Abstract
IMPORTANCE: High levels of health care professional (HCP) distress portend negative consequences for HCPs and health systems. OBJECTIVE: To evaluate whether a 13-week digital well-being training could improve Mexican HCP distress and well-being. DESIGN, SETTING, AND PARTICIPANTS: This 2-arm randomized clinical trial was conducted between March 2023 and March 2024 with 13-week postintervention and 37-week follow-up end points. Participants included 2315 adults with no previous well-being training experience who worked in 762 participating health care facilities across 7 Mexican states. Participants were randomly assigned (1:1) using stratified permuted blocks to well-being training or wait-list control. Outcomes assessors and study data analyst were masked to condition assignment. Assessments and intervention were conducted remotely. INTERVENTION: The digital well-being training consisted of nine 2-hour zoom sessions and 13 weeks of the Healthy Minds Program smartphone app structured on the premise that well-being skills can be strengthened through psychoeducation and contemplative practice. MAIN OUTCOMES: The primary prespecified outcomes were participant-reported distress (aggregate of z-scored National Institutes of Health Toolbox perceived stress, and Perceived Stress and Patient Reported Outcomes Measurement Information System anxiety and depression scales; mean = 0, SD = 1) and the World Health Organization-5 measure of well-being (range 0-25). RESULTS: Among 2315 participants, 1693 (73.1%) identified as female; 778 (33.4%) nurses, 736 (31.7%) physicians, 187 (8.1%) psychologists, 183 (7.9%) administrators, 154 (6.7%) dentists, 75 (3.2%) social workers, 64 (2.8%) nutritionists, 55 (2.4%) laboratory technicians, 40 (1.7%) physical therapists, 29 (1.3%) health promoters, and 8 (<0.1%) other health professionals; the mean (SD) age was 34.7 (11.4) years. Relative to control, in intention-to-treat analyses the intervention group reported 13-week reductions in distress (adjusted standardized mean difference [SMD], -0.24; 95% CI, -0.32 to -0.16) and increases in well-being (adjusted SMD, 0.27; 95% CI, 0.18 to 0.35) that increased in magnitude at 37-week follow-up (distress, -0.36; 95% CI, -0.44 to -0.28; well-being, 0.42; 95% CI, 0.34 to 0.50). Primary outcomes were robust in sensitivity analyses. There were 10 adverse events (intervention: 0.05% [6 of 1157]; control: 0.04% [4 of 1158]). CONCLUSIONS AND RELEVANCE: This randomized clinical trial found that scalable digital well-being training modestly improved Mexican HCP distress and well-being compared with a wait-list condition. As HCPs are essential to public health and report high levels of distress that interfere with their ability to provide optimal care, well-being training may be an avenue to better supporting HCPs. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05767970.