Table 2 Participatory and individual-level interventions
StudyDesign and methods appraisal*Setting and participantsInterventionImplementationPsychosocial outcomes (p<0.05)†,‡Health outcomes (p<0.05)‡
Mikkelsen et al. (2000)38Prospective cohort with comparison group Follow-up 1 week after completion of intervention Final sample n = 82 Methods appraisal: 1, 2, 3, 4, 5, 7, 8, 10Two hospitals, Norway Various health professionals, clerical, technical and managerial staffWorkers’ steering committees moderated by external consultant. Individual-level stress management and physical trainingMixed support for intervention from managers and staff. Intervention was dropped after evaluationJob demands (D) ↑§ Role harmony (D) ↑§ Decision authority (C) ↔ Autonomy (C) ↔ Opportunity to develop (C) ↑§ Social support (S) ↑§ Team style (S) ↔ Contentedness (O) ↑§Mental health (Job Content Questionnaire) ↑§ Self-reported “health complaints” ↔
Maes et al (1998)39Prospective cohort with comparison group 1-, 2- and 3-year follow-up Individual-level interventions in year 1 Organisation changes after year 1 Final sample: n = 264 Methods appraisal: 1, 2, 3, 4, 6, 7, 9, 10Factory, The Netherlands Manual workers and other staffConsultative committee (employees, managers and researchers) to discuss organisational change. Concurrent health promotion programme (smoking cessation and physical activity) and psychosocial skills trainingAuthors provide few details on implementation although employees were said to have been consulted and participation was voluntaryPsychological demands (D) ↑ Control (C) ↑ Social support (S) ↔ Ergonomic conditions (O) ↑Serum cholesterol levels in men ↑ Absenteeism ↑ Mental health (5 Symptom Checklist-90) ↔ Healthy lifestyles (smoking, exercise, alcohol, diet, sleep, BMI) ↔
Orth-Gomér et al. (1994)40Prospective cohort with comparison group 3- and 8-month follow-up (8-month only for comparison group) Final sample: n = 121 Methods appraisal: 1, 2, 3, 5, 7, 8, 9, 10Five work groups of civil servants, Sweden Specific job details not reported2-day educational course (on work stress, lifestyle factors and relaxation techniques). Employee work groups to increase control and support and reduce strain in the work environment“In many cases” managers allocated extra time for this intervention. However, work group members often met during breaks and in their own time. The work groups were largely autonomous, but were assisted in monthly follow-up sessions by researcher-trained health workersStimulation from and autonomy over work (C) ↑ Perceived support from supervisors (S) ↔ Other factors contributing to “work strain” and social support (details not reported) (O/S) ↔Net changes in total serum cholesterol ↔ Serum triglycerides ↔ Serum apolipoprotein AI to apolipoprotein B ratio ↑ Lifestyle factors (smoking, exercise, weight, diet and alcohol) ↔
Bunce and West (1996)41Prospective cohort comparing two interventions in two sites with a “no intervention” comparison site 3- and 12-month follow-up Final sample: n = 117 Methods appraisal: 1, 2, 4, 6, 7, 8, 9, 10Hospital, UK Health professionals and clerical staffSite A: individual-level stress management training and sessions for employees to propose stress reducing innovations to their work Site B: stress management training onlyAuthors provide few details on the degree to which proposed innovations were accepted by management. They refer to organisational constraints impeding the innovation groupIndividual innovation (C) ↑ Propensity to innovate (C) ↔Mental health (GHQ12) ↔
  • *Methods appraisal: 1 = prospective; 2 = representative sample; 3 = appropriate comparison group; 4 = baseline response >60%; 5 = follow-up >80% in cohort, >60% in cross-section; 6 = adjustment for non-response and drop-out; 7 = conclusions substantiated by data; 8 = adjustment for confounders; 9 = all intervention group exposed, non-contaminated comparison group; 10 = appropriate statistical tests. †D, demand; C, control; S, social support; O, other psychosocial outcome measures. ‡↑  =  improvement; ↓  =  worsening; ↔  =  little change/inconclusive (with reference to the DCS hypothesis that reduced demands and increased control and support are ‘improvements’). §Short-term effects (1 week after intervention).