Factors Influencing Job Satisfaction for Employed Adults With Multiple Sclerosis

Abstract

Given the high unemployment rates of adults with multiple sclerosis (MS) and the importance of job satisfaction as a predictor of turnover intention and job tenure, this investigation examined the relationship of perceived job satisfaction to social cognitive career theory and ecological model constructs. Highly compatible, the two formulations suggest that extent of job satisfaction is a function of personal or demographic, contextual or extrinsic, disability/health status, and self-perceived vocational situation variables. Based on responses to a national survey by 628 employed adults with MS, a four-block, hierarchical logistic regression analysis examined the extent to which the four variable groupings contributed to the prediction of job satisfaction. The following variables were retained in the regression equation: racial/ethnic status, satisfaction with current financial status, satisfaction with housing accessibility, illness duration, extent of job/person match, appropriateness of current work hours, and self-rated job performance level. Consequently, job satisfaction is influenced by multiple factors that counselors must consider in their rehabilitation planning and service delivery.

Keywords

multiple sclerosis employment job satisfaction work adjustment

The purpose of this investigation was to determine how job satisfaction (dependent variable) is related to four classes of independent variables: personal or demographic characteristics, contextual or extrinsic factors, disability/health status, and perceived vocational situation variables. Given the high unemployment rates of adults with multiple sclerosis (MS; Julian, Vella, Vollmer, Hadjimichael, & Mohr, 2008) and the importance of job satisfaction as a predictor of turnover intention and job tenure (Mahdi, Zinn, Nor, Sakat, & Naim, 2012; Perry, Hendricks, & Broadbent, 2000), the study focused on the job satisfaction of adults with MS who participated in a national survey supported by the National Multiple Sclerosis Society (NMSS).

This study is a replication of our previous investigation based on an empirical rather than theoretical rationale that resulted in a three-stage model of job satisfaction involving only perceptions of (a) adequacy of wage/salary level, (b) severity of MS, and (c) job match and expected job tenure (Roessler, Rumrill, & Fitzgerald, 2004). In this earlier investigation, perceived adequacy of household income and perceived job/person match were retained in the multivariate prediction model, resulting in a coefficient of determination of .38 for the job satisfaction criterion. To expand the prediction model for the current study, we selected two theoretical positions, social cognitive career theory (SCCT; Lent, 2013) and the ecological model (Szymanski, Enright, Hershenson, & Ettinger, 2010), as the basis for a four-stage prediction analysis.

Job Satisfaction: Theoretical Rationales for a Four-Stage Prediction Analysis

The four classes of variables for this study were identified as important based on two theoretical models explicating the predictors of (a) human performance (i.e., SCCT; Lent, 2013) and (b) human outcomes (i.e., ecological model; Szymanski et al., 2010). SCCT describes how person characteristics such as racial/ethnic background, gender, and health status influence choices and actions that ultimately result in performance attainments such as employment. It also describes the impact that distal (i.e., past educational opportunities) and proximal (i.e., current wage/salary level, adequacy of finances, and housing accessibility) contextual or extrinsic influences have on performance attainment.

The ecological model (Szymanski et al., 2010) presents a similar multivariate explanation for individual outcomes that even specifies job satisfaction as one example of such an outcome. Precursors to outcomes include contextual, individual, and work environment constructs similar to the independent variables selected for this study. For example, contextual factors include “aspects of an individual’s current or past situation that are external to the person” (p. 108) such as educational opportunities and attainments. Health status, gender, racial/ethnic status, and marital status are examples of individual constructs. Defined in this study in terms of perceptions of one’s vocational situation, work environment factors pertain to characteristics such as task requirements, work reinforcers, and organizational climate.

Drawing on SCCT (Lent, 2013) and the ecological model (Szymanski et al., 2010), we investigated the appropriateness of a four-stage or step prediction model of job satisfaction for adults with MS. The rationale for the four-step model was drawn in part from the multivariate models previously described and the potential for intervention by rehabilitation professionals. For example, Lent and Brown (2013) described how concepts in several stages of the model are worthy of consideration during counseling to help individuals increase their work satisfaction and performance. Thus, both theoretical models and the rehabilitation intervention priority support the inclusion of personal characteristics or life statuses in the first step of the prediction model, for example, gender, racial/ethnic status, past educational attainment, and marital status. Being somewhat tangential to typical rehabilitation emphases, though no less important, accessibility of housing, adequacy of transportation, and current financial status comprised the second step in the model focusing on contextual or extrinsic factors. Steps 3 and 4, traditionally considered targets of rehabilitation efforts, included health status (Step 3) and subjective vocational factors (Step 4). Although health status is an individual characteristic that could appear earlier in the stage model, a decision was made to place it later in the analysis to determine the extent to which it continued to influence job satisfaction after accounting for other person or contextual variables. The rationale for viewing health status as a third stage had to do with its mutability through medical and other therapy services provided as part of many rehabilitation programs. Stage 4 of the model consisted of perceived vocational situation constructs pertaining to the proximal environment in SCCT and the work environment in the ecological model. These perceived vocational situation constructs (i.e., job performance, job match, and preferred number of hours) are important considerations throughout the planning, placement, and job retention phases of vocational rehabilitation services.

The Importance of Job Satisfaction

According to Lent and Brown (2013), job satisfaction and satisfactory job performance are components of a larger construct referred to as work adjustment. Thus, it is important to study job satisfaction to gauge an individual’s overall level of work adjustment, which is a critical concern of the vocational rehabilitation counselor. For the job placement efforts of counselors to result in work adjustment on the part of clients and, therefore, higher probabilities of long-term tenure, they must ensure that clients secure employment in jobs compatible with both their work preferences and work skills. The reason for this is that job satisfaction and satisfactory job performance are in a complementary relationship in that satisfied workers are more likely to perform satisfactorily and satisfactory workers are more likely to be satisfied (Swanson & Schneider, 2013). Difficulties in either area are predictive of eventual job loss due to either the individual choosing to leave the position or being asked to leave by his or her employer. Consequently, an important part of rehabilitation counseling is to help clients understand why they are dissatisfied in their jobs and how that is affecting their performance and vice versa (Lent & Brown, 2013; Swanson & Schneider, 2013; Sypniewska, 2014).

Research Question

Based on comparable constructs in the two theoretical models underlying this investigation, the following research question was addressed:

Research Question 1: To what extent do factors at the demographic, contextual, illness, and work environment levels contribute to the predictability power for the dependent variable, job satisfaction?

Findings from this investigation pertain to reasons why individuals with MS are satisfied in their employment and what rehabilitation interventions are feasible to enhance job satisfaction and thus overall work adjustment.

Method

As the four groups of variables (i.e., demographic, contextual, illness-related, work environment) vary from the more objective to the more subjective, the statistical analysis addressed the extent to which the more subjective variables contributed to the differences in the outcome variable, job satisfaction, over and above the contribution of the more objective variables. Thus, the statistical analysis involved entering these groups of variables into a block-wise, hierarchical logistic regression analysis in a sequential order and evaluating the change in explanatory power associated with the inclusion of each group of variables.

Participants

The sample in this study was extracted from data collected in a national survey of the employment concerns of Americans with MS from nine NMSS chapters, representing 21 states and Washington, D.C., in the United States (Rumrill, Roessler, Li, Daly, & Leslie, 2015). The survey instrument included demographic, disease-related, and support system variables related to employment interventions that might benefit adults with MS. The sample for this study consisted of 628 participants with MS who were employed either part-time or full-time at the time of the survey and provided complete information on the employment-related measures. The sample included 511 women (81%) and 117 men (19%). Fifty-eight percent of respondents described their communities as suburban, whereas 23% lived in urban areas and 19% resided in rural settings. With an average age of 49 (SD = 10.55), participants in the sample were well educated (99% were high school graduates, 58% were college graduates). Most of the participants were White (77%); other racial/ethnic groups were represented in the sample with African Americans and Hispanic groups being oversampled (9% were African American, 12% were Hispanic, and 2% were Asian, Pacific Islanders, Native Americans, or Alaskan Natives).

Illness-related symptoms reported by the participants suggested a mixture from severe to non-severe MS conditions, as well as a wide range of physiological, sensory, and psychological effects. In descending order of frequency, the most commonly reported symptoms were fatigue (indicated by 77% of respondents), tingling (52%), balance/coordination problems (52%), numbness (46%), cognitive impairment (45%), diminished physical capacity (44%), bowel or bladder dysfunction (39%), gait/mobility impairment (38%), pain (32%), spasticity (31%), sleep disturbance (29%), vision problems (25%), anxiety (24%), depression (23%), and sexual dysfunction (18%). The mean number of reported MS symptoms was 6 (SD = 3.40).

Measures

Job satisfaction

Participants with MS who were employed either part-time or full-time at the time of the survey responded to a 5-point scale that measured their job satisfaction ranging from 1 (very dissatisfied) to 5 (very satisfied). Given that the frequency distributions on the five categories were uneven with some categories having very low frequencies, the categories were combined, and the variable was recoded into a dichotomous variable (0 = satisfied, 1 = not satisfied, a rating of “undecided” was categorized as not satisfied).

Personal/demographic characteristics

Four demographic variables were extracted and adopted for this study to represent participants’ personal backgrounds. These included gender (dichotomous; 0 = female, 1 = male), racial/ethnic status (dichotomous; 0 = White, 1 = non-White), educational attainment (dichotomous; 0 = elementary/secondary/some post-secondary education, 1 = college graduate or higher), and marital status (dichotomous; 0 = married or living with significant other/partner, 1 = single, divorced, separated, or widowed).

Extrinsic or contextual factors

Originally, on 5-point scales measuring factors related to or facilitating satisfaction with employment, three contextual variables were investigated and recoded into dichotomous variables given the unevenness in the categories in the frequency distributions. These included current financial status (dichotomous; 0 = able to meet expenses, 1 = difficulty meeting expenses), satisfaction with the transportation resources needed for daily living (dichotomous; 0 = satisfied or very satisfied, 1 = undecided, dissatisfied, or very dissatisfied), and satisfaction with current housing accessibility (dichotomous; 0 = satisfied or very satisfied, 1 = undecided, dissatisfied, or very dissatisfied).

Illness-related factors

Again, given the uneven frequency distributions with some categories having very low frequencies, six variables representing participants’ illness and disability status were recoded for the analyses in this study. Self-reported general health status was measured on a 5-point scale ranging from 1 (poor health) to 5 (excellent health). Cognitive symptoms, originally measured on a 6-point scale ranging from normal cognition to total cognitive disability, was recoded into a dichotomous variable representing the presence of a cognitive impairment (i.e., 0 = no, 1 = yes). Perceived symptom severity, originally measured on a 5-point scale ranging from no current symptoms to multiple severe symptoms significantly limiting daily functioning, was recoded into a three-level categorical variable representing (a) no or little current symptoms that affect daily functioning, (b) some symptoms that affect daily functioning, and (c) multiple severe symptoms significantly limiting daily functioning. Another estimate of severity of MS using the Patient-Determined Disease Steps Scale (PDDS; Hohol, Orav, & Weiner, 1995) measured gait/mobility impairment on a 9-point scale ranging from normal to bedridden. PDDS was recoded into a three-level categorical variable to represent (a) normal or mild disability, (b) moderate disability, and (c) severe disability. Two other continuous variables were collected to measure the self-reported number of symptoms at the time of the survey and the respondent’s illness duration in years.

Subjective vocational or work environment factors

Three variables were used to represent different aspects of the subjective vocational factors related to job satisfaction. Perceived job/person match was originally measured on a 5-point scale ranging from 1 (complete mismatch) to 5 (perfect match). Given that some of the categories had very low frequencies, the variable was recoded into a three-level categorical variable (1 = match perfectly, 2 = match well, 3 = match to a lesser degree). Participants also rated their perceived job performance on a 5-point scale ranging from 1 (very poor performance) to 5 (excellent performance). For the same reason as for perceived job/person match, perceived job performance was recoded into a dichotomous variable (0 = good or excellent performance, 1 = very poor to adequate performance) before the variable was entered into the analysis. Another three-level categorical variable examined participants’ preferred number of working hours (i.e., preferred to work fewer hours than they currently do, more hours than they currently do, and about the same number of hours that they currently do). For clearer interpretation, this variable was recoded into a dichotomous variable with 0 for the preference for the same number of working hours or more and 1 for the preference for fewer working hours.

Procedure

The original target sample for the national survey study included 8,000 people with MS representing the nine NMSS chapters that provided a strong representation of geographic areas, rural/urban/suburban settings, and diverse racial/ethnic groups. Based on the proportions of clients from diverse racial/ethnic backgrounds, eight of the participating NMSS chapters were asked to identify stratified random subsamples of 800 clients and one chapter was asked to draw a stratified random subsample of 1,600 clients. We oversampled Hispanic/Latino and African American clients within NMSS chapters that had relatively high proportions of these two groups on their client registries. The goal of this sampling procedure was to ensure that at least 5% of the overall respondent sample was comprised of Hispanic/Latino individuals with MS and that at least 5% were African Americans; these proportions are consistent with commonly held estimates of population parameters for people with MS (Minden et al., 2006).

We implemented several strategies including Dillman, Smyth, and Christian’s (2009) recommendations to improve survey return rates. First, NMSS chapter service directors sent a pre-notice letter to those selected for the national sample (N = 8,000) 2 weeks prior to mailing the survey. A package containing the survey and an explanatory cover letter was then mailed. The package was followed by “reminder/thank you” postcards and an email from the chapter service director 4 weeks and 10 weeks, respectively, after it was mailed. In the initial package, each potential respondent received a paper version of the survey, in either English or English and Spanish depending on his or her identified ethnicity. Also enclosed in that mailing, potential respondents received information pertaining to accessing the survey in an online or telephone format, again offered in both English and Spanish. In the end, 631 surveys were returned to participating chapters as undeliverable, reducing the available target sample to 7,369 people with MS. Of the target sample, 1,932 NMSS members returned questionnaires, resulting in a response rate of 26%. Among the 1,932 respondents, 628 employed respondents provided complete information on the measures used in this investigation; these individuals comprised the study sample.

Statistical Analysis

Data were analyzed using a block-wise, hierarchical logistic regression analysis with the variables in the four-stage prediction model (i.e., demographic or personal characteristics, extrinsic or contextual factors, illness-related factors, and subjective vocational or work environment factors) entered into the analysis in a sequential order. To be specific, the dependent variable was the dichotomous variable job satisfaction (0 = satisfied, 1 = not satisfied), and the independent variables were entered into the model in four blocks: (a) Block 1: gender, racial/ethnic status, educational attainment, and marital status; (b) Block 2: current financial status, satisfaction with transportation accessibility needed for daily living, and satisfaction with housing accessibility; (c) Block 3: health status, cognitive symptoms, perceived symptom severity, PDDS, number of symptoms, and illness duration; and (d) Block 4: perceived job/person match, perceived job performance, and preferred number of working hours. The categorical independent variables were dummy coded using the lowest level as the reference group when they were entered into the analyses.

A modeling procedure was used to ensure the parsimony of the final model. First, the model started with just the first block for demographic variables and was built up by adding the following blocks one at a time in sequential steps. When a new block was entered into the model, the significance of the independent variables in the newly entered block was assessed along with the significant independent variables from the previous block (if any), and the non-significant variables in the newly entered block were dropped. The more parsimonious model with the non-significant variables removed was rerun and the magnitude of the parameter estimates was compared with those in the model before the non-significant variable was removed (Hosmer, Lemeshow, & Sturdivant, 2013). If no critical change was observed, it was concluded that the removed variables were not confounders of the relationship between any of the remaining independent variables and the outcome variable. As a result, the modeling procedure moved on to add in the next block and iterate the same assessment process. If confounding was observed, the removed variables were added back into the model and interaction terms with other independent variables were explored and examined to identify the confounding effect before the modeling procedure proceeded to add in the next block.

To allow the sample to represent the national population of employed people with MS, a sampling weight variable was calculated based on the racial/ethnic status information provided in the NMSS Sonya Slifka Longitudinal Study (Minden et al., 2006) and used in the estimation process. Complex survey data present a variety of technical challenges in the analysis. For example, the maximum likelihood estimation (ML) used in the ordinary logistic regression was no longer appropriate as the ML assumption that cases are independent of each other was violated. As a solution, the logistic regression models were fitted through an approximate likelihood to incorporate the sampling weight variable in the analysis (Hosmer et al., 2013). Also, the assessment of the overall model significance and the parameter estimates was conducted via the multivariable F-adjusted Wald tests and the t statistic rather than the traditional likelihood ratio χ² tests and Z statistic.

In addition, model fit indices such as pseudo-R² are not reported for logistic regression analysis that incorporates survey design and sampling weight. Pseudo-R² statistics were obtained through the ordinary logistic regression when necessary (Hosmer et al., 2013). Because a variety of pseudo-R² statistics can be calculated for the same logistic regression model, McKelvey and Zavoina’s R² (McKelvey & Zavoina, 1975) was chosen in this study due to the fact that it resembles the closest to the ordinary least square R² in multiple regression models (Long, 1997; Long & Freese, 2006). The calculation of McKelvey and Zavoina’s R² assumes a continuous latent variable underlying the observed dichotomous outcomes, and therefore McKelvey and Zavoina’s R² represents the percentage of the variability of the continuous latent variable explained by the independent variables. All the analyses were conducted using the statistical computer package STATA 12.1 (StataCorp, 2011), and the alpha significance level for the hypothesis tests was set at .05.

Results

This section first presents descriptive statistics related to characteristics of the respondents for each independent variable and then provides a description of the results of the hierarchical logistic regression analysis for evaluating the job satisfaction model. Table 1 displays descriptive statistics related to the categorical independent variables for each categorical level of the dependent variable, job satisfaction, whereas Table 2 exhibits statistics related to the continuous independent variables given the differences in job satisfaction. The initial stage of analysis with only Block 1 entered into the model examined the importance of the four demographic variables in terms of their explanatory power for job satisfaction among employed people with MS. Results of entering Block 1 variables are presented in Table 3. Only the coefficient for racial/ethnic status was found to be significantly different from zero.

Table 1.

Descriptive Statistics of Respondents for Categorical Independent Variables.

Characteristic	Satisfied		Dissatisfied
Characteristic	n	%	n	%
Gender
Female	387	76	124	24
Male	91	78	26	22
Racial/ethnic status
White	385	79	101	21
Non-White	93	65	49	35
Educational attainment
Elementary/secondary/some post-secondary education	193	73	71	27
College graduate or above	285	78	79	22
Marital status
Married/living with other	351	78	97	22
Single/divorced/separated/widowed	127	71	53	29
Current financial status
Able to meet expenses	348	81	82	19
Difficulty meeting expenses	130	66	68	34
Satisfaction with transportation resources
Satisfied or very satisfied	386	77	117	23
Undecided or dissatisfied or very dissatisfied	92	74	33	26
Satisfaction with current housing accessibility
Satisfied or very satisfied	406	80	101	20
Undecided or dissatisfied or very dissatisfied	72	60	49	40
Health status
Bad	7	70	3	30
Fair	91	67	44	33
Good	208	77	61	23
Very good	123	80	30	20
Excellent	49	80	12	20
Presence of a cognitive impairment
No	117	81	28	19
Yes	361	75	122	25
Self-perceived severity of symptoms
No or little current symptoms	251	81	60	19
Some symptoms that affect daily functioning	193	71	79	29
Multiple, severe symptoms significantly limiting daily functioning	34	76	11	24
Patient-determined disease steps
Normal/mild disability	296	77	86	23
Moderate/gait/early cane	136	72	54	28
Late cane/bilateral support/wheelchair or scooter/bedridden	46	82	10	18
Perceived job/person match
Match perfectly	236	93	17	7
Match well	155	79	40	21
Match to a lesser degree	87	48	93	52
Preferred number of working hours
Same number of working hours or more	293	82	64	18
Fewer working hours	185	68	86	32
Perceived job performance
Good or excellent	440	80	113	20
Very poor to adequate	38	51	37	49

Table 2.

Descriptive Statistics of Respondents for Continuous Independent Variables.

Characteristic	Satisfied		Dissatisfied
Characteristic	M	SD	M	SD
Number of symptoms	5.76	3.36	6.42	3.46
Illness duration in years	13.27	9.73	11.05	7.50

Table 3.

Step 1 of Block-Wise Hierarchical Logistic Regression Analysis Including Demographic Characteristics.

Independent variable	Coefficient	Linearized SE	t	p	OR
Gender	−0.04	0.26	−0.17	.865	0.956
Racial/ethnic status	0.70	0.23	3.00	.003	2.008
Education attainment	−0.37	0.20	−1.86	.064	0.688
Marital status	0.24	0.22	1.07	.284	1.271
Constant	−1.18	0.18	−6.65	.000	0.307

Note. OR = odds ratio.

As a result, other demographic variables such as gender, educational attainment, and marital status were removed from the model, and the model with racial/ethnic status as the remaining variable in Block 1 was analyzed again. Racial/ethnic status was found to significantly contribute to the explanatory power of the model, F(1, 624) = 11.13, p < .001, and the change of its coefficients was minor when compared with that in the model with all four demographic variables. Therefore, the analysis proceeded to the next step with Block 2 added into the model. The three independent variables in Block 2 (current financial status, satisfaction with transportation resources, and satisfaction with current housing accessibility) were assessed along with the significant variable from the previous block (i.e., racial/ethnic status), and the variable satisfaction with transportation resources was the only variable in Block 2 that did not have a coefficient significantly different from zero. Results of entering Block 2 variables are displayed in Table 4.

Table 4.

Step 2 of Block-Wise Hierarchical Logistic Regression Analysis Including Significant Block 1 Variable Combined With Extrinsic Factors.

Independent variable	Coefficient	Linearized SE	t	p	OR
Racial/ethnic status	0.54	0.23	2.34	.019	1.713
Current financial status	0.54	0.22	2.50	.013	1.718
Satisfaction with transportation resources	−0.20	0.27	−0.75	.452	0.815
Satisfaction with current housing accessibility	0.94	0.26	3.69	.000	2.570
Constant	−1.65	0.15	−11.15	.000	0.191

Note. OR = odds ratio.

Following the same procedure, the non-significant variable in Block 2 (satisfaction with transportation resources) was removed from the model and the more parsimonious model was analyzed again. The two remaining variables in Block 2 (current financial status and satisfaction with housing accessibility) added significantly to the explanatory power, F(2, 624) = 11.33, p < .001, over and above the contribution made by Block 1. Next, Block 3 with six variables representing participants’ illness and disability status was entered into the model and results are presented in Table 5. The importance of Block 3 variables was assessed along with the remaining variables in the previous two blocks, and only illness duration had a coefficient significantly different from zero.

Table 5.

Step 3 of Block-Wise Hierarchical Logistic Regression Analysis Including Significant Variables in Blocks 1 and 2 Combined With Chronic Illness or Disability Factors.

Independent variable	Coefficient	Linearized SE	t	p	OR
Racial/ethnic status	0.46	0.24	1.86	.063	1.578
Current financial status	0.34	0.23	1.45	.148	1.401
Satisfaction with current housing accessibility	0.88	0.25	3.56	.000	2.406
Health status
Fair vs. bad	0.10	0.84	0.12	.902	1.109
Good vs. bad	−0.21	0.85	−0.25	.802	0.808
Very good vs. bad	−0.35	0.87	−0.40	.687	0.703
Excellent vs. bad	−0.30	0.93	−0.32	.749	0.742
Presence of a cognitive impairment	0.10	0.29	0.36	.716	1.110
Self-perceived severity of symptoms
Some symptoms versus no or little symptoms	0.55	0.28	1.93	.054	1.730
Multiple severe symptoms versus no or little symptoms	0.65	0.52	1.25	.213	1.915
Number of symptoms	−0.01	0.04	−0.20	.844	0.992
Patient-determined disease steps
Moderate/gait/early cane versus normal/mild disability	−0.28	0.28	−1.01	.314	0.755
Late cane/bilateral support/wheelchair or scooter/bedridden versus normal/mild disability	−0.76	0.47	−1.61	.108	0.470
Illness duration	−0.03	0.01	−2.24	.025	0.973
Constant	−1.27	0.91	−1.39	.164	0.281

Note. OR = odds ratio.

When the non-significant variables in Block 3 (health status, presence of a cognitive impairment, self-perceived severity of symptoms, number of symptoms, and PDDS) were removed from the model, illness duration in Block 3 contributed significantly to the explanatory power beyond what had been contributed by the previous blocks, F(1, 624) = 5.84, p < .05. Finally, Block 4 with three subjective vocational or work environment variables was entered into the model. Block 4 continued to add to the explanatory power over and above the contributions made by the blocks that had previously been entered into the analysis, F(4, 624) = 22.55, p < .001. In fact, all three variables in Block 4 (perceived job performance, perceived job match, and preferred number of work hours) had a coefficient significantly different from zero. Results of entering Block 4 variables are displayed in Table 6. At every step of the model-building procedure, the coefficients in the more parsimonious model were compared with those in the model before the variable removal. The changes of coefficients were always negligible.

Table 6.

Step 4 of Block-Wise Hierarchical Logistic Regression Analysis Including Significant Variables in Blocks 1, 2, and 3 Combined With Subjective Vocational Factors (Final Model).

Independent variable	Coefficient	Linearized SE	t	p	OR
Racial/ethnic status	0.28	0.31	0.90	.369	1.319
Current financial status	−0.07	0.26	−0.27	.788	0.932
Satisfaction with current housing accessibility	1.09	0.29	3.72	.000	2.986
Illness duration	−0.01	0.01	−0.96	.340	0.987
Perceived job/person match
Well match versus perfect match	1.47	0.33	4.46	.000	4.368
Lesser degrees versus perfect match	2.79	0.33	8.42	.000	16.332
Preferred number of working hours	0.59	0.24	2.52	.012	1.807
Perceived job performance	0.84	0.30	2.83	.005	2.324
Constant	−3.30	0.36	−9.09	.000	0.037

Note. OR = odds ratio.

All four blocks contributed significantly to the explanatory power over and above the contribution attributed to the blocks that had previously been entered in the model. However, in hierarchical multiple regression analysis, the relative importance of each block may vary and can be judged on the basis of the change in the R² (ΔR²) statistic (Wampold & Freund, 1987). As the pseudo-R² statistic was not reported for the logistic regression analysis that took the sampling weight into consideration, an ordinary hierarchical logistic regression model with the four blocks in the final model was fitted to the data to obtain the pseudo-R² statistic for each block. Although these pseudo-R² statistics were not exactly accurate, they provided some instrumental information regarding the relative importance of the blocks. To be specific, the changes in the pseudo-R² statistic for Blocks 1 through 4 were .03, .06, .01, and .26, respectively. The pseudo-R² statistic in the final model was .35. Obviously, the subjective vocational or work environment variables in Block 4 were relatively more important contributors to job satisfaction when compared with the variables in other blocks.

Although the greatest focus of hierarchical regression is on ΔR² and its corresponding change in F and p value statistics and less attention is paid to the regression coefficients of independent variables (Courville & Thompson, 2001; Petrocelli, 2003), a close examination of the coefficients in the final model yield useful insights and interpretations. In Table 6, the data presented under “Coefficient” represent the estimated logistic regression coefficients that predict job satisfaction in log-odds units for each independent variable included in the final model, the t statistic provides a test of each of these coefficients, and the odds ratio (OR) coefficient provides information related to the change in the odds of being dissatisfied that would be associated with a one-unit change in a given independent variable. Satisfaction with current housing accessibility, which had two categories (i.e., satisfied vs. not satisfied), was significantly related to job satisfaction (t = 3.72, p < .001). Its OR coefficient indicates that the odds of being dissatisfied with one’s job for those who reported dissatisfaction with their housing accessibility were 3 times greater than the odds for those who were satisfied with their housing accessibility. Perceived job/person match was also significantly related to job satisfaction. The odds of being dissatisfied with their jobs were 16.3 times greater for those who perceived greater degrees of job/person mismatch than for those who perceived their jobs to be a perfect match (t = 8.42, p < .001; OR = 16.33) and 4.4 times greater for those who perceived their jobs to simply match well than for those who perceived their jobs to be a perfect match (t = 4.46, p < .001; OR = 4.37). The odds of being dissatisfied with their jobs for those preferring to work fewer hours were about 2 times greater than the odds of being dissatisfied with their jobs for those who preferred to work for the same number of hours or more (t = 2.52, p < .05; OR = 1.81). In addition, the odds of being dissatisfied with their jobs among those who perceived their job performance as poor or just adequate were at least 2 times greater than the odds of being dissatisfied with their jobs among those who perceived their job performance as good or excellent (t = 2.83, p < .01; OR = 2.32). Although racial/ethnic status, current financial status, and illness duration all helped explain the variability in job satisfaction, their regression coefficients were not statistically significant in the final model.

Discussion

Hierarchical logistic regression results confirmed the utility of the four-stage prediction scheme based on the ecological (Szymanski et al., 2010) and SCCT models (Lent, 2013). More than a third of the variability in job satisfaction ratings of the survey respondents was explained by predictors representing the four sets of independent variables that were hypothesized to correlate with job satisfaction: personal or demographic characteristics, contextual or extrinsic factors, illness-related or disability/health status factors, and subjective work environment factors. In other words, all four blocks of the analysis contributed to the explanatory power over and above the contribution attributed to the blocks individually. These findings are consistent with the observations of others (Chiu, Chan, Bishop, da Silva Cardoso, & O’Neill, 2013) that one cannot understand the impact of MS on employment-related issues without considering the complex interaction of multiple factors in the personal, functional, financial, and psychosocial realms. Consequently, in their case planning, rehabilitation counselors need to think broadly about strategies to counter the influence of these multiple factors on the vocational and quality of life outcomes of adults with MS. Keeping in mind the importance of this notion of interaction, the discussion points to follow pertain to the interpretation of each of the variables in the prediction equation.

Demographic Factor: Racial/Ethnic Background

Racial/ethnic status was the only demographic variable significantly related to job satisfaction; gender, educational attainment, and marital status were not retained in the prediction model. Respondents who were people of color (i.e., non-Caucasians) reported lower levels of job satisfaction than did Caucasians. This finding parallels results from other studies indicating that workers with MS from traditionally underrepresented racial and ethnic groups encounter greater difficulties in the workplace such as higher levels of unemployment than do Caucasians with MS (Chiu et al., 2013). Antao et al. (2013) described the ways in which employment discrimination limits the opportunities of minority groups. In describing the SCCT model, Lent and Brown (2013) made similar points regarding the ways in which economic and cultural conditions can limit the ability of some individuals to find satisfying outcomes in employment and other life realms. They noted that prejudicial treatment forces some individuals to accept outcomes that are not entirely consistent with their personal values and interests. One insight into the operation of discrimination in the lives of minority group individuals with MS is revealed in the findings of several studies that indicate that being treated fairly in the hiring process is one of the most significant problems faced by adults with MS, presumably even more so for minority group individuals with MS (Roessler, Rumrill, & Hennessey, 2002; Rumrill, Roessler, & Koch, 1999). Moreover, unlawful discharge is the number one allegation of workplace discrimination filed with the U.S. Equal Employment Opportunity Commission (EEOC) by adults with MS, again presumably an issue pertaining even more to minority individuals with MS (Neath, Roessler, McMahon, & Rumrill, 2007) given the double disadvantagement that inheres in membership in a racial or ethnic minority group while experiencing a significant disability (Smart, 2009). Consequently, rehabilitation counselors must help minority group individuals with MS anticipate and cope with the effects of discrimination in their efforts to seek and maintain employment, which may be all the more prevalent due to stereotypes held by the general public regarding both their minority and disability status.

Within the larger group of minority adults with MS, additional research is needed to identify the specific employment concerns and experiences of African Americans and Hispanics/Latinos. Both of these groups are experiencing higher incidences of MS than ever before (Minden et al., 2006), and it is possible that they face different issues in their efforts to seek, secure, and maintain employment.

Contextual Factor: Current Financial Status

Given the financial exigencies faced by adults with MS, it is no surprise that more satisfying work is associated with a more comfortable financial situation, a contextual variable included in the four-stage model. Antao et al. (2013) stressed that long-term episodic conditions such as MS present individuals with barriers that can easily result in poverty status. In a study in England, Hakim et al. (2000) reported that 37% of their sample (n = 305) indicated that their standard of living had decreased since their diagnosis of MS due to high costs associated with treatment of their condition and to negative life outcomes such as unemployment. Although not the case for a significant number of respondents with MS, the high costs associated with MS treatment may explain why some respondents perceived their jobs to be more satisfying if they allowed them to have adequate finances for high priced prescription drugs, health insurance, child care and support, and medical care. Rehabilitation counselors should recognize the importance of Chiu’s et al. (2013) finding that maintenance support for food, transportation, housing, and clothing was one of the services of the state-federal vocational rehabilitation program that was related to success in the job placement process, presumably because wage/salary levels of some jobs are insufficient to meet basic needs. Findings from the present study suggest that a job is satisfying, in part, depending on the extent to which it helps adults with MS meet the financial pressures associated with the disease.

Contextual Factor: Satisfaction With the Accessibility of Current Housing

Although the contextual variable “satisfaction with transportation resources” was not retained in the model, satisfaction with accessibility of current housing was significantly and positively related to job satisfaction. Some adults with MS viewed their jobs as more satisfying if they enabled them to avoid negative life outcomes such as unsuitable housing. Honan et al. (2012) found that employed adults with MS who anticipated that financial concerns could affect their living arrangements were more likely to expect that they would need to reduce their work hours in the future, possibly reflecting expectations of a worsening condition and higher medical costs. Other research indicates that concerns about housing are associated with higher rates of unemployment among adults with MS. For example, Bishop et al. (2013) reported that individuals who indicated that they were less likely to need assistance in the home, less limited by finances to make home renovations, and more likely to function at high levels in the home were also more likely to be employed than adults with MS reporting difficulties in these areas. Rehabilitation counselors’ perspectives on vocational planning for adults with MS must include steps to secure and maintain appropriate housing to increase the probability of a successful vocational outcome as noted in Chiu’s et al. (2013) research. Again, a job that helped to solve one’s housing situation would have a high probability of being perceived as satisfying.

Illness-Related Factor: Duration of MS

Surprisingly, of the many disability/health status variables included in the original model, including presence of cognitive limitations, duration of illness was the only health-related variable significantly related to job satisfaction. Presence of cognitive impairment, self-perceived MS severity, number of symptoms, and extent of mobility limitations were not retained in the model. McGonagle, Fisher, Barnes-Farrell, and Grosch (2015) offered one theoretical explanation for this outcome in their description of the construct of “work ability.” They defined work ability as a person’s prediction that he or she would be able to continue working in his or her current job. This perception is greatly influenced by the resources that individuals perceive as available to help them maintain employment such as the nature of feasible job demands (e.g., time pressures), adequate job resources (e.g., supervisory support), and sufficient personal resources (e.g., health status and emotional stability). As workers with MS age, they are likely to have additional symptoms limiting their functioning (i.e., fewer personal resources), which might make their jobs less satisfying. If their performance suffers as a result, they may also experience less adequate job resources and less compatible job demands, both of which would decrease perceived work ability and make working less satisfying.

Research supports the expectation of fewer personal resources available as one ages while dealing with a severe chronic illness such as MS. Moore et al. (2013) found that older adults with MS who changed the nature of their employment by decreasing work demands and hours reported higher levels of fatigue, greater memory problems, and higher pain levels. Other research (Hakim et al., 2000) provided evidence of a correlation between the age of an individual with MS and the financial impact of the disease, suggesting fewer personal resources with time from both health and monetary standpoints. Thus, if perceived work ability decreases with age (i.e., duration of disability), then the satisfaction one experiences from working would decrease as well given that the job is less able to meet the personal needs and values of the worker. Rehabilitation counselors should keep in mind the multiple, complex health conditions faced by older adults with MS and incorporate medical interventions and health maintenance provisions in their vocational programming.

Subjective Work Environment Factors

The importance of the fourth stage in the prediction model is evident in the fact that all three variables in the work environment category were retained in the model, even after accounting for the influence of significant demographic, contextual, and illness-related health status variables. The odds of being dissatisfied with their jobs were significantly greater for participants perceiving greater levels of job/person mismatch, reporting a preference to reduce current work hours, and believing their job performance to be poor or inadequate.

Job/person match

Gilbride, Stensrud, Vandergoot, and Golden (2003) stressed that job/person match “has always been a key component of quality vocational rehabilitation” (p. 135). In the Minnesota Theory of Work Adjustment, two components are considered essential to job match, one being working in a job that meets one’s personal needs and the other being working in a position appropriate for one’s work skills. Considered together, these two components predict tenure on the job, an outcome warranting the rehabilitation counselor’s investments of time and money in client services. Thus, job satisfaction and satisfactoriness are considered interdependent constructs in that workers who enjoy their jobs are more likely to perform well and workers who perform well are more likely to be satisfied (Lent, 2013; Swanson & Schneider, 2013). To ensure job satisfaction, then, rehabilitation counselors must help individuals find work that meets their needs and that is compatible with their skills.

To enhance job match and therefore job satisfaction, Antao et al. (2013) proposed interventions at both the “micro” and “meso” levels. The “micro” level pertains to personal attributes of the individual, and the “meso” level refers to the workplace practices and policies that enable people with disabilities to find employment in satisfying work. In interviews with employees with disabilities, employers, and placement personnel, Gilbride et al. (2003) found that employers who were open to hiring and retaining individuals with disabilities were also open to helping them secure jobs that matched their personal needs, preferences, aptitudes, and abilities. Unfortunately, adults with MS have enduring concerns about the lack of support from employers (Hakim et al., 2000; Rumrill et al., 1999; Rumrill et al., 2015) with respect to the availability of reasonable accommodations, career counseling, and cross-training or retraining. Rehabilitation counselors can help fill this gap by providing follow-along career counseling and job training services to their clients and by working with employers to increase their understanding of the effects of chronic illnesses such as MS on an individual’s employability.

Preferred number of work hours

Respondents who reported satisfaction with their current number of work hours or even the desire to work more hours were more satisfied with their jobs than respondents who wished to work fewer hours. Lack of satisfaction resulting from working too many hours may reflect tensions arising from difficulties in balancing current job duties with family and household responsibilities due to increased MS symptom levels. Moore et al. (2013) reported that individuals with MS who had decreased their job responsibilities or hours tended to be older and have higher levels of fatigue, pain, and cognitive limitations than workers who had made no changes in their job roles.

Smith and Arnett (2005) offered another perspective on those who wish to cut back on their work hours. They found that adults with MS who wished to decrease their work hours or responsibilities had higher levels of fatigue than did non-working people with MS or employed people with MS who did not wish to decrease their hours. At the same time, those wishing to decrease their work hours had higher levels of education, financial security, and occupational status, suggesting that they might have more control over their job situations and the types of changes they wanted to make. Modifying their job responsibilities would enable them to enhance their job satisfaction by accommodating increased fatigue levels, thus allowing them to remain employed for a longer period of time. In either scenario regarding the relationship between job satisfaction and number of preferred work hours, the rehabilitation counselor’s role involves exploring accommodations regarding work hours or responsibilities with both the employer and employee to determine whether such accommodations are reasonable from the employer’s point of view and appropriate from the employee’s point of view (i.e., resulting in enhanced job satisfaction).

Perceived job performance

The Minnesota theory of work adjustment (Swanson & Schneider, 2013) and the SCCT (Lent, 2013) both posit that work adjustment is one part job satisfaction and one part capability to perform well in the job. In both theories, satisfaction with work and the ability to perform well in that work role are conceptualized as reciprocally related. Therefore, one would expect that respondents who rated their job performance higher would also rate their job satisfaction higher, which was observed in this study. Given the confirmation of this hypothesis in the present findings, the question becomes how to work with employees with MS and their employers to improve the level of employees’ work performance. The resulting improvements in performance would enhance job satisfaction and vice versa. Herein lies a major concern.

To modify his or her work roles, the employee with MS must initiate a request for an accommodation, which begins with self-disclosure of his or her status as a person with a disability under Title I of the Americans With Disabilities Act (ADA). In qualitative interviews with employees with MS, Vickers (2012) found high levels of mistrust and fear regarding the outcomes of such disclosure. Employees with MS discussed their fears of being viewed as incompetent and unreliable by their employers. Stressing the stigmatizing nature of MS, they also felt that employers would see them as employees who were making unreasonable demands and requiring high levels of support. In some cases, interviewees reported somewhat covert discriminatory reactions from employers to try to force them to quit or retire, such as raising work targets, critiquing performance more stringently and frequently, and bullying employees to force them to resign.

Research regarding barriers to employment retention that adults with MS encounter continues to underscore these concerns about disclosure and accommodation requests. In a survey of adults with MS, Roessler, Rumrill, Hennessey, Neath, and Nissen (2011) found that 30% of the sample had experienced discrimination on the job and that the most frequent complaint was about the employer’s failure to provide reasonable accommodations. Findings pertaining to recent allegations of employment discrimination made by adults with MS with the U.S. EEOC indicated that the four most prevalent allegations had to do with unlawful discharge, failure to provide reasonable accommodations, terms and conditions of employment, and harassment (Neath et al., 2007). The obvious implication of this situation is the need for rehabilitation counselors to intervene at the worksite prior to unlawful discharge by offering follow-up services. To prevent unlawful discharge, the counselor’s points of intervention could occur when allegations of failure to provide reasonable accommodations, presence of discriminatory terms and conditions of employment, and harassment occur.

Limitations

The present study had several limitations that should be kept in mind when interpreting results. These included the complete reliance on self-report data, the low response rate (26%) and associated threats to external validity in the original survey from which this study’s data were drawn, the use of a single-item measure of the job satisfaction criterion, possible bi-directionality in the relationship between satisfaction with housing accessibility and job satisfaction, and the restricted range of responses that resulted from the categorical coding of most independent and dependent variables. Readers should also note that findings from this study of Americans with MS may not generalize to people with MS in other countries due to international differences in the policies and practices that govern health care, human services, and workforce development.

Conclusion

Hierarchical logistic regression results support the premises of the SCCT and ecological models that outcomes in the lives of adults with severe chronic illnesses are influenced by multiple factors. In this study, demographic (racial/ethnic status), contextual (current financial situation and satisfaction with current housing accessibility), illness-related (duration of illness), and subjective work environment (self-rated job/person match, employment at preferred number of hours, and perceived adequacy of job performance) variables accounted for 35% of the variance in job satisfaction, an essential client goal for the work of vocational rehabilitation counselors.

To increase the probability of outcomes resulting in job satisfaction, rehabilitation counselors must carefully consider the impact of each of these variables on vocational planning efforts with individuals with MS. Counselors should prepare their clients to cope with discrimination in job acquisition and maintenance efforts arising from social stereotypes pertaining to both their minority and chronic illness statuses. Efforts to provide quality job placements and adequate maintenance support are also needed to improve the financial and housing conditions of adults with MS. Counselors should secure or provide follow-along services including job retraining and career planning as individuals with MS age to enable them to counter heightened symptom levels. Finally, in their vocational counseling efforts, rehabilitation counselors must engage clients in problem-solving discussions of negative self-perceptions regarding extent of job/person match, number of work hours, and adequacy of job performance.

Footnotes

Acknowledgements

The authors wish to thank the National Multiple Sclerosis Society, its participating chapters, and the study participants for their support and assistance with this research.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was funded through a Health Care Delivery and Policy Research grant from the National Multiple Sclerosis Society, New York, NY.

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