774The appropriateness of the Effort-Reward Imbalance ratio for investigating musculoskeletal symptoms

Background Effort-reward imbalance (ERI), an indicator of occupational stress, can provide valuable insights into musculoskeletal symptom (MSS) outcomes for workers. The ERI ratio is typically used in analysis, rather than the effort and reward variables individually, or the reward sub-scales (promotion opportunities, job security and esteem). The appropriateness of this approach has not been investigated. We were interested in the association between the ERI ratio and its components (e.g. effort, promotion opportunities), and MSS outcomes (the presence of any MSSs, and a range of consequences) in professional musicians. Methods Employed, professional musicians completed a questionnaire that included the short version of the Effort-Reward Imbalance questionnaire, and questions regarding their MSSs. Regressions were performed to determine the association between the ERI ratio and other ERI components, and MSS outcomes. Results The ERI ratio was associated with a number of MSS outcomes, including chronic MSSs and MSSs that impaired playing, however this relationship appeared to be driven by increased perceived effort, not by reward. Conclusions Our findings highlight the need to investigate the individual ERI components (e.g. subscales), rather than just the ERI ratio, when investigating the association between occupational stress and MSS outcomes. By doing so, more targeted recommendations can be made, which for musicians include reducing their perceived effort to lower their MSS burden. Key messages Studies investigating the association between occupational stress and MSS outcomes should investigate the individual components and subscales of the ERI model.

Working conditions in primary care: a qualitative interview study with physicians in Sweden informed by the Effort-Reward-Imbalance model

Background Many problems with primary care physicians’ psychosocial working conditions have been documented. Many studies on working condition have used the Effort-Reward-Imbalance (ERI) model, which posits that poor health and well-being may result from imbalances between the level of effort employees perceive that they put into their work and the rewards they receive. The model has not been used in qualitative research or applied to investigate primary care physicians’ working conditions. The aim of this study was to apply the ERI model to explore the perceived efforts and rewards by primary care physicians in Sweden and approaches they take to cope with potential imbalances between these efforts and rewards. Methods The study has a qualitative design, using semi-structured interviews. A purposeful sampling strategy was used to achieve a heterogeneous sample of primary care physicians who represented a broad spectrum of experiences and perceptions. We recruited 21 physicians; 15 were employed in public health care and 6 by private health care companies. Results The analysis of the interviews yielded 11 sub-categories: 6 were mapped to the efforts category, 3 were attributed to the rewards category and 2 were approaches to coping with effort/reward imbalances. Many of the statements concerned efforts in the form of high workload, restricted autonomy and administrative work burden. They also perceived resource restrictions, unpredictability of work and high expectations in their role as physicians as efforts. Three types of rewards emerged; the physicians found their job to be stimulating and meaningful, and the work climate to be supportive. The physicians coped with imbalances by means of job enrichment and using decisional latitude. Conclusions Primary care physicians perceive numerous types of efforts in their job, which is consistent with research concerning work stress and associated consequences, such as poor subjective health and well-being. There are also rewards according to primary care physicians, but the findings suggest a lack of reciprocity in terms of efforts and rewards although firm conclusions cannot be drawn since the study did not investigate the magnitude of the various efforts and rewards or the effectiveness of the approaches the physicians use to cope with imbalances. The ERI model was found to be useful to explore physicians’ primary care work and working conditions but its applicability likely depends on the type of work or professions being studied.

Burnout of Healthcare Workers Based on the Effort-Reward Imbalance Model: A Cross-Sectional Study in China

Background: The effort-reward imbalance (ERI) model is widely used in job stress research. However, few studies using this model have been conducted in developing countries. This study tested the extrinsic and intrinsic hypotheses regarding the burnout of healthcare workers in China with the ERI model.Method: Job stress was assessed by Siegrist’s ERI questionnaire, and burnout was evaluated by the Maslach Burnout Inventory-General Survey (MBI-GS). A total of 1,505 effective respondents were included in the final study. Multiple and hierarchical linear regression was used to analyze the association between components in the ERI model and burnout.Results: Emotional exhaustion and cynicism were positively correlated with ERI and overcommitment. Professional efficacy was positively related to ERI but not to overcommitment. ERI was the determining factor of emotional exhaustion and cynicism. Overcommitment moderated the relationship between ERI and emotional exhaustion and between ERI and cynicism.Conclusion: Changing workplace conditions and increasing personal resilience might alleviate burnout among hospital workers in China. The links between professional efficacy and stressful work environment need further exploration.

Working Conditions in Primary Care: A Qualitative Interview Study with Physicians in Sweden Informed by the Effort-Reward-Imbalance Model

Background: Many problems with primary care physicians’ psychosocial working conditions have been documented. Many studies on working condition have used the Effort-Reward-Imbalance (ERI) model, which posits that poor health and well-being may result from imbalances between the level of effort employees perceive that they put into their work and the rewards they receive. The model has not been used in qualitative research or applied to investigate primary care physicians’ working conditions. The aim of this study was to apply the ERI model to explore the perceived efforts and rewards by primary care physicians in Sweden and approaches they take to cope with potential imbalances between these efforts and rewards.Methods: The study has a qualitative design, using semi-structured interviews. A purposeful sampling strategy was used to achieve a heterogeneous sample of primary care physicians who represented a broad spectrum of experiences and perceptions. We recruited 21 physicians; 15 were employed in public health care and 6 by private health care companies.Results: The analysis of the interviews yielded 11 sub-categories: 6 were mapped to the efforts category, 3 were attributed to the rewards category and 2 were approaches to coping with effort/reward imbalances. Many of the statements concerned efforts in the form of high workload, restricted autonomy and administrative work burden. They also perceived resource restrictions, unpredictability of work and high expectations in their role as physicians as efforts. Three reward factors emerged; the physicians found their job to be stimulating and meaningful, and the work climate to be supportive. The physicians coped with imbalances by means of job enrichment and using decisional latitude.Conclusions: This study of primary care physicians suggests a lack of reciprocity in terms of high costs and low gains, providing a plausible explanation for work stress and associated consequences that have been shown in previous primary care research. We found the ERI model to be useful to explore physicians’ primary care work and working conditions and to identify effort and reward factors as well as approaches to managing effort/reward imbalances of relevance for their job satisfaction.

The Effect of Admission Year and Effort-Reward Imbalance Model on Engagement

Engagement has not been widely studied in the field of medical education. The purpose of this study was to determine the relationship between admission year and engagement, assuming that characteristics of admission cohorts might be different depending on year. Association between effort-reward imbalance (ERI) model and engagement was also reinvestigated. Data were collected from 164 students in The Catholic University of Korea, College of Medicine. Ninety-nine (18.97%) students in 2017 and 65 (12.38%) students in 2018 answered an online questionnaire measuring demographic variables, ERI, over-commitment (OC), negative affect, and engagement. Participants’ admission years were determined based on years in school they responded. Affiliation and year in school were removed because of their high correlation with admission year. Categorical regression analysis was performed. Admission year, binary ERI, and OC were significant explanatory variables in this categorical regression model (R2 = .312, Adjusted R2 = .255, F = 5.444, p = .000). Admission year, binary ERI, and OC accounted for 13.4%, 27.9%, and 9.4% of the importance in this model, respectively. Quantification plots for admission year and binary ERI showed that engagement was the highest in 2018 admission cohort but the lowest in 2013 admission cohort; being reciprocally rewarded for efforts was associated with higher scores of engagement. A certain admission cohort can be more engaged or less engaged in learning. This study also confirms that receiving proper rewards for efforts could be related to increase in engagement.

Elevated Psychosocial Stress at Work in Patients with Systemic Lupus Erythematosus and Rheumatoid Arthritis

Objective.Psychosocial stress at work not only affects the healthy working population, but also workers with chronic diseases. We aimed to investigate the psychosocial work stress levels in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA).Methods.A cross-sectional study applied the Effort-Reward Imbalance (ERI) questionnaire — an internationally established instrument that measures work stress — to patients with SLE and RA who were capable of work and to a group of controls without these diseases. Participants were recruited through rheumatologists in private practices, hospitals, and from self-help groups by personal communication, paper-based flyers, and online advertisements. Because very few studies tested the ERI’s applicability in patient groups, with a lack of evidence in patients with inflammatory rheumatic diseases, internal consistency and construct validity of the ERI measure were evaluated.Results.Data came from 270 patients with RA and 247 with SLE, and 178 controls. Patients showed elevated psychosocial stress at work compared to controls. Across the total sample and all groups, satisfactory internal consistencies of the scales effort, reward, and overcommitment were obtained (Cronbach’s alpha coefficients > 0.70), and confirmatory factor analysis replicated the theoretical structure of the ERI model (goodness-of-fit index > 0.80).Conclusion.We found elevated psychosocial stress at work in patients with SLE and RA compared to controls by applying the ERI model. Despite some heterogeneity in the sample, we achieved satisfactory psychometric properties of the ERI questionnaire. Our results suggest that the ERI questionnaire is a psychometrically useful tool to be implemented in epidemiological studies of employed patients with SLE and RA.

Long-Term Effectiveness of a Stress Management Intervention at Work: A 9-Year Follow-Up Study Based on a Randomized Wait-List Controlled Trial in Male Managers

Objective. Short- and medium-term effectiveness (up to 3 years) of individual level stress management interventions (SMI) at work were demonstrated, yet long-term effectiveness remains unexplored. We therefore aimed to address this research gap. Methods. 94 male middle managers participated in a randomized wait-list controlled trial between 2006 and 2008 and in a post-trial-follow-up survey in 2015. During the first two years, all received an 18-hour psychotherapeutic SMI intervention which was based on the Effort-Reward Imbalance (ERI) model: tackling stressor on mismatch between effort and reward and promoting recovery on overcommitment. Work stress (i.e., ERI indicators) was the primary outcome, and the secondary outcome was depressive symptoms. The long-term effectiveness of the SMI was examined by mixed modeling, using an external control group (n=94). Results. Effort and reward were substantially improved with significant intervention ⁎ time interaction effects (p<0.001) compared to the external control group; effects on overcommitment and depressive symptoms were also significant (p<0.05 and p<0.01, resp.), though their trajectories in the intervention group were less sustainable. Conclusions. The effectiveness of this psychotherapeutic SMI at work based on the ERI model was observed over a 9-year period, particularly on the effort-reward ratio.