JMIR Publications

ABSTRACT

Background:

Research has found internet-based stress management training programs (iSMT) to be efficacious. However, real-world uptake remains low and the implementation of Occupational eMental health in-terventions appears complex. Brief and scalable acceptance-facilitating interventions (AFIs) targeting stressed employees were discussed among facilitators. This randomized controlled trial (RCT) examined the effects of AFIs with different components on German employees’ intention to use an evidence-based iSMT.

Objective:

This study’s aim was to compare the incremental effect of personalized feedback with and without additional information about the expected stress reduction of participating in an iSMT against an in-formational video alone on employees' intention to use an evidence-based iSMT. We also explored determinants of such intention, utilizing the Unified Theory of Acceptance and Use of Technology (UTAUT).

Methods:

In a four-arm, parallel-group online RCT, 1,938 working adults from the general population (age: M=45.0, SD=12.7; female: 50.6%) were randomized to single or multicomponent AFIs: (A) video only; (B) video and stress assessment; (C) video, stress assessment, and automated feedback; or (D) video, stress assessment, and automated feedback with information on the expected benefit. The primary outcome was intention to use the iSMT within 6 months (0–100% scale) among participants with ele-vated stress. Elevated stress was defined as a Perceived Stress Scale-10 (PSS-10) score ≥15.

Results:

Higher perceived stress was associated with higher intention to use the iSMT (1.55 point increase per stress-point increase; p < .01). Participants with elevated stress (n = 864; 59.3 %) reporting substantially higher intentions than those below the threshold. Intentions did not differ between participants who received the video alone (group A) and those receiving the video plus stress assessment (group B). Among stressed participants, there was no difference in intentions between those who received the video plus stress assessment (group B) and those who received additional feedback (group C). However, participants in group D, who received information about the expected benefits, reported significantly higher intentions than those in group B (mean difference = 5.3 points; d = 0.17; p = .047). In regression analyses, performance expectancy, effort expectancy, risk perception, stress level, female gender, higher education, and recent use of stress-related services were associated with higher intentions.

Conclusions:

Stressed employees had higher intensions to use an iSMT program than those without stress. A multi-component AFI, that includes evidence-based information about the expected benefit of participating in iSMT can increase stressed employees' intention to use the iSMT program. However, the intention to use a proven stress management training program is strongly influenced by UTAUT-related determi-nants, like performance and effort expectancy. Future studies should investigate whether benefit in-formation works through chaining performance expectancy and whether other components, address-ing effort expectancy or risk perception, could increase intention further. Clinical Trial: Prospective OSF registration: February 28, 2023, https://osf.io/3wfr6