Determinants of Individual and Organizational Health in Human Service Professions

The psychosocial work environment in human service organizations is in many respects rewarding from the aspect of human interaction. However, it has also been described in several research reports as demanding and stressful both physically and mentally, resulting in a negative impact on employee health and a high degree of sickness absence. From a public health perspective it is important to focus on determinants of health in occupational groups that are characterized by caring and human relations. This thesis aims at identifying determinants of individual and organizational health in human service professions from a multifactorial perspective. Based on both cross-sectional and longitudinal data, four studies of various aspects of psychosocial work exposures are carried out. Study I, an explorative and qualitative study, examines determinants of the psychosocial work environment in the Church of Sweden. Study II consists of a retrospective, randomized study assessing effects of goal clarity work on organizational well-being in the Church. Study III examines exposures resulting in stress-related sick leave among elderly care employees. Study IV is a longitudinal study that assesses effects of organizational change on health and sickness absence among elderly care employees. The results show some positive experiences, despite overall demanding work conditions within both of the studied professions. In the Church (Paper I), experiences of freedom and influence at work and the Christian values tend be factors with modifying effect on health. Four patterns are identified for negative health impact; these include unclear organization, a sense of being different, stressful work and destructive communication style. Effects of goal clarity work (Paper II) indicate an overall positive impact on organizational well-being. In elderly care (Paper III), the results suggest, in general, a positive work climate and high effectiveness. Work related exhaustion was significantly higher among employees with stress related sickness absence. Factors of risk for being absent due to stress are approximately three times higher among employees dissatisfied with both their work and their social situations. Finally, measuring effects of organizational change (Paper IV), the results reveal evidence of unchanged self-rated health (SRH), work satisfaction and work exhaustion after reorganization. However, sickness absence increased across time and there is an indication of impaired levels of the anabolic hormone DHEA-S among those individuals affected by the reorganization. The results point to a challenge for further research on the interplay between perceived stressors, resources available, biological stress markers and health in order to find adequate measures for improvements in psychosocial work environment in human service professions