title: Process and Effects Evaluation of a Digital Mental Health Intervention Targeted at Improving Occupational Well-Being: Lessons From an Intervention Study With Failed Adoption.
abstract: BACKGROUND
  Digital interventions have the potential to serve as cost-effective ways to manage occupational stress and well-being. However, little is known about the adoption of individual-level digital interventions at organizations.
  
  
  OBJECTIVE
  The aim of this paper is to study the effects of an unguided digital mental health intervention in occupational well-being and the factors that influence the adoption of the intervention.
  
  
  METHODS
  The intervention was based on acceptance and commitment therapy (ACT) and its aim was to teach skills for stress management and mental well-being. It was delivered via a mobile and a Web-based app that were offered to employees of two information and communication technology (ICT) companies. The primary outcome measures were perceived stress and work engagement, measured by a 1-item stress questionnaire (Stress) and the Utrecht Work Engagement Scale (UWES-9). The intervention process was evaluated regarding the change mechanisms and intervention stages using mixed methods. The initial interviews were conducted face-to-face with human resource managers (n=2) of both companies in August 2013. The participants were recruited via information sessions and email invitations. The intervention period took place between November 2013 and March 2014. The participants were asked to complete online questionnaires at baseline, two months, and four months after the baseline measurement. The final phone interviews for the volunteer participants (n=17) and the human resource managers (n=2) were conducted in April to May 2014, five months after the baseline.
  
  
  RESULTS
  Of all the employees, only 27 (8.1%, 27/332) took the app into use, with a mean use of 4.8 (SD 4.7) different days. In the beginning, well-being was on good level in both companies and no significant changes in well-being were observed. The activities of the intervention process failed to integrate the intervention into everyday activities at the workplace. Those who took the app into use experienced many benefits such as relief in stressful situations. The app was perceived as a toolkit for personal well-being that gives concrete instructions on how mindfulness can be practiced. However, many barriers to participate in the intervention were identified at the individual level, such as lack of time, lack of perceived need, and lack of perceived benefits.
  
  
  CONCLUSIONS
  The findings suggest that neither the setting nor the approach used in this study were successful in adopting new digital interventions at the target organizations. Barriers were faced at both the organizational as well as the individual level. At the organizational level, top management needs to be involved in the intervention planning for fitting into the organization policies, the existing technology infrastructure, and also targeting the organizational goals. At the individual level, concretizing the benefits of the preventive intervention and arranging time for app use at the workplace are likely to increase adoption.
authors.affiliation: VTT Technical Research Centre of Finland Ltd, Digital Health, Oulu, Finland. salla.muuraiskangas@vtt.fi.
authors.forename: Salla
authors.identifier: http://orcid.org/0000-0002-9863-5877
authors.initials: S
authors.lastname: Muuraiskangas
authors.forename: Marja
authors.identifier: http://orcid.org/0000-0002-5919-5709
authors.initials: M
authors.lastname: Harjumaa
authors.forename: Kirsikka
authors.identifier: http://orcid.org/0000-0002-7261-8868
authors.initials: K
authors.lastname: Kaipainen
authors.forename: Miikka
authors.identifier: http://orcid.org/0000-0003-4849-9931
authors.initials: M
authors.lastname: Ermes
keywords: acceptance and commitment therapy; adoption; attrition; cccupational health; intervention studies; mHealth; mindfulness; process assessment; stress