Computer-based versus in-person stress management programmes for workers

What is the aim of this review?

We wanted to find out if stress management programmes at work had a different effect if they were given via a computer, compared to being given in person. We collected and analysed all relevant studies to answer this question. We found two studies that studied the effect of the delivery method on stress reduction in workers.

Key messages

The effects of the delivery method on stress reduction were unclear. More research should be conducted to directly compare equivalent stress management programmes delivered via a computer and in-person. Any future studies will likely affect the conclusions of this review.

What was studied in the review?
Many employers wish to reduce stress in their employees and are willing to invest in stress management programmes. It has been shown that workplace stress management programmes can reduce stress in employees, either when delivered by a computer or mobile device, or by a live person. However, it is unclear if the delivery method itself impacts how effective the programme is. Therefore, we evaluated the effect of the intervention delivery method (computer or in person) to reduce stress in workers.

What are the results of the review?

We found two studies, involving 159 employees, that looked at stress levels in workers after completing stress management programmes on a computer, compared to workers receiving that same programme content from a live person. Both studies taught participants, individually or in small groups, how to recognise and reduce stress, but had conflicting results.

How up to date is this review?

We searched for studies that had been published up to February 2017.

Authors' conclusions: 

We found very low-quality evidence with conflicting results, when comparing the effectiveness of computer-based stress management interventions with in-person stress management interventions in employees. We could include only two studies with small sample sizes. We have very little confidence in the effect estimates. It is very likely that future studies will change these conclusions.

Read the full abstract...
Background: 

Chronic exposure to stress has been linked to several negative physiological and psychological health outcomes. Among employees, stress and its associated effects can also result in productivity losses and higher healthcare costs. In-person (face-to-face) and computer-based (web- and mobile-based) stress management interventions have been shown to be effective in reducing stress in employees compared to no intervention. However, it is unclear if one form of intervention delivery is more effective than the other. It is conceivable that computer-based interventions are more accessible, convenient, and cost-effective.

Objectives: 

To compare the effects of computer-based interventions versus in-person interventions for preventing and reducing stress in workers.

Search strategy: 

We searched CENTRAL, MEDLINE, PubMed, Embase, PsycINFO, NIOSHTIC, NIOSHTIC-2, HSELINE, CISDOC, and two trials registers up to February 2017.

Selection criteria: 

We included randomised controlled studies that compared the effectiveness of a computer-based stress management intervention (using any technique) with a face-to-face intervention that had the same content. We included studies that measured stress or burnout as an outcome, and used workers from any occupation as participants.

Data collection and analysis: 

Three authors independently screened and selected 75 unique studies for full-text review from 3431 unique reports identified from the search. We excluded 73 studies based on full-text assessment. We included two studies. Two review authors independently extracted stress outcome data from the two included studies. We contacted study authors to gather additional data. We used standardised mean differences (SMDs) with 95% confidence intervals (CIs) to report study results. We did not perform meta-analyses due to variability in the primary outcome and considerable statistical heterogeneity. We used the GRADE approach to rate the quality of the evidence.

Main results: 

Two studies met the inclusion criteria, including a total of 159 participants in the included arms of the studies (67 participants completed computer-based interventions; 92 participants completed in-person interventions). Workers were primarily white, Caucasian, middle-aged, and college-educated. Both studies delivered education about stress, its causes, and strategies to reduce stress (e.g. relaxation or mindfulness) via a computer in the computer-based arm, and via small group sessions in the in-person arm. Both studies measured stress using different scales at short-term follow-up only (less than one month). Due to considerable heterogeneity in the results, we could not pool the data, and we analysed the results of the studies separately. The SMD of stress levels in the computer-based intervention group was 0.81 standard deviations higher (95% CI 0.21 to 1.41) than the in-person group in one study, and 0.35 standard deviations lower (95% CI -0.76 to 0.05) than the in-person group in another study. We judged both studies as having a high risk of bias.

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