Structural relationships among occupational dysfunction,stress coping,and occupational participation for healthcare workers

Abstract

BACKGROUND AND OBJECTIVE:

Occupational dysfunction is frequent among healthcare workers, but little is known about factors related to occupational participation and stress coping behavior among healthcare workers. This cross-sectional study aimed to analyze structural relationships among occupational dysfunction, stress coping, and occupational participation in healthcare workers.

METHODS:

Participants were 601 healthcare workers in 13 facilities. Data were collected with participant profile, Classification and Assessment of Occupational Dysfunction (CAOD), Coping Scale (CS), and Self-completed Occupational Performance Index (SOPI). Data were analyzed by descriptive statistics, item response theory (IRT), confirmatory factor analysis (CFA), correlation analysis, and path analysis.

RESULTS:

CFAs of CAOD, CS, and SOPI indicated good fit to the predicted models. In IRT, CAOD and SOPI showed conformity, but two items of CS showed nonconformity. The correlation between CAOD-SOPI was high to moderate (–0.486 to –0.246; p < 0.001), whereas that between CAOD and emotion-focused coping was weakly negative. SOPI and CS were negatively associated with occupational dysfunction (p < 0.000).

CONCLUSIONS:

This model demonstrated that SOPI and CS had a negative structural relationship with occupational dysfunction. Therefore, it seems important to encourage occupational participation (in the areas of self-care, productivity, and leisure) to reduce occupational dysfunction in healthcare workers.

Keywords

Structural equation modeling preventive occupational therapy stress coping healthcare workers

1 Introduction

Healthcare workers (such as doctors and nurses) suffer from different job- related stresses compared to other workers [1 –3]. Job-related stresses for healthcare workers refer to the long work hours, range of roles, job environment, responsibility, and the relationships with other healthcare workers [4, 5]. Job-related stress can lead to burnout syndrome and depression [6]. As a result, the quality of life of the healthcare worker and the quality of their healthcare practice are reduced [7, 8].

Preventive occupational therapy is an approach to improve the health and quality of life of clients who have no obvious medical disease and/or disorder,but who have occupational dysfunction [9, 10]. Occupational dysfunction is defined as people’s difficulty with choosing, performing or experiencing their occupations. In a previous study, preventive occupational therapy was shown to be beneficial for workers experiencing job stress and mental illness; positive results included prevention of occupational accidents, blood pressure control, smoking cessation, dietary improvements, and stress control have been reported [11]. Other studies have shown that the intervention to health promotion and the education by occupational therapists is able to prevent the office workers workplace and prevent disorders such as Repetitive Strain Injury (RSI) [12, 13]. Moreover, preventive occupational therapy has been shown to reduce workplace violence and improve productivity [14, 15]. Therefore, it is evident that this therapy significantly contributes to the occupational health of workers.

Despite this handful of studies, the potential of preventive occupational therapy to reduce occupational dysfunction has not been widely studied. Occupational dysfunction includes occupational imbalance, occupational deprivation, occupational alienation, and occupational marginalization [16]. Occupational imbalance is a loss of balance in engagement during daily activities [17]. Occupational deprivation is a lack of choices in daily activities that are beyond the individual’s control [18]. Occupational alienation is the failure to fulfill the inner needs related to meaning or purpose in everyday activities [19]. Occupational marginalization is defined as impeding in making choices and decisions about their participation in daily activities [20].

Occupational dysfunction is associated with stress, burnout syndrome, and depression [21]. The role of occupational therapy is prevention and improvement of occupational dysfunction [22]. As such, occupational therapists may contribute to healthcare management of healthcare worker through assessment and intervention of occupational dysfunction. The prevalence of occupational dysfunction is approximately 38% in the general corporate worker population and 75% among healthcare workers [23, 24]. In addition, psychological problems (stress response, burnout syndrome, and depression) in healthcare workers increase with worsening occupational dysfunction [21]. Therefore, it is important to identify the factors affecting the occupational dysfunction of healthcare workers.

Occupation-based Practice 2.0 (OBP2.0) is a theory that can assist occupational therapists with assessment of and interventions for clients’ occupational dysfunction [25]. Theoretically, the OBP2.0 posits that occupational dysfunction may be relieved by occupational participation, including participation in self-care, productivity, and leisure activities. Stress coping may also be related to reducing occupational dysfunction. The association between occupational dysfunction and job stress has been reported in previous studies [21], and job stress has been shown to be improved by stress coping [26, 27].

To date, there is no research demonstrating the possibility of decrease in occupational dysfunction by occupational participation and stress coping. In the present study, we formulated the hypothesis model that occupational dysfunction is changed by occupational participation and stress coping, as shown in Fig. 1. The purpose of this study is to clarify the fitness of the structural relationship model that occupational participation and stress coping change occupational dysfunction.

Fig.1

Hypothesis model. Covariates included age, gender, job category, years of job experience, job title, job system, job hours, commute time, opportunities for refreshment, time spent on leisure activities, drinking, smoking, marital status, divorce status, reproductive status, and work relationships.

2 Methods

2.1 Research design

This study followed a cross-sectional study design.

2.2 Ethics statement

This study was conducted with reference to the Helsinki Declaration and approved by the Ethics Review Committee of the Kibi International University (No.13-30). Written informed consent was obtained from all participants. We provided all participants with a letter explaining the purpose and outline of this study. Participants could interrupt research cooperation without any reason. Survey sheets were returned in anonymous sealed envelopes, and data obtained were used in this study analysis only.

2.3 Participants

We were selected the research collaborators in the seminar or workshop of occupational therapy in Japan. Research collaborators were expressed interest in this study when they heard explanations of this study at workshop or seminar. Before the start of the data collection documents were mailed to research collaborators and facilities informing of the purpose of this study. Participants responded to the questionnaire if they wished to participate. Data were collected using a convenience sampling method in Japan. Participants were recruited through snowballing techniques and participants agreed an informed consent from approved by the ethics committees in each hospitals and facilities after the approved by the Kibi International university’s ethics statement. A non-random sample of 601 healthcare workers (199 nurses, 222 physical therapists, 172 occupational therapists, and 8 other healthcare workers) were contacted in Japan. The research was conducted from February to May 2015.

2.4 Measures

2.4.1 Personal characteristics

All participants were asked to provide information about their age, gender, job category, years of job experience, job title, job system, job hours, commute time, opportunities for refreshment, time spent on leisure activities, drinking, smoking, marital status, divorce status, reproductive status, and work relationships.

2.4.2 Classification and Assessment of Occupational Dysfunction (CAOD)

CAOD [16] was developed based on the theoretical foundation of OBP2.0 [25] as this model provides a conceptual framework for the classification of occupational dysfunction in all individuals. The CAOD scale assesses four aspects of occupational dysfunction: occupational imbalance (4 items), occupational alienation (3 items), occupational marginalization (6 items), and occupational deprivation (3 items). Thus, CAOD consists of 16 items on a 7-point Likert scale (1 = strongly disagree, 7 = strongly agree). For example, “I am so busy that the rhythm of my life is confused” are included in items in CAOD. The Cronbach alpha of CAOD was 0.912.

2.4.3 Self-completed Occupational Performance Index (SOPI)

SOPI [28] was developed based on the Canadian Model of Occupational Performance, which provides a theoretical rationale for client-centered practice and for enabling occupation in all humans [29]. SOPI measures occupational participation in three domains: self-care (3 items), productivity (3 items), and leisure (3 items), thus, comprising nine items on a 5-point Likert scale (1 = not satisfied at all, 5 = highly satisfied). Occupational participation is defined as involving important occupation in life [29]. For example, “Whether you can decide activities of leisure of the past month on your own” is an item included in SOPI. The Cronbach alpha of SOPI was 0.93.

2.4.4 Coping Scale (CS)

CS [30, 31] was developed based on psychological stress and the coping process. The theory underlying this scale states that stress can vary according to the method used to cope with stress. CS measures the ability to cope with stress in three domains: problem-focused coping (5 items), emotion-focused coping (3 items), and escape-avoidance coping (6 items), thereby comprising 14 items on a 4-point Likert scale (0 = not at all, 3 = always). Problem-focused coping is an action directly related to problem solving [30]. For example, “Strive to change the current situation” is included as an item in this factor. Emotion-focused coping is an action focused on adjusting feelings of stress [30]. For example, “I will try to change the current situation” is included as an item in this factor. Escape-avoidance coping is an action to escape from unpleasant events [30]. For example, “I will not think deeply about the future” is included as an item in this factor. In CS, methods that include problem-focused coping and emotion-focused coping are classified as active coping because they are trying to solve the problem. Escape-avoidance coping is classified as passive coping because it does not attempt to solve the problem. The Cronbach alpha of CS was 0.62 for positive coping and 0.65 for negative coping.

2.5 Statistical analysis

2.5.1 Descriptive statistics

Age and years of job experience were calculated and expressed as mean±standard deviation. Job category, gender, opportunities for refreshment, time spent on leisure activities, and work relationships were calculated and expressed as frequency and percentage. Normality was assessed using the Jarque– Bera test. Data were analyzed using SPSS statistics ver. 22 (http://www.spss.com).

2.5.2 Item Response Theory (IRT)

Item discrimination and difficulty were determined using the Item Response Theory (IRT); specifically, a 2-parameter logistic model of a graded response model for CAOD, CS, and SOPI was used [32]. Categorical data analysis was performed. A marginal maximum likelihood estimation based on the expectation– maximization algorithm (MML-EM) was performed. The missing value was estimated using the full information maximum likelihood model. Discrimination parameters between 0.2 and 2.0 were considered appropriate, whereas difficulty parameters were considered acceptable if within 0.4. Data were analyzed using Exametrika ver. 5.3 (http://prt.nu/3/exametrika).

2.5.3 Confirmatory Factor Analysis (CFA)

We performed CFA as described in previous studies [16 , 30]. The factor structures of SOPI and CS were confirmed using a robust weighted least squares method with mean and variance along with missing data. CAOD was confirmed with maximum likelihood and robust standard error (MLR). The first index was the root mean square error of approximation (RMSEA), followed by the comparative fit index (CFI) and the Tucker– Lewis Index (TLI). Values of RMSEA below 0.08 show a good fit, those between 0.08 and 0.10 provides a mediocre fit, and those over 0.10 indicates a poor fit [33]. CFI and TLI values greater than 0.9 were regarded as a good fit [34]. The finding shows the result of a χ2 test according to tradition. However, because this value is depreciated in structural equation modeling (SEM), it is not used for judging the model fit [34].

Data were analyzed by Mplus ver. 7.3 (http://www.statmodel.com), which is a statistical model for SEM. SEM can be assessed using goodness-of-fit; it can also estimate structural relationships in cross-sectional data because it uses regression analysis, analysis of covariance, and generalized linear model.

2.5.4 Correlation analysis

Correlation analysis of CAOD, SOPI, and CS was performed by assessing the polyserial correlation coefficient. Moreover, correlations between the three assessments and patient characteristics were estimated. The missing values were estimated using multiple assignments [35]. Personal characteristics that showed correlation scores of more than 0.2 were used for covariance. Data were analyzed using SPSS statistics ver. 22 (http://www.spss.com).

2.5.5 Path analysis

Using SEM, we examined the structural relationship with a multiple indicator multiple cause (MIMIC) model to investigate whether occupational dysfunction was improved according to the method of stress coping (problem-focused coping, emotion-focused coping, and escape-avoidance coping) and occupational participation (self-care, productivity, and leisure). Moreover, this model contains personal characteristics including age, gender, job category, years of job experience, job title, job system, job hours, commute time, opportunities for refreshment, time spent on leisure activities, drinking, smoking, marital status, divorce status, reproductive status, and work relationships as covariates. When a negative standardized estimate was observed for CAOD, we concluded that stress coping and occupational participation had the potential to lower occupational dysfunction. However, because this value is depreciated in SEM, it is not used for judging model fit [34]. Data were analyzed using Mplus ver. 7.3 (https://www.statmodel.com).

3 Results

3.1 Descriptive statistics

Of the 601 participations, 207 (34.4%) were males, 386 (64.2%) females, and 8 (1.3%) unknown (Table 1). The mean age of the participants was 32.7 (±10.3) years. The mean years of job experience was 9.0 (±8.7). The result of the Jarque– Bera test was 0.072, confirming a normal distribution.

Table 1
Descriptive statistics (n = 601)

M±SD

Age Total 32.7 (±10.3)

Nurses 41.3 (±11.7)

Physical therapists 29.0 (±6.2)

Occupational therapists 27.6 (±5.2)

Years of work experience Total 9.0 (±8.7)

Nurses 16.0 (±10.1)

Physical therapists 5.9 (±5.5)

Occupational therapists 4.9 (±4.4)

Total N %

Gender Male 207 34.4

Female 386 64.2

Others 008 01.3

Job category Nurses 199 33.1

Physical therapists 222 37.0

Occupational therapists 172 28.6

Others 008 01.3

Opportunities for refreshment Very good 057 09.5

Good 344 57.2

Neither good nor bad 093 15.5

Fair 052 08.7

Poor 045 07.5

Others 010 01.7

Time spent on leisure activities Very good 045 07.5

Good 253 42.1

Neither good nor bad 154 25.6

Fair 099 16.5

Poor 039 06.5

Others 011 01.8

Work relationships Very good 079 01.3

Good 365 60.7

Neither good nor bad 119 19.8

Fair 019 03.2

Poor 003 00.5

Others 016 02.7

		M±SD
Age	Total	32.7 (±10.3)
	Nurses	41.3 (±11.7)
	Physical therapists	29.0 (±6.2)
	Occupational therapists	27.6 (±5.2)
Years of work experience	Total	9.0 (±8.7)
	Nurses	16.0 (±10.1)
	Physical therapists	5.9 (±5.5)
	Occupational therapists	4.9 (±4.4)
		Total N	%
Gender	Male	207	34.4
	Female	386	64.2
	Others	008	01.3
Job category	Nurses	199	33.1
	Physical therapists	222	37.0
	Occupational therapists	172	28.6
	Others	008	01.3
Opportunities for refreshment	Very good	057	09.5
	Good	344	57.2
	Neither good nor bad	093	15.5
	Fair	052	08.7
	Poor	045	07.5
	Others	010	01.7
Time spent on leisure activities	Very good	045	07.5
	Good	253	42.1
	Neither good nor bad	154	25.6
	Fair	099	16.5
	Poor	039	06.5
	Others	011	01.8
Work relationships	Very good	079	01.3
	Good	365	60.7
	Neither good nor bad	119	19.8
	Fair	019	03.2
	Poor	003	00.5
	Others	016	02.7

3.2 Item analysis

The discrimination and difficulty parameters in CAOD and SOPI were a good fit. The average of discrimination and difficulty parameters for CAOD were α= 1.275, β1 = –0.872, β2 = –0.231,β3 = 0.226, β4 = 0.776, β5 = 1.414, and β6 = 1.938. The corresponding values for SOPI were α= 1.551, β1 = –1.769, β2 = –0.735, β3 = 0.158, and β4 = 1.323. However, items 1 and 7 of CS exceeded the criteria of the difficulty parameter (β1 of item 1 = –4.605; β3 of item 7 = 4.322). Therefore, these two items were excluded.

3.3 CFA

CAOD was classified into four factors (includes occupational imbalance, occupational deprivation, occupational alienation, and occupational marginalization) [RMSEA = 0.067, CFI = 0.926, TLI = 0.910, χ² = 365.811, df = 98, p < 0.000]. The magnitude of factor correlations ranged from 0.438 to 0.713 for the four factors. The factor loading ranged from 0.730 to 0.812 in occupational imbalance, from 0.749 to 0.839 in occupational deprivation, from 0.761 to 0.835 in occupational alienation, and from 0.512 to 0.770 in occupational marginalization. Similar to the previous study, SOPI was classified into three factors (includes self-care, productivity, and leisure) (RMSEA = 0.096, CFI = 0.995, TLI = 0.993, χ² = 157.142, df = 24, p < 0.000) [16]. CS with the two items deleted was confirmed as a model of good fit for RMSEA and CFI, but TLI was not a good fit (RMSEA = 0.094, CFI = 0.906, TLI = 0.881, χ² = 323.945, df = 52, p < 0.000).

3.4 Correlation analysis

Moderately negative and weakly negative correlations were observed between CAOD and SOPI (Table 2). In addition, emotion-focused coping correlated weakly and negatively with occupational deprivation, occupational alienation, and occupational marginalization. Personal characteristics such as refreshment, time spent on leisure activities, and work relationships demonstrated moderate to weak correlations in CAOD, CS, and SOPI (Table 2).

Table 2
Correlation analysis of CAOD, CS, SOPI, and personal characteristics

CAOD

Occupational imbalance Occupational deprivation Occupational alienation Occupational marginalization

CS Problem-focused coping 0.043 –0.035 –0.047 –0.059

Emotion-focused coping 0.033 –0.111^ –0.292^ –0.166^

Escape-avoidance coping 0.032 –0.043 –0.053 –0.006

SOPI Leisure –0.343^ –0.486^ –0.281^ –0.246^

Productivity –0.343^ –0.382^ –0.344^ –0.284^

Self-care –0.402^ –0.441^ –0.248^ –0.251^

CAOD Active coping Passive coping SOPI

Age 0.102^ –0.011 0.119^ –0.101^

Gender 0.067^ 0.083^ 0.187^ –0.142^

Job category Nurses 0.150^ 0.021 0.140^ –0.111^

Physical therapists –0.097^ –0.004 –0.057^ 0.116^

Occupational therapists –0.048^ 0.002 –0.098^ –0.006

Years of job experience 0.106^ –0.006 0.095^ –0.089^

Job title –0.048^ –0.058^ –0.097^ –0.039^**

Job system 3 shifts 0.028 –0.016 0.038^* –0.024

2 shifts 0.092^ –0.055^ 0.105^ –0.068^

Duty 0.065^ 0.044^ 0.085^ –0.012

Day shifts 0.054^ 0.026 0.053^ –0.116^

PTOT night shifts 0.046^ –0.026 –0.010 –0.054^

Job hours 0.091^ 0.072^ –0.062^ –0.070^

Commute time –0.019 0.049^ –0.064^ 0.020

Opportunities for refreshment 0.460^** –0.037^* –0.133^ –0.540^

Time spent on leisure activities 0.527^** –0.037^* –0.133^ –0.540^

Drinking 0.127^ –0.096^ 0.095^ –0.083^

Smoking –0.055^ 0.020 0.017 –0.014

Marital status –0.002 0.016 –0.052^ 0.053^

Divorce status –0.106^ 0.048^ 0.131^ –0.077^

Reproductive status 0.070^ 0.032 0.172^ –0.119^

Work relationships 0.332^ –0.126^ –0.039^* –0.190^**

		CAOD
CS	Problem-focused coping	0.043	–0.035	–0.047	–0.059
	Emotion-focused coping	0.033	–0.111^**	–0.292^**	–0.166^**
	Escape-avoidance coping	0.032	–0.043	–0.053	–0.006
SOPI	Leisure	–0.343^**	–0.486^**	–0.281^**	–0.246^**
	Productivity	–0.343^**	–0.382^**	–0.344^**	–0.284^**
	Self-care	–0.402^**	–0.441^**	–0.248^**	–0.251^**
		CAOD	Active coping	Passive coping	SOPI
Age		0.102^**	–0.011	0.119^**	–0.101^**
Gender		0.067^**	0.083^**	0.187^**	–0.142^**
Job category	Nurses	0.150^**	0.021	0.140^**	–0.111^**
	Physical therapists	–0.097^**	–0.004	–0.057^**	0.116^**
	Occupational therapists	–0.048^**	0.002	–0.098^**	–0.006
Years of job experience	0.106^**	–0.006	0.095^**	–0.089^**
Job title		–0.048^**	–0.058^**	–0.097^**	–0.039^**
Job system	3 shifts	0.028	–0.016	0.038^*	–0.024
	2 shifts	0.092^**	–0.055^**	0.105^**	–0.068^**
	Duty	0.065^**	0.044^**	0.085^**	–0.012
	Day shifts	0.054^**	0.026	0.053^**	–0.116^**
PTOT night shifts		0.046^**	–0.026	–0.010	–0.054^**
Job hours		0.091^**	0.072^**	–0.062^**	–0.070^**
Commute time		–0.019	0.049^**	–0.064^**	0.020
Opportunities for refreshment	0.460^**	–0.037^*	–0.133^**	–0.540^**
Time spent on leisure activities	0.527^**	–0.037^*	–0.133^**	–0.540^**
Drinking		0.127^**	–0.096^**	0.095^**	–0.083^**
Smoking		–0.055^**	0.020	0.017	–0.014
Marital status		–0.002	0.016	–0.052^**	0.053^**
Divorce status		–0.106^**	0.048^**	0.131^**	–0.077^**
Reproductive status		0.070^**	0.032	0.172^**	–0.119^**
Work relationships		0.332^**	–0.126^**	–0.039^*	–0.190^**

^**<0.01, ^*<0.05.

3.5 Path analysis

In Fig. 2, the hypothesis model exhibited a good fit (RMSEA = 0.053, CFI = 0.958, TLI = 0.954, χ² = 1808.032, df = 677, p < 0.000). This was particularly true for emotion-focused coping [normalization factor = –0.325, 95% confidence interval (CI) = –0.484 to –0.166; p < 0.001] on CS as well as leisure (normalization factor = –0.300, 95% CI = –0.418 to –0.182, p < 0.001), productivity (normalization factor = –0.439, 95% CI = –0.548 to –0.331, p < 0.001), self-care (normalization factor = –0.362, 95% CI = –0.482 to –0.243, p < 0.001) on SOPI, with a significant normalization factor of p < 0.05. CAOD was positively related to CS and SOPI. Opportunities for refreshment (normalization factor = 0.246, 95% CI = 0.141–0.351, p < 0.001) and time spent on leisure activities (normalization factor = 0.470, 95% CI = 0.366–0.574, p < 0.001) were also related to CAOD.

Fig.2

Path analysis. Refresh is opportunities for refreshment and leisure (satisfaction) is time spent on leisure activities. CS includes the problem, emotion, and escape. SOPI includes leisure, productivity, and self-care. CAOD includes imbalance, deprivation, alienation, and marginalization. RMSEA = 0.053, CFI = 0.958, TLI = 0.954, χ² = 1808.032, df = 677, p < 0.000.

4 Discussion

4.1 Findings

In this study, we sought to clarify the fitness of the structural relationship model to determine whether occupational participation and stress coping change occupational dysfunction. As results, we were able to generate a model with goodness of fit. This model demonstrated that SOPI and CS had a negative structural relationship with occupational dysfunction.

Particularly, productivity of occupational participation showed the direct structural relationship in potentially changing occupational dysfunction. That is, to reduce occupational dysfunction in healthcare workers, it is important to encourage occupational participation (in self-care, productivity, and leisure) [28]. CS suggests that emotion-focused coping is promoted in reducing occupational dysfunction. As mentioned above, emotion-focused coping is used when a person has difficulty in dealing directly with stress [30, 31]. Moreover, opportunities for refreshment and time spent on leisure activities are necessary to understand occupational dysfunction. It is considered necessary for healthcare workers to reduce occupational dysfunction by promoting occupational participation and stress coping by taking opportunities for refreshment and leisure activities. Therefore, we believe that we were able to provide knowledge that can deal with occupational dysfunction.

Sixteen items on CAOD, 9 items on SOPI, and 12 items on CS properly functioned in item analysis of IRT. We think that it was reasonable to delete the items on CS.

CAOD was a good model fit by CFA. Therefore, CAOD was found to be a measure that is able to assess for an individual’s occupational dysfunction. The CFA of SOPI was slightly higher with RMSEA of 0.096, but CFI and TLI were a good model fit. We thought that SOPI model fits the data. CS deleted 2 items but showed a factor structure similar to that of the previous study. When checking the model fit of CS, RMSEA was slightly higher and TLI was somewhat lower. RMSEA means a mediocre fit at 0.8 to 1.0, and TLI always shows a value lower than CFI. The results show that CS’s CFI slightly exceed 0.9. We thought that the CFA’s model fit of CS was just within the acceptable range.

Confirming the results of the correlation analysis, CAOD and SOPI showed a moderately significant negative correlation. The CAOD gives ratings from 1 to 112, where the higher scores of CAOD represent worse occupational dysfunction. In opposition to the CAOD, the SOPI assesses occupational participation and higher scores of SOPI represent better involvement of self-care, productivity, and leisure. Thus, a negative correlation was actually expected.

CS and CAOD showed a weakly significant negative correlation between emotion-focused coping and occupational alienation. Emotion-focused coping consists of items that capture aspects of individual values. Occupational alienation consists of items that capture the meaning of life. These concepts reflect the subjectivity of the participants. Therefore, it is considered that occupational alienation scores are low when a person is able to practice emotion-focused coping. Problem-focused coping and escape-avoidance coping did not show a correlation with occupational imbalance, occupational deprivation, occupational alienation, and occupational marginalization. Therefore, it may be that direct coping strategies or escape from the problem were not as effective for alleviating the occupational dysfunction experienced by the healthcare workers.

4.2 Limitations and strengths

This study was a cross-sectional study that could not confirm a causal relationship. In the future, we aim to support a reduction in occupational dysfunction by performing a more effective longitudinal study. In this study, participants were not collected by random sampling, thereby limiting generalization of results. Because the average age of the nurses and the rehabilitation staff are far apart, there may be differences of the occupational dysfunction experience and the approaches to address the dysfunction. On the other hand, this study is the first quantitative research to demonstrate the possibility that occupational dysfunction may be alleviated by occupational participation and stress coping. This is the strength of this research and is the basis for further study in future research.

5 Conclusion

The purpose of this study was to clarify the fitness of the structural relationship model that occupational participation and stress coping change occupational dysfunction. As results, the findings of this study suggest there are correlations among occupational dysfunction, occupational participation, and stress coping. Additionally, SOPI and CS had a negative structural relationship with occupational dysfunction. Therefore, it seems important to encourage occupational participation (in the areas of self-care, productivity, and leisure) to reduce occupational dysfunction in healthcare workers. In the future, we should improve the occupational health for healthcare workers with occupational dysfunction. If they feel that they have not been able to improve their occupational participation and emotion-focused coping using self-help, it would be important to consult with an occupational therapist for intervention.

Conflict of interest

None to report.

Footnotes

Acknowledgments

We would like to thank all the participants who took part in this study.

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		CAOD
		Occupational imbalance	Occupational deprivation	Occupational alienation	Occupational marginalization
CS	Problem-focused coping	0.043	–0.035	–0.047	–0.059
	Emotion-focused coping	0.033	–0.111^**	–0.292^**	–0.166^**
	Escape-avoidance coping	0.032	–0.043	–0.053	–0.006
SOPI	Leisure	–0.343^**	–0.486^**	–0.281^**	–0.246^**
	Productivity	–0.343^**	–0.382^**	–0.344^**	–0.284^**
	Self-care	–0.402^**	–0.441^**	–0.248^**	–0.251^**
		CAOD	Active coping	Passive coping	SOPI
Age		0.102^**	–0.011	0.119^**	–0.101^**
Gender		0.067^**	0.083^**	0.187^**	–0.142^**
Job category	Nurses	0.150^**	0.021	0.140^**	–0.111^**
	Physical therapists	–0.097^**	–0.004	–0.057^**	0.116^**
	Occupational therapists	–0.048^**	0.002	–0.098^**	–0.006
Years of job experience		0.106^**	–0.006	0.095^**	–0.089^**
Job title		–0.048^**	–0.058^**	–0.097^**	–0.039^**
Job system	3 shifts	0.028	–0.016	0.038^*	–0.024
	2 shifts	0.092^**	–0.055^**	0.105^**	–0.068^**
	Duty	0.065^**	0.044^**	0.085^**	–0.012
	Day shifts	0.054^**	0.026	0.053^**	–0.116^**
PTOT night shifts		0.046^**	–0.026	–0.010	–0.054^**
Job hours		0.091^**	0.072^**	–0.062^**	–0.070^**
Commute time		–0.019	0.049^**	–0.064^**	0.020
Opportunities for refreshment		0.460^**	–0.037^*	–0.133^**	–0.540^**
Time spent on leisure activities		0.527^**	–0.037^*	–0.133^**	–0.540^**
Drinking		0.127^**	–0.096^**	0.095^**	–0.083^**
Smoking		–0.055^**	0.020	0.017	–0.014
Marital status		–0.002	0.016	–0.052^**	0.053^**
Divorce status		–0.106^**	0.048^**	0.131^**	–0.077^**
Reproductive status		0.070^**	0.032	0.172^**	–0.119^**
Work relationships		0.332^**	–0.126^**	–0.039^*	–0.190^**