Periodic Reporting for period 3 - EMPOWER (European platforM to PromOte Wellbeing and HEalth in the woRkplace)
Reporting period: 2023-01-01 to 2024-06-30
EMPOWER aims to address the burden of mental health (MH) problems at both, individual and societal level. Mental disorders are estimated to cost the global economy $16 trillion by 2030. Common mental conditions (stress, depression and anxiety) account for about 40% of all cases of occupational diseases. To promote wellbeing and treat mental disorders in the workplace, several interventions have been developed, focusing on organizations (to reduce the impact of psychosocial stressors) or on individuals. However, their overall impact has been moderate at best. Widespread implementation of (cost-) effective interventions faces several barriers: 1) MH is rarely prioritised by employers; 2) MH programmes are usually reactive, and not proactive/preventive; 3) The significance of MH at the workplace is not appreciated, partly due to difficulty in measuring its impact on business performance; 4), There is little information on multi-modal intervention effectiveness; 5) Stigma towards mental illness lowers participation in interventions.
Given the fragmented landscape of interventions and implementation barriers, there is an urgent need for a multi-modal and integrative eHealth platform aimed at reducing MH problems in the workplace and improving employees’ wellbeing, by compiling the most feasible, brief and cost-effective interventions currently available in Europe.EMPOWER was set to address the aforementioned issues and it is especially relevant for small and medium enterprises (SMEs), representing most of all EU enterprises but with limited resources. The consortium successfully achieved its objectives, including the development of an eHealth platform with significant potential to improve MH in the workplace and the implementation of the platform on several companies by means of a RCT in four European countries. The platform was based on previous interventions with a three-tiered approach, and was culturally adapted. The use of mixed methodology allowed us to gain valuable insight not only on the effectiveness and cost-effectiveness of the platform, but also on the usability and barriers and facilitators for a successful implementation that could contribute to set new standards for future mental health interventions in the workplace.
Given the fragmented landscape of interventions and implementation barriers, there is an urgent need for a multi-modal and integrative eHealth platform aimed at reducing MH problems in the workplace and improving employees’ wellbeing, by compiling the most feasible, brief and cost-effective interventions currently available in Europe.EMPOWER was set to address the aforementioned issues and it is especially relevant for small and medium enterprises (SMEs), representing most of all EU enterprises but with limited resources. The consortium successfully achieved its objectives, including the development of an eHealth platform with significant potential to improve MH in the workplace and the implementation of the platform on several companies by means of a RCT in four European countries. The platform was based on previous interventions with a three-tiered approach, and was culturally adapted. The use of mixed methodology allowed us to gain valuable insight not only on the effectiveness and cost-effectiveness of the platform, but also on the usability and barriers and facilitators for a successful implementation that could contribute to set new standards for future mental health interventions in the workplace.
The first phase of the project focused on the design of the intervention: modules based on cognitive behaviour therapy and psychoeducation, design of a triage assessment and algorithm to offer tailored content and design of the eHealth platform. We made cultural adaptations for the involved countries and co-designed materials with stakeholders (academics, employer and employee representatives, and occupational health experts).
In a second phase, we developed the EMPOWER eHealth platform (a website and mobile app), and pre-pilot tested with end-users. During this phase, we also made preparations for the control trial in the four countries, including 1) Design of the trial and protocol; 2) Recruitment of SMEs and public agencies in each country; 3) Registration in a clinical trial registry; 4) Preparation of study participant information , , and approval by Ethic Committees from each site. Other tasks included formulation of a dissemination and communication plan, and preparation of data management and protection plan.
In a third phase, we conducted the control trial in four countries (25/02/2022-30/9/2023). A total of a total of 9 SMEs, 5 Public Agencies, and 2 large company participated. AOverallf 877 employees were enrolled. The response rate varied from 80.7% at baseline to 46.3% at T4. As part of the fieldwork, we organised 1) regular meetings to follow-up control trails progress, 2) in-site follow-ups by the local teams and 3) intensive dissemination activities within companies to increase participation and adherence among employees. Additionally, qualitative interviews with employees and employers have been conducted in Spain, Finland and Poland, to understand the barriers, challenges and facilitators of a successful implementation of EMPOWER. We also conducted an impact analysis to gain further insight about the societal, economic, and academic impact of the project.
Finally, based on the results of the scoping review, we conducted an online survey targeting identified stakeholders to evaluate the relevance and ease of implementation strategies for Occupational eMental Health interventions (OeMH) interventions. The survey evaluated how the identified facilitators and barriers impacted the implementation process, leading to the development of a 28-items checklist designed to guide implementation strategies and address these factors.To summarise, the primary outcome of the EMPOWER project is the EMPOWER platform, which integrates a technological component (mobile application and website) with a theoretical component (knowledge and methodologies). To facilitate the platform's further exploitation post-project, we developed a roadmap encompassing intellectual property aspects, joint ownership, result protection agreements, future modification, a market analysis, a tentative business plan, and a proposed 4-year timeline. Other outcomes are: policy brief, 28-item tool to facilitate implementation of OeMH interventions, scientific papers and and public materials to address MH stigma and psychosocial risks at the workplace. The project’s results will be disseminated via European Commission platforms such as the Horizon Result Platform and Open Research Europe. The final event, exhibited the platform's effectiveness and impact, featuring presentations from HaDEA, WHO and private companies. Additionally, an EMPOWER video summarising the project and showcasing end-user experiences, along with short promotional clips, is available on our website and YouTube channel. The website will remain active for four years post-project, hosting all EMPOWER related information.
In a second phase, we developed the EMPOWER eHealth platform (a website and mobile app), and pre-pilot tested with end-users. During this phase, we also made preparations for the control trial in the four countries, including 1) Design of the trial and protocol; 2) Recruitment of SMEs and public agencies in each country; 3) Registration in a clinical trial registry; 4) Preparation of study participant information , , and approval by Ethic Committees from each site. Other tasks included formulation of a dissemination and communication plan, and preparation of data management and protection plan.
In a third phase, we conducted the control trial in four countries (25/02/2022-30/9/2023). A total of a total of 9 SMEs, 5 Public Agencies, and 2 large company participated. AOverallf 877 employees were enrolled. The response rate varied from 80.7% at baseline to 46.3% at T4. As part of the fieldwork, we organised 1) regular meetings to follow-up control trails progress, 2) in-site follow-ups by the local teams and 3) intensive dissemination activities within companies to increase participation and adherence among employees. Additionally, qualitative interviews with employees and employers have been conducted in Spain, Finland and Poland, to understand the barriers, challenges and facilitators of a successful implementation of EMPOWER. We also conducted an impact analysis to gain further insight about the societal, economic, and academic impact of the project.
Finally, based on the results of the scoping review, we conducted an online survey targeting identified stakeholders to evaluate the relevance and ease of implementation strategies for Occupational eMental Health interventions (OeMH) interventions. The survey evaluated how the identified facilitators and barriers impacted the implementation process, leading to the development of a 28-items checklist designed to guide implementation strategies and address these factors.To summarise, the primary outcome of the EMPOWER project is the EMPOWER platform, which integrates a technological component (mobile application and website) with a theoretical component (knowledge and methodologies). To facilitate the platform's further exploitation post-project, we developed a roadmap encompassing intellectual property aspects, joint ownership, result protection agreements, future modification, a market analysis, a tentative business plan, and a proposed 4-year timeline. Other outcomes are: policy brief, 28-item tool to facilitate implementation of OeMH interventions, scientific papers and and public materials to address MH stigma and psychosocial risks at the workplace. The project’s results will be disseminated via European Commission platforms such as the Horizon Result Platform and Open Research Europe. The final event, exhibited the platform's effectiveness and impact, featuring presentations from HaDEA, WHO and private companies. Additionally, an EMPOWER video summarising the project and showcasing end-user experiences, along with short promotional clips, is available on our website and YouTube channel. The website will remain active for four years post-project, hosting all EMPOWER related information.
EMPOWER has developed a eHealth intervention to address the increasing burden of mental health (MH) problems in the workplace. Its impact on mental health outcomes have been tested. Unfortunately, we were not able to definitely prove/disprove whether it was effective as we did not find a positive significant results on MH. However, it is important to note that external factors, such as the COVID-19 pandemic and the Ukraine conflict, likely influenced recruitment and participation rates. Additionally, while only about 34% of users engaged actively with the intervention, the complexity of an RCT design in a workplace setting, the high drop-out rates and a potential floor effect (i.e. a healthy sample with small room for improvement) may have limited observable changes. Nonetheless, EMPOWER has the potential to impact individual health outcomes. EMPOWER holds the potential for a significantly greater economic impact than its predecessors due to its scalability. This could lead to substantial cost reduction for SME companies and society at large. Given that SMEs constitute the largest proportion of companies in Europe, they are poised to directly benefit from the early identification and prevention of mental health problems. Finally, implementing cost-effective OeMH intervention can significantly benefit society by reducing human suffering, social exclusion, and the stigmatization of individuals with mental illness and their families, while also lowering the associated economic costs.