Internet Interventions 34 (2023) 100689

Contents lists available at ScienceDirect

Internet Interventions
journal homepage: www.elsevier.com/locate/invent

Design and development of a digital intervention for workplace stress and

mental health (EMPOWER)
Christina M. van der Feltz-Cornelis a, *, Jessie Shepherd a, Jessie Gevaert b, Karen Van Aerden b,
Christophe Vanroelen b, Oriol Borrega Cepa c, Laura González Recio c, Renaldo M. Bernard d,
Ellen Vorstenbosch e, Paula Cristóbal-Narváez e, Mireia Felez-Nobrega e, Carlota de Miquel e,
Dorota Merecz-Kot f, Kaja Staszewska g, Marjo Sinokki h, Päivi Naumanen h,
Leona Hakkaart-van Roijen i, Frédérique van Krugten i, Marleen de Mul i, Josep Maria Haro e,
Beatriz Olaya e
a
MHARG, Department of Health Sciences, Hull York Medical School, University of York, York, United Kingdom
b
Interface Demography, Vrije Universiteit Brussel, Brussels, Belgium
c
Òmada Interactiva, SLL, Barcelona, Spain
d
Swiss Paraplegic Research, Nottwil, Switzerland
e
Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Spain
f
Institute of Psychology, University of Lodz, Lodz, Poland
g
Nofer Institute of Occupational Medicine, Lodz, Poland
h
Turku Centre for Occupational Health, University of Turku, Turku, Finland
i
Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Rotterdam, the Netherlands

A R T I C L E I N F O A B S T R A C T

Keywords: Purpose: We describe the design and development of the European Platform to Promote health and wellbeing in
Digital intervention the workplace (EMPOWER) digital intervention that provides an integrative user programme meeting the needs
Workplace of employees and employers in addressing work stress.
Work stress
Results: A user-centred design process was followed from January 2020 until November 2021. A tailored algo­
Mental health
Wellbeing
rithm was developed to provide support at the individual employee level and the company level. Each element of
Qualitative research the digital intervention was developed in English and then translated in Spanish, English, Polish and Finnish. The
Employees digital intervention consists of a website and a mobile application (app) that provides algorithm-based per­
sonalised content after assessing a user’s somatic and psychological symptoms, work functioning, and psycho­
social risk factors for work stress. It has a public section and an employer portal that provides recommendations
to reduce psychosocial risks in their company based upon clustered input from employees. Usability testing was
conducted and showed high ease of use and completion of tasks by participants.
Conclusion: The EMPOWER digital intervention is a tailored multimodal intervention addressing wellbeing, work
stress, mental and physical health problems, and work productivity. This will be used in a planned RCT in four
countries to evaluate its effectiveness.

1. Introduction 2023; Lerner et al., 2010; Henderson et al., 2011; Harvey et al., 2013).
For example, 51 % of work-related ill health and 55 % of lost workdays
Depression and anxiety have an enormous impact on the well-being reported in the United Kingdom in 2019 were due to anxiety or
of employees, their employers, and society (GBD 2019 Diseases and depression, both of which can be treated successfully and might have
Injuries Collaborators, 2020). Symptoms of depression and anxiety are been prevented (Health and Safety Executive, 2020).
related to work stress and lowered productivity while at work, which Addressing work stress and mental well-being at the workplace
may have a substantial economic impact (Adler et al., 2006; Wang et al., might improve work functioning. Digital interventions have been

* Corresponding author at: Department of Health Sciences, ARRC Building, Room 204, University of York, York YO10 5DD, United Kingdom.
E-mail address: [email protected] (C.M. van der Feltz-Cornelis).

https://doi.org/10.1016/j.invent.2023.100689
Received 23 May 2023; Received in revised form 13 October 2023; Accepted 27 October 2023
Available online 4 November 2023
2214-7829/© 2023 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
C.M. van der Feltz-Cornelis et al. Internet Interventions 34 (2023) 100689

introduced with that objective and small to medium size effects have Institute. After the first 33 days, the Social Insurance Institution
been reported (Stratton et al., 2021; Heber et al., 2017; Miguel et al., covers the leave, generally at 80 % of the base pay for a maximum of
2023). They tend to have high attrition rates, for example, 48.5 % of 182 consecutive days per year (inclusive of the 33 days paid by the
participants were reported to have dropped out of one intervention employer). For employees aged 50+, the company must only cover
(European Commission, 2018). Although some digital interventions the first 14 days of sick leave. The rest is covered by Social Security
promise to be effective in addressing work stress or mental disorders at (Employee leave Entitlement, 2023).
the workplace, there is a general lack of interventions that address both
symptoms in employees and psychosocial risk factors at the workplace The European Intervention to Promote Wellbeing and Health in the
(Torous et al., 2020). Also, they generally focus on employees and do not Workplace (EMPOWER) intervention (Olaya et al., 2021) aims to
support employers in improving well-being in their workforce (Volker address work stress and well-being for employees at the individual level
et al., 2015). Additionally employers report a lack of knowledge and and to explore opportunities for employers to identify and address
ability to address work stress and well-being (Deloitte Global Human psychosocial risk factors in the workplace that might impact well-being.
Capital Trends, 2017). Moreover, there is a call for research to under­ The intervention was designed to be implemented in small and medium
stand which factors contribute to the variation in effectiveness of enterprises (SMEs), which are organizations with fewer than 250 em­
particular interventions depending on the mental health area and ployees and an annual turnover not exceeding EUR 50 million (Euro­
characteristics of participants and interventions, in other words, for pean Commission, 2020b) and public agencies, which are organizations
providing modules based on triage (Phillips et al., 2019). with a public legal personality dependent on the administration for the
A digital interventions’ ability to be adapted to the diverse contexts performance of activities within the competence of the region or country
in which they are employed is fundamental to practical application. under a functional decentralization regime. Large companies (i.e. ≥250
When using an intervention cross-culturally, the translation of language employees) can also participate despite not being the main focus. This
is a complex process, since there are differences in the connotations of will be done in the United Kingdom (UK), Spain, Finland and Poland,
words, particularly for mental health and wellbeing (Beck et al., 2003). that represents diverse welfare and health service models.
It is important then to not translate the words alone, without consider­
ation of cultural context, as this can lead to misunderstanding or for the 1.1. Study aim
intervention to not function in the way intended (Resnicow et al., 2000).
To cover a range for our cultural validation, we also aimed to allow In this study, we aim to describe in detail the design and develop­
for differences in legislation regarding sickness absence, which varies ment of the digital intervention in English, and translate and culturally
greatly from country to country. Some countries have generous wages validate each component of the intervention in Spanish, Polish and
paid during illness. For example, the Netherlands, where in the event of Finnish.
illness, wages are paid for 2 years, from the 2nd year generally at 70 % of
the salary; and Germany, where wages are paid for 6 weeks to a 2. Materials and methods
maximum of 78 weeks in 3 years, for 70 % of the salary. On the other
hand, in a country like Sweden employers pay wages for 14 working We aimed to develop a new digital intervention, which included a
days at 80 %, but some employers don’t; after that the employee can ask website and a mobile app. The design took one year and three months
for benefits from the Swedish Social Insurance Agency (European (Jan 2020 - March 2021). We followed a mixed method, co-design
Commission, 2023a). approach. We based the intervention on several building blocks:
Four countries were chosen to participate in the development and
cultural validation of the digital intervention: the United Kingdom (1) the outcomes of a systematic review (Byrne et al., 2022), that
(Anglo-Saxon model), Spain (Mediterranean model), Finland (Nordic defined tailored, personalized digital interventions;
model) and Poland (Central-Eastern model). Their regulations for sick (2) material from a study improving work productivity in common
leave are as follows: mental disorders in the workplace with a digital intervention
(Torous et al., 2020), and
• The UK, which has 28 weeks of continued wages payment with max. (3) publicly available intervention materials adapted as needed in
£109.40 per week gross, independent of actual salary, in case of English.
illness (Statutory Sick Pay) (Gov.uk. Working, Jobs and Pensions,
2023). In our design of the digital intervention, we applied personalization
• Spain, where the first 15 days of illness are paid. Full salary is and tailoring as follows: 1) an algorithm to triage based upon assessment
covered via the country’s social security system. It is standard or questionnaire scores and to provide summarised feedback, 2)
practice for employers to follow this mandatory minimum entitle­ participant choice for part of the modules; 3) automated messages to
ment (European Commission, 2023b). users, 4) indirect support by the managers or employers, based on rec­
• Finland, where wages are paid for 10 working days at 100 % of the ommendations from the app, to deal with psychosocial risks detected in
salary. Most employers also pay the full salary during the first one to that particular company.
two months. A doctor’s certificate is required for the period during The digital intervention was developed in the following eight months
which you are unable to work. Social security will pay sickness (April 2021–November 2021) after translation and cultural adaptation
allowance for a maximum of one year (300 working days). If you of the intervention for the other three countries planned to participate in
receive pay during the period of illness, social security will pay the the subsequent RCT to evaluate the effect of this intervention in small
compensation to the employer. To receive partial sickness allowance, and medium companies, public agencies and large companies (Olaya
working hours and pay must have been reduced by 40–60 %. Partial et al., 2021). We followed the APA approach for reporting of the qual­
sickness allowance can be claimed for a maximum of 120 working itative methods and results (American Psychological Association, 2020).
days (European Commission, 2023c).
• Poland, where Employers are responsible for paying employees on 2.1. Design of the intervention
sick leave 80 % of their salary for the first 33 days of illness in a
calendar year, regardless of breaks. The amount increases to 100 % if A four-step user-centered design process was followed to create de­
the employee becomes ill during pregnancy or if their illness were signs for the digital intervention’s website and app (Abras et al., 2004).
related to accidents at work or commuting to or returning from work. This process is illustrated in Fig. 1 and focuses on closely matching end-
The difference, in this case, is covered by the Social Security users needs and context of usage to the design (Biron et al., 2004).

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C.M. van der Feltz-Cornelis et al. Internet Interventions 34 (2023) 100689

Fig. 1. Four-step user-centered design process.

Designers first analysed the needs, goals and context of usage for 2) negotiated consensus: discussion between research teams on chal­
target users (workers) and key stakeholders (employers and managers). lenging concepts and documentation of such modifications to
This general requirement gathering exercise for the intervention maintain the core parts of the materials as well as allow for cultural
involved a multidisciplinary team consisting of researchers, developers sensitivity (McGreevy et al., 2014);
and clinicians (occupational physicians and psychiatrists). The app’s 3) pre-testing: evaluation by potential end-users and experts through
design was intended to meet the needs of persons with different digital online focus groups or functional alternatives (e.g., interviews,
literacy levels and various job and demographic profiles. User- written consultation) in all countries. Seeking input from key actors
experience requirements were mainly persona-based (Pruitt and Adlin, (i.e., potential end-users, employer representatives and legal ex­
2010) and relied on user-interface design principles (Nielsen et al., perts), can help inform and further tailor the intervention, which is
2019). Hence, the planning process was adapted to accommodate the known to increase positive results after the intervention (Sorensen
national shutdown and necessary safety restrictions. We created several et al., 2016).
target-user profiles based on assumptions about users, results from 4) modification of the material based on end-user feedback (El Masri
published literature on mental health apps, and past reports of user et al., 2019). This phased approach allowed for linguistic translation
experience with these apps. These profiles were designed to represent and cultural adjustment while maintaining the empirical and insti­
the needs of prototypical target users of the app and helped us build a tutional source material.
beta version of the digital intervention, which we tested during the us­
ability testing. Several high-fidelity functional prototypes were then For this approach, we used a Translation and Verification Follow-up
designed and developed as a non-interactive web-based prototype and Form based on the European Social Survey Translation Process (Mohler
then underwent usability testing by end-users and an expert evaluation et al., 2016), which was co-developed with an external service provider
by key stakeholders, such as Human Resources managers, unions rep­ specialized in language solutions for linguistic and cultural compara­
resentatives, and health professionals i.e. occupational physicians and bility (Mohler et al., 2016). This ensures continuous documentation on
psychologists. the types of modifications that have been made to the base version of the
intervention and records why modifications have been made. System­
3. Theory atically documenting the steps taken to ensure cultural sensitivity is a
common recommendation in literature on cross-cultural research prac­
3.1. Translation tices (Mohler et al., 2016; Escoffery et al., 2018).
This verification form is a way of establishing validity for our cultural
The EMPOWER intervention will be evaluated in an RCT in four sensitivity approach. It ensures replicability and reproducability by
countries representing different European welfare and health service tracking any potential modification that was made to the intervention as
models (Olaya et al., 2021): Finland (protective and universal regimes in a result of cultural sensitivity.
terms of welfare provision), Spain (a fragmented system of welfare This cultural sensitivity approach allowed for the adaptation of both
provision, and strong reliance on family and charitable sector), Poland surface structure (e.g., adaptations of language, names, activities etc.)
(an underdeveloped welfare system but strong labour market in­ and deep structure adaptations (e.g., adaptations in specific cultural
stitutions and solid industrial economy), and the United Kingdom (Na­ health behaviours and patterns) consistent with (Beck et al., 2003) while
tional Health Service, short-term benefits for sick-listed employees) continuously considering the ‘fidelity-adaptation dilemma’ (Castro
(Alvarez-Galvez et al., 2014). Hence, due to expected cultural differ­ et al., 2010) by deciding when to adapt specific components and when to
ences between these four countries, we followed a multistep or stage stay true to the core elements of the intervention.
model framework (Castro et al., 2010) inspired by both the “cultural Finally, experts’ evaluation of the material was arranged by organ­
sensitivity approach” and “negotiated consensus” approach (McGreevy ising online consultations with relevant local stakeholders in each of the
et al., 2014). There is plenty of evidence showing these methodologies to four countries. The main goal was to receive feedback on the EMPOWER
be commonly applied in the process of cultural adaptation (Beck et al., intervention and the content of the intervention materials from stake­
2003; Castro et al., 2010; McGreevy et al., 2014; Spanhel et al., 2021; holders with different areas of expertise to improve the intervention
Escoffery et al., 2019; Barrera and Castro, 2006). Together, they involve before its actual implementation. The final procedure for organising the
four steps: local stakeholder consultations was composed of six steps (preparation,
recruitment, first virtual meeting, execution, second virtual meeting,
1) forward translation (the process in which a text (e.g., in English) is and reporting). It was developed with the specific aim of ensuring a high
translated to the native language of the translator) with cultural degree of uniformity between the four settings. In the first phase, each of
adaptation to make content more understandable for the participants the country teams selected, based on a set of standard profile re­
from that setting (Phillips et al., 2019), following a cultural adap­ quirements, 6 to 10 potential participants to be included in the consul­
tation protocol that was developed for this purpose; tation round for their country. These individuals (at least: one academic

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C.M. van der Feltz-Cornelis et al. Internet Interventions 34 (2023) 100689

from outside the research team, one employee representative, one Table 1
employer representative and one occupational health expert or occu­ Aims of prototype and beta testing.
pational physician) were invited to participate in the consultation group Usability attributes Definition of attributes
using a standard e-mail explaining the goal and the procedure. The four
Prototype Branding used in the app Look of pictures, text, and layout
country teams then organised a first virtual meeting with all members of testing aims Comprehensibility (in Users understanding of the
their local consultation group, in which parts of the material of the English only) content in a mobile format
EMPOWER intervention were presented to the participants. These vir­ User satisfaction with Users attitude when using an app
tual meetings were based on a standard script and identical materials to material
Beta testing Comprehensibility (in all Users understanding of the
ensure consistency between the four countries. The meetings were also aims four languages) content in a mobile format
recorded to enable accurate processing of the information provided by User satisfaction with Users attitude when using an app
the participants later. In the execution phase, the participants of the material
stakeholder consultation groups received an e-mail containing the ma­ Simplicity The ease with which users
complete assigned tasks
terials selected for revision and a standard set of questions about these
Effectiveness The extent to which users are able
materials. to complete goals in the app
Literal answers were collected and summarised afterwards by each
research team to be presented and discussed in the second and final
virtual meeting. This second meeting allowed for a group discussion in the survey were anonymous and that no personally identifiable data
about the EMPOWER intervention and the materials that were reviewed. was collected. Volunteers were invited to access and use parts of the
The results of the local stakeholder consultations were then summarised app’s beta version in three iterations and a survey that guided them
in a comprehensive report, with specific attention to the remarks made through the testing tasks. The survey was delivered by Google form.
by the local stakeholders and the corresponding changes made to the Survey responses were analysed to determine comprehensibility, user
materials. satisfaction, simplicity, and effectiveness as defined in Table 1, including
During the EMPOWER digital intervention creation, it was essential ease of use, task completion, and usefulness of material in the app. Users
to consider gender and cultural differences that could impact successful were also asked open-ended questions around their recommendations
implementation. During the development of the intervention, cultural for improvements.
appropriateness and institutional context were considered for each of
the four cultural settings (Spain, Finland, United Kingdom, and Poland). 4. Results
The intervention was carefully adapted to ensure the usability, accept­
ability, and adherence for each setting and comparability of the material The design and development process yielded the following
across all four settings. EMPOWER intervention, as shown in Fig. 2. That provides an overview
The considered adaptations included ways of rephrasing parts of the of the components of the digital intervention and how each level con­
source materials or adding definitions and synonyms to complex con­ nects to the others.
cepts to ensure comprehension among the target population. Other
factors of usability, like the structure of the text, which was deemed
4.1. EMPOWER digital intervention
overly schematic by potential end-users, and overall framing, which end
users felt was too ‘negative’ (i.e., focus on ‘illness’ rather than ‘well­
The EMPOWER digital intervention has a website and app that are
ness’), were discussed and adapted. Unique practices and ‘social codes of
linked by assessment and triage. The main website is public and not
conduct’ within each setting were also considered (e.g., in the Spanish
individualised, providing a digital mental health awareness campaign at
text, the mention of standing desks was limited because it was not a
the company level that supports employees and employers in addressing
common practice in Spain). Further adaptations were related to the
work-related stress and mental health issues.
occupational health and safety regulations for each of the four settings
An employer portal within the website is designed to provide indi­
(e.g., the equality policy and occupational health care were elaborated
vidualisation for employers without impacting employee confidenti­
on in Finnish documents, and specific employee break regulations were
ality. It includes a brief assessment of psychosocial risk factors in the
clarified in Polish documents). In addition, cultural adaptation consid­
workplace by the employees, complemented by tailored recommenda­
ered inherent characteristics of the organisational culture and worker
tions for employers. It provides summarised feedback based upon their
characteristics, particularly gender.
employees’ assessment of psychosocial risk factors. This feedback is
provided without identifying information and gathered using all
3.2. Usability testing
participating employee responses to protect employees’ confidentiality.
This level is only accessible to employers who will participate in the
Qualitative usability testing was performed on a website-based non-
planned EMPOWER RCT.
interactive prototype and subsequently on a software-based interactive
The app portion of the EMPOWER intervention is available for use by
beta version of the EMPOWER app. The usability testing aimed to assess
individual employees in participating companies. An algorithm was
both in the workplace to report on user experience and to gather rec­
developed by the research group that uses outcomes from triage
ommendations from the participants. The specific aims of each phase of
assessment tools to individually tailor content modules to each
the usability testing and variables explored (Zhang and Adipat, 2005)
employee based on symptomatology and work functioning. Each user,
are mentioned in Table 1.
therefore, has an individualized experience to match symptomatology
The English-only prototype testing was completed by sending par­
and need.
ticipants a link to the prototype and a survey asking questions regarding
the branding, comprehensibility, user satisfaction and recommendations
for improvement. Survey responses were analysed and then incorpo­ 4.2. Components
rated into the design of the beta version of the app.
The usability testing for the beta version of the EMPOWER digital The intervention combines four components, that are described in
app took place in Spain, the United Kingdom, Finland, and Poland. more detail below.
Participants aged 18 or over were invited. A minimum of five to ten
participants per site was aimed at as is common in usability testing (Six 1. A component of mental health promotion at the workplace that in­
and Macefield, 2016). Participants were advised that all answers given cludes raising awareness about workplace mental health

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Fig. 2. EMPOWER digital intervention.

2. A component to screen for psychosocial working conditions and working conditions, which were thought to be potentially stressful. This
provide recommendations to address those for employers and proposal was conceptually grounded in the typology of workplace
employees stressors developed by Cox (Cox et al., 2003) and The European
3. A component to screen for mental health, physical health, and Framework for Psychosocial Risks Management PRIMA-EF (Leka et al.,
absenteeism of employees and provide recommendations to promote 2008) and supported by a large body of research which showed direct
well-being and mental health in employees relationships between workplace stress and burnout, depression, anxi­
4. A work functioning component to help deal with work-related ety, adjustment disorders, somatisation, chronic fatigue, psychotropic
problems such as presenteeism and frequent absenteeism drugs consumption and many other conditions (Godin et al., 2005;
LaMontagne et al., 2010). The resulting module consisted of a Psycho­
social Stressors at Work Scale (PSWS), individual recommendations for
4.2.1. Mental health promotion and raising awareness at the workplace employees and employers based on the screening results and supporting
(MHPA) educational materials for the website. The PSWS was developed entirely
Psychoeducational materials were explicitly designed to increase for the purpose of the EMPOWER project. This was done because
awareness about mental health in the workplace, including the existing tools measuring the burden of stress at work are either short but
following sections, which provide information, examples, and advice: very generic which makes it impossible to design an intervention or very
What is a healthy workplace?; What is good mental health?; Why mental detailed and long, which are over burdensome on users. It is based on
health matters; Workplace bullying; Types of mental health conditions; the Subjective Work Characteristics Questionnaire (SWCQ) (Dudek
Workplace stress, “are they ok?”; Starting a conversation; Helping a work­ et al., 2004) and Psychosocial Risk Scale (PRS) (Mościcka-Teske, 2014)
mate; Legal rights and responsibilities. This material is offered on the public tools for the assessment of psychosocial stress at work. The Psychosocial
website. Stressors at Work Scale consists of 16 items selected by six experts in
occupational and health psychology from the original SWCQ and PRS.
4.2.2. Screening instrument and recommendations for psychosocial working The psychosocial stress measure should, on one hand, give enough in­
conditions (PSWS) formation for designing sound intervention at the workplace aimed to
To raise awareness for factors that lead to mental ill-health at work, elimination or reduction of stress factors related to work and on the
psychosocial working conditions and how they shaped the health and other hand be short enough not to burden the users of Empower Plat­
well-being of employees were explored in material publicly available on form. The used version of the PSWS is shown in Fig. 3. The chosen items
the website. This was meant to familiarize both employees and em­ describe universal stressors which may appear in any job. The devel­
ployers with psychosocial risk factors which may appear at work and opment was guided by three basic assumptions:
their consequences for work functioning and health. These educational
materials included the following topics: work overload, role ambiguity, (1) the screening tool should be universal, i.e. it can be used in any
conflicts at work, social support, professional development, and pro­ workplace;
motion (career issues), presenteeism, atypical working hours, remote (2) it should be short so as not to burden employees,
work, burnout, sexual harassment, bullying, aggression, and workplace (3) screening results should be easily translated into recommenda­
traumas. tions enabling changes to be introduced at the individual and
We proposed a module devoted to screening universal psychosocial organisational levels.

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Fig. 3. Psychosocial stressors at work scale.

The general score of the PSWS is calculated. Then, matching the Each recommendation describes the actions that can be taken to
testing results with recommendations for employees is based on the improve working conditions in the company. The system will not pro­
threshold of ≥2 points. So, if an employee states that their level of stress vide information on sources of stress if the number of employees is less
is ≥2 points on one answer scale, they will receive recommendations than 10 to protect the anonymity of workers. In such cases, employers
related to that particular problem at work, as presented in Fig. 4. will receive a more general summary of what can be done to reduce the
Then, based upon sum scores for all questions taken together, general stress burden at work. Additionally, employers will be provided with a
recommendations would be provided as shown in Fig. 5. diagram on different steps that they can take to implement the
The PSWS questionnaire for employees is delivered through the app, EMPOWER intervention. They will also be provided with country-
and they also receive the tailored recommendations via the app. specific institutions or consultants that could help the companies with
Through a separate, dedicated and secure part of the EMPOWER this. This way, employers were supported to fulfil their legal duties in
website, employers will receive general information about the five most relation to national law to address health, mental health and safety at
common stressors regarding occupational stress in their company after work. This can especially be helpful for SMEs, which generally do not
the period in which their employees could fill in the PSWS. This infor­ have the resources to make use of the offer of specialists providing stress
mation will also be available for employees to ensure a transparent flow prevention programmes in the workplace.
of information. Employers will receive recommendations based on the Examples of recommendations for the employee and employer are
results of their employees. presented in Fig. 6.

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C.M. van der Feltz-Cornelis et al. Internet Interventions 34 (2023) 100689

Fig. 4. Algorithm for feedback based on the total score of Mini-PSWS.

Fig. 5. Example of recommendations based on total score.

All recommendations were the result of consultation with experts 4.2.3. Promoting well-being and mental health at work (PWMH)
(occupational health professionals, researchers, representatives of em­ Promoting Well-being and Mental Health (PWMH) is the third
ployees and employers) in Poland, United Kingdom, Spain and Finland. component of the intervention. This intervention is directed toward
Small-to-Medium Enterprises (SMEs) with up to 50 (small) or up to 250
(medium) employees (European Commission, 2020a), and public

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Comparison of the sample recommendations for an employee and an employer

Recommendation for an employee who declared Recommendations for an employers’ whose

that stress due to the lack of social support from employees suffer from high stress due to the lack of
co-workers and managers social support from co-workers and managers

1) Lack of social support at work is a profound Please consider:

factor affecting our wellbeing, thus, it is 1) Introduction of mentoring for new employees
important to be active in developing a which can help to socialize them with
supportive social network. colleagues, the work environment, demands
and procedures;
2) Analyse your strengths and weaknesses. If
you find something that could be improved, 2) Improve managerial skills by providing training
use the training opportunities available to on how to give constructive and supportive
you, to increase your competences. feedback to employees;
Consider how to use your strengths in
teamwork. 3) Promotion of team work and collective efforts to
achieve organizational goals;
3) Find one person at work with whom you
feel comfortable sharing your doubts and 4) Promotion of collective events which allow for
feelings. development of social bonds between
employees in your organization;
4) If you have problems with asking for help -
take a small step exercise and start to ask 5) Support employees by showing an
people who seem trustworthy for small understanding of work and private life and serve
things like an opinion on a particular topic, as a good example of being open to people’s
explanation of some procedure etc. problems at work;

5) Be supportive for others if they need it- a 6) Provision of training and courses which aim to
good example usually starts with the improve professional competences of
reciprocity rule employees;

6) Do not hesitate to use coaching services in 7) Building teams consisted of experienced and
your organization (if available). new employees, and thus giving them the
opportunity to acquire necessary skills and
experience.

Fig. 6. Comparison of the sample recommendations for an employee and an employer.

agencies; it has an individual approach and was designed based on physical health, presenteeism and absenteeism when they begin using
strategies and techniques of the Cognitive Behavioural Therapy (CBT) the app. The intervention builds on interventions designed to address
model. Previous evidence suggests that digital interventions that include the most common mental health symptoms, such as stress, anxiety,
a variety of mental health interventions, rather than a single mental insomnia, and depression, that were previously tested and proven
health intervention, have a higher success rate (El Masri et al., 2019) and effective and cost-effective in improving well-being and return to work
a higher participation and adherence rate (Robroek et al., 2009). in sick-listed employees with mental disorders (Torous et al., 2020;
Additionally, health promotion is more effective if it provides in­ Robroek et al., 2009). This component also combined interventions to
dividuals with an array of tools, and the individual is thereby empow­ address the most common comorbid conditions based upon triage
ered to use the more appropriate approach for their situation (El Masri (Torous et al., 2020; Lokman et al., 2017). It encouraged employees to
et al., 2019). seek guidance and the help of health professionals when appropriate and
PWMH presents several blocks of psychoeducational and practical was designed to complement treatment provided by a health
contents (e.g., relaxation exercises, breathing techniques), allows for professional.
tracking of daily-life moods, promotes healthy sleeping habits, and en­ The Work Functioning (WF) element of the app incorporated edu­
courages the development of personal attitudes and skills (e.g., problem- cation about work functioning in case of stress at the workplace and how
solving strategies, cognitive restructuring techniques) in order to to deal with mental health problems in the workplace in interactive,
manage symptoms of stress, anxiety and depression. All contents of this tailored modules designed to correspond to participants’
intervention were designed and presented using gamification elements symptomatology.
to promote self-learning and ongoing use and adherence to the program. The goal-setting section was designed to last three to six sessions. It
The psychoeducation material of this module was created to enhance involved four main elements:
literacy, attitudes and supportive behaviours about well-being and
mental health and includes information on core constructs of the 1) Describing the problem,
intervention (i.e., stress, depression, anxiety and insomnia). The content 2) Creating a goal to focus on,
offers a non-expert definition of each construct, information regarding 3) Creating an action plan,
signs, symptoms, potential causes and practical strategies. 4) Self-evaluation of steps taken.

4.2.4. Work functioning (WF) Each element contained advice and encouragement to assist the
The Work Functioning (WF) component is the fourth intervention participant in skills development and building self-awareness.
component. It was designed to provide participants with targeted pre­ Participants were allocated goal sessions during the initial planning
vention strategies and to support employees with presenteeism or for the WF goals setting based upon initial risk assessment scores. The
frequent absences from work. This intervention component is tailored to goal-setting feature was designed to be sequentially provided after
the individual employee’s needs based upon assessing their mental and another module was completed. This initial plan was amended following

8
C.M. van der Feltz-Cornelis et al. Internet Interventions 34 (2023) 100689

feedback from the development team. WF goal setting was then changed which involves questions on work functioning, physical and mental
to appear as a general tool in the app and provided concurrently with health, and comorbidity. Three core categories were created; within
other materials. This update allows all participants to use the goal them were multiple user profiles allocated based upon assessment
setting and repeat the goal setting if they decide to work on more than scores. It should be noted that while the app was designed to meet
one goal or feel they need to re-evaluate their initial choice, enabling individualised user needs, it was not designed to meet the needs of those
them to self-determine how to use the app according to their needs and with suicidal ideation or suicidal intent. If a user selected that they
desires. It provides access to this valuable tool to all participants rather experience suicidal ideation or intent when filling out assessment
than a subset of participants. This change in design is an example of how questionnaires, they received a popup message encouraging them to
the needs and feedback from the target population guided the devel­ speak with a medical professional who can provide treatment and
opment teams’ decision-making. monitor them and informing them that although the EMPOWER app was
not designed to address their specific needs, they were allowed to
continue to use the app if they choose to.
4.3. Triage design The three core categories for users are:

A triage process was designed to guide the employees through the A) participants who identified no current issues that affect their
different modules of the app. App content was put together based upon ability to get work done at their normal level in the 30 days prior
initial user assessment and allocation of material is made through the to the assessment;
use of an algorithm. The triage is based on the initial user assessment

Intervention and Model Design

The following work-related questions (1 = YES 0 = No):

1. Are you currently on sick leave? Yes/No
2. During the last 4 weeks have there been days in which you worked but during this time were bothered by any kind of problems that made it difficult for you to get as much work finished
as you normally do? Yes/No
3. Have you missed work 3 times or more in the last year as a result of being sick? Yes/No

1=0; 2=0; 3=0 1=0; 2=1; 3=0 1=0; 2=0 or 1; 3=1

No work problem A Presenteeism B Frequent absenteeism: ≥3 in the last year C
Sections that eligible participants Access to PWMH Access to PWMH Access to PWMH
will access AND AND
Access to the relevant WF modules as pointed out below Access to relevant WF modules as pointed out below
GAD7
No anxiety: < 5 AA0 BA0 CA0
Two content modules with general wellbeing focus, and goal Two content modules with general wellbeing focus, one module
setting on absences, and goal setting
Anxiety: 5-9 AA1 BA1 CA1
Two content modules with general wellbeing focus, two with Two content modules with general wellbeing focus, two with
anxiety focus, and goal setting anxiety focus, one module on absences, and goal setting
Anxiety: ≥10 AA2 BA2 CA2
Two content modules with general wellbeing focus, four with Two content modules with general wellbeing focus, four with
anxiety focus, and goal setting anxiety focus, one module on absences, and goal setting
PHQ9
No depression: < 5 AB0 BB0 CB0
Two content modules with general wellbeing focus, and goal Two content modules with general wellbeing focus, one module
setting on absences, and goal setting
Depression: 5-9 AB1 BB1 CB1
Two content modules with general wellbeing focus, two with Two content modules with general wellbeing focus, two with
depression focus, and goal setting depression focus, one module on absences, and goal setting
Depression: ≥10 AB2 BB2 CB2
Two content modules with general wellbeing focus, four with Two content modules with general wellbeing focus, four with
depression focus, and goal setting depression focus, one module on absences, and goal setting

PHQ15
No physical symptoms: <5 AC0 BC0 CC0
Two content modules with general wellbeing focus, and goal Two content modules with general wellbeing focus, one module
setting on absences, and goal setting
Physical symptoms: 5-10 AC1 BC1 CC1
Two content modules with general wellbeing focus, two with Two content modules with general wellbeing focus, two with
physical health focus, and goal setting physical health focus, one module on absences, and goal setting
Physical symptoms: ≥10 AC2 BC2 CC2
Two content modules with general wellbeing focus, four with Two content modules with general wellbeing focus, four with
physical health focus, one on use of painkillers, and goal setting physical health focus, one on use of painkillers, one on
absences, and goal setting
CBS
No CMC AD0 BD0 CD0
no score on CBS Two content modules with general wellbeing focus, and goal Two content modules with general wellbeing focus, one module
setting on absences, and goal setting
Yes CMC AD1 BD1 CD1
1 or more on CBS list Two content modules with general wellbeing focus, one with Two content modules with general wellbeing focus, one with
physical health focus, one on use of painkillers, one on chronic physical health focus, one on use of painkillers, one on chronic
medical conditions, and goal setting medical conditions, one on absences, and goal setting
Comorbidity
Psychological comorbidity: AE1 BE1 CE1
Score of >5 on GAD7 and PHQ9 Two content modules with general wellbeing focus, five with Two content modules with general wellbeing focus, five with
(no score on PHQ15 or CBS) depression and anxiety focus, and goal setting depression and anxiety focus, one on absences, and goal
setting
Somatic comorbidity: AE2 BE2 CE2
Score >5 on PHQ15 and tick any Two content modules with general wellbeing focus, four with Two content modules with general wellbeing focus, four with
condition on CBS physical health and chronic medical conditions focus, one on physical health and chronic medical conditions focus, one on
(no score on PHQ9 or GAD7) use of painkillers, and goal setting use of painkillers, one on absences, and goal setting
Mixed comorbidity AE3 BE3 CE3
Score of >5 on GAD7 and/or Two content modules with general wellbeing focus, two with Two content modules with general wellbeing focus, two with
PHQ9 and score >5 on PHQ15 physical health and chronic medical conditions focus, two with physical health and chronic medical conditions focus, two with
and/or tick any condition on CBS depression and anxiety focus, one on use of painkillers, two depression and anxiety focus, one on use of painkillers, two
focused on physical symptoms, anxiety, and depression, and focused on physical symptoms, anxiety, and depression, one on
goal setting absences, and goal setting

Fig. 7. Intervention and Model Design.

9
C.M. van der Feltz-Cornelis et al. Internet Interventions 34 (2023) 100689

B) participants who identified they have experienced a problem that 4.4. Differentiation within the app based upon target group profiles
led to difficulty completing as much work as normal in the 30 related to digital literacy
days prior to the assessment; and
C) participants who identified they missed work more than three Initially, we created a user journey to represent a general profile of a
times in the last 12 months as a result of being sick, may or may potential EMPOWER intervention participant in order to estimate the
not have also identified as having a problem that has led to dif­ general needs of users. Fig. 8 is an illustration of the design process used
ficulty completing as much work as they normally do in the 30 when creating the app (Vargas-Prada et al., 2016). During the initial
days prior to the assessment. planning phase, we created a first version of the navigation flow based
on the content and benchmarking (a comparison) of similar pre-existing
The period of 15 days or less of absence from work is considered apps (i.e., Return to Work (Torous et al., 2020), Headspace (HEAD­
appropriate for an early intervention, designed to prevent longer-term SPACE, 2021), Calm (Huberty et al., 2019), or Downdog (Downdog,
sickness absence (Lokman et al., 2017). Within each of the three main 2021). We then created the first wireframes (initial illustration of the
categories, there were multiple user profiles which were allocated to the screens and navigation) of the EMPOWER app, allowing us to investigate
participants based on their reported symptoms and assessment scores. potential issues, such as bottlenecks (when the developed app does not
The content offered within each profile was tailored to the participants’ meet the needs of the stakeholders). We followed the method of agile
needs and the intensity of symptoms reported. Triage of work func­ manufacturing for this as indicated in Fig. 8 (Gunasekaran, 1999).
tioning and symptomology was based upon users’ response to validated A total of 25 stakeholders participated in the local consultation
questionnaires (GAD7, PHQ9, PHQ15 (Kroenke et al., 2010), Checklist groups (9 in Poland, 4 men and 5 women; 8 in Finland, with 3 men and 5
chronic disease (CBS, 2005) exploring physical and mental health and women; and 8 in Spain, 4 men and 4 women). They were from the
work functioning as mentioned in Fig. 7. following fields: occupational health experts, representative of trade
The material provided within the intervention was chosen based on unions, psychologists, academics, psychosocial risk experts, and em­
triage using participant initial assessment scores. The higher the ployers’ representatives.
participant assessment scores, and the more symptoms are reported, the The stakeholders participating in the local consultation groups
more tools and psychoeducation were offered. At the first intervention expressed their views on different emergent topics, including the project
level, participants will have access to psychoeducational materials and in general, the strengths and weaknesses of the intervention materials,
tools related to their symptomatology and needs. In addition, if a par­ the design, lay-out and usability of the intervention and the use of
ticipant’s risk assessment showed comorbid conditions, there were potentially problematic terms or concepts. They were also asked spe­
specific modules designed for combinations of symptoms. The design of cifically to list some aspects they felt could be improved or should be
the app, allowed for a tailored user experience, which has been shown in changed or added in the final version of the intervention. The consul­
past literature to improve mental health, increase wellbeing, and reduce tations generated many relevant remarks and questions that are useful to
frequent absences (Volker et al., 2013). consider when developing the digital intervention. The overall impres­
As examples of this triaging, in the app a participant whose assess­ sion of the project, its aims and the intervention material were very
ment outcome suggested they had minimal symptoms of anxiety or positive. The consulted stakeholders liked the idea to raise awareness
depression received material about continuing to access appropriate about mental health and they were enthusiastic about the focus on the
supports, increasing their resilience to potentially prevent maladaptive workplace. In this context, the stakeholders pointed out that the actual
symptomology developing, and interactive goal setting. A user whose involvement of the employers/organizations should be strengthened.
initial assessment outcome suggested high levels of anxiety, depression, The stakeholders also liked the approach of a mobile phone application
or comorbidity, for example, was provided with psychoeducation, skills- with interactive elements as a tool for promoting and monitoring the
building modules, examples of symptomatology and ways to combat it, mental health of individuals, although they also expressed some con­
and interactive goal setting. This variation in intensity of support as well cerns about the use of an application. The stakeholders stressed the
as material which connects with participant symptoms, was an inno­ importance of developing an attractive and user friendly lay-out for the
vative and potentially highly effective way to design a workplace intervention. Each of these concerns was acted upon, to improve the
intervention to target mental health and absences. development and the implementation of the intervention.
Finalised target-user profiles, so called personas, included three
fictional characters representing specific user-groups based on

Fig. 8. Agile design process as used for the app.

10
C.M. van der Feltz-Cornelis et al. Internet Interventions 34 (2023) 100689

information from secondary sources (e.g., official government and 5. Discussion

organisational records, studies) about mental health and digital liter­
acies, socio-economic status, occupation, educational background, This study was a description of the design and development of the
goals, motivations, interests, and common life challenges. From the EMPOWER digital intervention prototype and beta version. Usability
profiles created, we extracted three main user personas to focus on. We testing results showed that users were able to complete tasks in the app
used key aspects such as level of digital literacy and level of mental and that they liked the design.
health awareness, and demographic and work backgrounds to differ­ As mentioned in the rationale, while there are a few digital in­
entiate between our personas. The final result of the process was a beta terventions already on the market, they typically target individual is­
version of the prototype which was ready for user testing leading to it­ sues, such as depression alone, rather than focusing on comorbidities
erations and improvements in design before the final release for evalu­ and integrative approaches that address mental health symptoms and
ation in a planned RCT (Olaya et al., 2021). work participation after illness (Stratton et al., 2021; Heber et al., 2017;
Deloitte Global Human Capital Trends, 2017). The triage design for the
EMPOWER app targets symptomology of individual users and is based
4.5. Usability testing upon validated risk assessment questionnaires. The resulting protocol
allows for variations in support level and material offered depending on
The prototype was tested by ten participants in the United Kingdom, participant need as well as specific modules to address comorbidity. This
40 % were 35–44 years of age, 20 % were 25–34, 20 % were less than 24, design provides an innovative approach to addressing workplace mental
10 % were 55–64, and 10 % were more than 65. 70 % were female, and health concerns and targeted support of employees as well as managers
80 % had a bachelor’s degree or above education. The majority of survey and employers for work related problems, unlike most digital in­
responses expressed favourability toward the apps appearance and terventions on the market currently that focus on employees only
critical feedback mostly surrounded limitations of the prototype design (Stratton et al., 2021; Heber et al., 2017; Deloitte Global Human Capital
(e.g. that it is not very navigable and has minimal material). Trends, 2017).
The beta version was tested by 31 participants from the four coun­ The focus during development on gender and cultural differences
tries. The majority were highly educated, females, mostly aged between that could impact successful implementation, while also translating the
35 and 45. There were 4 testing tasks along with follow up questions vocabulary and grammar of the text, is a unique feature of the
regarding ease of use, visual presentation, and participant suggestions. EMPOWER intervention. The intervention was carefully adapted to
Task 1 was navigating through the welcome screens at the beginning of ensure usability, acceptability, and adherence for each country as well
the app; task 2 was a learning module that participants needed to find as comparability of the material across all four settings. Another unique
and complete; task 3 was a relaxation activity; and task 4 was a feature was the participation of local consultation groups to provide
breathing activity. 30 (97 %) completed task 1; 31 (100 %) of partici­ feedback on the project in general, strengths and weaknesses of the
pants completed task 2; 24 (77 %) completed task 3; and (93.5 %) intervention materials, design, layout, usability, and any use of poten­
completed task 4. Ease of use ratings are summarised in Fig. 9. tially problematic terminology or concepts. Changes made following
In addition to the tasks and ratings for ease-of-use, participants were usability testing will potentially further enhance the usability and
asked for their suggestions, which were analysed. A list of conclusions effectiveness of the app.
regarding positive feedback and constructive feedback was compiled
and some parts of the testing process and development were adapted. 5.1. Limitations and strengths
The triage and algorithm described above were also tested to check if
users of the app were guided toward the appropriate parts of the app as The EMPOWER digital intervention is subject to limitations inherent
intended based upon their answers in the triage. In general, flow in any digital intervention. It requires the use of a computer and
through the app was reported to be simple and users found the app smartphone, as well as internet connectivity, digital literacy, and gen­
relevant and easy to use. Participant suggestions also led to further eral literacy, to access all aspects. While the app was designed to be
changes to the app navigation, such as the addition of a “finish” button, personalised to individual user needs, it was not designed to address
and to ease of use, such as increasing the font size of the text. While there suicidal ideation or intent. Users who identify as experiencing suicidal
were constructive recommendations and feedback, overall, the results ideation are allowed to use the app but are encouraged to speak with a
show a favourability for the look, navigation, and material in the app. medical professional and advised the app is not designed to address their
Usability testing participants especially appreciated the interactive mental health needs. As with any digital intervention of this kind, it is
features and said they could see themselves using or recommending the impossible to meet the needs of all users, although the EMPOWER digital
app. The final version of the intervention is available in a desktop intervention is designed to meet the needs of employees from a variety
version and in a mobile app. More information about the qualitative of contexts.
testing is provided in the supplementary file. Additionally, the usability testing did not provide users with the full
app but core parts of it in 3 iterations. The testing was done qualitatively
in a rather small and homogenous group, with the majority being female
employees with a higher education background. This may not be
representative of the end-user population. These limitations are appro­
priate for a test of this kind but should be considered when examining
the results of the RCT that is planned to follow with this app. We also did
not seek feedback from employers in the usability testing or explore how
employees would feel about grouped data on the psychosocial context
being shared with employers.
It will be a limitation of the future RCT that providing employers
with feedback on employees might pose ethical issues. We will only
provide anonymous and aggregated feedback regarding psychosocial
risks at a company level together with tailored recommendations to
reduce these risks. This will only be provided if 10 or more employees
have provided information about the psychosocial context at the
Fig. 9. Ease of use ratings by task. workplace. The personal information as to levels of anxiety, depression

11
C.M. van der Feltz-Cornelis et al. Internet Interventions 34 (2023) 100689

etc. will in no way be shared with employers. Employees will be grant CD20/00036). Carlota de Miquel has received funding in form of a
informed about this before signing the informed consent, and as pre-doctoral grant from the Generalitat de Catalunya (PIF-Salut grant,
participation will be completely voluntary, this might cause stress for code SLT017/20/000138).
the employees and limit their participation, which might result in The funders played no role in study design, data collection and
participation bias in the future trial. analysis, decision to publish, and preparation of the manuscript.
Despite these limitations, designing a digital intervention to address
work stress and psychological symptoms that contribute to presenteeism Declaration of competing interest
and absenteeism while improving wellbeing for employers and em­
ployees, is highly innovative and timely. Its multi-module and triage – Christina van der Feltz-Cornelis received honoraries from the Lloyds
algorithm led design provides a highly individualised and unique user Register Foundation and Janssen UK. Oriol Borrega Cepa and Laura
experience. While the ongoing pandemic presented a challenge to the González Recio have a paid consultancy and development of the Spanish
design process, it also increased the need for support at the workplace based project “SOM360 - Salud Mental” (https://www.som360.org),
for workers and companies, as COVID-19 and home confinement has participation in the European Project “Share4Rare” as analyst and
had a negative impact on mental health while also increasing use of developer (https://www.share4rare.org), and participation in the Eu­
digital devices (Ammar et al., 2021). The EMPOWER digital in­ ropean Project “ACADOM” as analyst and language expert (https://
tervention’s development is well-timed to provide a much-needed www.omada.es/blapp/). All other authors have no conflicts of interest
intervention that is highly accessible to a high percentage of the work­ to report.
ing population. Our documentation and publication of the design and
development process, along with our use of a cultural validation Acknowledgement
approach in co-design with stakeholders and end-users strengthen the
resulting intervention. Also, the usability testing before the planned start The EMPOWER Consortium supported the work and includes (in
of the evaluation in an RCT is a unique feature of the EMPOWER project alphabetic order):
and app development. Andysz A7; Ayuso-Mateos JL10,11; Bernard RM5; Borrega O4; Brach
M ; Cabello M11; Cabré J4; Chen T12; Cristóbal P2; de Miquel C2; de Mul
5

5.2. Conclusion M9; Felez-Nobrega M2; Gevaert J3; González L4; Gutiérrez D2; Hakkaart-
van Roijen L9; Haro JM2,10; Leonardi M14; Lima RA2,10; López-Carrión
The EMPOWER digital intervention is a tailored multimodal inter­ M4; Lukersmith S12; Mauro A13; Merezc-Kot D6; Miret M2; Naumanen P8;
vention addressing wellbeing, work stress, mental and physical health Olaya B2,10; Ortiz-Tello A11; Porcheddu D13; Raggi A14; Rodríguez-
problems, and work productivity. This will be used in a planned RCT to McGreevy K11; Sabariego C5,15,16; Salvador-Carulla L12; Seghezzi F13;
evaluate its effectiveness. Shepherd J1; Sinokki M8; Smith N10; Staszewska K7 Tiraboschi M13;
Toppo C14; van Aerden K3; Van der Feltz-Cornelis C1; van Krugten F9;
Ethical approval Vanroelen C3; Vorstenbosch E2,10;
Affiliations
1
The participation of stakeholders in the usability testing and cultural MHARG, Department of Health Sciences, Hull York Medical School,
adaptation have been approved by the ethics committees of Fundació University of York, York, United Kingdom.
2
Sant Joan de Déu (PIC-39-20), Turku University Hospital (PIC- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de
993966082), University of York (HSRGC250321) and Institute of Déu, Sant Boi de Llobregat, Spain.
3
Occupational Medicine, University of Lodz (9/2020). All participants for Interface Demography, Vrije Universiteit Brussel, Brussels, Belgium.
4
the translation and cultural validation gave their informed consent to Òmada Interactiva, SLL, Barcelona, Spain.
5
participate in the online focus groups and agreed to be videotaped. Swiss Paraplegic Research, Nottwil, Switzerland.
6
Institute of Psychology, University of Lodz, Lodz, Poland.
7
CRediT authorship contribution statement Nofer Institute of Occupational Medicine, Lodz, Poland.
8
Turku Centre for Occupational Health, University of Turku, Turku,
The manuscript text was written by: CvdF-C, JS, BO, JG, KvA, CV, Finland.
9
OBC, LGR, RMB, DM-K, MS, PN, LH-vR, FvK, and MdM. Review and Erasmus School of Health Policy and Management (ESHPM), Eras­
editing of the manuscript text was completed by all authors. All authors mus University Rotterdam, Rotterdam, the Netherlands.
10
approved the final manuscript. Funding acquisition for the EMPOWER Centro de Investigación Biomédica en Red de Salud Mental
project was conducted by: BO, CV, CM-K, MS, JMH, LH-vR, and CvdF-C. (CIBERSAM), Madrid, Spain.
11
Methodology for the manuscript was created by: JS, BO, JG, KvA, CV, Department of Psychiatry, Faculty of Medicine, Universidad
OBC, LGR, RMB, EV, DM-K, MS, PN, LH-vR, FvK, MdM, JMH, and CvdF- Autónoma de Madrid, Madrid, Spain.
12
C. Conceptualisation of the manuscript and article was completed by: JS, Centre for Mental Health Research, Research School of Population
JG, KvA, CV, OBC, LGR, RMB, DM-K, MS, PN, LH-vR, FvK, MdM, and Health, Australian National University, Canberra, Australia.
13
CvdF-C. Figures were prepared by: JS, JG, OBC, EV, and DM-K. All au­ Fondazione ADAPT, Milano, Italy.
14
thors approved the final manuscript. Fondazione IRRCS Istituto Neurologico Carlo Besta, UO Neurologia
Salute Pubblica e Disabilità. Milano, Italy.
15
Funding Department of Health Sciences and Medicine, University of
Lucerne, Lucerne, Switzerland.
16
This project has received funding from the European Union’s Hori­ Center for Rehabilitation in Global Health Systems, WHO Collab­
zon 2020 research (https://ec.europa.eu/programmes/horizon2020/e orating Center, University of Lucerne, Lucerne, Switzerland.
n/home) and innovation program under grant agreement No 848180,
and the National Health and Medical Research Council (NHMRC) of Appendix A. Supplementary data
Australia under Grant Agreement APP1195937.
Beatriz Olaya is supported by the Miguel Servet (CP20/00040) Supplementary data to this article can be found online at https://doi.
contract, funded by the Instituto de Salud Carlos III and co-funded by the org/10.1016/j.invent.2023.100689.
European Union (ERDF/ESF, “Investing in your future”). Mireia Félez
Nóbrega is supported by the Instituto de Salud Carlos III, (postdoctoral

12
C.M. van der Feltz-Cornelis et al. Internet Interventions 34 (2023) 100689

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14
 SYSTEMATIC REVIEW
published: 03 May 2022
doi: 10.3389/fpubh.2022.800880

Workplace Mental Health

Interventions in India: A Rapid
Systematic Scoping Review
Apurvakumar Pandya 1*, Niharika Khanal 2 and Mudita Upadhyaya 3
1
Parul Institute of Public Health, Faculty of Medicine, Parul University, Vadodara, India, 2 Public Health Researcher,
Ghaziabad, India, 3 Public Health Researcher, Germantown, TN, United States

The mental health initiatives at the workplace are growing in numbers over the past
few years. Public and private sectors continue to explore avenues to navigate and
adapt initiatives to promote employee’s mental wellbeing. However, such initiatives in
the Indian context are not thoroughly studied. We attempted to review existing literature
on workplace mental health interventions in the Indian context. The scoping review
was conducted following the standard process as recommended by the Joanna Briggs
Institute and the Preferred Reporting Items for Systematic Review and Meta-Analysis
extension for scoping reviews. We searched in the databases such as PubMed, Google
Scholar and Scopus. Scientific literature including gray literature of the past decade was
Edited by:
Samrat Singh Bhandari,
searched to synthesize evidence on types of mental health interventions and their unique
Sikkim Manipal University, India features. Of the 1,311 records, 30 records that met the inclusion criteria were included
Reviewed by: for the final review. The review highlights evidence on stress and mental health problems
Mohd Faizul Hassan,
faced by the working population and various strategies adopted by organizations to
Universiti Teknologi MARA Puncak
Alam, Malaysia address mental health problems. However, very few interventions were accompanied by
Avinash De Sousa, comprehensive needs assessment, impact evaluation and workplace policy initiatives.
Lokmanya Tilak Municipal Medical
College, India
Most interventions were curative–provisioning counseling services, limiting the scope of
*Correspondence:
mental health promotion activities. Addressing mental health wellbeing comprehensively
Apurvakumar Pandya and aligning an organization’s policies are crucial. Research on employee mental health,
apurvakumar.pandya20737
its risk factors, and cost-effectiveness analysis of workplace mental health interventions
@paruluniversity.ac.in
in the Indian context need to be prioritized.
Specialty section:
Keywords: workplace mental health, employee wellbeing, India, work place and improvement, wellbeing cost
This article was submitted to
Public Mental Health,
a section of the journal
Frontiers in Public Health INTRODUCTION
Received: 24 October 2021 Mental health problems in the working population (15–64 years of age) are growing public
Accepted: 29 March 2022
health concerns. Recent evidence indicates that non-communicable diseases (NCDs) including
Published: 03 May 2022
mental health problems such as stress, depression, and anxiety among working populations are
Citation:
directly linked to reduced work performance and increased absenteeism (1). Studies also show that
Pandya A, Khanal N and
Upadhyaya M (2022) Workplace
investment in such interventions is cost-saving (2).
Mental Health Interventions in India: A Mental disorders in the working population are a major cause of disability and unemployment
Rapid Systematic Scoping Review. (3, 4). The World Health Organization (WHO) estimates that the burden of mental health problems
Front. Public Health 10:800880. in India generates as high as 2,443 disability-adjusted life years (DALYs) per 100,000 population
doi: 10.3389/fpubh.2022.800880 followed by the estimated economic loss, between 2012 and 2030, at USD 1.03 trillion (5).

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Pandya et al. Workplace Mental Health Interventions in India

Importantly, most NCDs including mental disorders occur in interventions (16–21). Despite the extensive global literature
people below 60 years of age, in other words, among the working- on workplace mental health initiatives and improvement in
age population (6). The global cost of mental health conditions in employee’s productivity, the extent of workplace mental health
2010 was estimated at US$ 2.5 trillion, with the cost projected interventions in India remains unknown. Further, evidence on
to surge to US$ 6.0 trillion by 2030, which is a huge burden the effectiveness of workplace interventions particularly in India
on society (7). Thus, a multipronged approach to address NCDs is scarce. Therefore, the present rapid systematic scoping review
including mental health problems among the working population attempts to review existing evidence on workplace mental health
commands urgent attention. intervention in India and identify unique features.

Workplace Mental Health in Indian Context METHODS

According to Census 2011 (8), India has a 474 million working
population. Furthermore, the country’s Sample Registration Study Design
System’s 2018 report (9) shows that country’s demographic This rapid systematic scoping review aims to identify and
dividend continues to grow. The proportion of the working-age summarize diverse evidence on workplace mental health
population is expected to increase from 61% in 2011 to 65% promotion programs in India and their unique features. This
in 2036, adding 12 million people to the working population rapid review followed the standard process as recommended by
each year. the Joanna Briggs Institute (22) and adhered to the Preferred
Mental disorders are impacting millions of working Reporting Items for Systematic Review and Meta-Analysis
populations in India. Although there are no population- (PRISMA) extension for scoping reviews (PRISMA-ScR) (23).
based prevalence studies for working populations, there are
estimates of mental disorders in India, implying the burden of Definition of Population, Intervention
mental disorders in the working population. For example, the Comparator and Outcomes (PICO) of the
findings of the National Mental Health Survey 2015-16 (10) by
Study
the National Institute of Mental Health and Neuro-Sciences
• Population: Employees–primarily working population – (15–
(NIMHANS) estimated that nearly 150 million individuals suffer
64 years of age) in India.
from one or the other mental disorders of varying severity,
• Intervention: Any interventions introduced by the
comprising 10.5% of the population. In 2017, the Global Burden
organization to address mental health problems such as
of Disease Study published in 2020 (6) revealed 197 million
stress, psychological distress or promote mental wellbeing in
people experiencing mental illnesses, comprising 14.3% of the
the Indian organizational set-up.
total population. Both reports implicitly imply that the majority
• Comparators: Not applicable for this scoping review.
of the population with mental disorders in the working-age
• Outcome: Types of mental health interventions, key features
groups, between 15 and 59 years of age.
of mental health interventions, best practices and effect on
The survey by The7th Fold 2020 (11) with 509 working people
mental health status if reported.
across metros cities and diverse sectors from India revealed that
36% of employees were suffering from one or other types of
Search Strategy
mental health issues. The situation of mental health has been
A systematic search of the literature was conducted across four
exacerbated due to the COVID-19 pandemic, making it a more
databases: PubMed, Scopus, Google Scholar, and PsycINFO.
serious concern. Recent PwC’s 2021 Employee Financial Wellness
Keywords such as “employee wellbeing program,” “employee
Survey (12) reported that 63% of employees were experiencing
wellness,” “workplace mental health interventions,” and “India”
stress due to financial strain ever since the COVID-19 pandemic
were used and searches were narrowed by using Boolean
began. Another study (13) conducted during the second wave
operators. Two researchers conducted a literature search and the
of the pandemic by Deloitte ranked India as the highest among
third researcher reviewed the screening, resolved conflicts related
18 countries in terms of anxiety. These studies suggest that
to the final selection of records. Searches were limited to articles
workplace mental health requires immediate attention.
published until October 20, 2021.
Poor mental health at the workplace can be a contributor
to a range of physical illnesses like hypertension, diabetes
Inclusion and Exclusion Criteria
and cardiovascular conditions, amongst others (14). Recent
All records were imported in Microsoft excel and duplicates
evidence indicates that employee effectiveness resonates with the
were removed. Unqualified records were excluded based on the
mental health of the employees, and it contributes to overall
exclusion criteria.
organizational productivity (15). Thus, prioritizing the mental
Inclusion criteria of the study:
health of employees is essential.
Much of the literature on workplace health and mental health 1. Studies conducted with the working population in India.
promotion interventions originate from high-income countries 2. Any studies (quantitative, qualitative, or mixed-method
with a long history of industrial development. These countries studies) were included.
have made workplace health a priority and expanded government 3. Studies explaining or describing employee wellbeing
as well as private health-insurance regulations, which perhaps programs targeting mental health, key characteristics of
contributed to the growing number of workplace health different employee wellbeing programs and their effectiveness.

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Pandya et al. Workplace Mental Health Interventions in India

4. Studies published in English. RESULTS

5. Peer-reviewed articles, gray literature such as project reports,
annual reports explaining mental health interventions or The literature search resulted in 1,311 records. After removing
employee assistance programs, and journal blogs. duplicates, 1,047 were screened for the title. Of the 137 records
screened for full-text review, 30 records met inclusion criteria
Exclusion criteria of the study: and were finally included for the review. Figure 1 provides a
1. Publications published in other than the English language. summary of the PRISMA flow diagram.
2. Publications such as perspective, editorial, and commentary. Mental health interventions were further classified as (1)
3. Studies conducted in other country contexts and/or corporate wellness programs, (2) employee assistance programs
conducted with non-Indian participants. and (3) health promotion interventions. Table 1 presents the
type of mental health interventions and corresponding numbers
of studies.
Screening of Records
We piloted 10 records against a priori inclusion and exclusion
criteria to minimize selection bias. Each record title was reviewed Quality Assessment of Studies
by two independent screeners (AkP, NK). A third reviewer Out of 30 records, 7 were observational studies, 5 were reviews,
(MU) reviewed conflicts and resolved disagreements through 3 qualitative studies and 15 were websites and e-newspaper
discussion. Two reviewers also independently screened the full articles. We found that the overall methodological quality of
text of potentially eligible articles to check whether the records observational studies was moderate to weak. About 5 papers were
fulfilled the inclusion criteria. rated at moderate whereas, 2 were rated as weak studies. None of
the studies were rated to be of strong. The Critical Appraisal Skills
Programme quality assessment tool evaluated three qualitative
Data Extraction studies to be average.
We used Microsoft Excel to organize and code data used in the Anecdotal evidence of the ability to make positive impacts
scoping review. Selected records were extracted in the domains on improving employee’s mental health outcomes and overall
such as author’s name, year of publication, type of publication, wellbeing were noted in websites and e-newspapers; however, a
country of the study conducted, type of population, mental health lack of methodological rigor was a common problem. Overall,
problems, different types of mental health interventions, key there was a lack of properly controlled studies to attribute
findings, and recommendations. the mental health outcomes or employee wellbeing to the
interventions only.
Quality Assessment of Studies
The quality of included quantitative studies was assessed using
the Effective Public Health Practice Project quality assessment
Evidence on Stress and Mental Health
tool (24). The studies are evaluated in eight parameters such as Problems of the Working Population
study design, analysis, withdrawals and dropouts, data collection Occupational stress or work-related stress is a significant cause of
practices, selection bias, invention integrity, blinding as part poor physical and mental health, low productivity, and human
of a controlled trial, and confounders. Evaluation of each error. The World Health Organization defines occupational
parameter range between “strong,” “moderate,” and “weak.” stress as “. . . the response people may have when presented
Qualitative studies were assessed using the Critical Appraisal with work demands and pressures that challenge their ability to
Skills Programme quality assessment tool (25). The studies are cope” (3, 28). Occupational stress emerged as the most common
evaluated based on 10 questions followed by reviewer’s overall risk factor contributing to increased sickness absence, high staff
comments based on responses to 10 questions. turnover, sub-optimal performance and a possible increase in
accidents due to human err (4, 5).
Factors such as workload, lack of participation and control in
Data Synthesis the workplace, monotonous tasks, role ambiguity or role conflict,
Full text of selected records was appraised and thematically lack of recognition at work, poor interpersonal relationships,
organized. Both authors reviewed the data synthesis. Thematic poor working conditions, poor communication, and conflicting
analysis methods (26) were used to identify key themes across home and work demands contribute to stress (16–19). Bullying
studies. Thematic analysis was used as most of the studies were and sexual harassment at the workplace are also critical
descriptive in nature. A mind map was constructed to sort the causal factors of chronic stress (3). It is evident that chronic
type of features of workplace mental health interventions and stress leads to a range of physical illnesses like hypertension,
their unique features. Overarching themes were then reviewed, diabetes, cardiovascular conditions as well as mental health
refined, and named (27). Results were synthesized in five themes problems such as burnout, psychological distress, anxiety or
namely: classification of mental health interventions, quality depression, significantly affecting employees ability to contribute
assessment of studies, evidence on mental health problems of the meaningfully in their personal and professional lives (16, 18, 19).
working population, workplace mental health interventions, and Worryingly, these health problems especially in the working
outcomes of mental health interventions. population is on the rise (28).

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Pandya et al. Workplace Mental Health Interventions in India

FIGURE 1 | PRISMA flow diagram of the study.

Employees with mental illnesses also face discrimination at the TABLE 1 | Classification of workplace mental health interventions.
workplace. Brouwers et al. (29) have conducted a cross-sectional
Sr. No. Type of mental Key features No. of
study that reported that about 67% of employees who suffered health records
from depression either experienced discrimination at the present interventions
workplace or faced discrimination while applying for new jobs.
The stigma and discrimination push the working population to 1 Corporate wellness • Work-life balance strategies 15
suffer silently and avoid seeking professional mental health help program (such as wellbeing related
leaves, ‘no meeting Friday’s
(30). A study conducted by ASSOCHAM in 2015 (31) found policy, etc.)
that 43% of employees in the private sector experienced signs of • Wellness sessions
general anxiety disorder or depression. A survey conducted last (yoga/meditation/stress
year (11, 32) in India revealed that more than a quarter of Indian management sessions etc.)
employees (36%) were experiencing mental health problems, 2 Employee • Counseling services outsourced 8
and half of the sample (50%) were worried about an uncertain assistance program • Some offer counseling services
through Mobile application, 24*7
future due to the COVID-19 pandemic (32). Certainly, the tele helpline
negative impact of the COVID-19 outbreak on mental wellbeing 3 Employee wellbeing • Physical healthcare services 3
is undeniable. program • Mental health services
4 Peer Support • Mental health advocates 4
program • Peer support
Workplace Mental Health Interventions in • Peer-to-peer counseling

India
Indian multinational companies have been prominent in using
the workplace to promote long-term health behavioral change
to the measurable benefit of themselves, their employees and healthcare services, few companies (n = 4) emphasize work-
local communities. Supplementary Table 1 highlights notable life balance in addition to counseling services. Some companies
employee wellbeing programs in India (33–49). (n = 5) have strengthened primary mental healthcare through
As shown in Supplementary Table 1, many companies (n training employees on psychological first-aid and establishing
= 15) offer preventive and promotive physical and mental peer-support networks within the company. One company

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Pandya et al. Workplace Mental Health Interventions in India

has upgraded employee health insurance and provisioned policies to ensure the physical wellbeing of their employees,
reimbursement for mental health consultations and another very few organizations have explicit policies for mental
offering counseling services through an Artificial Intelligence health promotion and programs addressing employees’ mental
(AI) based chatbot (2). Many companies (n = 7) use the digital wellbeing. Those organizations having employee wellbeing
platform to provide mental healthcare services Many other programs, ironically, revealed difficulties in engaging their
companies do implement workplace mental health interventions employees in employee wellbeing programs (11, 33, 54–64).
but at a smaller scale. For example, the companies such as ICICI Perhaps, mental health stigma precludes employees identify and
Lombard, Capegemini India, Oyo, Uber India, Google India, seeks timely mental health help. Efforts are needed to create
Mondelez India, American Express India and Panasonic India mental health literacy at workplaces. Moreover, a proactive
offer mental health counseling by outsourcing services under approach to mental health at the workplace targeted to create safe
employee assistance programs (33). Many consulting agencies and conducive environment is commanded.
such as BetterLYF (34), MeeHappy (35), Trueworth wellness While research has established the link between wellbeing
(36), YourDost (37), WYSA (38), ePsyClinic (38), Trijog (38), (which encompasses positive mental health) and productivity,
Mindhouse (39), Mind Care India (40), Practo (41) and Optum organizations need to enforce guidelines based on acceptable
(42) provide mental health services for the national and multi- industrial practices for maintaining an optimal work-life balance.
national companie’s staff. Any wellbeing initiatives that are designed with the employee’s
needs in mind can certainly thrive. Thus, assessing employees
Outcomes of Workplace Mental Health need and their participation in designing and implementing
mental health interventions is crucial. Larger companies
Interventions
may benefit from “decentralizing and allowing regional
Although outcomes of these programs in the Indian context
business units to design and customize the execution of
are not yet published, such programs potentially prevent the
mental health interventions” can potentially increase employee
breakdown of the employees. The global literature highlights
participation rates.
that employee wellbeing programs (which include mental health
Psychological capital (such as efficacy, hope, optimism,
interventions) have prevented employees from mental illnesses
and resilience) (65, 66) can be fostered through mental
(43–49). Moreover, employee wellbeing programs (with a focus
health promotion interventions such as imparting life skills,
on mental health promotion) have been proved to be cost-saving;
stress management, fostering work-life balance, encouraging
companies save anywhere between $3 to 15 per for every 1$ spent
physical activities and create conducive environment through
on workplace mental health programs (50). The regular physical
peer support. Strengthening psychological capital has direct
activities and health check-ups were found promising in early
association with positive attitude, productivity and mental
diagnosis, treatment and controlling NCDs (43).
wellbeing (66).
Employee wellbeing programs also improve employee
engagement significantly (51, 52). Employee recognition
and constructive feedback practices too contribute to higher Implications for Policy, Practice, and
employee engagement levels (51). Most importantly, employee Research
wellbeing programs improve productivity and morale. When Employee wellbeing programs can potentially impact employee’s
employee wellbeing is optimized, employees focus more on experience. Many strategies organizations can implement to
their work, and their productivity increases (49). The available improve their employee’s wellbeing.
evidence highlights that health promotion activities, psychosocial Organizations need to introduce policy-level changes
intervention along stress management training have a positive to address employee wellbeing. Without clearly articulated
impact on mental wellbeing (53–55). workplace policy, employee wellbeing initiatives may not be
A recent survey report of human resources leaders (48) sustainable and impactful. The development and execution of a
from 400 organizations across 15 different industries in India workplace mental health policy and employee wellbeing program
revealed half of the organizations offer health benefits as will benefit the health of employees, increase the productivity of
screenings or health awareness programs to employees, dedicated the organization (2, 3).
resources to address the spectrum of wellbeing, including Employees need may vary depending up on their occupations
mental wellbeing. However, impact assessment, documentation and job roles. Thus, comprehensive needs assessment is
of workplace mental health interventions was lacking, only 40% recommended prior designing and implementing workplace
of organizations have a documented wellbeing plan (53). mental health program. Some additional strategies for fostering
positive mental health are enumerated as below:

DISCUSSION - Encourage collaboration in the organization to boost

teamwork, competitiveness, and employee morale. By
Organizations in India have certainly realized the need for enabling easy collaboration, organizations can leverage
protecting employee’s mental health and have started offering employee’s diverse skill sets, feel recognized, and decrease
policies and programs that promotes positive mental health. their stress levels.
Most programs are more employee growth oriented and family- - Formulate grievance redressal mechanism to listen and
friendly. Although, numerous organizations have introduced address employee’s concerns. Employees want to be listened to.

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Pandya et al. Workplace Mental Health Interventions in India

- Promote regular and constructive feedback. Regular determine the longitudinal impact. Despite these limitations, the
feedback provides scope for improvement, advancing present study provides a mapping of workplace mental health
their skills and make them feel satisfied with their jobs. The interventions in Indian companies and offer insights on key
feeling of satisfaction and learning attitude is crucial for features and presented strategies to address gaps in workplace
employee wellbeing. mental health interventions.
- Train employees on psychological first-aid and peer
counseling. There is a tremendous need to make workplaces CONCLUSIONS
more humane. Training employees on psychological first-aid
and peer counseling destigmatize mental health and empower A healthy population productively contributes to the economy
them to seek timely support at the primary level. It enables and it is in the benefit of organizations to safeguard public
timely referral for treatment when needed. Moreover, this will health. Given the substantial contributions of the private sector
equip employees to show empathy and compassion for others, to the economy, making an investment in formal and structured
ultimately creating an emotional bond between employees workplace mental health interventions should be a strategic
and employers, and making workplace a better place to work. priority. There is a need to map the impact of workplace mental
- Introduce periodic general health screening. Ensuring annual health programs on productivity and health outcomes. Also,
health screening can help identify diseases early and treat documenting best practices around workplace mental health
employee’s health issues timely. interventions and positive case stories are worthy exercises.
- Establish in-house psychological counseling services or Research on employee mental health, associated risk factors, and
formulate linkages with trained mental health service cost-effectiveness analysis should be promoted.
providers. By offering psychological counseling services,
organizations can reduce stigma. DATA AVAILABILITY STATEMENT
- Other strategies such as flexible work options, introducing
health initiatives like an organization-wide competition in The original contributions presented in the study are included
running or cycling, and promoting mental wellbeing mobile in the article/Supplementary Material, further inquiries can be
applications can help cope with stress and improve quality directed to the corresponding author.
of life.
- Promote research. Organizations can establish linkages with
academic and research institutions to carry out researches
AUTHOR CONTRIBUTIONS
including impact assessment periodically. AkP conceptualized, prepared the protocol, and revised the
manuscript. NK and AkP carried out the literature search and
Strengths and Limitations of This Study screened records for inclusion in the study. MU synthesized the
A rapid systematic scoping review was conducted to map
evidence and drafted the manuscript. All authors have reviewed,
workplace mental health interventions, identify key features
edited, and approved the submitted version of the manuscript.
of these interventions and gaps in workplace mental health
interventions. In order to ensure the relevance of our review,
the review scope, review questions, protocol and literature search ACKNOWLEDGMENTS
strategies were defined based on the targeted literature review
conducted by both authors. The study provides a descriptive Authors thank Mr. Himanshu Gupta for his support in reviewing
synthesis of current evidence on interventions to prevent mental the manuscript.
health for working people. Most details regarding mental health
interventions found from gray literature i.e., e-magazines and SUPPLEMENTARY MATERIAL
websites, left us with limited information about the interventions.
The authors did write to the company for detailed information; The Supplementary Material for this article can be found
however, only two companies responded to our queries. Further, online at: https://www.frontiersin.org/articles/10.3389/fpubh.
few studies used cross-sectional surveys, making it difficult to 2022.800880/full#supplementary-material

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 Proceedings of the 7th International Conference on Economic Management and Green Development
DOI: 10.54254/2754-1169/33/20231643

Impact of Digital Technology on Employee Wellbeing in the

Context of Teleworking During COVID-19
Peiqi Xu1,a,*
1
University of Exeter Business School, University of Exeter, Exeter,EX4 4QJ, UK
a. [email protected]
*corresponding author

Abstract: COVID-19 significantly impacted economic and social life worldwide, and
telecommuting has become the only option for many companies and organizations to continue
operating during this time. While telecommuting is not a new concept, the mass adoption of
telecommuting during a pandemic is unprecedented. The widespread adoption of digital
technology has highlighted the importance of digital technology in enabling telecommuting.
However, the emerging telecommuting model brings new challenges and raises concerns
about employee wellbeing. One of the key issues is employee health and well-being. This
paper examines the impact of digital technology on employee wellbeing in a telecommuting
environment through a literature review and an empirical study. The study finds that using
digital technology has positive and negative impacts on employee wellbeing. Digital
technology can improve communication, collaboration, and productivity, providing
employees greater flexibility and autonomy. On the other hand, however, digital technology
can also lead to problems such as information overload, blurred boundaries between work
and life, and increased stress and fatigue. The impact of digital technology on employee
wellbeing depends on various factors, including the type of technology used, the nature of
the work performed, and the characteristics of the employee.

Keywords: digital technology, employee wellbeing, teleworking

1. Introduction
Since 2020, the global COVID-19 pandemic has significantly impacted global economies, societies,
and personal lives, resulting in the most significant global experiment in teleworking ever. As coun-
tries worldwide went into lockdown to contain the spread of the virus, teleworking became the only
option for many companies and organizations to continue operations during this time. Organizations
were forced to transition to teleworking quickly. While teleworking is not a new concept, adopting
remote working on a large scale during a pandemic is unprecedented. The widespread use of digital
technology to make it possible has highlighted the importance of digital technology in enabling re-
mote working. However, the emerging teleworking model brings new challenges and raises concerns
about employee impact. One of the key issues is the well-being and health of employees.
Employee Benefits have become increasingly important in recent years, with organizations recog-
nizing the importance of health and engagement. The term 'employee benefits' refers to employees'
physical, mental, and emotional health, influenced by various factors, including work-related stress,
job satisfaction, work-life balance, and social support [1]. Digital technology can potentially impact
© 2023 The Authors. This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0
(https://creativecommons.org/licenses/by/4.0/).

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employee benefits positively and negatively, and its effects may be particularly evident in the context
of teleworking during the COVID-19 pandemic [2]. This paper aims to explore the impact of digital
technology on employee Benefits in the teleworking context and propose relevant solutions.
2. Background and Literature Review
As teleworking patterns become more prevalent, researchers are exploring digital technology's impact
on employee benefits. The literature on the effects of digital technology on employee benefits is ex-
tensive, and it highlights the benefits and drawbacks of using technology in the workplace. On the
one hand, digital technology can enhance communication, collaboration, and productivity and pro-
vide employees greater flexibility and autonomy. On the other hand, it can lead to information over-
load, blurred boundaries between work and life, and increased stress and burnout. In early studies,
some researchers found that teleworking increased employees' self-efficacy and job satisfaction [3,
4]. However, over time, more and more studies began to find that teleworking may hurt employees'
physical and mental health and social life [5, 7].
Research has shown that the impact of digital technology on employee benefits depends on a range
of factors, including the type of technology used, the nature of the work performed, and the employ-
ee's characteristics. For example, a study by Kamerade et al. found that using instant messaging in-
creased job-related stress and reduced job satisfaction, particularly for employees already prone to
stress [8]. Similarly, a study by Derks et al. found that using email outside of work hours was associ-
ated with increased emotional exhaustion and work-family conflict [9]. Other studies have found that
remote work's uncertainty and virtual nature make it difficult for employees to interact face-to-face
with colleagues and leaders, which can lead to communication barriers and isolation [10, 11]. On the
other hand, teleworking may also have a negative impact on employees' physical health. Due to the
lack of a normal office environment and regular working hours, employees may face problems such
as prolonged sitting, lack of exercise, and unhealthy eating habits, which may lead to health problems
such as obesity and cardiovascular disease [12].
Therefore, the impact of digital technology on employee well-being in a teleworking context is an
area of considerable research interest. The impact of digital technology on employee benefits may be
compounded in the context of teleworking during the COVID-19 pandemic. The sudden and un-
planned shift to teleworking may lead to a lack of preparation and training for employees, which may
increase their stress levels [13]. In addition, the blurring of work-life boundaries when working from
home can lead to increased job-related stress and reduced job satisfaction [14]. In recent years, many
studies have begun to explore how digital technologies can improve employee benefits and health,
including providing virtual health support, promoting physical activity, and improving communica-
tion and collaboration tools [15].
The COVID-19 pandemic has dramatically changed the way people work, live, and interact with
each other. As countries worldwide take measures to control the spread of the virus, many employees
are forced to telecommute. According to a report by Gartner, Inc., nearly half of the employees sur-
veyed in the United States said they worked from home full-time during the pandemic [16]. The shift
to remote work has created new challenges for employers and employees. Employers are faced with
managing remote teams, maintaining productivity, and securing digital systems. Employees face is-
sues such as maintaining work-life balance, managing physical and mental health, and staying con-
nected with colleagues.
Digital technology has played a key role in enabling remote working during the pandemic. Com-
munication and collaboration tools such as Zoom, Microsoft Teams, and Slack have become essential
for remote working, allowing employees to communicate and collaborate with colleagues at a dis-
tance. However, the heavy reliance on digital technology has also created new challenges for the well-
being of employees.

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This study aims to explore the impact of digital technology on employee benefits in the context of
teleworking in Tahiti. The study will examine how digital technology affects employee benefits, in-
cluding physical health, mental health, and social connectedness, and identify potential solutions to
improve. The study will use quantitative analysis to answer these research questions, incorporating
quantitative data. The quantitative component will involve a questionnaire survey of employees
across various industries. The study will also draw on existing literature on the impact of digital
technology on employee benefits to inform its findings.
3. Methodology
The study hypothesis is that digital universe technology has a negative impact on the well-being of
teleworking employees, as employees are exposed to electronic devices for long periods and in a
virtual office environment, which may lead to physical discomfort and psychological problems.
The independent variables are time spent using digital technology—frequency of digital technol-
ogy use, and mode of digital technology use. Dependent variables are employee well-being, including
physical health, mental health, job satisfaction, etc. And Control variables, including employees' age,
gender, education level, and type of occupation.
Data were obtained using a questionnaire survey, and multiple regression analysis and structural
equation modeling were used to analyse and interpret the data. The source of data regarding this study
was a 27-question questionnaire with data collected using an online survey platform designed to ex-
amine the impact of digital technology on the well-being of teleworking employees during the pan-
demic. The survey was collected online from the technical staff of major Chinese Internet companies,
and 356 technical staff participated.
4. Results
The survey results show that over 58% of respondents use digital technology more than seven times
daily. In addition, over 54% of respondents use digital technology for more than 7 hours daily.
Health Problems. The survey results show that more than 60% of respondents regularly experience
health problems such as visual fatigue, wrist pain, and shoulder pain. In addition, more than 55% of
respondents have frequent insomnia.
Emotional problems. The survey results show that more than 69% of respondents frequently ex-
perience feelings of loneliness. In addition, more than 41% of respondents frequently experience
emotional problems such as anxiety and depression.
Social Problems. The survey results show that more than 52% of respondents often face social
problems related to stress at work. In addition, more than 48% of the respondents often face social
difficulties.
Company-related issues. The survey results show that more than 26% of respondents are dissatis-
fied with the company's performance appraisal system. In addition, more than 28% of respondents
were very dissatisfied with the level of attention and support given by the company to the well-being
of its employees.
Overall satisfaction. The survey results show that over 53% of respondents are dissatisfied or dis-
satisfied with their current job.
The results of this survey show that digital technology use has a non-negligible impact on the
benefits of teleworking employees. In particular, the impact of digital technology use on employees
is more evident in relation to health and emotional issues. In addition, companies' level of attention
and support to employee benefits needs to be improved.
This report explores the impact of digital technology use on the benefits of teleworking employees
based on the 27-question questionnaire above. This study used a multiple linear regression model to

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examine the impact of digital technology use on employee Benefits. The following are the results of
the model:
The adjusted R-squared is 0.42, indicating that the model explains approximately 42% of the var-
iance. Scores for frequency of use of digital technology and affective state were significantly and
negatively related to employee benefits (p < 0.05). This suggests that the more frequently digital
technology is used, the lower the level of employee benefits, the worse the affective state, and the
lower the employee benefits. Overall satisfaction with the company was significantly and positively
correlated with employee benefits (p < 0.05). This indicates that the more satisfied employees are
with their company, the higher their level of well-being.
It can also find no significant correlations between the other variables (time spent using digital
technology, physical condition, and satisfaction with the company's performance appraisal system)
and employee benefits.
In summary, the frequency of digital technology use and emotional state are important factors
influencing the benefits of teleworking employees. Companies can take steps to help employees re-
duce the frequency of digital technology use and improve their emotional state and overall satisfaction
with the company to improve employee benefits.
In addition, this study aims to explore the impact of digital technology use on the benefits of tele-
working employees, using data from 27 questionnaires administered to teleworking employees for
structural equation modeling. Firstly, the data was processed for the 27 questions. For the single-
choice questions, the proportion of each option was used as data; for the multiple-choice questions,
the proportion that selected that option was used as data; and for the scale questions, the mean score
was used as data.
A structural equation model based on the relationship between variables was used for the analysis
in this report. First, an initial model was constructed using the frequency of digital technology use,
time of use, and various psychological, financial, and social issues as independent variables, and the
degree to which individuals' lives are affected, employee well-being, and overall satisfaction with the
company as dependent variables. The model was then subjected to goodness-of-fit tests and model
corrections. In the end, we obtained a well-fitting model in which the effects of the independent var-
iables on the dependent variables were significant.
The results of the structural equation model showed that the frequency and duration of use of
digital technology had a significant negative impact on employee well-being and overall satisfaction
with the company. In contrast, various psychological, financial, and social problems significantly
negatively impacted employee well-being and overall happiness with the company. At the same time,
the level of influence on personal life significantly negatively affects employee well-being and overall
satisfaction with the company.
5. Conclusion
The use of digital technology has a negative impact on the well-being of employees working remotely
and overall satisfaction with the company. In contrast, psychological problems, financial problems,
and social problems also have a negative impact on the well-being of employees and overall satisfac-
tion with the company. The degree to which personal lives are affected also has a negative impact on
employee benefits and overall satisfaction with the company. Therefore, measures should be taken to
reduce the frequency and duration of digital technology use while focusing on employees' physical
and mental health and financial well-being.
With the spread of the new crown epidemic, remote working is increasingly becoming the norm
for companies, allowing many to continue to conduct business and keep their staff safe. They make
remote work more efficient and convenient. However, this working method also brings challenges,
such as poor employee communication and work-life balance issues. Digital technology, one of the

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key proponents of remote working, impacts employee benefits while increasing productivity. Alt-
hough digital technologies may negatively impact employees, they are still important to teleworking.
In the future, digital technologies will continue to evolve to improve employee productivity and well-
being. While there are many advantages to digital technology in remote working, there is still a need
for continuous improvement and optimization to make it work better for employee benefits and the
company's long-term success.
More user-friendly digital tools: digital technology will continue evolving to serve employees'
needs better. The digital tools of the future will be more user-friendly and can better meet the needs
and preferences of employees working remotely. For example, some companies may develop more
advanced video conferencing platforms that allow employees to communicate and collaborate face-
to-face more easily without having to worry about unstable connections or poor video quality.
Data privacy and security: As digital technology becomes more prevalent, protecting employee
data privacy and security will become even more important. The future of digital technology will
require higher security standards and more robust data privacy measures to ensure that employees'
personal and confidential company information is not misappropriated or compromised.
Better remote collaboration tools: working remotely requires better collaboration tools, and the
future of digital technology will focus on improving the efficiency and functionality of collaboration
tools. For example, more advanced collaboration platforms could be developed that allow employees
to share documents better, collaborate in real time, and better manage tasks to achieve team goals.
Adaptive work environments: Digital technologies will help companies better adapt to the future
work environment. The digital tools of the future will better adapt to employees' work styles and work
needs to improve productivity and employee well-being. For example, intelligent work environments
can be developed to manage employees' time and tasks better and provide a better work experience
for employees.
Artificial intelligence and automation: the future of digital technology will focus on artificial in-
telligence and automation. This will lead to greater efficiency and a better employee experience for
companies. For example, intelligent automated processes can be developed to manage employee tasks
and projects better. This will enable employees to manage their time and energy, complete tasks, and
achieve goals.
In summary, digital technology will continue to play an important role in remote working, provid-
ing a better work experience for both companies and employees. The impact of singular digital tech-
nologies on employee benefits is also complex. Future developments in digital technology will focus
on better serving the needs and preferences of employees and improving productivity and employee
well-being. At the same time, data privacy and security issues will be a focus of future digital tech-
nology developments to enhance employee productivity and well-being.
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 information

Article
Employee Well-Being and Digital Work during
the COVID-19 Pandemic
Marta Juchnowicz 1 and Hanna Kinowska 2, *

1 Department of Innovation and Entrepreneurships, WSB University in Warsaw, 03-504 Warsaw, Poland;
[email protected]
2 Collegium of Business Administration, SGH Warsaw School of Economics, 02-554 Warsaw, Poland
* Correspondence: [email protected]

Abstract: The digitalisation of work is resulting in a transformation in the relationship between

employees and employers as well as the perception of quality of life. Under the conditions of
the COVID-19 pandemic, individuals whose work could be done with digital tools were directed to
work remotely. Performing work duties at a distance from the workplace, colleagues, and supervisors
affects the workplace resources available to employees and can have an impact on employee well-
being. The main purpose of this paper is to analyse the relationship between remote working and
employee well-being. The research hypothesis was that there is a relationship between employee
well-being and the level of digitisation of work performed, as measured by the frequency of remote
working. This article presents the results of empirical research conducted in January 2021, using
the CAWI method, on a representative sample of Polish workers (n = 1000). An exploratory factor
analysis and logistic regression were carried out. The results point to the three-dimensional nature of




employee well-being, which includes workplace relationships, health, and work–life balance. Based

 on the results, working exclusively remotely was shown to negatively affect well-being in terms
Citation: Juchnowicz, M.; Kinowska, of workplace relationships and work–life balance. There was no statistically significant association
H. Employee Well-Being and Digital between remote working and subjective health assessment. The results have important implications
Work during the COVID-19 for the management of employee well-being in remote working settings. Originality/value lies in
Pandemic. Information 2021, 12, 293. the fact that the article provides practical guidance in planning hybrid work arrangements.
https://doi.org/10.3390/info12080293
Keywords: corporate social responsibility; employee well-being; digital work; COVID-19
Academic Editors:
Joanna Paliszkiewicz and
Marcin Ratajczak

1. Introduction
Received: 24 June 2021
Accepted: 20 July 2021
The COVID-19 pandemic caused sudden changes in work organisation (e.g., working
Published: 23 July 2021
from home, virtual teamwork) and affected workers (e.g., through social distancing, stress,
and unemployment) [1]. It has imposed the need to digitise work and forced a focus
Publisher’s Note: MDPI stays neutral
on the quality of life and health of employees. Studies have shown negative effects of
with regard to jurisdictional claims in
COVID-19 on well-being [2], job satisfaction, and family life [3]. Throughout the pandemic,
published maps and institutional affil- employee well-being has become one of the main priorities of employers [4].
iations. The responses of organisations to the pandemic have taken into account the need to
respond to changes in employee needs. This has resulted in a heightened focus on corporate
social responsibility (CSR) [5] and organisations are placing increasing importance on
the well-being of their employees [6]. They have been introducing various work-integrated
Copyright: © 2021 by the authors.
learning programmes or embedding a well-being approach in their organisational culture.
Licensee MDPI, Basel, Switzerland.
Through this, they are not only contributing toward the improvement of employee moods
This article is an open access article
but also providing working conditions conducive to high performance [7]. As many as
distributed under the terms and 80% of organisations operating globally (71% in Poland) declare that employee well-being
conditions of the Creative Commons is important or very important for their success [8]. However, only 12% (10% in Poland)
Attribution (CC BY) license (https:// express full readiness to implement this approach. This limited interest in practice results
creativecommons.org/licenses/by/ in a research gap on the components of employee well-being and its relationship with
4.0/). digital work performance [9,10].

Information 2021, 12, 293. https://doi.org/10.3390/info12080293 https://www.mdpi.com/journal/information

Information 2021, 12, 293 2 of 13

The dynamics of the pandemic environment have made it necessary for organisations
to act and make decisions based on individual experiences. As they have been unable
to experiment with different approaches, they have instead been selecting those with
proven effectiveness. Lack of knowledge regarding optimal solutions can potentially lead
to repeated disruptions in the organisation. The sudden, rapid need for the digitalisation
of work from the COVID-19 pandemic resulted in challenges in the spheres of maintaining
work efficiency, commitment, and work–life balance. There is therefore a pressing need for
up-to-date research on employee well-being.
Although every activity, even those performed in the office without the use of technol-
ogy, requires a degree of digital support, “remote work” involves the extensive use of new
technologies in the performance of daily duties. For the purpose of this article, the terms
“remote work”, “telecommuting”, and “digital work” are used interchangeably.
The present article aims to explore the relationship between employee well-being
and digital working by adopting the following research hypothesis: there is a relationship
between employee well-being and the level of digitisation of work performed, measured
by the frequency of remote work. The analysis is based on the results of a survey of
Polish workers on their opinions of employee well-being, which was conducted during
the COVID-19 pandemic in January 2021. The article is structured in three sections:
(1) a theoretical introduction on the essence and research models of employee well-being
and the characteristics of remote working in Poland during the pandemic, (2) a section
devoted to the methodology of empirical research, including a description of the aim,
assumptions, and the research sample, and (3) a section presenting the results of statistical
analyses, ending with conclusions.

2. Theoretical Background
2.1. Employee Well-Being
Organisations’ efforts to promote employee well-being stem from the concept of
corporate social responsibility, which reflects the initiatives that a company undertakes
to positively influence society and contribute to its well-being [11]. One of the main
objectives of these activities is to maximise the positive and minimise the negative impacts
of the company on the environment [12]. Through CSR initiatives, organisations reveal to
their stakeholders that they care about society, the environment, and their employees [13,14].
CSR initiatives include creating working conditions where employees are healthy and
happy, which are especially relevant in times of a pandemic. The bidirectional relationship
between CSR and employee well-being has been confirmed by research [15–17].
The notion of well-being can be analysed from different standpoints. From a macro
perspective, it includes dimensions such as life expectancy, poverty rates, and environ-
mental factors. From the individual’s point of view, it includes subjective or psychological
measures of a person’s well-being—an individual’s assessment of their quality of life
and employment, which is determined through three main aspects: physical, social, and
psychological. Well-being, i.e., the state in which a person feels good, healthy, and happy,
is associated with connecting to all spheres of life, among which work activity and occupa-
tional functioning play a special role.
Subsequent analyses have identified the category of employee well-being, although it
still lacks a clear definition [18–23]. However, one comprehensive definition of employee
well-being is given by the World Health Organization—at its core, it is the state of each
employee in which they understand their capabilities, cope with life stresses, work pro-
ductively, and contribute to their community [24]. Research indicates that in the work
process, psychological well-being is the most important well-being factor [25]. Well-being
is therefore conceptualised using the construct of psychological well-being [26], based on
an individual’s development and self-actualisation along six dimensions: positive attitudes
toward oneself, trusting interpersonal relationships, a sense of freedom from unacceptable
norms governing everyday life, opportunities to control and contribute to one’s environ-
ment, a sense of purpose in life, and opportunities to develop one’s potential. The first three
Information 2021, 12, 293 3 of 13

dimensions are derived from theories of self-actualisation and self-determination [26,27].

The last three are derived from the concepts of mastery and optimal functioning. A separate
stream of research on workplace well-being has also emerged in the literature, defined as
the comprehensive experiences and function of an employee in both physical and psycho-
logical dimensions [28]. This construct corresponds to the specificity of work performed in
stable conditions and subordinated structures.
Research into employee well-being with regard to human resource management
utilises the five-element PERMA model, in which P is positive emotion, E is engagement, R
is positive relationships, M is meaning, and A is accomplishments/achievements [21].
Another concept is a three-dimensional model [20] consisting of the following compo-
nents: health, happiness, and relationships [29]. The first dimension describes well-being in
terms of mental and physical health as well as their proper function. The second consists of
two aspects of happiness: experiencing hedonistic pleasure at work and the eudemonistic
perception of work as meaningful and engaging [30]. The relational dimension considers
the perception of the quality of the employee’s interpersonal relationships and includes
aspects such as trust, fairness in the workplace, and social support [31]. This model was
the inspiration for the methodological assumptions of the present research project.
Well-being can be diagnosed using tools aimed at employees and employers. Diagnos-
tic instruments aimed at employees cover multiple dimensions, including quality of life,
meaning in work, likelihood of burnout, severe fatigue, work–life integration, and suicidal
ideation (e.g., Employee Well-Being Index) [32]. The Gallup and Sharecare Well-being
Index scale consists of five items: (1) having a positive attitude toward daily activities and
motivation to achieve goals, (2) having supportive relationships with others in one’s life,
(3) being financially secure, (4) feeling safe and proud to belong to a certain community,
and (5) having good health and enough energy to perform tasks on a daily basis [33]. This
tool was used to prepare the study design.

2.2. Digital Work in Poland during the COVID-19 Pandemic

Exploring the relationship between digital work and employee well-being in Poland
during the COVID-19 crisis requires an understanding of local labour market conditions.
The effects of the COVID-19 pandemic were quickly shown in the Polish labour market.
An increase in the number of unemployed was observed due to growth in the economically
active population alongside a simultaneous decrease in the number of job offers. The num-
ber of economically active persons in the third quarter of 2020 amounted to 17.2 million,
which was up by 423 thousand (2.5%) relative to the second quarter of 2020 and by 73 thou-
sand (0.4%) compared to the same period in 2019 [34]. In April 2020, 57 thousand job
vacancies were reported to labour offices, 20 thousand (26%) less than in March 2020. In
November 2020, seven months later, 79 thousand vacancies were reported to labour offices;
21 thousand (21.2%) less than a month earlier [35,36]. Due to the decreasing number of job
offers and an increase in the number of economically active people, the unemployment
rate grew, reaching 5.7% in April 2020 and 6.1% in November 2020. A month after the start
of the crisis, 964.8 thousand unemployed were registered in labour offices (55.4 thousand
more than a month earlier) and by November 2020 this number had increased to over
1 million [34,37].
The pandemic has forced a change in the way work is done. Many employees,
especially those doing office work, were forced to stay at home and change to methods of
telecommuting. Some people whose tasks required them to be present at the workplace
were directed to hybrid work, allowing them to be present on the company’s premises only
during designated times.
The pandemic has had an impact on changing people’s quality of life in general, with
particular effects in the context of work. It has forced decisions regarding the establishment
of remote work and the management of employees in new conditions without access to
data evaluating their impact due to the previous low popularity of this type of work.
At the end of 2019, only 345 thousand of the 16.4 million working population of Poland
Information 2021, 12, 293 4 of 13

were performing their work duties outside the workplace [37]. During the pandemic,
the number of people working remotely increased exponentially. In the second quarter
of 2020, the number of people usually doing their work from home reached 2.1 million
(which accounted for 13.1% of all those employed) and had doubled compared to the first
quarter of 2020. The majority of those working at home (72.5%) were doing so due to
the COVID-19 pandemic [38].
Research shows that Polish employees generally accept the remote form of work—88%
of workers surveyed in August 2020 by ManpowerGroup wish to remain telecommuting
to a certain degree, of which 13% expect to be able to work from home full-time [39].
A hybrid model, i.e., working partly in the office and partly remotely, was identified as
being the most desirable by 75% of respondents. Most of them (54%) would like to work
remotely for up to 10 days per month, while 46% would prefer a higher number of days
working from home. Only 12% would like to return to the office full-time. The majority of
employers (55%) plan to stay with remote working, with 2% preferring to adopt a full-time
approach and 53% a hybrid model. Among their organisations, 54% of employers intend
to offer their employees up to 10 days per a month of working from home and 46% intend
to offer more days than this. One in four organisations plan to return to full-time working
in the office, while one in five have not yet made their plans clear [39].
This growing popularity of remote working and the interest in maintaining it once
the pandemic has subsided justifies the need for research into its impact on employee
well-being.

3. Materials and Methods

The present research aimed to analyse the well-being of Polish employees during
the COVID-19 pandemic. Data were collected in January 2021 through a survey conducted
on a sample of economically active Polish workers (n = 1000) using the CAWI method
based on a nationwide, accredited research panel. The representativeness of the sample
was achieved using random sampling. The research was dominated by respondents with
higher education (52%) and employed on the basis of an employment contract (77%) in
the private sector (77%). The research sample was balanced in terms of gender (55% male
and 45% female) and age (each of the four age groups covered between 18% and 28%
of respondents). More than half (56%) of respondents had not worked remotely during
the pandemic. The remainder had worked remotely from less than 1 day per week
(13%) to full-time remote work (10%). Health care workers played a special role during
the pandemic as they were classified as essential workers. The difficult epidemic situation
resulted in longer working hours, increased stress, and anxiety. At the same time, limited
opportunities to work remotely and contact with infected people may have had a particular
impact on well-being. Therefore, work in health care, which made up 20% of the sample,
was separated in the metrics for comparison to other industries.
Detailed characteristics of the research sample are presented in Table 1.

Table 1. Structure of the research sample.

Characteristic % of the Sample

Female 45%
Gender
Male 55%
18–29 18%
30–39 28%
Age
40–49 27%
over 50 27%
Vocational 8%
Education Secondary 41%
Higher 52%
Information 2021, 12, 293 5 of 13

Table 1. Cont.

Characteristic % of the Sample

Employment contract 77%
Form of employment Civil law agreement 9%
Own business (b2b) 14%
Up to 50 employees 42%
50–249 employees 27%
Size of company
250–500 employees 12%
Over 500 employees 9%
Public 20%
Sector Private 77%
Foundations, associations and others 3%
Health care 20%
Health care
Others 80%
Not working remotely 56%
Less than 1 day per week 13%
Remote work 1–2 days per week 14%
3–4 days per week 7%
Fully remote working 10%

The survey consisted of 22 questions relating to respondents’ views on particular

aspects of employee well-being, engagement, and evaluation of remuneration fairness.
Using the Angoff Method on Cutoff Scores and Judgment Consensus, questions related
to engagement and pay equity were identified and excluded. Finally, for the purpose of
this article, responses to nine questions related to employee well-being perceptions were
analysed. The questions assessing employee well-being were adapted from the diagnostic
tool “Gallup-Healthways, Well-Being 5 Index” [40]. Four dimensions from the above tool
were included in the research:
• Purpose, i.e., liking what you do every day and being motivated to achieve your
goals—examined through questions exploring job satisfaction and being able to do
what you do best (questions 7 and 8 in Table 2)
• Relationships, i.e., having supportive relationships in one’s life—examined through
items diagnosing the evaluation of the quality and partnership in the relationship
with the supervisor (questions 2 and 3 in Table 2)
• Community, i.e., being satisfied with where you are and feeling safe in your own
community—examined using questions identifying trust and team atmosphere (ques-
tions 1 and 4 in Table 2)
• Health, i.e., good health and enough energy to get things done on a daily
basis—explored through questions about the adequacy of health to fulfil the job
and hope for the future (questions 5 and 6 in Table 2)

Table 2. Rotated component matrix—“employee well-being”.

Workplace Physical and Work–Life

Item
Relationship Mental Health Balance
1. There is a nice and friendly atmosphere in my team. 0.503 0.187 0.063
2. My relationship with my supervisor is very good. 0.748 −0.031 0.061
3. My supervisor treats me more like a partner than a subordinate. 0.772 −0.012 −0.089
4. I have confidence in my colleagues and supervisor. 0.798 0.022 −0.024
5. My health and physical condition are suitable for the work I do. −0.031 0.539 0.212
6. I look to the future with hope and enthusiasm. 0.137 0.302 0.278
7. My work gives me satisfaction. 0.023 0.918 −0.197
8. I do my best at work every day. −0.016 0.692 −0.016
9. I have a good balance between work and personal life. −0.025 −0.156 0.951
Information 2021, 12, 293 6 of 13

The Gallup-Healthways global survey shows that Polish people assess their well-being
at a level similar to that of Western European countries. The exception is the financial di-
mension, which, for example, is assessed positively by 55% of respondents in neighbouring
Germany, but only by 31% in Poland [41]. Due to the atypical results of Polish employees
in their assessment of well-being in the financial area, this dimension was not included
in the analysis of employee well-being. Additionally, a question on the assessment of
work–life balance was added (question 9 in Table 2). Although this is not a component of
the Gallup-Healthways tool, research suggests that it significantly forms an indicator of
employee well-being [42].
Respondents rated statements on a five-point Likert scale, with 1 being ‘strongly
disagree’ and 5 being ‘strongly agree’. Calculations were performed using the statistical
package R (version 4.0.2).
Exploratory factor analysis (EFA) with Promax rotation and with Kaiser normalisa-
tion was conducted to isolate the factors responsible for employee well-being based on
the questions asked in the survey. The KMO coefficient was 0.904, meaning it was close
to 1, and Bartlett’s test of sphericity (approximate chi-squared = 4126.47; 36 degrees of
freedom) was statistically significant. Both measures indicate the validity of performing
an EFA on the dataset.
As a result of the exploratory factor analysis, it was concluded that there was a solid ba-
sis for differentiating between three components of employee well-being,
respectively named:
1. “Workplace relationships”—atmosphere, relationship with supervisor, camaraderie,
and trust
2. “Physical and mental health”—physical condition appropriate to perform the job,
hope for the future, job satisfaction, and the opportunity to do one’s best
3. “Work–life balance”
The factor structure explained more than 68.4% of the variation in the entire study
construct and the limiting value of the component loadings was 0.3. Table 2 presents
the statements included in the individual extracted components and the levels of the fac-
tor loadings.

4. Results
To determine the impact of telecommuting on the identified employee well-being fac-
tors, three logistic regression models were estimated—a separate one for each of the three
components. The response variables in each model were the employee well-being fac-
tors: “workplace relationships”, “physical and mental health”, and “work–life balance”.
The explanatory variable was “remote working”. Three control variables were included
in each model: “sector”, “heath care”, and “size of the company”, relating to the type of
organisations in which the respondents were employed.
First, the descriptive statistics of the individual employee well-being factors examined
were counted (Table 3).

Table 3. Descriptive statistics of employee well-being factors.

Item n Mean SD Median Min Max

Workplace relationships 1000 3.70 0.855 3.75 1 5
Physical and mental health 1000 3.82 0.785 4.00 1 5
Work–life balance 1000 3.76 0.993 4.00 1 5

The analysis was conducted using logistic regression to make it possible to examine
the influence of explanatory variables on the dichotomous response variable. To be able
to analyse the logistic regression models, it was necessary to determine a uniform index
within each of the components of employee well-being. Given that the scores for all three
factors were derived from the Likert scale, they were divided into two groups in relation
Information 2021, 12, 293 7 of 13

to the median values. The following measures of individual employee well-being factors
were adopted:
• “Workplace relationships” = 1 for values ≥ 3.75, 0 for values < 3.75
• “Physical and mental health” = 1 for values ≥ 4.0, 0 for values < 4.0
• “Work–life balance” = 1 for values ≥ 4.0, 0 for values < 4.0
For each of the examined variables, a reference value was adopted, i.e., one against
which comparisons were made. In the case of “remote working”, the reference value
was the declaration by the employee that he/she did not work remotely. Situations in
which remote work was carried out with varying frequency, from less than once a week to
exclusive remote work, were referred to through the lack of remote working. For “sector”,
the public sector was taken as the reference value, with the private sector and the category
combining foundations with associations being referred to. For the variable defining
work in “health care”, the reference was the exercise of work in this industry and for
the “size of the company”, the smallest organisations, i.e., up to 50 employees, were taken
as the reference value. Their share in the surveyed sample was the highest (42%).
Based on the results obtained, we can conclude that “remote working” has a significant
impact on the first of the identified employee well-being factors—“workplace relationships”
(Table 4). The odds ratio for the “workplace relationships” factor to be greater than or equal
to the median level in the survey (3.75) was less than 1 for both working remotely 1–2 days
per week (0.66) and when working fully remotely (0.5). This implies that working remotely
1–2 days per week or working remotely full-time decreases the probability of well-being in
the “workplace Relationships” dimension compared to not working remotely.

Table 4. A logistic model explaining the chance of well-being—“workplace relationships” factor.

Lower Upper
Reference Bound of Bound of
Variable Coefficient Std. Error Stat. Z p-Value OR
Category the Conf. the Conf.
Interval Interval
Intercept −0.440 0.207 −2.123 0.034 0.644 0.428 0.965
Private −0.213 0.167 −1.280 0.201 0.808 0.583 1.121
Sector Public
Foundations,
associations, and −0.383 0.396 −0.966 0.334 0.682 0.306 1.464
others
Heath
Others Health care 0.429 0.174 2.457 0.014 1.535 1.094 2.169
care
50–249 employees 0.182 0.166 1.101 0.271 1.200 0.867 1.661
Size of Up to 50
250–500 employees 0.323 0.215 1.504 0.133 1.382 0.906 2.107
company employees
Over 500
0.041 0.187 0.218 0.827 1.042 0.721 1.501
employees
Less than 1 day per
−0.261 0.202 −1.292 0.196 0.771 0.517 1.141
week Not
Remote
1–2 days per week working −0.413 0.197 −2.096 0.036 0.661 0.447 0.970
work
3–4 days per week remotely −0.022 0.253 −0.088 0.930 0.978 0.592 1.606
Fully remote
−0.667 0.238 −2.802 0.005 0.513 0.318 0.811
working

Of the control variables, a significant relationship linked “health care” with employees’
ratings of “workplace relationships”. Based on the analysis, the chance that the value
of the “workplace relationships” factor would indicate a level greater than or equal to
the median in the survey was approximately 1.5 times higher when working in other
industries compared to health care.
Due to a lack of statistical significance, no relationship could be established between
the factor “physical and mental health” and the factor “remote working” based on the find-
ings (Table 5). Of the control variables, work in the “health care” industry was the only
Information 2021, 12, 293 8 of 13

statistically significant relationship linked with this factor. Based on the analysis, we can
conclude the chance that the score of the factor “physical and mental health” will indicate
a value greater than or equal to the median in the study (4.0) is approximately 3.2 times
higher for jobs in industries other than health care, assuming a constant value of the other
parameters of the model.

Table 5. A logistic model explaining the chance of well-being—“physical and mental health” factor.

Lower Upper
Reference Bound of Bound of
Variable Coefficient Std. Error Stat. Z p-Value OR
Category the Conf. the Conf.
Interval Interval
Intercept −1141 0.220 −5177 <0.001 0.319 0.206 0.489
Private −0.042 0.170 −0.249 0.804 0.959 0.687 1337
Sector Public
Foundations,
associations, and −0.101 0.390 −0.259 0.796 0.904 0.417 1943
others
Heath
Others Health care 1156 0.187 6194 <0.001 3176 2218 4614
care
50–249 employees 0.095 0.166 0.573 0.566 1100 0.794 1524
Size of Up to 50
250–500 employees 0.303 0.217 1395 0.163 1354 0.884 2075
company employees
Over 500
0.282 0.186 1514 0.130 1325 0.921 1910
employees
Less than 1 day per
−0.093 0.204 −0.454 0.650 0.912 0.610 1358
week Not
Remote
1–2 days per week working −0.075 0.195 −0.384 0.701 0.928 0.632 1359
work remotely
3–4 days per week 0.281 0.259 1088 0.277 1325 0.800 2212
Fully remote
−0.350 0.227 −1540 0.123 0.704 0.449 1097
working

The results indicate that there is a statistically significant relationship between “work–life
balance” assessment and “remote working” (Table 6). The coefficient for the chance that
the “work–life balance” score would indicate a value greater than or equal to the survey
median (4.0) was less than one (0.58), i.e., the chance of work–life balance well-being was
decreasing for fully remote work relative to office-based work.

Table 6. A logistic model explaining the chance of well-being—“work–life balance” factor.

Lower Upper
Reference Bound of Bound of
Variable Coefficient Std. Error Stat. Z p-Value OR
Category the Conf. the Conf.
Interval Interval
Intercept −0.431 0.209 −2.059 0.039 0.650 0.429 0.977
Private −0.039 0.173 −0.226 0.821 0.962 0.687 1354
Sector Public
Foundations,
associations, and −0.194 0.415 −0.468 0.639 0.823 0.352 1815
others
Heath care Others Health care −0.233 0.172 −1356 0.175 0.792 0.566 1112
50–249 employees −0.005 0.172 −0.031 0.975 0.995 0.710 1391
Size of Up to 50
250–500 employees −0.137 0.227 −0.605 0.545 0.872 0.555 1352
company employees
Over 500 employees −0.022 0.194 −0.113 0.910 0.978 0.667 1427
Less than 1 day per
0.389 0.200 1948 0.051 1476 0.995 2181
week
Remote Not working
1–2 days per week 0.163 0.198 0.822 0.411 1177 0.795 1731
work remotely
3–4 days per week 0.176 0.260 0.675 0.500 1192 0.709 1973
Fully remote working −0.542 0.260 −2088 0.037 0.581 0.342 0.952
Information 2021, 12, 293 9 of 13

5. Discussion
The conducted research indicates that in the case of workers in Poland, employee
well-being consists of three factors. The results obtained from the exploration of the col-
lected data allow us to extend the knowledge by proposing a model including workplace
relationships, physical and mental health, and work–life balance. The first of these ad-
dresses the relationship with superiors and co-workers. It includes the assessment of
the atmosphere—perceiving it as accommodating and approachable—and also a positive
evaluation of the relationship with the superior and the belief that he/she treats the em-
ployee as a partner rather than a subordinate. A component of this dimension is also
the declaration of trust in colleagues and the supervisor. This is the lowest rated workplace
well-being factor by Polish employees. The second well-being factor of Polish employ-
ees is the belief that their physical and mental health is in good condition. It includes
the assertion that the employee’s health and psycho-physical condition is adequate relative
to the performed job. It includes job satisfaction, a generally positive attitude toward
the future, and the ability to do what one does best every day. Physical and mental health
is the highest-rated employee well-being factor by Polish employees. The last component
is the employees’ belief that they have a balance between work and personal life.
There is a consensus in the literature on the difficulty of maintaining a work–life
balance when working exclusively remotely [1]. When working from home, it is difficult to
draw lines between work and non-work [43]. During the pandemic, in addition to coping
with the increased workload that can result from the shift to remote working, workers had
to also cope with childcare due to the widespread suspension of schools and training, as
well as ongoing concerns about the health of family and friends. The additional demands
have blurred work and family roles, making it difficult to maintain appropriate boundaries
between work and family [44]. The present research has confirmed the validity of these
claims in the case of Polish workers during the COVID-19 pandemic by indicating that
exclusive remote working negatively affects an employee’s work–life balance. Employers
aiming to support remote work should favour hybrid solutions—combining aspects of
remote working with presence in the workplace. One way in which employers could
support workers balancing blurred work–family roles could be to provide information and
support, e.g., information about whether and when local childcare or eldercare options are
available, as well as self-development and training opportunities that can help workers
adapt to changing roles and demands [45].
Research available in the literature suggests that social support and workplace rela-
tionships, particularly with the supervisor, influence work during a pandemic [46]. Social
support is an important factor in well-being. It improves happiness levels, which in turn
helps to increase physical health and well-being [47]. In addition, the empathy and shared
responsibility that social support brings helps employees overcome the stress caused by
social distance [48]. Remote working significantly limits the opportunities for supportive re-
lationships in the workplace. The present study concluded that telecommuting performed
full-time or 1–2 days per week reduces the likelihood of high well-being scores in the “work-
place relationships” factor. Lack of personal contact with the supervisor and co-workers
negatively affects trust in others and assessment of the atmosphere in the workplace. In
the case of exclusive remote work, the relationship with the supervisor is also rated lower.
The situation is analogous in the case of hybrid work with a predominance of office-based
work, i.e., remote work 1–2 days a week. In the present analysis, no relationship was found
between occasional remote work (less than once a week) or frequent but not exclusive
work (3–4 times a week) and the assessment of well-being in terms of relationships with
colleagues and the supervisor. This means that employers concerned for the well-being of
their employees should be cautious about the use of remote working on a permanent or
exclusive basis. It would instead be advisable to use remote working occasionally, but not
exclusively, from the perspective of well-being in the dimension of workplace relationships.
These results extend the knowledge on the impact of remote working on relationships with
co-workers, an important dimension of employee well-being. The need for research in this
Information 2021, 12, 293 10 of 13

area is indicated in the literature as first on the list of issues for future research in relation
to COVID-19 and the workplace [1].
The study showed no relationship between the assessment of the factor “physical and
mental health” and remote working. Based on the results, it is not possible to conclude
an effect of remote working on employees’ positive perceptions of their own physical
health, hope for a positive future, and job satisfaction. Results presented in the literature
indicate that the pandemic has caused an increase in anxiety and depression [49] and it has
also been previously shown that confronting negative life events influences an increased
risk of mental and physical health problems [50]. On this basis, one would expect there
to be a relationship between the remote nature of work and perceptions of mental and
physical health. However, the results of our study do not verify this expectation. For
Polish employees, the intensity of remote work is not a differentiating factor for subjective
well-being in physical and mental health. Further research would be needed to identify
the reason behind this lack of relationship. It may be that unfavourable pandemic condi-
tions for mental and physical health have a similar effect on employees, regardless of their
ability to work remotely.

6. Conclusions
The conducted research made it possible to positively verify the research hypothesis
about the relationship between employees’ well-being and the level of digitalisation of their
work, measured by the degree of telecommuting. The results were able to fill the research
gap in terms of proving significant relationships between the studied constructs. They also
provided information on the impact of remote working on factors making up employee
well-being. The paper extends theoretical knowledge on the components of employee
well-being by proposing a model including workplace relationships, physical and mental
health, and work–life balance and their relationship with the intensity of remote working.
Contrary to views expressed in the literature, the study found no statistically significant
relationship between employees’ perceptions of physical and mental health and their
remote work. Instead, it showed the existence of a significant impact of telecommuting on
workplace relationships and the employee’s ability to maintain a work–life balance. These
findings provide practical implications—important information in terms of its applicability,
indicating desirable ways to shape well-being programmes in organisations.

Limitations and Future Research

The study captured the relationship between remote working with digital instruments
and three exploratory dimensions of employee well-being. The research was conducted
during the COVID-19 pandemic, which forced the process of digitisation and remote
working. A static snapshot is presented as relationships were not explored longitudinally.
As the factors examined are time-dependent and variable in nature, further research is
needed to consider changes during and after the pandemic. In addition, employee well-
being may change sometime after the onset of remote working, so a longitudinal study is
therefore recommended.
As this study only concerned Polish employees, it would also be advisable to survey
employees working in other countries and regions in order to generalise the results.
Research on employee well-being should take into account both perspectives—those
of employees and their employers. The present study identified relationships between
the constructs on a sample of employees. To get a complete picture, it would be advisable
to conduct the study from the employers’ perspective as well. Furthermore, this study mea-
sured the constructs through the construction of an employee self-assessment questionnaire.
Research validating the results through other sources of assessment is recommended.
Future research could explore related variables and their components in more detail.
Additionally, future research could be expanded to include mediators and moderators of
the relationship between employee well-being and digital work.
Information 2021, 12, 293 11 of 13

Author Contributions: Conceptualization, M.J. and H.K.; methodology, M.J. and H.K.; software,
H.K.; validation, H.K.; formal analysis, H.K.; investigation, M.J. and H.K.; resources, M.J. and H.K.;
data curation, H.K.; writing—original draft preparation, H.K.; writing—review and editing, M.J.;
visualization, H.K.; supervision, M.J.; project administration, H.K.; funding acquisition, M.J. All
authors have read and agreed to the published version of the manuscript.
Funding: This research was funded by the National Science Centre in Poland under Grant “Compen-
sation justice”, 2016/21/B/ HS4/02992.
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.
Data Availability Statement: Not applicable.
Conflicts of Interest: The authors declare no conflict of interest.

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32. Dyrbye, L.N.; Satele, D.; Shanafelt, T. Ability of a 9-Item Well-Being Index to Identify Distress and Stratify Quality of Life in US
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33. Roy, B.; Riley, C.; Herrin, J.; Spatz, E.S.; Arora, A.; Kell, K.P.; Welsh, J.; Rula, E.Y.; Krumholz, H.M. Identifying county characteristics
associated with resident well-being: A population based study. PLoS ONE 2018, 13, e0196720. [CrossRef]
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publications/publication/rynek-pracy-edukacja-kompetencje-marzec-2020-3-1 (accessed on 4 June 2021).
36. PARP. Rynek Pracy, Edukacja, Kompetencje. Aktualne Trendy i Wyniki Badań (Grudzień 2020) (Labour Market, Education, Com-
petences. Current Trends and Research Results (December 2020)). 2020. Available online: https://www.parp.gov.pl/component/
publications/publication/rynek-pracy-edukacja-kompetencje-aktualne-trendy-i-wyniki-badan-grudzien-2020 (accessed on 4
June 2021).
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Poland, 2020.
39. Manpower Group. Ocena Nowej Rzeczywistości Rynku Pracy—Perspektywa Pracowników i Pracodawców (Assess-
ment of the New Reality of the Labour Market—Employees’ and Employers’ Perspective). 2020. Available online:
https://www.hrlink.pl/blog/raport-rynku-pracy-od-hrlink-i-manpower-group-ocena-nowej-rzeczywistosci-rynku-pracy-
perspektywa-pracownikow-i-pracodawcow/#raportManpower (accessed on 4 June 2021).
40. Gallup-Healthways. Well-Being 5 Toolkit. 2017. Available online: http://static1.squarespace.com/static/55badabde4b0315175
afa387/t/5679899ac647ad4d61528831/1450805658499/Workplace+Well-Being+5+FAQS.pdf (accessed on 2 April 2021).
41. Gallup-Healthways. State of Global Well-Being. Results of the Gallup-Healthways Global Well-Being Index. 2013. Available
online: http://info.healthways.com/hs-fs/hub/162029/file-1634508606-pdf/WBI2013/Gallup-Healthways_State_of_Global_
Well-Being_vFINAL.pdf (accessed on 2 April 2021).
42. Pradhan, R.K.; Hati, L. The Measurement of Employee Well-being: Development and Validation of a Scale. Glob. Bus. Rev. 2019.
[CrossRef]
43. Ramarajan, L.; Reid, E. Shattering the myth of separate worlds: Negotiating nonwork identities at work. Acad. Manag. Rev. 2013,
38, 621–644. [CrossRef]
44. Giurge, L.M.; Bohns, V.K. 3 Tips to Avoid WFH Burnout. Available online: https://hbr.org/2020/04/3-tips-to-avoid-wfh-burnout
(accessed on 4 June 2021).
45. Carnevale, J.B.; Hatak, I. Employee adjustment and well-being in the era of COVID-19: Implications for human resource
management. J. Bus. Res. 2020, 116, 183–187. [CrossRef] [PubMed]
46. Bartsch, S.; Weber, E.; Büttgen, M.; Huber, A. Leadership matters in crisis-induced digital transformation: How to lead service
employees effectively during the COVID-19 pandemic. J. Serv. Manag. 2021, 32, 71–85. [CrossRef]
47. Freeborne, N. Social Support Improves Health During Social Distancing. Psychol. Today 2020. Available online: https://www.
psychologytoday.com/gb/blog/the-power-community/202004/social-support-improves-health-during-social-distancing (ac-
cessed on 4 June 2021).
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48. Abel, T.; McQueen, D. The COVID-19 pandemic calls for spatial distancing and social closeness: Not for social distancing! Int. J.
Public Health 2020, 65, 231. [CrossRef] [PubMed]
49. Polizzi, C.; Lynn, S.J.; Perry, A. Stress and Coping in the Time of COVID-19: Pathways to Resilience and Recovery. Clin.
Neuropsychiatry 2020, 59–62. [CrossRef]
50. Luhmann, M.; Hofmann, W.; Eid, M.; Lucas, R.E. Subjective Well-Being and Adaptation to Life Events: A Meta-Analysis on
Differences Between Cognitive and Affective Well-Being. J. Personal. Soc. Psychol. 2012, 102, 592–615. [CrossRef] [PubMed]
 MENTAL
WELLBEING
AND DIGITAL
WORK
An evidence review

Evidence summary
July 2021
 Mental wellbeing and digital work

5 The CIPD is the professional body for HR and people

development. The registered charity champions better work
6 and working lives and has been setting the benchmark for
excellence in people and organisation development for
7
more than 100 years. It has more than 150,000 members
across the world, provides thought leadership through
independent research on the world of work, and offers
professional training and accreditation for those working in
HR and learning and development.

c2
 Mental wellbeing and digital work

1
Evidence summary

2
Mental wellbeing and digital work

4 Contents
1 Introduction 2
5
2 What is the nature of mental wellbeing? 3

6 3 Work-related risk factors 5

4 Workplace mental health interventions 10

7 5 Socio-demographic risk factors 11

6 Conclusions 11

7 Notes 12

Acknowledgements
This report was written by Jonny Gifford, Gill Maxwell and Jake Young of the CIPD,
based on a rapid evidence assessment conducted by Eric Barends, Emilia Wietrak and
Denise Rousseau of the Center for Evidence-Based Management.
We thank a number of people for their contributions to this report. First, our HR
director panel, including Cathy Donnelly of Liberty IT, Kate Griffiths-Lambeth of
Charles Stanley, Dr. Tracey Leghorn of SUEZ recycling and recovery UK, Katie Obi of
Rizing, Eugenio Pirri of Dorchester Collection, Lynne Rennie-Smith, freelance, Debbie
Ryan of DS Smith, Amy Taylor of PFK Francis Clark, Rebekah Wallis of Ricoh UK, and
Marc Weedon of Zuora. We also thank CIPD colleagues Rachel Suff and Holly Ivins for
their feedback and support on this research.

Publication information
Please cite this report as: Gifford, J., Maxwell, G. and Young, J. (2021) Mental
wellbeing and digital work: evidence summary. London: Chartered Institute of
Personnel and Development.
This and the accompanying scientific summary are available at: cipd.co.uk/evidence-
mental-wellbeing

1
 Mental wellbeing and digital work

1 Introduction
1 Background
Work can and should have a positive impact on people’s lives,1 but day to day, we can often
2 find ourselves under pressure. Persistent stress can lead to mental ill health of varying
degrees, affecting both our personal and working lives. Pressures can be practical, physical,
emotional, psychological, social, relational, financial or technological. They can be singular or
3 apply in combination, compounding the pressure individuals feel.
Over recent years, campaigns have increased public awareness about the importance of
4 promoting mental wellbeing and attempted to reduce the stigma that surrounds mental
health problems.2 At the same time, there are concerns contemporary ways of working may
lead to increased workloads and affect mental wellbeing.3
5
Digital technologies are an undeniable feature of modern working life that can facilitate a
great deal and are valuable tools for many. However, they have added to concerns about job
6 quality and mental health. Criticisms include that they can deskill jobs through automation,
create precarious work through the ‘gig economy’, damage work–life balance by encouraging
‘always-on’ work climates, weaken social relationships, and damage our health through the
7 physical effects of blue light and screen time.4 These effects have sometimes been labelled
‘technostress’.
The global pandemic has exacerbated such concerns over the last year, putting mental
wellbeing high on the agenda of many employers and HR leaders. The availability of
videoconferencing and other remote ICT has been a saving grace in that they have enabled
many organisations to continue functioning during COVID-19 lockdowns. All the same, an
unprecedented rise in remote and digital working has been seen to lead to cases of social
isolation, large workloads and long working hours. Post-pandemic, we can expect a partial
return to the office for the many who have been homeworking, with ‘hybrid’ workplaces and
greater options for flexible working becoming more common than they were before.
Employers in the UK have a legal duty of care for their employees to do what is reasonably
practical to safeguard their mental wellbeing. There are also important organisational
outcomes closely related to mental wellbeing, such as sickness absence and reduced
performance. Employers clearly play an important role in helping lower the risk of mental
health problems and encouraging good mental health.
Research focus
This evidence review focuses on work-related risk factors in mental wellbeing – in particular
those relating to digital working – and what employers can do to help manage them. We
summarise the scientific literature on the following questions:
1 What is the nature of mental wellbeing and how is it measured?
2 How do work and people management affect mental wellbeing? In particular, what is the
evidence that working digitally (for example, email, cloud-based platforms or enterprise
social networks) affects mental wellbeing?
3 How are these impacts on mental wellbeing moderated by other factors – for example,
management behaviour, work location, occupation, seniority, work patterns or socio-
demographics?
4 What contribution can management or training interventions make to workplace mental
wellbeing?

2 Introduction
 Mental wellbeing and digital work

This is not the whole story of how mental ill health plays out at work. In particular, its causes are
often not the nature of people’s work or how they are managed, but factors in their personal
1 lives. These too are areas in which employers can play an active role – for example, in providing
support during bereavement. However, in order to give a robust, systematic view of the research
evidence, the current review narrows the focus to the main ways that work, people management
2 and workplace interventions make a positive or negative difference to mental health.
Our approach was a ‘rapid evidence assessment’ (REA), a core method in evidence-based
3 practice.5 REAs are short, systematic reviews that identify, critically appraise and synthesise the
best available research evidence. As such, they give a reliable summary of the current state of
the body of knowledge. We also discussed the implications of the research with ten HR directors
4 across two online workshops.
This report brings together the main research insights along with the professional expertise of
5 our HR director panel. We summarise the main findings and present practical recommendations
for managers and HR and L&D professionals. The detail of the REA itself is available in the
6 accompanying scientific summary at cipd.co.uk/evidence-mental-wellbeing.

7 2 What is the nature of mental

wellbeing?
A continuum of mental health
Mental wellbeing is a positive term describing the social and emotional wellbeing of individuals.
It is often used as a synonym for mental health.6 The World Health Organization (WHO)
describes mental health as ‘an integral and essential component of health’. It states that mental
health is more than just the absence of mental health problems or disorders. In other words, not
being mentally ill does not necessarily mean that an individual is mentally healthy, as positive
states such as satisfaction, contentment and happiness also come into play. As we note in our
guide on responding to suicide risk in the workplace, ‘We all have mental health, just as we all
have physical health. How we feel can vary from good mental wellbeing, to difficult feelings and
emotions, to severe mental health problems. Mental health, like physical health, can fluctuate on a
spectrum from good to poor and we all have times when we feel better or worse.’ 7

Figure 1: A continuum of mental health states

Positive mental
Mental ill health, for States related to wellbeing: for example
example anxiety and mental ill health, for Lack of mental contentment, happiness,
depression disorders example stress ill health satisfaction

Mental health conditions

However, when we look at the best research on mental wellbeing, it overwhelmingly
centres on mental health problems. In workplace or work-related mental wellbeing, the
most common conditions investigated are depression and anxiety. Both of these are
recognised clinical conditions. Depression relates to persistent feelings of sadness and

3 What is the nature of mental wellbeing?

 Mental wellbeing and digital work

hopelessness and lost interest in usually enjoyable activities. Anxiety relates to intense,
excessive and persistent worrying in everyday situations. They are serious but relatively
common conditions: among general adult populations, typically 6–10% will experience
1 them in a given year.8 These figures include high-risk groups such as the unemployed: for
the working population, this number is lower, typically about one in twenty.9

2 A more common and usually less serious condition is stress. The UK Health and Safety
Executive (HSE) defines workplace stress in terms of people’s reaction to ‘excessive pressures
or other types of demand’. It can be momentary – for example, being experienced when an
3 employee lacks the skills or time to meet the demands of their job – and can affect people
in different ways, such that some will cope with or even thrive in high-stress environments
much more so than others. It is estimated that almost half of British workers frequently
4 experience work-related stress.10 Stress is a risk factor in mental health conditions,11 but most
researchers do not consider it an adequate indicator of poor mental wellbeing.
5 Another widely used term used in discussions of work-related wellbeing is ‘burnout’.
However, due to problems with its definition and measurement – including that it is not
6 clear how it differs from depression – it is not a diagnosable condition, but rather, as the
WHO terms it, an ‘occupational phenomenon’.
The figures above on prevalence give a more nuanced picture than the common statement
7 that one in four UK adults experience a mental health problem of some kind each year.12 On
the one hand, work-related stress is more common, but clinically recognised mental health
conditions are far less common. It is thus advisable to distinguish clinical conditions such as
anxiety and depression from typically less serious conditions such as workplace stress.
This evidence review prioritises the most trustworthy studies of cause and effect in work-
related mental health. Because of this, it focuses on recognised mental health conditions
and factors that either cause or help prevent or alleviate them. We do not review the
research on positive mental states at work, or on work-related stress, as the body of
research here is weaker.
Measures of mental wellbeing
A range of validated measures exist for mental health conditions (see the scientific
summary for detail). These are based on survey-type questions – for example, the
Depression, Anxiety and Stress Scale (DASS)13 collects responses to items in reference to
‘the past week’, including:
• ‘I couldn’t seem to experience any positive feeling at all’ and ‘I felt that I had nothing to
look forward to’ (depression).
• ‘I felt I was close to panic’ and ‘I experienced trembling (for example in the hands)’
(anxiety).
• ‘I found it hard to wind down’ and ‘I tended to over-react to situations’ (stress).
More generic measures of mental health are also available – for example, the Mental Health
Inventory-5 (MHI-5) is a validated scale that is brief and easy to administer.
These measures are primarily designed to inform clinical assessment and decisions, and
clearly collect sensitive personal data. Outside of targeted occupational health services, it
is unlikely that measuring mental health conditions will be appropriate for most employers.
Given how common it is, measures of stress may be more appropriate than those for
anxiety and depression, but even here the guidance of the relevant scales should be
followed closely. Other options for employers include raising awareness and promoting

4 What is the nature of mental wellbeing?

 Mental wellbeing and digital work

guidance on mental health issues (for example, from the charity Mind14), referring to
bespoke occupational health or counselling resources, or assessing mental health risk
factors, which we discuss below.
1

2
3 Work-related risk factors
Over recent decades, a large number of high-quality studies have been published on
3 factors that predict mental wellbeing. To identify the most trustworthy studies of cause
and effect, we limited our search to meta-analyses and to single studies at least as robust
as prospective cohort studies, a longitudinal design that allows us to identify not only
4 associations (or correlations), but predictive relationships.15
A consistent view emerges of a wide range of work-related antecedents. The individual factors
5 that have the largest impact on employees’ mental health are listed in Table 1. These factors all
related to measures of anxiety, depression and/or generic mental health. We also give the typical
effect sizes of these factors. Effect sizes are crucial for understanding the practical importance of
6 factors. Unlike statistical significance, which relates to the likelihood that research findings are due
to chance, effect sizes explain the magnitude of an intervention or factor of influence.

7 The effect sizes of the factors listed in Table 1 are all ‘small’ or ‘moderate’ according to Cohen’s
rule of thumb, which interprets often obscure statistical measures into simple terms.16 However,
this doesn’t mean that they are unimportant, as they relate to crucial health-related outcomes.
To illustrate this in more tangible terms, we have used the effect sizes to estimate the increase
or reduction in sickness absence. Clearly, sickness absence is not the only important outcome
from mental ill health, but it is striking that for an organisation of 100 employees, some of the
risk factors equate to as many as 80 or 100 days’ absence per year.17

It is striking that for an organisation of 100 employees,

some of the risk factors equate to as many as 80 or 100 days’
absence per year.
Table 1: Greatest risk factors in mental wellbeing at work

Effect size Effect on absence (ADY/100)

Bullying +58 to 103

Long working hours +80

Perceived injustice +13 to 80

Sense of coherence −18 to 52

Effort–reward imbalance +14 to 44

Organisational change +9 to 37

Job control or autonomy −12 to 21

Social support −15

Job demands +2 to 13
Notes: Effect sizes,18 marked yellow for positive impacts on mental health, green for negative: ••••• very large;
••••o large, anybody can easily see the difference; •••oo moderate, visible to the naked eye of an expert or
careful observer; ••ooo small, the difference probably needs to be measured to be detected; •oooo very small.
Effect on absence: likely positive or negative change in days’ absence per year per 100 employees (ADY/100).

5 Work-related risk factors

 Mental wellbeing and digital work

In the following sections, we discuss these factors under three groupings: work
relationships; job design and the nature of work; and employee perceptions.
1 Work relationships
Social support and cohesion
2 The relationships we have with colleagues, bosses, reports, customers and suppliers
are central to our working lives. The positives, such as social cohesion, support and
psychological safety, are important factors not only for performance but also for mental
3 wellbeing. Receiving help and advice from supervisors and co-workers has a positive
impact on mental wellbeing; this is especially so for support from colleagues.19 And
unsurprisingly, a perceived lack of support predicts mental health problems.
4
HR directors noted that reaching out to colleagues for support and having ‘water cooler’
conversations – key to alleviating stress and pressure – has become more difficult with
5 working remotely. Providing that support, therefore, has become more important. Leaders
have been much more proactive, whether organising team events to replicate the social
6 dimension of work, or creating a stronger personal connection with their employees
through showing greater interest in their personal lives .

7 Things like virtual poker nights, virtual quizzes, Q&As with

our leaders (…) I think that has definitely helped in terms of
not just recreating that social dimension but also that feeling
of isolation, which could otherwise have crept up during the
remote working time.
Marc Weedon, HR Director, Zuora

Bullying
Social support makes an important contribution to workplace mental health, but its
influence is outweighed by overtly negative aspects of work relationships – that is, conflict,
bullying and harassment have much larger impacts. Bullying involves targeted incivility,
repeated over a period of time, that can take the form of physical or verbal abuse,
harassment, ridicule or social exclusion.20 We find strong evidence showing that these
behaviours are not only a potentially major legal risk, but also personally very harmful.
They relate to an array of health-related outcomes, including anxiety, depression, burnout,
frustration, negative emotions and physical symptoms. In short, bullying is quite clearly the
highest individual risk factor for work-related mental health.
Employers should have robust and well-communicated policies and guidance promoting
dignity and respect at work. This needs to be backed up by the climate or social norms,
which make it clear that inappropriate behaviour won’t be tolerated. Senior leaders play
a critical role in setting norms by demonstrating strong values of dignity and respect. For
more information, see our factsheet on harassment and bullying at work.
Job design and the nature of work
Working hours
The nature of our jobs can affect our mental wellbeing in various ways. One of the most
prominent risk factors is long working hours, especially for women. This is especially concerning,
as working hours and work–life balance are particularly challenging areas in the UK. The CIPD’s
Good Work Index has found that the UK fares worse in work–life balance than the great majority
of OECD countries, with many workers doing substantially longer hours than they would
realistically like to (for example, one in four overworks by ten or more hours per week).21

6 Work-related risk factors

 Mental wellbeing and digital work

Work autonomy and coping with demands

Related to working hours, the demands or intensity of the job are also influential. Jobs
1 that are very physically or psychologically demanding can lead to smaller but all the same
notable drops in mental wellbeing.

2 One reason work demands are less impactful than working hours is that other factors
can mitigate their effects. In particular, job control or work autonomy is an important
‘protective’ feature that enables people to cope with high demands. Indeed, as can be seen
3 in Table 1, the positive influence of job control generally outstrips the negative influence of
job demands.

4 Job control or work autonomy is an important ‘protective’

feature that enables people to cope with high demands.
5 Work autonomy is about loosening managerial control and allowing workers to make
decisions about the tasks they do, how they do them or how their work is scheduled.22
6 High job demands are a common reality in many organisations. There is a limit as to what
is acceptable, which is why the legal protection of working time regulations is important.23
But job demands are a fact of life, so empowering people to handle them is an essential
7 aspect of management. Work autonomy is a core way this happens.
How much scope there is for autonomy is context specific, as industries and jobs differ
naturally in how prescriptive managerial controls need to be. Nonetheless, as the context
allows, increasing work autonomy can offer real gains to workers and their employers.
Autonomy was singled out by HR directors as especially important when working remotely,
not only to allow employees to work flexibly and balance their work and home lives more
successfully, but also to reduce pressure to be ‘always on’ and make it less difficult to
switch off from work. A common view was that employees need to feel they genuinely
have the permission to control as much of their working environment as possible. So it
may help to create a manifesto or template for working, which normalises using autonomy
throughout the whole organisation, or leaders setting a positive example by introducing
and demonstrating flexible working to their teams, such as taking physical breaks during
the day and engaging in social activities. Senior leaders were seen to have a particular
responsibility in setting healthy norms.
In addition, other uses of digital technology may facilitate work autonomy. For example,
employees can to let others know their schedule, blocking out time in their electronic
diaries so that colleagues don’t set up too many meetings, or setting automatic email
replies outside of their normal hours. Our panel noted that individuals’ work patterns differ
naturally, so it can help to acknowledge this – for example, by letting others know that
even if you are sending an email outside normal work hours, you don’t expect them to
reply out of hours.

I think it’s how you introduce permission to give people control

(…) Whether it’s you don’t have meetings on a Friday, or it’s
understood that you do this in the morning, you do that in the
afternoon.
Rebekah Wallis, Director of People & Corporate Responsibility, Ricoh UK

7 Work-related risk factors

 Mental wellbeing and digital work

Questioning, ‘Do you need to be at that meeting?’ Thinking

about not sending emails after 6.00 in the evening, not
1 scheduling meetings before 9:00 in the morning. But what
we did then was we role-modelled that as a senior leadership
2 team so that it felt okay, but also then acknowledging that it
doesn’t work for everyone (…) But we encourage teams to come
3 together and almost set their own norms that would work for
them that would give the majority the headspace. I think that’s
pretty powerful.
4 Cathy Donnelly, Senior Director for Talent, Liberty IT

5 Government policy and autonomy in digital work

There are also implications here for government employment policy. For example, on the
face of it, ‘gig economy’ workers have a choice in what work they accept, but the way
6 they are managed on the online platforms can be highly controlled and may contribute to
overwork and exhaustion.24 For zero-hour contracts, there is more evidence that they give
workers genuine choice in how they manage their work-life balance, but here too some
7 employers have been accused of using job insecurity to coerce people to work long hours.
Thus, governments should strive to ensure a fundamentally fair basis to modern working
practices like these.25
Organisational change
Major structural and procedural change is a common feature of organisational life and
has profound implications for the nature of people’s work. Research shows that mergers,
downsizing and restructuring substantially increase the risk of mental health problems.
The mental health risks increase when employees perceive the change negatively
and when there are multiple or repeated incidents of change. This underscores the
importance of effective change management, which includes treating employees as
valued stakeholders, listening to their concerns and seeking to understand and work
through reasons for resistance.26
The relationships workers have with colleagues, managers, people who report to them,
customers and suppliers are central to people’s working lives. The positive aspects of these
relationships, such as social cohesion, support and psychological safety, are important
factors not only for performance but also for mental wellbeing. Receiving help and
advice from supervisors and co-workers has a positive impact on mental wellbeing; this is
especially so for support from colleagues.27 And unsurprisingly, a perceived lack of support
predicts mental health problems.
Work-related psychological attitudes and states
Sense of coherence
One psychological factor closely related to organisational change is employees’ sense of
coherence. This describes whether people can comprehend events, find meaning in them
and feel that they can manage them. Although it is particularly relevant during a period
of change, it can also be a more general outcome from management style. For example,
people managers should not keep their people guessing or behave in ways that cause
feelings of insecurity. Instead, they should be open in explaining decisions, help people
have a clear line of sight between their work and wider organisational objectives and, as
far as is possible, give certainty about potential change.

8 Work-related risk factors

 Mental wellbeing and digital work

Fairness at work
Other psychological factors also play an important role in work-related mental wellbeing.
1 Two of the main risk factors concern fairness: a perceived imbalance between effort and
reward, and more generally perceived injustice. There are three types of organisational
justice, all of which can be important:
2
• distributive justice: how fair the allocated outcomes of a decision are

3 • procedural justice: how fair the processes or approaches used to make decisions are
• interactional or social justice: how fairly people are treated when procedures are
implemented.
4
Clearly, pay and other forms of reward are a major part of the terrain of fairness. As we
found in our previous evidence review on the behavioural science of reward, people have
5 a deeply ingrained need for fairness and, as a result of this, look for demonstrable rigour
and transparency in determining pay and progression.28 For further insights into fairness at
6 work more generally, see our thematic review.29
Does digital work affect mental wellbeing?
This was a core question at the outset of our review. In short, however, we find no direct
7 evidence of an association between digital work and mental wellbeing. There is a growing
body of research on work-related technology and digital work, including some on the
links with mental health. From this, the term ‘technostress’ has been coined for what is
perceived to be a unique phenomenon.30 However, as it stands, the research evidence
linking digital work and mental wellbeing is weak and inconclusive, and thus not sufficient
to give confident recommendations. There are also seemingly conflicting findings – for
example, that digital communication technology can cause stress or can help people
achieve better work–life balance. In short, we find no direct evidence of an association
between digital work and mental wellbeing.
However, this does not leave us with nothing on the links between digital work and
mental health. We do have evidence that digital working relates to mental wellbeing risk
factors discussed above. For example, an excessive volume of emails is evidently a sign
of excessive work demands, and we have evidence that it creates anxiety by reducing
workers’ sense of control, as they fear they will fall behind in their work or miss important
information. We also find good evidence that expectations or demands to respond swiftly
via digital communication tools is bad for workers’ mental health. And we find evidence
that ICT work contributes to the tendency to be ‘always on’ and work longer hours than is
healthy. Dragano et al (2020) summarise the current body of research as follows:
…the use of digital technologies is associated with specific psychosocial demands (e.g.
higher workload, complexity, conflicts between work and other life domains) and resulting
psychobiological stress reactions. It is, however, still unclear if this kind of technostress
causes mental disorders because epidemiological studies are missing. Yet, an increasing
number of studies suggests that well designed digital work may promote good health
if it optimizes work organization or enables greater flexibility, and increases control and
autonomy at work… Digitalization of work seems to have both opportunities and risks for
the mental health of employees.31
Perhaps the lack of clear evidence here should not be a complete surprise. After all, work
channels, platforms and ‘spaces’ (physical or virtual) can be used in different ways, and it
is our work methods, management approaches and the amount of work we have that will
be the primary influences.

9 Work-related risk factors

 Mental wellbeing and digital work

Our panel discussions support these ideas, with HR directors suggesting that digital
working leads to more intense working conditions as employees are often in the same
1 space for a long period of time, with meetings sometimes running back-to-back and
little opportunity for a change of environment. Panel members acknowledged that
2 working in this way has the potential to amplify the risk factors mentioned above, but
organisational approaches to these new ways of working are ultimately likely to influence
things more strongly.
3
There is definitely more focus and intensity to those meetings,
which I think is having an impact. As you say, people don’t
4 actually leave their chair. At least you’d move to a different
meeting room, wouldn’t you? You’d grab yourself a cup of tea in
5 the same room, but there is a different nature of the working day.
Amy Taylor, People Director, PFK Francis Clark
6

7
4 Workplace mental health
interventions
Any attempt to manage the risk factors discussed above could be described as an
intervention. For example, introducing a right to disconnect or encouraging colleagues to
avoid emailing out of hours may help prevent excessive working hours. Aside from this,
however, we reviewed studies of specifically designed workplace interventions that aim to
reduce the risk of mental health problems. Evaluation research of this kind is important, as
organised training and support programmes are always a major option for employers.
Most of the interventions focused on helping prevent anxiety and depression. The research
points to the most effective interventions, including stress management training that
borrows techniques from cognitive behavioural therapy (CBT) and covers areas like
coping skills and problem-solving skills. Related to this, resilience training can also have
an important impact by developing employees’ psychological resilience – our separate
evidence review on employee resilience discusses this in more detail. At a psychologically
deeper level, contemplative techniques such as mindfulness are also effective.
Knowledge-based interventions to develop mental health literacy – that is, developing
people’s understanding of mental health issues – can also help mental health, but we don’t
know from the existing research how big the effects are.
Interestingly, these knowledge- and technique-based approaches can be delivered
effectively through digital channels.
However, looking across these interventions, the effects on work-related wellbeing are
small when compared with the risk factors discussed in section 3 above. Effective action
on these risk factors will be the best way to support employees’ mental wellbeing. Our
advice therefore is that the development interventions described may be useful additions,
but above all, employers and HR professionals should prioritise directly managing the
known risk factors.

10 Workplace mental health interventions

 Mental wellbeing and digital work

5 Socio-demographic risk factors

1 Finally, as well as risk factors and interventions, our review also looked at how biological and
socio-demographic factors can affect work-related mental wellbeing.
2 We find strong evidence that family history and genetic vulnerability predispose people
to mental ill health, as can the experience of traumatic life events. Sex is also an influence:
3 women are twice as likely to be diagnosed with depression or anxiety disorders than men,
especially young women between the ages of 25 and 35 years. Overall, however, age is not in
itself a risk factor.
4 Other socio-demographic factors include low educational attainment, low socioeconomic
status and psychosocial stressors such as financial strain, perceived discrimination and social
5 isolation. These are all important risk factors predicting mental wellbeing.
There may be little that employers can do to actively manage these risks – for example,
6 discrimination law would clearly prevent profiling on this basis. However, employers can play
an important role in providing or signposting employees to guidance and support.32

7
6 Conclusions
Digital communication tools and work platforms are an ever-present feature of many
people’s working life. This has only increased over the last year, through an unprecedented
rise in remote working due to the global pandemic and national lockdowns.
The body of research on how digital work affects mental wellbeing is in its early stages
and we wait for more robust evidence. Developing this body of research is something
that employers can be a part of, for example, by teaming up with academics to conduct
evaluations or observational studies in-house. However, we already have a strong body
of research on the factors that predict work-related mental wellbeing, and we can draw
conclusions from this on how best to manage digital work.
Strengthen workplace relationships
A first area for employers to consider is strengthening workplace relationships. Managing
and resolving interpersonal conflict, in particular bullying and harassment, is of paramount
importance as this is the greatest risk factor in work-related mental wellbeing. On the
flipside, social support and cohesion help prevent work-related mental conditions, so
employers and managers should work hard to build strong, positive teams.
Design of jobs and processes
A second broad area to focus on is the design of jobs and HR and management processes
that directly affect the nature of work people do. A particular risk is working long hours.
Sometimes this can simply be a result of high work demands, but it’s also a problem that
digital working has often been seen to exacerbate. We can be overwhelmed by the number
of emails we receive, or the number of videoconferences we have scheduled, and can find
it harder to disconnect because of mobile and remote technology. Employers should work
to foster the right work climates – that is, employees’ shared understanding of policies,
practices and normal behaviour – on excessive working hours. In particular, they would do
well to set policies and expectations that deter an ‘always-on’ work climate.
Job control or autonomy is another important aspect of the nature of work – indeed, it can
help employees manage high workloads. Increasing work autonomy is both a question of

11 Conclusions
 Mental wellbeing and digital work

management style and HR or operational systems and processes. Across these, there is a
good case for delegating or pushing control down the hierarchy as much as is appropriate.
1 We also see affects from organisational change programmes such as mergers and
restructuring. Like high job demands, these are also a fact of modern working life, but
2 when change is repeated or excessive, it can be detrimental to mental health.
Psychological states or perceptions
3 A third area of risk factors that employers should prioritise relates to psychological states
or perceptions. A particularly helpful factor in preventing mental health conditions is
employees’ sense of coherence. So, when managing organisational change, it is important
4 to make sure they comprehend and understand the reasons for change and feel that they
can manage the changes that they encounter in their jobs. Beyond this, workers’ sense of
fairness or justice – for example, in perceiving a reasonable balance between the effort
5 they put in and the rewards they receive – also influences mental wellbeing.
We advise HR professionals and managers to target these risk factors as directly as
6 possible to minimise the risk of and maximise protection from mental health problems.
This is important in an increasingly digital era, just as it was previously.

7 Finally, employers should gauge the wellbeing of their workforces and the main associated
risk factors, and seek to understand their employees’ main concerns and challenges.
Measures can be used in employee surveys, but these should be proportionate to the level
of information that is needed – clinical measures of stress and anxiety are unlikely to be
appropriate in general. Alternative measures of risk factors can be replicated from the
CIPD’s Good Work Index.

7 Notes
1 See the CIPD’s research on Good Work www.cipd.co.uk/goodwork
2 For example, www.headstogether.org.uk/ and www.timetotalkuk.org.uk/
3 Green, F., Felstead, A., Gallie, D. and Henseke, G. (2018) Work intensity in Britain: first
findings from the Skills and Employment Survey 2017. London: Centre for Learning
and Life Chances in Knowledge Economies and Societies, UCL Institute of Education.
Available at: www.cardiff.ac.uk/research/explore/find-a-project/view/626669-skills-and-
employment-survey-2017
Williams, M., Zhou, Y. and Zou, M. (2020) CIPD Good Work Index 2020: UK working lives
survey. London: CIPD. Available at: www.cipd.co.uk/goodwork
4 For example, see: Schlachter, S., McDowall, A., Cropley, M. and Inceoglu, I. (2018)
Voluntary work-related technology use during non-work time: a narrative synthesis of
empirical research and research agenda. International Journal of Management Reviews.
Vol 20. pp825–46.
Gifford, J. and Houghton, E. (2019) People and machines: from hype to reality. London:
Chartered Institute of Personnel and Development.
Wood, A.J., Graham, M., Lehdonvirta, V. and Hjorth, I. (2019) Good gig, bad gig:
autonomy and algorithmic control in the global gig economy. Work, Employment and
Society. Vol 33, No 1. pp56–75.

12 Notes
 Mental wellbeing and digital work

5 Young, J. (2021) Evidence-based practice for effective decision-making. Factsheet.

London: Chartered Institute of Personnel and Development. Available at: www.cipd.
1 co.uk/knowledge/strategy/analytics/evidence-based-practice-factsheet
6 NHS. (2021) Mental health. Available at: www.nhs.uk/mental-health/
2 7 Reeves, A. and Suff, R. (2021) Responding to Suicide Risk in the Workplace: A guide
for People Professionals. London: Chartered Institute of Personnel and Development.
3 Available at: www.cipd.co.uk/knowledge/culture/well-being/responding-to-suicide-risk-
in-workplace
8 See the scientific summary for further detail. For example, McManus, S., Bebbington,
4 P., Jenkins, R. and Brugha, T. (eds) (2016) Mental health and wellbeing in England: adult
psychiatric morbidity survey 2014. NHS Digital.
5 9 For example, Silva, M., Loureiro, A. and Cardoso, G. (2016) Social determinants of mental
health: a review of the evidence. European Journal of Psychiatry. Vol 30, No 4. pp259–92.
6 10 OSHA. (2013) OSHA annual report 2013: working for safer, healthier and more productive
workplaces in the European Union. Bilbao: European Agency for Safety and Health at
Work (EU-OSHA).
7
11 Virtanen, M., Honkonen, T., Kivimäki, M., Ahola, K., Vahtera, J., Aromaa, A. and Lönnqvist,
J. (2007) Work stress, mental health and antidepressant medication findings from the
Health 2000 Study. Journal of Affective Disorders. Vol 98, No 3. pp189–97.
12 Mind. (no date) Mental health facts and statistics. Available at: www.mind.org.uk
13 Psychology Foundation of Australia. (2018) Depression Anxiety Stress Scales (DASS).
Available at: www2.psy.unsw.edu.au/dass//
14 See www.mind.org.uk/information-support/types-of-mental-health-problems/
15 See Gifford, J. (2016) In search of the best available evidence. London: Chartered
Institute of Personnel and Development. Available at: www.cipd.co.uk/evidencebased
16 Cohen, J. (1988) Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale,
NJ: Lawrence Erlbaum Associates.
Barends, E., Rousseau, D.M. and Briner, R.B. (eds) (2017) CEBMa guideline for rapid
evidence assessments in management and organizations, Version 1.0. Amsterdam:
Center for Evidence-Based Management. Available at: cebma.org/resources-and-tools/
Chen, H., Cohen, P. and Chen, S. (2010) How big is a big odds ratio? Interpreting the
magnitudes of odds ratios in epidemiological studies. Communications in Statistics –
Simulation and Computation. Vol 39, No 4. pp860–64.
17 See the scientific summary for further detail on effect size calculations.
18 Chen, H., Cohen, P. and Chen, S. (2010) How big is a big odds ratio? Interpreting the
magnitudes of odds ratios in epidemiological studies. Communications in Statistics –
Simulation and Computation. Vol 39, No 4. pp860–64.
19 See our evidence review on employee resilience at www.cipd.co.uk/evidence-resilience
20 See also: Acas. (no date) If you’re treated unfairly at work: being bullied. London: Acas.
Available at: www.acas.org.uk/if-youre-treated-unfairly-at-work/being-bullied.
21 Wheatley, D. and Gifford, J. (2019) UK working lives: survey report 2019. London:

13 Notes
 Mental wellbeing and digital work

Chartered Institute of Personnel and Development. Available at: www.cipd.co.uk/

goodwork
1 22 Breaugh, J.A. (1985) The measurement of work autonomy. Human Relations. Vol 38,
No 6. p551.
2 23 CIPD. (no date) Working time: guidance on working time and working time regulations.
London: Chartered Institute of Personnel and Development. Available at: www.cipd.
3 co.uk/knowledge/fundamentals/emp-law/working-time
24 Veen, A., Barratt, T. and Goods, C. (2020) Platform-capital’s ‘app-etite’ for control:
a labour process analysis of food-delivery work in Australia. Work, Employment and
4 Society. Vol 34, No 3. pp388–406.
Wood, A.J., Graham, M., Lehdonvirta, V. and Hjorth, I. (2019) Good gig, bad gig:
5 autonomy and algorithmic control in the global gig economy. Work, Employment and
Society. Vol 33, No 1. pp56–75.
6 25 CIPD. (no date) The gig economy hub. London: Chartered Institute of Personnel and
Development. Available at: www.cipd.co.uk/knowledge/work/trends/gig-economy-hub

7 26 CIPD. (2020) Change management. Factsheet. London: Chartered Institute of Personnel

and Development. Available at: www.cipd.co.uk/knowledge/strategy/change/
management-factsheet#8086
27 See our evidence review on employee resilience at www.cipd.co.uk/evidence-resilience
28 Lupton, B., Rowe, A. and Whittle, R. (2015) Show me the money! The behavioural science
of reward. London: Chartered Institute of Personnel and Development. Available at:
www.cipd.asia/knowledge/reports/reward-behavioural-science
29 Sparrow, P., Wong, W., Otaye, L. and Bevan, S. (2013) The changing contours of fairness:
can we match individual and organisational perspectives? London: Chartered Institute of
Personnel and Development. Available at: www.cipd.co.uk/knowledge/culture/ethics/
fairness-report
30 Ragu-Nathan, T.S., Tarafdar, M. and Ragu-Nathan, B.S. (2008) The consequences of
technostress for end users in organizations: conceptual development and empirical
validation. Information Systems Research. Vol 19. pp417–33.
31 Dragano, N. and Lunau, T. (2020). Technostress at work and mental health: concepts
and research results. Current Opinion in Psychiatry. Vol 33, No 4. pp407–13.
32 For example, see CIPD guidance on financial wellbeing and ‘learning in the flow of
work’.

14 Notes
Chartered Institute of Personnel and Development
151 The Broadway London SW19 1JQ United Kingdom
T +44 (0)20 8612 6200 F +44 (0)20 8612 6201
E [email protected] W cipd.co.uk
Incorporated by Royal Charter
Registered as a charity in England and Wales (1079797)
Scotland (SC045154) and Ireland (20100827)
Issued: July 2021 Reference: 8156 © CIPD 2021
 TYPE Review
PUBLISHED 04 August 2022
DOI 10.3389/fpsyt.2022.934357

The association between

OPEN ACCESS digitalization and mental health:
The mediating role of wellbeing
EDITED BY
Monica Izvercianu,
Politehnica University of
Timisoara, Romania

REVIEWED BY
at work
Awais Farid,
Hong Kong University of Science and
Technology, Hong Kong SAR, China Jianmin Sun1 , Hongzhou Shen1 , Syed Ibn-ul-Hassan2*,
Tung-Ju Wu,
Harbin Institute of Technology, China Amir Riaz3 and Aura Emanuela Domil4
1
*CORRESPONDENCE School of Management, Nanjing University of Posts and Telecommunications, Nanjing, Jiangsu,
Syed Ibn-ul-Hassan China, 2 Department of Commerce and Business, Government College University Faisalabad, Layyah
[email protected] Campus, Layyah, Pakistan, 3 Department of Management Sciences, COMSATS University Islamabad,
Lahore Campus, Lahore, Pakistan, 4 Faculty of Economics and Business Administration, West
SPECIALTY SECTION
University of Timisoara, Timisoara, Romania
This article was submitted to
Digital Mental Health,
a section of the journal
Frontiers in Psychiatry The study aims to measure the mediating relationship of wellbeing at work
RECEIVED 02 May 2022 between digitalization (IT infrastructure, IT business spanning, and IT proactive
ACCEPTED 08 July 2022
stance) and their effect on mental health. The study uses primary data
PUBLISHED 04 August 2022
collection techniques to gather data and used purposive sampling to analyze
CITATION
Sun J, Shen H, Ibn-ul-Hassan S, Riaz A the data. The sample size of the study is 349 respondents. The research uses
and Domil AE (2022) The association Smart PLS software to measure the relationship through bootstrapping and
between digitalization and mental
health: The mediating role of wellbeing
algorithms. The study finds a significant positive mediating role of wellbeing
at work. Front. Psychiatry 13:934357. between digitalization (IT infrastructure, IT business spanning, and IT proactive
doi: 10.3389/fpsyt.2022.934357 stance) and their effect on mental health. The study outcomes are helpful for
COPYRIGHT managers and policymakers.
© 2022 Sun, Shen, Ibn-ul-Hassan, Riaz
and Domil. This is an open-access
article distributed under the terms of KEYWORDS
the Creative Commons Attribution
mental health, digital health, digitalization, job performance, IT infrastructure,
License (CC BY). The use, distribution
well-being, IT proactive stance
or reproduction in other forums is
permitted, provided the original
author(s) and the copyright owner(s)
are credited and that the original
publication in this journal is cited, in
Introduction
accordance with accepted academic
practice. No use, distribution or In the past decades, technological advancement has profoundly altered global work
reproduction is permitted which does
practices with innovative developments. Significantly, the disruptive digital landscape
not comply with these terms.
has become the impetus for novel digitization, substantially overriding traditional digital
tools with modern interventions. In recent years, the twenty-first-century modern
technological revolution has developed promising digital capabilities to cover humans’
personal and professional lives, potentially bringing positive health outcomes (1).
Digitalization is a novel phenomenon that has elevated the use of information
technology across various domains. There has been strong demand for its application in
the healthcare sector. However, in recent years, the mental health of frontline workers
has not received adequate attention despite healthcare being a highly competitive
industry in which employees are exposed to significant psychological challenges (2). As
such, this literature states that as healthcare psychological problems are accelerating,
it has become essential to focus on their impairing impact on employees’ overall
mental health (3, 4).

Frontiers in Psychiatry 01 frontiersin.org

Sun et al. 10.3389/fpsyt.2022.934357

Mental health in relation to technology has become a prime contribute to elevating workplace problems. However, these
interest of current researchers, with some researchers signaling increasing psychological vulnerabilities encourage medical
the potential for the use of technology to considerably improve institutions to mitigate health issues, thereby ensuring
employees’ mental health. While in recent years, technology workplace wellbeing (15, 18). A healthy technological
adoption has been shown to bring promising health outcomes environment influences individuals’ psychological health
in many fields, unfortunately, the value of digital capabilities and, ultimately, workplace wellbeing and behavior. As a result
has not been realized in the healthcare industry (5). One of IT’s increasing significance, organizations are adopting novel
study states that the emerging role of digitalization in the IT capabilities for ensuring wellness at work (19).
healthcare sector is vital, thus highlighting the need to realize Undoubtedly, technological abilities have the potential
and understand the association between IT capabilities and as a global solution to growing psychological vulnerabilities.
employees’ psychological wellness (6). However, the healthcare sector demands that firms implement
The technological solutions implemented across medical digitalization to gain greater attention in the coming
domains (e.g., medicine and psychology) are of increasing decades (20). Technological health interventions provide
interest to researchers in terms of novel innovations. numerous opportunities to combat the growing health crises.
Digitalization, a technology-driven notion, has diffused its They maximize frontline technical support to establish a
characteristics into the origin of the healthcare sector. Novel healthy environment. However, besides the influential role of
IT capabilities have allowed healthcare organizations to adapt technology, the literature shows that current employees are
to changing working conditions, thus supporting employees’ reluctant to adopt digitalization tools (21). In particular, one
mental health (7). The real-time access afforded by IT has study states that this fear leads to health organizations lacking
assisted the hospital industry by optimizing workflow. In fact, technological implementation, adversely influencing employees’
in healthcare, the accelerating technological advancement has psychological wellbeing (22).
garnered a tremendous boost to employees’ wellbeing. Engaging However, against this drawback, this study demonstrates
and involving frontline technical staff in the design and rolling a novel conceptual model, presenting a systematic literature
out of new IT infrastructure (ITI) has allowed organizations to review on employees’ mental health and workplace wellness.
understand the value of digital tools in improving employees’ This study consolidates dominant factors that boost employees’
mental health. mental and workplace wellbeing. Then, to reach a possible
The ITI alludes to organizations’ digital assets such as conclusion, the study highlights the role of digitalization (e.g.,
tools, software, hardware, and applications (8). Significantly, ITI, ITB, and ITP) in influencing employees’ mental health.
ITI is recognized as a vital tool for fostering employees’ Moreover, it also sheds light on the effect of IT capabilities on
mental health (9, 10). Technology is deeply rooted in the workplace wellbeing. In the same vein, the study investigates the
health economy, with IT business spanning (ITB) facilities mediating role of the wellbeing at work nexus on digitalization
impacting employees’ mental health. As such, ITB refers to and employees’ mental health.
an organization’s ability to adopt novel digital tools, therefore Significantly, this study promotes employees’ mental health
improving firms’ operations (11). This novel business capability and wellbeing regarding digitalization. In particular, to the best
(i.e., ITB) helps organizations boost employees’ mindfulness and of our knowledge, this study is pioneering in illustrating the
productivity (12–14). role of IT capabilities (e.g., ITI, ITB, and ITP) in influencing
In particular, at present, an overwhelming number of employees’ mental health. It explains a new concept that
technologies are available, meaning organizations need to highlights the mediating role of wellbeing at work in this
understand the role of digital innovations in influencing context. Therefore, on the scale of digitalization, this study
employees’ mental health. In this regard, the literature review presents valuable knowledge on employees’ mental health
provides evidence that to ensure the psychological needs and wellbeing. The study’s findings are targeted toward
of the frontline workers, health institutions should focus researchers, policymakers, healthcare institutions, and the
on developing technological capabilities for combating the medical administration to suggest ways to improve employees’
progressing psychological vulnerabilities (15). Therefore, the IT mental wellbeing.
proactive stance (ITP) has become prominent, whereby being This study comprises six different sections. The next
forward-thinking about IT is used to achieve the business goal section (i.e., “Literature review”) presents a conceptual model
(16). Significantly, to achieve such goals, an organization must highlighting the study background. The “Methodology” section
ensure its employees’ healthy mindset. As a result, the ITP has prescribes the methodological tools and techniques needed for
emerged as a popular tool for ensuring employees’ mindfulness. study analysis. The “Results” section explains the analysis results,
Significantly, in recent years, occupational digital mental while the “Discussion” section discusses the significant study
health has played a profound role in eradicating the potential outcomes. Finally, the “Conclusion” section concludes the study
barriers to achieving workplace wellness (17). Numerous factors by suggesting the research findings and implications.

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Sun et al. 10.3389/fpsyt.2022.934357

Literature review psychological needs, thereby ensuring a higher degree of

mindfulness (13, 30, 31). Those working in the hospital industry
IT infrastructure and mental health face high-level psychological issues (e.g., stress, anxiety, and
depression). However, the rapid digital developments have
In recent years, the rapid advancement in digital profoundly altered the nature of the work, thereby combating
technologies has altered the nature of work, thereby requiring the growing health vulnerabilities. As such, the ITB advances
employees to radically respond to the technological change. employees’ mental health by mitigating the psychological risks
Among these developments, the ITI has emerged as an associated with the workplace (32). Therefore, rather than
inevitable tool in assisting employees’ workplace activities. just implementing technology, firms should build a clear
The ITI has empowered workers to perform to their potential, understanding of its use for promoting employees’ mindfulness.
thus bringing positive healthcare outcomes. In particular, this Consequently, based on the literature, this study proposes the
mental health innovation (e.g., ITI) is a convenient way of following hypothesis:
overcoming health crises in the workplace setting (17, 23). In
recent years, technology has significantly evolved, bringing H2: IT business spanning has a positive and significant
numerous opportunities for frontline workers. In explaining impact on mental health.
this notion, the literature states that, in healthcare, the high
potential of digital technology fosters employees’ psychological
wellbeing and performance (10, 24). IT proactive stance and mental health
In particular, workplace mental health is structured around
modern digital developments. Novel IT innovations reduce In the digitization world, IT capabilities have brought
the growing health ramifications, thereby engendering positive numerous opportunities that support a workplace’s mental
health outcomes (e.g., psychological wellbeing) (25). In fact, wellbeing environment. Therefore, the workplace changes
technology’s rapid transformation of the world has worked as derived from the IT tools have encouraged the employees
a catalyst, resolving problems across the healthcare ecosystem. to learn novel tools for minimizing the effect of growing
As such, prior research states that digital tools have inevitably psychological vulnerabilities. As such, the literature states
made healthcare organizations embrace novel technologies, that owing to the effectiveness of the ITP, organizations
thus promoting employers’ positive psychological wellbeing should quickly respond to the changing workplace needs,
(26). Overall, with the increasing significance of technology in optimally predicting the new opportunities (33, 34). In this
healthcare, medical institutions should ensure proper utilization regard, the ITP helps detect the employees’ psychological
of technology to foster employees’ mental health. Therefore, in needs, thereby illuminating the signs of health crises. The
light of the previous literature, the current study suggests the ITP provides opportunities to present organizations with
following hypothesis: critical information regarding their employees’ health and
wellbeing. Prior research shows that, at present, mental
H1: IT infrastructure has a positive and significant impact health technology enables organizations to respond to
on mental health. growing health challenges (35). Due to the increasing ITP
role, the literature suggests making a high investment
in disruptive technologies, thus ensuring positive health
IT business spanning and mental health outcomes (i.e., psychological wellness) (36). Therefore,
in light of the literature review, this study suggests the
Mental health is a significant part of a person’s wellbeing. following hypothesis:
With the growing number of individuals experiencing mental
health crises, understanding the impact of technological H3: IT proactive stance has a positive and significant impact
change has become vital for ensuring individuals’ psychological on mental health.
health. Technology integration helps organizations enhance
employees’ mental health. In the present digital era, IT-enabled
advancements (i.e., ITB) are deeply rooted in firms’ structures IT infrastructure, IT business spanning, IT
(27). Therefore, in ensuring positive mental health, ITB proactive, and wellbeing at work
integrates preventive health technologies into the firm’s
structure (28, 29). IT infrastructure and wellbeing at work
In particular, at present, the high pace of disruption (e.g., In recent years, digitization and the prioritization of ITI have
ITB) has updated and transformed firms’ activities, shifting gained firms’ attention, thereby nurturing employees’ workplace
researchers’ focus to mental wellbeing. The literature suggests wellbeing. In particular, current focus on employees’ wellbeing
that virtual IT platforms have made employees assess their has profoundly extended beyond just focusing on building a

Frontiers in Psychiatry 03 frontiersin.org

Sun et al. 10.3389/fpsyt.2022.934357

FIGURE 1
Conceptual framework.

healthy workplace environment. ITI is crucial for maintaining workplace wellbeing. In the context of digital innovation
optimal wellbeing (37). It increases employees’ happiness and supporting workplace wellness, one study showed that
workplace wellbeing (38). Numerous tools have been found modern development had fostered a change in the nature
to support workplace wellbeing, with studies demonstrating of work, thus leading to the health interventions (e.g., ITB)
that ITI works as an effective means to ensure employees’ to become the prime determinants of workplace wellbeing
workplace wellness (39). Undoubtedly, predicting employees’ (41). The digitalization capability (i.e., ITB) supports the
workplace wellbeing has become the top priority of current technology used in firms’ practices. ITB is a disruptive
firms. Due to information communication technologies (ICTs) technological model that has surprised researchers with
growing relevance, the intensified role of ICT improves the its transformational aspects (for example, AI-based digital
employees’ wellbeing at work. IT acceleration plays a critical assistants) (42). The ITB capability nurtures the workplace
role in managing workplace health issues. As such, the research environment by minimizing the workload. In recent decades,
shows that digital transformation focuses strongly on improving intense workloads have caused employees to face severe health
workplace wellbeing (40). In fact, ITI is critical to developing repercussions, thus decreasing their workplace effectiveness. In
workplace wellbeing. Hence, given the literature review, this explaining this notion, the study states that the ITB embedded
study proposed the following hypothesis: in the firm’s processes influences the employees’ health,
thereby shaping the workplace structure and work demand
H4: IT infrastructure has a positive and significant impact (43). In particular, technological advancement profoundly
on wellbeing at work. alters employees’ workplace activities. The ITB elevating
the technological change increases individual support for
wellness. In this regard, the literature suggests that this
novel innovation encourages management to realize the use
IT business spanning and wellbeing at work of digitization to achieve workplace improvements (44).
Undoubtedly, advancing globalization has allowed Hence, based on the prior literature, this study proposes the
IT developments to open new avenues for improving following hypothesis:

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TABLE 1 Descriptive statistics. TABLE 2 Reliability and validity results.

Items Frequency (%) Construct Items Loading α CR AVE

(N = 349)
IT infrastructure ITI_1 0.737 0.847 0.848 0.583
Gender ITI_2 0.703
Male 161 46.1 ITI_3 0.779
Female 188 53.9 ITI_4 0.830
Age IT business spanning ITB_1 0.676 0.843 0.842 0.572
19–30 44 12.6 ITB_2 0.779
31–40 95 27.2 ITB_3 0.733
41–50 84 24.1 ITB_4 0.830
51–60 76 21.8 IT proactive stance ITP_1 0.704 0.836 0.836 0.560
>60 50 14.3 ITP_2 0.787
Education ITP_3 0.781
Intermediate 67 19.2 ITP_4 0.719
Bachelor 113 32.4 Well-being at work WBW_1 0.784 0.929 0.929 0.592
Master 124 35.5 WBW_2 0.836
MPhil/Others 45 12.9 WBW_3 0.710
Marital Status WBW_4 0.702
Single 59 16.9 WBW_5 0.837
Married 290 83.1 WBW_6 0.783
WBW_7 0.735
WBW_8 0.800
WBW_9 0.724

H5: IT business spanning has a positive and significant Mental health MH_1 0.758 0.877 0.877 0.588
impact on wellbeing at work. MH_2 0.728
MH_3 0.731
MH_4 0.825
MH_5 0.787

IT proactive stance and wellbeing at work

Modern inventions have gradually become popular in
TABLE 3 Discriminant validity results.
ensuring workplace success. In recent years, digital-enabled
wellbeing measures have been popularized as an integral Constructs 1 2 3 4 5
initiative for raising awareness regarding wellbeing at work
(45). Workplace wellness is a critical development that 1. IT business spanning 0.757 0.505 0.565 0.569 0.564

demands digital tools to improve employees’ wellbeing. This 2. IT infrastructure 0.507 0.763 0.568 0.547 0.547

technological capability provides solutions to the organization, 3. IT proactive stance 0.562 0.565 0.749 0.556 0.555

thus encouraging a healthy workplace (46). The ITP renders 4. Mental health 0.570 0.548 0.559 0.767 0.563
tech support to the employees, potentially ensuring workplace 5. Well-being at work 0.568 0.548 0.555 0.566 0.770
wellness. The ITP supports effective IT programs for identifying
the opportunities for achieving workplace growth. Additionally,
it enhances the organization’s internal environment by causing
H6: IT proactive stance has a positive and significant impact
organizations to invest in workplace wellbeing. Prior research
on wellbeing at work.
states that this health-increasing technology considerably
satisfies organizations’ needs for workplace wellness (47). These
digital technologies minimize the negative impact of the
growing workplace problems (48). Since technology has been Mediating role of wellbeing at work
applied to firms’ structures in a widespread manner, it has
become important for the organization to effectively utilize In the healthcare sector, workplace wellness supports
IT capabilities to combat workplace challenges, thus ensuring employees’ psychological health. Employees with good
workplace wellbeing (49). Therefore, in light of the past studies, mental health assist organizations to cope with increasing
the following hypothesis is proposed: workplace stressors, thus, in turn, ensuring the employees’

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FIGURE 2
Measurement model PLS-SEM diagram.

wellbeing. As such, the research states that workplace Undoubtedly, the massive shift toward technology has
wellbeing predicts employees’ mental health (50). Mental fostered numerous opportunities for organizations. It has
health is a product of workplace wellbeing. However, highlighted how the workplace well-influences employees’
understanding this phenomenon involves recognizing the mental health. Furthermore, it has been observed that the
worth of maintaining wellbeing at work. Healthy workplace implementation of novel technologies in the workplace creates a
activities manifest in workers’ mindfulness. In this regard, positive wellness culture, thus supporting employees’ wellbeing.
research suggests that organizations tailor their workplace Employees’ mental health highly depends on workplace
practices to engage individuals in wellness activities, thus wellness. Accordingly, the research states that digital capabilities
facilitating employees’ mental health (51). Therefore, at present, have gained significant popularity by scaling up employees’
creating and building a healthier organizational environment health outcomes by improving workplace wellbeing (53). In
is critical to achieving wellbeing. In explaining this notion, particular, the ITI ensures employees’ positive mental health and
the research states that employees from different domains wellbeing at work. Therefore, ITI increases workplace happiness
have recorded workplace wellness as a significant predictor of and wellbeing by minimizing the growing workplace stressors
their mental health (52). Accordingly, this study proposes the (54). In fact, ITI is a novel phenomenon influencing employee
following hypothesis: mindfulness and wellness at work (55).
The increasingly demanding nature of work in many
H7: Wellbeing at work has a positive and significant impact industries has led to calls for technology adoption to improve
on mental health. employees’ wellbeing. At present, technological changes have

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TABLE 4 Results of direct effects. TABLE 5 Results of mediation effects.

Hypothesis Direct Std. Std. T- P- Hypothesis Indirect Std. Std. T- P-

relationships Beta error values values relationships Beta error values values

H1 ITI → MH 0.202 0.066 3.079 ** H7a ITI → WBW 0.055 0.025 2.224 *
H2 ITB → MH 0.239 0.076 3.158 ** → MH
H3 ITP → MH 0.192 0.073 2.642 * H7b ITB → WBW 0.064 0.026 2.481 *
H4 ITI → WBW 0.26 0.062 4.186 *** → MH
H5 ITB → WBW 0.302 0.069 4.390 *** H7c ITP → WBW 0.051 0.024 2.133 *
H6 ITP → WBW 0.239 0.073 3.267 *** → MH
H7 WBW → MH 0.213 0.065 3.279 **
*p < 0.05.

*p < 0.05, **p < 0.01, ***p < 0.001.

H7(c): Wellbeing at work mediates the relationship between

IT proactive stance and mental health.
enhanced global working conditions, improving the workers’
health quality. Digital innovation fundamentally changes the
work landscape, thereby yielding the positive effects of IT Methodology
on employees’ wellbeing. Prior research explains that the
ITB capability narrows down the pathology of distress by The study’s primary objective was to analyze the impact of
inserting technology into the business process (56). In fact, digitalization on employees’ mental health while considering
such digitalization measures significantly enhance the workplace the mediating role of wellbeing at work. The study has
environment by boosting employees’ mindfulness. Based on this adopted a quantitative approach for the data collection.
statement, the research shows that the ITB promotes wellness at The data were collected from the employees working in
work, thereby the ICT aspect can be used to ensure psychological the service sector of Pakistan. A convenience sampling
gratification (57). Consequently, to address mental health technique was adopted, and data were collected through
problems, organizations should consider the prevalence of novel questionnaires. We have developed the questionnaire in dual
digital measures (e.g., ITB) in ways that can promote work-life languages (English and Urdu). Back-to-back translation for
balance and positive psychological outcomes (19). collecting data was used for “Urdu” language questionnaires
In the present world, employees’ wellbeing is a prominent as the data were collected from Pakistan, where the mother
focal point. In achieving this goal, IT capability has opened language is not English. We distributed 420 questionnaires
new avenues, with healthcare institutions being encouraged among the employees from November 2021 to December
to embrace novel digital tools for promoting workplace 2021; 349 valid questionnaires were received from the
wellness and influencing employees’ mental wellbeing. At participants. The Statistical Package for the Social Sciences
present, the technical intervention has assisted organizations (SPSS) and Partial Least Squares regression (PLS) were used for
to improve workplace wellness. In this regard, the ITP data analysis.
has become a dominant capability in fostering workplace The measurement scale for the IT infrastructure, IT business
wellness. Furthermore, building on this notion, the ITP spanning, and IT proactive stance consisted of three items
innovations have helped companies to maintain a healthy and was adapted from the study of Nwankpa and Roumani
working environment, thus boosting employees’ mental health. (58). The sample items include “Data management services
In particular, this ICT measure has enabled organizations to and architectures (databases, data warehousing, data availability,
establish a positive workplace atmosphere, thereby promoting storage, accessibility, sharing, etc.),” “Developing a clear vision
employees’ psychological wellbeing (47). Overall, digital health regarding how IT contributes to business value,” and “We
technology has contributed to enhancing employees’ mental are capable of and continue to experiment with new IT as
health and workplace wellbeing (19). Therefore, based on the necessary.” Wellbeing at work was measured on the nine-
data gathered, this study proposed the following hypotheses item scale adopted from the study of Demo and Paschoal
(refer to Figure 1): (59). The sample items include “Over the past 6 months, my
work made me feel proud” and “Over the past 6 months,
H7(a): Wellbeing at work mediates the relationship between my work made me feel active.” Employees’ mental health was
IT infrastructure and mental health. measured on the 5-item scale adapted from the study of Wu
H7(b): Wellbeing at work mediates the relationship between et al. (60). The sample item includes “I have everything to look
IT business spanning and mental health. forward to.”

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FIGURE 3
Structural model PLS-SEM diagram.

This study applied the common method bias using Harman’s percentages of the study participants in terms of gender, age,
single-factor approach. The variance extracted by one single highest qualification, and marital status.
factor is 10.435%, <50%, indicating no common method
bias (61).
Measurement model
Results
Reliability and validity of the measurements were first
ensured through measurement model testing before testing the
SmartPLS is used to analyze data in this study using the
study’s hypotheses. These results are reported in Tables 2, 3. The
partial least square structural equation modeling (PLS-SEM)
scores of factor loadings exceeded 0.65, and the average variance
approach. This approach can examine complex models
extracted (AVE) values were also above 0.50, as reported in
simultaneously, less restrictive to data assumptions. It can
Table 2. These factors’ loading and AVE scores warranted the
handle constructs with few measurement items compared to
convergent validity of the study measures (63). Moreover, as
conventional approaches such as covariance-based SEM or
reported in Table 2, the Cronbach’s alpha (α) reliability score and
multiple regression (62).
composite reliability (CR) of all the variables well exceeded the
cutoff value of 0.70 (64), establishing the reliability of the scales.
Descriptive analysis In addition, Table 3 revealed the discriminant validity scores
of the study variables using the Fornell and Larcker (65)
Descriptive analysis results relating to the study participants criterion and a more robust and advanced approach named the
are reported in Table 1. These results show the frequencies and heterotrait-monotrait (HTMT) ratio. According to Fornell and

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Sun et al. 10.3389/fpsyt.2022.934357

Larcker’s (65) criterion, the square root scores of the AVE of each Traditionally, digital innovations have mainly been the
construct should be more than its correlation values, which was focus on researchers, but now organizations are placing
well achieved in the case of this study. Finally, the HTMT ratio more emphasis on technology as a fundamental part of
score of the construct should be <0.85 to establish discriminant their structures. The research suggests that technological
validity. Both these results ensured the discriminant validity of infrastructure supports employees’ mental health (66). ITB has
the study scales. Measurement model results are presented in emerged as a solution to resolving employees’ mental issues, with
Figure 2. one study stating that technology integration (i.e., ITB and ITP)
has enabled organizations to modify business activities, thereby
ensuring positive mental health (32). Moreover, the growth in
Hypotheses testing ICT has led IT capabilities to emerge as novel tools for fulfilling
employees’ psychological demands. In fact, our study’s findings
Table 4 presents the standardized path coefficient scores
agree with the previous literature, thereby accepting H1, H2,
of all the hypotheses proposed in the direct relationships of
and H3.
the study (H1–H7). The relationship of IT infrastructure with
Technology has often represented a disruptive yet positive
mental health (β = 0.202∗∗ , t = 3.079), IT business spanning
force in its impact on workplace wellness. IT can be
with mental health (β = 0.239∗∗ , t = 3.158), IT proactive stance
used to solve workplace problems by effectively allowing
with mental health (β = 0.192∗ , t = 2.642), IT infrastructure
the institution’s technical capability to enhance workplace
with wellbeing at work (β = 0.26∗∗∗ , t = 4.186), IT business
wellbeing (67). The use of health technology infrastructure has
spanning with wellbeing at work (β = 0.302∗∗∗ , t = 4.390),
increased in recent years. Prior research shows that good ITI
IT proactive stance with wellbeing at work (β = 0.239∗∗∗ ,
decreases psychological vulnerabilities, ultimately facilitating
t = 3.267), and wellbeing at work with mental health (β =
employees’ workplace wellbeing (68). As the global health crisis
0.213∗∗ , t = 3.279) were found to be significant, statistically.
increases, ensuring workplace wellbeing has become necessary
Overall, the above results statistically supported this study’s first
for organizations in this sector. In this regard, a growing
seven hypotheses (H1–H7).
body of research states that digital health inventions (i.e.,
Furthermore, the last three hypotheses (H7a-c) claimed that
ITB and ITP) bolster employees’ workplace wellness (69). In
wellbeing at work mediates the relationship of IT infrastructure,
explaining this notion, the existing literature states that to gain
IT business spanning, and IT proactive stance, respectively, with
long-term benefits in the form of employees’ mental health,
mental health. First, as reported in Table 5, wellbeing at work
organizations should create a healthy working environment,
mediated the relationship between IT infrastructure and mental
thus supporting workplace wellness (70). In fact, our research
health (β = 0.055∗ , t = 2.224), empirically supporting the
findings also revealed the same results, thus verifying the
H7(a) of the study. Next, as claimed in the H7(b) of the study,
research assumptions made in H4, H5, and H6.
the mediating role of wellbeing at work for the relationship
Digital technological innovation has brought numerous
between IT business spanning and mental health (β = 0.064∗ ,
benefits to healthcare organizations, by facilitating workplace
t = 2.481) was also empirically supported. Finally, wellbeing at
wellbeing and employees’ mental health. As such, technology
work also mediated the relationship between IT proactive stance
adoption in the healthcare sector reflects the notion that
and mental health (β = 0.051∗ , t = 2.133) and got empirical
modern tools influence workplace wellbeing (71). In particular,
support for the H7(c) of the study. Figure 3 shows the structural
digitalization (e.g., ITI, ITB, and ITP) plays a significant role
model analysis results.
in enabling positive outcomes in this sector. The findings
reveal that digital health capabilities have become increasingly
Discussion popular as a means to provide employees with a good quality of
living (i.e., mental health), thereby supporting their wellbeing at
In recent years, novel technological advancement has work (68). Hence, our study also supports the prior literature,
significantly enhanced employees’ mental health irrespective of substantially accepting H7 (a, b, and c). To sum up, our research
the industry. IT plays an essential role in ensuring workplace findings support the previous literature, reiterating the view
wellness and employees’ mental health. As such, many that technology adoption in the healthcare sector has a positive
organizations have invested in digital solutions for expanding outcome in terms of employees’ mental health.
their services. Organizations are increasingly realizing the value
of modern advancements. With the technical developments,
healthcare employees have found support to offer best practice Conclusion
care, thereby empowering their mental health and wellbeing
at work. In explaining this phenomenon, this section explores Undoubtedly, over the years, an overwhelming number of
the effect of digitalization on employees’ mental health and digital innovations has led employees to integrate the digital
wellbeing at work, considering the previous literature findings. tools that create a healthy psychological work environment.

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Sun et al. 10.3389/fpsyt.2022.934357

Studies show that a poor workplace environment leaves Author contributions

a heavy toll on employees’ mental health. Accordingly, to
understand the effect of digitization on mental health in the All authors listed have made a substantial, direct,
workplace, this study presented a systematic review of how and intellectual contribution to the work and approved it
digitalization capabilities in healthcare influence employees’ for publication.
psychological health. The study explored the relationship
between IT capabilities and employees’ mental health. It
drew a link between digitization approaches and employees’ Funding
mental health concerning the mediating effect of wellbeing
at work. The authors acknowledge financial support from the
Good IT practices are essential for fostering employees’ National Natural Science Foundation of China (Grant No:
wellbeing. Our research findings indicate that IT capabilities 71974102) and the Philosophy and Social Science Fund of
(e.g., ITI, ITB, and ITP) positively influence employees’ mental Tianjin City, China (Grant No: TJYJ20-012).
health and workplace wellbeing. A review of the literature
revealed that the technology deployed in the healthcare
Conflict of interest
sector has improved employees’ mental health and wellbeing.
Altogether, our results are positive, thus supporting the
The authors declare that the research was conducted in the
previous studies. In fact, the findings of this study open
absence of any commercial or financial relationships that could
pathways for future researchers, policymakers, and healthcare
be construed as a potential conflict of interest.
institutions, by directing their focus on studying technology
and mental health toward the healthcare sector. This study
holds valuable knowledge for healthcare organizations regarding Publisher’s note
the need for a focus on employees’ mental health. In
fact, the findings of the study are significant in terms of All claims expressed in this article are solely those of the
identifying digitization as supporting employee psychological authors and do not necessarily represent those of their affiliated
wellness. It recommends that policymakers in healthcare organizations, or those of the publisher, the editors and the
should consider how technology can improve employees’ reviewers. Any product that may be evaluated in this article, or
workplace wellbeing and mental health to gain positive claim that may be made by its manufacturer, is not guaranteed
health outcomes. or endorsed by the publisher.

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