title: Effort-reward imbalance and self-rated health among Gambian healthcare professionals.
abstract: BACKGROUND
  The effort-reward imbalance (ERI) model of work stress has been widely applied in investigating association between psychosocial factors at work and health. This study examined associations between perceived psychosocial work stress as measured by the ERI model and self-rated health (SRH) among nurses and environmental health officers (EHOs) working in secondary public healthcare facilities in the Gambia.
  
  
  METHODS
  A cross-sectional study on a random sample of 287 health care professionals (201 nurses and 86 EHOs). A 22-item ERI questionnaire was used to collect data on the psychosocial factors defined by the ERI model. SRH was assessed using a single item measure.
  
  
  RESULTS
  The distribution of subjective health was not statistically different between nurses and EHOs. However, our study uncovered significant associations between perceived psychosocial work stress and subjective health. Specifically, we found that a perceived high effort-reward imbalance (ER-ratio > 1) is a significant risk factor for poor SRH, in both occupational groups. However, over-commitment was not significantly associated with poor SRH in the two groups. When efforts and rewards were considered as separate variables in the analysis, rewards were inversely associated with poor SRH in both groups.
  
  
  CONCLUSIONS
  Because of the high perceived Effort-Reward Imbalance among healthcare professionals at secondary public healthcare facilities, it is necessary to modify working conditions through improvement of psychosocial work environment, such as reasonable allocation of resources to increase pay, incentives or other forms of rewards from government. Interventions that could mitigate and prevent stress at work are worth considering in future healthcare policies.
authors.affiliation: Ministry of Health and Social Welfare, Banjul, The Gambia.|International Health Program, Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Amadou
authors.initials: A
authors.lastname: Darboe
authors.affiliation: Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
authors.forename: I-Feng
authors.initials: IF
authors.lastname: Lin
authors.affiliation: Institute of Environmental and Occupational Health Sciences, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112, Taiwan, ROC. hwkuo@ym.edu.tw.|School of Public Health, National Defense Medical Center, Taipei, Taiwan. hwkuo@ym.edu.tw.
authors.forename: Hsien-Wen
authors.initials: HW
authors.lastname: Kuo
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005714:Gambia; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009726:Nurses; D012201:Reward; D012307:Risk Factors; D057566:Self Report; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires; D017132:Workplace; D055815:Young Adult
keywords: ERI model; Gambia; Healthcare workers; Sub-Saharan Africa