The measurement of effort–reward imbalance at work: European comparisons
Introduction
In advanced societies, work continues to play an important role for health and well-being in adult life. Having a job is often a prerequisite for a continuous income, and, more thoroughly than any other social circumstances, employment characteristics determine adult socioeconomic status. Beyond economic livelihood a person's occupation is important for socialization. It provides opportunities for personal growth and development, including the favorable experience of self in a core social role, and allows participation in social networks beyond primary groups.
The nature of work has undergone profound changes during recent decades. Today, fewer jobs are defined by physical demands and more by mental and emotional demands. While jobs in mass production are decreasing, employment in the service sector continues to rise. Computer-based information processing is becoming a part of a growing number of job profiles. In a large survey of European workers (Paoli & Merllié, 2001) 60 percent work at very high speeds, 40 percent are confined to monotonous work, 49 percent indicate permanent and direct contact with clients, and 25 percent are working on shift rotation.
These changes in the nature of work have coincided with changes in the labor market. Women and older people comprise a growing proportion of the work force. Part-time working and flexible work arrangements have also increased. Perhaps most importantly for health, job instability, forced mobility and unemployment are becoming more prevalent, resulting in an increase in job career discontinuity, forced early retirement and job loss. Surveys report that 30 percent of workers are currently in insecure jobs (Ferrie, Marmot, Griffiths, & Ziglio, 1999), and a significant proportion of middle-aged men and women are no longer participating in the labor market due to early, often involuntary retirement (Brugiavini, 2001).
Social inequalities in the quality of work and in access to the labor market have been reported in numerous studies, such that it can be concluded that the benefits and costs of working life are unequally distributed across society. This conclusion also holds true for the health burden of working life. A social gradient of health according to occupational standing has been documented for all-cause mortality (Fox & Adelstein, 1978; Kitagawa & Hauser, 1973; Marmot, Shipley, & Rose, 1984), coronary heart disease morbidity and mortality (Marmot, Adelstein, Robinson, & Rose, 1978; Marmot, Bosma, Hemingway, & Stansfeld, 1997), psychiatric disorders, especially depression (Marmot, Shipley, Brunner, & Hemingway, 2001; Stansfeld, Fuhrer, Shipley, & Marmot, 1999) and chronic bronchitis (Marmot et al., 2001). These social inequalities in health deserve particular attention considering that after the first years of childhood, midlife is the time when social differences in mortality are most pronounced (Goldblatt, 1990; Marmot et al., 1998). Therefore, the role of work in explaining health inequalities in midlife provides a core research task. More specifically, an adverse psychosocial work environment is likely to contribute to the unequal health burden in a significant way (Marmot, Theorell, & Siegrist, 2002; Schrijvers, van de Mheen, Stronks, & Mackenbach, 1998). Despite considerable progress in this field there is still a lack of agreement among scientists on how to define and measure an adverse psychosocial work environment.
The aim of this article is to advance this debate by focusing on one measurement approach termed effort–reward imbalance at work. The theoretical model underlying this measure is briefly outlined, and the scales measuring the components of this model are described. In the main part, psychometric properties of these measures are analyzed by drawing upon several epidemiologic investigations, thus enabling comparisons across different working populations in Europe.
Health adverse and health promoting psychosocial work environments are defined by the interaction between a person's cognitions, emotions, and behaviors and his or her social environment. Traditional biomedical approaches cannot directly measure this interaction. While crude measures may focus on particular characteristics of the work place, the stressful character of a psychosocial factor is more appropriately assessed by using self-report data obtained from questionnaires and interviews. But, given the complexity and variability of work-related psychosocial factors, these measurements need to be based on a theoretical model.
Theoretical models of work stress selectively reduce the complexity and variation of interactions between the work environment and the working person by focusing on those general components that may explain its direct or indirect effects on health. Several such models have been developed and tested (for review, e.g., see Cooper, 1998; Dunham, 2001), with two models receiving particular attention in recent years: the demand-control model (Karasek, 1979; Karasek & Theorell, 1990) and the model of effort–reward imbalance (Karasek & Theorell (1996a), Siegrist (1996b)). The former model has been tested in a large number of investigations (for review see Marmot et al., 2002; Schnall, Belkic, Landsbergis, & Baker, 2000). Although a few studies show negative findings, an impressive body of evidence documents the explanatory power of the model or its single components.
The latter model has been developed and tested more recently, with a rapid increase of evidence documenting its role in explaining adverse health (for review see Schnall et al., 2000; Marmot et al., 2002; Siegrist, 2002). While these two models complement each other (see Discussion) the focus of this contribution is on the effort–reward imbalance model, and more specifically on the psychometric properties of its measurement. This model assumes that effort at work is spent as part of a contract based on the norm of social reciprocity where rewards are provided in terms of money, esteem, and career opportunities including job security. Furthermore, the model assumes that work contracts often fail to be fully specified and to provide a symmetric exchange where complete equivalence exists between requested efforts and given rewards. In particular, this is the case when there is little choice on the part of employees, such as a lack of alternatives in the labour market (e.g. low level of skill) or restricted mobility. Moreover, employees themselves may accept such contracts for strategic reasons (e.g. to improve their chances for career promotion at a later stage). Non-symmetric contracts are expected to be frequent in a global economy that is characterized by job insecurity, forced occupational mobility, short-term contracts and increased wage competition.
According to the model, the experience of a lack of reciprocity in terms of high ‘costs’ and low ‘gains’ elicits negative emotions in exposed people. Feelings of not being appreciated in an adequate way or of being treated unfairly and disappointments resulting from inappropriate rewards are paralleled by sustained strain reactions in the autonomic nervous system. This is due to the fact that the recurrent experience of reward deficiency in a core social role impairs successful self-regulation (Siegrist, 2000). Thus, in the long run, the imbalance between high effort and low reward at work increases illness susceptibility as a result of continued strain reactions.
So far, structural conditions of ‘high cost/low gain’ conditions at work have been specified by the model. A final assumption concerns individual differences in the experience of effort–reward imbalance. People characterized by a motivational pattern of excessive work-related commitment and a high need for approval (‘overcommitment’) are at increased risk of strain from non-symmetric exchange. For instance, they may expose themselves more often to high demands at work, or they exaggerate their efforts beyond what is formally needed. As a result, their susceptibility to the frustration of reward expectancies is increased. There is some evidence of intrapersonal stability over time of this motivational pattern (Siegrist, 1996b). Therefore, it can be considered a psychological risk factor in its own, even in the absence of structural conditions of imbalance at work. However, the proposed model posits that strongest effects on health and well-being are expected to occur if structural and personal conditions act in concert. Hence, on this theoretical ground, overcommitment is hypothesized to modify (i.e. increase) the effect on health produced by effort–reward imbalance at work.
In summary, the proposed theoretical model is based on the sociological hypothesis that formalized social exchange, as mediated through core social roles (the work role), is rooted in contracts of reciprocity of cost and gain. It defines structural conditions of non-symmetric contracts that result in strain from an imbalance between high effort and low reward. In addition, it addresses individual differences in the experience of this imbalance (overcommitment) by assuming an effect modification of overcommitment on the association of effort–reward imbalance with health. It is important to stress that this model does not represent a black-box approach towards studying work stress that is restricted to the structural level of analysis (such as e.g. the demand-control model (Karasek & Theorell, 1990)), but integrates structural and personal components. However, these two components are distinguished both at the conceptual and methodological level. It is assumed that a combination of both sources of information according to predefined procedures (see below) provides a more accurate estimate of the adverse health effects resulting from non-reciprocity compared to a restriction of information to one of these sources.
Section snippets
Study samples
This report is based on data obtained from working men and women in five different European countries: Belgium, France, Germany, Sweden and UK. Coordinated data collection and analysis was the result of the authors’ collaboration in the frame of a scientific programme on social variations in health expectancy in Europe, supported by the European Science Foundation. In most instances the measures analyzed in this contribution were administered as part of data collection in already established
Results
The five study populations vary considerably with regard to their occupational and sociodemographic composition. While the French GAZEL cohort, the Swedish WOLF cohort and the Belgian Somstress cohort are composed of different occupational groups, including blue-collars and white-collars, the British Whitehall cohort of civil servants and the German public transport employees represent professionally more homogeneous groups. In terms of age and gender these samples also differ quite remarkably,
Discussion
The results of this comparative epidemiologic investigation in five European countries reveal good psychometric properties of the scales measuring effort–reward imbalance at work.
For the five samples, internal consistency and discriminant validity were assessed and their factorial structure was analyzed by using parallel confirmatory factor analyses. In addition, one aspect of content validity was examined with self-rated health as the outcome. In almost all subgroups, significantly elevated
Acknowledgements
The collaborative research presented in this paper was supported by the European Science Foundation's Scientific Programme on ‘Social Variations in Health Expectancy in Europe’. Authors thank Craig Pollack and Andreas Roedel for their help in finalizing the paper. Further acknowledgement concerns the single studies. SOMSTRESS: This study was supported by the Federal Office for Scientific, Technical and Cultural Affairs (SSTC) in Belgium. GAZEL and WOLF-Norrland: The authors would like to thank
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