Navigating Workplace Stress: A Qualitative Exploration of Mental Healthcare Workers’ Lived Experiences with STAPP@Work, a Mobile Stress Management Intervention

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Demirel, Y. Roke, N. H. Chavannes, P. N. Harten This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6611387/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Mental health workers (MHWs) face ongoing challenges, including heavy workloads, staff shortages, and pressure due to long patient waiting lists. These factors contribute to high levels of stress, affecting both their well-being and the quality of patient care. Digital interventions have shown promising results in supporting stress management among healthcare professionals. However, little is known about MHWs’ experiences with such interventions. This study aims to explore the lived experiences of MHWs regarding the use of STAPP@Work, a self-monitoring stress management app designed for the workplace. Methods A qualitative study was conducted using semi-structured interviews with MHWs (N = 14) who used STAPP@Work for two weeks. Thematic analysis was performed to identify key patterns related to app experiences, engagement, stress recognition, and coping behaviours at work. Results Participants reported increased self-awareness and early stress recognition, which facilitated timely intervention. The app prompted "self-check-ins", enabling users to reflect on their well-being and recognize stress signals throughout the day. MHWs engaged in both problem-focused and emotion-focused coping strategies, such as prioritizing tasks, reframing thoughts, and relaxation techniques. While most found the app useful and easy to use, barriers included time constraints, perceived effort, and the need for more personalized coping strategies. The app encouraged lasting behavioural changes, with some employees continuing stress management strategies beyond app use. Conclusions STAPP@Work shows potential as a preventive stress management tool for MHWs by promoting self-awareness and early intervention. While employees benefited from increased stress awareness and coping, sustained engagement remained a challenge. Future research should explore long-term use facilitators and workplace integration and its applicability for other working populations. Trial registration ClinicalTrials.gov NCT06991439, registered on 27 May 2025. Retrospectively registered. Mobile health (mHealth) Workplace stress Health professional Stress management Self-monitoring app Qualitative research Ecological momentary assessment User experience Figures Figure 1 Background Work-related stress is a leading cause of burnout among mental health workers (MHWs), driven by high workloads, emotional demands, staff shortages and pressure due to long waiting lists [ 1 , 2 ]. From July 2023 to June 2024, stress-related absenteeism in Dutch sectors increased by 8%, with healthcare being the most affected [ 3 ]. In five years, absenteeism increased by 30%, with emotional exhaustion higher in mental healthcare than in other areas [ 3 ]. Around 20% of Dutch therapists reported being emotional exhausted, compared to 12.4% among hospital workers [ 4 ]. Research shows that one in seven employees previously absent due to stress will experience another absence within three years, often within the first year of returning to work [ 4 ]. The 2021 Don’t Forget Yourself study found that nearly half of Dutch MHWs reported high stress levels, with 30% showing depressive symptoms and 14% experiencing anxiety [ 5 ]. Alarmingly, 4.2% intended to leave the field. A follow-up study in 2023 showed some improvement, but 36% of workers still reported elevated stress [ 6 ]. Workplace stress arises when job demands exceed an individual’s capacity to cope. While short-term stress is useful for performance, prolonged stress without recovery leads to chronic stress. Chronic stress, if unmanaged, can cause physical, emotional, and cognitive impairments, impacting both individuals and organizations. It is linked to anxiety [ 7 ], depression [ 8 ], and burnout - a syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment [ 9 ]. Cognitive functions, like memory [ 10 ], decision-making [ 11 , 12 ], and problem-solving are negatively affected. Physically, prolonged stress disrupts multiple bodily systems, leading to weakened immune function [ 13 ], gastrointestinal issues [ 14 ], hormonal imbalances [ 15 ], and persistent fatigue [ 16 ], increasing long-term health risks. The consequences of chronic stress among employees extend to organizations, through reduced productivity, increased absenteeism, and higher turnover rates [ 9 ]. These challenges result in substantial financial losses due to healthcare expenses [ 17 ] and lower efficiency [ 9 ]. Workforce shortage puts pressure on remaining staff, reduces care quality, and limit patient access to mental health services [ 18 ]. It is therefore of great significance to develop effective workplace interventions to support MHWs in becoming more resilient to the adverse effects of work stress. In recent years, mobile health interventions have gained recognition as tools for workplace stress management. These apps can offer evidence-based, in-the-moment support, engaging employees in stress management practices with flexibility and easy integration into their schedules [ 19 ]. They often require little time and effort, which is especially valuable in high-pressure work sectors [ 19 ]. For organizations, such interventions are a cost-effective way to reach a broad workforce with scalable implementation [ 20 ]. Stress management apps incorporate various techniques including self-monitoring, mindfulness practices, cognitive-behavioural strategies, and psychoeducation [ 21 ]. Research shows such interventions can be effective in reducing stress and improving well-being among employees [ 22 – 24 ]. Though limited, existing literature on the effectiveness of these interventions among healthcare professionals also reported lower stress levels [ 25 – 29 ]. Earlier qualitative studies have explored how healthcare workers experience and interact with these apps. For instance, features such as mood tracking, personalized goals, and in-app resources were valued [ 30 ]. Also, improvements in stress management were reported despite barriers like time constraints and motivation [ 30 , 31 ]. Building on the need for tailored self-directed interventions in managing daily work stress among MHWs, the STAPP@Work app was developed. This self-management app supports by tracking daily stress levels and activities, providing personalized feedback, identifying stress patterns, and offering real-time coping strategies. Based on Ecological Momentary Assessment (EMA) principles [ 32 ], the app helps users recognize and address stress trends over time through visual overviews of their stress levels across workdays and weeks. A prior quantitative study demonstrated the app’s effectiveness in reducing perceived stress, improving problem-focused coping self-efficacy, and lowering burnout symptoms over time [ 33 ]. While these findings showed promising evidence, they left a critical gap in understanding users’ subjective experiences. This study adopts a qualitative approach to explore the lived experiences, perceptions, and attitudes of MHWs using STAPP@Work. By delving deeper into these experiences, this research aims to provide a richer understanding of the app’s use and complex interactions between stress management, work settings, and technology. Methods Design This study followed a qualitative design using a phenomenological approach, aimed at exploring the lived experiences and perspectives of MHWs who used the STAPP@Work app for two weeks. Phenomenology focuses on understanding the meaning behind lived experiences, making it ideal for examining how employees perceive the app’s impact at work [ 34 ]. This design enables an in-depth exploration of employees’ experiences, shedding light on the app’s perceived benefits, limitations, and its role within the broader context of workplace stress management [ 35 ]. The COREQ (Consolidated Criteria for Reporting Qualitative Research) framework [ 36 ] was used to guide the reporting of this study (Supplementary File 1). Setting GGz Centraal is one of the largest mental healthcare organizations in the Netherlands, serving approximately 28,000 patients annually. Located in the central region, it provides a broad spectrum of specialized services, including both inpatient and outpatient care. GGz Centraal employs a multidisciplinary team of 3,500 professionals across multiple locations, offering diverse expertise and roles to provide mental health support. Participants and Recruitment Participants in this study were employees of GGz Centraal. Inclusion criteria involved individuals actively employed at GGz Centraal during the study period. Those who had been part of the development phase or the effectiveness study of the STAPP@Work app were excluded. The study aimed to achieve data saturation, a key principle in qualitative research for comprehensive and valid data collection [ 37 ]. Saturation is reached when no new themes or insights emerge, further coding becomes unfeasible, and the study can be reliably replicated. A purposeful sampling approach was used to ensure diversity in participants’ roles within GGz Centraal. Participants were recruited using targeted and broad-reaching methods to ensure visibility across GGz Centraal. Flyers were distributed throughout the organization and shared digitally with team leaders. Digital presentations were delivered during team meetings to provide additional information and raise awareness. The flyers included a QR code for interested employees to register directly or contact the researchers via email. Researchers followed up with interested individuals, providing study information Intervention : the STAPP@Work app STAPP@Work is a self-management app designed to help employees monitor stress levels, receive personalized coping strategies, and visualize stress patterns over time. The app was co-developed with a varying group of MHWs through iterative focus group discussions, ensuring alignment with their needs, experiences, and preferences. The app is rooted in the stress-signalling plan, a widely implemented tool in Dutch mental healthcare to monitor client stress levels and symptoms [ 38 ]. This framework divides stress into four phases which are green (low stress), yellow, orange, and red (high stress), each representing varying intensity levels and associated symptoms. This model helps individuals understand their stress triggers and how their stress evolves [ 38 ]. By integrating this structured approach with EMA, the app facilitates real-time stress tracking, linking stress levels to specific daily activities and situations. App functionalities STAPP@Work allows users to monitor their stress levels throughout the day by completing 2, 3 or 4 questionnaires at time intervals of 4 hours. The user can set how many questionnaires to receive for each day of the week and at what time points. Each questionnaire, available for one hour, asks about past activities and includes seven validated self-report stress questions related to emotional and physical stress indicators (Fig. 1 A). The response options were: "no" , "yes, but not more than usual" , "yes, more than usual" , and "yes, much more than usual" . The app then measures a stress score based on the questions and provides users with a direct overview of their stress level. This score determined the user's perceived stress level, categorizing it into one of four groups: “ no stress”, “little stress”, “stress” , or “ high stress” ( Fig. 1 B). Alongside the score, users receive practical coping strategies to manage stress for at work or home. The app includes a list of suggested coping strategies, which users can personalize by adding their own strategies or removing existing ones to better suit their needs. When a stress score is calculated, the app randomly selects and displays a coping suggestion from the user’s customized list. As the app links calculated stress scores to the activities users have recorded, it generates a visual summary of these insights. This overview displays daily and weekly stress levels, highlighting which activities and moments were associated with high or low stress (Fig. 1 C). Data Collection Semi-structured interviews (SSIs) were used to collect data. SSIs allowed open-ended questions, facilitating interaction between the interviewer and interviewee to gain insight into participants' experiences and perspectives [ 35 ]. The use of SSIs enables the collection of more reliable and comparable data by combining structured questions with flexibility [ 35 ]. The interviews were guided by a set of predetermined topics, including app usability, stress detection, coping with stress and improvements (Supplementary File 2). These topics were paired with open-ended questions, including 'probing' questions, to elicit detailed narratives around app use. The topics and questions covered the app's functionalities related to stress signalling, recognizing one's own stress patterns, and applying coping strategies. Additionally, the questions inquired about the participants' experiences of using the app and its impact on their workday. This approach allowed the identification of both positive and negative experiences, as well as the perceived benefits and limitations of use. Once developed, the interview guide was trialled through pilot interviews to improve consistency between interviews and variability through training for the interviewer [ 35 ]. Experts and researchers reviewed the guide beforehand, ensuring content validity. Pilot studies, conducted with GGz Centraal employees not included in the main study, assessed its relevance and representativeness [ 39 ]. Feedback from these trials was incorporated into the final version, refining the guide to reflect the research aim. Procedure Prior to participation, respondents received study information, the opportunity to ask questions, and time to reflect before signing informed consent. Individualized guidance on installing and using the STAPP@Work app was provided in an online briefing, where participants agreed on a start date for two weeks of app use and scheduled a follow-up interview. A helpdesk was available for study- or app-related queries. Interviews were conducted at an agreed time and place; if in-person meetings were not feasible, an online Teams appointment was arranged. A PhD researcher (SD) conducted the interviews. The researcher has been trained in qualitative research through attending courses and workshops and has experience in conducting qualitative studies employing in-depth interviews and focus groups. No prior relationship was established between the interviewer and participants before the study commenced. At the start of each interview, the interviewer briefly introduced herself and explained the purpose and relevance of the study. The interviewer maintained a respectful, open attitude with empathetic and active listening to establish a relationship based on mutual interest, support, and understanding [ 40 ]. The interviews took place in a distraction-free setting at the workplace of the interviewee lasting up to 60 minutes, allowing for exploration of all topics while avoiding fatigue [ 41 ]. The interviews were conducted in Dutch. The interviews were recorded with two audio recorders. Insights from previous sessions were used to refine questions for subsequent interviews [ 42 ]. To ensure credibility, efforts were made to minimize bias and inconsistency from both researchers and participants, striving for data accurately reflecting reality while reducing the influence of subjective interpretation [ 35 , 43 ]. After each interview, researchers documented their experiences, observations, and thoughts in a reflexive log, to reflect on the interview process and data [ 44 ]. This promoted reflexivity, making researchers aware of their assumptions and how these could influence data collection and analysis [ 43 ]. To further enhance accuracy, member checking was employed. Participants received a summary of their transcribed interview to review and confirm alignment with their experiences, ensuring researchers' interpretations were correct [ 43 ]. Data Analysis Each interview was transcribed verbatim using a local version of OpenAI's Whisper, making sure the process remained completely secure and independent of the cloud. First, the transcripts were thoroughly reviewed to gain familiarity with the data. To explore the nuances and complexities of participants' experiences, the six-step model by Braun and Clarke [ 45 ] was used to guide the thematic analysis, applying both an inductive and deductive approach. Theme development was informed by predefined topics, as reflected in the interview guide which are based on the functionalities of the STAPP@Work app. At the same time, the analysis remained open to an inductive approach to identify data-driven themes [ 35 ]. Given the study’s exploratory nature, this grounded, inductive approach was essential for capturing participants’ experiences with STAPP@Work and finding common themes. Data were analysed in Atlas.ti (v8.4.4) through an iterative coding process of analysing, comparing and categorizing the data to identify patterns and themes [ 35 ]. Codes were reviewed and grouped into overarching themes based on recurring patterns and underlying concepts across participants. These patterns reflect how participants gave meaning to their experiences, capturing both the content of what was said and the way it was experienced. Themes were then refined to ensure clarity and alignment with the research question [ 45 ], and each was defined in terms of its relevance to participants’ experiences and its contribution to the overall understanding of using STAPP@Work in the workplace. Two independent coders reviewed and coded the data separately before comparing their findings with the primary researcher and coder [ 35 ]. This allowed for the exchange of insights and perspectives related to the data. Regarding transferability, the results were reported as 'thick descriptions,' providing clear contextualization and understanding of the findings to individuals outside this study [ 43 ]. Results General findings The study included 14 MHWs employed at GGz Centraal, a mental health organization in the Netherlands, with a mean age of 41.1 years (Table 1 ). To preserve anonymity, age is presented in 10-year ranges. Most participants were female (n = 10), with diverse roles including nurses (n = 5), psychologists (n = 2), psychosocial therapists (n = 2), a functional administrator, an outreached therapist, a psychiatrist, and a social psychiatric nurse. Table 1 Demographic Characteristics of Study Participants. Participant Sex Age Range Function 1 F 20–29 Nurse 2 F 20–29 Nurse 3 F 20–29 Psychologist 4 M 30–39 Psychosocial therapist 5 M 30–39 Nurse triagist 6 M 30–39 Nurse triagist 7 F 30–39 Outreached therapist 8 F 30–39 Nurse 9 F 40–49 Psychiatrist 10 F 40–49 Functional Administrator 11 F 50–59 Psychologist 12 M 50–59 Psychosocial therapist 13 F 60–69 Nurse 14 F 60–69 Social Psychiatric Nurse The results are organized into the following key themes: (I) Barriers and facilitators of app use, (II) Usability, (III) Stress recognition, (IV) Coping with stress, and (V) Motivations for app use. Barriers and facilitators of app use at work Barriers to app use at work The interviews revealed several barriers to app use among MHWs. Many participants found it difficult to integrate the app into their daily routine due to a packed schedule, administrative tasks, and unexpected work interruptions. One participant described the challenge of finding time to use the app: “Yes, it is often the case that your schedule is full. So that you have a patient from 9 to 9:45 and then 9:45 to 10.30. Sometimes there are 15 minutes in between. But then you often think, oh yes, I still have to report, I still have to do this, I still have to do that. I can also do this now, so it doesn't have to be this afternoon. Then the conversation runs late, or a phone call comes in between” (P9). This high workload often led to forgetting or delaying app use until the questionnaires expired. Notifications were frequently dismissed due to more pressing responsibilities, and by the time participants had a free moment, the questionnaire had often already expired. Some mentioned that their work required full attention on clients, making it difficult to engage with the app during shifts. Others noted that the unpredictability of their work environment, such as sudden phone calls or emergencies, made it difficult to plan dedicated moments for the app. The fast-paced nature of their job roles also meant that breaking concentration to use the app was felt as disruptive. Some felt that once they were immersed in work, shifting focus to the app was difficult. Even when they intended to complete the questionnaires, they often became so caught up in their daily tasks that the app was deprioritized: “And I find that I, sometimes I'm so caught up in the day, in the structure, in the groups, that I thought, oh yes, I still have to do that app, those questionnaires and making it just, I didn't always manage to complete those lists on time” (P12). Additionally, irregular shifts and unpredictable schedules created further obstacles. The app’s notifications did not always align with the availability, and those working alone had fewer opportunities to step away and complete questionnaires. Some found it easier to engage with the app when working in pairs, as shared responsibilities allowed for brief moments of use. Others lacked access to work phones or use shared devices, which limited their ability to interact with the app consistently. Many participants believed that if completing the questionnaires had been easier from the start, it might have helped establish a habit, making app use more manageable over time: “What I say, if I could have filled it in more easily at the beginning, that there would be a bit of a rhythm that you go and fill it in. That would have made it easier” (P6). Facilitators of App Use at Work Participants identified several factors that facilitated regular app use. Over time, completing the questionnaires became part of their daily routine, eventually turning into an automatic habit. While integrating the app into their workday initially required effort, consistent use made it easier. Notifications played a key role in reminding participants to engage with the app: “It is thanks to the notifications that I did think about it” (P8). The fixed timing of notifications also helped users anticipate them, reinforcing the habit even when they were not actively thinking about or using the app. One participant noted how quickly the notifications became part of her routine, to the point where its absence was felt: “Maybe not at five to two, but I do think somewhere in the afternoon I think ‘this is weird, how empty it is.’ Yes, I do think that, yes, funny how quickly that goes. How you actually just make something your own very quickly” (P2). Setting fixed moments for app use helped participants integrate it into their workday without disruptions, which was both appreciated and contributed to habit forming. Some participants found specific moments in their workday to complete the questionnaires, such as during breaks, between appointments, or at the start of the day: “I did sometimes just have 5–10 minutes of very little time between people. And then, I took advantage of that to just fill it in then” (P8). Usability Most participants found the app convenient and easy to use. Its simplicity allowed quick session completion without consuming much time, while the relatable language and intuitive interface made it user-friendly. The Stress Questionnaire Participants appreciated the questionnaire’s clarity and the four-hour timeframe for reflecting on activities and feelings. The response options and the use of their own "normal" as a reference point felt personalized: “ So I think that 'yes, more than normal' made it very personal. Even though it wasn't personal at all, of course, but it gave you a more personal feeling” (P2). What also made it feel more personalized was that the app did not only indicate a stress level, but also asked users if they could identify with the score, which involved participants more in their own assessment of stress. However, the one-hour window for completion was often challenging with workloads: “I was disappointed that if I was busy with something else and came back later, the questionnaire was already gone” (P2). Visual Overview Some participants reported missing the app’s insight page due to time constraints or its lack of prominence. However, the majority would have appreciated the visual overview because of the additional insights it provides. They considered it useful for identifying stressful moments and activities: ”I think if you are more aware of that, it can just be helpful to look at, did I indeed have more stressful thoughts yesterday than usual, that you can then also look back a bit more of where was that due to this week?” (P5). Those who viewed the overview appreciated its ability to highlight stress patterns and provide perspective: “You also see green, and you think, ‘oh yeah, I was chill somewhere this week too.’ It helps put things in perspective” (P2). However, some felt it offered little value as they were already aware of their stress factors: “Personally, I don't run into it very much that I think, ‘what's stressing me out?’ I actually know that, I think. But I do believe that if you find that difficult, that can be very helpful” (P7). Stress Tips The app’s stress tips were well-received and seen as reminders to take stress-reducing actions: “Yes, that is nice, because in the moment you do not really think about that. So, a reminder is quite nice” (P3). Several participants added that even if the tips are something you know yourself, it is still helpful if the app offers it: “I always think that it can be important or nice for us people that something or someone says things to you. Even if sometimes these are things that you could actually have thought of yourself, it's still helpful if it's just said to you” (P7). This was further explained that it can be difficult to take the step to rest or relax in stressful situations. As it was pointed out, the brain often doesn't work optimally under stress, so you'd be less likely to think or do it yourself: “When you're in stress, our brain doesn't always function optimally, so it's hard to still think of that yourself, and so it can be nice if it's kind of pre-cooked” (P7). For participants operating in solitary working environments, this external reminder was found to be especially important. Some participants explained that they work without direct colleagues who could notice signs of stress or check in on them. Furthermore, participants appreciated the ability to view the full list of stress tips, as it provided them with more ideas. One participant noted that this feature reminded her of the variety of ways to relax beyond her usual approach: “There are quite a lot of options actually. And normally out of myself I would probably just only think about of taking a break or something” (P3). In addition, the option to personalize the list by adding your own stress reducing tips was well received: “You can say ‘go listen to a podcast,’ and that is good because then it’s personal.” (P4). Although, some participants felt that the app’s tips offered little added value, as these were mostly suggestions they already knew while others found them repetitive or uninspiring: “It’s the same answer every time. What innovates it anymore?” (P6). They suggested offering more varied and creative tips to sustain interest and engagement: “I think it would be nice, for example, if there were two of them, one that you might have filled in yourself beforehand, because of course that is also very useful, that works well for you, but also something completely new of which you can indeed think, ‘oh no this really isn't for me’, or ‘oh what fun, I'll give it a try’” (P9). Stress recognition Self-awareness All participants reported that the app prompted them to take a moment for themselves and reflect on their day and feelings. App notifications served as reminders to shift attention inward, helping them become more self-aware. One participant described this as a valuable pause for self-reflection: “But also really what I get out of it myself especially is that it gave me a moment to think of ‘hey, how do I feel right now?’, ‘how am I doing now?’, ‘how have the last few hours been?’ and this awareness, I think, is just really nice already” (P1). One participant set the first questionnaire in the morning, before starting work. Although she initially found this inconvenient, as no activities had yet taken place, it helped her begin the day more consciously: “Because it does make me think again of, hey, did I actually get a good night's sleep? How do I actually start my day? I thought that was a positive thing. That did make a difference. At first, I thought I would fill out the questionnaire with no stress, but later I became aware that it's also good to reflect on how I start my day and how I feel” (P7). Participants noted that with busy and full schedules, they were often so focused on their tasks that they operated on a so-called ‘autopilot’ mode, getting caught up in the flow of the day. The app provided a necessary pause, interrupting this continuous work cycle and compelling them to take a moment for self-reflection. As one participant described: “The app makes it necessary to pause for a moment anyway. Which is really good for me, because otherwise I just drift on. Yeah especially, when I'm busy” (P1). Without this reminder, such self-reflection often happened only later in the day: “It was earlier in the day, rather than just continuing and then, in the afternoon, driving home and thinking, ‘oh yes, what kind of day was it?’” (P9). Awareness of stress signals Nearly all participants reported that completing the app’s stress questionnaire encouraged reflection on their mental and physical states, making them more aware of stress signals such as bodily tension, a full head, or hunched shoulders. Many acknowledged that without the app, they would have noticed these signs far less or not at all. For instance, filling out the questionnaire forced an participant to listen to her body, leading to notice physical symptoms in moments of stress: “And it forces you to reflect on how you feel in your body at that moment. So, in my case, I feel the stress especially in my body, so I often sit very tense, usually with clenched fists, or I breathe very fast, or I have a high heart rate, or I constantly have the idea that I have to cry. I started to recognize that at one point” (P2). Additionally, the response options encouraged deeper reflection by prompting participants to assess whether their experience of stress signals are different from their “normal” or not: “Particularly with those answers, I was consciously engaged in that for a while of, ‘is it actually like usual or is it more than usual?’” (P13). This comparison further helped them to distinguish between stressful and less stressful moments. Awareness of Stress Level All participants stated that seeing their calculated stress score increased their awareness of their stress levels, with some describing it as a "wake-up call." Participants described that the app revealed stressful moments they might have otherwise overlooked, prompting them to reflect on situations that might impacted them more than expected: “At some point also through those questionnaires that I thought, oh yeah no, I think this has given me more stress than what I might have initially noticed” (P13). Seeing the stress score also allowed participants to notice rising stress levels earlier, enabling quicker intervention. One participant described how awareness of moderate stress can prevent escalation to high stress: “Instead of just going on and on, when you might be in orange at 12 o'clock, but not quite signalling that... you go on, on, on, on and eventually you end up in red, for example” (P7). For many, the score represented an accurate validation of their feelings, confirming their personal assessment. Others were surprised by higher-than-expected scores, which made them reconsider how certain activities had affected them. Low stress scores reassured participants that they were managing well in terms of stress: “Green I always found reassuring. Then I thought, okay, it is not too bad. That is fine, that is nice” (P2). Some even explained that they felt like they were doing a good job and had a sense of accomplishment. Low scores positively influenced participants’ outlook on their workday and reassured them that their workload was manageable: “And everyone also always just talks about busy, busy, busy. And then it always just feels like work is stressful then. But then when you see such a low stress score, you think, well, it's really not that bad at all” (P3). This realization led some to approach the rest of their day more relaxed, preventing further stress accumulation: “Maybe going into it more relaxed [...] it also ensures that you do not get as much stress afterwards” (P3). Conversely, for some participants, high stress scores provoked confrontation and disappointment: “Sometimes I did think, oh well, I do feel I'm in orange or something, but then I was in red. Then I thought, yeah this is unfortunate. I wasn't quite expecting this. So, I found that confronting at times” (P2). However, for most, a high score acted as a signal to take action: “Well, that would just be a strong signal for me to make sure the stress is going to decrease” (P12). However, it was also stated that seeing an elevated stress score encouraged participants to consider the causes, such as work pressure or personal circumstances, helping them become more conscious of stressors. Insight into stress patterns and factors Participants reported that using the STAPP@Work app increased their awareness of stress factors and moments of high stress: “I do notice that I know when I get a little stressed and sure I knew that maybe before using that app too, but not as consciously as now, so I take that from it” (P8). Although most participants had not actively used the visual overview, completing the questionnaire and seeing their stress scores provided valuable insights into stress factors. For example, one participant realized that intake interviews caused unexpected tension: “I see client contact, I have an intake today, I see that an intake with a first patient apparently creates tension for me, I didn't know, but then when I started thinking about that and filling it out, I thought, oh yeah that does create a little stress” (P8). Participants differed in how much new insight the app provided. Some found the app helped structure and clarify stress factors they already suspected, while others felt like they learned little new, as they were already aware of their stress sources. However, among those who found no new insights, all did state that the app could have been more helpful at an earlier, more stressful, stage in life: “I can imagine that back then, it could have helped me gain insight into my daily patterns and the things happening around me. So, for that reason, I think it could be helpful again in the future, but it definitely would have helped me back then to guide me through that” (P6). Implications of Awareness Using the app helped participants recognize the importance of stress management and maintaining good health. This further encouraged them to monitor their well-being more closely and pay preventive attention to stress, for instance by setting and safeguarding their own boundaries: “It's a kind of wake-up call, you could call it. Yes, it makes me think, 'oops, I have to be careful,' or 'I have to make sure it keeps going well,' or 'I have to watch my own boundaries', or those kinds of thoughts. And that does help me overall to make sure that I too don't fall out” (P13). With this increased awareness, many participants also started reflecting on what was contributing to their stress levels: “And then, of course, it's also important to explore where that stress is coming from. Is it just coming from my work or is it coming from other factors? It could also be that there are underlying factors that also cause a certain amount of stress” (P12). Awareness of stress helped participants place and better understand their feelings throughout the day. One participant described how this awareness and self-check-in prevented her from feeling completely drained at the end of the day without understanding why: “I think I have experienced this less now, that I am like this, especially at work … but that you go through the day like this, actually a bit on a kind of busy autopilot, and then at the end of the day… that sometimes you can think: 'I'm completely exhausted, but what is this now?'” (P7). She further noted that simply identifying her stress level and placing it in context could already help in reducing stress: “Then I probably start wondering how that came about or where that came from. I think then sometimes I also manage to maybe when I'm sitting in red by thinking, 'what was this?' to go to orange because it's already kind of helpful to place it anyway” (P7). Coping with Stress As participants became aware of their stress, many applied various coping strategies during the workday, either by following the app’s stress-reducing tips or by their own initiative. Most participants indicated that they had consciously taken a moment to rest and take a break from their work to relieve stress. Some did breathing exercises to relax and relieve stress: “But also spent some time with my breathing, that I just breathed for a moment. Because then my breathing is somewhere near my ears, instead of it just coming from my belly” (P2). while others started paying more attention to their posture, such as having more relaxed shoulders and an upright sitting position. It was also frequently mentioned by participants to opt for a short walk to clear their heads. For example, one participant indicated that after using the app and seeing the stress score, he decided to have lunch outside during a walk break. Also, distractions were sought by doing something else for a while, such as looking on social media. Participants that were highly immersed in their daily tasks made sure to take breaks to eat and drink. Those working in isolated environments actively sought social interaction with colleagues. Furthermore, some participants decided to let go of certain tasks until later in the day where others restructured their thoughts and made them less negatively charged. Beyond immediate stress relief, participants also focused on addressing the causes for stress for future stress: “I think I also ask myself, 'should I do something about this?’, ‘can I do something about this preventively?’” (P3) For example, one participant had pointed out that she was extra aware that the weekly meeting caused more tension which made her think: “And maybe you can also prepare something for it, that you're going to do a meeting like that standing up or in a different way, yes…that I can look more actively into ‘how am I going to keep this fun and sustain it?’” (P9). As STAPP@Work helped to identify stress sources, participants reported to take targeted action. For example, one participant prioritized doing administrative work when he realized that it contributed to a full head: “Yes, in the sense that you have the insight then, you can also look at what do I need now. So, for example, when my head was full I would really focus on getting rid of my paperwork while sometimes I would also chat with a colleague. And now I think ‘oh, that administration is putting pressure on how I work now and I have to do something about that’” (P5). Implications of Coping Participants who took a break or engaged in a relaxing activity because of the app reported feeling calmer during the workday: “That I think I end up going through my week a little calmer, I do think. Yes, I think so” (P7). One participant followed the app’s tip to create an overview of work tasks, which helped her organize her thoughts and avoid feeling overwhelmed: “Well, I do notice that I feel calmer. It was far from always going well though, that I really felt better. But I felt calmer and I also always had the idea that my head was a little bit, what do I call it, less cloudy or something. That I could think much more sharply like okay, but what do I actually need to do?” (P2). Another participant found that simply knowing she could take a break when needed made the workday feel more manageable: “Yeah, it does give you a little more peace or something. That you just think oh yeah, I can always just take a little moment which is already helpful then again and then the whole day immediately feels a little less overwhelming” (P3). Taking a break outside, such as having lunch in the fresh air, also contributed to feeling refreshed and better prepared to continue the workday. However, some participants noted that the calming effect of these moments was temporary, as work pressure and stress returned throughout the day: “But then the further away you are from the moment you used that app, the stress just increases again” (P2). Lasting Behaviour Change Some participants reported continuing certain behaviours even after they stopped using the app. One participant became more mindful of how she started her workday, now regularly reflecting on her herself without the app. Another participant still thought about the app’s stress tips, recognizing moments when she would normally receive advice and choosing to follow it: “And when something happened, I thought, oh yes, if I had filled it in now, it would probably give as a tip to do this for a moment. So, then I very briefly went to do that without using the app. Yes” (P8). A participant that described the app as a tool for recognizing stress signals, reported that after a week and a half, she began independently checking for signs of stress and taking a moment to reflect, without using the app. Another participant explained that the app changed how he approached breaks. Previously, he often skipped them and had to adjust his recorded work hours. After using the app, he started scheduling and taking breaks more consistently, reducing the need for adjustments. Motivations for App Use Participants shared their thoughts on why MHWs might or might not use the app. Some suggested that a lack of work phones or the inconvenience of using a personal device could be a barrier. Others felt that colleagues might perceive the app as an additional task in an already demanding work environment. It was reported that implementing new tools could be seen as time-consuming, which might discourage MHWs from trying them. Some participants believed that certain professionals might feel they already know how to manage stress and therefore may not see the added value of the app: “And I think some also say, yeah, but what's it going to help me or I'm a professional after all... Whereas I think, we know just fine how to guide our clients, but that doesn't mean you have yourself completely in control” (P5). For others, the app’s focus on self-reflection could be confronting, as it encourages MHWs to acknowledge stress patterns they might avoid or overlook: "It is very confronting to also have to look at yourself, at certain patterns that you have consciously or unconsciously, to recognize that what you are doing is not so functional" (P2). Conversely, participants also discussed potential reasons why colleagues could find the app beneficial. Many believed it might help increase awareness of stress levels and provide early insights into stress patterns which would make it easier to manage workloads. This was perceived important, particularly in high-pressure environments because MHWs might not always recognize their own stress levels, as they tend to focus on their work: "I think a lot of people don't realize it and just go on, go on, go on. And if you were to ask a lot of people, do you have stress? Most people would say no but probably have it" (P8). Discussion The findings illustrate how STAPP@Work supported MHWs in increasing self-awareness, recognizing stress patterns, and applying coping strategies. The app motivated employees to reflect on their well-being and to prioritize and integrate stress management into their workday. Barriers and Facilitators of App Use Most employees found STAPP@Work user-friendly, quick to complete, and easy to use. Short and consistent interactions were seen as habit-forming, increasing engagement with app interventions at work [ 46 ]. This aligns with our findings, where several participants reported that, over time, using the app became part of their daily routine. The two-week usage period may not have been sufficient for all employees to fully integrate the app into their workdays. However, employees also faced challenges in sustaining engagement causing them to forget or deprioritize the app. While participants recognized its benefits, time constraints made consistent use difficult as many found it challenging to find suitable moments for self-assessment. Prior research has shown that perceived effort and user intention were key drivers of engaging with digital interventions [ 46 ], which may explain why some employees struggled to integrate the app into their routines. Greater flexibility in app functionality, such as extended response windows, could reinforce engagement by making it easier to use the app at more convenient moments. Self-Awareness and Stress Recognition In high-pressure environments, employees often prioritize their responsibilities over their own well-being, creating an imbalance between work demands and recovery that can result in chronic stress [ 47 ]. Prolonged cognitive demands contribute to mental fatigue, reducing cognitive performance and increasing the risk of burnout [ 47 – 49 ]. Many participants acknowledged that without an external reminder, they were less likely to take time for self-reflection. STAPP@Work helped disrupt this cycle by prompting brief “self-check-ins” through stress questionnaires, encouraging employees to pause, evaluate their well-being, and recognize stress signals that might otherwise go unnoticed. These moments of reflection supported self-awareness, a key factor in managing work-related stress and protecting against high workloads and mental fatigue [ 49 ]. By becoming more attuned to their stress levels, employees could regulate their emotions, adjust their behaviour, and preserve their energy. Prior research also highlights that mood-tracking apps foster self-awareness, helping users reflect on themselves [ 50 , 51 ]. Without intervention, employees can experience stress accumulation or gradually become worn out throughout the day, only realizing this at the end of the day. The app mitigated this by encouraging ‘microbreaks’ which sustain energy, increase engagement, and reset attention [ 52 , 53 ]. The stress questionnaires made participants recognize their stress level and associated signs. Without the app, many only noticed stress when it was high, missing the gradual build-up that became visible through app use. This means that the app allows workers to intervene and deal with this stress early to prevent stress accumulation [ 54 ]. Participants also identified stress patterns which is helpful in preparing for similar situations and prevent future stress [ 54 ]. These findings suggest that the app may help reduce chronic stress, prevent physical and emotional exhaustion, and mitigate it’s long-term negative effects [ 54 ]. Low stress scores provided reassurance, whereas high scores, although confronting, motivated employees to prioritize stress management. This indicates that real-time feedback, whether positive or negative, can trigger self-regulatory behaviours, which is essential for adaptive change and the development of resilience [ 55 ]. Coping with work stress After using the app, participants engaged in problem-focused strategies, such as prioritizing and organizing tasks and addressing responsibilities, as well as emotion-focused strategies like reframing thoughts, practicing self-compassion, and using relaxation techniques. Recognizing and contextualizing stress scores often alleviated feelings of overwhelm, aligning with findings that self-monitoring apps help externalize distress and process emotions [ 56 ]. STAPP@Work motivated employees to apply both problem-focused and emotional coping, though the quantitative study found it only improved problem-focused coping [ 33 ]. This may be explained by the fact that qualitative findings revealed deeper insights into emotion-focused strategies that were not captured in measurable outcomes. The app contributed to lasting behavioural changes even after use ended. This aligns with earlier findings showing that STAPP@Work consistently improved coping self-efficacy and reduced exhaustion over time [ 33 ]. Participants reported using the skills learned from the app independently without use, highlighting the app’s role in promoting long-term resilience. Furthermore, those open to exploring stress triggers engaged more with the app, while those confident in their stress management engaged less. Motivation played a key role, with employees turning to the app during high-stress periods, as similarly seen in studies where negative life events increased engagement [ 31 , 51 ]. Strengths and Limitations Strengths This study provides a novel contribution to research by offering in-depth qualitative insights into the experiences of MHWs using a self-monitoring stress management app. It represents the first qualitative exploration of such experiences in this specific occupational group, an area that remains underexplored in current literature. A diverse sample was used, providing a broad representation across age, gender and job roles with the gender distribution reflecting that of the Dutch mental health care workforce [ 57 ]. This approach provided rich insights into how the app was perceived and experienced. Another key strength is that this study complements a preceding quantitative study within the same organization. By combining qualitative and quantitative approaches, it offers a holistic understanding of the app’s impact, increasing knowledge about its usability and effectiveness among MHWs. Limitations A potential limitation is social desirability bias, as participants may have given responses they believed aligned with study goals. This risk was heightened by recruitment within GGz Centraal, where the organization’s role as both employer and research setting could raise confidentiality concerns. However, employees were reassured through anonymity assurances, secure data storage, and clear communication that no identifying information would be shared. The sample may have favoured employees already receptive to stress management, potentially excluding those less inclined toward such interventions. While this limits broader applicability, it aligns with the app’s target audience, providing valuable insights into its impact and usability. Additionally, the study did not assess participants’ mental health conditions, which may have influenced their experiences with stress and the app. The findings are limited in generalizability to other work settings, particularly those where there is less familiarity with mental health topics. The app’s effectiveness may vary in industries where stress management is less emphasized. Yet, the focus on MHWs provides a unique opportunity to study the app’s use in a high-stress work context, forming a basis for adapting and testing similar interventions in other settings. Implications This study shows the potential of STAPP@Work to facilitate preventive stress management in mental health care. By promoting early stress detection, self-awareness, and timely intervention, the app helps combat chronic stress, emotional exhaustion and other burnout symptoms. Giving employees control over their stress management in an accessible way, rather than reacting to its effects, helps organizations protect employee health, reduce absenteeism and turnover, and improve long-term performance and job satisfaction. The results reveal that MHWs adopted lasting stress management behaviours, showing how self-monitoring technologies can contribute to a more mindful, resilient and sustainable workforce. Given the increasing demand for mental health services and rising workforce pressure, retaining MHWs is essential [ 2 ]. In this context, scalable and accessible interventions like STAPP@Work offer a meaningful contribution in supporting staff well-being. To improve engagement, implementation strategies should emphasize flexibility and customization, aligning with MHWs' work routines. Research on digital health interventions [ 19 , 46 , 58 ] further stresses the importance of overcoming such barriers. Additionally, perceived obstacles, such as viewing the app as an extra task, time-consuming, or confronting, require clear communication about its benefits. Some employees doubted its necessity, believing they had sufficient stress management skills. Targeted implementation strategies should focus on reducing resistance and increase adoption. Future research Examining the app's effectiveness within specific departments and job functions is essential, as this exploratory study included employees with diverse backgrounds, roles, and responsibilities, which likely influenced their experiences differently. Such research could provide a deeper understanding of how workplace roles affect app usage and outcomes. Additionally, expanding research to other work sectors would be valuable for assessing the app’s applicability beyond MHWs, especially in industries where employees may have less familiarity with or openness to stress management practices. Future studies should also delve into identifying and addressing specific barriers and facilitators to app usage. This would provide more detailed insights into strategies to enhance engagement and adoption, particularly in workplace settings like the mental health sector. While this study touched upon these aspects, they were not the primary focus. Understanding these factors in greater depth could inform tailored interventions to encourage consistent use of self-management apps. Moreover, the STAPP@Work app focuses solely on the individual employee, while it is well established that work-related stress is also shaped by factors such as leadership, organizational culture, and working conditions. These broader systemic influences should also be included in further developments and research for optimal stress prevention at work. Conclusion This study reveals that self-management workplace stress apps like STAPP@Work are an accessible means in helping MHWs manage stress and increase resilience. The app provided employees with valuable moments for self-reflection, increasing their awareness of stress signals and levels while encouraging them to prioritize their well-being. Participants reported heightened attention to their own stress management practices and were motivated to apply coping strategies. By facilitating early identification of stress indicators and moments of introspection, employees become more equipped to preventively tackle work-related stress, making it especially relevant in high-pressure work sectors. However, barriers inherent to the mental health sector, such as high workload, need for flexibility and hectic schedules should be taken into consideration to optimize adoption and user-engagement. These findings help fill a gap in the literature on mobile interventions for MHWs, providing insights into its real-world use to improve workplace well-being, and informing future research and innovation in digital stress management tools. Abbreviations EMA: Ecological Momentary Assessment MHWs: Mental Health Workers SSI: Semi-Structured Interview Declarations Availability of data Due to the sensitive nature of the interview data and to protect participant privacy, the datasets generated and analysed during the current study are not publicly available. Data are available from the corresponding author upon reasonable request. Acknowledgements The authors express their sincere thanks to all participants who participated in this study. They thank the project team who contributed to all developments surrounding the STAPP@Work app. The authors also thank GGz Centraal for their support in facilitating this research and Eaglescience for developing the app software. Also, many thanks to the author’s colleagues at GGz Centraal who collaborated in the development of STAPP@Work. Funding No funding was received for this study. Authors' contributions SD designed the study, conducted data collection and analysis, interpreted the data, and drafted the manuscript. YR, PNvH, and NHC provided supervision and contributed to the reviewing and editing of the manuscript. All authors read and approved the final manuscript. Corresponding author Correspondence to Sevda Demirel. Ethics approval and consent to participate This study was reviewed and approved by the Medical Ethics Review Committee Leiden The Hague Delft (METC LDD) (Ref: N25.024), and was conducted in accordance with the principles of the Declaration of Helsinki. Participants were informed about the aims and procedures of the study and provided informed consent prior to participation. They were informed of their right to withdraw from the study at any time without consequences. Interviews were audio-recorded with permission and anonymized to ensure confidentiality. All user data in the app was handled in accordance with the General Data Protection Regulation of the European Union, ensuring user privacy and data security. Consent for publication Not applicable. Competing interests YR became co-founder of a new version of the STAPP@Work app after completion of this study. The STAPP@Work app was transferred to an independent third party, who further developed, modified, and released it under a different name. All other authors declare no competing interests. References Kober M, Chang Y. Healthcare workers’ perceptions of work-related stress and burnout: strategies and barriers for self-care. Am J Lifestyle Med. 2024. doi:10.1177/15598276241230043 Bootsma J, van de Glind I, van de Ven G. Op het tweede gezicht: een blik op ontwikkelingen in de ggz. Utrecht: Stichting FWG; 2023. 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Available from: https://www.cbs.nl/nl-nl/longread/statistische-trends/2020/arbeidsmarktprofiel-van-zorg-en-welzijn. Accessed 16 Dec 2024. Carolan S, De Visser RO. Employees' perspectives on the facilitators and barriers to engaging with digital mental health interventions in the workplace: qualitative study. JMIR Ment Health. 2018;5(1):e8. doi:10.2196/mental.9146 Additional Declarations Competing interest reported. YR became co-founder of a new version of the STAPP@Work app after completion of this study. The STAPP@Work app was transferred to an independent third party, who further developed, modified, and released it under a different name. All other authors declare no competing interests. Supplementary Files Supplementaryfile1COREQchecklist.pdf Supplementary File 1 Checklist van COREQ Supplementaryfile2Interviewguide.docx Supplementary File 2. Interview guide Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 03 Nov, 2025 Reviews received at journal 01 Nov, 2025 Reviews received at journal 30 Oct, 2025 Reviewers agreed at journal 29 Oct, 2025 Reviews received at journal 14 Oct, 2025 Reviewers agreed at journal 27 Sep, 2025 Reviewers agreed at journal 27 Sep, 2025 Reviewers invited by journal 07 Jul, 2025 Editor assigned by journal 04 Jul, 2025 Editor invited by journal 19 Jun, 2025 Submission checks completed at journal 18 Jun, 2025 First submitted to journal 18 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6611387","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":482235917,"identity":"71acbdf1-b92b-48c7-b347-a7b3ee080aef","order_by":0,"name":"S. Demirel","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAUlEQVRIiWNgGAWjYHACAzDiY29AEnvAwCBDUAsbzwEIlwdEJEBp3FqAgE0igUgt8g3MGx/dKLgnxyb5/PLLHzU2efbShx9+SGC4g1OLwQG2YuMcg2JjNumcMguJY2nFPHxpxkAbn+HWwsBjJp1jkJDYJp2TZmDYcDixh4fBAKjlMB6H8Zj/Bmqpb5M8k2aQ2PAfqIX98w98WhgO8JgxA7UksEmwH35wsOEAUAuPGV5bDA6zFYMcZtjGk8PG2HAsObHnDE+ZRYIBHoe1N2/8nPMnQZ6f/fjjjz9q7BLbe9g33/hQcVgOp8OY4Syge5CDhRjA/vgDUepGwSgYBaNgxAEAzhVPrwwOmSIAAAAASUVORK5CYII=","orcid":"","institution":"GGz Centraal","correspondingAuthor":true,"prefix":"","firstName":"S.","middleName":"","lastName":"Demirel","suffix":""},{"id":482235918,"identity":"60a8ce27-9049-485a-9c24-bd3933702975","order_by":1,"name":"Y. Roke","email":"","orcid":"","institution":"GGz Centraal","correspondingAuthor":false,"prefix":"","firstName":"Y.","middleName":"","lastName":"Roke","suffix":""},{"id":482235919,"identity":"1b76bd2d-f894-4d2e-9ce9-2dc2de980f5c","order_by":2,"name":"N. H. Chavannes","email":"","orcid":"","institution":"Leiden University Medical Centre","correspondingAuthor":false,"prefix":"","firstName":"N.","middleName":"H.","lastName":"Chavannes","suffix":""},{"id":482235920,"identity":"9302905f-76f4-4e85-9ce7-15407df84913","order_by":3,"name":"P. N. Harten","email":"","orcid":"","institution":"Maastricht University","correspondingAuthor":false,"prefix":"","firstName":"P.","middleName":"N.","lastName":"Harten","suffix":""}],"badges":[],"createdAt":"2025-05-07 11:08:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6611387/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6611387/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86420739,"identity":"1dfa52ce-046f-4be2-8091-ba230af56573","added_by":"auto","created_at":"2025-07-10 12:47:34","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":229388,"visible":true,"origin":"","legend":"\u003cp\u003eScreenshots of the STAPP@Work app illustrating key functionalities. (A) Example of a stress questionnaire item. (B) Display of the calculated stress score on the home screen. (C) Visual overview. Image reproduced with permission from GGz Centraal, which owned and developed the app.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6611387/v1/c7b3b5fc61845529e4d8bdcd.png"},{"id":86422601,"identity":"16a3bbd4-1d54-4bff-b004-1a624e528b71","added_by":"auto","created_at":"2025-07-10 13:03:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1238370,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6611387/v1/50fef13a-7615-4897-aeda-98d6e5d38c7a.pdf"},{"id":86420744,"identity":"190d2437-8431-483d-bd0c-f69dcc40dae1","added_by":"auto","created_at":"2025-07-10 12:47:34","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":452161,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupplementary File 1\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChecklist van COREQ\u003c/p\u003e","description":"","filename":"Supplementaryfile1COREQchecklist.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6611387/v1/40053b48ac7641bf187c7e54.pdf"},{"id":86420747,"identity":"60bee7c9-7292-425c-a5ff-50d3782a22a0","added_by":"auto","created_at":"2025-07-10 12:47:34","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":23840,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupplementary File 2.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInterview guide\u003c/p\u003e","description":"","filename":"Supplementaryfile2Interviewguide.docx","url":"https://assets-eu.researchsquare.com/files/rs-6611387/v1/075b8c5c227b0494df4143e3.docx"}],"financialInterests":"Competing interest reported. YR became co-founder of a new version of the STAPP@Work app after completion of this study. The STAPP@Work app was transferred to an independent third party, who further developed, modified, and released it under a different name. All other authors declare no competing interests.","formattedTitle":"Navigating Workplace Stress: A Qualitative Exploration of Mental Healthcare Workers’ Lived Experiences with STAPP@Work, a Mobile Stress Management Intervention","fulltext":[{"header":"Background","content":"\u003cp\u003eWork-related stress is a leading cause of burnout among mental health workers (MHWs), driven by high workloads, emotional demands, staff shortages and pressure due to long waiting lists [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. From July 2023 to June 2024, stress-related absenteeism in Dutch sectors increased by 8%, with healthcare being the most affected [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In five years, absenteeism increased by 30%, with emotional exhaustion higher in mental healthcare than in other areas [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Around 20% of Dutch therapists reported being emotional exhausted, compared to 12.4% among hospital workers [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Research shows that one in seven employees previously absent due to stress will experience another absence within three years, often within the first year of returning to work [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The 2021 \u003cem\u003eDon\u0026rsquo;t Forget Yourself\u003c/em\u003e study found that nearly half of Dutch MHWs reported high stress levels, with 30% showing depressive symptoms and 14% experiencing anxiety [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Alarmingly, 4.2% intended to leave the field. A follow-up study in 2023 showed some improvement, but 36% of workers still reported elevated stress [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWorkplace stress arises when job demands exceed an individual\u0026rsquo;s capacity to cope. While short-term stress is useful for performance, prolonged stress without recovery leads to chronic stress. Chronic stress, if unmanaged, can cause physical, emotional, and cognitive impairments, impacting both individuals and organizations. It is linked to anxiety [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], depression [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], and burnout - a syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Cognitive functions, like memory [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], decision-making [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], and problem-solving are negatively affected. Physically, prolonged stress disrupts multiple bodily systems, leading to weakened immune function [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], gastrointestinal issues [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], hormonal imbalances [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], and persistent fatigue [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], increasing long-term health risks.\u003c/p\u003e\u003cp\u003eThe consequences of chronic stress among employees extend to organizations, through reduced productivity, increased absenteeism, and higher turnover rates [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. These challenges result in substantial financial losses due to healthcare expenses [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] and lower efficiency [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Workforce shortage puts pressure on remaining staff, reduces care quality, and limit patient access to mental health services [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. It is therefore of great significance to develop effective workplace interventions to support MHWs in becoming more resilient to the adverse effects of work stress.\u003c/p\u003e\u003cp\u003eIn recent years, mobile health interventions have gained recognition as tools for workplace stress management. These apps can offer evidence-based, in-the-moment support, engaging employees in stress management practices with flexibility and easy integration into their schedules [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. They often require little time and effort, which is especially valuable in high-pressure work sectors [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. For organizations, such interventions are a cost-effective way to reach a broad workforce with scalable implementation [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eStress management apps incorporate various techniques including self-monitoring, mindfulness practices, cognitive-behavioural strategies, and psychoeducation [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Research shows such interventions can be effective in reducing stress and improving well-being among employees [\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Though limited, existing literature on the effectiveness of these interventions among healthcare professionals also reported lower stress levels [\u003cspan additionalcitationids=\"CR26 CR27 CR28\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Earlier qualitative studies have explored how healthcare workers experience and interact with these apps. For instance, features such as mood tracking, personalized goals, and in-app resources were valued [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Also, improvements in stress management were reported despite barriers like time constraints and motivation [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBuilding on the need for tailored self-directed interventions in managing daily work stress among MHWs, the STAPP@Work app was developed. This self-management app supports by tracking daily stress levels and activities, providing personalized feedback, identifying stress patterns, and offering real-time coping strategies. Based on Ecological Momentary Assessment (EMA) principles [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], the app helps users recognize and address stress trends over time through visual overviews of their stress levels across workdays and weeks. A prior quantitative study demonstrated the app\u0026rsquo;s effectiveness in reducing perceived stress, improving problem-focused coping self-efficacy, and lowering burnout symptoms over time [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. While these findings showed promising evidence, they left a critical gap in understanding users\u0026rsquo; subjective experiences. This study adopts a qualitative approach to explore the lived experiences, perceptions, and attitudes of MHWs using STAPP@Work. By delving deeper into these experiences, this research aims to provide a richer understanding of the app\u0026rsquo;s use and complex interactions between stress management, work settings, and technology.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eDesign\u003c/h2\u003e\u003cp\u003eThis study followed a qualitative design using a phenomenological approach, aimed at exploring the lived experiences and perspectives of MHWs who used the STAPP@Work app for two weeks. Phenomenology focuses on understanding the meaning behind lived experiences, making it ideal for examining how employees perceive the app\u0026rsquo;s impact at work [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. This design enables an in-depth exploration of employees\u0026rsquo; experiences, shedding light on the app\u0026rsquo;s perceived benefits, limitations, and its role within the broader context of workplace stress management [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The COREQ (Consolidated Criteria for Reporting Qualitative Research) framework [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] was used to guide the reporting of this study (Supplementary File 1).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSetting\u003c/h3\u003e\n\u003cp\u003eGGz Centraal is one of the largest mental healthcare organizations in the Netherlands, serving approximately 28,000 patients annually. Located in the central region, it provides a broad spectrum of specialized services, including both inpatient and outpatient care. GGz Centraal employs a multidisciplinary team of 3,500 professionals across multiple locations, offering diverse expertise and roles to provide mental health support.\u003c/p\u003e\n\u003ch3\u003eParticipants and Recruitment\u003c/h3\u003e\n\u003cp\u003eParticipants in this study were employees of GGz Centraal. Inclusion criteria involved individuals actively employed at GGz Centraal during the study period. Those who had been part of the development phase or the effectiveness study of the STAPP@Work app were excluded.\u003c/p\u003e\u003cp\u003eThe study aimed to achieve data saturation, a key principle in qualitative research for comprehensive and valid data collection [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Saturation is reached when no new themes or insights emerge, further coding becomes unfeasible, and the study can be reliably replicated. A purposeful sampling approach was used to ensure diversity in participants\u0026rsquo; roles within GGz Centraal.\u003c/p\u003e\u003cp\u003eParticipants were recruited using targeted and broad-reaching methods to ensure visibility across GGz Centraal. Flyers were distributed throughout the organization and shared digitally with team leaders. Digital presentations were delivered during team meetings to provide additional information and raise awareness. The flyers included a QR code for interested employees to register directly or contact the researchers via email. Researchers followed up with interested individuals, providing study information\u003c/p\u003e\u003cp\u003e\u003cb\u003eIntervention\u003c/b\u003e: \u003cb\u003ethe STAPP@Work app\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSTAPP@Work is a self-management app designed to help employees monitor stress levels, receive personalized coping strategies, and visualize stress patterns over time. The app was co-developed with a varying group of MHWs through iterative focus group discussions, ensuring alignment with their needs, experiences, and preferences. The app is rooted in the stress-signalling plan, a widely implemented tool in Dutch mental healthcare to monitor client stress levels and symptoms [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. This framework divides stress into four phases which are green (low stress), yellow, orange, and red (high stress), each representing varying intensity levels and associated symptoms. This model helps individuals understand their stress triggers and how their stress evolves [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. By integrating this structured approach with EMA, the app facilitates real-time stress tracking, linking stress levels to specific daily activities and situations.\u003c/p\u003e\n\u003ch3\u003eApp functionalities\u003c/h3\u003e\n\u003cp\u003eSTAPP@Work allows users to monitor their stress levels throughout the day by completing 2, 3 or 4 questionnaires at time intervals of 4 hours. The user can set how many questionnaires to receive for each day of the week and at what time points. Each questionnaire, available for one hour, asks about past activities and includes seven validated self-report stress questions related to emotional and physical stress indicators (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA). The response options were: \u003cem\u003e\"no\"\u003c/em\u003e, \u003cem\u003e\"yes, but not more than usual\"\u003c/em\u003e, \u003cem\u003e\"yes, more than usual\"\u003c/em\u003e, and \u003cem\u003e\"yes, much more than usual\"\u003c/em\u003e. The app then measures a stress score based on the questions and provides users with a direct overview of their stress level. This score determined the user's perceived stress level, categorizing it into one of four groups: \u0026ldquo;\u003cem\u003eno stress\u0026rdquo;, \u0026ldquo;little stress\u0026rdquo;, \u0026ldquo;stress\u0026rdquo;\u003c/em\u003e, or \u0026ldquo;\u003cem\u003ehigh stress\u0026rdquo; (\u003c/em\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB). Alongside the score, users receive practical coping strategies to manage stress for at work or home. The app includes a list of suggested coping strategies, which users can personalize by adding their own strategies or removing existing ones to better suit their needs. When a stress score is calculated, the app randomly selects and displays a coping suggestion from the user\u0026rsquo;s customized list. As the app links calculated stress scores to the activities users have recorded, it generates a visual summary of these insights. This overview displays daily and weekly stress levels, highlighting which activities and moments were associated with high or low stress (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eC).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eSemi-structured interviews (SSIs) were used to collect data. SSIs allowed open-ended questions, facilitating interaction between the interviewer and interviewee to gain insight into participants' experiences and perspectives [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The use of SSIs enables the collection of more reliable and comparable data by combining structured questions with flexibility [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The interviews were guided by a set of predetermined topics, including app usability, stress detection, coping with stress and improvements (Supplementary File 2). These topics were paired with open-ended questions, including 'probing' questions, to elicit detailed narratives around app use. The topics and questions covered the app's functionalities related to stress signalling, recognizing one's own stress patterns, and applying coping strategies. Additionally, the questions inquired about the participants' experiences of using the app and its impact on their workday. This approach allowed the identification of both positive and negative experiences, as well as the perceived benefits and limitations of use.\u003c/p\u003e\u003cp\u003eOnce developed, the interview guide was trialled through pilot interviews to improve consistency between interviews and variability through training for the interviewer [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Experts and researchers reviewed the guide beforehand, ensuring content validity. Pilot studies, conducted with GGz Centraal employees not included in the main study, assessed its relevance and representativeness [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Feedback from these trials was incorporated into the final version, refining the guide to reflect the research aim.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eProcedure\u003c/h2\u003e\u003cp\u003e Prior to participation, respondents received study information, the opportunity to ask questions, and time to reflect before signing informed consent. Individualized guidance on installing and using the STAPP@Work app was provided in an online briefing, where participants agreed on a start date for two weeks of app use and scheduled a follow-up interview. A helpdesk was available for study- or app-related queries. Interviews were conducted at an agreed time and place; if in-person meetings were not feasible, an online Teams appointment was arranged.\u003c/p\u003e\u003cp\u003eA PhD researcher (SD) conducted the interviews. The researcher has been trained in qualitative research through attending courses and workshops and has experience in conducting qualitative studies employing in-depth interviews and focus groups. No prior relationship was established between the interviewer and participants before the study commenced. At the start of each interview, the interviewer briefly introduced herself and explained the purpose and relevance of the study. The interviewer maintained a respectful, open attitude with empathetic and active listening to establish a relationship based on mutual interest, support, and understanding [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. The interviews took place in a distraction-free setting at the workplace of the interviewee lasting up to 60 minutes, allowing for exploration of all topics while avoiding fatigue [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. The interviews were conducted in Dutch. The interviews were recorded with two audio recorders. Insights from previous sessions were used to refine questions for subsequent interviews [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTo ensure credibility, efforts were made to minimize bias and inconsistency from both researchers and participants, striving for data accurately reflecting reality while reducing the influence of subjective interpretation [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. After each interview, researchers documented their experiences, observations, and thoughts in a reflexive log, to reflect on the interview process and data [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. This promoted reflexivity, making researchers aware of their assumptions and how these could influence data collection and analysis [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. To further enhance accuracy, member checking was employed. Participants received a summary of their transcribed interview to review and confirm alignment with their experiences, ensuring researchers' interpretations were correct [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003e Each interview was transcribed verbatim using a local version of OpenAI's Whisper, making sure the process remained completely secure and independent of the cloud. First, the transcripts were thoroughly reviewed to gain familiarity with the data. To explore the nuances and complexities of participants' experiences, the six-step model by Braun and Clarke [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e] was used to guide the thematic analysis, applying both an inductive and deductive approach. Theme development was informed by predefined topics, as reflected in the interview guide which are based on the functionalities of the STAPP@Work app. At the same time, the analysis remained open to an inductive approach to identify data-driven themes [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Given the study\u0026rsquo;s exploratory nature, this grounded, inductive approach was essential for capturing participants\u0026rsquo; experiences with STAPP@Work and finding common themes.\u003c/p\u003e\u003cp\u003eData were analysed in Atlas.ti (v8.4.4) through an iterative coding process of analysing, comparing and categorizing the data to identify patterns and themes [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Codes were reviewed and grouped into overarching themes based on recurring patterns and underlying concepts across participants. These patterns reflect how participants gave meaning to their experiences, capturing both the content of what was said and the way it was experienced. Themes were then refined to ensure clarity and alignment with the research question [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e], and each was defined in terms of its relevance to participants\u0026rsquo; experiences and its contribution to the overall understanding of using STAPP@Work in the workplace.\u003c/p\u003e\u003cp\u003eTwo independent coders reviewed and coded the data separately before comparing their findings with the primary researcher and coder [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. This allowed for the exchange of insights and perspectives related to the data. Regarding transferability, the results were reported as 'thick descriptions,' providing clear contextualization and understanding of the findings to individuals outside this study [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eGeneral findings\u003c/h2\u003e\u003cp\u003eThe study included 14 MHWs employed at GGz Centraal, a mental health organization in the Netherlands, with a mean age of 41.1 years (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). To preserve anonymity, age is presented in 10-year ranges. Most participants were female (n\u0026thinsp;=\u0026thinsp;10), with diverse roles including nurses (n\u0026thinsp;=\u0026thinsp;5), psychologists (n\u0026thinsp;=\u0026thinsp;2), psychosocial therapists (n\u0026thinsp;=\u0026thinsp;2), a functional administrator, an outreached therapist, a psychiatrist, and a social psychiatric nurse.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic Characteristics of Study Participants.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParticipant\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAge Range\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFunction\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u0026ndash;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u0026ndash;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u0026ndash;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePsychologist\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30\u0026ndash;39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePsychosocial therapist\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30\u0026ndash;39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNurse triagist\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30\u0026ndash;39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNurse triagist\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30\u0026ndash;39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOutreached therapist\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30\u0026ndash;39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40\u0026ndash;49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePsychiatrist\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40\u0026ndash;49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFunctional Administrator\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50\u0026ndash;59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePsychologist\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50\u0026ndash;59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePsychosocial therapist\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60\u0026ndash;69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60\u0026ndash;69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSocial Psychiatric Nurse\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe results are organized into the following key themes: (I) Barriers and facilitators of app use, (II) Usability, (III) Stress recognition, (IV) Coping with stress, and (V) Motivations for app use.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eBarriers and facilitators of app use at work\u003c/h2\u003e\u003cdiv id=\"Sec13\" class=\"Section3\"\u003e\u003ch2\u003eBarriers to app use at work\u003c/h2\u003e\u003cp\u003eThe interviews revealed several barriers to app use among MHWs. Many participants found it difficult to integrate the app into their daily routine due to a packed schedule, administrative tasks, and unexpected work interruptions. One participant described the challenge of finding time to use the app: \u003cem\u003e\u0026ldquo;Yes, it is often the case that your schedule is full. So that you have a patient from 9 to 9:45 and then 9:45 to 10.30. Sometimes there are 15 minutes in between. But then you often think, oh yes, I still have to report, I still have to do this, I still have to do that. I can also do this now, so it doesn't have to be this afternoon. Then the conversation runs late, or a phone call comes in between\u0026rdquo;\u003c/em\u003e (P9).\u003c/p\u003e\u003cp\u003eThis high workload often led to forgetting or delaying app use until the questionnaires expired. Notifications were frequently dismissed due to more pressing responsibilities, and by the time participants had a free moment, the questionnaire had often already expired. Some mentioned that their work required full attention on clients, making it difficult to engage with the app during shifts. Others noted that the unpredictability of their work environment, such as sudden phone calls or emergencies, made it difficult to plan dedicated moments for the app.\u003c/p\u003e\u003cp\u003eThe fast-paced nature of their job roles also meant that breaking concentration to use the app was felt as disruptive. Some felt that once they were immersed in work, shifting focus to the app was difficult. Even when they intended to complete the questionnaires, they often became so caught up in their daily tasks that the app was deprioritized: \u003cem\u003e\u0026ldquo;And I find that I, sometimes I'm so caught up in the day, in the structure, in the groups, that I thought, oh yes, I still have to do that app, those questionnaires and making it just, I didn't always manage to complete those lists on time\u0026rdquo;\u003c/em\u003e (P12).\u003c/p\u003e\u003cp\u003eAdditionally, irregular shifts and unpredictable schedules created further obstacles. The app\u0026rsquo;s notifications did not always align with the availability, and those working alone had fewer opportunities to step away and complete questionnaires. Some found it easier to engage with the app when working in pairs, as shared responsibilities allowed for brief moments of use. Others lacked access to work phones or use shared devices, which limited their ability to interact with the app consistently.\u003c/p\u003e\u003cp\u003eMany participants believed that if completing the questionnaires had been easier from the start, it might have helped establish a habit, making app use more manageable over time: \u003cem\u003e\u0026ldquo;What I say, if I could have filled it in more easily at the beginning, that there would be a bit of a rhythm that you go and fill it in. That would have made it easier\u0026rdquo;\u003c/em\u003e (P6).\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eFacilitators of App Use at Work\u003c/h2\u003e\u003cp\u003eParticipants identified several factors that facilitated regular app use. Over time, completing the questionnaires became part of their daily routine, eventually turning into an automatic habit. While integrating the app into their workday initially required effort, consistent use made it easier. Notifications played a key role in reminding participants to engage with the app: \u003cem\u003e\u0026ldquo;It is thanks to the notifications that I did think about it\u0026rdquo;\u003c/em\u003e (P8).\u003c/p\u003e\u003cp\u003eThe fixed timing of notifications also helped users anticipate them, reinforcing the habit even when they were not actively thinking about or using the app. One participant noted how quickly the notifications became part of her routine, to the point where its absence was felt: \u003cem\u003e\u0026ldquo;Maybe not at five to two, but I do think somewhere in the afternoon I think \u0026lsquo;this is weird, how empty it is.\u0026rsquo; Yes, I do think that, yes, funny how quickly that goes. How you actually just make something your own very quickly\u0026rdquo;\u003c/em\u003e (P2).\u003c/p\u003e\u003cp\u003eSetting fixed moments for app use helped participants integrate it into their workday without disruptions, which was both appreciated and contributed to habit forming. Some participants found specific moments in their workday to complete the questionnaires, such as during breaks, between appointments, or at the start of the day: \u003cem\u003e\u0026ldquo;I did sometimes just have 5\u0026ndash;10 minutes of very little time between people. And then, I took advantage of that to just fill it in then\u0026rdquo;\u003c/em\u003e (P8).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eUsability\u003c/h2\u003e\u003cp\u003eMost participants found the app convenient and easy to use. Its simplicity allowed quick session completion without consuming much time, while the relatable language and intuitive interface made it user-friendly.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eThe Stress Questionnaire\u003c/h2\u003e\u003cp\u003eParticipants appreciated the questionnaire\u0026rsquo;s clarity and the four-hour timeframe for reflecting on activities and feelings. The response options and the use of their own \"normal\" as a reference point felt personalized: \u0026ldquo;\u003cem\u003eSo I think that 'yes, more than normal' made it very personal. Even though it wasn't personal at all, of course, but it gave you a more personal feeling\u0026rdquo;\u003c/em\u003e (P2). What also made it feel more personalized was that the app did not only indicate a stress level, but also asked users if they could identify with the score, which involved participants more in their own assessment of stress. However, the one-hour window for completion was often challenging with workloads: \u003cem\u003e\u0026ldquo;I was disappointed that if I was busy with something else and came back later, the questionnaire was already gone\u0026rdquo;\u003c/em\u003e (P2).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eVisual Overview\u003c/h2\u003e\u003cp\u003eSome participants reported missing the app\u0026rsquo;s insight page due to time constraints or its lack of prominence. However, the majority would have appreciated the visual overview because of the additional insights it provides. They considered it useful for identifying stressful moments and activities: \u003cem\u003e\u0026rdquo;I think if you are more aware of that, it can just be helpful to look at, did I indeed have more stressful thoughts yesterday than usual, that you can then also look back a bit more of where was that due to this week?\u0026rdquo;\u003c/em\u003e (P5).\u003c/p\u003e\u003cp\u003eThose who viewed the overview appreciated its ability to highlight stress patterns and provide perspective: \u003cem\u003e\u0026ldquo;You also see green, and you think, \u0026lsquo;oh yeah, I was chill somewhere this week too.\u0026rsquo; It helps put things in perspective\u0026rdquo;\u003c/em\u003e (P2). However, some felt it offered little value as they were already aware of their stress factors: \u003cem\u003e\u0026ldquo;Personally, I don't run into it very much that I think, \u0026lsquo;what's stressing me out?\u0026rsquo; I actually know that, I think. But I do believe that if you find that difficult, that can be very helpful\u0026rdquo;\u003c/em\u003e (P7).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eStress Tips\u003c/h2\u003e\u003cp\u003eThe app\u0026rsquo;s stress tips were well-received and seen as reminders to take stress-reducing actions: \u003cem\u003e\u0026ldquo;Yes, that is nice, because in the moment you do not really think about that. So, a reminder is quite nice\u0026rdquo;\u003c/em\u003e (P3). Several participants added that even if the tips are something you know yourself, it is still helpful if the app offers it: \u003cem\u003e\u0026ldquo;I always think that it can be important or nice for us people that something or someone says things to you. Even if sometimes these are things that you could actually have thought of yourself, it's still helpful if it's just said to you\u0026rdquo;\u003c/em\u003e (P7). This was further explained that it can be difficult to take the step to rest or relax in stressful situations. As it was pointed out, the brain often doesn't work optimally under stress, so you'd be less likely to think or do it yourself: \u003cem\u003e\u0026ldquo;When you're in stress, our brain doesn't always function optimally, so it's hard to still think of that yourself, and so it can be nice if it's kind of pre-cooked\u0026rdquo;\u003c/em\u003e (P7). For participants operating in solitary working environments, this external reminder was found to be especially important. Some participants explained that they work without direct colleagues who could notice signs of stress or check in on them.\u003c/p\u003e\u003cp\u003eFurthermore, participants appreciated the ability to view the full list of stress tips, as it provided them with more ideas. One participant noted that this feature reminded her of the variety of ways to relax beyond her usual approach: \u003cem\u003e\u0026ldquo;There are quite a lot of options actually. And normally out of myself I would probably just only think about of taking a break or something\u0026rdquo;\u003c/em\u003e (P3). In addition, the option to personalize the list by adding your own stress reducing tips was well received: \u003cem\u003e\u0026ldquo;You can say \u0026lsquo;go listen to a podcast,\u0026rsquo; and that is good because then it\u0026rsquo;s personal.\u0026rdquo;\u003c/em\u003e (P4).\u003c/p\u003e\u003cp\u003eAlthough, some participants felt that the app\u0026rsquo;s tips offered little added value, as these were mostly suggestions they already knew while others found them repetitive or uninspiring: \u003cem\u003e\u0026ldquo;It\u0026rsquo;s the same answer every time. What innovates it anymore?\u0026rdquo;\u003c/em\u003e (P6). They suggested offering more varied and creative tips to sustain interest and engagement: \u003cem\u003e\u0026ldquo;I think it would be nice, for example, if there were two of them, one that you might have filled in yourself beforehand, because of course that is also very useful, that works well for you, but also something completely new of which you can indeed think, \u0026lsquo;oh no this really isn't for me\u0026rsquo;, or \u0026lsquo;oh what fun, I'll give it a try\u0026rsquo;\u0026rdquo;\u003c/em\u003e (P9).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eStress recognition\u003c/h2\u003e\u003cdiv id=\"Sec20\" class=\"Section3\"\u003e\u003ch2\u003eSelf-awareness\u003c/h2\u003e\u003cp\u003eAll participants reported that the app prompted them to take a moment for themselves and reflect on their day and feelings. App notifications served as reminders to shift attention inward, helping them become more self-aware. One participant described this as a valuable pause for self-reflection: \u003cem\u003e\u0026ldquo;But also really what I get out of it myself especially is that it gave me a moment to think of \u0026lsquo;hey, how do I feel right now?\u0026rsquo;, \u0026lsquo;how am I doing now?\u0026rsquo;, \u0026lsquo;how have the last few hours been?\u0026rsquo; and this awareness, I think, is just really nice already\u0026rdquo;\u003c/em\u003e (P1).\u003c/p\u003e\u003cp\u003eOne participant set the first questionnaire in the morning, before starting work. Although she initially found this inconvenient, as no activities had yet taken place, it helped her begin the day more consciously: \u003cem\u003e\u0026ldquo;Because it does make me think again of, hey, did I actually get a good night's sleep? How do I actually start my day? I thought that was a positive thing. That did make a difference. At first, I thought I would fill out the questionnaire with no stress, but later I became aware that it's also good to reflect on how I start my day and how I feel\u0026rdquo;\u003c/em\u003e (P7).\u003c/p\u003e\u003cp\u003eParticipants noted that with busy and full schedules, they were often so focused on their tasks that they operated on a so-called \u0026lsquo;autopilot\u0026rsquo; mode, getting caught up in the flow of the day. The app provided a necessary pause, interrupting this continuous work cycle and compelling them to take a moment for self-reflection. As one participant described: \u003cem\u003e\u0026ldquo;The app makes it necessary to pause for a moment anyway. Which is really good for me, because otherwise I just drift on. Yeah especially, when I'm busy\u0026rdquo;\u003c/em\u003e (P1). Without this reminder, such self-reflection often happened only later in the day: \u003cem\u003e\u0026ldquo;It was earlier in the day, rather than just continuing and then, in the afternoon, driving home and thinking, \u0026lsquo;oh yes, what kind of day was it?\u0026rsquo;\u0026rdquo;\u003c/em\u003e (P9).\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eAwareness of stress signals\u003c/h2\u003e\u003cp\u003eNearly all participants reported that completing the app\u0026rsquo;s stress questionnaire encouraged reflection on their mental and physical states, making them more aware of stress signals such as bodily tension, a full head, or hunched shoulders. Many acknowledged that without the app, they would have noticed these signs far less or not at all. For instance, filling out the questionnaire forced an participant to listen to her body, leading to notice physical symptoms in moments of stress: \u003cem\u003e\u0026ldquo;And it forces you to reflect on how you feel in your body at that moment. So, in my case, I feel the stress especially in my body, so I often sit very tense, usually with clenched fists, or I breathe very fast, or I have a high heart rate, or I constantly have the idea that I have to cry. I started to recognize that at one point\u0026rdquo;\u003c/em\u003e (P2).\u003c/p\u003e\u003cp\u003eAdditionally, the response options encouraged deeper reflection by prompting participants to assess whether their experience of stress signals are different from their \u0026ldquo;normal\u0026rdquo; or not: \u003cem\u003e\u0026ldquo;Particularly with those answers, I was consciously engaged in that for a while of, \u0026lsquo;is it actually like usual or is it more than usual?\u0026rsquo;\u0026rdquo;\u003c/em\u003e (P13). This comparison further helped them to distinguish between stressful and less stressful moments.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eAwareness of Stress Level\u003c/h2\u003e\u003cp\u003eAll participants stated that seeing their calculated stress score increased their awareness of their stress levels, with some describing it as a \"wake-up call.\" Participants described that the app revealed stressful moments they might have otherwise overlooked, prompting them to reflect on situations that might impacted them more than expected: \u003cem\u003e\u0026ldquo;At some point also through those questionnaires that I thought, oh yeah no, I think this has given me more stress than what I might have initially noticed\u0026rdquo;\u003c/em\u003e (P13).\u003c/p\u003e\u003cp\u003eSeeing the stress score also allowed participants to notice rising stress levels earlier, enabling quicker intervention. One participant described how awareness of moderate stress can prevent escalation to high stress: \u003cem\u003e\u0026ldquo;Instead of just going on and on, when you might be in orange at 12 o'clock, but not quite signalling that... you go on, on, on, on and eventually you end up in red, for example\u0026rdquo;\u003c/em\u003e (P7).\u003c/p\u003e\u003cp\u003eFor many, the score represented an accurate validation of their feelings, confirming their personal assessment. Others were surprised by higher-than-expected scores, which made them reconsider how certain activities had affected them. Low stress scores reassured participants that they were managing well in terms of stress: \u003cem\u003e\u0026ldquo;Green I always found reassuring. Then I thought, okay, it is not too bad. That is fine, that is nice\u0026rdquo;\u003c/em\u003e (P2). Some even explained that they felt like they were doing a good job and had a sense of accomplishment.\u003c/p\u003e\u003cp\u003eLow scores positively influenced participants\u0026rsquo; outlook on their workday and reassured them that their workload was manageable: \u003cem\u003e\u0026ldquo;And everyone also always just talks about busy, busy, busy. And then it always just feels like work is stressful then. But then when you see such a low stress score, you think, well, it's really not that bad at all\u0026rdquo;\u003c/em\u003e (P3). This realization led some to approach the rest of their day more relaxed, preventing further stress accumulation: \u003cem\u003e\u0026ldquo;Maybe going into it more relaxed [...] it also ensures that you do not get as much stress afterwards\u0026rdquo;\u003c/em\u003e (P3).\u003c/p\u003e\u003cp\u003eConversely, for some participants, high stress scores provoked confrontation and disappointment: \u003cem\u003e\u0026ldquo;Sometimes I did think, oh well, I do feel I'm in orange or something, but then I was in red. Then I thought, yeah this is unfortunate. I wasn't quite expecting this. So, I found that confronting at times\u0026rdquo;\u003c/em\u003e (P2). However, for most, a high score acted as a signal to take action: \u003cem\u003e\u0026ldquo;Well, that would just be a strong signal for me to make sure the stress is going to decrease\u0026rdquo;\u003c/em\u003e (P12). However, it was also stated that seeing an elevated stress score encouraged participants to consider the causes, such as work pressure or personal circumstances, helping them become more conscious of stressors.\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eInsight into stress patterns and factors\u003c/h2\u003e\u003cp\u003eParticipants reported that using the STAPP@Work app increased their awareness of stress factors and moments of high stress: \u003cem\u003e\u0026ldquo;I do notice that I know when I get a little stressed and sure I knew that maybe before using that app too, but not as consciously as now, so I take that from it\u0026rdquo;\u003c/em\u003e (P8).\u003c/p\u003e\u003cp\u003eAlthough most participants had not actively used the visual overview, completing the questionnaire and seeing their stress scores provided valuable insights into stress factors. For example, one participant realized that intake interviews caused unexpected tension: \u003cem\u003e\u0026ldquo;I see client contact, I have an intake today, I see that an intake with a first patient apparently creates tension for me, I didn't know, but then when I started thinking about that and filling it out, I thought, oh yeah that does create a little stress\u0026rdquo;\u003c/em\u003e (P8).\u003c/p\u003e\u003cp\u003eParticipants differed in how much new insight the app provided. Some found the app helped structure and clarify stress factors they already suspected, while others felt like they learned little new, as they were already aware of their stress sources. However, among those who found no new insights, all did state that the app could have been more helpful at an earlier, more stressful, stage in life: \u003cem\u003e\u0026ldquo;I can imagine that back then, it could have helped me gain insight into my daily patterns and the things happening around me. So, for that reason, I think it could be helpful again in the future, but it definitely would have helped me back then to guide me through that\u0026rdquo;\u003c/em\u003e (P6).\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003eImplications of Awareness\u003c/h2\u003e\u003cp\u003eUsing the app helped participants recognize the importance of stress management and maintaining good health. This further encouraged them to monitor their well-being more closely and pay preventive attention to stress, for instance by setting and safeguarding their own boundaries: \u003cem\u003e\u0026ldquo;It's a kind of wake-up call, you could call it. Yes, it makes me think, 'oops, I have to be careful,' or 'I have to make sure it keeps going well,' or 'I have to watch my own boundaries', or those kinds of thoughts. And that does help me overall to make sure that I too don't fall out\u0026rdquo;\u003c/em\u003e (P13).\u003c/p\u003e\u003cp\u003eWith this increased awareness, many participants also started reflecting on what was contributing to their stress levels: \u003cem\u003e\u0026ldquo;And then, of course, it's also important to explore where that stress is coming from. Is it just coming from my work or is it coming from other factors? It could also be that there are underlying factors that also cause a certain amount of stress\u0026rdquo;\u003c/em\u003e (P12).\u003c/p\u003e\u003cp\u003eAwareness of stress helped participants place and better understand their feelings throughout the day. One participant described how this awareness and self-check-in prevented her from feeling completely drained at the end of the day without understanding why: \u003cem\u003e\u0026ldquo;I think I have experienced this less now, that I am like this, especially at work \u0026hellip; but that you go through the day like this, actually a bit on a kind of busy autopilot, and then at the end of the day\u0026hellip; that sometimes you can think: 'I'm completely exhausted, but what is this now?'\u0026rdquo;\u003c/em\u003e (P7). She further noted that simply identifying her stress level and placing it in context could already help in reducing stress: \u003cem\u003e\u0026ldquo;Then I probably start wondering how that came about or where that came from. I think then sometimes I also manage to maybe when I'm sitting in red by thinking, 'what was this?' to go to orange because it's already kind of helpful to place it anyway\u0026rdquo;\u003c/em\u003e (P7).\u003c/p\u003e\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\u003ch2\u003eCoping with Stress\u003c/h2\u003e\u003cp\u003eAs participants became aware of their stress, many applied various coping strategies during the workday, either by following the app\u0026rsquo;s stress-reducing tips or by their own initiative. Most participants indicated that they had consciously taken a moment to rest and take a break from their work to relieve stress. Some did breathing exercises to relax and relieve stress: \u003cem\u003e\u0026ldquo;But also spent some time with my breathing, that I just breathed for a moment. Because then my breathing is somewhere near my ears, instead of it just coming from my belly\u0026rdquo;\u003c/em\u003e (P2). while others started paying more attention to their posture, such as having more relaxed shoulders and an upright sitting position.\u003c/p\u003e\u003cp\u003e It was also frequently mentioned by participants to opt for a short walk to clear their heads. For example, one participant indicated that after using the app and seeing the stress score, he decided to have lunch outside during a walk break. Also, distractions were sought by doing something else for a while, such as looking on social media. Participants that were highly immersed in their daily tasks made sure to take breaks to eat and drink. Those working in isolated environments actively sought social interaction with colleagues. Furthermore, some participants decided to let go of certain tasks until later in the day where others restructured their thoughts and made them less negatively charged.\u003c/p\u003e\u003cp\u003eBeyond immediate stress relief, participants also focused on addressing the causes for stress for future stress: \u003cem\u003e\u0026ldquo;I think I also ask myself, 'should I do something about this?\u0026rsquo;, \u0026lsquo;can I do something about this preventively?\u0026rsquo;\u0026rdquo;\u003c/em\u003e (P3) For example, one participant had pointed out that she was extra aware that the weekly meeting caused more tension which made her think: \u003cem\u003e\u0026ldquo;And maybe you can also prepare something for it, that you're going to do a meeting like that standing up or in a different way, yes\u0026hellip;that I can look more actively into \u0026lsquo;how am I going to keep this fun and sustain it?\u0026rsquo;\u0026rdquo;\u003c/em\u003e (P9).\u003c/p\u003e\u003cp\u003eAs STAPP@Work helped to identify stress sources, participants reported to take targeted action. For example, one participant prioritized doing administrative work when he realized that it contributed to a full head: \u003cem\u003e\u0026ldquo;Yes, in the sense that you have the insight then, you can also look at what do I need now. So, for example, when my head was full I would really focus on getting rid of my paperwork while sometimes I would also chat with a colleague. And now I think \u0026lsquo;oh, that administration is putting pressure on how I work now and I have to do something about that\u0026rsquo;\u0026rdquo;\u003c/em\u003e (P5).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec26\" class=\"Section3\"\u003e\u003ch2\u003eImplications of Coping\u003c/h2\u003e\u003cp\u003eParticipants who took a break or engaged in a relaxing activity because of the app reported feeling calmer during the workday: \u003cem\u003e\u0026ldquo;That I think I end up going through my week a little calmer, I do think. Yes, I think so\u0026rdquo;\u003c/em\u003e (P7).\u003c/p\u003e\u003cp\u003eOne participant followed the app\u0026rsquo;s tip to create an overview of work tasks, which helped her organize her thoughts and avoid feeling overwhelmed: \u003cem\u003e\u0026ldquo;Well, I do notice that I feel calmer. It was far from always going well though, that I really felt better. But I felt calmer and I also always had the idea that my head was a little bit, what do I call it, less cloudy or something. That I could think much more sharply like okay, but what do I actually need to do?\u0026rdquo;\u003c/em\u003e (P2).\u003c/p\u003e\u003cp\u003eAnother participant found that simply knowing she could take a break when needed made the workday feel more manageable: \u003cem\u003e\u0026ldquo;Yeah, it does give you a little more peace or something. That you just think oh yeah, I can always just take a little moment which is already helpful then again and then the whole day immediately feels a little less overwhelming\u0026rdquo;\u003c/em\u003e (P3).\u003c/p\u003e\u003cp\u003eTaking a break outside, such as having lunch in the fresh air, also contributed to feeling refreshed and better prepared to continue the workday. However, some participants noted that the calming effect of these moments was temporary, as work pressure and stress returned throughout the day: \u003cem\u003e\u0026ldquo;But then the further away you are from the moment you used that app, the stress just increases again\u0026rdquo;\u003c/em\u003e (P2).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec27\" class=\"Section3\"\u003e\u003ch2\u003eLasting Behaviour Change\u003c/h2\u003e\u003cp\u003eSome participants reported continuing certain behaviours even after they stopped using the app. One participant became more mindful of how she started her workday, now regularly reflecting on her herself without the app. Another participant still thought about the app\u0026rsquo;s stress tips, recognizing moments when she would normally receive advice and choosing to follow it: \u003cem\u003e\u0026ldquo;And when something happened, I thought, oh yes, if I had filled it in now, it would probably give as a tip to do this for a moment. So, then I very briefly went to do that without using the app. Yes\u0026rdquo;\u003c/em\u003e (P8).\u003c/p\u003e\u003cp\u003eA participant that described the app as a tool for recognizing stress signals, reported that after a week and a half, she began independently checking for signs of stress and taking a moment to reflect, without using the app. Another participant explained that the app changed how he approached breaks. Previously, he often skipped them and had to adjust his recorded work hours. After using the app, he started scheduling and taking breaks more consistently, reducing the need for adjustments.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec28\" class=\"Section2\"\u003e\u003ch2\u003eMotivations for App Use\u003c/h2\u003e\u003cp\u003eParticipants shared their thoughts on why MHWs might or might not use the app. Some suggested that a lack of work phones or the inconvenience of using a personal device could be a barrier. Others felt that colleagues might perceive the app as an additional task in an already demanding work environment. It was reported that implementing new tools could be seen as time-consuming, which might discourage MHWs from trying them.\u003c/p\u003e\u003cp\u003eSome participants believed that certain professionals might feel they already know how to manage stress and therefore may not see the added value of the app: \u003cem\u003e\u0026ldquo;And I think some also say, yeah, but what's it going to help me or I'm a professional after all... Whereas I think, we know just fine how to guide our clients, but that doesn't mean you have yourself completely in control\u0026rdquo;\u003c/em\u003e (P5).\u003c/p\u003e\u003cp\u003eFor others, the app\u0026rsquo;s focus on self-reflection could be confronting, as it encourages MHWs to acknowledge stress patterns they might avoid or overlook: \u003cem\u003e\"It is very confronting to also have to look at yourself, at certain patterns that you have consciously or unconsciously, to recognize that what you are doing is not so functional\"\u003c/em\u003e (P2).\u003c/p\u003e\u003cp\u003eConversely, participants also discussed potential reasons why colleagues could find the app beneficial. Many believed it might help increase awareness of stress levels and provide early insights into stress patterns which would make it easier to manage workloads. This was perceived important, particularly in high-pressure environments because MHWs might not always recognize their own stress levels, as they tend to focus on their work: \u003cem\u003e\"I think a lot of people don't realize it and just go on, go on, go on. And if you were to ask a lot of people, do you have stress? Most people would say no but probably have it\"\u003c/em\u003e (P8).\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings illustrate how STAPP@Work supported MHWs in increasing self-awareness, recognizing stress patterns, and applying coping strategies. The app motivated employees to reflect on their well-being and to prioritize and integrate stress management into their workday.\u003c/p\u003e\n\u003ch3\u003eBarriers and Facilitators of App Use\u003c/h3\u003e\n\u003cp\u003eMost employees found STAPP@Work user-friendly, quick to complete, and easy to use. Short and consistent interactions were seen as habit-forming, increasing engagement with app interventions at work [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. This aligns with our findings, where several participants reported that, over time, using the app became part of their daily routine. The two-week usage period may not have been sufficient for all employees to fully integrate the app into their workdays.\u003c/p\u003e\u003cp\u003eHowever, employees also faced challenges in sustaining engagement causing them to forget or deprioritize the app. While participants recognized its benefits, time constraints made consistent use difficult as many found it challenging to find suitable moments for self-assessment. Prior research has shown that perceived effort and user intention were key drivers of engaging with digital interventions [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], which may explain why some employees struggled to integrate the app into their routines. Greater flexibility in app functionality, such as extended response windows, could reinforce engagement by making it easier to use the app at more convenient moments.\u003c/p\u003e\u003cdiv id=\"Sec31\" class=\"Section2\"\u003e\u003ch2\u003eSelf-Awareness and Stress Recognition\u003c/h2\u003e\u003cp\u003eIn high-pressure environments, employees often prioritize their responsibilities over their own well-being, creating an imbalance between work demands and recovery that can result in chronic stress [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Prolonged cognitive demands contribute to mental fatigue, reducing cognitive performance and increasing the risk of burnout [\u003cspan additionalcitationids=\"CR48\" citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Many participants acknowledged that without an external reminder, they were less likely to take time for self-reflection. STAPP@Work helped disrupt this cycle by prompting brief \u0026ldquo;self-check-ins\u0026rdquo; through stress questionnaires, encouraging employees to pause, evaluate their well-being, and recognize stress signals that might otherwise go unnoticed.\u003c/p\u003e\u003cp\u003eThese moments of reflection supported self-awareness, a key factor in managing work-related stress and protecting against high workloads and mental fatigue [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. By becoming more attuned to their stress levels, employees could regulate their emotions, adjust their behaviour, and preserve their energy. Prior research also highlights that mood-tracking apps foster self-awareness, helping users reflect on themselves [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. Without intervention, employees can experience stress accumulation or gradually become worn out throughout the day, only realizing this at the end of the day. The app mitigated this by encouraging \u0026lsquo;microbreaks\u0026rsquo; which sustain energy, increase engagement, and reset attention [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe stress questionnaires made participants recognize their stress level and associated signs. Without the app, many only noticed stress when it was high, missing the gradual build-up that became visible through app use. This means that the app allows workers to intervene and deal with this stress early to prevent stress accumulation [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. Participants also identified stress patterns which is helpful in preparing for similar situations and prevent future stress [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. These findings suggest that the app may help reduce chronic stress, prevent physical and emotional exhaustion, and mitigate it\u0026rsquo;s long-term negative effects [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. Low stress scores provided reassurance, whereas high scores, although confronting, motivated employees to prioritize stress management. This indicates that real-time feedback, whether positive or negative, can trigger self-regulatory behaviours, which is essential for adaptive change and the development of resilience [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec32\" class=\"Section2\"\u003e\u003ch2\u003eCoping with work stress\u003c/h2\u003e\u003cp\u003eAfter using the app, participants engaged in problem-focused strategies, such as prioritizing and organizing tasks and addressing responsibilities, as well as emotion-focused strategies like reframing thoughts, practicing self-compassion, and using relaxation techniques. Recognizing and contextualizing stress scores often alleviated feelings of overwhelm, aligning with findings that self-monitoring apps help externalize distress and process emotions [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSTAPP@Work motivated employees to apply both problem-focused and emotional coping, though the quantitative study found it only improved problem-focused coping [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. This may be explained by the fact that qualitative findings revealed deeper insights into emotion-focused strategies that were not captured in measurable outcomes. The app contributed to lasting behavioural changes even after use ended. This aligns with earlier findings showing that STAPP@Work consistently improved coping self-efficacy and reduced exhaustion over time [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Participants reported using the skills learned from the app independently without use, highlighting the app\u0026rsquo;s role in promoting long-term resilience.\u003c/p\u003e\u003cp\u003eFurthermore, those open to exploring stress triggers engaged more with the app, while those confident in their stress management engaged less. Motivation played a key role, with employees turning to the app during high-stress periods, as similarly seen in studies where negative life events increased engagement [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec33\" class=\"Section3\"\u003e\u003ch2\u003eStrengths and Limitations\u003c/h2\u003e\u003c/div\u003e\u003cdiv id=\"Sec34\" class=\"Section3\"\u003e\u003ch2\u003eStrengths\u003c/h2\u003e\u003cp\u003eThis study provides a novel contribution to research by offering in-depth qualitative insights into the experiences of MHWs using a self-monitoring stress management app. It represents the first qualitative exploration of such experiences in this specific occupational group, an area that remains underexplored in current literature. A diverse sample was used, providing a broad representation across age, gender and job roles with the gender distribution reflecting that of the Dutch mental health care workforce [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. This approach provided rich insights into how the app was perceived and experienced. Another key strength is that this study complements a preceding quantitative study within the same organization. By combining qualitative and quantitative approaches, it offers a holistic understanding of the app\u0026rsquo;s impact, increasing knowledge about its usability and effectiveness among MHWs.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eA potential limitation is social desirability bias, as participants may have given responses they believed aligned with study goals. This risk was heightened by recruitment within GGz Centraal, where the organization\u0026rsquo;s role as both employer and research setting could raise confidentiality concerns. However, employees were reassured through anonymity assurances, secure data storage, and clear communication that no identifying information would be shared.\u003c/p\u003e\u003cp\u003eThe sample may have favoured employees already receptive to stress management, potentially excluding those less inclined toward such interventions. While this limits broader applicability, it aligns with the app\u0026rsquo;s target audience, providing valuable insights into its impact and usability. Additionally, the study did not assess participants\u0026rsquo; mental health conditions, which may have influenced their experiences with stress and the app.\u003c/p\u003e\u003cp\u003eThe findings are limited in generalizability to other work settings, particularly those where there is less familiarity with mental health topics. The app\u0026rsquo;s effectiveness may vary in industries where stress management is less emphasized. Yet, the focus on MHWs provides a unique opportunity to study the app\u0026rsquo;s use in a high-stress work context, forming a basis for adapting and testing similar interventions in other settings.\u003c/p\u003e\n\u003ch3\u003eImplications\u003c/h3\u003e\n\u003cp\u003eThis study shows the potential of STAPP@Work to facilitate preventive stress management in mental health care. By promoting early stress detection, self-awareness, and timely intervention, the app helps combat chronic stress, emotional exhaustion and other burnout symptoms. Giving employees control over their stress management in an accessible way, rather than reacting to its effects, helps organizations protect employee health, reduce absenteeism and turnover, and improve long-term performance and job satisfaction. The results reveal that MHWs adopted lasting stress management behaviours, showing how self-monitoring technologies can contribute to a more mindful, resilient and sustainable workforce. Given the increasing demand for mental health services and rising workforce pressure, retaining MHWs is essential [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In this context, scalable and accessible interventions like STAPP@Work offer a meaningful contribution in supporting staff well-being.\u003c/p\u003e\u003cp\u003eTo improve engagement, implementation strategies should emphasize flexibility and customization, aligning with MHWs' work routines. Research on digital health interventions [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e] further stresses the importance of overcoming such barriers. Additionally, perceived obstacles, such as viewing the app as an extra task, time-consuming, or confronting, require clear communication about its benefits. Some employees doubted its necessity, believing they had sufficient stress management skills. Targeted implementation strategies should focus on reducing resistance and increase adoption.\u003c/p\u003e\n\u003ch3\u003eFuture research\u003c/h3\u003e\n\u003cp\u003eExamining the app's effectiveness within specific departments and job functions is essential, as this exploratory study included employees with diverse backgrounds, roles, and responsibilities, which likely influenced their experiences differently. Such research could provide a deeper understanding of how workplace roles affect app usage and outcomes. Additionally, expanding research to other work sectors would be valuable for assessing the app’s applicability beyond MHWs, especially in industries where employees may have less familiarity with or openness to stress management practices.\u003c/p\u003e\u003cp\u003eFuture studies should also delve into identifying and addressing specific barriers and facilitators to app usage. This would provide more detailed insights into strategies to enhance engagement and adoption, particularly in workplace settings like the mental health sector. While this study touched upon these aspects, they were not the primary focus. Understanding these factors in greater depth could inform tailored interventions to encourage consistent use of self-management apps. Moreover, the STAPP@Work app focuses solely on the individual employee, while it is well established that work-related stress is also shaped by factors such as leadership, organizational culture, and working conditions. These broader systemic influences should also be included in further developments and research for optimal stress prevention at work.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study reveals that self-management workplace stress apps like STAPP@Work are an accessible means in helping MHWs manage stress and increase resilience. The app provided employees with valuable moments for self-reflection, increasing their awareness of stress signals and levels while encouraging them to prioritize their well-being. Participants reported heightened attention to their own stress management practices and were motivated to apply coping strategies. By facilitating early identification of stress indicators and moments of introspection, employees become more equipped to preventively tackle work-related stress, making it especially relevant in high-pressure work sectors. However, barriers inherent to the mental health sector, such as high workload, need for flexibility and hectic schedules should be taken into consideration to optimize adoption and user-engagement. These findings help fill a gap in the literature on mobile interventions for MHWs, providing insights into its real-world use to improve workplace well-being, and informing future research and innovation in digital stress management tools.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003e\u003cem\u003eEMA:\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eEcological Momentary Assessment\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e\u003cem\u003eMHWs:\u003c/em\u003e\u003c/strong\u003e Mental Health Workers\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e\u003cem\u003eSSI:\u003c/em\u003e\u003c/strong\u003e Semi-Structured Interview\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAvailability of data\u0026nbsp;\u003cbr\u003e\u003c/strong\u003eDue to the sensitive nature of the interview data and to protect participant privacy, the datasets generated and analysed during the current study are not publicly available. Data are available from the corresponding author upon reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors express their sincere thanks to all participants who participated in this study. They thank the project team who contributed to all developments surrounding the STAPP@Work app. The authors also thank GGz Centraal for their support in facilitating this research and Eaglescience for developing the app software. Also, many thanks to the author\u0026rsquo;s colleagues at GGz Centraal who collaborated in the development of STAPP@Work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSD designed the study, conducted data collection and analysis, interpreted the data, and drafted the manuscript. YR, PNvH, and NHC provided supervision and contributed to the reviewing and editing of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCorresponding author\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence to Sevda Demirel.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was reviewed and approved by the Medical Ethics Review Committee Leiden The Hague Delft (METC LDD) (Ref: N25.024), and was conducted in accordance with the principles of the Declaration of Helsinki.\u0026nbsp;Participants were informed about the aims and procedures of the study and provided informed consent prior to participation. They were informed of their right to withdraw from the study at any time without consequences. Interviews were audio-recorded with permission and anonymized to ensure confidentiality. All user data in the app was handled in accordance with the General Data Protection Regulation of the European Union, ensuring user privacy and data security.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYR became co-founder of a new version of the STAPP@Work app after completion of this study. The STAPP@Work app was transferred to an independent third party, who further developed, modified, and released it under a different name. All other authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKober M, Chang Y. Healthcare workers\u0026rsquo; perceptions of work-related stress and burnout: strategies and barriers for self-care. 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JMIR Ment Health. 2018;5(1):e8. doi:10.2196/mental.9146\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-digital-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [BMC Digital Health](https://bmcdigitalhealth.biomedcentral.com/)","snPcode":"44247","submissionUrl":"https://submission.nature.com/new-submission/44247/3","title":"BMC Digital Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Mobile health (mHealth), Workplace stress, Health professional, Stress management, Self-monitoring app, Qualitative research, Ecological momentary assessment, User experience","lastPublishedDoi":"10.21203/rs.3.rs-6611387/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6611387/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMental health workers (MHWs) face ongoing challenges, including heavy workloads, staff shortages, and pressure due to long patient waiting lists. These factors contribute to high levels of stress, affecting both their well-being and the quality of patient care. Digital interventions have shown promising results in supporting stress management among healthcare professionals. However, little is known about MHWs\u0026rsquo; experiences with such interventions. This study aims to explore the lived experiences of MHWs regarding the use of STAPP@Work, a self-monitoring stress management app designed for the workplace.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA qualitative study was conducted using semi-structured interviews with MHWs (N\u0026thinsp;=\u0026thinsp;14) who used STAPP@Work for two weeks. Thematic analysis was performed to identify key patterns related to app experiences, engagement, stress recognition, and coping behaviours at work.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParticipants reported increased self-awareness and early stress recognition, which facilitated timely intervention. The app prompted \"self-check-ins\", enabling users to reflect on their well-being and recognize stress signals throughout the day. MHWs engaged in both problem-focused and emotion-focused coping strategies, such as prioritizing tasks, reframing thoughts, and relaxation techniques. While most found the app useful and easy to use, barriers included time constraints, perceived effort, and the need for more personalized coping strategies. The app encouraged lasting behavioural changes, with some employees continuing stress management strategies beyond app use.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSTAPP@Work shows potential as a preventive stress management tool for MHWs by promoting self-awareness and early intervention. While employees benefited from increased stress awareness and coping, sustained engagement remained a challenge. Future research should explore long-term use facilitators and workplace integration and its applicability for other working populations.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTrial registration\u003c/b\u003e\u003c/p\u003e\u003cp\u003eClinicalTrials.gov NCT06991439, registered on 27 May 2025. Retrospectively registered.\u003c/p\u003e","manuscriptTitle":"Navigating Workplace Stress: A Qualitative Exploration of Mental Healthcare Workers’ Lived Experiences with STAPP@Work, a Mobile Stress Management Intervention","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-10 12:47:30","doi":"10.21203/rs.3.rs-6611387/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-03T10:44:09+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-01T13:56:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-30T19:37:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"280239071332083890583167139246021150624","date":"2025-10-29T10:49:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-14T07:01:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"167819808145656014605248491843927633408","date":"2025-09-27T15:42:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"334209542530694870400594240517468466304","date":"2025-09-27T10:41:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-07T13:21:52+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-04T19:02:33+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-19T14:40:49+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-18T18:02:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Digital Health","date":"2025-06-18T17:59:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-digital-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [BMC Digital Health](https://bmcdigitalhealth.biomedcentral.com/)","snPcode":"44247","submissionUrl":"https://submission.nature.com/new-submission/44247/3","title":"BMC Digital Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b4b22cc0-6d78-473f-9ab1-5e4aef17e829","owner":[],"postedDate":"July 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-14T15:08:52+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-10 12:47:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6611387","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6611387","identity":"rs-6611387","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}