Psychosocial factors at hospital work: experienced conditions related to job strain and effort-reward imbalance

Abstract Introduction: inadequate hospital work conditions and organization constitute psychosocial factors at work (PSFW) that trigger stress and may have negative outcomes for workers, patients and institutions. Objective: to evaluate the prevalence of PSFW and associated personal and occupational conditions among hospital workers. Methods: cross-sectional study with 1,795 workers from a hospital in São Paulo, Brazil. A self-administered form was used to evaluate demographic and occupational features and PSFW (questionnaires based on the Demand-Control and Effort-Reward models). Descriptive analysis and ordinal logistic regression of partial proportional odds were performed. Results: prevalence rates of conditions related to job strain were: 13.6% low risk, 73.0% intermediate risk and 13.4% high risk. Effort-reward imbalance prevalence rates were: 33.1% low imbalance, 31.3% moderate imbalance, 30.8% high imbalance and 4.8% non-answer. Individual and occupational features were associated with the occurrence of PSFW. Conclusion: the two models evaluate different aspects of the work activities and social insertion of individuals at work, and individual and occupational conditions were associated with PSFW. The results show that different issues should be considered when planning intervention to improve the psychosocial environment at work.

摘要 引言：医院工作环境与组织架构的不足属于工作相关社会心理因素（psychosocial factors at work, PSFW），可引发工作压力，并可能对医护人员、患者及医疗机构产生负面影响。
研究目的：评估医院职工中工作相关社会心理因素的流行率，以及与之相关的个人与职业特征。
研究方法：针对巴西圣保罗某医院的1795名职工开展横断面研究（cross-sectional study）。采用自填式问卷收集人口学与职业特征数据，并基于工作要求-控制（Demand-Control）模型与付出-回报（Effort-Reward）模型设计问卷以评估工作相关社会心理因素。数据分析采用描述性统计分析及偏比例优势有序逻辑回归（ordinal logistic regression of partial proportional odds）方法。
研究结果：与工作紧张相关的各类状况流行率分别为：低风险13.6%、中等风险73.0%、高风险13.4%。付出-回报失衡的流行率分别为：低失衡33.1%、中度失衡31.3%、高失衡30.8%，另有4.8%的受访者未作答。个人与职业特征与工作相关社会心理因素的发生存在关联。
研究结论：上述两种模型分别评估了工作活动的不同维度及个体的工作社会融入状况，个人与职业特征与工作相关社会心理因素存在关联。研究结果提示，在制定改善工作社会心理环境的干预方案时，需综合考量多方面相关因素。