Multi-level health-promoting interventions: what did participating organisations need and how effective were the H-WORK interventions in responding to these needs?

by NTNU team

Work Package 3 (“COLLECT”) was interested in answering two key questions: (1) What are participating organisations’ (i.e., public and small to medium enterprises) needs in relation to promoting mental health and well-being, and (2) how effective the selected multi-level interventions were in addressing these needs.

For this reason, the H-WORK Assessment Tool (HAT) was developed.

The tool consists of two parts: needs assessment and evaluation. Whereas the needs assessment tool primarily relies on focus groups and semi-structured interviews, the evaluation tool primarily relies on structured questionnaires to collect data. The evaluation tool contained both distal (i.e., indirect and causally far) and proximal (i.e., direct causally close) outcome measures. It was administered thrice (i.e., before, just after the intervention, and again after six months). In this way, we could measure improvement from a baseline and determine the sustainability of these improvements over time.

Concerning our first question, results indicated that the needs of the organisations differed. However, all participants wanted to preserve elements at the individual (e.g., autonomy and balance with personal life), group (e.g., cohesive and supportive teams, transparency and horizontal trust among workers, psychological safety), leader (e.g., support, trust, and communication), and organisational (e.g., mental health awareness and involvement and a “people first mindset”) levels. Similarly, they identified several elements they would like to improve at the individual (e.g., emotional distress, work pressure, and mental health awareness), group (e.g., intra-team and inter-departmental team building programmes), leader (e.g., skills training, recognition, and awareness and sensibility when dealing with mentally stressed and/or ill employees.), and organisational (e.g., improving organisational practices like overtime, career planning and development, wellness policy, and work-life balance) levels.

Considering these needs, different interventions were suggested through a stakeholder meeting, including all organisational stakeholders and implemented after consultation.

At the time of reporting, five European organisations implemented 18 interventions.

Following these interventions (and concerning our second question), results indicated that sustained changes in knowledge about mental health management among leaders, team support, and mental health (e.g., work engagement) were absent. However, there were no increases in mental ill-health (e.g., burnout, stress, and depression) and stigma. Participants were, therefore, not worse off in terms of their mental health and well-being as they reported non-significant changes in mental ill-health and ill-being. The results also shed some light on the potential spillover effect of the H-WORK interventions. By splitting the group into two to compare those who indicated they actively participated in the intervention with those who stated that they did not actively participate in the interventions, we concluded that these two groups did not differ significantly from each. Both these groups reported no changes in important health and well-being indicators but also that their mental ill-health and ill-being did not increase. Results illustrate that those who did not actively participate in the intervention may still have benefitted from their colleagues’ participation as their mental ill-health and ill-being also did not decline. Overall, our findings suggest that multi-level interventions are promising for countering adverse outcomes, especially in the presence of detrimental external events, such as a pandemic. As most of these interventions (and needs analyses) were online due to the pandemic, our work illustrates the potential of this modality in managing employee well-being in an increasingly digital workspace.

Intriguingly, the effect evaluation indicated that the interventions were less impactful for the positive components of mental health, well-being, and performance than we initially anticipated. Several explanations could be offered, including the pandemic, its associated lockdowns, and organisational changes that may have limited the effectiveness of these interventions. However, given that more than four in ten respondents across the European Union indicated that their mental health and well-being worsened because of the pandemic, it is encouraging to see that the H-WORK participants’ mental health and well-being and performance did not decline, and their absenteeism did not increase. In light of the pandemic, a non-significant change could be seen as a positive outcome of the buffering potential of the H-WORK interventions.

Furthermore, as the participating organisations could not implement organisational-level interventions for various reasons, the results could emphasise that organisational-level interventions are needed in addition to interventions only targeting the individual, group, or team level. Even more so because the need for organisational-level interventions was identified during the needs analysis. Furthermore, researchers suggest that participation in more than one intervention on different levels is more likely to lead to changes in mental health and well-being. For example, participating in an individual- and group-level intervention. We were, however, pleasantly surprised by the spillover effect on those who did not actively participate in the interventions.

From a practical perspective, our work illustrates the value-add of a comprehensive needs analysis that aims to identify needs at multiple levels of the organisation, and that includes key stakeholders who know and are affected by mental health and well-being issues. Such a participatory approach to needs analyses ensures the use of key stakeholders’ local knowledge of the critical issues throughout the organisation, what changes need to be made, and how they feel valued, empowered, and taken care of. Our work also illustrates that we need multi-level, health-promoting interventions because they protect against mental ill-health and ill-being. Even more so during challenging times. Therefore, organisations should focus on interventions at the individual, group, leader, and organisational levels, and employees should ideally participate in interventions at more than one level.

We want to encourage readers to keep an eye out for some interesting future developments.

These developments will include information regarding the use of the (digitalised) needs analysis tool in targeting needs at different levels (i.e., individual, group, leader, and organisation), including the benefits of a participatory approach to needs analysis. We also aim to replicate the analyses for the effect evaluation and update our findings once the second group of organisations have completed their interventions. We will also investigate and report on contextual (e.g., opportunities to integrate learning, social support, and work demands and resources) elements that could provide valuable insights into our findings. These elements explain for whom these interventions work (or not) and under which circumstances. They also influence the mechanisms that make these interventions work. Such an approach to identify context-mechanism-outcome configurations ties in with a realist evaluation and goes beyond asking whether an intervention works. We are also interested in combining the quantitative results of the effect evaluation with qualitative findings to draw definitive conclusions regarding the effectiveness and workings of the interventions.