http://dx.doi.org/10.2224/sbp.2012.40.x.xxx
MENTAL HEALTH INFORMATION DEMAND AND SEEKING AMONG FEMALE HOSPITAL STAFF
WEN-HUIYANG China Medical University
SHU-CHENTANG Cardinal Tien Hospital
RHAY-HUNGWENG
Chia Nan University of Pharmacy and Science
MAO- HUNGLIAO Cardinal Tien Hospital
We explored demand for and sources of mental health information seeking among female hospital staff in Taiwan. Results showed that nurses had higher demand for information about emotion, gender, and career. Administrators were more inclined and physicians less inclined to seek mental health information from interpersonal sources than were other groups of medical staff. Basic level staff had higher demand for information about mental disorders. Participants who held a bachelor’s or higher degree needed more information about gender and career. Employees with a longer work tenure considered information about emotion and disorders to be less necessary. Those working more than 8 hours a day showed higher demand for gender information. We suggest that human resources managers in hospitals should meet these information demands to ensure staff’s mental well-being.
Keywords: mental health, information demand, information seeking, female
hospital staff.
Wen-Hui Yang, Department of Health Services Administration, China Medical University; Shu-Chen Tang, Department of Management, Cardinal Tien Hospital; Rhay-Hung Weng, Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science.
This study was partially financed by two research grants: one from National Science Council (grant number NSC 98-2815-C-039-014-H), and the other from Program of Grants for Research from China Medical University (CMU98-College-14).
Correspondence concerning this article should be addressed to Wen-Hui Yang, No 91 Hsueh-Shih Rd., Taichung, Taiwan 40402. Email: whyang@mail.cmu.edu.tw
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the rate of depression among women is twice that among men, and women are two to three times more likely to develop dysthymic disorder than are men (Wu, 2007). Al-Modallal, Abuidhail, Sowan, and Al-Rawashdeh (2010) suggested that the causes of women’s depressive symptoms may be embedded in their familial and social environment. Concerns such as pregnancy, sexual and domestic violence, as well as the burden of balancing work and family can be significantly related to depressive feelings among women (National Asian Women’s Health Organization, 2001). Michael, Anastasios, Helen, Catherine, and Christine (2009) indicated that women experience higher levels of occupational stress than do men. Women are often stretched to fulfill functions, and yet they feel guilty and as if they are failures for not meeting the demanding mothering ideal (Medina & Magnuson, 2009). The role overload, however, is strongly negatively associated with women’s mental health (Glynn, Maclean, Forte, & Cohen, 2009).
Hospital staff have to deal with both a large workload and mental stress. High work stress can easily cause burnout, psychosocial health problems, and may even lead to suicide (Piko, 2006; Yang, Pan, & Yang, 2004). Su, Weng, Tsang, and Wu(2009) found that nearly half of the hospital staff they surveyed had either a minor psychiatric disorder or a minor depressive disorder. Medical staff promote and maintain the health of patients and people in the community. However, if hospital staff neglect their own health and living conditions, they can hardly become successful health promoters. Hospital staff disregarding their own mental health may even reduce the quality of the care they are able to provide.
Berkowitz (2006) stated that when an internal search does not produce an alternative to solve the recognized problem, individuals may resort to an external search. An external information search involves seeking information from one or more sources when an internal search is insufficient. These sources can be media in the form of advertisements, personal sources (such as friends or salespersons), or public sources (such as government data) (Berkowitz, 2006). In fact, most people will rely on various information sources to access mental health-related information, including symptoms, treatments, side effects, and diagnoses Researchers studying female staff in hospitals have focused on the
mental health of hospital employed women rather than on their demand for mental health information and information sources (Lam-Po-Tang & McKay, 2010). Not much is known about the specific mental health information demands of female hospital staff or their information seeking behaviors. In this study, we therefore aimed to explore the demand for mental health information and sources of information seeking among female hospital staff in Taiwan to help hospitals provide an adequate work environment that would allow their female employees to suffer less job stress, enhance their quality of life, and stay physically and mentally healthy.
Method
Sample and Procedures
The survey participants were female employees who worked at public and private hospitals in Taiwan. Using the convenience sampling method, 15 hospitals were selected from each hierarchy of healthcare organization. There were two medical centers, nine regional hospitals, and four local hospitals. We identified four major departments in each hospital: medical department, nursing department, administrative department, and medical affairs department. Female staff employed in each of the four departments were recruited from sample hospitals. All the participants had to be full-time employees. Explanatory cover letters, requesting informed consent, and questionnaires were provided for target participants. Participation was voluntary, anonymous, and no incentives were offered. A total of 600 questionnaires were distributed, and 488 valid responses were collected, resulting in a valid response rate of 81.3%. The average age of respondents was 36.07 (SD = 10.62). The majority of the participants were nurses (32.8%). Mean tenure was 6.9 years (SD = 7.29). A total of 88.9% of the sample worked over eight hours a day.
Questionnaire and Data Collection
The research instrument was a structured questionnaire developed for this study, based on previous literature. In our research framework, the independent variables were demographic variables and job characteristics. The first dependent variable was demand for mental health information. We identified categories of mental
health information, including adaptation to stress, emotion management, depression relief, grief counseling, family and marriage, job, gender relation, career planning, and psychiatric disorder. The demand for each category of information was measured on a 5-point scale, ranging from 5 = demand very much to 1 = not demand at all. The second dependent variable was sources of seeking mental health information. Based on the information source classifications proposed by Kotler and Clarke (1987), we identified seven information sources: relatives or friends with medical knowledge; relatives or friends without medical knowledge; television, newspapers, and magazines; radio; the Internet; posters; and leaflets. The information seeking behavior with regard to each source was measured on a 5-point scale, ranging from 5 = strongly agree to 1 = strongly disagree.
Multiple experts from related fields and psychiatrists invited to review and help modify the questionnaire evaluated the content validity of the questionnaire. The reliability of the questionnaire was assessed by testing the inter-item consistency reliability using Cronbach’s α. Cronbach’s α was .786 for the scale for demand for mental health information and .724 for the scale for sources of seeking mental health information; all the scales had a Cronbach’s α above .7.
Data Analysis
The collected responses were analyzed using SPSS 17.0. First, descriptive statistics of the respondents’ variables were computed. The initial factors were determined using principal component analysis. Second, factor analysis was conducted to extract principal components of demand for mental health information and sources of seeking mental health information to reduce variables. The extracted variables were then used for multivariate analysis of variance (MANOVA). Finally, multiple regression analysis was performed, with the categories of mental health information that were needed and the sources of mental health information seeking as dependent variables and employees’ basic data and job characteristics as independent variables.
Results
We performed factor analysis to analyze the inter-relationship among a large number of variables of demand for mental health information and sources of seeking mental health information and to explain these variables in terms of their common underlying dimensions (factors). We extracted four factors from the nine categories of mental health information. We named these factors emotion, gender, career, and disorder. In addition, two factors were extracted from the seven mental health information sources. We named them interpersonal sources and media sources respectively. Main Analyses
At the significance level α = .05, the associations between respondents’ demand for and sources of seeking mental health information and their basic data and job characteristics were examined using multiple regression analysis. Six multiple regression analyses were performed.
As is shown in Table 1, multiple regression analyses revealed that the respondents’ demands for information about emotion, gender, and career were significantly associated with their job title. Nurses had higher demand for these three types of information. Results from further MANOVA also showed that there was a more significant need for information about emotion and gender among nurses than there was among other groups of medical staff (F = 5.293, df = 3, p = .001; F = 4.047, df = 3, p = .007). More senior staff tended to have a lower demand for information about gender and disorder. Respondents who held a bachelor’s degree or higher degree needed gender- and career-related information more than did those who held a high school degree or less. Respondents working more than eight hours a day also needed gender-related information more than did those working less than eight hours a day. Basic level employees had higher demand for information about disorder.
The results of multiple regression analyses of sources of seeking mental health information indicated that respondents who held a bachelor’s or higher degree were more likely to obtain mental health information from interpersonal sources than were those who held a high school degree or less. Medical technicians, administrators, and nurses were more reliant on interpersonal sources than were physicians, and basic level staff seldom obtained information through interpersonal interactions. Furthermore, a
MANOVA showed significant differences between the four groups only in terms of interpersonal source (F = 11.29, df = 1, p = .000). Post hoc analyses by least significant difference (LSD), with α = . 05, showed that administrators were significantly more inclined and physicians significantly less inclined to seek mental health information from interpersonal sources than were other groups of medical staff.
---Insert Table 1 here
---Discussion
According to our findings, nurses needed more information about emotion, gender, and career than did other medical staff and usually relied on interpersonal sources to obtain such information. Of the nurses, 88.13% (n = 141) reported working more than eight hours a day. Aiken, Clarke, Sloane, Sochalski, and Silber (2002) indicated that adequate staffing and organizational support are important and useful in improving the quality of care. In hospitals with inadequate staffing, nurses were more likely to experience job dissatisfaction and burnout than they were in hospitals with adequate staffing. Therefore, most nurses had long work hours and faced a significant amount of stress, so that they considered information about emotion and stress relief, family and gender relations, and career to be more necessary. Because they had frequent and direct interaction with people at work, interpersonal sources became their main sources for the information they needed. The results of our analyses corroborated findings by Powell and Clarke (2006). They found that people particularly valued hearing other people’s experience of mental health problems. Adequate staffing, support, counseling, or psychological intervention are required for making progress on management, and may result in better mental health on the part of the staff and a better quality of care (Su et al., 2009).
Basic level staff showed high demand for disorder-related information and usually obtained such information from interpersonal sources. Employees in this category had less medical knowledge and thus needed disorder-related information more than did other medical staff. Their understanding of mental disorders
could be improved by attending courses or lectures delivered by physicians in the hospital on topics such as causes of frequent diseases, their treatment methods, and preventive measures. However, consumer health information provision is particularly important in the area of mental health problems, as such problems are frequently associated with stigma and isolation (Dinos,Stevens, Serfaty, Weich, & King, 2004). Hospital administrators and managers should adopt information sources that can be perceived as accessible and credible within a nonthreatening and reassuring context (Mishra, Lucksted, Gioia, Barnet, & Baquet, 2009).
Female employees who held a bachelor’s or higher degree showed higher demand for gender- and career-related information and frequently obtained information from interpersonal sources. Better educated female employees usually occupied higher positions within the organizations and were thus likely to consider career-related information as more necessary. Hospital management should offer them more opportunities for continuous growth by building a good reward and promotion system and providing professional on the job training. Senior employees probably considered emotion-related information less necessary because they have worked in the medical industry for a long time and had developed their own emotion and stress relief methods. Hence, senior employees can share their emotion and stress relief methods with junior employees in order to help them cope with stress. In addition, we also found that employees working more than eight hours a day had a higher demand for gender-related information. However, having a heavier workload and being more likely to burnout may result in poor quality of care, an increased risk of making mistakes, and a higher patient mortality rate (Rogers, Hwang, Scott, Aiken, & Dinges, 2004). Das, Do, Friedman, and McKenzie (2009) also found significant associations between poor mental health and lowered labor force participation (especially for women) and higher frequency visits to health centers. Therefore, hospital management can work with other organizations to organize activities that allow their employees to maintain family harmony or develop relationships with specifically members of the opposite sex.
According to Lee (2008), mentally healthy people are able to cope with environmental stress, develop individual abilities to
achieve growth, make rational judgments in the face of difficulties or problems, be stable and realistic, react to contingencies, and shoulder responsibilities for decisions they have made. Workplace counseling schemes can help employees experiencing psychological problems reduce the symptoms of their problems (Arthur, 2000). In addition, Employee Assistance Programs (EAPs) can increase employees’ resistance to stress, promote their mental health, or prevent them from developing mental disorders. Kirk and Brown (2003) invited experts in stress relief, emotion management, and physical feedback to teach the employees in three firms how to relieve and cope with stress and enhance their operating skills through five sessions of relief resistance and counseling. They found a significant decline in requests for sick leave during the next year, from 4.83% to 2.07%. EAPs are currently an important part of workplace stress management, as they help to prevent and solve mental health problems that employees encounter in the workplace as well as promote their mental health (Brown, 2003). Therefore, hospitals can strengthen their EAPs, set up occupational stress counseling schemes, hold social activities, invite experts to deliver lectures, build a good promotion system, offer on the job training, and provide adequate mental health promoting information in order to improve employees’ mental health.
In conclusion, better mental health on the part of the staff can result in better quality patient care. In this study, we provided the first in-depth exploration of information needs and information seeking behavior in this area. Meeting these needs and providing adequate relevant information for different hospital staff can result in staff members’ mental well-being.
Several limitations of this study should be noted. Firstly, our data were derived from the self-reports of a relatively small number of hospital staff. In addition, the convenience sampling method was used to select participants. Therefore, the findings in this study are not generalizable to the population at large. Secondly, the participants’ data relied on self-reports, and there was no corroboration of reported experiences. These data were subject to reporting bias. However, our survey guaranteed the participants’ privacy and anonymity, and self-reported data may be valid and reliable when the participants’ privacy can be protected.
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Table 1. Multiple regression analysis of demand for and sources of seeking
mental health information
Types of mental health information InformationSources Emotion Gender Career Disorder Interpersonal Media Independent Variable β p β p β p β p β p β p Age (years) 0.06 -5 0.33 1 -0.07 8 0.24 9 -0.06 8 0.31 2 0.042 0.53 -0.01 1 0.87 0 -0.17 0 0.0 14* Education High school or less (Ref) College 0.091 0.204 0.120 0.098 0.126 0.079 0.032 0.656 0.117 0.096 0.046 0.532 Bachelor’s degree or higher 0.11 7 0.133 0.240 0.002** 0.233 0.003**0.111 0.158 0.167 0.030* 0.020 0.800 Marital status Unmarried (Ref) Married 0.079 0.145 0.097 0.077 0.07 -0 0.19 7 0.067 0.219 -0.01 3 0.80 2 -0.03 3 0.5 49 Others 0.025 0.593 0.087 0.071 0.02 -2 0.64 2 0.067 0.160.036 0.444 -0.06 7 0.1 66 Job titles Physicians - - 0.00 0.97 - - 0.05 0.53 - - 0.31 0.3
2 6 6 1 7 17 Medical technicians 0.117 0.124 -0.06 6 0.25 7 0.061 0.422 -0.07 7 0.31 3 0.191 0.010**0.100 0.199 Nurses 0.235 0.007** 0.117 0.049* 0.177 0.041* - - 0.291 0.001** - Administrators 0.156 0.08 - - 0.269 0.003** 0.016 0.856 0.361 0.00 0** * 0.01 3 0.883 Job position First level supervisor (Ref) Second level supervisor 0.012 0.834 -0.10 8 0.06 8 0.103 0.079 -0.10 8 0.06 7 -0.11 2 0.05 1 -0.06 9 0.2 45 Basic level supervisor -0.09 2 0.20 8 -0.07 6 0.30 2 0.011 0.877 -0.10 5 0.15 4 0.054 0.455 -0.19 3 0.0 10* * Basic level staff 0.091 0.226 0.029 0.706 0.081 0.280 0.149 0.049* -0.17 1 0.02 1* -0.07 5 0.3 32 Tenure (years) 0.12 -1 0.03 6* -0.03 9 0.50 4 -0.04 2 0.46 7 -0.11 4 0.04 8* 0.08 6 0.12 7 0.13 6 0.0 21* Daily work hours
Less than 8 hours (Ref) More than 8 hours 0.082 0.083 0.098 0.041* 0.027 0.562 0.079 0.097 -0.03 7 0.42 2 -0.10 7 0.0 27* Holidays Irregular (Ref) Regular -0.03 3 0.50 1 -0.01 6 0.34 9 -0.14 7 0.00 3** -0.00 2 0.96 5 -0.05 4 0.26 3 0.051 0.309 F 2.64 2.52 2.99 2.48 2.36 3.73 p 0.000*** 0.000*** 0.000*** 0.000*** 0.000* 0.000*** R2 0.129 0.098 0.113 0.104 0.143 0.073
