaire, so as to equip the staff in assessing and understanding their own mental status with an app on their mobile device. Methods: We recruited 352 respiratory therapists (RTs) working in Taiwan medical centers and regional hospitals to fill out the 44-item ELMH questionnaire in March 2019. The exploratory factor analysis (EFA), Rasch analysis, and CNN were used as unsupervised and supervised learnings for (1) dividing RTs into 4 classes (ie, MI, false MI, health, and false health) and (2) building an ELMH predictive model to estimate 108 parameters of the CNN model. We calculated the prediction accuracy rate and created an app for classifying MI for RTs at the workplace as a web-based assessment. Results: We observed that (1) 8 domains in ELMH were retained by EFA, (2) 4 types of mental health (n=6, 63, 265, and 18 located in 4 quadrants) were classified using the Rasch analysis, (3) the 44-item model yields a higher accuracy rate (0.92), and (4) an MI app available for RTs predicting MI was successfully developed and demonstrated in this study. Conclusions: The 44-item model with 108 parameters was estimated by using CNN to improve the accuracy of mental health for RTs. An MI app developed to help RTs self-detect work-related MI at an early stage should be made more available and viable in the future. %M 32735232 %R 10.2196/17857 %U https://mhealth.jmir.org/2020/7/e17857 %U https://doi.org/10.2196/17857 %U http://www.ncbi.nlm.nih.gov/pubmed/32735232 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17914 %T Using Internet of Things to Reduce Office Workers’ Sedentary Behavior: Intervention Development Applying the Behavior Change Wheel and Human-Centered Design Approach %A Huang,Yitong %A Benford,Steve %A Price,Dominic %A Patel,Roma %A Li,Benqian %A Ivanov,Alex %A Blake,Holly %+ School of Media and Communication, Shanghai Jiaotong University, 800 Dongchuan Road, Shanghai, , China, 86 57782665881, huang.yitong@foxmail.com %K sedentary behavior %K workplace %K just-in-time adaptive intervention %K internet of things %D 2020 %7 29.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Sedentary behavior (SB) is associated with various adverse health outcomes. The prevalence of prolonged sitting at work among office workers makes a case for SB interventions to target this setting and population. Everyday mundane objects with embedded microelectronics and ubiquitous computing represent a novel mode of delivering health behavior change interventions enabled by internet of things (IoTs). However, little is known about how to develop interventions involving IoT technologies. Objective: This paper reports the design and development of an IoT-enabled SB intervention targeting office workers. Methods: The process was guided by the behavior change wheel (BCW), a systematic framework for theory-informed and evidence-based development of behavior change interventions, complemented by the human-centered design (HCD) approach. Intervention design was shaped by findings from a diary-probed interview study (n=20), a stakeholder design workshop (n=8), and a series of theoretical mapping and collaborative technical design activities. Results: The resulting intervention named WorkMyWay targets a reduction in office workers’ prolonged stationary behaviors at work and an increase in regular breaks by modifying behavioral determinants in 11 theoretical domains with 17 behavior change techniques. The delivery technology consists of a wearable activity tracker, a light-emitting diode reminder device attached to a vessel (ie, water bottle or cup), and a companion Android app connected to both devices over Bluetooth. The delivery plan consists of a 2-week baseline assessment, a 30-min face-to-face action planning session, and 6-week self-directed use of the delivery technology. Conclusions: This is the first study to demonstrate that it is possible to develop a complex IoT-enabled intervention by applying a combination of the BCW and HCD approaches. The next step is to assess the feasibility of WorkMyWay prior to testing intervention efficacy in a full-scale trial. The intervention mapping table that links individual intervention components with hypothesized mechanisms of action can serve as the basis for testing and clarifying theory-based mechanisms of action in future studies on WorkMyWay. %M 32723716 %R 10.2196/17914 %U http://mhealth.jmir.org/2020/7/e17914/ %U https://doi.org/10.2196/17914 %U http://www.ncbi.nlm.nih.gov/pubmed/32723716 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e14951 %T Sedentary Work in Desk-Dominated Environments: A Data-Driven Intervention Using Intervention Mapping %A Berninger,Nathalie M %A ten Hoor,Gill A %A Plasqui,Guy %A Kok,Gerjo %A Peters,Gjalt-Jorn Ygram %A Ruiter,Robert A C %+ Department of Work and Social Psychology, Maastricht University, PO Box 616, WSP, Universiteitssingel 40, Maastricht, Netherlands, 31 433881908, nathalie.berninger@maastrichtuniversity.nl %K intervention mapping %K sedentary behavior %K sedentary work %K computer-based %K occupational health %K eHealth %K mHealth %K data-driven programs %D 2020 %7 20.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Since desk-dominated work environments facilitate sedentary behavior, office workers sit for 66% of their working days and only 8% succeed in interrupting their prolonged periods of sitting within the first 55 minutes. Yet stretches of long and uninterrupted sitting increase the likelihood of several chronic metabolic and cardiovascular diseases. Objective: We therefore developed a computer-based app designed to interrupt periods of prolonged sitting among office employees. Methods: When developing the intervention, we applied the intervention mapping protocol. This approach for the systematic design of theory and evidence-based behavior change programs consists of 6 steps: creation of a logic model of the problem, creation of a logic model of change, program design, program production, design of an implementation plan, and development of an evaluation plan. Results: Working through all 6 steps has resulted in an individually adaptable intervention to reduce sedentary behavior at work. The intervention, UPcomplish, consists of tailored, half-automatized motivational components delivered by a coach. To register sedentary behavior, the VitaBit (VitaBit Software International BV) toolkit, a wearable accelerometry-based monitoring device, is used. Among others, UPcomplish includes personalized goal setting, tailored suggestions to overcome hurdles, and weekly challenges. The VitaBit toolkit supports the participants to monitor their behavior in relation to self-set goals. Conclusions: Intervention mapping is a useful protocol not only for the systematic development of a comprehensive intervention to reduce sedentary behavior but also for planning program adherence, program implementation, and program maintenance. It facilitates obtaining the participation of relevant stakeholders at different ecological levels in the development process of the intervention and anticipating facilitators to and barriers of program implementation and maintenance. Trial Registration: Netherlands Trial Register NL7503; https://www.trialregister.nl/trial/7503 %M 32706695 %R 10.2196/14951 %U http://formative.jmir.org/2020/7/e14951/ %U https://doi.org/10.2196/14951 %U http://www.ncbi.nlm.nih.gov/pubmed/32706695 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 7 %P e18693 %T Internet-Delivered Cognitive Behavioral Therapy for Problematic Alcohol Use in a Workplace Setting: Protocol for Quantitative and Qualitative Evaluation of Feasibility and Outcomes %A Forsström,David %A Sundström,Christopher %A Berman,Anne H %A Sundqvist,Kristina %+ Department of Psychology, Stockholm University, Frescati Hagväg 8, Stockholm, 10691, Sweden, 46 708112319, david.forsstrom@su.se %K workplace setting %K ICBT %K alcohol %K protocol %K mental health %K feasibility %K CBT %K cognitive behavioral therapy %K intervention %K workplace %D 2020 %7 15.7.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Internet-based cognitive behavioral therapy (ICBT) for mental health issues has been successfully implemented in routine health care settings, and research indicates that ICBT can also be applied to decrease problematic alcohol use in workplace settings. However, studies investigating the feasibility of implementing ICBT in a workplace setting have been lacking. Objective: The current study aims to investigate the feasibility of delivering ICBT for problematic alcohol use within an employee assistance program (EAP). Methods: The study has a quantitative naturalistic design, quantitively comparing ICBT and face-to-face treatment, and allowing for qualitative interviews with employees and employers. Recruitment of participants follows a five-session in-person psychological assessment at an EAP regarding an employee’s presumed problematic alcohol consumption. All assessed employees referred to ICBT or face-to-face treatment will be offered participation in the study. Interviews will be held with employees and their employer representatives following ICBT to elucidate both stakeholders’ experience and perception of ICBT and its context. Outcome comparisons between ICBT and face-to-face treatment will be assessed quantitatively using a Reliable Change Index and analysis of variance. Thematic analysis and Grounded Theory will be used to analyze the interview material. Results: The study is set to begin in April 2020 and to end in September 2021. The aim is to recruit up to 150 participants to the quantitative part of the study and 45 participants (15 employees and 30 employer representatives) to the qualitative part of the study. Conclusions: The current study will provide knowledge that is lacking and urgently needed on how to implement ICBT for problematic alcohol use in a workplace setting. International Registered Report Identifier (IRRID): PRR1-10.2196/18693 %M 32673266 %R 10.2196/18693 %U https://www.researchprotocols.org/2020/7/e18693 %U https://doi.org/10.2196/18693 %U http://www.ncbi.nlm.nih.gov/pubmed/32673266 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 7 %P e17368 %T Promoting Employees’ Recovery During Shift Work: Protocol for a Workplace Intervention Study %A Niks,Irene MW %A van Drongelen,Alwin %A de Korte,Elsbeth M %+ The Netherlands Organization for Applied Scientific Research (TNO), Schipholweg 77, Leiden, 2316 ZL, Netherlands, 31 61 129 79 41, irene.niks@tno.nl %K shift work %K recovery during work %K fatigue %K intervention study %K participatory action research %K ecological momentary assessment %K mobile phone %D 2020 %7 14.7.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Shift work can be demanding owing to disturbances in the biological and social rhythms. This can cause short-term negative effects in employees, such as increased fatigue and reduced alertness. A potential way to counteract these negative effects is to enhance employees’ recovery from work during working hours. Objective: The aim of this study is to develop and implement an intervention that focuses on promoting “on-job” recovery of shift workers. Methods: This study is performed in 2 department units with shift workers at a multinational company in the steel industry. For each department, an intervention will be developed and implemented through an iterative process of user-centered design and evaluation. This approach consists of various sessions in which employees and a project group (ie, researchers, line managers, human resource managers, and occupational health experts) provide input on the intervention content and implementation. Intervention effects will be evaluated using pretest and posttest web-based surveys. Digital ecological momentary assessment will be performed to gain insight into the link between the intervention and daily within-person processes. The intervention process and participants’ perception of the interventions will be assessed through a process evaluation. Intervention results will be analyzed by performing mixed model repeated measures analyses and multilevel analyses. Results: This study is supported by the Netherlands Organization for Applied Scientific Research Work and Health Research Program, which is funded by the Ministry of Economic Affairs and supported by the Dutch Ministry of Social Affairs and Employment, program number 19.204.1-3. This study was approved by the institutional review board on February 7, 2019. From June to August 2019, baseline data were collected, and from November to December 2019, the first follow-up data were collected. The second follow-up data collection and data analysis are planned for the first two quarters of 2020. Dissemination of the results is planned for the last two quarters of 2020. Conclusions: A strength of this study design is the participatory action approach to enhance the stakeholder commitments, intervention adherence, and compliance. Moreover, since the target group will be participating in the development and implementation of the intervention, the proposed impact will be high. In addition, the short-term as well as the long-term effects will be evaluated. Finally, this study uses a unique combination of quantitative and qualitative evaluation methods. A limitation of this study is that it is impossible to randomly assign participants to an intervention or control group. Furthermore, the follow-up period (6 months) might be too short to establish health-related effects. Lastly, the results of this study might be specific to the department, organization, or sector, which limits the generalizability of the findings. However, as workplace intervention research for shift workers is scarce, this study might serve as a starting point for future research on shift work interventions. %M 32459635 %R 10.2196/17368 %U https://www.researchprotocols.org/2020/7/e17368 %U https://doi.org/10.2196/17368 %U http://www.ncbi.nlm.nih.gov/pubmed/32459635 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e18181 %T Exploring Public Awareness of Overwork Prevention With Big Data From Google Trends: Retrospective Analysis %A Lin,Ro-Ting %A Cheng,Yawen %A Jiang,Yan-Cheng %+ Department of Occupational Safety and Health, College of Public Health, China Medical University, No 91, Hsueh-Shih Road, Taichung, 40402, Taiwan, 886 4 2205 3366 ext 6215, roting@ntu.edu.tw %K overwork %K working hours %K policy %K big data %D 2020 %7 26.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: To improve working conditions and prevent illness and deaths related to overwork, the Taiwanese government in 2015, 2016, and 2018 amended regulations regarding working time, overtime, shifts, and rest days. Such policy changes may lead to a rising public awareness of overwork-related issues, which may in turn reinforce policy development. Objective: This study aimed to investigate to what extent public awareness of overwork-related issues correlated with policy changes. Methods: Policies, laws, and regulations promulgated or amended in Taiwan between January 2004 and November 2019 were identified. We defined 3 working conditions (overwork, long working hours, and high job stress) related to overwork prevention, generated a keyword for each condition, and extracted the search volumes for each keyword on the Google search engine as proxy indicators of public awareness. We then calculated the monthly percentage change in the search volumes using the Joinpoint Regression Program. Results: Apparent peaks in search volumes were observed immediately after policy changes. Especially, policy changes in 2010 were followed by a remarkable peak in search volumes for both overwork and working hours, with the search volumes for overwork increased by 29% per month from June 2010 to March 2011. This increase was preceded by the implementation of new overwork recognition guidelines and media reports of several suspected overwork-related events. The search volumes for working hours also steadily increased, by 2% per month in September 2013 and afterward, reaching a peak in January 2017. The peak was likely due to the amendment to the Labor Standards Act, which called for “1 fixed and 1 flexible day off per week,” in 2016. The search volumes for job stress significantly increased (P=.026) but only by 0.4% per month since March 2013. Conclusions: Over the past 15 years, Taiwanese authorities have revised and implemented several policies to prevent overwork-related health problems. Our study suggests a relationship between the implementation of policies that clearly defined the criteria for overwork and working hours and the rising public awareness of the importance of overwork prevention and shorter working hours. %M 32589160 %R 10.2196/18181 %U https://www.jmir.org/2020/6/e18181 %U https://doi.org/10.2196/18181 %U http://www.ncbi.nlm.nih.gov/pubmed/32589160 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 6 %P e18236 %T Prospective Associations Between Working Time Arrangements and Psychiatric Treatment in Denmark: Protocol for a Cohort Study %A Hannerz,Harald %A Albertsen,Karen %A Nielsen,Martin Lindhardt %A Garde,Anne Helene %+ The National Research Center for the Working Environment, Lersø Parkallé 105, Copenhagen, 2100, Denmark, 45 39165460, hha@nrcwe.dk %K occupational health %K long working hours %K night shift work %K mood disorders %K anxiety %K stress-related disorders %K psychiatric hospital treatment %K prescription drugs %K psychotropic medicine %D 2020 %7 15.6.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: The burden of mental ill health in working-age populations has prompted research on possible links between work-related factors and mental ill health. Long working hours and night shift work are some of the factors that have been studied in relation to the risk of developing mental ill health. Yet, previous studies have not generated conclusive evidence, and further studies of high quality are needed. Objective: This study aims to investigate the prospective association between working time arrangements and mental health in terms of psychotropic drug usage or psychiatric hospital treatment in the general working population of Denmark. Methods: Data on total weekly working hours in any job and night shift work from the Danish Labor Force Survey 2000–2013 will be linked to data from the Psychiatric Central Research Register (expected 2400 cases during 700,000 person years at risk) and National Prescription Registry (expected 17,400 cases during 600,000 person years at risk). Participants will be followed for up to 5 years. We will use Poisson regression to separately analyze incidence rates of redeemed prescriptions for psychotropic medicine and incidence rates of psychiatric hospital treatment due to mood disorders, anxiety disorders, or stress-related disorders as a function of weekly working hours and night shift work. The analyses will be controlled for sex, age, calendar time of the interview, and socioeconomic status. Results: This is a study protocol. Power calculations indicate that the study has sufficient statistical power to detect relatively small differences in risks and minor interactions (eg, ~90% power to detect a rate ratio of 1.1 for psychoactive medication use). We expect the analyses to be completed by the end of 2020 and the results to be published in 2021. Conclusions: In this study protocol, all hypotheses and statistical models of the project have been completely defined before we link the exposure data to the outcome data. The results of the project will indicate to what extent and in what direction the national burden of mental ill health in Denmark has been influenced by long working hours and night shift work. International Registered Report Identifier (IRRID): DERR1-10.2196/18236 %M 32442158 %R 10.2196/18236 %U https://www.researchprotocols.org/2020/6/e18236 %U https://doi.org/10.2196/18236 %U http://www.ncbi.nlm.nih.gov/pubmed/32442158 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e14093 %T Occupational Health Needs and Predicted Well-Being in Office Workers Undergoing Web-Based Health Promotion Training: Cross-Sectional Study %A Tchir,Devan Richard %A Szafron,Michael Lorne %+ School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada, 1 3069665468, michael.szafron@usask.ca %K eHealth %K health promotion %K occupational health %K well-being %K internet %K workplace %D 2020 %7 26.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Office workers face workplace-related health issues, including stress and back pain, resulting in considerable cost to businesses and health care systems. Workplace health promotion attempts to prevent these health issues, and the internet can be used to deliver workplace health promotion interventions to office workers. Data were provided by Fitbase GmbH, a German company, which specializes in workplace health promotion via the internet (Web-based health). The Web-based health intervention allowed workers to focus on different health categories by using information modules (reading health information) and/or completing practical exercises (guided, interactive health tutorials). Objective: This study aimed to identify the extent to which office workers have workplace-related health issues, assess whether office workers who differ in their health focus also differ in their improved well-being, and assess whether completing practical exercises is associated with improved well-being compared with reading information modules. Methods: Fitbase GmbH collected data for the period of February 2016 to May 2017 from health insurance employees undergoing Web-based health training in Hamburg, Germany. The data consisted of a needs assessment examining health issues faced by office workers, a wellness questionnaire regarding one’s perception of the Web-based health intervention, and activity logs of information modules and practical exercises completed. Through logistic regression, we determined associations between improved well-being from Web-based health training and differences in a worker’s health focus and a worker’s preferred intervention method. Results: Nearly half of the office workers had chronic back pain (1532/3354) and felt tense or irritated (1680/3348). Over four-fifth (645/766) of the office workers indicated that the Web-based health training improved their well-being (P<.001). Office workers who preferred practical exercises compared with information modules had 2.22 times greater odds of reporting improved well-being from the Web-based health intervention (P=.01; 95% CI 1.20-4.11). Office workers with a focus on practical exercises for back health had higher odds of improved well-being compared with other health foci. Office workers focused on practical exercises for back pain had at least two times the odds of having their well-being improved from the Web-based health intervention compared with those focused on stress management (P<.001), mindfulness (P=.02), stress management/mindfulness (P=.005), and eye health (P=.003). No particular health focus was associated with improved well-being for the information modules. Conclusions: Office workers frequently report having back pain and stress. A focus on Web-based health training via practical exercises and practical exercises for back health predict an improvement in office workers’ reported well-being. %M 32452806 %R 10.2196/14093 %U http://www.jmir.org/2020/5/e14093/ %U https://doi.org/10.2196/14093 %U http://www.ncbi.nlm.nih.gov/pubmed/32452806 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15085 %T Use of the Healthy Lifestyle Coaching Chatbot App to Promote Stair-Climbing Habits Among Office Workers: Exploratory Randomized Controlled Trial %A Piao,Meihua %A Ryu,Hyeongju %A Lee,Hyeongsuk %A Kim,Jeongeun %+ College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, 03080, Republic of Korea, 82 2 740 8803, rnyoo@snu.ac.kr %K exercise %K habits %K reward %K health behavior %K healthy lifestyle %D 2020 %7 19.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Lack of time for exercise is common among office workers given their busy lives. Because of occupational restrictions and difficulty in taking time off, it is necessary to suggest effective ways for workers to exercise regularly. Sustaining lifestyle habits that increase nonexercise activity in daily life can solve the issue of lack of exercise time. Healthy Lifestyle Coaching Chatbot is a messenger app based on the habit formation model that can be used as a tool to provide a health behavior intervention that emphasizes the importance of sustainability and involvement. Objective: This study aimed to assess the efficacy of the Healthy Lifestyle Coaching Chatbot intervention presented via a messenger app aimed at stair-climbing habit formation for office workers. Methods: From February 1, 2018, to April 30, 2018, a total of 106 people participated in the trial after online recruitment. Participants were randomly assigned to the intervention group (n=57) or the control group (n=49). The intervention group received cues and intrinsic and extrinsic rewards for the entire 12 weeks. However, the control group did not receive intrinsic rewards for the first 4 weeks and only received all rewards as in the intervention group from the fifth to twelfth week. The Self-Report Habit Index (SRHI) of participants was evaluated every week, and the level of physical activity was measured at the beginning and end of the trial. SPSS Statistics version 21 (IBM Corp) was used for statistical analysis. Results: After 4 weeks of intervention without providing the intrinsic rewards in the control group, the change in SRHI scores was 13.54 (SD 14.99) in the intervention group and 6.42 (SD 9.42) in the control group, indicating a significant difference between the groups (P=.04). When all rewards were given to both groups, from the fifth to twelfth week, the change in SRHI scores of the intervention and control groups was comparable at 12.08 (SD 10.87) and 15.88 (SD 13.29), respectively (P=.21). However, the level of physical activity showed a significant difference between the groups after 12 weeks of intervention (P=.045). Conclusions: This study provides evidence that intrinsic rewards are important to enhance the sustainability and effectiveness of an intervention. The Healthy Lifestyle Coaching Chatbot program can be a cost-effective method for healthy habit formation. Trial Registration: Clinical Research Information Service KCT0004009; https://tinyurl.com/w4oo7md %M 32427114 %R 10.2196/15085 %U https://mhealth.jmir.org/2020/5/e15085 %U https://doi.org/10.2196/15085 %U http://www.ncbi.nlm.nih.gov/pubmed/32427114 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e15083 %T A Persuasive mHealth Behavioral Change Intervention for Promoting Physical Activity in the Workplace: Feasibility Randomized Controlled Trial %A Haque,Md Sanaul %A Kangas,Maarit %A Jämsä,Timo %+ Research Unit of Medical Imaging Physics and Technology, Faculty of Medicine, University of Oulu, PO Box 5000, Oulu, 90014, Finland, 358 469557272, md.haque@oulu.fi %K mHealth behavioral change intervention %K persuasive app %K UCD %K game elements %K physical activity %K SDT %D 2020 %7 4.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Employees in an office setting are more likely to remain physically inactive. Physical inactivity has become one of the major barriers to overcoming the risk factors for anxiety, depression, coronary heart disease, certain cancers, and type 2 diabetes. Currently, there is a gap in mobile health (mHealth) apps to promote physical activity (PA) for workers in the workplace. Studies on behavior change theories have concluded that health apps generally lack the use of theoretical constructs. Objective: The objective of this study was to study the feasibility of a persuasive app aimed at encouraging PA among employees and to understand the motivational aspects behind the implementation of mHealth apps among office workers. Methods: A 4-week study using a mixed methods (quantitative and qualitative) design was conducted with office-based employees in cities in 4 countries: Oulu, Finland; Carlow, Ireland; London, United Kingdom; and Dhaka, Bangladesh. Of the 220 invited participants (experimental group, n=115; control group, n=105), 84 participated (experimental group, n=56; control group, n=28), consisting of working-age volunteers working in an office setting. Participants used 2 different interventions: The experimental group used an mHealth app for PA motivation, and the control group used a paper diary. The purpose was to motivate employees to engage in healthier behavior regarding the promotion of PA in the workplace. A user-centered design process was followed to design, develop, and evaluate the mHealth app, incorporating self-determination theory (SDT) and using game elements. The paper diary had no specific theory-driven approach, design technique, nor game elements. Results: Compliance with app usage remained relatively low, with 27 participants (experimental group, n=20; control group, n=7) completing the study. The results support the original hypothesis that the mHealth app would help increase PA (ie, promoting daily walking in the workplace) in comparison to a paper diary (P=.033). The mHealth app supported 2 of the basic SDT psychological needs, namely autonomy (P=.004) and competence (P=.014), but not the needs of relatedness (P=.535). Conclusions: The SDT-based mHealth application motivated employees to increase their PA in the workplace. However, compliance with app usage remained low. Future research should further develop the app based on user feedback and test it in a larger sample. %M 32364506 %R 10.2196/15083 %U https://formative.jmir.org/2020/5/e15083 %U https://doi.org/10.2196/15083 %U http://www.ncbi.nlm.nih.gov/pubmed/32364506 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 4 %P e15416 %T How Contextual Constraints Shape Midcareer High School Teachers' Stress Management and Use of Digital Support Tools: Qualitative Study %A Manning,Julia B %A Blandford,Ann %A Edbrooke-Childs,Julian %A Marshall,Paul %+ University College London Interaction Centre, 66-72 Gower Street, London, WC1E 6EA, United Kingdom, 44 7973312358, j.manning.17@ucl.ac.uk %K school teachers %K stress %K health %K self-management %K computers %K technology %K qualitative research %K secondary schools %K wearable devices %K mobile applications %K education %D 2020 %7 27.4.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Persistent psychosocial stress is endemic in the modern workplace, including among midcareer high school (secondary comprehensive) teachers in England. Understanding contextual influences on teachers' self-management of stress along with their use of digital health technologies could provide important insights into creating more usable and accessible stress support interventions. Objective: The aim of this study was to investigate the constraints on stress management and prevention among teachers in the school environment and how this shapes the use of digitally enabled stress management tools. Methods: Semistructured interviews were conducted with 14 teachers from southern England. The interviews were analyzed using thematic analysis. Results: Teachers were unanimous in their recognition of workplace stress, describing physical (such as isolation and scheduling) and cultural (such as stigma and individualism) aspects in the workplace context, which influence their ability to manage stress. A total of 12 participants engaged with technology to self-manage their physical or psychological well-being, with more than half of the participants using consumer wearables, but Web-based or smartphone apps were rarely accessed in school. However, digital well-being interventions recommended by school leaders could potentially be trusted and adopted. Conclusions: The findings from this study bring together both the important cultural and physical contextual constraints on the ability of midcareer high school teachers to manage workplace stress. This study highlights correlates of stress and offers initial insight into how digital health interventions are currently being used to help with stress, both within and outside high schools. The findings add another step toward designing tailored digital stress support for teachers. %M 32338623 %R 10.2196/15416 %U http://mental.jmir.org/2020/4/e15416/ %U https://doi.org/10.2196/15416 %U http://www.ncbi.nlm.nih.gov/pubmed/32338623 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 1 %P e15812 %T Occupational Exposure to Needle Stick Injuries and Hepatitis B Vaccination Coverage Among Clinical Laboratory Staff in Sana’a, Yemen: Cross-Sectional Study %A Al-Abhar,Nabil %A Moghram,Ghuzlan Saeed %A Al-Gunaid,Eshrak Abdulmalek %A Al Serouri,Abdulwahed %A Khader,Yousef %+ Jordan Field Epidemiology Training Program, Jordan Ministry of Health, Pr. Hamzah St, Amman, 11118, Jordan, 962 796802040, yskhader@just.edu.jo %K injury %K hepatitis B %K vaccination %K biosafety %K laboratory staff %K Yemen %D 2020 %7 31.3.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Laboratory staff handling blood or biological samples are at risk for accidental injury or exposure to blood-borne pathogens. Hepatitis B virus (HBV) vaccinations for laboratory staff can minimize these risks. Objective: The aims of this study were to determine the prevalence of occupational exposure to needle stick injuries (NSIs) and assess HBV vaccination coverage among clinical laboratory staff in Sana’a, Yemen. Methods: A cross-sectional survey was conducted among clinical laboratory staff who were involved in handling and processing laboratory samples at the main public and private clinical laboratories in Sana’a. Data collection was done using a semistructured questionnaire. The questionnaire was divided into 3 parts. Part 1 included information on sociodemographic characteristics of participants. Part 2 included information on the availability of the personal protective equipment in the laboratories, such as lab coats and gloves. Part 3 included questions about the history of injury during work in the laboratory and the vaccination status for HBV. Results: A total of 219/362 (60%) participants had been accidentally injured while working in the laboratory. Of those, 14.6% (32/219) had been injured during the last 3 months preceding the data collection. Receiving the biosafety manual was significantly associated with lower risk of injury. Out of those who were injured, 54.8% (120/219) had received first aid. About three-quarters of respondents reported that they had been vaccinated against HBV. The vaccination against HBV was significantly higher among laboratory staff who were working at private laboratories (P=.01), who had postgraduate degrees (P=.005), and who received the biosafety manual (P=.03). Conclusions: Occupational exposure to NSI is still a major problem among laboratory staff in public and private laboratories in Sana’a, Yemen. The high incidence of injuries among laboratory staff and the low rate of receiving first aid in laboratories combined with low vaccination coverage indicates that all laboratory staff are at risk of exposure to HBV. Therefore, strengthening supervision, legalizing HBV vaccinations for all laboratory staff, and optimizing laboratory practices regarding the management of sharps can minimize risks and prerequisites in Yemen. %M 32229462 %R 10.2196/15812 %U http://publichealth.jmir.org/2020/1/e15812/ %U https://doi.org/10.2196/15812 %U http://www.ncbi.nlm.nih.gov/pubmed/32229462 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 2 %P e12950 %T Effectiveness of an Educational Intervention in Reducing New International Postgraduates’ Acculturative Stress in Malaysian Public Universities: Protocol for a Cluster Randomized Controlled Trial %A Al-Jaberi,Musheer Abdulwahid %A Juni,Muhamad Hanafiah %A Kadir Shahar,Hayati %A Ismail,Siti Irma Fadhilah %A Saeed,Murad Abdu %A Ying,Lim Poh %+ Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang, Selangor Darul Ehsan, MY 43400, Selangor, , Malaysia, 60 3 8947 2425, hanafiah_juni@upm.edu.my %K acculturative stress %K acculturation %K international students %K adjustment %K protocol %K cluster %K randomized controlled trial %D 2020 %7 27.2.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Universities around the world, including Malaysia, have attracted many international students from different countries. Research has reported that acculturative stress resulting from international students’ attempts to adjust to the cultures of host countries is one of the most challenging issues that affects their lives in general and academic lives in particular. Objective: This study aims to examine the effectiveness of an educational intervention on acculturative stress among new postgraduate international students joining Malaysian public universities. Methods: A cluster randomized controlled trial design with Malaysian public universities as the unit of randomization will be used in this study. Public universities will be randomized in a 1:1 ratio to be either in the intervention (educational program) or control group (waiting list). Participants in the intervention group will receive 7 sessions in 9 hours delivered by an expert in psychology and the researcher. The control group will receive the intervention once the 3-month follow-up evaluation is completed. Results: The data will be analyzed using the generalized estimation equation with a confidence interval value of 95%; significant differences between and within groups are determined as P<.05. The results of the study underlie the effectiveness of educational program in decreasing acculturative stress of new international students and enabling them to cope with a new environment. The results of this study will contribute to previous knowledge of acculturative stress, acculturation, and adjustment of international students. Furthermore, such results are expected to play a role in raising university policy makers’ awareness of their postgraduate international students’ acculturative stress issues and how they can help them avoid such stress and perform well in their academic life. Conclusions: We expect that the intervention group will score significantly lower than the wait-list group on the immediate and 3-month postintervention evaluation of acculturative stress and achieve a higher level of adjustment. Results will have implications for international students, policy makers at universities, the Malaysian Ministry of Higher Education, and future research. Trial Registration: Clinical Trials Registry India CTRI/2018/01/011223; http://ctri.nic.in/Clinicaltrials/showallp.php?mid1= 21978&EncHid=&userName=Muhamad%20Hanafiah%20Juni International Registered Report Identifier (IRRID): PRR1-10.2196/12950 %M 32130180 %R 10.2196/12950 %U http://www.researchprotocols.org/2020/2/e12950/ %U https://doi.org/10.2196/12950 %U http://www.ncbi.nlm.nih.gov/pubmed/32130180 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 2 %P e15809 %T Exploring Drivers of Work-Related Stress in General Practice Teams as an Example for Small and Medium-Sized Enterprises: Protocol for an Integrated Ethnographic Approach of Social Research Methods %A Rind,Esther %A Emerich,Sigrid %A Preiser,Christine %A Tsarouha,Elena %A Rieger,Monika A %A , %+ Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, University of Tuebingen, Wilhelmstr 27, Tuebingen, 72074, Germany, 49 (0)70712980154, esther.rind@med.uni-tuebingen.de %K occupational health %K work-related stress %K small and medium-sized enterprises %K general practice teams %K ethnography %K method triangulation %K grounded theory %D 2020 %7 11.2.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: An increasing shortage of skilled personnel, including medical personnel, has been reported in many postindustrial economies. Persisting and growing trends in absenteeism and incapacity to work due to mental disorders are concerning and have increased political, economic, and scientific interest in better understanding and management of determinants related to the work environment and health. Objective: This study protocol describes an integrated approach of social research methods to explore determinants of work-related stress in general practice teams as an example for micro, small, and medium-sized enterprises (SMEs). Methods: The methods applied will allow an in-depth exploration of work practices and experiences relating to psychological well-being in general practice teams. An ethnographic approach will be used to develop an in-depth understanding of the drivers of work-related stress in general practice teams. We will combine participating observation and individual interviews with five to seven general practitioners (GPs), and five to seven focus group discussions with the nonphysician staff (3-4 participants per group) in approximately four GP group practices and one single practice in Germany. Data collection and analysis will follow a grounded theory approach. Results: The Ethics Committee of the Medical Faculty, University Hospital of Tuebingen, Germany, has approved this study (reference number: 640/2017BO2). Recruitment has commenced with study completion anticipated in mid-2020. Conclusions: The data from this project will be used in follow-up projects to develop and test an intervention to reduce and prevent work-related stress in GP practices and other SMEs. International Registered Report Identifier (IRRID): DERR1-10.2196/15809 %M 32044759 %R 10.2196/15809 %U https://www.researchprotocols.org/2020/2/e15809 %U https://doi.org/10.2196/15809 %U http://www.ncbi.nlm.nih.gov/pubmed/32044759 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 1 %P e13346 %T Efficacy of a Self-Help Web-Based Recovery Training in Improving Sleep in Workers: Randomized Controlled Trial in the General Working Population %A Behrendt,Doerte %A Ebert,David Daniel %A Spiegelhalder,Kai %A Lehr,Dirk %+ Department of Health Psychology and Applied Biological Psychology, Institute of Psychology, Leuphana University of Lueneburg, Universitätsallee 1, Lueneburg, 21335, Germany, 49 41316772374, behrendt@leuphana.de %K occupational health %K e-mental-health %K insomnia %K Web-based, cognitive behavioral therapy %K mediators %D 2020 %7 7.1.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Sleep complaints are among the most prevalent health concerns, especially among workers, which may lead to adverse effects on health and work. Internet-delivered cognitive behavioral therapy for insomnia (iCBT-I) offers the opportunity to deliver effective solutions on a large scale. The efficacy of iCBT-I for clinical samples has been demonstrated in recent meta-analyses, and there is evidence that iCBT-I is effective in the working population with severe sleep complaints. However, to date, there is limited evidence from randomized controlled trials that iCBT-I could also be an effective tool for universal prevention among the general working population regardless of symptom severity. Although increasing evidence suggests that negatively toned cognitive activity may be a key factor for the development and maintenance of insomnia, little is known about how iCBT-I improves sleep by reducing presleep cognitive activity. Objective: This study aimed to examine the efficacy of a self-help internet-delivered recovery training, based on principles of iCBT-I tailored to the work-life domain, among the general working population. General and work-related cognitive activities were investigated as potential mediators of the intervention’s effect. Methods: A sample of 177 workers were randomized to receive either the iCBT-I (n=88) or controls (n=89). The intervention is a Web-based training consisting of six 1-week modules. As the training was self-help, participants received nothing but technical support via email. Web-based self-report assessments were scheduled at baseline, at 8 weeks, and at 6 months following randomization. The primary outcome was insomnia severity. Secondary outcomes included measures of mental health and work-related health and cognitive activity. In an exploratory analysis, general and work-related cognitive activities, measured as worry and work-related rumination, were investigated as mediators. Results: Analysis of the linear mixed effects model showed that, relative to controls, participants who received iCBT-I reported significantly lower insomnia severity scores at postintervention (between-group mean difference −4.36; 95% CI −5.59 to − 3.03; Cohen d=0.97) and at 6-month follow-up (between-group difference: −3.64; 95% CI −4.89 to −2.39; Cohen d=0.86). The overall test of group-by-time interaction was significant (P<.001). Significant differences, with small-to-large effect sizes, were also detected for cognitive activity and for mental and work-related health, but not for absenteeism. Mediation analysis demonstrated that work-related rumination (indirect effect: a1b1=−0.80; SE=0.34; 95% boot CI −1.59 to −0.25) and worry (indirect effect: a2b2=−0.37; SE=0.19; 95% boot CI −0.85 to −0.09) mediate the intervention’s effect on sleep. Conclusions: A self-help Web-based recovery training, grounded in the principles of iCBT-I, can be effective in the general working population, both short and long term. Work-related rumination may be a particularly crucial mediator of the intervention’s effect, suggesting that tailoring interventions to the workplace, including components to reduce the work-related cognitive activity, might be important when designing recovery interventions for workers. Trial Registration: German Clinical Trials Register DRKS00007142; https://www.drks.de/DRKS00007142 %M 31909725 %R 10.2196/13346 %U https://www.jmir.org/2020/1/e13346 %U https://doi.org/10.2196/13346 %U http://www.ncbi.nlm.nih.gov/pubmed/31909725 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e11158 %T A Mobile-Based Comprehensive Weight Reduction Program for the Workplace (Health-On): Development and Pilot Study %A Han,Min Kyu %A Cho,Belong %A Kwon,Hyuktae %A Son,Ki Young %A Lee,Hyejin %A Lee,Joo Kyung %A Park,Jinho %+ Department of Family Medicine, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea, 82 2 2072 0865, kkolzzi0@gmail.com %K weight loss programs %K smartphone %K mobile phone %K workplaces %K obesity %K obesity management %D 2019 %7 4.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is a growing interest in mobile technology for obesity management. Despite the known effectiveness of workplace-based weight loss programs, there are few studies on mobile phone–delivered interventions. Objective: This study aimed to develop and verify an integrated and personalized mobile technology–based weight control program, named Health-On, optimized for workplaces. Methods: A weight reduction algorithm was developed for calorie prescription, continuous monitoring, periodic feedback and reevaluation, goal resetting, and offline intervention with behavior-changing strategies. A total of 30 obese volunteers (body mass index ≥25 kg/m2) participated in the 12-week Health-On pilot program. The primary outcome was weight reduction, and secondary outcomes were improved anthropometric measures, metabolic profiles, and fat computed tomography measures, all assessed pre- and postintervention. Results: Health-On incorporated proprietary algorithms and several strategies intended to maximize adherence, using compatible online and offline interventions. The mean weight of 30 participants decreased by 5.8%, and median weight also decreased from 81.3 kg (interquartile range [IQR] 77.1-87.8) before intervention to 76.6 kg (IQR 70.8-79.5) after the 12-week intervention period (P<.001). The metabolic profiles and fat measures (blood pressure, glycosylated hemoglobin, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, alanine aminotransferase, and visceral and subcutaneous adipose tissue; P<.05) also improved significantly. Conclusions: In this single-group evaluation of 30 participants before and after the Health-On program, body weight decreased and metabolic profiles and fat measures improved. Follow-up studies are needed to assess effectiveness and long-term adherence. %M 31682576 %R 10.2196/11158 %U https://mhealth.jmir.org/2019/11/e11158 %U https://doi.org/10.2196/11158 %U http://www.ncbi.nlm.nih.gov/pubmed/31682576 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 10 %P e15303 %T A Salutogenic Approach to Understanding the Potential of Green Programs for the Rehabilitation of Young Employees With Burnout: Protocol for a Mixed Method Study on Effectiveness and Effective Elements %A Pijpker,Roald %A Vaandrager,Lenneke %A Veen,Esther J %A Koelen,Maria A %+ Health and Society, Department of Social Sciences, Wageningen University, Hollandseweg 1, Wageningen, 6706 KN, Netherlands, 31 (0) 620187620, roald.pijpker@wur.nl %K burnout %K health promotion %K occupational health %K program evaluation %K rehabilitation %K sense of coherence %K workforce %D 2019 %7 30.10.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Burnout is the leading cause of absenteeism in the Netherlands, with associated sick leave costs amounting to around €1.8 billion. Studies have indicated that burnout complaints increased from almost 14.4% in 2014 to 17.3% in 2018, especially among employees between the ages of 18 and 35 years, and further increases are expected. Although there are many published articles on burnout, not much is known about what constitutes effective rehabilitation (ie, the reduction of burnout complaints and the facilitation of returning to work). At the same time, multiple pilot studies have indicated that green programs are effective in both reducing burnout complaints and facilitating return to work. Green programs have been developed by professionals experienced in using the natural environment to facilitate rehabilitation (eg, through green exercise and healing gardens). The literature nevertheless lacks comprehensive and contextual insight into what works and why. Objective: The overarching aim of this study is to explore the potential of green programs for young employees with burnout. We present the study protocol from an ongoing research project consisting of 2 phases, each composed of 2 research objectives that sequentially build upon each other. Methods: The study is based on a sequential design with 4 research objectives, using both qualitative and quantitative research methods. In the first phase, a systematic literature review (research objective 1) and in-depth interviews (research objective 2) will be used to explore mechanisms underlying the rehabilitation of young employees with burnout. In the second phase, a multicase study will be conducted to examine the extent to which green programs are built on mechanisms identified in the first phase (research objective 3). By employing a pretest and posttest design, a specific green program that captures most of those mechanisms will then be evaluated on its effect and process with regard to the rehabilitation of young employees with burnout (research objective 4). The project started in June 2018 and will continue through June 2022. Results: The first phase (research objectives 1 and 2) is intended to generate information on the mechanisms underlying the rehabilitation of young employees with burnout. The second phase (research objectives 3 and 4) is designed to demonstrate the extent to which and how the selected green program facilitates the rehabilitation of young employees with burnout. Conclusions: Understanding how green programs can facilitate the rehabilitation of young employees with burnout complaints can help to address this societal issue. International Registered Report Identifier (IRRID): DERR1-10.2196/15303 %M 31670699 %R 10.2196/15303 %U http://www.researchprotocols.org/2019/10/e15303/ %U https://doi.org/10.2196/15303 %U http://www.ncbi.nlm.nih.gov/pubmed/31670699 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 7 %N 3 %P e14763 %T Mining Hidden Knowledge About Illegal Compensation for Occupational Injury: Topic Model Approach %A Min,Jin-Young %A Song,Sung-Hee %A Kim,HyeJin %A Min,Kyoung-Bok %+ Department of Preventive Medicine, Seoul National University College of Medicine, 1 Daehak-ro, Jongro-gu, Seoul, Republic of Korea, 82 027408968, minkb@snu.ac.kr %K occupational injuries %K worker’s compensation %K social media %K Korea %D 2019 %7 26.9.2019 %9 Original Paper %J JMIR Med Inform %G English %X Background: Although injured employees are legally covered by workers’ compensation insurance in South Korea, some employers make agreements to prevent the injured employees from claiming their compensation. Thus, this leads to underreporting of occupational injury statistics. Illegal compensation (called gong-sang in Korean) is a critical method used to underreport or cover-up occupational injuries. However, gong-sang is not counted in the official occupational injury statistics; therefore, we cannot identify gong-sang–related issues. Objective: This study aimed to analyze social media data using topic modeling to explore hidden knowledge about illegal compensation—gong-sang—for occupational injury in South Korea. Methods: We collected 2210 documents from social media data by filtering the keyword, gong-sang. The study period was between January 1, 2006, and December 31, 2017. After completing natural language processing of the Korean language, a morphological analyzer, we performed topic modeling using latent Dirichlet allocation (LDA) in the Python library, Gensim. A 10-topic model was selected and run with 3000 Gibbs sampling iterations to fit the model. Results: The LDA model was used to classify gong-sang–related documents into 4 categories from a total of 10 topics. Topic 1 was the greatest concern (60.5%). Workers who suffered from industrial accidents seemed to be worried about illegal compensation and legal insurance claims, wherein keywords on the choice between illegal compensation and legal insurance claims were included. In topic 2, keywords were associated with claims for industrial accident insurance benefits. Topics 3 and 4, as the second highest concern (19%), contained keywords implying the monetary compensation of gong-sang. Topics 5 to 10 included keywords on vulnerable jobs (ie, workers in the construction and defense industry, delivery riders, and foreign workers) and body parts (ie, injuries to the hands, face, teeth, lower limbs, and back) to gong-sang. Conclusions: We explored hidden knowledge to identify the salient issues surrounding gong-sang using the LDA model. These topics may provide valuable information to ensure the more efficient operation of South Korea’s occupational health and safety administration and protect vulnerable workers from illegal gong-sang compensation practices. %M 31573948 %R 10.2196/14763 %U https://medinform.jmir.org/2019/3/e14763 %U https://doi.org/10.2196/14763 %U http://www.ncbi.nlm.nih.gov/pubmed/31573948 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 8 %P e13744 %T Early Effect Markers and Exposure Determinants of Metalworking Fluids Among Metal Industry Workers: Protocol for a Field Study %A Hopf,Nancy B %A Bourgkard,Eve %A Demange,Valérie %A Hulo,Sébastien %A Sauvain,Jean-Jacques %A Levilly,Ronan %A Jeandel,Fanny %A Robert,Alain %A Guichard,Yves %A Pralong,Jacques André %A Chérot-Kornobis,Nathalie %A Edmé,Jean-Louis %A Wild,Pascal %+ National Research and Safety Institute (INRS), Rue du Morvan, CS 60027, Vandoeuvre cedex, 54519, France, 33 383502194, pascal.wild@inrs.fr %K metalworking fluid %K oxidative stress %K exposure biomarkers %K early effect biomarkers %K genotoxic effects %K occupational epidemiology %D 2019 %7 02.08.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Exposure to aerosols from metalworking fluids (MWF) has previously been related to a series of adverse health outcomes (eg, cancer, respiratory diseases). Our present epidemiological study focuses on occupational exposures to MWF and a panel of exposure and effect biomarkers. We hypothesize that these health outcomes are caused by particle exposure that generates oxidative stress, leading to airway inflammation and ultimately to chronic respiratory diseases. We aimed to assess whether MWF exposure, in particular as characterized by its oxidative potential, is associated with biomarkers of oxidative stress and inflammation as well as genotoxic effects. Objective: The ultimate goal is to develop exposure reduction strategies based on exposure determinants that best predict MWF-related health outcomes. The following relationships will be explored: (1) exposure determinants and measured exposure; (2) occupational exposure and preclinical and clinical effect markers; (3) exposure biomarkers and biomarkers of effect in both exhaled breath condensate and urine; and (4) biomarkers of effect, genotoxic effects and respiratory symptoms. Methods: At least 90 workers from France and Switzerland (30 controls, 30 exposed to straight MWF and 30 to aqueous MWF) were followed over three consecutive days after a nonexposed period of at least two days. The exposure assessment is based on MWF, metal, aldehyde, and ultrafine particle number concentrations, as well as the intrinsic oxidative potential of aerosols. Furthermore, exposure biomarkers such as metals, metabolites of polycyclic aromatic hydrocarbons and nitrosamine are measured in exhaled breath condensate and urine. Oxidative stress biomarkers (malondialdehyde, 8-isoprostane, 8-hydroxy-2’-deoxyguanosine, nitrates, and nitrites) and exhaled nitric oxide, an airway inflammation marker, are repeatedly measured in exhaled breath condensate and urine. Genotoxic effects are assessed using the buccal micronucleus cytome assay. The statistical analyses will include modelling exposure as a function of exposure determinants, modelling the evolution of the biomarkers of exposure and effect as a function of the measured exposure, and modelling respiratory symptoms and genotoxic effects as a function of the assessed long-term exposure. Results: Data collection, which occurred from January 2018 until June 2019, included 20 companies. At the date of writing, the study included 100 subjects and 29 nonoccupationally exposed controls. Conclusions: This study is unique as it comprises human biological samples, questionnaires, and MWF exposure measurement. The biomarkers collected in our study are all noninvasive and are useful in monitoring MWF exposed workers. The aim is to develop preventative strategies based on exposure determinants related to health outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/13744 %M 31376276 %R 10.2196/13744 %U https://www.researchprotocols.org/2019/8/e13744/ %U https://doi.org/10.2196/13744 %U http://www.ncbi.nlm.nih.gov/pubmed/31376276 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 6 %P e12285 %T Implementation of a Web-Based Work-Related Psychological Aftercare Program Into Clinical Routine: Results of a Longitudinal Observational Study %A Zwerenz,Rüdiger %A Baumgarten,Carlotta %A Dahn,Ingo %A Labitzke,Nicole %A Schwarting,Andreas %A Rudolph,Matthias %A Ferdinand,Peter %A Dederichs-Masius,Ute %A Beutel,Manfred E %+ Department for Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg-University, Untere Zahlbacher Str 8, Mainz, 55131, Germany, 49 6131175981, ruediger.zwerenz@unimedizin-mainz.de %K aftercare %K internet %K mental health %K psychotherapeutic processes %K return to work %K occupational stress %K health plan implementation %D 2019 %7 18.06.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: As inpatient medical rehabilitation serves to promote work ability, vocational reintegration is a crucial outcome. However, previous Web-based trials on coping with work-related stress have been limited to Web-based recruitment of study participants. Objective: The aim of our study was to evaluate the implementation of an empirically supported transdiagnostic psychodynamic Web-based aftercare program GSA (Gesund und Stressfrei am Arbeitsplatz [Healthy and stress-less at the workplace])-Online plus into the clinical routine of inpatient medical rehabilitation, to identify characteristics of patients who have received the recommendation for GSA-Online plus, and to determine helpfulness of the intervention and satisfaction of the participants as well as improvement in quality of life and mental health status of the regular users of GSA-Online plus. Methods: GSA-Online plus was prescribed by physicians at termination of orthopedic psychosomatic inpatient rehabilitation. Participants’ use of the program, work-related attitudes, distress, and quality of life were assessed on the Web. Results: In 2 rehabilitation centers, 4.4% (112/2562) of rehabilitants got a recommendation for GSA-Online plus during inpatient rehabilitation. Compared with usual person aftercare, the Web-based aftercare program was rarely recommended by physicians. Recommendations were made more frequently in psychosomatic (69/1172, 5.9%) than orthopedic (43/1389, 3.1%) rehabilitation (χ21=11.845, P=.001, Cramér V=−0.068) and to younger patients (P=.004, d=0.28) with longer inpatient treatment duration (P<.001, r=−0.12) and extended sick leaves before inpatient medical rehabilitation (P=.004; Cramér V=0.072). Following recommendation, 77% (86/112) of rehabilitants participated in Web-based aftercare. Completers (50/86, 58%) reported statistically significant improvements between discharge of inpatient treatment and the end of the aftercare program for subjective work ability (P=.02, d=0.41), perceived stress (P=.01, d=−0.38), functioning (P=.002, d=−0.60), and life satisfaction (P=.008, d=0.42). Conclusions: Physicians’ recommendations of Web-based aftercare are well accepted by patients who derive considerable benefits from participation. However, a low rate of prescription compared with other usual aftercare options points to barriers among physicians to prescribing Web-based aftercare. %M 31215515 %R 10.2196/12285 %U http://www.jmir.org/2019/6/e12285/ %U https://doi.org/10.2196/12285 %U http://www.ncbi.nlm.nih.gov/pubmed/31215515 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e12246 %T A Web-Based Cognitive Behavior Therapy Intervention to Improve Social and Occupational Functioning in Adults With Type 2 Diabetes (The SpringboarD Trial): Randomized Controlled Trial %A Clarke,Janine %A Sanatkar,Samineh %A Baldwin,Peter Andrew %A Fletcher,Susan %A Gunn,Jane %A Wilhelm,Kay %A Campbell,Lesley %A Zwar,Nicholas %A Harris,Mark %A Lapsley,Helen %A Hadzi-Pavlovic,Dusan %A Christensen,Helen %A Proudfoot,Judy %+ Black Dog Institute, Hospital Road, Randwick, Sydney,, Australia, 61 0293824521, p.baldwin@unsw.edu.au %K type 2 diabetes %K depression %K internet %D 2019 %7 21.05.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Depressive symptoms are common in people with type 2 diabetes mellitus (T2DM). Effective depression treatments exist; however, access to psychological support is characteristically low. Web-based cognitive behavioral therapy (CBT) is accessible, nonstigmatizing, and may help address substantial personal and public health impact of comorbid T2DM and depression. Objective: The aim of this study was to evaluate the Web-based CBT program, myCompass, for improving social and occupational functioning in adults with T2DM and mild-to-moderate depressive symptoms. myCompass is a fully automated, self-guided public health treatment program for common mental health problems. The impact of treatment on depressive symptoms, diabetes-related distress, anxiety symptoms, and self-care behavior was also examined. Methods: Participants with T2DM and mild-to-moderate depressive symptoms (N=780) were recruited online via Google and Facebook advertisements targeting adults with T2DM and via community and general practice settings. Screening, consent, and self-report scales were all self-administered online. Participants were randomized using double-blind computerized block randomization to either myCompass (n=391) for 8 weeks plus a 4-week tailing-off period or an active placebo intervention (n=379). At baseline and postintervention (3 months), participants completed the Work and Social Adjustment Scale, the primary outcome measure. Secondary outcome measures included the Patient Health Questionnaire-9 item, Diabetes Distress Scale, Generalized Anxiety Disorder Questionnaire-7 item, and items from the Self-Management Profile for Type 2 Diabetes. Results: myCompass users logged in an average of 6 times and completed an average of .29 modules. Healthy Lifestyles users logged in an average of 4 times and completed an average of 1.37 modules. At baseline, mean scores on several outcome measures, including the primary outcome of work and social functioning, were near to the normal range, despite an extensive recruitment process. Approximately 61.6% (473/780) of participants completed the postintervention assessment. Intention-to-treat analyses revealed improvement in functioning, depression, anxiety, diabetes distress, and healthy eating over time in both groups. Except for blood glucose monitoring and medication adherence, there were no specific between-group effects. Follow-up analyses suggested the outcomes did not depend on age, morbidity, or treatment engagement. Conclusions: Improvement in social and occupational functioning and the secondary outcomes was generally no greater for myCompass users than for users of the control program at 3 months postintervention. These findings should be interpreted in light of near-normal mean baseline scores on several variables, the self-selected study sample, and sample attrition. Further attention to factors influencing uptake and engagement with mental health treatments by people with T2DM, and the impact of illness comorbidity on patient conceptualization and experience of mental health symptoms, is essential to reduce the burden of T2DM. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12615000931572; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368109&isReview=true (Archived by WebCite at http://www.webcitation.org/7850eg8pi) %M 31115345 %R 10.2196/12246 %U http://www.jmir.org/2019/5/e12246/ %U https://doi.org/10.2196/12246 %U http://www.ncbi.nlm.nih.gov/pubmed/31115345 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 4 %P e11401 %T Evaluating the Feasibility of an Innovative Self-Confidence Webinar Intervention for Depression in the Workplace: A Proof-of-Concept Study %A Wan Mohd Yunus,Wan Mohd Azam %A Musiat,Peter %A Brown,June SL %+ Department of Psychology, School of Human Resource Development and Psychology, Faculty of Social Sciences and Humanities, Universiti Teknologi Malaysia, UTM Johor Bahru, Skudai, Johor, 81310, Malaysia, 60 176136163, azam.yunus@kcl.ac.uk %K online %K videoconferencing %K cognitive behavioral therapy %K depression %K workplace %D 2019 %7 26.04.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Depression in the workplace is a very common problem that exacerbates employees’ functioning and consequently influences the productivity of organizations. Despite the commonness of the problem and the currently available interventions, a high proportion of employees do not seek help. A new intervention, a webinar (Web-based seminar), was developed, which integrated the use of technology and the traditional guided therapist support to provide accessible help for the problem of depression in the workplace. Objective: The aim of this study was to explore the feasibility, preliminary outcome, and acceptability of the webinar intervention conducted in organizations. Methods: In total, 2 organizations were invited to participate, and 33 employees participated in this proof-of-concept study. The webinar intervention consisted of 6 1-hour sessions conducted via the Adobe Connect platform, developed by Adobe Inc. The intervention was developed based on a systematic review, focus group studies, and face-to-face self-confidence workshops that utilized cognitive behavior therapy (CBT). The final webinar intervention used CBT and the coping flexibility approach. The structure of the intervention included PowerPoint presentations, animation videos, utilization of chat panels, and whiteboard features. The intervention was conducted live and guided by a consultant psychologist assisted by a moderator. Study outcomes were self-assessed using self-reported Web surveys. The acceptability of the intervention was assessed using self-reported user experience Web surveys and open-ended questions. Results: The findings showed: (1) evidence of feasibility of the intervention: the webinar intervention was successfully conducted in 3 groups, with 6 1-hour sessions for each group, with 82% (23/28) participants completing all 6 sessions; (2) positive improvements in depression: the linear mixed effects modeling analysis recorded a significant overall effect of time primarily for depression (F2, 48.813=31.524; P<.001) with a Hedge g effect size of 0.522 at 1-month follow-up. Individually, 8 subjects showed significant reliable and clinically significant changes, with 3 subjects showing clinically significant change only; and (3) encouraging evidence regarding the acceptability of the webinar intervention among the employees: the user experience score was above average for 4 out of 6 domains measured (perspicuity mean 1.198 [95% CI 0.832-1.564], efficiency mean 1.000 [95% CI 0.571-1.429], dependability mean 1.208 [95% CI 0.899-1.517], and stimulation mean 1.323 [95% CI 0.987-1.659]). The open-ended questions also yielded 52% (47/91) of the responses that reported facilitators, whereas only 12% (11/91) of the responses reported barriers. Conclusions: The self-confidence webinar intervention appears to be a potentially feasible, effective, and acceptable intervention for depression in the workplace that merits further investigation. %M 31025943 %R 10.2196/11401 %U http://mental.jmir.org/2019/4/e11401/ %U https://doi.org/10.2196/11401 %U http://www.ncbi.nlm.nih.gov/pubmed/31025943 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e11832 %T Effect of Serial Anthropometric Measurements and Motivational Text Messages on Weight Reduction Among Workers: Pilot Randomized Controlled Trial %A Chan,Renee %A Nguyen,Matthew %A Smith,Rachel %A Spencer,Sarah %A Pit,Sabrina Winona %+ School Of Medicine, University Centre for Rural Health, Western Sydney University, 62 Uralba Street, Lismore, 2480, Australia, 61 266207570, sabrina.pit@sydney.edu.au %K text messages %K obesity %K waist-hip ratio %K weight reduction programs %K mHealth %D 2019 %7 24.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Obesity is an endemic problem with significant health and financial consequences. Text messaging has been shown to be a simple and effective method of facilitating weight reduction. In addition, waist-to-hip ratio (WHR) has emerged as a significant anthropometric measure. However, few studies have examined the effect of serial anthropometric self-measurement combined with text messaging. Objective: The primary aim of this study was to assess whether an 8-week program, consisting of weekly serial self-measurements of waist and hip circumference, combined with motivational text messages, could reduce WHR among Australian workers. Methods: This was a community-based, participant-blinded, staggered-entry, parallel group study. Adult workers with access to mobile phones were eligible and recruited through an open access Web-based survey. Participants were randomly allocated to receive intervention or control messages for 8 weeks. Outcome data were self-assessed through a Web-based survey. Results: A total of 60 participants were randomized with 30 participants each allocated to a control and an intervention group. There was no significant change in WHR (P=.43), and all secondary outcome measures did not differ between the intervention group and the control group at the end of the 8-week intervention. Both groups, however, showed a significant decrease in burnout over time (mean [SE]: pre 4.80 [0.39] vs post 3.36 [0.46]; P=.004). The intervention uptake followed a downward trend. Peak participant replies to weekly self-measurements were received in week 3 (14/23, 61%) and the least in week 8 (8/23, 35%). No harm was found to result from this study. Conclusions: This study is an innovative pilot trial using text messaging and serial anthropometric measurements in weight management. No change was detected in WHRs in Australian workers over 8 weeks; therefore, it could not be concluded whether the intervention affected the primary outcome. However, these results should be interpreted in the context of limited sample size and decreasing intervention uptake over the course of the study. This pilot trial is useful for informing and contributing to the design of future studies and the growing body of literature on serial self-measurements combined with text messaging. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616001496404; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371696&isReview=true (Archived by WebCite at http://www.webcitation.org/73UkKFjSw) %M 31017585 %R 10.2196/11832 %U https://mhealth.jmir.org/2019/4/e11832/ %U https://doi.org/10.2196/11832 %U http://www.ncbi.nlm.nih.gov/pubmed/31017585 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11600 %T Cultural Adaptation of a Scalable World Health Organization E-Mental Health Program for Overseas Filipino Workers %A Garabiles,Melissa R %A Harper Shehadeh,Melissa %A Hall,Brian J %+ Global and Community Mental Health Research Group, The University of Macau, E21-3040, Avenida da Universidade, Macau, 99908, China, 86 62899837, brianhall@um.edu.mo %K cultural adaptation %K migrant workers %K e-mental health %K overseas Filipino workers %D 2019 %7 29.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic mental (e-mental) health interventions can address mental health needs of different populations. Cultural adaptation of these interventions is crucial to establish a better fit with the cultural group and to achieve better treatment outcomes. Objective: This study aimed to describe the cultural adaptation of the World Health Organization’s e-mental health program Step-by-Step for overseas Filipino workers. We used a framework which posits that cultural adaptation should enhance (1) relevance, wherein the cultural group can relate with the content; (2) acceptability, where the cultural group will not find any element offensive; (3) comprehensibility, where the program is understandable; and (4) completeness, wherein the adapted version covers the same concepts and constructs as the original program. We aimed to have English and Filipino and male and female versions. Methods: Overall, 3 experienced Filipino psychologists provided their perspectives on the program and how it might be adapted for overseas Filipino workers. We then adapted the program and obtained feedback from 28 overseas Filipino workers from diverse industries through focus group discussions. We conducted 7 and 9 focus group discussions with male and female participants, respectively. Per discussion, cognitive interviewing was used to probe for relevance, acceptability, comprehensibility, and completeness of illustrations and text. Participant feedback guided iterative program adaptations, which were again shown to participants for validation and improvement. Results: Several issues were raised by participants about the generic version of Step-by-Step. There were elements deemed irrelevant, like unfitting characters, lack of Filipino values, and unsuitable problems and activities. There were unacceptable components that were stigmatizing, political, inappropriate to context or subgroups, and too feminine for male users. Some elements were incomprehensible, unclear, or complicated. To address these issues, we made key adaptations. To enhance relevance, we adapted the narrative to match the experiences of overseas Filipino workers, incorporated Filipino values, and illustrated familiar problems and activities. To increase acceptability, our main characters were changed to wise elders rather than health professionals (reducing mental health and help-seeking stigma), political or unacceptable content was removed, and the program was made suitable for overseas Filipino workers from different sectors. To increase comprehension, we used English and Filipino languages, simplified the text to ease interpretation of abstract terms, and ensured that text and illustrations matched. We also used Taglish (ie, merged English and Filipino) when participants deemed pure Filipino translations sounded odd or incomprehensible. Finally, we retained the core elements and concepts included in the original Step-by-Step program to maintain completeness. Conclusions: This study showed the utility of a 4-point framework that focuses on acceptance, relevance, comprehensibility, and completeness in cultural adaptation. Moreover, we achieved a culturally appropriate adapted version of the Step-by-Step program for overseas Filipino workers. We discuss lessons learned in the process to guide future cultural adaptation projects of e-mental health interventions. %M 30924784 %R 10.2196/11600 %U https://formative.jmir.org/2019/1/e11600/ %U https://doi.org/10.2196/11600 %U http://www.ncbi.nlm.nih.gov/pubmed/30924784 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e11224 %T Health-Related Internet Usage and Design Feature Preference for E-Mental Health Programs Among Men and Women %A Smail-Crevier,Rachel %A Powers,Gabrielle %A Noel,Chelsea %A Wang,JianLi %+ Work & Mental Health Research Unit, The Royal's Institute of Mental Health Research, University of Ottawa, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada, 1 613 722 6521 ext 6057, jianli.wang@theroyal.ca %K occupational health %K workplace %K mental health %K preventive health program %K depression %K internet %D 2019 %7 18.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Major depressive episodes (MDEs) are prevalent in the workplace and affect workers’ health and productivity. Therefore, there is a pressing need for innovation in the prevention of MDEs in the workplace. Electronic mental (e-mental) health programs are a cost-effective approach toward the self-management of stress and emotional issues. E-mental health dropout rate, MDE prevalence, and symptoms greatly vary by sex and age. Thus, the development and implementation of e-mental health programs for the prevention of MDEs need to be examined through a sex and age lens to enhance program use and effectiveness. Objective: This study aimed to examine design feature preferences based on sex and age for an e-mental health program targeted toward depression prevention. Methods: Household residents across Canada were contacted using the random digit dialing method. 500 women and 511 men who were 18 years and older and who were at high risk of having MDEs were interviewed. Internet use was assessed using questions from the 2012 Canadian Internet Use Survey conducted by Statistics Canada, and preferred design features of e-mental health program questions were developed by the BroMatters team members. The proportions of likely use of specific features of e-mental health programs in women were estimated and compared with those in men using chi-square tests. The comparisons were made overall and by age groups. Results: Men (181/511, 35.4%) and women (211/500, 42.2%) differed significantly in their likelihood of using an e-mental health program. Compared with men (307/489, 62.8%), women (408/479, 85.2%) were more likely to use the internet for medical or health-related information. Women were more likely to use the following design features: practices and exercises to help reduce symptoms of stress and depression (350/500, 70.7%), a self-help interactive program that provides information about stress and work problems (302/500, 61.8%), the ability to ask questions and receive answers from mental health professionals via email or text message (294/500, 59.9%), and to receive printed materials by mail (215/500, 43.4%). Men preferred to receive information in a video game format (156/511, 30.7%). Younger men (46/73, 63%) and younger women (49/60, 81%) were more likely to access a program through a mobile phone or an app, and younger men preferred having access to information in a video game format. Conclusions: Factors such as sex and age influenced design feature preferences for an e-mental health program. Working women who are at high risk for MDEs preferred interactive programs incorporating practice and exercise for reducing stress, quality information about work stress, and some guidance from professionals. This suggests that sex and age should be taken into account when designing e-mental health programs to meet the needs of individuals seeking help via Web-based mental health programs and to enhance their use. %M 30882361 %R 10.2196/11224 %U http://www.jmir.org/2019/3/e11224/ %U https://doi.org/10.2196/11224 %U http://www.ncbi.nlm.nih.gov/pubmed/30882361 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e12894 %T Resilience@Work Mindfulness Program: Results From a Cluster Randomized Controlled Trial With First Responders %A Joyce,Sadhbh %A Shand,Fiona %A Lal,Tara J %A Mott,Brendan %A Bryant,Richard A %A Harvey,Samuel B %+ School of Psychiatry, Faculty of Medicine, University of New South Wales, The Black Dog Institute, Hospital Road, Randwick, 2031, Australia, 61 401297711, sadhbh.joyce@unsw.edu.au %K resilience training %K workplace mental health %K occupational health %K well-being %K online intervention %K employee resilience %K health and safety %K psychological health %K first responders %D 2019 %7 19.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: A growing body of research suggests that resilience training can play a pivotal role in creating mentally healthy workplaces, particularly with regard to protecting the long-term well-being of workers. Emerging research describes positive outcomes from various types of resilience training programs (RTPs) among different occupational groups. One specific group of workers that may benefit from this form of proactive resilience training is first responders. Given the nature of their work, first responders are frequently exposed to stressful circumstances and potentially traumatic events, which may impact their overall resilience and well-being over time. Objective: This study aimed to examine whether a mindfulness-based RTP (the Resilience@Work [RAW] Mindfulness Program) delivered via the internet can effectively enhance resilience among a group of high-risk workers. Methods: We conducted a cluster randomized controlled trial (RCT) comprising 24 Primary Fire and Rescue and Hazmat stations within New South Wales. Overall, 12 stations were assigned to the 6-session RAW Mindfulness Program and 12 stations were assigned to the control condition. A total of 143 active full-time firefighters enrolled in the study. Questionnaires were administered at baseline, immediately post training, and at 6-month follow-up. Measurements examined change in both adaptive and bounce-back resilience as well as several secondary outcomes examining resilience resources and acceptance and mindfulness skills. Results: Mixed-model repeated measures analysis found that the overall test of group-by-time interaction was significant (P=.008), with the intervention group increasing in adaptive resilience over time. However, no significant differences were found between the intervention group and the control group in terms of change in bounce-back resilience (P=.09). At 6-month follow-up, the group receiving the RAW intervention had an average increase in their resilience score of 1.3, equating to a moderate-to-large effect size compared with the control group of 0.73 (95% CI 0.38-1.06). Per-protocol analysis found that compared with the control group, the greatest improvements in adaptive resilience were observed among those who completed most of the RAW program, that is, 5 to 6 sessions (P=.002). Conclusions: The results of this RCT suggest that mindfulness-based resilience training delivered in an internet format can create improvements in adaptive resilience and related resources among high-risk workers, such as first responders. Despite a number of limitations, the results of this study suggest that the RAW Mindfulness Program is an effective, scalable, and practical means of delivering online resilience training in high-risk workplace settings. To the best of our knowledge, this is the first time a mindfulness-based RTP delivered entirely via the internet has been tested in the workplace. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12615000574549; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368296 (Archived by WebCite at http://www.webcitation.org/75w4xtrpw). %M 30777846 %R 10.2196/12894 %U http://www.jmir.org/2019/2/e12894/ %U https://doi.org/10.2196/12894 %U http://www.ncbi.nlm.nih.gov/pubmed/30777846 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e11079 %T Digital Interventions to Reduce Sedentary Behaviors of Office Workers: Scoping Review %A Huang,Yitong %A Benford,Steve %A Blake,Holly %+ Horizon Centre for Doctoral Training, University of Nottingham, B06, Computer Science, Wollaton Road, Nottingham, NG8 1BB, United Kingdom, 44 115 823255, yitong.huang@nottingham.ac.uk %K telemedicine %K sedentary behavior %K workplace %K technology %K internet %K microcomputers %D 2019 %7 07.02.2019 %9 Review %J J Med Internet Res %G English %X Background: There is a clear public health need to reduce office workers’ sedentary behaviors (SBs), especially in the workplace. Digital technologies are increasingly being deployed in the workplace to measure and modify office workers’ SBs. However, knowledge of the range and nature of research on this topic is limited; it also remains unclear to what extent digital interventions have exploited the technological possibilities. Objective: This study aimed to investigate the technological landscape of digital interventions for SB reduction in office workers and to map the research activity in this field. Methods: Terms related to SB, office worker, and digital technology were applied in various combinations to search Cochrane Library, Joanna Briggs Institute Database of Systematic Reviews, MEDLINE, PsycARTICLES, PsycINFO, Scopus, Association for Computing Machinery Digital Library, Engineering index Compendex, and Google Scholar for the years 2000 to 2017. Data regarding the study and intervention details were extracted. Interventions and studies were categorized into development, feasibility and/piloting, evaluation, or implementation phase based on the UK Medical Research Council (MRC) framework for developing and evaluating complex interventions. A novel framework was developed to classify technological features and annotate technological configurations. A mix of quantitative and qualitative approaches was used to summarize data. Results: We identified 68 articles describing 45 digital interventions designed to intervene with office workers’ SB. A total of 6 common technological features had been applied to interventions with various combinations. Configurations such as “information delivery and mediated organizational and social support” and “digital log and automated tailored feedback” were well established in evaluation and implementation studies; in contrast, the integration of passive data collection, connected devices, and ATF or scheduled prompts was mostly present in development and piloting research. Conclusions: This review is the first to map and describe the use of digital technologies in research on SB reduction in office workers. Interdisciplinary collaborations can help to maximize the potential of technologies. As novel modes of delivery that capitalize on embedded computing and electronics, wireless technologies have been developed and piloted in engineering, computing, and design fields, efforts can be directed to move them to the next phase of evaluation with more rigorous study designs. Quality of research may be improved by fostering conversations between different research communities and encouraging researchers to plan, conduct, and report their research under the MRC framework. This review will be particularly informative to those deciding on areas where further research or development is needed and to those looking to locate the relevant expertise, resources, and design inputs when designing their own systems or interventions. %M 30730294 %R 10.2196/11079 %U http://www.jmir.org/2019/2/e11079/ %U https://doi.org/10.2196/11079 %U http://www.ncbi.nlm.nih.gov/pubmed/30730294 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 1 %P e9711 %T Farm Owners and Workers as Key Informants in User-Centered Occupational Health Prototype Development: A Stakeholder-Engaged Project %A Weichelt,Bryan %A Bendixsen,Casper %A Keifer,Matthew %+ Marshfield Clinic Research Institute, National Farm Medicine Center, 701 W Kalsched Ave, Marshfield, WI, 54449, United States, 1 715 221 7276, weichelt.bryan@mcrf.mfldclin.edu %K agriculture %K farmworkers %K injuries %K occupational medicine %K return to work %K software application %D 2019 %7 29.01.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The cost of workplace injuries and illnesses significantly impacts the overall cost of health care and is a significant annual economic burden in the United States. Many dairy and pork farm owners in the Upper Midwest have expanded operations and taken on the role of manager and employer yet receive little training in injury prevention, farm safety, or workers’ compensation programs and processes. Clinicians play a key role in the return to work of injured and ill farmers and farmworkers to their jobs, though little to no formal training is offered by medical schools. Objective: This stakeholder-engaged project aimed to develop a prototype application designed to assist clinicians in returning injured farmworkers to light-duty job assignments with their current employers and to assess farm owners’ and managers’ attitudes toward and barriers to adopting mobile health tools for themselves or their employees. Methods: We conducted 12 semistructured interviews with English-speaking farm owners and farmworkers from the Upper Midwest: 5 English-speaking and Spanish-speaking farmworker focus groups and 8 postproject interviews with farm owners that focused on attitudes and barriers to adoption of the developed software. Interviews and focus groups were audio recorded, and data were analyzed and thematically coded using audio coding. Results: Interviews and worker focus groups guided an iterative design and development cycle, which informed workflow design, button placement, and output sheets that offer specific light-duty farm work recommendations for the injured worker to discuss with his or her employer. Conclusions: The development of a complex prototype intended to impact patient care is a significant undertaking. Reinventing a paper-based process that can eventually integrate with an electronic health record or a private company’s human resources system requires substantial stakeholder input from each facet including patients, employers, and clinical care teams. The prototype is available for testing, but further research is needed in the form of clinical trials to assess the effectiveness of the process and the software’s impact on patients and employers. %M 30694202 %R 10.2196/jmir.9711 %U https://www.jmir.org/2019/1/e9711/ %U https://doi.org/10.2196/jmir.9711 %U http://www.ncbi.nlm.nih.gov/pubmed/30694202 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 12 %P e10272 %T Effects of a Participatory Ergonomics Intervention With Wearable Technical Measurements of Physical Workload in the Construction Industry: Cluster Randomized Controlled Trial %A Brandt,Mikkel %A Madeleine,Pascal %A Samani,Afshin %A Ajslev,Jeppe ZN %A Jakobsen,Markus D %A Sundstrup,Emil %A Andersen,Lars L %+ National Research Centre for the Working Environment, Lersø Parkalle 105, Copenhagen, DK-2100, Denmark, 45 39165342, mbp@nrcwe.dk %K back pain %K low back pain %K shoulder pain %K musculoskeletal pain %K musculoskeletal diseases %K occupational health %K building industry %K heavy industries %K organizational ergonomics %K action research %D 2018 %7 19.12.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Construction work frequently involves heavy physical work, and a reduction of the physical workload should have high priority. Technological development has made it possible to obtain field measurements with surface electromyography (sEMG), kinematics measured with inertial measurement units (IMUs), and video recordings. However, no studies have used these methods simultaneously to detect situations with excessive physical workload (events) during a working day. Thus, knowledge about these specific events may combat work-related risk factors. Participatory ergonomics (PE) has shown promising results, but whether it can be used as a tool to reduce the physical workload during construction work remains unknown. Objective: This cluster randomized controlled trial investigated whether a PE intervention with technical measurements consisting of IMUs, sEMG, heart rate monitoring, and video recordings of physical workload could reduce the number of events with excessive physical workload during a working day. Furthermore, other outcomes were obtained from questionnaires. Methods: A total of 80 male full-time construction workers (aged 19 to 67 years) were randomized at the cluster level (gang) to a PE intervention consisting of 3 workshops (7 gangs and 32 workers) or to a control group (8 gangs and 48 workers). The physical workload was recorded by technical measurements, that is, IMUs, sEMG, heart rate monitoring, and video recordings during a full working day at baseline and 3 and 6 months’ follow-up. On the basis of the technical measurements, a custom-made computer program detected the situations (events) where the construction workers were exposed to excessive physical workload and used in the intervention. Differences in the number of events from baseline to follow-up between intervention and control were evaluated using linear mixed models (intention-to-treat), with individual nested in cluster as a random factor. Furthermore, questionnaires were filled out on test days. Results: The results of the primary outcome showed no change in the number of events with excessive physical workload. However, compared with the control group, the other outcomes showed decreased general fatigue after a typical working day (P=.001) and increased influence on own work (P=.04). Conclusions: This PE intervention with technical measurements did not reduce the number of events with excessive physical workload during construction work. However, the intervention led to decreased general fatigue and increased influence on own work. Trial Registration: ClinicalTrials.gov NCT02498197; https://clinicaltrials.gov/ct2/show/NCT02498197 (Archived by WebCite at http://www.webcitation.org/74SZ3DIWS) %M 30567694 %R 10.2196/10272 %U https://www.jmir.org/2018/12/e10272/ %U https://doi.org/10.2196/10272 %U http://www.ncbi.nlm.nih.gov/pubmed/30567694 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 12 %P e10215 %T Establishing Digital Biomarkers for Occupational Health Assessment in Commercial Salmon Fishermen: Protocol for a Mixed-Methods Study %A Wilbur,Rachel Elizabeth %A Griffin,Jacob Spencer %A Sorensen,Mark %A Furberg,Robert Daniel %+ RTI International, 3040 Cornwallis Rd, RTP, NC,, United States, 1 919 316 3726, rfurberg@rti.org %K digital health %K digital biomarkers %K occupational health %K health and safety %K fishermen %K physiological health %K stress %D 2018 %7 10.12.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Commercial salmon fishing in Alaska is one of the most dangerous occupations in the United States. Between 1992 and 2008, the average annual industry mortality rate was 128 deaths per 100,000 workers, and despite an increase in industry regulations, there has not been a significant decrease in mortality rate since 2000. Unpredictable fishing openings and fierce competition for limited resources result in periods of intense sleep deprivation and physical strain during the short commercial salmon season in Alaska. Objective: We hypothesize that the combined effect of sleep deprivation, intense physical workload, and significant short-term chronic stress may be deleterious to health in both the short- and long-term among commercial salmon drift gillnet fishermen in Alaska. The objective of this protocol is to determine the feasibility of the study design to test this hypothesis. Methods: The study design uses mixed methods and includes biometric monitoring consisting of heart rate variability, respiration, and movement data collected via a personal, wearable biometric device. Additional methods include observational data on activity, including duration and quality of sleep, weather, catch, and financial gain, as well as the collection of salivary cortisol. As such, the study will provide a holistic assessment of individual stress on multiple simultaneous timescales: immediately and continuously through the personal wearable biometric device, on the minute-hour level through the multiple daily collections of salivary cortisol, and by the hour-day through the use of participant and environment observational data. Results: Data collection was initiated in July 2017 and will extend through August 2019. Initial data collection has indicated that the methods outlined in this protocol are feasible and allow for effective collection of qualitative and quantitative data related to the psychological and physiological impact of Alaska commercial salmon fishing. Conclusions: We anticipate that the use of a biometric device will be crucial in establishing measures of stress and physical activity within a population and environment uniquely challenged by physical isolation, strong weather patterns, and the potential for significant financial gain by fishermen. The potential exists for individuals engaged long-term in the fishing industry, through repeated and extended exposure to periods of intense sleep deprivation and chronic stress, to be at increased risk of cardiovascular disease. International Registered Report Identifier (IRRID): DERR1-10.2196/10215 %M 30530453 %R 10.2196/10215 %U http://www.researchprotocols.org/2018/12/e10215/ %U https://doi.org/10.2196/10215 %U http://www.ncbi.nlm.nih.gov/pubmed/30530453 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e11661 %T Preliminary Effectiveness of a Smartphone App to Reduce Depressive Symptoms in the Workplace: Feasibility and Acceptability Study %A Deady,Mark %A Johnston,David %A Milne,David %A Glozier,Nick %A Peters,Dorian %A Calvo,Rafael %A Harvey,Samuel %+ Black Dog Institute, Faculty of Medicine, University of New South Wales, Hospital Road, Randwick, Sydney,, Australia, 61 293824517, m.deady@unsw.edu.au %K depression %K workplace %K mHealth %K smartphone %K eHealth %K pilot %D 2018 %7 04.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The workplace represents a unique setting for mental health interventions. Due to range of job-related factors, employees in male-dominated industries are at an elevated risk. However, these at-risk groups are often overlooked. HeadGear is a smartphone app–based intervention designed to reduce depressive symptoms and increase well-being in these populations. Objective: This paper presents the development and pilot testing of the app’s usability, acceptability, feasibility, and preliminary effectiveness. Methods: The development process took place from January 2016 to August 2017. Participants for prototype testing (n=21; stage 1) were recruited from industry partner organizations to assess acceptability and utility. A 5-week effectiveness and feasibility pilot study (n=84; stage 2) was then undertaken, utilizing social media recruitment. Demographic data, acceptability and utility questionnaires, depression (Patient Health Questionnaire-9), and other mental health measures were collected. Results: The majority of respondents felt HeadGear was easy to use (92%), easily understood (92%), were satisfied with the app (67%), and would recommend it to a friend (75%; stage 1). Stage 2 found that compared with baseline, depression and anxiety symptoms were significantly lower at follow-up (t30=2.53; P=.02 and t30=2.18; P=.04, respectively), days of sick leave in past month (t28=2.38; P=.02), and higher self-reported job performance (t28=−2.09; P=.046; stage 2). Over 90% of respondents claimed it helped improve their mental fitness, and user feedback was again positive. Attrition was high across the stages. Conclusions: Overall, HeadGear was well received, and preliminary findings indicate it may provide an innovative new platform for improving mental health outcomes. Unfortunately, attrition was a significant issue, and findings should be interpreted with caution. The next stage of evaluation will be a randomized controlled trial. If found to be efficacious, the app has the potential to reduce disease burden and improve health in this at-risk group. %M 30514694 %R 10.2196/11661 %U https://mhealth.jmir.org/2018/12/e11661/ %U https://doi.org/10.2196/11661 %U http://www.ncbi.nlm.nih.gov/pubmed/30514694 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 11 %P e286 %T Using Facebook for Health Promotion in “Hard-to-Reach” Truck Drivers: Qualitative Analysis %A Sendall,Marguerite C %A McCosker,Laura K %A Crane,Phil %A Rowland,Bevan %A Fleming,Marylou %A Biggs,Herbert C %+ School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Brisbane, 4059, Australia, 61 +617 3138 3526, m.sendall@qut.edu.au %K communication %K health promotion interventions %K mobile phone %K social media %K transport industry %K truck drivers %K workplace health promotion %K workplace managers %D 2018 %7 01.11.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Workers in the road transport industry, and particularly truck drivers, are at increased risk of chronic diseases. Innovative health promotion strategies involving technologies such as social media may engage this “hard-to-reach” group. There is a paucity of evidence for the efficacy of social media technologies for health promotion in the Australian transport industry. Objective: This study analyzed qualitative data from interviews and focus group discussions to evaluate a social media health promotion intervention, the Truckin’ Healthy Facebook webpage, in selected Australian transport industry workplaces. Methods: We engaged 5 workplace managers and 30 truck drivers from 6 transport industry organizations in developing workplace health promotion strategies, including a social media intervention, within a Participatory Action Research approach. Mixed methods, including a pre- and postintervention manager survey, truck driver survey, key informant semistructured interviews, truck driver focus groups, and focused observation, were used to evaluate the social media intervention. We asked questions about workplace managers’ and truck drivers’ opinions, engagement, and satisfaction with the intervention. This paper focuses on qualitative data. Results: Of the workplace managers who reported implementing the social media intervention at their workplace, all (3/3, 100%) reported satisfaction with the intervention and expressed a keen interest in learning more about social media and how it may be used for workplace health promotion and other purposes. Truck drivers were poorly engaged with the intervention because (1) many believed they were the “wrong age” and lacked the necessary skills; (2) the cost of smartphone technology was prohibitive; (3) they confined their use of social media to nonwork-related purposes; and (4) many workplaces had “no Facebook” policies. Conclusions: The use of social media as a health promotion intervention in transport industry workplaces has potential. Workplace interventions using social media can benefit from a Participatory Action Research approach. Involving managers and workers in the design of social media health promotion interventions and developing strategies to support and deliver the interventions helps to facilitate their success. The workers’ profile, including their age and familiarity with social media, and work, workplace, and family context is important to consider in this process. Much more research needs to be undertaken to better understand the effective use of social media to engage “hard-to-reach” groups. %M 30389653 %R 10.2196/jmir.9689 %U https://www.jmir.org/2018/11/e286/ %U https://doi.org/10.2196/jmir.9689 %U http://www.ncbi.nlm.nih.gov/pubmed/30389653 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 4 %P e11383 %T The WorkingWell Mobile Phone App for Individuals With Serious Mental Illnesses: Proof-of-Concept, Mixed-Methods Feasibility Study %A Nicholson,Joanne %A Wright,Spenser M %A Carlisle,Alyssa M %A Sweeney,Mary Ann %A McHugo,Gregory J %+ Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS 035, Waltham, MA, 20453, United States, 1 781 736 3978, jnicholson@brandeis.edu %K mHealth %K mobile apps %K mental disorders %K employment %D 2018 %7 25.10.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: The disparities in employment for individuals with serious mental illnesses have been well documented, as have the benefits of work. Mobile technology can provide accessible in-the-moment support for these individuals. The WorkingWell mobile app was developed to meet the need for accessible follow-along supports for individuals with serious mental illnesses in the workplace. Objective: We explore the usability, usage, usefulness, and overall feasibility of the WorkingWell mobile app with individuals with serious mental illnesses who are actively employed and receiving community-based services. Methods: In this proof-of-concept, mixed-methods, 2-month feasibility study (N=40), employed individuals with serious mental illnesses were recruited in mental health agencies. Participants completed surveys regarding background characteristics and cellphone use at enrollment and responded to interview items regarding app usability, usage, and usefulness in technical assistance calls at 1, 2, 4, and 6 weeks of participation and in the exit interview at 8 weeks. Data on the frequency of app usage were downloaded on a daily basis. A version of the System Usability Scale (SUS) was administered in the exit interview. Overall feasibility was determined by the percent of users completing the study, responses to an interview item regarding continued use, and findings on usability, usage, and usefulness. General impressions were obtained from users regarding user support materials, technical assistance, and study procedures. Results: Most participants were male (60%, 24/40), aged 55 or younger (70%, 28/40), white (80%, 32/40), had less than a 4-year college education (78%, 31/40), were employed part-time (98%, 39/40), had been working more than 6 months (60%, 24/40), and indicated a diagnosis of bipolar, schizoaffective, or depressive disorder (84%, 16/25). The majority of participants owned cellphones (95%, 38/40) and used them multiple times per day (83%, 33/40). Their average rating on SUS usability items was 3.93 (SD 0.77, range 1.57-5.00), reflecting positive responses. In general, participants indicated WorkingWell was “very easy,” “straightforward,” “simple,” and “user friendly.” Usability challenges were related to personal issues (eg, memory) or to difficulties with the phone or app. Data on app usage varied considerably. The most frequent navigations were to the home screen, followed by Rate My Day and My Progress, and then by Manage the Moment and Remind Me. The app was described as useful by most participants; 86% (30/35) agreed the app would help them manage better on the job. Of the 40 original participants, 35 (87%) completed the study. Conclusions: The WorkingWell app is a feasible approach to providing accessible, as-needed employment support for individuals with serious mental illnesses. The app would benefit from modifications to address recommendations from feasibility testing. Controlled research with larger samples, more diverse in individual characteristics and workplace settings, is essential to demonstrating the effectiveness of the app. %M 30361199 %R 10.2196/11383 %U http://mental.jmir.org/2018/4/e11383/ %U https://doi.org/10.2196/11383 %U http://www.ncbi.nlm.nih.gov/pubmed/30361199 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 10 %P e10821 %T Effect of an eHealth Intervention to Reduce Sickness Absence Frequency Among Employees With Frequent Sickness Absence: Randomized Controlled Trial %A Notenbomer,Annette %A Roelen,Corné %A Groothoff,Johan %A van Rhenen,Willem %A Bültmann,Ute %+ Division Community and Occupational Medicine, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Gebouw 3217 FA10, kamer 609, Antonius van Deusinglaan 1, Groningen, 9713 AV, Netherlands, 31 6 22417514, annette.notenbomer@gmail.com %K occupational health %K sick leave %K randomized controlled trial %K adult %K occupational health physicians %K eHealth %D 2018 %7 23.10.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Frequent sickness absence—that is, 3 or more episodes of sickness absence in 1 year—is a problem for employers and employees. Many employees who have had frequent sickness absence in a prior year also have frequent sickness absence in subsequent years: 39% in the first follow-up year and 61% within 4 years. Moreover, 19% have long-term sickness absence (≥6 weeks) in the first follow-up year and 50% within 4 years. We developed an electronic health (eHealth) intervention, consisting of fully automated feedback and advice, to use either as a stand-alone tool (eHealth intervention–only) or combined with consultation with an occupational physician (eHealth intervention–occupational physician). Objective: This study aimed to evaluate the effect of the eHealth intervention, with or without additional occupational physician consultation, to reduce sickness absence frequency for employees with frequent sickness absence, versus care as usual (CAU). Methods: This study was a three-armed randomized controlled trial. Employees with frequent sickness absence received invitational letters, which were distributed by their employers. The primary outcome measure was the number of register-based sickness absence episodes 12 months after completing the baseline questionnaire. Secondary outcome measures were register-based total sickness absence days and self-assessed burnout, engagement, and work ability. In a process evaluation 3 months after baseline, we examined adherence to the intervention and additional actions such as general practitioner and occupational physician visit, communication with the manager, and lifestyle change. Results: A total of 82 participants were included in the analyses, 21 in the eHealth intervention–only group, 31 in the eHealth intervention–occupational physician group, and 30 in the CAU group. We found no significant difference in sickness absence frequency between the groups at 1-year follow-up. Sickness absence frequency decreased in the eHealth intervention–only group from 3 (interquartile range, IQR 3-4) to 1 episode (IQR 0.3-2.8), in the eHealth intervention–occupational physician group from 4 (IQR 3-5) to 3 episodes (IQR 1-4), and in the CAU group from 3 (IQR 3-4) to 2 episodes (IQR 1-3). For secondary outcomes, we found no significant differences between the intervention groups and the control group. The process evaluation showed that only 3 participants from the eHealth intervention–occupational physician group visited the occupational physician on invitation. Conclusions: Among employees with frequent sickness absence, we found no effect from the eHealth intervention as a stand-alone tool in reducing sickness absence frequency, nor on total sickness absence days, burnout, engagement, or work ability. This might be due to low adherence to the intervention because of insufficient urgency to act. We cannot draw any conclusion on the effect of the eHealth intervention tool combined with an occupational physician consultation (eHealth intervention–occupational physician), due to very low adherence to the occupational physician consultation. An occupational physician consultation could increase a sense of urgency and lead to more focus and appropriate support. As this was the first effectiveness study among employees with frequent sickness absence, strategies to improve recruitment and adherence in occupational eHealth are included. Trial Registration: Netherlands Trial Register NTR4316; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4316 (Archived by WebCite at http://www.webcitation.org/713DHhOFU). %M 30355551 %R 10.2196/10821 %U http://www.jmir.org/2018/10/e10821/ %U https://doi.org/10.2196/10821 %U http://www.ncbi.nlm.nih.gov/pubmed/30355551 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 10 %P e10760 %T A Mobile Videoconference-Based Intervention on Stress Reduction and Resilience Enhancement in Employees: Randomized Controlled Trial %A Kim,Johanna Inyang %A Yun,Je-Yeon %A Park,Heyeon %A Park,Suk-Young %A Ahn,Youngsheen %A Lee,Hansol %A Kim,Tae-Kwon %A Yoon,Sooran %A Lee,Young-Joon %A Oh,Sohee %A Denninger,John W %A Kim,Bung-Nyun %A Kim,Jeong-Hyun %+ Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Seongnam,, Republic Of Korea, 82 31 787 2025, retrial3@hanmail.net %K employees %K mobile phone %K randomized controlled trial %K resilience enhancement %K stress reduction %K videoconferencing %D 2018 %7 22.10.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Videoconferencing-based treatments have shown great potential in increasing engagement and compliance by decreasing the barriers of time and distance. In general, employees tend to experience a lot of stress, but find it difficult to visit a clinic during office hours. Objective: The purpose of this study was to investigate the effectiveness of a mobile videoconference-based intervention for stress reduction and resilience enhancement in employees. Methods: In total, 81 participants were randomly allocated to one of the three conditions: mobile videoconferencing, in-person, and self-care; of these, 72 completed the study. All participants underwent assessment via self-reported questionnaires before, immediately after, and 1 month after the intervention. Intervention lasted for 4 weeks and consisted of elements of cognitive behavioral therapy, positive psychology, and meditation. Changes in clinical variables regarding stress and resilience across time were compared between treatment conditions. Results: There were significant condition × time effects on variables measuring perceived stress, resilience, emotional labor, and sleep, demonstrating significantly differential effects across time according to treatment condition. Moreover, there were significant effects of condition on perceived stress and occupational stress. There were no significant differences in any variable between the mobile videoconferencing and in-person conditions at 1 month after the intervention. Conclusions: Results indicate that both mobile videoconferencing and in-person interventions were comparably effective in decreasing stress and enhancing resilience. Further studies with a larger sample size and a longer follow-up period are warranted to investigate the long-term effect of mobile videoconferencing interventions. Trial Registration: ClinicalTrials.gov identifier NCT03256682; https://clinicaltrials.gov/ct2/show/NCT03256682 (Archived by WebCite at http://www.webcitation.org/71W77bwnR) %M 30348630 %R 10.2196/10760 %U http://www.jmir.org/2018/10/e10760/ %U https://doi.org/10.2196/10760 %U http://www.ncbi.nlm.nih.gov/pubmed/30348630 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 10 %P e267 %T Promoting Psychological Well-Being at Work by Reducing Stress and Improving Sleep: Mixed-Methods Analysis %A Meyer,Denny %A Jayawardana,Madawa W %A Muir,Samuel D %A Ho,David Yen-Teh %A Sackett,Olivia %+ Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, John Street, Hawthorn, Melbourne, VIC 3122, Australia, 61 392144824, dmeyer@swin.edu.au %K exercise %K productivity %K healthy lifestyle %D 2018 %7 19.10.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Workplace programs designed to improve the health and psychological well-being of employees are becoming increasingly popular. However, there are mixed reports regarding the effectiveness of such programs and little analysis of what helps people to engage with such programs. Objective: This evaluation of a particularly broad, team-based, digital health and well-being program uses mixed methods to identify the elements of the program that reduce work stress and promote psychological well-being, sleep quality, and productivity of employees. Methods: Participation in the Virgin Pulse Global Challenge program during May to September 2016 was studied. Self-reported stress, sleep quality, productivity, and psychological well-being data were collected both pre- and postprogram. Participant experience data were collected through a third final survey. However, the response rates for the last 2 surveys were only 48% and 10%, respectively. A random forest was used to estimate the probability of the completion of the last 2 surveys based on the preprogram assessment data and the demographic data for the entire sample (N=178,350). The inverse of these estimated probabilities were used as weights in hierarchical linear models in an attempt to address any estimation bias caused by the low response rates. These linear models described changes in psychological well-being, stress, sleep, and productivity over the duration of the program in relation to gender and age, engagement with each of the modules, each of the program features, and participant descriptions of the Virgin Pulse Global Challenge. A 0.1% significance level was used due to the large sample size for the final survey (N=18,653). Results: The final analysis suggested that the program is more beneficial for older people, with 2.9% greater psychological well-being improvements observed on average in the case of women than men (P<.001). With one exception, all the program modules contributed significantly to the outcome measures with the following average improvements observed: psychological well-being, 4.1%-6.0%; quality of sleep, 3.2%-6.9%; work-related stress, 1.7%-6.8%; and productivity, 1.9%-4.2%. However, only 4 of the program features were found to have significant associations with the outcome measures with the following average improvements observed: psychological well-being, 3.7%-5.6%; quality of sleep, 3.4%-6.5%; work-related stress, 4.1%-6.4%; and productivity, 1.6%-3.2%. Finally, descriptions of the Virgin Pulse Global Challenge produced 5 text topics that were related to the outcome measures. Healthy lifestyle descriptions showed a positive association with outcomes, whereas physical activity and step count tracking descriptions showed a negative association with outcomes. Conclusions: The complementary use of qualitative and quantitative survey data in a mixed-methods analysis provided rich information that will inform the development of this and other programs designed to improve employee health. However, the low response rates and the lack of a control group are limitations, despite the attempts to address these problems in the analysis. %M 30341045 %R 10.2196/jmir.9058 %U https://www.jmir.org/2018/10/e267/ %U https://doi.org/10.2196/jmir.9058 %U http://www.ncbi.nlm.nih.gov/pubmed/30341045 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e167 %T Behavior Change Techniques in mHealth Apps for the Mental and Physical Health of Employees: Systematic Assessment %A de Korte,Elsbeth %A Wiezer,Noortje %A Bakhuys Roozeboom,Maartje %A Vink,Peter %A Kraaij,Wessel %+ Netherlands Organization for Applied Scientific Research, Schipholweg 77-89, Leiden, 2316 ZL, Netherlands, 31 6 21134434, elsbeth.dekorte@tno.nl %K behavior change techniques %K mHealth %K mental health %K physical health %K lifestyle %K workplace %K app %K employee %K work %D 2018 %7 03.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Employees remain at risk of developing physical and mental health problems. To improve the lifestyle, health, and productivity many workplace interventions have been developed. However, not all of these interventions are effective. Mobile and wireless technology to support health behavior change (mobile health [mHealth] apps) is a promising, but relatively new domain for the occupational setting. Research on mHealth apps for the mental and physical health of employees is scarce. Interventions are more likely to be useful if they are rooted in health behavior change theory. Evaluating the presence of specific combinations of behavior change techniques (BCTs) in mHealth apps might be used as an indicator of potential quality and effectiveness. Objective: The aim of this study was to assess whether mHealth apps for the mental and physical health of employees incorporate BCTs and, if so, which BCTs can be identified and which combinations of BCTs are present. Methods: An assessment was made of apps aiming to reduce the risk of physical and psychosocial work demands and to promote a healthy lifestyle for employees. A systematic search was performed in iTunes and Google Play. Forty-five apps were screened and downloaded. BCTs were identified using a taxonomy applied in similar reviews. The mean and ranges were calculated. Results: On average, the apps included 7 of the 26 BCTs (range 2-18). Techniques such as “provide feedback on performance,” “provide information about behavior-health link,” and “provide instruction” were used most frequently. Techniques that were used least were “relapse prevention,” “prompt self-talk,” “use follow-up prompts,” and “provide information about others’ approval.” “Stress management,” “prompt identification as a role model,” and “agree on behavioral contract” were not used by any of the apps. The combination “provide information about behavior-health link” with “prompt intention formation” was found in 7/45 (16%) apps. The combination “provide information about behavior-health link” with “provide information on consequences,” and “use follow-up prompts” was found in 2 (4%) apps. These combinations indicated potential effectiveness. The least potentially effective combination “provide feedback on performance” without “provide instruction” was found in 13 (29%) apps. Conclusions: Apps for the occupational setting might be substantially improved to increase potential since results showed a limited presence of BCTs in general, limited use of potentially successful combinations of BCTs in apps, and use of potentially unsuccessful combinations of BCTs. Increasing knowledge on the effectiveness of BCTs in apps might be used to develop guidelines for app developers and selection criteria for companies and individuals. Also, this might contribute to decreasing the burden of work-related diseases. To achieve this, app developers, health behavior change professionals, experts on physical and mental health, and end-users should collaborate when developing apps for the working context. %R 10.2196/mhealth.6363 %U https://mhealth.jmir.org/2018/10/e167/ %U https://doi.org/10.2196/mhealth.6363 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e17 %T Assessing the Feasibility and Pre-Post Impact Evaluation of the Beta (Test) Version of the BeUpstanding Champion Toolkit in Reducing Workplace Sitting: Pilot Study %A Healy,Genevieve Nissa %A Eakin,Elizabeth G %A Winkler,Elisabeth AH %A Hadgraft,Nyssa %A Dunstan,David W %A Gilson,Nicholas D %A Goode,Ana D %+ School of Public Health, The University of Queensland, 266 Herston Road, Herston, Brisbane, 4006, Australia, 61 733655528, g.healy@uq.edu.au %K BeUpstanding Champion Toolkit %K implementation %K physical activity %K sedentary %K workplace sitting %D 2018 %7 28.08.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The Web-based, evidence-informed BeUpstanding Champion Toolkit was developed to provide employers (via a “train-the-champion approach”) with resources and support to help in reducing prolonged sitting in their own desk-based workplace. As part of a five-phase research-to-dissemination process, this study reports on the evaluation of the beta (test) version of this toolkit (Phase 2). Objective: The objective of our study was to evaluate (1) the implementation of the toolkit by workplace champions and (2) the impact of the toolkit on sitting (primary outcome), standing, and moving; use of activity-promoting strategies; knowledge and attitudes; and indicators of health and work performance. Methods: An implementation study using a pre-post design was conducted in 7 desk-based workplaces in Australia (September 2015 to May 2016), with work teams (one per workplace) purposively recruited to ensure representation across a range of sectors (white- or blue-collar), organizational sizes (small or medium or large), and locations (metropolitan or regional). All staff within participating teams were invited to participate in the relevant toolkit activities. Implementation outcomes (time commitment required by champions and toolkit activities completed) were collected from each champion via telephone interviews. Changes in impact outcomes, measured via a Web-based questionnaire completed by employees at baseline and 3 months postimplementation, were assessed using mixed models, correcting for clustering. Results: Champions reported a 30-60 minutes per week time commitment to the toolkit activities. All teams formed a wellbeing committee and sent the staff surveys at both time points; most champions held a staff consultation workshop (6/7), identified team-level strategies within that workshop (5/7), used the communication resources provided within the toolkit (emails, posters; 6/7), and completed the action plan (5/7). In total, 52% (315 of ≈600) employees participated in at least one survey and 97 (16%) participated in both. At follow-up, there was a significant (P<.05) reduction in self-reported workplace sitting time compared to baseline (−6.3%, 95% CI −10.1 to −2.5; n=85) equating to ≈30 minutes per workday. Significant benefits were also observed for the use of activity-promoting strategies, with small, nonsignificant changes observed for knowledge and attitudes and indicators of health and work performance. Conclusions: The beta version of the BeUpstanding Champion Toolkit was feasible to implement and effective in reducing self-reported workplace sitting across a broad range of desk-based workplaces. The next phase (Phase 3) will build on these findings to optimize the toolkit for wider-scale implementation and longer term evaluation. %M 30684420 %R 10.2196/formative.9343 %U http://formative.jmir.org/2018/2/e17/ %U https://doi.org/10.2196/formative.9343 %U http://www.ncbi.nlm.nih.gov/pubmed/30684420 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 8 %P e10231 %T Differences in the Effect of Internet-Based Cognitive Behavioral Therapy for Improving Nonclinical Depressive Symptoms Among Workers by Time Preference: Randomized Controlled Trial %A Imamura,Kotaro %A Furukawa,Toshi A %A Matsuyama,Yutaka %A Shimazu,Akihito %A Kuribayashi,Kazuto %A Kasai,Kiyoto %A Kawakami,Norito %+ Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan, 81 3 5841 3522, nkawakami@m.u-tokyo.ac.jp %K internet-based computerized cognitive behavioral therapy %K time preference %K nonclinical depressive symptoms %K workers %D 2018 %7 10.08.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous randomized controlled trials (RCTs) have shown a significant intervention effect of internet-based computerized cognitive behavioral therapy (iCBT) on improving nonclinical depressive symptoms among healthy workers and community residents in a primary prevention setting. Time preference is one’s relative valuation for having a reward (eg, money) at present than at a later date. Time preference may affect the effectiveness of cognitive behavioral therapy. Objective: This RCT aimed to test the difference of intervention effect of an iCBT program on improving nonclinical depressive symptoms between two subgroups classified post-hoc on the basis of time preference among workers in Japan. Methods: All workers in one corporate group (approximate n=20,000) were recruited. Participants who fulfilled the inclusion criteria were randomly allocated to either intervention or control groups. Participants in the intervention group completed 6 weekly lessons and homework assignments within the iCBT program. The Beck Depression Inventory-II (BDI-II) and Kessler’s Psychological Distress Scale (K6) measures were obtained at baseline and 3-, 6-, and 12-month follow-ups. Two subgroups were defined by the median of time preference score at baseline. Results: Only few (835/20,000, 4.2%) workers completed the baseline survey. Of the 835 participants, 706 who fulfilled the inclusion criteria were randomly allocated to the intervention or control group. Participants who selected irrational time preference options were excluded (21 and 18 participants in the intervention and control groups, respectively). A three-way interaction (group [intervention/control] × time [baseline/follow-up] × time preference [higher/lower]) effect of iCBT was significant for BDI-II (t1147.42=2.33, P=.02) and K6 (t1254.04=2.51, P=.01) at the 3-month follow-up, with a greater effect of the iCBT in the group with higher time preference. No significant three-way interaction was found at the 6- and 12-month follow-ups. Conclusions: The effects of the iCBT were greater for the group with higher time preference at the shorter follow-up, but it was leveled off later. Workers with higher time preference may change their cognition or behavior more quickly, but these changes may not persist. Trial Registration: UMIN Clinical Trials Registry UMIN000014146; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi? recptno=R000016466 (Archived by WebCite at http://www.webcitation.org/70o2rNk2V) %M 30097419 %R 10.2196/10231 %U http://www.jmir.org/2018/8/e10231/ %U https://doi.org/10.2196/10231 %U http://www.ncbi.nlm.nih.gov/pubmed/30097419 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e35 %T Team Resilience Training in the Workplace: E-Learning Adaptation, Measurement Model, and Two Pilot Studies %A Bennett,Joel B %A Neeper,Michael %A Linde,Brittany D %A Lucas,Gale M %A Simone,Lindsay %+ Organizational Wellness & Learning Systems, 3200 Riverfront Drive (Suite 102), Fort Worth, TX,, United States, 1 817 921 4260, owls@organizationalwellness.com %K workplace %K resilience %K stress %K quasi-experimental %K experimental design %K online learning %K early intervention %K questionnaire design %K incentives %K social support %K psychological theory %K gender %D 2018 %7 02.05.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: The majority of resilience interventions focus on the individual. Workplace resilience is a growing field of research. Given the ever-increasing interconnectedness in businesses, teamwork is a guarantee. There is also growing recognition that resilience functions at the team level. Objective: The objective of our work was to address three shortcomings in the study of workplace resilience interventions: lack of interventions focusing on group-level or team resilience, the need for brief interventions, and the need for more theoretical precision in intervention studies. Methods: The authors took an established evidence-based program (Team Resilience) and modified it based on these needs. A working model for brief intervention evaluation distinguishes outcomes that are proximal (perceptions that the program improved resilience) and distal (dispositional resilience). A total of 7 hypotheses tested the model and program efficacy. Results: Two samples (n=118 and n=181) of engineering firms received the Web-based training and provided immediate reactions in a posttest-only design. The second sample also included a control condition (n=201). The findings support the model and program efficacy. For example, workplace resilience was greater in the intervention group than in the control group. Other findings suggest social dissemination effects, equal outcomes for employees at different stress levels, and greater benefit for females. Conclusions: This preliminary research provides evidence for the capabilities of e-learning modules to effectively promote workplace resilience and a working model of team resilience. %M 29720362 %R 10.2196/mental.8955 %U http://mental.jmir.org/2018/2/e35/ %U https://doi.org/10.2196/mental.8955 %U http://www.ncbi.nlm.nih.gov/pubmed/29720362 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e30 %T Worker Preferences for a Mental Health App Within Male-Dominated Industries: Participatory Study %A Peters,Dorian %A Deady,Mark %A Glozier,Nick %A Harvey,Samuel %A Calvo,Rafael A %+ Wellbeing Technology Lab, Faculty of Engineering and IT, University of Sydney, Bldg J03, Electrical Engineering, Sydney, 2006, Australia, 61 0289015604, dorian.peters@sydney.edu.au %K mental health %K mhealth %K mobile apps %K workplace %K men %K participatory design %D 2018 %7 25.04.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Men are less likely to seek help for mental health problems, possibly because of stigma imposed by cultural masculine norms. These tendencies may be amplified within male-dominated workplaces such as the emergency services or transport industries. Mobile apps present a promising way to provide access to mental health support. However, little is known about the kinds of mental health technologies men would be willing to engage with, and no app can be effective if the intended users do not engage with it. Objective: The goal of this participatory user research study was to explore the perceptions, preferences, and ideas of workers in male-dominated workplaces to define requirements for a mental health app that would be engaging and effective at improving psychological well-being. Methods: Workers from male-dominated workplaces in rural, suburban, and urban locations took part in an exploratory qualitative study involving participatory workshops designed to elicit their perspectives and preferences for mental health support and the design of an app for mental health. Participants generated a number of artifacts (including draft screen designs and promotional material) designed to reify their perceptions, tacit knowledge, and ideas. Results: A total of 60 workers aged between 26 and 65 years, 92% (55/60) male, from male-dominated workplaces in rural (16/60, 27%), suburban (14/60, 23%), and urban (30/60, 50%) locations participated in one of the 6 workshops, resulting in 49 unique feature ideas and 81 participant-generated artifacts. Thematic analysis resulted in a set of feature, language, and style preferences, as well as characteristics considered important by participants for a mental health app. The term “mental health” was highly stigmatized and disliked by participants. Tools including a mood tracker, self-assessment, and mood-fix tool were highly valued, and app characteristics such as brevity of interactions, minimal on-screen text, and a solutions-oriented approach were considered essential by participants. Some implementation strategies based on these findings are included in the discussion. Conclusions: Future mental health mobile phone apps targeting workers in male-dominated workplaces need to consider language use and preferred features, as well as balance the preferences of users with the demands of evidence-based intervention. In addition to informing the development of mental health apps for workers in male-dominated industries, these findings may also provide insights for mental health technologies, for men in general, and for others in high-stigma environments. %M 29695371 %R 10.2196/mental.8999 %U http://mental.jmir.org/2018/2/e30/ %U https://doi.org/10.2196/mental.8999 %U http://www.ncbi.nlm.nih.gov/pubmed/29695371 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e145 %T Usage of a Digital Health Workplace Intervention Based on Socioeconomic Environment and Race: Retrospective Secondary Cross-Sectional Study %A Senecal,Conor %A Widmer,R Jay %A Bailey,Kent %A Lerman,Lilach O %A Lerman,Amir %+ Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, United States, 1 507 255 1622, lerman.amir@mayo.edu %K race and ethnicity %K socioeconomic position %K computers %K health services research %K health disparities %D 2018 %7 23.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health tools have been associated with improvement of cardiovascular disease (CVD) risk factors and outcomes; however, the differential use of these technologies among various ethnic and economic classes is not well known. Objective: To identify the effect of socioeconomic environment on usage of a digital health intervention. Methods: A retrospective secondary cross-sectional analysis of a workplace digital health tool use, in association with a change in intermediate markers of CVD, was undertaken over the course of one year in 26,188 participants in a work health program across 81 organizations in 42 American states between 2011 and 2014. Baseline demographic data for participants included age, sex, race, home zip code, weight, height, blood pressure, glucose, lipids, and hemoglobin A1c. Follow-up data was then obtained in 90-day increments for up to one year. Using publicly available data from the American Community Survey, we obtained the median income for each zip code as a marker for socioeconomic status via median household income. Digital health intervention usage was analyzed based on socioeconomic status as well as age, gender, and race. Results: The cohort was found to represent a wide sample of socioeconomic environments from a median income of US $11,000 to $171,000. As a whole, doubling of income was associated with 7.6% increase in log-in frequency. However, there were marked differences between races. Black participants showed a 40.5% increase and Hispanic participants showed a 57.8% increase in use with a doubling of income, compared to 3% for Caucasian participants. Conclusions: The current study demonstrated that socioeconomic data confirms no relevant relationship between socioeconomic environment and digital health intervention usage for Caucasian users. However, a strong relationship is present for black and Hispanic users. Thus, socioeconomic environment plays a prominent role only in minority groups that represent a high-risk group for CVD. This finding identifies a need for digital health apps that are effective in these high-risk groups. %M 29685862 %R 10.2196/jmir.8819 %U http://www.jmir.org/2018/4/e145/ %U https://doi.org/10.2196/jmir.8819 %U http://www.ncbi.nlm.nih.gov/pubmed/29685862 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e72 %T Evaluating an mHealth App for Health and Well-Being at Work: Mixed-Method Qualitative Study %A de Korte,Elsbeth Marieke %A Wiezer,Noortje %A Janssen,Joris H %A Vink,Peter %A Kraaij,Wessel %+ Netherlands Organisation for Applied Scientific Research, Schipholweg 77-89, Leiden, 2316 ZL, Netherlands, 31 6 211 34434, elsbeth.dekorte@tno.nl %K mHealth %K work %K qualitative research methods %K interview %K focus group %K technology acceptance %K user satisfaction %K usability %K well-being %K prevention %D 2018 %7 28.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To improve workers’ health and well-being, workplace interventions have been developed, but utilization and reach are unsatisfactory, and effects are small. In recent years, new approaches such as mobile health (mHealth) apps are being developed, but the evidence base is poor. Research is needed to examine its potential and to assess when, where, and for whom mHealth is efficacious in the occupational setting. To develop interventions for workers that actually will be adopted, insight into user satisfaction and technology acceptance is necessary. For this purpose, various qualitative evaluation methods are available. Objective: The objectives of this study were to gain insight into (1) the opinions and experiences of employees and experts on drivers and barriers using an mHealth app in the working context and (2) the added value of three different qualitative methods that are available to evaluate mHealth apps in a working context: interviews with employees, focus groups with employees, and a focus group with experts. Methods: Employees of a high-tech company and experts were asked to use an mHealth app for at least 3 weeks before participating in a qualitative evaluation. Twenty-two employees participated in interviews, 15 employees participated in three focus groups, and 6 experts participated in one focus group. Two researchers independently coded, categorized, and analyzed all quotes yielded from these evaluation methods with a codebook using constructs from user satisfaction and technology acceptance theories. Results: Interviewing employees yielded 785 quotes, focus groups with employees yielded 266 quotes, and the focus group with experts yielded 132 quotes. Overall, participants muted enthusiasm about the app. Combined results from the three evaluation methods showed drivers and barriers for technology, user characteristics, context, privacy, and autonomy. A comparison between the three qualitative methods showed that issues revealed by experts only slightly overlapped with those expressed by employees. In addition, it was seen that the type of evaluation yielded different results. Conclusions: Findings from this study provide the following recommendations for organizations that are planning to provide mHealth apps to their workers and for developers of mHealth apps: (1) system performance influences adoption and adherence, (2) relevancy and benefits of the mHealth app should be clear to the user and should address users’ characteristics, (3) app should take into account the work context, and (4) employees should be alerted to their right to privacy and use of personal data. Furthermore, a qualitative evaluation of mHealth apps in a work setting might benefit from combining more than one method. Factors to consider when selecting a qualitative research method are the design, development stage, and implementation of the app; the working context in which it is being used; employees’ mental models; practicability; resources; and skills required of experts and users. %M 29592846 %R 10.2196/mhealth.6335 %U http://mhealth.jmir.org/2018/3/e72/ %U https://doi.org/10.2196/mhealth.6335 %U http://www.ncbi.nlm.nih.gov/pubmed/29592846 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 1 %P e5 %T Usage, Acceptability, and Effectiveness of an Activity Tracker in a Randomized Trial of a Workplace Sitting Intervention: Mixed-Methods Evaluation %A Brakenridge,Charlotte L %A Healy,Genevieve N %A Winkler,Elisabeth AH %A Fjeldsoe,Brianna S %+ School of Public Health, The University of Queensland, Herston Rd, Brisbane, 4006, Australia, 61 733655163, c.brakenridge@uq.edu.au %K wearable electronic devices %K fitness trackers %K sedentary lifestyle %K exercise %K workplace %K adult %D 2018 %7 02.03.2018 %9 Original Paper %J Interact J Med Res %G English %X Background: Wearable activity trackers are now a common feature of workplace wellness programs; however, their ability to impact sitting time (the behavior in which most of the desk-based workday is spent) is relatively unknown. This study evaluated the LUMOback, an activity tracker that targets sitting time, as part of a cluster-randomized workplace sitting intervention in desk-based office workers. Objective: Study objectives were to explore: (1) office workers’ self-directed LUMOback use, (2) individual-level characteristics associated with LUMOback use, (3) the impact of LUMOback use on activity and sitting behaviors, and (4) office workers’ perceived LUMOback acceptability. Methods: Exploratory analyses were conducted within the activity tracker intervention group (n=66) of a 2-arm cluster-randomized trial (n=153) with follow-up at 3 and 12 months. The intervention, delivered from within the workplace, consisted of organizational support strategies (eg, manager support, emails) to stand up, sit less, and move more, plus the provision of a LUMOback activity tracker. The LUMOback, worn belted around the waist, provides real-time sitting feedback through a mobile app. LUMOback usage data (n=62), Web-based questionnaires (n=33), activPAL-assessed sitting, prolonged (≥30 min bouts) and nonprolonged (<30 min bouts) sitting, standing and stepping time (7-day, 24 h/day protocol; n=40), and telephone interviews (n=27) were used to evaluate study aims. LUMOback usage data were downloaded and described. Associations between user characteristics and LUMOback usage (in the first 3 months) were analyzed using zero-inflated negative binomial models. Associations between LUMOback usage and 3-month activity outcomes were analyzed using mixed models, correcting for cluster. LUMOback acceptability was explored using 3-month questionnaire data and thematic analysis of telephone interviews (conducted 6 to 10 months post intervention commencement). Results: Tracker uptake was modest (43/61, 70%), and among users, usage over the first 3 months was low (1-48 days, median 8). Usage was greatest among team leaders and those with low self-perceived scores for job control and supervisor relationships. Greater tracker use (≥5 days vs <5 days) was significantly associated only with changes in prolonged unbroken sitting (−50.7 min/16 h; 95% CI −94.0 to −7.3; P=.02) during all waking hours, and changes in nonprolonged sitting (+32.5 min/10 h; 95% CI 5.0 to 59.9; P=.02) during work hours. Participants found the LUMOback easy to use but only somewhat comfortable. Qualitatively, participants valued the real-time app feedback. Nonuptake was attributed to being busy and setup issues. Low usage was attributed to discomfort wearing the LUMOback. Conclusions: The LUMOback—although able to reduce prolonged sitting time—was only used to a limited extent, and its low usage may provide a partial explanation for the limited behavior changes that occurred. Discomfort limited the feasibility of the LUMOback for ongoing use. Such findings yield insight into how to improve upon implementing activity trackers in workplace settings. %M 29500158 %R 10.2196/ijmr.9001 %U http://www.i-jmr.org/2018/1/e5/ %U https://doi.org/10.2196/ijmr.9001 %U http://www.ncbi.nlm.nih.gov/pubmed/29500158