The Use of a Mobile Application to Reduce Work-related Stress Symptoms Among Healthcare Workers

Not Applicable

Completed

Conditions: Stress, Psychological
Burnout, Professional

Interventions: Behavioral: The DIARY mobile application

Registration Number: NCT04719351

Lead Sponsor: Karolinska Institutet

Brief Summary: The current pandemic highlighted an urgent need for early interventions to mitigate the psychological effects of extreme work demands that healthcare workers currently experience. This project aims at developing a data driven monitoring system to efficiently track work-related stress reactions over time. The system will also include a self-awareness intervention grounded on evidence-based strategies to improve workers' recovery. The solution will be delivered through a mobile application for a rapid implementation among healthcare workers and related professions. The mobile application will be developed through an initial analysis of pilot data, a factorial experiment and a user-experience analysis. Qualitative user experience data will also be used to validate the functionality of the monitoring system. The solution developed in this project will be easily scalable to related occupations, for example workers at elderly homes and social workers. After the pandemic, it can also be used as a preventive intervention for workers who are at risk of burnout and as a support for patients returning to work after treatment for common mental disorders.

Detailed Description: Symptoms indicating possibly pathological stress reactions among healthcare workers are more prevalent during the current pandemic than they were before. Possible reasons for that include higher levels of known risk factors such as cognitive, emotional, and physical demands at work; new stressors such as risk for moral injury and worry about personal safety; and diminished protective mechanisms, which include recovery opportunities and psychological detachment. Thus, frontline healthcare workers should be given priority in access to psychological support.

Despite the urgent need for it, a rapid implementation of psychological support for healthcare workers has proved to be challenging during previous crises and the current pandemic. Guidelines published thus far underline the necessity of close real-time monitoring in order to early identify at risk populations and individuals, who should be referred to seek professional support. However, appropriate tools for efficient real-time monitoring of stress responses and early screening for possibly pathological reactions among healthcare workers are currently lacking. Available tools focus either on tracking of stress indicators e.g. sleep disturbances, or on teaching strategies to better cope with stress e.g. mindfulness.

In this study, the investigators will test whether a separate use or a combination of these different functions may be the most efficient in managing work-related stress symptoms among healthcare workers. The study has a factorial design in order to closely investigate the functionalities focused on real-time monitoring of emotional responses and the functionalities based on evidence-based strategies to improve workers' recovery, as well as the possible interactions among them.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 330

Inclusion Criteria

adult participants
working (active employment)

Exclusion Criteria

no active employment e.g. sick leave, maternity leave during the entire period of an intervention (four weeks)

Study Type: INTERVENTIONAL

Study Design: FACTORIAL

Arm && Interventions

Group	Intervention	Description
Condition 26: Positive: yes; Workload: no; Controllability: no; Open: yes; Prompt: yes;	The DIARY mobile application	Component list: 1. Questions about positive emotions: included; 2. Questions about workload/work environment: not included; 3. Questions about controllability: not included; 4. Questions with open answers: included; 5. Behavioral prompts: included;
Condition 4: Positive: yes; Workload: yes; Controllability: no; Open: no; Prompt: no;	The DIARY mobile application	Component list: 1. Questions about positive emotions: included; 2. Questions about workload/work environment: included; 3. Questions about controllability: not included; 4. Questions with open answers: not included; 5. Behavioral prompts: not included;
Condition 8: Positive: yes; Workload: yes; Controllability: yes; Open: no; Prompt: no;	The DIARY mobile application	Component list: 1. Questions about positive emotions: included; 2. Questions about workload/work environment: included; 3. Questions about controllability: included; 4. Questions with open answers: not included; 5. Behavioral prompts: not included;
Condition 10: Positive: yes; Workload: no; Controllability: no; Open: yes; Prompt: no;	The DIARY mobile application	Component list: 1. Questions about positive emotions: included; 2. Questions about workload/work environment: not included; 3. Questions about controllability: not included; 4. Questions with open answers: included; 5. Behavioral prompts: not included;
Condition 14: Positive: yes; Workload: no; Controllability: yes; Open: yes; Prompt: no;	The DIARY mobile application	Component list: 1. Questions about positive emotions: included; 2. Questions about workload/work environment: not included; 3. Questions about controllability: included; 4. Questions with open answers: included; 5. Behavioral prompts: not included;
Condition 5: Positive: no; Workload: no; Controllability: yes; Open: no; Prompt: no;	The DIARY mobile application	Component list: 1. Questions about positive emotions: not included; 2. Questions about workload/work environment: not included; 3. Questions about controllability: included; 4. Questions with open answers: not included; 5. Behavioral prompts: not included;
Condition 7: Positive: no; Workload: yes; Controllability: yes; Open: no; Prompt: no;	The DIARY mobile application	Component list: 1. Questions about positive emotions: not included; 2. Questions about workload/work environment: included; 3. Questions about controllability: included; 4. Questions with open answers: not included; 5. Behavioral prompts: not included;
Condition 11: Positive: no; Workload: yes; Controllability: no; Open: yes; Prompt: no;	The DIARY mobile application	Component list: 1. Questions about positive emotions: not included; 2. Questions about workload/work environment: included; 3. Questions about controllability: not included; 4. Questions with open answers: included; 5. Behavioral prompts: not included;
Condition 2: Positive: yes; Workload: no; Controllability: no; Open: no; Prompt: no;	The DIARY mobile application	Component list: 1. Questions about positive emotions: included; 2. Questions about workload/work environment: not included; 3. Questions about controllability: not included; 4. Questions with open answers: not included; 5. Behavioral prompts: not included;
Condition 6: Positive: yes; Workload: no; Controllability: yes; Open: no; Prompt: no;	The DIARY mobile application	Component list: 1. Questions about positive emotions: included; 2. Questions about workload/work environment: not included; 3. Questions about controllability: included; 4. Questions with open answers: not included; 5. Behavioral prompts: not included;
Condition 9: Positive: no; Workload: no; Controllability: no; Open: yes; Prompt: no;	The DIARY mobile application	Component list: 1. Questions about positive emotions: not included; 2. Questions about workload/work environment: not included; 3. Questions about controllability: not included; 4. Questions with open answers: included; 5. Behavioral prompts: not included;
Condition 13: Positive: no; Workload: no; Controllability: yes; Open: yes; Prompt: no;	The DIARY mobile application	Component list: 1. Questions about positive emotions: not included; 2. Questions about workload/work environment: not included; 3. Questions about controllability: included; 4. Questions with open answers: included; 5. Behavioral prompts: not included;
Condition 16: Positive: yes; Workload: yes; Controllability: yes; Open: yes; Prompt: no;	The DIARY mobile application	Component list: 1. Questions about positive emotions: included; 2. Questions about workload/work environment: included; 3. Questions about controllability: included; 4. Questions with open answers: included; 5. Behavioral prompts: not included;
Condition 1: Positive: no; Workload: no; Controllability: no; Open: no; Prompt: no;	The DIARY mobile application	Component list: 1. Questions about positive emotions: not included; 2. Questions about workload/work environment: not included; 3. Questions about controllability: not included; 4. Questions with open answers: not included; 5. Behavioral prompts: not included;
Condition 3: Positive: no; Workload: yes; Controllability: no; Open: no; Prompt: no;	The DIARY mobile application	Component list: 1. Questions about positive emotions: not included; 2. Questions about workload/work environment: included; 3. Questions about controllability: not included; 4. Questions with open answers: not included; 5. Behavioral prompts: not included;
Condition 12: Positive: yes; Workload: yes; Controllability: no; Open: yes; Prompt: no;	The DIARY mobile application	Component list: 1. Questions about positive emotions: included; 2. Questions about workload/work environment: included; 3. Questions about controllability: not included; 4. Questions with open answers: included; 5. Behavioral prompts: not included;
Condition 15: Positive: no; Workload: yes; Controllability: yes; Open: yes; Prompt: no;	The DIARY mobile application	Component list: 1. Questions about positive emotions: not included; 2. Questions about workload/work environment: included; 3. Questions about controllability: included; 4. Questions with open answers: included; 5. Behavioral prompts: not included;
Condition 18: Positive: yes; Workload: no; Controllability: no; Open: no; Prompt: yes;	The DIARY mobile application	Component list: 1. Questions about positive emotions: included; 2. Questions about workload/work environment: not included; 3. Questions about controllability: not included; 4. Questions with open answers: not included; 5. Behavioral prompts: included;
Condition 19: Positive: no; Workload: yes; Controllability: no; Open: no; Prompt: yes;	The DIARY mobile application	Component list: 1. Questions about positive emotions: not included; 2. Questions about workload/work environment: included; 3. Questions about controllability: not included; 4. Questions with open answers: not included; 5. Behavioral prompts: included;
Condition 21: Positive: no; Workload: no; Controllability: yes; Open: no; Prompt: yes;	The DIARY mobile application	Component list: 1. Questions about positive emotions: not included; 2. Questions about workload/work environment: not included; 3. Questions about controllability: included; 4. Questions with open answers: not included; 5. Behavioral prompts: included;
Condition 29: Positive: no; Workload: no; Controllability: yes; Open: yes; Prompt: yes;	The DIARY mobile application	Component list: 1. Questions about positive emotions: not included; 2. Questions about workload/work environment: not included; 3. Questions about controllability: included; 4. Questions with open answers: included; 5. Behavioral prompts: included;
Condition 30: Positive: yes; Workload: no; Controllability: yes; Open: yes; Prompt: yes;	The DIARY mobile application	Component list: 1. Questions about positive emotions: included; 2. Questions about workload/work environment: not included; 3. Questions about controllability: included; 4. Questions with open answers: included; 5. Behavioral prompts: included;
Condition 17: Positive: no; Workload: no; Controllability: no; Open: no; Prompt: yes;	The DIARY mobile application	Component list: 1. Questions about positive emotions: not included; 2. Questions about workload/work environment: not included; 3. Questions about controllability: not included; 4. Questions with open answers: not included; 5. Behavioral prompts: included;
Condition 24: Positive: yes; Workload: yes; Controllability: yes; Open: no; Prompt: yes;	The DIARY mobile application	Component list: 1. Questions about positive emotions: included; 2. Questions about workload/work environment: included; 3. Questions about controllability: included; 4. Questions with open answers: not included; 5. Behavioral prompts: included;
Condition 25: Positive: no; Workload: no; Controllability: no; Open: yes; Prompt: yes;	The DIARY mobile application	Component list: 1. Questions about positive emotions: not included; 2. Questions about workload/work environment: not included; 3. Questions about controllability: not included; 4. Questions with open answers: included; 5. Behavioral prompts: included;
Condition 20: Positive: yes; Workload: yes; Controllability: no; Open: no; Prompt: yes;	The DIARY mobile application	Component list: 1. Questions about positive emotions: included; 2. Questions about workload/work environment: included; 3. Questions about controllability: not included; 4. Questions with open answers: not included; 5. Behavioral prompts: included;
Condition 22: Positive: yes; Workload: no; Controllability: yes; Open: no; Prompt: yes;	The DIARY mobile application	Component list: 1. Questions about positive emotions: included; 2. Questions about workload/work environment: not included; 3. Questions about controllability: included; 4. Questions with open answers: not included; 5. Behavioral prompts: included;
Condition 28: Positive: yes; Workload: yes; Controllability: no; Open: yes; Prompt: yes;	The DIARY mobile application	Component list: 1. Questions about positive emotions: included; 2. Questions about workload/work environment: included; 3. Questions about controllability: not included; 4. Questions with open answers: included; 5. Behavioral prompts: included;
Condition 31: Positive: no; Workload: yes; Controllability: yes; Open: yes; Prompt: yes;	The DIARY mobile application	Component list: 1. Questions about positive emotions: not included; 2. Questions about workload/work environment: included; 3. Questions about controllability: included; 4. Questions with open answers: included; 5. Behavioral prompts: included;
Condition 23: Positive: no; Workload: yes; Controllability: yes; Open: no; Prompt: yes;	The DIARY mobile application	Component list: 1. Questions about positive emotions: not included; 2. Questions about workload/work environment: included; 3. Questions about controllability: included; 4. Questions with open answers: not included; 5. Behavioral prompts: included;
Condition 27: Positive: no; Workload: yes; Controllability: no; Open: yes; Prompt: yes;	The DIARY mobile application	Component list: 1. Questions about positive emotions: not included; 2. Questions about workload/work environment: included; 3. Questions about controllability: not included; 4. Questions with open answers: included; 5. Behavioral prompts: included;
Condition 32: Positive: yes; Workload: yes; Controllability: yes; Open: yes; Prompt: yes;	The DIARY mobile application	Component list: 1. Questions about positive emotions: included; 2. Questions about workload/work environment: included; 3. Questions about controllability: included; 4. Questions with open answers: included; 5. Behavioral prompts: included;

Primary Outcome Measures

Name	Time	Method
Emotional exhaustion delayed effect	A month after completed intervention	Emotional exhaustion is measured using Shirom-Melamed Burnout questionnaire (SMBQ), a 22-item instrument designed to assess burnout: Shirom, A., \& Melamed, S. (2006). A comparison of the construct validity of two burnout measures in two groups of professionals. International journal of stress management, 13(2), 176. This study uses the SMBQ-6, a subset of six items, specifically measuring emotional exhaustion. A Swedish version is used for this study: Lundgren-Nilsson, Å., Jonsdottir, I. H., Pallant, J., \& Ahlborg, G. (2012). Internal construct validity of the Shirom-Melamed Burnout questionnaire (SMBQ). BMC public health, 12(1), 1. Items are scored on a 7-point Likert scale (1 = Very rarely, 7 = Very frequently).
Emotional exhaustion immediate effect	Immediately post-intervention	Emotional exhaustion is measured using Shirom-Melamed Burnout questionnaire (SMBQ), a 22-item instrument designed to assess burnout: Shirom, A., \& Melamed, S. (2006). A comparison of the construct validity of two burnout measures in two groups of professionals. International journal of stress management, 13(2), 176. This study uses the SMBQ-6, a subset of six items, specifically measuring emotional exhaustion. A Swedish version is used for this study: Lundgren-Nilsson, Å., Jonsdottir, I. H., Pallant, J., \& Ahlborg, G. (2012). Internal construct validity of the Shirom-Melamed Burnout questionnaire (SMBQ). BMC public health, 12(1), 1. Items are scored on a 7-point Likert scale (1 = Very rarely, 7 = Very frequently).
Stress symptoms immediate effect	Immediately post-intervention	Stress is measured using the Perceived Stress Scale (PSS), designed to measure "the degree to which situations in one´s life are appraised as stressful" (Cohen, S., Kamarck, T., \& Mermelstein, R. \[1983\]. A global measure of perceived stress. Journal of health and social behavior, 385-396). The original scale contains 14 items, and this study uses the PSS-10 version which contains 10 items. A Swedish translation of the scale is used: Nordin, M., \& Nordin, S. (2013). Psychometric evaluation and normative data of the Swedish version of the 10-item perceived stress scale. Scandinavian journal of psychology, 54(6), 502-507. The items are scored on a 5-point Likert scale (1 = Never, 5 = Very often).
Burnout symptoms immediate effect	Immediately post-intervention	Burnout is measured using Oldenburg Burnout Inventory (Olbi), an instrument designed to measure exhaustion and disengagement: (Demerouti, E, Bakker, A.B, Vardakou, I, \& Kantas, A. \[2003\]. The convergent validity of two burnout instruments : a multitrait-multimethod analysis. European Journal of Psychological Assessment : Official Organ of the European Association of Psychological Assessment, 19(1), 12-23. https://doi.org/10.1027//1015-5759.19.1.12) The full Olbi scale consists of twelve items, and this study uses a subset of seven items. The study uses a Swedish version: Gustavsson, J. P., Hallsten, L., \& Rudman, A. (2010). Early career burnout among nurses: modelling a hypothesized process using an item response approach. International Journal of Nursing Studies, 47(7), 864-875. The items are scored on a 4-point Likert scale (1 = Not at all, 4 = Exactly).
Burnout symptoms delayed effect	A month after completed intervention	Burnout is measured using Oldenburg Burnout Inventory (Olbi), an instrument designed to measure exhaustion and disengagement: (Demerouti, E, Bakker, A.B, Vardakou, I, \& Kantas, A. \[2003\]. The convergent validity of two burnout instruments : a multitrait-multimethod analysis. European Journal of Psychological Assessment : Official Organ of the European Association of Psychological Assessment, 19(1), 12-23. https://doi.org/10.1027//1015-5759.19.1.12) The full Olbi scale consists of twelve items, and this study uses a subset of seven items. The study uses a Swedish version: Gustavsson, J. P., Hallsten, L., \& Rudman, A. (2010). Early career burnout among nurses: modelling a hypothesized process using an item response approach. International Journal of Nursing Studies, 47(7), 864-875. The items are scored on a 4-point Likert scale (1 = Not at all, 4 = Exactly).
Stress symptoms delayed effect	A month after completed intervention	Stress is measured using the Perceived Stress Scale (PSS), designed to measure "the degree to which situations in one´s life are appraised as stressful" (Cohen, S., Kamarck, T., \& Mermelstein, R. \[1983\]. A global measure of perceived stress. Journal of health and social behavior, 385-396). The original scale contains 14 items, and this study uses the PSS-10 version which contains 10 items. A Swedish translation of the scale is used: Nordin, M., \& Nordin, S. (2013). Psychometric evaluation and normative data of the Swedish version of the 10-item perceived stress scale. Scandinavian journal of psychology, 54(6), 502-507. The items are scored on a 5-point Likert scale (1 = Never, 5 = Very often).

Secondary Outcome Measures

Name	Time	Method
Post-traumatic stress immediate effect	Immediately post-intervention	PTSD is measured using the Posttraumatic Stress Disorder checklist (PCL-5), a widely used self-report measure of PTSD using criteria from the DSM-5 (Bovin, M. J., Marx, B. P., Weathers, F. W., Gallagher, M. W., Rodriguez, P., Schnurr, P. P., \& Keane, T. M. \[2015\]. Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5) in Veterans. Psychological Assessment, 28, 1379-1391. doi:10.1037/pas0000254). The entire scale contains 20 items, and a subset of three items is used for this study. A Swedish version is used. Items are scored on a 5-item Likert scale (1 = A lot, 5 = Not at all).
Controllability delayed effect	A month after completed intervention	Controllability is measured using the "control" subscale from the Recovery Experience Questionnaire (REQ) (Sonnentag, S., \& Fritz, C. \[2007\]. The Recovery Experience Questionnaire: development and validation of a measure for assessing recuperation and unwinding from work. Journal of occupational health psychology, 12(3), 204). This subscale includes 4 items that are scored on a 5-point Likert scale (1 = Not at all, 5 = Very much). A Swedish version is used. To measure controllability in the work context, the study also uses the Task Crafting subscale from the Job Crafting Questionnaire (Slemp, G. R., \& Vella-Brodrick, D. A. \[2013\]. The Job Crafting Questionnaire: A new scale to measure the extent to which employees engage in job crafting. International Journal of wellbeing, 3(2)). A Swedish version is used. This subscale includes 7 items scored on a 5-point Likert scale (1 = Hardly ever, 5 = Very often).
Social support immediate effect	Immediately post-intervention	Questions regarding the degree to which participants engage with their social context for emotional support. We use the Relation Crafting subscale from the Job Crafting Questionnaire: (Slemp, G. R., \& Vella-Brodrick, D. A. (2013). The Job Crafting Questionnaire: A new scale to measure the extent to which employees engage in job crafting. International Journal of wellbeing, 3(2)). The subscale includes 7 items scored on a 5-point Likert scale (1 = Hardly ever, 5 = Very often).
Anxiety symptoms immediate effect	Immediately post-intervention	Anxiety is measured using the GAD-7 scale, a 7-item questionnaire designed to assess generalized anxiety disorder (Spitzer, R. L., Kroenke, K., Williams, J. B., \& Löwe, B. \[2006\]. A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of internal medicine, 166(10), 1092-1097). A Swedish version of the scale will be used. The items are scored on a 4-point Likert scale (1 = Not at all, 4 = Almost every day).
Emotional awareness delayed effect	A month after completed intervention	Awareness of emotions is measured using Mindful Attention Awareness Scale (MAAS) (Brown, K. W., \& Ryan, R. M. \[2009\]. The Mindfulness Attention Awareness Scale (MAAS). Acceptance and Commitment Therapy. Measures Package, 82). This study uses a subset of six questions, focusing on emotional awareness. A Swedish version is used in this study. Items are rated on a 6-point Likert scale (1 = Very frequently, 6 = Very rarely).
Depressive symptoms delayed effect	A month after completed intervention	Depressive symptoms are measured using the Patient Health Questionnaire-2 (PHQ-2), a 2-item screening tool for assessing depression (Kroenke, K., Spitzer, R. L., \& Williams, J. B. \[2003\]. The Patient Health Questionnaire-2: validity of a two-item depression screener. Medical care, 1284-1292). A Swedish translation is used. The items are scored on a 4-point Likert scale (1 = Not at all, 4 = Almost every day)
Recovery experience immediate effect	Immediately post-intervention	Questions regarding the degree to which participants engage in behavioral recovery strategies, for instance spending time on a hobby or letting go of work-related thoughts. This is measured using the Recovery Experience Questionnaire (REQ) (Sonnentag, S., \& Fritz, C. \[2007\]. The Recovery Experience Questionnaire: development and validation of a measure for assessing recuperation and unwinding from work. Journal of occupational health psychology, 12(3), 204). The study uses two subscales - psychological detachment and relaxation, resulting in 8 items. Items are scored on a 5-point Likert scale (1 = Not at all, 5 = Very much). A Swedish version is used.
Anxiety symptoms delayed effect	A month after completed intervention	Anxiety is measured using the GAD-7 scale, a 7-item questionnaire designed to assess generalized anxiety disorder (Spitzer, R. L., Kroenke, K., Williams, J. B., \& Löwe, B. \[2006\]. A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of internal medicine, 166(10), 1092-1097). A Swedish version of the scale will be used. The items are scored on a 4-point Likert scale (1 = Not at all, 4 = Almost every day).
Depressive symptoms immediate effect	Immediately post-intervention	Depressive symptoms are measured using the Patient Health Questionnaire-2 (PHQ-2), a 2-item screening tool for assessing depression (Kroenke, K., Spitzer, R. L., \& Williams, J. B. \[2003\]. The Patient Health Questionnaire-2: validity of a two-item depression screener. Medical care, 1284-1292). A Swedish translation is used. The items are scored on a 4-point Likert scale (1 = Not at all, 4 = Almost every day)
Post-traumatic stress delayed effect	A month after completed intervention	PTSD is measured using the Posttraumatic Stress Disorder checklist (PCL-5), a widely used self-report measure of PTSD using criteria from the DSM-5 (Bovin, M. J., Marx, B. P., Weathers, F. W., Gallagher, M. W., Rodriguez, P., Schnurr, P. P., \& Keane, T. M. \[2015\]. Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5) in Veterans. Psychological Assessment, 28, 1379-1391. doi:10.1037/pas0000254). The entire scale contains 20 items, and a subset of three items is used for this study. A Swedish version is used. Items are scored on a 5-item Likert scale (1 = A lot, 5 = Not at all).
Emotional awareness immediate effect	Immediately post-intervention	Awareness of emotions is measured using Mindful Attention Awareness Scale (MAAS) (Brown, K. W., \& Ryan, R. M. \[2009\]. The Mindfulness Attention Awareness Scale (MAAS). Acceptance and Commitment Therapy. Measures Package, 82). This study uses a subset of six questions, focusing on emotional awareness. A Swedish version is used in this study. Items are rated on a 6-point Likert scale (1 = Very frequently, 6 = Very rarely).
Controllability immediate effect	Immediately post-intervention	Controllability is measured using the "control" subscale from the Recovery Experience Questionnaire (REQ) (Sonnentag, S., \& Fritz, C. \[2007\]. The Recovery Experience Questionnaire: development and validation of a measure for assessing recuperation and unwinding from work. Journal of occupational health psychology, 12(3), 204). This subscale includes 4 items that are scored on a 5-point Likert scale (1 = Not at all, 5 = Very much). A Swedish version is used. To measure controllability in the work context, the study also uses the Task Crafting subscale from the Job Crafting Questionnaire (Slemp, G. R., \& Vella-Brodrick, D. A. \[2013\]. The Job Crafting Questionnaire: A new scale to measure the extent to which employees engage in job crafting. International Journal of wellbeing, 3(2)). A Swedish version is used. This subscale includes 7 items scored on a 5-point Likert scale (1 = Hardly ever, 5 = Very often).
Recovery experience delayed effect	A month after completed intervention	Questions regarding the degree to which participants engage in behavioral recovery strategies, for instance spending time on a hobby or letting go of work-related thoughts. This is measured using the Recovery Experience Questionnaire (REQ) (Sonnentag, S., \& Fritz, C. \[2007\]. The Recovery Experience Questionnaire: development and validation of a measure for assessing recuperation and unwinding from work. Journal of occupational health psychology, 12(3), 204). The study uses two subscales - psychological detachment and relaxation, resulting in 8 items. Items are scored on a 5-point Likert scale (1 = Not at all, 5 = Very much). A Swedish version is used.
Social support delayed effect	A month after completed intervention	Questions regarding the degree to which participants engage with their social context for emotional support. We use the Relation Crafting subscale from the Job Crafting Questionnaire: (Slemp, G. R., \& Vella-Brodrick, D. A. (2013). The Job Crafting Questionnaire: A new scale to measure the extent to which employees engage in job crafting. International Journal of wellbeing, 3(2)). The subscale includes 7 items scored on a 5-point Likert scale (1 = Hardly ever, 5 = Very often).

Trial Locations

Locations (1): Aleksandra Sjostrom-Bujacz
🇸🇪
Stockholm, Sweden

The Use of a Mobile Application to Reduce Work-related Stress Symptoms Among Healthcare Workers

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