"Dear Doctor" text message intervention to reduce burnout in trainee anaesthetists: an interview study. (November 2021) - Brazier, Alix
Abstract: Background: Burnout in doctors is reported in many countries. Following a randomised controlled trial of a novel 10-month fortnightly text message intervention to reduce burnout in trainee anaesthetists, an interview study was conducted. The intervention's format and content were developed based on findings from a preceding literature review and interview study with trainee anaesthetists, and messages incorporated 11 evidenced themes including gratitude and self-efficacy from the wellbeing and behavioural science literatures. Objectives of the interviews were to explore experiences of the intervention, understand perceived mechanisms of impact (or lack thereof), and identify improvements. Methods: In the trial's endline survey (ISRCTN11418903), all 74 participants in the treatment group (those who received the text messages) were invited to interview and sampled purposively. Semi-structured interviews (audio-recorded and transcribed) were conducted following verbal consent (the participant information sheet and consent questions were sent by email before the interview). Data were managed using the Framework Approach and analysed thematically. The Imperial Joint Research Compliance Office approved this study on July 13, 2020 in an amendment to an original application to the Imperial College Research Ethics Committee (reference number 19IC5205, approval Aug 14, 2019). Findings: The pool of 23 potential participants (who registered interest) was resampled five times (eg, when the research team did not receive a response to the initial recruitment or subsequent reminder emails) until no volunteers remained. Nine interviews (three women, six men) were conducted, with diversity captured across training location, year, and change in burnout over the trial. Reported engagement (reading or acting on messages) varied. Factors affecting engagement were work pressures, mood, and COVID-19 (due to wearing personal protective equipment and wellbeing information overload). Interviewees described the content as useful, varied and interesting, among other positive descriptors. Critique referenced the intervention's impersonal nature, and that some content was generic or basic. Interviewees enjoyed the low-intensity, passive nature of the intervention. Text message was viewed as a novel, unsaturated (not heavily used) delivery mechanism (better than email). Messages provoking meaningfulness, professional value, and community were highlighted as higher impact, along with those fostering perceptions of shared experience and encouraging communication between colleagues. Suggestions for no perceived impact included personal factors (eg, high existing resilience and support) and the intervention's impersonal nature. Interviewees suggested content to add and remove, and ways of personalising format and content. Interpretation: Interviewees generally found the intervention acceptable and recommended it. Although the trial only observed an effect in a subsample, the intervention may benefit from re-evaluation following adaptation based on interviewees' recommendations. Funding: National Institute for Health Research.