Reducing Work-related Screen Time in Health Care Workers During Leisure Time (REDUCE-SCREEN)

The purpose of this study is to determine the effect that uninstalling work email applications from mobile devices during leisure time has on health care worker stress levels.

Burnout is more common in physicians than in the general population. The recent COVID-19 pandemic has increased burnout and stress levels among health care workers, leading to a peak of 34% of health care workers experiencing burnout symptoms. But even before the COVID-19 pandemic, the prevalence of burnout symptoms among health care workers was trending upwards. In fact, most health care workers experience burnout to some degree. Managing email inboxes and working with electronic health records (EHR) can increase screen time levels for health care workers who use them. High amounts of screen time have been linked to depression and stress in teenagers and adults. EHR digital work is a noted burden on physicians, and inbox management has been linked to physician stress and burnout. A study that measured physician stress during electronic health record inbox work found that accessing and responding to EHR inbox outside of work hours increased stress levels in physicians. The effect of an intervention that lowers screen time usage in health care workers during leisure time has not been measured. Determining this effect can influence new protocols on inbox and work email management during leisure time for health care workers. This can benefit organizations by improving employee performance, employees by reducing stress and burnout levels, and patients by providing more refreshed patient care. This study aims to determine the effect that uninstalling email from mobile devices during leisure time has on health care worker stress levels.

This group would complete a survey that measures stress before and after leisure time with no added instructions.

Participants randomized to the intervention group are encouraged to set up an automated response to emails received during their weekend off, reduce their screen time for duration of leisure time, and uninstall work applications from their mobile device. Surveys are sent prior to and after leisure time.

The intervention is information provided via email on how to set up an automated response to emails received during their weekend off, reduce screen time for duration of leisure time, and uninstall work applications from their mobile device.

Individual scores on the Perceived Stress Scale can range from 0 to 40 with higher scores indicating higher perceived stress.

Change in scale measured at baseline and after leisure time (through study completion, an average of 1 week)

Inclusion Criteria: 1) be an active health care worker 2) be ≥ 19 years old 3) routinely use a smartphone 4) have a work email application (e.g., Outlook) installed on their smartphone. Exclusion Criteria: None

Afonso AM, Cadwell JB, Staffa SJ, Zurakowski D, Vinson AE. Burnout Rate and Risk Factors among Anesthesiologists in the United States. Anesthesiology. 2021 May 1;134(5):683-696. doi: 10.1097/ALN.0000000000003722.

Salazar de Pablo G, Vaquerizo-Serrano J, Catalan A, Arango C, Moreno C, Ferre F, Shin JI, Sullivan S, Brondino N, Solmi M, Fusar-Poli P. Impact of coronavirus syndromes on physical and mental health of health care workers: Systematic review and meta-analysis. J Affect Disord. 2020 Oct 1;275:48-57. doi: 10.1016/j.jad.2020.06.022. Epub 2020 Jun 25.

Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J, West CP. Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Mayo Clin Proc. 2015 Dec;90(12):1600-13. doi: 10.1016/j.mayocp.2015.08.023. Erratum In: Mayo Clin Proc. 2016 Feb;91(2):276.

Janosy NR, Anderson CTM. Toward physician well-being and the mitigation of burnout. Curr Opin Anaesthesiol. 2021 Apr 1;34(2):176-179. doi: 10.1097/ACO.0000000000000969.

Gunnell KE, Flament MF, Buchholz A, Henderson KA, Obeid N, Schubert N, Goldfield GS. Examining the bidirectional relationship between physical activity, screen time, and symptoms of anxiety and depression over time during adolescence. Prev Med. 2016 Jul;88:147-52. doi: 10.1016/j.ypmed.2016.04.002. Epub 2016 Apr 14.

Maras D, Flament MF, Murray M, Buchholz A, Henderson KA, Obeid N, Goldfield GS. Screen time is associated with depression and anxiety in Canadian youth. Prev Med. 2015 Apr;73:133-8. doi: 10.1016/j.ypmed.2015.01.029. Epub 2015 Feb 2.

Yu B, Gu Y, Bao X, Meng G, Wu H, Zhang Q, Liu L, Sun S, Wang X, Zhou M, Jia Q, Song K, Niu K. Distinct associations of computer/mobile devices use and TV watching with depressive symptoms in adults: A large population study in China. Depress Anxiety. 2019 Sep;36(9):879-886. doi: 10.1002/da.22932. Epub 2019 Jul 3.

Colicchio TK, Cimino JJ, Del Fiol G. Unintended Consequences of Nationwide Electronic Health Record Adoption: Challenges and Opportunities in the Post-Meaningful Use Era. J Med Internet Res. 2019 Jun 3;21(6):e13313. doi: 10.2196/13313.

Shanafelt TD, Dyrbye LN, Sinsky C, Hasan O, Satele D, Sloan J, West CP. Relationship Between Clerical Burden and Characteristics of the Electronic Environment With Physician Burnout and Professional Satisfaction. Mayo Clin Proc. 2016 Jul;91(7):836-48. doi: 10.1016/j.mayocp.2016.05.007. Epub 2016 Jun 27.

Gardner RL, Cooper E, Haskell J, Harris DA, Poplau S, Kroth PJ, Linzer M. Physician stress and burnout: the impact of health information technology. J Am Med Inform Assoc. 2019 Feb 1;26(2):106-114. doi: 10.1093/jamia/ocy145.

Tai-Seale M, Dillon EC, Yang Y, Nordgren R, Steinberg RL, Nauenberg T, Lee TC, Meehan A, Li J, Chan AS, Frosch DL. Physicians' Well-Being Linked To In-Basket Messages Generated By Algorithms In Electronic Health Records. Health Aff (Millwood). 2019 Jul;38(7):1073-1078. doi: 10.1377/hlthaff.2018.05509.

Lieu TA, Freed GL. Unbounded-Parent-Physician Communication in the Era of Portal Messaging. JAMA Pediatr. 2019 Sep 1;173(9):811-812. doi: 10.1001/jamapediatrics.2019.2309. No abstract available.

Akbar F, Mark G, Prausnitz S, Warton EM, East JA, Moeller MF, Reed ME, Lieu TA. Physician Stress During Electronic Health Record Inbox Work: In Situ Measurement With Wearable Sensors. JMIR Med Inform. 2021 Apr 28;9(4):e24014. doi: 10.2196/24014.

Agyapong VIO, Hrabok M, Vuong W, Shalaby R, Noble JM, Gusnowski A, Mrklas KJ, Li D, Urichuk L, Snaterse M, Surood S, Cao B, Li XM, Greiner R, Greenshaw AJ. Changes in Stress, Anxiety, and Depression Levels of Subscribers to a Daily Supportive Text Message Program (Text4Hope) During the COVID-19 Pandemic: Cross-Sectional Survey Study. JMIR Ment Health. 2020 Dec 18;7(12):e22423. doi: 10.2196/22423.

Berlowitz J, Hall DL, Joyce C, Fredman L, Sherman KJ, Saper RB, Roseen EJ. Changes in Perceived Stress After Yoga, Physical Therapy, and Education Interventions for Chronic Low Back Pain: A Secondary Analysis of a Randomized Controlled Trial. Pain Med. 2020 Oct 1;21(10):2529-2537. doi: 10.1093/pm/pnaa150.