Exploring the effect of job demands and resources on psychological resilience of occupational therapists

Abstract

Background: The job demands and resources model is a planning and management approach used to manage job demands/resources effectively. Resilience may be affected by an imbalance between occupational therapists’ job demands and resources. Objective: This study investigated the relationship between job demands/resources and occupational therapists’ resilience. Methods: Ninety-four occupational therapists (aged between 22 and 32 years) participated in the study. Occupational therapists completed the Demographic Information Form, the Job Demands and Resources Scale and the Resilience Scale. Results: The resilience scores of occupational therapists were positively correlated with personal development opportunities (p < 0.001), workload (p = 0.005), emotional demands (p = 0.004), and emotional dissonance (p = 0.004). The independent variables of job demands and resources explained 30% of the variance in resilience (F = 7.853, p = 0.001, R = 0.555, R² = 0.309, Durbin-Watson = 2.018). The contribution of personal development opportunity (p < 0.001) and emotional dissonance (p = 0.010) variables to the model showing the effect of resilience on the total score was statistically significant (p < 0.001). Conclusions: These results suggest that occupational therapists’ strategies for managing job demands and resources may affect their resilience levels and should be carefully considered.

Keywords

job demand job resource occupational therapy resilience

Introduction

Health systems worldwide are constantly evolving due to technological advances, an ageing population, changing diseases patterns, and new discoveries for treating these diseases.¹ These changes require healthcare professionals, who serve as the pioneers of health systems, to continuously adapt to various challenges and barriers to provide “high-quality” healthcare.² Navigating dynamic changes can be difficult because it creates an unstable working environment and requires the efforts of healthcare professionals to maintain competency in this environment.³ In order to adapt to these changes, healthcare professionals are expected to work harder, assume more administrative responsibilities, and contribute to improving the overall quality of the healthcare system.¹ Poor working environments, long and irregular working hours, shift work, unhealthy lifestyles, and an increasing number of patients negatively affect both the physical and psychological health of healthcare professionals.⁴ Healthcare professionals are at risk for increased stress, physical inactivity, poor sleep quality, emotional exhaustion, and insensitivity.⁵ They also have insomnia, loneliness, and depression as a result of workload and related stress.⁶

Occupational therapists, like other healthcare professionals, face a variety of challenges in their practice. Occupational therapists are healthcare professionals who design and implement occupation-based interventions to adress physical, cognitive, psychosocial, and sensory-perceptual problems that affect clients’ ability to perform their daily tasks.⁷ They believe that each client is unique; as a result, they consistently strive to broaden their professional skills.⁸ Since occupational therapists often work with client with illnesses or disabilities, they must constantly develop and change; this can lead to regulatory, educational, professional, and individual challenges. Additionally, the Workforce and Salary Survey of the American Occupational Therapy Association (AOTA) stated that 15.6% of occupational therapists consider leaving the field due to problems related to job demands, workload, emotional aspects, and their rights.⁹ Furthermore, it is strongly recommended in the literature to examine occupational therapists’ job-related factors.¹⁰

The Job Demands and Resources (JD-R) Model is a theoretical framework used to conceptualize the factors that influence job performance across multiple levels of analysis.¹¹ According to the model, the well-being of employees is affected by the demands and resources of the job.¹² The job demands component of the model is defined as the physical, social, and psychological effects of the effort required for the job. Job demands include workload, emotional demands, emotional dissonance, and organizational changes. Exposure to the demands of the work environment challenges employees’ capacities and is consequently associated with psychological and physiological consequence.¹³ Excessive workload, organizational constraints, emotional demands, and conflicts are associated with stress.¹⁴ The job resources component of the model is defined as aspects that can reduce the demands of the job and encourage development in order to reach the targets. Resources include autonomy, colleague support, supervisor support, and personal development opportunities. According to the JD-R Model, job resources enable one to cope with the challenging aspects of the job and positively affect professional participation and motivation.¹⁵ Insufficient job resources and high job demands are associated with absenteeism and excessive use of leave, turnover or reduced job performance.^16,17 Furthermore, it causes various psychological problems such as increased stress and anxiety.¹⁸ Occupational therapists face high patient loads, provide care in clinical settings, perform administrative tasks, manage the emotional states of patients and their families, and adapt to policy and protocol changes.^19,20 Although job demands of occupational therapists are estimated, information on the autonomy, collegial and supervisory support and personal development opportunities provided by the work environment is limited. Moreover, an imbalance between increasing job demands and resources may have an effect on the psychological resilience of occupational therapist.^19,21,22

Resilience is the ability to overcome adversity or achieve positive results despite unpleasant situations or events.²³ It refers to the dynamic process shaped by a change that enables the person to find a new balance and develop in a positive way.²⁴ This dynamic process includes both intrapersonal/developmental, social mechanisms and various contexts.²⁵ In this regard, Hart et al. mention that the positive outcomes of individuals when faced with a negative situation will not depend only on the individual; the context also plays an important role.²⁶ According to various models, resilience appears ultimately to depend on the balance between individual and ecological/environmental variables, as well as the balance between so-called “protective” factors and “risk factors”.²⁵ This is particularly important for healthcare professionals, who face numerous physical and mental risk factors. Resilience plays a crucial role in the adaptation and control of problematic situations and in overcoming difficulties in the workplace for healthcare professionals.²⁷

Occupational therapists try to cope with job demands and resources such as conflicts with other professionals and managers, high workload, feeling of professional self-insufficiency, limited time, insufficient resources, inability to maintain work-life balance, the need to expend excessive effort and energy at work, insufficient number of occupational therapists in workplaces, pressures to work outside the field or role as well as the necessity of being dynamic required by the profession.^28,29 Although studies in the literature examine the relationship between these problems seen in occupational therapists and various psychological factors, studies examining resilience, which has recently become a very important issue, are limited.^10,30,31 It is also indicated the association between resilience and job-related factors, there is not enough emphasis on job demands and resources.¹⁰ Furthermore, more detailed studies on the resilience and professional problems of occupational therapists would be of great importance for occupational therapists, employers and managers.³² To our knowledge, there are no previous studies in the literature on job demands, resources, and the psychological resilience of occupational therapists.

The research question of this study:

Is there any relationship between occupational therapists’ job demands/resources and their psychological resilience?

Materials and methods

Study design

This study was designed as a cross-sectional survey. It was conducted in accordance with the Declaration of Helsinki, and ethical approval was granted by Hacettepe University. Written informed consent form was obtained from the individuals who agreed to participate in the study.

Participants

The research sample consisted of occupational therapists working in health services in Turkey. The sample size was determined as 94 individuals based on the G-Power program (1–β = 0.90 and α = 0.05). The convenience sampling method was used to reach the samples. The inclusion criteria were (I) graduating from the occupational therapy license program of universities, (II) working in healthcare, and (III) being a volunteer to participate in the study. Occupational therapists who were not currently employed or had taken a leave from the profession were excluded from the study. To reach the sample group, the Turkish Occupational Therapy Association was contacted. Two hundred fifty-six occupational therapists were informed about the study. The data collection tools were sent via Google Forms to 108 participants who volunteered to participate. Due to various situations such as missing forms and rejection during the survey, 14 were removed and the study was completed with responses from 94 occupational therapists (87.03% response rate).

Data collection tools

Demographics

Participants completed an information form that included sociodemographic characteristics and clinical experience information, as well as the Job Demands and Resources Scale and the Psychological Resilience Scale. Demographic inofrmation such as age, gender, education level, and years of work experience were recorded.

The resiliency scale

The Resiliency Scale was used to assess the psychological resilience levels of the participants. The scale was developed by Gürgan, who examined resilience based on factors such as strength, initiative, optimism, commitment to life, communication/relationship building, foresight, goal achievement, leadership, and curiosity.³³ It consists of a total of 50 items. Some items examples are “I know how to cope with negative life situations that others cannot cope with.”, “I have the ability to heal myself even in the most difficult conditions.”, “When I am in a difficult situation, I can usually find my way out of it.” It is scored as a 5-point Likert (1-defines me very well to 5 never defines me). The scale allows for a minimum score of 50 and a maximum score of 250, where higher scores indicate a higher degree of resilience. The Cronbach's alpha coefficient of the scale is 0.87. Additionally, the scale is psychometrically positively related to learned resourcefulness, internal locus of control, hopefulness, and problem-solving skills. In this study, the reliability of the Resiliency Scale was acceptable (Cronbach's alpha = 0.697).

Job demands and resources scale

The Job Demands and Resources Scale (JD-R Scale), developed by Xanthopoulou et al. and adapted to Turkish by Metin et al. was used to assess job demand and resources.^34,35 It was observed that the internal consistency of all components was higher than Cronbach's alpha 0.66.³⁵ It is a Likert-type scale that goes from never (1) to all-time (5). The scale consists of 4 sub-parameters and 14 questions, including autonomy, colleague support, supervisor support, and personal development in the job resources section. The job demands section consists of 4 sub-parameters and 36 questions that cover the workload, emotional demands, emotional dissonance, and organizational changes. An increase in scale subscores indicates an increase in job demands or resources. The reliability coefficients of the Job Demands and Resources sections were found to be 0.76 and 0.86.³⁵ In this study, the reliability of the JD-R Scale was good and acceptable (Cronbach's alpha = 0.765).

Statistical analysis

The statistical analysis of the data obtained in the study was performed using SPSS 28.0 (Statistical Packages for the Social Sciences) software. Descriptive statistics including frequency tables for categorical variables, minimum/maximum values for numerical variables, mean, and standard deviation values were used. The conformity of the variables to the normal distribution was analyzed by visual (histogram and probability graphs) and analytical (Kolmogorow-Smirnov tests) methods. The relationship between normally distributed data was analyzed by Pearson correlation analysis. A multiple linear regression analysis was conducted to model the factors associated with psychological resilience. The statistical significance level was accepted as p < 0.05.

Results

A total of ninety-four occupational therapists with a mean age of 25.15 ± 2.18 years (min: 22, max: 32), 80.9% of whom were female, participated in the study. Most participants (41.5%) had 2-3 years of experience, and 74.5% were employed full-time. The demographic characteristics of the participants are summarised in Table 1.

Table 1.

The demographics of the Participants.

Descriptive Features	n	%
Gender
Female	76	80.9
Male	18	19.1
Marital Status
Single	81	86.2
Married	13	13.8
Academic Qualification
Bachelor degree	58	61.7
Master's or PhD	36	38.3
Work Experience (year)
≤1 years	35	37.2
2-3 years	39	41.5
≥4 years	20	21.3
Employed Institution
Special Education and Rehabilitation Center	37	39.4
Hospital	34	36.2
Counseling Center	14	14.9
University	9	9.6
Practice Area
Pediatrics	55	58.5
Neurology	6	6.4
Mental Health	11	11.7
Adult and Hand Rehabilitation	22	23.4
Employment status
Part-time	24	25.5
Full-time	70	74.5
Total	94	100

Note. n: sample size, %: percentage.

Respectively, the mean scores for job demands, resources and resilience were 63.92 ± 11.16, 54.62 ± 8.58 and 141.95 ± 10.71. These results indicate that the job demands, resources, and resilience levels of occupational therapists are moderate. The descriptive statistics of the scales are presented in Table 2.

Table 2.

Descriptive statistics of job demands-resources and resilience.

Values	Min-Max	M	SD
Job Demands (23–115)	45–93	63.92	11.16
Workload (3–15)	3–15	9.09	2.69
Emotional Demands (8–40)	16–35	24.05	4.64
Emotional Dissonance (5–25)	7–25	14.96	3.51
Organizational Changes (7–35)	7–31	16.06	5.26
Job Resources (14–70)	34–70	54.62	8.58
Autonomy (5–15)	5–15	12.00	1.87
Colleague Support (3–15)	5–15	12.47	2.30
Supervisor Support (5–25)	5–25	17.95	5.01
Personal Development Opportunity (3–15)	8–15	12.19	2.01
Psychological Resilience (50–250)	116–178	141.95	10.71

Note. M: mean, SD: standard deviation, Min-Max: observed score range. Values in parentheses indicate possible theoretical score ranges for each scale or subscale.

Workload (r = 0.286, p = 0.005), emotional demands (r = 0.298, p = 0.004), emotional dissonance (r = 0.296, p = 0.004) and total score of job demands (r = 0.348, p = 0.001) showed positively significant relationships between resilience. Only the personal development opportunity variable of job resources and psychological resilience were positively correlated (r = 0.381, p < 0.001). Correlations between variables are shown in Table 3.

Table 3.

Findings on the relationship between job demands-resources and psychological resilience.

	Psychological Resilience
	r	p
Job Demands	0.348**	0.001
Workload	0.286**	0.005
Emotional Demands	0.298**	0.004
Emotional Dissonance	0.296**	0.004
Organizational Changes	0.161	0.146
Job Resources	0.179	0,084
Autonomy	0.019	0.854
Colleague Support	0.079	0.446
Supervisor Support	0.109	0.294
Personal Development Opportunity	0.381**	0.001

Note. r: correlation coefficient, p: p-value for statistical significance.

** p < 0.001.

Multiple linear regression analysis was performed as there was a statistically significant relationship between psychological resilience and workload, emotional demands, emotional dissonance, and personal development opportunity. As a result of the analysis with the enter method, the independent variables of job demands and resources explained 30% of the variance in the dependent variable of psychological resilience (F = 7.853, p = 0.001, R = 0.555^a, R² = 0.309, Durbin-Watson = 2.018). The contribution of personal development opportunity (p < 0.001) and emotional dissonance (p = 0.010) variables to the model showing the effect on the total score of psychological resilience was found to be statistically significant. Multiple linear regression results of the variables are presented in Table 4.

Table 4.

Regression analysis of the effects of job demands and resources on resilience.

	Unstandardized Coefficients		Standardized Coefficients		95% CI
	B	SE	β	t	LB	UB	p
Constant*	93.881	8.075		8.150	70.978	116.784	0.001
Job Demands
Workload	0.401	0.404	0.014	0.103	−1.044	1.159	0.520
Emotional Demands	0.220	0.247	−0.019	−0.140	−0.476	1.502	0.395
Emotional Dissonance	0.850	0.325	0.240	2.141	−0.625	0.680	0.010
Job Resources
Personal Development Opportunity	2.449	0.636	0.461	3.852	1.185	3.713	0.001

Note. Constant: Psychological Resilience R = 0.555^a R² = 0.309 F = 7.853 (p < 0.001).

B: unstandardized coefficients, CI: confidence interval for B, LB: lower bound, SE: standard error, UL: upper bound, β: standardized coefficients.

Discussion

The study aimed to investigate the relationship between job demands/resources and the psychological resilience of occupational therapists. The main findings showed that the psychological resilience of occupational therapists was significantly positively related to personal development opportunity, workload, emotional demands, and emotional dissonance. According to the regression model established in this study, the variables of personal development opportunity and emotional dissonance made a statistically significant contribution to resilience. This study is probably the first to examine the relationship between occupational therapists’ job demands and resources and psychological resilience.

The concept of resilience is crucial for employees to effectively cope with adversity in a dynamic work environment.³⁶ Arrogante and Zaldivar, as well as Shakir et al., highlighted the negative relationship between psychological resilience and professional burnout in their studies on healthcare professionals.^37,38 In the study of Yu and Lee, it was found that resilience had a favorable direct effect on job involvement.³⁹ Eley et al., examined the relationship between positive personality traits and resilience and stated that the effect of job factors on resilience should be examined in detail.⁴⁰ This study, which examined the impact of job demands and resources on resilience, made a unique contribution to the literature in terms of emphasizing important factors in ensuring the resilience of occupational therapists.

Many studies in the literature have found that job demands are associated with negative psychological characteristics such as stress, burnout, anxiety, and depression.^39,41 However, it is assumed that the successful use of job resources can protect individuals from the damaging effects of excessive job demands.²⁸ In general, opinions are widespread that occupational therapy is highly demanding and causes burnout among healthcare professionals.⁴² Drawing on their professional knowledge and skills, it is thought that occupational therapists are successful in realizing job demands by using their creativity and problem-solving abilities, and they can protect themselves from work stress and burnout.¹⁹ On the other hand, the burnout levels of occupational therapists are increasing continue to rise due to the increasing workload and emotional demands.^9,43 In our study, a positive and significant relationship was found between job demands and psychological resilience of occupational therapists. The study by Schilbach et al., which stated that moderate job demands increase the psychological resilience of employees, supports the results of our study.⁴⁴ We think that the emergence of this result may be due to the fact that the occupational therapists included in the study have only recently started their professional careers. In addition, if occupational therapists have high job satisfaction, their current workloads may have significantly contributed in enhancing their motivation and psychological resilience. Conducting studies examining the relationship between the workload of experienced occupational therapists and their resilience will contribute to the literature. In addition, emotional demands and emotional dissonance were also positively related with resilience in our study. In their study, Rees and Smith stated that occupational therapists experience greater emotional demands than many other healthcare professionals.⁴⁵ The literature suggests that increased emotional demands provide psychological resilience, and thus emotional exhaustion is prevented.⁴⁶ In addition, emotional dissonance, which expresses the conflict between personal feelings and norms that require certain attitudes, is another important point that is frequently seen in healthcare professionals, especially occupational therapists, who prioritize patient satisfaction.⁴⁷ These findings support the results of our study.

Job resources are fundamentally considered to have a positive impact on resilience.³⁴ Additionally, the literature explores resilience and personal development from a various perspectives. Resilience may emerge spontaneously or be cultivated through various training. Individual and environmental elements alter throughout time, personal developmental stage, outcome, and context, making resilience a dynamic process. Individuals may be resilient at one point in time or in one environment, or in relation to one outcome or indicator but not others.⁴⁸

It is emphasized that the resources of personal development positively affect resilience and should be developed in healthcare professionals.^49,50 Schlenz et al. reported that there is a relationship between the personal development of occupational therapists and physiotherapists and their psychological resilience.⁵¹ In our study, parallel to the literature, we found that psychological resilience was only related to personal development opportunity of job resources. This indicates that occupational therapists may have ample opportunities for personal development in the work environment. AOTA has reported that occupational therapists need continuing education in order to increase their repertoire and manage their responsibilities.⁵² This situation actually plays a significant role in fostering their psychological resilience. The work environment supporting the professional development of occupational therapists can contribute to enhancing their strengths and professional skills. This, in turn, can improve their motivation and commitment to their profession, enabling them to better cope with challenges in the work environment. Thus, the promotion of personal development in the work setting may play a crucial role in enhancing the psychological resilience of occupational therapists.

Various studies have indicated that colleague and supervisor support job resources have a positive relationship with psychological resilience.⁵³ Surprisingly unlike the literature, autonomy, colleague support and supervisor support are not associated with psychological resilience. As in many studies in the literature, the insufficient number of occupational therapists and supervisors in workplaces and the pressure to work outside the field may have played an important role in this situation.^54–56 The not high scores for autonomy and colleague support also support this result. For example, in a contrasting way, in a study in Greece, occupational therapists’ psychological resilience was associated with good peer relations and autonomy.³¹ Autonomy refers to an individual's ability to manage their tasks and make decisions independently. However, occupational therapists in their current institutions are likely to be the only occupational therapists, so they often work in units other than occupational therapy (e.g., physical therapy units, community mental health centers), which limits their autonomy and decision-making processes. Additionally, occupational therapists often work in different hospitals and cities, leading to limited colleague support. The Royal College of Occupational Therapists recommends that occupational therapists receive ongoing clinical supervision to ensure continued professional development throughout their careers.⁵⁷ For this reason, perhaps occupational therapists should be better at advocating for their profession, revealing the importance of always supporting each other with their colleagues.

There are some limitations of our study. Because of the cross-sectional nature of the study, the results are not generalizable. In addition, occupational therapists included are mostly new to the profession may have prevented us from examining long-term resources and demands. In addition, studies that examine the psychological resilience of occupational therapists in more detail are needed. In future studies, we suggest a more detailed examination of job-related factors that may affect the resilience of occupational therapists. There was no distinction between senior and junior occupational therapists in our study; therefore, it may be important to examine the relationship between burnout and these factors. In addition, similar studies within large samples to be conducted in different geographies will contribute to the literature.

Conclusion

This study provides evidence that resilience in occupational therapists is shaped both by the demands they face and the resources available to them in their work environment. In particular, emotional dissonance and personal development opportunities emerged as key factors affecting resilience. These findings suggest that resilience is not only a personal characteristic, but also a quality that can be enhanced by supportive workplace conditions. By fostering environments that reduce emotional strain and increase opportunities for growth, organizations can contribute to the resilience and long-term well-being of occupational therapists.

Footnotes

Ethical considerations

This study was approved by Hacettepe University Non-Interventional Clinical Research Ethics Committee at its meeting dated November 16, 2021, with project number GO/21/1229 and decision number 2021/19-22. This study was conducted in accordance with the procedures of the Declaration of Helsinki with the study involving human participants.

Consent to participate

Prior to the assessment, participants were given a written informed consent form. Participants were included in the study after verbally and in writing approving this form.

Consent for publication

Participants consented to the publication of their information for this research.

Author contributions

Study design and conceptualization MNÖD, HA; data collection and carrying out the study MNÖD, EG, HA; interpretation of study findings MNÖD, EG; writing the article MNÖD, EG, HA; critical review MNÖD, EG, HA.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability statement

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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