Technology-Assisted Telephone Intervention for Employees with Decreased Mental Well-Being: A Randomized Controlled Trial (Preprint)

BACKGROUND Health interventions combining technology with human involvement have the potential to improve the cost-effectiveness of solely human-delivered interventions. However, the optimal combination of human and technology involvement is unclear. OBJECTIVE The aim of the study was to compare the intervention effectiveness and time use of coaches (as an approximation of intervention cost) between a technology-assisted telephone intervention and a traditional telephone intervention for stress management. METHODS A two-arm, randomized controlled trial of nine months (four months intensive and five months maintenance) for stress management was conducted. Participants were recruited online through a regional occupational health care provider in Finland, and randomized equally to a research (technology-assisted telephone intervention) and a control (telephone intervention) group. For both groups, coaching was provided by three occupational health coaches. The coaching methodology was based on habit formation, motivational interviewing and the transtheoretical model. For the research group, technology (web-based tools and wearables) was supporting both the coaches and participants in identifying behaviour change needs (goal setting), setting the initial coaching plan by recommending personalized coaching tasks, progress monitoring, and communication. Technology had greater role in the intensive phase. During the maintenance, technology was mostly used to replace coaching calls. Primary outcomes were participants’ self-assessed mental well-being (WorkOptimum index) and the self-reported time use of coaches. Secondary outcomes included adherence and self-assessed satisfaction with coaching. RESULTS Altogether, 49 eligible participants were randomized to the research (N=24) and control (N=25) groups. Most of the participants were middle-aged (mean 46.26 years, SD 9.74) and females (95.92%, 47/49). Mental well-being improved significantly in both groups (WorkOptimum from ‘at risk’ to ‘good’ P <.001), but no between-group differences were observed in the end (-0.47 vs -0.44, P=.56). The total time use of coaches did not differ significantly between the groups (366.0 min vs. 343.0 min, P=.48). Regarding adherence, the dropout rate was 12.50% (3/24) for the research and 24.00% (6/25) for the control group; the mean adherence rate to coaching calls was 91.67% and 85.50% for the two groups, respectively; the frequency of performing the coaching tasks was similar for both groups after both phases; and the diligence in performing coaching tasks during the intensive phase was better for the research group (5.0 vs. 4.0, P=.03), but no difference was observed for the maintenance phase. Satisfaction was significantly higher in the research group during the intensive phase (5.0 vs 4.0, P<.001), but not during the maintenance phase. CONCLUSIONS Technology-assisted telephone intervention seems to be as effective as the traditional telephone intervention but does not necessarily reduce time use of coaches with the realized human-technology involvement combination. Offering digital tools to complement telephone coaching seems to increase satisfaction with coaching. CLINICALTRIAL ClinicalTrials.gov NCT02445950