14/03/2016. List of papers. Aim of the thesis. Hur kan vi mäta stressupplevelser på jobbet och fritiden? ISM Institutet för stressmedicin

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1 Hur kan vi mäta stressupplevelser på jobbet och fritiden? Emina Hadžibajramović Med dr, Statistiker Institutet för stressmedicin ISM Nätverksträff 8 mars 2016 Aim of the thesis To increase knowledge about validity evaluation and interpretability of a multi-item self-report questionnaire used in occupational health and stress research To investigate longitudinal associations between the psychosocial work environment and symptoms of burnout List of papers I. Hadžibajramović E., Svensson E., Ahlborg G Jr. Construction of a global score from multi-item questionnaires in epidemiological studies. Working paper series 4/2013, Örebro University, II. III. IV. Hadžibajramović E., Ahlborg G. Jr., Grimby-Ekman A., Lundgren-Nilsson Å., Internal Construct Validity of the Stress-Energy Questionnaire in a working population, a cohort study. BMC Public Health, 201, 1:180 Hadžibajramović E., Ahlborg G. Jr., Håkansson C., Lundgren-Nilsson Å., Grimby- Ekman A., Affective stress responses during leisure time validity evaluation of a modified version of the Stress-Energy Questionnaire, Scan J Public Health 201 doi: / , Epub ahead of print September 201. Sage Publications Hadžibajramović E., Ahlborg G. Jr., Grimby-Ekman A., A longitudinal study of the impact of psychosocial job stressors on symptoms of burnout, synchronous and delayed effects, Manuscript 1

2 Mätprocessen Att mäta känslor, upplevelser, arbetsmiljö STRESS Stress-Energy Questionnaire (SEQ) Hur har du känt dig i arbetet under den senaste veckan? Inte alls Hur har Du känt Dig i arbetet under den senaste veckan (besvaras bara om Du förvärvsarbetat en eller flera av de senaste 7 dagarna)? Svara genom att markera rutan under det svarsalternativ som bäst motsvarar hur Du känt Dig. Fyll i snabbt utan att tänka efter alltför mycket. Inte Knappast Alls alls 0 Något Knappast Något alls 1 Ganska Ganska 3 Mycket Mycket, Mycket mycket 2 4 Mycket, mycket Avslappnad Stress Avspänd Lugn Stressad Pressad Spänd Energisk Energy Aktiv Skärpt Ineffektiv Passiv Slö Less Mor e 2

3 Frågeformulär som mätinstrument Kvalitetsbegrepp Validity Reliability Vad vill jag mäta? Vad är syftet? Finns det etablerade formulär? Mätkvalitet? Sensitivity Responsiveness Interpretability Validitet och reliabilitet Material and methods Cohort study of mainly healthcare employees (86%) Baseline 2004 (T1) Follow-ups 2006 (T2), 2008 (T3), 2010 (T4) Study group Measures Methods Paper I T1 n=2817 SEQ CBA, Median Paper II T1 n=880 SEQ Rasch analysis Reliable Not valid Valid Not reliable Not valid Not reliable Both Valid and reliable Paper III T1 n=92 SEQ-LT Rasch analysis, CBA Paper IV T1 T2 T3 T4 n=3209 n=266 n=1970 n=1422 SMBQ (Burnout) Demand, Decision Effort, Reward SEQ, SEQ-LT Mixed effects regression with random intercept, CBA 3

4 Paper I What is the global level of stress? Not at all Hardly Somewhat Fairly Much Very much Stressed Pressured Tense Relaxed Rested Calm Arithmetic operations and equidistant scale categories Results paper I Median approach Criterion based approach (CBA) Not at all Hardly Somewhat Fairly Much Very much Stressed Pressured Tense Relaxed Rested Not at all Hardly Somewhat Fairly Much Very much Calm

5 ' 14/03/2016 Criterion based approach (CBA) cont. Conclusion paper I Not at all/hardly Somewhat/Fairly Much/Very much Low stress or 0 0 or or 1 0 or Medium All other combinations Both CBA and median fit the ordinal data well CBA better choice when the goal is to identify risk groups CBA here applied on SEQ, can be easily applied on other questionnaires High stress or 1 1 or 0 0,1 or 2 2,1 or Paper II Rasch analysis, objective measurement and stress P{ x x} ni e mi x' 0 1i e 2i... xi x( n i ) 1i 2i... x i x'( n i ) Questionnaires development and construct validity Unidimensionality Invariance Monotonicity Local dependence Sufficient statistics Less Mor e

6 Results paper II - stress Results paper II - stress All items worked properly Results paper II - stress Results paper II - energy All items worked properly No DIF for gender Problems with local dependency Good targeting Transformation table presented Out-of-bound residuals items inefficient and passive Disordered thresholds item dull 6

7 Results paper II - energy Results paper II - energy Out-of-bound residuals items inefficient and passive Disordered thresholds item dull DIF for gender item passive Problems with local dependency Not optimal targeting Conclusion paper II Paper III Good psychometric properties both stress and energy scale after adjusting for local dependency Transformation table for stress scale to be used instead of mean scores Stress scale works for group and individual comparisons Energy for group comparisons only 7

8 Stress-Energy Questionnaire leisure time (SEQ-LT) Conclusion paper III During the past when you were week, how did you not working usually feel when you were at work? Good psychometric properties after adjusting for local dependency SEQ-leisure time can be used in present form as standalone or in combination with SEQ (e.g. work-life balance) Stress scale valid for groups and individual Energy scale for group comparison only Att skatta utbrändhet Lundgren-Nilsson, A., I. H. Jonsdottir, J. Pallant and G. Ahlborg, Jr. (2012). "Internal construct validity of the Shirom- Melamed Burnout Questionnaire (SMBQ)." BMC Public Health 12: 1. Shirom-Melamed Burnout Questionnaire - SMBQ Känslomässigt/fysisk trötthet trött pigg fysisk utmattad att jag har fått nog mina batterier är uttömda utbränd mentalt trött att jag inte orkar gå till arbetet på morgonen Spändhet spänd avspänd rastlös stark inre spänning Håglöshet full av energi alert aktiv dåsig Mental trötthet Trött i huvudet Svårt att koncentrera mig Trögtänkt Kan inte tänka klart Svårt att tänka på komplicerade saker Splittrad i tankarna 8

9 SMBQ Good psychometric properties showed for revised 18 item questionnaire (SMBQ18) SMBQ18 can be used in clinical settings, where many individuals are not currently working Can also be used for working populations Cut-off point (4.4) offers opportunity to identify potential clinical cases of burnout Can be used to follow the course of symptoms over time Transformation table available Paper IV Lundgren-Nilsson, A., I. H. Jonsdottir, J. Pallant and G. Ahlborg, Jr. (2012). "Internal construct validity of the Shirom- Melamed Burnout Questionnaire (SMBQ)." BMC Public Health 12: 1. Theoretical model SEQ, SEQ-LT Demand Decision authority Effort Reward SMBQ Thank you for your attention! 9