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Computer-assisted resilience training to prepare healthcare workers for pandemic influenza: a randomized trial of the optimal dose of training
Open accessAbstract
BACKGROUND: Working in a hospital during an extraordinary infectious disease outbreak can cause significant stress and contribute to healthcare workers choosing to reduce patient contact. Psychological training of healthcare workers prior to an influenza pandemic may reduce stress-related absenteeism, however, established training methods that change behavior and attitudes are too resource-intensive for widespread use. This study tests the feasibility and effectiveness of a less expensive alternative - an interactive, computer-assisted training course designed to build resilience to the stresses of working during a pandemic. METHODS: A "dose-finding" study compared pre-post changes in three different durations of training. We measured variables that are likely to mediate stress-responses in a pandemic before and after training: confidence in support and training, pandemic-related self-efficacy, coping style and interpersonal problems. RESULTS: 158 hospital workers took the course and were randomly assigned to the short (7 sessions, median cumulative duration 111 minutes), medium (12 sessions, 158 minutes) or long (17 sessions, 223 minutes) version. Using an intention-to-treat analysis, the course was associated with significant improvements in confidence in support and training, pandemic self-efficacy and interpersonal problems. Participants who under-utilized coping via problem-solving or seeking support or over-utilized escape-avoidance experienced improved coping. Comparison of doses showed improved interpersonal problems in the medium and long course but not in the short course. There was a trend towards higher drop-out rates with longer duration of training. CONCLUSIONS: Computer-assisted resilience training in healthcare workers appears to be of significant benefit and merits further study under pandemic conditions. Comparing three "doses" of the course suggested that the medium course was optimal.
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“Four studies (Aiello et al., 2011; Maunder et al., 2010; Chen et al., 2006; Wu and Wei, 2020) described four different interventions to reduce the mental health impact of viral epidemic outbreaks in HCWs (Online Appendix 6). None of them used an experimental design.”
From Impact of viral epidemic outbreaks on mental health of healthcare workers: a rapid systematic review and meta-analysis (2020) · cites this paper as Maunder et al., 2010
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“The intervention improved confidence in support and training, pandemic self-efficacy and interpersonal problems (p<0.05).”
From Impact of viral epidemic outbreaks on mental health of healthcare workers: a rapid systematic review and meta-analysis (2020) · cites this paper as Maunder et al., 2010
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“Although very limited, evidence from intervention studies indicates that educational interventions have the potential to increase knowledge and resilience (Aiello et al., 2011; Maunder et al., 2010), even when implemented during an outbreak (Chen et al., 2006).”
From Impact of viral epidemic outbreaks on mental health of healthcare workers: a rapid systematic review and meta-analysis (2020) · cites this paper as Maunder et al., 2010
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Bates, A., Ottaway, J., Moyses, H., Perrrow, M., Rushbrook, S., & Cusack, R. (2020) · Journal of the Intensive Care Society · doi:10.1177/1751143720965109 · Cited by 13
Ghogare, A. S., Aloney, S., Spoorthy, M. S., Patil, P. S., Ambad, R. S., & Bele, A. (2021) · International Journal of Academic Medicine · doi:10.4103/ijam.ijam_105_20 · Cited by 15
Amsalem, D., Wall, M. M., Lazarov, A., Markowitz, J. C., Fisch, C. T., LeBeau, M., Hinds, M. T., Liu, J., Fisher, P. W., Smith, T. E., et al. (2022) · BJPsych Open · doi:10.1192/bjo.2022.575 · Cited by 15
“These findings corroborate those of other intervention studies 31 among healthcare workers, mainly using non-contact-based educational programmes, which also showed no lasting effects.”
Maunder, R., Rosen, B., Heeney, N. D., Jeffs, L. P., Merkley, J., Wilkinson, K., Hunter, J., Johnstone, J., Greenberg, R. A., & Wiesenfeld, L. A. (2023) · BMC Health Services Research · doi:10.1186/s12913-023-09731-x · Cited by 13
Self-citationValiee, S., Jelyani, Z. Z., Kia, M., Jajarmizadeh, A., Delavari, S., Shalyari, N., & Marzaleh, M. A. (2023) · Human Resources for Health · doi:10.1186/s12960-023-00844-2 · Cited by 18
“designing a resilience model to anticipate, plan and deter responder risk [21, 61], creating organizational justice besides promoting a flexible organizational culture based on a teamwork atmosphere [21, 37, 38, 43, 61], offering rewards and financial support [48, 67], and extending support to HCWs during times of con…”
BackgroundResilience enhancement interventions for disaster rescue workers: a systematic review
Mao, X., Suo, Y., Wei, X., & Luo, Y. (2025) · Scandinavian Journal of Trauma Resuscitation and Emergency Medicine · doi:10.1186/s13049-025-01397-0 · Cited by 11
“Other psychological skills or knowledge such as communication and relationships [7, 9, 37], energy management [23, 37, 50], relaxation skills [32, 49], psychological first aid [9, 32], and survival skills [5], were adopted in the studies.”
InfluentialRosen, B., Preisman, M., Read, H., Chaukos, D. C., Greenberg, R. A., Jeffs, L. P., Maunder, R., & Wiesenfeld, L. A. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-08131-x · Cited by 11
Self-citationBranjerdporn, G., Bowman, C., Kenworthy, S., & Stapelberg, N. J. C. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.812365 · Cited by 10
Maunder, R., Kiss, A., Heeney, N. D., Wallwork, E., Hunter, J., Johnstone, J., Wiesenfeld, L. A., Jeffs, L. P., McGeer, A., Lee, K., et al. (2023) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2023.06.005 · Cited by 10
“The PSAF intervention is based on previous work [22], and so the consistency of findings adds confidence in the current result.”
InfluentialSelf-citationSixsmith, J., Doyle, P. A., & Barry, M. M. (2014) · ARAN (University of Galway Research Repository) (Ollscoil na Gaillimhe – University of Galway) · doi:10.2900/16366 · Cited by 15
Armaou, M., Araviaki, E., Dutta, S., Konstantinidis, S. T., & Blake, H. (2022) · European Journal of Investigation in Health Psychology and Education · doi:10.3390/ejihpe12100102 · Cited by 14
“However, they were assessed as secondary intervention outcomes [77,87].”
BackgroundMethodInfluentialSkilbeck, L., Spanton, C., & Roylance, I. (2020) · Cognitive Behaviour Therapy · doi:10.1017/s1754470x20000379 · Cited by 7
“Similarly Maunder et al. (2010) described the benefits of computer-assisted resilience training for healthcare worker preparedness for flu pandemics.”
BackgroundWatanabe, K., Tran, T. T. T., Sripo, N., Sakuraya, A., Imamura, K., Boonyamalik, P., Sasaki, N., Tienthong, T., Asaoka, H., Iida, M., et al. (2024) · Journal of Medical Internet Research · doi:10.2196/50071 · Cited by 8
“A few studies have reported positive responses to group-based resilience training [6] and an improvement in self-efficacy and interpersonal problems after conducting a web-based resilience training program among health care workers during the influenza pandemic [7].”
Capili, J. T., Luis, L. M. G., Asuncion, J. E. L., Luyun, J. L., Canapi, J. B., & Rimban, E. L. (2022) · Jàmbá Journal of Disaster Risk Studies · doi:10.4102/jamba.v14i1.1284 · Cited by 8
Supporting the pursuit of professionalism during a crisis
Cooper, W. O., Lorenzi, N. M., Davidson, H. A., Baldwin, C. A., Feinberg, D. M., Hopkins, J. R., Spell, N. O., Uthe, C. J., & Hickson, G. B. (2021) · BMJ Leader · doi:10.1136/leader-2021-000458 · Cited by 8
How Shift Schedules Shape Nurses’ Sleep and Compassion: A Comparative Study
Al‐Hammouri, M. M., Rababah, J. A., & AL‐Jdeetawey, N. A. (2025) · International Nursing Review · doi:10.1111/inr.70085 · Cited by 7
Gao, Q., Xu, H., Zhang, C., Huang, D., Zhang, T., & Liu, T. (2022) · PLoS ONE · doi:10.1371/journal.pone.0279071 · Cited by 8
“Some coping-focused efforts like coping skills training courses and online virtual stress adaptation training may also be helpful as our results have verified the positive effect of coping style on resilience [58, 59].”
ResultBank, W. (2021) · The World Bank Open Knowledge Repository (World Bank) · doi:10.1596/35842 · Cited by 7
Theron, E., Erasmus, H. C., Wylie, C., Khan, W., Geduld, H. I., & Stassen, W. (2022) · African Journal of Emergency Medicine · doi:10.1016/j.afjem.2022.08.004 · Cited by 6
“(47) This interactive computer-assisted course, which includes knowledgebased modules, relaxation skills, self-assessment modules, and feedback was found to improve pandemic self-efficacy, confidence in support and training, and interpersonal problems.”
Perceived Stress among Health Care Workers of an Emerging Infectious Covid-19 Outbreak in Indonesia
Novelia, S., Usman, A. M., & Pamungkas, R. A. (2021) · Asian Community Health Nursing Research · doi:10.29253/achnr.2021.3962 · Cited by 6
Walking the Talk: Reimagining Primary Health Care after COVID-19
Bank, W. (2022) · World Bank, Washington, DC eBooks · doi:10.1596/978-1-4648-1768-7 · Cited by 5
Siebenhofer, A., Scott, A. M., Avian, A., Terebessy, A., Mergenthal, K., Schaffler‐Schaden, D., Bachler, H., Huter, S., Zelko, E., Murray, A., et al. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.1072515 · Cited by 5
“On the other hand, such aspects as social support and quality of sleep, and precrisis education and training programmes, can also increase self-confidence (44, 45).”
BackgroundThe COVID-19 Healthcare Personnel Study (CHPS): Overview, Methods, and Preliminary Findings
DiMaggio, C., Abramson, D., Susser, E., Hoven, C. W., Chen, Q., Andrews, H. F., Herman, D., Kreniske, J., Ryan, M., Susser, I., et al. (2021) · Journal of Neurosurgical Anesthesiology · doi:10.1097/ana.0000000000000813 · Cited by 5
Building Resilience Among Frontline Health Care Workers
Bartuska, A. D., & Marques, L. M. (2021) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.21com136869 · Cited by 4
Foo, C. Y. S., Verdeli, H., & Tay, A. K. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-85726-0.00008-9 · Cited by 4
Hurst, K. P., Ramsden, R., Roach, C., & Colbran, R. (2023) · Australian Journal of Rural Health · doi:10.1111/ajr.13062 · Cited by 4
Khoddam, H., Modanloo, M., Mohammadi, R., & Talebi, R. (2023) · Nursing Open · doi:10.1002/nop2.2035 · Cited by 3
“…causes extreme stress in healthcare providers due to the fear of being infected by the disease, family-related health concerns, job stress, interpersonal isolation, and quarantine (Maunder et al., 2004, 2010; Wong et al., 2005) and affects their ability in doing their duty (Aiello et al., 2011).”
BackgroundPerceived Stress among Health Care Workers of an Emerging Infectious Covid-19 Outbreak in Indonesia
Novelia, S., Usman, A. M., & Pamungkas, R. A. (2021) · Asian Community Health Nursing Research · doi:10.29253/achnr.2021.3.9 · Cited by 4
Sim, K., & Chew, Q. H. (2021) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.21lr14035a · Cited by 4
Kawakami, N., Nguyen, H. T. M., Kaewboonchoo, O., Imamura, K., Tran, T. T. T., Boonyamalik, P., Sasaki, N., Sripo, N., Tienthong, T., Asaoka, H., et al. (2023) · Preprints.org · doi:10.20944/preprints202303.0450.v1 · Cited by 4
Velosa-Forero, J. (2022) · Investigaciones en Seguridad Social y Salud · doi:10.56085/20277970.453 · Cited by 3
Vulnerability and the Covid-19 pandemic: educating to a new notion of health
Girotto, S. (2023) · International Journal of Ethics Education · doi:10.1007/s40889-023-00175-9 · Cited by 3
“Many studies have stressed vulnerabilities experienced by healthcare workers, while less attention has been paid to patients (Maunder et al. 2010; Marinaci et al. 2021; Tsonis et al. 2021; Smeltzer et al. 2022 ).”
Estrategias etnográficas para un encuadre innovador del COVID-19
Teves, L., Remoriní, C., & Morgante, M. G. (2020) · Innovación y Desarrollo Tecnológico y Social · doi:10.24215/26838559e026 · Cited by 3
Mohammed, R. S., Salem, M. R., Mahmoud, A. T., Sabbahy, L. E., & El-Jaafary, S. I. (2021) · Open Access Macedonian Journal of Medical Sciences · doi:10.3889/oamjms.2021.5934 · Cited by 4
“These were also included as stress reducing factors in the previous studies [12], [18].”
BackgroundResultInfluentialBuilding Resilience and Well-Being in Health Care Workers in the COVID-19 Era
Peccoralo, L. A., DePierro, J. M., Feingold, J. H., Feder, A., Charney, D. S., Southwick, S. M., Ripp, J., & Pietrzak, R. H. (2021) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.21lr14035b · Cited by 3
Ménard, A. D., Soucie, K. M., Ralph, J., Pratt, S., & Freeman‐Gibb, L. (2025) · Clinical Simulation in Nursing · doi:10.1016/j.ecns.2025.101802 · Cited by 2
Maunder, R., Heeney, N. D., & Hunter, J. (2022) · Health Psychology and Behavioral Medicine · doi:10.1080/21642850.2022.2123806 · Cited by 2
“Pandemic self-efficacy was measured with an instrument first developed for the 2009 H1N1 pandemic (Maunder et al., 2010).”
MethodSelf-citationIshak, H., Silim, U. A., & Suhaimi, A. F. (2023) · Malaysian Journal of Medicine and Health Sciences · doi:10.47836/mjmhs.19.1.28 · Cited by 2
Metadata
- Authors
- Maunder, R. G., Lancee, W. J., Mae, R., Vincent, L., Peladeau, N., Beduz, M. A., Hunter, J. J., & Leszcz, M.
- Affiliations
- Mount Sinai Hospital (CA)
- Corresponding author
- Maunder, Robert G
- Venue
- BMC Health Services Research
- Published
- 2010-03-22
- Volume
- 10
- Issue
- 1
- Pages
- 72-72
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC2851711
- OpenAlex
- W2008615047
- Cited by
- 129
- References
- 46
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 3 · 2023: 17 · 2022: 28 · 2021: 39 · 2020: 24 · 2019: 1 · 2018: 4 · 2017: 3 · 2016: 1 · 2014: 1 · 2013: 1
- FWCI
- 1.05
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- TSpace (University of Toronto) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Canadian Institutes of Health Research (83139_1, 83139)
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Health Sciences › Health Professions › Emergency Medical Services › Disaster Response and Management
- Social Sciences › Psychology › Clinical Psychology › Resilience and Mental Health
- Keywords
- computer-based training, resilience training, healthcare workers, pandemic influenza, occupational stress, self-efficacy, coping styles, interpersonal problems, training dose, hospital staff, absenteeism
- MeSH terms
- Absenteeism, Adaptation, Psychological, Canada, Computer-Assisted Instruction, Curriculum, Disaster Planning, Humans, Influenza, Human, Personnel, Hospital, Stress, Psychological, Time Factors, Intention to Treat Analysis, Pandemics
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