title: Increasing engagement with, and effectiveness of, an online CBT-based stress management intervention for employees through the use of an online facilitated bulletin board: study protocol for a pilot randomised controlled trial.
abstract: The evidence for the benefits of online cognitive behaviour therapy (CBT)-based programmes delivered in a clinical context is clear, but this evidence does not translate to online CBT-based stress management programmes delivered within a workplace context. One of the challenges to the delivery of online interventions is programme engagement; this challenge is even more acute for interventions delivered in real-world settings such as the workplace. The purpose of this pilot study is to explore the effect of an online facilitated discussion group on engagement, and to estimate the potential effectiveness of an online CBT-based stress management programme.
  
  
  
  This study is a three-arm randomised controlled trial (RCT) comparing a minimally guided, online, CBT-based stress management intervention delivered with and without an online facilitated bulletin board, and a wait list control group. Up to 90 employees from six UK-based organisations will be recruited to the study. Inclusion criteria will include age 18 years or over, elevated levels of stress (as measured on the PSS-10 scale), access to a computer or a tablet and the Internet. The primary outcome measure will be engagement, as defined by the number of logins to the site; secondary outcome measures will include further measures of engagement (the number of pages visited, the number of modules completed and self-report engagement) and measures of effectiveness (psychological distress and subjective wellbeing). Possible moderators will include measures of intervention quality (satisfaction, acceptability, credibility, system usability), time pressure, goal conflict, levels of distress at baseline and job autonomy. Measures will be taken at baseline, 2 weeks (credibility and expectancy measures only), 8 weeks (completion of intervention) and 16 weeks (follow-up). Primary analysis will be conducted on intention-to-treat principles.
  
  
  
  To our knowledge this is the first study to explore the effect of an online discussion group on the engagement and effectiveness of an online CBT-based stress management intervention. This study could provide a solution to the growing problem of poor employee psychological health and begin to address the challenge of increasing engagement with Internet-delivered health interventions.
  
  
  
  ClinicalTrials.gov Identifier: NCT02729987 . Registered on 18 Mar 2016.
authors.affiliation: Research and Development Department, Sussex Partnership NHS Foundation Trust and School of Psychology, University of Sussex, Falmer, BN1 9QH, UK. sc587@sussex.ac.uk.
authors.forename: Stephany
authors.identifier: 0000-0001-5911-2793
authors.initials: S
authors.lastname: Carolan
authors.affiliation: Research and Development Department, Sussex Partnership NHS Foundation Trust and School of Psychology, University of Sussex, Falmer, BN1 9QH, UK.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Harris
authors.affiliation: Research and Development Department, Sussex Partnership NHS Foundation Trust and School of Psychology, University of Sussex, Falmer, BN1 9QH, UK.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Greenwood
authors.affiliation: Research and Development Department, Sussex Partnership NHS Foundation Trust and School of Psychology, University of Sussex, Falmer, BN1 9QH, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Cavanagh
mesh_terms: D001291:Attitude of Health Personnel; D002985:Clinical Protocols; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D057194:Intention to Treat Analysis; D020407:Internet; D008603:Mental Health; D009784:Occupational Diseases / Q000175:diagnosis / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D016272:Occupational Health; D009786:Occupational Health Services; D010358:Patient Participation; D010865:Pilot Projects; D011615:Psychotherapy, Group / Q000379:methods*; D012107:Research Design; D013315:Stress, Psychological / Q000175:diagnosis / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D011795:Surveys and Questionnaires; D013813:Therapy, Computer-Assisted / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom
keywords: CBT; Internet; Online; Stress; Work