{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T01:43:53Z","timestamp":1792374233440,"version":"4.4.0"},"reference-count":53,"publisher":"JMIR Publications Inc.","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"\n Background<\/jats:title>\n Emotional exhaustion (EE) in health care workers is common and consequentially linked to lower quality of care. Effective interventions to address EE are urgently needed.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This randomized single-exposure trial examined the efficacy of a gratitude letter\u2013writing intervention for improving health care workers\u2019 well-being.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A total of 1575 health care workers were randomly assigned to one of two gratitude letter\u2013writing prompts (self- vs other focused) to assess differential efficacy. Assessments of EE, subjective happiness, work-life balance, and tool engagement were collected at baseline and 1-week post intervention. Participants received their EE score at baseline and quartile benchmarking scores. Paired-samples t tests, independent t tests, and correlations explored the efficacy of the intervention. Linguistic Inquiry and Word Count software assessed the linguistic content of the gratitude letters and associations with well-being.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Participants in both conditions showed significant improvements in EE, happiness, and work-life balance between the intervention and 1-week follow-up (P<.001). The self-focused (vs other) instruction conditions did not differentially predict improvement in any of the measures (P=.91). Tool engagement was high, and participants reporting higher motivation to improve their EE had higher EE at baseline (P<.001) and were more likely to improve EE a week later (P=.03). Linguistic analyses revealed that participants high on EE at baseline used more negative emotion words in their letters (P=.005). Reduction in EE at the 1-week follow-up was predicted at the level of a trend by using fewer first-person (P=.06) and positive emotion words (P=.09). No baseline differences were found between those who completed the follow-up assessment and those who did not (Ps>.05).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This single-exposure gratitude letter\u2013writing intervention appears to be a promising low-cost, brief, and meaningful tool to improve the well-being of health care workers.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/15562","type":"journal-article","created":{"date-parts":[[2020,5,4]],"date-time":"2020-05-04T15:54:10Z","timestamp":1588607650000},"page":"e15562","source":"Crossref","is-referenced-by-count":52,"title":["Gratitude at Work: Prospective Cohort Study of a Web-Based, Single-Exposure Well-Being Intervention for Health Care Workers"],"prefix":"10.2196","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4886-0002","authenticated-orcid":false,"given":"Kathryn C","family":"Adair","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4998-1519","authenticated-orcid":false,"given":"Larissa G","family":"Rodriguez-Homs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7758-3545","authenticated-orcid":false,"given":"Sabran","family":"Masoud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3388-9013","authenticated-orcid":false,"given":"Paul J","family":"Mosca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0578-2924","authenticated-orcid":false,"given":"J Bryan","family":"Sexton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2020,5,14]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e1717"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000000844"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2012.3199"},{"issue":"9","key":"ref4","first-page":"626","volume":"40","author":"McCray, LW","year":"2008","journal-title":"Fam Med"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1177\/0013164410391579"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.1389"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.12615"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-149-5-200809020-00008"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.1384"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2016-006032"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2018-007933"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1002\/jclp.22020"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1007\/s10902-011-9257-7"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1007\/s10902-017-9931-5"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1080\/17439760.2016.1221127"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1037\/\/0022-3514.84.2.377"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1037\/0003-066X.60.5.410"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1177\/1948550616651681"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1080\/02699930441000030"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1802331115"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2018.00645"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-018-3743-0"},{"key":"ref23","unstructured":"Duke Qualtrics2020-01-23Gratitude Letterhttps:\/\/duke.qualtrics.com\/jfe\/form\/SV_200ktTwZpgGTi6x?Q_JFE=qdg"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-022695"},{"key":"ref25","author":"Maslach, C","year":"1996","journal-title":"Maslach Burnout Inventory Manual. 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