Summary of findings 4. A combination of individual‐level interventions compared to no intervention/wait list/no stress‐reduction intervention for stress reduction in healthcare workers.
| A combination of individual‐level interventions compared to no intervention/wait list/no stress‐reduction intervention for stress reduction in healthcare workers | ||||
| Patient or population: healthcare workers Setting: various healthcare settings Intervention: a combination of individual‐level interventions Comparison: no intervention/wait list/no stress‐reduction intervention | ||||
| Outcomes | Anticipated absolute effects* (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | What happens |
| Effect with a combination of individual‐level interventions | ||||
| Stress symptoms (follow‐up up to and including 3 months after end of intervention) | SMD 0.67 lower (0.95 lower to 0.39 lower) | 1003 (15 RCTs) | ⊕⊕⊝⊝ Low 1 | On the short term, a combination of individual‐level interventions may result in a reduction in stress symptoms. The standardized mean difference translates back to 8.2 fewer (11.7 fewer to 4.8 fewer) points on the MBI‐Emotional exhaustion scale4. |
| Stress symptoms (follow‐up > 3 to 12 months after end of intervention) | SMD 0.48 lower (0.95 lower to 0.00) | 574 (6 RCTs) | ⊕⊕⊝⊝ Low 2 | On the medium term, a combination of individual‐level interventions may result in a reduction in stress symptoms, but the evidence does not exclude no effect. The standardized mean difference translates back to 5.9 fewer points (11.7 fewer to no difference) on the MBI‐Emotional exhaustion scale4. |
| Stress symptoms (follow‐up >12 months after end of intervention) | no effect estimate | 88 (1 RCT) | ⊕⊝⊝⊝ Very low 3 | The evidence is very uncertain about the long‐term effect of a combination of individual‐level interventions on stress symptoms. |
| CI: confidence interval; SMD: standardized mean difference | ||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||
1 The certainty of the evidence was downgraded by two levels for very serious risk of bias (bias arising from the randomisation process and lack of blinding; i.e. performance bias) in combination with some inconsistency and suspicion of publication bias.
2 The certainty of the evidence was downgraded by two levels for very serious risk of bias (lack of blinding; i.e. performance bias) and inconsistency. We did not downgrade for imprecision, as the wide confidence interval is due to the inconsistency between study results.
3 The certainty of the evidence was downgraded by three levels for very serious risk of bias (bias arising from the randomisation process and lack of blinding; i.e. performance bias) and very serious imprecision (small sample size, the confidence interval includes both a benefit and a harm).
4 The MBI‐emotional exhaustion scale has a total score of 54 and we used the mean score (23.6) and standard deviation (12.2) of the control HCW population in Fiol DeRoque 2021 as reference for interpreting the effect sizes. A score below 18 points is regarded as a low score on emotional exhaustion and a score above 36 as a high score on emotional exhaustion (Maslach 1996).