The Role of Tailored Timing and Frequency Prompts on the Efficacy of an Internet-Delivered Stress Recovery Intervention for Healthcare Workers: A Randomized Controlled Trial (Preprint)

Abstract

Prompts offer a promising strategy to promote client engagement in internet-delivered cognitive behavioral therapy (ICBT). However, if the prompts do not meet the needs of clients, they can potentially be more obtrusive rather than helpful.

The aim of this study was to test if prompts tailored based on timing and frequency, aligned with pre-intervention goal setting, can increase usage and the efficacy of a therapist-supported ICBT stress recovery intervention for healthcare workers.

The two-arm randomized controlled trial included 87 healthcare workers (98.9% female, aged 19-68 years: M = 39.61, SD = 11.49): 43 in the standard intervention group and 44 in the tailored prompts group. The primary outcome measure was the Recovery Experiences Questionnaire (REQ), and the secondary outcomes were the Perceived Stress Scale (PSS-4), the Patient Health Questionnaire (PHQ-4), and the World Health Organization-Five Well-Being Index (WHO-5). The self-report data were collected online at pre-intervention (September 2022), post-intervention (October 2022), and 6-month follow-up (May 2023).

The results showed that tailored prompts, although appreciated by the majority (95.5%), did not improve intervention usage indicators, such as the number of logins (P = .364), modules completed (P = .482), exercises completed (P = .297), or the time spent using the program (P = .567). Similarly, tailored prompts did not increase the effects of the intervention in terms of stress recovery skills (Cohens d ranging from 0.31 to 0.85), perceived stress (d: -0.08; -0.70), depression (d: -0.11; -0.38), anxiety (d: -0.32; -0.64) or psychological well-being (d: 0.26; 0.46). In addition, the standard intervention group showed greater long-term stress recovery effects than the group using the internet-delivered intervention supplemented by tailored prompts (β = -0.24, P = .029).

Although the study confirmed the efficacy of the program, the merits of tailored prompts in ICBT for stress recovery were not supported. Future research is needed to test the effects of the stress recovery intervention supplemented by goal setting and tailored prompts.

The trial has been registered on ClinicalTrials.gov (NCT05553210).