Strengthening Health Literacy in Healthcare Workers Through Mind Body Medicine and Nutrition

Measured with the Resilience Scale (RS-25), a 25-item self-report instrument assessing personal competence and acceptance of life on one sum scale. Higher scores indicate greater resilience.

Assessed using the Maslach Burnout Inventory - Human Services Survey (MBI-HSS), a 22-item scale measuring emotional exhaustion, depersonalization, and personal accomplishment (three subscales). Higher exhaustion and depersonalization scores with lower personal accomplishment scores indicate a higher risk of burnout.

Measured using the "Coping" subscale of the Stress- und Coping-Inventory (SCI-COPE), a 20-item self-report scale assessing five coping strategies on five subscales: positive thinking, active coping, social support, religion, and substance use (four items each). Higher scores indicate better coping skills.

Measured using the "Symptoms"-subscale of the Stress- und Coping-Inventory (SCI-SYMPT), a 13-item self-report scale assessing physical and psychological stress symptoms (e.g., sleep disturbances, concentration issues). Higher scores indicate greater symptom burden on one sum scale.

Assessed with the subscale "Physical Resilience" of the Questionnaire for Assessing Health Behavior (FEG). It consists of five items rated on a Likert scale (1 = does not apply at all to 5 = fully applies), covering aspects such as perceived robustness, recovery after illness, and endurance in stressful situations. The mean of all items is calculated, with higher mean values indicating greater resilience.

Measured with the World Health Organization (WHO-5) Well-Being Index, a self-report instrument measuring mental well-being. It consists of five statements summed up to one total scale. Each statement is rated on a 6-point scale, with higher scores indicating better mental well-being.

Psychological distress is assessed using the total score of the Patient Health Questionnaire-4 (PHQ-4), a brief self-report screening tool for anxiety and depressive symptoms. The PHQ-4 consists of four items rated on a 4-point Likert scale (0-3), yielding a total score ranging from 0 to 12. Higher scores indicate greater psychological distress.

This outcome measures participants' self-reported engagement in five domains of health-promoting behavior: relaxation, physical activity, breathing, nutrition, and complementary self-care. Assessment is conducted using the "Temple of Health," a pictorial tool consisting of five pillars representing these domains. Each pillar is 10 cm in height and serves as an visual analogue scale, with the bottom representing "I do not engage in this behavior" and the top representing "I fully engage in this behavior." Participants are instructed to color or draw on each pillar to indicate their perceived level of engagement.

Adverse events are documented using participant self-report sheets provided at the beginning of the intervention period. Participants are instructed to record any physical or psychological complaints, discomfort, or other unexpected events that occur during the course of the study. Each entry includes the date, a brief description of the event, perceived severity, and whether the event is ongoing. The collected sheets are reviewed by the study team to identify, classify, and evaluate adverse events according to their frequency, severity, and potential relation to the intervention.

Measured with the Resilience Scale (RS-25), a 25-item self-report instrument assessing personal competence and acceptance of life on one sum scale. Higher scores indicate greater resilience.

Assessed using the Maslach Burnout Inventory - Human Services Survey (MBI-HSS), a 22-item scale measuring emotional exhaustion, depersonalization, and personal accomplishment (three subscales). Higher exhaustion and depersonalization scores with lower personal accomplishment scores indicate a higher risk of burnout.

Measured using the "Coping"-subscale of the Stress- und Coping-Inventory (SCI-COPE), a 20-item self-report scale assessing five different coping strategies on five subscales: positive thinking, active coping, social support, religion and substance use with four items each. Higher scores indicate better coping skills.

Measured using the "Symptoms"-subscale of the Stress- und Coping-Inventory (SCI-SYMPT), a 13-item self-report scale assessing physical and psychological stress symptoms (e.g., sleep disturbances, concentration issues). Higher scores indicate greater symptom burden on one sum scale.

Assessed with the subscale "Physical Resilience" of the Questionnaire for Assessing Health Behavior (FEG). It consists of five items rated on a Likert scale (1 = does not apply at all to 5 = fully applies), covering aspects such as perceived robustness, recovery after illness, and endurance in stressful situations. The mean of all items is calculated, with higher mean values indicating greater resilience.

Measured with the World Health Organization (WHO-5) Well-Being Index, a self-report instrument measuring mental well-being. It consists of five statements summed up to one total scale. Each statement is rated on a 6-point scale, with higher scores indicating better mental well-being.

Psychological distress is assessed using the total score of the Patient Health Questionnaire-4 (PHQ-4), a brief self-report screening tool for anxiety and depressive symptoms. The PHQ-4 consists of four items rated on a 4-point Likert scale (0-3), yielding a total score ranging from 0 to 12. Higher scores indicate greater psychological distress.

This outcome measures participants' self-reported engagement in five domains of health-promoting behavior: relaxation, physical activity, breathing, nutrition, and complementary self-care. Assessment is conducted using the "Temple of Health," a pictorial tool consisting of five pillars representing these domains. Each pillar is 10 cm in height and serves as an visual analogue scale, with the bottom representing "I do not engage in this behavior" and the top representing "I fully engage in this behavior." Participants are instructed to color or draw on each pillar to indicate their perceived level of engagement.

Measured with the Mindful Attention Awareness Scale (MAAS), a 15-item self-report scale assessing everyday mindfulness. The mean of all items is calculated, with higher mean values indicating greater mindfulness in daily life.

Assessed using a Numeric Rating Scale (NRS), where participants rate their perceived workload on a scale from 0 (no burden) to 10 (maximum burden).

The Perception, Intention and Ability to Change (PIAC) questionnaire is used to assess participants' perceived motivation and capability to initiate and implement health-related behavioral changes. It consists of nine items rated on a 5-point Likert scale ranging from 0 (strongly disagree) to 4 (strongly agree). The items can be summarized to two subscales: perceptions and intentions regarding the need for change, and the perceived ability and implementation of behavioral changes. A total score is calculated by summing all items, with higher scores indicating a greater perceived internal ability to change.

Assessed with the sum and subscores of the Eating Behavior (SEV) questionnaire, which assesses participants' self-reported eating behaviors and consists of two subscales: Health-Conscious Eating Behavior (GB-EV) and Weight-Controlled Eating Behavior (GK-EV). Items are rated on a 5-point Likert scale ranging from 1 (does not apply at all) to 5 (applies exactly). Higher scores indicate a stronger tendency toward health-conscious or weight-controlled eating behavior.

Physical activity is assessed using the Movement and Sport Activity (BSA) questionnaire, which evaluates occupational, leisure-time, and sports-related activity on three subscales through a point-based scoring system. Occupational activity is calculated by combining sedentary, moderate, and vigorous activity items, with higher scores reflecting higher activity levels, resulting in an overall Occupational Physical Activity Index. Leisure-time activity is measured with frequency (days over the past four weeks) and duration (minutes per day) of eight activities to yield the Leisure-Time Physical Activity Index, Sport activity is assessed in the same manner, producing a Sports Activity Index in minutes per week. Higher index values indicate greater levels of physical activity.

Participants report the total number of hours they actually work per week. Data are collected via self-report. Higher values indicate a greater weekly workload.

This outcome assesses participants' expectations regarding how useful they believe the SOULFOOD program will be in strengthening their stress resilience. The measure is collected using a Numeric Rating Scale (NRS) ranging from 0 to 10, where 0 represents "not useful at all" and 10 represents "very useful". Higher scores indicate greater expectations.

Measured with the Mindful Attention Awareness Scale (MAAS), a 15-item self-report scale assessing everyday mindfulness. The mean of all items is calculated, with higher mean values indicating greater mindfulness in daily life.

Assessed using a Numeric Rating Scale (NRS), where participants rate their perceived workload on a scale from 0 (no burden) to 10 (maximum burden).

The Perception, Intention and Ability to Change (PIAC) questionnaire is used to assess participants' perceived motivation and capability to initiate and implement health-related behavioral changes. It consists of nine items rated on a 5-point Likert scale ranging from 0 (strongly disagree) to 4 (strongly agree). The items can be summarized to two subscales: perceptions and intentions regarding the need for change, and the perceived ability and implementation of behavioral changes. A total score is calculated by summing all items, with higher scores indicating a greater perceived internal ability to change.

Assessed with the sum and subscores of the Eating Behavior (SEV) questionnaire, which assesses participants' self-reported eating behaviors and consists of two subscales: Health-Conscious Eating Behavior (GB-EV) and Weight-Controlled Eating Behavior (GK-EV). Items are rated on a 5-point Likert scale ranging from 1 (does not apply at all) to 5 (applies exactly). Higher scores indicate a stronger tendency toward health-conscious or weight-controlled eating behavior.

Physical activity is assessed using the Movement and Sport Activity (BSA) questionnaire, which evaluates occupational, leisure-time, and sports-related activity on three subscales through a point-based scoring system. Occupational activity is calculated by combining sedentary, moderate, and vigorous activity items, with higher scores reflecting higher activity levels, resulting in an overall Occupational Physical Activity Index. Leisure-time activity is measured with frequency (days over the past four weeks) and duration (minutes per day) of eight activities to yield the Leisure-Time Physical Activity Index, Sport activity is assessed in the same manner, producing a Sports Activity Index in minutes per week. Higher index values indicate greater levels of physical activity.

Participants report the total number of hours they actually work per week. Data are collected via self-report. Higher values indicate a greater weekly workload.

Measured with the Mindful Attention Awareness Scale (MAAS), a 15-item self-report scale assessing everyday mindfulness. The mean of all items is calculated, with higher mean values indicating greater mindfulness in daily life.

Assessed using a Numeric Rating Scale (NRS), where participants rate their perceived workload on a scale from 0 (no burden) to 10 (maximum burden).

The Perception, Intention and Ability to Change (PIAC) questionnaire is used to assess participants' perceived motivation and capability to initiate and implement health-related behavioral changes. It consists of nine items rated on a 5-point Likert scale ranging from 0 (strongly disagree) to 4 (strongly agree). The items can be summarized to two subscales: perceptions and intentions regarding the need for change, and the perceived ability and implementation of behavioral changes. A total score is calculated by summing all items, with higher scores indicating a greater perceived internal ability to change.

Assessed with the sum and subscores of the Eating Behavior (SEV) questionnaire, which assesses participants' self-reported eating behaviors and consists of two subscales: Health-Conscious Eating Behavior (GB-EV) and Weight-Controlled Eating Behavior (GK-EV). Items are rated on a 5-point Likert scale ranging from 1 (does not apply at all) to 5 (applies exactly). Higher scores indicate a stronger tendency toward health-conscious or weight-controlled eating behavior.

Physical activity is assessed using the Movement and Sport Activity (BSA) questionnaire, which evaluates occupational, leisure-time, and sports-related activity on three subscales through a point-based scoring system. Occupational activity is calculated by combining sedentary, moderate, and vigorous activity items, with higher scores reflecting higher activity levels, resulting in an overall Occupational Physical Activity Index. Leisure-time activity is measured with frequency (days over the past four weeks) and duration (minutes per day) of eight activities to yield the Leisure-Time Physical Activity Index, Sport activity is assessed in the same manner, producing a Sports Activity Index in minutes per week. Higher index values indicate greater levels of physical activity.

Participants report the total number of hours they actually work per week. Data are collected via self-report. Higher values indicate a greater weekly workload.

Adherence to the intervention program is assessed based on participants' attendance at each group session, marked as present or absent. Adherence is calculated as the proportion of attended sessions relative to the total number of scheduled sessions. Higher values indicate greater adherence to the course program.

Monitored through an adherence journal, where participants set personal goals related to mindful exercise, nutrition, relaxation, and complementary self-care strategies and earning points for daily use (as well as consistent engagement) outside of the group sessions.