{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T01:41:26Z","timestamp":1783820486124,"version":"3.55.0"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T00:00:00Z","timestamp":1756080000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Healthcare workers in the UK report high levels of burnout and poor wellbeing, and interventions are urgently needed to address this issue. Expressive writing, whereby individuals write about emotionally laden thoughts or experiences, is an effective intervention for reducing stress and enhancing wellbeing, and is a potential candidate for use with healthcare workers. However, it is crucial that the preferences of healthcare workers are taken into account in the design of future trials in this area, and that perceived barriers and facilitators to engaging with expressive writing activities are considered. Therefore, the present study aimed to seek healthcare workers\u2019 views on expressive writing activities for enhancing wellbeing. We informed 11 UK-based health and social care professionals about current research into the potential wellbeing benefits of expressive writing activities and conducted 1:1 semi-structured interviews to determine their preferences, perceived facilitators and barriers to engaging routinely with expressive writing. Data were analysed using deductive, reflective thematic analysis, with the coding framework informed by the Capability-Opportunity-Motivation-Behaviour (COM-B) Model. Key findings, from the perspective of future trial design, were that participants preferred the three good things (writing down three good things that have happened during the day), written benefit finding (writing about positive emotions, thoughts, feelings and life changes in relation to an unfavourable experience) and gratitude letter (writing a letter of appreciation to someone who has never been properly thanked) activities. Participants expressed preferences for simple, brief activities that could be easily embedded into a daily routine. However, it was clear that support from managers, researchers or friends and family would be needed to promote engagement with the activities. Most notably, participants expressed a preference for flexibility in terms of how, when and where they write.<\/jats:p>","DOI":"10.1371\/journal.pone.0328801","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T17:25:32Z","timestamp":1756142732000},"page":"e0328801","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Facilitators and barriers to engaging in expressive writing among health and social care professionals"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5107-6441","authenticated-orcid":true,"given":"Michael A.","family":"Smith","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren M.","family":"Hoult","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Rippon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7773-6871","authenticated-orcid":true,"given":"Nicola","family":"O\u2019Brien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0105-5495","authenticated-orcid":true,"given":"Dawn","family":"Branley-Bell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucie","family":"Byrne-Davis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitriona","family":"Collins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Gallagher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gail","family":"Kinman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6158-6943","authenticated-orcid":true,"given":"Arron","family":"Mark","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4117-4093","authenticated-orcid":true,"given":"Daryl B.","family":"O\u2019Connor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kavita","family":"Vedhara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glenn P.","family":"Williams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A.","family":"Wetherell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,8,25]]},"reference":[{"key":"pone.0328801.ref001","article-title":"NHS staff survey underlines need for national workforce strategy","volume":"377","author":"A Waters","year":"2022","journal-title":"BMJ"},{"key":"pone.0328801.ref002","article-title":"Staff burnout: MPs demand \u201ctotal overhaul\u201d of NHS workforce planning","volume":"373","author":"G Iacobucci","year":"2021","journal-title":"BMJ"},{"key":"pone.0328801.ref003","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1136\/bmj.p1","article-title":"NHS crisis: rebuilding the NHS needs urgent action","volume":"380","author":"T Cooksley","year":"2023","journal-title":"BMJ"},{"key":"pone.0328801.ref004","article-title":"Persistent understaffing of the NHS is putting patients at risk, say MPs","volume":"378","author":"J Wise","year":"2022","journal-title":"BMJ"},{"issue":"2","key":"pone.0328801.ref005","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0229706","article-title":"A grounded theory study on work related stress in professionals who provide health & social care for people who exhibit behaviours that challenge","volume":"15","author":"D Rippon","year":"2020","journal-title":"PLoS One"},{"key":"pone.0328801.ref006","unstructured":"NHS England. NHS long term workforce plan; 2023. Available from: https:\/\/www.england.nhs.uk\/publication\/nhs-long-term-workforce-plan\/"},{"key":"pone.0328801.ref007","unstructured":"Bajorek Z, Holmes J. Health and wellbeing interventions in healthcare: a rapid evidence review; 2020. Available from: https:\/\/www.employment-studies.co.uk\/resource\/health-and-wellbeing-interventions-healthcare"},{"issue":"1","key":"pone.0328801.ref008","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1186\/s12889-018-6283-y","article-title":"Barriers and facilitators to implementing workplace health and wellbeing services in the NHS from the perspective of senior leaders and wellbeing practitioners: a qualitative study","volume":"18","author":"H Quirk","year":"2018","journal-title":"BMC Public Health"},{"issue":"3","key":"pone.0328801.ref009","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1111\/j.1467-9280.1997.tb00403.x","article-title":"Writing about emotional experiences as a therapeutic process","volume":"8","author":"JW Pennebaker","year":"1997","journal-title":"Psychol Sci"},{"key":"pone.0328801.ref010","doi-asserted-by":"crossref","first-page":"112697","DOI":"10.1016\/j.psychres.2019.112697","article-title":"Online writing about positive life experiences reduces depression and perceived stress reactivity in socially inhibited individuals","volume":"284","author":"SF Allen","year":"2020","journal-title":"Psychiatry Res"},{"issue":"2","key":"pone.0328801.ref011","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1177\/1745691617707315","article-title":"Expressive writing in psychological science","volume":"13","author":"JW Pennebaker","year":"2018","journal-title":"Perspect Psychol Sci"},{"issue":"5","key":"pone.0328801.ref012","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0308928","article-title":"Positive expressive writing interventions, subjective health and wellbeing in non-clinical populations: a systematic review","volume":"20","author":"LM Hoult","year":"2025","journal-title":"PLoS One"},{"issue":"4","key":"pone.0328801.ref013","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1111\/bjhp.12320","article-title":"The physical and psychological health benefits of positive emotional writing: investigating the moderating role of Type D (distressed) personality","volume":"23","author":"MA Smith","year":"2018","journal-title":"Br J Health Psychol"},{"issue":"1","key":"pone.0328801.ref014","doi-asserted-by":"crossref","first-page":"2060628","DOI":"10.1080\/23311908.2022.2060628","article-title":"Positive expressive writing as a tool for alleviating burnout and enhancing wellbeing in teachers and other full-time workers","volume":"9","author":"EK Round","year":"2022","journal-title":"Cogent Psychol"},{"issue":"3","key":"pone.0328801.ref015","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-022695","article-title":"Forty-five good things: a prospective pilot study of the Three Good Things well-being intervention in the USA for healthcare worker emotional exhaustion, depression, work-life balance and happiness","volume":"9","author":"JB Sexton","year":"2019","journal-title":"BMJ Open"},{"issue":"10","key":"pone.0328801.ref016","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1080\/08870446.2021.1936521","article-title":"Written benefit finding for improving psychological health during the Covid-19 pandemic first wave lockdown","volume":"37","author":"SR Hansen","year":"2022","journal-title":"Psychol Health"},{"issue":"1","key":"pone.0328801.ref017","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1080\/13229400.2015.1020987","article-title":"Assessing the feasibility and efficacy of written benefit-finding for caregivers of children with autism: a pilot study","volume":"22","author":"B Lovell","year":"2015","journal-title":"J Fam Stud"},{"issue":"2","key":"pone.0328801.ref018","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1111\/aphw.12195","article-title":"Building resources in caregivers: feasibility of a brief writing intervention to increase benefit finding in caregivers","volume":"12","author":"S Gallagher","year":"2020","journal-title":"Appl Psychol Health Well Being"},{"issue":"10","key":"pone.0328801.ref019","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1002\/jclp.22469","article-title":"Feeling thanks and saying thanks: a randomized controlled trial examining if and how socially oriented gratitude journals work","volume":"73","author":"BH O\u2019Connell","year":"2017","journal-title":"J Clin Psychol"},{"issue":"6","key":"pone.0328801.ref020","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1080\/17439760.2019.1651888","article-title":"Gratitude and health: an updated review","volume":"15","author":"L Jans-Beken","year":"2019","journal-title":"J Posit Psychol"},{"issue":"2","key":"pone.0328801.ref021","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1007\/s10902-012-9346-2","article-title":"What is the optimal way to deliver a positive activity intervention? The case of writing about one\u2019s best possible selves","volume":"14","author":"K Layous","year":"2012","journal-title":"J Happiness Stud"},{"issue":"4","key":"pone.0328801.ref022","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1007\/s11606-016-3886-9","article-title":"The relationship between professional burnout and quality and safety in healthcare: a meta-analysis","volume":"32","author":"MP Salyers","year":"2017","journal-title":"J Gen Intern Med"},{"issue":"1","key":"pone.0328801.ref023","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.jradnu.2021.11.001","article-title":"Self-care in nurses","volume":"41","author":"SG Williams","year":"2022","journal-title":"J Radiol Nurs"},{"key":"pone.0328801.ref024","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1348\/135910707X250910","article-title":"Effects of (very) brief writing on health: the two-minute miracle","volume":"13","author":"CM Burton","year":"2008","journal-title":"Br J Health Psychol"},{"key":"pone.0328801.ref025","first-page":"13","article-title":"Expressive writing. A tool to help health workers. Research project on the benefits of expressive writing","volume":"88","author":"A Tonarelli","year":"2017","journal-title":"Acta Biomed"},{"issue":"11","key":"pone.0328801.ref026","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0277196","article-title":"Caring for Carers (C4C): results from a feasibility randomised controlled trial of positive written disclosure for older adult carers of people with psychosis","volume":"17","author":"CJ Jones","year":"2022","journal-title":"PLoS One"},{"key":"pone.0328801.ref027","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/1748-5908-6-42","article-title":"The behaviour change wheel: a new method for characterising and designing behaviour change interventions","volume":"6","author":"S Michie","year":"2011","journal-title":"Implement Sci"},{"issue":"12","key":"pone.0328801.ref028","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0188418","article-title":"Whole-system approaches to improving the health and wellbeing of healthcare workers: a systematic review","volume":"12","author":"SL Brand","year":"2017","journal-title":"PLoS One"},{"key":"pone.0328801.ref029","volume-title":"Thematic analysis: a practical guide","author":"V Braun","year":"2021"},{"issue":"6","key":"pone.0328801.ref030","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1080\/13645579.2015.1005453","article-title":"Supporting thinking on sample sizes for thematic analyses: a quantitative tool","volume":"18","author":"AJB Fugard","year":"2015","journal-title":"Int J Soc Res Methodol"},{"key":"pone.0328801.ref031","doi-asserted-by":"crossref","first-page":"1078797","DOI":"10.3389\/fpsyt.2023.1078797","article-title":"A systematic scoping review on the evidence behind debriefing practices for the wellbeing\/emotional outcomes of healthcare workers","volume":"14","author":"TR Evans","year":"2023","journal-title":"Front Psychiatry"},{"key":"pone.0328801.ref032","doi-asserted-by":"crossref","first-page":"1248924","DOI":"10.3389\/fpsyg.2023.1248924","article-title":"Revisiting the debriefing debate: does psychological debriefing reduce PTSD symptomology following work-related trauma? A meta-analysis","volume":"14","author":"HM Stileman","year":"2023","journal-title":"Front Psychol"},{"issue":"2","key":"pone.0328801.ref033","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1080\/17437199.2020.1814836","article-title":"Participants\u2019 enactment of behavior change techniques: a call for increased focus on what people do to manage their motivation and behavior","volume":"15","author":"N Hankonen","year":"2021","journal-title":"Health Psychol Rev"},{"issue":"3","key":"pone.0328801.ref034","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1080\/17437199.2013.876238","article-title":"A review and analysis of the use of \u201chabit\u201d in understanding, predicting and influencing health-related behaviour","volume":"9","author":"B Gardner","year":"2015","journal-title":"Health Psychol Rev"},{"issue":"6","key":"pone.0328801.ref035","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1080\/17439760.2014.927905","article-title":"When do people benefit from gratitude practice?","volume":"9","author":"CN Harbaugh","year":"2014","journal-title":"J Posit Psychol"},{"issue":"3","key":"pone.0328801.ref036","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0090347","article-title":"The effectiveness of financial incentives for health behaviour change: systematic review and meta-analysis","volume":"9","author":"EL Giles","year":"2014","journal-title":"PLoS One"},{"issue":"1","key":"pone.0328801.ref037","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/s12160-013-9486-6","article-title":"The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions","volume":"46","author":"S Michie","year":"2013","journal-title":"Ann Behav Med"},{"issue":"1","key":"pone.0328801.ref038","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1093\/bmb\/ldac003","article-title":"\u201cThe WOW factors\u201d: comparing workforce organization and well-being for doctors, nurses, midwives and paramedics in England","volume":"141","author":"C Taylor","year":"2022","journal-title":"Br Med Bull"},{"issue":"1","key":"pone.0328801.ref039","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1111\/jonm.12910","article-title":"A longitudinal assessment of occupational stress in Emergency Department Nursing Staff","volume":"28","author":"S Basu","year":"2020","journal-title":"J Nurs Manag"},{"issue":"18","key":"pone.0328801.ref040","doi-asserted-by":"crossref","first-page":"6464","DOI":"10.3390\/ijerph17186464","article-title":"Work stress in NHS employees: a mixed-methods study","volume":"17","author":"JM Ravalier","year":"2020","journal-title":"Int J Environ Res Public Health"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0328801","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T17:25:41Z","timestamp":1756142741000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0328801"}},"subtitle":[],"editor":[{"given":"Fatma Refaat","family":"Ahmed","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,8,25]]},"references-count":40,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8,25]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0328801","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,25]]}}}