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Psychosocial Factors and Health at Work: Evaluation and Intervention

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 March 2021) | Viewed by 52715

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Special Issue Editors

Dr. Michael Leiter

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Guest Editor

Acadia University (retired), Canada
Interests: burnout; engagement

Prof. Dr. Miguel Ángel Santed

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Guest Editor

Universidad Nacional de Educación a Distancia (UNED), Spain
Interests: anxiety; stress; treatment; intervention

Dr. Santiago Gascón

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Guest Editor

Department of Psychology and Sociology, University of Zaragoza, 50009 Zaragoza, Spain
Interests: work stress; intervention; burnout
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Maria José Chambel

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Guest Editor

Faculdade de Psicologia, Alameda da Universidade, 1648-013 Lisboa, Portugal
Interests: psychosocial factors at work; health

Special Issue Information

Dear Colleagues,

It is our pleasure to announce the launch of a new Special Issue on psychosocial factors and health at work.
With your impressive professional career and the focus of your latest research, we believe you could make an excellent contribution to this Special Issue. We are specifically inviting papers outlining studies and research in the field of psychosocial factors linked to work stress and burnout, as well the evaluation of these and experiences in intervention to prevent them.
You are more than welcome to share any questions you may have related to this Special Issue with us. It would also be greatly appreciated if you forward this call for papers to any colleagues specialized in this topic who you believe may also be interested in contributing with a research paper, review, or commentary.

Dr. Michael Leiter
Prof. Dr. Miguel Ángel Santed
Dr. Santiago Gascón
Prof. Maria José Chambel
Guest Editors

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Published Papers (14 papers)

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16 pages, 352 KiB

Open AccessArticle

A Qualitative Exploration of Addiction Disclosure and Stigma among Faculty Members in a Canadian University Context

by Victoria F. Burns, Christine A. Walsh and Jacqueline Smith

Int. J. Environ. Res. Public Health 2021, 18(14), 7274; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18147274 - 07 Jul 2021

Cited by 3 | Viewed by 3554

Abstract

Addiction is one of the most stigmatized public health issues, which serves to silence individuals who need help. Despite emerging global interest in workplace mental health and addiction, scholarship examining addiction among university faculty members (FMs) is lacking, particularly in a Canadian context. Using a Communication Privacy Management (CPM) framework and semi-structured interviews with key informants (deans and campus mental health professionals), this qualitative study aimed to answer the following research questions: (1) What is the experience of key informants who encounter FM addiction? (2) How may addiction stigma affect FM disclosure and help-seeking? and (3) What may help reduce addiction stigma for FMs? Thematic analysis was used to identify three main themes: (1) Disclosure was rare, and most often involved alcohol; (2) Addiction stigma and non-disclosure were reported to be affected by university alcohol and productivity cultures, faculty type, and gender; (3) Reducing addiction stigma may involve peer support, vulnerable leadership (e.g., openly sharing addiction-recovery stories), and non-discriminatory protective policies. This study offers novel insights into how addiction stigma may operate for FMs in relation to university-specific norms (e.g., drinking and productivity culture), and outlines some recommendations for creating more recovery-friendly campuses. Full article

(This article belongs to the Special Issue Psychosocial Factors and Health at Work: Evaluation and Intervention)

12 pages, 367 KiB

Open AccessArticle

Interactions between Personality and Types of Mindfulness Practice in Reducing Burnout in Mental Health Professionals

by Raquel Ruiz-Íñiguez, Ana Carralero Montero, Francisco A. Burgos-Julián, Justo Reinaldo Fabelo Roche and Miguel A. Santed

Int. J. Environ. Res. Public Health 2021, 18(13), 6721; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18136721 - 22 Jun 2021

Cited by 1 | Viewed by 2357

Abstract

Research on mindfulness-based interventions reports mainly on improvements at the group level. Thus, there is a need to elaborate on the individual differences in their effectiveness. The aim of this study was twofold: (1) to examine which personality factors could influence burnout reduction associated with different types of mindfulness practice and (2) to evaluate the interaction between personality factors and the amount of home practice; both aims were controlled for sociodemographic characteristics. A total of 104 Cuban mental health professionals, who participated in a crossover trial, were included. The effect of personality (Cattell’s 16 Personality Factors) was analyzed through regression analysis. First, the results revealed that Emotional Stability and Vigilance could negatively moderate the effectiveness of mindfulness-based interventions. Second, participants who scored low in Sensitivity or Vigilance could benefit more from the body-centered practices (i.e., body scan and Hatha yoga practices), but no significant results for the mind-centered practices (i.e., classical meditation) were found. Third, participants who scored high in Self-reliance could benefit more from informal practice. Other personality factors did not appear to moderate the effect of the interventions, though previous experience in related techniques must be considered. Recommendations and clinical implications are discussed. Trial registration number is NCT03296254 (clinicaltrials.gov). Full article

(This article belongs to the Special Issue Psychosocial Factors and Health at Work: Evaluation and Intervention)

18 pages, 1244 KiB

Open AccessArticle

The Role of Organizational Culture and Climate for Well-Being among Police Custody Personnel: A Multilevel Examination

by Christopher Robert Mark Werner-de-Sondberg, Maria Karanika-Murray, Thomas Baguley and Nicholas Blagden

Int. J. Environ. Res. Public Health 2021, 18(12), 6369; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18126369 - 11 Jun 2021

Cited by 5 | Viewed by 2936

Abstract

United Kingdom Police custody is one of the most challenging of work environments, liable to excessive demands and reduced well-being. Being difficult to access, it is also a much-neglected area of research that has focused on one or two roles, rather than the full range available, and on individual-level research, rather than a more comprehensive multilevel understanding of how organizational culture and climate can simultaneously influence a range of well-being outcomes. The present longitudinal study explored all types of roles, in both the public and private sectors, across seven English police forces and 26 custody sites (N = 333, response rate 46.57%, with repeated returns = 370). The Integrated Multilevel Model of Organizational Culture and Climate (IMMOCC) was applied to examine the organizational-level influences on individual well-being. Results indicated that (1) custody sergeants were most vulnerable to low well-being, followed by publicly contracted detention officers; (2) shared leadership (a source of team cohesion) was linked to four of six well-being outcomes; (3) two sub-components of culture reflected tensions never acknowledged before, especially in respect of role; and (4) reverse relationships existed between well-being outcomes and the dimensions of culture and climate. The findings inform practical recommendations, including resilience training and the need to raise the status of police custody, while also highlighting concerns about private sector scrutiny that may be relevant to other professions. Full article

(This article belongs to the Special Issue Psychosocial Factors and Health at Work: Evaluation and Intervention)

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13 pages, 618 KiB

Open AccessArticle

Initiative in Work Teams: Lever between Authentic Leadership and Results

by Ana Lisbona, Abel Las Hayas, Francisco J. Palací and Michael Frese

Int. J. Environ. Res. Public Health 2021, 18(9), 4947; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18094947 - 06 May 2021

Cited by 3 | Viewed by 3967

Abstract

Background: The central point of this study is team initiative, and we analyzed how the theoretical model of antecedents and consequents of personal initiative contribute to explaining the relationship between team initiative and its antecedents and consequents. Authentic leadership is proposed as the antecedent, and the consequent leads to two types of outcomes, one of which is related to employee well-being, and the other is related to performance. However, little is known about what occurs in this relationship once the focus shifts to the team level. From a team perspective, with the label team initiative, we propose a collective construct defined similarly to personal initiative. This study shows the relationship between team initiative and its two consequences, team work engagement and performance, which are measured in terms of team productivity by the leader. Methods: Our model was tested in a field study with 344 employees of 79 work teams belonging to 55 organizations. Results: The analysis of the results using SEM and a regression analysis supported our main hypotheses. Conclusions: The finding that initiative is related to performance establishes the importance of initiative at the team level. It also emphasizes its impact on employee well-being through team work engagement and suggests the importance of authentic leadership. Full article

(This article belongs to the Special Issue Psychosocial Factors and Health at Work: Evaluation and Intervention)

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12 pages, 332 KiB

Open AccessArticle

Inclusive Communication Model Supporting the Employment Cycle of Individuals with Autism Spectrum Disorders

by Michał T. Tomczak, Joanna Maria Szulc and Małgorzata Szczerska

Int. J. Environ. Res. Public Health 2021, 18(9), 4696; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18094696 - 28 Apr 2021

Cited by 15 | Viewed by 5314

Abstract

Difficulties with interpersonal communication experienced by individuals with autism spectrum disorders (ASD) significantly contribute to their underrepresentation in the workforce as well as problems experienced while in employment. Consistently, it is vital to understand how communication within the employment cycle of this group can be improved. This study aims to identify and analyze the possibilities of modifying the communication processes around recruitment, selection, onboarding, and job retention to address the specific characteristics and needs of the representatives of this group. This qualitative study is based on 15 in-depth interviews conducted with 21 field experts, i.e.,: therapists, job trainers, and entrepreneurs employing people with ASD. The findings of this research informed the creation of an inclusive communication model supporting the employment cycle of individuals with ASD. The most important recommendations within the model that was created include the modification of job advertisements, use of less structured job interviews, providing opportunities for mentorship, and supportive and non-direct, electronically mediated communication. To apply the above-mentioned solutions and take full advantage of the talents of people with ASD, it is also necessary to provide tailored sensitivity and awareness training programs for their direct addressees as well as their neurotypical colleagues, including managerial staff. Full article

(This article belongs to the Special Issue Psychosocial Factors and Health at Work: Evaluation and Intervention)

12 pages, 501 KiB

Open AccessArticle

Mediating Roles of Cognitive Complaints on Relationships between Insomnia, State Anxiety, and Presenteeism in Japanese Adult Workers

by Kuniyoshi Toyoshima, Takeshi Inoue, Akiyoshi Shimura, Yoshihiro Uchida, Jiro Masuya, Yota Fujimura, Shinji Higashi and Ichiro Kusumi

Int. J. Environ. Res. Public Health 2021, 18(9), 4516; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18094516 - 24 Apr 2021

Cited by 12 | Viewed by 2299

Abstract

Complaints of cognitive functions (CCFs), defined as subjective cognitive dysfunction, affect social function; additionally, for workers, this condition is an important factor in presenteeism and mediates the effect of depressive symptoms on presenteeism. This study aimed to investigate whether CCFs mediate the relationships among insomnia, state anxiety (SA), and presenteeism. Participants were 471 Japanese adult workers evaluated using the Athens Insomnia Scale, State-Trait Anxiety Inventory (Form Y), Cognitive Complaints in Bipolar Disorder Rating Assessment, and Work Limitations Questionnaire 8 to assess insomnia, SA, CCFs, and presenteeism, respectively. Path analysis was used to evaluate the correlations between variables. CCFs significantly mediated the associations among insomnia, SA, and presenteeism. To address the presenteeism associated with insomnia and SA, it may be useful to assess the mediating roles of CCFs. Full article

(This article belongs to the Special Issue Psychosocial Factors and Health at Work: Evaluation and Intervention)

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11 pages, 903 KiB

Open AccessArticle

Ticket to Ride: A Longitudinal Journey to Health and Work-Attendance in the JD-R Model

by Benedicte Langseth-Eide and Joar Vittersø

Int. J. Environ. Res. Public Health 2021, 18(8), 4327; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18084327 - 19 Apr 2021

Cited by 5 | Viewed by 2906

Abstract

The present study addresses one of the limitations of the JD-R model, namely, that analyses of the outcomes of the motivational process have largely focused on organizational outcomes and have neglected to investigate the associations between job resources, work engagement and health-related outcomes. Specifically, the aim of this paper is to show that health-related indicators may be outcomes of the motivational process in the job demands-resources (JD-R) model. We achieve this through a two-wave panel study with a two-year time lag. The results provide longitudinal evidence that two well-established job resources (i.e., social support and feedback) predicted work engagement, that work engagement was negatively related to sick leave and that this relation was mediated by subjective health. By showing that health-related indicators could also be outcomes of the motivational process in the JD-R model, we have strengthened the model. Full article

(This article belongs to the Special Issue Psychosocial Factors and Health at Work: Evaluation and Intervention)

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12 pages, 8203 KiB

Open AccessFeature PaperArticle

Assessment of Workplace Social Encounters: Social Profiles, Burnout, and Engagement

by Michael P. Leiter

Int. J. Environ. Res. Public Health 2021, 18(7), 3533; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18073533 - 29 Mar 2021

Cited by 8 | Viewed by 2716

Abstract

Employed people (N = 826) completed questionnaires including the Social Encounters Scale that assessed civility, incivility, and intimidation from supervisors, coworkers, and respondents on identical frequency scale. Factor analyses, correlations, and profile analysis addressed the first research question by demonstrating the benefits of assessing various dimensions of workplace social dynamics on a common rating scale. A subsample (N = 275 completed a second survey, confirming consistency over time. To address the second research question a Latent Profile Analysis (LPA) identified five social profiles: Civil, Low Contact, Uncivil Coworkers, Uncivil Supervisor, and Uncivil. These profiles were associated with distinct perceptions of the work environment, addressing the third research question. To address the fourth research question, crosstabulation with a profile structure based on the Maslach Burnout Scale demonstrated close links of workplace social culture with psychological connections with work. Full article

(This article belongs to the Special Issue Psychosocial Factors and Health at Work: Evaluation and Intervention)

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17 pages, 417 KiB

Open AccessArticle

Is Stress in Contact Centers Inevitable?

by Diogo Gonçalves-Candeias, Maria José Chambel and Vânia Sofia Carvalho

Int. J. Environ. Res. Public Health 2021, 18(6), 2999; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18062999 - 15 Mar 2021

Cited by 5 | Viewed by 2210

Abstract

It is broadly acknowledged that contact center employees are subject to high levels of stress. In this profession, there is a distinction between back-office and front-office employees. In addition, employees may perform duties in various companies with different characteristics (i.e., human resources practices, job characteristics, social support, work–personal life relationship, among others). Thus, this study focuses on the analysis of the contact centers’ (CC) psychosocial work environment and employees’ levels of stress and well-being, seeking to understand whether they change due to the specific nature of the duties they perform and the characteristics of the company. This study involved 1440 participants from 15 companies. The results indicate that front-office and back-office duties influence the perception of some job characteristics and their environment and, consequently, the stress and well-being of these employees. Furthermore, the exhaustion and general well-being of employees are seemingly independent of the duties performed and common to all companies. However, the job characteristics, psychosocial environment and employees’ levels of cynicism, work engagement and general stress were found to change according to the company in which they worked, thus highlighting the need for action in the psychosocial environment of these work duties. Full article

(This article belongs to the Special Issue Psychosocial Factors and Health at Work: Evaluation and Intervention)

22 pages, 388 KiB

Open AccessArticle

Nurse Motivation, Engagement and Well-Being before an Electronic Medical Record System Implementation: A Mixed Methods Study

by Rebecca M. Jedwab, Alison M. Hutchinson, Elizabeth Manias, Rafael A. Calvo, Naomi Dobroff, Nicholas Glozier and Bernice Redley

Int. J. Environ. Res. Public Health 2021, 18(5), 2726; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18052726 - 08 Mar 2021

Cited by 16 | Viewed by 6507

Abstract

Implementation of an electronic medical record (EMR) is a significant workplace event for nurses in hospitals. Understanding nurses’ key concerns can inform EMR implementation and ongoing optimisation strategies to increase the likelihood of nurses remaining in the nursing workforce. This concurrent mixed-methods study included surveys from 540 nurses (response rate 15.5%), and interviews with 63 nurses to examine their perceptions of using a new EMR prior to implementation at a single healthcare organisation. Survey findings revealed 32.2% (n = 174) of nurses reported low well-being scores and 28.7% (n = 155) were experiencing burnout symptoms. In contrast, 40.3% (n = 216) of nurses reported high work satisfaction, 62.3% (n = 334) had high intentions of staying in their role, and 34.3% (n = 185) were engaged in their work. Nearly half (n = 250, 46.3%) reported intrinsic motivation towards EMR use. Thematic analysis of focus group interviews revealed two themes, each with three subthemes: (1) Us and Them, detailed the juxtaposition between nurses’ professional role and anticipated changes imposed on them and their work with the EMR implementation; and (2) Stuck in the middle, revealed nurses’ expectations and anticipations about how the EMR may affect the quality of nurse-patient relationships. In conclusion, anticipation of the EMR implementation emerged as a stressor for nursing staff, with some groups of nurses particularly vulnerable to negative consequences to their well-being. Full article

(This article belongs to the Special Issue Psychosocial Factors and Health at Work: Evaluation and Intervention)

22 pages, 441 KiB

Open AccessArticle

The Motivations for and Well-Being Implications of Social Media Use at Work among Millennials and Members of Former Generations

by Reetta Oksa, Tiina Saari, Markus Kaakinen and Atte Oksanen

Int. J. Environ. Res. Public Health 2021, 18(2), 803; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18020803 - 19 Jan 2021

Cited by 23 | Viewed by 8051

Abstract

Working life has digitalized considerably in recent decades and organizations have taken into use new forms of collaborative technologies such as social media platforms. This study examined the relationship between social media use at work and well-being at work for millennials and members of former generations in Finland. The research data contained focus group interviews (N = 52), an expert organization survey (N = 563), and a nationally representative survey (N = 1817). Well-being measures included technostress, burnout, psychological distress, and a set of background variables. Content analysis and linear regression models were used as analysis methods. The results showed that millennials have various intrinsic and extrinsic motivations for social media use at work. Intrinsic motivations included employees’ personal choice and their pure interest to follow the market and discussions in their own field. Extrinsic motivations were related mainly to organizations’ work culture and personal branding. The survey findings revealed, however, that millennials were not only more active social media users for work, but they also experienced higher technostress and burnout than members of former generations. Social media use motivations were associated with both higher and lower technostress and burnout depending on motivation, indicating that social media use can have both positive and negative effects. Overall, our findings suggest that employees tend to utilize social media more if their needs for autonomy, competence, and relatedness are fulfilled. Full article

(This article belongs to the Special Issue Psychosocial Factors and Health at Work: Evaluation and Intervention)

12 pages, 590 KiB

Open AccessArticle

Value Conflict, Lack of Rewards, and Sense of Community as Psychosocial Risk Factors of Burnout in Communication Professionals (Press, Radio, and Television)

by Santiago Gascón, Ricardo Fueyo-Díaz, Luis Borao, Michael P. Leiter, Álvaro Fanlo-Zarazaga, Bárbara Oliván-Blázquez and Alejandra Aguilar-Latorre

Int. J. Environ. Res. Public Health 2021, 18(2), 365; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18020365 - 06 Jan 2021

Cited by 10 | Viewed by 3660

Abstract

Journalists are at particular risk of work-related stress and burnout. The objective of this study is to describe and analyze the principal factors involved in the appearance of burnout in communication professionals, as well as the possible interactions between them and with self-reported health, and to observe whether the variables involved are the same in different types of environments. To achieve this objective, 292 participants answered the following measurement instruments: Demographic and labor datasheet; Maslach Burnout Inventory (MBI General survey); Areas of Worklife Scale (AWS); and General Health Questionnaire (GHQ -12). The results were the following: Emotional Exhaustion (EE) shows direct correlation and statistical significance with the other two burnout dimensions, Depersonalization (DP) and Personal Accomplishment (PA), also with health perception variables and inverse and statistical significance with the workload, control, rewards, community, fairness, and values. A multiple linear regression model shows workload and values as inverse EE predictors, which confirms a burnout process in which EE contributes as the main dimension in DP and is shown to be a precursor of PA, itself. When comparing different types of media, journalists who work in institutional press offices presented significantly lower scores in PA and higher in control, rewards, community, justice, and values. Therefore, further research should be carried out in order to analyze the protective role of these variables regarding PA and burnout. Full article

(This article belongs to the Special Issue Psychosocial Factors and Health at Work: Evaluation and Intervention)

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14 pages, 1033 KiB

Open AccessArticle

An Analysis of the Relationship between the Modified Theory of Planned Behavior and Leisure Rumination of Korean Employees

by Young-Jae Kim and Seung-Woo Kang

Int. J. Environ. Res. Public Health 2021, 18(1), 320; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18010320 - 04 Jan 2021

Cited by 3 | Viewed by 2470

Abstract

An increasing trend among employees has been to engage in leisure activities, which has been proven to be an effective method of overcoming work stress. As a result, employees are doing “Other Things” (i.e., non-work activities) as a way to relieve stress. Based on the existing studies on rumination, this study considered doing “Other Things” as a new concept of “leisure rumination” and identified its influence as a means to help employees recover from work stress. Accordingly, this study provided basic data on the meaning of leisure activities and leisure rumination in office workers who suffer from failure to recover from work stress using partial least squares structural equation modeling. This study was conducted on employees residing in the Seoul metropolitan area and the Gyeongsang-do district in November 2019 through a structured questionnaire. The results of this study verified the significance of leisure rumination and the possibility of it being utilized as a practical research tool for leisure activities. Our findings may be considered when planning interventions for work addiction and burnout through leisure rumination. Full article

(This article belongs to the Special Issue Psychosocial Factors and Health at Work: Evaluation and Intervention)

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7 pages, 726 KiB

Open AccessCase Report

How a Depressive Medical Doctor Profited in the Long-Term from a New and Short Psychological Group-Treatment against Major Depressive Disorder

by Daryl Wayne Niedermoser, Nadeem Kalak, Martin Meyer, Nina Schweinfurth, Marc Walter and Undine E. Lang

Int. J. Environ. Res. Public Health 2021, 18(4), 1925; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18041925 - 17 Feb 2021

Viewed by 2246

Abstract

Background: Individuals suffering from major depressive disorder (MDD) often describe workplace-related stress as one of the main causes of their disorder. Here, we present the story of a 33 year old “Bob” (a pseudonym) who suffered from a moderate (Hamilton-21 = 18) major depressive episode. Workplace-related stress seemed to be the main stressor for Bob at the time. We were interested in long-lasting effects of a newly established group called “work-related interpersonal Psychotherapy, W-IPT”. W-IPT consists of eight weekly 90 min sessions. The follow-ups were 12 weeks after the group-treatment and 18 months later. Bob was chosen because he agreed in advance to participate in a follow-up. We were interested if the group-treatment of W-IPT also has a persistent positive effect. Case presentation: We present the case of a 33-year-old man “Bob”. He was included in our previous published pilot-study 2020 with diagnosed moderate MDD, and he attended the group treatment. This case report focuses on a follow-up period of 18 months. A structured clinical interview for DSM-IV was carried out in order to be included in the study, and no comorbid diagnoses were detected. Conclusions: However, the psychotherapeutic effects in this case seem enduring and prolonged. Of course, additional research to study the long-term effects of W-IPT is needed, and more patients need to be included. Full article

(This article belongs to the Special Issue Psychosocial Factors and Health at Work: Evaluation and Intervention)

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