February 23, 2024

Part 1. Perceptions of the prevail training

Overall, 492 people completed the evaluation of the Prevail intervention. No demographic information was taken. A summary of the quantitative results for the Prevail Staff Intervention is given in Fig. 2. The four questions relating to the palatability of the Prevail Staff Intervention all received overwhelming endorsement: 92% of participants thought the aims of the intervention were met, with 95% finding the content easy to understand. For those that disagreed that the intervention was easy to understand, the comments mainly focused on physical reasons, in particular the sound quality of the videos. 90% of participants thought the pace of the intervention was appropriate and 86% felt its duration was appropriate. Those that disagreed generally wanted a faster and shorter intervention. Hence, overall, we can conclude that the majority of participants were happy with the intervention programme.

Importantly, three questions in the quantitative evaluation aimed to examine if participants felt the intervention had equipped them with the knowledge and skills that had been intended: to be able to apply in practice what they had learnt; to be able to improve their own mental health; and to be able to help and assist others with their mental health difficulties. Again, these questions elicited very positive responses. 92% of participants endorsed that the aims of the intervention were met. 86% of people felt that they were able to immediately apply what they had learnt about mental health and evidence-based low intensity psychological interventions, and 81% of people felt that they were able to help others with their mental health difficulties (compared to 3% disagreeing for each of these latter two questions). Examination of the responses of those who did disagree identified the theme of “there was nothing new/I already do this” which was identified by seven respondents. There will clearly be some people in any organisation who have a history of mental health difficulties and who have had the benefit of already receiving low intensity psychological intervention or cognitive behavioural therapy. For these people, a lot of the content of Prevail may not be new (as Prevail has its foundation in evidence-based psychological practice) and may be more of a revision and reinforcement of effective interventions for mental health and well-being. Hence, overall, we can conclude that the majority of participants felt the intervention programme had achieved the core aims of using positive strategies to improve their own mental health and to support the mental health difficulties of others.

Thematic examination of responses to the question “What (if any) part(s) of the course did you find useful?” revealed four major themes. The most common theme (56 respondents) was termed “all of it” which is exemplified by the comments:

  • Everything about the course. I really enjoyed it and have suffered with mental illness myself”; and.

  • I feel overall it will create a great attitude in the workplace around mental health”.

Fig. 2
figure 2

Quantitative Feedback from Prevail Staff Intervention

The theme “videos and case studies” was reported as being particularly useful by 50 respondents, where they expressed that seeing real people (and their colleagues in particular) talking about their mental health difficulties and well-being, enhanced their understanding of these issues (with one video and case study included for each of anxiety, depression, stress, and bereavement).

For example:

The theme “mental health as a continuum” was mentioned as being particularly useful by 22 respondents and as important in tackling stigma and self-stigma.

For example:

Finally, 16 people mentioned the section on “stress” as being particularly useful, with the theme emerging that this is often ignored and not treated as a real or significant problem impacting mental health and well-being in the workplace.

For example:

  • I particularly found the section about stress the most useful as it’s something that applies to everyone. Whereas depression and anxiety is something that’s regularly talked about and advertised everywhere, stress doesn’t usually get talked about in as much detail, which is why I found it the most interesting”.

In total 49 people undertook the Prevail Managers training. This included the 38 managers in the active arm of the study alongside 11 other senior managers not directly involved in the main study. No demographic information was taken. A summary of the quantitative results for the Prevail Manager Intervention is given in Fig. 3. The four questions relating to the palatability of the Prevail Manager Intervention programme all received overwhelming endorsement: 96% of managers thought that the aims of the intervention were met, 92% finding the content easy to understand, 88% of managers thought that the pace of the intervention was appropriate, and 85% felt its duration was suitable. Examination of those that disagreed with any of these statements did not establish any common comments or themes, with the reasons given being contradictory (e.g. one person thinking the intervention programme was “too slow” whereas another felt it was “too fast”).

Fig. 3
figure 3

Quantitative Feedback from Prevail Managers Intervention

Three questions aimed to examine if managers felt that the intervention programme had equipped them with the knowledge and skills that had been intended: to be able to apply in practice what they had learnt; to be able to improve their own mental health; and to be able to help and assist others with their mental health difficulties. Again, these questions elicited positive responses. Particularly encouraging were the responses to the question about being able to help others, as this was integral to the aims of the Prevail Managers programme. 94% of managers agreed that Prevail Managers had improved their ability to help others with their mental health difficulties, compared to 0% who disagreed. Examination of the responses of those who were neutral on this question (neither agreeing nor disagreeing) showed very few comments with no common theme.

Thematic examination of responses to the question “What (if any) part(s) of the intervention did you find useful?” revealed one theme mentioned by eight respondents. This consisted of comments stating that they found the section of the intervention programme related to “Active Problem Solving” to be particularly beneficial, but managers did not provide more detail than that.

The feedback for both the Prevail Staff Intervention and the Prevail Manager Intervention programmes has shown an overwhelming endorsement by staff and managers that the aims of the intervention programme have been met, the content of the intervention is fit for purpose, and the delivery of the programme is satisfactory.

We thought it useful to summarise with two comments from delegates:

  • The whole course was very informative and useful. It has encouraged myself to improve my mental health. It also allows me to help colleagues, friends and family.”

  • “I hoped to enjoy the course prior to joining and must say that I did. Interesting topics, good conversations, thought invoking case studies and a good pace all helped. Plus, the phrase ‘a sexy herd of zebras’ has never been said at any other course I’ve attended and was a highlight! Thank you.”

Part two. Changes in mental health literacy

The descriptive statistics for the sample, stratified by condition (active vs. control) and wave (pre-assessment or Wave 1 vs. post-assessment or Wave 2) are presented in Table 1. Chi-square tests did not reveal any significant differences (all ps > 0.05) between the groups on any of these variables. Unfortunately, the number of completed questionnaires was considerably below our expected levels, particularly for the control group in the second wave of data collection. This is likely to be because these staff and managers were not receiving the Prevail Intervention programme and may not have felt the need to complete the questionnaires on a repeat occasion.

Table 1 Demographic Information on RCT participants

The psychometric properties for the SASS scales were highly similar to a previous report of the properties of SASS in a workplace population [20]. This included the poor reliability of the Avoidance Scale, which was therefore omitted from further analysis.

Effects of prevail on attitudes: stigma and self-stigma scale (SASS)

To examine if the Prevail programme had significant effects upon mental health attitudes each of the scales of the SASS was examined in turn using univariate two by two analysis of variance (ANOVA), with factors of intervention condition (active vs. control) and wave (pre- vs. post-intervention). Prior to statistical analysis data were inspected for suitability for ANOVA and all were deemed to be acceptable.

Stigma to others. Stigma to others refers to a person’s negative beliefs about people with mental disorders (e.g. “People with mental disorders are weak”). The results are depicted in Fig. 4a which illustrates that there may be a modest effect of Prevail in reducing levels of stigma to others, but no effect in the control group. However, the main effects of intervention condition (F(1, 1020) = 0.28, p = .60) and wave (F(1, 1020) = 0.39, p = .52) were not significant, and neither was the intervention by wave interaction (F(1, 1020) = 0.42, p = .52). Hence, there was no evidence that Prevail had produced any change in people’s stigmatic attitudes about mental health to other people. However, it may be noteworthy that scores on this scale were very low in the pre-intervention (Wave 1) stage. Thus, the small reduction in stigmatic attitudes after Prevail which is apparent in Fig. 4 may have been subject to a floor effect (i.e., this was so low already it was not possible to bring it down still further; see Discussion).

Fig. 4
figure 4

Effects of Prevail on SASS scores. Error bars represent ± SEM.

Social Distance. Social distance is another form of stigma to others, but is more related to the “affective”, or emotional, component of stigma and how close people want to be to a person with a mental health problem (e.g. “If I were an employer, I would feel comfortable employing someone with a mental disorder” (reverse scored)). The Social Distance scale measures acceptance of people with mental health problems into their communities (be that the work-place, family/friends, or their local neighbourhood). The results are depicted in Fig. 4b which illustrates that the Prevail intervention reduced levels of Social Distance for the Prevail group (and, therefore, increased acceptance of people with mental health difficulties). However, surprisingly there also appears to have been a decrease in Social Distance in the control group. This is supported by the statistical analysis which found that there were main effects of intervention condition (F(1, 1022) = 6.49, p = .01) and of wave (F(1, 1022) = 4.33, p = .04). However, there was no significant intervention by wave interaction (F(1, 1022) = 0.25, p = .62). An a priori t-test showed that participants’ acceptance of people with mental health difficulties was increased by the Prevail programme (t(654) = 2.23, p = .03). This improvement over time did not reach significance for the control group (t(368) = 0.93, p = .35). Thus, Prevail was successful in increasing acceptance of (or decreasing social distance from) people with mental health problems.

Self-stigma. Self-stigma refers to what a person thinks about themselves if they have, or were to have, a mental health problem (e.g. “If I had a mental disorder, I would feel ashamed”). The results are depicted in Fig. 4c which illustrates that the Prevail intervention has reduced levels of Self-stigma for the Prevail group. This is supported by the statistical analysis which found that the main effect of intervention condition (F(1, 1022) = 5.25, p = .02) was significant while that of wave (F(1, 1022) = 3.15, p = .07) was marginally significant. As predicted, there was a significant intervention by wave interaction (F(1, 1022) = 5.13, p = .02). An a priori t-test showed that participants’ Self-stigma was reduced in the Prevail programme (t(654) = 3.23, p < .001) while there was no such reduction over time for the control group. Hence, the Prevail intervention was successful in reducing levels of self-stigma.

Anticipated stigma. Anticipated stigma refers to what people think other people would think about them if they have, or were to have, a mental health problem (e.g. “If I had a mental disorder, I would worry other people would think of me as a failure”). Anticipated Stigma is believed to be strongly associated with Self-stigma in that if a person believes negative things about themselves due to their mental health difficulty, they will also be highly likely to believe that others hold the same negative views of them. The results are depicted in Fig. 4d which illustrates that the Prevail intervention has reduced levels of Anticipated Stigma for the Prevail group. This is supported by the statistical analysis which found that the main effect of intervention condition was significant (F(1, 1016) = 8.84, p = .003) while that of wave (F(1, 1016) = 2.56, p = .11) was not significant. As predicted, there was a significant intervention by wave interaction (F(1, 1016) = 5.54, p = .02). An a priori t-test showed that participants’ Anticipated Stigma was reduced by the Prevail programme (t(650) = 3.03, p < .001) while there was no such reduction over time for the control group. Hence, the Prevail intervention was successful in reducing levels of Anticipated Stigma.

(Lack of) Disclosure/Help-seeking. The (lack of) Disclosure/help-seeking scale examines the reluctance of an individual to disclose or seek help for a mental health problem (e.g. “I would not feel comfortable discussing my mental health problems with a colleague”). The results are depicted in Fig. 4e which illustrates that the Prevail intervention decreased levels of Lack of help-seeking (i.e., increased disclosure about mental health difficulties and increased help-seeking behaviour for mental health difficulties). However, interestingly there also appears to have been an increase in help-seeking and disclosure in the control group. This is supported by the statistical analysis which found that there were main effects of intervention condition (F(1, 1020) = 7.66, p = .006) and of wave (F(1, 1020) = 5.73, p = .02). However, there was no significant intervention by wave interaction (F(1, 1020) = 0.76, p = .38). An a priori t-test showed that participants’ lack of help-seeking/disclosure was decreased by the Prevail programme (t(652) = 2.75, p = .006). This improvement in help-seeking and disclosure over time did not reach significance for the control group (t(368) = 0.93, p = .35). Thus, the Prevail intervention programme was successful in increasing help-seeking and disclosure.

The results show clear effects of the Prevail Intervention programme on levels of self-stigma and anticipated stigma. There were also significant reductions in levels of social distance, and (lack of) disclosure/help-seeking behaviours for those in the intervention arm of the study. However, there were also reductions in these scale scores for those in the control arm of the study. This latter effect was somewhat surprising. We suspect that these reductions in scores in the control participants were due to “leakage” of the Prevail Intervention to people in the control group. The implementation of Prevail within the organisation may have raised awareness of mental health issues in general, and it seems inevitable (and, perhaps, desirable) that people in the intervention arm of the study would have discussed the content and aims of the intervention with their colleagues, including those in the control arm. Hence, the impact of the Prevail Intervention was probably not strictly confined to those in the active arm of the study.

Part three. Sickness absence

Statistical methods

Chi-square analysis was performed to compare the active and control arms on demographic characteristics including age, gender, and directorate. Chi-square analysis and unadjusted odds ratios (OR) with 95% confidence intervals (95% CI) were used to compare the treatment arms on the number of “all sickness” and “mental disorder” days taken as sick leave between two time periods. Finally, Cochran-Mantel-Haenszel tests were employed to compare men and women on their respective “all sickness” and “mental disorder” days taken as sick leave from work. Frequency and percentage statistics were reported for each of the analyses in a cross-tabulation format. Statistical significance was assumed at an alpha value of 0.05 and all analyses were performed using SPSS Version 29 (Armonk, NY: IBM Corp.).

Statistical results

The results of the demographic variable comparisons are presented in Table 2. There were no differences between the active and control arms for age, p = .59, or gender, p = .25.

Table 2 Demographics and chi-square analysis for the participants in the RCT for sickness absence

For the analysis of summary sickness absences, there was a significantly higher proportion of “all sickness” absence days in the control group during the second period of observation (n = 1147, 58.4%) versus the active group (n = 817, 41.6%), Χ2(1) = 99.33, p < .001, OR 1.79, 95% CI 1.60–2.01. For “mental disorder” absences, there was also a significantly higher proportion of control group absent days (n = 311, 68.1%) versus the active group (n = 146, 31.9%), Χ2(1) = 79.06, p < .001, OR = 2.74, 95% CI 2.19–3.44. See Table 3 for the frequency statistics related to summary absences.

Table 3 Analysis of Summary Absences (days taken as sick leave)

For the comparison of gender related to absences, significant conditional independence was detected between females and males for “all absences,” Χ2(1) = 99.73, p < .001. Conditional independence was also detected between males and females for “mental health absences,” Χ2(1) = 131.80, p < .001. See Table 4 for the frequencies and percentages related to the Cochran-Mantel-Haenszel findings.

Table 4 Gender Analyses of Absences (days taken as sick leave)

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