May 23, 2023

Family Medicine researchers publish new paper on the impact of a gratitude intervention delivered to health care workers via text message

While the intervention showed initial positive effects in well-being, results were not sustained over the long-term. The paper is now available in the Annals of Family Medicine.

As healthcare workers face increasing rates of mental distress and burnout exacerbated by the pandemic, researchers are looking for solutions. Katherine J. Gold, MD, MPH, MS, Margaret L. Dobson, M.D., and Ananda Sen, Ph.D. of the Department of Family Medicine recently published the results of a research study analyzing the impact of a positive psychology-based gratitude intervention, “Three Good Things,” (3GT). They hypothesized that the innovative approach may help alleviate emotional burden and improve well-being among health care professionals.


Katherine J. Gold, M.D., M.S.W., M.S.
Lead author Katherine J. Gold, MD, MPH, MS

Their study found that while the intervention was well-received and showed short-term improvement in positive affect, those benefits waned over time. Their paper was published in the May/June 2023 issue of Annals of Family Medicine.


The researchers tested a digital version of 3GT among department clinicians and staff at Michigan Medicine to assess whether the gratitude practice improved well-being. They engaged 223 providers in the study with each participant randomized to an immediate intervention or delayed intervention control group. During the study, participants received text messages three times per week for three weeks, prompting them to document three positive things that had occurred that day. 


Participants completed surveys measuring levels of depression, positive affect, gratitude and life satisfaction at the study’s launch and then one month and three months post-intervention. Control group participants completed additional measures at months four and six after completing the delayed intervention. The researchers compared intervention and control groups to look at the effects of department role, gender, age and time on outcomes.


The intervention and control groups showed no significant differences in depression, gratitude, or satisfaction with life scores at months zero, one or three. For depression and gratitude, scores in the intervention group were favorable immediately after the intervention but gains had been mostly lost by the third month and were not significant.


Measures of positive affect were significantly different between the two groups, particularly in the first month after the intervention. However, differences between the two groups had mostly disappeared by the third month. There were no differences between groups in self-reported mental and physical health ratings.


The researchers concluded that while 3GT showed initial improvement in well-being among participants directly after the intervention began, sustaining those feelings proved elusive in the longer term.  Future research could test longer interventions or strategies to encourage staff to identify 3GT over a longer period of time than three weeks.


“Interventions like 3GT may have value as low-cost and simple strategies to improve positive feelings but cannot address burnout alone,” the authors write, suggesting that promoting a social norm of gratitude may lead to changes in workplace culture or practice while also promoting employee joy, which could also benefit patients.


Article cited: Gold, K. J., Dobson, M. L., &; Sen, A. (2023). “Three good things” digital intervention among health care workers: A randomized controlled trial. The Annals of Family Medicine, 21(3), 220–226.