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DOI: 10.5958/j.2319-5886.2.2.

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International Journal of Medical Research & Health Sciences


www.ijmrhs.com
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Volume 2 Issue 2 April - June

Coden: IJMRHS
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Copyright @2013

ISSN: 2319-5886
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Received: 25 Feb 2013 Research article

Revised: 24 Mar 2013

Accepted:29 Mar 2013

THE PREVALENCE AND ANTECEDENTS OF OCCUPATIONAL STRESS AMONG RADIOGRAPHERS IN ZIMBABWE: INTERPLAY OF ECONOMICS AND CULTURE. *Chingarande George R, Ndlovu Bekezela Radiology Department, University of Zimbabwe, Zimbabwe *Corresponding author email:gchingarande@yahoo.com; grchingarande@medsch.uz.ac.zw
ABSTRACT

The purpose and objectives of this study were to find out the incidence of Occupational Stress amongst radiographers and also to find out the main stressors that they are exposed to. A cross sectional survey using both qualitative and quantitative methodologies and a questionnaire as a research tool was conducted. The questionnaire was given to all radiographers working in the general radiology department of the six departments/centres that participated in the study. The results revealed that there is a high incidence of occupational stress among medical radiographers working in general radiology. The results also showed that the most frequently encountered stressors in the general radiology department are pressure to complete tasks/overwork, inadequate salaries and inadequate holiday/vacation time. There were no significant differences in the incidences of occupational stress between male and female radiographers. However, there were differences in the perceptions of the two genders on the causes of stress. This was attributed to the cultural gender role expectations. Keywords : Occupational stress; Radiographers, Gender role, Culture, Stressors
INTRODUCTION

Occupational stress has been linked to a range of adverse physical and mental effects, including insomnia, depression, cardiovascular disease and anxiety1. Stressful working conditions have also been reported to impact negatively on employee well-being by directly contributing to negative health behaviours or by limiting an individuals ability to make positive changes to lifestyle behaviors, such as smoking and sedentary behaviours2. Occupational stress can result from the job itself (i.e., heavy workload, lack of control) or the social and organizational contexts in which the job is done (i.e., poor Chingarande George et al.,

communication, interpersonal conflict). Workers perceive and respond differently to the environment in which they work. Health care workers have been reported to be among the most stressed professionals3. This has been attributed to the increased risk of infection, high job demands, compassion fatigue, understaffing, inadequate resources, a lack of control and/or participation in planning, and a lack of work security. Zimbabwes health care system is characterized by inadequate staffing, reduced accessibility by the general population, shortages of essential drugs and medical
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supplies, and outdated and poorly functioning equipment (USAID, 2009)4. This, coupled with long working hours, exposure to infectious diseases and hazardous substances, the threat of malpractice litigation and constant encounters with death and dying conspires to expose radiographers to occupational stress. The deleterious effects of occupational stress on work performance have also been reported5. Extant literature review reveals that the prevalence of Occupational stress among radiographers has not been investigated in Zimbabwe. The current study sought to address that lacuna by seeking to establish firstly, the prevalence of occupational stress among radiographers in Harare and Chitungwiza, and secondly its antecedent causes. Harare is the capital city of Zimbabwe whereas Chitungwiza is a town about thirty kilometers to the south of Harare, which was originally established as a dormitory to the capital. The two were selected because they were deemed convenient and easily accessible sites to conduct an exploratory study of this nature.
MATERIALS AND METHODS

hand delivered and then completion on agreed dates.


RESULTS

collected

after

After ethical approval was granted by the University of Zimbabwe College of Health Sciences Joint Research and Ethics Committee, 38 consenting radiographers employed in the government hospitals were enrolled into the study. A self report questionnaire was employed as the data collection instrument. The questionnaire was arranged into three thematic sections. The first section was designed to elicit information on demographic data such as age band, gender, professional experience, marital status and tenure with the present employer. The second section was designed to measure the prevalence of occupational stress and its causes. The third section was open-ended and requested the participants to suggest solutions of alleviating occupational stress. The questionnaires were

A total of 41 questionnaires was delivered and 38 usable questionnaires were returned yielding a 93% response rate. 58% of the participants were female, while 42% were married. There were no divorcees and widowed. 68% of the participants were in the age band 21-30; 21% were in the 3039 age-band, 3% were in the 40-49 band and 8% were above 50 years old. Furthermore 13% of the participants had less than one year experience, 37% had more than one year but less than two years experience, 15% had more than two years but less than five years, 13% had more than five years but less than 10 years while 21% had more than 10 years professional experience. The fact that 50% of the participants had less than two years experience is a graphic but a grim illustration of the impact that brain drain has had on the radiography profession in Zimbabwe. Analysis of tenure in current workplace revealed that 63% of the participants have been with the current employer for less than two years while 8% had been with their current employer for more than two years but less than five years and 29% had been at their current workplace for more than 5 years, with 8% reporting that they had been with the current employer for more than ten years. To establish the prevalence of occupational stress the radiographers were asked to indicate the extent to which they agreed with six statements. These are; Work commitments are affecting my social relationships; I am so busy I find it increasingly difficult to concentrate on the job at hand; I am often exhausted in the morning at the thought of work; I find it difficult to control my emotions; I feel so tired during the day, when at work and I feel that my experience stress at work. These questions were based on factors and symptoms of stress which are fatigue, dread of work, lack of emotional control, no time for social relationships and being overwhelmed by work. The options available to the respondents
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ranged from strongly agree (indicating the severity of the stressor) to strongly disagree (indicating the absence of the stressor). A scoring system was designed in which, strongly disagree was given a value of one with strongly agree given the maximum value of five. Thus the higher the individual score, the more severe the exposure to the stressors hence the more stressed the individual. This means that the total score for an extremely stressed person

would be thirty (from 5*6=30) and the least stressed person would score a total of six (from 6*1=6). Under this system, a score of 12 or less would mean that the person is experiencing insignificant occupational stress; a total score between 13 and 18 would indicate moderate stress and a total score above 18 would mean the presence of significant occupational stress. Table 1 below presents a summary of the prevalence of occupational stress.

Table 1:Prevalence of occupational stress among radiographers. Stress Category Number of participants Prevalence Insignificant Moderate Significant Total 7 12 19 38 18.4% 31.6% 50% 100%

Table 2: Causes of occupational stress.

Main stressors Variable Lack of control Lack of recognition Lack of respect from supervisors Overwork/arc work pace Inadequate pay Fear of illness Exposure to radiation Forced overtime/long hrs Too much pressure Call duty Harassment Job insecurity Sexism Lack of prospective promotion Workplace noise Poor ventilation Poor lighting Poor communication Inadequate holiday/vacation/time off

Number of participants reporting this variable as a stressor. Total No (%) 15 (39.4) 18 (47.4) 11 (28.9) 29 (76.3) 24 (63.2) 6 (15.8) 10 (26.3) 12 (31.6) 18 (47.4) 14 (36.8) 7 (18.4) 3 (7.8) 4 (10.5) 11 (28.9) 3 (7.8) 12 (31.6) 4 (10.5) 14 (36.8) 23 (60.5) Women (%) 8 (53.33) 9 (50.0) 4 (36.4) 15 (51.7) 9 (34.6) 2 (33.3) 5 (50.0) 7 (58.3) 11 (61.1) 6 (42.9) 2 (28.6) 0 1 (25) 4 (36.4) 0 4 (33.3) 1 (25) 8 (57.1) 12 (47.8) Men (%) 7 (46.66) 9 (50.0) 7 (63.6) 14 (48.3) 15 (65.4) 4 (66.7) 5 (50.0) 5 (41.7) 7 (38.9) 8 (57.1) 5 (71.4) 3 (100) 3 (75) 7 (73.6) 3 (100) 8 (66.7) 3 (75) 6 (42.9) 11 (52.2)

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Fifty percent of the radiographers rated their occupational stress level in the significant region. Furthermore, the respondents were presented with a more direct item, I feel my experience stress at work. prefaced by an instruction to indicate the extent to which they agreed with the statement. A total of 71.1% (27) of the sample perceived that they were experiencing occupational stress and only 15.8% (6) of the sample perceived that they did not experience any occupational stress. The remaining 13.1% (5) was undecided. To establish the major causes of occupational stress the radiographers were presented with a list of stressors gleaned from the literature and asked to indicate the stressors that were applicable to them. They were also asked to identify what they believed to be the three main stressors The most frequently mentioned stressors were Overwork/accelerated work pace with (76.3%), Inadequate pay (63.2%) and Inadequate holidays/vacations/time away from work with (60.5%). The top three stressors among females were Overwork, Inadequate holidays and Too Much pressure. Males reported Inadequate Pay, Overwork and Inadequate Holidays as the most common antecedents of stress. When asked to list the three main stressors 81.6% of the participants listed Overwork/accelerated work pace, inadequate pay and inadequate holidays/ vacation/ time off. The most frequently suggested solutions to occupational stress were; Pay increase, Reduction of working hours, Provision of more time for vacation and leave, Increasing the staff complement and Staff development aimed at improving staff-supervisor relationships.
DISCUSSION

The main thrust of this study was to investigate the prevalence of occupational stress among radiographers working in public hospitals in Harare and Chitungwiza. Hence extrapolation to cover all radiographers in Zimbabwe should be

done with extreme caution. In this study 50% of the radiographers reported experiencing significant occupational stress. Such a high incidence of stress can therefore lead to a high incidence of ill health since the link between occupational stress and an increase in a whole spectrum of physical illnesses, from the common cold to cancer, heart disease, diabetes and sudden death is well established6. In the long run this will be negatively repercussive on the productivity of the radiology departments. The study revealed that the most common antecedents of occupational stress were overwork/Accelerated work pace, inadequate pay, inadequate holiday/vacation/time, too much pressure and lack of recognition. A further finding was that male radiographers consider inadequate pay as a stressor higher than their female counterparts. The cultural milieu within which these radiographers work emphasizes the role of the male as the bread winner and protector of the family. This assumes more significance and salience during perilous times such as the prevailing economic environment. Failure to discharge this role is viewed as social deviance and impotence on the part of the male. Hence the culture is placing an even higher burden of stress on the male radiographer. Wilkes et al (1998)7 reported that work overloads and time constrains were significant contributors to work stress among nurses. The results of the current study are in keeping with that finding although the focus here is on radiographers. Untenable workloads are a constant characteristic of a healthcare workers job in developing countries. The workload conundrum among radiographers in Zimbabwe can be traced to the economic imbroglio that blighted the country in the last decade. Economic hardships resulted in less and less people affording and accessing private health care; and more and more people patronizing radiography services in public hospitals. This increased patronage spawned increased workload on the radiographers. The economic meltdown also gave impetus to a brain drain which saw many
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experienced radiographers seeking employment abroad leaving the public radiography departments inadequately staffed. This problem was further complicated by the government decision to impose a moratorium on recruitment of staff in the civil service which adversely affected the health sector in general and radiography in particular. The second most commonly cited stressor was inadequate pay. This finding is in concordance with the findings of Sehlen (2009)8 and Ernst and colleagues9. The problem is not unique to Zimbabwe as the National Institute of Occupational Safety and Health in the United States10 (2008) also identifies financial and economic factors as stress. However, remuneration for radiographers working in the public service in Zimbabwe remains untenably low with junior cadres earning less than US$400 per month in comparison with a poverty datum line of $600. The unsustainably low remuneration incentives radiographers to moonlight in the private radiology centers. Ironically the already overworked radiographers, who should be seeking to rest and recuperate, seek more work in an effort to mitigate their financial woes and in the process exacerbate burn out. The third most commonly cited stressor was Inadequate holidays, vacations and time away from work. This stressor is symbiotically linked to the other two stressors already discussed. Inadequate staffing levels and work overload result in more work and longer working hours for the radiographers. On the other hand the radiographers opt to work extra hours as a way of augmenting their low salaries by boosting their overtime pay. This creates a vicious cycle in that inadequate time away from work invariably leads to burn out; burn out leads to reduced productivity; reduced productivity results in work backlogs which in turn have a direct impact on occupational stress. Both male and female radiographers cited inadequate time away from work as stressors. However, further probing,

revealed that their reasons for this were different. The males want more time away from their regular jobs so that they can engage in other income generating activities to fend for the family while their female counterparts expressed a desire to spend more time with the family. The culturally prescribed roles (mother role for the female and bread winner role for the male) have a huge influence on how the two genders perceive the antecedents to occupational stress.
CONCLUSION AND RECOMMENDATIONS

Occupational stress among radiographers in Zimbabwe is linked to the interplay between economics and culture. Remuneration of radiographers, and indeed all civil servants, remains an intractable issue. While the need for upward revision of the salaries is not disputed, the government pleads that it does not have the requisite resources. There is no easy panacea to the economics dimension of the cryptic puzzle. Therefore, while the stakeholders are engaged in discussions over improvement of remuneration, it is imperative that other initiatives to alleviate occupational stress be explored and implemented. These include unfreezing the moratorium on recruitment of radiographers; reduction in working hours and introduction of flexible working hours to accord the radiographers adequate time to rest and recuperate and also fulfill their culturally prescribed roles; introduction of work stress intervention programs designed to teach radiographers about the nature and sources of stress, the effects of stress on health, and personal skills to reduce stress; and the introduction of regular medical checks. Specialist services should be made freely available to those radiographers in need of treatment for occupational stress.
ACKNOWLEDGEMENTS

The study was fully sponsored from the authors own resources.

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