See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/379726097

The efficacy of psychoeducation to improve personal skills and well-being

among health-care professionals returning to clinical practice: a pilot pre-
post study

Article in Journal of Mental Health Training · April 2024

DOI: 10.1108/JMHTEP-11-2022-0089

CITATIONS READS

0 24

9 authors, including:

Raul Szekely Anita Bignell

University of Surrey South London and Maudsley NHS Foundation Trust
5 PUBLICATIONS 5 CITATIONS 10 PUBLICATIONS 6 CITATIONS

SEE PROFILE SEE PROFILE

Hannah Iannelli Marta Ortega Vega

South London and Maudsley NHS Foundation Trust South London and Maudsley NHS Foundation Trust
18 PUBLICATIONS 27 CITATIONS 15 PUBLICATIONS 36 CITATIONS

SEE PROFILE SEE PROFILE

All content following this page was uploaded by Owen P. O'Sullivan on 10 April 2024.

The user has requested enhancement of the downloaded file.

The efficacy of psychoeducation to
improve personal skills and well-being
among health-care professionals returning
to clinical practice: a pilot pre-post study
Raul Szekely, Syrgena Mazreku, Anita Bignell, Camilla Fadel, Hannah Iannelli,
Marta Ortega Vega, Owen P. O’Sullivan, Claire Tiley and Chris Attoe

Abstract (Information about the

Purpose – Many health-care professionals leave clinical practice temporarily or permanently. authors can be found at the
Interventions designed to facilitate the return of health-care professionals fail to consider returners’ end of this article.)
psychosocial needs despite their importance for patient care. This study aims to evaluate the efficacy of a
psychoeducational intervention in improving personal skills and well-being among UK-based health-care
professionals returning to clinical practice.
Design/methodology/approach – In total, 20 health-care professionals took part in the one-day
intervention and completed measures of demographics, self-efficacy, positive attitudes towards work
and perceived job resources before and after the intervention. A baseline comparison group of 18 health-
care professionals was also recruited.
Findings – Significant associations were detected between return-to-work stage and study group.
Following the intervention, participants reported improvements in self-efficacy and, generally, perceived
more job resources, whereas positive attitudes towards work decreased. While none of these changes
were significant, the intervention was deemed acceptable by participants. This study provides modest
but promising evidence for the role of psychoeducation as a tool in supporting the psychosocial needs of
returning health-care professionals.
Research limitations/implications – Additional research is needed to clarify the reliability of
intervention effects, its effectiveness compared to alternative interventions, and the impact across
different subgroups of returning health-care professionals.
Practical implications – Return-to-practice interventions should address the psychosocial needs of
health-care professionals in terms of their personal skills and well-being. Psychoeducation can increase
self-efficacy and perceptions of job resources among returning health-care professionals. Received 4 November 2022
Revised 4 September 2023
Originality/value – This study sheds light on a relatively understudied, but fundamental area – the Accepted 1 March 2024
psychosocial challenges of health-care professionals returning to clinical practice – and further justifies
the need for tailored interventions. The authors specially thank the
whole team at Maudsley
Keywords Self-efficacy, Job resources, Health-care professionals, Psychoeducation, Learning and South London
Positive attitudes towards work, Return to clinical practice and Maudsley (SLaM) NHS
Foundation Trust for organising
Paper type Research paper the workshops and facilitating
access to participants. The
authors are also thankful to all
the participants for taking time
Background out of their busy schedules to
complete the survey and
The demand for medical care is growing across the world; yet, health-care systems are without whom this study would
not have been possible.
currently facing an unprecedented workforce crisis with shortages in key sectors of activity
Conflicts of interest: The
(Buchan et al., 2019; Cull et al., 2020; Jansen and Venter, 2015; Marchand and Peckham, authors have no conflicts of
2017). This crisis has been aggravated by the COVID-19 pandemic as the occupational interest to declare.

DOI 10.1108/JMHTEP-11-2022-0089 © Emerald Publishing Limited, ISSN 1755-6228 j THE JOURNAL OF MENTAL HEALTH TRAINING, EDUCATION AND PRACTICE j
 stress associated with the exposure to infected patients, lack of physical resources,
increased time pressure, poor communication and reduced participation in decision-
making has escalated the risk of sickness absence and turnover intention among health-
care staff (Liberati et al., 2021; van der Plaat et al., 2021).
In the UK, the National Health Service (NHS) reports higher rates of sickness absence
compared to the private sector and other public sector organisations (Office for National
Statistics, 2017). Health care is an occupation characterised by prolonged exposure to
excessive physical and psychological demands; therefore, professionals in this industry are
at risk of developing physical and mental ill-health (Demou et al., 2018; Imo, 2017; Zhou
et al., 2017). Indeed, mental health conditions (e.g. anxiety, depression) and
musculoskeletal conditions (e.g. back problems) are the leading causes of absenteeism in
the NHS (NHS Digital, 2020; Zhou et al., 2017). In turn, health-care professionals’ sickness
absence is associated with a myriad of negative outcomes, including increased pressure
on remaining staff, reduced patient care quality and mounting financial costs for the
organisation (Henderson et al., 2005; Whitaker, 2001). Official reports, for example, have
estimated that staff sickness alone cost the NHS more than £2.4bn each year (NHS
England, 2018).
Health-care professionals may also take time away from clinical practice for a variety of non-
health-related reasons. For instance, every year about 10% of speciality trainee doctors in
the UK are out of their approved programme to pursue research or further training, gain
additional clinical experience or have a planned career break (Health Education England,
2017; Valliani et al., 2011). Additionally, with the introduction of paternity and shared leave
options in the UK, more NHS staff are now able to take time off to manage their childcare
responsibilities (Academy of Medical Royal Colleges, 2016).
It becomes apparent that by facilitating the return of health-care professionals, the NHS
may promote staff retention, reduce recruitment costs and enhance the quality of patient
care (Bower et al., 2010; Burns et al., 2006; Guth et al., 2020). Current organisational
strategies have, however, focused less on the integration of returners as a potential strategy
for minimising the burden of the workforce crisis (NHS England, 2019). Nevertheless,
health-care professionals returning to clinical practice face unique psychosocial and
occupational challenges pertaining to personal skills and well-being, which, despite their
well-documented importance for patient care outcomes, are seldom reflected in return-to-
practice interventions (Attoe et al., 2022; Saunders et al., 2020).
For example, returning health-care professionals report reduced self-efficacy towards their
clinical and professional skills, which may fade after a period of clinical inactivity (Williams
et al., 2020). Moreover, health-care professionals who feel engaged with their work are likely
to return more quickly to practice and provide better care (Keyko et al., 2016). Similarly,
whether returning health-care professionals perceive their jobs and working conditions as
being resourceful (i.e. role autonomy, task variety, feedback, support) is also likely to
influence their return to practice (Haveraaen et al., 2016). However, irrespective of the
length and reason for absence, re-entering clinical practice is regarded as a challenging
experience; thus, it is without surprise that, alongside clinical skills re-training, there is an
accentuated need for psychosocial support and interventions among returning health-care
professionals (Brightwell et al., 2013; Henderson et al., 2012; Kenward et al., 2017; Payne,
2010).
Psychoeducation is an example of an evidence-based, cost-effective intervention that
equips the individual with the knowledge, skills and abilities to understand and manage
their personal and/or professional demands more effectively (Cummings and Cummings,
2008; Lukens and McFarlane, 2004). Psychoeducation can be delivered either individually
or in groups, and the content of the interventions can vary from passive activities (e.g.
informative leaflets, didactic sessions) to more active ones (e.g. peer discussions,

j THE JOURNAL OF MENTAL HEALTH TRAINING, EDUCATION AND PRACTICE j

self-reflection exercises, problem-solving techniques, goal setting) (Donker et al., 2009;
Jones and Robinson, 2000). This flexibility makes psychoeducation particularly well-suited
to address the needs and circumstances of health-care professionals.
Furthermore, a great deal of attention has been paid in recent years to the role of
psychoeducation as a tool for promoting well-being and preventing ill-health in the
workplace (Carolan et al., 2017; Ravalier et al., 2016). For instance, one meta-analytic
review provided evidentiary support for the effectiveness of brief psychoeducational
interventions in reducing perceived stress (van Daele et al., 2012). In addition, several
quasi-experimental or experimental studies showed that psychoeducation is associated
with increased job satisfaction in a general working population (Shimazu et al., 2005) and
decreased burnout (Yilmaz et al., 2009), reduced anxiety (Regehr et al., 2014) and
enhanced personal skills (McDonald et al., 2012) among health-care staff.
However, to date, and to the best of our knowledge, psychoeducation has not been
explored as an intervention for health-care professionals returning to clinical practice.
Additionally, the need for developing and evaluating such interventions among health-care
professionals returning to clinical practice is further justified by the methodological
inconsistencies and conflicting findings between studies addressing the impact of
psychoeducation on return-to-work outcomes among sick-listed employees (Højfeldt et al.,
2015; Pedersen et al., 2015).
In particular, Pedersen and colleagues (2015) asserted that psychoeducation decreases
the likelihood of an early return to work. However, return to (clinical) work is a multiphase,
dynamic process (Franche et al., 2007; Young et al., 2005), hence it is unlikely that a single
intervention will result in a complete return (Cullen et al., 2018). Moreover, in the study by
Pedersen et al. (2015), intervention effectiveness was inferred from the number of days until
the individual fully resumed work. Yet, this measure can be influenced by numerous factors
unrelated to the actual outcomes of the intervention. More plausibly, psychoeducation will
lead to changes in knowledge and attitudes towards work.
Building upon the readiness for return-to-work model (Franche et al., 2007) and the
ecological systems theory (Cummings and Cummings, 2008; Lukens and McFarlane,
2004), a tailored, theoretically and empirically-informed psychoeducational intervention has
been created to support the psychosocial needs of health-care professionals returning to
clinical practice after break or absence. As such, our aim was to conduct a pilot pre-post
study to assess the efficacy of the psychoeducational intervention in improving personal
skills and well-being among this group. We hypothesised that self-efficacy, positive
attitudes towards work and perceived job resources would increase after the intervention.

Methods
Design
This pilot study assessed the efficacy of a psychoeducational intervention in improving
personal skills and well-being. We used a questionnaire design with pre- and post-
intervention measurements among UK-based health-care professionals returning to clinical
practice.

Participants and procedure

An opportunity sampling strategy was used to recruit participants into this study. Health-
care professionals across NHS trusts and higher education institutions in the southeast of
England were invited to take part in a one-day intervention advertised as a free well-being
workshop for returning professionals. Recruitment was facilitated through various channels,
including training and education sessions, email circulars, professional networks and social
media platforms.

j THE JOURNAL OF MENTAL HEALTH TRAINING, EDUCATION AND PRACTICE j

 Prior to the intervention, participants had the opportunity to read an information sheet about
the study and provided informed consent if they wished to take part. They were informed
about the voluntary nature of their participation, the confidentiality of their answers, as well
as their right to withdraw.
Participants were considered eligible for our study if they had either returned to clinical practice
within the 12 months preceding the study after a minimum break or absence of at least 3 months,
or if they were in the process of preparing to return within the next 6 months following a minimum
3-month break or absence from work. This ensured a long enough time away from work to
capture the potential challenges and needs associated with re-entering the clinical setting.
In total, 20 health-care professionals took part in the intervention and in our study, and they
completed a battery of psychological and occupational measures on two occasions, before
and after the intervention, via an online survey platform (Qualtrics). To ensure a robust
baseline for comparison, a group consisting of 18 health-care professionals was also
recruited. They completed pre-intervention measures only and did not participate in the
intervention. In total, 38 participants, 20 in the intervention group and 18 in the comparison
group, completed measures on at least one occasion.

Measures

Demographic characteristics. Participants were asked to provide information about their

age, gender, ethnicity, current role, speciality, years of professional experience and
absence history. Participants were also asked to self-assess their return-to-practice stage
based on the readiness for return-to-work model (Table 1).
Positive attitudes towards work. Positive work-related attitudes were measured using the Utrecht
Work Engagement Scale (UWES; Schaufeli and Bakker, 2003). The instrument is composed of 17
items, covering three dimensions: vigour, dedication and absorption. Some examples include “At
my job, I am very resilient, mentally” and “Time flies when I am working”. Participants were asked
to rate on a seven-point scale how often they experience these statements from 0 (never) to 6
(always/every day). The total score was obtained by averaging all item responses. The UWES
displays very good internal consistency (Cronbach’s alpha 0.88 – 0.94) and acceptable test-retest
reliability (correlation coefficients 0.60 – 0.70) (Mauno et al., 2007; Mills et al., 2012).
Self-efficacy. The New General Self-Efficacy (NGSE) Scale was used to assess health-care
professionals’ belief in their ability to effectively perform tasks upon their return to practice
(Chen et al., 2001). The instrument has eight items measured on a five-point response scale
from 1 (strongly disagree) to 5 (strongly agree). Some examples include “I am confident
that I can perform effectively on many different tasks” and “Compared to other people, I can

Table 1 Stages of return to practice adapted from the readiness for return-to-work model
(Franche et al., 2007)
Stage General description

Precontemplation The health-care professional is currently off work and not thinking
about returning to clinical practice
Contemplation The health-care professional is currently off work but considers
returning to clinical practice in the foreseeable future
Preparation for action The health-care professional is still off work but makes active plans to
return to clinical practice in the near future
Action The health-care professional has recently returned to clinical practice
in some capacity and is trying to adapt to change
Maintenance The health-care professional has returned to clinical practice in full
capacity and is maintaining their work-related goals
Source: Tables by the authors

j THE JOURNAL OF MENTAL HEALTH TRAINING, EDUCATION AND PRACTICE j

do most tasks very well”. The NGSE scale demonstrates a good degree of internal
consistency (Cronbach’s alpha ranging from 0.83 to 0.86) (Chen et al., 2004; Scherbaum
et al., 2006).
Perceived job resources. The Job Demands-Resources Scale (JDRS) was adapted to
measure perceived job demands and job resources as proxies for the psychosocial
working conditions of health-care professionals (Rothmann et al., 2006). The JDSR is a 40-
item questionnaire covering seven dimensions: job insecurity, growth opportunities,
relationships with colleagues, rewards, overload, control and organisational support. Items
are rated on a four-point Likert scale from 1 (never) to 4 (always) with examples including
“Do you work under time pressure?”, “Does your job offer you opportunities for personal
growth and development?”. Psychometric evaluations of the JDRS indicate good to very
good levels of internal consistency, with Cronbach’s alpha ranging from 0.76 to 0.92 for
each subscale of the instrument (Braine and Roodt, 2011; Rothmann et al., 2006).
Acceptability. To assess the acceptability of the psychoeducational intervention,
participants were asked to rate on a five-point Likert scale (1 – extremely likely, 5 –
extremely unlikely) how likely they are to recommend the workshop to a colleague or friend,
based on their experience.

Intervention
Experts in clinical education, occupational health and organisational psychology from Maudsley
Learning, the education and training arm of the South London and Maudsley NHS Foundation
Trust, developed a tailored psychoeducational intervention to support the psychosocial needs
of health-care professionals returning to clinical practice. Psychoeducation is an evidence-
based practice that equips individuals to better manage personal and/or professional demands
and has been previously shown to improve health and well-being across various settings
(Carolan et al., 2017; Ravalier et al., 2016).
The psychoeducational intervention was delivered online, via a videoconferencing platform
(Zoom), by experienced facilitators on three occasions between March and June 2021. The
one-day workshop consisted of reflective exercises, group discussion and personal case
studies. The intervention covered three main themes reflecting emerging research: self-
care, identity and personal reflection and group care and relationships (Attoe et al., 2022).
These themes were carefully selected to address the multifaceted challenges and concerns
that health-care professionals experience during their return to clinical practice. See Table 2
for the structure and content of the intervention.

Ethics
The study was conducted following the British Psychological Society (2021) Code of Human
Research Ethics, and all data were coded for anonymity and securely stored on password-
protected devices. Ethical approval was provided by the Psychiatry, Nursing and Midwifery
Research Ethics Subcommittee at King’s College London on behalf of the Health Research
Authority.

Statistical analysis
Prior to analysis, the data set was screened for entry errors and missing data. The
significance level has been set at 0.05, and data were analysed using an open-source
statistical package (jamovi). Descriptive statistics were computed, and the Chi-squared test
of association was applied to determine whether there is any relationship between each
demographic category and the intervention and comparison groups. An independent-
samples analysis was conducted to compare the mean baseline differences in the variables
of interest between the two groups. Given that self-efficacy, positive attitudes towards work

j THE JOURNAL OF MENTAL HEALTH TRAINING, EDUCATION AND PRACTICE j

 Table 2 Structure and content of the psychoeducational intervention
Session title Main themes covered Examples of activities

Welcome 䊏 Introduction Ice breakers, TED talks, book

䊏 Pre-workshop evaluation recommendations, peer
䊏 Preparing for re-entering clinical practice support/community groups
Session A – Self-care 䊏 The concept of individual wellbeing Psychoeducation, group
䊏 The working environment and areas of discussions, vignettes,
concern for returning to practice reflective exercises
䊏 Burnout and the resilience to bounce back
䊏 Life stressors
䊏 Absenteeism and presenteeism
Session B – Identity and 䊏 Rediscovering and redefining your Value identification, lifeline
personal reflection professional self exercise, coaching wheel,
䊏 Imposter syndrome visualisation
䊏 SMART goals for returning to practice
䊏 Setting boundaries and expectations
Session C – Group care 䊏 Psychological safety at work, kindness and Speaker-listener
and relationships compassion communication exercise,
䊏 Communication challenges vignettes, reflection
䊏 Teamwork
䊏 Active listening
Closing 䊏 Takeaway messages Further resources and support
䊏 Feedback
䊏 Post-workshop evaluation
Source: Tables by the authors

and perceived job resources scores did not meet the distributional assumptions of
normality, the Mann–Whitney U Test was conducted. A paired-samples analysis was then
used to compare mean differences before and after the intervention in the intervention
group. As the mean differences between paired observations violated the assumptions of
normality, the Wilcoxon Signed-Rank Test was run instead. Rank biserial correlations were
computed to estimate the effect size.

Results
The 38 participants had a mean age of 43 years (SD 10.4); 89.5% were women. In total,
18.4% were speciality trainee doctors, 15.8% consultants, 13.2% foundation doctors, 7.9%
nurses, 5.3% allied health professionals, 5.3% core trainee doctors, whereas the majority
(34.2%) had other occupational roles within health care. Most participants (50.0%) had
been away from clinical work for 12 months or more, while 28.9% had been away for less
than 6 months. The most common reasons for absence were health-related (44.7%),
personal reasons (39.5%) and professional reasons (15.8%).
As outlined in Table 3, there were statistically significant associations between return-to-
practice stage and group, x2 (3, N ¼ 38) ¼ 8.42, p ¼ 0.04. Participants in the intervention
group were more likely to be in the “action” stage of the return, whereas those in the
comparison group were more likely to prepare for action. All other associations were non-
significant.
In addition, no statistically significant differences in self-efficacy (U ¼ 125, rrb ¼ 0.31, p ¼
0.45), positive attitudes towards work (U ¼ 119, rrb ¼ 0.34, p ¼ 0.07) and perceived job
resources (U ¼ 141, rrb ¼ 0.22, p ¼ 0.25) were detected between the intervention and
comparison groups at baseline.
Table 4 shows the Wilcoxon Signed-Rank comparisons of participants’ scores of self-efficacy,
perceived job resources and positive attitudes towards work before and after the intervention.
Participants reported higher self-efficacy scores after the intervention (Mafter ¼ 3.87) when

j THE JOURNAL OF MENTAL HEALTH TRAINING, EDUCATION AND PRACTICE j

 Table 3 Descriptive statistics and chi-squared test of association for the demographic characteristics of the sample by
group
Intervention (N ¼ 20) Control (N ¼ 18)
Demographic category n % of total n % of total x2 (df) p

Gender 0.89 (1) 0.34

Female 17 85.0 17 94.4
Male 3 15.0 1 5.6
Ethnicity 2.44 (4) 0.66
White 12 60.0 11 61.1
Mixed or multiple ethnic backgrounds 1 5.0 – 0.0
Asian or Asian British 5 25.0 3 16.7
Black or Black British 1 5.0 3 16.7
Other ethnic group 1 5.0 1 5.6
Years of professional experience 6.63 (6) 0.36
<1 year – 0.0 3 16.7
1–2 years 1 5.0 – 0.0
2–3 years 1 5.0 2 11.1
3–4 years 1 5.0 1 5.6
4–5 years – 0.0 1 5.6
5–6 years 1 5.0 1 5.6
6þ years 16 80.0 10 55.6
Current role 10.8 (6) 0.09
Foundation doctor 2 10.0 3 16.7
Core trainee – 0.0 2 11.1
Speciality trainee 7 35.0 – 0.0
Consultant 4 20.0 2 11.1
Nurse 1 5.0 2 11.1
Allied health professional 1 5.0 1 5.6
Other (e.g. clinical research, management, etc.) 5 25.0 8 44.4
Return-to-practice stage 8.42 (3) 0.04
Precontemplation – 0.0 – 0.0
Contemplation – 0.0 2 11.1
Preparation for action 9 45.0 7 38.9
Action 11 55.0 5 27.8
Maintenance – 0.0 4 22.2
Reason for absence 3.71 (2) 0.16
Personal reason 10 50.0 5 27.8
Health-related reason 6 30.0 11 61.1
Professional reason 4 20.0 2 11.1
Length of absence 0.57 (3) 0.90
3–6 months 6 30.0 5 27.8
6–12 months 2 10.0 1 5.6
>12 months 10 50.0 9 50.0
Not disclosed 2 10.0 3 16.7
Any other episodes of absence from clinical work 3.14 (1) 0.08
Yes 10 50.0 4 22.2
No 10 50.0 14 77.8
Notes: n = subsample size; x2 = Chi-squared test of association statistic; df = degrees of freedom p = probability
Source: Tables by the authors

compared to the scores before (Mbefore ¼ 3.80). However, this difference was not statistically
significant (W ¼ 42, rrb ¼ 0.08, p ¼ 0.42). After the intervention, participants also perceived
greater job control (Mafter ¼ 2.69, Mbefore ¼ 2.66, W ¼ 44.5, rrb ¼ 0.15, p ¼ 0.31), rewards
(Mafter ¼ 2.54, Mbefore ¼ 2.45, W ¼ 14, rrb ¼ 0.50, p ¼ 0.09) and growth opportunities
(Mafter ¼ 2.77, Mbefore ¼ 2.76, W ¼ 47.5, rrb ¼ 0.10, p ¼ 0.39), but these differences were

j THE JOURNAL OF MENTAL HEALTH TRAINING, EDUCATION AND PRACTICE j

 Table 4 Wilcoxon Signed-Rank test results comparing scores of self-efficacy, positive
attitudes towards work and perceived job resources before and after the
intervention
Before After
Measure M SD M SD W p Rrb

Self-efficacy (NGSE) 3.80 0.61 3.87 0.55 42.0 0.42 0.08

Positive attitudes towards work (UWES) 4.79 1.00 4.62 1.20 139.0 0.96 0.46
Vigour 4.58 1.10 4.48 1.20 83.0 0.79 0.22
Dedication 5.02 1.10 4.90 1.20 99.0 0.86 0.30
Absorption 4.81 1.10 4.53 1.20 160.5 0.98 0.52
Perceived job resources (JDRS) 2.69 0.43 2.68 0.42 96.5 0.70 0.13
Organisational support 2.67 0.51 2.63 0.57 78.0 0.70 0.15
Growth opportunities 2.76 0.60 2.77 0.52 47.5 0.39 0.10
Relationships with colleagues 3.07 0.55 2.97 0.60 23.5 0.96 0.70
Control 2.66 0.36 2.69 0.45 44.5 0.31 0.15
Rewards 2.44 0.84 2.54 0.80 14.0 0.09 0.50
Note: M = mean; SD – standard deviation; W = Wilcoxon Signed-Rank Test statistic; p = probability;
rrb = rank biserial correlation (effect size)
Source: Tables by the authors

not significant. Perceived relationships with colleagues (Mafter ¼ 2.97, Mbefore ¼ 3.07, W ¼
23.5, rrb ¼ 0.70, p ¼ 0.96) and organisational support (Mafter ¼ 2.63, Mbefore ¼ 2.67, W ¼ 78,
rrb ¼ 0.15, p ¼ 0.70) decreased non-significantly after the intervention. Then, in terms of
positive attitudes towards work, participants reported lower scores on the vigour (Mafter ¼
4.48, Mbefore ¼ 4.58, W ¼ 83, rrb ¼ 0.22, p ¼ 0.79), dedication (Mafter ¼ 4.90, Mbefore ¼ 5.02,
W ¼ 99, rrb ¼ 0.30, p ¼ 0.86) and absorption (Mafter ¼ 4.53, Mbefore ¼ 4.81, W ¼ 160.5, rrb ¼
0.52, p ¼ 0.98) subscales; however, these results did not reach statistical significance.
Finally, when asked to evaluate the acceptability of the psychoeducational intervention,
85% of participants reported that they were likely or extremely likely to recommend the
intervention to a colleague or friend, x2 (4, N ¼ 20) ¼ 18.0, p < 0.01.

Discussion
This pilot study evaluated the efficacy of a tailored psychoeducational intervention to
improve personal skills and well-being among health-care professionals who have recently
returned to clinical practice or are currently preparing to return following absence or break.
The impact of the intervention was assessed through three main outcome measures: self-
efficacy, positive attitudes towards work and perceived job resources.
Following the intervention, participants showed improvements in self-efficacy scores. A lack
of confidence in personal and professional skills among returning health-care professionals
has been highlighted as an area of concern in the literature, with implications for care
quality (Health Education England, 2017). As expected, and in line with previous work,
psychoeducation was found to increase – although only marginally – self-efficacy among
our participants (Shimazu et al., 2005). Providing health-care professionals with information
on returning to clinical work, facilitating group discussions and encouraging them to set
goals has positively influenced the cognitive appraisal process leading to improved general
self-efficacy post-intervention.
Unexpectedly, and contrary to previous studies finding positive or even neutral effects,
participants in our study showed a decrease across all subscales of work engagement as
an indicator of work-related attitudes (Keyko et al., 2016). Positive attitudes towards work
are key determinants of workplace behaviour; therefore, it is essential for returning health-
care professionals to feel engaged with their work to successfully readjust to the work
environment and provide a good standard of patient care (Freeney and Fellenz, 2013;

j THE JOURNAL OF MENTAL HEALTH TRAINING, EDUCATION AND PRACTICE j

Loerbroks et al., 2017). However, the observed decrease can be explained by several
factors, such as the depletion of resources associated with thinking about work during non-
work time or the demographic composition of the intervention group which mainly consisted
of health-care professionals who were absent from work due to personal reasons and for
more than 12 months.
Furthermore, following the intervention, participants perceived greater job resources
including greater job control, rewards and growth opportunities. Generally, health-care
professionals working in resourceful jobs tend to be more satisfied with their work and
deliver better care (Gregory and Demartini, 2017; Teoh et al., 2019). Our findings are
aligned to the wider training and social exchange literature, research suggesting that
workers (in this case, health-care professionals) who perceive greater opportunities for skill
development in the workplace are more committed to their work and organisation as a
reciprocity response (Guglielmi et al., 2019). In turn, committed workers are more likely to
ask for feedback, seek new development opportunities and perform better in their jobs,
initiating, together with the actual resource gain arising from learning activities, an upward
gain cycle of individual and job resources. Nonetheless, the post-intervention improvements
seen in most, but not all, job resources were not statistically significant.
Our study poses a few methodological limitations which should be considered when
interpreting its results. Firstly, the reduced sample size due to the opportunistic nature of
the intervention and the impact of the COVID-19 outbreak on research recruitment limits
the generalisability of the findings. Secondly, the pre-post design does not ensure direct
causality as it is not clear whether the observed changes are due to the psychoeducational
intervention itself or are caused by some other unaccounted effects. Thirdly, psychosocial
needs and intervention outcomes might differ between different occupational groups and
between different reasons for absence, but the by existing sampling issues did not allow
for any rigorous sub-group comparisons to be conducted. Instead, these provide scope
for future studies with improved sampling strategies. Importantly, participants in the
intervention group were more likely to be already back to clinical work before the
intervention, whereas participants in the comparison group were more likely to be in
the “preparation for action” stage. It is, thus, possible that the psychoeducational
intervention would have greater benefit for those health-care professionals preparing to
return to practice and those with greater needs in relation to their personal skills and
well-being than those who have already returned.
A number of strengths must also be emphasised. First and foremost, we propose an
acceptable psychoeducational intervention that health-care supervisors and occupational
health practitioners could easily implement in their daily work to facilitate the transition of
health-care professionals back to clinical duties. The intervention was developed by a team
of specialists in clinical education and organisational psychology drawing upon their
professional expertise and adopting an evidence-based approach, aligning with wider
efforts in the health-care community to enhance education and training quality. Our study
demonstrates methodological rigour given the use of valid and reliable psychological and
occupational measures that were relevant markers of efficacy in the context of our
intervention. Lastly, we were able to make important contributions to health-care training,
education and practice as we shed light on a relatively understudied, but fundamental
area – the psychosocial challenges of health-care professionals returning to clinical
practice – and further justify the need for tailored interventions.
Bearing these points in mind, we argue that our study has provided some modest, but
promising evidence for the efficacy (and acceptability) of psychoeducational interventions
in improving personal skills and well-being among health-care professionals returning to
practice and their potential use in the clinical workplace. We have seen that
psychoeducation increases self-efficacy in returning health-care professionals, as well as

j THE JOURNAL OF MENTAL HEALTH TRAINING, EDUCATION AND PRACTICE j

 positively influences their perception of job resources. Yet, existing study limitations warrant
caution in interpreting these findings and further research work is required.

References
Academy of Medical Royal Colleges (2016), “Maternity/paternity survey results”, available at: https://
aomrc.org.uk/wp-content/uploads/2016/06/Maternity_paternity_survey_200416-1.pdf

Attoe, C., Matei, R., Thompson, L., Teoh, K., Cross, S. and Cox, T. (2022), “Returning to clinical work and
doctors’ personal, social and organisational needs: a systematic review”, BMJ Open, Vol. 12 No. 5,
p. e053798, doi: 10.1136/bmjopen-2021-053798.
Bower, E.A., English, C., Choi, D., Cedfeldt, A.S. and Girard, D.E. (2010), “Education to return
nonpracticing physicians to clinical activity: a case study in physician reentry”, Journal of Continuing
Education in the Health Professions, Vol. 30 No. 2, pp. 89-94, doi: 10.1002/chp.20064.

Braine, R.D. and Roodt, G. (2011), “The job demands-resources model as predictor of work identity and
work engagement: a comparative analysis”, SA Journal of Industrial Psychology, Vol. 37 No. 2, pp. 52-62,
doi: 10.4102/sajip.v37i2.889.
Brightwell, A., Minson, S., Ward, A. and Fertleman, C. (2013), “Returning to clinical training after maternity
leave”, BMJ, Vol. 347, pp. 1-3, doi: 10.1136/bmj.f5965.
British Psychological Society (2021), “Code of human research ethics”, available at: www.bps.org.uk/
guideline/bps-code-human-research-ethics

Buchan, J., Gershlick, B., Charlesworth, A. and Seccombe, I. (2019), “Falling short: the NHS workforce
challenge. Workforce profile and trends of the NHS in England”, The Health Foundation, available at:
www.health.org.uk/publications/reports/falling-short-the-nhs-workforce-challenge
Burns, H.K., Sakraida, T.J., Englert, N.C., Hoffmann, R.L., Tuite, P. and Foley, S.M. (2006), “Returning
nurses to the workforce: developing a fast track back program”, Nursing Forum, Vol. 41 No. 3,
pp. 125-132, doi: 10.1111/j.1744-6198.2006.00048.x.

Carolan, S., Harris, P.R. and Cavanagh, K. (2017), “Improving employee well-being and effectiveness:
systematic review and meta-analysis of web-based psychological interventions delivered in the
workplace”, Journal of Medical Internet Research, Vol. 19 No. 7, p. e271, doi: 10.2196/jmir.7583.
Chen, G., Gully, S.M. and Eden, D. (2001), “Validation of a new general self-efficacy scale”,
Organizational Research Methods, Vol. 4 No. 1, pp. 62-83, doi: 10.1177/109442810141004.
Chen, G., Gully, S.M. and Eden, D. (2004), “General self-efficacy and self-esteem: toward theoretical and
empirical distinction between correlated self-evaluations”, Journal of Organizational Behavior, Vol. 25
No. 3, pp. 375-395, doi: 10.1002/job.251.
Cull, J., Hunter, B., Henley, J., Fenwick, J. and Sidebotham, M. (2020), “Overwhelmed and out of my
depth”: responses from early career midwives in the United Kingdom to the work, health and emotional
lives of midwives study”, Women and Birth, Vol. 33 No. 6, pp. e549-e557, doi: 10.1016/j.
wombi.2020.01.003.
Cullen, K.L., Irvin, E., Collie, A., Clay, F., Gensby, U., Jennings, P.A., Hogg-Johnson, S., Kristman, V.,
Laberge, M., McKenzie, D. and Newnam, S. (2018), “Effectiveness of workplace interventions in return-
to-work for musculoskeletal, pain-related and mental health conditions: an update of the evidence and
messages for practitioners”, Journal of Occupational Rehabilitation, Vol. 28 No. 1, pp. 1-15, doi: 10.1007/
s10926-016-9690-x.
Cummings, N.A. and Cummings, J.L. (2008), “Psychoeducation in conjunction with psychotherapy
practice”, in O’Donohue, W. and Cummings, N.A. (Eds), Evidence-Based Adjunctive Treatments,
Academic Press, New York, NY, pp. 41-60, doi: 10.1016/B978-012088520-6.50004-4.

Demou, E., Smith, S., Bhaskar, A., Mackay, D.F., Brown, J., Hunt, K., Vargas-Prada, S. and Macdonald,
E.B. (2018), “Evaluating sickness absence duration by musculoskeletal and mental health issues: a
retrospective cohort study of Scottish healthcare workers”, BMJ Open, Vol. 8 No. 1, p. e018085, doi:
10.1136/bmjopen-2017-018085.
Donker, T., Griffiths, K.M., Cuijpers, P. and Christensen, H. (2009), “Psychoeducation for depression,
anxiety and psychological distress: a meta-analysis”, BMC Medicine, Vol. 7 No. 1, pp. 1-9, doi: 10.1186/
1741-7015-7-79.

j THE JOURNAL OF MENTAL HEALTH TRAINING, EDUCATION AND PRACTICE j

Franche, R.L., Corbière, M., Lee, H., Breslin, F.C. and Hepburn, C.G. (2007), “The readiness for return-to-
work (RRTW) scale: development and validation of a self-report staging scale in lost-time claimants with
musculoskeletal disorders”, Journal of Occupational Rehabilitation, Vol. 17 No. 3, pp. 450-472, doi:
10.1007/s10926-007-9097-9.
Freeney, Y. and Fellenz, M.R. (2013), “Work engagement as a key driver of quality of care: a study with
midwives”, Journal of Health Organization and Management, Vol. 27 No. 3, pp. 330-349, doi: 10.1108/
jhom-10-2012-0192.
Gregory, S. and Demartini, C. (2017), “Satisfaction of doctors with their training: evidence from UK”, BMC
Health Services Research, Vol. 17 No. 1, pp. 1-8, doi: 10.1186/s12913-017-2792-0.
Guglielmi, D., Gallı̀, L., Simbula, S. and Mazzetti, G. (2019), “Gain cycles in healthcare workers: the role of
job resources and hardy personality”, International Journal of Workplace Health Management, Vol. 12
No. 2, pp. 71-84, doi: 10.1108/IJWHM-10-2017-0086.
Guth, T.A., Luber, S.D., Marcolini, E. and Lo, B.M. (2020), “Physician Reentry–a timely topic for
emergency medicine”, Journal of the American College of Emergency Physicians Open, Vol. 1 No. 6,
pp. 1614-1622, doi: 10.1002/emp2.12317.
Haveraaen, L.A., Skarpaas, L.S., Berg, J.E. and Aas, R.W. (2016), “Do psychological job demands,
decision control and social support predict return to work three months after a return-to-work (RTW)
programme? The rapid-RTW cohort study”, Work, Vol. 53 No. 1, pp. 61-71, doi: 10.3233/WOR-152216.
Health Education England (2017), “Supported return to training”, available at: www.hee.nhs.uk/sites/
default/files/documents/Supported%20Return%20to%20Training.pdf

Henderson, M., Glozier, N. and Elliott, K.H. (2005), “Long term sickness absence”, BMJ, Vol. 330
No. 7495, pp. 802-803, doi: 10.1136/bmj.330.7495.802.
Henderson, M., Brooks, S.K., Del Busso, L., Chalder, T., Harvey, S.B., Hotopf, M., Madan, I. and Hatch, S.
(2012), “Shame! Self-stigmatisation as an obstacle to sick doctors returning to work: a qualitative study”,
BMJ Open, Vol. 2 No. 5, p. e001776, doi: 10.1136/bmjopen-2012-001776.
Højfeldt, L.H., Pedersen, P., Petersen, K.S. and Andersen, L.P. (2015), “Psychoeducation: perspectives
from individuals on sick leave who are at risk of having a mental disorder”, Nordic Journal of Social
Research, Vol. 6 No. 1, pp. 184-200, doi: 10.7577/njsr.2089.
Imo, U.O. (2017), “Burnout and psychiatric morbidity among doctors in the UK: a systematic literature
review of prevalence and associated factors”, BJPsych Bulletin, Vol. 41 No. 4, pp. 197-204, doi: 10.1192/
pb.bp.116.054247.

Jansen, R. and Venter, I. (2015), “Psychiatric nursing: an unpopular choice”, Journal of Psychiatric and
Mental Health Nursing, Vol. 22 No. 2, pp. 142-148, doi: 10.1111/jpm.12138.
Jones, K.D. and Robinson, E.M. (2000), “Psychoeducational groups: a model for choosing topics and
exercises appropriate to group stage”, The Journal for Specialists in Group Work, Vol. 25 No. 4,
pp. 356-365, doi: 10.1080/01933920008411679.
Kenward, G., Marshall, S. and Irvine, K. (2017), “How much is enough? Using Delphi to explore the
clinical-contact-time and return-to-practice needs of military nurses”, Nursing Management, Vol. 24
No. 2, pp. 20-24, doi: 10.7748/nm.2017.e1574.
Keyko, K., Cummings, G.G., Yonge, O. and Wong, C.A. (2016), “Work engagement in professional
nursing practice: a systematic review”, International Journal of Nursing Studies, Vol. 61, pp. 142-164, doi:
10.1016/j.ijnurstu.2016.06.003.

Liberati, E., Richards, N., Willars, J., Scott, D., Boydell, N., Parker, J., Pinfold, V., Martin, G., Dixon-Woods,
M. and Jones, P.B. (2021), “A qualitative study of experiences of NHS mental healthcare workers during
the covid-19 pandemic”, BMC Psychiatry, Vol. 21 No. 1, pp. 1-12, doi: 10.1186/s12888-021-03261-8.
Loerbroks, A., Glaser, J., Vu-Eickmann, P. and Angerer, P. (2017), “Physician burnout, work engagement and
the quality of patient care”, Occupational Medicine, Vol. 67 No. 5, pp. 356-362, doi: 10.1093/occmed/kqx051.
Lukens, E.P. and McFarlane, W.R. (2004), “Psychoeducation as evidence-based practice:
considerations for practice, research, and policy”, Brief Treatment and Crisis Intervention, Vol. 4 No. 3,
pp. 205-225, doi: 10.1093/brief- treatment/mhh019.
McDonald, G., Jackson, D., Wilkes, L. and Vickers, M.H. (2012), “A work-based educational intervention
to support the development of personal resilience in nurses and midwives”, Nurse Education Today,
Vol. 32 No. 4, pp. 378-384, doi: 10.1016/j.nedt.2011.04.012.

j THE JOURNAL OF MENTAL HEALTH TRAINING, EDUCATION AND PRACTICE j

 Marchand, C. and Peckham, S. (2017), “Addressing the crisis of GP recruitment and retention: a
systematic review”, British Journal of General Practice, Vol. 67 No. 657, pp. e227-e237, doi: 10.3399/
bjgp17X689929.
Mauno, S., Kinnunen, U. and Ruokolainen, M. (2007), “Job demands and resources as antecedents of
work engagement: a longitudinal study”, Journal of Vocational Behavior, Vol. 70 No. 1, pp. 149-171, doi:
10.1016/j.jvb.2006.09.002.

Mills, M.J., Culbertson, S.S. and Fullagar, C.J. (2012), “Conceptualizing and measuring engagement: an
analysis of the Utrecht work engagement scale”, Journal of Happiness Studies, Vol. 13 No. 3,
pp. 519-545, doi: 10.1007/s10902-011-9277-3.
NHS Digital (2020), “NHS sickness absence rates - October 2019 to December 2019”, available at:
https://digital.nhs.uk/data-and-information/publications/statistical/nhs-sickness-absence-rates/october-2019-
to-december-2019-provisional-statistics
NHS England (2018), “NHS staff health & wellbeing: CQUIN 2017-19 indicator 1 implementation
support”, available at: www.england.nhs.uk/wp-content/uploads/2018/05/staff-health-wellbeing-cquin-
2017-19-implementation-support.pdf
NHS England (2019), “The NHS long term plan”, available at: www.longtermplan.nhs.uk/wp-content/
uploads/2019/01/nhs-long-term-plan-june-2019.pdf
Office for National Statistics (2017), “Sickness absence in the UK labour market: 2016”,
available at: www.ons.gov.uk/employmentandlabourmarket/peopleinwork/labourproductivity/
articles/sicknessabsenceinthelabourmarket/2016
Payne, S. (2010), “Why midwives fail to stay in practice following a return to practice course”, British
Journal of Midwifery, Vol. 18 No. 6, pp. 376-381, doi: 10.12968/bjom.2010.18.6.48311.
Pedersen, P., Søgaard, H.J., Labriola, M., Nohr, E.A. and Jensen, C. (2015), “Effectiveness of
psychoeducation in reducing sickness absence and improving mental health in individuals at risk of
having a mental disorder: a randomised controlled trial”, BMC Public Health, Vol. 15 No. 1, pp. 1-12, doi:
10.1186/s12889-015-2087-5.
Ravalier, J.M., Wegrzynek, P. and Lawton, S. (2016), “Systematic review: complementary therapies and
employee well-being”, Occupational Medicine, Vol. 66 No. 6, pp. 428-436, doi: 10.1093/occmed/kqw047.
Regehr, C., Glancy, D., Pitts, A. and LeBlanc, V.R. (2014), “Interventions to reduce the consequences of
stress in physicians: a review and meta-analysis”, Journal of Nervous & Mental Disease, Vol. 202 No. 5,
pp. 353-359, doi: 10.1097/NMD.0000000000000130.
Rothmann, S., Mostert, K. and Strydom, M. (2006), “A psychometric evaluation of the job demands-
resources scale in South Africa”, SA Journal of Industrial Psychology, Vol. 32 No. 4, pp. 76-86, doi:
10.4102/sajip.v32i4.239.
Saunders, A., Brooks, J., El Alami, W., Jabur, Z., Laws-Chapman, C., Schilderman, M., Tooley, C. and
Attoe, C. (2020), “Empowering healthcare professionals to return to work through simulation training:
addressing psychosocial needs”, BMJ Simulation and Technology Enhanced Learning, Vol. 6 No. 6,
pp. 1-3, doi: 10.1136/bmjstel-2019-000566. doi

Schaufeli, W.B. and Bakker, A.B. (2003), “Utrecht work engagement scale: preliminary manual”,
Occupational Health Psychology Unit, Utrecht University, available at: www.wilmarschaufeli.nl/
publications/Schaufeli/Test%20Manuals/Test_manual_UWES_English.pdf
Scherbaum, C.A., Cohen-Charash, Y. and Kern, M.J. (2006), “Measuring general self- efficacy: a
comparison of three measures using item response theory”, Educational and Psychological
Measurement, Vol. 66 No. 6, pp. 1047-1063, doi: 10.1177/0013164406288171.
Shimazu, A., Kawakami, N., Irimajiri, H., Sakamoto, M. and Amano, S. (2005), “Effects of web-based
psychoeducation on self-efficacy, problem solving behavior, stress responses and job satisfaction
among workers: a controlled clinical trial”, Journal of Occupational Health, Vol. 47 No. 5, pp. 405-413, doi:
10.1539/joh.47.405.
Teoh, K., Hassard, J. and Cox, T. (2019), “Doctors’ perceived working conditions and the quality of
patient care: a systematic review”, Work & Stress, Vol. 33 No. 4, pp. 385-413, doi: 10.1080/
02678373.2019.1598514.
Valliani, T., Khan, M., Lockett, M. and Tham, T.C. (2011), “Out of programme experience and training:
going away to bring something back”, Frontline Gastroenterology, Vol. 2 No. 1, pp. 43-44, doi: 10.1136/
fg.2010.002931.

j THE JOURNAL OF MENTAL HEALTH TRAINING, EDUCATION AND PRACTICE j

 van Daele, T., Hermans, D., Van Audenhove, C. and Van den Bergh, O. (2012), “Stress reduction through
psychoeducation: a meta-analytic review”, Health Education & Behavior, Vol. 39 No. 4, pp. 474-485, doi:
10.1177/1090198111419202.
van der Plaat, D.A., Edge, R., Coggon, D., van Tongeren, M., Muiry, R., Parsons, V., Cullinan, P. and
Madan, I. (2021), “Impact of COVID-19 pandemic on sickness absence for mental ill health in national
health service staff”, BMJ Open, Vol. 11 No. 11, p. e054533, doi: 10.1186/s12888-021-03261-8.
Whitaker, S.C. (2001), “The management of sickness absence”, Occupational and Environmental
Medicine, Vol. 58 No. 6, pp. 420-424, doi: 10.1136/oem.58.6.420.

Williams, S., Bowbrick, V.A. and Chan, S. (2020), “Return to work for higher surgical trainees: a deanery
perspective”, The Bulletin of the Royal College of Surgeons of England, Vol. 102 No. 6, pp. 264-269, doi:
10.1308/rcsbull.2020.173.
_ Gürman, G. and Kumbasar, H. (2009), “Burnout at a bone
Yilmaz, A., Soykan, A., Ayaz, T., Kale, E.I.,
marrow transplantation unit in Turkey: effects of interactive psychoeducational seminars”, Turkish Journal
of Medical Sciences, Vol. 39 No. 6, pp. 933-939, doi: 10.3906/sag-0902-13.

Young, A.E., Roessler, R.T., Wasiak, R., McPherson, K.M., Van Poppel, M.N. and Anema, J.R. (2005), “A
developmental conceptualization of return to work”, Journal of Occupational Rehabilitation, Vol. 15 No. 4,
pp. 557-568, doi: 10.1007/s10926-005-8034-z.

Zhou, A.Y., Carder, M., Gittins, M. and Agius, R. (2017), “Work-related ill health in doctors working in
Great Britain: incidence rates and trends”, British Journal of Psychiatry, Vol. 211 No. 5, pp. 310-315, doi:
10.1192/bjp.bp.117.202929.

Author affiliations
Raul Szekely is based at the Division of Academic Psychiatry, King’s College London,
London, UK and the School of Psychology, University of Surrey, Guildford, UK.
Syrgena Mazreku is based at the Division of Academic Psychiatry, King’s College London,
London, UK.
Anita Bignell, Camilla Fadel, Hannah Iannelli and Marta Ortega Vega are all based at the
Maudsley Learning, South London and Maudsley NHS Foundation Trust, London, UK.
Owen P. O’Sullivan is based at the Maudsley Simulation, South London and Maudsley NHS
Foundation Trust, London, UK and the Barnet Enfield and Haringey Mental Health NHS
Trust, London, UK.
Claire Tiley and Chris Attoe are both based at the Maudsley Learning, South London and
Maudsley NHS Foundation Trust, London, UK.

Corresponding author
Raul Szekely can be contacted at: r.szekely@surrey.ac.uk

For instructions on how to order reprints of this article, please visit our website:
www.emeraldgrouppublishing.com/licensing/reprints.htm
Or contact us for further details: permissions@emeraldinsight.com

j THE JOURNAL OF MENTAL HEALTH TRAINING, EDUCATION AND PRACTICE j

View publication stats