Author(s): Ellis Lourijsen, Irene Houtman, Michiel Kompier and Robert Grundemann                 Level of Intervention:  Primary

Is the intervention sector specific?

Is the intervention usable with different enterprise sizes?

Is the intervention equally applicable to both genders?

Is the intervention based on theory?

Can the intervention approach be adapted/ tailored?

Does the intervention promote CSR and how?

Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Overview (including risk assessment and law – legal requirements etc.):

In the Netherlands, work stress has been an important policy issue. It was in 1990, with the enforcement of Article 3 of the Working Conditions Act that work stress became a high priority. This legislation has also promoted risk management at source. Since 1994 the legislation on Working Conditions for amended to fit the European Framework Directive (89/391/EEC), this resulted in more responsibility for employers and employees with respect to risk management and social security aspects. The shift to preventive action is considered effective by many practitioners as well many employers.

Under this legislative framework, a tailor-made and step-by step strategy for risk prevention and management was implemented at in a hospital employing around 850 people in five sectors with the aim of reducing the high absenteeism rates reported. Based on the idea that a risk prevention strategy can only work if it is supported by the entire organisation, a steering committee with a broad based composition was selected to carry out the project. The ‘Healthy Working for Health’ steering committee comprised: the head of the care sector (also chair person), the head of personnel affairs, two supervisory staff members, the organisational expert, a work council member, a nurse, and an operational member of the radiology department and two consultants. The steering committee was responsible for the implementation and progress of the project programme.

Implementation:

From the start, the project programme was integrated into the hospital’s normal working conditions policy. To create support for the project an initial meeting was organised with the complete workforce to explain the goals and structure of the project. To gain a general impression of the problems at work in the hospital, a limited number of staff (all levels), known as ‘key respondents’, were interviewed using existing checklists on job content and organisation of work, on working conditions, on social relations at work and on terms of employment. The interviews were followed up with an organisation wide survey (questionnaire used was based on validated instruments) to analyse stress and health problems in more details. On the basis of the survey, a number of positions were selected for further analysis using the WEBA (Dutch abbreviation for Well-being at work). This method can be used to determine job-related stress risks and learning and developing opportunities. The WEBA method complies with the provisions of Section 3 of the Dutch Working Environment Act.

The results of the survey revealed that there were a number of organisation- related problems, which lead to organisation related and sector-specific health complaints. Although no direct statistical relationship and absenteeism could be demonstrated, the literature on absenteeism suggested that the organisational problems were likely to influence it. Consequently, the choice of measures was based on a ‘multi-track’ policy aimed at both the improvement of working conditions and employee’s physical and mental health, and the intensification of inspection and absentees. An approach that combines three types of measures and positively influences employees’ health and well-being in a more structured manner is an instance of integrated health promotion. Such an approach intends to go further than solely removing health hazards at the workplace.

In order to arrive at a coordinated set of measures, the steering committee first examined the question whether the problems identified could be solved. The criteria used were: whether the cause of the problem was sufficiently clear, what measures could the hospital take, the cost of such measures and the expected (additional) yield. Following this examination, the committee decided to start sub-projects (interventions) to address work pressure, interior climate, physical load, provision of information, working hours and rosters, training and career opportunities, managerial style and lifestyle. The purpose of the sub-projects was to further elaborate and implement measures and solutions. The sequence of the interventions was mainly determined by the clarity of the solutions and time and manpower available to carry out the sub-projects. Each intervention was assigned a steering committee member as a coordinator. Responsibility for the implementation of each intervention was given to a single project group and the progress and coordination of the intervention was monitored by the steering committee.

Practical applications:

The intervention requires external expertise to initiate the process, but the programme is flexible as it relies on in-house expertise in the form of employees and management of the organisation to design and implement the interventions. Such a programme is easily applicable in most large companies across industrial sectors.

Innovative aspects:

The programme uses the WEBA method, which can be used to determine job-related stress risks and learning and developing opportunities. It complies with the local legislative provisions (in this case) Section 3 of the Dutch Working Environment Act). It also allows rules for improvement to be inferred.

Evaluation (including process issues, outcomes and sustainability):
 

The programme was evaluated for a period of 6 months post implementation of the interventions. It involved a repetition of the survey, an analysis of the absenteeism data and cost benefit analysis. Results indicated that the employees expressed significantly fewer complaints related to aspects of job content, emotional stress and appreciation fro working environment. The survey also indicated a number of improvements in the workplace which are (possibly) associated with the measures already implemented. A significant reduction in absenteeism was also found.

Benefits (including cost effectiveness): 
 

More employees thought they were more involved in improving the work situation and were more critical of their work situation. There was a shift in the organisational culture with a move from ‘a wait-and-see attitude’ when it came to bringing about improvements, to actively engaging in bringing change. The overall programme made the employees more aware of what was going on the various departments of the hospital, which led to a better understanding of each other and a more pleasant atmosphere. A cost-benefit analysis conducted indicated an overall financial benefit. The results of the inventions were also expected to continue to bear fruit in the future.

References:

Lourijsen, E., Houtman, I., Kompier, M., and Grundeman, R. (1999). The Netherlands: A hospital, ‘Healthy working for health’. In C.L. Cooper & M. Kompier Preventing Stress, Improving Productivity: European Case Studies in the Workplace (pg85-120). London, UK: Routledge.

Comments:

Middle management felt insufficiently involved in the project, while operational personnel in the steering group could not commit adequate time to discussions. Care must be taken that members of the steering committee represent all sections of the organisations and also are able to commit adequate time to participate in the process.

Author(s):   Saskia Duijts, Ijmert Kant, Piet van den Brandt, & Gerard Swaen                     Level of Intervention:  Secondary

Is the intervention sector specific?

Is the intervention usable with different enterprise sizes?

Is the intervention equally applicable to both genders?

Is the intervention based on theory?

Can the intervention approach be adapted/ tailored?

Does the intervention promote CSR and how?

Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Overview (including risk assessment and law – legal requirements etc.):

The aim of ‘preventative coaching’ is to target employees ‘at risk’ for sickness absence due to psychosocial health complaints. It is an approach that can be used to enhance employee wellbeing and performance, and to improve overall functioning, achievement of goals, and management of stress. It aims to:

• assist individuals by promoting strengths and minimising weaknesses,

• gain a better understanding of underlying individual behaviour,

• and successfully manage changes.

   

The role of the coach, during this process, is not to provide advice or solutions; but rather to facilitate the process by attempting to improve internal reflection.

Implementation: 

The initial stage of this intervention begins by identifying those employees ‘at risk’ of sickness absence due to psychosocial health complaints; this is accomplished by using a screening instrument. Those employees identified ‘at risk’ of sickness absence are invited to participate in the preventive coaching intervention. The preventive coaching intervention consists of 7 to 9 one-hour sessions within the time period of six months. The intervention begins with an introductory interview (between coach and employee) where an outline of personal and coaching objectives are discussed and an overall problem is formulated. Following this, an introductory 3-way consultation with the employee, his/her supervisor, and the coach is conducted; outlining the aim and process of coaching. The next four to six meetings are individual meetings between the employee and the coach where underlying behavioural characteristics are identified in the employee, and methodologies and instruments are discussed and identified to help facilitate change. The programme ends with a final 3-way consultation meeting with the employee, supervisor and coach; where a discussion and overall evaluation of the coaching programme transpires. During this final meeting, future plans are outlined to support and promote the continuation of the initiated changes to the workplace setting. Following the completion of the intervention, follow up meetings are arranged with the coach to exchange experiences and provide a general update.

Practical applications:

The preventive coaching intervention has been standardized and outlined in a fully developed intervention protocol. A checklist for coaches has been developed. This checklist provides a general outline of all the main features of each session; and is a useful resource tool for the effective implementation of preventive coaching.  A trained professional is required to support the successful implementation of preventive coaching. Preventive coaching has been successfully implemented in both the healthcare and education sectors with large-scale organisations. However the authors emphasise that medium and small companies can utilize this intervention.

Innovative aspects:

This intervention provides an instrument to identify/successfully screen ‘at risk’ employees of sickness absence due to psychosocial health complaints; and provide these individuals with an early intervention in order to reduce the risk, and the overall level of sickness absence.

Evaluation (including process issues, outcomes and sustainability):

The present intervention was assessed by comparing a reference group (non-intervention group) to the intervention group; at baseline and follow up (12 months, 24 months, and 36 months).

Benefits (including cost effectiveness):

The authors conclude that preventive coaching is an appropriate intervention for employees ‘at risk’ for sickness absence. Preliminary evidence, as the evaluative research of this intervention is currently ongoing, demonstrated that preventative coaching was significantly effective at lowering sickness absence days; a reduction of 14% as compared to the control group.

References:

Duijts, S., Kant, I,  can den Brandt, P., & Swaen, G. (2007). The compatibility between characteristics of employees at risk for sickness absence and components of a preventive coaching intervention. International Journal of Evidence Based Coaching and Mentoring, 5, 19-29.

Comments:

This intervention primarily focuses on the individual level and does not consider risk sources (hazards) at the organisational level.

Author(s): Judith Sluiter, Albert P. Bos, Dirk Tol, Mart Calff, Margot Krijnen, & Monique H. W. Frings-Dresen         Level of Intervention:  Secondary

Is the intervention sector specific?

Is the intervention usable with different enterprise sizes?

Is the intervention equally applicable to both genders?

Is the intervention based on theory?

Can the intervention approach be adapted/ tailored?

Does the intervention promote CSR and how?

Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Overview (including risk assessment and law – legal requirements etc.):

The overall objective of the intervention was to enhance team communication by way of using multidisciplinary structured work shift evaluations. In so doing, by increasing and facilitating increased communication within the worksite and among work colleagues; an ‘emotional pressure valve’ during working hours would be developed resulting in stimulating recovery from work and decreasing the persistence of unnecessary worries and accompanying bodily stress reactions after working time for employees.

Implementation:

On two predetermined days per week, the remaining 30 minutes of the day shift were allocated for the multidisciplinary structured work shift evaluation within the department. During this meeting, all members of staff working on that shift gathered and assessed how well the working day went and what had occurred during the shift. These meetings were facilitated by the evaluation leader (staff members were provided training in leading these discussion) who structured the process, ensured the proper time span, guided the type of interaction between team members (i.e., ensuring a safe environment for feedback) and organised the communication (in regards to emotional events, teamwork, work roles, and organisational aspects) using predefined models of communication.

Two training courses were conducted to prepare for the implementation phase of the multidisciplinary structured work shift evaluation:

Firstly, a 1-day training course was provided for all staff members, with the overall objective of improving their interpersonal communication skills;

Secondly, a 2-day course to train eight selected staff members to supervise the structure of the multidisciplinary work shift evaluation

Practical applications:

Prior to designing the intervention a risk assessment was conducted; in so doing, it identified communication within the targeted worksite/and among various staff members as the central issues. Additionally, the administration of the two training courses was provided by a professional communication trainer. This particular intervention was implemented and evaluated in the healthcare sector; major components of the intervention were designed to address the concerns identified in the risk assessment previously conducted in the department.

Innovative aspects:

The intervention used a structured communication process using predefined communication models as a means of increasing effective communication within a multidisciplinary worksite; and thereby increasing employee health and wellbeing.

Evaluation (including process issues, outcomes and sustainability):

To assess the effectiveness of the intervention, employees were assessed prior to and following the intervention using a series of self-report questionnaires: examining (a) the quality and process of the intervention, assessed during the first 3 months of implementation; (b) the perceived effectiveness of the intervention and work organisation; and (c) staff health (ie., work-related fatigue and emotional exhaustion).

Benefits (including cost effectiveness):

Based on the results of the evaluation of the intervention, several benefits were observed:

• The improvement of team communication was reported by the majority of intervention participants.

• Emotional exhaustion problems significantly decreased during the course of the intervention.

• A trend towards a decrease in work-related fatigue was also observed.

• Almost all of the participating employees reported experiencing satisfying communication with colleagues following the intervention.

In general, the authors conclude, based on the evaluation of the collected evidence, that the multidisciplinary structured work shift evaluation was successful in improving communication and decreasing problems relating to emotional exhaustion.

References:

Sluiter, J.K., Bos, A.P., Tol, D., Calff, M., Krijnen, M., & Frings-Dresen, M.H.W. (2005). Is staff well-being and communication enhanced by multidisciplinary work shift evaluations? Intensive Care Medicine, 31, 1409-1414.

Comments:

The predefined models for communication used are as follows:

Author(s):  David S Rebergen, David J Bruinvels, Allard J van der Beek & Willem van Mechelen               Level of Intervention:  Tertiary

Is the intervention sector specific?

Is the intervention usable with different enterprise sizes?

Is the intervention equally applicable to both genders?

Is the intervention based on theory?

Can the intervention approach be adapted/ tailored?

Does the intervention promote CSR and how?

Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Overview (including risk assessment and law – legal requirements etc.):

In early 2000, the Dutch Association of Occupational Physicians (NVAB) published a set of guidelines concerning the management of employees with mental health problems by occupational physicians. These guidelines are based on national-driven evidence and aim to promote the active attitude and activating approach by occupational physicians. Specifically, the guidelines seek to teach occupational physicians how to identify and diagnose mental health problems, and in turn how to facilitate and provide early intervention by using counselling techniques, positive behavioural instruments and return to work. Within the guidelines, return to work is viewed as part of the recovery process; not solely as the desired outcome.

Implementation:

Occupational physicians were provided with training on the guidelines and in their effective implementation in a three day course.  The training course reflected the structural components of the guidelines; namely, occupational physicians were trained in multiple cognitive-behavioural prescriptive interventions (with the overall aim of promoting problem solving skills and to structure the patients’ daily activities), and were trained to diagnose mental health problems using a simplified classification system as outlined in the guidelines. Additionally, occupational physicians were trained on delivering a graded activity treatment: phase 1, educating patients on the causes and consequences of loss of control; phase 2, patients are asked to create an inventory of stressors and to develop problem solving strategies to address these stressors; and phase 3, patients are asked to put these problem solving strategies into practice and extend their activities to include more challenging and demanding ones.

Practical applications:

The guidelines are outlined and detailed in a protocol, making it easily accessible to all occupational physicians. The delivery of the training course, to further inform and develop the implementation of the guidelines, was conducted by four professionals: including an occupational physician with experience on the guidelines, a psychologist/therapist, an experienced general practitioner/researcher on emotional distress, and a psychiatrist. The guidelines have been widely distributed to all occupational physicians, in a large variety of occupational sectors; however, they have only been formally evaluated in the police force.

Innovative aspects:

The use of a non-regulatory approach in psychosocial risk management, specifically in rehabilitation of workers with mental health issues and problems; with the overall objective of facilitating increased return to work.

Evaluation (including process issues, outcomes and sustainability):

The effectiveness of the guidelines was tested by randomly assigning participants to two groups: those who were treated by occupational physicians trained in delivering treatment in accordance to the guidelines; or to a group receiving usual care, consisting of minimal involvement from the occupational physician and, if applicable, access to the services of a psychologist. These two groups were comparatively assessed on a variety of outcome measures to determine their effectiveness. The primary outcome measures used to assess the effectiveness of the guidelines were levels of depression and anxiety, return-to-work, treatment satisfaction measured in all key stakeholders (patient, employer and occupational physician), and the overall cost-effectiveness of the programme (specifically, assessing both the direct cost to health care and the indirect cost associated to the consequences of absence from work). Additionally, the compliance and adherence level of occupational physicians to the implementation guidelines was examined. Measurements were taken at four time points: pre-intervention, post-intervention, at partial/full return to work and at a one year follow up point to assess the effectiveness of the guidelines and the sustainability of the observed effects.

Benefits (including cost effectiveness):

Presented observed benefits are preliminary findings as the study and its analyses are currently on going. The observed benefits resulting from the use of the guidelines by occupational physicians in the treatment of individuals on sick-leave due to stress-related illness were:

• A significant difference can be observed in return to work. 

• Occupational physicians reported a higher level of treatment satisfaction, and preferring to work according to the guidelines.

• The guidelines were found to be more effective for minor mental health disorders (like stress related disorders); however usual care was found to be more effective for more severe disorders (in part due to the easier access to a psychologist).

The cost-effectiveness measurements suggest that the guidelines have a positive effect.

References:

Rebergen, D.S., Bruinvels, D.J., van der Beek, A.J. & van Mechelen, W. (2007). Study Protcol: Design of a Randomized Controlled trail on the effects of Counselling of Mental Health problems by Occupational Physicians on Return to Work: the Co-op Study. BMC Public Health: BioMed Central Open Access, published July 26 retrieved from http://www.biomedcentral.com/content/pdf/1471-2458-7-183.pdf

Comments:

One primary result of the preliminary investigation of the implementation and effectiveness of the guidelines was the observation that mental health problems in the workplace were highly prevalent; and, moreover, were more prevalent than previously believed by the occupational physicians.

Author(s): Sandra Oostrom, Johannes Anema, Berend Terluin, Anita Venema, Henrica deVet & Willem Mechelen        Level of Intervention:  Tertiary

Is the intervention sector specific?

Is the intervention usable with different enterprise sizes?

Is the intervention equally applicable to both genders?

Is the intervention based on theory?

Can the intervention approach be adapted/ tailored?

Does the intervention promote CSR and how?

Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Overview (including risk assessment and law – legal requirements etc.):

The intervention is designed for employees who are currently on sick leave due to or related to stress-related mental disorders; and has the overall objective of helping facilitate successful return to work. This intervention is based on a previous intervention for return to work of sick-listed employees due to low back pain; whereby its effectiveness has been substantiated through numerous scientific evaluations. The current intervention is a participatory workplace intervention; underpinned by the principles of participatory ergonomics¹. This participatory workplace intervention for return to work consists of a stepwise process aimed to identify and resolve barriers for return to work. Accomplished by mutually developed return-to-work action plan by the sick-listed employee and his/her supervisor; through a structured process of communication facilitated by a return-to-work (RTW) co-ordinator

Implementation:

There are several steps to this intervention: In the first step, the sick-listed employee is referred to the RTW coordinator by their occupational physician. Secondly, the RTW co-ordinator contacts the employee and his or her supervisor to arrange a series of meetings. Then, separate meetings are held between the RTW co-ordinator and the employee, and, subsequently, with the supervisor; with the overall objective of discussing the barriers for return to work in structured conversations. The structured conversation with the RTW co-ordinator are based on a task analysis where the tasks involved in the employees’ job are identified and outlined, and for each task the barriers for return to work are identified. Based on the outlined barriers for RTW, the employee and supervisor discuss possible solutions to the identified problems/barriers; these solutions can relate to changes in work conditions, work content or relationships. Based on the list of solutions derived through the series of discussions between employee and supervisor, the solutions identified with a high degree of feasibility to implement are outlined; and, moreover, a method in which to implement these solutions is developed. One month following the meetings and developed action plan, the RTW co-ordinator contacts the supervisor and employee to evaluate the progress of implementation and how these solutions have contributed to the RTW of the employee.

Practical applications:

It should be noted that prior to instigating the intervention the RTW co-coordinator received training, provided by a trained psychologist. The intervention is currently being implemented and evaluated in three occupational sectors: in industry, a hospital, and a university. However, the main structure of this intervention, conducted on individuals with low back pain, has been successfully used and evaluated in a large variety of  occupational sectors and sizes of enterprises (small, medium and large).

Innovative aspects:

This participatory workplace intervention for return to work consists of a stepwise process to identify and solve barriers for return to work; based on a consensus of an action plan to facilitate return to work between the sick-listed employee and his/her supervisor.

Evaluation (including process issues, outcomes and sustainability):

The evaluation of the effectiveness of this intervention is currently ongoing. Participants, individuals on sick leave for 2 to 8 weeks with common mental disorders, were randomly assigned to either: (a) the participatory workplace intervention; or (b) usual care. Measurements were taken prior to the intervention/usual care and assessed at 3, 6, 9, and 12 months following. The primary outcome to assess the effectiveness of the intervention is lasting return-to-work, which will be acquired from continuous registration systems of the companies after the follow-up. Secondary outcomes are total number of days of sick leave during the follow-up, severity of common mental disorders, coping style, job content, and attitude, social influence, and self-efficacy determinants. An evaluation of the effectiveness of the implementation of the intervention will be assessed by: examining the level of participation by both employee and supervisor during the process; and the overall level of satisfaction with the intervention by both health professionals, and the employee and supervisor. Additionally, an economic evaluation of cost effectiveness of the intervention will be conducted.

Benefits (including cost effectiveness):

The evaluation of the current study is currently ongoing, and benefits accrued due to intervention cannot be at this time specifically discussed nor outlined. Albeit the principle investigator informally suggests that even at this early stage, the intervention appears to have a beneficial impact on sick-listed employees’ overall well-being.

References:

Van Oostrom, S.H., Anema, R.J., Terluin, B., Venema, A., de Vet, CW, & van Mechelen, W. (2007). Development of a workplace intervention for sick-listed employees with stress-related mental disorders: Intervention Mapping as a useful tool. BMC Health Services Research, 7, 127 retrieved from http://www.biomedcentral.com/content/pdf/1472-6963-7-127.pdf.

Van Oostrom S.H., Anema J.R, Terluin B. ; de Vet H., Knol D., van Mechelen W. (2007). Cost-effectiveness of a workplace intervention for sick-listed employees with common mental disorders: design of a randomized controlled trial. BMC Health Services Research, 8(1), 12.

Comments:

¹ Participatory ergonomics refers to a broad range of methods and techniques. These methods apply the active participation of workers/ and or other key stakeholders in the process in the planning and controlling their work activities; and moreover innovating their workplace. In so doing, developing or further promoting a health workplace.

Author(s): Willem Rhenen, Roland W. B. Blonk, Jac J. L. van der Klink, Frank J.H. van Dijk, & Wilmar B. Schaufeli            Level of Intervention:  Tertiary

Is the intervention sector specific?

Is the intervention usable with different enterprise sizes?

Is the intervention equally applicable to both genders?

Is the intervention based on theory?

Can the intervention approach be adapted/ tailored?

Does the intervention promote CSR and how?

Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Overview (including risk assessment and law – legal requirements etc.):

A newly developed intervention combining physical exercise and relaxation techniques was developed by van Rhenen and colleagues with the overall objective of reducing health complaints resulting from individuals experiencing high levels of work-related stress. This is a brief and concise intervention to help those suffering with stress-related illness to manage and cope more effectively. The aim of this intervention is to provide awareness and the introduction of physical exercise in daily work activities.

Implementation:

The intervention is based on four sessions taking place during working hours. The exercise programmes utilized during the intervention were designed and conducted by an authorised physical therapist. Prior to commencing the exercise programme, a consultation, takes place to modify the level and intensity of exercise programmes on an individual basis. Each training session lasted one hour and was delivered over the course of 8 weeks: the intervals between sessions were 2 weeks, 2 weeks, and 4 weeks. Every session consisted of four main components: (1) an introduction; (2) warming up and physical exercise; (3) relaxation exercise; (4) an assignment.

·         Session 1: During this introductory session the term ‘stress’ and its associated effects on physical, psychological and behavioural aspects of health were outlined. Additionally, the use of physical activities as a key coping strategy was emphasised. Next, participants began with warming up and keep fit exercises followed by teaching and practicing a relaxation exercise. At the end of the session the participants were given homework; namely, they were asked to practice the learned relaxation technique during experienced stressful situations.

·         Session 2: This session began with a review of the past 2 weeks: including a discussion of participants’ homework. A warm up session, exercise, and muscle stretching followed. During this session a concentrated focus on the relationship between heart rate and strain was emphasised. Participants were encouraged to utilize the knowledge acquired during this, and the pervious, session as homework.

·         Session 3: The third session started with an assessment and a keep-fit exercise. Subsequently, participants were asked to plan their daily exercises; and evaluate their progress.

Session: 4: In this final session, the different physical exercises & relaxation techniques were reviewed. The session ended with advice on prevention relapse

Practical applications:

The intervention has a developed protocol facilitating its easier applicability at a practical level. The exercise programme was conducted by a trained physical therapist; thus, the implementation of this intervention requires a trained professional. The current intervention has been applied in the private sector, a large-scale organisation. Albeit the author(s) emphasise their belief of its applicability and adaptability to a larger variety of occupational sectors; and various sizes of enterprises.

Innovative aspects:

The current intervention is a purposefully designed brief intervention underpinned by multi-component design: combining physical activity and teaching relaxation techniques, thereby training and teaching individuals affected by stress, and its associated negative effects on health, with a repertoire of skills to manage and cope more effectively.

Evaluation (including process issues, outcomes and sustainability):

Participants were randomly assigned to one of two conditions: (a) the newly developed combined intervention of physical exercise and relaxation; or (b) a standard cognitive therapy intervention. Participants were assessed pre-intervention, directly following the intervention and 6 months following. The outcome measures used to evaluate the effectiveness of the intervention consisted of three self-reported questionnaires on psychological complaints (i.e., measurements of depression, anxiety, distress, and somatisation).

Benefits (including cost effectiveness):

The evaluation of the combined intervention found that a demonstrated positive impact on psychological complaints, burnout and fatigue and that these effects were maintained at the 6 months’ follow up. This suggests that this newly developed physical exercise and relaxation programme is an effective method of reducing stress and increasing workers well-being.

References:

Van Rhenen, W., Blonk., R.W.B., van der Klink, J.J.L., van Dijk, F.J.H., & Schaufeli, W.B. (2005). The effect of a cognitive and physical stress-reducing programme on psychological complaints. International Archives of Occupational and Environmental Health, 78(2), 139-148.

Comments:

The intervention target group was individuals with above average stress levels; this was determined by conducting a health survey prior to commencing the intervention. Additionally, in the comparative evaluation of the interventions no significant differential effects between the two conditions were observed.