1. bookVolume 74 (2023): Issue 1 (March 2023)
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Archives of Industrial Hygiene and Toxicology
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1848-6312
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26 Mar 2007
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A study on the relationship between sociodemographic characteristics and job stress and satisfaction among healthcare workers in Turkey during the COVID-19 pandemic

Hasan Tuna,
Hasan Tuna,
Osman Oğulcan Türkmen and
Osman Oğulcan Türkmen and
Sirer Albayrak
Sirer Albayrak
Published Online: 04 Apr 2023
Volume & Issue: Volume 74 (2023) - Issue 1 (March 2023)
Page range: 42 - 47
Received: 01 Jul 2022
Accepted: 01 Feb 2023
Archives of Industrial Hygiene and Toxicology's Cover Image
Archives of Industrial Hygiene and Toxicology
Journal Details
License
Format
Journal
eISSN
1848-6312
First Published
26 Mar 2007
Publication timeframe
4 times per year
Languages
English, Slovenian

The COVID-19 pandemic brought additional stress to healthcare workers, which included concern about coronavirus infection, inadequate protection, heavy workload, isolation from the family, and hopelessness (1–4). Frontline healthcare workers seem to have taken the brunt of the pandemic-related stress, and one of the consequences has been lower satisfaction with their jobs (3). This, in particular, concerns healthcare workers assigned to intensive care units (ICU) treating COVID-19 patients, including specialisations unrelated to pulmonary infections to make up for the shortage of staff (5–7).

Studies of job satisfaction and stress in healthcare workers done so far have relied on many different factors. However, there are but a few studies dealing with the job stress and job satisfaction of healthcare workers in terms of various sociodemographic variables during the COVID-19 epidemic in Turkey. The aim of this study was therefore to assess how gender, age, marital status, department (including the COVID-19 unit), and educational status related to job stress and satisfaction in Turkish healthcare workers and how they related to each other during the COVID-19 pandemic.

PARTICIPANTS AND METHODS
Study design and data collection

This cross-sectional study included 454 of 500 invited (over 90 % response rate) healthcare workers (physicians, nurses, midwives, technicians, and other health personnel) working with COVID-19 patients in primary healthcare institutions across Turkey selected through convenience sampling. They all received an email with a link to a web-based questionnaire, which explained the purpose of the study and information that participation was voluntary. The survey took place between 9 and 30 August 2021.

The study was approved by the Gümüşhane University Scientific Research and Publication Ethics Committee (approval No. E-95674917-108.99-56174). As authors, we take the full responsibility for the integrity of the questionnaire, study design, and data collection and analysis. Instead of a written consent, the respondents provided one by completing the agreement section of the questionnaire.

The survey consisted of a personal information form and adapted job stress and Minnesota satisfaction questionnaires. Personal information included gender, age, marital status, department, and whether the respondent ever worked in a COVID-19 intensive care unit (at the time of the study or any time before that), and education.

For the job stress scale we relied on the questionnaire developed by Dr Suzanne Haynes and adapted to Turkish by Aktaş (8). The questionnaire consists of 10 questions, and total scores <12 indicate low stress, 12–30 moderate stress, and >30 high stress. The reliability of the Turkish version was high in two different studies (8, 9). In our study, Cronbach’s alpha was 0.46 when all items were included. To raise it to an acceptable level, we ran factor analysis to eventually remove items 2 and 5, which had a low relationship with the scale. This boosted reliability to an acceptable level of 0.61.

To measure job satisfaction we relied on the questionnaire developed by Weiss et al. (10) and adapted to Turkish by Baycan (11). It consists of 20 items scored on a 5-point Likert-type scale, each ranging from “I am not satisfied” (1 point) to “Very satisfied” (5 points). The reported reliability is 0.77, but in our study it was 0.93.
Statistical analysis

All statistics were run on the IBM SPSS 26 package (IBM Corp., Armonk, NY, USA). The significance level was set to p<0.05. First we determined the normality of distribution with the Shapiro-Wilk test and it resulted normal (p=0.148). We then used the independent samples t-test and one-way analysis of variance (ANOVA) for paired comparisons. Data showing significant differences were then further analysed with Tukey’s test for pairwise comparison, since the groups were homogeneously distributed and the frequencies of the groups were not equal. The effect of sociodemographic characteristics on job stress and job satisfaction was analysed with multiple regression, and categorical variables compared with the chi-squared test.
RESULTS
Participants’ characteristics

Table 1 shows no significant differences between male and female healthcare workers by marital status, whether they worked in the COVID-19 ICU, or age, but differences were significant in the distribution by department and education.

Healthcare worker distribution by sociodemographic characteristics (N=454)

Variables Total(N=454)Female(N=280)Male(N=174)χ2p*
Marital statusSingle289177 (63.2)112 (64.4)0.060.804
Married165103 (36.8)62 (35.6)
DepartmentEmergency7851 (18.2)27 (15.5)13.360.004
Outpatient clinic10550 (17.9)55 (31.6)
COVID-19 ICU#6447 (16.8)17 (9.8)
Other (surgery, radiology, laboratory, etc.)207132 (47.1)75 (43.1)
Ever working in a COVID-19 ICUYes270168 (60.0)102 (58.6)0.080.771
No184112 (40.0)72 (41.4)
EducationSecondary4830 (10.7)18 (10.3)13.020.005
Vocational18194 (33.6)87 (50.0)
Bachelor’s degree183128 (45.7)55 (31.6)
Master’s degree and higher4228 (10.0)14 (8.0)
tp**
AgeMean±SD27.89±7.2327.92±7.2327.85±7.240.100.923

*Chi-squared test; **Independent samples t-test; # at the time of the study (August 2021)
Job stress and satisfaction by sociodemographic characteristics

Table 2 shows the relationship between job stress and satisfaction with sociodemographic characteristics of healthcare workers determined with the t-test and one-way ANOVA. As expected, healthcare workers ever stationed in the COVID-19 ICU had higher stress and lower job satisfaction. Married respondents also reported significantly higher stress. No significant differences were found between the genders.

Self-reported job stress and satisfaction by sociodemographic characteristics among healthcare workers

VariablesCategoryNJob stressJob satisfaction
MeanSDt/FpMeanSDt/Fp
GenderFemale28027.274.65t=0.980.33062.444.70t=-0.970.335
Male17426.824.9663.865.19
Marital statusSingle28926.774.98t=-2.010.045**65.1314.75t=4.060.000*
Married16527.674.3559.2215.19
Department1. Emergency7827.364.56F=1.100.35060.1914.24F=9.220.000*
2. Outpatient clinic10526.444.7768.0214.65
3. COVID-19 ICU#6427.704.41 56.4812.34Significant difference between 1 vs 2; 2 vs 3; 3 vs 4***
4. Other (surgery, radiology, lab, etc.)20727.154.96 63.4915.66
Ever working in a COVID-19 ICUYes27027.784.34t=3.600.000*59.9814.95t=-5.260.000*
No18426.105.2067.3914.40
Education1. Secondary4825.815.02F=2.400.06769.2714.27F=15.470.000*
2. Vocational18126.785.2967.0515.42
3. Bachelor’s degree18327.574.3358.1513.73 Significant difference between 1 vs 3; 1 vs 4; 2 vs 3; 2 vs 4***
4. Master’s degree and higher4227.863.5959.3113.67

*p<0.001; **p<0.05; ***Tukey’s test; # at the time of the study (August 2021)

Gender also did not influence self-reported job satisfaction, but marital status did, as single healthcare workers reported significantly higher satisfaction than the married ones. The same is true for healthcare workers with the lowest education compared to the rest, and the satisfaction dropped with higher education. In contrast, respondents who worked in the emergency department and the COVID-19 ICU at the time of the survey reported significantly lower satisfaction than those working in other departments.
Prediction of job stress and job satisfaction by sociodemographic characteristics of healthcare workers

Table 3 shows the results of multiple regression analysis predicting the effects of sociodemographic characteristics on job stress and job satisfaction. Sociodemographic characteristics explain 5 % of the variance related to job stress and 12 % of the variance related to job satisfaction.

Predictors of job stress and satisfaction by sociodemographic characteristics of healthcare workers

ModelJob stressJob satisfaction
BSEβtpBSEβtp
Constant26.961.40-19.250.00064.974.26-15.240.000
Gender-0.390.45-0.04-0.860.3880.501.380.020.360.718
Marital status-0.130.56-0.01-0.240.812-4.781.70-0.15-2.810.005
Department-0.030.19-0.01-0.140.8850.140.590.010.240.807
Ever working in a COVID-19 ICU1.550.450.163.410.001-6.191.38-0.20-4.470.000
Education0.190.320.030.600.548-4.560.97-0.24-4.710.000
Age0.100.040.142.330.0200.220.120.101.760.079
R=0.23, R2=0.05, F(6–447)=4.31, p=0.000R=0.36, R2=0.12, F(6–447)=11.29, p=0.000

B – beta coefficient; β – standardized beta coefficient; p – statistical significance; R2 – coefficient of determination; SE – standard error

In the order of importance the most significant predictors of job stress were working in the COVID-19 ICU and older age and of job satisfaction education level, working in the COVID-19 ICU and being married.
DISCUSSION

Our finding of no significant difference in job stress between the genders opposes earlier reports of higher stress in female healthcare workers in China (4, 12) and Turkey (13).

As concerns job satisfaction, our findings that there are no significant gender differences support an earlier report on Turkish healthcare workers (14), but other studies report higher satisfaction in men (15–18).

Marital status, on the other hand, seems to significantly predict job stress and satisfaction in our study, which is in line with reports of higher job stress among married healthcare workers in China (19).

In line with the above, single healthcare workers reported higher job satisfaction. This is an interesting finding, considering that marital status did not seem to affect job satisfaction before the pandemic (15, 17, 18). This shift may be related to increased workload during the pandemic, pushing the married healthcare workers to extremes, as they also have families to take care of.

As for working in an intensive care unit for COVID-19 patients, our findings are quite expected and confirm earlier reports of higher stress for healthcare workers in China, Japan, or Germany (4, 20, 21).

Significantly lower self-reported job satisfaction in these healthcare workers working in a specialised COVID-19 ICU is also in line with expectations and corroborates other reports (22–24).

Lower education was also one of significant predictors of higher job satisfaction in our study and is in line with Şenturan et al. (25), who reported a negative relationship between education level and job satisfaction, but not with Tekingündüz et al. (18), who reported no significant relationship between education and job satisfaction.

Besides working in a COVID-19 ICU, age was the most significant predictor of job stress. Earlier studies reported diverse results, some showing lower (26, 27) and others higher (28, 29) stress with age.
CONCLUSION

The limitations of our study include selection bias and the possibility that our sample may not be representative of all healthcare workers in Turkey. Even so, it does raise some issues related to the pandemic that need to be addressed to improve satisfaction and to lower stress at work. This can be achieved through stress-coping strategies psychoeducation programmes (30, 31), professional psychological support to dissatisfied and overloaded workers, rewards (through salaries and bonuses), training, and improved working conditions.

Future research should include other sociodemographic variables that may affect stress and satisfaction at work, and similar studies should follow up to see what was left in the wake of the pandemic.

Predictors of job stress and satisfaction by sociodemographic characteristics of healthcare workers

Model Job stress Job satisfaction
B SE β t p B SE β t p
Constant 26.96 1.40 - 19.25 0.000 64.97 4.26 - 15.24 0.000
Gender -0.39 0.45 -0.04 -0.86 0.388 0.50 1.38 0.02 0.36 0.718
Marital status -0.13 0.56 -0.01 -0.24 0.812 -4.78 1.70 -0.15 -2.81 0.005
Department -0.03 0.19 -0.01 -0.14 0.885 0.14 0.59 0.01 0.24 0.807
Ever working in a COVID-19 ICU 1.55 0.45 0.16 3.41 0.001 -6.19 1.38 -0.20 -4.47 0.000
Education 0.19 0.32 0.03 0.60 0.548 -4.56 0.97 -0.24 -4.71 0.000
Age 0.10 0.04 0.14 2.33 0.020 0.22 0.12 0.10 1.76 0.079
R=0.23, R2=0.05, F(6–447)=4.31, p=0.000 R=0.36, R2=0.12, F(6–447)=11.29, p=0.000

Self-reported job stress and satisfaction by sociodemographic characteristics among healthcare workers

Variables Category N Job stress Job satisfaction
Mean SD t/F p Mean SD t/F p
Gender Female 280 27.27 4.65 t=0.98 0.330 62.44 4.70 t=-0.97 0.335
Male 174 26.82 4.96 63.86 5.19
Marital status Single 289 26.77 4.98 t=-2.01 0.045** 65.13 14.75 t=4.06 0.000*
Married 165 27.67 4.35 59.22 15.19
Department 1. Emergency 78 27.36 4.56 F=1.10 0.350 60.19 14.24 F=9.22 0.000*
2. Outpatient clinic 105 26.44 4.77 68.02 14.65
3. COVID-19 ICU# 64 27.70 4.41 56.48 12.34 Significant difference between 1 vs 2; 2 vs 3; 3 vs 4***
4. Other (surgery, radiology, lab, etc.) 207 27.15 4.96 63.49 15.66
Ever working in a COVID-19 ICU Yes 270 27.78 4.34 t=3.60 0.000* 59.98 14.95 t=-5.26 0.000*
No 184 26.10 5.20 67.39 14.40
Education 1. Secondary 48 25.81 5.02 F=2.40 0.067 69.27 14.27 F=15.47 0.000*
2. Vocational 181 26.78 5.29 67.05 15.42
3. Bachelor’s degree 183 27.57 4.33 58.15 13.73 Significant difference between 1 vs 3; 1 vs 4; 2 vs 3; 2 vs 4***
4. Master’s degree and higher 42 27.86 3.59 59.31 13.67

Healthcare worker distribution by sociodemographic characteristics (N=454)

Variables Total(N=454) Female(N=280) Male(N=174) χ2 p*
Marital status Single 289 177 (63.2) 112 (64.4) 0.06 0.804
Married 165 103 (36.8) 62 (35.6)
Department Emergency 78 51 (18.2) 27 (15.5) 13.36 0.004
Outpatient clinic 105 50 (17.9) 55 (31.6)
COVID-19 ICU# 64 47 (16.8) 17 (9.8)
Other (surgery, radiology, laboratory, etc.) 207 132 (47.1) 75 (43.1)
Ever working in a COVID-19 ICU Yes 270 168 (60.0) 102 (58.6) 0.08 0.771
No 184 112 (40.0) 72 (41.4)
Education Secondary 48 30 (10.7) 18 (10.3) 13.02 0.005
Vocational 181 94 (33.6) 87 (50.0)
Bachelor’s degree 183 128 (45.7) 55 (31.6)
Master’s degree and higher 42 28 (10.0) 14 (8.0)
t p**
Age Mean±SD 27.89±7.23 27.92±7.23 27.85±7.24 0.10 0.923

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