Developing an Intervention and Evaluation Model of Outdoor Therapy for Employee Burnout: Unraveling the Interplay Between Context, Processes, and Outcomes

BACKGROUND Burnout is a major societal issue adversely affecting employees' health and performance, which over time results in high sick leave costs for organizations. Traditional rehabilitation therapies show suboptimal effects on reducing burnout and the return-to-work process. Based on the health-promoting effects of nature, taking clients outdoors into nature is increasingly being used as a complementary approach to traditional therapies, and evidence of their effectiveness is growing. Theories explaining how the combination of general psychological support and outdoor-specific elements can trigger the rehabilitation process in outdoor therapy are often lacking, however, impeding its systematic research. AIM The study aims to develop an intervention and evaluation model for outdoor therapy to understand and empirically evaluate whether and how such an outdoor intervention may work for rehabilitation after burnout. METHODOLOGICAL APPROACH We build on the exemplary case of an outdoor intervention for rehabilitation after burnout, developed by outdoor clinical psychologists in Netherlands. We combined the generic context, process, and outcome evaluation model and the burnout recovery model as an overarching deductive frame. We then inductively specified the intervention and evaluation model of outdoor therapy, building on the following qualitative data: semi-structured interviews with outdoor clinical psychologists and former clients; a content analysis of the intervention protocol; and reflective meetings with the intervention developers and health promotion experts. RESULTS We identified six key outdoor intervention elements: (1) physical activity; (2) reconnecting body and mind; (3) nature metaphors; (4) creating relationships; (5) observing natural interactions; and (6) experiential learning. The results further showed that the implementation of these elements may facilitate the rehabilitation process after burnout in which proximal, intermediate, and distal outcomes emerge. Finally, the results suggested that this implementation process depends on the context of the therapist (e.g., number of clients per day), therapy (e.g., privacy issues), and of the clients (e.g., affinity to nature). CONCLUSION The intervention and evaluation model for outdoor therapy shows how key outdoor intervention elements may contribute to the rehabilitation process after burnout. However, our model needs to be further tested among a larger group of clients to empirically evaluate whether and how outdoor therapy can support rehabilitation

The Role of Off-Job Crafting in Burnout Prevention during COVID-19 Crisis: A Longitudinal Study

The COVID-19 pandemic and remote working challenge employees' possibilities to recover from work during their off-job time. We examined the relationship between off-job crafting and burnout across the COVID-19 crisis. We used a longitudinal research design, comprising one wave collected before the onset of the pandemic, in March 2019 (T1), and one wave collected during the first lockdown of the crisis in April 2020 (T2). We measured the six off-job crafting dimensions (Crafting for Detachment, Relaxation, Autonomy, Mastery, Meaning, and Affiliation) and burnout (fatigue/exhaustion) via a questionnaire among German and Swiss employees (N = 658; Age M = 47; 55% male). We found that both burnout levels and crafting for affiliation significantly decreased at T2 compared to T1. All off-job crafting dimensions and burnout correlated negatively cross-sectionally and longitudinally. Regression analyses showed that employees who crafted in their off-job time before and during the crisis experienced fewer burnout complaints during the crisis. Looking more closely at the subdimensions of off-job crafting, employees who crafted for detachment before and during, and for affiliation before the crisis, reported less burnout during the crisis. We conclude that off-job crafting may act as a buffer mechanism against burnout during the COVID-19 crisis

The Role of Off-Job Crafting in Burnout Prevention during COVID-19 Crisis: A Longitudinal Study

The COVID-19 pandemic and remote working challenge employees’ possibilities to recover from work during their off-job time. We examined the relationship between off-job crafting and burnout across the COVID-19 crisis. We used a longitudinal research design, comprising one wave collected before the onset of the pandemic, in March 2019 (T1), and one wave collected during the first lockdown of the crisis in April 2020 (T2). We measured the six off-job crafting dimensions (Crafting for Detachment, Relaxation, Autonomy, Mastery, Meaning, and Affiliation) and burnout (fatigue/exhaustion) via a questionnaire among German and Swiss employees (N = 658; Age M = 47; 55% male). We found that both burnout levels and crafting for affiliation significantly decreased at T2 compared to T1. All off-job crafting dimensions and burnout correlated negatively cross-sectionally and longitudinally. Regression analyses showed that employees who crafted in their off-job time before and during the crisis experienced fewer burnout complaints during the crisis. Looking more closely at the subdimensions of off-job crafting, employees who crafted for detachment before and during, and for affiliation before the crisis, reported less burnout during the crisis. We conclude that off-job crafting may act as a buffer mechanism against burnout during the COVID-19 crisis

The relationship between individual, social and national coping resources and mental health during the COVID-19 pandemic in the Netherlands

BackgroundThe COVID-19 pandemic has a potential negative impact on mental health. Adopting the salutogenic model of health, this study examined the predictive value of personal (sense of coherence), social (social support, trust in institutions), and national (sense of national coherence) resources for mental health in the Netherlands during the COVID-19 pandemic.Participants and procedureAn online survey was administered in the Netherlands (N = 622) in April 2020. A multiple regression analysis was performed to test the predictive value of the resources for mental health.ResultsMental health was significantly predicted by the sense of coherence, social support and sense of national co-herence, but not by trust in institutions. The results showed that personal and social resources were most strongly related to mental health.ConclusionsThe results suggest that mental health is predicted by various resources. Hence, strengthening resources seems vital in promoting mental health in times of crisis

Understanding educational care farms as outdoor learning interventions for children who have dropped out of school in the Netherlands

When children drop out of school, either temporarily or permanently, this poses a significant problem for both children and society. In the Netherlands, care farms offering care-education programs for school dropouts are emerging. While there is evidence for their effectiveness, models explaining how such outdoor interventions may facilitate positive developments of children and their return to school are lacking. Using the generic Context-Intervention-Mechanisms-Outcome Model as an overarching deductive frame, this study inductively examines how care-educational programs facilitate the positive development of children who have dropped out of school. Focusing on nine educational care farms, we conducted observations and interviews with children, parents, teachers, and farmers. We conclude that the outdoor learning intervention in combination with the underlying farm context enables children to enjoy rest, freedom, tailored education, and a feeling of acceptance. These mechanisms support children to develop themselves, particularly regarding their socio-environmental functioning

Unravelling salutogenic mechanisms in the workplace : The role of learning

Objective: To explore the moderating and mediating role(s) of learning within the relationship between sense of coherence (SOC) and generalized resistance resources. Method: Cross-sectional study (N = 481), using a self-administered questionnaire, of employees working in the healthcare sector in the Netherlands in 2017. Four residential healthcare settings and one healthcare-related Facebook group were involved. Multiple linear regression models were used to test for moderating and mediating effects of learning. Results: Social relations, task significance, and job control significantly explained variance in SOC. Conceptual, social, and instrumental learning, combined, moderated the relationship between SOC and task significance. Instrumental learning moderated the relationship between job control and SOC. Social learning also mediated this relationship. Conceptual learning did not show any moderating or mediating effect. Conclusions: The relationship between SOC and the three GRRs seems to be strengthened or explained. -to a certain extent. -by instrumental and social learning. Healthcare organizations are recommended to promote learning through formal activities as well as through cooperation, feedback, sharing experiences, and job challenges. This requires employee participation and a multilevel interdisciplinary approach

Combined Interventions to Reduce Burnout Complaints and Promote Return to Work: A Systematic Review of Effectiveness and Mediators of Change

Burnout has adverse effects on the health and work-related outcomes of employees. Nevertheless, little is known about effective ways of reducing burnout complaints and facilitating full return to work, which defines rehabilitation. This study consists of a systematic review of the effects of combined interventions (i.e., both person-directed and organization-directed). It also includes the identification and description of mediators of change, thereby explaining how combined interventions do or do not work. Seven electronic databases were searched for English peer-reviewed publications: the Psychology and Behavioral Sciences Collection; PsycARTICLES; Web of Science; Scopus; SocINDEX; PubMed; and PsycINFO, using various combinations of search terms (e.g., burnout AND intervention). Out of 4110 abstracts published before 29 September, 2019, 10 studies (reporting the effects of nine combined interventions) fulfilled the inclusion criteria, which were defined using PICOS criteria (participants, interventions, comparators, outcomes and study design). Although the risk of bias of the included studies is high, all combined interventions were effective in facilitating rehabilitation. Results suggest that involving employees in decision-making and enhance their job control and social support, while eliminating stressors, explain the effectiveness of the intentions. With caution, workplace health promotion practitioners are encouraged to use these findings to tackle burnout among employees

A Salutogenic Approach to Understanding the Potential of Green Programs for the Rehabilitation of Young Employees With Burnout: Protocol for a Mixed Method Study on Effectiveness and Effective Elements

Background: Burnout is the leading cause of absenteeism in the Netherlands, with associated sick leave costs amounting to around €1.8 billion. Studies have indicated that burnout complaints increased from almost 14.4% in 2014 to 17.3% in 2018, especially among employees between the ages of 18 and 35 years, and further increases are expected. Although there are many published articles on burnout, not much is known about what constitutes effective rehabilitation (ie, the reduction of burnout complaints and the facilitation of returning to work). At the same time, multiple pilot studies have indicated that green programs are effective in both reducing burnout complaints and facilitating return to work. Green programs have been developed by professionals experienced in using the natural environment to facilitate rehabilitation (eg, through green exercise and healing gardens). The literature nevertheless lacks comprehensive and contextual insight into what works and why.Objective: The overarching aim of this study is to explore the potential of green programs for young employees with burnout. We present the study protocol from an ongoing research project consisting of 2 phases, each composed of 2 research objectives that sequentially build upon each other.Methods: The study is based on a sequential design with 4 research objectives, using both qualitative and quantitative research methods. In the first phase, a systematic literature review (research objective 1) and in-depth interviews (research objective 2) will be used to explore mechanisms underlying the rehabilitation of young employees with burnout. In the second phase, a multicase study will be conducted to examine the extent to which green programs are built on mechanisms identified in the first phase (research objective 3). By employing a pretest and posttest design, a specific green program that captures most of those mechanisms will then be evaluated on its effect and process with regard to the rehabilitation of young employees with burnout (research objective 4). The project started in June 2018 and will continue through June 2022.Results: The first phase (research objectives 1 and 2) is intended to generate information on the mechanisms underlying the rehabilitation of young employees with burnout. The second phase (research objectives 3 and 4) is designed to demonstrate the extent to which and how the selected green program facilitates the rehabilitation of young employees with burnout.Conclusions: Understanding how green programs can facilitate the rehabilitation of young employees with burnout complaints can help to address this societal issue