Abstract
There are growing concerns on stress among nurses in low- and middle-income countries (LMICs) in South-East Asia. It is important to improve mental health among nurses in these countries. The objective of this study was to examine the efficacy of two types of newly developed smartphone-based stress management programs in improving depressive and anxiety symptoms among hospital nurses in Vietnam. This study was a three-arm (including two intervention groups and one control group) randomized trial. Participants were recruited from nurses in a large general hospital in Hanoi, Vietnam. Two types (free-choice and fixed sequential order) of smartphone-based stress management programs were developed. Participants were randomly allocated to Program A (a free-choice, multimodule stress management), Program B (a fixed-order, internet cognitive behavioral therapy, iCBT), or a control group (treatment as usual). The depressive and anxiety symptoms were measured by using the Depression Anxiety and Stress Scales at baseline, 3-, and 7-month follow-up surveys. 951 participants were randomly allocated to each of the three groups. Program B showed a statistically significant effect on improving depressive symptoms at 3-month (p = 0.048), but not at 7-month (p = 0.92); Cohen’s d was − 0.18 (95% CI − 0.34 to − 0.02) and 0.03 (95% CI − 1.00 to 1.05), respectively. Program A failed to show a significant intervention effect on any of the outcomes at 3- or 7-month follow-up (p > 0.05). Despite the small effect size, the present fixed-order iCBT program seems effective in improving depression of hospital nurses in Vietnam. A public health impact of the intervention can be scalable, when considering its accessibility and minimal cost.Trial registration number: The study protocol is registered at the UMIN Clinical Trials Registry (UMINCTR; ID = UMIN000033139). Registered date of the protocol is 1st Jul. 2018. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000037796
Highlights
There are growing concerns on stress among nurses in low- and middle-income countries (LMICs) in South-East Asia
The present randomized controlled trial (RCT) found that Program B, an iCBT program with a fixed-sequential order of modules, showed a significant intervention effect on improving depressive symptoms at 3-month follow-up among hospital nurses in Vietnam, with a small effect size
The newly developed smartphone-based iCBT stress management program with fixed sequential order modules may be useful for improving depressive symptoms among nurses in Vietnam
Summary
There are growing concerns on stress among nurses in low- and middle-income countries (LMICs) in South-East Asia. One randomized controlled trial (RCT) reported that a web-based stress management program including cognitive behavioral techniques reduced perceived work-related stress among nurses in the USA21, while no significant effect was found on emotional or physical symptoms. It has been reported that a free-choice program in European countries had a higher completion rate and was more effective than a fixed order program[24] It is not clear whether these findings are applicable to countries in other cultures, such as those in South-East Asia. In addition to test the effectiveness of an iCBT program for improving depression and anxiety among nurses, it would be worthwhile to investigate which of free-choice or fixed order iCBT program could achieve better completion rate in Asian countries that have collectivism- and hierarchy-oriented organizational c ultures[25]
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