Different effort constructs and effort-reward imbalance: effects on employee well-being in ancillary health care workers

J Adv Nurs. 2001 Apr;34(1):128-36. doi: 10.1046/j.1365-2648.2001.3411726.x.


Aims of the study: The present study investigates the relationship between Effort-Reward Imbalance (ERI) and employee well-being, using three different concepts of efforts (i.e. psychological demands, physical demands and emotional demands).

Background: The ERI model had been used as a theoretical framework, indicating that work stress is related to high efforts (i.e. job demands) and low occupational rewards (e.g. money, esteem and security/career opportunities). The ERI model also predicts that, in overcommitted workers, effects of ERI on employee well-being are stronger compared with their less committed counterparts.

Methods: A cross-sectional survey among 167 ancillary health care workers of two nursing homes was conducted. Multiple univariate logistic regression analyses were used to test the relationship between ERI and employee well-being.

Results: Results of the logistic regression analyses showed that employees with both high (psychological, physical and emotional) efforts and low rewards had higher risks of psychosomatic health complaints, physical health symptoms and job dissatisfaction (odds ratios (ORs) ranged from 5.09 to 18.55). Moreover, employees who reported both high efforts and high rewards had elevated risks of physical symptoms and exhaustion (ORs ranged from 6.17 to 9.39). No support was found for the hypothesis on the moderating effect of overcommitment.

Conclusion: Results show some support for the ERI model; ancillary health care workers with high effort/low reward imbalance had elevated risks of poor employee well-being. In addition, results show that the combination of high efforts and high rewards is important for employee well-being. Finally, some practical implications are discussed to combat work stress in health care work.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Allied Health Personnel / psychology*
  • Analysis of Variance
  • Cross-Sectional Studies
  • Fatigue / epidemiology
  • Fatigue / psychology
  • Female
  • Humans
  • Job Satisfaction
  • Logistic Models
  • Male
  • Middle Aged
  • Models, Psychological
  • Netherlands / epidemiology
  • Nursing Assistants / psychology
  • Nursing Homes*
  • Occupational Diseases / epidemiology
  • Occupational Diseases / psychology
  • Odds Ratio
  • Personnel Management*
  • Psychophysiologic Disorders / epidemiology
  • Psychophysiologic Disorders / psychology
  • Reinforcement, Psychology*
  • Stress, Psychological / prevention & control*
  • Stress, Psychological / psychology
  • Workforce