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The aim of this study is to describe a research protocol of a multi-country randomized controlled trial to investigate the effect of a smartphone CBT stress management program on improving depression and other health- and work-related outcomes among hospital nurses in Vietnam and Thailand during the COVID-19 epidemic as a part of the COCONATS project. The study is a two-arm, parallel randomized control trial. Hospital nurses (N = 1,500) will be recruited in Vietnam and Thailand, and those who meet the criteria will be randomly allocated to the intervention or control (treatment as usual) group. A seven-week, seven-module smartphone-based stress management program will be developed to teach CBT skills. The intervention group will participate in the program for 10 weeks. Depression as the primary outcome will be measured using the DASS21 at baseline and in 3- and 6-month follow-up surveys. A mixed model repeated measures analysis will be used to test the intervention effect in the total combined sample, on an intention-to-treat basis. This is the first study to investigate the effectiveness of a self-guided smartphone CBT program on improving depression among hospital nurses using a RCT design in South-East Asian middle-income countries during the COVID-19 pandemic.

There are growing concerns on stress among nurses in low- and middle-income countries (LMICs) in South-East Asia. It is important to improve mental health among nurses in these countries. The objective of this study was to examine the efficacy of two types of newly developed smartphone-based stress management programs in improving depressive and anxiety symptoms among hospital nurses in Vietnam. This study was a three-arm (including two intervention groups and one control group) randomized trial. Participants were recruited from nurses in a large general hospital in Hanoi, Vietnam. Two types (free-choice and fixed sequential order) of smartphone-based stress management programs were developed. Participants were randomly allocated to Program A (a free-choice, multimodule stress management), Program B (a fixed-order, internet cognitive behavioral therapy, iCBT), or a control group (treatment as usual). The depressive and anxiety symptoms were measured by using the Depression Anxiety and Stress Scales at baseline, 3-, and 7-month follow-up surveys. 951 participants were randomly allocated to each of the three groups. Program B showed a statistically significant effect on improving depressive symptoms at 3-month (p = 0.048), but not at 7-month (p = 0.92); Cohen’s d was − 0.18 (95% CI − 0.34 to − 0.02) and 0.03 (95% CI − 1.00 to 1.05), respectively. Program A failed to show a significant intervention effect on any of the outcomes at 3- or 7-month follow-up (p > 0.05). Despite the small effect size, the present fixed-order iCBT program seems effective in improving depression of hospital nurses in Vietnam. A public health impact of the intervention can be scalable, when considering its accessibility and minimal cost.Trial registration number: The study protocol is registered at the UMIN Clinical Trials Registry (UMINCTR; ID = UMIN000033139). Registered date of the protocol is 1st Jul. 2018. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000037796

Introduction In low and middle-income countries, the manually operated municipal waste collection system prominently depended on the performance of waste collectors (WC). Most of the literature has focused on the impact of waste collection tasks on WCs’ physical health, while little was known about the psychological effects of work-related stress. This study aimed to examine the prevalence of psychological stress and related factors among waste collectors in Hanoi, Vietnam. Methods A cross-sectional survey was conducted among 802 WCs in 2017. The questionnaire included the 7-item Stress component of the 21-item Depression, Anxiety and Stress Scale, and questions on demographics and work conditions. Descriptive and multivariate logistics regression analyses were conducted to examine the factors related to psychological stress among WCs. Results Results showed that 13.4% of WCs reported stress symptoms; among them, 3.3% of WCs experienced severe stress. Factors related to lower odds of self-reported psychological stress included self-perceived frequent exposure to high and low temperatures in the working environment (OR = 0.51 and 0.52, respectively). Factors associated with the increased likelihood of symptoms included frequent exposure to hot/flammable objects (OR = 2.41), working a night shift in the last three months (OR = 1.82), education lever lower than high school (OR = 1.82), and having an insufficient monthly income (OR = 1.99). Conclusion The high percentage of workers with severe stress implies the need for mental health prevention and treatment for WCs who participated in this study.

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. CLINICALTRIAL University Hospital Medical Information Network Clinical Trials Registry UMIN000033139; tinyurl.com/55gxo253 INTERNATIONAL REGISTERED REPORT RR2-10.1136/bmjopen-2018-025138

Background: Musculoskeletal disorders are prevalent among waste collectors in developing countries. This study aimed to investigate the prevalence of musculoskeletal disorders and risk factors of persistent musculoskeletal disorders among waste collectors in Hanoi, Vietnam. Methods: A cross-sectional survey was utilized to study 468 waste collectors in 2017. The Örebro Musculoskeletal Pain Questionnaire and questionnaires on demographic and work conditions were used to collect data. Descriptive and Multivariate logistics regression analyses were applied at the significant level p

BACKGROUND: Musculoskeletal disorders (MSDs) are prevalent among waste collectors (WCs) in developing countries. AIM: This study aimed to investigate the prevalence of MSDs and the factors associated with the risk of persistent musculoskeletal pain among WCs in Hanoi, Vietnam. METHODS: A cross-sectional survey was utilized to study 468 WCs in 2017. The Örebro Musculoskeletal Pain Questionnaire and a questionnaire on demographic and work conditions were used to collect data. Descriptive and multivariate logistics regression analyzes were applied at a significance level of 0.05 to examine the factors related to the risk of persistent pain. FINDINGS: About 74.4% of the participants of this study experienced MSDs in at least one body region and 9.4% reported MSDs in all 10 body sites. The lower back was reported to be the most affected followed by the neck and shoulders. The risk of persistent musculoskeletal pain was significantly associated with age (odds ratio (OR) = 2.31, confidence interval (CI) = 1.05–5.09), gender (OR = 3.29, CI = 1.28–8.44), work hours (OR = 2.35, CI = 1.12–4.92), work shift (OR = 0.48, CI = 0.26–0.92), duration of poor postures of the neck (OR = 0.31, CI = 0.13–0.76), bent back (OR = 0.4 CI = 0.18–0.92) and for medial rotation (OR = 3.01, CI = 1.42–6.36), carrying heavy objects (OR = 2.94, CI = 1.15–7.48), and experience of work dissatisfaction (OR = 3.31, CI = 1.46-7.52), stress (OR = 7.14, CI = 3.14–16.24), or anxiety (OR = 6.37, CI = 3.07–13.21). CONCLUSIONS: High prevalence of MSDs among WCs and its association with self-assessed unfavorable work postures and work-related stress implies the need of mechanical and social support at work for WC to prevent the development of MSDs and persistent pain.

Objectives The present study investigated the reliability and validity of a newly developed Vietnamese version of the 9‐item Utrecht Work Engagement Scale (UWES‐9‐V) in a sample of hospital nurses in Hanoi, Vietnam. Methods The UWES‐9 was translated into Vietnamese following a standard procedure. A survey was conducted of 949 registered nurses in a large tertiary general hospital in Hanoi, Vietnam, in 2018, using a self‐administered questionnaire including the Vietnamese UWES‐9, other scales measuring health status, work performance, job demand, job control, and workplace social support, and questions pertaining to demographic variables. Cronbach’s alpha and interclass correlation coefficients (ICC) were calculated to assess reliability. Explanatory and confirmatory factor analyses were conducted to assess factorial validity. Convergent validity was tested based on associations between the UWES‐9‐V and subscales and other scales. Results The Cronbach’s alpha coefficients of the UWES‐9‐V and the Vigor, Absorption, and Dedication subscales were 0.93, 0.86, 0.77, and 0.90, respectively. ICC of the UWES‐9‐V in a subsample after 3 months was 0.48. Confirmatory factor analyses indicated an acceptable fit of both one‐factor and three‐factor structures, with the three‐factor model having the better fit. The UWES‐9‐V and its subscales correlated with depression, anxiety and stress, health‐related quality of life and health condition, job performance, and psychosocial work environment. Conclusions The study findings suggest that the UWES‐9‐V is a reliable and valid instrument to measure work engagement among hospital nurses in Vietnam, a low‐ and middle‐income country. Future studies should confirm the validity and reliability of the UWES‐9‐V among various occupations.

The present study investigated the internal consistency reliability, construct validity, and item response characteristics of a newly developed Vietnamese version of the Kessler 6 (K6) scale among hospital nurses in Hanoi, Vietnam. The K6 was translated into the Vietnamese language following a standard procedure. A survey was conducted of nurses in a large general hospital in Hanoi, Vietnam, using a questionnaire including the Vietnamese K6, other scales (DASS21, health-related QOL, self-rated health, and psychosocial work environment), and questions about demographic variables. Internal consistency reliability (Cronbach's alpha coefficient) was calculated. A confirmatory factor analysis was conducted. Eleven hypotheses were tested (as Pearson's correlations with the K6) to assess the scale's construct validity. Item response theory (IRT) analysis was conducted to identify the item response characteristics. The Cronbach's alpha coefficient was 0.864. The explanatory and confirmatory factor analyses indicated a one-factor structure. Most hypotheses tested for construct validity were supported. IRT analysis indicated that response categories were located in order according to severity. K6 provided reliable information regarding higher levels of psychological distress. The findings suggest that the Vietnamese version of the K6 is a reliable and valid instrument to measure psychological distress among hospital nurses in Vietnam.

IntroductionDue to an increasing demand for healthcare in low-income and middle-income countries in Asia, it is important to develop a strategy to manage work-related stress in healthcare settings, particularly among nurses in these countries. The purpose of this three-arm randomised controlled trial (RCT) is to examine the effects of a newly developed smartphone-based multimodule stress management programme on reducing severity of depressive and anxiety symptoms as primary outcomes at 3-month and 7-month follow-ups among hospital nurses in Vietnam.Methods and analysisThe target study population will be registered nurses working in a large general hospital (which employs approximately about 2000 nurses) in Vietnam. They will be invited to participate in this study. Participants who fulfil the eligibility criteria will be randomly allocated to the free-choice, multimodule stress management (intervention group A, n=360), the internet cognitive behavioural therapy (iCBT), that is, fixed-order stress management (intervention group B, n=360), or a treatment as usual control group (n=360). Two types (free-choice and fixed sequential order) of smartphone-based six-module stress management programmes will be developed. Participants in the intervention groups will be required to complete one of the programmes within 10 weeks after the baseline survey. The primary outcomes are depressive and anxiety symptoms, measured by using the Depression Anxiety and Stress Scales (DASS) at 3-month and 7 month follow-ups.Ethics and disseminationThe study procedures have been approved by the Research Ethics Review Board of Graduate School of Medicine/Faculty of Medicine, the University of Tokyo (no 11991) and the Ethical Review Board for Biomedical Research of Hanoi University of Public Health (no 346/2018/YTCC-HD3). If a significant effect of the intervention programmes will be found in the RCT, the programmes will be made available to all nurses in the hospital including the control group. If the positive effects are found in this RCT, the e-stress management programmes will be disseminated to all nurses in Vietnam.Trial registration numberUMIN000033139; Pre-results.

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

Objectives: This paper examined the prevalence of after-shift musculoskeletal symptoms and work-related factors in female workers in a seafood processing company in Vietnam. Methods: A cross sectio...

The seafood processing industry has been developing and providing marked contribution to Vietnam’s economic growth in recent years. However, information on working conditions and their impacts to workers’ health in this sector, focusing on musculoskeletal problems in female workers, has been poorly documented.Objectives:This paper examines the prevalence of after-shift musculoskeletal disorder symptoms (A-MSDS) and work-related factors in female workers in a seafood processing factory in Vietnam.Materials and Methods:As part of a comprehensive study, a cross-sectional survey was implemented in one seafood processing factory in the center of Vietnam in 2014. A self-administered questionnaire was completed by 394 female workers to collect information about their A-MSDS state, demographic characteristics, health status and work conditions. Descriptive analysis and logistic regression were applied to describe and analyse the results.Results:Nearly four-fifths of female workers experienced MSDs in at least one body part (77.7%) and 20.1% of them had MSDs in all investigated regions. The prevalence of A-MSDS in different body parts markedly varied, with the proportion of pain in the hips and lower extremities being as high as 53.3%, followed by pain in the shoulders and upper extremities (42.6%)and the neck (41.1%). A humid working environment, exposure to vibration and chemicals as well as taxing task demands and work organizations were found to significantly contribute to the increased risk of after-shift musculoskeletal disorders in female workers.Conclusion:Approximately 80% of female workers in the seafood processing factory experienced musculoskeletal pains after work, especially in the hips, extremities, neck and shoulders which were contributed by work conditions and task demands.