Implementation and evaluation of a multi-level mental health promotion intervention for the workplace (MENTUPP): study protocol for a cluster randomised controlled trial

Background Well-organised and managed workplaces can be a source of wellbeing. The construction, healthcare and information and communication technology sectors are characterised by work-related stressors (e.g. high workloads, tight deadlines) which are associated with poorer mental health and wellbeing. The MENTUPP intervention is a flexibly delivered, multi-level approach to supporting small- and medium-sized enterprises (SMEs) in creating mentally healthy workplaces. The online intervention is tailored to each sector and designed to support employees and leaders dealing with mental health difficulties (e.g. stress), clinical level anxiety and depression, and combatting mental health-related stigma. This paper presents the protocol for the cluster randomised controlled trial (cRCT) of the MENTUPP intervention in eight European countries and Australia. Methods Each intervention country will aim to recruit at least two SMEs in each of the three sectors. The design of the cRCT is based on the experiences of a pilot study and guided by a Theory of Change process that describes how the intervention is assumed to work. SMEs will be randomly assigned to the intervention or control conditions. The aim of the cRCT is to assess whether the MENTUPP intervention is effective in improving mental health and wellbeing (primary outcome) and reducing stigma, depression and suicidal behaviour (secondary outcome) in employees. The study will also involve a process and economic evaluation. Conclusions At present, there is no known multi-level, tailored, flexible and accessible workplace-based intervention for the prevention of non-clinical and clinical symptoms of depression, anxiety and burnout, and the promotion of mental wellbeing. The results of this study will provide a comprehensive overview of the implementation and effectiveness of such an intervention in a variety of contexts, languages and cultures leading to the overall goal of delivering an evidence-based intervention for mental health in the workplace

Death Education and the Management of Fear of Death Via Photo-Voice: An Experience Among Undergraduate Students

The article presents the results of a research intervention aimed at exploring the differences among some factors (death anxiety, ontological representation of death as annihilation, alexithymia, spirituality, resilience, happiness) in two different groups of university students: one that attended a course of Death Education (DeEd; 83 students: DeEd-gr) and another one that did not participate in it (149: NoDeEd-gr). The DeEd course utilized the photo-voice as an elective strategy aimed at facilitating the performative experience. It was hypothesized that this method could help DeEd-gr in sharing emotions and spiritual experiences while managing the increase of death anxiety, inevitably caused by the deathrelated issues introduced during the lessons. The results confirmed that, despite the higher death anxiety, the DeEd-gr had a greater level of happiness and lower alexithymia compared with NoDeEd-gr, suggesting that the use of photo-voice can be useful in the course because it facilitates the management of communication and relationships. A further analysis was realized to explain the relationships between the different dimensions considered. Results evidenced that spirituality was inversely correlated with the representation of death as annihilation and with alexithymia, which was positively related to personal happiness. However, in DeEd-gr, spirituality impacted less on happiness, while the representation of death as annihilation impacted significantly more on resilience among participants of NoDeEd-gr. The discussion analyzes some characteristics that differentiated women and men, compared with men, and considers how DeEd courses should recognize the role of the ontological representations of death with their relationships with spirituality

Implementing a complex mental health intervention in occupational settings: process evaluation of the MENTUPP pilot study

Background According to the Medical Research Council (MRC) framework, the theorisation of how multilevel, multicomponent interventions work and the understanding of their interaction with their implementation context are necessary to be able to evaluate them beyond their complexity. More research is needed to provide good examples following this approach in order to produce evidence-based information on implementation practices.Objectives This article reports on the results of the process evaluation of a complex mental health intervention in small and medium enterprises (SMEs) tested through a pilot study. The overarching aim is to contribute to the evidence base related to the recruitment, engagement and implementation strategies of applied mental health interventions in the workplace.Method The Mental Health Promotion and Intervention in Occupational Settings (MENTUPP) intervention was pilot tested in 25 SMEs in three work sectors and nine countries. The evaluation strategy of the pilot test relied on a mixed-methods approach combining qualitative and quantitative research methods. The process evaluation was inspired by the RE-AIM framework and the taxonomy of implementation outcomes suggested by Proctor and colleagues and focused on seven dimensions: reach, adoption, implementation, acceptability, appropriateness, feasibility and maintenance.Results Factors facilitating implementation included the variety of the provided materials, the support provided by the research officers (ROs) and the existence of a structured plan for implementation, among others. Main barriers to implementation were the difficulty of talking about mental health, familiarisation with technology, difficulty in fitting the intervention into the daily routine and restrictions caused by COVID-19.Conclusions The results will be used to optimise the MENTUPP intervention and the theoretical framework that we developed to evaluate the causal mechanisms underlying MENTUPP. Conducting this systematic and comprehensive process evaluation contributes to the enhancement of the evidence base related to mental health interventions in the workplace and it can be used as a guide to overcome their contextual complexity.Trial registration number ISRCTN14582090