Work conditions as predictors of Swedish occupational therapists’ occupational balance

Abstract

Background

There is little knowledge of how organizational and social work environmental conditions impact workers’ perceptions of occupational balance. The aim of the present study was to investigate organizational and social work environmental conditions as predictors of Swedish occupational therapists’ perceptions of occupational balance.

Materials/Methods

This prospective study collected data twice, with a one-year interval, and used a web survey. The present study included 1835 participants. Logistic regression analysis was used to analyze the work predictors of occupational balance.

Results

A reasonable workload, high control, and high reward predicted high occupational balance. Having no children living at home, a satisfactory financial situation, and being physically active also predicted high occupational balance.

Conclusion

A reasonable workload, high control and high reward predicted occupational balance among the occupational therapists. All these factors may be of importance for a sustainable working life for occupational therapists.

Significance

This knowledge can support occupational therapists in the development of interventions at the work place, with focus on the workload and the resources (control and reward), to promote employees’ occupational balance.

Keywords:

• Health professionals
• psychosocial work environment
• prospective study
• survey
• work-life balance

Introduction

The results of a national study of Swedish occupational therapists’ occupational health [1] showed that 67% rated their workload as high or too high, leading to stress and job turnover, where 18% reported mild to moderate stress symptoms and 7% indications of severe exhaustion. Furthermore, they rated difficulties in maintaining occupational balance. In another study of occupational therapists, a reasonable workload and other aspects of the organizational and social work environment such as high control, a high sense of community, high justice as well as high occupational balance were associated with no or negligible signs of stress. The results further showed that the possibility of not perceiving stress was highest for those who perceived a high occupational balance [2]. Occupational imbalance has in previous research been shown to predict stress-related disorders [3]. Additionally, occupational balance has been shown to be important for health [2–7], work ability [8], and job turnover [9]. Based on these results, it seems that occupational balance is a health-promoting factor, and it is therefore important to identify factors in the work environment that affect occupational balance in order to reduce stress and job turnover.

Occupational balance takes into account the perception of all occupations in everyday life, while work-life balance usually focuses mainly on the ability to balance work and family demands [10]. Occupational balance is subjectively defined by the individual. It is a subjective perception of the mix of occupations in everyday life, regardless of what kind they are [11]. Occupational balance is dynamic and what feels right fluctuates depending on the occupations the individual needs or wants to do. It is, however, important that the individual has variation between different occupations, namely between paid work, domestic work, rest and recreational occupations; or between obligatory and self-chosen occupations. Furthermore, the individual needs to perceive that he or she engages in the right amount of each occupation, and the right amount in total, in relation to the individual’s resources and other available resources [11]. Occupational balance also fluctuates depending on whether the environment supports or limits the occupations [12]. It is therefore plausible to think that the organizational and social work environment affects the perception of occupational balance. The work environment can be seen as a structure that governs what an individual can do and when, and the work environment can contribute to both occupational balance and occupational justice [13]. ‘Organizational work environment encompasses conditions and prerequisites for the work that include: management and governance, communication, participation, room for action, and allocation of work tasks, as well as demands, resources, and responsibilities. Social work environment deals with conditions and prerequisites for the work that include social interaction, collaboration, and social support from managers and colleagues’ [14, p.6]. A previous study has shown that work resources (autonomy and control) were more important for satisfaction concerning work-life balance than family resources in employed adults [15]. High workload has also been shown to be associated with a low satisfaction with work-life balance, just as perceived workload has been associated with turnover intention among nurses. Nevertheless, these were mediated by satisfaction with work-life balance [15]. In another study of nurses it was seen as essential to have time and energy for both work and private life [16]. Among parents with young children there were associations between having strategies for handover when absent from work, positive attitudes towards parenthood and parental leave, and high occupational balance [17]. To be able to promote health and a sustainable work life, occupational therapists need to gain an understanding of how different factors in the organizational and social work environment affect occupational balance. The aim of the present study is thus to investigate organizational and social work environmental conditions as predictors of Swedish occupational therapists’ perceptions of occupational balance.

Materials and methods

The present study has a prospective design. The same web survey was used twice, with a one-year interval in between.

Participants

A web survey with an information letter and a side to give written informed consent was sent to all members of the Swedish Association of Occupational Therapists in 2018 (n = 7600). Of these 7600, 3658 gave their written informed consent and responded to the survey (response rate 48%) This sample is representative of Swedish occupational therapists concerning age and gender (Personal communication Martin Östberg, the Swedish Occupational Therapist Association). Exactly one year later, the same web survey was sent to those who had responded at the first opportunity, and 2288 answered the follow-up survey (a response rate of 63%). Of these, 1835 answered both times and were included in the present study. The present study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Regional Ethical Review Board in Lund, Sweden (Dnr 2017/975).

Measures

Organizational and social work environmental conditions

To measure the organizational and social work environmental conditions the QPS-mismatch was used. QPS-mismatch is a shorter form of QPS Nordic (General Nordic Questionnaire for Psychological and Social Factors at Work) [18,19]. This shorter form was developed to provide an approximate picture of an individual’s mismatch between organizational and social work environment conditions and his/her work ability. The questions in the QPS-mismatch have been grouped according to Maslach and Leiter’s model of burnout development [20] into the following groups or dimensions: (1) Workload, (2) Control, (3) Community, (4) Reward, (5) Justice, and (6) Values. See the definitions of the dimensions in Table 1. QPS-mismatch has five response alternatives ranging from very seldom or never (1) to very often or always (5). In the present study, the response alternatives were reversed to instead measure match between the individual’s organizational and social work environment conditions and his/her work ability. The reliability was shown to be good (Cronbach alpha 0.72–0.90 in all dimensions) according to the developer (Österberg, 2016, personal communication).

Table 1. The dimensions of the QPS-mismatch and their definitions.

Workload	Evenly distributed; A reasonable amount to do; few disruptive interruptions; the demands of work do not affect family life; work with clients; complaints from clients
Control	Clearly defined goals; a defined area of responsibility; ability to perform tasks in a way that suits you; sufficient resources; compatible requirements; being able to influence the amount of work, the pace of work, and important decisions
Reward	Appreciation; money, and encouragement
Community	Getting help and support from co-workers and managers; co-workers and managers listen to problems related to work; a lack of disruptive conflicts; a stress-free relationship with the manager and enough communication in the workplace
Justice	Having someone who looks after one’s interests in the workplace; the manager supporting the development of skills; the manager tackling problems when they arise; a fair distribution of work; good care; interest in the health and well-being of employees
Values	Personal values congruent with the workplace’s values; the employees recommend the workplace; confidence in the management’s ability

Occupational balance

Occupational balance was measured with the Occupational Balance Questionnaire (OBQ11) [21]. The OBQ11 consists of 11 statements such as ‘I balance the different kinds of occupations in my life, e.g. work, home, family, rest, and recovery’ and ‘I am satisfied with the amount of time that I spend relaxing, recovering, and sleeping’. The statements have four response alternatives, ranging from disagree (0) to fully agree (3). The total sum score (0–33) shows the level of occupational balance, from low to high, with higher scores indicating a better level of occupational balance. It has been shown to have good content validity, sufficient test–retest reliability [22], and good construct validity [21]. In the present study the sum score was dichotomized into low vs. high occupational balance according to a median cut.

Sociodemographic characteristics

Sociodemographic characteristics, which are known to influence occupational balance, were also included, from baseline data, as potential confounders. These were gender (women vs. men), children living at home (yes vs. no), living with someone (no vs. yes), age (divided into five age groups). Furthermore, years of experience (dichotomized according to the median ≤17 years vs. ≥18 years), working hours (≤75% vs. >75% of 40 h a week), a satisfactory financial situation (no vs. yes), and physical activity (mainly sedentary vs. more active).

Statistical analysis

Descriptive statistics were used to describe the participating occupational therapists’ social and organizational working conditions, occupational balance, and socio-demographic characteristics. Multicollinearity between the variables, which measures organizational and social work environment conditions was evaluated by means of Spearman rank order correlations. The relationship between the variables was not too great (<0.80), and the items do not seem to measure the same thing. Simple logistic regression analyses were used to analyze which of the social and organizational working conditions, as well as socio-demographic characteristics, predicted high occupational balance. A logistic regression was used to analyze the possibility to perceive high occupational balance depending on whether the participants rated their work environment as good or bad. In this analysis, we also controlled for a number of socio-demographic variables that have been shown to be associated with occupational balance. In a predictive analysis, one strives to build a low-variable model, therefore only variables with a p-value <0.10 in the simple logistic analysis were used [23].The predictive analysis was done with a multiple logistic regression analysis in two steps. In step 1 unadjusted and in step 2 adjusted for the sociodemographic variables with a p-value <0.10. All statistical analyses were performed using SPSS version 27.0 software.

Results

The great majority of participants were women and lived with someone. More than half of the participants had children living at home. The participants mean age was 45 years (22–68 years old). Half of the participants had ≤17 years of professional experience and half had ≥18 years of professional experience. About half were satisfied with their financial situation. The great majority worked more than 75 percent of full-time (40 h a week) and were more or less physically active (Table 2).

Table 2. Characteristics of the participants (n = 1835).

	n (%)
Gender
Men	95 (5)
Women	1732 (95)
Living with someone
Yes	1479 (80)
No	349 (20)
Children living at home
Yes	1004 (81)
No	349 (19)
Age groups
21–30	222 (12)
31–40	427 (24)
41–50	478 (26)
51–60	541 (30)
61–70	143 (8)
Years of professional experience
≤17 years	901 (50)
≥18 years	915 (50)
Working hours
≤75% of full–time (40 h a week)	182 (10)
>75% (40 h a week)	1569 (90)
Satisfactory financial situation
Yes	874 (48)
No	957 (52)
Physical activity
Mainly sedentary	230 (13)
More active	1602 (87)

Of the organizational and social work environment conditions, community had the highest mean, and reward had the lowest mean (Table 3). The median of the summed occupational balance was 14 (min-max: 1–33, Q1 = 10 Q3 = 20) at baseline and 14 (min-max: 1–33, Q1 = 10, Q3 = 19) at follow-up.

Table 3. Organizational and social work environmental conditions at baseline (n = 1835).

	Mean
Workload (1–5)	3.2
Control (1–5)	3.5
Reward (1–5)	2.6
Community (1–5)	3.9
Justice (1–5)	3.3
Values (1–5)	3.5

All variables except age, working hours and years of professional experience predicted occupational balance in the univariate analyses (Table 4).

Table 4. Associations between organizational and social work environmental conditions, sociodemographic characteristics at baseline, and occupational balance at follow-up (simple logistic regression) (n = 1835).

	OR (95% CI) p-value	p-Value
Reasonable workload	2.32 (2.01–2.68)	<0.001
High control	2.36 (2.00–2.79)	<0.001
High reward	1.37 (1.25–1.51)	<0.001
High sense of community	1.77 (1.54–2.05)	<0.001
High justice	1.50 (1.34–1.68)	<0.001
Value congruence	1.53 (1.35–1.73)	<0.001
Men (vs. women)	1.57 (1.04–2.36)	0.031
Living with someone (vs. single)	1.22 (0.98–1.53)	0.031
No children living at home (vs. children living at home)	1.32 (1.11–1,58)	0.002
Age groups (from younger to older)	0.99 (0.92–1.07)	0.882
Working hours (>75 % vs. <75% of 40 h a week)	1.25 (0.93–1.68)	0.137
Years of professional experience (≤17 years vs. ≥18 years)	1.09 (0.91–1.30)	0.353
Satisfactory financial situation (vs not)	1.71 (1.43–2.05)	<0.001
Physically active (vs. mainly sedentary)	1.95 (1.48–2.56)	<0.001

Predictors of high occupational balance

A reasonable workload, high control, and high reward predicted high occupational balance in the unadjusted analysis. In the adjusted analyses, the same organizational and social work conditions predicted high occupational balance. However, physical activity, no children living at home, and a satisfactory financial situation were also significant in this model. The odds ratio for a reasonable workload decreased in the adjusted model (Table 5).

Table 5. Organizational and social work environmental conditions, and sociodemographic factors at baseline, predicting high occupational balance at follow up (n = 1835).

	Step 1 unadjusted OR (95% CI)	Step 2 adjusted OR (95% CI)
Reasonable workload	1.87 (1.57–2.23)	1.78 (1.48–2.14)
High control	1.29 (1.01–1.64)	1.31 (1.02–1.70)
High reward	1.24 (1.09–1.42)	1.21 (1.06–1.38)
High sense of community	1.22 (0.97–1.51)	1.21 (0.96–1.53)
High justice	0.85 (0.69–1.05)	0.83 (0.67–1.04)
Value congruence	1.06 (.0.89–1.26)	1.03 (0.86–1.24)
Men (vs. women)		1.53 (0.96–2.44)
Living with someone (vs. single)		1.20 (0.92–1.57)
No children living at home (vs. children living at home)		1.37 (1.11–1.69)
Satisfactory financial situation (vs not)		1.32 (1.07–1.62)
Physically active (vs mainly sedentary)		1.80 (1.32–2.47)

The figures in bold are statistically significant.

Discussion

The main findings in the present study were that a reasonable workload, high control, and high reward predicted high occupational balance.

The most important predictor of high occupational balance in the present study was a reasonable workload. This result confirms the results of previous studies that showed that a higher workload was negatively related to lower levels of satisfaction with work-life balance [11,24]. In these studies, work-life balance was defined as the balance between work and family occupations. However, as the definition of work-life balance focuses on the balance between work and family in the above mentioned studies, the focus on occupational balance in the present study added that a reasonable workload is of importance also for rest and recovery occupations. The result of the present study can be interpreted as meaning that people with a reasonable workload also have the time and energy for home and family occupations as well as rest and recovery, which enables the perception of occupational balance (the right amount and variety of different occupations in everyday life).The work environment and other external factors such as norms, expectations, family situation and support all together contribute to the perception of occupational balance [12].

The results also showed that control predicted occupational balance. This result is in line with the results of another study showing that control has an important relation with work-life balance [25]. Control is about setting boundaries for work, such as sufficient resources and the ability to influence the amount of work and the pace of work [26] so that there is time and energy left for family, rest, and recovery, i.e. control contributes to the participants’ perception of high occupational balance. Having energy left for domestic work and leisure after work are also important for high subjective health [4].

Furthermore, high reward contributes to high occupational balance in the present study. Reward can be about positive feedback/appreciation and/or a higher salary. This confirms the results of studies of work-life balance that have shown that reward has a significant impact on work-life balance [24,27]. A possible explanation for this can be that positive feedback/appreciation contributes to people’s ability to manage life [28,29], and a higher salary enables them to engage in leisure occupations [30], which may lead to increased occupational balance. That it may lead to occupational balance is only a speculation and further research is needed to confirm it.

The results of the present study showed that reasonable demands (workload) and reasonable resources (control and reward) predicted high occupational balance. According to the job demands-resources model [31], people can meet demands if they have the resources they need. In contrast, they can be stressed even by simple requirements if they do not have the resources to manage the situation and do not receive any support. Previous studies have shown that high demands and insufficient resources predict psychological disease [32] and higher burnout rates [33]. Taken together, it seems that a workplace, where the employees have a manageable level of demands in relation to the available resources, enables the employees to perceive high occupational balance. Both have been shown to be associated with absent or negligible stress symptoms among occupational therapists [2].

Based on the results of the present study it seems important for the employer that the employees have a reasonable amount to do, a defined area of responsibility, the demands of the work do not affect the rest of the employees’ lives, the organization has clearly defined goals and that the employees receive appreciation to facilitate the employees’ occupational balance. Based on the results, the occupational therapist can develop an intervention where employees, who are their clients, are involved in identifying what can be improved when it comes to the workload and the resources (control and reward), and support them in the improvement process to promote their occupational balance.

Methodological considerations

The present study has strengths as well as limitations. A strength is the prospective design that makes it possible to establish causality. A limitation is that QPS mismatch has not been sufficiently tested for validity and reliability, which can threaten the internal validity in the present study. Limitations of using a web-based survey include inflexibility a lower response rate, and lack of potential depth. Further studies with qualitative design can add further knowledge about why the participants experience the organizational and social environment as they do. In the present study, variables related to the organizational and social work environment were included. However, there are additional environmental factors that promote high occupational balance, such as the division of responsibilities in the home and for the children. This possible shortcoming in the present study highlights the importance for more research in the area. Of importance to think of when reading the results is that the study has a Western world perspective. Further studies are also needed to examine the generalizability of our findings to other populations.

Conclusion

A reasonable workload, high control and high reward predicted occupational balance among the occupational therapists. All these factors may be of importance for a sustainable working life for occupational therapists.

Acknowledgement

We are grateful to the occupational therapists for their participation. No funding was received for conducting this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data underlying this article will be shared upon reasonable request to the corresponding author.

Additional information

Funding

Open Access funding was provided by Lund University.