Reclassification of the work-related stress questionnaires scales based on the work system model: A scoping review and qualitative study

Abstract

BACKGROUND:

Given the wide variety of factors affecting work-related stress, a work system approach could be adopted in order to better identify factors that impact individual stress.

OBJECTIVES:

To provide a scoping review of the available work-related stress questionnaires and to reclassify their scales on the basis of the five elements included in the work system model using a content analysis method.

METHODS:

The main available work-related stress questionnaires used in previous studies in the time range of 1975 to 2017 were collected through a search in several indexing and citation databases. To reclassify the scales of these questionnaires, a qualitative content analysis was used and then reclassified in accordance with the five components of work system model: job (tasks), organizational condition, individual characteristics, technology and tools, and physical environmental.

RESULTS:

In total, 22 questionnaires met the conditions required to be entered into the final stage of the study. Emphasis of these questionnaires was on measuring job-related factors and organizational condition-related factors. 22.7% of them had considered no scales to measure the individual characteristics-related factors.

CONCLUSIONS:

The results of the reclassification can help organizations select areas that encompass their own specific problems. Practical implications are also discussed.

Keywords

Occupational stress psychosocial factors risk assessment work system model macroergonomic questionnaire

1 Introduction

One of the major health problems at workplaces, which recently has become evident more than ever, is work-related stress accompanied by relevant health problems. The International Labor Organization (ILO) 2016 World Day for Occupational Safety and Health used the slogan “Workplace Stress: A Collective Challenge.” Currently, all occupations and workers, in both industrialized and developing countries, are faced with this major problem [1]. Since the workforce is considered the essential component of efficiency in an organization [2], its reduced capability and performance quality due to the impact of work-related stress factors may lead to reduced efficiency and productivity and also imposed costs in an organization [3].

Previous studies have revealed several psychosocial (e.g., demands, control, role ambiguity, etc.) and physical (e.g., noise, ergonomic conditions, etc.) stress factors and problems in the workplace that can have negative effects on employee health (e.g., anxiety and depression, sleep problems, cardiovascular disease, sexual function, etc.) and productivity of an organization (e.g., absenteeism, turnover, etc.) [4 –10]. Therefore, identification of the work-related stressors and subsequent implementation of goal-directed intervention programs are considered vital requirements for any organization [11]. Identifying and controlling such factors, and consequently promoting quality of work life and job satisfaction of employees, can decrease employee complaints and absenteeism, increase positive attitudes, working morale, and commitment, which in turn may empower and improve the productivity of an organization to fulfill its goals [7, 12].

Different objective and subjective methods such as standardized questionnaires, clinical examinations, observational methods, registers, secondary data, and qualitative interviews have been used to identify and assess such problems [13]. Currently, standardized self-report questionnaires are considered the most important and widely used approach to identify and assess work-related stress factors in terms of their low costs and ease of analysis [14]. To facilitate and improve the practical use of these questionnaires they were reviewed in previous studies [7 , 15]. These studies successfully showed available questionnaires and described their main characteristics, such as versions (i.e., full/short versions, languages), dimensions (i.e., stressors measured), number of items, internal validity. Organizations interested in workplace screening can select one of these questionnaires, but it is more difficult for them to select specific measures of stressors needed for their specific context. In fact, a quick overview of the work-related stress questionnaires revealed a wide variety of scales associated with the different components of work systems [5, 16]; however, none of the questionnaires available were complete in terms of comprehensiveness and inclusion of all stress factors related to the components of work systems. In fact, each of the existing questionnaires focused on few sections of these factors and there is no comprehensive questionnaire encompassing all the stressors related to the components of work systems. Therefore, based on the data of such questionnaires, no comprehensive planning for implementation of intervention programs can be done in order to reduce work-related stress [5]. In order to fully consider the wide range of work stressors, it could be useful to adopt a work system approach to design and develop a comprehensive tool that can adequately identify and assess all work-related stressors in a specific organizational context.

The work system model is one of the macroergonomic approaches extracted from balance theory of job design [12, 17]. According to this theory, the work system is composed of five interdependent components that need to be analyzed systematically and jointly in order to maximize performance and wellbeing of workers. These components include person, tasks, organization conditions, physical environment, and tools and technologies. In fact, the work system model includes psychosocial, cognitive, and physical aspects of work that can cause psychosocial and cognitive loads to a person. Demands are imposed on the individual by the components of the work system, which create loads that can promote or harm health. Harmful loads then bring about stress and subsequently adverse health consequences in employees [12] on physical and mental health ofindividuals [6].

Accordingly, the purpose of the current study was to classify the scales of work-related stress questionnaires using a directed content analysis method based on the five components of the work system model. In particular, we first aimed to provide an overall description of the available work-related stress questionnaires and of the components of the work system model measured by each one. Second, we aimed to further describe each of the components of the work system model providing detailed information about the specific factors measured and the referenced questionnaires.

Considering the mutual impact among stress factors associated with different components of the work system, a reclassification of the scales available in work-related stress questionnaires can help researchers and professionals of different organizations to better design or select scales encompassing entire elements of the work system model, and ones associated with an organizations’ specific objectives and/or challenges. No research studies have been conducted to date with this objective.

2 Methods

We adopted a scoping review approach. Contrary to traditional or narrative literature reviews, which have often-unclear aims and do not adopt an explicit or systematic method, scoping reviews adopt a replicable, scientific and transparent process to identify and examine key characteristics or factors related to a concept (i.e., scales available in work-related stress questionnaires). Generally, they do not include a critical appraisal, synthesized result or answer to a particular question (e.g., the goodness of the scales and questionnaires) [18]. In this study, work-related stress questionnaires in a time span from 1975 to 2017 were collected and examined. To find these questionnaires the following databases were searched: Science Direct, Pro-quest, Pub-Med, Psych-INFO and Google Scholar. Individual and a combination of keywords included: “index”, “survey”, “instrument”, “stress”, “stressors”, “job” “questionnaire”, “inventory”, “tool”, “indicator”, “risk factors”, “occupational”, “work”, “hazardous”, and “psychosocial factors”. To increase the accuracy of our search and to find more resources, the reference lists of the selected articles were searched manually. In addition, the results of the survey presented in the National Institute for Occupational Safety and Health (NIOSH) website [15], as well as the findings of the studies by Tabanelli et al. [14] and Rick et al. [19] were used. Next two authors reviewed the titles of the articles and the duplicates were excluded. Then, the titles and the abstracts of the remaining articles were carefully examined; only articles that used work-related stress questionnaires were selected. Finally, the full-texts of the remaining articles were analyzed and the ones in which work-related stress questionnaires had been designed and developed were selected. At this stage, three restrictions were taken into account for the final selection of eligible questionnaires including: (1) comprehensiveness (with a minimum of three scales), (2) being published in scientific journals and access to the detailed content, (3) applicability for all jobs and work environments. The questionnaires lacking the given criteria were excluded. To reclassify the scales of the final questionnaires, an occupational health specialist (ergonomist and expert in macroergonomic approaches) and an organizational psychologist (expert in work-related stress) used a directed content analysis method in accordance with the work system model to reclassify the questionnaires into five categories: job (task)-related factors, organizational condition-related factors, individual characteristics-related factors, technology and tools-related factors, and physical environmental-related factors.

3 Results

According to the study criteria, a total of 22 questionnaires met the inclusion criteria of the final stage of the study and the overall results of our analysis are showed in Table 1. The emphasis of these questionnaires was mostly on factors related to the job and organization conditions. The findings showed that 100% of the questionnaires had at least one scale to measure components of job (task)-related factors and 95.5% had at least one organizational condition-related factors. On the contrary, only 36.4%, 22.7% and 18.2% had at least one scale to measure components of physical environmental-related factors, individual characteristics-related factors and technology and tools-related factors, respectively. The NIOSH generic job stress instrument (GJSI _NIOSH), Stress Profile (SP), Occupational Stress Index (OSI(, and Shortened Stress Evaluation Tool (ASSET) were the most complete questionnaires and consisted of four dimensions of the work system model. On the other hand, the Health and Safety Executive Management Standards Indicator Tool (HSE-MS), Perceived Work Characteristics (PWCH), Stress Questionnaire (SQ), Workplace Stressors Assessment Questionnaire (WSAQ), Job Characteristic Inventory (JCI(, Work Well Index (WWI), Work Health Check (WHC), Effort Reward Imbalance (ERI) and Occupation Stress Indicator (OSInd) only consisted of two dimensions of work system model including job (task)-related factors and organizational condition-related factors.

Table 1
Questionnaires aimed to measure work related stress included in this study

Questionnaire name [Reference] Abbreviated name Version (Number of items/scales) Components of work system model

J O E T I

1. Copenhagen Psychosocial questionnaire [22] COPSOQ Short (40/23) √ √ √

Medium (87/28)

Long (127/41)

2. Job diagnostic survey [23] JDS Original (15/5) √

3. General Nordic questionnaire for psychological and social factors at work [26] QPS_Nordic Short (34/N) √ √ √

Long (123/26)

4. NIOSH generic job stress instrument [27] GJSI _NIOSH Original (246/22) √ √ √ √

5. Health and Safety Executive Management Standards Indicator Tool [28] HSE-MS Original (35/6) √ √

6. Perceived Work Characteristics [29] PWCh Original (43/9) √ √

7. Stress Questionnaire [30] SQ Original (26/5) √ √

8. Brief Job Stress Questionnaire [31] BJSQ Original (141/34) √ √ √

9. Stress profile [32] SP Original (224/19) √ √ √ √

10. Workplace Stressors Assessment Questionnaire [33] WSAQ Original (22/6) √ √

11. Occupational stress questionnaire [34] OSQ Original (56/10) √ √ √

12. Occupational Stress Inventory [35] OSInv Total (140/14) √ √ √

13. Job content questionnaire [20] JCQ Recommended format (49/ 9) √ √ √

Original (27/4)

14. Job characteristic inventory [36] JCI Original (30/6) √ √

15. Occupational stress index [37] OSI Generic (65/7) √ √ √ √

16. Work Well index [38] WWi Original (10/5) √ √

17. Work health check [39] WHC Original (44/10) √ √

18. Pressure management indicator [40] PMI Original (120/24) √ √ √

19. Effort reward imbalance [41] ERI short (16/3) √ √

Original (23/5)

20. A shortened Stress Evaluation Tool [42] ASSET Original (55/14) √ √ √ √

21. Occupation stress indicator [43] OSInd Original (167/10) √ √

22. Job stress survey [44] JSS Original (30/3) √ √ √

Questionnaire name [Reference]	Abbreviated name	Version (Number of items/scales)	Components of work system model
1. Copenhagen Psychosocial questionnaire [22]	COPSOQ	Short (40/23)	√	√			√
		Medium (87/28)
		Long (127/41)
2. Job diagnostic survey [23]	JDS	Original (15/5)	√
3. General Nordic questionnaire for psychological and social factors at work [26]	QPS_Nordic	Short (34/N)	√	√			√
		Long (123/26)
4. NIOSH generic job stress instrument [27]	GJSI _NIOSH	Original (246/22)	√	√	√		√
5. Health and Safety Executive Management Standards Indicator Tool [28]	HSE-MS	Original (35/6)	√	√
6. Perceived Work Characteristics [29]	PWCh	Original (43/9)	√	√
7. Stress Questionnaire [30]	SQ	Original (26/5)	√	√
8. Brief Job Stress Questionnaire [31]	BJSQ	Original (141/34)	√	√	√
9. Stress profile [32]	SP	Original (224/19)	√	√	√		√
10. Workplace Stressors Assessment Questionnaire [33]	WSAQ	Original (22/6)	√	√
11. Occupational stress questionnaire [34]	OSQ	Original (56/10)	√	√	√
12. Occupational Stress Inventory [35]	OSInv	Total (140/14)	√	√	√
13. Job content questionnaire [20]	JCQ	Recommended format (49/ 9)	√	√	√
		Original (27/4)
14. Job characteristic inventory [36]	JCI	Original (30/6)	√	√
15. Occupational stress index [37]	OSI	Generic (65/7)	√	√	√	√
16. Work Well index [38]	WWi	Original (10/5)	√	√
17. Work health check [39]	WHC	Original (44/10)	√	√
18. Pressure management indicator [40]	PMI	Original (120/24)	√	√			√
19. Effort reward imbalance [41]	ERI	short (16/3)	√	√
		Original (23/5)
20. A shortened Stress Evaluation Tool [42]	ASSET	Original (55/14)	√	√	√	√
21. Occupation stress indicator [43]	OSInd	Original (167/10)	√	√
22. Job stress survey [44]	JSS	Original (30/3)	√	√		√

Note: J = job components; O = organization condition components; E = physical environment components; T = technology and tool components; I = individual components.

The more detailed results of our analysis, describing specific factors measured for each component of the work system model, are presented in Tables 2 to 6. The results of the reclassification of the scales on job-related factors are shown in Table 2. The findings indicated that 91% and 77% of the questionnaires had scales to measure job demands and autonomy (control), respectively. On the other hand, the least emphasis (4.5%) was put on the scales of interdependence and job complexity and specialization, respectively. This result is understandable given that the Job Demand-Control model (JDC, [20]), also known as the job strain model [21], is one of the most effective and the most widely used models to examine the relationship between work and health. In scale of job demands, the emphasis of the most assessed questionnaire was on measuring physical and psychological-cognitive demands of job. However, in the Copenhagen Psychosocial Questionnaire (COPSOQ), a separate subscale was provided to measure emotional demands of jobs in addition to the physical and psychological-cognitive subscales [22]. The scales of role problems (conflict and ambiguity) and skill variety were other scales emphasized in different questionnaires. In fact, one of the most comprehensive and influential theories in job design is the job characteristics theory [23], which has been the basis for the design of Job Diagnostic Survey (JDS). According to this theory, five characteristics are required to be considered in the design of each job in order to make it motivating for an individual: (1) skill variety, (2) task identity, (3) task significance, (4) autonomy, and (5) feedback [23]. As can be seen from Table 2, however, the theory involved a very small number of job-related stress factors. In addition, the psychometric properties of the JDS were questionable and there have been multiple reports about low internal consistencies of its scales as well as problems in its factor structure [24].

Table 2

Reclassification of scales-related job components in available work-related stress questionnaires

Category	Scale		Source
Job Characteristics	Role Conflict		[22 , 26–32]
	Role Ambiguity (or Clarity)		[22 , 31–35]
	Autonomy (Control)	Decision-Making	[20 , 36–40]
		Work Methods
		Work Scheduling
	Job Demands	Quantitative and Physical Demands	[20 , 37–42]
		Cognitive and Mental Demands	[20 , 38–44]
		Emotional Demands	[22 , 39]
	Task or Skill Variety		[22 , 37]
	Task Identity		[23, 29]
	Task Significance (Meaning of Work)		[22 , 31]
	Interdependence		[20]
	Job Complexity and Specialization		[34]
	Skill (Under)utilization		[20 , 39]
	Skill Development (Skill Discretion)		[20 , 33]
	Job Responsibility		[27 , 40]
	Feedback	Job Feedback (Intrinsic)	[20 , 34]
		Feedback from Others (Extrinsic)	[22 , 36]
	Predictability at Work		[22 , 37]

The results of the reclassification of the scales of stressor factors associated with organizational characteristics in the questionnaires examined are illustrated in Table 3. The findings showed that 77% of these questionnaires had scales to measure coworkers’ support. On the other hand, the least emphasis (4.5%) was placed on the scales of innovative climate, anticipated organizational change and work rules and instructions; in fact, 95% of the questionnaires examined had ignored these three factors.

Table 3

Reclassification of scales-related organization condition components in available work-related stress questionnaires

Category	Scale	Source
Organization Characteristics	Coworkers Support	[20 , 42–44]
	Confidence in Peers	[22, 40]
	Supervisors Support	[20 , 42–44]
	Confidence in Management	[22, 31]
	Quality of Leadership	[22 , 32]
	Social Climate & Relationships	[22 , 44]
	Innovative Climate	[26]
	Job (In)Security	[20 , 40–42]
	Work-Family (Family-Work) Conflict	[22 , 43]
	Work Schedule	[27, 37]
	Fairness (Justice)	[22 , 43]
	Recognition	[22 , 40–43]
	Reward and Pay	[26 , 41–43]
	Anticipated Organizational Change	[28]
	Harassment and Violence	[22 , 40]
	Promotion Opportunities	[31 , 43]
	Work Rules and Instructions	[37]

Social support, including support from the colleagues and support from the supervisors, had the highest frequency (81.8%) among the scales of organizational condition components. It is to note that to complete the Job Demand-Control model mentioned above, the social support dimension was added in later years and turned it into a Job Demand-Control-Support model (JDCS) [20]. According to this model, social support has a determining role in moderating the effects of stress on individuals, (i.e., it moderates the impact of high tension in jobs with high demands and low control on employees’ health [20]). According to the fundamental roles of macroergonomics, one of the essential principles in the design of jobs is to ensure that job design will enable persons to satisfy social needs on the job [25].

In general, as can be observed in Table 3, there were few questionnaires encompassing all the dimensions of work-related stress associated with organization condition element. Even comprehensive questionnaires such as COPSOQ and General Nordic Questionnaire for Psychological and Social Factors at Work (QPS_Nordic) were also defected in this respect and did not cover all the givenfactors.∥Results of the reclassification of scales of stressor factors associated with physical environment, technology and tools, as well as the characteristics and features of individual are presented in Tables 4 to 6. The results indicated that most of the questionnaires (63.6%, 81.8% and 77.3% respectively) had less consideration of these three components of the work system model.∥The scales of risk factors relevant to physical environment hazards (32%) and safety hazards (23%) were the most frequent ones among the scales related to physical environment component, and resource adequacy received the highest frequency rates (14%) among the elements of technology and tools.∥In terms of characteristics and features of individual, the highest frequency rates were related to self-efficacy and personality (14% both). In accordance with the theory of Socio-Technical Systems (STS, [45] and macroergonomic principles [12, 25], creating balance and equilibrium in the work system requires close attention to this component. For example, low level of staff knowledge and skills in using technology and tools not only leads to stress and health problems for them but also reduces their confidence, which consequently lowers the incentive to participate in organization’s activities [16]. Consequently, not paying attention to features and characteristics of employees including level of expertise and degree of professionalism, demographic characteristics (such as age, gender, personality type) and psycho-social aspects (e.g., ideological, cultural, cognitive complexity and thinking characteristics) in the work system design can impose stress on staff and lead to inefficiency of the worksystem [16].

Table 4

Reclassification of scales-related physical environment components in available work-related stress questionnaires

Category	Scale	Source
Physical Environment Characteristics	Housekeeping	[20 , 42]
	Physical Environment Hazards	[20 , 42]
	Toxic Exposure	[20, 37]
	Safety Hazards	[20 , 37]
	Micro – Ergonomics	[20, 32]

Table 5

Reclassification of scales-related technology and tool components in available work-related stress questionnaires

Category	Scale	Source
Technology and Tool Characteristics	Resource Adequacy (Poor Quality)	[37 , 44]
	Work with Machines or Automatic Devices	[37]
	Technology Demands	[39]

Table 6

Reclassification of scales-related individual components in available work-related stress questionnaires

Category	Scale	Source
Individual Characteristics	Self-efficacy (Self-esteem)	[22 , 40]
	Sense of Coherence	[32]
	Self-perception	[32, 40]
	Personality	[26 , 40]
	Mastery of Work	[26]
	Intrinsic and Extrinsic Motivation to Work	[26]

4 Discussion

The findings of this scoping review show that the scales of work-related stress questionnaires can be reclassified into five categories including job, organizational condition, physical environment, and personal factors as well as those related to technology and tools.

The obtained results revealed that stress factors related to job (100%) and organizational condition (95.5%) components were the most frequent scales that had been mentioned in the reviewed questionnaires. Overall questionnaires paid less attention to the other components and this gap was particularly evident in the component of characteristics of individual.

Altogether, the results suggested that questionnaires covering all the work-related factors that can bring about stress in employees were not available. As an example, even the relatively comprehensive questionnaires such as COPSOQ did not encompass the elements of physical environment, technology and tools, features and characteristics of individual and elements of organization condition and job. Because the design of most of the available questionnaires was based on a specific theory, it became obvious why some scales were selected and why some others were left out. However, the results of our reclassification showed that there were a lot of work-related stress factors. It is hard to design a comprehensive and common questionnaire covering all these factors and with a usability across all different industries and organizations. In addition, given the specific stress factors related to any organization, using common questionnaires for all organizations (even with the same operations and job duties) did not seem logical. Therefore, different organizations are required to make use of qualitative studies at first to identify stress factors related to their work system and then design standardized scales or employ the scales of the questionnaires available covering their specific problems in order to measure and evaluate such problems. Our reclassification can provide organizations a useful framework aimed to design their own customized tool, so that they can implement targeted intervention programs to control or eliminate specific stress factors related to their work system. The tables provided in this study can assist organizations in this task, selecting specific scales (and references) that they need.

Although we adopted a strong methodological procedure (scoping review and directed content analysis), our results and their use in practice could be biased by some limits. First, we provided a reclassification of the available work-related stress questionnaires, but the evaluation of their validity and psychometric properties was out of our scope. Consequently, when designing their customized tool, organizations should also pay attention to the psychometric properties of the scales and some previous studies could assist in this task [14 , 19]. Second, our categorization was based on the description of the scales provided by the referred studies and not examining the content of the scales’ items. This means that we cannot guarantee the full consistency between the component of the work system model identified and the content of the items. However, the questionnaires analyzed in this study are mainly well-known instruments and we can be confident about the description provided by the authors and, consequently, about our results.

5 Conclusion

This scoping review allowed us to reclassify existing work-stress questionnaires on the basis of the five elements included in the work system model: job/tasks, organizational condition, individual characteristics, technology and tools, and physical environmental. We further described each of the components of the work system model providing detailed information about the specific factors measured and the referenced questionnaires.

Previous reviews on work-stress questionnaires [7 , 15] showed the available instruments and described their main characteristics. Because none of the questionnaires are complete in terms of comprehensiveness and inclusion of all stress factors, no comprehensive planning for implementation of intervention programs can be done in order to reduce work-related stress.

We suggest organizations and researchers develop their own customized tool on the basis of the specific context and necessities. Our results and tables could assist in this task, selecting the needed factors/scales from different questionnaires. In so doing, organizations can implement targeted intervention programs to control or eliminate specific stress factors related to their work system.

Conflict of interest

The authors declare that they have no conflicts of interest.

Footnotes

Acknowledgments

This study was conducted with financial support from Shiraz University of Medical Sciences.

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