The effects of counseling via a smartphone application on microentrepreneurs’ work ability and work recovery: a study protocol

The sustained work ability of microentrepreneurs has a significant impact on regional labor markets and society in general, because microenterprises form a significant portion of all enterprises in the EU and in Finland. In such enterprises, with 1–9 employees and whose annual turnover and/or annual balance sheet total does not exceed two million euros [ 1 ], working long hours and finding a healthy work-life balance tends to be challenging: as many as 55% of the self-employed with employees and 35% of those without employees reported working 48 h or more per week [ 2 ]. Heavy workloads, financial insecurity, and lack of free time are known to lead to increased levels of stress [ 3 ]. Health concerns following such challenges include cardiovascular diseases [ 4 , 5 ], coronary heart disease, stroke and type 2 diabetes [ 6 , 7 ]. Thus, the promotion of work ability highlights the importance of recovery from work [ 8 ]. A few studies have been published on the factors associated with work ability among microentrepreneurs [ 9 , 10 ]. Cross-sectional studies have found good planning and control over work; flexibility at work; good social support from family, friends and other entrepreneurs; and regular exercise to be associated with maintaining entrepreneurs’ good health [ 11 ]. Furthermore, intervention studies have produced promising results related to increasing physical activity [ 12 ] and reducing alcohol consumption [ 13 ]. There are studies that address mental health apps, for example stress management intervention [ 14 ]. There are also some studies that address recovery as primary outcome among employees who suffer from both work-related strain and sleep problems [ 15 ]. However, to our knowledge, there is a gap of intervention studies on the promotion of microentrepreneurs’ work ability and recovery from work using a smartphone application as the key means of delivering counseling. One reason for poor results from intervention studies might be that behavior change interventions often lack a solid theoretical background [ 16 , 17 ], although some of the previous studies suggest a link between the application of a theory and the effectiveness of an intervention [ 18 , 19 , 20 ]. We adopted Self-Determination Theory as the theoretical framework for the intervention study as it has shown potential for effectiveness in meta-analyses and systematic reviews [ 21 , 22 ]. SDT is a theory of human motivation and personality [ 23 ], which sees an individual as inherently active, motivated and having a tendency toward growth development. According to the SDT, an individual’s motivation is divided into amotivation, controlled motivation and autonomous or self-determined motivation. The more autonomous the motivation for behavior change is, the more likely the person is to change their current behavior and maintain the newly acquired behavior. Further, the theory sees three basic human needs as the driving force for developing more autonomous motivation. These are: 1) the need for autonomy (i.e. the feeling of being the origin of one’s own actions and possessing the ability to express one’s own free will through behavior), 2) the need for competence (i.e. the feeling of being a true actor, who is able to set goals and exploit their own skills and competences) and 3) the need for relatedness (i.e. being understood and appreciated) [ 23 ]. These general principles were chosen to be followed in designing the tasks for the application. Previous systematic reviews of health behavior change as in our interventions have highlighted the effectiveness of some behavior change techniques over others. These include goal-setting [ 20 , 24 , 25 ], social support [ 26 , 27 , 28 ], social comparison [ 20 , 29 , 30 ] and giving information and instructions [ 30 , 31 , 32 ]. These techniques are applied in a way that fits with the guiding principles of SDT. When aiming to utilize the evidence of effective behavior change techniques provided by previous systematic reviews, two points should be taken into account. First, systematic reviews [ 20 , 25 , 32 ] also offer inconsistent results in comparison to each other, which illustrates the importance of understanding not only what is done but also how the techniques are put into practice Secondly, some behavior change techniques have been utilized in previous interventions so infrequently that there is insufficient data to conduct meta-analysis and establish the bottom line regarding effectiveness [ 20 , 30 , 33 ]. One plausible explanation for this is publication bias. We published recently a reflective discussion on how we identified evidence-based behavior change techniques and counseling themes for the intervention [ 34 ]. Persuasive technology is increasingly used for promoting behavior change. It has been used in mobile applications for assisting people with issues such as weight management, sleep problems, and depression [ 35 , 36 , 37 ]. However, a recent review identified only a small number of currently available stand-alone apps that have been evaluated in RCTs, and concluded that overall, the evidence of effectiveness is of relatively low quality [ 38 ]. A recent conceptualization for developing applications with evidence-based effectiveness is known as the Behaviour Change Support Systems (BCSS) framework [ 39 ]. The BCSS framework aims to support and enable people in their behavior change efforts. Furthermore, it builds upon the Persuasive Systems Design model, developed for designing and evaluating information systems that aim to influence the attitudes or behaviors of users through technological persuasion without deception or coercion [ 40 ]. The intervention build by us utilizes these established and validated design and development approaches to implement carefully tailored intervention content into a persuasive smartphone application. This paper describes the protocol of a randomized controlled trial, because publication of study protocols increases research quality and transparency [ 41 ]. The overall aim of the trial is to examine the effects of counseling delivered via a mobile application on work ability among microentrepreneurs. The secondary outcome will be change in recovery from work. In promotion of work ability, enhancing recovery from work is especially important among microentrepreneurs, who do long working hours weekly, and might have high levels of stress due to their personal responsibility of their business. Our hypothesis is that high level of stress and long working hours increase the need for recovery from work and decrease work ability independently and via unhealthy behaviors (Fig. 1 ). Mindfulness, relaxation and detachment from work improve recovery from work and work ability independently, and also through healthy behaviors. Healthy exercise, dietary and sleep habits enhance recovery from work independently as well as improved recovery from work improves work ability. When the levels of stress decrease, the need for recovery from work is lower, and moderate weekly amounts of working hours allow enough time for healthy behaviors in order to enhance physiological recovery of the body, that means repletion of body energy sources [ 42 ]. These basic intervention components (Fig. 1 ) have also direct effects on work ability. Additionally, the best ways to enhance recovery from work are different among those with low and high level of physical strenuousness of work, and thus the counselling will be tailored according to the level of physical strenuousness of work. Process evaluation will be conducted to detect the mechanisms of change and to study why the results are what they are. The basic intervention components of the intervention to enhance work ability (primary outcome) and recovery from work (secondary outcome) among microentrepreneurs The design is a randomized controlled trial comparing one intervention arm (Recovery! application intervention) with a waiting list control group among microentrepreneurs in Finland. The waiting list control group will receive the Recovery! app six months from the commencement of the trial and will use it for eight weeks. Eligible participants are Finnish-speaking microentrepreneurs (those with enterprises of 1–9 employees) whose companies are in Finland. The target group excludes the employees of these enterprises. Included participants must work full-time as entrepreneurs, understand Finnish, and have an Android phone. Entrepreneurs who are also employed in another organization, or who are on sick leave or off work for another reason, will be excluded. The intervention consists of a mobile application for microentrepreneurs. The application aims to promote health and work-related behavior changes and to enhance recovery from work and work ability during working hours and free time. The intervention group will receive the mobile application after baseline survey and will be asked to use it for at least eight weeks, but may continue longer. In the mobile app users select relevant modules (key components), goals for themselves, and subsequently select exercises to complete with guidance from the app. The users can also use additional support tools, such as a meal planner or step counter, and use tracking tools such as self-assessment of stress levels. These modules and tools will be described in closer detail in the forthcoming paper related to process evaluation. During the trial period the control group receives no intervention. However, the waitlist control group will receive the same mobile application at six months, and will be followed for two months. The intervention program to promote work ability and recovery from work among microentrepreneurs will be delivered and implemented via a smartphone application), that is, it is designed directly as mobile application using compiled language [ 43 ], rather than web application to be used via mobile devices. The application was developed for the Android smartphone platform and it only works on smartphones using this operating system. The plan of action merges: 1) the contents based on the needs of the target population and evidence from research on health- and work-related behavior that enhances recovery from work, 2) a theoretical framework for counseling (Self Determination Theory, SDT), and counseling methods including behavior change techniques [ 44 , 45 ], and 3) tailored content and counselling according to the trans-theoretical change model [ 46 ] and the physically strenuousness of the work. The key contents (Fig. 1 ) and components of the mobile application to enhance work ability and recovery from work are 1) not too much stress, 2) effective working hours, 3) detachment from work, 4) relaxing), 5) sufficient, good-quality sleep, 6) regular meals that provide rhythm and energy for work, and 7) physical activity as the key to recovery for those doing physically strenuous work, and sitting less, moving more for those doing light, sedentary work. The application also includes short 8) mindfulness exercises for enhancing recovery and helping the user pay attention and on at These exercises are because research that mindfulness may support behavior change [ , 48 , and promote recovery from work [ ]. The behavior change techniques used in the application have been according to the evidence of their The of techniques also the aims to 1) include different as the of techniques has to increase the effectiveness of an intervention [ 27 , ], and 2) techniques related to the different of behavior in the Behaviour Change [ 44 ]. The application of each behavior change is by using the Self-Determination Theory [ 23 ]. This means that of the it was it competence and relatedness and more of motivation. the that the application provided reflective based on [ 17 ], we to support both autonomy and competence of or other of which lead to motivation. The development process of the contents and theoretical as well as the counseling and will be described in more detail in an additional paper [ 34 ]. background theory for developing the intervention is trans-theoretical model of change [ 46 ]. 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