Behavioral data in health interventions – Aleksandra Sjöström-Bujacz's team

We strive to find ways in which behavioral data can be used to optimize health interventions. We are currently focusing on interventions targeting work-related stress and improving workers’ well-being.

Our vision

Our vision is to create an overarching multilevel framework for designing and evaluating digital interventions in which user-centered design features and implementation principles can be aligned with individual and group behavioral change processes that an intervention is targeting. This means that an intervention can be optimized for maximum efficiency, tailored to individual needs, and delivered in a timely manner thanks to a data-driven process of monitoring, assessing, and modeling behaviors.


All publications from group members

Staff and contact

Group leader

All members of the group


Andreas Stenling, Umeå Universitet

Anna Finnes, Akademiskt primärvårdscentrum Kunskapsteam: Försäkringsmedicin

Louise Bergman, Stockholms University

Pamela Mazzocato, Clinical Management

Rikard Wicksell, Rikard Wicksell's Research Group

Former Students

Andrea Nordström - Master’s thesis, Study Programme in Medicine

Anna Nordberg, Bachelor’s thesis, Study programme in Psychology 

Belinda Blomqvist - Master’s thesis, Study Programme in Psychology 

Diego Civera - Master’s Programme in Health Informatics, Involved in SFO project 

Hanna Sallmén, Master’s thesis, Study programme in Psychology 

Jan Lorenz - Master’s thesis, Programme in Health Informatics 

Jasmin Lukas, Exchange Student, University of Duisburg-Essen

Katarina Wallin, Bachelor’s thesis, Study programme in Psychology 

Kristina Nylund - Master’s thesis, Study Programme in Psychology   

Vanja Beslic, Master’s thesis, Study programme in Psychology 

Samantha Khoo, Study programme in Psychology

Research projects

It's about time: Dynamic temporal effects of psychosocial work environment on chronic and acute stress symptoms

In this project we aim to systematically compare when strain symptoms develop as a result of an exposure to chronic vs acute occupational stressors, and how these stressors-strain effects change over time. We investigate when chronic and acute stressors lead to the development of both psychological strain (e.g., depression, burnout) and physical strain (e.g., sleep disturbance). Combinations of diverse types of stressors and strain symptoms, under varying individual factors (e.g., gender, age, recovery opportunities), will likely result in different time frames during which symptoms develop. Thus, in this project we aim to provide a novel and dynamic view on the relationship between work-related stress and strain symptoms.

Research questions

  • What is the typical duration of exposure to chronic stressors after which strain symptoms start developing?
  • How long do strain symptoms persist after the exposure to acute stressors?
  • What is the typical time needed for the effects of change in stressors to result with change in strain symptoms?
  • Does the over-time variability in strain symptoms relate to the onset of clinical levels of strain (e.g., burnout)?
  • To what extent the time estimates specified above vary depending on individual and organizational factors?

Study details

Long-term perspective: Using a large dataset of nurses that were followed at the beginning of their careers until about 15 years later, we investigate multivariate and long-term associations among stressors in the work environment, including both psychosocial working conditions and shift work schemes, and their health consequences.

Over-time variability: We study variability in stressor-strain relations over time using intensive longitudinal data collected weekly and daily among healthcare workers. Understanding how stress experience varies over time, depending on the range of individual and organizational factors, is crucial for the development of timely interventions.

Daily recovery: Focusing specifically on daily recovery from work-related stress, we model the extent to which an individual may benefit from sufficient recovery opportunities (e.g., days off work, vacation), depending on the work environment characteristics and individual differences. We aim at discovering individual patterns of daily recovery experience that may be linked to symptoms of mental health problems.


The Swedish Research Council for Health, Working Life and Welfare FORTE Swecris database

Project time

2018 – 2024


Intensive longitudinal study of newly graduated nurses' quick returns and self-rated stress.
Dahlgren A, Tucker P, Bujacz A, Frögéli E, Rudman A, Gustavsson P. Scand J Work Environ Health 2021 Jul;47(5):404-407

Psychosocial working conditions of shiftworking nurses: A long-term latent transition analysis.
Bujacz A, Rudman A, Gustavsson P, Dahlgren A, Tucker P. J Nurs Manag 2021 Nov;29(8):2603-2610

Completed projects

Psychological reactions and the need for psychological support for healthcare workers during the Covid-19 pandemic

The aim of the project is to investigate psychological reactions in healthcare workers during the Covid-19 pandemic, as well as meaningfulness and feasibility of the psychological support directed to them. A longitudinal data collection, following healthcare workers up to one year from the first wave of the pandemic, will help describing the development of psychological stress reactions over time and the contextual, organizational, and individual factors that may increase the risk of mental health problems during and after the crisis. The project will also allow for short- and long-term evaluations of meaningfulness and feasibility of the psychological support that has been implemented during the pandemic.

Research questions

  • How do psychological reactions among healthcare staff vary over time, during and after the crisis?
  • How do individual and organizational factors relate to the experience of work-related stress during and after the crisis?
  • What forms of psychological support for healthcare workers and their managers are requested, meaningful, and feasible during a crisis?
  • What factors facilitate the implementation of psychological support initiatives during a crisis?

Study details

Longitudinal survey: An ongoing longitudinal survey is currently following 1026 Swedish healthcare workers divided into three cohorts that spread across five hospitals in Region Stockholm and Gävleborg. The survey measures perception of the psychosocial work environment, participation in and meaningfulness of the psychological support initiatives, as well as work-related stress reactions such as symptoms of burnout, depression, PTSD, and sleep disturbance.

Psychological support for healthcare managers: During the Covid-19 pandemic, managers have played a vital role in providing psychological support to their staff. At the same time, they also faced pressures and challenges on their own, often with little knowledge and resources at hand. In a mixed methods study, using both survey data and interviews, we investigate what type of psychological support would be meaningful and feasible for healthcare managers in a crisis situation.

Implementation of a psychological support model: During the first wave of the pandemic, a comprehensive model of psychological support for frontline healthcare workers was rapidly implemented at the intensive care unit of Capio S:t Görans hospital in Stockholm. We have analyzed and evaluated this case study to better understand factors related to a successful organization of psychological support during a crisis.


AFA Insurance

Project time

May 2020-May 2023 


The Rapid Implementation of a Psychological Support Model for Frontline Healthcare Workers During the COVID-19 Pandemic: A Case Study and Process Evaluation.
Appelbom S, Bujacz A, Finnes A, Ahlbeck K, Bromberg F, Holmberg J, Larsson L, Olgren B, Wanecek M, Wetterborg D, Wicksell R. Front Psychiatry 2021 ;12():713251

Technical report (in Swedish)
Appelbom, Bernhardtz & Bujacz (2023)

When a crisis hits, send in the psychologists? A latent transition analysis of help-seeking behavior among Swedish healthcare workers during the Covid-19 pandemic. 
Appelbom, S., Finnes, A., Wicksell, R., & Bujacz, A. (2024).  Scandinavian Journal of Work and Organizational Psychology, 9(1), 1–15. 

Diary of a pandemic: Monitoring of work-related stress symptoms among healthcare workers through a mobile application.

This project aims at developing a data-driven monitoring system to efficiently track work-related stress reactions over time. The system includes a self-awareness intervention based on evidence-based strategies to improve workers’ recovery.

A mobile application has been developed through an initial analysis of pilot data, a factorial experiment, and a user-experience analysis. Apart from the self-reported data, objective workload estimates, and qualitative user experience data will be used to validate the functionality of the monitoring system.

Research questions

  • Are daily measurements a feasible, acceptable, and valid way of monitoring work-related stress among healthcare workers?
  • Is the mobile application a feasible way for administering an intervention?
  • Can a pattern of responses to daily measurements predict the development of psychological strain symptoms?
  • What is the optimal content and structure of a daily intervention aiming to manage work-related stress?

Study details

Pilot studies:  In two pilot studies we investigated the feasibility of the daily monitoring approach by looking at factors such as recruitment rates, protocol adherence, and usability. Data from these studies will inform the further development of the intervention and the mobile application, in accordance with an iterative design process.

Optimization study: In an experimental study with a factorial design, we aim to determine the optimal structure and content of the intervention. By testing different versions of the mobile application and their impact on psychological health and user experience, we investigate which version may be the most efficient and acceptable.

DIARY Application 

As part of the project we developed DIARY, a mobile application functioning as an intervention as well as a data collection tool. For details regarding the DIARY mobile application used in the study, please see the PDF outlining all functionality available in the application. The application is open to use by any parties - if you are interested in using the app for research purposes or within your organization, please contact us for more information. 


The Swedish Research Council Vetenskapsrådet Swecris database

Project time 

May 2020 – December 2021


User engagement with organizational mHealth stress management intervention - A mixed methods study.
Kowalski L, Finnes A, Koch S, Bujacz A
Internet Interv 2024 Mar;35():100704

Feasibility of a clustered randomized controlled trial for a diary intervention to prevent stress-related health problems  

The study aims at investigating whether a clustered randomized trial of a daily stress recovery intervention is feasible to be conducted at workplaces. Specifically, we will assess recruitment rates, protocol adherence, usability of the intervention, as well as the quality of data (on both individual and group levels) that can be gathered with this approach.   

Research questions  

Is a clustered randomized trial of a daily stress recovery intervention feasible to conduct at workplaces in terms of reaching adequate recruitment rates, protocol adherence, and usability?  

Does aggregating individual level effects of an intervention to a group level provide a sufficient data quality to assess the effectiveness of an intervention on a group level?  

Study details

A 28-day daily intervention for stress recovery is developed based on results from previous pilot and experimental studies. The intervention promotes users to reflect on current stress levels and recovery processes, as well as providing evidence-based behavioral strategies for stress recovery.   

Three experimental groups will receive different behavioral strategies in order to test their effectiveness on outcome measures related to mental health. A pilot study will be conducted with nursing students in which participants are randomized (“clustered”) into experimental groups based on groupings in a course.   



Project time 

January 2022 – June 2023 


We are involved in teaching psychometrics, measurement construction, and multilevel modelling. We are also open for individual consultations regarding issues related to behavioral measurement, including for example survey and questionnaire construction, validation of measurement instruments, and modelling of multilevel behavioral data.  

Interested in our courses or individual consultations? Please contact Aleksandra Sjöström-Bujacz for more information. 


Construction and validation of measurement 

The course covers those aspects of classical test theory and modern latent variables theory that are necessary for doctoral students to successfully use a measurement instrument in their research projects. All lectures, discussions and workshops during the course will be available for online participation. Interested doctoral students and postdocs are warmly welcomed to the course.

Practical Introduction to Multilevel Data Analysis: From Data Collection to Results Interpretation 

The purpose of this course is to give doctoral students a possibility to acquire practical understanding and hands-on statistical skills required to use multilevel analysis in their research projects. The course also aims at inspiring the students to apply novel data collection designs in their research (e.g., hierarchical and cross-classified data, clustered randomized trials, collecting data with diary and experience sampling designs, using data from tracking and mobile devices).