| Study | Design and methods appraisal* | Setting and participants | Intervention | Implementation | Psychosocial outcomes (p<0.05)†,‡ | Health outcomes (p<0.05)‡ |
| Mikkelsen et al. (2000)38 | Prospective 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, 10 | Two hospitals, Norway Various health professionals, clerical, technical and managerial staff | Workers’ steering committees moderated by external consultant. Individual-level stress management and physical training | Mixed support for intervention from managers and staff. Intervention was dropped after evaluation | Job 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)39 | Prospective 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, 10 | Factory, The Netherlands Manual workers and other staff | Consultative committee (employees, managers and researchers) to discuss organisational change. Concurrent health promotion programme (smoking cessation and physical activity) and psychosocial skills training | Authors provide few details on implementation although employees were said to have been consulted and participation was voluntary | Psychological 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)40 | Prospective 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, 10 | Five work groups of civil servants, Sweden Specific job details not reported | 2-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 workers | Stimulation 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)41 | Prospective 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, 10 | Hospital, UK Health professionals and clerical staff | Site A: individual-level stress management training and sessions for employees to propose stress reducing innovations to their work Site B: stress management training only | Authors provide few details on the degree to which proposed innovations were accepted by management. They refer to organisational constraints impeding the innovation group | Individual 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).