|
|
Understanding Effort-Reward Imbalance among Kinshasa’s Physiotherapists
|
Abstract:
Background: The issue of psychosocial risks at work has gained significant attention due to an improved recognition of the professional environmental cause of physical and psychological symptoms. Objective: To establish the typical profile of the Kinshasa physiotherapist most exposed to the Effort-Reward imbalance (ERI) using the Siegrist model, which evaluates both efforts, rewards and overinvestment. Method: A total of 174 physiotherapists practicing in Kinshasa were included in the study. The Siegrist model was administered to all participants, and 40 physiotherapists were selected to respond to an open questionnaire in the form of interviews, but after 17 interviews, semantic and theoretical saturation had been reached. Quantitative data were analyzed using ANOVA and principal component analysis (PCA), while qualitative insights enriched the interpretation of these findings by providing contextual depth. Results: The average ERI score was 0.43 ± 0.19 with 3% of physiotherapists having a score > 1. The ANOVA shows that working at patients’ homes and aiming for a high salary were significantly related with the ERI score and the sub-score “Efforts” (p < 0.01). Also, male physiotherapists overcommit more than female physiotherapists. The PCA has identified 9 major determinants of the ERI: diplomas, experience, specialty, workplace, self-esteem, status control, rewards, time and volume of work. Conclusion: Despite precarious working conditions and a difficult socio-economic context, only 3% of Kinshasa physiotherapists are subject to ERI. This surprising contrast may reflect high resilience, adaptive coping strategies, or a normalization of adversity that lowers reward expectations. The typical profile of the most exposed physiotherapist to the ERI in Kinshasa is a male physiotherapist who invest high effort, seeks high remuneration and provide home-based care. Both individual factors (such as education, experience, and self-esteem) and contextual elements (including workplace, workload, and perceived rewards) play a key role in shaping ERI in this population. Clinical Implications: Working at the patient’s home allows physiotherapists to have work, and therefore a salary or a supplement to their salary; but this way could also expose them to imbalance and stress.
| [1] | Khammissa, R.A.G., Nemutandani, S., Feller, G., Lemmer, J. and Feller, L. (2022) Burnout Phenomenon: Neurophysiological Factors, Clinical Features, and Aspects of Management. Journal of International Medical Research, 50. https://doi.org/10.1177/03000605221106428 |
| [2] | Ataboho, E.E., Atipo-Galloye, P. and Kokolo, J.G. (2020) Évaluation des Facteurs de Risques Psychosociaux chez les Professionnels de Santé à Pointe-Noire (Congo). Health Sciences and Disease, 21, 108-113. |
| [3] | Lubanzadio-Mengi, P., Lechevalier, A., Cullus, P., Faoro, V. and Foucart, J. (2019) Profil type du kinésithérapeute satisfait au travail: Étude du déséquilibre efforts-récompense chez les kinésithérapeutes bruxellois. Mains Libres, 36, 27-36. https://doi.org/10.55498/mainslibres.2019.36.4.0027 |
| [4] | Siegrist, J. (2016) Effort-Reward Imbalance Model. In: Stress: Concepts, Cognition, Emotion, and Behavior, Elsevier, 81-86. https://doi.org/10.1016/b978-0-12-800951-2.00009-1 |
| [5] | de Jonge, J., Bosma, H., Peter, R. and Siegrist, J. (2000) Job Strain, Effort-Reward Imbalance and Employee Well-Being: A Large-Scale Cross-Sectional Study. Social Science & Medicine, 50, 1317-1327. https://doi.org/10.1016/s0277-9536(99)00388-3 |
| [6] | Siegrist, J. and Li, J. (2020) Effort-Reward Imbalance and Occupational Health. In: Handbook Series in Occupational Health Sciences, Springer, 355-382. https://doi.org/10.1007/978-3-030-31438-5_14 |
| [7] | van Vegchel, N., de Jonge, J., Bosma, H. and Schaufeli, W. (2005) Reviewing the Effort-Reward Imbalance Model: Drawing up the Balance of 45 Empirical Studies. Social Science & Medicine, 60, 1117-1131. https://doi.org/10.1016/j.socscimed.2004.06.043 |
| [8] | Notelaers, G., Törnroos, M. and Salin, D. (2019) Effort-Reward Imbalance: A Risk Factor for Exposure to Workplace Bullying. Frontiers in Psychology, 10, Article 386. https://doi.org/10.3389/fpsyg.2019.00386 |
| [9] | Cohidon, C., Arnaudo, B. and Murcia, M. (2009) Mal-être et environnement psychosocial au travail: Premiers résultats du programme Samotrace, volet entreprise, France. Santé Publique France, 25, 265-269. |
| [10] | Niedhammer, I. and Siegrist, J. (1998) Facteurs psychosociaux au travail et maladies cardio-vasculaires: L’apport du modèle du Déséquilibre Efforts/Récompenses. Revue d’Epidemiologie et de Sante Publique, 46, 398-410. |
| [11] | Eddy, P., Wertheim, E.H., Kingsley, M. and Wright, B.J. (2017) Associations between the Effort-Reward Imbalance Model of Workplace Stress and Indices of Cardiovascular Health: A Systematic Review and Meta-Analysis. Neuroscience & Biobehavioral Reviews, 83, 252-266. https://doi.org/10.1016/j.neubiorev.2017.10.025 |
| [12] | Calnan, M., Wainwright, D. and Almond, S. (2000) Job Strain, Effort-Reward Imbalance and Mental Distress: A Study of Occupations in General Medical Practice. Work & Stress, 14, 297-311. https://doi.org/10.1080/02678370110040920 |
| [13] | Christiansen, F., Gynning, B.E., Lashari, A., Johansson, G. and Brulin, E. (2024) Associations between Effort-Reward Imbalance and Risk of Burnout among Swedish Physicians. Occupational Medicine, 74, 355-363. https://doi.org/10.1093/occmed/kqae039 |
| [14] | Ge, J., He, J., Liu, Y., Zhang, J., Pan, J., Zhang, X., et al. (2021) Effects of Effort-Reward Imbalance, Job Satisfaction, and Work Engagement on Self-Rated Health among Healthcare Workers. BMC Public Health, 21, Article No. 195. https://doi.org/10.1186/s12889-021-10233-w |
| [15] | Lee, S., Lee, J.H., Gillen, M. and Krause, N. (2013) Job Stress and Work-Related Musculoskeletal Symptoms among Intensive Care Unit Nurses: A Comparison between Job Demand-Control and Effort-Reward Imbalance Models. American Journal of Industrial Medicine, 57, 214-221. https://doi.org/10.1002/ajim.22274 |
| [16] | Enberg, B., Öhman, A. and Keisu, B.-I. (2015) Work Experiences among Healthcare Professionals in 2002 and 2012—A 10-Year Follow up. Physiotherapy, 101, e361-e362. https://doi.org/10.1016/j.physio.2015.03.575 |
| [17] | Scacighini, L., Prati, A. and Sala De Filippis, T. (2021) Moral Distress, Job Satisfaction and Intention to Leave the Profession among Independently Working Nurses, Physicians and Physiotherapists in Southern Switzerland: A Quantitative Study. University of Applied Sciences, Southern Switzerland/Competence Net Work Heath Work Force. |
| [18] | Devreux, I.A.J., Kittel, F., Mamdouh, K. and Al-Awa, B. (2012) Determinants of Rehabilitation Services Staffs’ Job Satisfaction (by Effort Reward Imbalance) and Variations in Teaching, Profit Making and Non-Profit Hospitals. Research Journal of Medical Sciences, 6, 154-158. https://doi.org/10.3923/rjmsci.2012.154.158 |
| [19] | Pónusz, R., Kovács, D., Varga, A., Hock, M., Raposa, B., Boncz, I., et al. (2015) Survey of the Hungarian Physiotherapists’ Migration and Career Changing Behaviour. Value in Health, 18, A555. https://doi.org/10.1016/j.jval.2015.09.1791 |
| [20] | Handlery, K., McQueeney, S., Handlery, R., Regan, E.W. and Fritz, S.L. (2024) Factors Contributing to Physical Therapist Attrition: A Qualitative Study. Journal of Allied Health, 53, e1-e12. |
| [21] | Darboe, A., Lin, I. and Kuo, H. (2016) Effort-reward Imbalance and Self-Rated Health among Gambian Healthcare Professionals. BMC Health Services Research, 16, Article No. 125. https://doi.org/10.1186/s12913-016-1347-0 |
| [22] | Département fédéral de justice et police and Office national de migration Suisse (2014) Focus RD Congo Le système sanitaire à Kinshasa: Médicaments et soins du VIH-sida, de l’hypertension artérielle, du diabète de type II et des troubles mentaux. |
| [23] | Lubanzadio-Mengi, P., Mayaka Manitu, S., Faoro, V. and Foucart, J. (2024) Typical Profile of the Most Satisfied Physiotherpists Working in Kinshasa. Journal of Public Health and Disease Prevention, 7, 1-18. |
| [24] | Ravez, L.J., Rennie, S., Yemesi, R., Chalachala, J., Makindu, D., Behets, F., et al. (2019) Les grèves de médecins en République Démocratique du Congo: Quels repères éthiques généralisables? Canadian Journal of Bioethics, 2, 63-72. https://doi.org/10.7202/1062303ar |
| [25] | Stasse, S., Vita, D., Kimfuta, J., da Silveira, V.C., Bossyns, P. and Criel, B. (2015) Improving Financial Access to Health Care in the Kisantu District in the Democratic Republic of Congo: Acting Upon Complexity. Global Health Action, 8, Article 25480. https://doi.org/10.3402/gha.v8.25480 |
| [26] | Kahombera, R. and Duranton, F. (2018) Satisfaction des étudiants dans une institution d’enseignement universitaire. Cahiers de Psychologie Cognitive, 596-606. |
| [27] | Creswell, J.W. and Clark, V.L. (2011) Concevoir et mener des recherches à méthodes mixtes. Sage Publications. |
| [28] | El Achhab, Y., El Ammari, A., El Kazdouh, H., Najdi, A., Berraho, M., Tachfouti, N., et al. (2016) Health Risk Behaviours Amongst School Adolescents: Protocol for a Mixed Methods Study. BMC Public Health, 16, Article No. 1209. https://doi.org/10.1186/s12889-016-3873-4 |
| [29] | Bergeron, J. and Renaud, S. (2005) Les formes de représentation collective désirées par les salariés des services privés au Québec. Relations industrielles, 55, 250-272. https://doi.org/10.7202/051308ar |
| [30] | Jager, J., Putnick, D.L. and Bornstein, M.H. (2017) II. More Than Just Convenient: The Scientific Merits of Homogeneous Convenience Samples. Monographs of the Society for Research in Child Development, 82, 13-30. https://doi.org/10.1111/mono.12296 |
| [31] | Sillero Sillero, A., Ayuso Margañon, R., Moreno-Segura, N., Carrasco, J.J., Atef, H., Ayuso Margañon, S., et al. (2023) Physiotherapists’ Ethical Climate and Work Satis-faction: A Strobe-Compliant Cross-Sectional Study. Healthcare, 11, Article 2631. https://doi.org/10.3390/healthcare11192631 |
| [32] | Siegrist, J., Starke, D., Chandola, T., Godin, I., Marmot, M., Niedhammer, I., et al. (2004) The Measurement of Effort-Reward Imbalance at Work: European Comparisons. Social Science & Medicine, 58, 1483-1499. https://doi.org/10.1016/s0277-9536(03)00351-4 |
| [33] | Gale, N.K., Heath, G., Cameron, E., Rashid, S. and Redwood, S. (2013) Using the Framework Method for the Analysis of Qualitative Data in Multi-Disciplinary Health Research. BMC Medical Research Methodology, 13, Article No. 117. https://doi.org/10.1186/1471-2288-13-117 |
| [34] | Rossettini, G., Latini, T.M., Palese, A., Jack, S.M., Ristori, D., Gonzatto, S., et al. (2018) Determinants of Patient Satisfaction in Outpatient Musculoskeletal Physiotherapy: A Systematic, Qualitative Meta-Summary, and Meta-Synthesis. Disability and Rehabilitation, 42, 460-472. https://doi.org/10.1080/09638288.2018.1501102 |
| [35] | Mayaka Manitu, S., Muvudi Lushimba, M., Macq, J. and Meessen, B. (2015) Arbitrage d’une controverse de politique de santé: Application d’une démarche délibérative au Financement basé sur la Performance en Afrique subsaharienne. Santé Publique, 27, 425-434. https://doi.org/10.3917/spub.153.0425 |
| [36] | Guest, G., Bunce, A. and Johnson, L. (2006) How Many Interviews Are Enough? Field Methods, 18, 59-82. https://doi.org/10.1177/1525822x05279903 |
| [37] | Hennink, M.M., Kaiser, B.N. and Marconi, V.C. (2016) Code Saturation versus Meaning Saturation. Qualitative Health Research, 27, 591-608. https://doi.org/10.1177/1049732316665344 |
| [38] | Saunders, B., Sim, J., Kingstone, T., Baker, S., Waterfield, J., Bartlam, B., et al. (2017) Saturation in Qualitative Research: Exploring Its Conceptualization and Operationalization. Quality & Quantity, 52, 1893-1907. https://doi.org/10.1007/s11135-017-0574-8 |
| [39] | Ritchie, J. and Spencer, L. (2002) Qualitative Data Analysis for Applied Policy Research. In: The Qualitative Researcher’s Companion, Sage Publications, 305-329. https://doi.org/10.4135/9781412986274.n12 |
| [40] | Derycke, H., Vlerick, P., Burnay, N., Decleire, C., D’Hoore, W., Hasselhorn, H.M., et al. (2010) Impact of the Effort-Reward Imbalance Model on Intent to Leave among Belgian Health Care Workers: A Prospective Study. Journal of Occupational and Organizational Psychology, 83, 879-893. https://doi.org/10.1348/096317909x477594 |
| [41] | Snell, R., Fyfe, S., Fyfe, G., Blackwood, D. and Itsiopoulos, C. (2020) Development of Professional Identity and Professional Socialisation in Allied Health Students: A Scoping Review. Focus on Health Professional Education: A Multi-Professional Journal, 21, 29-56. https://doi.org/10.11157/fohpe.v21i1.322 |
| [42] | Narain, S. and Mathye, D. (2023) Strategies to Integrate Physiotherapists into Primary Health Care in South Africa. South African Journal of Physiotherapy, 79, a1796. https://doi.org/10.4102/sajp.v79i1.1796 |
| [43] | Stander, J., Grimmer, K. and Brink, Y. (2019) Factors Influencing Clinical Practice Guideline Uptake by South African Physiotherapists: A Qualitative Investigation of Barriers and Facilitators. Journal of Evaluation in Clinical Practice, 26, 728-737. https://doi.org/10.1111/jep.13182 |
| [44] | Abaraogu, U.O., Ezema, C.I. and Nwosu, C.K. (2016) Job Stress Dimension and Work-Related Musculoskeletal Disorders among Southeast Nigerian Physiotherapists. International Journal of Occupational Safety and Ergonomics, 23, 404-409. https://doi.org/10.1080/10803548.2016.1219476 |
| [45] | Cantu, R., Carter, L. and Elkins, J. (2021) Burnout and Intent-To-Leave in Physical Therapists: A Preliminary Analysis of Factors under Organizational Control. Physiotherapy Theory and Practice, 38, 2988-2997. https://doi.org/10.1080/09593985.2021.1967540 |
| [46] | Choksi, K., Patel, J. and Solanki, S. (2024) Job Satisfaction among Physiotherapists Working as an Academician in Gujarat—A Cross-Sectional Study. Physiotherapy Research International, 29, e2082. https://doi.org/10.1002/pri.2082 |
| [47] | Eker, L., Tüzün, E.H., Daşkapan, A. and Sürenkök, Ö. (2004) Predictors of Job Satisfaction among Physiotherapists in Turkey. Journal of Occupational Health, 46, 500-505. https://doi.org/10.1539/joh.46.500 |
| [48] | Santos, M.C., Barros, L. and Carolino, E. (2010) Occupational Stress and Coping Resources in Physiotherapists: A Survey of Physiotherapists in Three General Hospitals. Physiotherapy, 96, 303-310. https://doi.org/10.1016/j.physio.2010.03.001 |
| [49] | Manganelli, L., Thibault-Landry, A., Forest, J. and Carpentier, J. (2018) Self-Determination Theory Can Help You Generate Performance and Well-Being in the Workplace: A Review of the Literature. Advances in Developing Human Resources, 20, 227-240. https://doi.org/10.1177/1523422318757210 |
| [50] | Carneiro, P., Braga, A.C. and Barroso, M. (2017) Work-Related Musculoskeletal Disorders in Home Care Nurses: Study of the Main Risk Factors. International Journal of Industrial Ergonomics, 61, 22-28. https://doi.org/10.1016/j.ergon.2017.05.002 |
| [51] | Desai, R.G. and Shah, M.K. (2021) Prevention of Work-Related Musculoskeletal Disorders in Physiotherapist—A Review. International Journal of Research and Review, 8, 497-502. https://doi.org/10.52403/ijrr.20211261 |
| [52] | Mulligan, E.P., Hegedus, E.J., Foucrier, J. and Dickson, T. (2023) Influences of Financial and Workplace Factors on Physical Therapist Job Satisfaction. Physical Therapy, 103, pzad093. https://doi.org/10.1093/ptj/pzad093 |
| [53] | Khumaera, A. and Bakar, R.M. (2024) Between Work and Family: The Impact of Workload on Career Women. International Journal of Research and Innovation in Social Science, 8, 2781-2788. https://doi.org/10.47772/ijriss.2024.803193 |
| [54] | Barrie, R.E., Crooks, N., Robertson, V., Parikh, R., Obioha, C. and Whitaker, N. (2025) There’s More to Being a Provider: Qualitative Exploration of Marriage Socialization of African-American Men. The Family Journal. https://doi.org/10.1177/10664807241312207 |
| [55] | Makusha, T. (2024) Young Fatherhood, Masculinities, and Structural Factors in South Africa. Frontiers in Sociology, 9, Article 801. https://doi.org/10.3389/fsoc.2024.1410801 |
| [56] | Sougou, N.M., Ndiaye, O., Nabil, F., Folayan, M.O., Sarr, S.C., Mbaye, E.M., et al. (2022) Barriers of West African Women Scientists in Their Research and Academic Careers: A Qualitative Research. PLOS ONE, 17, e0265413. https://doi.org/10.1371/journal.pone.0265413 |
| [57] | Liani, M.L., Nyamongo, I.K., Pulford, J. and Tolhurst, R. (2021) An Intersectional Gender Analysis of Familial and Socio-Cultural Drivers of Inequitable Scientific Career Progression of Researchers in Sub-Saharan Africa. Global Health Research and Policy, 6, Article No. 30. https://doi.org/10.1186/s41256-021-00213-3 |
| [58] | Mohamed, S., Abbashar, A. and Abushama, H. (2023) Women’s Career Motivation: Social Barriers and Enablers in Sudan. Frontiers in Psychology, 14, Article 1153613. https://doi.org/10.3389/fpsyg.2023.1153613 |
