Absence of conflict of interest.
Citation
Highlights
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The study’s objective was to examine the impact of the STAR intervention, designed to increase employees’ social support and sense of control over work and schedules, on perceived stress and psychological distress.
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The study used a cluster-randomized controlled trial design to compare the outcomes of employees in long-term health care facilities assigned to treatment and control groups. Data came from baseline and follow-up surveys.
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The study did not find the STAR intervention had statistically significant impacts on either perceived stress or psychological distress.
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The quality of causal evidence presented in this report is high because it was based on a well-implemented randomized controlled trial. This means we would be confident that any estimated effects would be attributable to the STAR intervention and not to other factors. However, the study did not find statistically significant effects.
Intervention Examined
STAR
Features of the Intervention
STAR was designed to increase supervisor and organizational social support for direct health care workers, and to increase these employees’ sense of control over work and schedules. It integrated two work interventions, the Results-Oriented Work Environment and Leader Social Support for Family and Work Roles, and was tailored to the specific long-term care employer. Delivered regularly over four months, STAR involved both supervisors and employees. Supervisors received training on strategies to demonstrate support for employees’ personal and family lives while also supporting employees’ job performance. Employees received training on identifying new work practices and processes to increase their control over work time through group sessions, computer-based training, and work-improvement assessment activities. The intervention serves direct health care workers and their supervisors.
Features of the Study
The study used a cluster-randomized controlled trial design. Thirty long-term health care facilities across the New England region of the United States were randomly assigned on a rolling basis to either receive the intervention or engage in business-as-usual work procedures. Within these facilities, 1,524 eligible employees participated in the study. About 92 percent of the participants were female, 66 percent were White, and their average age was 39.7. About 56 percent reported having at least one child living at home and about 30 percent reported engaging in elder care activities for an adult relative. The authors collected survey data from the treatment and control groups at baseline and at 6, 12, and 18 months after random assignment. Outcome data came from two measures: psychological distress was measured using six items from the K-6 Mental Health Screening Questionnaire (Kessler et al., 2003), and perceived stress was measured using four items from the Perceived Stress Scale (Cohen et al., 1983). The authors used a statistical model to compare the outcomes of treatment and control group members and to assess if providing family care moderated the impact of STAR.
Findings
The study did not find the STAR intervention had statistically significant impacts on either perceived stress or psychological distress. There were favorable impacts on some outcomes for subgroups of participants providing either elder care or both elder care and child care at home, and unfavorable impacts on some outcomes for subgroups of participants providing child care at home.
Considerations for Interpreting the Findings
The authors used adaptive randomization to assign facilities into treatment or control groups. This procedure was intended to balance assignment by three criteria for random assignment: staff retention rate, geographic location, and number of eligible direct care employees. The research team was not aware of which sites were assigned to the intervention until after baseline data were collected.
Causal Evidence Rating
The quality of causal evidence presented in this report is high because it was based on a well-implemented randomized controlled trial. This means we would be confident that any estimated effects would be attributable to the STAR intervention and not to other factors. However, the study did not find statistically significant effects.