Evaluation of a Mindfulness-based programme in public sector workplaces for stress management: A cost consequence business case analysis

  • Sharon Hadley

    Student thesis: Doctor of Philosophy

    Abstract

    Abstract
    Rising costs to the economy from absenteeism and a greater public awareness of
    stress, anxiety and depression have raised the profile and desire to tackle mental health
    issues in the workplace.
    This thesis considers the advancement and transferability of Mindfulness from its
    original setting in healthcare into the workplace sector. A multidisciplinary perspective
    brings together health economics, psychology and leadership theory perspectives.
    Various intervention types and outcomes of Mindfulness trials are reviewed, with the
    principal exploration of programme transferability across sectors. The novel element of
    this thesis reviews both health and business outcomes of Mindfulness in the workplace
    and importantly considers an economic evaluation from the employer’s perspective.
    Process and methods
    This thesis is structured in the following way: the rationale for a workplace mental health
    intervention and consideration of the evidence-base of Mindfulness in various settings
    is discussed in Chapter one. In Chapter two, a systematic review of the impact on job
    performance and the cost-effectiveness of Mindfulness interventions in the workplace
    is presented. Chapter three reports on the randomised control trial (RCT) which was
    conducted for this PhD project (registration number: CRD42021279822). The chapter
    reports on the process and results for effectiveness, with the main outcome of stress
    measured using the “The Perceived Stress Scale”. Secondary measures included Five
    Facet Mindfulness Questionnaire, The World Health Organization Quality of LifeBREIF, Cognitive Failures Questionnaire, Multifactor Leadership Questionnaire,
    bespoke Service Use Measure, ICECAP-A and EQ-5D-3L. Chapter four presents the
    results from the RCT and considers cost-effectiveness via a cost-consequence
    analysis. This method was chosen as the trial did not find effects when evaluating the
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    primary outcome. Chapter five reports on the employer perspective considering
    outcomes relevant to the workplace. Chapter six brings together the findings in a
    discussion and makes future recommendations.
    Results
    In terms of the primary outcome measure, Perceived Stress Scale (PSS), the
    intervention was not found to be effective. Reasons for this are presented in Chapter
    three and discussed in detail in Chapter six. From an employer perspective, the cost
    consequence analysis provides the full range of costs and outcomes for the employer
    to consider. The outcomes and possible reasons for the results are explored with
    theories offered and recommendations made for further research. The secondary
    outcome measures: the Five Factor Mindfulness Questionnaire found statistically
    significant changes with higher Mindfulness traits in the intervention group. There were
    no statistically significant changes observed in either of the World Health Organization
    measures or the leadership measure. The three economic evaluation measures,
    ICECAP-A, EQ5D-3L including the VAS reported no statistically significant changes.
    The Cognitive Failures Questionnaire reported no statistically significant changes
    immediately following the intervention, however at the 12-month follow-up there were
    statistically significant changes in favour of the intervention group.
    Conclusions
    The Mindfulness intervention used in this trial was not found to be effective nor costeffective when delivered in a public sector workplace in the United Kingdom (UK). It is
    important that results of trials and studies are published even if they are not found to
    be effective or cost-effective, in such cases a cost consequence analysis allows
    analysts to unpack wider findings and link them to process evaluation considerations.
    The trial provided valuable insights and learning when considering Mindfulness in the
    workplace. This thesis reviews various outcomes and considers healthcare, the costeffectiveness and the business case of Mindfulness from an employer perspective
    Date of Award6 Jun 2024
    Original languageEnglish
    Awarding Institution
    • Bangor University
    SupervisorRhiannon Tudor Edwards (Supervisor)

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