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OBJECTIVE: Work stress is a serious problem for employees in primary education. This study evaluates the effects of a work stress prevention approach on emotional exhaustion and work stress determinants (job crafting behavior, quantitative and emotional demands, leadership, support, autonomy, team culture and feelings of competence), and the impact of implementation success (management commitment, employee involvement, communication during implementation) on these outcomes. METHODS: A quasi-experimental study was conducted with an intervention group (4 schools, N=102 employees) and a control group (26 schools, N=656 employees) using questionnaires at baseline (T0), one-year (T1) and two-year (T2) follow-up. Multilevel mixed model analyses were performed to test effects of condition and implementation success on changes in emotional exhaustion and work stress determinants between T0 and T2 in the intervention and control group. RESULTS: No effect were found for emotional exhaustion. Improvement of quality of leadership between T0 and T2 was significantly larger in the intervention compared to the control group. Additionally, implementation success was associated with a decrease in unnecessary demands and an increase in quality of leadership, team culture and job crafting behavior. CONCLUSIONS: This study shows no direct effect of the approach on emotional exhaustion, but it does show beneficial effects on quality of leadership. Additionally, results suggest that, when successfully implemented, the approach also has beneficial effects on other work stress determinants (ie, job crafting behavior, unnecessary demands and team culture). Results indicate that – if implemented successfully – the organizational-level intervention has the potential to improve the psychosocial work context.

Abstract Background Work stress is an important problem among employees in education in the Netherlands. The present study aims to investigate the effects of a participatory organizational level work stress prevention approach to reduce (quantitative) job demands, increase resources (i.e. autonomy, supervisor and coworker support) and to reduce work stress and increase job satisfaction of employees in primary education. Methods This study makes use of a multiple case study research design. The stress prevention approach is implemented at 5 primary schools and questionnaires were filled out by 119 employees of the 5 schools at baseline and 1 year later, measuring job demands, resources, work stress, job satisfaction and implementation factors. Results Multilevel analyses showed a significant decrease in job demands and a significant increase in job satisfaction between baseline and follow up. In addition, employees that were more satisfied with the communication about the intervention showed more improvements in autonomy and job satisfaction. However, employees reporting an increased dialogue in work stress between employees and management showed a smaller decrease in job demands. Conclusion The study shows a decrease in job demands and an increase in job satisfaction in the schools that implemented a stress prevention approach. Results of the study underline the importance of communication about the intervention as part of the implementation process, impacting the effectiveness of the intervention to improve autonomy and job satisfaction. Trial registration ISRCTN registry, study ID: ISRCTN14697835 , registration date: 11-10-2019 (retrospectively registered).

BackgroundWork stress is a serious problem in primary education. Decades of research underline the importance of participatory, organizational-level work stress prevention approaches. In this approach, measures are planned to tackle causes of work stress in a participatory manner and implemented by a working group consisting of members of the organization. This approach can only be effective if the measures contain effective ingredients to decrease work stress risks and are successfully implemented. The aim of this paper is to present an outline of a work stress prevention approach that is evaluated in primary education. To ensure the appropriateness of measures, a logic model of change is built as part of the risk assessment to facilitate the selection of appropriate measures. Progression on target behaviors as well as implementation factors are real-time monitored during implementation and fed back to the working groups, to provide the opportunity to adjust action plans when needed to optimize implementation.MethodsThe approach consists of five steps: (1) preparation: installing an advisory board and working groups, (2) risk assessment: inventory of work stress risks (questionnaires and focus groups). In addition, a behavioral analysis is performed to build a logic model of change to facilitate selection of measures, (3) action planning: conducting an action plan with appropriate measures (focus groups), (4) implementation: implementing the action plan. During implementation progression on target behaviors and implementation factors are monthly monitored and fed back to the working groups, and (5) evaluation: effects of the approach are studied in a controlled trial with measurements at baseline (T0), 1 year (T1), and 2 years (T2) follow-up. A process evaluation is carried out using quantitative (questionnaires and real-time monitoring data) and qualitative (interviews and data logs) data to study the implementation process of all steps of the work stress approach.DiscussionWe believe that building a logic model of change and real-time monitoring of implementation could be of added value to improve the success of the work stress prevention approach. With this study, we aim to provide more insights into work stress intervention research, especially in primary education.Clinical Trial RegistrationThe study is registered in Netherlands Trial Register (ClinicalTrials.gov #NL9797, October 18, 2021).

Abstract Background Work-related stress is highly prevalent in the educational sector. The aim of the current study was to evaluate the effectiveness of an organizational level, participatory intervention on need for recovery and vitality in educational workers. It was hypothesized that the intervention would decrease need for recovery and increase vitality. Methods A quasi-experiment was conducted at two secondary Vocational Education and Training schools (N = 356) with 12- and 24-months follow-up measurements. The intervention consisted of 1) a needs assessment phase, wherein staff and teachers developed actions for happy and healthy working under supervision of a facilitator, and 2) an implementation phase, wherein these actions were implemented by the management teams. Mixed model analysis was applied in order to assess the differences between the intervention and control group on average over time. All analyses were corrected for baseline values and several covariates. Results No effects of the intervention were found on need for recovery, vitality and most of the secondary outcomes. Two small, statistically significant effects were in unfavorable direction: the intervention group scored on average over time significantly lower on absorption (i.e. a subscale of work engagement) and organizational efficacy than the control group. Conclusions Since no beneficial effects of this intervention were found on the primary and most of the secondary outcomes, further implementation of the intervention in its current form is not eligible. We recommend that future organizational level interventions for occupational health 1) incorporate an elaborate implementation strategy, 2) are more specific in relating actions to stressors in the context, and 3) are integrated with secondary preventive, individual focused stress management interventions. Trial registration Netherlands Trial Register NTR3284 (date registered: February 14 2012).

Abstract Background The importance of process evaluations in examining how and why interventions are (un) successful is increasingly recognized. Process evaluations mainly studied the implementation process and the quality of the implementation (fidelity). However, in adopting this approach for participatory organizational level occupational health interventions, important aspects such as context and participants perceptions are missing. Our objective was to systematically describe the implementation process of a participatory organizational level occupational health intervention aimed at reducing work stress and increasing vitality in two schools by applying a framework that covers aspects of the intervention and its implementation as well as the context and participants perceptions. Methods A program theory was developed, describing the requirements for successful implementation. Each requirement was operationalized by making use of the framework, covering: initiation, communication, participation, fidelity, reach, communication, satisfaction, management support, targeting, delivery, exposure, culture, conditions, readiness for change and perceptions. The requirements were assessed by quantitative and qualitative data, collected at 12 and 24 months after baseline in both schools (questionnaire and interviews) or continuously (logbooks). Results The intervention consisted of a needs assessment phase and a phase of implementing intervention activities. The needs assessment phase was implemented successfully in school A, but not in school B where participation and readiness for change were insufficient. In the second phase, several intervention activities were implemented at school A, whereas this was only partly the case in school B (delivery). In both schools, however, participants felt not involved in the choice of intervention activities (targeting, participation, support), resulting in a negative perception of and only partial exposure to the intervention activities. Conditions, culture and events hindered the implementation of intervention activities in both schools. Conclusions The framework helped us to understand why the implementation process was not successful. It is therefore considered of added value for the evaluation of implementation processes in participatory organizational level interventions, foremost because of the context and mental models dimensions. However, less demanding methods for doing detailed process evaluations need to be developed. This can only be done if we know more about the most important process components and this study contributes to that knowledge base. Trial registration Netherlands Trial Register NTR3284 .

Depressive disorders are highly prevalent in the working population and lead to excessive costs. Online interventions have shown to be effective treatments for depression but are not often applied in the work setting, despite the importance of work related aspects in the development and perpetuation of depression. We developed a worker-directed web-based intervention for employees with depressive symptoms named Happy@Work. A process evaluation was conducted alongside a randomized controlled trial to assess the feasibility of the intervention and to explore barriers and facilitators for further implementation of the intervention. Employees from different companies in the Netherlands who experienced elevated depressive symptoms and were not on sick leave were eligible to take part in this study. Happy@Work contains six lessons and every lesson has several assignments. When completed, a coach provides feedback to assignments via the website. Process measures investigated were: reach, dose delivered, dose received, and fidelity. Recruitment methods and participant satisfaction with the intervention were described and analyzed as well. Data was collected at baseline and 8 weeks later via online questionnaires and data registrations on the website. The implementation score of the intervention was sufficient, but reach of the target population was low. The dose delivered was high, with 93.1% of participants who used the intervention components that were offered to them. However, adherence to the intervention was low; the dose received was 57.8%. The fidelity of the implementation of the intervention was satisfactory. Recruitment of companies and participants was difficult. Participants were satisfied with the different aspects of the intervention, especially with the feedback from the coach. The results of this process evaluation showed that the intervention was conducted according to protocol and seems feasible for further implementation. Potential barriers to further implementation of the intervention include the reach of the target population, intervention adherence and the quality of the feedback. Based on the results of the effectiveness of the intervention, we do not recommend further implementation of the intervention in its current form.