Effectiveness of an online text-based stress management program for employees who work in micro- and small-sized enterprises: A randomized controlled trial

Natsu Sasaki; Sayaka Ogawa; Utako Sawada; Taichi Shimazu; Byron J Powell; Hajime Takeno; Akizumi Tsutsumi; Kotaro Imamura

doi:10.1016/j.invent.2024.100754

Effectiveness of an online text-based stress management program for employees who work in micro- and small-sized enterprises: A randomized controlled trial

Internet Interv. 2024 Jun 24:37:100754. doi: 10.1016/j.invent.2024.100754. eCollection 2024 Sep.

Authors

Natsu Sasaki^{1

2

3}, Sayaka Ogawa¹, Utako Sawada⁴, Taichi Shimazu⁵, Byron J Powell^{2

3

6}, Hajime Takeno¹, Akizumi Tsutsumi⁷, Kotaro Imamura⁸

Affiliations

¹ Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
² Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO, United States.
³ Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, United States.
⁴ Department of Psychiatric Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁵ Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan.
⁶ Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States.
⁷ Department of Public Health, Kitasato University School of Medicine, Sagamihara, Japan.
⁸ Department of Digital Mental Health, Graduate School of Medicine, The University of Tokyo.

Abstract

Background: Internet psychoeducational interventions improve employees' mental health. However, implementing them for employees in micro- and small-sized enterprises (MSEs) is challenging.

Objectives: This randomized controlled trial examined the effectiveness of a fully automated text-based stress management program, "WellBe-LINE," in improving mental health and job-related outcomes for employees in workplaces with fewer than 50 employees.

Methods: The program was developed based on stakeholder interviews and surveys of 1000 employees at MSEs. Adult full-time employees at an enterprise with fewer than 50 employees were recruited from registered members of a web survey company in Japan. Participants were randomly allocated to the intervention or control group (1:1). Participants in the intervention group were invited to register for the program using the LINE app. Psychological distress measured by Kessler 6 (K6) was a primary outcome, with self-administrated questionnaires at baseline, 2-month (post), and 6-month follow-ups. A mixed model for repeated measures conditional growth model analysis was conducted using a group ∗ time interaction as an intervention effect. Implementation outcomes were measured through implementation outcome scales for digital mental health (iOSDMH).

Results: 1021 employees were included in this study. No significant effects were shown in any outcome. The reported implementation outcomes were positively evaluated, with 80 % acceptability, 86 % appropriateness, and feasibility (ease of understanding the contents [88 %], frequency [86 %], and length of content [86 %]).

Conclusions: A simple text-message program for employees at MESs was acceptable, appropriate, and feasible; however, it did not result in improved mental health or job-related outcomes.

Trial registration: UMIN clinical trial registration: UMIN000050624 (registration date: March 18, 2023).

Keywords: Digital health; Occupational health; Public health; Stress prevention; Well-being.