Employment Insecurity, Workplace Justice and Employees Burnout in Taiwanese Employees: A Validation Study

Transcription

1 Int.J. Behav. Med. (2011) 18: DOI /s y Employment Insecurity, Workplace Justice and Employees Burnout in Taiwanese Employees: A Validation Study Yawen Cheng & Hsun-Yin Huang & Pei-Rong Li & Jin-Huei Hsu Published online: 8 March 2011 # International Society of Behavioral Medicine 2011 Abstract Background Employment insecurity and workplace injustice are important psychosocial hazards. However, few studies of these associations have been conducted in Chinese-speaking populations. Purpose This study evaluated the psychometric properties of a Chinese version of employment insecurity and workplace justice scales, and examined their associations with the levels of workers burnout status in Taiwanese workers. Method Study subjects were participants in a national survey of employees in Taiwan, consisting of 9,636 men and 7,406 women. A self-administered questionnaire was used to assess employment insecurity (six items) and workplace justice (nine items), as well as other psychosocial work characteristics. After the survey was completed, in-depth interviews with 10 employees were conducted for a qualitative evaluation. Results Cronbach s α was 0.87 or greater for the workplace justice scale and 0.76 or greater for the employment insecurity scale, indicating satisfactory internal consistencies. Exploratory factor analyses revealed a factor pattern Y. Cheng : H.-Y. Huang Department of Public Health, National Taiwan University, Taipei, Taiwan Y. Cheng (*) : H.-Y. Huang : P.-R. Li Institute of Health Policy and Management, College of Public Health, National Taiwan University, 17, Xu-Zhou Rd, Taipei, Taiwan ycheng@ntu.edu.tw J.-H. Hsu Institute of Occupational Safety and Health, Council of Labor Affairs, Taipei, Taiwan consistent with the theoretically assumed structure, except that the items with statements in reversed direction were loaded on separated factors. Higher levels of employment insecurity and lower levels of workplace justice were associated with higher burnout scores. However, results from the qualitative interviews suggested that some questionnaire items contained double-barreled questions, and some questions were misinterpreted or considered irrelevant by participants. Conclusion The Chinese version of employment insecurity and workplace justice scales were found to have satisfactory reliability and validity. However, improvement of these scales is still needed. Keywords Employment insecurity. Workplace injustice. Validity. Reliability. Taiwan Introduction Recent epidemiological studies have shown that both employment insecurity and workplace injustice are important psychosocial hazards for stress-related illnesses in the workplace. Employment insecurity has been found to be associated with poor self-rated health and increased risks of psychological problems [1 4]. Different from job insecurity which measures the likelihood of being able to maintain desired continuity of a particular job, employment insecurity reflects the likelihood of being able to remain in paid employment in the labor market [5 7]. In economies that are dominated by smaller-sized enterprises and characterized by less-regulated work contracts and high labor mobility rates, it can be postulated that lacking in employment security, or having fewer suitable employment opportunities, would constitute a greater threat to workers than job insecurity per

2 392 Int.J. Behav. Med. (2011) 18: se [1]. Employment insecurity might be more prevalent among socio-economically disadvantaged groups and its impacts might be greater in poorly regulated labor markets. Most studies on this topic have used single-item question to assess job insecurity [8 12], and most studies concerning employment security have been conducted in western European countries where employment practices are more strictly regulated [13, 14]. Workplace justice, defined as whether a worker is treated fairly in the workplace, has emerged as an important determinant of workers health. Most scales to assess workplace justice are based on questionnaires originally developed by Moorman (18 items) [15] and Colquitt (20 items) [16]. As originally conceptualized by Moorman, workplace justice consists of the following components: distributive justice, procedural justice, interpersonal justice, and informational justice; the latter two could be combined and categorized as interactional justice [15]. Distributive justice refers to the fairness or equality of reward systems; items of this subscale measure the degree to which the respondent perceives that he or she is fairly rewarded based on performance, effort, qualification, etc. Procedural justice denotes justice in the decision-making process, and items tapping this dimension are designed to measure the degree to which fair procedures are used. For instance, decision processes are considered to have high procedural justice if they involve democratic participation of employees, provide opportunities to challenge the decision, and are based on reasonable rationales. Interpersonal justice refers to the justice of interpersonal relationship, as is related to whether a worker is treated by authorities with politeness, respect, dignity, and fairness. Informational justice focuses on the extent to which an employee is informed in a timely and truthful manner about major decisions of the work organization as well as related labor rights [15 18]. Studies have associated lower levels of workplace justice with a variety of health problems, including poor self-rated health, mental disorders, sleeping problems, metabolic syndrome, and chronic inflammation [18 21]. The measures of both employment insecurity and workplace justice have been developed and examined by researchers in western societies [3, 13, 14, 21, 22] and recently in Japan [23, 24]. However, to our knowledge, these measures have not been tested and their associations with health risks have not been studied in Chinese-speaking populations. As stress-related health problems have become a rapidly growing concern in Taiwan as well as in China, there is an urgent need to develop reliable and valid measures for these two important aspects of psychosocial work characteristics. This study was designed to investigate psychometric properties of the Chinese version of employment insecurity and workplace justice scales and to examine their associations with the levels of workers burnout status in a representative sample of paid employees in Taiwan. It is generally agreed that there are gender differences in psychosocial work conditions, health status, as well as some gender-specific factors that might alter the relations between work and health, such as social roles, social expectations, and family workloads [25, 26]. To explore potential gender differences, we conducted analyses separately in men and women. Methods Study Subjects and Procedures The Council of Labour Affairs of Taiwan has conducted a nationwide survey of paid employees every 3 5 years since Subjects for this study were participants of the survey conducted in September Participants were selected through a two-stage random sampling process. In the first stage, all districts and villages throughout Taiwan were grouped into strata according to their levels of urbanization. A random sample of districts and villages was chosen from each stratum. In the second stage, a random sample of households was selected within each district or village, and residents of the sampled households who were currently working as paid employees at the time of survey were identified and invited to participate in the survey. More detailed information with regard to the sampling scheme can be found elsewhere [11, 27] A total of 22,476 employees were sampled. Selfadministered questionnaires were delivered to the selected households by trained interviewers. After 1 week, completed questionnaires were collected and onsite checking was performed by the same interviewer. A total of 19,329 subjects completed and returned questionnaires, with an overall response rate of 86%. For this study, we excluded subjects who were aged younger than 25 or older than 65 years. This resulted in a sample of 9,636 men and 7,636 women (N=17,042). Questionnaire Based on existing questionnaires, six items for the assessment of perceived employment insecurity and nine items for workplace justice were selected. Due to the constraint of our questionnaire, only selected items were included. For the employment insecurity scale, two items (job security is good and career prospects are good) were adopted from Karasek s Job Content Questionnaire (JCQ), and four items were modified from the Copenhagen Psychosocial Questionnaire [22, 28].

3 Int.J. Behav. Med. (2011) 18: The nine-item workplace justice scale consists of three items for distributive justice, two items for procedural justice, two items for informational justice, and two items for interpersonal justice [15, 16, 23, 29]. Each item was listed as a statement and the response was recorded on a four-point Likert scale, ranging from 1 (strongly disagree) to 4 (strongly agree). The full statements and the calculation formulas of their scores are listed in Appendix 1. Items of the Chinese version of JCQ were also included in the questionnaire. This included nine items for the job control scale (learning new things, non-repetitive work, creative work, allowing own decision, high level of skills, freedom to make decision, various tasks, influential opinions, and develop one s abilities), seven items for psychological job demands (fast work, hard work, excessive work, insufficient time, concentrate on job for long time, hectic work, insufficient manpower) and one item for physical job demand (physically demanding work). The job control scale consists of two sub-components: decision authority (assessed by three items) and skill discretion (assessed by six items). The JCQ was based on Karasek s Demand Control model. This model postulates that the combination of high psychological job demands and low job control causes job strain and stress-related illnesses. Information regarding the psychosocial properties of the C-JCQ can be found elsewhere [30]. In this study, we expanded the original five-item scale for psychosocial job demands to seven items, because previous studies found that the internal consistency of the five-item demand scale was low [27, 30]. The survey also obtained information on age, gender, employment grade, as well as general burnout and workrelated burnout status as assessed by the Chinese version of the Copenhagen Burnout Inventory [31]. For all the scales, scores of reversed items were reordered in order to make the items additive in the same direction. Data Analysis Cronbach s α coefficient was calculated for employment insecurity and workplace justice to assess internal consistency. To test construct validity, all of the items for employment insecurity, workplace justice, job control, and psychosocial job demands were subjected to an exploratory factor analysis using maximum likelihood method and Promax rotation. Factors with eigenvalues of 1.0 or above were extracted. Pearson correlations of all the four scale scores as well as scores of two burnout scales were examined in order to assess concurrent validity. Multivariable regression models were applied to examine the association of psychosocial work characteristics (with scores classified into tertiles) with burnout status. All the analyses were performed separately for men and women to explore potential gender differences. The SAS 9.1 edition (SAS Institute, Cary, NC, USA) was used for the analyses. Qualitative Assessment after the Survey We conducted in-depth interviews after the survey to obtain a better understanding of the validity of data produced by the employment insecurity and workplace justice scales. While a growing number of standardized scales have been developed to obtain information with regard to the perceived levels of justice, fairness, and employment security, few studies have been conducted to investigate how participants interpreted questions and formulated answers. Evidence from psychological and sociological research have shown that the processes involved in interpreting questions and formulating answers are quite complex, and qualitative evaluations could help shed light on the complexities of the cognitive process [32, 33]. Five male and five female employees aged between 25 and 65 years old were invited to participate. The demographic and work characteristics of these individuals were presented in Appendix 2. The interviews took place in their own homes or workplaces. Prior to the interviews, the purposes of this questionnaire as well as the rationale of this ongoing study were explained by two trained interviewers, and informed consent was obtained. Interviewees were first asked to complete the questionnaire on their own, and afterwards face-to-face interviews were conducted to explore interviewees interpretation of questions and their rationales for choosing different responses. Interviewees were also asked to provide their understanding of each question. Interviews were recorded, transcribed, and the content was analyzed qualitatively. Results Characteristics of Study Subjects Table 1 summarizes age, employment grades, and the average and standard deviation values of scale scores by gender. The average age for men and women were 40.1 and 38.6, respectively. The majority of men were manual workers. Skilled manual skilled and low-skilled manual workers accounted for 51% of the males; for women, manual work accounted for 27.3% of workers. Men scored significantly higher on job control, psychosocial job demands, but women scored significantly higher on personal and work burnout scales (p value <0.05). No substantial gender difference was found on scores of employment insecurity and workplace justice (Table 1).

4 394 Int.J. Behav. Med. (2011) 18: Table 1 Demographic characteristics, work conditions, and burnout status of the study population (n=17,042) Demographic characteristics: Men (n=9,636) Women (n=7,406) Gender difference Mean (SD) n (%) Mean (SD) n (%) p value Age (9.78) (9.41) <0.001 Employment grade <0.001 Administrator/manager 410 (4.25) 97 (1.31) Professional 910 (9.44) 855 (11.54) Non-manual skilled 2,155 (22.36) 1,697 (22.91) Non-manual low-skilled 1,247 (12.94) 2,737 (36.96) Manual skilled 2,095 (21.74) 192 (2.59) Manual low-skilled 2,819 (29.25) 1,828 (24.68) Job control (14.07) (14.37) <0.001 Skill discretion (14.75) (14.79) <0.001 Decision authority (16.97) (17.47) <0.001 Psychological Job demands (11.71) (12.54) <0.001 Employment insecurity (18.51) (16.07) n.s. Workplace justice (13.91) (14.11) n.s. Personal burnout (19.64) (20.88) <0.001 Work burnout (18.94) (19.80) <0.001 Gender differences were tested with t test (for continuous variables) and chi-square test (for categorical variables) n.s. non significant Internal Consistency Table 2 shows the average, standard deviation, itemsubtotal correlations, and Cronbach s alpha coefficients for all the items of employment insecurity and workplace justice. All of the items with statements framed in an opposite direction were recoded prior to the analyses, in order to make the items of the same scale additive in the Table 2 Mean values, standard deviation, and internal consistency of items of employment insecurity and workplace justice (n=17,042) Men (n=9,636) Women (n=7,406) Mean (SD) α if item is deleted Cronbach s α Mean (SD) α if item is deleted Cronbach s α Employment insecurity Job security a 2.57 (0.42) (0.42) 0.76 Career prospects a 2.73 (0.32) (0.30) 0.79 Worry about job loss 2.56 (0.65) (0.66) 0.69 Worry skills are outdated 2.48 (0.57) (0.59) 0.71 Difficulty in finding a suitable job if laid off 2.68 (0.58) (0.59) 0.71 Unwanted job transfer 2.46 (0.50) (0.53) 0.73 Workplace justice Trust 2.83 (0.69) (0.68) 0.86 Information reliable 2.85 (0.67) (0.67) 0.86 Information hidden a 2.58 (0.11) (0.12) 0.90 Employees influential 2.62 (0.49) (0.49) 0.87 Work arranged fairly 2.67 (0.73) (0.73) 0.85 Rewards arranged fairly 2.67 (0.72) (0.72) 0.85 Performance evaluated fairly 2.66 (0.76) (0.75) 0.85 Information during decision making process 2.73 (0.73) (0.71) 0.85 Respect 2.81 (0.72) (0.73) 0.85 a Item with statement in an opposite direction; score of the item was recorded for analysis

5 Int.J. Behav. Med. (2011) 18: same direction. For both men and women, Cronbach s α coefficients were 0.87 or greater for the workplace justice scale, and 0.76 or greater for the employment insecurity scale, indicating satisfactory internal consistencies (Table 2). However, analyses of item-subtotal correlations suggested that deleting items with statement which were originally framed in a reversed direction (job security, career prospects, and information hided) improved internal consistency. Construct Validity All of the items for employment insecurity, workplace justice, job control, and psychosocial job demands were examined using exploratory factor analysis. As seen in Table 3, seven factors were extracted and the factor structures were similar for men and women. Eight out of nine items for workplace justice were loaded on the first factor, which explained more than 20% of total variance; seven out of nine items for job control were loaded on the second factor, explaining about 12 13% of variance; and four out of six items for employment insecurity were loaded on the third factor, explaining 9.8% of variance. The rest of the items were loaded on the other four factors. Items with statements in an opposite direction were all loaded in different factor from the other items of thesamescale(table3). Concurrent Validity Table 4 presents Pearson correlation coefficients of the measured psychosocial work characteristics as well as general and work-related burnout scores. Higher scores in job control were found to be associated with lower levels in employment insecurity as well as higher levels in workplace justice; higher levels of employment insecurity were associated with lower levels of workplace justice; and higher levels of burnout status were significantly associated lower scores in workplace justice. These patterns were similar for males and females. Multivariate regression analyses were performed on general burnout and work-related burnout scores, including employment insecurity, workplace justice, job control and psychological job demands as explanatory variables, and with adjustment of age, employment grade, physical job demands, and average working hours. As shown in Table 5, higher levels in psychological job demands and low levels of workplace justice were found to be the most important predictors of workers burnout status. Qualitative Assessment In face-to-face interviews, interviewees were asked about how they interpreted the questions and how they chose the answers. The questionnaire items were considered straightforward and most of the questions were answered in a reasonable manner. Occupation- or context-specific situations were brought out during the interviews, but were mostly covered by the generic questions. However, a number of problems arose. 1. Double-barreled questions Some questionnaire items for employment insecurity contain double-barreled questions (Q3, Q4, Q5, and Q6). In such items, participants are asked whether or not they agree that they have encountered a specified situation, and are also asked whether or not they are bothered or distressed with it. For example, to the question If being laid off, I am worried that I would have difficulty finding a suitable job, a middle-aged women who worked as a nursing aid in a government-owned medical center (F8) answered disagree. She explained that she was not worried, because her current job as a nursing aid was already quite unsuitable considering her educational background (accounting) and previous work experiences. Another respondent, a young woman with a college degree in education who worked in a private pre-school institute (F9) also answered disagree. But she expressed confidence in finding suitable job opportunities in the labor market if she was to be laid off. Such questions mix objective conditions with subjective evaluation, thus making responses difficult to interpret. 2. Unfamiliar, irrelevant, or misinterpreted terms Some terms appeared to be unfamiliar or irrelevant to some participants. For example, a female security janitor in her mid-50s (F10) did not respond to the question I am worried that my skills would be outdated because of new technology. When asked why skipped this question, she explained that she did not understand what new technology would mean in her job. Some employees in service sectors (M4, M5, F9) expressed uncertainty about the definition of new technology or found it irrelevant to their job tasks, but some employees in high tech and manufacturing industries (M1, M2, F6) found this question very relevant and agreed that this aspect contributes to their employment opportunities. With regard to the statement of My prospects for career development and promotions are good, a 50- year-old blue-collar machine operator in a small-sized factory (M1) commented that this statement was irrelevant, nevertheless, he still chose agree to this statement and explained that he was satisfied with this job, despite that the job tasks were routine and there was no room for development or promotion. This finding suggested that expectation toward career development or promotion opportunities might vary according to people s socioeconomic positions.

6 396 Int.J. Behav. Med. (2011) 18: Table 3 Exploratory factor analysis of four scales using maximum likelihood method and Promax rotation for workers (n=17,042) Scale Items Male (n=9,636) Female (n=7,406) F1 F2 F3 F4 F5 F6 F7 F1 F2 F3 F4 F5 F6 F7 SD Learn new things Work not repetitive a Creative work High level of skills Various tasks Develop own abilities DA Allow own decisions Freedom to make decision a Opinions influential (lot of say) PD Work fast Work hard Excessive work a Insufficient time a Concentrate on job for a long time Hectic work Insufficient manpower EI Job security a Career prospects a Worry about job loss Worry skills are outdated Difficulty in finding a suitable job if laid off Unwanted job transfer WJ Trust Information reliable Information hidden a Employees influential Work arranged fairly Rewards arranged fairly Performance evaluated fairly Information during decision making process Respect Variance explained (%) a Item with statement in an opposite direction; score of the item was recorded for analysis SK skill discretion, DA decision authority, PD psychological demands, EI employment insecurity, WJ workplace justice The statement During the process of making important decisions, my supervisor or the management department actively inform employees and provide sufficient information wasdesignedtoassesslevelsof procedural justice. However, based on participants explanations of their answers, we found that several participants had misinterpreted this question. For instance, several interviewees (M1, M2, M3, M4, and M8) responded to this question by judging how well the decision results were made publicized, rather than by judging the extent to which information was released during the decision-making process. It seemed that people who were more distant from management were less concerned about opportunities to participate in decision making, and thus were more likely to miss the procedural dimension which was meant to be explored by this statement. 3. Other aspects not addressed by the questionnaire When asked to give an overall evaluation on the questionnaire, participants commented that some important aspects which they considered important were not adequately addressed. For example, several

7 Int.J. Behav. Med. (2011) 18: interviewees (M2, M5, F9, and F10) considered level of income and pension as major issues of employment security; however, these were not addressed in this questionnaire. In addition, a preschool teacher (F9) was concerned about her legal responsibility for the safety of children, and she considered heavy workloads and lack of adequate accident insurance for the children as major sources of employment insecurity. Discussion Results from this study indicated that both the scales of employment insecurity and workplace justice had high internal consistency. Exploratory factor analyses of items of the four scales revealed a factor pattern that was generally consistent with the theoretically assumed structure. As predicted, higher levels of employment insecurity and lower levels of workplace justice were associated with higher burnout scores, indicating reasonable concurrent validity. A growing number of epidemiologic researches have been conducted to explore adverse health impacts of job insecurity [34 36]. To our knowledge, only a few studies have adopted multiple-item scales for the assessment of job insecurity. For instance, in studies conducted by Danish researchers, employment insecurity was assessed by a fouritem scale. The scale consisted of questions asking participants if they were worried about the following situations: becoming unemployed, being involuntarily transferred to another job; being made redundant due to the implementation of new technology, and having difficulty in finding a new job. The Danish scale was reported to have Cronbach s α coefficients ranging between 0.58 and 0.77 [3, 14, 22]. In our study, the Cronbach s α coefficients of the six-item employment insecurity scale were 0.76 and 0.77 in men and women, respectively, indicating sufficient internal consistency. Various measures have been developed to evaluate workplace or organizational justice. For instance, in a study based on the British Whitehall II Study cohort, a singleitem question was used to assess unfairness [37]. In another study based on the Whitehall II Study cohort, a five-item scale for organizational justice was constructed by using items from existing scales that were originally designed to measure effort-reward imbalance and social support [38]. This five-item scale had Cronbach s α coefficients ranging between 0.71 and 0.73 [39 42]. In studies from Finnish researchers, organizational justice was evaluated with three subscales distributive justice scale (four items, α=0.62), procedural justice (seven items, α= 0.92) and interpersonal justice (six items, α=0.95) [43]. In two recent studies from Japan, organizational justice was measured using multiple scales, including procedural justice (seven items, α= ), distributive justice (four items, α=0.96), interpersonal justice (4 6 items, α= 0.94), and information justice (five items, α=0.93) [23, 24]. Due to the constraint on the length of the questionnaire used in national surveys, we compiled nine items to assess workplace justice. Results from this present study showed that the internal consistency of the nine-item workplace justice scale (Cronbach s α coefficients above 0.87) was comparable to values obtained from other international studies. Results of exploratory factor analysis of all the items for assessment of psychosocial work characteristics showed a factor solution that was consistent to the theoretically Table 4 Pearson correlation coefficients of psychosocial work variables for males and females (n=17,042) Job control Psychological demands Employment insecurity Workplace justice Personal burnout Job control 1 1 Psychological demands 0.15*** *** 1 Employment insecurity 0.35*** 0.17*** *** 0.11*** 1 Workplace justice 0.28*** 0.15*** 0.30*** *** 0.20*** 0.29*** 1 Personal burnout *** 0.16*** 0.30*** ** 0.40*** 0.12*** 0.34*** 1 Work burnout *** 0.18*** 0.32*** 0.84*** *** 0.14*** 0.36*** 0.84*** Upper value in each cell is for men and lower value for women **p<0.01, ***p<0.001

8 398 Int.J. Behav. Med. (2011) 18: Table 5 The multivariable regression model of burnout score on age, employment grade, psychosocial work-related factors among the employees Male (n=9,636) Female (n=7,406) Personal burnout Work burnout Personal burnout Work burnout ß 95% CI ß 95% CI ß 95% CI ß 95% CI Age , , , , 0.47** , , 0.64*** , , 0.83*** , , 1.03*** , 0.62** , 2.05*** Employment grade Administrator/manager , 5.09** , 5.81*** , 9.29** , 8.15** Professional , , 3.37** , 5.50*** , 6.44*** Non-manual skilled , , 2.97*** , 4.51*** , 5.17*** Non-manual low-skilled , , , 3.55*** , 3.33*** Manual skilled , , , 5.75* , 4.43 Manual low-skilled Physical job demands No Yes , 6.02*** , 4.43*** , 8.78*** , 7.08*** Work hours per week <40 h , , , , working hours >48 h , 2.45** , , , 1.81 Employment insecurity Low Medium , 3.27*** , 3.49*** , , 2.52** High , 2.68*** , 3.36*** , 2.20** , 3.11*** Workplace justice Low ,11.87*** , 11.97*** , 14.48*** , 13.91*** Medium , 3.72*** , 3.81*** , 5.06*** , 4.92*** High Job control Low Medium , 3.90*** , 3.55*** , 2.93*** , 2.52** High , 3.81*** , 2.93*** , 4.40*** , 3.11** Psychological job demands Low Medium , 4.56*** , 4.72*** , 5.16*** , 5.60*** High , 13.11*** , 12.17*** , 14.54*** , 14.09*** R 2 (R square) *p<0.05, **p<0.01, ***p<0.00 postulated structure. However, it was noticed that items with statements in an opposite direction were all loaded on different factors from the other items of the same scale. For example, for the scale of workplace justice, the only item that was phrased in a negative manner My supervisor or the management department hides important information from employees was loaded on a separate factor, and for the scale of employment insecurity, the two items that were positively phrased My job security is good and my career prospects are good were loaded on different factors. We suspect that the few items that were asked in opposite directions might have caused confusion to participants thus resulting in stereotyped responses, i.e., a tendency to mark response choices in the same direction. When examining the

9 Int.J. Behav. Med. (2011) 18: scales used in other studies, we found that the item statements designed to measure workplace justice were mostly phrased in a positively manner [21, 23, 24]. Only the five-item scale for relational justice used in the British Whitehall Study contained an item that was reversely coded [18]. To avoid this problem, we suggest that all items should be stated in the same direction, or the numbers of items assessing both positive and negative directions should be balanced. Results from the correlation analyses indicated that employment insecurity, workplace justice, and job control were highly correlated with each other. This suggests that these measures tend to coexist in a work environment, or share overlapping concepts. Consistent with existing literature, we found that higher levels of employment insecurity and lower levels of workplace justice were associated with higher burnout levels, even with adjustment of other work factors in the multivariate regression models. It is especially worth noticing that the regression coefficients of workplace justice were substantial and were comparable to that of psychological job demands. In contrast, lower levels of job control were only moderately associated with higher burnout scores in this study these findings echoed that from our prior work from a national survey conducted in 2004 [27]. It suggested that job control plays a less important role on the risk of psychosocial health problems in Taiwanese populations than in western populations. However, due to the nature of cross-sectional study design, the observed associations between adverse psychosocial work factors and poor health might reflect reverse causation and should be interpreted with caution. Despite that these questions being straightforward, a number of issues arose during the qualitative interviews after the survey. First, as mentioned earlier, some questionnaire items contain double-barreled questions participants were asked to evaluate the likelihood of a certain unfavorable work condition, and at the same time were asked to evaluate his or her level of distress on this condition. We suggested that such questions should be modified by separating out the assessment of work conditions from the assessment of an individual s response to them. Secondly, some terms are unfamiliar or irrelevant to participants. For example, some participants were uncertain about the definition of new technology. Another point to note is that levels of salary, income, and other work-related benefits were considered by participants as major issues in employment security. We recommend that the scale of employment insecurity should be expanded to capture the dimension of financial instability associated with employment. There are other limitations that warrant mention. First, because we adopted questionnaire items based on existing literature and only a limited number of items were included, the questionnaire might not cover all important aspects of employment insecurity and workplace justice. Secondly, while results from the qualitative interviews suggested that workers social position and age might affect people s attitude and expectation toward employment security and workplace justice, we were not able to study these issues in-depth because of the small number of participants in qualitative interviews. In conclusion, findings from this study revealed satisfactory reliability and validity of the scales of employment insecurity and workplace justice. With some minor revisions, these scales may be used for the assessment of psychosocial work conditions in Taiwan. Future studies should be conducted to explore how social and cultural factors might affect perceptions and health effects of employment insecurity and workplace justice. Acknowledgment This study was supported by the Institute of Occupational Safety and Health, Council of Labour Affairs, research grants from the National Science Council (NSC H SS2), Taiwan. The authors thank study subjects who kindly agreed to participate in this study and Dr. David L. Parker for helpful comments. Appendix 1 Table 6 Full statements and the calculation formulas of scores No. Statement Abbreviated form Employment insecurity (six items) Original score (range 6 24)=(5-Q1)+(5-Q2)+Q3+Q4+Q5+Q6 Standardized score (range 0 100)=[(original score-6)/(24 6)]x100% Q1. My job security is good Job security Q2. My prospects for career development and promotion are good Career prospects Q3. I am worried that I might face job loss or layoff Worry about job loss Q4. I am worried that my skills are outdated because of new technology Worry skills are outdated Q5. If being laid off, I am worried that I would have difficulty finding a suitable job Difficulty in finding a suitable job if laid off Q6. I am worried that I might be transferred to an unwanted job position Unwanted job transfer

10 400 Int.J. Behav. Med. (2011) 18: Table 6 (continued) No. Statement Abbreviated form Workplace justice (9 items) Original score (range 9 36)=Q1+Q2+(5-Q3)+Q4+Q5+Q6+Q7+Q8+Q9 Standardized score (range 0 100)=[(original score-9)/(36 9)] 100% Q1. My supervisor and management trust employees (interpersonal justice) Trust Q2. Information released by my supervisor and management is reliable Information reliable (informational justice) Q3. My supervisor and management hide important information from employees Information hidden (informational justice) Q4. In my company, employees opinions are influential in the company s decision Employees influential making (procedural justice) Q5. In my company, employees work duties and responsibilities are arranged fairly Work arranged fairly (distributive justice) Q6. In my company, employees monetary rewards, benefits and welfare are arranged Rewards arranged fairly fairly (distributive justice) Q7. In my company, employees performance is evaluated fairly (distributive justice) Performance evaluated fairly Q8. During the process of making important decisions, my supervisor and management Information during decision making process inform employees and provide sufficient information (procedural justice) Q9. My supervisor and management treat employees with respect (interpersonal justice) Respect Appendix 2 Table 7 Demographic characteristics and employment conditions of participants in the post-survey interview study ID Age Educational level Job title Employment status Industry Sector Number of worker in company M1 50 Primary Machine operator Long-term Machinery Private M5 manufacturing M2 51 Junior Designer Long-term Furniture Private 20 manufacturing M3 26 Two-year Assistant manager Long-term Food services Private 3,000 college M4 30 Master Consultant Long-term Consultancy/ Private 170 management M5 56 Master Chief Executive Long-term Telecommunication State-funded enterprise Officer F6 46 Junior high Operator Long-term Electronics Private 20,000 F7 51 Junior high Cleaner Contract Services Private 25 F8 47 Senior high Nursing aid Contract Health care Services Public/medical center 800 people F9 25 College Preschool teacher Long-term Education Private 10 F10 55 College security janitor Contract/out-sourcing worker Security services Private unknown M male, F female References 1. Virtanen P. Employment security and health. Qual Saf Health Care. 2002;56(8): Virtanen M, Kivimäki M, Joensuu M, Virtanen P, Elovainio M, Vahtera J. Temporary employment and health: a review. Intern J Epidemiol. 2005;34(3): Rugulies R, Bultmann U, Aust B, Burr H. Psychosocial work environment and incidence of severe depressive symptoms: prospective findings from a 5-year follow-up of the Danish Work Environment Cohort Study. Am J Epidemiol. 2006;163(10): Burgard SA. Perceived job insecurity and worker health in the United States. Soc Sci Med. 2009;69(5): Greenhalgh L, Rosenblatt Z. Job insecurity: toward conceptual clarity. Acad Manage Rev. 1984;9:

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