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IJWHM
11,1
2
Received 31 August 2017
Revised 21 October 2017
28 November 2017
Accepted 29 November 2017
Is the gap between experienced
working conditions and
the perceived importance
of these conditions related to
subjective health?
Emma Hagqvist and Stig Vinberg
Department of Health Sciences, Mid Sweden University, Östersund, Sweden
Bodil J. Landstad
Department of Health Sciences, Mid Sweden University, Östersund, Sweden and
Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway, and
Mikael Nordenmark
Department of Health Sciences, Mid Sweden University, Östersund, Sweden
Abstract
Purpose – The purpose of this paper is to explore the gaps between experienced working conditions (WCs) and
the perceived importance of these conditions in relation to subjective health in Swedish public sector workplaces.
Design/methodology/approach – In total, 379 employees answered questions concerning WCs and health.
Nine WC areas were created to measure the gap between the experienced WCs and the perceived importance
of each condition. These WC areas were: physical work environment, social relationships, communication,
leadership, job control, recognition, self-development, workplace culture and work/life satisfaction. Subjective
health was measured using mental ill health, well-being and general health.
Findings – The results indicated relatively large gaps in all nine WC areas. Leadership, physical work
environment and work/life satisfaction in particular seemed to be problematic areas with relatively large
gaps, meaning that employees have negative experiences of these areas while perceiving these areas as very
important. Additionally, all WC areas were significantly related to subjective health, especially regarding
mental ill health and well-being; the larger the gaps, the worse the subjective health. The WC areas of
work/life satisfaction, self-development, social relationships, communication and recognition had the highest
relationships and model fits. This indicates that it is most problematic from an employee’s point of view if
there are large gaps within these WC areas.
Originality/value – This study improves the understanding of workplace health by exploring the gap
between experienced WCs and the perceived importance of these conditions.
Keywords Public sector, Sweden, Health, Working conditions, Dissonance
Paper type Research paper
Background
Public sector workplaces have the highest levels of sick leave in Sweden, and deterioration of
employees’ psychosocial work environment has been the most pronounced in this sector
(Berntson et al., 2012; Danielsson et al., 2012; Dellve et al., 2006; Lidwall and Marklund, 2006).
When examining the Swedish labor market, approximately half of women on long-term sick
leave were employed in female-dominated welfare services such as healthcare, education and
parental care (Forte, 2016; Social Insurance Agency, 2015). These services are considered
particularly vulnerable to a high level of sick leave ( Josephson et al., 2008; Dellve et al., 2006).
International Journal of Workplace
Health Management
Vol. 11 No. 1, 2018
pp. 2-15
© Emerald Publishing Limited
1753-8351
DOI 10.1108/IJWHM-08-2017-0067
The authors want to express gratitude to Region Jämtland Härjedalen, Sweden, and Mid Sweden
University, for financing the study. The authors owe special gratitude to the leaders and co-workers
who participated in the study and answered the questionnaires.
There are also regional differences in sick leave. Central Sweden, where the data for this study
were collected, has one of the highest levels of long-term sick leave (Social Insurance
Agency, 2017). Previous studies indicate that this high prevalence of sick leave is related to
extensive organizational changes, downsizing and role changes that negatively influence
public sector leaders’ and co-workers’ working conditions (WCs) and health (Hansson et al.,
2008; Härenstam and MOA Research Group, 2005). The high level of sick leave in public
workplaces in Sweden calls for further action to improve WCs. Several researchers
(e.g. Kelloway et al., 2008) have argued for a more positive focus in studies of WCs to
complement the outcome of employee sick leave with other health-related outcomes.
Public sector workplaces are often dominated by women, and the WCs are considered
demanding. A systematic review of gender inequalities in occupational health in Europe
(Campos-Serna et al., 2013) showed that employed women had more job insecurity, lower
control, worse WCs and poorer self-rated physical and mental health than men. A Swedish
review of WCs in highly gender-segregated occupations (Forte, 2016) indicated that these
are characterized by lower education requirements, higher physical demands, more repeated
heavy lifting, more physically demanding work, high work demands and difficulties
controlling one’s own work pace. According to Danielsson et al. (2012), the balance between
healthy and unhealthy factors among public sector employees has shifted toward less
favorable conditions, which increases mental stress. Potential explanations for this
development include that employed women with regular interpersonal contact often
experience a double burden of both paid and unpaid work and that they are exposed to
insufficient work organization (Björk and Härenstam, 2016).
A review of health care organizations (Bronkhorst et al., 2015) found that perceptions of a
good organizational climate were significantly associated with positive outcomes for
employee mental health, including lower levels of burnout, depression and anxiety.
More specifically, the findings indicated that co-worker relationships were very important in
explaining the perceived mental health status of health care workers. However, the
association of communication and participation with mental health outcomes was less clear.
Additionally, aspects of leadership and supervision were found to affect mental health
outcomes (Bronkhorst et al., 2015). This finding is in line with studies showing that leaders’
strategies for managing their own and their subordinates’ stress in public sector human
service organizations play a key role in shaping the psychosocial working environment
(Skagert et al., 2008). However, leaders in public sector workplaces identified an imbalance
between the high level of job demands and the lack of job resources to meet these demands
(Corin and Björk, 2016).
Scandinavian researchers have historically focused on work organization, work
environment and organizational health and performance outcomes (e.g. Docherty et al., 2002;
Gardell, 1982; Huzzard, 2003; Thorsrud and Emery, 1969). The concept of healthy work
organizations has similarities with this research about concepts of quality of working life.
Although there has been research on the organizational characteristics related to good
health and low rates of long-term sick leave among employees, there are no systematic
analyses of healthy work organization models (Lindberg and Vingård, 2012). In general,
research shows that work can both increase and decrease depression and mental illness
(van der Noordt et al., 2014; Waddell and Burton, 2006). Additionally, extensive research
emphasizes that WCs can contribute to decreasing or increasing employee health and job
satisfaction (Borritz et al., 2005; Forte, 2016; Herzberg, 1987; Lohela et al., 2009;
Kivimäki et al., 2006). Herzberg et al.’s (1959) motivation-hygiene theory is still valid to
contemporary working life (Sachua, 2007). This theory stipulates that job satisfaction
depends on motivators (e.g. responsibilities, stimulating work and recognition), while
dissatisfaction is a result of hygiene factors (e.g. salaries and benefits, WCs and
interpersonal relationships) (Herzberg et al., 1959).
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and perceived
WCs
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Research on work stress notes that job complexity, autonomy, role ambiguity and work
load are factors associated with employee health outcomes. High job demands combined
with low control increase the risk of stress and illness (e.g. de Lange et al., 2004; Karasek and
Theorell, 1990), while a high degree of control can lead to positive health outcomes
and increased employee motivation (Karasek and Theorell, 1990). A review of the
associations between psychosocial WCs and absence due to mental ill health among
employees showed that the key factors involved were related to demands (work overload
and pressure, conflicting demands), control (lack of control over work, lack of participation
in decision making) and social support (poor social support) (Michie and Williams, 2003).
Other important psychosocial WCs that affect employee health and job satisfaction include
social support (e.g. Sundin, 2009; Johnson and Hall, 1988) and a high degree of control in
work teams (Delarue et al., 2008; Rasmussen and Jeppesen, 2006; Wall et al., 1986). However,
increased autonomy in groups can also have negative effects, such as increasing stress
among employees (Delarue et al., 2008).
Research has also shown a relationship between, on the one hand, organizational culture
and organizational climate and, on the other hand, different health outcomes. For example,
based on studies of Swedish organizations, Wreder (2006) and Lagrosen et al. (2007) show
that a culture of developed core values improves co-worker health. In addition, researchers
from other countries have pointed at the relationship between organizational culture/climate,
organizational values and health and satisfaction outcomes (e.g. Arons et al., 2006;
Sauter et al., 1996). Additionally, research has identified relationships between leadership
and different health outcomes (e.g. Zwingmann et al., 2016; Kuoppala et al., 2008;
Westerlund et al., 2010). Concerning leader behaviors, one review has found positive
associations between employee health and behaviors such as a considerate approach to
co-workers, initiating structures when needed, giving co-workers autonomy, and involvement
in and control over their work (Nyberg et al., 2005). According to Nyberg et al. (2008),
psychosocial WCs, such as balanced job demands and a high level of job control, can be
considered mediating factors between leadership behaviors and employee health.
The above studies indicate that insufficient WCs, excessive job complexity, low
autonomy, excessive workloads, role ambiguity, low social support, negative organizational
climate, poor leadership and low control in work combined with high job demands may
decrease health. Good WCs, however, may increase employee health. We have not identified
any other studies on the relationship between health outcomes and gaps between actual and
perceived WCs. A key distinction from previous research that forms the basis for this study
is the hypothesis that health status is affected by not only actual WCs, but also the actual
WCs in relation to the perceived importance of these conditions. This hypothesis was
influenced by other studies and theories that propose a large gap between experience and
perceptions may be frustrating for individuals (Strandh and Nordenmark, 2006; Cooper,
2007). Based on this belief, the main assumption in this study was that a large discrepancy
between the experience of WCs and the perceived importance of these conditions would be
frustrating to individuals and would therefore have a negative influence on health and wellbeing. Furthermore, it was assumed that the larger the discrepancy was, the more health
and well-being would be negatively influenced. For instance, if an employee stated that the
communication in a work group was poor, this evaluation would be more problematic if he/
she also stated that communication was important for workplace well-being. It would likely
be even more problematic if a person said that the current communication was very bad and
that communication was extremely important to well-being.
Research on cognitive dissonance and the theory of cognitive dissonance provide insight
into why a large gap between experience and the perceived significance of the situation can
be problematic for individuals (Cooper, 2007; Festinger, 1957). In his theory of cognitive
dissonance, Festinger (1957) states that when a person holds two similar cognitions
(ideas about something), he/she experiences a satisfying state of consonance. However,
having two or more inconsistent cognitions results in dissonance. Dissonance is a painful,
unpleasant state that may reduce the individual’s well-being. Festinger (1957) argued that
the individual is therefore motivated to reduce cognitive dissonance by changing a cognition
or behavior. In terms of the theory of cognitive dissonance, one could argue that the actual
experience of WCs and the perceived significance of these WCs are two ideas, and thus a
state of cognitive dissonance can occur if these are inconsistent. The individual may try to
reduce the dissonance by changing his/her perspectives on the present state of the WCs or
by adjusting his/her perspectives on the importance of these conditions. However, as long as
there is a significant discrepancy between these two perceptions, the theory of cognitive
dissonance (Cooper, 2007; Festinger, 1957) suggests that there will be a high risk that this
state will negatively influence well-being and health; furthermore, the larger the dissonance
is, the higher the risk of a negative influence on health status.
In this study, three different measures of subjective health were used: general health,
well-being and mental ill health. Health should be viewed as something more than merely
the absence of biomedical defined diseases. Rather, health includes individual’s experience
of physical, mental and emotional dimensions (Schofield, 2010). Eriksson (2000) argued that
individuals can feel well and experience well-being even if they have a medically defined
disease. Additionally, individuals can experience low well-being or illness when they do not
have defined biomedical disease. The three health measurements used in this study
represent different dimensions of health. Well-being refers to a state of inner balance or
equilibrium, a sense of belonging in the world, and ability to be active and vigorous in
everyday activities (Gadamer, 1996), while general health refers to a greater extent to an
absence of disease (Eriksson, 2000). In this study, mental ill health was measured as the
presence of depressive symptoms and thus experiences of an unpleasant subjective state
(Mirowsky and Ross, 2003). As these three health measurements reflect different dimensions
of health, we hypothesized that their relationships with the gap between the experience of
WCs and the importance of these conditions would differ.
Aim and research questions
The aim of the study was to explore how the gap between employees’ experience of WCs
and the perceived importance of these conditions is related to subjective health outcomes in
Swedish public sector workplaces.
The following questions were addressed:
RQ1. Is there a gap between actual WCs and the perceived importance of these
conditions? If so, how large is the gap?
RQ2. Are the gaps related to general health, well-being and mental ill health, and what
gaps have the strongest relationships to these health outcomes?
RQ3. Between general health, well-being and mental ill health, which has the strongest
relationship with the gaps between the experience of WCs and the perceived
importance of these conditions?
Method
This study was conducted in a region in Central Sweden and included men and women
working in regional health care and within municipalities. The data were collected using a
questionnaire which was distributed to employees through the leaders at each workplace.
These leaders were selected because they participated in a leader-based workplace health
intervention. Leaders were selected as participant in the intervention project or references
by the human resources department. The goal of the intervention project was to give leaders
Gap between
experiences
and perceived
WCs
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tools to create a health-promoting workplace. The intervention project was oriented toward
the leaders and focused on issues of management, psychosocial WCs and workers’ health.
The intervention lasted for one year and consisted of eight educational meetings.
The questionnaire which we analyze for this paper was completed prior to the intervention.
Subjects
The inclusion criterion for employees to answer the questionnaire was that they had been
present at work ( full-time or part-time) in the last three months. Questionnaires were sent to a
total of 743 individuals, and 379 responses were received (51 percent). Among the
respondents, 24 held a mid-level leadership position at their workplace. The sample contained
307 women and 69 men (3 respondents did not state their sex) from 25 different workplaces,
including hospital care, day care, home care, cleaning and kindergarten. Due to the low
prevalence of men, no analyses exploring gender differences were conducted. The mean age of
the respondents was 45 years (SD 11.9). Of the 379 respondents, 100 reported that they had a
university degree, 155 a high school credential and 59 an upper secondary credential.
Measurements
This study focused on the relationship between WCs and health. First, the measures of WCs
were based on a total of 47 questions (see Lindberg et al., 2016, 2017). Each question had
two elements. Deploying questions using two elements has some similarities to Herzberg’s
(1987) two-factor theory of motivation and hygiene factors and emphasizes the difference
between these two factors. The main approach of this theory is the difference between
motivation factors and hygiene factors. However, in our study the focus is not explicit on these
factors. Instead, differences between the experience of WCs and the perceived importance of
these conditions are studied for both motivation and hygiene factors in relation to different
health outcomes. In this study, the first element explored how important a specific WC was for
subjective well-being on a 6-point Likert scale ( from very unimportant to very important; 0-5),
and the second element asked to what degree that factor existed at the workplace, with six
response options ranging from not at all to an extremely high degree (0-5). The score from the
first element was then subtracted from the second to estimate the gap between the experience
of WCs and the perceived importance of these conditions. This resulted in a scale for each
question, with 0 indicating no gap and 5 the largest possible gap. For instance, if an employee
stated that communication in the work group was extremely important for well-being
(response choice 5) and that the current communication state was very poor (response choice
0), the resulting value 5 indicated a large gap. Thus, 47 units were created measuring the gap
between the experience of WCs and the perceived importance of these conditions.
A factor analysis was conducted to examine how the 47 units representing the gaps
between the experience of WCs and the perceived importance of these conditions were
correlated in our sample. The results showed support for nine components. The 47 units
were thus categorized into nine areas, hereafter called WC areas. Indices were then
constructed for each of the nine WC areas based on the included units. The WC areas
consisted of different numbers of units, and each index was thus standardized with a scale
from 0 to 100 for comparability. Zero indicated no gap, while higher numbers indicated a
greater gap between experienced WCs and the perceived importance of these conditions.
The nine WC areas and a summary of the included questions were as follows: physical work
environment (α ¼ 0.72) – safety prevention and physical work load; social relationships
(α ¼ 0.81) – cooperation, relationships with colleagues and customers and support in work;
communication (α ¼ 0.83) – dialog within and between work groups, adequate information,
ability to express opinions and knowledge about what is expected; leadership (α ¼ 0.93) –
leader engagement, support and accessibility; job control (α ¼ 0.81) – participation in
decisions and ability to define work; recognition (α ¼ 0.89) – feeling of being needed, seen,
and treated with respect; self-development (α ¼ 0.87) – stimulating work tasks and feeling
engaged and vigorous at work, possibilities for development; workplace culture (α ¼ 0.85) –
common values and respectfulness at work; and work/life satisfaction (α ¼ 0.82) – workfamily balance, enjoyment and contribution to workplace development.
General health was measured with a single question. Respondents were asked to rate
their general health on a 5-point scale ranging from bad to excellent. A higher number
indicated better general health. Respondents were asked to rate their well-being using a
seven-point visual analog scale (VAS) with faces showing happy and sad expressions. The
variable was coded from zero, indicating low well-being, to six, indicating high well-being.
Finally, mental ill health was measured by five questions that asked whether the respondent
had experienced any of the following symptoms in the past four weeks: restlessness,
irritation, anxiety, dispiritedness and concentration deficiencies (experienced no symptoms,
symptoms once or twice, symptoms several times and symptoms every day). An index
was created from zero, representing no symptoms at any point in the past four weeks, to 15,
experiencing all symptoms every day (α ¼ 0.85).
Three control variables were used: sex, age and education. Age ranges from 19 to
67 years with mean 45 years (SD ¼ 11.8). Education was used as an indicator of
socioeconomic position. Each responded stated on a three-point-scale highest level
of education; 15 percent stated they had finished the lowest grade, 45 percent had completed
high school and 37 percent had a university degree.
Analysis
To answer the three research questions, analyses were performed in four steps. Initially,
mean values were computed for each of the nine WC areas (to measure the gap) as well as
for the three health measurements. In the second step, we analyzed the relationship between
gaps in each WC area and the three health measurements using regression analysis.
Additionally, we computed the adjusted R2 values to assess the model fit for each WC area
with each of the health variables. In step three, we evaluated the stability of the relationship
between the nine WC area gaps and the three health measurements by controlling for
employees’ experience of WCs (the second aspect of each question). Finally, all nine gap
variables were summarized into one aggregate gap variable, which was analyzed in relation
to all three health variables.
Ethical approval
This project was approved by the Regional Ethical Review Board in Umeå, Sweden
(2016/76-31Ö).
Results
In Table I we report the mean values of all measurements included in the model. The mean
values represent the mean size of the gap between the experience and importance of WCs. A
higher mean indicates a greater gap. Table I shows that the WC area of leadership has the
highest mean gap (26.5), closely followed by physical environment and work/life satisfaction.
The smallest gaps between the experience of WCs and their importance were in the areas of
job control and recognition. The high mean gap values indicated that these were WC areas in
which employees’ experience of WCs were substantially worse than their perceived
importance. Therefore, these areas might be important for subjective health. Regarding health
measurements, emphasis was placed on the standard deviation (SD) rather than the mean
value. For general health, the SD indicated that 66 percent of respondents rated their health
between 1.3 and 3.1. Thus, the variation was rather small, and most respondents rated their
health around the middle of the scale. Regarding well-being, the SD indicated that 66 percent
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Table I.
Descriptive statistics
for the nine WC area
gaps and health
variables based on
mean values
Variable
n
Physical work environment
376
Social relationships
373
Communication
373
Leadership
364
Job control
372
Recognition
372
Self-development
372
Workplace culture
369
Work/life satisfaction
370
General health
379
Well-being
378
Mental ill health
365
Note: Values for WC area gaps range from 0 to 100
Mean
SD
25.9
21.4
23.2
26.5
13.1
18.8
22.0
21.6
24.6
2.2
4.0
4.2
20.2
16.8
17.4
21.7
13.9
19.0
18.6
17.8
19.1
0.9
1.3
3.4
of the respondents rated their well-being between 2.7 and 5.3, on the upper side of the scale.
Mental ill health had a mean value of 4.2 and an SD of 3.4; thus, most of the sample
experienced at least one symptom at one point.
In the next step, the impact of each WC area gap was assessed in relation to the three
health measurements. All analyses were controlled for sex, age and education. In Table II,
for Model 1, each WC area gap was inputted separately for each health measure. Overall,
mental ill health and well-being seemed to be more closely related to the gaps than general
health. The β values for general health were lower and less significant. Additionally, the
model fit was lower for general health than for well-being and mental ill health.
For mental ill health and well-being, the gaps regarding social relationships,
communication, recognition, self-development and work/life satisfaction seemed
pronounced, with high β values. For mental ill health, workplace culture also stood out.
Mental ill health
Model 1
Model 2
Well-being
Model 1
Model 2
General health
Model 1
Model 2
Physical work environment
0.124*
0.041
−0.235***
−0.084
−0.134*
0.038
Model fit (%)
4.0
4.3
4.5
7.3
4.9
7.4
Social relationships
0.365***
0.219*
−0.429***
−0.158*
−0.236***
−0.085
Model fit (%)
15.5
16.6
17.2
21.5
8.6
10.3
Communication
0.354***
0.196*
−0.425***
−0.204*
−0.257***
−0.062
Model fit (%)
14.9
16.2
17.0
20.7
9.7
12.0
Leadership
0.242***
0.027
−0.295***
−0.136
−0.152**
0.014
Model fit (%)
8.2
10.6
7.8
9.0
5.4
6.6
Job control
0.199***
0.065
−0.222***
−0.062
−0.114*
−0.016
Model fit (%)
6.4
7.6
4.1
7.4
4.5
4.8
Recognition
0.336***
0.268***
−0.340***
−0.150*
−0.277***
−0.170*
Model fit (%)
13.7
14.6
10.6
13.3
10.8
10.9
Self-development
0.381***
0.256***
−0.408***
−0.225*
-0.257***
0.101
Model fit (%)
16.8
20.6
15.6
18.7
9.7
11.9
Workplace culture
0.298***
0.172*
−0.304***
−0.094
−0.170**
−0.47
Table II.
11.0
14.1
8.1
13.6
5.9
6.8
Regression analysis of Model fit (%)
Work/life
satisfaction
0.325***
0.288***
−0.513***
−0.278***
−0.325
−0.185*
the nine WC areas
12.9
19.7
23.3
30.0
12.9
14.4
with mental ill health, Model fit (%)
well-being and general Notes: In Model 1, each WC area is input separately, and in Model 2, respondents’ reports of working
health as outcome
conditions in each specific WC area are also included. Both models control for sex, age and education.
variables
*p⩽0.05; **p⩽0.01; ***p⩽0.001
Regarding general health, recognition and work/life satisfaction had high β values. Notably,
although the WC areas of leadership and physical work environment had the highest mean
gap values (Table I), their relationship to health was moderate in relation to those of the
other WC areas.
The gaps in WC areas are based on two elements, the first reflecting the importance of
WCs and the second reflecting actual WCs. To ensure that the β values in Model 1 were not
merely an effect of employees’ evaluation of actual WCs, the second elements were included
as control variables (Model 2). The relationships between the studied health outcomes and
the WC area gaps for social relationships, communication, recognition, self-development
and work/life satisfaction decreased marginally when controlling for actual WCs, indicating
that it was mainly the gap per se that influenced subjective well-being. For mental ill health,
workplace culture remained stable when including variables measuring actual workplace
culture. For physical work environment, leadership, job control and workplace culture (at
least for well-being), employees’ reports of actual WCs seemed more important for health
than the gap between the importance and experience of WCs.
Table II presents the model fit for all the relationships tested to determine whether
there were differences between WC area gaps. As stated above, model fit was greater for
all variables for mental ill health and well-being than for general health, except for
physical work environment. For mental ill health and well-being in particular, the WC
areas of social relationships, communication, self-development and work/life satisfaction
had a relatively high model fit, indicating that they explained a great extent of the
variation in the outcome variables. For mental ill health, workplace culture also had a
model fit (11 and 14 percent, respectively). For example, the model fit for the relationship
between work/life satisfaction and well-being, controlling for employees’ actual WCs, sex,
age and education, was 30.0 percent. This means that the model explained 30 percent of
the individual variation in well-being.
Each model was tested with the control variables age, sex and education. All variables
remained stable, and none of the control variables were significant (results shown on request).
Because of the high multicollinearity between the gap variables for WC areas, they were
all added to create one total gap variable. Total gap was inputted in three separate models
for mental ill health, well-being and general health. Table III shows that the gap explained
more of the variance in mental ill health and well-being than in general health and that the
β coefficients were higher for mental ill health and well-being. As much as 19.2 percent of the
variance in well-being was explained by the gap, and each unit increase in total gap reduced
well-being by 0.45.
Gap between
experiences
and perceived
WCs
9
Discussion and conclusion
Women employed in public sector workplaces in municipalities and county councils are
exposed to demanding WCs, including high physical demands, high mental job demands
and insufficient ability to control their work pace (Campos-Serna et al., 2013; Forte, 2016).
Although there is extensive research about how actual WCs contribute to different health
measures in this work sector, the knowledge is limited when considering the relationship
between the experience of WCs and their perceived importance among employees. The aim
of this study was to explore how the gap between employees’ experience and their perceived
Mental ill health
Well-being
Total WC gap
0.366***
−0.453***
Model fit (%)
15.5
19.2
Notes: Control for sex, age and education. *p⩽0.05; **p⩽0.01; ***p⩽0.001
General health
−0.260***
9.7
Table III.
Regression analysis of
total WC gap and
model fit
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importance of WCs was related to three health outcomes among Swedish employees
working in the public sector. Based on the dissonance theory (Cooper, 2007; Festinger, 1957),
we argued that a greater gap should be related to worse health.
The first research question asked how large the gaps were between the experience of
different WCs and the perceived importance of these conditions. The results indicate
relatively large gaps for all nine of the studied WC areas. In particular, leadership, physical
working environment and work/life satisfaction seemed to be problematic areas with
relatively large gaps. Interestingly, job control had the lowest gap values, indicating a
positive result, as the ability to influence and control one’s work situation is fundamental to
healthy WCs (Karasek and Theorell, 1990; de Lange et al., 2003).
Regarding the second research question about how the gaps were related to the three health
measures, our results show that the total gap index and all analyzed WC area gaps were
statistically significantly related to subjective health, especially mental ill health and well-being;
the larger the gaps were, the worse subjective health was rated. The WC areas of work/life
satisfaction, workplace culture, self-development, social relationships, communication and
recognition had the strongest relationships and model fit, especially for mental ill health and
well-being. When controlling for the experience of WCs, the relationships between these
two health outcomes and the abovementioned WC areas remained statistically significant.
This finding indicates that independent of the experience of WCs (which are also important to
subjective health according to earlier research), the gaps between the experience and the
perceived importance of WCs are important for subjective health. This result can be explained
by the theory of cognitive dissonance, that states that having two or more cognitions that are
inconsistent results in dissonance (Cooper, 2007; Festinger, 1957). Dissonance is an unpleasant
condition that is painful and may reduce the individual’s well-being.
Interestingly, some WC areas were more strongly correlated than others to subjective
health; this finding is difficult to explain. One explanation could be that areas with relatively
large gaps should be more important to subjective health than areas with smaller gaps, but
that does not seem to reflect the overall picture. WC areas with both relatively large and
relatively small gaps were strongly correlated to subjective health. However, it seems that
most of the WC areas that were strongly correlated to subjective health (social relationships,
communication, recognition, self-development and for mental ill health also workplace
culture) represented a psychosocial and interpersonal dimension. This indicates that gaps
between the experience of WCs and the perceived importance of these conditions may be
more frustrating for individuals when they pertain to psychosocial and interpersonal
domains than to areas such as physical work environment and leadership.
More holistic workplace health interventions, in which individual and organizational
measures are combined and there is a high degree of participation by employees, are
effective in contributing to employee health (e.g. Landstad, 2001; Vinberg, 2008). In addition,
organization-level changes related to the psychosocial work environment have the potential
to achieve important beneficial health effects and to reduce health inequalities amongst
employees (Bambra et al., 2009). It is important to consider these results when targeting
improvements related to social relationships, communication, recognition and selfdevelopment. As we have noted, previous research points to the importance of leadership to
improve employees’ health and create a healthy work organization (Zwingmann et al., 2014;
Dellve et al., 2007; Nyberg et al., 2005; Larsson and Vinberg, 2010). The weak association
between the gap in the WC area of leadership and subjective health may be explained by the
fact that psychosocial WCs are mediating factors between leadership and employee health
(Skakon et al., 2010). This relatively high gap suggests the importance of improving
leadership skills.
The third research question addressed which of the three health measures had the
strongest association with the WC areas studied, and the analyses showed interesting
differences between the measures. Using the appropriate health variable is important when
studying WCs. Our results indicate that mental ill health and well-being are better suited
than general health for studying associations with WCs. Well-being reflects an individual’s
state of inner balance and sense of belonging. Mental ill health reflects an unpleasant
subjective state. General health, on the other hand, refers to the absence of disease and
does not include the holistic dimension identified in well-being and mental illness.
Thus, measurements that include a holistic dimension of health seem better suited to
studying WCs (e.g. Grawitch et al., 2006; Landstad, 2001; Vinberg, 2008).
Methodological discussion
The workplaces included in this study were part of a health promotion intervention focusing
on leadership. The workplaces were selected because they had high levels of sick leave.
Though not intended, in retrospect, we found that the selected workplaces were
predominantly female, which reflects the present literature regarding sick leave
(Campos-Serna et al., 2013; Forte, 2016). As the data were cross-sectional, we cannot
elaborate on causal relationships and we do not know if a given response could have been
affected by the respondent’s feelings that day. This should be considered when interpreting
the results. The WC areas showed high intercorrelations. Both the high Cronbach’s α values
and the factor analysis supported the construction of the nine WC areas. Studying the gaps
between employees’ perceptions of actual WCs and the importance of these WCs in relation to
employee health is innovative and represents a development in the field of workplace health.
In future studies, it will be important to include longitudinal designs to examine the gaps
between employees’ perceptions of WCs and their importance in relation to employee health.
Conclusions and implications
This study found that the difference between employees’ perceptions of WCs and the
perceived importance of these conditions was strongly related to health outcomes including
mental ill health and well-being in the Swedish public sector. These results contribute to the
large number of previous studies showing that WCs are important to subjective health.
From a theoretical perspective, the results point at the importance of taking into account
differences between experienced WCs and the perceived importance of these conditions
when using models as, for example, Herzberg’s two-factor theory and healthy work
organization models.
The strong associations between subjective health and gaps in WC areas such as work/
life satisfaction, self-development, social relationships, communication and recognition
emphasize the importance of reducing these gaps when designing workplace health
interventions. One way to do this is to improve the WCs in these areas so that the actual
conditions meet employee expectations. Our respondents had jobs that exposed them to
demanding physical and psychosocial WCs. Therefore, at a societal level, it is important
to acknowledge the importance of health-promoting WCs and focus action toward
public sector organizations. Workplaces need to have discussions about employees’
expectations in relation to WCs. Our findings can help organizations to develop policies for
health-promoting workplaces. Finally, leaders need to be more engaged with the importance
of the relationship between these gaps and health.
When evaluating such interventions, it is important to study outcomes such as mental ill
health and well-being, i.e., to combine relevant workplace health outcomes. More qualitative
studies are needed to gain more insights into the importance of these gaps and the
relationship between the gaps and health for individuals. This study should help
researchers prioritize the right areas for workplace health interventions in public sector
organizations. Additionally, it would be of interest to study the private sector with regards
to gaps in WCs and health.
Gap between
experiences
and perceived
WCs
11
IJWHM
11,1
12
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Corresponding author
Emma Hagqvist can be contacted at: Emma.Hagqvist@miun.se
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