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Organizational Support Factors Associated with Fatigue and Turnover Intention among Workers with Chronic Health Conditions

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Abstract

Background/Purpose

One-third of US workers report chronic health conditions that can limit their ability to work, sometimes leading to extended sickness absence, job loss, or premature retirement. The purpose of this study was to evaluate whether selected organizational factors were associated with fatigue and turnover intent among workers with chronic health conditions.

Method

Workers with chronic physical health conditions (N = 119) volunteered for a worksite group intervention program and completed a pre-intervention survey including the Work Limitations Questionnaire, Areas of Worklife Survey, Job Leeway Scale, the Occupational Fatigue Exhaustion Recovery scale, and a measure of turnover intention. We evaluated whether perceptions of organizational support (control, fairness, community, and leeway) were associated with fatigue and intention to leave.

Results

Workers reported a median of 3 chronic conditions with moderate levels of work-related fatigue, and 30% were considering a job change. All four organizational support factors were negatively correlated with fatigue and turnover intention. In multiple regression analyses controlling for severity of work limitations, fatigue was uniquely explained by fairness and leeway, while turnover intention was uniquely explained by fairness. There was a statistically significant age interaction showing greater benefits of leeway to prevent turnover among younger workers.

Conclusions and Implications

Organizations that implement policies and practices that provide greater control, fairness, sense of community, and health-related leeway may reduce worker fatigue and turnover among workers with chronic health conditions.

Trial registration

Clinicaltrials.gov; NCT01978392 (issued November 6, 2013).

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Data Availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Code Availability

The code that supports the findings of this study are available on request from the corresponding author.

References

  • Aili, K., Svartengren, M., Danielsson, K., Johansson, E. & Hellman, T. (2023). Active engagement of managers in employee RTW and manager-employee relationship: managers’ experiences of participating in a dialogue using the Demand and Ability Protocol. Disability & Rehabilitation, in press.

  • Boot, C. R. L., de Kruif, A. T. C. M., Shaw, W. S., van der Beek, A. J., Deeg, D. J., & Abma, T. (2016). Factors important for work participation among older workers with depression, cardiovascular disease, and osteoarthritis: A mixed methods study. Journal of Occupational Rehabilitation, 26, 160–172.

    Article  PubMed  Google Scholar 

  • Boot, C. R. L., Koppes, L. L., van den Bossche, S. N., Anema, J. R., & van der Beek, A. J. (2011). Relation between perceived health and sick leave in employees with a chronic illness. Journal of Occupational Rehabilitation, 21(2), 211–219.

    Article  PubMed  Google Scholar 

  • Bosma, A. R., Boot, C. R. L., Schaafsma, F. G., & Anema, J. R. (2020). Facilitators, barriers and support needs for staying at work with a chronic condition: A focus group study. BMC Public Health, 20(10), 201.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bosma, A. R., Boot, C. R. L., Snippen, N. C., Schaafsma, F. G., & Anema, J. R. (2021). Supporting employees with chronic conditions to stay at work: Perspectives of occupational health professionals and organizational representatives. BMC Public Health, 21(1), 592.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bugajska, J., & Sagan, A. (2014). Chronic musculoskeletal disorders as risk factors for reduced work ability in younger and ageing workers. International Journal of Occupational Safety & Ergonomics, 20(4), 607–615.

    Article  Google Scholar 

  • Buttorff, C., Ruder, T., & Bauman, M. (2017). Multiple chronic conditions in the United States, pp. 5–12. Santa Monica, CA: RAND Corporation.

  • Chumo, I., Kabaria, C., & Mberu, B. Social inclusion of persons with disability in employment: what would it take to socially support employed persons with disability in the labor market? Frontiers in Rehabilitation Science, Jun 30:4:1125129.

  • Cullen, K. L., Irvin, E., Collie, A., Clay, F., Gensby, U., Jennings, P. A., Hogg-Johnson, S., Kristman, V., Laberge, M., McKenzie, D., Newnam, S., Palagyi, A., Ruseckaite, R., Sheppard, D. M., Shourie, S., Steenstra, I., Van Eerd, D., & Amick, B. C., 3rd. (2018). Effectiveness of workplace interventions in return-to-work for musculoskeletal, pain-related and mental health conditions: An update of the evidence and messages for practitioners. Journal of Occupational Rehabilitation, 28(1), 1–15.

    Article  PubMed  Google Scholar 

  • de Jong, M., de Boer, A. G., Tamminga, S. J., & Frings-Dresen, M. H. (2015). Quality of working life issues of employees with a chronic physical disease: A systematic review. Journal of Occupational Rehabilitation, 25(1), 182–196.

    Article  PubMed  Google Scholar 

  • de Vroome, E. M., Uegaki, K., van der Ploeg, C. P., Treutlein, D. B., Steenbeek, R., de Weerd, M., & van den Bossche, S. N. J. (2015). Burden of sickness absence due to chronic disease in the Dutch workforce from 2007 to 2011. Journal of Occupational Rehabilitation, 25(4), 675–684.

    Article  PubMed  Google Scholar 

  • Ekberg, K., Pransky, G.S., Besen, E., Fassier, J., Feuerstein, M., Munir, F., Blanck, P. & the Hopkinton Conference Working Group on Workplace Disability Prevention (2016). New business structures creating organizational opportunities and challenges for work disability prevention. Journal of Occupational Rehabilitation, 26(4), 480-489

  • Esteban, E., Coenen, M., Ito, E., Gruber, S., Scaratti, C., Leonardi, M., Roka, O., Vasilou, E., Muñoz-Murillo, A., Ávila, C. C., Kovačič, D. S., Ivandic, I., & Sabariego, C. (2018). Views and experiences of persons with chronic diseases about strategies that aim to integrate and re-integrate them into work: A systematic review of qualitative studies. International Journal of Environmental Research & Public Health, 15(5), 1022.

    Article  Google Scholar 

  • Gifford, B., & Zong, Y. (2017). On-the-job productivity losses among employees with health problems: The role of work accommodations. Journal of Occupational and Environmental Medicine, 59(9), 885–893.

    Article  PubMed  Google Scholar 

  • Gignac, M. A. M., Bowring, J., Jetha, A., Beaton, D. E., Breslin, F. C., Franche, R., Irvin, E., Macdermid, J. C., Shaw, W. S., Smith, P. M., Thompson, A., Tompa, E., Van Eerd, D., & Saunders, R. (2021). Disclosure, privacy, and workplace accommodation of episodic disabilities: Organizational perspectives on disability communication-support processes to sustain employment. Journal of Occupational Rehabilitation, 31(1), 153–165.

    Article  PubMed  Google Scholar 

  • Gignac, M. A. M., Kristman, V., Smith, P. M., Beaton, D. E., Badley, E. M., Ibrahim, S., & Mustard, C. A. (2018). Are there differences in workplace accommodation needs, use and unmet needs among older workers with arthritis, diabetes and no chronic conditions? Examining the role of health and work context. Work, Aging, and Retirement, 4(4), 381–398.

    Article  PubMed  Google Scholar 

  • Heinrichs, K., Angerer, P., & Loerbroks, A. (2018). Psychosocial working conditions as determinants of asthma self-management at work: A systematic review. Journal of Asthma, 55(10), 1095–1104.

    Article  Google Scholar 

  • Hyun, J., Sliwinski, M. J., Almeida, D. M., Smyth, J. M., & Scott, S. B. (2018). The moderating effects of aging and cognitive abilities on the association between work stress and negative affect. Aging & Mental Health, 22(5), 611–618.

    Article  Google Scholar 

  • IBM Corporation (2020). IBM SPSS Statistics for Windows. Version 27.0 (released 2020). Armonk, NY: IBM Corporation.

  • Jason, K. J., Carr, D. C., Washington, T. R., Hilliard, T. S., & Mingo, C. A. (2017). Multiple chronic conditions, resilience, and workforce transitions in later life: A socio-ecological model. The Gerontologist, 57(2), 269–281.

    PubMed  Google Scholar 

  • Karasek, R. A. (1979). Job demands, job decision latitude and mental strain: Implications for job redesign. Administrative Science Quarterly, 24, 285–308.

    Article  Google Scholar 

  • Karasek, R., & Theorell, T. (1990). Healthy work: Stress, productivity and the reconstruction of working life. Basic Books.

    Google Scholar 

  • Kelloway, E. K., Gottlieb, B. H., & Barham, L. (1999). The source, nature, and direction of work and family conflict: A longitudinal investigation. Journal of Occupational Health Psychology, 4(4), 337–346.

    Article  PubMed  Google Scholar 

  • Kiss, P., De Meester, M., & Braeckman, L. (2008). Differences between younger and older workers in the need for recovery after work. International Archives of Occupational & Environmental Health, 81(3), 311–320.

    Article  Google Scholar 

  • Kristman, V.L., Shaw, W.S., Boot, C.R.L., Delclos, G.L., Sullivan, M.J., Ehrhart, M.G. & Hopkinton Conference Working Group on Workplace Disability Prevention (2016). Researching complex and multi-level workplace factors affecting disability and prolonged sickness absence. Journal of Occupational Rehabilitation, 26(4), 399-416

  • Laditka, J. N., & Laditka, S. B. (2017). Work disability in the United States, 1968–2015: Prevalence, duration, recovery, and trends. SSM Population Health, 4, 126–134.

    Article  PubMed  PubMed Central  Google Scholar 

  • Leiter, M. P., & Maslach, C. (2000). Areas of Worklife Survey. Mind Garden Inc.

    Google Scholar 

  • Leiter, M. P., & Maslach, C. (2009). Nurse turnover: The mediating role of burnout. Journal of Nurse Management, 17(3), 331–339.

    Google Scholar 

  • Leiter, M. P., & Maslach, C. (2011). Areas of Worklife Survey Manual (5th ed.). Mind Garden Inc.

    Google Scholar 

  • Lerner, D., Adler, D. A., Chang, H., Berndt, E. R., Irish, J. T., Lapitsky, L., Hood, M. Y., Reed, J., & Rogers, W. H. (2004). The clinical and occupational correlates of work productivity loss among employed patients with depression. Journal of Occupational & Environmental Medicine, 46(6 Suppl), S46–S55.

    Article  Google Scholar 

  • Lerner, D., Amick, B. C., 3rd., Lee, J. C., Rooney, T., Rogers, W. H., Chang, H., & Berndt, E. R. (2003). Relationship of employee-reported work limitations to work productivity. Medical Care, 41(5), 649–659.

    Article  PubMed  Google Scholar 

  • Lerner, D., Chang, H., Rogers, W. H., Benson, C., Schein, J., & Allaire, S. (2009). A method for imputing the impact of health problems on at-work performance and productivity from available health data. Journal of Occupational & Environmental Medicine, 51(5), 515–524.

    Article  Google Scholar 

  • Lerner, D., Reed, J. I., Massarotti, E., Wester, L. M., & Burke, T. A. (2002). The Work Limitations Questionnaire’s validity and reliability among patients with osteoarthritis. Journal of Clinical Epidemiology, 55, 197–208.

    Article  PubMed  Google Scholar 

  • Lindsay, S., Cagliostro, E., Leck, J., Shen, W., & Stinson, J. (2019). Disability disclosure and workplace accommodations among youth with disabilities. Disability & Rehabilitation, 41(16), 1914–1924.

    Article  Google Scholar 

  • Muijzer, A., Geertzen, J. H., de Boer, W. E., Groothoof, J. W., & Brouwer, S. (2012). Identifying factors relevant in the assessment of return-to-work efforts in employees on long-term sickness absence due to chronic low back pain: A focus group study. BMC Public Health, 12, 77.

    Article  PubMed  PubMed Central  Google Scholar 

  • Naessens, J. M., Stroebel, R. J., Finnie, D. M., Shah, N. D., Wagie, A. E., Litchy, W. J., Killinger, P. J. F., O’Byrne, T. J. D., Wood, D. L., & Nesse, R. E. (2011). Effect of multiple chronic conditions among working-age adults. Ambulatory Journal of Managed Care, 17(2), 118–122.

    Google Scholar 

  • O’Hagan, F. (2019). Work, organisational practices, and margin of manoeuver during work reintegration. Disability & Rehabilitation, 41(2), 172–181.

    Article  Google Scholar 

  • Organisation for Economic Co-operation and Development. (2010). Sickness, disability and work: Breaking the barriers: A synthesis of findings across OECD countries. OECD Publishing.

    Google Scholar 

  • Pransky, G. S., Fassier, J. B., Besen, E., Blanck, P., Ekberg, K., Feuerstein, M., Munir, F., et al. (2016). Sustaining work participation across the life course. Journal of Occupational Rehabilitation, 26(4), 465–479.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rojanasarot, S., Bhattacharyya, S. K., & Edwards, N. (2023). Productivity loss and productivity loss costs to United States employers due to priority conditions: A systematic review. Journal of Medical Economics, 26(1), 262–270.

    Article  PubMed  Google Scholar 

  • Schofield, D. J., Shrestha, R. N., Cunich, M., Tanton, R., Kelly, S., Passey, M. E., & Veerman, L. J. (2015). Lost productive life years caused by chronic conditions in Australians aged 45–64 years, 2010–2030. Medical Journal of Australia, 203(6), e1-6.

    Article  Google Scholar 

  • Shaw, W. S., McLellan, R. K., Besen, E., Namazi, S., Nicholas, M. K., Dugan, A. G., & Tveito, T. H. (2022). A worksite self-management program for workers with chronic health conditions improves worker engagement and retention, but not workplace function. Journal of Occupational Rehabilitation, 32(1), 77–86.

    Article  PubMed  Google Scholar 

  • Shaw, W. S., Besen, E., Pransky, G., Boot, C. R. L., Nicholas, M. K., McLellan, R. K., & Tveito, T. H. (2014). Manage at work: A randomized, controlled trial of a self-management group intervention to overcome workplace challenges associated with chronic physical health conditions. BMC Public Health, 14, 515.

    Article  PubMed  PubMed Central  Google Scholar 

  • Shaw, W. S., Dugan, A. G., McGonagle, A. K., Nicholas, M. K., & Tveito, T. H. (2023). The Job Leeway Scale: Initial evaluation of a self-report measure of health-related flexibility and latitude at work. Journal of Occupational Rehabilitation, 33(3), 581–591.

    Article  PubMed  PubMed Central  Google Scholar 

  • Shaw, W. S., Tveito, T. H., & Boot, C. R. L. (2013). Introduction to the special section: Sustainability of work with chronic health conditions. Journal of Occupational Rehabilitation, 23(2), 157–161.

    Article  PubMed  Google Scholar 

  • Shaw, W.S., van der Windt, D.A., Main, C.J., Loisel, P., Linton, S.J., & the “Decade of the Flags” Working Group (2009). Early patient screening and intervention to address individual-level occupational factors (“blue flags”) in back disability. Journal of Occupational Rehabilitation, 19(1), 64-80

  • Silvaggi, F., Leonardi, M., Guastafierro, E., Quintas, R., Toppo, C., Foucaud, J., Lamore, K., Rothe, U., & Scaratti, C. (2019). Chronic diseases and employment: An overview of existing training tools for employers. International Journal of Environmental Research and Public Health, 16(5), 718.

    Article  PubMed  PubMed Central  Google Scholar 

  • Thompson, L., Ford, H. L., Stroud, A., & Madill, A. (2019). Managing the (in)visibility of chronic illness at work: Dialogism, pardoy, and reported speech. Quality of Health Research, 29(8), 1213–1226.

    Article  Google Scholar 

  • Tveito, T. H., Sembajwe, G., Boden, L. I., Dennerlein, J. T., Wagner, G. R., Kenwood, C., Stoddard, A. M., Reme, S. E., Hopcia, K., Hashimoto, D., Shaw, W. S., & Sorensen, G. (2014). Impact of organizational policies and practices on workplace injuries in a hospital setting. Journal of Occupational & Environmental Medicine, 56(8), 802–808.

    Article  Google Scholar 

  • Tveito, T. H., Shaw, W. S., Huang, Y.-H., Nicholas, M. K., & Wagner, G. (2010). Managing pain in the workplace: A focus group study of challenges, strategies and what matters most to workers with low back pain. Disability & Rehabilitation, 32(24), 2035–2045.

    Article  Google Scholar 

  • van der Doef, M. P., & Schelvis, R. M. C. (2019). Relations between psychosocial job characteristics and work ability in employees with chronic headaches. Journal of Occupational Rehabilitation, 29(1), 119–127.

    Article  PubMed  Google Scholar 

  • van Zon, S.K.R., Ots, P., Robroek, S.J.W., Burdorf, A., Oude-Hengel, K.M., & Brouwer, S. (2023). Do chronic diseases moderate the association between psychosocial working conditions and work exit? Longitudinal results from 55,950 Dutch workers. Journal of Epidemiology & Community Health, in press.

  • Vanajan, A., Bültmann, U., & Henkens, K. (2020a). Health-related work limitations among older workers – the role of flexible work arrangements and organizational climate. The Gerontologist, 60(3), 450–459.

    Article  PubMed  Google Scholar 

  • Vanajan, A., Bültmann, U., & Henkens, K. (2020b). Why do older workers with chronic health conditions prefer to retire early? Age and Ageing, 49, 403–410.

    Article  PubMed  PubMed Central  Google Scholar 

  • Varekamp, I., & van Dijk, F. J. H. (2010). Workplace problems and solutions for employees with chronic diseases. Occupational Medicine (london), 60(4), 287–293.

    Article  Google Scholar 

  • Vooijs, M., Leensen, M. C., Hoving, J. L., Daams, J. G., Wind, H., & Frings-Dresen, M. H. (2015a). Disease-generic factors of work participation of workers with a chronic disease: A systematic review. International Archives of Occupational & Environmental Health, 88(8), 1015–1029.

    Article  Google Scholar 

  • Vooijs, M., Leensen, M. C., Hoving, J. L., Wind, H., & Frings-Dresen, M. H. (2015b). Interventions to enhance work participation of workers with a chronic disease: A systematic review of reviews. Occupational & Environmental Medicine, 72(11), 820–826.

    Article  Google Scholar 

  • Watson, K. B., Carlson, S. A., Loustalot, F., Town, M., Eke, P. I., Thomas, C. W., & Greenlund, K. J. (2022). Chronic conditions among adults aged 18–34 years – United States, 2019. MMWR Morbidity & Mortality Weekly Report, 71, 964–970.

    Article  Google Scholar 

  • Williams-Whitt, K., Bültmann, U., Amick, B., Munir, F., Tveito, T.H., Anema, J.R., & Hopkinton Conference Working Group on Workplace Disability Prevention (2016). Workplace interventions to prevent disability from both the scientific and practice perspectives: A comparison of scientific literature, grey literature and stakeholder observations. Journal of Occupational Rehabilitation, 26(4), 417-433

  • Winwood, P. C., Lushington, K., & Winefield, A. H. (2006). Further development and validation of the Occupational Fatigue Exhaustion Recovery (OFER) scale. Journal of Occupational & Environmental Medicine, 48(4), 381–389.

    Article  Google Scholar 

  • Winwood, P. C., Winefield, A. H., Dawson, D., & Lushington, K. (2005). Development and validation of a scale to measure work-related fatigue and recovery: The Occupational Fatigue Exhaustion/Recovery scale (OFER). Journal of Occupational & Environmental Medicine, 47(6), 594–606.

    Article  Google Scholar 

  • World Health Organization. (2011). World report on disability. World Health Organization.

    Google Scholar 

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Funding

This work was funded through the intramural research program of the Liberty Mutual Research Institute for Safety (Project LMRIS 11–08 awarded to WS Shaw).

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Authors and Affiliations

  1. Department of Medicine, Division of Occupational and Environmental Medicine, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA

    William S. Shaw & Alicia G. Dugan

  2. University of Sydney, Royal North Shore Hospital, St. Leonards, Sydney, NSW, 2065, Australia

    Michael K. Nicholas

  3. University of South-Eastern Norway, Horten, Norway

    Tone Langjordet Johnsen & Torill H. Tveito

Authors
  1. William S. Shaw
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  2. Alicia G. Dugan
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  3. Michael K. Nicholas
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  4. Tone Langjordet Johnsen
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  5. Torill H. Tveito
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Contributions

WS Shaw, TH Tveito, and MK Nicholas contributed to the original intervention study conception and design. All authors contributed to the design and conceptualization for the analytic approach used in this publication. All authors drafted portions of the work or revised it critically for important intellectual content. The first full draft of the manuscript was written by WS Shaw, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Alicia G. Dugan.

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Relevance to Special Issue

Improving work outcomes for individuals with chronic health conditions may require an organizational context that supports and accommodates workers more readily when intermittent or permanent needs arise. In this study, workers interested in a worksite program to improve coping with chronic health conditions completed a pre-intervention survey related to their health, function, and organizations. Measures of organizational fairness, leeway, control, and sense of community were negatively associated with fatigue and turnover intention, and the effect of leeway on turnover was more pronounced among younger workers. Thus, employer practices that convey messages of inclusion and flexibility to the workforce may sustain employment and reduce fatigue among workers with chronic health conditions.

Conflicts of interest/Competing interests

The authors have no relevant financial or non-financial interests to disclose.

Ethics Approval

All procedures were reviewed and approved by the Institutional Review Board of the Liberty Mutual Research Institute for Safety, where the lead author was affiliated at the time of data collection. All study participants provided written consent.

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Written informed consent was obtained by all study participants.

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Shaw, W.S., Dugan, A.G., Nicholas, M.K. et al. Organizational Support Factors Associated with Fatigue and Turnover Intention among Workers with Chronic Health Conditions. Occup Health Sci (2024). https://doi.org/10.1007/s41542-024-00184-0

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