Spring out of Burnout: A Theory Driven Stress Management Intervention for State Public Health Employees in Georgia Presentation to: APHA Conference 2017 Presented by: Carmen N. Daniel, MPH November 8, 2017 Date:
Presenter Disclosures No relationships to disclose. 2
Learning Objectives 1. Identify the benefits of work-related stress management interventions in workplaces. 2. Explain the barriers in accessing stress management resources in organizations of 1,000 employees or larger. 3. Discuss how to implement a theory driven, population specific stress management program. 4. Recognize the value of a stress management program to address work-related stressors. Adapt a workplace stress model. 3
Program Sequence Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 • Health Climate • Surveys (1-on- • Program • Program • Evaluation and Survey 1; online) Development Execution Dissemination 4
Health Climate Survey Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 • Health • Surveys (1- • Program • Program • Evaluation Climate on-1; online) Development Execution and Survey Dissemination 5
Significant Stress Correlations Variable Pearson Correlation P-value Variable Pearson Correlation P-value Consideration of participating in programs Travel for work 0.131 0.028 Employee Assistance Program -0.161 0.006 Depression Scale 0.337 <0.001 (EAP) How often do you drink 0.119 0.044 Work-Life Balance -0.124 0.035 alcoholic beverages? Physical/Emotion Problems (Work Limitations Questionnaire) How would you rate your sleep 0.211 <0.001 overall? WLQ Time Domain 0.459 <0.001 Work-life Balance Scale 0.473 <0.001 WLQ Mental Demands Domain 0.394 <0.001 WLQ Output Domain 0.441 <0.001 Current job questions on job satisfaction/stress at work Generally speaking, I am very 0.487 <0.001 satisfied with my job. I am generally satisfied with 0.288 <0.001 the kind of work I do in this job. 6
Stress Correlations* Variable Label Employee Assistance 0=not participated, Program (EAP) Participation 1=participated Stress Awareness Program 0=not participated, Participation 1=participated Employees who participated in EAP had higher stress. Employees who participated in stress awareness programs had lower stress scores. 7
Health Climate Survey Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 • Health • Surveys (1- • Program • Program • Evaluation Climate on-1; online) Development Execution and Survey Dissemination 8
Preliminary Research – Qualitative Interviews • Signed and verbal consent • Recorded informal interviews with outside consultant • Qualitative Interviews (Formative) • Confidentiality 9
Qualitative Informal Interviews Field Example Questions Demographics “Job Title” “How many people do you supervise?” “How many people are on the team?” Baseline Assessment “Are you stressed?” “What would you say are your main causes of stress at work? “Does it interfere with your personal life?” “Do you currently experience stress outside of work? If so, how would you say that stress compares to the stress you feel at work?” Self-Report: Social Influence “How valued do you feel at work?” on Stress “Do you feel apart of the team?” Self-Report: Job Efficiency “Do you value your work?” “Do you feel you have enough time to get tasks done?” Current Methods of “What do you do/use to ease your stress? What has worked and what hasn’t?” Controlling Stress Levels Other “How can DPH support you and address your needs relating to stress?” “Is there anything you’d like to share about your stress levels at work?” 10
Online Survey and Recruitment 11
Online Survey Field Example Questions Response options Characteristics “The number of projects and/or assignments I have.” Produces no stress. • of Work “The time pressures I experience” Produces a little stress. • “The level of job security I have.” Produces tolerable stress. • Produces a lot of stress. • Clarity of “The degree to which relationships rather than Produces excessive stress. • Objectives performance affects organizational decisions.” N/A • “The ability to accomplish my job while adhering to policies and procedures.” Time and Travel “The amount of time I spend in meetings.” “The amount of traveling I must do.” Additional comments and Location 12
Program Development Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 • Health • Surveys (1- • Program • Program • Evaluation Climate on-1; online) Development Execution and Survey Dissemination 13
Transactional Model of Stress and Coping • Overarching programmatic focus • Constructs – Attitudes – Knowledge – Skill – Self-efficacy – Barriers – Intention – Social support (“Transactional Model,” 2016) 14
Transactional Model of Stress and Coping Stage 1- Appraisal of Stress Stage 2- Coping Primary Appraisal Insufficient coping Problem-focused Emotion-Focused resources Constructs Constructs Individual ’s judgment Analysis of resources to Attitude Social support • • Positive or Irrelevant or Knowledge Avoidance of insure positive outcome • • Desirable Insignificant Skills particular • Active coping situations • Problem solving Distancing oneself • • Dangerous Secondary Appraisal Information from events • seeking Seeking emotional • Self-efficacy support from • others Venting feelings • (Editor, P., 2015) 15
Transactional Model of Stress and Coping 16
Program Logic Model 17
Matrices of Change Behavioral Performance Objectives (BPO) Environmental Performance Objectives (EPO) BPO Knowledge Self- Attitudes EPO Attitudes & Cost & Efficacy Beliefs Beliefs Affordability BPO.1 K.1 SE.1 AB.1 EPO.1 AB.1 CA.1.a. CA.1.b. BPO.2 K.2 SE.2 AB.2 CA.1.c. EPO.2 AB.2 CA.2 BPO.3 K.3.a. SE.3 AB.3.a. K.3.b. AB.3.b. EPO.3 AB.3.a. CA.3 BPO.4 K.4 SE.4.a. AB.4 AB.3.b SE.4.b. See handout for detailed descriptions 18
Methods and Strategies Behavioral Determinants Determinant & Change Methods Strategies Program Behavioral Determinants Objectives Components Knowledge Self-Efficacy BPO.1 – BPO.4 Attitudes & Beliefs BPO.4 See handout for detailed descriptions 19
Methods and Strategies Environmental Determinants Determinant & Change Methods Strategies Program Objectives Components Determinants EPO.1 – Attitudes & Beliefs Environmental Cost & Affordability EPO.4 See handout for detailed descriptions 20
Program Development Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 • Health • Survey: (1-on- • Program • Program • Evaluation Climate 1; online) Development Execution and Survey Dissemination 21
Process & Outcome Evaluations • Program effectiveness • Program efficacy • Quality of programmatic components See handout for detailed descriptions 22
Contact Information Presenter Carmen N. Daniel, MPH, CWWPM Worksite Wellness Program Manager Georgia Department of Public Health Workforce Management – Worksite Wellness Carmen.Daniel@dph.ga.gov 23
References American Psychological Association. (2017, February 15). Many Americans Stressed about Future of Our Nation, New APA Stress in America™ Survey Reveals [Press release]. Retrieved February 20, 2017, from http://www.apa.org/news/press/releases/2017/02/stressed-nation.aspx American Psychological Association. (2017, February 15). Stress In America: Coping with Change [Press release]. Retrieved February 20, 2017, from http://www.apa.org/news/press/releases/stress/2016/coping-with-change.pdf Cope. (n.d.). Retrieved April 26, 2017, from https://www.merriam-webster.com/dictionary/cope Doran, K., Resnick, B., Kim, N., Lynn, D., & McCormick, T. (2017). Applying the Social Ecological Model and Theory of Self-Efficacy in the Worksite Heart Health Improvement Project-PLUS. Research and Theory for Nursing Practice , 31 (1), 8-27. Editor, P. (2015, January 21). Transactional Model of Stress and Coping. Retrieved April 26, 2017, from https://flowpsychology.com/transactional-model-of-stress-and-coping/ Grawitch, M. J., Ballard, D. W., & Erb, K. R. (2015). To be or not to be (stressed): The critical role of a psychologically healthy workplace in effective stress management. Stress and Health , 31 (4), 264-273. Harvey, S. B., Modini, M., Joyce, S., Milligan-Saville, J. S., Tan, L., Mykletun, A., ... & Mitchell, P. B. (2017). Can work make you mentally ill? A systematic meta-review of work-related risk factors for common mental health problems. Occup Environ Med , oemed-2016. 24
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