e281
Neurophysiology technicians: a cross-sectional study
Research article
Clin Ter 2018; 169 (6):e281-286.
doi: 10.7417/CT.2018.2094
The perception of psychosocial risks through the HSE
questionnaire of a population of neurophysiology technicians:
a cross-sectional study
F. Cedrone1 , F. Lungo2, A. Feliciangeli2, F. Muccino2, E. Greco3
Department of Sciences for Health Promotion and Mother-Child Care “G. D’Alessandro”, University of Palermo; 2 Department of
Experimental Medicine, University of Rome “Sapienza”, Rome; 3Department of Public Health and Infectious Diseases, University
of Rome “Sapienza”, Rome, Italy
1
Abstract
Objectives. The Neurophysiopathology Technicians (NTs) are
exposed to psychosocial risks, exposure to psychosocial risks that
cause related work stress has been related to numerous physical and
mental illnesses. The aim of this study is to evaluate the perception of
psychosocial risks in a population of this population.
Materials and methods. 54 technicians of Neurophysiopathology
were enrolled, consisting of 23 males (42,6 %) and 31 females (57,4
%). All subjects were administered the HSE questionnaire developed
by the Health and Safety Executive. the statistical analysis provided
for the assessment of the reliability of the questionnaires and the nonparametric analysis of gender differences.
Results. In the total population emerges as critical the perception
of the domain “Managers’ Support” with Cronbach’s alpha values for
total males and females respectively of 0,87, 0,85, 0,88. In the female
population is added the critical perception of the “Peer Support” domain
(p=0,026), shows that the employees indicated that they do not receive
adequate information and support from their colleagues.
Discussion. The study highlights the exposure to psychosocial risks
by technicians of neurophysiopathology able to mediate the phenomenon of WRS. The HSE questionnaire represents a tool capable of
highlighting specific risks to which workers are exposed. Furthermore,
its ability to capture elements of the work context significantly increases
if an analysis is carried out that takes into account the worker’s gender.
Clin Ter 2018; 169(6):e281-286. doi: 10.7417/CT.2018.2094
Key words: gender differences, psychosocial risk, work-related
stress
Objectives
Significant changes that have occurred in the world of
work in recent decades have led to emerging risks in the
field of occupational safety and health and more and more
importance has been given to psychosocial risks in addition
to the so-called traditional risks such as chemical, physical
and biological (1). The psychosocial risks according to the
International Labor Office arise from the interaction between those aspects of the content of work, the organization
of work and its management and other environmental and
organizational conditions, on the one hand, and the skills
and needs of workers from other (2). Scientific evidence
suggests that the experience of work-related stress (WRS)
is closely correlated with worker exposure to psychosocial
risks in the workplace (3,4). WRS is defined as the psychophysical reaction that occurs when job demands exceed the
individual’s ability or resources to cope or over-collide with
their own needs (5,6).
Among the psychosocial risks that most influence the
perception of stress in the worker we find: excessive workloads, a lack of decisional autonomy in the management of
one’s work, the lack of support from one’s colleagues or
superiors, the presence of relational conflicts in the workplace, the scarce definition of the first role within the company
and the lack of involvement regarding the changes in the
organization (7,8). The scientific literature has shown that
through the phenomenon of WRS, exposure to psychosocial
risks has the potential to cause both mentals (9) and physicals
(10,11,12,13) diseases.
Given the strong impact of WRS on workers’ health, in
Italy, the assessment and management of this phenomenon
are mandatory, as indicated by Legislative Decree no. No.
81/2008. The law requires the assessment of all risks for the
health and safety of workers, including the risk from WRS,
also indicates to pay attention to groups of workers exposed
to particular risks including those related to gender differences, age and origin from other Countries. In order to comply
with this regulatory obligation with methodological rigor the
Department of Occupational and Environmental Medicine,
Epidemiology and Hygiene (Dimeila) of the Italian Workers’
Compensation Authority (INAIL) developed a methodological approach for the assessment and management of WRS.
Workers’ perceptions of exposure to psychosocial risks can be
Correspondence: Dr. Fabrizio Cedrone, E-email: fabrizio.cedrone@unipa.it Tel. 3208408819.
Copyright © Società Editrice Universo (SEU)
ISSN 1972-6007
e282
investigated through the use of standardized and scientifically
validated questionnaires. Among these the Italian version
of the Management Standard Indicator Tool developed by
the Health Safety Executive (HSE) is able to measure those
aspects of the work content and context that most frequently
represent potential WRS factors. This questionnaire was developed starting from the Standard Management model (14)
and subsequently it has been validated in the Italian version
(15) and is recommended by the INAIL guidelines which
identify how it is advisable to take into consideration the
questionnaires of groups of workers that are homogeneous
by tasks or role in the ‘organization.
Healthcare professionals are at high risk of development
of disorders caused by exposure to psychosocial risks in
the workplace such as high workloads, low control of their
work and high emotional demands (16,17). A category of
health professionals very homogeneous for work tasks and
type of patients observed is represented by the Neurophysiopathology Technicians (NTs). The professional training
of the (NT) was activated in 1972 at the Universities of
Rome and Bologna, followed by other universities. The
professional profile of the NT was regulated by decrees of
the Ministry of Health on 26 January 1988 and lastly on 15
March 1995, act, n. 183. The NTs are engaged in the field
of the diagnosis of diseases of the nervous system, directly
applying, on prescription, the specific diagnostic methods in
the neurological and neurosurgical field (Electroencephalogram, Electroneurography, Polygraphy, Evoked Potentials,
etc.) and has direct responsibility in the application and in
the final result of the diagnostic method used. The NTs employs diagnostic-instrumental methods for the detection of
electrocerebral activity for clinical and / or legal purposes;
is able to manage operations that underlie the execution
of the neurophysiological examination for diagnostic and
/ or research purposes. It also provides for the preparation
and quality control of the instrumentation of the equipment
supplied, monitors the proper functioning of the equipment,
ascertaining the precision and general quality of its work
tools. Their specific task leads them to deal with patients of
different ages who suffer from diseases that have important
repercussions on both quality of life and survival and it is
known that confrontation with death and suffering are upsetting and destructive experiences despite for many operators
health services represent routine’s elements (18).
There are no studies in the literature that focused on
assessing the perception of psychosocial risks in the professional category of NTs. The aim of this cross-sectional
study is to evaluate the perception of psychosocial risks in
a homogeneous working group represented by NTs through
the HSE Indicator Tool (HSE-IT) questionnaire and evaluate
gender differences.
Materials and methods
To carry out the study of a population of only NTs, workers belonging to 17 hospitals in the city of Rome, in which
the NTs carry out outpatient activities in the same working
hours (40 hours per week), were taken into consideration and
contacted directly. It has been decided a priori to take into
consideration, in order to limit the confounding factors, only
F. Cedrone et al.
NTs of Italian nationality and with a permanent contract. In
fact, the origin from other countries represents a separate
risk group as also indicated by the law (Legislative Decree
No. 81/2008) and the fixed-term contract can be a factor
that affects the job insecurity and that represents a specific
psychosocial risk which can modify the perception of other
psychosocial risks investigated by the study (19,20). All
subjects were self-administered the HSE Indicator Tool
(HSE-IT) questionnaire developed by the Health and Safety
Executive (21, 22, 23) in the Italian version (24) consisting
of 35 items, each item provides an articulated answer in a
five-level Likert, which refer to 7 domains known in literature as potential sources of stress at work:
1.“Demand” : this includes issues such as workload, work
patterns and the work environment;
2.“Control”: how much say the person has in the way they
do their work;
3.“Managers’ Support”: this includes the encouragement,
sponsorship and resources provided by management;
4.the “Peer’s Support”: this includes the encouragement,
sponsorship and resources provided by the colleagues;
5.“Relationship”: this includes promoting positive working to avoid conflict and dealing with unacceptable
behaviour;
6.“Role”: whether people understand their role within the
organisation and whether the organisation ensures that
they do not have conflicting roles;
7.“Changes”: how organisational change (large or small) is
managed and communicated in the organisation ;
All workers’ HSE-IT questionnaires were collected and
they were verified, for each, the correct and full compilation.
All subjects agreed to the processing of their personal data
indicating the availability of sensitive data and accepted that
they could be treated, with an anonymous and collective
protocol, through scientific procedures, according to the
principles of the Helsinki Declaration.
The data of the questionnaires have been loaded into a
specific software, Analysis Tool, elaborated by the same HSE
that compares the performances of the populations through
the comparison with the scores obtained from a reference
sample (benchmark) collected by 136 organizations (25),
and indicates the stress condition for each domain:
• Those below the 20th percentile (20% of the lowest
reference values), for which corrective action is urgently
needed.
• Those above the 20th percentile but below the 50th
percentile, for which corrective action is required.
• Those above the 50th percentile but below the 80th
percentile who do not require any corrective action.
• Those above the 80th percentile, which represent an
ideal population and do not need any corrective action.
The statistical analysis, initially, provided for the calculation of Cronbach’s alpha to determine the reliability
and internal consistency of the questionnaire for each domain explored by it for the total male and female samples.
Subsequently, the non-parametric statistical analysis was
performed through the Median Test of the differences in
scores obtained from the questionnaires of women and men
for each domain explored in order to test the null hypothesis
that the male and female populations are identical. Statistical
analysis was performed with STATA 14 software.
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Neurophysiology technicians: a cross-sectional study
Results
Overall were collected 54 questionnaires compiled by
the participating NTs and all were admitted to the study
as they were correctly filled out in all their parts, and as
compiled by workers who met the criteria of nationality
and type of contract. The population of NTs participating
in the study consists of 23 males (42.6%) and 31 females
(57.4%). The median of the ages and the values ​​of the first
and third quartiles of the total, male and female samples
are summarized in Table 1.
Table 1. Population data: median and quartiles of the age of the
total, male and female samples.
Num (%)
Total sample
54
Male sample
23
(42,6 %)
31
(57,4 %)
54
(100%)
54
(100%)
Female sample
Permanent employment
Italian nationality
Median Age
(Q1-Q3)
42
(34-54)
46
(38-59)
39
(32-44)
---------
The statistical analysis performed for the calculation of
Cronbach’s alpha for each domains explored by the questionnaire for the total, male and female population is summarized
in Table 2. the values obtained from Cronbach’s alpha can
be evaluated according to the De Vellis’ classification (26),
which considers unacceptable values (<0.60) , undesirable
values (≥ 0.60 and <0.65), minimally acceptable values (≥
0.65 and <0.70), respectable values (≥ 0.70 and <0.80), very
good values (≥ 0 , 80 and <0.90), finally, in the case of values
higher than 0.90, it attributes a high reliability to the scale.
The Cronbach’s alpha showed a very good reliability
for the “Demands” domain with values for the total, male
and female samples respectively of 0.87, 0.87, 0.86; for the
“Control” domain, minimally acceptable values of reliability
were obtained for the total and male samples, respectively
0.65 and 0.66, and respectable values for the female sample
with a value of 0.71; for the “Managers’ Support” domain,
very good values of reliability were obtained with values
for the total male and female samples respectively of 0.87,
0,85, 0,88; for the “Peer Support” domain, very good values
of reliability were obtained with values for the total male
and female samples respectively of 0,84, 0,81, 0,87; for
the “Relationships” domain respectable values of reliability
were obtained for the total sample, with a value of 0,74,
while they are unacceptable for the male sample, with a
value 0,57, and very good for the female sample, with a
value of 0,82; for the “Role” domain respectable values
of reliability were obtained for the total and male samples,
respectively 0,71 and 0.,77, and minimally acceptable for
the female sample with a value of 0.67; for the “Change”
domain unacceptable values of reliability, 0.58 and 0.53,
respectively, were obtained in the total and female samples,
and values considered undesirable for the male sample, with
a value of 0.62.
The HSE-IT scores obtained from the administration of
the questionnaire in the total, male and female samples are
summarized in Table 3. In the total population emerges as
critical the perception of the domain “Managers’ Support”
indicating that the employees suggest that they do not receive
adequate information and support from their superiors. This
domain is critical in the total males and females samples, in
these latter the lower score is achieved that is lower than the
20th percentile and such to require urgent corrective action.
The authors emphasize that the “Managers’ Support” domain
has a value considered very good for the reliability of the
questionnaire in all three samples.
In the female sample is added the critical perception
of the “Peer Support” domain, where in fact a score is obtained that requires corrective action. The critical score in
this domain shows that the employees indicated that they
do not receive adequate information and support from their
colleagues. The authors emphasize that the “Peer Support”
domain has a value considered very good for the reliability
of the questionnaire in all three samples.
Table 2. Cronbach’s alpha for the totale, male and female samples.
Total Sample
Male Sample
Female Sample
N=54
N=23
N=31
0,872
0,862
Demands
0,872
Control
0,654
0,664
0,713
Managers’ Support
0,872
0,852
0,882
2
2
Peer Support
0,84
0,81
0,872
3
Relationships
0,74
0,57
0,822
3
3
Role
0,71
0,77
0,674
6
5
Change
0,58
0,62
0,536
1
2
3
Classificazione secondi De Lellis: valori molto affidabili (≥0,90); valori molto buoni (≥ 0,80 e < 0,90); valori rispettabili (≥ 0,70 e
<0,80); 4 valori minimamente accettabili (≥ 0,65 e <0,70); 5 valori indesiderabili (≥ 0,60 e <0,65); 6 valori inaccettabili (<0,60).
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F. Cedrone et al.
Table 3. HSE-IT profile of the 3 samples: mean values total, male and female samples.
Total Sample
Male Sample
Female Sample
N=54
N=23
N=31
3,55a
3,77a
Demands
3,69a
Control
3,77a
3,66b
3,81a
Managers’ Support
3,29c
3,33c
3,26d
Peer Support
3,80b
3,93a
3,69c
Relationships
4,01b
4,04a
3,96b
Role
4,35a
4,35a
4,32a
Change
3,33a
3,43a
3,25a
a
Performance classified above the 80th percentile, which represent an ideal population; b Performance classified above the 50th percentile but below the 80th percentile, potential for improvement; c Performance classified above the 20th percentile but below the 50th
percentile, requiring improvement; d Performance classified below the 20th percentile requiring urgent improvement measures.
The non-parametric statistical analysis performed
through the Median Test of the differences in the scores
obtained from the questionnaires of women and men for
each domain explored in order to verify the null hypothesis that the male and female populations are identical are
showed in Table 4.
The null hypothesis can be refused only in the case of
gender differences concerning “Peer Support” and this data
is added to the high reliability of the HSE-IT questionnaire
for this domain in our samples and to the ability of this questionnaire to highlight the critical perception of the female
sample to this domain with respect to the male sample.
Discussion
The study highlights the NTs’ exposure to psychosocial
risks that is able to mediate the phenomenon of WRS through
the HSE-IT questionnaire.
Observing the results of the questionnaires obtained
from the total, male and female samples a cross-critical
problem emerges regarding the “Managers’ Support” domain
and one that concerns only the female sample that regards
the “Peer Support” domain. With the aim of assessing the
phenomenon of stress in workers, these results are very
important because the support perceived from superiors and
colleagues represents a barrier capable of protecting the
worker from exposure to other psychosocial risks capable
of damaging his health in the long run (27) in particular for
health professionals (28).
Regarding the critical domain concerning the “Managers’ Support”, the result obtained from the questionnaire
must be taken into consideration because, as emerged from
the reliability analysis calculated with Cronbach’s alpha,
it obtained a score considered very good. The lack of this
support perceived by the workers may depend on the type
of leadership proposed by the organization and in the cases
of our sample by the health management of the different
outpatient centers located in the different structures where
NTs operate. Please note that the HSE-IT questionnaire has
the ability to identify specific psychosocial risks and is able
to contextualize them within the organizational tissue as it
has been developed to plan effective corrective interventions
and in the specific case shows clearly how to moderate this
Table 4. HSE-IT score of the male and female sample and of the workers, median and first (Q1) and third (Q3) quartile of the obtained
score and non parametric analysis with Median Test.
Male Sample
Female Sample
Pearson Chi2
P value
N=23
N=31
HSE-IT
Median value
HSE-IT
Median value
score
(Q1-Q3)
score
(Q1-Q3)
3,62
3,87
0,827
0,363
Demands
(3,12-4,00)
3,77a
(3,50-4,25)
3,55a
3,83
3,83
0,043
0,836
Control
(3,33-4,00)
3,81a
(3,66-4,16)
3,66b
3,6
3,20
0,969
0,325
Managers’ Support
(2,80-4,00)
3,26d
(2,80-4,00)
3,33c
4,00
3,75
4,961
0,026
Peer Support
(3,50-4,50)
3,69c
(3,25-4,00)
3,93a
4,00
4,25
0,001
0,975
Relationships
(3,75-4,50)
3,96b
(3,50-4,50)
4,04a
4,60
4,40
0,556
0,456
Role
(4,20-4,80)
4,32a
(4,00-4,80)
4,35a
3,66
3,00
2,169
0,141
Change
(3,00-4,00)
3,25a
(3,00-3,66)
3,43a
a
Performance classified above the 80th percentile, which represent an ideal population; b Performance classified above the 50th percentile but below the 80th percentile, potential for improvement; c Performance classified above the 20th percentile but below the 50th
percentile, requiring improvement; d Performance classified below the 20th percentile requiring urgent improvement measures.
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Neurophysiology technicians: a cross-sectional study
exposure in our population it is necessary to plan focus
groups focused on the lack of leadership support and on
the strengthening, awareness and specific training of the
leadership about the importance of the managerial role.
Regarding the critical domain concerning “Peer Support” of the female sample it is necessary to emphasize
that this specific risk concerns first of all a domain with
high reliability of Cronbach’s alpha and that this difference
in the perception of gender is statistically significant (p =
0,026). It should be underlined that without the carrying out
a gender analysis in our sample the exposure to this risk
would not have been highlighted. The individual characteristics can modulate the perception of psychosocial risks at
each level (28) and between the individual characteristics
the gender is the most important (29). The differences underlying the perception of psychosocial risks by men and
women depend on the different coping strategies that they
put in place. The male is more inclined to respond with
strategies of “problem-focused coping” that are adaptively
more effective in the workplace and in the management of
emerging issues, instead the woman would tend to put in
place an “emotional-focused coping” that would to ruminate
on experienced emotional states and this would expose the
woman to experience the emotional symptoms of stress and
the psychical pathologies related to it (30, 31). The lack of
support from colleagues could be linked to environmental
risks in the context of the work to which women are most
exposed, for example harassment and violence in the
workplace (32) that has been related to a predisposition to
emotional exhaustion syndromes, such as burnout (33) also
associated with anger, frustration , shock, irritation, fear,
anxiety, depression and sleep disorders (34). However, this
is not the case for the female sample in this cross-sectional
study because such unacceptable behavior is highlighted by
the HSE-IT questionnaire from the “Relationship” domain
and in this domain the women have obtained a score with a
performance above the 50th percentile but below the 80th
percentile, with a reliability of the questionnaire for the
female sample calculated with the Cronbach alpha of 0,82,
considered very good.
The limits of the present study are given by the number
of the obtained sample which is small and as such provided
with discreet variance and which does not allow the randomization of a stratified sample on which to perform parametric
analysis capable of generating more solid evidence.
The strength, however, is given by having focused on a
subpopulation of the healthcare professionals given by the
NTs that represent a homogeneous group regarding the
tasks and the role within the organization. Furthermore, this
professional population has never been specifically studied
in terms of psychosocial risk perception and WRS.
In conclusion, the HSE-IT questionnaire represents a tool
capable of highlighting specific risks to which workers are
exposed. Furthermore, its ability to capture elements of the
work context significantly increases if an analysis is carried
out that takes into account the worker’s gender.
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