Comparative Effectiveness And Acceptability Of Interventions For Burnout Among Healthcare Workers: Systematic Review And Network Meta-analysis

Objective:This study aims to compare the effectiveness and acceptability of different interventions in reducing the burnout of healthcare workers by using network meta-analysis and provide a guide for managers and researchers to carry out interventions.Methods:A systematic review and network meta-analysis were conducted by searching the Cochrane Central Register of Controlled Trials,Medline,Embase,Web of Science,and CINAHL,from inception until 1 April 2022.Randomized controlled trials,quasi-randomized controlled trials,and mixed methods studies published in peer-reviewed journals were included.Nonrandomized,uncontrolled trials and studies involving occupational groups other than healthcare workers were excluded.Two groups of researchers independently extracted relevant information from included studies and assessed the risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions.Primary outcomes included postintervention effectiveness and acceptability,as measured by emotional exhaustion scores and dropout rates,respectively.The primary endpoint was within 2 months after the end of the intervention,and the rest of the follow-up outcomes were secondary endpoints.Based on the Bayesian method,the random effect model was used to conduct a network Meta-analysis on the outcomes of effectiveness and acceptability.The study is registered with PROSPERO,number CRD42021258063.Results:85 studies involving 12200 healthcare workers were included.In terms of effectiveness,only cognitive behavioral therapy(SMD:-0.62,95%Cr I:[-0.97,-0.28])was more effective than the blank control after the intervention,and the effect of cognitive behavioral therapy still existed at the mid-term follow-up(SMD:-0.62,95%Cr I:[-1.16,-0.06]);in terms of acceptability,behavioral therapy(ORs:3.77,95%Cr I:[1.26,11.07]),cognitive behavioral therapy(ORs:1.96,95%Cr I:[1.32,2.70])and mindfulness interventions(ORs:1.43,95%Cr I:[1.03,2.00])were less acceptable,and no active intervention was found to be more acceptable than the blank control.Significant differences were found for the intervention effectiveness outcomes(tau~2:0.51;95%Cr I:[0.38,0.69],I~2:83%)and acceptability outcomes(tau~2:0.29;95%Cr I:[0.05,0.54],I~2:20%)Heterogeneity.The results of Meta-regression showed the baseline standardized mean difference and the sample size might be the effect modifier of the effectiveness and acceptability of interventions,respectively.Conclusions:Cognitive behavioral therapy appears to be the only effective individual-intervention for reducing burnout among healthcare workers.Acceptance of interventions by healthcare workers was generally poor.However,due to the insufficient number of included organizational interventions,the effectiveness and relative acceptability of organizational interventions cannot be evaluated and compared.Our findings can provide some scientific reference for policy makers and managers to implement interventions to alleviate job burnout in healthcare workers.