Managers’ Action-Guiding Mental Models towards Mental Health-Related Organizational Interventions—A Systematic Review of Qualitative Studies
Abstract
:1. Introduction
1.1. Mental Health-Related Organizational Interventions—What They Are and What Makes Them Unique?
1.2. Mental Health-Related Organizational Interventions—What Is It about Implementation?
1.3. Implementation of Mental Health-Related Organizational Interventions—Why Focus on Managers’ Mental Models?
2. Methods
2.1. Design
2.2. Systematic Literature Search
2.3. Selection of Studies
2.4. Appraisal of Primary Studies
2.5. Data Extraction and Synthesis
2.6. Specification of the Framework Model Based on the Theory of Planned Behavior (TPB)
3. Results
3.1. Description of Selected Studies
3.2. Quality Appraisal
3.3. Data Extraction and Synthesis
3.4. Overview of Other Theoretical Models and Approaches
- Horstmann & Remdisch (2019) examine drivers and barriers related to the four components of the health-specific leadership model (“health value”, “health awareness”, “role modeling”, “health behavior”) [66] at the leader, employee and organizational level. “Health value” refers to managers’ interest in their own health and the health of their employees. “Health awareness” refers to managers’ awareness of their own and their employee’s health status, their employees’ work demands and resources, and possible interventions. “Role modeling” refers to managers’ self-care, which can serve as an example to employees and encourage healthier behavior [67]. “Health behavior” refers to all of managers’ health-related actions, including changing work conditions or job design (i.e., health-related organizational interventions), which is what should be explained by the TPB components in our framework model. Similarly, Efimov et al. (2020) address the importance of “health awareness” and “health value” using the health-oriented leadership model [68].
- Based on the social-ecological model (SEM) for health promotion [69], Zhang et al. (2016) argue that barriers and supporting factors for implementing health-related organizational interventions can be described on four different levels: the intrapersonal, interpersonal, organizational and corporate level. The study distinguishes between the corporate level and the organizational level, as the study is based on a company with several subsidiaries. “Intrapersonal” refers to characteristics of the individual, such as knowledge, attitudes, self-concept and skills. “Interpersonal” refers to formal and informal social networks and social support systems. “Organizational” refers to formal and informal rules in the organization, and “corporate” refers to the relationships among different subsidiaries. The SEM assumes that the different levels interact with each other, mutually affecting the effectiveness of organizational interventions [47,69].
- According to the health action process approach (HAPA) [70], applied by Schulte & Bamberg (2002), managers are likely to engage in health-related behavior when they experience their own health as threatened, when they know about appropriate and effective interventions, when they believe that these interventions can be carried out successfully (self-efficacy), when the intention to do something to improve is translated into concrete action planning, and when hindering factors (barriers) are low and promoting factors (facilitators) are high.
- The diffusion of innovations model [71], applied by Kalef et al. (2016) describes five characteristics of an innovation (including a health-related organizational intervention) that can affect implementation: (1) “Relative advantage”: the perception of whether the measure improves the current situation. (2) “Compatibility”: the degree to which the measure is perceived as consistent with the values and needs of potential users. (3) “Observability”: how visible the results of the measure are to others. (4) “Trialability”: the extent to which the innovation can be tested. (5) “Complexity”: whether the measure is perceived as easy or difficult to understand and apply.
- Five of the eleven inductive studies identify critical individual or organizational conditions (as barriers or facilitators) for the implementation of health-related organizational interventions [72,73,74,75,76]. Quirk et al. (2018) identify three levels of barriers and facilitators: interpersonal, cultural and policy. Another five studies focus on the role or responsibility of managers in the context of promoting employee’s mental health [77,78,79,80,81]. One study focuses on responsibility for mental health promotion from an ethical point of view [81].
3.5. Mapping the Results
3.5.1. “Belief in Importance” of Mental Health-Related Organizational Interventions
3.5.2. “Belief in Outcome” of Mental Health-Related Organizational Interventions
3.5.3. “Belief in Role” in Implementing Health-Related Organizational Interventions
3.5.4. Perceived Organizational Norms
3.5.5. “Perceived Behavioral Control”: Barriers to the Implementation of Health-Related Interventions
3.5.6. “Perceived Behavioral Control”: Facilitators for the Implementation of Health-Related Interventions
3.5.7. Identified Background Factors for Managers’ Mental Models
4. Discussion Regarding of Managers’ Action-Guiding Mental Models
5. Limitations and Directions for Future Research
6. Implications for Practice
7. Conclusions
Author Contributions
Funding
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
PubMed (N = 6057) | PICo Scheme | |
((((((“Nurse Administrators”[Mesh]) OR “Physician Executives”[Mesh])) OR (((((“manager”) OR “supervisor”) OR “leader”) OR “chief”) OR “senior physician”))) AND | P = Population | |
((((((“Attitude”[Mesh]) OR “Social Norms”[Mesh]) OR “Self Efficacy”[Mesh]) OR “Personal Autonomy”[Mesh])) OR ((“perspective”) OR “point of view”)) AND | I = Phenomenon of Interest | |
(((((“Occupational Health Services”[Mesh]) OR “Organization and Administration”[Mesh]) OR “Health Promotion”[Mesh])) OR (((((“mental health promotion”) OR “occupational health promotion”) OR “workplace health promotion”) OR “job design”) OR “work design”))) | Co = Context | |
PsycInfo (N = 522) | PICo Scheme | |
1 | exp Top Level Managers/or exp Middle Level Managers/or managers.mp. | P = Population |
2 | supervisor.mp. or exp Management Personnel/ | |
3 | exp Leadership/or leader.mp. | |
4 | chief.mp. | |
5 | senior physician.mp. | |
6 | physician executives.mp. | |
7 | nurse administrators.mp. | |
8 | 1 or 2 or 3 or 4 or 5 or 6 or 7 | |
9 | Attitudes.mp. or exp Attitudes/or exp Employer Attitudes/ | I = Phenomenon of Interest |
10 | Social norms.mp. or exp Social Norms/ | |
11 | Self Efficacy.mp. or exp Self-Efficacy/ | |
12 | exp Autonomy/or personal autonomy.mp. | |
13 | perspective.mp. | |
14 | point of view.mp. | |
15 | 9 or 10 or 11 or 12 or 13 or 14 | |
16 | exp Health Promotion/ | Co = Context |
17 | occupational health promotion.mp. | |
18 | workplace health promotion.mp. | |
19 | job design.mp. | |
20 | work design.mp. | |
21 | occupational health/or occupational health psychology/or occupational safety/ | |
22 | 16 or 17 or 18 or 19 or 20 or 21 | |
23 | 8 and 15 and 22 | |
Scopus (N = 2000) | PICo scheme | |
(( “Nurse administrators” OR “Physician Executives” OR “manager” OR “supervisor” OR “leader” OR “chief” OR “senior physician” )) AND | P = Population | |
( “Attitude” OR “Social Norms” OR “Self Efficacy” OR “Personal Autonomy” OR “perspective” OR “point of view” ) AND | I = Phenomenon of Interest | |
(( “Occupational Health Services” OR “Organization and Administration” OR “Health Promotion” OR “mental health promotion” OR “occupational health promotion” OR “workplace health promotion” OR “job design” OR “work design” )) | Co = Context | |
(TITLE-ABS-KEY (LIMIT-TO (DOCTYPE, “ar”)) AND (LIMIT TO (SUBJAREA, “MEDI”) OR LIMIT TO (SUJAREA, “BUSI”) OR LIMIT-TO (SUBJAREA, “SOCI”) OR LIMIT-TO (SUBJAREA,”PSYC”) OR LIMIT-TO (SUBJAREA, “NURS”))) -> BEST MATCH | Limits |
Inclusion | Exclusion | |
---|---|---|
Target population |
|
|
Setting |
|
|
Topic area |
|
|
Methodology |
|
|
Language |
|
|
Study design |
|
|
Criteria of Quality Checklist | √ | X | ? |
---|---|---|---|
(1) Was there a clear statement of the aims of the research? | 17 | - | - |
(2) Is a qualitative methodology appropriate? | 17 | - | - |
(3) Was the research design appropriate to address the aims of the research? | 16 | - | 1 |
(4) Was the recruitment strategy appropriate to the aims of the research? | 9 | 1 | 6 |
(5) Was the data collected in a way that addressed the research issue? | 14 | - | 3 |
(6) Has the relationship between researcher and participants been adequately considered? | 2 | 12 | 3 |
(7) Have ethical issues been taken into consideration? | 12 | 4 | - |
(8) Was the data analysis sufficiently rigorous? | 16 | - | 1 |
(9) Is there a clear statement of findings? | 14 | 1 | 2 |
(10) How valuable is the research? | 13 | - | 4 |
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Author, Title, Year | Design | Sample | Aim/Research Question | Theoretical Framework | Key Findings | |
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1 | Efimov, I., Harth, V., Mache, S. (2020) Health-oriented self- and employee leadership in virtual teams: A qualitative study with virtual leaders. Int. Journal of Environmental Research and Public Health | Qualitative study: semi-structured, guideline-based telephone interviews, problem centered interviews. | 13 managers (IT-sector, manufacturing industry, aerospace industry) from medium-sized and large companies. | Insights on the health awareness of leaders and on affecting enablers and hindrances to the implementation of health-oriented leadership. | Health-oriented leadership (HoL): health value, health awareness, behavior |
|
2 | Eriksson, A., Axelsson, B., Axelsson, S.B. (2011) Health-promoting leadership—Different views of the concept. Work | Qualitative study: semi-structured interviews analyzed following the principles of phenomenography. | 10 middle-managers, 4 personnel managers, 1 area manager, 1 administrative director, 2 project leaders of eight Swedish municipalities | Analysis of the different perceptions of health-promoting leadership among stakeholders (including managers) engaged in workplace health promotion. How is health-promoting leadership characterized? What are the motives for it? What critical circumstances are noticed for such a leadership? | Inductive approach. Focused on critical individual and organizational conditions for the development of health promoting leadership. |
|
3 | Genrich, M. et al. (2020) Hospital Medical and Nursing Managers’ Perspectives on Health-Related Work Design Interventions. A Qualitative Study. Frontiers Psychology | Qualitative study: semi-structured interviews. Analyzed by content analysis. | 37 managers (chief physicians, senior physicians, and senior nurses) from a German hospital. | Hospital managers’ perspectives on health-related organizational interventions. | Theory of planned behavior (TPB), regarding the predictors attitude, perceived organizational norms, and perceived behavioral control. |
|
4 | Hasson, H. et al. (2014) Managing implementation: roles of line managers, senior managers, and human resource professionals in an occupational health intervention Journal of Occupational and Environmental Medicine | Qualitative study: semi-structured interviews as part of an intervention study | 29 interviews with line managers (n = 13), senior managers (n = 7), and HR professionals (n = 9) from 9 organizations in Stockholm, Sweden. Branches: higher education, information technology, trade union, media, and government authorities. | How do line managers, senior managers and HR specialists perceive their own and each other’s roles and tasks and the possibilities for fulfilling these tasks during the implementation of an occupational health intervention? | Inductive approach. Focused on role-taking. |
|
5 | Havermans, B.M. (2018) Work stress prevention needs of employees and supervisors BMC Public Health | Qualitative study: Semi-structured telephone interviews. Thematic content analysis. | 7 employees and 7 supervisors (focused on in this review) from different sectors, such as the finance, health care, and services industry. | Employee and supervisor needs regarding organizational work stress prevention. Main issues: (1) communication on work stress, (2) attention to the determinants of work stress, (3) supporting circumstances for the prevention of work stress, (4) involvement of stakeholders in the prevention of work stress and (5) availability of work stress prevention measures. | Inductive approach. Focused on conditions that managers need to prevent work stress. | Supervisors need:
|
6 | Horstmann, D. & Remdisch, S. (2019) Drivers and barriers in the practice of health-specific leadership: A qualitative study in healthcare Work | Qualitative study: semi-structured interviews, analyzed by qualitative content analysis. | Interviews with 51 managers from 18 geriatric-care facilities in Germany. | Managers’ perceptions of drivers and barriers in the successful practice of health-specific leadership in the healthcare sector.
| Drivers and barriers are identified at the leader level, the employee level, and the organizational level. The factors identified relate to the theoretical aspects of the health-specific leadership model: health value, health awareness, health behavior, and role modeling. | Perceived drivers on three levels: Leader level: for all 4 health-specific leadership aspects:
|
7 | Kalef, L. et al. (2016) Employers’ Perspectives on the Canadian National Standard for Psychological Health and Safety in the Workplace Employee Responsibilities and Rights Journal | Qualitative study: through in-person and telephone, explorative semi-structured interviews | 10 Toronto and Montreal area business employers of varying workplace sizes. | Canadian employers’ perspectives on the Canadian National Standard for Psychological Health and Safety in the Workplace. (1) employers’ existing understanding of the Standard; (2) the difficulties and advantages of implementing the Standard in their workplace; (3) if the Standard was useful for the employers or not; and (4) the effects of the Standard on the workplace to date. | Concept of Diffusion of Innovation (DOI, Rogers, 2003). A framework that explains how new “innovations” or processes spread throughout social systems such as the workplace. |
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8 | Kunyk, D. et al. (2016) Employers’ perceptions and attitudes toward the Canadian national standard on psychological health and safety in the workplace: A qualitative study International Journal of Law and Psychiatry | Qualitative, exploratory study: series of 5 focus groups | 17 managers from the fields of healthcare, construction/utilities, manufacturing industries, business services, and finance of a large Western Canadian city. | Employers’ receptivity to implementing the Canadian national standard on psychological health and safety in the workplace. | Inductive approach. Focused on Factors influencing Workplace Mental Health, Reaction to the Standard, Benefits and Barriers to Standard Implementation, Facilitators and Suggestions for the Implementation. |
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9 | Landstad, B.J. et al. (2017) How managers of small-scale enterprises (SSEs) can create a health promoting corporate culture International Journal of Workplace Health Management | Qualitative study: analyzed by using an inductive strategy, in accordance with the proposed concepts grounded theory (Glaser & Strauss, 1967) and step-deductive induction (Tjora, 2012). | 8 managers from Norwegian and 10 managers from Swedish small-scale enterprises with less than 20 employees. Branches: building and construction/industry; service delivery | Perspective from managers in small-scale enterprises towards workplace health management (WHM)
| Inductive approach. Focused on conditions for workplace health management. |
|
10 | Larsson, R. et al. (2016) Managing workplace health promotion in municipal organizations: The perspective of senior managers. Work | Qualitative study: Semi-structured interviews were conducted individually using open-ended questions based on an interview guide | 14 senior managers (part of the upper management) of two Swedish municipal organizations (Stockholm region) from different departments: childcare and education, elderly and social care, traffic and urban planning, environment, human resources (HR), and municipal district administration | How is workplace health promotion (WHP) managed and put into practice by senior management in a municipal organizational context?
| Inductive approach. Focused on five issues: The dominance on fitness programs, following a problem-solving cycle, building leadership competence, providing managerial support, organizational politics. |
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11 | Moore, A. et al. (2010) Managers’ understanding of workplace health promotion within small and medium-sized enterprises: A phenomenological study Health Education Journal | Qualitative study: a Heideggerian interpretive phenomenological methodology, in-depth telephone interviews | 18 managers from small and medium-sized enterprises of a Health and Social Care Trust area of Northern Ireland | Managers’ views on workplace health promotion (WHP) and their experiences with WHP. | Inductive approach. The “Social Diagnosis” of workplace health, adapted from Green & Kreuter (1991) is modified to include an ecological consideration of workplace health determinants, at employee, environmental, business and community levels. |
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12 | Pescud, M. et al. (2015) Employers’ views on the promotion of workplace health and wellbeing: a qualitative study BMC Public Health | Qualitative study: Phenomenological approach; 10 focus groups | 79 employers from a range of industries and geographical locations within Western Australia. | Employers’ perceptions of promoting health and well-being in the workplace and the drivers of those perceptions. | Inductive approach. Focused on three main factors influencing employers’ views on health promotion in the workplace: (1) employers’ conceptualization of workplace health and wellbeing, (2) employers’ descriptions of (un)healthy workers and perceptions surrounding importance of healthy workers, (3) employers’ beliefs around the role the workplace should play in influencing employee’s health. |
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13 | Quirk, H. et al. (2018) Barriers and facilitators to implementing workplace health and wellbeing services (HWB) in the NHS from the perspective of senior leaders and wellbeing practitioners: A qualitative study BMC Public Health | Qualitative study: semi-structured interviews, analyzed by thematic analysis. | Interviews with 4 senior leaders, 4 heads of department and 3 health and wellbeing practitioners of the National Health Service (NHS) in one region of the UK. | Perspective of NHS managers and health and well-being experts about obstacles and enablers to implementing HWB for NHS employees. | Inductive approach. Cultural approach for designing and implementing HWB regarding facilitators and barriers on different levels: individual, interpersonal, organizational, cultural, policy. |
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14 | Rodham, K. & Bell, J. (2002) Work stress: an exploratory study of the practices and perceptions of female junior healthcare managers Journal of Nursing Management | A combination of critical incident diaries and semi-structured interviews. The themes emerging from the diary entries were identified using a grounded theory approach. | Sample of 6 junior managers (JM) from a large NHS hospital in London. Nonclinical manager (N = 2), clinical manager (N = 4). | Investigation of the beliefs and behaviors of junior managers in the health care sector towards stress in the workplace. | Inductive approach. Focused on attitudes and beliefs concerning the definitions of stress, recognition, responsibility for management, personal stressors and awareness of stress. |
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15 | Schulte, M. & Bamberg, E. (2002) Ansatzpunkte und Nutzen betrieblicher Gesundheitsförderung aus der Sicht von Führungskräften. Gruppendynamik und Organisationsberatung | Qualitative study: semi-structured individual interviews; content-analysis according to Miles & Huberman (1994) | 40 senior and top-level managers (director and board level) of a Scandinavian and a German aviation company | Manager’s perspective on:
| Schwarzer’s Health Action Process Approach HAPA (1996), with the following health psychological approaches: the “Health Belief Model” (Rosenstock, 1966; Becker 1974; Janz & Becker, 1984), the “Theory of Reasoned Action” (Fishbein & Ajzen, 1975; Fishbein & Ajzen, 1980; Ajzen, 1985) and the “Protection Motivation Theory” by Rogers (1975; 1983; 1985) |
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16 | van Berkel, J. et al. (2014) Ethical considerations of worksite health promotion: an exploration of stakeholders’ views BMC Public Health | Semi-structured focus group discussions: Data analyzing according to the constant comparison method. | Employees (N = 6) and Employers (N = 4) from large and smaller organizations (industry and service) involved in WHP. | A comparison of stakeholder views on workplace health promotion and resulting ethical aspects. Themes of the analysis: the definition of occupational health, occupational health risk factors, worksite health promotion, and taking responsibility. | Inductive approach: focused on ethical aspects of worksite health promotion. |
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17 | Zhang, Y. et al. (2016) Workplace participatory occupational health/health promotion program: Facilitators and barriers observed in three nursing homes Journal of Gerontological Nursing | Qualitative study: focus group discussions (employees) and in-depth interviews (manager) as part of the evaluation of the participatory occupational health/health promotion program. | In-depth interviews with 5 top managers (i.e., administrators and directors of nursing and 13 middle managers (i.e., department heads and unit managers) of three nursing homes in the eastern united states. | Perception of the facilitators and barriers for the participatory occupational health/health promotion program from managers’ and employees’ perspectives. | The Social Ecological Model (SEM) for health promotion (McLeroy et al., 1988). Regard of different levels: Intrapersonal, interpersonal, organizational, corporate. |
|
Components of the TPB-Based Framework (in Genrich et al., 2020) | Health Specific Leadership Model 1 (in Horstmann & Remdisch, 2019) and Health-Oriented Leadership 2 (in Efimov et al., 2020) | Social Ecological Model for Health Promotion (in Zhang et al., 2016) | The Health Action Process Approach (in Schulte & Bamberg, 2002) | Diffusion of Innovation (in Kalef et al., 2016) | Inductive Approaches (in Included Studies of the Other Authors) |
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Attitude—Belief in importance | Health value 1,2 Health awareness 1,2 | Perception of a threatening situation for their own health | |||
Attitude—Belief in outcome | Health value 1,2 | Relative advantage | |||
Attitude—Belief in role | Role modeling 1 | Role taking, Managers’ responsibility | |||
Organizational norms | Compatibility | ||||
Perceived behavioral control (PBC) due to internal or organizational facilitators or barriers | Drivers and Barriers at leader, employee and organizational levels in relation to the components of the model (see above), incl. health behavior. 1 Decisive factors for the implementation of HoL 2 | Facilitators and Barriers with consideration of different levels of influence, including intrapersonal, interpersonal, organizational, corporate. | Barriers Feeling of self-efficacy, Knowledge about measures, Facilitators | Observability Trialability Complexity | Critical individual or organizational conditions |
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Genrich, M.; Angerer, P.; Worringer, B.; Gündel, H.; Kröner, F.; Müller, A. Managers’ Action-Guiding Mental Models towards Mental Health-Related Organizational Interventions—A Systematic Review of Qualitative Studies. Int. J. Environ. Res. Public Health 2022, 19, 12610. https://doi.org/10.3390/ijerph191912610
Genrich M, Angerer P, Worringer B, Gündel H, Kröner F, Müller A. Managers’ Action-Guiding Mental Models towards Mental Health-Related Organizational Interventions—A Systematic Review of Qualitative Studies. International Journal of Environmental Research and Public Health. 2022; 19(19):12610. https://doi.org/10.3390/ijerph191912610
Chicago/Turabian StyleGenrich, Melanie, Peter Angerer, Britta Worringer, Harald Gündel, Friedrich Kröner, and Andreas Müller. 2022. "Managers’ Action-Guiding Mental Models towards Mental Health-Related Organizational Interventions—A Systematic Review of Qualitative Studies" International Journal of Environmental Research and Public Health 19, no. 19: 12610. https://doi.org/10.3390/ijerph191912610