Corrections Work's Adverse Effects and a Total Worker Health Program to Enhance Well-being

Conduct a quasi-experimental pre-post study of a mindfulness-enhanced, web/app-enabled, scalable Total Worker Health (TWH) program among higher stress Corrections Professionals. The primary outcomes relate to behaviors promoted by the program: being mindful/reduced stress/improved mood; healthier eating; more physical activity; greater restorative sleep; improved work-life balance and greater positive feelings about the organization.

This proposed project will assess an innovative, scalable total worker health and wellness intervention among high stress Corrections Professionals. As stated in the proposal request, organizational and interpersonal factors have been associated with significant stress among Corrections Professionals, but there is limited assessment of effective and feasible interventions to mitigate these stress factors. Our current research has established robust constructs for characteristics of the organization and work environment, noting significant relationships with perceived stress. This critical understanding along with corresponding adverse mental and physical effects informs our proposed intervention to reduce potential stressors, enhance wellbeing, improve work performance, and reduce health care costs. This project will include a prospective interrupted time-series effectiveness trial of a mindfulness-enhanced, website/application-based, scalable Total Worker Health (TWH) program among higher risk corrections personnel working in restrictive housing units. Quantitative outcomes will include process measures; validated self-report indices of primary and secondary outcomes, and proximal potentially mediating factors; anthropometrics; laboratory studies of inflammation, vascular reactivity, and cellular aging; measures of job performance and health care costs. Qualitative measures will provide a deeper understanding of the quantitative findings. At program conclusion, there will be a cost effective easy to use work based health and wellness program tailored to corrections departments ready for dissemination. The robust dissemination plan includes coordinating the website and digital materials with the American Correctional Association marketing and media campaign site along with presentations at national corrections conferences making this freely available to all law enforcement and corrections personnel and agencies.

This study will use a quasi-experimental pre-post design to compare values of outcome measures at the three times points: baseline, immediately post-intervention (3 months after baseline), and follow-up (9 months after baseline). Randomization of the intervention is not feasible at the individual level due to contamination effects within a site and no appropriate control condition. Furthermore, as each of the sites is unique, a randomized cluster design would not be able to account for confounders since there are only three sites, each with institutional differences. An advantage of the pre-post design is that each participant will act as their own control, increasing the power of the study.

The Total Worker Health Mindful Program will include 12, 45-minute sessions completed each week at participant's workplace. Sessions will be guided by written curriculum and focus on healthy eating, exercise, sleep and stress reducing behaviors enhanced by mindfulness activities. Participants will be provided with free enrollment codes to use the Headspace® application (app).

The intervention will be delivered during 12, 45-minute weekly meetings of Correctional Professionals while on shift. Those sessions will be a combination of a video, mindfulness activity, and a group learning activity. It will conclude with members stating personal goals that will be followed up at the next meeting. Sessions will be scripted to make them easy to implement with high fidelity, and include tasks, learning activities, and wrap-up with practice instructions for each week. Coworkers will be responsible for running the sessions, which promotes shared norms and social support.

Change between timepoints: Before intervention implementation, 3 months after the intervention completion, and 9 months after intervention completion

Change between timepoints: Before intervention implementation, 3 months after the intervention completion, and 9 months after intervention completion

Relevant excerpts from the National Cancer Institute's fruit and vegetable all day screener and Diet History Questionnaire (DHQ), percent calories from fat, and health dietary behaviors (Elliot et al., 2007; Kuehl et al., 2014)

Change between timepoints: Before intervention implementation, 3 months after the intervention completion, and 9 months after intervention completion

Change in physical activity will be assessed using this survey question: "How many days per week did you exercise or take part in moderate physical activities that increased your breathing a bit for a total of at least 30 minutes during the day (such as brisk walking or bicycling)?". This is measured in days per week (with a scale of 0-7 days). Relevant excerpts from previous research on physical activity behaviors (Elliot et al., 2007).

Change between timepoints: Before intervention implementation, 3 months after the intervention completion, and 9 months after intervention completion

Change in sleep will be assessed using this survey question: "In the past seven days, I had trouble sleeping" measures in a scale of 1-5 (1=very good, 2=good, 3=fair, 4=poor, 5=very poor). Short Form from the National Institutes of Health's Patient-Reported Outcomes Information System's Sleep Disturbance (PROMIS-SD-SF); Pittsburgh Sleep Quality Index (PSQI)

Change between timepoints: Before intervention implementation, 3 months after the intervention completion, and 9 months after intervention completion

Change in work-life balance will be assessed using this survey question: "In the past month, how often have you felt that you were able to control the important things in your life?" measured in a scale of 1-5 (1=none of the time, 2=a little of the time, 3=some of the time, 4=most of the time, 5=all of the time). Ballin et al., 2021.

Change between timepoints: Before intervention implementation, 3 months after the intervention completion, and 9 months after intervention completion

Change in feelings about organization will be assessed using this survey question: "The Department of Corrections has processes in place that improve my work environment" measured with a scale from 1-5 (1=strongly disagree, 2=disagree, 3=neither disagree or agree, 4=agree, 5=strongly agree). Ballin et al., 2021.

Change between timepoints: Before intervention implementation, 3 months after the intervention completion, and 9 months after intervention completion

Change in life satisfaction will be assessed with the survey question: "Would you say your general health is:" with a scale of a)excellent, b)very good, c)good, d)fair, and e)poor.

Change between timepoints: Before intervention implementation, 3 months after the intervention completion, and 9 months after intervention completion

Change between timepoints: Before intervention implementation, 3 months after the intervention completion, and 9 months after intervention completion

Change between timepoints: Before intervention implementation, 3 months after the intervention completion, and 9 months after intervention completion

Change between timepoints: Before intervention implementation, 3 months after the intervention completion, and 9 months after intervention completion

Change between timepoints: Before intervention implementation, 3 months after the intervention completion, and 9 months after intervention completion

Change between timepoints: Before intervention implementation, 3 months after the intervention completion, and 9 months after intervention completion

Change between timepoints: Before intervention implementation, 3 months after the intervention completion, and 9 months after intervention completion

Change between timepoints: Before intervention implementation, 3 months after the intervention completion, and 9 months after intervention completion

Change in Worker's Compensation Claims from Oregon Department of Corrections Human Resources data that report the number of worker's compensation claims there are.

Change between timepoints: Before intervention implementation, 3 months after the intervention completion, and 9 months after intervention completion

Change in Worker's Compensation Claims from Oregon Department of Corrections Human Resources data that report the number of missed days due to work-related illness or injury

Change between timepoints: Before intervention implementation, 3 months after the intervention completion, and 9 months after intervention completion

Inclusion Criteria: - Currently employed as a corrections professional at participating Oregon Department of Corrections facilities (Coffee Creek Correctional Facility and Oregon State Correctional Institution) for at least one month Exclusion Criteria: - Those who are not employed with participating Oregon Department of Corrections facilities listed above.

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Ballin, J. , Niederhausen, M. , Kuehl, K. , Elliot, D. , McGinnis, W. and DeFrancesco, C. (2021) Defining Stress among Corrections Professionals. Open Journal of Preventive Medicine, 11, 237-250. doi: 10.4236/ojpm.2021.116019.