Abstract
Three institutions predominantly care for preschool children in Japan: kindergartens, authorized childcare institutions, and nursery centers. Recently, the turnover rates of preschool workers in these institutions have been high, and Japan has been facing a shortage of kindergarten teachers. The study aimed to provide concrete counterplans to reduce preschool workers’ turnover rate. To determine the causes of turnover, we conducted a cross-sectional survey. We recruited preschool workers from several kindergartens, authorized childcare institutions, and nursery centers in Japan to fill out a survey regarding counterplans for employment. Of the 1002 surveys, 551 (541 women; 10 men) complete surveys were received (response rate: 55%). A total of 295 participants answered that they were unwilling to continue working for longer than five years and completed the questionnaires. The Jiro Kawakita method was used to categorize and analyze the four sections of the counterplan questionnaires. The results showed that the main reasons for high turnover were overtime work, low salary, and difficult human relations. To solve these issues, the counterplan ideas such as workshop ideas and conditions conducive to continuing working longer were related to human relations, work conditions, and mental health.
1. Introduction
The three institutions that care for preschool children in Japan are kindergartens (3–5 years old), authorized childcare institutions (from birth to 5 years old), and nursery centers (from birth to 5 years old). According to the Cabinet Office of Japan, kindergarten is defined as a preschool that offers education-based playing and singing, practical activities such as drawing, and social interaction as part of the transition from home to school; it is an ambulatory institution that cares for babies and toddlers whose guardians are working. An authorized childcare institution is a center that has both kindergarten and nursery center functions. Recently, the turnover rates of preschool workers in these institutions have been high [,]. The importance of reducing the turnover rate among preschool workers is increasing in developed countries, including those in East Asia [], and Japan has been facing a shortage of kindergarten teachers. These workforce changes have resulted in insufficient childcare in these institutions [].
Researchers have attempted to solve this problem by identifying individual and environmental factors that correlate with preschool workers’ willingness to continue working. In particular, a previous study found that sex, age, mental health, social support, and work engagement were associated with teachers’ willingness to continue working []. Another study suggested that age, family environment, work responsibilities, mental health, and work engagement were significantly associated with the willingness to continue working. Accordingly, welfare benefits and individual support systems can be key elements in encouraging teachers to continue working and improve their job satisfaction, mental health, and wellbeing. In addition, balanced work conditions and workers’ high agreement with workplace childcare/education policies may reduce turnover [].
Although earlier studies have provided suggestions for reducing the turnover rate, more concrete counterplans should be investigated to implement them. Thus, the main objective of this study was to determine the reasons preschool/nursery center/kindergarten teachers and workers leave employment and to provide concrete counterplans to reduce the turnover rate in these occupations. It aimed to find counterplans to reduce preschool workers’ turnover rate and contribute to the social issues in Japan.
2. Materials and Methods
2.1. Participants
This study recruited 1002 preschool workers in Japan as its potential participants. Of them, 451 participants either did not fully answer the questionnaires or did not return them. Thus, 551 complete surveys were received (response rate: 55%). Finally, of the 551 potential participants, 295 answered that they were unwilling to continue working for longer than five years and completed the questionnaires.
Informed consent was obtained from all participants prior to the study. The study was approved by the Ethics Committee of Nishi Kyushu University (approval No. 21VDV15) and complied with the Declaration of Helsinki [].
2.2. Procedure
The study was conducted in 2018 as a cross-sectional survey. We recruited participants from kindergartens, authorized childcare institutions, and nursery centers in representative cities in Japan. We included only full-time teachers and individuals working in non-managerial positions to ensure that part-time workers with fixed-term contracts and managers would not affect the results. The study questionnaires took approximately ten minutes for participants to complete. All participants provided written informed consent in their workplaces and completed the survey about counterplans that could reduce the turnover rate. All questionnaire responses were self-reported and anonymous, and participants returned the completed questionnaires in sealed envelopes.
2.3. Measures
First, the participants were asked to choose the reasons for their unwillingness to continue working for longer than five years. Second, they were asked about their motivations for leaving and counterplan ideas. The counterplans questionnaire comprised four sections: reasons for considering leaving employment, contents of overtime work, necessary workshops to solve work problems, and ideas for continuing to work longer. These questions were all answered descriptively.
2.4. Data Analysis
All the data collected in this study were descriptive data. Thus, data categorization was required to calculate the result. To this end, four sections of the counterplans questionnaire described in the Measures section (above) were categorized using the Jiro Kawakita method (KJ method), also known as affinity diagramming []. The KJ method is widely used in participatory learning as a means to collect and organize information. It extracts and categorizes key words from the results of the questionnaire using text mining.
3. Results
3.1. Willingness to Participate
The reasons for the unwillingness to continue working for longer than five years are shown in Table 1. The main factor was enormous overtime work, followed by low salaries and difficult human relations. The results of the counterplans questionnaire are shown in Table 2, Table 3, Table 4 and Table 5. Table 2 presents the reasons for participants’ willingness to quit a job, with most responses attributing “low salary” for it, followed by “too much overtime work/no payment for overtime” and “human relations”. Table 3 describes the content of overtime work at the workplace and at home. At the workplace, “preparation for events” received the most responses, followed by “administrative work” and “extension of childcare/education”. Most participants chose “administrative work” for the content at home, followed by “preparation for events” and “making teaching materials”.
Table 1.
Reasons for limiting willingness to continue employment to five years or less as a full-time preschool worker.
Table 2.
Categorized reasons for considering quitting a job as a full-time preschool worker.
Table 3.
Categorized contents and context of OT work performed by participating preschool workers in the last 30 days.
3.2. Workshop Idea Categories
The workshop ideas were divided into the following eight sections by types of ideas: “children’s guardians”, “taking care of children”, “understanding children”, “place to share suffering”, “basic skills for work”, “mental health”, “the way of working”, and “others.” The ideas to solve job problems with the highest percentage were “the ways to take care of/support children’s guardians”, followed by “the ways to take care of children requiring support” and “create places to share suffering and advisement” (Table 4). The ideas regarding conditions conducive to continue working longer were divided into the following 12 sections based on types of ideas: “employment conditions”, “workforce”, “workload”, “human relations”, “relationship with boss/seniors”, “work environment”, “welfare benefits”, “duty framework”, “taking care of children”, “taking care of children’s guardians”, “mental health”, and “others.” The ideas with the highest percentages were “better salary”, followed by “more workers”, and “easier to have holidays/private time” (Table 5).
Table 4.
Categorized workshop ideas to solve full-time preschool workers’ job problems.
Table 4.
Categorized workshop ideas to solve full-time preschool workers’ job problems.
| Rank No. | Workshop Ideas for Proposed Solutions | n (%) n = 479 |
|---|---|---|
| Guardians | ||
| 1 | The ways to take care of/support children’s guardians | 41 (9) |
| 15 | Common understanding between guardians and childcare workers | 18 (4) |
| 24 | Workshop for children’s guardians | 11 (2) |
| 38 | The ways to support parents and children | 7 (1) |
| Taking care of children | ||
| 2 | The ways to take care of children requiring support | 39 (8) |
| 7 | The ways to take care of children with developmental disorder | 27 (6) |
| 12 | The ways to take care of children | 21 (4) |
| 19 | Methods of activities for childcare | 13 (3) |
| 18 | Case examination of children | 14 (3) |
| 21 | Highly professional workshop | 12 (3) |
| 25 | Contents of childcare/the ways of childcare | 11 (2) |
| 31 | The ways to take care of children in the grey zone/undiagnosed | 9 (2) |
| 32 | Methods of playing and hand playing | 9 (2) |
| 34 | Practical workshop/experience-based workshop | 9 (2) |
| 40 | Skill up | 7 (1) |
| Understanding children | ||
| 29 | Group discussion | 10 (2) |
| 41 | The ways to understand children | 6 (1) |
| 42 | The ways to understand disability | 6 (1) |
| 43 | Special needs of children | 6 (1) |
| Place to share suffering | ||
| 3 | Create places to share suffering and advisement | 35 (7) |
| 4 | Interaction with other kindergartens and workers working in different places | 34 (7) |
| 36 | Interaction with coeval workers | 9 (2) |
| 37 | Interaction with childminders | 8 (2) |
| Basic skills for work | ||
| 8 | Human relations | 26 (5) |
| 11 | Communication methods | 23 (5) |
| 28 | Methods of coaching freshers and juniors | 10 (2) |
| 47 | Common sense/manners | 5 (1) |
| Mental health | ||
| 13 | Refresh for workers’ mind | 21 (4) |
| 16 | Resolution of stress for workers | 15 (3) |
| 17 | Mental health for workers | 14 (3) |
| 20 | Exercises/dance for workers | 13 (3) |
| 27 | Psychology | 10 (2) |
| 30 | Counseling | 10 (2) |
| 45 | The ways to think | 6 (1) |
| 46 | Relaxation | 6 (1) |
| The ways of working | ||
| 9 | Workshop for directors and bosses | 26 (5) |
| 14 | Methods for efficient work | 18 (4) |
| 22 | High quality workshop inside of kindergarten | 12 (3) |
| 23 | The ways to work/work system | 11 (2) |
| 26 | The ways of class governance | 10 (2) |
| 33 | How to work | 9 (2) |
| 35 | All-hands workshop | 9 (2) |
| 44 | Cooperative framework | 6 (1) |
| Others | ||
| 5 | Workshop is burden | 30 (6) |
| 6 | The problems cannot be solved with workshops | 29 (6) |
| 10 | Others | 24 (5) |
| 39 | Workshop is unnecessary | 7 (1) |
The numbers on the left indicate the ideas’ ascending ranking by n (%). The ideas were divided into eight sections based on the types of ideas. The workshop ideas to solve job problems with the highest percentages were “the ways to take care of/support guardians”, followed by “the ways to take care of children requiring support” and “create places to share suffering and advisement”.
Table 5.
Categorized ideas of effective conditions for preschool workers to stay longer in the job.
Table 5.
Categorized ideas of effective conditions for preschool workers to stay longer in the job.
| No. | Workshop Ideas to Solve Job Problems/Improve Conditions | n = 716 n (%) |
|---|---|---|
| Employment conditions | ||
| 1 | Better salary | 310 (43) |
| 3 | Easier to have holidays/private time | 83 (12) |
| 6 | Overtime work is paid | 57 (8) |
| 10 | Easier to have paid holidays | 44 (6) |
| 11 | Can leave work on time | 37 (5) |
| 23 | Two days’ holiday in a week | 16 (2) |
| 49 | Have holidays on weekdays | 7 (1) |
| 50 | Increase in paid holidays | 7 (1) |
| 58 | Can have long vacation | 6 (1) |
| 59 | No work on days off | 6 (1) |
| Workforce | ||
| 2 | More workers | 95 (13) |
| 18 | More subsidiary/workers for miscellaneous duties | 26 (4) |
| 61 | More full-time workers | 6 (1) |
| Workload | ||
| 4 | Less or simplification of administrative work/document work | 81 (11) |
| 5 | Less take-out work | 76 (11) |
| 7 | Less/simplification of kindergarten festivals | 48 (7) |
| 8 | Less/no overtime work | 47 (7) |
| 9 | Less workload | 46 (6) |
| 12 | Can do document work in work time | 35 (5) |
| 20 | Effective and equal assigning tasks | 20 (3) |
| 34 | Less workshops | 10 (1) |
| 38 | Less/simplification of making materials/preparation of childcare | 9 (1) |
| 69 | Can prepare for childcare in work time | 5 (1) |
| Human relations | ||
| 13 | Good human relations | 32 (4) |
| 30 | Atmosphere to enable advice seeking | 13 (2) |
| 32 | Better communication with guardians/children/colleagues | 12 (2) |
| 41 | A friendly workplace | 9 (1) |
| 42 | Place to share suffering | 9 (1) |
| 45 | Agreement among coworkers | 8 (1) |
| 54 | Discussion between workers | 7 (1) |
| 56 | Teamwork of workers | 7 (1) |
| 72 | Common understanding of children between workers | 5 (1) |
| Relationship with boss/seniors | ||
| 25 | Directors and boss understand the field | 15 (2) |
| 39 | Good relationship with boss | 9 (1) |
| 44 | Boss listens to opinions of workers | 8 (1) |
| 52 | Evaluation and praise by directors and boss | 7 (1) |
| 57 | No power harassment | 7 (1) |
| 65 | Can tell opinions and discuss with not only juniors but also seniors | 6 (1) |
| 71 | Boss listens to workers’ suffering and takes care of it | 5 (1) |
| Work environment | ||
| 14 | Governance of duty hours | 32 (4) |
| 15 | Readjustment of work framework/work contents | 29 (4) |
| 16 | Readjustment of staffing standards | 28 (4) |
| 17 | Can have break time | 27 (4) |
| 37 | Less burden on the ones in charge | 9 (1) |
| 47 | Good workplace atmosphere | 8 (1) |
| 51 | Efficient work | 7 (1) |
| 60 | Use of timecard | 6 (1) |
| 62 | Digitalization/use artificial intelligence | 6 (1) |
| 67 | Fun workplace | 6 (1) |
| 74 | Management well | 5 (1) |
| Welfare benefits | ||
| 19 | Can balance work with family life/marriage and giving birth | 26 (4) |
| 21 | Better welfare (allowance of house/sustenance/commutation/maternal leave, etc.) | 19 (2) |
| 26 | Better compensation package for workers | 14 (2) |
| Duty framework | ||
| 22 | Abrogation of one person being in charge/Having multiple persons in charge | 17 (2) |
| 24 | Have cooperative framework | 16 (2) |
| 40 | Small class | 9 (1) |
| 63 | Concert of policies/restructuring of workplace | 6 (1) |
| Taking care of children | ||
| 29 | Have specialists for special needs/visits by advisors | 13 (2) |
| 46 | Acceptance of and environment for handicapped children | 8 (1) |
| 66 | Place and time to take care of guardians and children enough | 6 (1) |
| 68 | Skill-up/improvement of childcare quality | 6 (1) |
| 70 | Sufficient workshops | 5 (1) |
| 73 | Improvement of facility and environment for childcare | 5 (1) |
| Taking care of guardians | ||
| 31 | Check actual needs of childcare service (guardians’ days off/weekends/extended childcare) | 12 (2) |
| 35 | Better understanding of kindergarten policy by guardians | 10 (1) |
| 43 | Understanding of expertness and evaluation by guardians and society | 9 (1) |
| 48 | Less taking care of guardians | 8 (1) |
| 64 | Place to make guardians understand about children (developmental disorders, etc.) | 6 (1) |
| Mental health conditions | ||
| 36 | Good mental health | 10 (1) |
| 53 | Counselor | 7 (1) |
| 55 | Work engagement | 7 (1) |
| Others | ||
| 27 | Others | 14 (2) |
| 28 | Improvement of the way to train up freshers | 13 (2) |
| 33 | Advancement in social status of kindergarten teachers | 12 (2) |
The numbers on the left indicate the ideas’ ascending ranking by n (%). The ideas were divided into 12 sections based on the type of ideas. The ideas of effective conditions to continue working longer with the highest percentages were “better salary”, followed by “more workers”, and “easier to have holidays/private time”.
4. Discussion
This study investigated the reasons for unwillingness to continue working for longer than five years to provide concrete ideas to reduce the turnover rate among preschool teachers in kindergartens, authorized childcare institutions, and nursery centers. The primary factors for unwillingness to continue working for longer than five years were overtime work, followed by low salary and human relations, which were consistent with the findings of previous research []. Additionally, the reasons for wanting to quit a job with the highest percentages were low salary, followed by too much overtime work/no payment for overtime and human relations, which were similar to the factors for unwillingness to continue working for longer than five years []. Preparation for events was indicated as the content at workplace with the highest percentage of responses, followed by administrative work and the extension of childcare/education. The contents at home with the highest percentages were administrative work, followed by preparation for events and making teaching materials. These results indicate that workers may have high levels of stress resulting from the need to work a lot, even in their private time, with low salaries in workplaces with difficult human relations.
To solve these issues, we asked the participants about their counterplan ideas. The results showed that the workshop ideas to solve job problems were related to “children’s guardians”, “taking care of children”, “understanding children”, “place to share suffering”, “basic skills for work”, “mental health”, and “the way of working.” In addition, the ideas of conditions most conducive to continue working longer were related to “employment conditions”, “workforce”, “workload”, “human relations”, “relationship with boss/seniors”, “work environment”, “welfare benefits”, “duty framework”, “taking care of children”, “taking care of children’s guardians”, and “mental conditions.”
Integrating these ideas, we found common keywords for solving the problems: human relations (with children’s guardians, children, boss, and colleagues, a place to share suffering), work conditions (salary, workforce, holidays, workload, and welfare benefits), and mental health. As such, the focus should be on a reward system, welfare benefits from the government or workplace, work conditions, human relations, and mental health. Additionally, preschool workers need places to share their suffering and learn to care for children and their guardians.
First, an analysis of work conditions suggested that a supportive work environment and better welfare benefits (e.g., flexible work options and paid maternal or paternal leave) and home telecommuting allowed them to continue working [,]. Similarly, efforts should be made to improve the conditions in both work-related and outside-work areas []. For example, Bhattacharya and Ramachandran reported that heavy workload-related pressures compel workers to leave work []; thus, supervisors should attempt to maintain the right workload balance [].
Second, in terms of human relations, some studies have reported that challenging workplace relationships can lead to workplace stress across occupations and that providing counseling support for human relations can lead to better mental health [,,,,]. Third, in terms of mental health, a survey indicated that a greater involvement in their work might reduce workers’ stress and increase job satisfaction.
Finally, another study suggested that better government implementation of stress management plans could benefit the workers’ psychosocial needs []. However, a randomized controlled trial found that nondirective social support focused on workers’ intrapsychic challenges was significantly associated with fewer health problems [,,,]. Furthermore, nondirective social support, which focuses on workers’ intrapsychic challenges, often improves positive health behavior, health outcomes, life satisfaction, self-esteem, hope, and optimism [,,].
Hence, a better reward system (e.g., higher salary), welfare benefits (e.g., maternal leave) from the government or workplace, work conditions (e.g., less overtime work), human relations (e.g., compliments from the boss), and mental health (e.g., places to share suffering) affect their willingness to continue working. This study also has certain limitations. In particular, we recruited participants from one prefecture in Japan; therefore, the findings may not be generalizable across Japan or in other countries. Additionally, the study was limited in its ability to explore differences in responses across key demographic categories such as gender, age, experience in the field, etc., which must be considered in future research. Finally, future research should include participants from other prefectures and countries and attempt more specific questions suggested by the present research (e.g., letting the participants choose important workshop ideas from the given list). Despite these limitations, the findings provide meaningful new insights for addressing the shortage of preschool workers in childcare institutions.
5. Conclusions
The findings of this study suggest that the workshop ideas to solve job problems were related to children’s guardians, taking care of children, understanding children, place to share suffering, basic skills for work, mental health, and the way of working. In addition, the ideas of conditions most conducive to continuing working longer were related to employment conditions, workforce, workload, human relations, relationship with boss/seniors, work environment, welfare benefits, duty framework, taking care of children, taking care of children’s guardians, and mental conditions. As such, better reward systems, welfare benefits from the government or workplace, work conditions, human relations, and mental health can be key elements of counterplans to encourage preschool workers to continue working. In addition, these recommendations may assist in effectively addressing the high turnover rate among preschool workers in Japan.
Author Contributions
Conceptualization, M.M. and M.H.; methodology, M.M.; software, M.M.; validation, M.M. and M.H.; investigation, M.M.; resources, M.M.; data curation, M.M.; writing—original draft preparation, M.M.; writing—review and editing, M.H.; visualization, M.M.; supervision, M.H.; project administration, M.M. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
The study was approved by the Ethics Committee of Nishi Kyushu University (approval No. 21VDV15) and complied with the Declaration of Helsinki.
Informed Consent Statement
Informed consent was obtained from all participants prior to the study.
Data Availability Statement
The datasets generated and analyzed during the current study are not publicly available due to a lack of participants’ agreement to put the data in public but are available from the corresponding author on reasonable request.
Acknowledgments
The authors would like to express their appreciation to the participants of this study.
Conflicts of Interest
The authors declare no conflict of interest.
References
- Tham, P. Why are they leaving? Factors affecting intention to leave among social workers in child welfare. Br. J. Soc. Work 2007, 37, 1225–1246. [Google Scholar] [CrossRef]
- Wong, Y.P.; Zhang, L.F. Perceived school culture, personality types, and wellbeing among kindergarten teachers in Hong Kong. Australas. J. Early Child. 2014, 39, 100–108. [Google Scholar] [CrossRef]
- Yang, C.C.; Fan, C.W.; Chen, K.M.; Hsu, S.C.; Chien, C.L. As a happy kindergarten teacher: The mediating effect of happiness between role stress and turnover intention. Asia Pac. Educ. 2018, 27, 431–440. [Google Scholar] [CrossRef]
- Tayama, J.; Yoshida, Y.; Iwanaga, R.; Tokunaga, A.; Tanaka, G.; Imamura, A.; Shimazu, A.; Shirabe, S. Factors associated with preschool workers’ willingness to continue working. Medicine 2018, 97, e13530. [Google Scholar] [CrossRef]
- Matsuo, M.; Tanaka, G.; Tokunaga, A.; Higashi, T.; Honda, S.; Shirabe, S.; Yoshida, Y.; Imamura, A.; Ishikawa, I.; Iwanaga, R. Factors associated with kindergarten teachers’ willingness to continue working. Medicine 2021, 100, e27102. [Google Scholar] [CrossRef] [PubMed]
- World Medical Association. World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA 2013, 310, 2191–2194. [Google Scholar] [CrossRef] [PubMed]
- Yasuhara, T.; Sone, T.; Konishi, M.; Kushihata, T.; Nishikawa, T.; Yamamoto, Y.; Kurio, W.; Kohno, T. Studies using text mining on the differences in learning effects between the KJ and World Café Method as learning strategies. Yakugaku Zasshi J. Pharm. Soc. Jpn. 2015, 135, 753–759. [Google Scholar] [CrossRef][Green Version]
- Tei-Tominaga, M.; Asakura, K.; Asakura, T. Generation-common and -specific factors in intention to leave among female hospital nurses: A cross-sectional study using a large Japanese sample. Int. J. Environ. Res. Public Health 2018, 15, 1591. [Google Scholar] [CrossRef] [PubMed]
- Kessler, R.C.; Andrews, G.; Colpe, L.J.; Hiripi, E.; Mroczek, D.K.; Normand, S.L.; Walters, E.E.; Zaslavsky, A.M. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol. Med. 2002, 32, 959–976. [Google Scholar] [CrossRef]
- He, R.; Liu, J.; Zhang, W.H.; Zhu, B.; Zhang, N.; Mao, Y. Turnover intention among primary health workers in China: A systematic review and meta-analysis. BMJ Open 2020, 10, e037117. [Google Scholar] [CrossRef]
- Bhattacharya, I.; Ramachandran, A. A path analysis study of retention of healthcare professionals in urban India using health information technology. Hum. Resour. Health 2015, 13, 65. [Google Scholar] [CrossRef][Green Version]
- Amponsah-Tawiah, K.; Jain, A.; Leka, S.; Hollis, D.; Cox, T. Examining psychosocial and physical hazards in the Ghanaian mining industry and their implications for employees’ safety experience. J. Saf. Res. 2013, 45, 75–84. [Google Scholar] [CrossRef]
- Mazzola, J.J.; Schonfeld, I.S.; Spector, P.E. What qualitative research has taught us about occupational stress. Stress Health J. Int. Soc. Investig. Stress 2011, 27, 93–110. [Google Scholar] [CrossRef] [PubMed]
- Viswesvaran, C.; Sanchez, J.I.; Fisher, J. The role of social support in the process of work stress: A meta-analysis. J. Vocat. Behav. 1999, 54, 314–334. [Google Scholar] [CrossRef]
- Mackenzie, C.R.; Keuskamp, D.; Ziersch, A.M.; Baum, F.E.; Popay, J. A qualitative study of the interactions among the psychosocial work environment and family, community and services for workers with low mental health. BMC Public Health 2013, 13, 796. [Google Scholar] [CrossRef]
- Bhattacherjee, A.; Kunar, B.M. Miners’ return to work following injuries in coal mines. Med. Pr. 2016, 67, 729–742. [Google Scholar] [CrossRef]
- Mościcka-Teske, A.; Sadłowska-Wrzesińska, J.; Najder, A.; Butlewski, M. The relationship between psychosocial risks and occupational functioning among miners. Int. J. Occup. Med. Environ. Health 2019, 32, 87–98. [Google Scholar] [CrossRef]
- Darboe, A.; Lin, I.F.; Kuo, H.W. Effort-reward imbalance and self-rated health among Gambian healthcare professionals. BMC Health Serv. Res. 2016, 16, 125. [Google Scholar] [CrossRef] [PubMed]
- Harber, K.D.; Schneider, J.K.; Everard, K.M.; Fisher, E.B. Directive support, nondirective support, and morale. J. Soc. Clin. Psychol. 2005, 24, 691–722. [Google Scholar] [CrossRef]
- Øyeflaten, I.; Gabriele, J.M.; Fisher, E.B.; Eriksen, H.R. Social support and subjective health complaints in occupational rehabilitation. Int. J. Ther. Rehabil. 2010, 17, 424–435. [Google Scholar] [CrossRef]
- Stewart, D.W.; Gabriele, J.M.; Fisher, E.B. Directive support, nondirective support, and health behaviors in a community sample. J. Behav. Med. 2012, 35, 492–499. [Google Scholar] [CrossRef] [PubMed]
- Blanch, A. Social support as a mediator between job control and psychological strain. Soc. Sci. Med. 2016, 157, 148–155. [Google Scholar] [CrossRef] [PubMed]
- Johnsen, T.L.; Eriksen, H.R.; Indahl, A.; Tveito, T.H. Directive and nondirective social support in the workplace – Is this social support distinction important for subjective health complaints, job satisfaction, and perception of job demands and job control? Scand. J. Public Health 2018, 46, 358–367. [Google Scholar] [CrossRef] [PubMed]
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