A self-monitoring wellbeing screening methodology for keyworkers, ‘My Personal Wellbeing’, using an integrative wellbeing model

The recent pandemic of a respiratory virus has posed a significant challenge to the mental health of nations, [1]. Part of the resilience of the nation is based on the capacity of its essential services to continue to function, particularly healthcare. In the UK, there was a concern that the strain of the pandemic may have a detrimental impact on staff wellbeing and both system and personal ‘resilience’. As part of a compassionate response to health workers and key workers, systems needed to be set up to support them. The scope of this new support task was to address any specific psychological disorders that were an understandable response to the challenges. Traditional models of mental health services would screen for disorder and have data on this held by health support services. However, wellbeing is a broader concept of mental health that considers strengths and functioning as well as symptoms. A support service for staff based around wellbeing could work on prevention, address systemic leadership and organisational aspects of mental health, deal with the complexity of the struggles of our colleagues and address ‘disorders’. Self-monitoring was thought to be one way of contributing to such a model. It can aid mindful awareness and empowered choices about when to seek help. Such a model fits better with the concept of trauma informed care that seeks to understand mental health ‘problems’ as survival strategies to a particular context and sees mental health as related to empowerment, linked to personally meaningful goals and based on compassionate, mutual relationships, [2]. This diary emerged from that context, where a regional NHS staff wellbeing hub aspired to develop a service for NHS and social care staff based on empowering and non-stigmatising principles from that available in mainstream mental health services or occupational health teams. That required a novel way of screening staff with focus on self-monitoring of wellbeing rather than mental health diagnosis and a need was identified to develop a diary tool, “My Personal Wellbeing’, to provide people with an anonymous means for monitoring their wellbeing in real time. The diary data could also contribute to an agile service able to respond to staff issues in a proactive way. The tool aims to: determine which factors affect wellbeing; identify the aspects of wellbeing that are improving / declining; identify the aspects of wellbeing that correlate together and may indicate more serious health situations. The diary integrates both mental health symptoms tracking as well as wellbeing indicators monitoring, while similar interventions categorised in the literature typically monitor either symptoms or wellbeing indicators, not both [3‐5]. The choice of combining mental health symptoms and wellbeing indicators monitoring was intentional, in order to allow for exploring correlations between changes in symptoms and wellbeing indicators.

The pandemic has had a significant impact on staff. A meta-analysis on the impact on staff mental health during pandemics (n = 38 studies) reported that staff with face-to-face contact with affected patients had greater levels of both acute and post traumatic and stress and psychological distress when compared to lower risk controls, [6]. Similarly, frontline workers in the UK during covid had higher prevalence rates of depression, anxiety and PTSD compared to the rest of the population. In the US, the Panchal et al., [7], survey compared all essential workers in any role or setting compared to non-essential workers, finding essential workers to report higher symptoms of depression and anxiety (42% vs. 30%), the onset or increase of substance use (25% vs. 11%), or to have seriously considered suicide in the past 30 days (22% vs. 8%). In a UK poll of healthcare staff (n = 996) 50% of staff reported that their mental health was impacted because of the Covid-19 crisis, [8].

An integrative model of wellbeing was adopted for this study [9], with tracking of symptoms, which refer to the impact of distress on functioning, [10], as well as providing an appreciation of strengths and wellbeing indicators, [11, 12]. Importantly, for healthcare staff in a pandemic, this new tool needed to also incorporate items of work-related impact e.g., burnout, compassion fatigue and vicarious post-traumatic stress disorder [13]. We know that other factors relate to personal resilience too, e.g., meaning to life, [14, 15], sense of threat, [16], self-compassion, [17], sense of connectedness to others, [18], addictions, [19], and moral injury, [20].

The core of the wellbeing model as previously used in assessing the relationship between wellbeing and leadership capability, in the development of a protocol for interoceptive self-awareness in email communication, [21], as well as in evaluating the effect of music listening on wellbeing, [22]. Developing ones awareness of experiences as they unfold includes: witnessing present moment, sensations, bodily states (alert, quiet, pleasant, unpleasant), mental activity (thoughts, feelings, memory, intentions, beliefs, attitudes, etc.) and relational experience (connectedness to others, to nature, etc.), sense of meaning and purpose, and compassionate attitude, [18], ensuring observation nurtures wellbeing as it is conducted in a kind and gentle way, [23]. This has important implications for understanding and evaluation and measurement of human experience.

Thus, a diary method was considered appropriate for this study, [24]. It empowered the participants to monitor and reflect on their own experience while being understanding towards oneself (self-kind), thus supporting recovery, [2, 25].

The impetus for the development of the diary tool emerged from an NHS region’s systems level leadership looking to support the wellbeing of critical NHS and care staff. The diary was co-produced in a process involving NHS staff and university researchers, [26], refined, and trialled for inclusion in the diary. All items were worded with both positive and negative polarity. This enabled both pathology, e.g., severe anxiety, and strengths, e.g., self-compassion, to be tracked. Diary users were encouraged to reflect on their experience and sense of wellbeing, considering the factors identified.