Innovations in organisational-level work stress interventions: An application in primary schools

Work stress is a significant problem among employees in primary education worldwide and effective interventions are urgently needed. Organisational-level interventions which focus on eliminating work stress at its’ source are recommended by e.g. the World Health Organisation. These interventions involve collaborative efforts of all members of the organisation to identify and implement tailored measures to mitigate work stress risks. However, while organisational-level interventions are the recommended approach to prevent and decrease work stress, these interventions are not always successful. The main aim of this thesis was to increase our understanding of how organisational-level interventions can be designed and implemented to effectively decrease work stress in primary schools, whilst applying innovations that can optimise these interventions to prevent program failure. The objectives of this thesis were: 1. To explore the effects of an organisational-level intervention (version 1) in primary schools to decrease work stress. 2. To explore the relation between design, implementation and effects of occupational risk prevention and health promotion interventions. 3. To design an enhanced organisational-level intervention (version 2) to decrease work stress in primary schools, and to evaluate the implementation process and effects. The organisational-level intervention (version 1) that was studied first, was implemented at five Dutch primary schools. While positive effects were observed in reducing job demands and improving job satisfaction, results varied depending on the quality of implementation. Results of the study specifically underlined the importance of communication about the intervention as part of the implementation process, impacting the effectiveness of the intervention on autonomy and job satisfaction. The aim of the second study was to gain more insights in designing interventions that are successfully implemented and effective within the broader occupational health domain. These insights could potentially be used to further improve the work stress prevention approach to decrease work stress in primary schools. Findings of this study indicated that organising a participative approach and planning its implementation can be challenging in practice. Additionally, the results implied that incorporating a theory-based approach in the development of interventions, despite being complex and time-consuming, may ultimately be worthwhile, leading to a more tailored intervention that aligns with the needs of the target group Insights from the previous studies informed the development of an enhanced organisational-level work stress intervention, incorporating innovations to address earlier shortcomings. The enhanced approach (version 2) introduced a logic model to help schools select appropriate measures and monthly pulse surveys to monitor progress and implementation. These surveys provided real-time feedback, enabling working groups to adjust action plans and improve their implementation. The enhanced approach was implemented at four Dutch primary schools. Results of the process evaluation revealed differences between schools in the level of implementation of the approach. The real-time feedback during the implementation of the action plans appeared only to be of value for schools that already were successful in implementing the approach, but it did not prevent implementation problems at other schools. To study the effects of this intervention a quasi-experimental study was conducted involving four intervention schools and 26 schools. Results showed no direct effects of the intervention on emotional exhaustion and most of the work stress determinants, but results did indicate an effect on quality of leadership. Additionally, when considering the level of implementation of the approach, results showed that implementation success was associated with a decrease in other work stress determinants as well. The findings of the studies in this dissertation suggest that organizational-level work stress interventions have the potential to reduce work stress, provided they are well-implemented. However, since successful implementation is very challenging further research is needed on preventing implementation failure throughout all phases of the approach.