Evaluation of a Web-Based Stress Management Program for Persons Experiencing Work-Related Stress in Sweden (My Stress Control): Randomized Controlled Trial

Caroline Eklund, Anne Söderlund, Magnus L Elfström, Caroline Eklund, Anne Söderlund, Magnus L Elfström

Abstract

Background: Stress is one of the most common reasons for sick leave. Web-based interventions have the potential to reach an unlimited number of users at a low cost and have been shown to be effective in addressing several health-related problems. Handling stress on an individual level is related to behavior change. To support behavioral changes in stress management, My Stress Control (MSC) was developed. The development of MSC was based on several health psychology theories and models; however, central in the development were Social Cognitive Theory, Theory of Reasoned Action, Theory of Planned Behavior, Transactional Theory of Stress and Coping, and the Transtheoretical Model and Stages of Change. MSC is a fully automated program. The program is tailored to the user's specific needs for stress management and behavior change.

Objective: In this study, we aim to conduct a randomized controlled trial to evaluate the extent to which MSC affects perceived stress in persons experiencing work-related stress.

Methods: This was a randomized controlled trial with 2 arms. Study participants were recruited by visiting the worksites and workplace meetings. Participants were assigned to the intervention or wait-list group. Web-based questionnaires were used before and after the intervention to collect data. Perceived stress measured using the Perceived Stress Scale-14 was the primary outcome measurement. Analyses were conducted for both between-group and within-group changes.

Results: A total of 92 participants were included in this study: 48 (52%) in the intervention group and 44 (48%) in the wait-list group. Overall, 25% (12/48) of participants in the intervention group and 43% (19/44) of participants in the wait-list group completed the postintervention assessment. There were no significant effects on perceived stress between the intervention and wait-list groups or within the groups. A small effect size (Cohen d=0.25) was found when comparing mean change over time on the primary outcome measure between the intervention and wait-list groups. In addition, a small effect size was found between pre- and postintervention assessments within the intervention group (Cohen d=0.38) as well as within the wait-list group (Cohen d=0.25).

Conclusions: The effect of MSC on perceived stress remains uncertain. As adherence was low in the intervention group, elements or features that facilitate adherence and engagement must be further developed before firmer conclusions regarding the effect of MSC can be made.

Trial registration: ClinicalTrials.gov NCT03077568; https://ichgcp.net/clinical-trials-registry/NCT03077568.

Keywords: behavior change; behavior medicine; internet; stress prevention.

Conflict of interest statement

Conflicts of Interest: The authors are the developers of the web-based program My Stress Control (MSC) together with a programmer. The authors declare that they have no conflicts of interest.

©Caroline Eklund, Anne Söderlund, Magnus L Elfström. Originally published in JMIR Mental Health (https://mental.jmir.org), 09.12.2021.

Figures

Figure 1
Figure 1
Flowchart of enrollment, randomization, and exclusion. HADS: Hospital Anxiety and Depression Scale; ITT: intention-to-treat; PSS: Perceived Stress Scale.
Figure 2
Figure 2
Overview of the flow through the program, content of each step and with a more detailed example from the relaxation module. ABC-model: Antecedent-Behavior-Consequence model; HADS: Hospital Anxiety and Depression Scale; PSS-14: Perceived Stress Scale, 14-item.

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