BURNOUT, SENSE OF COHERENCE, AND HEALTH STATUS IN NEW YORK CITY HIV SERVICE PROVIDERS José E. Nanín, EdD, CHES NYC DOH HIV Training Institute and Teachers.

BURNOUT, SENSE OF COHERENCE,

AND HEALTH STATUSIN NEW YORK CITY

HIV SERVICE PROVIDERS

José E. Nanín, EdD, CHESNYC DOH HIV Training Institute

andTeachers College, Columbia

University 

BURNOUT

• a “state of psychosocial and physical exhaustion that results from chronic exposure to high levels of stress with little personal control” (Sarafino, 1998).

• term first introduced by Freudenberger in 1973 based on observations of volunteers involved in the free clinic movement in the 1960s

• Maslach (1978) provided empirical evidence and a measurable construct

MASLACH’S DEFINITION OF BURNOUT

• a psychosocial condition of emotional exhaustion, depersonalization, and reduced personal accomplishment

• “an individual stress experience embedded in a context of complex social relationships… [involving] the person’s conception of both self and others” (Maslach

and Goldberg, 1998, p. 64)

•Emotional Exhaustion: feelings of “being emotionally overextended and depleted of one’s emotional resources”

•Depersonalization: the “negative, callous, or excessive detached response to other people,” including a sense of diminished idealism

•Reduced personal accomplishment: diminished or absence of “feelings of competence and productivity at work” encompassing a “lowered sense of self-efficacy”

DIMENSIONS OF BURNOUT

RESILIENCE

• “ability to bounce back from adversity…a “challenge every human eventually faces in living” (Dyer and McGuinness, 1996, p. 276)

• More specifically, “the capacity for successful adaptation, positive functioning, or competence… despite high-risk status, chronic stress, or following prolonged or severe trauma” (Egeland, Carlson, and Sroufe, 1993, p. 517)

RESILIENCE AND SOC

• In this study, resilience is measured via sense of coherence (SOC), a construct of human resilience, in which one’s world and everyday occurrences in that world are perceived as comprehensible, manageable, and meaningful. (Antonovsky, 1996)

HEALTH• Based on biopsychosocial model (Engel, 1977)

– “a positive state of physical, mental, and social well-being—not simply the absence of injury or disease—that varies over time along a continuum” (Sarafino, 1998, p. 4)

– health is seen as a dynamic entity along the “illness/wellness continuum” with death on one end and optimal health on the other, suggesting how “health and sickness are not entirely separate concepts,” just overlapping phenomena (Sarafino, 1998, p. 4)

Why was this study conducted?

• Burnout has been documented by many researchers to be highly prevalent in the HIV field, as well as in the general health and human services field. (Bennett, Miller, and Ross, 1995; Maslach and Leiter, 1997; Wells, Kutscher, Seeland, Selder, Cherico, and Clark, 1989)

• Anecdotal evidence revealed that burnout was having a negative impact on job performance and service delivery to clients.

• Many HIV service providers were complaining about being burnt out from their jobs in HIV. This had a negative impact not just on their jobs, but on their abilities to learn how to do their jobs better by attending trainings.

• To determine the prevalence of burnout• To determine levels of sense of coherence• To assess health status• To explore the relationships between

selected demographic and work-related variables and the main variables of interest

• To determine the best predictors of the main variables of interest

Aims of the Study

Sample and Method • Design: cross-sectional survey• Convenience sample: 150 HIV service providers who

attended classes at the HIV Training Institute of the New York City Department of Health from November 2000 to February 2001

• Surveys with consent forms attached were distributed at the start of each class session.

• Informed consent form was read aloud by the P.I. and had to be signed by participants before any surveys were completed.

• NOTE: Surveys were tracked by a pre-determined code number that was not associated with person’s name on the consent form.

Surveys

• Maslach Burnout Inventory (MBI)– measures the three burnout dimensions of emotional

exhaustion, depersonalization, and personal accomplishment

• Demographic/Background questionnaires – age, sexual orientation, years married, religion, etc.

• Orientation To Life Questionnaire (OTLQ)– measures resilience through Sense of Coherence

• RAND Medical Outcomes Survey SF-36 (RAND/MOS)– measures health status

Reliability of Measurements

• MBI (3 scales) – coefficients alpha from .68 to .88

• OTLQ – coefficient alpha of .50

• RAND/MOS (8 scales) -- coefficients alpha from .61 to .91

SIGNIFICANT FINDINGS

Sample Profile (N = 150)• Female (72%)• Black and Latino (61%)• Catholic and Protestant (48%)• Not married (77%)• Heterosexual (79%)• Attended college and above (61%)• Associate’s and Bachelor’s degrees (54%)• Social services and counseling (45%)• Front-line staff (including trainers) (66%)• Have had up to 10 days of training (67%)

• Often / very often receive supervision (54%)

• Up to 50% of clients are PLWHIV (60%)

• Mean age = 35.64

• Mean number of years in HIV field = 3

• Mean level of religiosity = 3.95 (on scale of 1 to 7) -- Moderately religious

• Mean hours worked per week = 35.86

• Mean number of years at present job = 2.72

• Mean number of years in helping field = 4.99

Burnout Prevalence(Aim #1)

• MBI measured level of burnout via 3 subscales (i.e., Emotional Exhaustion, Depersonalization, and Personal Accomplishment). To streamline data analysis, a composite score was derived.

• The composite burnout score, which ranges from a low of 0 to a high of 97 in this sample, attained a mean of 46.82 (SD = 18.75).

• Low burnout, which comprises the range of 0 to 54, existed among 67% of the sample.

• YET…among the subscale scores, 78% fell into the low-to-moderate personal accomplishment categories. – NOTE: Low personal accomplishment is a characteristic of high

burnout.

Level of Resilience(Aim #2)

• Resilience was measured via the OTLQ, which quantifies the construct of Sense of Coherence.

• Sense of Coherence scores can range from a low of 29 to a high of 203.

• The mean Sense of Coherence score was 144.8 (SD = 22.73).

• Moderate SOC ranges from 134 to 156. Thus, resilience via Sense of Coherence was moderate in this sample.

Level of Health Status(Aim #3)

• Health status was measured via 8 subscales of the RAND/MOS Survey. To streamline data analysis, a composite score was derived.

• The composite health status score, which ranges from 0 to 790 in this sample, attained a mean of 607.45 (SD = 123.46).

• When broken down categorically, moderate health status comprises a range from 565 to 687. Thus, most members of this sample experience moderate health status.

Relationships with Burnout(Aim #4)

• Burnout had a significant negative relationship with– age (r = -.21, p < .05)– level of religiosity (r = -.22, p < .05)– SOC (r = -.51, p < .01)– health status (r = -.49, p < .01)

•Domestic partnership status was found to have a significant effect on burnout (F = 3.01, p = .05).

Post hoc Scheffé contrast tests revealed that the means between the “Yes” and “No” groups were significantly different (α = .05). Thus, respondents in a domestic partnership experienced less burnout than respondents who are not in a domestic partnership.

Correlates of SOC(Aim #4)

• SOC was positively correlated with:– age (r = .21, p < .05)– level of religiosity (r = .31, p < .01)– health status (r = .56, p < .01)

• As mentioned before, SOC was negatively correlated with burnout (r = .51, p < .01) .

•Sex was found to have a significant effect on SOC (t = -2.13, p < .05).

SOC means for males and females were significantly different from each other. Thus, female respondents possessed significantly more SOC (i.e., more resilience) than males.

•Marital status was found to have a significant effect on SOC (F = 4.29, p < .05).

Post hoc Scheffé contrast tests revealed that the means between the single and married groups were significantly different (α < .05). Thus, married respondents in this sample were significantly higher in SOC (i.e., more resilient) than single respondents.

Correlates of Health Status(Aim #4)

• Health status was positively correlated with:– level of religiosity (r = .18, p < .05)– highest level of school completed (r = .23, p < .01)– SOC (r = .56, p < .01), as mentioned

• Health status was negatively correlated with burnout (r = -.49, p < .01), as mentioned.

Predictions of Variables of Interest

(Aim #5)• Predictors for burnout were determined. The best

predictors of the composite burnout score were SOC, health status, and domestic partnership. These 3 variables explained 33% of the variance in burnout (β = -.49, p < .01).

• Predictors of SOC included health status, burnout, level of religiosity, sex, and marital status. These 5 variables were able to explain 40% of the variance in SOC (β = .50, p < .01).

• Predictors of health status included 3 variables: SOC, burnout, and highest level of school completed. They explained 36% of the variance (β = .50, p < .01).

Limitations of Study

• Use of volunteers (i.e., only people who gave consent)– Self-selection bias

• English surveys were administered.– Those with limited English reading ability may

have provided useful and important information

• No deception was used.—Effects from demand characteristics– Respondents knew what the study was about– May have skewed the results

• P.I. administered the surveys. – Experimenter effect– Expectations may have influenced responses

• Low reliability of OTLQ• Only self-report measures were used.

– More direct measures may have provided more accurate information

Implications• Even though 67% reported experiencing low

burnout (based on the composite score), among the subscales, there were 78% of respondents who reported low –to-moderate personal accomplishment, which is characteristic of high burnout.

• Service providers may not be fulfilled with their jobs even though they are performing their jobs and/or staying in the HIV field.

• Administrators need to develop interventions to help their employees feel more personal accomplishment in their work.

• In addition, employees themselves may need to access counseling/therapy and other self-help resources to help them reframe their work goals so that they may feel more fulfilled about the work they do or to pursue other goals that may be more fulfilling.

• Research implications– Replication in other U.S. AIDS

epicenters• San Francisco, Los Angeles, among others

– Larger sample size • Better representation of HIV service

providers• More meaningful results

– Conduct similar studies in areas of the world like South Africa where there is rising incidence of HIV

• Noteworthy remarks– AIDS is presently considered a manageable disease

in the US; yet, in developing areas of the world, like sub-Saharan Africa and South and Southeast Asia, the epidemic has multiplied three-fold and six-fold, respectively (Schoub, 1999).

– Burnout, resilience, and health status in HIV service providers of countries in these areas, especially South Africa, are worth investigating to foster new ideas that can make HIV/AIDS a manageable disease in those countries, as it has become here in America.

Useful References

• Maslach, C. and Leiter, M. P. (1997). The truth about burnout. San Francisco, CA: Jossey-Bass.

• Skovholt, T. M. (2001). The resilient professional. Needham Heights, MA: Allyn & Bacon.

Thank you!Thank you!To receive a complete research report, please email your name and address to:

[email protected]

Give me your contact information / business card at the end of the

session.

Handout of this presentation is available online at:http://apha.confex.com/apha/129am/techprogram/paper_31608.htm