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How Great Leaders Communicate

• Carmine Gallo

Four strategies to motivate and inspire your team.

Transformational leaders are exceptional communicators. In this piece, the author outlines four communication strategies to help motivate and inspire your team: 1) Use short words to talk about hard things. 2) Choose sticky metaphors to reinforce key concepts. 3) Humanize data to create value. 4). Make mission your mantra to align teams.

In the age of knowledge, ideas are the foundation of success in almost every field. You can have the greatest idea in the world, but if you can’t persuade anyone else to follow your vision, your influence and impact will be greatly diminished. And that’s why communication is no longer considered a “soft skill” among the world’s top business leaders. Leaders who reach the top do not simply pay lip service to the importance of effective communication. Instead, they study the art in all its forms — writing, speaking, presenting — and constantly strive to improve on those skills.

• Carmine Gallo is a Harvard University instructor, keynote speaker, and author of 10 books translated into 40 languages. Gallo is the author of The Bezos Blueprint: Communication Secrets of the World’s Greatest Salesman  (St. Martin’s Press).

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• 15 May 2024
• Research & Ideas

A Major Roadblock for Autonomous Cars: Motorists Believe They Drive Better

With all the advances in autonomous vehicle technology, why aren't self-driving cars chauffeuring more people around? Research by Julian De Freitas, Stuti Agarwal, and colleagues reveals a simple psychological barrier: Drivers are overconfident about their own abilities, so they resist handing over the wheel.

• 09 May 2024

Called Back to the Office? How You Benefit from Ideas You Didn't Know You Were Missing

As companies continue to weigh the benefits and drawbacks of remote work, a study of how knowledge flows among academic researchers by Karim Lakhani, Eamon Duede, and colleagues offers lessons for hybrid workplaces. Does in-person work provide more opportunities for innovation than people realize?

• 06 May 2024

The Critical Minutes After a Virtual Meeting That Can Build Up or Tear Down Teams

Weak communication and misunderstandings during virtual meetings can give way to resentment and rifts when the cameras turn off. Research by Leslie Perlow probes the nuances of digital communication. She offers advice for improving remote teamwork.

• 16 Feb 2024

Is Your Workplace Biased Against Introverts?

Extroverts are more likely to express their passion outwardly, giving them a leg up when it comes to raises and promotions, according to research by Jon Jachimowicz. Introverts are just as motivated and excited about their work, but show it differently. How can managers challenge their assumptions?

• 06 Nov 2023

Did You Hear What I Said? How to Listen Better

People who seem like they're paying attention often aren't—even when they're smiling and nodding toward the speaker. Research by Alison Wood Brooks, Hanne Collins, and colleagues reveals just how prone the mind is to wandering, and sheds light on ways to stay tuned in to the conversation.

• 31 Oct 2023

Checking Your Ethics: Would You Speak Up in These 3 Sticky Situations?

Would you complain about a client who verbally abuses their staff? Would you admit to cutting corners on your work? The answers aren't always clear, says David Fubini, who tackles tricky scenarios in a series of case studies and offers his advice from the field.

• 24 Jul 2023

Part-Time Employees Want More Hours. Can Companies Tap This ‘Hidden’ Talent Pool?

Businesses need more staff and employees need more work, so what's standing in the way? A report by Joseph Fuller and colleagues shows how algorithms and inflexibility prevent companies from accessing valuable talent in a long-term shortage.

• 23 Jun 2023

This Company Lets Employees Take Charge—Even with Life and Death Decisions

Dutch home health care organization Buurtzorg avoids middle management positions and instead empowers its nurses to care for patients as they see fit. Tatiana Sandino and Ethan Bernstein explore how removing organizational layers and allowing employees to make decisions can boost performance.

• 24 Jan 2023

Passion at Work Is a Good Thing—But Only If Bosses Know How to Manage It

Does showing passion mean doing whatever it takes to get the job done? Employees and managers often disagree, says research by Jon Jachimowicz. He offers four pieces of advice for leaders who yearn for more spirit and intensity at their companies.

• 10 Jan 2023

How to Live Happier in 2023: Diversify Your Social Circle

People need all kinds of relationships to thrive: partners, acquaintances, colleagues, and family. Research by Michael Norton and Alison Wood Brooks offers new reasons to pick up the phone and reconnect with that old friend from home.

• 15 Nov 2022

Why TikTok Is Beating YouTube for Eyeball Time (It’s Not Just the Dance Videos)

Quirky amateur video clips might draw people to TikTok, but its algorithm keeps them watching. John Deighton and Leora Kornfeld explore the factors that helped propel TikTok ahead of established social platforms, and where it might go next.

• 03 Nov 2022

Feeling Separation Anxiety at Your Startup? 5 Tips to Soothe These Growing Pains

As startups mature and introduce more managers, early employees may lose the easy closeness they once had with founders. However, with transparency and healthy boundaries, entrepreneurs can help employees weather this transition and build trust, says Julia Austin.

• 15 Sep 2022

Looking For a Job? Some LinkedIn Connections Matter More Than Others

Debating whether to connect on LinkedIn with that more senior executive you met at that conference? You should, says new research about professional networks by Iavor Bojinov and colleagues. That person just might help you land your next job.

• 08 Sep 2022

Gen Xers and Millennials, It’s Time To Lead. Are You Ready?

Generation X and Millennials—eagerly waiting to succeed Baby Boom leaders—have the opportunity to bring more collaboration and purpose to business. In the book True North: Emerging Leader Edition, Bill George offers advice for the next wave of CEOs.

• 05 Aug 2022

Why People Crave Feedback—and Why We’re Afraid to Give It

How am I doing? Research by Francesca Gino and colleagues shows just how badly employees want to know. Is it time for managers to get over their discomfort and get the conversation going at work?

• 23 Jun 2022

All Those Zoom Meetings May Boost Connection and Curb Loneliness

Zoom fatigue became a thing during the height of the pandemic, but research by Amit Goldenberg shows how virtual interactions can provide a salve for isolation. What does this mean for remote and hybrid workplaces?

• 13 Jun 2022

Extroverts, Your Colleagues Wish You Would Just Shut Up and Listen

Extroverts may be the life of the party, but at work, they're often viewed as phony and self-centered, says research by Julian Zlatev and colleagues. Here's how extroverts can show others that they're listening, without muting themselves.

• 24 May 2022

Career Advice for Minorities and Women: Sharing Your Identity Can Open Doors

Women and people of color tend to minimize their identities in professional situations, but highlighting who they are often forces others to check their own biases. Research by Edward Chang and colleagues.

• 12 May 2022

Why Digital Is a State of Mind, Not Just a Skill Set

You don't have to be a machine learning expert to manage a successful digital transformation. In fact, you only need 30 percent fluency in a handful of technical topics, say Tsedal Neeley and Paul Leonardi in their book, The Digital Mindset.

• 08 Feb 2022

Silos That Work: How the Pandemic Changed the Way We Collaborate

A study of 360 billion emails shows how remote work isolated teams, but also led to more intense communication within siloed groups. Will these shifts outlast the pandemic? Research by Tiona Zuzul and colleagues. Open for comment; 0 Comments.

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Article Contents

2 nonstandard abbreviations.

• < Previous

The Importance of Effective Communication: Some Food for Thought

• Article contents
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Nikola A Baumann, The Importance of Effective Communication: Some Food for Thought, The Journal of Applied Laboratory Medicine , Volume 1, Issue 4, 1 January 2017, Pages 460–461, https://doi.org/10.1373/jalm.2016.021865

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Having been active in the Society for Young Clinical Laboratorians (SYCL) 2 for several years, the opportunity to give something back as a speaker at the SYLC Workshop preceding the 2016 AACC Annual Meeting was an honor. The SYCL workshop centered around the theme of communication and leadership, and I was asked to provide insight into effective communication with staff and trainees—a rare chance to reflect on the soft skills that we all use every day. These are the skills that some believe can't be taught. This may be true, but time spent on thoughtful contemplation of what we do and how we do it is usually time well spent. Researching and reflecting on this topic has raised my awareness of the importance of communication, including communication challenges such as providing constructive feedback and listening. Below, I attempt to share my findings and my experience.

Mind the say-do gap.

Make the complex simple.

Find your own voice.

Be visible.

Listen with your eyes as well as your ears.

Notice that these 5 habits have little to do with what one says but rather how one says it. Keeping your message simple and genuine will go a long way. In addition, more than half of communication is nonverbal including body language, gestures, and eye contact. It is important to be aware of what you are saying nonverbally. Even a brief moment of checking your email during someone's presentation conveys a nonverbal message. Styles of communication vary. An excellent article by Mark Murphy distills communication into 4 styles: analytical, intuitive, functional, and personal ( 2 ). Although no style is superior, effective communicators know how to recognize and match their communication style with their audience whether it be their boss, peers, direct reports, or trainees.

As leaders and educators, some of our most valuable and formative communication will be in the form of feedback. Statements such as “great job” and “well done” are easy to give and are certainly well received. However, the receiver may be left wondering what specifically they did that was great and wondering if there are areas that could be improved. When giving feedback, it is important to be positive (if it is genuine), be specific, be immediate (or at least timely), and be tough if needed, but not mean (or rob the recipients of their dignity) ( 3 ). In many cases, the person receiving the feedback recognizes what is going well and what is not, so start by asking for his or her perspective. Ask them how they feel they performed or if there are areas they want to improve upon. This step opens the door for constructive feedback without a defensive atmosphere. Formative feedback should be given in private and not in the hallway or in front of peers. And although it is often a delicate process, honest assessment of a person's progress can lead to substantial growth and improvement.

In my experience, the most underused and least perfected communication skill is listening. In professional settings, individuals with authority should listen more (i.e., talk less). I have a favorite quote: “Most people do not listen with the intent to understand; they listen with the intent to reply” (Stephen Covey). To illustrate the truth of this statement, I asked the SYCL workshop attendees to pair up and do an exercise in listening. Each pair chose one person to be a speaker and one to be a listener. The speaker was asked to talk about any topic they wanted to for 2 minutes. The listener's job was to listen and not say a word. Just listen. As I watched this exercise unfold, I observed listeners who were struggling not to speak, desperately wanting to share their own story, offer their advice, and provide their feedback. On discussing the activity, attendees felt that “just listening” was difficult and far more challenging than speaking. This is more food-for-thought in our daily interactions.

Finally, it was indeed a rare (and somewhat terrifying) opportunity to stand in front of the next generation of leaders and be asked to provide them with a few personal golden nuggets of professional advice. Initially, it was overwhelming, but once I really thought about what I have found to be important in my professional interactions, the following came to light: ( a ) Say what you mean and mean what you say (even when it's easier to say what you think people want to hear). ( b ) In leadership and management relations, a “unified front” will make your job easier and your team more confident. Conversely, a “divided front” will do the opposite—create division in the work unit and drain positive energy from the team. ( c ) Don't tip-toe around the hard stuff, it won't go away. ( d ) Be real. And perhaps most importantly, ( e ) wrap it all up in a package of kindness.

Society for Young Clinical Laboratorians.

Author Contributions:   All authors confirmed they have contributed to the intellectual content of this paper and have met the following 4 requirements: (a) significant contributions to the conception and design, acquisition of data, or analysis and interpretation of data; (b) drafting or revising the article for intellectual content; (c) final approval of the published article; and (d) agreement to be accountable for all aspects of the article thus ensuring that questions related to the accuracy or integrity of any part of the article are appropriately investigated and resolved.

Authors' Disclosures or Potential Conflicts of Interest:   Upon manuscript submission, all authors completed the author disclosure form.   Employment or Leadership: None declared. Consultant or Advisory Role: None declared. Stock Ownership: None declared. Honoraria: N.A. Baumann, AACC. Research Funding: None declared. Expert Testimony: None declared. Patents: None declared.

Forbes /Leadership, Susan Tardanico. 5 habits of highly effective communicators [internet] . http://www.forbes.com/sites/susantardanico/2012/11/29/5-habits-of-highly-effective-communicators/#428f682225fc (Accessed July 2016).

Forbes /Leadership, Mark Murphy. Which of these 4 communication styles are you?   http://www.forbes.com/sites/markmurphy/2015/08/06/which-of-these-4-communication-styles-are-you/#6dd000f11ecb (Accessed July 2016).

Entrepreneur. www.entrepreneur.com (Accessed July 2016).

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• Study Protocol
• Open access
• Published: 13 May 2024

Enhancing Pragmatic Language skills for Young children with Social communication difficulties (E-PLAYS-2) trial: study protocol for a cluster-randomised controlled trial evaluating a computerised intervention to promote communicative development and collaborative skills in young children

• Suzanne Murphy 1 ,
• Kerry Bell 2 ,
• Erica Jane Cook 1 ,
• Sarah Crafter 3 ,
• Rosemary Davidson 1 ,
• Caroline Fairhurst 2 ,
• Kate Hicks 2 ,
• Victoria Joffe 4 ,
• David Messer 3 ,
• Lyn Robinson-Smith 2 ,
• Luke Strachan 2 ,
• David Torgerson 2 &
• Charlie Welch 2  

BMC Psychology volume  12 , Article number:  266 ( 2024 ) Cite this article

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A number of children experience difficulties with social communication and this has long-term deleterious effects on their mental health, social development and education. The E-PLAYS-2 study will test an intervention (‘E-PLAYS’) aimed at supporting such children. E-PLAYS uses a dyadic computer game to develop collaborative and communication skills. Preliminary studies by the authors show that E-PLAYS can produce improvements in children with social communication difficulties on communication test scores and observed collaborative behaviours. The study described here is a definitive trial to test the effectiveness and cost-effectiveness of E-PLAYS delivered by teaching assistants in schools.

The aim of the E-PLAYS-2 trial is to establish the effectiveness and cost-effectiveness of care as usual plus the E-PLAYS programme, delivered in primary schools, compared to care as usual. Cluster-randomisation will take place at school level to avoid contamination. The E-PLAYS intervention will be delivered by schools’ teaching assistants. Teachers will select suitable children (ages 5–7 years old) from their schools using guidelines provided by the research team. Assessments will include blinded language measures and observations (conducted by the research team), non-blinded teacher-reported measures of peer relations and classroom behaviour and parent-reported use of resources and quality of life. A process evaluation will also include interviews with parents, children and teaching assistants, observations of intervention delivery and a survey of care as usual.

The primary analysis will compare pragmatic language scores for children who received the E-PLAYS intervention versus those who did not at 40 weeks post-randomisation. Secondary analyses will assess cost-effectiveness and a mixed methods process evaluation will provide richer data on the delivery of E-PLAYS.

The aim of this study is to undertake a final, definitive test of the effectiveness of E-PLAYS when delivered by teaching assistants within schools. The use of technology in game form is a novel approach in an area where there are currently few available interventions. Should E-PLAYS prove to be effective at the end of this trial, we believe it is likely to be welcomed by schools, parents and children.

Trial registration

ISRCTN 17561417, registration date 19th December 2022.

Protocol version: v1.1 19th June 2023.

Peer Review reports

Children who have difficulties with social communication (also known as pragmatic language ability) experience problems with using language for social purposes. Whilst their knowledge of grammar and vocabulary may be adequate or even advanced, they struggle with communicative tasks such as appropriate use of greetings, conversational turn-taking, understanding non-literal language such as jokes, irony or sarcasm, social conventions such as politeness, taking the perspective of their listener and responding with relevant information [ 1 ].

'Social communication difficulties' (SCDs) or 'pragmatic language impairments' represent a continuously distributed trait in the population. This trait includes individuals at the extreme end who are diagnosed with autistic spectrum disorder and/or severe language disorders but also a much larger group who show milder, but still detrimental, communication difficulties [ 2 ].

Children with SCDs are commonly rejected and victimised by peers [ 3 , 4 ] and can be severely disruptive [ 5 , 6 , 7 ]. In groups, they fail to contribute appropriately, and are often ignored or dominated by peers [ 8 , 9 ]. Children with pragmatic language problems experience lower quality of life; in adulthood these individuals experience more mental health problems, lower academic achievement and make fewer friends [ 10 ]. Health economic evaluations have also been called for as healthcare costs have been shown to be 36% higher for children with language disorders at 4–5 years old [ 11 ].

These communication difficulties frequently cause troubled interactions with family, peers, teachers and the criminal justice system [ 12 , 13 ]. For primary school children of low socio-economic status, pragmatic language skills appear to be especially important [ 14 ].

Children with language difficulties in the UK are served by NHS Speech and Language therapists and/or by schools’ own speech and language services and schools’ other provisions. However, services are stretched, particularly since the pandemic. Furthermore, schools and speech and language therapists have few rigorously tested interventions that they can use for SCDs. The most recently available surveys of usual care reported a ‘proliferation of locally-developed programmes based on clinical experience’ due to a lack of ‘strongly evidence-based programmes’ [ 15 , 16 ]. These findings were borne out by interviews with schools and speech and language therapists in our earlier work [ 17 ]. Activities typically include exercises on turn-taking, topic management, and conversational skills, sometimes with role-play or modelling. There is little evidence concerning the efficacy of these constituent activities [ 16 ]. Whilst the use of technology and gaming has been highlighted as a positive tool for facilitating communication and collaboration in children with social communication difficulties [ 18 , 19 ], its use is generally viewed as emerging rather than established [ 20 ].

E-PLAYS (Enhancing Pragmatic Language skills for Young children with Social communication difficulties) is a computer-based intervention that has been developed and piloted by our team.

Collaborative and team-building skills are recognised as vital to future adult employment and participation in society [ 21 ]. However, some of the most challenging contexts for children with social communication difficulties are precisely those requiring collaboration, such as joint problem-solving or creative free play [ 8 , 9 , 22 , 23 ]. E-PLAYS aims to facilitate and enhance children’s interactions by providing socio-cognitive scaffolding within a fun, cooperative computer game.

E-PLAYS supports communication based around naturalistic play with a peer and aims to embed learning in relevant contexts, thus promoting the generalisation of these social skills.

An earlier version of E-PLAYS (known as the Maze Game [ 9 , 23 ]) was tested on 32 children. Children receiving the intervention showed significant improvement by comparison to a control group on pragmatic language test scores. A recent feasibility study of E-PLAYS [ 17 ] with 50 children showed good response and completion rates, realistic recruitment and high acceptability by children and schools. These studies laid the groundwork for the present study which will conduct a randomised controlled trial of E-PLAYS seeking to establish its clinical- and cost-effectiveness.

Design and methods

The aim of the E-PLAYS-2 trial is to establish the effectiveness and cost-effectiveness of care as usual plus the E-PLAYS programme, which is designed to improve pragmatic language skills in children with social communication difficulties, delivered in primary schools, compared to care as usual.

Trial design

The E-PLAYS-2 trial is a multi-centre, two-arm, cluster-randomised controlled trial with an internal pilot.

The trial will take place in state-funded mainstream primary schools and state-funded special primary schools in Bedfordshire, Hertfordshire and North London. Following slightly lower than anticipated recruitment during the internal pilot phase, primary schools in Buckinghamshire will also be recruited for the main trial.

Participants

Both the school and the children’s parents/carers must agree to take part before either may be included. Eligibility to take part will be ascertained using the following criteria.

School eligibility

Inclusion criteria:.

A state-funded infant or primary school or special needs school based in the target recruitment areas;

Exclusion criteria:

Independent, fee-paying schools;

Schools participating in other language and communication research/trials aimed at pupils in Year 1 and Year 2 (aged 5–7 years);

Schools who have previously used E-PLAYS;

Child participants

Teachers will use the Social Communication Behaviour Checklist [ 24 ] which comprises a short 5-item questionnaire to confirm or reject their selection for ‘Focal’ children. Similarly, teachers will use the Social Communication Behaviour Checklist to confirm the selected ‘Partner’ children do not meet the criteria for social communication difficulties (see ‘ Intervention ’ section for definitions of Focal and Partner children). Child recruitment will take place prior to school randomisation.

Child eligibility (Focal children)

Focal child eligibility criteria are as follows:

Children aged 5–7 years old;

Children who meet the criteria for social communication difficulties as determined by the Social Communication Behaviour Checklist [ 24 ];

Children whose parents/carers give consent for them to take part in the E-PLAYS-2 trial;

Children who have not used E-PLAYS before;

Children whose parents/carers are willing to complete relevant questionnaires;

Children who complete the key trial baseline assessments (assuming all other eligibility criteria are met);

Baseline and outcome data will be sought for all Focal children (subject to potential withdrawals from some or all aspects of follow-up data collection by participating schools or parents).

Child eligibility (Partner children)

Partner child eligibility criteria are as follows:

Children who do not meet the criteria for social communication difficulties as determined by the Social Communication Behaviour Checklist [ 24 ];

Children whose parent/carers give consent for them to take part in the E-PLAYS-2 trial.

Not all Partner children will complete assessments. We will randomly select one Partner child from each school to complete the Test of Pragmatic Skills (TPS) at baseline and follow-up assessments (see details of the TPS below). This will allow for a comparison of the outcomes in this subsample of typically-developing children between intervention (where the child will partner a participating child in E-PLAYS-2) and control schools (care as usual). Parents/carers of the Partner children will be asked to consent to the Partner child completing the TPS (although only one randomly selected participant in each school will complete these assessments as stated above).

Intervention

The E-PLAYS programme is designed for children with SCDs aged 5–7 years old (referred to hereafter as ‘Focal’ children). Using a computer game, E-PLAYS guides the Focal child through real-life conversational exchanges with a specific focus on (a) requesting optimally useful information (b) giving helpful directions and (c) asking for clarification. Each Focal child is matched with a ‘Partner’; a typically-developing child from the same year group.

Each E-PLAYS session uses the computer game which is designed for two players using interlinked laptops. There are ten weekly sessions of 30 min each; schools’ teaching assistants are trained to deliver and supervise all sessions. Five sessions are with the Focal child and the teaching assistant only, five are with the Focal and Partner child together supervised by the teaching assistant. Sessions with the classmate (Partner child) give the child an opportunity to practice newly-acquired skills and also to learn collaboration skills through joint problem-solving with a peer. E-PLAYS is web-based, enabling us to distribute E-PLAYS directly to schools. Teaching assistants will self-train using a comprehensive manual with online support. The E-PLAYS software automatically records the number of sessions along with date accessed and sends this data directly to the research team.

Recruitment

School recruitment.

Recruitment strategies include directly emailing schools based in the target recruitment areas, use of social media channels and working with contacts in relevant local authorities by providing them with recruitment materials to distribute at a local level. During initial contact, schools will be provided with an information sheet about the trial. Where schools express an interest in participating, a member of the research team will arrange a convenient time discuss the trial with an appropriate staff member (e.g., a Head Teacher or a Special Educational Needs Co-ordinator (SENCO)) in greater detail. Schools wishing to proceed will be required to sign a memorandum of understanding (MoU) agreeing to the expectations of the trial, and a Data Sharing Agreement (DSA) between the school and the research team.

School retention and withdrawal

Schools will receive £350 as a thank you for taking part in the trial. This will be paid in instalments by the University of Bedfordshire after key milestones have been reached (such as completion of mid-trial surveys).

Where a school indicates that they wish to withdraw from the study this will result in the full withdrawal of all participants and staff at this school. No further data will be collected. The school will inform the parents/carers that they have withdrawn.

Child recruitment

Once teachers have identified the children eligible to take part in the trial, the teacher will distribute paper information sheets and consent forms to their parents/carers. Translated versions will be offered for parents with English as an additional language (EAL). The participant information sheets will be supplied to schools by the research team, along with a simplified illustrated information sheet for children to read together with their parents/carers. The information sheets and consent forms will be tailored to Focal and Partner children. Schools will be asked to send a reminder to parents/carers if no response is received approximately two weeks after receipt of the original invitation pack. Completed consent forms are to be returned to the school for collection by the research team.

Child consent procedure

All parents will be given the option to speak to a member of the research team or to contact the Chief Investigator in the event of additional questions. Consent to enter the study will be sought from each participant only after a full explanation has been given, an information leaflet offered and time allowed for consideration.

Participation in the study will be entirely voluntary and written informed consent from parents/carers will be obtained before child baseline data is collected and randomisation is conducted. On the consent form, parents/carers will be requested to consent for their child’s school to provide data including child’s name, date of birth, gender, home postcode, ethnicity, religion/belief, English as an additional language (EAL), education, health and care plan (EHCP) status, help received from a Speech & Language Therapist and/or an Educational Psychologist and receipt of Pupil premium and/or free school meals (FSM, a proxy for deprivation) for the purposes of sample description and potentially for use as covariates in analyses. The consent form for Focal children will also request parent/carers to provide their educational qualifications, employment status, ethnicity and consent/commitment to complete the EQ-5D-Y (proxy version 1), CHU-9D, and resource use data questionnaires at specified time-points. Parents/carers will return completed consent forms to the school.

Child and parent/carer retention and withdrawal

At the end of the trial and following completion of all questionnaires, parents/carers of Focal children will receive a £15 voucher to offset any incidental expenses and in recognition of their participation.

All participants are free to withdraw at any time from either the intervention or follow-up data collection without giving reasons and without prejudicing further care. The Chief Investigator will preserve the confidentiality of participants taking part in the study and is registered under the Data Protection Act. If a child does not appear to want to take part at the time the E-PLAYS intervention is being delivered and/or assessments are taking place, their wishes will be respected. Where a parent/carer wishes to withdraw from the study, it will be clarified as to whether they wish their child to withdraw from the intervention or if they themselves wish to withdraw (i.e., stop completing outcome measures). Where withdrawal is only for the participating parent/carer, the child may continue to take part in all other aspects of the trial and follow-up data will continue to be collected when possible. If a Partner child withdraws, another child from the school will be recruited as a replacement for the purposes of intervention delivery.

Teaching assistant recruitment

All teaching assistants will be asked to provide information at baseline on their work training and experience. School staff will also be asked to complete a survey exploring usual care for children with social communication difficulties. A subset of teaching assistants will be asked to participate in interviews, observations and focus groups; for these a separate information sheet and consent form will be provided by the research team.

Teaching assistant retention and withdrawal

Where withdrawal is only for the teaching assistant, we will ask schools to replace them for the intervention period. Where a teaching assistant cannot be replaced, the study team will discuss the implications of this with affected participant(s) to establish if they wish to continue providing outcome data.

Randomisation

The trial will be cluster-randomised to prevent within-school contamination. Schools will be allocated to intervention or control group using minimisation based on geographical location and proportion of children with free school meals (a proxy for deprivation) by a trial statistician at York Trials Unit using dedicated software (MinimPY [ 25 ]). Randomisation will occur following baseline data collection. Schools will be informed of their allocation via email. Schools will be advised to tell the parents/carers of participating children the schools random allocation.

Children in schools allocated to the intervention group will receive E-PLAYS plus whatever constitutes care as usual in their school. Participating children in schools allocated to the control group will receive whatever constitutes care as usual in their school. ‘Care as usual’ is defined as the existing support routinely provided for a child with social communication difficulties from educational and health services.

Outcome measures

Outcome data will be provided by three different kinds of observers: blinded research assistants, parents/carers and teachers.

Blinding of outcome data collection

Research assistants will be blind to group allocations when collecting the quantitative outcome measures listed below. They will have received relevant training from the research team. All research assistants will have an enhanced Disclosure and Barring Service (DBS) check and undergo relevant safeguarding and data protection training. When a research assistant visits a school to administer the assessments, teachers and teaching assistants at the school will be reminded on every visit not to reveal allocation to the research assistants. Any instances of unblinding during the assessments will be recorded (using a bespoke unblinding form which will include information on who was unblinded, the source of unblinding, and the reason for unblinding) and the unblinded research assistant will be replaced with another research assistant who is blind. Research assistants will also collect qualitative data from schools; for this data, they will not be blinded. Hence, each school will be allocated both a blinded and unblinded research assistant.

Teachers and parents/carers will be requested to complete outcome measures for Focal children. Whilst blinded during the completion of these outcome measures at baseline, due to the nature of the intervention, it is not possible for them to be blinded at 15–20- or 35–40-weeks post-tests.

Primary outcome

The primary outcome is the Focal children’s pragmatic language ability measured using the validated Test of Pragmatic Skills (TPS [ 26 ]). This assessment will be administered by a blinded research assistant at baseline, and at 15–20- and 35–40-weeks post-randomisation. The measurement at 35–40 weeks will serve as the primary endpoint for the trial, with the 15–20-week measurement being a secondary outcome.

Secondary outcomes

The following secondary outcome measures will also be administered to Focal children by a blinded research assistant at baseline, 15–20 weeks, and 35–40 weeks post-randomisation.

Clinical Evaluation of Language Fundamentals-5 (CELF-5 [ 27 ])—Recalling Sentences and Following Directions subscales.

Expression, Reception and Recall of Narrative Instrument (ERRNI [ 24 ]) assesses the ability to relate, comprehend and remember information after a short delay.

Droodles Tasks and Communication Test [ 28 , 29 ].

The Droodles Task and Communication Test are a series of tasks and puzzles testing children’s ability to evaluate the effects of ambiguous versus informative communications, a key skill targeted by E-PLAYS. The tests are embedded in play sessions with dolls and puppets and have previously been used for this age group.

The battery of assessments above will take approximately 50 min to administer per child at each data collection time-point. The children’s tests are mostly tasks presented as fun games to play and therefore not onerous for the children. These tests can be divided into two or more sessions as the children are very young and may tire.

The following secondary outcome measures (relating to health-related quality of life) will be completed by Focal children’s parents/carers at baseline, 15–20 weeks and 35–40 weeks post-randomisation:

Child Health Utility (CHU-9D), paediatric generic preference-based measure of quality of life. The CHU-9D includes specific dimensions on school and joining in with activities [ 30 , 31 ].

EQ-5D-Y (proxy version 1). This is a widely used standardised generic measure of health-related quality of life for younger children [ 32 ].

Resource use data: A bespoke questionnaire (developed for the E-PLAYS feasibility study [ 17 ]) will collect resource use data about healthcare, voluntary organisations and educational resources.

We anticipate that it will take parents/carers approximately 30 min to complete the questionnaires at each data collection time-point.

The following secondary outcome measures will be completed by the Focal children’s teacher at baseline, 15–20 weeks and 35–40 weeks post-randomisation; these measures are completed by the teachers without the child present:

Children’s Communication Checklist-2 (CCC-2[ 33 ]). CCC-2 is a standardised questionnaire of children’s communication impairment.

The Strengths and Difficulties Questionnaire (SDQ [ 34 ]). The SDQ is widely used as a mental health indicator with subscales assessing behavioural, emotional and peer problems.

We anticipate the questionnaires listed above will take teachers no longer than ten minutes per child to complete at each data collection time-point.

The following secondary outcome measures will be administered to a randomly selected subgroup of 88 Partner children (1 per school) in school by a research assistant at baseline, 15–20 weeks and 35- 40 weeks post-randomisation:

Partner children’s pragmatic language ability measured using the validated TPS [ 26 ].

Sample size calculations

We will recruit single- and multi-form entry schools. Pupils will be recruited from Years 1 and 2; assuming an average of two classes per year, based on our feasibility study [ 17 ] we expect to identify a mean of ten eligible Focal children per school, of which six will consent and be recruited. The intervention will be delivered to the participating children by teaching assistants and we expect an average of 1.5 teaching assistants per class.

In multi-form entry schools, we will have clustering of classes within year groups, but in one-form entry schools the levels of class and year will be equivalent. We consider that in multi-form entry schools the difference in clustering between class and year will be negligible so we shall ignore the level of class. Therefore, this cluster randomised trial assumes a three-level structure in that pupils (level 1) are nested within year group (level 2) nested within schools (level 3). Randomisation will take place at school-level. The year groups participating in this trial are consecutive (Years 1 and 2) so the difference between them will be minimal and the cluster effect of school will likely dominate the effect of class; therefore, we have not explicitly accounted for clustering at the class level in this sample size calculation. The largest influence within schools is likely to be between teaching assistants since these will be the ones delivering the intervention to the children; however, in most schools we expect that the ratio of teaching assistants to participating children will be approximately 1:1 so this level of clustering is eliminated. In the feasibility trial [ 17 ], the school-level ICC was small (< 0.01); here we have assumed a conservative ICC of 0.05 at the school-level to account for all levels of potential clustering.

In our feasibility trial the standard deviation (SD) of the primary outcome measure, the TPS [ 26 ], at baseline was 7.2 (95% CI 5.4 to 9.7) and the observed correlations between the TPS score at baseline and the scores at weeks 15–20 and 35–40, respectively, were 0.84 (95% CI 0.71 to 0.91) and 0.79 (95% CI 0.63 to 0.89). In the calculation for this trial we assume: a SD of 7, an ICC of 0.05 at the school-level, a mean cluster size of six (Focal children per school, at randomisation), 20% pupil level attrition at follow-up and a more conservative pre-post correlation of 0.6. To detect a difference in TPS score of 2 points (a third of a year’s progress based on the standardisation sample given in the TPS manual), with 90% power and a two-sided alpha of 5%, we would require 84 schools (504 focal children).

We will undertake an exploratory analysis to assess the potential impact of the intervention on Partner children’s (i.e., those who do not have social communication difficulties) pragmatic language skills. We will randomly select one Partner child from each school to complete the TPS [ 26 ] at baseline, at 15–20 weeks post-randomisation and at 35–40 weeks post-randomisation with a blinded, independent research assistant. This will allow for a comparison of the outcomes in these typically-developing children between intervention (where the child will partner a participating Focal child in E-PLAYS) and control schools (care as usual).

Since this is an exploratory analysis, we have planned the sample size of one typically-developing child from each school for logistical reasons. Collecting the TPS [ 26 ] from only one extra child per school will not substantially increase the time or burden to complete outcome measures. Assuming a SD of 7, a pre- post-test correlation of 0.6 and 20% attrition, a sample size of 84 children (one per school) will give 80% power to detect a difference of 3.9 points in the TPS [ 26 ]. We shall compare TPS [ 26 ] scores of the typically developing children.

For the 20 school clusters recruited as part of the internal pilot phase, the observed mean cluster size (at randomisation) was 4.55 participants per cluster, around 25% less than the anticipated six participants per cluster detailed in the previous section.

Following discussion with the funder, the total target number of school clusters was changed to 88. Assuming a mean cluster size (at randomisation) of 4.55 and keeping all assumptions the same as previously (e.g. \(\delta\) = 2, SD = 7, pre-post correlation = 0.6, school level intra-cluster correlation of 0.05 and 20% participant level attrition), 44 clusters per group would provide approximately 85.2% power for a two sided test of \({H}_{0}:\delta =0\) (where \(\delta\) is the difference in expected TPS score at 35–40 weeks).

As per the original proposal we will randomly select one Partner child per school to complete the primary outcome (TPS [ 26 ],) at baseline and 15–20- and 35–40-weeks post-randomisation. Under the same assumptions as before, a sample size of 88 children (one per school) will give 80% power to detect a difference of 3.4 points in the TPS [ 26 ].

Statistical analysis plan

Statistical analysis will primarily be conducted in Stata/MP v18 [ 35 ] or later, unless specified otherwise. All analyses will be conducted just once at the end of the trial follow-up period, according to precise specifications detailed in a Statistical Analysis Plan (SAP) that will be approved by the TMG and TSC prior to the end of follow-up. Any departures from the analysis plan will be reported and justified in the final trial reports and other relevant published articles.

The flow of clusters and participants through the study will be presented according to CONSORT guidance for cluster RCTs. Continuous characteristics will be summarised in terms of the available sample size, arithmetic mean, standard deviation, median, interquartile range, minimum and maximum. Categorical characteristics will be summarised in terms of frequencies and percentages.

For all between group comparisons, clusters and participants (both Focal and Partner) will be analysed as part of the groups to which they were randomised, regardless of subsequent engagement with the allocated treatment. All analyses estimating between group contrasts will include all participants with data available for the relevant outcome (unless explicitly stated otherwise in the SAP). Point estimates of contrasts between randomised groups will be reported together with appropriate 95% confidence intervals. Point and interval estimates will be reported on the scale of the original measurements (as well as the scale used for the analysis should these differ). P-values for statistical tests will be two-sided unless specified otherwise in the SAP.

Baseline data participants

Baseline data for the participating focal children will be summarised descriptively by randomised group and overall, according to the principles outlined above. Two sets of tables will be reported: one set including all randomised Focal children and another including just the subset of Focal children included in the primary analysis model. Baseline data for the participating Partner children will be summarised similarly in a separate set of tables. No formal comparison of baseline data between randomised groups will be undertaken (for either Focal or Partner children).

Primary outcome analysis (focal children)

The planned primary analysis model will include all available post-randomisation TPS [ 26 ] scores as outcomes, modelling these measurements using a linear mixed effect model. This model will include fixed effects for treatment group, time point, and their interaction, and will also condition on fixed effects for baseline TPS mean composite score, year group, child FSM status, geographical location of school, and school level random intercepts. Correlation between repeated measurements within participants will be modelled using an unstructured covariance matrix for the model residuals. Precise details of the terms included in the model will be provided in the SAP (including plans for dealing with any incomplete baseline covariate data). If the fit of the planned primary analysis model is reasonable (see below), then the fitted model will be used to estimate differences (Intervention – Control) in expected TPS scores at both post-randomisation time points, together with 95% confidence intervals and p-values for tests of H 0 : \(\delta\) = 0 (where \(\delta\) is the difference in expected score at the relevant time point).

The appropriateness of key model assumptions will be checked using diagnostic plots based on the standardised residuals from the fitted model. If these plots (or indeed other extra-data considerations) suggest the observed data show important departures from the assumptions of the planned analysis, then we will undertake semi-parametric analyses of the scores at each post-randomisation time point in isolation. This will be accomplished using cumulative probability models based on ordinal regression [ 36 ]. The ordinal regression models will include fixed effects for treatment group, baseline TPS [ 26 ] mean composite score, year group and child FSM status, and a random intercept for school.

Sensitivity analyses (Focal children)

Several additional planned analyses of the primary outcome will be undertaken to investigate the sensitivity of the results of the primary analysis to departures from the key statistical assumptions that underpin this analysis. In particular, we will investigate the impact that various alternative adjustment sets have on the results of the primary analysis, investigate the potential impacts of departures from the planned schedule of assessments, and undertake analyses of the primary outcome under different assumptions about any missing primary outcome data.

Principal stratum analyses (Focal children)

Participants allocated to the control group will not have access to the E-PLAYS intervention. Participants allocated to the intervention group will be offered the E-PLAYS intervention, but may not receive any sessions at all, or may receive only a proportion of the planned ten sessions (or potentially none of them).

We will estimate two different CACE estimands under different definitions of compliance: (1) The difference in expected TPS mean composite score at 35–40 weeks among participants that would complete at least one session of the E-PLAYS programme if they were randomised to E-PLAYS; (2) The difference in expected TPS mean composite score at 35–40 weeks among participants that would complete at least seven E-PLAYS sessions (70% of the programme) if they were randomised to E-PLAYS.

We will use instrumental variable estimators to estimate both of these principal stratum estimands. Specifically, we will use random allocation as an instrument for the relevant definitions of treatment receipt in each case, with estimation performed using a generalised two-stage least squares random effects estimator. These analyses will include the same baseline covariates as included in the primary analysis and random intercepts for school cluster. Point estimates of the two principal stratum estimands outlined above will be reported together with two-sided 95% confidence intervals and p-values for tests of H 0 : \(\delta\) = 0.

Secondary outcome analyses (Focal children)

Continuous secondary outcomes will be analysed similarly to the primary outcome, with the baseline TPS score replaced with the baseline score for the relevant outcome. Ordered categorical secondary outcomes will be analysed using appropriate ordinal regression models with similar fixed and random effects as included in the primary analysis.

Fidelity analysis

E-PLAYS software will record the content, duration and number of intervention sessions each child receives using a unique login ID. This monitoring data will be summarised as part of the process evaluation and used to estimate Complier Average Causal Effect (CACE) estimands (see above).

Primary outcome analysis (Partner children)

The TPS scores for Partner children will be analysed following a similar approach to the primary analysis but will not include random intercepts for school cluster (since there will be no replication at the participant at within cluster level) (Fig. 1 ).

Flow diagram of the E-PLAYS-2 recruitment, randomisation and data collection

Process evaluation

A mixed-methods process evaluation, following MRC recommendations for RCTs [ 37 ], will assess E-PLAYS' acceptability and fidelity of implementation, mechanism of impact, and examine contextual influences on implementation and outcomes. This evaluation will use quantitative and qualitative data across the school sample alongside observation, interview and focus group data from four purposively selected case study schools. Research assistants will conduct the interviews, observations and focus groups described below.

Case study schools

Eight intervention schools (four from the internal trial and a further four from the main trial) will be purposively sampled to act as case studies [ 38 ]. Schools will be profiled to include at least the following: one special needs and one mainstream school plus one school with high levels of deprivation and another with a high proportion of children with English as an additional language. These schools will be approached to be case studies before the E-PLAYS intervention is given to them and will continue to be observed throughout intervention delivery. The following assessments will take place with a subgroup of case study participants:

Structured observations of the children (Focal and Partner) and teaching assistants as they use E-PLAYS, based on an observation schedule developed for the E-PLAYS feasibility study ([ 17 ] mid-intervention);

Focus groups conducted with teaching assistants exploring their experiences of delivering E-PLAYS (end intervention);

Interviews with the children (Focal and Partner) with a card sorting task and visual analogue scale to give an indication of their liking of E-PLAYS (mid-intervention);

Structured interviews with parents exploring the extent to which children play computer games at home before and after the intervention and any changes to game-playing (baseline and 40-week follow-up);

In addition, a training questionnaire will be sent to all teaching assistants delivering E-PLAYS to obtain feedback on the training manual and online support. This survey will also include questions on the teaching assistants training and experience. A further survey will be sent to all participating schools based on our findings from the E-PLAYS feasibility study [ 17 ], asking about the content of usual care for children with SCD. We will also include 6–8 structured interviews with a subset of teaching assistants to further explore usual care provided. Surveys will be delivered via Qualtrics online survey software, with a paper version available on request. Written consent will be obtained from teaching assistants to participate in focus groups and interviews.

Process evaluation analyses

Qualitative data will be (with written consent) audio-recorded, transcribed verbatim and managed using NVivo11 software. A six-step reflexive thematic analysis approach [ 39 ] will be used to report the experiences, meanings, and reality of participants. Two experienced qualitative researchers will independently code a subsample of transcripts where initial codes will be compared, discussed, and agreed on prior to coding on all other interviews. Codes will be generated both from the topics explored in the interview guides and iteratively from the data to attain both the facilitators and challenges of the intervention. Interim themes will then be discussed, refined, and agreed by two researchers and the research team. Detailed analysis of each theme will be presented with illustrative anonymised quotes used to illustrate themes arising from the data. Individual interview and focus group data will be analysed both separately, followed by a cross-synthesis, to identify and map overarching themes related to experiences of the intervention. Comparative analysis across the case study schools will also be conducted to explore the impact of the intervention and examine experiences across different school contexts.

Economic evaluation

The costing approach will be undertaken primarily from the perspective of the National Health Service (NHS) but will also consider the perspective of both Social and Education Services. The economic evaluation will assess the cost-effectiveness of E-PLAYS compared with usual care. Individual participant data from the trial will be used to evaluate resource use, costs, health and social outcomes associated with the intervention and will be collected over the follow-up period of the trial.

The primary economic outcome will be the difference in costs and the difference in quality-adjusted life years gained by receiving E-PLAYS using an intention-to-treat approach. Costs and outcome data for the economic analysis will be collected prospectively during the trial using proxy-reported questionnaires at baseline and at each follow-up.

The primary analysis will be conducted using the CHU-9D [ 30 , 31 ] which is a paediatric generic preference-based measure of quality of life that includes specific dimensions on school and joining in with activities and allows for the calculation of QALYs [ 31 ]. To ensure comparability with similar interventions, a secondary analysis will be conducted using the EQ-5D-Y [ 32 ]. Both instruments will be collected from proxies at baseline and at each follow-up. Mean within-trial costs and benefits will be calculated using regression methods adjusting for baseline covariates as well as any correlation between costs and utility. Multiple imputation methods will be used to deal with missing data if appropriate. Uncertainty will be described using confidence intervals and cost effectiveness acceptability curves (CEACs). A range of sensitivity analyses will be conducted to test the robustness of the results under different scenarios.

The bespoke resource use questionnaire developed for the feasibility trial of EPLAYs will be used. Healthcare resource use will be presented for both arms in terms of mean value, standard deviation and mean difference (with 95% confidence interval) between the groups. The cost of the intervention will be estimated according to treatment and resource use costs. Treatment costs will include staff, equipment and software costs. Unit costs will be derived from established national costing sources such as NHS Reference Costs and PSSRU Unit costs of health and social care. Unit costs will be multiplied by resource use to obtain a total cost for each patient (pupil).

The cost of delivering E-PLAYs was estimated in the feasibility trial. To confirm this, a costing exercise will be undertaken taking a bottom-up approach to identify and place a value on the constituent parts of the intervention delivery, e.g., staff and training costs, to estimate total cost both in monetary terms and time required including that of existing school staff.

The results of the trial will provide an estimate of the relative effect of E-PLAYs compared with usual care for the time horizon of the trial. However, there is potential for the impact of the intervention to extend far beyond what is measurable during the trial period, for instance, long-term educational outcomes and future criminal activity/anti-social behaviour. We will consider existing models that link the shorter-term outcomes of the trial, for example behavioural problems as measured by the SDQ, to longer term outcomes. One potential such model is the Dartington model [ 40 ] which could be used as the basis for linking short term outcomes to longer term educational attainment, future criminal activity and labour market productivity, though there are possibly other models available. We will use any identified models to examine the likely additional costs and benefits of the intervention over the longer term. As with the within trial analysis, health and educational effects will be presented separately and the potential values of the outcomes will be explored for both sectors. A discount rate of 3.5% will be applied for costs and outcomes.

Data management

Data collection, management and verification.

The five primary sources of quantitative data for this trial are:

Data collected by research assistants during school visits at baseline, 15–20 weeks and 35–40 weeks. The TPS and ERRNI will be audio recorded, with these recording being subsequently scored, and the relevant data entered into the REDCap database. All of the other Research Assistant completed measures (CELF-5, Droodles and Communication Test) will be entered into the REDCap database after testing.

Data collected from the teachers of participating focal children at baseline, 15–20 weeks and 35–40 weeks (CCC-2 and SDQ). These data will be collected via online Qualtrics surveys sent directly to teachers of participating focal children.

Data collected from the parents of participating focal children at baseline, 15–20 weeks and 35–40 weeks. Parent/household demographic data (e.g. parent/carer employment, parent/carer ethnicity etc.) are collected as part of the paper consent forms completed by parents of participating focal children. These forms are returned to the research team who enter these into the REDCap database. Parent completed data for the economic evaluation (i.e. EQ-5D-Y, CHU-9D and resource use) will be collected electronically (via direct entry into the trial REDCap database), or via paper questionnaires (which are subsequently returned to the trial team and entered into the trial database)

Data collected directly from the schools of participating children at baseline (provided for both focal and partner children). These data (e.g. age, gender, ethnicity etc.) are entered into password protected spreadsheets by school staff (one for each school). These are then securely shared with the research team.

Data collected by research assistants during intervention fidelity assessments.

Monitoring data: E-PLAYS-2 software will record the content, duration and number of intervention sessions each child receives using a unique login ID. Access to the E-PLAYS information is password protected and will be accessed on University computers with Bitlocker Windows security. Data within the E-PLAYS software is anonymised.

Most of the quantitative trial data will be stored and managed using REDCap (Research Electronic Data Capture). REDCap is a secure, web-based software platform designed to support data capture for research studies, providing 1) an intuitive interface for validated data capture; 2) audit trails for tracking data manipulation and export procedures; 3) automated export procedures for seamless data downloads to common statistical packages; and 4) procedures for data integration and interoperability with external sources [ 41 , 42 ]. Data provided by teachers (CCC-2 and SDQ responses at baseline, 15–20 weeks, and 35–40 weeks) will be collected using a bespoke Qualtrics questionnaire [ 43 ] created by the research team at YTU. Data provided by schools via password protected Excel spreadsheets will serve as the raw data for these variables.

Validation of the quantitative data will be implemented as part of the REDCap and Qualtrics systems, so that data will be checked at the point of data entry. The validation rules implemented as part of the REDCap system were reviewed and agreed by the trial statistician and health economist prior to the start of data entry. The trial statistician and health economist have permissions to download the data stored in REDCap, saving these exports to secure password protected servers managed by YTU. Electronic datasets from the Qualtrics survey will be accessed directly from the Qualtrics software by the trial statistician, with these again being saved locally to YTU managed servers. Electronic datasets (.xlsx format) completed by schools will be stored in a central location accessible by the research team at YTU (including the trial statistician and health economist).

All quantitative data (REDCap, Qualtrics and school completed data stored on YTU servers) will be imported into statistical software (precise details reported in any outputs/reports). Further checks to investigate the consistency and completeness of the data will be undertaken. Any anomalies identified during these processes will be documented and resolved in accordance with the procedures outlined in YTU SOP S02: Statistical Quality Control. Any changes to the analysis data will be detailed in an assumptions log as described in YTU SOP S02: Statistical Quality Control.

There will also be qualitative data from interviews, surveys and structured observations in the form of audio recordings. Recordings will be securely transferred to the transcription company via a secure file transfer service. Audio recordings will be deleted once anonymised transcriptions have been received by the research team.

Access to Data

The final anonymised trial dataset will be available to all trial team members/investigators if a formal request describing their plans is approved by the Trial Management Group. To ensure confidentiality, data dispersed to trial team members will be blinded of any identifying participant information. Appropriate anonymised datasets will be made available in a public repository, such as the UK Data Archive. Any participants that do not have explicit consent in place for publicly sharing anonymised data will have their data removed from any publicly available datasets.

Data protection

The University of York will be the Data Controller who also processes data. Data subjects are the participants in the evaluation, which includes children in participating schools, their parents/carers and staff members in participating schools. Personal data will be processed under Article 6 (1) (e) ( Processing necessary for the performance of a task carried out in the public interest ) and Special Category data under Article 9 (2) (j) ( Processing necessary for … scientific … research purposes) of the General Data Protection Regulation (GDPR; 2018). Any sharing of data between research team institutions will be made explicit in all participant information sheets and will be based on the procedures given in relevant Data Sharing Agreements. The study consent form will include optional statements affirming agreement with sharing anonymised data.

Potential participants of the trial will be informed about the research via an information sheet sent on behalf of the research team by Schools to parents/carers/children/staff. Parents/carers willing for their child to participate will provide written informed consent. Paper consent forms will be securely transported and stored in a locked filing cabinet at the University of Bedfordshire. A unique trial identification number (Trial/Child ID) will be generated for each participant. Data sharing agreements will be put in place with participating Schools before data transfer.

Recordings comprising audio-recordings from focus groups and interviews will be removed/deleted from audio-recorders by research assistants and stored on an encrypted flash drive (memory stick) before being transferred to university laptops compliant with university security regulations. Recordings will be securely transferred to the transcription company via a secure file transfer service. Audio recordings will be deleted once anonymised transcriptions have been received.

The dataset for statistical analysis will hold pseudonymised data. No Schools, staff members, or children will be identifiable in the report or dissemination of any results. Electronic data and paper documents including identifiable personal child data will be securely archived and disposed of by the research team five years after the end of the study (2029). Identifiable personal data about adult data subjects (e.g., parents/carers, school staff) will be kept for five years after the end of the study (2029). Pseudonymised electronic data and paper documents will be kept indefinitely.

Ethics and regulatory considerations

Ethical approval for the trial has been received from University of Bedfordshire, institute for Health Research Ethics Committee.

The proposed study will be conducted in accordance with ICH Good Clinical Practice guidelines.

A Memorandum of Understanding signed by schools will cover the requirements of the trial.

Data Sharing Agreements (DSAs) will be signed by the University of Bedfordshire and each participating school.

Ethical amendments and reporting.

Substantial amendments will require approval by both NIHR in the first instance, and where necessary the Institute for Health Research ethics committee. All correspondence with the ethics committee and NIHR will be retained in the Trial Master File (TMF). Any changes relevant to schools will be communicated in writing at the earliest opportunity following approval.

Trial monitoring

Protocol amendments.

Protocol amendments will be approved by the Chief Investigator, sponsor, Trial Steering Committee and funder and then submitted to the ethics committee (if necessary).

Protocol compliance and breaches

Accidental protocol deviations will be documented on the relevant forms and reported to the CI.

Trial management group

The Trial Management Group (TMG) will be the decision-making body who will be responsible for the day-to-day running and management of the trial. The TMG will comprise the Chief Investigator, the co-applicants, the trial manager and other key members of the research team. The Trial Management Group will meet at least monthly.

Trial steering committee

A Trial Steering Committee (TSC) will be established to govern the conduct of this study. This committee will function in accordance with YTU SOPs. The TSC will be led by an independent chair, a senior academic with relevant expertise and will comprise 75% independent members (as per NIHR’s definition https://www.nihr.ac.uk/documents/research-governance-guidelines/12154 ). The TSC will meet approximately every 6 months from the start of the trial.

Advisory group (Public and Patient Involvement)

An advisory group will input into the trial and advise on matters such as recruiting a diverse sample, producing an accessible Participant Information Sheet and other relevant participant-facing study documents, support for teaching assistants and dissemination of our findings to participants and the public. The advisory group will comprise a mix of parents of children with SCD, teachers, speech and language therapists and relevant charity representatives. All members of the advisory group will be supported by a dedicated research team member. They will plan activities such as the preparation of information sheets and newsletters and other promotion of E-PLAYS. The dedicated research team member will provide feedback on these activities and their impact and will plan to distribute and promote E-PLAYS nationally if it is found to be effective at the end of the study.

Adverse events and safeguarding

Serious adverse events (saes) and adverse events (aes).

Due to the nature of participant involvement no serious adverse events or adverse events that are unexpected and related are anticipated. However, the study team will monitor adverse events throughout the study.

Expected Events

This is a low-risk study and the trial team has not identified any adverse events that could be related to the intervention, therefore this will be determined on a case by case basis by the Chief Investigator. It is expected that there may be unrelated incidents of hospitalisations, illnesses, disabling/incapacitating/life-threatening conditions, other common illnesses and rarely deaths in the study population.

Related Events

An event is defined as ‘related’ if the event was due to the administration of any research procedure. The relatedness of an event will be reviewed by the Chief Investigator and the Trial Steering Committee. An ‘unexpected event’ is defined as a type of event not listed in the protocol as an expected occurrence.

Reporting of adverse events

Details of any SAEs or AEs reported to the study team by the participants will be considered by the Chief Investigator and the trial team. All AEs/SAEs will be recorded and reported to the Sponsor immediately upon knowledge of the event or as soon as is practicably possible to do so, and the Trial Steering Group and Trial Management Group at the next scheduled meetings. Any SAE which is unexpected and related will be reported immediately upon knowledge of the event or as soon as is practicably possible to do so to the Sponsor and Trial Steering Committee and will be reported to the Research Ethics Committee within fifteen days of the unexpected and related SAE being reported.

Child safeguarding issue

In the very rare circumstance where a child safeguarding issue is suspected, for example during data collection, a set procedure will be followed, including contacting Chief Investigator Dr Suzanne Murphy. The child’s school and parents/carers will then be informed accordingly. Both the school’s and the University of Bedfordshire’s usual safeguarding policy will then be followed. A SOP will be written to detail these arrangements.

Dissemination policy

On completion of the trial, the data will be analysed and a Final Trial Report will be prepared for NIHR and submitted after ratification by the TSC. We will publish the trial results in peer-reviewed journals irrespective of the findings. NIHR will be acknowledged as the funders in all publications. Participants will be provided with a report of the findings written in a style accessible for lay people, which will be accessible via schools. We will also provide on-going reports through our website as the trial progresses.

In order to disseminate E-PLAYS to professionals, we will offer workshops with the Royal College of Speech and Language Therapists and the children’s communication charity Speech and Language UK: Changing Young Lives. We will also publicise through National Association of Professionals concerned with Language Impaired Children (NAPLIC), Autistica, the National Autistic Society and the Communication Trust Consortium. We will also apply to have E-PLAYS registered on websites listing and reviewing evidence-based language interventions e.g., Education Endowment Foundation, the Learning Foundation. Special Educational Needs and Disabilities (SEND) teams in local authorities and CCGs are likely to be responsive to efforts to distribute a cost-free product. Should E-PLAYS prove to be effective at the end of this trial, distribution and implementation could start at once as it is a web-based intervention.

The E-PLAYS-2 trial aims to definitively test the effectiveness and cost-effectiveness of the E-PLAYS programme for children with social communication difficulties (SCDs). Should E-PLAYS prove to be effective, it will be offered as one of few evidence-based interventions available to schools and speech and language therapists.

Educationalists have long advocated computerised approaches as having considerable advantages for children with SCD. In spite of this, technological approaches have rarely been used and are widely seen as a missed opportunity [ 19 , 44 ]. There is a lack of interventions for children with social communication difficulties, and language therapies as a whole have attracted little research funding (Bishop, 2010). However, with the recent COVID pandemic, the importance of IT devices and internet connectivity to schools has taken centre-stage. There have been calls to provide schools with more and better IT equipment to which the Government has responded with a £1bn package [72]. This recent recognition of the importance of technology for schools together with increased training and interest of school staff means that we believe they are likely to be receptive to computerised interventions.

Sample selection

Wieckowski and White [ 20 ] in their extensive review of technological interventions for children with social communication impairments, commented that the focus in this field has been overwhelmingly on children with autism spectrum disorder (ASD); very few studies have evaluated technology use for the broader group of children with social communication difficulties. Furthermore, reviews have reported that participants who are male, white, and from professional-class backgrounds tend to be over-represented in ASD studies [ 45 ] and that it is likely that those who are most socially disadvantaged access speech and language therapy (SLT) services the least [ 46 ].

The E-PLAYS trial will aim to recruit as wide a variety of children with social communication difficulties as possible and will not limit the sample to those with an ASD diagnosis and/or in receipt of SLT service support. Teachers select the children in their class that they believe would benefit from E-PLAYS using a short questionnaire; this selection process aims to replicate conditions in the real-world in which schools are unlikely to have the resources to undertake a detailed assessment.

Study strengths and limitations

As far as we are aware, this is one of few major trials investigating an intervention targeting social communication difficulties in young children. A major strength of the study is that we will use a blinded outcome measure to assess children’s language pre- and post-test. Pragmatic language skills are difficult to assess as they manifest only during dynamic social interaction, therefore, testing with standardised questionnaires may not be appropriate [ 47 ]. In spite of this, much social communication literature is based on non-blinded parent-, teacher- or clinician-report [ 48 ]. To address this limitation, we are using measures administered by independent, blinded outcome assessors; the TPS and CELF-5 subscales administered by blinded research assistants. We will also collect parent and teacher reports for comparison with other studies.

Another strength of the study is that we will be able to obtain a precise measure of the number and timing of E-PLAYS sessions delivered for fidelity purposes as this will be automatically recorded by the software. This is preferable to alternative methods such as asking teaching assistants to record sessions or keep a diary. This reporting will be supplemented with live observations to paint a detailed picture of intervention delivery.

A limitation of the study is that it is impossible to blind participants, parents and teachers due to the nature of the intervention. However, the primary outcome measure, the TPS, is administered by blinded research assistants and the trial statisticians remain blinded to mitigate any impacts.

Against a backdrop in 2020 and 2021 where children’s socialisation with peers, communication skills and peer relations have suffered and the most deprived individuals have been hit the hardest, E-PLAYS is particularly timely. Its aim is to develop children’s social and collaborative skills by making novel use of technology; we believe it is likely to be welcomed by schools, parents and children.

Availability of data and materials

No datasets were generated or analysed during the current study.

Abbreviations

Adverse event

Complier Average Causal Effect

Cost-Effectiveness Acceptability Curve

Children’s Communication Checklist

Clinical Evaluation of Language Fundamentals-5

Child Health Utility questionnaire

Chief Investigator

Consolidated Standards of Reporting Trials

Case Report Form

Data Sharing Agreement

English as an Additional Language

Education, Health and Care Plan (outlining special educational needs)

Expression, Reception and Recall of Narrative Instrument

Enhancing Pragmatic Language skills for Young children with Social communication difficulties (2)

European Quality of Life-5 Dimension

Free School Meals

Good Clinical Practice

General Data Protection Regulation

International Standard Randomised Controlled Trials Number

Intra-Cluster Correlation

Intention To Treat

Multi-academy trust

Medical Research Council

Memorandum of Understanding

National Health Service

National Institute for Health Research

Participant Information Sheet

Personal Social Services Research Unit

Quality-Adjusted Life Years

Research Assistant

Randomised Control Trial

Serious Adverse event

Social communication difficulties

Standard Deviation

Special Educational Needs and Disability

Special Educational Needs Co-ordinator

Strengths and Difficulties Questionnaire

Standard Operating Procedure

Teaching Assistant

Trial Master File

Trial Management Group

Test of Pragmatic Skills

Trial Steering Committee

United Kingdom

York Trials Unit

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Acknowledgements

Our grateful thanks to Robin Allen of Robin Allen (consulting) Ltd, games developer for the E-PLAYS computer game and to Professor Chloe Marshall of University College, London, chair of the Trial Steering Committee.

Trial Sponsor

The sponsor is the University of Bedfordshire, the sponsor’s representative is Professor Gurch Randhawa.

This project is funded by the National institute for Health Research (NIHR) Public Health Research programme (award number NIHR131745). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders do not play a role in study design, data collection, analysis, or reporting.

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York Trials Unit, University of York, Heslington, York, YO10 5DD, UK

Kerry Bell, Caroline Fairhurst, Kate Hicks, Lyn Robinson-Smith, Luke Strachan, David Torgerson & Charlie Welch

Open University, Walton Hall, Kents Hill, Milton Keynes, Milton, MK7 6AA, UK

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SM is the Chief Investigator and developed the E-PLAYS intervention and drafted the initial protocol for the E-PLAYS-2 study. LRS, KB and KH made substantial amendments to the protocol in particular data management, trial monitoring and trial delivery. CF, CW and LS were responsible for the design of the statistical analysis sections of the protocol, KB was responsible for design of the health economic component of the trial. DM and VJ contributed to outcome measures and recruitment sections, DT provided advice on trial management, SC, EC and RD were responsible for the process evaluation sections. All authors read and approved the final manuscript.

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Correspondence to Suzanne Murphy .

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Ethical approval for the study was granted by the University of Bedfordshire’s Institute for Health Research Ethics Committee on 23rd February 2022 (Reference IHREC971). Written consent to participate will be obtained from all participating parents/carers and school staff. Parents/carers will provide written consent on behalf of their participating children.

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Murphy, S., Bell, K., Cook, E.J. et al. Enhancing Pragmatic Language skills for Young children with Social communication difficulties (E-PLAYS-2) trial: study protocol for a cluster-randomised controlled trial evaluating a computerised intervention to promote communicative development and collaborative skills in young children. BMC Psychol 12 , 266 (2024). https://doi.org/10.1186/s40359-024-01749-y

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10 Good Communication Skills In The Workplace (Guide 2024)

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Introduction

Effective communication skills are essential in the modern workplace, regardless of your job level or industry. The ability to communicate information clearly, concisely and with impact can make the difference between success and failure.

In this comprehensive guide, we’ll explore 10 key communication skills that can help you excel in your career. We’ll also discuss why communication skills are so important, the different types of communication, and how to highlight your communication abilities on your CV and in job interviews.

Why Communication Skills Are Important in the Workplace

Communication is one of the most sought-after skills by employers today. Strong communication abilities allow you to:

• Convey information, instructions and ideas effectively
• Build positive relationships with colleagues, managers and clients
• Collaborate productively on projects and solve problems efficiently
• Negotiate, persuade and influence others
• Provide excellent customer service
• Advance your career through effective self-promotion

When communication breaks down in the workplace, it can lead to misunderstandings, reduced productivity, low morale and even conflict. That’s why honing your communication skills is so crucial, no matter what your role or industry.

The 4 Types of Communication Skills

Effective communication is multi-faceted, involving a range of verbal, nonverbal, written and visual skills. The four main types of communication skills are:

Mastering each of these four communication skill types is essential for thriving in the modern workplace.

10 Good Communication Skills Examples for 2024

Here are 10 key communication skills that can help you excel in your career:

Developing these 10 communication skills takes time and practice, but the payoff can be significant for your career success. Regularly assess your communication strengths and weaknesses, and seek out opportunities to improve.

Which Jobs Require Strong Communication Skills?

Communication skills are crucial in virtually every job and industry. Some roles where excellent communication abilities are particularly important include:

• Customer service and sales positions
• Management and leadership roles
• Consultancy and advisory roles
• Public relations and marketing roles
• Teaching, training and coaching roles
• Creative roles like writing, journalism and public speaking

Even for highly technical or specialized jobs, the ability to communicate complex information in a clear and engaging way is invaluable. Strong communication skills can help you excel in your current role and open doors to new career opportunities.

Emphasizing Communication Skills on Your CV and in Interviews

When applying for jobs, it’s important to highlight your communication skills throughout your CV and in job interviews. Here are some tips:

On Your CV:

• Include communication-focused achievements and responsibilities in your work history
• Showcase written communication skills through well-structured, error-free writing
• List relevant communication-related skills and training (e.g. public speaking, negotiation, active listening)
• Provide examples of how you’ve used communication skills to benefit your employer

In Interviews:

• Prepare examples of times you’ve demonstrated strong communication abilities
• Use confident, clear and friendly body language and tone of voice
• Listen carefully to questions and respond concisely and directly
• Ask thoughtful questions that show your engagement and communication skills
• Emphasize your ability to communicate effectively with diverse stakeholders

By emphasizing your communication prowess, you can demonstrate to employers that you have the essential skills to succeed in the role and contribute to the organization.

Effective communication skills are vital for career success in the modern workplace. By mastering the 10 communication skills outlined in this guide – including emotional intelligence, clarity, friendliness, confidence, empathy and more – you can set yourself up for professional advancement.

Remember that communication is a multi-faceted skill that can always be improved through regular practice and self-reflection. Consider taking a career test or psychometric test to better understand your communication strengths and development areas.

With commitment and the right strategies, you can become an exceptional communicator and unlock new opportunities for growth and success in your career.

Leveraging collective action and environmental literacy to address complex sustainability challenges

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Developing and enhancing societal capacity to understand, debate elements of, and take actionable steps toward a sustainable future at a scale beyond the individual are critical when addressing sustainability challenges such as climate change, resource scarcity, biodiversity loss, and zoonotic disease. Although mounting evidence exists for how to facilitate individual action to address sustainability challenges, there is less understanding of how to foster collective action in this realm. To support research and practice promoting collective action to address sustainability issues, we define the term “collective environmental literacy” by delineating four key potent aspects: scale, dynamic processes, shared resources, and synergy. Building on existing collective constructs and thought, we highlight areas where researchers, practitioners, and policymakers can support individuals and communities as they come together to identify, develop, and implement solutions to wicked problems. We close by discussing limitations of this work and future directions in studying collective environmental literacy.

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Reimagining the language of engagement in a post-stakeholder world

Can public awareness, knowledge and engagement improve climate change adaptation policies?

Leverage points for sustainability transformation

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Introduction

For socio-ecologically intertwined issues—such as climate change, land conversion, biodiversity loss, resource scarcity, and zoonotic diseases—and their associated multi-decadal timeframes, individual action is necessary, yet not sufficient, for systemic, sustained change (Amel et al. 2017 ; Bodin 2017 ; Niemiec et al. 2020 ; Spitzer and Fraser 2020 ). Instead, collective action, or individuals working together toward a common good, is essential for achieving the scope and scale of solutions to current sustainability challenges. To support communities as they engage in policy and action for socio-environmental change, communicators, land managers, policymakers, and other practitioners need an understanding of how communities coalesce and leverage their shared knowledge, skills, connections, and experiences.

Engagement efforts, such as those grounded in behavior-change approaches or community-based social marketing initiatives, that address socio-environmental issues have often emphasized individuals as the pathway to change. Such efforts address a range of domains including, but not limited to, residential energy use, personal transportation choices, and workplace recycling efforts, often doing so in a stepwise fashion, envisioning each setting or suite of behaviors as discrete spheres of action and influence (Heimlich and Ardoin 2008 ; McKenzie-Mohr 2011 ). In this way, specific actions are treated incrementally and linearly, considering first the individual barriers to be removed and then the motivations to be activated (and, sometimes, sustained; Monroe 2003 ; Gifford et al. 2011 ). Once each behavior is successfully instantiated, the next barrier is then addressed. Proceeding methodically from one action to the next, such initiatives often quite successfully alter a series of actions or group of related behaviors (at least initially) by addressing them incrementally, one at a time (Byerly et al. 2018 ). Following this aspirational logic chain, many resources have been channeled into such programs under the assumption that, by raising awareness and knowledge, such information, communication, and educational outreach efforts will shift attitudes and behaviors to an extent that, ultimately, mass-scale change will follow. (See discussion in Wals et al. 2014 .)

Numerous studies have demonstrated, however, that challenges arise with these stepwise approaches, particularly with regard to their ability to address complex issues and persist over time (Heimlich and Ardoin 2008 ; Wals et al. 2014 ). Such approaches place a tremendous—and unrealistic—burden on individuals, ignoring key aspects not only of behavioral science but also of social science more broadly, including the view that humans exist nested within socio-ecological systems and, thus, are most successful at achieving lasting change when it is meaningful, relevant, and undertaken within a supportive context (Swim et al. 2011 ; Feola 2015 ). Individualized approaches often require multiple steps or nudges (Byerly et al. 2018 ), or ongoing reminders to retain their salience (Stern et al. 2008 ). Because of the emphasis on decontextualized action, such approaches can miss, ignore, obfuscate, or minimize the importance of the bigger picture, which includes the sociocultural, biophysical, and political economic contexts (Ardoin 2006 ; Amel et al. 2017 ). Although the tightly trained focus on small, actionable steps and reliance on individual willpower may help in initially achieving success with initial habit formation (Carden and Wood 2018 ), it becomes questionable in terms of bringing about a wave of transformation on larger scales in the longer term. For those decontextualized actions to persist, they require continued prompting, constancy, and support in the social and biophysical context (Schultz 2014 ; Manfredo et al. 2016 ; Wood and Rünger 2016 ).

Less common in practice are theoretically based initiatives that embrace the holistic nature of the human experience, which occurs within complex systems spanning time and space in a multidimensional, weblike fashion (Bronfenbrenner 1979 ; Rogoff 2003 ; Barron 2006 ; DeCaro and Stokes 2008 ; Gould et al. 2019 ; Hovardas 2020 ). These systems-thinking approaches, while varying across disciplines and epistemological perspectives, envision human experiences, including learning and behavior, as occurring within a milieu that include the social, political, cultural, and historical contexts (Rogoff 2003 ; Roth and Lee 2007 ; Swim et al. 2011 ; Gordon 2019 ). In such a view, people’s everyday practices continuously reflect and grow out of past learning and experiences, not only at the individual, but also at the collective level (Lave 1991 ; Gutiérrez and Rogoff 2003 ; Nasir et al. 2020 ; Ardoin and Heimlich 2021 ). The multidimensional context in which we exist—including the broader temporal and spatial ecosystem—both facilitates and constrains our actions.

Scholars across diverse areas of study discuss the need for and power of collective thought and action, using various conceptual frames, models, and terms, such as collective action, behavior, impact, and intelligence; collaborative governance; communities of practice; crowdsourcing; and social movement theory; among many others (Table 1 ). These scholars acknowledge and explore the influence of our multidimensional context on collective thought and action. In this paper, we explore the elements and processes that constitute collective environmental literacy . We draw on the vast, relevant literature and, in so doing, we attempt to invoke the power of the collective: by reviewing and synthesizing ideas from a variety of fields, we strive to leverage existing constructs and perspectives that explore notions of the “collective” (see Table 1 for a summary of constructs and theories reviewed to develop our working definition of collective environmental literacy). A primary goal of this paper is to dialogue with other researchers and practitioners working in this arena who are eager to uncover and further explore related avenues.

First, we present a formal definition of collective environmental literacy. Next, we briefly review the dominant view of environmental literacy at the individual level and, in support of a collective take on environmental literacy, we examine various collective constructs. We then delve more deeply into the definition of collective environmental literacy by outlining four key aspects: scale, dynamic processes, shared resources, and synergy. We conclude by providing suggestions for future directions in studying collective environmental literacy.

Defining collective environmental literacy

Decades of research in political science, economics, anthropology, sociology, psychology, and the learning sciences, among other fields (Chawla and Cushing 2007 ; Ostrom 2009 ; Sawyer 2014 ; Bamberg et al. 2015 ; Chan 2016 ; Jost et al. 2017 ) repeatedly demonstrates the effectiveness, and indeed necessity of, collective action when addressing problems that are inherently social in nature. Yet theoretical frameworks and empirical documentation emphasize that such collective activities rarely arise spontaneously and, when they do, are a result of preconditions that have sown fertile ground (van Zomeren et al. 2008 ; Duncan 2018 ). Persistent and effective collective action then requires scaffolding in the form of institutional, sociocultural, and political economic structure that provides ongoing support. To facilitate discussions of how to effectively support collective action around sustainability issues, we suggest the concept of “collective environmental literacy.” We conceptualize collective environmental literacy as more than collective action; rather, we suggest that the term encapsulates action along with its various supporting structures and resources. Additionally, we employ the word “literacy” as it connotes learning, intention, and the idea that knowledge, skills, attitudes, and behaviors can be enhanced iteratively over time. By using “literacy,” we strive to highlight the efforts, often unseen, that lead to effective collective action in communities. We draw on scholarship in science and health education, areas that have begun over the past two decades to theorize about related areas of collective science literacy (Roth and Lee 2002 , 2004 ; Lee and Roth 2003 ; Feinstein 2018 ) and health literacy (Freedman et al. 2009 ; Papen 2009 ; Chinn 2011 ; Guzys et al. 2015 ). Although these evolving constructs lack consensus definitions, they illuminate affordances and constraints that exist when conceptualizing collective environmental literacy (National Academies of Sciences, Engineering, and Medicine [NASEM] 2016 ).

Some of the key necessary—but not sufficient—conditions that facilitate aligned, collective actions include a common body of decision-making information; shared attitudes, values, and beliefs toward a motivating issue or concern; and efficacy skills that facilitate change-making (Sturmer and Simon 2004 ; van Zomeren et al. 2008 ; Jagers et al. 2020 ). In addition, other contextual factors are essential, such as trust, reciprocity, collective efficacy, and communication among group members and societal-level facilitators, such as social norms, institutions, and technology (Bandura 2000 ; Ostrom 2010 ; McAdam and Boudet 2012 ; Jagers et al. 2020 ). Taken together, we term this body of knowledge, dispositions, skills, and the context in which they flourish collective environmental literacy . More formally, we define collective environmental literacy as: a dynamic, synergistic process that occurs as group members develop and leverage shared resources to undertake individual and aggregate actions over time to address sustainability issues within the multi-scalar context of a socio-environmental system (Fig.  1 ).

Key elements of collective environmental literacy

Environmental literacy: Historically individual, increasingly collective

Over the past five decades, the term “environmental literacy” has come into increasingly frequent use. Breaking from the traditional association of “literacy” with reading and writing in formal school contexts, environmental literacy emphasizes associations with character and behavior, often in the form of responsible environmental stewardship (Roth 1992 ). Footnote 1 Such perspectives define the concept as including affective (attitudinal), cognitive (knowledge-based), and behavioral domains, emphasizing that environmental literacy is both a process and outcome that develops, builds, and morphs over time (Hollweg et al. 2011 ; Wheaton et al. 2018 ; Clark et al. 2020 ).

The emphasis on defining, measuring, and developing interventions to bring about environmental literacy has primarily remained at the individual scale, as evidenced by frequent descriptions of an environmentally literate person (Roth 1992 ; Hollweg et al. 2011 among others) rather than community or community member. In most understandings, discussions, and manifestations of environmental literacy, the implicit assumption remains that the unit of action, intervention, and therefore analysis occurs at the individual level. Yet instinctively and perhaps by nature, community members often seek information and, as a result, take action collectively, sharing what some scholars call “the hive mind” or “group mind,” relying on each other for distributed knowledge, expertise, motivation, and support (Surowiecki 2005 ; Sunstein 2008 ; Sloman and Fernbach 2017 ; Paul 2021 ).

As with the proverbial elephant (Saxe, n.d.), each person, household, or neighborhood group may understand or “see” a different part of an issue or challenge, bring a novel understanding to the table, and have a certain perspective or skill to contribute. Although some environmental literacy discussions allude to a collective lens (e.g., Hollweg et al. 2011 ; Ardoin et al. 2013 ; Wheaton et al. 2018 ; Bey et al. 2020 ), defining, developing frameworks, and creating measures to assess the efficacy of such collective-scale sustainability-related endeavors has remained elusive. Footnote 2 Looking to related fields and disciplines—such as ecosystem theory, epidemiology and public health, sociology, network theory, and urban planning, among others—can provide insight, theoretical frames, and empirical examples to assist in such conceptualizations (McAdam and Boudet 2012 ; National Research Council 2015 ) (See Table 1 for an overview of some of the many areas of study that informed our conceptualization of collective environmental literacy).

Seeking the essence of the collective: Looking to and learning from others

The social sciences have long focused on “the kinds of activities engaged in by sizable but loosely organized groups of people” (Turner et al. 2020 , para. 1) and addressed various collective constructs, such as collective behavior, action, intelligence, and memory (Table 1 ). Although related constructs in both the social and natural sciences—such as communities of practice (Wenger and Snyder 2000 ), collaborative governance (Ansell and Gash 2008 ; Emerson et al. 2012 ), and the collaboration–coordination continuum (Sadoff and Grey 2005 ; Prager 2015 ), as well as those from social movement theory and related areas (McAdam and Boudet 2012 ; de Moor and Wahlström 2019 )—lack the word “collective” in name, they too leverage the benefits of collectivity. A central tenet connects all of these areas: powerful processes, actions, and outcomes can arise when individuals coalesce around a common purpose or cause. This notion of a dynamic, potent force transcending the individual to enhance the efficacy of outcomes motivates the application of a collective lens to the environmental literacy concept.

Dating to the 1800s, discussions of collective behavior have explored connections to social order, structures, and norms (Park 1927 ; Smelser 2011 /1962; Turner and Killian 1987 ). Initially, the focus emphasized spontaneous, often violent crowd behaviors, such as riots, mobs, and rebellions. More contemporarily, sociologists, political scientists, and others who study social movements and collective behaviors acknowledge that such phenomena may take many forms, including those occurring in natural ecosystems, such as ant colonies, bird flocks, and even the human brain (Gordon 2019 ). In sociology, collective action represents a paradigm shift highlighting coordinated, purposeful pro-social movements, while de-emphasizing aroused emotions and crowd behavior (Miller 2014 ). In political science, Ostrom’s ( 1990 , 2000 , 2010 ) theory of collective action in the context of the management of shared resources extends the concept’s reach to economics and other fields. In education and the learning sciences, social learning and sociocultural theories tap into the idea of learning as a social-cognitive-cultural endeavor (Vygotsky 1980 ; Lave and Wenger 1991 ; Tudge and Winterhoff 1993 ; Rogoff 2003 ; Reed et al. 2010 ).

Collective action, specifically, and collective constructs, generally, have found their way into the research and practice in the fields of conservation, natural resources, and environmental management. Collective action theory has been applied in a range of settings and scenarios, including agriculture (Mills et al. 2011 ), invasive species management (Marshall et al. 2016 ; Sullivan et al. 2017 ; Lubeck et al. 2019 ; Clarke et al. 2021 ), fire management (Canadas et al. 2016 ; Charnley et al. 2020 ), habitat conservation (Raymond 2006 ; Niemiec et al. 2020 ), and water governance (Lopez-Gunn 2003 ; Baldwin et al. 2018 ), among others. Frameworks and methods that emphasize other collective-related ideas—like collaboration, co-production, and group learning—are also ubiquitous in natural resource and environmental management. These constructs include community-based conservation (DeCaro and Stokes 2008 ; Niemiec et al. 2016 ), community natural resource management (Kellert et al. 2000 ; Dale et al. 2020 ), collaboration/coordination (Sadoff and Grey 2005 ; Prager 2015 ), polycentricity (Galaz et al. 2012 ; Heikkila et al. 2018 ), knowledge co-production (Armitage et al. 2011 ; Singh et al. 2021 ), and social learning (Reed et al. 2010 ; Hovardas 2020 ). Many writings on collective efforts in the social sciences broadly, and applied in the area of environment specifically, provide insights into collective action’s necessary preconditions, which prove invaluable to further defining and later operationalizing collective environmental literacy.

Unpacking the definition of collective environmental literacy: Anchoring principles

As described, we propose the following working definition of collective environmental literacy drawing on our analysis of related literatures and informed by scholarly and professional experience in the sustainability and conservation fields: a dynamic, synergistic process that occurs as group members develop and leverage shared resources to undertake individual and aggregate actions over time to address sustainability issues within the multi-scalar context of a socio-environmental system (Fig.  1 ). This definition centers on four core, intertwined ideas: the scale of the group involved; the dynamic nature of the process; shared resources brought by, available to, and needed by the group; and the synergy that arises from group interaction.

Multi-scalar

When transitioning from the focus on individual to collective actions—and, herein, principles of environmental literacy—the most obvious and primary requisite shift is one of scale. Yet, moving to a collective scale does not mean abandoning action at the individual scale; rather, success at the collective level is intrinsically tied to what occurs at an individual level. Such collective-scale impacts leverage the power of the hive, harnessing people’s willingness, ability, and motivation to take action alongside others, share their ideas and resources to build collective ideas and resources, contribute to making a difference in an impactful way, and participate communally in pro-social activities.

Collective environmental literacy is likely dynamic in its orientation to scale, incorporating place-based notions, such as ecoregional or community-level environmental literacy (with an emphasis on geographic boundaries). On the other hand, it may encapsulate environmental literacy of a group or organization united by a common identity (e.g., organizational membership) or cause (e.g., old-growth forests, coastal protection), rather than solely or even primarily by geography. Although shifting scales can make measuring collective environmental literacy more difficult, dynamic levels may be a benefit when addressing planetary boundary issues such as climate change, biodiversity, and ocean acidification (Galaz et al. 2012 ). Some scholars have called for a polycentric approach to these large-scale issues in response to a perceived failure of global-wide, top-down solutions (Ostrom 2010 , 2012 ; Jordan et al. 2018 ). Conceptualizing and consequently supporting collective environmental literacy at multiple scales can facilitate such desired polycentricity.

Rather than representing a static outcome, environmental literacy is a dynamic process that is fluctuating and complex, reflective of iterative interactions among community members, whose discussions and negotiations reflect the changing context of sustainability issues. Footnote 3 Such open-minded processes allow for, and indeed welcome, adaptation in a way that builds social-ecological resilience (Berkes and Jolly 2002 ; Adger et al. 2005 ; Berkes 2007 ). Additionally, this dynamism allows for collective development and maturation, supporting community growth in collective knowledge, attitudes, skills, and actions via new experiences, interactions, and efforts (Berkman et al. 2010 ). With this mindset, and within a sociocultural perspective, collective environmental literacy evolves through drawing on and contributing to the community’s funds of knowledge (González et al. 2006 ). Movement and actions within and among groups impact collective literacy, as members share knowledge and other resources, shifting individuals and the group in the course of their shared practices (Samerski 2019 ).

In a collective mode, effectiveness is heightened as shared resources are streamlined, waste is minimized, and innovation maximized. Rather than each group member developing individual expertise in every matter of concern, the shared knowledge, skills, and behaviors can be distributed, pursued, and amplified among group members efficiently and effectively, with collective literacy emerging from the process of pooling diverse forms of capital and aggregating resources. This perspective builds on ideas of social capital as a collective good (Ostrom 1990 ; Putnam 2020 ), wherein relationships of trust and reciprocity are both inputs and outcomes (Pretty and Ward 2001 ). The shared resources then catalyze and sustain action as they are reassembled and coalesced at the group level for collective impact.

The pooled resources—likely vast—may include, but are not limited to, physical and human resources, funding, time, energy, and space and place (physical or digital). Shared resources may also include forms of theorized capital, such as intellectual and social (Putnam 2020 ). Also of note is the recognition that these resources extend far beyond information and knowledge. Of particular interest when building collective environmental literacy are resources previously ignored or overlooked by those in power in prior sustainability efforts. For example, collective environmental literacy can draw strength from shared resources unique to the community or even subgroups within the larger community. Discussions of Indigenous knowledge (Gadgil et al. 1993 ) and funds of knowledge (González et al. 2006 ; Cruz et al. 2018 ) suggest critical, shared resources that highlight strengths of an individual community and its members. Another dimension of shared resources relates to the strength of institutional connections, such as the benefits that accrue from leveraging the collective knowledge, expertise, and resources of organizational collaborators working in adjacent areas to further and amplify each other’s impact (Wojcik et al. 2021 ).

Synergistic

Finally, given the inherent complexities related to defining, deploying, implementing, and measuring these dynamic, at-times ephemeral processes, resources, and outcomes at a collective scale, working in such a manner must be clearly advantageous to pressing sustainability issues at hand. Numerous related constructs and approaches from a range of fields emphasize the benefits of diverse collaboration to collective thought and action, including improved solutions, more effective and fair processes, and more socioculturally just outcomes (Klein 1990 ; Jörg 2011 ; Wenger and Snyder 2000 ; Djenontin and Meadow 2018 ). These benefits go beyond efficient aggregation and distribution of resources, invoking an almost magical quality that defines synergy, resulting in robust processes and outcomes that are more than the sum of the parts.

This synergy relies on the diversity of a group across various dimensions, bringing power, strength, and insight to a decision-making process (Bear and Woolley 2011 ; Curşeu and Pluut 2013 ; Freeman and Huang 2015 ; Lu et al. 2017 ; Bendor and Page 2019 ). Individuals are limited not only to singular knowledge-perspectives and skillsets, but also to their own experiences, which influence their self-affirming viewpoints and tendencies to seek out confirmatory information for existing beliefs (Kahan et al. 2011 ). Although the coming together of those from different racial, cultural, social, and economic backgrounds facilitates a collective literacy process that draws on a wider range of resources and equips a gestalt, it also sets up the need to consider issues of power, privilege, voice, and representation (Bäckstrand 2006 ) and the role of social capital, leading to questions related to trust and reciprocity in effective collectives (Pretty and Ward 2001 ; Folke et al. 2005 ).

Leveraging the ‘Hive’: Proceeding with collective environmental literacy

This paper presents one conceptualization of collective environmental literacy, with the understanding that numerous ways exist to envision its definition, formation, deployment, and measurement. Characterized by a collective effort, such literacies at scale offer a way to imagine, measure, and support the synergy that occurs when the emphasis moves from an individual to a larger whole. By expanding the scale and focusing on shared responsibility among actors at the systems level, opportunities arise for inspiring and enabling a broader contribution to a sustainable future. These evolving notions serve to invite ongoing conversation, both in research and practice, about how to enact our collective responsibility toward, as well as vision of, a thriving future.

Emerging from the many discussions of shared and collaborative efforts to address socio-environmental issues, our conceptualization of collective environmental literacy is a first step toward supporting communities as they work to identify, address, and solve sustainability problems. We urge continued discussions on this topic, with the goal of understanding the concept of collective environmental literacy, how to measure it, and the implications of this work for practitioners. The conceptual roots of collective environmental literacy reach into countless fields of study and, as such, a transdisciplinary approach, which includes an eye toward practice, is necessary to fully capture and maximize the tremendous amount of knowledge, wisdom, and experience around this topic. Specifically, next steps to evolve the concept include engaging sustainability researchers and practitioners in discussions of the saliency of the presented definition of collective environmental literacy. These discussions include verifying the completeness of the definition and ensuring a thorough review of relevant research: Are parts of the definition missing or unclear? What are the “blank, blind, bald, and bright spots” in the literature (Reid 2019 p. 158)? Additionally, recognizing and leveraging literacy at a collective scale most certainly is not unique to environmental work, nor is adopting literacy-related language to conceptualize and measure process outcomes, although the former has consistently proven more challenging. Moreover, although we (the authors) appreciate the connotations and structures gained by using a literacy framework, we struggle with whether “environmental literacy” is the most appropriate and useful term for the conceptualizations as described herein; we, thus, welcome lively discussions about the need for new terminology.

Even at this early stage of conceptualization, this work has implications for practitioners. For scientists, communicators, policymakers, land managers, and other professionals desiring to work with communities to address sustainability issues, a primary take-away message concerns the holistic nature of what is needed for effective collective action in the environmental realm. Many previous efforts have focused on conveying information and, while a lack of knowledge and awareness may be a barrier to action in some cases, the need for a more holistic lens is increasingly clear. This move beyond an individually focused, information-deficit model is essential for effective impact (Bolderdijk et al. 2013 ; van der Linden 2014 ; Geiger et al. 2019 ). The concept of collective environmental literacy suggests a role for developing shared resources that can foster effective collective action. When working with communities, a critical early step includes some form of needs assessment—a systematic, in-depth process that allows for meaningfully gauging gaps in shared resources required to tackle sustainability issues (Braus 2011). Following this initial, evaluative step, an understanding of the components of collective environmental literacy, as outlined in this paper, can be used to guide the development of interventions to support communities in their efforts to address those issues.

Growing discussion of collective literacy constructs, and related areas, suggests researchers, practitioners, and policymakers working in pro-social areas recognize and value collective efforts, despite the need for clearer definitions and effective measures. This definitional and measurement work, in both research and practice, is not easy. The ever-changing, dynamic contexts in which collective environmental literacy exists make defining the concept a moving target, compounded by a need to draw upon work in countless, often distinct academic fields of study. Furthermore, the hard-to-see, inner workings of collective constructs make measurement difficult. Yet, the “power of the hive” is intriguing, as the synergism that arises from communities working in an aligned manner toward a unified vision suggests a potency and wave of motivated action essential to coalescing and leveraging individual goodwill, harnessing its power and potential toward effective sustainability solutions.

See Stables and Bishop’s ( 2001 ) idea of defining environmental literacy by viewing the environment as “text.”

The climate change education literature also includes a nascent, but growing, discussion of collective-lens thinking and literacy. See, for example, Waldron et al. ( 2019 ), Mochizuki and Bryan ( 2015 ), and Kopnina ( 2016 ).

This conceptualization is similar to how some scholars describe collective health literacy (Berkman et al., 2010 ; Mårtensson and Hensing, 2012 ).

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Acknowledgements

We are grateful to Maria DiGiano, Anna Lee, and Becca Shareff for their feedback and contributions to early drafts of this paper. We appreciate the research and writing assistance supporting this paper provided by various members of the Stanford Social Ecology Lab, especially: Brennecke Gale, Pari Ghorbani, Regina Kong, Naomi Ray, and Austin Stack.

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Ardoin, N.M., Bowers, A.W. & Wheaton, M. Leveraging collective action and environmental literacy to address complex sustainability challenges. Ambio 52 , 30–44 (2023). https://doi.org/10.1007/s13280-022-01764-6

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Understanding the stressors and coping strategies of nursing students in their first clinical training is important for improving student performance, helping students develop a professional identity and problem-solving skills, and improving the clinical teaching aspects of the curriculum in nursing programmes. While previous research have examined nurses’ sources of stress and coping styles in the Arab region, there is limited understanding of these stressors and coping strategies of nursing students within the UAE context thereby, highlighting the novelty and significance of the study.

A qualitative study was conducted using semi-structured interviews. Overall 30 students who were undergoing their first clinical placement in Year 2 at the University of Sharjah between May and June 2022 were recruited. All interviews were recorded and transcribed verbatim and analyzed for themes.

During their first clinical training, nursing students are exposed to stress from different sources, including the clinical environment, unfriendly clinical tutors, feelings of disconnection, multiple expectations of clinical staff and patients, and gaps between the curriculum of theory classes and labatories skills and students’ clinical experiences. We extracted three main themes that described students’ stress and use of coping strategies during clinical training: (1) managing expectations; (2) theory-practice gap; and (3) learning to cope. Learning to cope, included two subthemes: positive coping strategies and negative coping strategies.

Conclusions

This qualitative study sheds light from the students viewpoint about the intricate interplay between managing expectations, theory practice gap and learning to cope. Therefore, it is imperative for nursing faculty, clinical agencies and curriculum planners to ensure maximum learning in the clinical by recognizing the significance of the stressors encountered and help students develop positive coping strategies to manage the clinical stressors encountered. Further research is required look at the perspective of clinical stressors from clinical tutors who supervise students during their first clinical practicum.

Peer Review reports

Nursing education programmes aim to provide students with high-quality clinical learning experiences to ensure that nurses can provide safe, direct care to patients [ 1 ]. The nursing baccalaureate programme at the University of Sharjah is a four year program with 137 credits. The programmes has both theoretical and clinical components withs nine clinical courses spread over the four years The first clinical practicum which forms the basis of the study takes place in year 2 semester 2.

Clinical practice experience is an indispensable component of nursing education and links what students learn in the classroom and in skills laboratories to real-life clinical settings [ 2 , 3 , 4 ]. However, a gap exists between theory and practice as the curriculum in the classroom differs from nursing students’ experiences in the clinical nursing practicum [ 5 ]. Clinical nursing training places (or practicums, as they are commonly referred to), provide students with the necessary experiences to ensure that they become proficient in the delivery of patient care [ 6 ]. The clinical practicum takes place in an environment that combines numerous structural, psychological, emotional and organizational elements that influence student learning [ 7 ] and may affect the development of professional nursing competencies, such as compassion, communication and professional identity [ 8 ]. While clinical training is a major component of nursing education curricula, stress related to clinical training is common among students [ 9 ]. Furthermore, the nursing literature indicates that the first exposure to clinical learning is one of the most stressful experiences during undergraduate studies [ 8 , 10 ]. Thus, the clinical component of nursing education is considered more stressful than the theoretical component. Students often view clinical learning, where most learning takes place, as an unsupportive environment [ 11 ]. In addition, they note strained relationships between themselves and clinical preceptors and perceive that the negative attitudes of clinical staff produce stress [ 12 ].

The effects of stress on nursing students often involve a sense of uncertainty, uneasiness, or anxiety. The literature is replete with evidence that nursing students experience a variety of stressors during their clinical practicum, beginning with the first clinical rotation. Nursing is a complex profession that requires continuous interaction with a variety of individuals in a high-stress environment. Stress during clinical learning can have multiple negative consequences, including low academic achievement, elevated levels of burnout, and diminished personal well-being [ 13 , 14 ]. In addition, both theoretical and practical research has demonstrated that increased, continual exposure to stress leads to cognitive deficits, inability to concentrate, lack of memory or recall, misinterpretation of speech, and decreased learning capacity [ 15 ]. Furthermore, stress has been identified as a cause of attrition among nursing students [ 16 ].

Most sources of stress have been categorized as academic, clinical or personal. Each person copes with stress differently [ 17 ], and utilizes deliberate, planned, and psychological efforts to manage stressful demands [ 18 ]. Coping mechanisms are commonly termed adaptation strategies or coping skills. Labrague et al. [ 19 ] noted that students used critical coping strategies to handle stress and suggested that problem solving was the most common coping or adaptation mechanism used by nursing students. Nursing students’ coping strategies affect their physical and psychological well-being and the quality of nursing care they offer. Therefore, identifying the coping strategies that students use to manage stressors is important for early intervention [ 20 ].

Studies on nursing students’ coping strategies have been conducted in various countries. For example, Israeli nursing students were found to adopt a range of coping mechanisms, including talking to friends, engaging in sports, avoiding stress and sadness/misery, and consuming alcohol [ 21 ]. Other studies have examined stress levels among medical students in the Arab region. Chaabane et al. [ 15 ], conducted a systematic review of sudies in Arab countries, including Saudi Arabia, Egypt, Jordan, Iraq, Pakistan, Oman, Palestine and Bahrain, and reported that stress during clinical practicums was prevalent, although it could not be determined whether this was limited to the initial clinical course or occurred throughout clinical training. Stressors highlighted during the clinical period in the systematic review included assignments and workload during clinical practice, a feeling that the requirements of clinical practice exceeded students’ physical and emotional endurance and that their involvement in patient care was limited due to lack of experience. Furthermore, stress can have a direct effect on clinical performance, leading to mental disorders. Tung et al. [ 22 ], reported that the prevalence of depression among nursing students in Arab countries is 28%, which is almost six times greater than the rest of the world [ 22 ]. On the other hand, Saifan et al. [ 5 ], explored the theory-practice gap in the United Arab Emirates and found that clinical stressors could be decreased by preparing students better for clinical education with qualified clinical faculty and supportive preceptors.

The purpose of this study was to identify the stressors experienced by undergraduate nursing students in the United Arab Emirates during their first clinical training and the basic adaptation approaches or coping strategies they used. Recognizing or understanding different coping processes can inform the implementation of corrective measures when students experience clinical stress. The findings of this study may provide valuable information for nursing programmes, nurse educators, and clinical administrators to establish adaptive strategies to reduce stress among students going clinical practicums, particularly stressors from their first clinical training in different healthcare settings.

A qualitative approach was adopted to understand clinical stressors and coping strategies from the perspective of nurses’ lived experience. Qualitative content analysis was employed to obtain rich and detailed information from our qualitative data. Qualitative approaches seek to understand the phenomenon under study from the perspectives of individuals with lived experience [ 23 ]. Qualitative content analysis is an interpretive technique that examines the similarities and differences between and within different areas of text while focusing on the subject [ 24 ]. It is used to examine communication patterns in a repeatable and systematic way [ 25 ] and yields rich and detailed information on the topic under investigation [ 23 ]. It is a method of systematically coding and categorizing information and comprises a process of comprehending, interpreting, and conceptualizing the key meanings from qualitative data [ 26 ].

Setting and participants

This study was conducted after the clinical rotations ended in April 2022, between May and June in the nursing programme at the College of Health Sciences, University of Sharjah, in the United Arab Emirates. The study population comprised undergraduate nursing students who were undergoing their first clinical training and were recruited using purposive sampling. The inclusion criteria for this study were second-year nursing students in the first semester of clinical training who could speak English, were willing to participate in this research, and had no previous clinical work experience. The final sample consisted of 30 students.

Research instrument

The research instrument was a semi structured interview guide. The interview questions were based on an in-depth review of related literature. An intensive search included key words in Google Scholar, PubMed like the terms “nursing clinical stressors”, “nursing students”, and “coping mechanisms”. Once the questions were created, they were validated by two other faculty members who had relevant experience in mental health. A pilot test was conducted with five students and based on their feedback the following research questions, which were addressed in the study.

How would you describe your clinical experiences during your first clinical rotations?

In what ways did you find the first clinical rotation to be stressful?

What factors hindered your clinical training?

How did you cope with the stressors you encountered in clinical training?

Which strategies helped you cope with the clinical stressors you encountered?

Data collection

Semi-structured interviews were chosen as the method for data collection. Semi structured interviews are a well-established approach for gathering data in qualitative research and allow participants to discuss their views, experiences, attitudes, and beliefs in a positive environment [ 27 ]. This approach allows for flexibility in questioning thereby ensuring that key topics related to clinical learning stressors and coping strategies would be explored. Participants were given the opportunity to express their views, experiences, attitudes, and beliefs in a positive environment, encouraging open communication. These semi structured interviews were conducted by one member of the research team (MAS) who had a mental health background, and another member of the research team who attended the interviews as an observer (JMD). Neither of these researchers were involved in teaching the students during their clinical practicum, which helped to minimize bias. The interviews took place at the University of Sharjah, specifically in building M23, providing a familiar and comfortable environment for the participant. Before the interviews were all students who agreed to participate were provided with an explanation of the study’s purpose. The time and location of each interview were arranged. Before the interviews were conducted, all students who provided consent to participate received an explanation of the purpose of the study, and the time and place of each interview were arranged to accommodate the participants’ schedules and preferences. The interviews were conducted after the clinical rotation had ended in April, and after the final grades had been submitted to the coordinator. The timings of the interviews included the month of May and June which ensured that participants have completed their practicum experience and could reflect on the stressors more comprehensively. The interviews were audio-recorded with the participants’ consent, and each interview lasted 25–40 min. The data were collected until saturation was reached for 30 students. Memos and field notes were also recorded as part of the data collection process. These additional data allowed for triangulation to improve the credibility of the interpretations of the data [ 28 ]. Memos included the interviewers’ thoughts and interpretations about the interviews, the research process (including questions and gaps), and the analytic progress used for the research. Field notes were used to record the interviewers’ observations and reflections on the data. These additional data collection methods were important to guide the researchers in the interpretation of the data on the participants’ feelings, perspectives, experiences, attitudes, and beliefs. Finally, member checking was performed to ensure conformability.

Data analysis

The study used the content analysis method proposed by Graneheim and Lundman [ 24 ]. According to Graneheim and Lundman [ 24 ], content analysis is an interpretive technique that examines the similarities and differences between distinct parts of a text. This method allows researchers to determine exact theoretical and operational definitions of words, phrases, and symbols by elucidating their constituent properties [ 29 ]. First, we read the interview transcripts several times to reach an overall understanding of the data. All verbatim transcripts were read several times and discussed among all authors. We merged and used line-by-line coding of words, sentences, and paragraphs relevant to each other in terms of both the content and context of stressors and coping mechanisms. Next, we used data reduction to assess the relationships among themes using tables and diagrams to indicate conceptual patterns. Content related to stress encountered by students was extracted from the transcripts. In a separate document, we integrated and categorized all words and sentences that were related to each other in terms of both content and context. We analyzed all codes and units of meaning and compared them for similarities and differences in the context of this study. Furthermore, the emerging findings were discussed with other members of the researcher team. The final abstractions of meaningful subthemes into themes were discussed and agreed upon by the entire research team. This process resulted in the extraction of three main themes in addition to two subthemes related to stress and coping strategies.

Ethical considerations

The University of Sharjah Research Ethics Committee provided approval to conduct this study (Reference Number: REC 19-12-03-01-S). Before each interview, the goal and study procedures were explained to each participant, and written informed consent was obtained. The participants were informed that participation in the study was voluntary and that they could withdraw from the study at any time. In the event they wanted to withdraw from the study, all information related to the participant would be removed. No participant withdrew from the study. Furthermore, they were informed that their clinical practicum grade would not be affected by their participation in this study. We chose interview locations in Building M23that were private and quiet to ensure that the participants felt at ease and confident in verbalizing their opinions. No participant was paid directly for involvement in this study. In addition, participants were assured that their data would remain anonymous and confidential. Confidentiality means that the information provided by participants was kept private with restrictions on how and when data can be shared with others. The participants were informed that their information would not be duplicated or disseminated without their permission. Anonymity refers to the act of keeping people anonymous with respect to their participation in a research endeavor. No personal identifiers were used in this study, and each participant was assigned a random alpha-numeric code (e.g., P1 for participant 1). All digitally recorded interviews were downloaded to a secure computer protected by the principal investigator with a password. The researchers were the only people with access to the interview material (recordings and transcripts). All sensitive information and materials were kept secure in the principal researcher’s office at the University of Sharjah. The data will be maintained for five years after the study is completed, after which the material will be destroyed (the transcripts will be shredded, and the tapes will be demagnetized).

In total, 30 nursing students who were enrolled in the nursing programme at the Department of Nursing, College of Health Sciences, University of Sharjah, and who were undergoing their first clinical practicum participated in the study. Demographically, 80% ( n  = 24) were females and 20% ( n  = 6) were male participants. The majority (83%) of study participants ranged in age from 18 to 22 years. 20% ( n  = 6) were UAE nationals, 53% ( n  = 16) were from Gulf Cooperation Council countries, while 20% ( n  = 6) hailed from Africa and 7% ( n  = 2) were of South Asian descent. 67% of the respondents lived with their families while 33% lived in the hostel. (Table  1 )

Following the content analysis, we identified three main themes: (1) managing expectations, (2) theory-practice gap and 3)learning to cope. Learning to cope had two subthemes: positive coping strategies and negative coping strategies. An account of each theme is presented along with supporting excerpts for the identified themes. The identified themes provide valuable insight into the stressors encountered by students during their first clinical practicum. These themes will lead to targeted interventions and supportive mechanisms that can be built into the clinical training curriculum to support students during clinical practice.

Theme 1: managing expectations

In our examination of the stressors experienced by nursing students during their first clinical practicum and the coping strategies they employed, we identified the first theme as managing expectations.

The students encountered expectations from various parties, such as clinical staff, patients and patients’ relatives which they had to navigate. They attempted to fulfil their expectations as they progressed through training, which presented a source of stress. The students noted that the hospital staff and patients expected them to know how to perform a variety of tasks upon request, which made the students feel stressed and out of place if they did not know how to perform these tasks. Some participants noted that other nurses in the clinical unit did not allow them to participate in nursing procedures, which was considered an enormous impediment to clinical learning, as noted in the excerpt below:

“…Sometimes the nurses… They will not allow us to do some procedures or things during clinical. And sometimes the patients themselves don’t allow us to do procedures” (P5).

Some of the students noted that they felt they did not belong and felt like foreigners in the clinical unit. Excerpts from the students are presented in the following quotes;

“The clinical environment is so stressful. I don’t feel like I belong. There is too little time to build a rapport with hospital staff or the patient” (P22).

“… you ask the hospital staff for some guidance or the location of equipment, and they tell us to ask our clinical tutor …but she is not around … what should I do? It appears like we do not belong, and the sooner the shift is over, the better” (P18).

“The staff are unfriendly and expect too much from us students… I feel like I don’t belong, or I am wasting their (the hospital staff’s) time. I want to ask questions, but they have loads to do” (P26).

Other students were concerned about potential failure when working with patients during clinical training, which impacted their confidence. They were particularly afraid of failure when performing any clinical procedures.

“At the beginning, I was afraid to do procedures. I thought that maybe the patient would be hurt and that I would not be successful in doing it. I have low self-confidence in doing procedures” (P13).

The call bell rings, and I am told to answer Room No. XXX. The patient wants help to go to the toilet, but she has two IV lines. I don’t know how to transport the patient… should I take her on the wheelchair? My eyes glance around the room for a wheelchair. I am so confused …I tell the patient I will inform the sister at the nursing station. The relative in the room glares at me angrily … “you better hurry up”…Oh, I feel like I don’t belong, as I am not able to help the patient… how will I face the same patient again?” (P12).

Another major stressor mentioned in the narratives was related to communication and interactions with patients who spoke another language, so it was difficult to communicate.

“There was a challenge with my communication with the patients. Sometimes I have communication barriers because they (the patients) are of other nationalities. I had an experience with a patient [who was] Indian, and he couldn’t speak my language. I did not understand his language” (P9).

Thus, a variety of expectations from patients, relatives, hospital staff, and preceptors acted as sources of stress for students during their clinical training.

Theme 2: theory-practice gap

Theory-practice gaps have been identified in previous studies. In our study, there was complete dissonance between theory and actual clinical practice. The clinical procedures or practices nursing students were expected to perform differed from the theory they had covered in their university classes and skills lab. This was described as a theory–practice gap and often resulted in stress and confusion.

“For example …the procedures in the hospital are different. They are different from what we learned or from theory on campus. Or… the preceptors have different techniques than what we learned on campus. So, I was stress[ed] and confused about it” (P11).

Furthermore, some students reported that they did not feel that they received adequate briefing before going to clinical training. A related source of stress was overload because of the volume of clinical coursework and assignments in addition to clinical expectations. Additionally, the students reported that a lack of time and time management were major sources of stress in their first clinical training and impacted their ability to complete the required paperwork and assignments:

“…There is not enough time…also, time management at the hospital…for example, we start at seven a.m., and the handover takes 1 hour to finish. They (the nurses at the hospital) are very slow…They start with bed making and morning care like at 9.45 a.m. Then, we must fill [out] our assessment tool and the NCP (nursing care plan) at 10 a.m. So, 15 only minutes before going to our break. We (the students) cannot manage this time. This condition makes me and my friends very stressed out. -I cannot do my paperwork or assignments; no time, right?” (P10).

“Stressful. There is a lot of work to do in clinical. My experiences are not really good with this course. We have a lot of things to do, so many assignments and clinical procedures to complete” (P16).

The participants noted that the amount of required coursework and number of assignments also presented a challenge during their first clinical training and especially affected their opportunity to learn.

“I need to read the file, know about my patient’s condition and pathophysiology and the rationale for the medications the patient is receiving…These are big stressors for my learning. I think about assignments often. Like, we are just focusing on so many assignments and papers. We need to submit assessments and care plans for clinical cases. We focus our time to complete and finish the papers rather than doing the real clinical procedures, so we lose [the] chance to learn” (P25).

Another participant commented in a similar vein that there was not enough time to perform tasks related to clinical requirements during clinical placement.

“…there is a challenge because we do not have enough time. Always no time for us to submit papers, to complete assessment tools, and some nurses, they don’t help us. I think we need more time to get more experiences and do more procedures, reduce the paperwork that we have to submit. These are challenges …” (P14).

There were expectations that the students should be able to carry out their nursing duties without becoming ill or adversely affected. In addition, many students reported that the clinical environment was completely different from the skills laboratory at the college. Exposure to the clinical setting added to the theory-practice gap, and in some instances, the students fell ill.

One student made the following comment:

“I was assisting a doctor with a dressing, and the sight and smell from the oozing wound was too much for me. I was nauseated. As soon as the dressing was done, I ran to the bathroom and threw up. I asked myself… how will I survive the next 3 years of nursing?” (P14).

Theme 3: learning to cope

The study participants indicated that they used coping mechanisms (both positive and negative) to adapt to and manage the stressors in their first clinical practicum. Important strategies that were reportedly used to cope with stress were time management, good preparation for clinical practice, and positive thinking as well as engaging in physical activity and self-motivation.

“Time management. Yes, it is important. I was encouraging myself. I used time management and prepared myself before going to the clinical site. Also, eating good food like cereal…it helps me very much in the clinic” (P28).

“Oh yeah, for sure positive thinking. In the hospital, I always think positively. Then, after coming home, I get [to] rest and think about positive things that I can do. So, I will think something good [about] these things, and then I will be relieved of stress” (P21).

Other strategies commonly reported by the participants were managing their breathing (e.g., taking deep breaths, breathing slowly), taking breaks to relax, and talking with friends about the problems they encountered.

“I prefer to take deep breaths and breathe slowly and to have a cup of coffee and to talk to my friends about the case or the clinical preceptor and what made me sad so I will feel more relaxed” (P16).

“Maybe I will take my break so I feel relaxed and feel better. After clinical training, I go directly home and take a long shower, going over the day. I will not think about anything bad that happened that day. I just try to think about good things so that I forget the stress” (P27).

“Yes, my first clinical training was not easy. It was difficult and made me stressed out…. I felt that it was a very difficult time for me. I thought about leaving nursing” (P7).

I was not able to offer my prayers. For me, this was distressing because as a Muslim, I pray regularly. Now, my prayer time is pushed to the end of the shift” (P11).

“When I feel stress, I talk to my friends about the case and what made me stressed. Then I will feel more relaxed” (P26).

Self-support or self-motivation through positive self-talk was also used by the students to cope with stress.

“Yes, it is difficult in the first clinical training. When I am stress[ed], I go to the bathroom and stand in the front of the mirror; I talk to myself, and I say, “You can do it,” “you are a great student.” I motivate myself: “You can do it”… Then, I just take breaths slowly several times. This is better than shouting or crying because it makes me tired” (P11).

Other participants used physical activity to manage their stress.

“How do I cope with my stress? Actually, when I get stressed, I will go for a walk on campus” (P4).

“At home, I will go to my room and close the door and start doing my exercises. After that, I feel the negative energy goes out, then I start to calm down… and begin my clinical assignments” (P21).

Both positive and negative coping strategies were utilized by the students. Some participants described using negative coping strategies when they encountered stress during their clinical practice. These negative coping strategies included becoming irritable and angry, eating too much food, drinking too much coffee, and smoking cigarettes.

“…Negative adaptation? Maybe coping. If I am stressed, I get so angry easily. I am irritable all day also…It is negative energy, right? Then, at home, I am also angry. After that, it is good to be alone to think about my problems” (P12).

“Yeah, if I…feel stress or depressed, I will eat a lot of food. Yeah, ineffective, like I will be eating a lot, drinking coffee. Like I said, effective, like I will prepare myself and do breathing, ineffective, I will eat a lot of snacks in between my free time. This is the bad side” (P16).

“…During the first clinical practice? Yes, it was a difficult experience for us…not only me. When stressed, during a break at the hospital, I will drink two or three cups of coffee… Also, I smoke cigarettes… A lot. I can drink six cups [of coffee] a day when I am stressed. After drinking coffee, I feel more relaxed, I finish everything (food) in the refrigerator or whatever I have in the pantry, like chocolates, chips, etc” (P23).

These supporting excerpts for each theme and the analysis offers valuable insights into the specific stressors faced by nursing students during their first clinical practicum. These insights will form the basis for the development of targeted interventions and supportive mechanisms within the clinical training curriculum to better support students’ adjustment and well-being during clinical practice.

Our study identified the stressors students encounter in their first clinical practicum and the coping strategies, both positive and negative, that they employed. Although this study emphasizes the importance of clinical training to prepare nursing students to practice as nurses, it also demonstrates the correlation between stressors and coping strategies.The content analysis of the first theme, managing expectations, paves the way for clinical agencies to realize that the students of today will be the nurses of tomorrow. It is important to provide a welcoming environment where students can develop their identities and learn effectively. Additionally, clinical staff should foster an environment of individualized learning while also assisting students in gaining confidence and competence in their repertoire of nursing skills, including critical thinking, problem solving and communication skills [ 8 , 15 , 19 , 30 ]. Another challenge encountered by the students in our study was that they were prevented from participating in clinical procedures by some nurses or patients. This finding is consistent with previous studies reporting that key challenges for students in clinical learning include a lack of clinical support and poor attitudes among clinical staff and instructors [ 31 ]. Clinical staff with positive attitudes have a positive impact on students’ learning in clinical settings [ 32 ]. The presence, supervision, and guidance of clinical instructors and the assistance of clinical staff are essential motivating components in the clinical learning process and offer positive reinforcement [ 30 , 33 , 34 ]. Conversely, an unsupportive learning environment combined with unwelcoming clinical staff and a lack of sense of belonging negatively impact students’ clinical learning [ 35 ].

The sources of stress identified in this study were consistent with common sources of stress in clinical training reported in previous studies, including the attitudes of some staff, students’ status in their clinical placement and educational factors. Nursing students’ inexperience in the clinical setting and lack of social and emotional experience also resulted in stress and psychological difficulties [ 36 ]. Bhurtun et al. [ 33 ] noted that nursing staff are a major source of stress for students because the students feel like they are constantly being watched and evaluated.

We also found that students were concerned about potential failure when working with patients during their clinical training. Their fear of failure when performing clinical procedures may be attributable to low self-confidence. Previous studies have noted that students were concerned about injuring patients, being blamed or chastised, and failing examinations [ 37 , 38 ]. This was described as feeling “powerless” in a previous study [ 7 , 12 ]. In addition, patients’ attitudes towards “rejecting” nursing students or patients’ refusal of their help were sources of stress among the students in our study and affected their self-confidence. Self-confidence and a sense of belonging are important for nurses’ personal and professional identity, and low self-confidence is a problem for nursing students in clinical learning [ 8 , 39 , 40 ]. Our findings are consistent with a previous study that reported that a lack of self-confidence was a primary source of worry and anxiety for nursing students and affected their communication and intention to leave nursing [ 41 ].

In the second theme, our study suggests that students encounter a theory-practice gap in clinical settings, which creates confusion and presents an additional stressors. Theoretical and clinical training are complementary elements of nursing education [ 40 ], and this combination enables students to gain the knowledge, skills, and attitudes necessary to provide nursing care. This is consistent with the findings of a previous study that reported that inconsistencies between theoretical knowledge and practical experience presented a primary obstacle to the learning process in the clinical context [ 42 ], causing students to lose confidence and become anxious [ 43 ]. Additionally, the second theme, the theory-practice gap, authenticates Safian et al.’s [ 5 ] study of the theory-practice gap that exists United Arab Emirates among nursing students as well as the need for more supportive clinical faculty and the extension of clinical hours. The need for better time availability and time management to complete clinical tasks were also reported by the students in the study. Students indicated that they had insufficient time to complete clinical activities because of the volume of coursework and assignments. Our findings support those of Chaabane et al. [ 15 ]. A study conducted in Saudi Arabia [ 44 ] found that assignments and workload were among the greatest sources of stress for students in clinical settings. Effective time management skills have been linked to academic achievement, stress reduction, increased creativity [ 45 ], and student satisfaction [ 46 ]. Our findings are also consistent with previous studies that reported that a common source of stress among first-year students was the increased classroom workload [ 19 , 47 ]. As clinical assignments and workloads are major stressors for nursing students, it is important to promote activities to help them manage these assignments [ 48 ].

Another major challenge reported by the participants was related to communicating and interacting with other nurses and patients. The UAE nursing workforce and population are largely expatriate and diverse and have different cultural and linguistic backgrounds. Therefore, student nurses encounter difficulty in communication [ 49 ]. This cultural diversity that students encounter in communication with patients during clinical training needs to be addressed by curriculum planners through the offering of language courses and courses on cultural diversity [ 50 ].

Regarding the third and final theme, nursing students in clinical training are unable to avoid stressors and must learn to cope with or adapt to them. Previous research has reported a link between stressors and the coping mechanisms used by nursing students [ 51 , 52 , 53 ]. In particular, the inability to manage stress influences nurses’ performance, physical and mental health, attitude, and role satisfaction [ 54 ]. One such study suggested that nursing students commonly use problem-focused (dealing with the problem), emotion-focused (regulating emotion), and dysfunctional (e.g., venting emotions) stress coping mechanisms to alleviate stress during clinical training [ 15 ]. Labrague et al. [ 51 ] highlighted that nursing students use both active and passive coping techniques to manage stress. The pattern of clinical stress has been observed in several countries worldwide. The current study found that first-year students experienced stress during their first clinical training [ 35 , 41 , 55 ]. The stressors they encountered impacted their overall health and disrupted their clinical learning. Chaabane et al. [ 15 ] reported moderate and high stress levels among nursing students in Bahrain, Egypt, Iraq, Jordan, Oman, Pakistan, Palestine, Saudi Arabia, and Sudan. Another study from Bahrain reported that all nursing students experienced moderate to severe stress in their first clinical placement [ 56 ]. Similarly, nursing students in Spain experienced a moderate level of stress, and this stress was significantly correlated with anxiety [ 30 ]. Therefore, it is imperative that pastoral systems at the university address students’ stress and mental health so that it does not affect their clinical performance. Faculty need to utilize evidence-based interventions to support students so that anxiety-producing situations and attrition are minimized.

In our study, students reported a variety of positive and negative coping mechanisms and strategies they used when they experienced stress during their clinical practice. Positive coping strategies included time management, positive thinking, self-support/motivation, breathing, taking breaks, talking with friends, and physical activity. These findings are consistent with those of a previous study in which healthy coping mechanisms used by students included effective time management, social support, positive reappraisal, and participation in leisure activities [ 57 ]. Our study found that relaxing and talking with friends were stress management strategies commonly used by students. Communication with friends to cope with stress may be considered social support. A previous study also reported that people seek social support to cope with stress [ 58 ]. Some students in our study used physical activity to cope with stress, consistent with the findings of previous research. Stretching exercises can be used to counteract the poor posture and positioning associated with stress and to assist in reducing physical tension. Promoting such exercise among nursing students may assist them in coping with stress in their clinical training [ 59 ].

Our study also showed that when students felt stressed, some adopted negative coping strategies, such as showing anger/irritability, engaging in unhealthy eating habits (e.g., consumption of too much food or coffee), or smoking cigarettes. Previous studies have reported that high levels of perceived stress affect eating habits [ 60 ] and are linked to poor diet quality, increased snacking, and low fruit intake [ 61 ]. Stress in clinical settings has also been linked to sleep problems, substance misuse, and high-risk behaviors’ and plays a major role in student’s decision to continue in their programme.

Implications of the study

The implications of the study results can be grouped at multiple levels including; clinical, educational, and organizational level. A comprehensive approach to addressing the stressors encountered by nursing students during their clinical practicum can be overcome by offering some practical strategies to address the stressors faced by nursing students during their clinical practicum. By integrating study findings into curriculum planning, mentorship programs, and organizational support structures, a supportive and nurturing environment that enhances students’ learning, resilience, and overall success can be envisioned.

Clinical level

Introducing simulation in the skills lab with standardized patients and the use of moulage to demonstrate wounds, ostomies, and purulent dressings enhances students’ practical skills and prepares them for real-world clinical scenarios. Organizing orientation days at clinical facilities helps familiarize students with the clinical environment, identify potential stressors, and introduce interventions to enhance professionalism, social skills, and coping abilities Furthermore, creating a WhatsApp group facilitates communication and collaboration among hospital staff, clinical tutors, nursing faculty, and students, enabling immediate support and problem-solving for clinical situations as they arise, Moreover, involving chief nursing officers of clinical facilities in the Nursing Advisory Group at the Department of Nursing promotes collaboration between academia and clinical practice, ensuring alignment between educational objectives and the needs of the clinical setting [ 62 ].

Educational level

Sharing study findings at conferences (we presented the results of this study at Sigma Theta Tau International in July 2023 in Abu Dhabi, UAE) and journal clubs disseminates knowledge and best practices among educators and clinicians, promoting awareness and implementation of measures to improve students’ learning experiences. Additionally we hold mentorship training sessions annually in January and so we shared with the clinical mentors and preceptors the findings of this study so that they proactively they are equipped with strategies to support students’ coping with stressors during clinical placements.

Organizational level

At the organizational we relooked at the available student support structures, including counseling, faculty advising, and career advice, throughout the nursing program emphasizing the importance of holistic support for students’ well-being and academic success as well as retention in the nursing program. Also, offering language courses as electives recognizes the value of communication skills in nursing practice and provides opportunities for personal and professional development.

For first-year nursing students, clinical stressors are inevitable and must be given proper attention. Recognizing nursing students’ perspectives on the challenges and stressors experienced in clinical training is the first step in overcoming these challenges. In nursing schools, providing an optimal clinical environment as well as increasing supervision and evaluation of students’ practices should be emphasized. Our findings demonstrate that first-year nursing students are exposed to a variety of different stressors. Identifying the stressors, pressures, and obstacles that first-year students encounter in the clinical setting can assist nursing educators in resolving these issues and can contribute to students’ professional development and survival to allow them to remain in the profession. To overcome stressors, students frequently employ problem-solving approaches or coping mechanisms. The majority of nursing students report stress at different levels and use a variety of positive and negative coping techniques to manage stress.

The present results may not be generalizable to other nursing institutions because this study used a purposive sample along with a qualitative approach and was limited to one university in the Middle East. Furthermore, the students self-reported their stress and its causes, which may have introduced reporting bias. The students may also have over or underreported stress or coping mechanisms because of fear of repercussions or personal reasons, even though the confidentiality of their data was ensured. Further studies are needed to evaluate student stressors and coping now that measures have been introduced to support students. Time will tell if these strategies are being used effectively by both students and clinical personnel or if they need to be readdressed. Finally, we need to explore the perceptions of clinical faculty towards supervising students in their first clinical practicum so that clinical stressors can be handled effectively.

Data availability

The data sets are available with the corresponding author upon reasonable request.

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The authors are grateful to all second year nursing students who voluntarily participated in the study.

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Jacqueline Maria Dias, Muhammad Arsyad Subu, Nabeel Al-Yateem, Fatma Refaat Ahmed, Syed Azizur Rahman, Mini Sara Abraham, Sareh Mirza Forootan, Farzaneh Ahmad Sarkhosh & Fatemeh Javanbakh

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JMD conceptualized the idea and designed the methodology, formal analysis, writing original draft and project supervision and mentoring. MAS prepared the methodology and conducted the qualitative interviews and analyzed the methodology and writing of original draft and project supervision. NY, FRA, SAR, MSA writing review and revising the draft. SMF, FAS, FJ worked with MAS on the formal analysis and prepared the first draft.All authors reviewed the final manuscipt of the article.

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Dias, J.M., Subu, M.A., Al-Yateem, N. et al. Nursing students’ stressors and coping strategies during their first clinical training: a qualitative study in the United Arab Emirates. BMC Nurs 23 , 322 (2024). https://doi.org/10.1186/s12912-024-01962-5

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Mindfulness and Leadership: Communication as a Behavioral Correlate of Leader Mindfulness and Its Effect on Follower Satisfaction

Johannes f. w. arendt.

1 Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany

Armin Pircher Verdorfer

2 TUM School of Management, Technical University of Munich, Munich, Germany

Katharina G. Kugler

In recent years, the construct of mindfulness has gained growing attention in psychological research. However, little is known about the effects of mindfulness on interpersonal interactions and social relationships at work. Addressing this gap, the purpose of this study was to investigate the role of mindfulness in leader–follower relationships. Building on prior research, we hypothesize that leaders’ mindfulness is reflected in a specific communication style (“mindfulness in communication”), which is positively related to followers’ satisfaction with their leaders. We used nested survey data from 34 leaders and 98 followers from various organizations and tested mediation hypotheses using hierarchical linear modeling. Our hypotheses were confirmed by our data in that leaders’ self-reported mindfulness showed a positive relationship with several aspects of followers’ satisfaction. This relationship was fully mediated by leaders’ mindfulness in communication as perceived by their followers. Our findings emphasize the potential value of mindfulness in workplace settings. They provide empirical evidence for a positive link between leaders’ dispositional mindfulness and the wellbeing of their followers, indicating that mindfulness is not solely an individual resource but also fosters interpersonal skills. By examining leaders’ mindfulness in communication as an explanatory process, we created additional clarification about how leaders’ mindfulness relates to followers’ perceptions, offering a promising starting point for measuring behavioral correlates of leader mindfulness.

Introduction

In the last decades, the construct of mindfulness, an open, non-judging awareness of the current experience ( Baer, 2003 ), has received growing attention in psychological research (for overviews see Brown et al., 2015 ; Creswell, 2017 ; Good et al., 2016 ). While the bulk of research on mindfulness has been conducted in the field of health sciences, less attention has been devoted to the work context. In recent years, however, a number of researchers have started to explore whether, how, and to what degree individuals can benefit from mindfulness in the work environment (for an overview see Good et al., 2016 ). This research has mostly focused on positive intrapersonal effects (i.e., effects within individuals) of mindfulness, for instance on employee wellbeing ( Roche et al., 2014 ; Schultz et al., 2014 ; Reb et al., 2015a ; Malinowski and Lim, 2015 ), emotion regulation ( Hülsheger et al., 2013 ), psychological detachment from work ( Hülsheger et al., 2014 ), and job performance ( Dane, 2011 ; Dane and Brummel, 2013 ; Reb et al., 2015a ), while studies on interpersonal effects (i.e., effects between individuals) are just beginning to emerge. This is reflected in the recent call by Good et al. (2016) , stating that “research in neuropsychology, cognitive psychology, medicine, and related disciplines has laid the groundwork for developing and testing theory about how mindfulness might affect relational processes, such as teamwork and leadership, but management scholars have not yet seriously undertaken that challenge” (p. 127).

The present research attempts to address this call by focusing on the relationship between leaders and followers. While some theoretical work has addressed the potential role of mindfulness in the leadership process (e.g., Glomb et al., 2011 ; Sauer and Kohls, 2011 ; Sauer et al., 2011 ), empirical evidence is scant. Two studies reported by Reb et al. (2014) provided first evidence for a positive effect of leaders’ mindfulness on follower wellbeing and work performance. Similarly, Reb et al. (2018) found a positive relationship between leader mindfulness and followers’ reports of leader–member (LMX) quality. These studies, however, did not investigate how leaders’ mindfulness manifests in actual behaviors that influence their interactions. Thus, the specific mechanisms and “behavioral correlates” of leaders’ mindfulness as well as its effects remain unclear and are yet to be explored. Against this backdrop, the main purpose of the present research is to enhance our understanding of the underlying behavioral mechanisms linking leaders’ mindfulness to follower outcomes. We adopt a communication-centered view of leadership ( de Vries et al., 2010 ; Fairhurst and Connaughton, 2014 ; Ruben and Gigliotti, 2016 ) and propose that leaders’ mindfulness relates to a specific communication style of leaders that we term “mindfulness in communication.” This communication style, in turn, is assumed to predict followers’ interaction satisfaction as well as their overall satisfaction with the leader.

Overall, there are several reasons why exploring the interpersonal effects of leaders’ mindfulness in more detail is enriching and worthwhile, thus offering valuable contributions to the pertinent literature. First, we contribute to the emerging literature on mindfulness at work, especially with regard to its interpersonal qualities. By examining the relationship between leader mindfulness and actual leader behaviors, we identify interesting and compelling relations that help us better understand the mechanisms that carry the effects of leader mindfulness to employees ( Good et al., 2016 ; Sutcliffe et al., 2016 ). Second, we contribute to the literature on leader communication by exploring the assumption that mindfulness may serve as a determinant of a more successful communication style. Related to this, by introducing a behavioral measure of mindfulness in communication, we add to a more thorough understanding of effective leader communication repertoires ( Sager, 2008 ; de Vries et al., 2010 ).

Mindfulness

Given the heterogeneous strands of research on mindfulness, definitions of the construct vary. However, most definitions share two key elements: attention and acceptance ( Bishop et al., 2004 ). Specifically, with regard to these key elements, mindfulness means fully paying attention to what is happening in the present moment, both to internal (i.e., emotions and thoughts) and external stimuli with an open, non-judging attitude. Accordingly, Baer (2003) defined mindfulness as “the non-judgmental observation of the ongoing stream of internal and external stimuli as they arise” (p. 125). At this point, however, it is important to emphasize that the non-judgmental aspect of mindfulness does not imply that mindful individuals do not make any judgments at all. It rather refers to the ability to pay attention and to equanimously observe the current experience instead of getting carried away by the own immediate reactions ( Dreyfus, 2011 ). Thus, the non-judgmental attitude should not be misunderstood as being indifferent or aloof, but it describes a form of equanimity which allows individuals to act cautiously instead of react reflexively. In connection with this, a key process of mindfulness, postulated by various scholars, is the ability to mentally “step back” from one’s own experiences which allows an individual “to observe rather than to identify with thoughts and emotions” ( Hülsheger et al., 2014 , p. 2). This process has been labeled as reperceiving ( Shapiro et al., 2006 ) or decentering ( Hayes et al., 2004 ), both referring to a shift of perspective leading to the experience of thoughts and emotions as transient mental states and not as aspects of the self.

The conceptual roots of mindfulness are usually ascribed to centuries-old eastern and Buddhist contemplative traditions ( Baer, 2003 ; Brown and Ryan, 2003 ) and a large body of research is still influenced by a Buddhist understanding of mindfulness. Some scholars (e.g., Dreyfus, 2011 ; Grossman, 2011 ; Quaglia et al., 2015 ; Purser and Milillo, 2015 ) even doubt whether it is suitable, in general, to investigate mindfulness detached from mindfulness practice and its cultural roots. They object that the current approaches in Western psychology and the conceptualization of mindfulness as a bare, non-judgmental awareness of the current experience do not fully live up to the true nature and complexity of the “original” Buddhist concept of mindfulness (for a reply to Grossman, 2011 , see Brown et al., 2011 ). However, this criticism is countered by a growing body of research that views mindfulness as “an inherent human capacity” ( Kabat-Zinn, 2003 , p. 146) varying between and within individuals ( Brown et al., 2011 ), which can be investigated detached from Buddhism and mindfulness practice ( Brown and Ryan, 2004 ; Brown et al., 2007 , 2011 ). Related to this, it is helpful to know that mindfulness has been studied from both a state- and a trait-perspective, depending on the research focus ( Hülsheger et al., 2014 ). Scholars have used the term state mindfulness for the extent to which an individual is paying attention to what is happening in the present moment with an open, non-judging attitude. At the same time, however, research has consistently recognized that the average frequency and intensity with which individuals experience states of mindfulness varies between individuals, suggesting that there is a trait-like tendency toward mindful states ( Brown and Ryan, 2003 ; Glomb et al., 2011 ; Hülsheger et al., 2013 ; Jamieson and Tuckey, 2017 ; Mesmer-Magnus et al., 2017 ). Accordingly, it is well-established in the pertinent literature to use the terms dispositional mindfulness or trait-mindfulness to describe this tendency (e.g., Chiesa, 2013 ; Good et al., 2016 ; Mesmer-Magnus et al., 2017 ) and to employ self-report measures for its assessment ( Bergomi et al., 2013 ; Sauer et al., 2013b ). Longitudinal studies revealed a significant and positive association between individuals’ overall dispositional mindfulness scores and state mindfulness scores, assessed in their regular day-to-day lives ( Brown and Ryan, 2003 ; Hülsheger et al., 2013 , 2014 , 2015 ). Also, there is solid evidence that dispositional mindfulness can be increased by mindfulness practice such as mindfulness meditation or other mindfulness-based interventions (for meta-analytic evidence see Eberth and Sedlmeier, 2012 ; Cavanagh et al., 2014 ; Quaglia et al., 2016 ).

Against this background, the focus of our study is on self-reported dispositional mindfulness and its effects on the outcome variables under investigation. This is in line with previous research on leader–employee relations that “reflect experiences and behaviors over extended time periods, making a state-level approach less suitable” ( Reb et al., 2018 , p. 2). For the sake of simplicity, we herein use the term mindfulness (or mindful leaders) to describe those higher in self-reported dispositional mindfulness.

Mindfulness and Leadership

In organizational research, scholars have mainly focused on intrapersonal effects of mindfulness and mindfulness-based interventions (e.g., Hülsheger et al., 2014 , 2015 ; Roche et al., 2014 ; Shonin et al., 2014 ), whereas the effects of mindfulness on interpersonal interactions and relationships have been largely neglected ( Good et al., 2016 ). However, it is the interpersonal relationship between the leader and the followers which is at the core of leadership ( Northouse, 2013 ) and thus, especially interesting for research in this area. Yet, only a few theoretical papers have so far addressed the role of mindfulness in leader–follower relationships ( Glomb et al., 2011 ; Sauer and Kohls, 2011 ), examining the possibility that mindfulness generally helps leader better deal with various demands of leadership. Yet, as mentioned at the outset of this article, empirical evidence in this area is at a rather early stage. In two studies, Reb et al. (2014) found that followers of leaders scoring high on dispositional mindfulness reported higher levels on different aspects of wellbeing and job performance. These studies identified psychological need satisfaction as a mediator in the relationship between self-reported dispositional mindfulness of the leader and follower outcomes. In a similar vein, in a very recent study, Reb et al. (2018) found a positive relationship between leader mindfulness and follower reports of LMX quality. This effect was mediated by reduced employee stress and perceptions of increased interpersonal justice. Importantly, psychological need satisfaction and reduced stress describe internal states of followers. Also, while interpersonal justice refers to perceived fair treatment, Reb et al. (2018) conceptualized and measured it as a rather subjective assessment and therefore, the question of what behaviors mindful leaders actually show remain largely unanswered in their studies.

Leadership and Communication

In the present study, we expand prior research by investigating how leader mindfulness may be reflected in visible leader behaviors, which, in turn, are expected to positively affect employee satisfaction. Specifically, we draw on a communication perspective of leadership ( Fairhurst and Connaughton, 2014 ; Ruben and Gigliotti, 2016 ) and propose that the answer can be partly found in how leaders communicate, as perceived by followers. In fact, leadership is inherently about influencing others ( Yukl, 2010 ; Northouse, 2013 ) and accordingly, the notion that communication is central to leadership is well established in leadership research. Organizational behavior researchers typically study leadership communication from a transmissional perspective [see Fairhurst and Connaughton (2014) for a detailed discussion of this issue], describing it in terms of “the intentional creation of messages with particular influence outcomes in mind” ( Ruben and Gigliotti, 2016 , p. 470). In particular, approaches of transformational and charismatic leadership have portrayed effective leaders as effective communicators, who convey an inspiring vision and high performance expectations to their followers ( Antonakis, 2012 ). At the same time, research in this field has emphasized that the nature of leadership as an influencing process is neither leader-centric nor follower-centric but relational ( Uhl-Bien et al., 2012 ; Fairhurst and Connaughton, 2014 ). That means that communication in leadership is not adequately conceptualized as a linear process, in which intentional messages simply flow in a straight and predictable line from the leader to the follower. Rather, leaders and followers continuously interact and communicate reciprocally. This is also reflected in the literature on LMX quality. Whereas high-quality relationships are characterized by cooperative communication, lower quality relationships reflect more traditional supervision with one-sided top-down communication, including higher levels of interpersonal dominance and autocratic decision-making ( Sparrowe et al., 2006 ). That being said, and given the inherent power differential associated with most leader–follower relationships ( Dulebohn et al., 2012 ), the way leaders shape their communication with followers is pivotal for fostering relationship quality and relevant work outcomes, such as followers’ satisfaction, commitment, and performance ( Penley et al., 1991 ; Fix and Sias, 2006 ; Abu Bakar et al., 2010 ). Based on this, we below develop the argument that mindfulness enables leaders to engage in a more successful communication style.

Mindfulness and Leader Communication

Following de Vries et al. (2010) a leader’s communication style represents a “distinctive set of interpersonal communicative behaviors” (p. 368). Mindfulness, with its inherent focus on being present and non-judgmental, seems particularly suitable for promoting the quality of communication. Specifically, we assume mindfulness to be related to specific communication behaviors that we term mindfulness in communication . Drawing on the mindfulness literature, we propose that mindfulness in communication consists of three facets: (a) being present and paying attention in conversations, (b) an open, non-judging attitude, and (c) a calm, non-impulsive manner. These features inherently reflect interpersonal attunement ( Parker et al., 2015 ) and thereby fit well with a relational view of communication in leadership, in which influence is understood to result from interaction ( Ruben and Gigliotti, 2016 ). In what follows, we provide a detailed rationale for our assumption that leader dispositional mindfulness is reflected in these three facets of mindfulness in communication.

First, an inherent element of mindfulness is presence, referring to “the bare awareness of the receptive spaciousness of our mind” ( Siegel, 2007 , p. 160). With this, the link to communication is straightforward: bare awareness, or the conscious and “direct experience of here-and-now sensory information” ( Parker et al., 2015 , p. 226) is expected to result in a high level of attention in interactions. Individuals who are able to focus on the immediate now are not distracted by thoughts and rumination concerning past or future events. This, in turn, is an important prerequisite for effective listening ( Brownell, 1985 ). The importance of listening for effective leader–follower communication has been stressed by several scholars ( Bechler and Johnson, 1995 ; Johnson and Bechler, 1998 ; Alvesson and Sveningsson, 2003 ; van Vuuren et al., 2007 ). In a survey of van Vuuren et al. (2007) , for example, listening was shown to be the second most important factor of leader communication style for follower commitment. Furthermore, there is empirical evidence that careful listening is associated with transformational leadership ( Berson and Avolio, 2004 ) and effective interpersonal influence ( Ames et al., 2012 ). Also, a qualitative study conducted by Alvesson and Sveningsson (2003) revealed that leaders themselves consider listening a central feature of their role. Empirical support for the notion that leaders’ dispositional mindfulness may translate into improved listening skills comes from several studies linking dispositional mindfulness and mindfulness trainings to reduced rumination and improved attentional performance (e.g., Chambers et al., 2008 ; Jensen et al., 2012 ; Flook et al., 2013 ; Roeser et al., 2013 ). Moreover, an intervention study conducted by Beckman et al. (2012) showed that physicians who participated in a communication training, which included mindfulness meditation, reported that mindfulness improved their abilities to be attentive and to better listen to their patients.

The second rationale for linking leader mindfulness to leader communication style is based on the second essential feature of mindfulness, namely acceptance. Acceptance refers to “being experientially open to the reality of the present moment” ( Bishop et al., 2004 , p. 233), “without being swept up by judgments” ( Parker et al., 2015 , p. 226). This non-judgmental, present-centered awareness may help leaders to keep an open mind in interactions with their followers and to be open to other perspectives and opinions without rashly evaluating and categorizing incoming information. By paying attention in a non-judgmental manner, mindful individuals (i.e., leaders) are better able “to retain information and thus see their true significance rather than being carried away by their reactions” ( Dreyfus, 2011 , p. 47). In this understanding, mindful leaders are not free of making judgments and evaluations. However, before doing so, they give their followers the opportunity to fully communicate their message and let their attention not be influenced by automatic reactions and rash interpretations.

The third rationale refers to research linking mindfulness to effective emotion regulation ( Chambers et al., 2009 ; Heppner et al., 2015 ). Accounting for this effect, scholars have consistently referred to the process of reperceiving ( Shapiro et al., 2006 ) or decentering ( Hayes et al., 2004 ) and argued that mindfulness permits individuals to disidentify from their emotions and experience them as transient cognitive events rather than aspects of their self and thus as less threatening. There is robust empirical evidence that mindfulness is associated with lower levels of negative affect and higher levels of positive affect ( Baer et al., 2006 ; Luberto et al., 2014 ; Pepping et al., 2014 ; Prakash et al., 2015 ). Accordingly, mindfulness enables leaders to better deal with negative affective states and stressful events. In terms of communication, better emotion regulation should be reflected in an increased ability to maintain composure in tense situations instead of being overwhelmed by emotions.

Empirical support for the assumed relation of mindfulness and communication behavior comes from marital and family research ( O’Kelly and Collard, 2012 ). Several studies in this area found a positive relationship between mindfulness and outcomes pertaining to communication quality among couples, such as perspective taking and empathic concern ( Block-Lerner et al., 2007 ), constructive conflict ( Barnes et al., 2007 ), and mutual acceptance ( Carson et al., 2004 ). Moreover, Krasner et al. (2009) designed and evaluated a communication training for primary care physicians that included mindfulness meditation (see also Beckman et al., 2012 ). After the training, participants demonstrated improvements in dispositional mindfulness and, importantly, perspective taking when relating to patients.

Taken together, we propose that leaders’ dispositional mindfulness is positively related to specific communication behaviors ( mindfulness in communication) , as perceived by their followers.

• simple  Hypothesis 1 : Leaders’ dispositional mindfulness is positively related to specific communication behaviors – i.e., “mindfulness in communication.”

Leader Mindfulness, Mindfulness in Communication, and Follower Satisfaction

In this section, we develop the argument that leaders’ dispositional mindfulness has positive effects on followers’ outcomes mediated by mindfulness in communication. Most notably, as a very proximal outcome, we explore the degree to which followers are satisfied with the communication with their leader. Thereby, we assume all three components of mindfulness in communication (i.e., paying attention, being open and non-judgmental, and a calm, non-impulsive manner) to be important for how followers perceive the communication with their leaders.

According to Thayer (1968) , individuals experience satisfaction with the communication when communication is perceived as successful. Following Ruben and Gigliotti (2016) , who state that, “leadership communication always has both content and relational consequences” (p. 476), successful communication refers to the quality and accuracy of information transmission (i.e., content consequences) as well as to the fulfillment of personal needs, aspirations, and expectations of the involved agents (i.e., relational consequences). Leaders’ mindfulness in communication is likely to foster followers’ satisfaction on the content level because less information gets lost between “sender” and “receiver” and the information is processed in a less biased manner. This assumption is supported by various empirical findings, linking mindfulness to increased attention focus and less attentional biases (e.g., Chambers et al., 2008 ; Flook et al., 2013 ; Roeser et al., 2013 ). With regard to the relational level, we follow Reb et al. (2014) and draw on self-determination theory (SDT; Deci and Ryan, 2000 ; Ryan and Deci, 2000 ), implying that leaders who communicate mindfully can help satisfy the basic needs of followers, which results in increased satisfaction ( Deci et al., 2017 ).

The need for autonomy describes the desire to be in control of one’s environment. One way for leaders to help ensure that followers experience some level of control is to provide voice, listen attentively, and treat requests seriously ( Folger and Cropanzano, 1998 ). By paying full attention and listening to their followers, leaders signalize that they are open to the input of their followers and are serious about what they have to say ( Ashford et al., 2009 ). Furthermore, by showing an open and non-judgmental attitude, leaders signal that they are willing to see things from their followers’ perspective and offer them voice-opportunities ( Ashford et al., 2009 ; Lloyd et al., 2015 ), which enables followers to address and openly speak about organizational problems.

In a similar vein, mindfulness in communication is likely to satisfy followers’ need of competence, which refers to feelings of growth, ability, and achievement. Specifically, through paying full attention and a high degree of acceptance and calmness, leaders show their followers that their opinion and viewpoints are regarded as important and worthwhile to consider, reflecting genuine appreciation of their strengths and unique abilities ( Van Quaquebeke and Felps, 2016 ; Deci et al., 2017 ).

Finally, individuals, who have their relatedness need met, feel secure and safe in their environment and in their relationships with others. When leaders are fully paying attention with an accepting, non-judging attitude, they are likely to generate a feeling of being valued and respected in of their followers ( Reb et al., 2014 ). Furthermore, this kind of leader communication behavior may foster a feeling of psychological safety and intimacy in their followers ( Ashford et al., 2009 ; Lloyd et al., 2015 ) as well as a feeling of being cared about ( Van Quaquebeke and Felps, 2016 ) which has empirically been linked with relatedness ( Reis et al., 2000 ). Thus, leaders’ mindfulness in communication is likely to result in an enhancement of followers’ experience of relatedness.

Given that communication is central to leadership ( Alvesson and Sveningsson, 2003 ; Yukl, 2010 ; Ruben and Gigliotti, 2017 ) this satisfaction is likely to correspond to an increase in overall satisfaction with the leader ( Miles et al., 1996 ). This claim can also be deduced from theory on human affective experiences. Fully present, non-judging leaders who keep calm even in intense situations are likely to elicit positive affective reactions in their followers due to an immediate satisfaction of basic psychological needs. Reversely, non-listening, rashly judging leaders, who easily get worked up are likely to elicit negative affective reactions from their followers. According to affective events theory ( Weiss and Cropanzano, 1996 ), such affective reactions, especially if experienced repeatedly, likely result in generalized satisfaction judgments about the leader. Notably, this notion is reflected in prior research, positioning the way leaders listen and pay attention to what employees have to say as an important facet of employees’ satisfaction with their leader ( Scarpello and Vandenberg, 1987 ). In a similar vein, two studies by Bechler and Johnson (1995) and Johnson and Bechler (1998) showed that the evaluation of leadership skills is positively related to perceived listening skills. Taken together, we predict:

• simple  Hypothesis 2 : Leaders’ mindfulness in communication mediates the positive relationship between leaders’ dispositional mindfulness and (a) their followers’ satisfaction with the communication with the leader and (b) the satisfaction with the leader in general.

Figure 1 shows the hypothesized theoretical model.

Hypothesized theoretical model.

Materials and Methods

We certify that the research presented in this manuscript has been conducted within the DGPs (German Psychological Society) ethical standards regarding research with human participants and scientific integrity. We adhere to the ethical standards of the DGPs, since in Germany there is no legal regulation for approval of research through a research ethics committee for the social sciences, but ethics questions are addressed within a framework by professional associations. Participants were free to not participate and to terminate participation at any time without any consequences or any loss of benefits that the subject was otherwise entitled to receive. All subjects have given written informed consent in accordance with the Declaration of Helsinki.

Sample and Procedures

In order to test our hypotheses, we conducted a multilevel field study. Online surveys were sent to leaders as well as their followers. We assessed leaders’ self-rated dispositional mindfulness on the one hand and followers’ perceptions of leaders’ mindfulness in communication as well as followers’ self-reported satisfaction with the leader (i.e., satisfaction with the leader–follower communication and general satisfaction) on the other hand. The study had a cross-sectional design. Given this design, no causal conclusions can be drawn from our study, which has to be taken into account when interpreting the results.

Followers and their leaders were recruited from various organizations of different industries in Germany, Austria, and the German speaking part of Switzerland by using three different strategies. First, individuals from our personal and professional networks were contacted. Second, we contacted HR departments of various organizations and third, the study was advertised in social networks (mainly XING). Individuals who were interested in participating received a link to the online questionnaire in addition to instructions on how to forward a separate link to their supervisor or followers, respectively. Anonymous identification codes generated by the participants were used to match the data of leaders and followers.

A total of 351 participants (147 leaders and 204 followers) completed the questionnaires. Out of the 204 followers, 141 could be matched to 77 leaders. For 43 leaders, we received responses from one follower only; for 34 leaders, we received responses from more than one follower (ranging from two to six followers, M = 2.88, SD = 1.17). Since we were interested in a general assessment of leaders by their followers, independent of specific biases of single followers, we used only those leaders for our final analysis, for which we had responses of multiple followers (i.e., at least two followers). Thus, the final sample consisted of 98 followers nested in 34 leaders.

In our final sample, 50% of the participants were female, the average age was 37.21 years ( SD = 9.86), and 64% of the participants had a university degree. The sample consisted of individuals from Germany (64%), Austria (28%), Switzerland (5%), and other nationalities (3%). The participants’ average tenure in the organizations was 7.93 years ( SD = 7.52), their average weekly working hours were 42.91 h ( SD = 10.33). Followers’ average tenure with their leaders was 3.18 years ( SD = 3.18), the average interaction frequency between leaders and followers was 11.05 h ( SD = 11.78) per week. Because we were interested in leaders’ mindfulness, we also assessed if they practiced mindfulness meditation in their daily lives: 10 of the 34 leaders of our final sample reported practicing some form of mindfulness meditation. However, we did not assess the amount or the specific nature of the mindfulness practice since this was beyond the scope of the present study.

Dispositional Mindfulness

Leaders’ dispositional mindfulness was measured with the short-version of the Freiburg Mindfulness Inventory ( Walach et al., 2004 , 2006 ). The scale consists of 14 items assessing the frequency of mindful states. A sample item is “I am open to the experience of the present moment”. The items were answered on a 6-point frequency scale (ranging from 1 = never to 6 = almost always ). Cronbach’s alpha was 0.90.

Followers’ Satisfaction With Leader–Follower Communication

In order to measure followers’ satisfaction with leader–follower communication , we used two items from the questionnaire for communication in organizations developed by Sperka (1997) . The two items were “I am content about how the communication with my leader takes place” and “I would like to have a better communication with my leader” (reverse coded). Each follower was asked to rate their own level of satisfaction. Again, a 6-point response scale (ranging from 1 = strongly disagree to 6 = strongly agree ) was employed. The reliability of this measure was estimated by using the Spearman–Brown formula (see the recommendations for the use of two-item scales by Eisinga et al., 2013 ), and was 0.66.

Followers’ General Satisfaction With Their Leaders

Followers’ general satisfaction with their leaders was measured with two items taken from Felfe (2006) . The two items were: “My leader uses methods of leadership that are satisfying” and “My leaders works with me in a satisfactory way.” Responses were given on a 6-point scale, ranging from 1 = strongly disagree to 6 = strongly agree . The reliability of this measure was again estimated by using the Spearman–Brown formula (see the recommendations for the use of two-item scales by Eisinga et al., 2013 ), and was r = 0.84.

Mindfulness in Communication

Since there was no existing scale for what we call mindfulness in communication , we developed a new scale for this study. The purpose of the scale was to assess “behavioral correlates” of leaders’ mindfulness when communicating with followers. Followers were explicitly asked to rate their leaders’ behavior in communication situations. Below, we describe in more detail how the measure was constructed.

Item development and exploratory factor analysis

We first generated 14 items based on a review of the literature addressing mindfulness in leadership ( Glomb et al., 2011 ; Sauer and Kohls, 2011 ; Sauer et al., 2011 ; Reb et al., 2014 ). The items addressed the following three facets of mindfulness in communication: (1) being present and paying attention in conversations, (2) showing an open, non-judging attitude during a conversation, and (3) being calm and non-impulsive during conversations, not becoming overwhelmed by emotional reactions. Second, the content validity was assessed by asking four experts (i.e., experts on mindfulness practice) to rate the items in terms of their conceptual fit. As a result of the expert rating, four items were omitted. The remaining 10 items were included in the questionnaire described above and were answered in total by 204 followers (including followers that could be matched with a leader and followers that could not be matched with a leader and were therefore not considered in the main analyses). For the analyses of the scale and the items, all followers ( N = 204) were included. One item showed a low level of communality (communality = 0.17) and was therefore excluded. With the remaining nine items, an Exploratory Factor Analysis using a principal–axis analysis with Promax rotation was performed. The results suggested one factor with an Eigenvalue > 1 explaining 59% of the variance. The factor loadings, communalities, and standardized item-scale-correlations were satisfactory ( Table 1 ). Therefore, the final scale consists of nine items and shows adequate reliability (α = 0.91) which could not be improved by deleting further items.

Items of the scale “mindfulness in communication” including their factor loadings, communalities, and corrected item-scale-correlations.

Confirmatory factor analysis

Because a new measure of mindfulness in communication was created for this study, we collected data from a separate sample to confirm the construct validity using confirmatory factor analysis (CFA). Specifically, 214 employees from various organizations in Germany completed the newly developed measure. The mean age of the participants was 33.36 ( SD = 8.89); 47% were male and 65% had a university degree. The majority of the participants worked in the for-profit sector (69%) and the average tenure in the current position was 3.92 years ( SD = 3.25).

We conducted a CFA using the Lavaan package in R ( Rosseel, 2012 ) and compared the fit of two nested models. The first one was a single-factor model with all nine items loading on the same factor. The second one was a second-order factor model in which items loaded on their respective factors (i.e., presence, openness, and calmness) and the three factors loaded on a second-order latent mindfulness in communication factor. This second-order factor model showed a reasonable fit with χ 2 = 58.65, df = 24, p < 0.001, comparative fit index (CFI) = 0.96, root mean square error of approximation (RMSEA) = 0.08, SRMR = 0.04 and was clearly preferable over the single-factor model (χ 2 = 219.82, df = 27, p < 0.001, CFI = 0.80, RMSEA = 0.18, SRMR = 0.85; Δχ 2 = 161.17, df = 3, p < 0.001, ΔCFI = 0.16). It should be noted that with three latent factors, the second-order model is mathematically equivalent to a first-order model (i.e., a model in which items load on their respective factors and the factors are allowed to correlate) and thus, both solutions produce identical fit statistics ( Rindskopf and Rose, 1988 ; Hoyle, 2011 ). Yet, since we assumed that a common latent mindfulness in communication factor accounts for the relation between the three subscales (i.e., presence, openness, and calmness), the second-order model represents a more parsimonious and meaningful approach ( Rindskopf and Rose, 1988 ; Chen et al., 2005 ). This supports the use of the combined mindfulness in communication scale (comprising the three sub-facets) in the analysis presented below ( McGartland Rubio et al., 2001 ).

Discriminant validity

To examine the discriminant validity among the follower-related outcome measures that we used in our main study (i.e., perceived mindfulness in communication, satisfaction with the communication with the leader, and general satisfaction with the leader), we again used CFA. For mindfulness in communication, we used parcels as indicators (i.e., the three sub-dimensions, which is in line with the content-based algorithm of parcel building, see Matsunaga, 2008 ). For the two satisfaction constructs, items were used as indicators. Table 2 reports the models we tested. To compare the fit for different models, we used the chi-square difference test. However, given that chi-square tests are very sensitive to sample size and non-normality, even small differences may become statistically significant ( Brannick, 1995 ; Kline, 2011 ). Thus, in line with the recommendations of Chen (2007) , we also relied on the change in CFI and RMSEA. Specifically, for small samples (i.e., N < 300) a change of 0.005 in CFI, supplemented by a change of 0.010 in RMSEA indicates that the models are significantly different. As shown in Table 2 , the proposed three-factor model (Model 1) fitted the data reasonably well and was preferable over all alternative models (Models 2, 3, and 4). Taken together, these results provide evidence that our follower reported measures captured distinct constructs.

Test of measurement models.

Descriptive Statistics

Correlations, means, and standard deviations of all variables are shown in Table 3 [calculated in R using psych ( Revelle, 2016 ); apaTables ( Stanley, 2015 )]. Neither tenure with the leader nor perceived interaction frequency was related to our main variables 1 . In turn, leaders’ dispositional mindfulness was positively correlated with followers’ perceptions of leaders’ mindfulness in communication as well as with the two satisfaction ratings. Also, the correlations between followers’ perceptions of leaders’ mindfulness in communication and the two satisfaction measures were in the expected direction.

Means, standard deviations, ICC(1), ICC(2), and correlations.

Analytic Strategy

Our dataset had a multilevel structure, given that we asked leaders about their level of mindfulness (i.e., independent variable on Level-2), and we asked at least two followers of those leaders about their leaders’ mindfulness in communication and their own satisfaction (i.e., mediator and dependent variable on Level-1). Thus, we first examined the nested structure of our data ( Bliese, 2000 ; LeBreton and Senter, 2008 ) using R ( R Core Team, 2017 ); multilevel ( Bliese, 2016 ). First we examined the variance between the groups of followers reporting to one leader. An ANOVA showed significant differences between the groups of followers. The ICC(1), which is reported in Table 3 , indicated that 24–29% of the variance resided between groups. Second, we examined the agreement within groups of followers reporting to one leader. The ICC(2), which is also shown in Table 3 , indicated an agreement between 0.48 and 0.54. It is helpful to note that ICC(2) is dependent on the group size ( Bliese, 1998 ). In our study, the average group size was 2.8 and ICC(2) values ranging from 0.48 to 0.54 correspond with Bliese’s (1998) estimates about what can be statistically expected.

To test our hypotheses within the multilevel framework, we followed the suggestions for multilevel mediations suggested by ( Zhang et al., 2009 ). Our mediation model reflects a 2–1–1 design ( Zhang et al., 2009 ) with leaders’ dispositional mindfulness representing the Level-2-predictor, perceived leaders’ mindfulness in communication representing the Level-1 mediator, and followers’ satisfaction ratings representing Level-1 outcomes ( Figure 1 ). In 2–1–1 models the within-group effects and between-group effects are confounded ( Zhang et al., 2009 ) – in our case the effect between followers of different leaders on the one hand and within followers of a particular leader on the other hand. To address this problem, Zhang et al. (2009) suggested to differentiate the between and the within group effects by inserting the mediator at both levels in the following way: At Level 1, the mediator is centered around the group mean, specifying the within-group effect. At Level 2, the mediator is aggregated for each group using the group mean in order to specify the between-group effect. In line with these recommendations, we included our mediator variable (i.e., perceived leaders’ mindfulness in communication) at both levels (i.e., group mean centered at Level 1 and aggregated for the followers of a particular leader at Level 2). Because mindfulness in communication was thought to be a characteristic of each leader, we were especially interested in the effect between followers of different leaders and thus, the effect at Level 2. Consequently, the effects within followers (i.e., Level 1) were treated as control variable “only.” Nevertheless, we report the coefficient for both effects (within-groups effects and between-groups effects). Given that we used the aggregated values of mindfulness in communication as our mediator, we calculated the r wg statistic ( James et al., 1984 ) to assess the appropriateness of aggregating [in addition to relying on the ICC(2) value, which was reported above]. The mean r wg for perceived mindfulness in communication was 0.74, indicating strong interrater agreement ( LeBreton and Senter, 2008 ).

The results of the multilevel analysis are reported in Table 4 . All calculations were conducted in R using the packages: multilevel ( Bliese, 2016 ), nlme ( Pinheiro et al., 2017 ), sjmisc / sjstats ( Lüdecke, 2017 ), and reghelper ( Hudghes, 2008 ).

Results of multilevel mediation analyses.

Hypothesis Tests

Supporting Hypothesis 1, leaders’ dispositional mindfulness was positively related to followers’ perceptions of leaders’ mindfulness in communication (see Table 4 , Model 1). In line with Hypotheses 2 and 3, we found that leaders’ dispositional mindfulness was also positively related to both followers’ satisfaction with the leader–follower communication and followers’ general satisfaction with their leaders (see Table 4 , Model 2 and Model 5). In addition, we predicted that these two positive relationships were mediated by leaders’ mindfulness in communication as perceived by the followers. When followers’ satisfaction with the leader–follower communication was regressed on both mindfulness in communication and leaders’ dispositional mindfulness, the relationship with mindfulness in communication was significant whereas the relationship with leaders’ dispositional mindfulness was no longer significant (see Table 4 , Model 4). Using the Monte-Carlo method for assessing indirect effects with 20,000 replications [cf., Selig and Preacher, 2008 ), we found that the mediation was significant (95% bias-corrected bootstrap CI (0.07, 0.52)]. Similarly, when followers’ general satisfaction with their leaders was regressed on both mindfulness in communication and leaders’ dispositional mindfulness, the relationship with mindfulness in communication was significant, whereas the relationship with leaders’ dispositional mindfulness was no longer significant (see Table 4 , Model 7). Using again the Monte-Carlo method for assessing indirect effects with 20,000 replications, we found that the mediation again was significant [95% bias-corrected bootstrap CI (0.06, 0.45)]. In sum, when leaders scored high on dispositional mindfulness their followers perceived them as showing mindfulness in communication, which in turn was positively related to both followers’ satisfaction regarding their communication with the leader and satisfaction with the leader in general.

The aim of the present study was to enhance the understanding of whether and how leaders’ dispositional mindfulness may translate into leader behaviors that relate to follower’s perceptions and satisfaction with their leaders. We hypothesized that leaders’ mindfulness would be positively linked to specific communication behaviors, which we labeled “mindfulness in communication.” In turn, perceived mindfulness in communication was hypothesized to mediate the relationship between leaders’ dispositional mindfulness and followers’ satisfaction regarding the communication with the leader and the leader in general. The results of our empirical study supported our hypotheses.

Contributions and Theoretical Implications

Research on mindfulness in the workplace in general and mindfulness of leaders in particular is still at an early stage and, so far, mainly consists of theoretical considerations (e.g., Glomb et al., 2011 ). By empirically confirming interpersonal effects of mindfulness, the results of the present research have several theoretical implications.

First, our findings provide additional evidence for a positive link between an individual’s (the leader’s) dispositional mindfulness and the wellbeing of other people (their followers), suggesting that mindfulness is not only an internal capital but also aids individuals in interpersonal relations. These results are in line with the findings of Reb et al. (2014) who first provided scientific evidence for such interpersonal effects of mindfulness in leader–follower relationships. Also, our results expand evidence that has been provided in a very recent study by Reb et al. (2018) , in which leader mindfulness predicted follower reports of enhanced LMX quality. With this, our study also contributes more generally to the perennial interest in leadership research regarding the effects of leaders’ affect and emotions on their followers (for reviews see Gooty et al., 2010 ; Rajah et al., 2011 ; Walter et al., 2011 ). Mindfulness, which is assumed to play an important role in emotion regulation, affect, stress, and well-being (cf., Good et al., 2016 ; Lomas et al., 2017 ; Mesmer-Magnus et al., 2017 ), constitutes a concept that is likely to offer new and fruitful insights for research in this area, where the emotional states of individuals have wide-ranging consequences on others.

Second, by examining leaders’ communication style as an underlying mechanism, we take a step forward in clarifying how leaders’ mindfulness may affect their followers. More specifically, we identify a behavioral mechanism – mindfulness in communication – which explains the interpersonal effect of leaders’ mindfulness. The high agreement of multiple followers in their ratings of the leaders’ mindfulness in communication that we found in our data (as indicated by the mean r wg ) suggests that mindfulness fosters a specific communication style, which is relatively stable across situations and followers. This is in line with emerging evidence that leader mindfulness is reflected in specific leadership styles, as perceived by others. Specifically, Pircher Verdorfer (2016) conducted a study which found a positive relationship between leaders’ mindfulness and followers’ perceptions of specific servant leader behaviors, that is, humility, standing back, and authenticity. Interestingly, our notion of mindfulness in communication fits well with these features. In fact, it is plausible that leaders who are mindfully present, accepting, and calm when communication with others signal humility (e.g., being open to different views and opinions of others), the ability to stand back (e.g., not chasing recognition or rewards), and authenticity (e.g., being open about own limitations and weaknesses).

Third, our results indicate that mindfulness in communication is a useful approach that meaningfully adds to previous perspectives in the field of leader communication style. Established instruments, such as the Communication Styles Inventory (CSI) by de Vries et al. (2011) have a strong focus on how information is conveyed (e.g., in terms of preciseness or expressiveness) and whether one is generally supportive versus aggressive or tense when communication with others. With a behavioral measure of mindfulness in communication, we gain a better understanding of genuine interpersonal attunement of leaders that goes beyond the transmission of leadership messages ( Parker et al., 2015 ). Related to this, an interesting implication of our results refers to the relationship between individual dispositions or personality traits and communication styles. de Vries et al. (2011) found support for the notion that a person’s communication style is, partially, a function of his/her personality traits. They found, for instance, expressiveness in communication to be strongly related to extraversion, while verbal aggressiveness in communication was, not surprisingly, negatively related to agreeableness. Our results add to this picture by showing that mindfulness, as a distinct disposition ( Rau and Williams, 2016 ), likely translates into a distinct communication pattern.

Limitations and Future Research

Despite its contributions, our work is not without limitations, offering interesting directions for future research. Most notably, due to the cross-sectional design, causal conclusions cannot be drawn from our data and the direction of the revealed effects are based on theoretical deliberations. Accordingly, alternative explanations and common underlying antecedents of all examined variables cannot be entirely excluded. For instance, research has started to explore socio-contextual factors at work, such as managerial need support, as antecedents of mindful states ( Olafsen, 2016 ). While contextual factors may facilitate or inhibit the experience of mindful states, they may also affect the well-being and communication behavior of leaders and followers. Hence, future research would benefit from using longitudinal data and controlling for more context variables. This would also permit to shed further light on potential moderating effects. For instance, it is plausible that the beneficial effects of mindfulness in communication may best unfold in fast-paced and volatile high performance contexts, where the quality of leadership communication is particularly important for organizational adaption and functioning ( Uhl-Bien et al., 2007 ). In contrast, in highly bureaucratic organizations with strict regulations and protocols for decision-making, communication is usually organized and formal and thus, mindfulness may be less relevant.

A second limitation refers our sample size, in that we were able to recruit, on average, only a few followers per leader. While our sample size is in line with similar studies in this field, we nonetheless hope that future studies will address this limitation and gather more data from multiple raters assessing mindfulness in communication. Importantly, high agreement among multiple raters will further corroborate our notion of mindfulness in communication as a stable communication pattern.

A third issue, one that is both a limitation and, we believe, a strength, refers to our mindfulness in communication measure, which we developed for this study. It is a strength because it allowed us to capture very proximal behavioral correlates of core aspects of mindfulness in a person’s communication behavior, while similar measures in this field tend to be much wider. For instance, measures of active listening or general communication style typically focus on being generally sensitive to the feelings and concerns of others ( Drollinger et al., 2006 ; Bodhi, 2011 ; de Vries et al., 2011 ). Also, such measures usually include skills pertaining to information processing (i.e., remembering, summarizing, and clarifying points) and responding (i.e., asking for feedback, nonverbal signals). At the same time, however, given the constitutive nature of our work, the construct of mindfulness in communication requires further exploration and validation. Although we substantiated the psychometric properties of our newly developed measure in a separate sample, there remains room for further scrutiny with regard to its nomological network as well as its discriminant, convergent, and predictive validity. Concretely, it would be useful in future research to test our measure against the above mentioned measures of active listening ( Drollinger et al., 2006 ) and interpersonal communication style ( de Vries et al., 2010 ). Such studies would benefit from considering additional, more diverse outcomes, at both the individual and the interpersonal level. In terms of individual outcomes, it would be particularly fruitful to capture followers’ basic need satisfaction, as we used this in our theoretical framework but did not include it in our measurement strategy. At the interpersonal level, it would be interesting to see whether mindfulness in communication has a unique effect on the relationship quality between leaders and followers, reflected in LMX and trust ( Dulebohn et al., 2012 ) as well as integrative conflict resolution ( Rahim and Magner, 1995 ).

A fourth limitation of our study refers to the role of emotion regulation and how it is thought to translate into leaders’ communication behaviors. Specifically, we exclusively referred to the regulation of unpleasant emotions, while ignoring positive emotions. However, even though research on mindfulness and emotion regulation (for an overview, see Ostafin et al., 2015 ) has a strong focus on unpleasant emotions, such as anger, fear, or avoidance, from the perspective of Buddhism, also pleasant emotions, such as pride or desire, can be disturbing ( Chambers et al., 2009 ). That said, mindful leaders should not only stay calm when unpleasant emotions arise but also in the presence of pleasant emotions. Thus, it will be interesting in future research on mindfulness in communication to give a stronger focus on the interplay and regulation of both pleasant and unpleasant emotional states. Such studies could include direct measures of specific emotion regulation strategies, most notably expressive suppression and cognitive reappraisal ( Gross and John, 2003 ), and test whether and to what extent they may exert differential effects on mindfulness in communication.

In terms of more general directions for future research, it will be useful to replicate our results in different settings, such as mentoring or coaching relationships. In such studies it would be interesting to include alternative, more differentiated mindfulness scales which assess different facets of mindfulness (for a review see Sauer et al., 2013b ). Although the Freiburg Mindfulness Inventory is a well-established instrument which is currently available in various languages ( Sauer et al., 2013a ), the use of other instruments such as the Five Factors Mindfulness Questionnaire (FFMQ) ( Bohlmeijer et al., 2011 ; de Bruin et al., 2012 ) or the Comprehensive Inventory of Mindfulness Experiences (CHIME) ( Bergomi et al., 2014 ), which measure different sub-facets of mindfulness, may help to further clarify the effects of mindfulness on communication behaviors. Notably, by further investigating the utility of the newly developed mindfulness in communication measure across different samples and contexts, and by comparing it to more nuanced measures of dispositional mindfulness, future research may address the call for alternative, “indirect” measures of a person’s level of mindfulness, which is grounded in the ongoing criticism of self-assessment questionnaires (e.g., Grossman, 2008 ). Although the validation of our newly developed instrument is still at an early stage, our study offers a promising basis for such indirect measures of dispositional mindfulness. In other words, measuring mindfulness in communication may aid future research in addressing the question of whether there are “objective and observable criteria of mindfulness” ( Grossman, 2008 , p. 407).

Another interesting avenue for future research could be to examine the cognitive processes behind mindfulness in communication in more detail. This is particularly true for the role of the capacity to disengage the self from the event, as reflected in the notion of reperceiving ( Shapiro et al., 2006 ) or decentering ( Hayes et al., 2004 ). Future studies could include a separate decentering measure ( Fresco et al., 2007 ) and explore whether there are distinct relationships with the features of mindfulness in communication. Such studies may also benefit from more thoroughly disentangling the process of decentering. Recent research suggests that this kind of perspective shifting may be better understood as a process, including meta-awareness, disidentification from inner experience, and reduced reactivity to thought content (see Bernstein et al., 2015 ).

Finally, mindfulness research in general could benefit from taking up the reflections and criticisms of several scholars ( Bodhi, 2011 ; Dreyfus, 2011 ; Purser and Milillo, 2015 ) who advocate a notion of mindfulness that goes beyond its current conceptualization in Western psychology.

Practical Implications

Our focus on interpersonal benefits of mindfulness points to several practical implications, especially with regard to leadership development. While a large body of research on mindfulness-based interventions provides evidence that mindfulness can be trained (for meta-analyses see Grossman et al., 2004 ; Chiesa and Serretti, 2009 ; Cavanagh et al., 2014 ), research on mindfulness interventions in the workplace is still in its infancy. However, in practice, there is already a growing interest in mindfulness-based training programs, and many organizations presently use mindfulness-based trainings in personnel and leadership development (for examples see Marturano, 2010 ; Tan, 2012 ). This interest of practitioners is accompanied, and partly caused, by a growing body of non-scientific, popular literature, and a number of articles in newspapers and magazines, praising the benefits of a “mindful leadership style” (e.g., Caroll, 2008 ; Boyatzis and McKee, 2014 ). However, such reports are often grounded in anecdotal evidence and more rigorous research is needed to explore the role of mindfulness in the leadership context and to provide evidence-based approaches for practitioners in organizations. The findings of our study provide preliminary empirical support for the potential value of fostering mindfulness in organizations and suggest that mindfulness may not just promote personal wellbeing and resilience, as it has been shown by other scholars before, but also may have positive effects on interpersonal skills and communication behavior. Thus, since communication competencies are key to effective leadership, mindfulness-based interventions and training may represent a promising tool for effective leadership development. Despite the promising value of such leadership trainings, it is, however, important to consider potential pitfalls of mindfulness too. For instance, it is conceivable that a leader may use mindful communication for the mere purpose of impression management with selfish or unhealthy goals in mind ( Reb et al., 2015b ). An ethically informed view on corporate mindfulness, as advocated by several scholars in the last years ( Purser and Milillo, 2015 ), may help to prevent potential dark side-effects of mindfulness.

As a general note of caution, it should be noted that mindfulness interventions in the workplace are not without risks. Several studies have shown that some participants may experience mindfulness interventions and related outcomes as challenging and distressing ( Cebolla et al., 2017 ; Lindahl et al., 2017 ). One should generally not see mindfulness as a panacea for all sorts of challenges and problems leaders (and followers) are facing in their organizational practice. Mindfulness interventions can be useful if they are conducted by experts and carefully tailored to the needs and individual requirements of the participants. Furthermore, as Purser (2018) pointed out, the trend of mindfulness interventions at work can also be problematic because it tends to focus exclusively on the individual when it comes to cope with stress, instead of changing tasks or thinking about job design.

By identifying mindfulness in communication as a behavioral manifestation of leaders’ dispositional mindfulness which mediates the latter’s relationship with followers’ satisfaction, our study provides a valuable contribution to the increasing body of literature on mindfulness in the workplace. Hopefully, it will stimulate more research on the role of mindfulness in communication behavior and in organizational contexts in general.

Ethics Statement

The authors certify that the research presented in this manuscript has been conducted within the DGPs (German Psychological Society) ethical standards regarding research with human participants and scientific integrity.

Author Contributions

JA and APV contributed conception and design of the study. JA contributed the acquisition of participants and data collection, and wrote the first draft of the manuscript. JA, APV, and KK performed the statistical analysis, wrote sections of the manuscript, and contributed to manuscript revisions, read, and approved the submitted version.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer MV and handling Editor declared their shared affiliation at the time of review.

Acknowledgments

The authors thank Felix C. Brodbeck for his insightful comments on earlier versions of this manuscript. An earlier version of this paper has been presented at the 49th Congress of the DGPs (Deutsche Gesellschaft für Psychologie), Bochum, Germany.

1 For exploratory purposes, we examined the difference between leaders who indicated practicing some form of mindfulness meditation ( n = 10) and leaders who reported not practicing any form of mindfulness meditation ( n = 24) with regard to their average dispositional mindfulness scores. Results showed that there was a significant difference with higher scores in the meditation group ( M = 4.56, SD = 0.73) compared to the non-meditation group ( M = 3.87, SD = 0.81), t (32) = 2.34, p < 0.05, d = 0.88.

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