Factors affecting the job satisfaction of employed adults with multiple sclerosis.
Dissatisfaction with one's job is an important consideration in vocational rehabilitation Noun 1. vocational rehabilitation - providing training in a specific trade with the aim of gaining employment
rehabilitation - the restoration of someone to a useful place in society (VR) services because it is an early warning sign that vocational closures are in jeopardy. Specifically, dissatisfaction with employment is related to absenteeism ab·sen·tee·ism
1. Habitual failure to appear, especially for work or other regular duty.
2. The rate of occurrence of habitual absence from work or duty. , turnover intentions (i.e., thinking about quitting), turnover (Moore, 1998; Perry, Hendricks, Broadbent, 2000), and disability retirement (Krause et al., 1997). In addition to diminishing the long-term cost-effectiveness of VR services, voluntarily leaving employment has devastating dev·as·tate
tr.v. dev·as·tat·ed, dev·as·tat·ing, dev·as·tates
1. To lay waste; destroy.
2. To overwhelm; confound; stun: was devastated by the rude remark. effects on the individual. Premature job loss threatens both the economic self-sufficiency and the psychological well-being psychological well-being Research A nebulous legislative term intended to ensure that certain categories of lab animals, especially primates, don't 'go nuts' as a result of experimental design or conditions of the person (Kirsch kirsch
A colorless brandy made from the fermented juice of cherries.
[French, short for German Kirschwasser; see kirschwasser. , 2000; McReynolds, 2001; Szymanski & Hershenon, 1998), sometimes referred to as the intended and unintended outcomes of employment, respectively (Jahoda, 1981 as cited in Merz, Bricout, & Koch, 2001).
Consistent with recommendations that it operate from a new paradigm New Paradigm
In the investing world, a totally new way of doing things that has a huge effect on business.
The word "paradigm" is defined as a pattern or model, and it has been used in science to refer to a theoretical framework. (Habeck, 1999), the VR program should address concerns about job satisfaction in the workplace as soon as possible so that individuals with disabilities or chronic illnesses can resolve those issues before losing their jobs or voluntarily leaving them (Roessler & Rumrill, 1995; Szymanski, 1999). Certainly, the best employment strategy for people with disabilities is to ameliorate a·mel·io·rate
tr. & intr.v. a·me·lio·rat·ed, a·me·lio·rat·ing, a·me·lio·rates
To make or become better; improve. See Synonyms at improve.
[Alteration of meliorate. job dissatisfaction before a job is lost in the first place (Habeck, 1999), although feasibility research suggests that special efforts are required to encourage individuals with chronic illnesses to participate in early intervention ear·ly intervention
n. Abbr. EI
A process of assessment and therapy provided to children, especially those younger than age 6, to facilitate normal cognitive and emotional development and to prevent developmental disability or delay. programs at the worksite (LaRocca, Kalb, & Gregg, 1996).
In order to design appropriate interventions to help employed people with disabilities maintain their employment, rehabilitation rehabilitation: see physical therapy. professionals must understand the factors affecting job satisfaction. The purpose of this study is, therefore, to identify factors affecting the job satisfaction of employed individuals with multiple sclerosis multiple sclerosis (MS), chronic, slowly progressive autoimmune disease in which the body's immune system attacks the protective myelin sheaths that surround the nerve cells of the brain and spinal cord (a process called demyelination), resulting in damaged areas (MS) and to discuss the implications of those findings for on-the-job rehabilitation services.
Employment among Adults with MS
The need to implement this study with employed adults with MS is evident in the employment statistics for this group. Although approximately 60% to 80% of adults with MS are unemployed (LaRocca, 1995; Rumrill & Hennessey, 2001), the vast majority of them have held jobs in the past. Jackson and Quaal (1991) reported that 91% of the individuals with MS in their sample had an employment history. Approximately 60% of people with MS are employed at the time of diagnosis, but only 20% to 30% are working 10 to 15 years later, with the majority leaving work in the first five years (LaRocca et al., 1996). Furthermore, in other studies, researchers have found that 40% to 50% of unemployed individuals with MS desired to resume employment (Gordon & Feldman, 1997). Thus, the high unemployment rate among adults with MS is occurring in a group of individuals who have a positive work history, a strong work ethic work ethic
A set of values based on the moral virtues of hard work and diligence.
a belief in the moral value of work , and a desire to resume their employment. Rehabilitation interventions that ameliorate dissatisfying conditions in one's job can, therefore, contribute significantly to the lives of many employed adults with MS by helping them maintain a salient and valued social role, namely that of a worker.
Factors Affecting Job Satisfaction
Szymanski and Hershenson (1998) defined job satisfaction as an outcome resulting from the interaction of several variables. For people with disabilities or chronic illnesses, three factors can affect satisfaction with employment--extrinsic factors such as wage and salary levels (Bokemeier & Lacy, 1986), chronic illness or disability factors affecting one's ability to perform work tasks (Hershenson, 1996), and subjective factors such as perceived job match and job tenure (Dawis, 2002).
According to according to
1. As stated or indicated by; on the authority of: according to historians.
2. In keeping with: according to instructions.
3. Bokemeier and Lacy (1986), the most basic theory regarding job satisfaction is that workers are satisfied if their jobs provide what they desire, and certainly the amount and perceived adequacy of financial remuneration REMUNERATION. Reward; recompense; salary. Dig. 17, 1, 7. is one concrete way in which employment helps people meet their needs. Unfortunately, the cost associated with treating and living with a serious medical condition can quickly erode Erode (ĕrōd`), city (1991 urban agglomeration pop. 361,755), Tamil Nadu state, S India, on the Kaveri River. The city is located in a cotton-growing region, and its industries include cotton ginning and the manufacture of transport equipment. the satisfactoriness of wage and salary levels (McMahon, 1979). In a recent study, Henriksson, Fredrikson, Masterman, and Jonsson (2001) reported that the direct costs of MS resulting from "detection, treatment, rehabilitation, and long-term care long-term care (LTC),
n the provision of medical, social, and personal care services on a recurring or continuing basis to persons with chronic physical or mental disorders. " (including personal assistance) are even higher than previously estimated (p. 28) and have a devastating impact on the quality of life of adults with MS and their families.
Hershenson (1996) discussed the ways in which health factors related to disability and chronic illness negatively affect worker competencies, which eventually takes its toll on job satisfaction. For example, MS alters certain intra-individual psychological and physical characteristics that affect the person's productivity (Beveridge, Craddock, Liesener, Stapleton, & Hershenson, 2001). Gulick (1992) described the MS-related symptoms that impair im·pair
tr.v. im·paired, im·pair·ing, im·pairs
To cause to diminish, as in strength, value, or quality: an injury that impaired my hearing; a severe storm impairing communications. a person's ability to work, including "gait and motor disturbance, visual problems, fatigue, bladder/bowel dysfunction dysfunction /dys·func·tion/ (dis-funk´shun) disturbance, impairment, or abnormality of functioning of an organ.dysfunc´tional
erectile dysfunction impotence (2). , ..., presence of pain.... and weakness" (p. 267). Other studies (e.g., Rao et al., 1991; Hakim et al, 2000; Roessler, Rumrill, Fitzgerald, & Koch, 2001) have demonstrated that cognitive impairments resulting from MS are frequently associated with employment difficulties. Chronic illnesses and disabilities, therefore, place workers in less congenial con·gen·ial
1. Having the same tastes, habits, or temperament; sympathetic.
2. Of a pleasant disposition; friendly and sociable: a congenial host.
3. , i.e., less satisfying, situations because they create barriers that frustrate efforts to perform position requirements.
As documented in a study by Abrams, DonAroma, and Karan (1997) and in research generated by the Minnesota Theory of Work Adjustment (MTWA MTWA Microvolt T-Wave Alternans
MTWA Maximum Total Weight Authorised
MTWA Metro Toronto Wrestling Association
MTWA Maximum Takeoff Weight Authorized ; Dawis, 2002), job satisfaction is also influenced by subjective factors such as perceived levels of job match and expected job tenure. In the MTWA, feelings of job satisfaction result from a match (i.e., correspondence) between the worker's reinforcer reinforcer /re·in·forc·er/ (-in-for´ser) any stimulus that produces reinforcement, a positive r. being a desirable event strengthening responses preceding its occurrence and a negative r. preferences and the reinforcers offered by the position. Feelings of job satisfaction are also a function of satisfactoriness in the position, which results from correspondence between worker abilities and job tasks. In other words Adv. 1. in other words - otherwise stated; "in other words, we are broke"
put differently , satisfaction and satisfactoriness are interdependent in·ter·de·pen·dent
Mutually dependent: "Today, the mission of one institution can be accomplished only by recognizing that it lives in an interdependent world with conflicts and overlapping interests" in that unsatisfied employees are quite likely to soon become unsatisfactory employees and vice versa VICE VERSA. On the contrary; on opposite sides. .
The importance of a satisfactory match between job and person is a fundamental precept An order, writ, warrant, or process. An order or direction, emanating from authority, to an officer or body of officers, commanding that officer or those officers to do some act within the scope of their powers. Rule imposing a standard of conduct or action. in VR practice and theory (Gilbride, Stensrud, Vandergoot, & Golden, 2003). According to Dawis (2002), career choices with good potential for job tenure require, in part, a good fit between individuals' skills and values and the task requirements and reinforcers of jobs. Such career choices should also be ones that people believe they can maintain over time (i.e., expected job tenure) based on positive efficacy and outcome expectations, which Szymanski and Hershenson (1998) referred to as mediating constructs affecting the interaction of people and work environments. Expecting that one will not be working in twelve months is yet another manifestation man·i·fes·ta·tion
An indication of the existence, reality, or presence of something, especially an illness.
(man´ifestā´sh of perceived mismatch mismatch
1. in blood transfusions and transplantation immunology, an incompatibility between potential donor and recipient.
2. one or more nucleotides in one of the double strands in a nucleic acid molecule without complementary nucleotides in the same position on the other between person and job and, thus, potentially an important factor affecting job satisfaction. For individuals with disabilities, negative expectations about job tenure may originate from concerns pertaining per·tain
intr.v. per·tained, per·tain·ing, per·tains
1. To have reference; relate: evidence that pertains to the accident.
2. to the mismatch between person and work tasks, the lack of on-the-job support and accommodations, inadequacies in transportation and childcare services, and lack of support from significant others (Fraser & Wehman, 1995; Szymanski & Parker, 2003).
Prediction of Job Satisfaction: A 3-step Model
Given findings in the literature on job satisfaction and on the impact of MS, the following variables are hypothesized to be significant predictors of job satisfaction among employed adults with MS:
1. Perceived adequacy of household income (income adequacy)
2. Annual income received from employment (annual income)
3. Perceived Severity of MS (disease factor)
4. Number of MS symptoms (disease factor)
5. Presence of cognitive impairment Impairment
1. A reduction in a company's stated capital.
2. The total capital that is less than the par value of the company's capital stock.
1. This is usually reduced because of poorly estimated losses or gains.
2. (specific disease factor)
6. The expectation of being employed in one year (expected job tenure)
7. Perceived job/person match (match)
Evaluated in a block-wise, hierarchical logistic regression In statistics, logistic regression is a regression model for binomially distributed response/dependent variables. It is useful for modeling the probability of an event occurring as a function of other factors. analysis, the above predictors were arrayed in a 3-level model of job satisfaction beginning with the intended effects of employment, that is, receipt of adequate compensation, and ending with more subjective estimates of job match and job tenure. The first level in the model included monthly wage and perceived adequacy of income (level 1); followed by disease characteristics such as severity of MS, number of MS symptoms, and presence of cognitive symptoms (level 2); which was followed by perceived job match and expected job tenure (level 3). To some degree, the variables in the job satisfaction model proceed from the more objective to the more subjective, that is, from monthly income to perceived job/person match (McMahon, 1979). Difficulties related to the variables in each level of the job satisfaction model (wage/salary level, disease characteristics, and perceived job/person match and job tenure) are amenable AMENABLE. Responsible; subject to answer in a court of justice liable to punishment. to rehabilitation interventions to prevent job termination, voluntarily or involuntarily in·vol·un·tar·y
1. Acting or done without or against one's will: an involuntary participant in what turned out to be an argument.
2. . Without immediate on-the-job rehabilitation programming of these types, the high rates of unemployment among adults with MS will continue into the future.
Data for this study were drawn from a large national survey of the employment concerns of people with MS. Ten National Multiple Sclerosis Society The National Multiple Sclerosis Society, a United States-based non-profit organization, and its network of chapters nationwide promote research, educate, advocate on issues relating to multiple sclerosis, and organize a wide range of programs, including support for the newly (NMSS NMSS National Multiple Sclerosis Society
NMSS Nuclear Material Safety and Safeguards
NMSS New Model Special Schools
NMSS Network Management Support Services ) chapters throughout the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. participated in the survey (Roessler, Rumrill, & Hennessey, 2002).
The total sample for this study consisted of 1,291 members of ten NMSS chapters and divisions representing nine states (California, Kansas, Missouri, Florida, New Jersey, Oregon, Montana, Delaware, and Ohio) and Washington, DC. Forty-three percent (43%) of the sample (N = 555) was employed at the time of the study and available for the job satisfaction analysis. Representing rural and urban/suburban areas (23% and 77% respectively), the employed sample was a well-educated (99% were high school graduates, 39% were college graduates), mid-career group of adults with MS (average age = 46 years, SD = 9.5). Most of the respondents were white (91%), although other racial/ethnic groups were represented in the sample (e.g., 6% were African American African American Multiculture A person having origins in any of the black racial groups of Africa. See Race. , 2% were Hispanic). This racial/ethnic representation is consistent with epidemiological epidemiological
emanating from or pertaining to epidemiology.
the associative relationships between the frequency of occurrence of a disease and its determinants, its predisposing and precipitating parameters in the broader population of Americans with MS (Rumrill & Hennessey, 2001). The vast majority of people with MS are Caucasian, with a much lower prevalence of the disease among African-American and Hispanic individuals.
Illness-related symptoms reported by the group suggested a mixture from severe to non-severe MS conditions, as well as a wide range of physiological, sensory, and psychological effects. Frequently reported symptoms were as follows: fatigue (indicated by 80% of respondents), balance/coordination problems (58%), diminished physical capacity (53%), numbness numbness /numb·ness/ (num´nes) anesthesia (1).
Loss of feeling or sensation.
Mentioned in: Topical Anesthesia (56%), spasticity spasticity /spas·tic·i·ty/ (spas-tis´i-te) the state of being spastic; see spastic (2).
1. A spastic state or condition.
2. Spastic paralysis. (40%), pain (38%), bowel/bladder dysfunction (36%), depression (36%), vision problems (33%), cognitive impairment (32%), motor dysfunction (30%), sexual dysfunction sexual dysfunction
Inability to experience arousal or achieve sexual satisfaction under ordinary circumstances, as a result of psychological or physiological problems. (23%), anxiety (21%), speech problems (13%), and bipolar disorder bipolar disorder, formerly manic-depressive disorder or manic-depression, severe mental disorder involving manic episodes that are usually accompanied by episodes of depression. (2%).
In addition to demographic variables such as employment status and employment concern items, components of the 86-item national survey used in this prediction study included questions on a) the independent variables of adequacy of income, annual income, course of illness, number of symptoms, presence of cognitive impairments, job match, and expected job tenure and b) the dependent variable of job satisfaction.
With the assistance of the NMSS, the authors identified 10 chapters and divisions representative of different geographic areas, rural/urban/suburban settings, and racial/ethnic groups. A random sub-sample of 500 NMSS members was selected from each chapter and division (one chapter selected 540 participants). Two weeks prior to mailing the survey, chapter service directors sent a pre-notice letter (Dillman, 2000) to those selected for the national cluster sample (N = 5,040). The survey was mailed with another explanatory cover letter from a member of the research team, followed by "reminder/thank you" postcards (Dillman, 2000) four weeks later.
Three hundred seventy-four (374) surveys were returned to participating chapters and divisions as undeliverable un·de·liv·er·a·ble
Difficult or impossible to deliver: undeliverable mail.
un , reducing the available target sample to 4,666 people with MS. One thousand three hundred ten (1,310) members of the target sample returned questionnaires, resulting in a response rate of 28% (1,310 out of 4,666), and 1,291 of those surveys contained complete employment status data needed for this analysis. Mailing the survey during the holiday season and in the midst Adv. 1. in the midst - the middle or central part or point; "in the midst of the forest"; "could he walk out in the midst of his piece?"
midmost of the "anthrax anthrax (ăn`thrăks), acute infectious disease of animals that can be secondarily transmitted to humans. It is caused by a bacterium (Bacillus anthracis " scare negatively affected the survey return rate, which is acknowledged as a limitation of this study.
Consistent with the 3-step job satisfaction model that addressed predictors from a more objective to more subjective point of view, data were analyzed an·a·lyze
tr.v. an·a·lyzed, an·a·lyz·ing, an·a·lyz·es
1. To examine methodically by separating into parts and studying their interrelations.
2. Chemistry To make a chemical analysis of.
3. using a block-wise, hierarchical logistic regression analysis with the predictor variables Noun 1. predictor variable - a variable that can be used to predict the value of another variable (as in statistical regression)
variable quantity, variable - a quantity that can assume any of a set of values entered in three blocks: a) block 1 : income adequacy and annual income; b) block 2: perceived severity, number of symptoms, and cognitive impairment; and c) block 3: perceived job match and expected job tenure. Ratings on job satisfaction (not satisfied--which included not satisfied and undecided ratings--and satisfied) were used as the dependent variable.
Hierarchical logistic regression is appropriate when the dependent variable is measured on a nominal scale See: principal scale; scale. and the independent variables are measured on any type of measurement scale (i.e., nominal, ordinal (mathematics) ordinal - An isomorphism class of well-ordered sets. , interval, or ratio). The logic involved in conducting and interpreting a block-wise, hierarchical logistic regression analysis is similar to that of a block-wise, hierarchical linear regression Linear regression
A statistical technique for fitting a straight line to a set of data points. analysis--which is used when the dependent variable is measured on an interval or ratio scale of measurement. In each case, it is desirable to find the best set of predictor variables that describes differences observed on the dependent variable. However, logistic regression analysis uses a different method to estimate parameters from the sample data. Specifically, parameters are estimated using the "maximum-likelihood" (ML) approach, as opposed to the ordinary least squares (OLS OLS Ordinary Least Squares
OLS Online Library System
OLS Ottawa Linux Symposium
OLS Operation Lifeline Sudan
OLS Operational Linescan System
OLS Online Service
OLS Organizational Leadership and Supervision
OLS On Line Support
OLS Online System ) approach used in multiple linear regression. With the ML approach, values of the coefficients are selected that make the observed results most "likely" (Cizek & Fitzgerald, 1999). Because of this unique difference, regression coefficients Regression coefficient
Term yielded by regression analysis that indicates the sensitivity of the dependent variable to a particular independent variable. See: Parameter.
regression coefficient can be expressed as odds ratios (i.e., "ExpB" in logistic regression analysis) that indicate the likelihood of a change in the dependent variable for a unit change in the value of the independent variable. A coefficient equal to 1.00 indicates no change in the odds of being in one category of the dependent measure versus the other category for a unit change on some independent variable; coefficients greater than 1.00 indicate that the odds of being in one category of the dependent measure versus the other category for a unit change on some independent variable increase; coefficients less than 1.00 indicate that the odds of being in one category of the dependent measure versus the other category for a unit change on some independent variable decrease (Cizek & Fitzgerald, 1999; Hosmer & Lemeshow, 1989).
Because several of the independent variables in this analysis were measured on nominal scales (i.e., income adequacy, severity of MS symptoms, presence of a cognitive impairment, expected job tenure, perceived job match), it was necessary to code each using "dummy Sham; make-believe; pretended; imitation. Person who serves in place of another, or who serves until the proper person is named or available to take his place (e.g., dummy corporate directors; dummy owners of real estate). coding" procedures specified by Hosmer and Lemeshow (1989) and Pedhauzer (1997). The multiple logistic regression procedures specified in The Statistical Package for the Social Sciences (statistics, tool) Statistical Package for the Social Sciences - (SPSS) The flagship program of SPSS, Inc., written in the late 1960s.
["SPSS X User's Guide", SPSS, Inc. 1986]. (SPSS A statistical package from SPSS, Inc., Chicago (www.spss.com) that runs on PCs, most mainframes and minis and is used extensively in marketing research. It provides over 50 statistical processes, including regression analysis, correlation and analysis of variance. version 11.0, 2003) were used to analyze these data. All tests were conducted at the .05 level of significance.
This section first presents data on the characteristics of the respondents regarding the independent variables considered in the analysis and then describes the results of the block-wise, hierarchical logistic regression analysis for predicting job satisfaction from the set of income-related, disease-related, and perceived job match and tenure variables. Table 1 presents descriptive statistics descriptive statistics
see statistics. related to the categorical That which is unqualified or unconditional.
A categorical imperative is a rule, command, or moral obligation that is absolutely and universally binding.
Categorical is also used to describe programs limited to or designed for certain classes of people. independent variables considered, whereas Table 2 presents descriptive statistics related to the continuous independent variables. The three blocks were entered in sequential steps with income adequacy and annual income entered first (block 1); disease severity, number of symptoms, and presence of cognitive impairment entered next (block 2); and perceived job match and expected job tenure entered last (block 3). The initial stage of analysis considered the significance of predictors in block 1. Each additional step considered the next block of variables along with significant predictors from a previous step to determine the best model for predicting satisfaction among employed individuals with MS.
The initial stage of the analysis (entering block 1) assessed the importance of income-related factors in explaining job satisfaction among employed individuals with MS. It was determined that only perception of income adequacy significantly improved the explanatory power of the model ([X.sup.2] - 21.62, p < .05, df = 1). Results of entering block 1 predictors are presented in Table 3.
When entering the next block of predictors, the significance of these variables was assessed along with the significant predictor from the previous block (i.e., income adequacy). Predictor variables that did not add to the explanatory power of the model were deleted and not considered at the next stage of analysis. It was determined that none of the disease-related predictors entered in the second block added to the explanatory power of the model ([X.sup.2] 9.96, p = .13, df = 3). Only perception of income adequacy remained as a significant predictor of job satisfaction. Results of entering block 2 predictors are presented in Table 4.
When entering the last block of job-related predictors, the significance of these variables was assessed along with the significant predictor from the previous block (i.e., income adequacy). Predictor variables that did not add to the explanatory power of the model were deleted. Analysis revealed that, in addition to income adequacy, perceived job/person match added to the explanatory power of the model ([X.sup.2] = 131.68, p < .05, df = 2). Results of entering block 3 predictors are presented in Table 5.
Predictors in the final model combined to explain 38% of the variability in respondents' job satisfaction ([R.sup.2] = .38). These results are presented in Table 6. The data presented under "B" represent the estimated regression coefficients that predict job satisfaction for each variable included in the final model, the Wald statistic statistic,
n a value or number that describes a series of quantitative observations or measures; a value calculated from a sample.
a numerical value calculated from a number of observations in order to summarize them. provides a test of each of these coefficients, and the Exp(B) coefficient provides information related to the change in the odds of being unsatisfied with one's job that would be associated with a one-unit change in the predictor variable.
Interpretations related to the individual effects of each of the variables included in the final model can be derived from Table 6. Income adequacy, which had two categories (i.e., able to meet expenses versus some difficulty meeting expenses), was significantly related to job satisfaction (Wald (1) = 20.53, p =.001). The Exp(B) for this variable (2.83) indicates that respondents who had difficulty meeting expenses were almost 3 times more likely to be unsatisfied with their jobs than were respondents who indicated that they were able to meet expenses. Perceived job/person match (i.e., matches to a lesser degree, matches well, perfect match) was also significantly related to job satisfaction (Wald (1) = 94.137, p = .001). Those respondents who reported greater degrees of job/person mismatch were almost 22 times more likely to be unsatisfied than those who perceived their job to be a perfect match (Exp(B) = 22.54). In addition, respondents who perceived their jobs to be a perfect match were almost 4 times more likely to be satisfied than those who perceived their jobs to simply match well with their personal attributes (Exp(B) = 3.69).
The final model for predicting job satisfaction included income adequacy and perceived job/person match. Job satisfaction decreased as adequacy of income and extent of job/person match diminished. Somewhat surprisingly, no disease characteristics contributed significantly to the model at level 2 of the hierarchical regression analysis In statistics, a mathematical method of modeling the relationships among three or more variables. It is used to predict the value of one variable given the values of the others. For example, a model might estimate sales based on age and gender. . Neither reported annual income nor expected job tenure (working there in one year--yes/no) were retained as part of the model.
With respect to income in level 1 of the model, the subjective evaluation of its adequacy to meet financial needs appears more critical than the actual amount. This finding is similar to theoretical speculation by McMahon (1979) regarding the impact of disability on critical factors in the Minnesota Theory of Work Adjustment. He commented on the way in which disability costs disturb the balance between one's income and expenses. The resulting budget shortfall may lead to a subjective conclusion that one's employment is no longer sufficiently reinforcing with respect to providing sufficient compensation to meet personal and family needs.
Findings pertaining to the perceived adequacy of income are consistent with research indicating that the costs of coping with MS on a daily basis are even higher than previously estimated (Henriksson et al., 2001). In discussing the social impact of MS, Hakim et al. (2000) reported results from 305 adults with MS indicating that 37% of the group experienced significant declines in their overall standard of living since receiving a diagnosis of MS. Financial difficulties arose due to loss of employment and/or increases in medication and treatment costs associated with MS. Gender and age were related to extent of financial pressures. Men were more likely than women to report stress due to financial pressures, as was the case for older individuals with MS.
Results of a recent national survey regarding the employment-related concerns of people with MS shed additional light on the financial situation of people with MS (Roessler et al., 2002). Some of the most pressing issues reported by respondents included access to a) reasonably priced prescription drugs prescription drug Prescription medication Pharmacology An FDA-approved drug which must, by federal law or regulation, be dispensed only pursuant to a prescription–eg, finished dose form and active ingredients subject to the provisos of the Federal Food, Drug, , b) adequate health insurance, and c) financial help to stay on the job. Without adequate health insurance and financial assistance with the costs of retaining employment, individuals with chronic illnesses such as MS have little hope of perceiving their current incomes as sufficient. As a result, they derive less satisfaction from their work and may begin to consider leaving the workforce and seeking Social Security benefits (O'Day, 1998).
Strategies are needed to increase access to reasonably priced prescription medications (which may cost as much as $1,200 per month), health insurance, and financial assistance to stay on the job. Based on results of focus groups of adults with MS and service providers, Roessler et al. (2002) described programs such as discount cards from pharmaceutical companies, legislation adding prescription drug coverage to Medicare, and bulk purchasing Bulk Purchasing is when products are bought in large quantities. This often results in a lower price per item, or Unit price. Wholesale is selling or related to selling goods in large quantities for resale to the consumer. of prescription drugs by State Medicaid agencies that would reduce prescription drug costs. Individuals may also seek group health insurance coverage in creative ways such as forming, at the local level, insurance groups based on membership in a community advocacy organization, library reading group, or the Chamber of Commerce. Access to car pools, publicly supported van services, and financial assistance with job accommodations are other ideas that might improve perceived sufficiency of income and, by extension, perceived job satisfaction.
Perceived job match made the other significant contribution to the prediction of job satisfaction. Based on the Minnesota Theory of Work Adjustment, job match is a two-fold construct including correspondence between a) reinforcer preferences and job reinforcers and b) worker abilities and job tasks (Dawis, 2002). Acknowledgement of a poor job match may reflect perceived early signs of inability to perform the job and to meet personal needs through work, which culminate culminate, in astronomy, the maximum height in the sky reached by a celestial body on a given day. At the culminate the body is crossing the observer's celestial meridian and is said to be in upper transit. in lower ratings of job satisfaction. Given that dissatisfaction with one's job is potentially a precursor precursor /pre·cur·sor/ (pre´kur-ser) something that precedes. In biological processes, a substance from which another, usually more active or mature, substance is formed. In clinical medicine, a sign or symptom that heralds another. to turnover intentions, rehabilitation professionals must respond quickly to expressed feelings of poor job/person match.
Szymanski (1999) discussed the need for rehabilitation professionals to take an early, proactive role in helping employees deal with disability-related distressing aspects of their work. Sources of stress may exist in the job itself as in physical and psychological demands or in work-home demands that become more difficult to perform due to disability or chronic illness. Regardless of their origin, these factors cause individuals to experience a sense of job mismatch and, thus, based on this research, decreased feelings of job satisfaction. As Szymanski stressed, strategies are needed to deal with this situation because "A good fit between individuals and their work environments may lessen the impact of job stress" (p. 282).
Szymanski (1999) recommended a variety of strategies to help people with disabilities manage workplace stress and enhance job/person match. In addition to helping people identify job stressors, develop strategies to respond to those stressors, and use resources more effectively, rehabilitation professionals can help employees with disabilities learn time management, career planning, overload See information overload and overloading. avoidance, and personal lifestyle management skills. Rehabilitation providers can also intervene early on the job by using indications of perceived job mismatch as an occasion for developing a Career Resilience resilience (r·zilˑ·yens),
n Portfolio with the individual. Section 4 of the Portfolio is particularly germane ger·mane
Being both pertinent and fitting. See Synonyms at relevant.
[Middle English germain, having the same parents, closely connected; see german2. to improving job/person match. Practical directions for enhancing job/person match are revealed in answers to the following questions in the Portfolio: "What are my current sources of job and personal stress?", "What additional job or personal stressors are connected to my future goals?", "How can I anticipate and lessen unhealthy levels of stress?", "What other aspects of my lifestyle help me to deal well with stress?", "What job characteristics do I need to thrive under these anticipated circumstances (e.g., more flexibility, ability to work at home)?", and "What can I do now to prepare (e.g., obtain education for a more flexible job, begin occasional telecommuting telecommuting, an arrangement by which people work at home using a computer and telephone, transmitting work material to a business office by means of a modem and telephone lines; it is also known as telework. ) for a possible worsening wors·en
tr. & intr.v. wors·ened, wors·en·ing, wors·ens
To make or become worse.
Noun 1. worsening - process of changing to an inferior state
decline in quality, deterioration, declension of my condition?"
Early intervention in the workplace precipitated by workers" reports of perceived job/person mismatch is a practice strongly recommended by advocates of disability management. Consistent with the principle of moving disability services "upstream" (Habeck, Kress, Scully, & Kirchner, 1994), this "front-line first response" focuses on problem-solving in the workplace (D'Zurilla & Nezu, 1999), which is far superior to "last ditch" clinical rehabilitation responses after the worker has terminated employment (Habeck, 1999). Disability management proficiencies in ergonomics ergonomics, the engineering science concerned with the physical and psychological relationship between machines and the people who use them. The ergonomicist takes an empirical approach to the study of human-machine interactions. , rehabilitation engineering Rehabilitation engineering is the systematic application of engineering sciences to design, develop, adapt, test, evaluate, apply, and distribute technological solutions to problems confronted by individuals with disabilities. , job modification, and accommodation are critical if the front line-first response approach is to succeed.
Evidence indicates that many workers with chronic illnesses express the need for job accommodation and modification even if the effects of their condition are in the mild stage (Allaire, Li, & LaValley, 2003). Reporting large numbers of work barriers and concerns about difficulties at work, factors directly related to estimates of job satisfaction (Roessler & Rumrill, 1995), individuals with mild rheumatoid arthritis rheumatoid arthritis
Chronic, progressive autoimmune disease causing connective-tissue inflammation, mostly in synovial joints. It can occur at any age, is more common in women, and has an unpredictable course. failed to seek accommodation services. Gulick (1992) reported a similar response among employees with MS who often waited until their conditions progressed to the point that job accommodations were essentially "too little--too late." For this reason, Allaire et al. recommended that rehabilitation professionals teach employees with disabilities how to manage the accommodation process. They need to learn not only the discrete skills of requesting an accommodation but also to develop a more complex understanding of accommodation in the work setting as a social, rather than technical, process (Gates, 2000). The fact that feelings of job dissatisfaction stimulated by encountering work barriers and difficulty at work occur in the lives of workers with chronic illnesses at all stages of their condition, mild to advanced, may also provide one tentative explanation for the failure of disease factors to contribute to the job satisfaction prediction model in this study.
Of course, all of the interventions proposed for the rehabilitation counselor must occur in the context of the work organization. As Gilbride et al. (2003) reported, some work environments are more conducive con·du·cive
Tending to cause or bring about; contributive: working conditions not conducive to productivity. See Synonyms at favorable. than others to accommodating people with disabilities. Results of focus group interviews with employees with disabilities, employers, and placement specialists helped to clarify the employment policies and practices that are needed. Employers who would be particularly responsive to the front line-first response approach would stress employee competencies and strive to match employee and job. They would seek input from employees with disabilities on factors affecting their productivity and involve them in all discussions about possible accommodations. They would develop job descriptions that emphasize essential, rather than marginal, functions and provide internships and other types of training opportunities to help employees with disabilities develop those essential skills. Employees with MS who were working in such conducive atmospheres would be more likely to be proactive regarding their accommodation needs and more likely to maintain their employment for a longer period of time.
Conclusions and Implications
Results of this research indicate that a model predicting job satisfaction should include variables related to income adequacy and perceived job match. Other variables hypothesized as related to job satisfaction such as annual income, disease characteristics, and expected job tenure were not included in the model. Thus, statements about financial pressures and feelings of being mismatched with one's job take on great significance as they are indicators of lack of satisfaction with one's job. Because lack of satisfaction with one's job may be construed as a "turnover intention," rehabilitation interventions are needed immediately at the worksite (front line-first response) to ameliorate those feelings of mismatch and financial exigency.
Strategies to improve perceived adequacy of income must address access to reasonably priced prescription medication, quality health insurance, and financial support to stay on the job. Policy initiatives such as including prescription medications in Medicare and organizing efforts to form local collectives that can apply for group medical insurance have promise. Finding resources for reliable, low-cost transportation to work such as car pools or van services or for on-the-job or daily living accommodations or modifications would also enhance the perceived adequacy of the income of working people with MS.
Implementing the front line-first response approach to improving job satisfaction requires a proactive posture on the part of the rehabilitation professional to respond at the first report of job/person match difficulties on the employee's part. This move upstream in the disability management process means that the counselor might offer the person training in skills such as time management, career planning, and workload and lifestyle management. The counselor could initiate efforts to develop a Career Resilience Portfolio to help the individual with MS take steps needed to reduce work difficulties. The counselor might offer services to the employer that would help employees with MS identify barriers to productivity and the accommodations needed to reduce or remove those barriers. Employees with MS may also need instruction on how to request, implement, and evaluate those accommodations, keeping in mind that introduction of an accommodation involves more than just an isolated technical change in a job. Finally, rehabilitation professionals need to help employers develop work environments that are conducive to hiring and accommodating people with MS through training focusing on how to a) improve work adjustment and job tenure for employees with MS; b) write job descriptions that stress essential functions; and c) identify, secure, and implement reasonable accommodations reasonable accommodations A standard of providing for a worker's or customer's needs, as mandated by the ADA, which requires that a business make appropriate changes in the environment to accommodate those with mental or physical disabilities as long as such .
Techniques that improve the perceived adequacy of income and extent of job/person match have the potential to decrease turnover intentions and turnover itself. Consequently, people with disabilities and chronic illnesses such as MS maintain their connections to the workforce, which is acknowledged by all as one of the highest priorities of rehabilitation services.
Table 1 Characteristics of Respondents for Categorical Independent Variables. Characteristic n % Income Adequacy (1) Able to Meet Expenses 432 79 (2) Difficulty Meeting 113 21 Self-Perceived Disease Severity (1) No Current Symptoms 89 17 (2) Symptoms Rarely Occur 222 41 (3) Occasional Symptoms 158 29 (4) Frequent Symptoms 41 08 (5) Multiple Severe Symptoms 31 05 Presence of a Cognitive Impairment (1) No 374 68 (2) Yes 176 32 Expected Job Tenure (working there in 1 year?) (1) Not Really Certain 66 12 (2) Fairly Certain 208 39 (3) Completely Certain 263 49 Perceived Job Match (1) Job Matches to a Lesser Degree 190 36 (2) Job Matches Quite Well 163 31 (3) Job Matches Perfectly 175 33 Table 2 Characteristics of Respondents for Continuous Independent Variables. Characteristic M SD Average Annual Income 40,865 49,150 Average Number of Symptoms 5 3.3 Table 3 Step 1 of Block-wise Hierarchical Logistic Regression Analysis Including Income-related Predictors. Predictor B S.E. Wald df p Exp(B) Annual Income 0.01 .007 1.43 1 .207 1.000 Income Adequacy 1.04 .23 20.53 1 .001 2.835 Constant 0.37 .21 .03 1 .860 1.003 Table 4 Step 2 of Block-wise Hierarchical Logistic Regression Analysis Including Significant Income-related Predictors Combined with Disease-related Predictors. Predictor B S.E. Wald df p Exp(B) Number of MS 0.07 .048 2.18 1 .140 1.074 Symptoms Presence of 0.08 .255 0.10 1 .751 1.084 Cognitive Impairment Severity of 6.48 4 .166 Symptoms Income 1.04 .23 20.53 1 .001 2.835 Adequacy Constant 1.76 .8 4.83 1 .028 0.172 Table 5 Step 3 of Block-wise Hierarchical Logistic Regression Analysis Including Significant Income and Disease-related Predictors Combined with Job-related Predictors. Predictor B S.E. Wald df p Exp(B) Number of MS 0.06 .056 1.05 1 .306 1.059 Symptoms Presence of 0.19 .299 0.45 1 .505 1.221 Cognitive Impairment Severity of 5.53 4 .237 Symptoms Expected Job 0.611 2 .737 Tenure Perceived Job/ 94.14 2 .002 Person Match Income Adequacy 1.04 .23 20.53 1 .001 2.835 Constant 3.94 .99 15.52 1 .001 0.020 Table 6 Final Model of Block-wise Hierarchical Logistic Regression Analysis. Predictor B S.E. Wald df p Exp(B) Perceived Job/ 94.14 2 .002 Person Match Lesser degree 3.12 .36 74.43 1 .001 22.54 versus Perfect Match Quite Well 1.31 .38 11.32 1 .002 3.69 versus Perfect Match Income Adequacy 1.04 .23 20.53 1 .001 2.835 Constant 2.10 .38 20.26 1 .001 0.122
The research presented in this article was conducted with the support of a Healthcare Delivery and Policy Research Contract from the National Multiple Sclerosis Society, New York New York, state, United States
New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of , NY. The authors wish to thank the Society for its support of their work.
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Richard T. Roessler
University of Arkansas The University of Arkansas strives to be known as a "nationally competitive, student-centered research university serving Arkansas and the world." The school recently completed its "Campaign for the 21st Century," in which the university raised more than $1 billion for the school, used
Phillip D. Rumrill
Kent State University
Shawn M. Fitzgerald
Kent State University
Professor Richard T. Roessler, University of Arkansas, Department of Rehabilitation, Human Resources The fancy word for "people." The human resources department within an organization, years ago known as the "personnel department," manages the administrative aspects of the employees. , and Communication Disorders communication disorder
Any of various disorders, such as stuttering or perseveration, characterized by impaired written or verbal expression. , 155 Graduate Education Building, Fayetteville, AR 72701. E-mail: email@example.com