Accepted for/Published in: JMIR Formative Research
Date Submitted: May 20, 2025
Date Accepted: Apr 2, 2026
Digital Health Monitoring and Intervention Suite for Stress (DHMI-S) in Frontline Nurses: A Prospective Cohort Trial
ABSTRACT
Background:
Stress contributes to choric physical and mental health issues, especially in frontline healthcare workers. Recent advancements in technology and digital interventions provide new opportunities for monitoring and eliciting stress among users.
Objective:
This study examines the efficacy of our multimodal digital health monitoring and intervention suite for stress (DHMI-S) where we evaluated: (1) the impact of a VR simulation and psychoeducational intervention on stress outcomes; (2) the relationship between data collected using the DHMI-S and mental health outcomes.
Methods:
This study evaluated a Digital Health Monitoring and Intervention suite for Stress (DHMI-S), which included a stressful VR simulation, psychoeducation, ecological momentary assessments, and a wearable device. Following the Medical Research Council’s guidelines for complex interventions, a single-arm prospective cohort trial was conducted with 99 healthcare workers and registered on ClinicalTrials.gov (NCT05923398; December 20, 2022). An engagement strategy was employed to encourage data completeness.
Results:
After a two-week pre-intervention phase, participants experienced two VR stress simulations separated by psychoeducation. The VR simulation effectively induced stress, indicated by subjective reports and increased distress scores (p<0.0001). Stress responses were lower in the second VR run (p<0.0001), though heart rate variability remained unchanged. Post-VR assessments showed reduced stress and anxiety at two weeks but not 12 weeks. High data completion rates (>90%) support the DHMI-S’ feasibility for continuous stress monitoring. However, the absence of a control group limits causal conclusions, underscoring the need for randomized trials.
Conclusions:
Supported by the obtained results, the DHMI-S is feasible for continuous stress monitoring and providing psychoeducational interventions within the VR environment. The DHMI-S is suitable for monitoring through wearables and frequent EMAs for a holistic approach to mental health. Clinical Trial: NCT05923398; December 20, 2022
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