# Effects of a smartphone-based stress management program on work performance, sick leave, and intention to leave among nurses during COVID-19 in Vietnam and Thailand: an analysis of secondary outcomes of a randomized controlled trial

## TL;DR

A smartphone-based stress management program improved nurses' job performance and reduced sick leave during the pandemic in Vietnam and Thailand.

## Contribution

First study to show iCBT improves work-related outcomes like performance and sick leave in nurses during a pandemic.

## Key findings

- The program improved on-the-job performance at 3-month follow-up.
- It reduced sick leave days at 6-month follow-up.
- No significant effect on quality of care or intention to leave the profession.

## Abstract

Objectives: The purpose of this secondary analysis of data from a previous randomized controlled trial (RCT) was to investigate whether an internet-based cognitive behavioral therapy (iCBT) stress management program improved work performance, sick leave, and intention to leave among nurses in Vietnam and Thailand during the COVID-19 pandemic.

Methods: Full-time nurses were recruited from hospitals in Vietnam and Thailand. A 2-arm, parallel-group, RCT was conducted. The intervention groups were provided a 7-week self-guided iCBT program. As secondary outcomes, work performance (on-the-job performance and quality of nursing care), sick leave days, and intention to leave the profession and the organization were assessed at baseline and 3-month and 6-month follow-ups in each group.

Results: A total of 1203 participants were randomly allocated to the intervention and the control group. The program significantly improved on-the-job performance at 3-month follow-up (P = .0499), although the effect was nonsignificant at 6-month follow-up; Cohen’s d was 0.16 and 0.04, respectively. The program also significantly reduced sick leave at 6-month follow-up (coefficient = −0.21; 95% CI, −0.36 to −0.07; prevalence ratio 0.81), although the effect at 3 months was nonsignificant. However, the effects of the intervention on the quality of nursing care and the intention to leave the profession or the organization were not significant.

Conclusions: A smartphone-based iCBT stress management program improved on-the-job performance at 3-month follow-up and decreased sick leave days at 6-month follow-up among hospital nurses in Vietnam and Thailand during the COVID-19 pandemic.

Key points:

Previous randomized controlled trials reported the effectiveness of internet-based cognitive behavioral therapy (iCBT) on the mental health of nurses or health care professionals in pandemics such as COVID-19.However, no previous study addressed the effectiveness of iCBT programs on improving work-related outcomes such as on-the-job performance, sick leave, or intention to leave of nurses under such circumstances.This study examined the effect of a 7-week self-guided iCBT program on these outcomes among nurses in Vietnam and Thailand during the COVID-19 pandemic, demonstrating significant effects on improving on-the-job performance and sick leave.Our research findings may help to improve these work-related outcomes among nurses during a pandemic.

Previous randomized controlled trials reported the effectiveness of internet-based cognitive behavioral therapy (iCBT) on the mental health of nurses or health care professionals in pandemics such as COVID-19.

However, no previous study addressed the effectiveness of iCBT programs on improving work-related outcomes such as on-the-job performance, sick leave, or intention to leave of nurses under such circumstances.

This study examined the effect of a 7-week self-guided iCBT program on these outcomes among nurses in Vietnam and Thailand during the COVID-19 pandemic, demonstrating significant effects on improving on-the-job performance and sick leave.

Our research findings may help to improve these work-related outcomes among nurses during a pandemic.