Occupational Psychosocial Risks of Health Professionals

. This study aimed to evaluate the Effort-Reward Imbalance among nurses and its association with burnout syndrome. This is an observational study of a cross-sectional type. A self-administered survey was used to collect the socio-demographic and professional characteristics. The Siegrist Effort-Reward Imbalance scale to measure the psychosocial risks and the Copenhagen Burnout Inventory to assess burnout. The results indicate that the level of burnout is moderate [patient-related burnout (2.77±0.95), general burnout (3.00±0.67)], but there is an imbalance between the efforts and rewards received by nurses (1.50±0.51). The indices calculated by Cronbach's alpha are very important for effort (α=0.79), and reward (α=0.75). The results raise questions about the importance of a better understanding of the effect of psychosocial risks on health through perceived effort/reward. The use of information and communication technologies to accurately identify psychosocial risks at work is recommended.


Introduction
The theme of psychosocial factors at work in the epidemiology of occupational risks has grown considerably in recent years, particularly in occupations where there are many social interactions. The Siegrist model was developed to assess the psychosocial constraints of the work environment, it is a model of the imbalance between effort and rewards at work [1]. In this model, Siegrist considers that the efforts made by the individual at work are part of an aspect of a social reciprocity agreement in which the individual receives a reward in the form of salary, career development, esteem, and job security [2]. It is therefore the imbalance between the reward obtained and the efforts made that could be at the origin of both psychological and somatic effects, so it can have consequences on musculoskeletal disorders, cardiovascular diseases, etc [3]. According to Siegrist, the employee will put effort into the work and he expects that this work will provide him with rewards (feeling of selfefficacy, self-esteem...). Siegrist identifies two main categories of effort, extrinsic and intrinsic [4]. Extrinsic effort corresponds to the constraints of the work; they include time constraints, numerous responsibilities, increased demand, and frequent interruptions. The extrinsic effort is also related to the physical effort required and the obligation to work overtime. Intrinsic efforts, also known as overcommitment, reflect the motivations and attitudes related to excessive commitment to work or controlling a threatening situation [5], the individual's involvement in the work will therefore be more extensive, serving more resources, including in situations where earnings will be relatively low [6]. In this model, rewards can take three main forms, namely: monetary gains (bonuses, salaries, etc.), the esteem received from superiors and colleagues, and the degree of control over one's professional status (job security, promotion prospects, etc.) [7]. This model predicts that the lack of reciprocity between gains and costs can lead to stress and burnout syndrome.
This article is composed of three main sections: • In the first section, we present the research methodology adopted to measure effort-reward imbalance and to evaluate burnout syndrome. • In the second section, we reveal the results of the survey. • In the third section, we tried to compare the results found with results from other studies, and suggest IT solutions for dealing with psychosocial risks.

Data collection
This is an observational study of a cross-sectional type [8], the data collected with the help of a self-administered questionnaire made up of three sections:  [11]. This instrument has been adapted and validated in French by Niedhammer. It has three sub-scales: the first is effort, which is measured by six items that refer to demanding situations of the work environment, a total sum score based on the six items measuring effort varies between 6 and 30. The second is a reward, which is measured by eleven items that refer to reward-related to promotion prospects, esteem, and job security, a total sum score based on the eleven items measuring reward varies between 11 and 55. Responses are measured on a 5-point Likert scale. The scoring procedure for effort and reward is defined as (1) does not apply; (2) does apply, but the subject does not consider herself or himself distressed; (3) does apply and subject considers herself or himself somewhat distressed; (4) does apply and subject considers her or himself distressed; (5) does apply and subject considers herself and himself very distressed. The effort/reward imbalance (ERI) score is obtained by calculating a ratio of the effort score to the reward score [11,12].
As a result, a value close to zero indicates a favorable condition (relatively low effort, relatively high reward), whereas values beyond 1 indicate a high amount of effort spent that is not met by the rewards received or expected in turn. The last is over-commitment, which is measured by six items. The six 4-point Likert scaled items are computed to a total score varying from 6 to 24. The higher the score, the more likely a subject is to be overcommitted to work. • The burnout was assessed using the Copenhagen Burnout Inventory [12]- [17]. The result of the Copenhagen Burnout Inventory is a score defined as: • low: 1 to 2.4; • medium: 2.5 to 3.5; • high: 3.6 to 5.

Statistical analysis
The result of the Effort-Reward Imbalance and the Copenhagen Burnout Inventory was verified and processed using IPM-SPSS software. The Fisher Exact Test has been used to identify any associations between burnout syndrome and the effort/reward imbalance.

Sample characteristics
The present study involved 30 nurses out of a total of 53 healthcare professionals at the Hassan II Oncology Centre -Oujda, Morocco. 13 men and 17 women. Nurses are mostly single with a proportion of 63%. The mean age is 29 years (29 ± 5.85). The age of the nurses is between 21 and 51 years.

Burnout: prevalence
The analysis of the results revealed that 20% of the participating nurses had a low general burnout score, 63% had a medium score, and 16% had a high score. Regarding burnout related to the patient, 43% had a low score (23% high and 34% medium) (see Tab. 2). The average patientrelated burnout score was (2.77 ± 0.95) and the average for general burnout was (3.00 ± 0.67), this means that the level of burnout among nurses is moderate.    No statistically significant association was found in this study using the Fisher Exact Test at the threshold of (p=0.05), between burnout and the effort/reward model.

Related works
This study aims to determine the psychosocial risks in health care professionals using Siegrist's model of effortreward imbalance and to identify any association between burnout syndrome and effort-reward imbalance. This study revealed that the ratio (effort/reward) calculated according to the Siegrist questionnaire shows a rate of 1.5 for all participants, which is similar to the result found in a study involving medical and paramedical personnel of the SAMU/SMUR in Tunisia [18]. Analyses using the Fisher Exact Test have not revealed any significant link between the effort/reward model and other variables at the threshold of (p=0.05). On the other hand, in another study that aims to investigate the impact of psychosocial factors among nurses, they showed that there was a significant association between marital status and effort-reward imbalance and that married nurses experienced more stress than single nurses [19]. Another research was conducted to investigate whether organizational constraints at the work unit level can be related to depressive symptoms in hospital workers, in which they indicated that a better understanding of the effect of psychosocial risks on health through perceived effort/reward imbalance would provide targets for successful interventions [20]. A research study was conducted among Japanese workers to assess the prospective effects of psychosocial job characteristics evaluated with the Demand-Control-Support and Effort-Reward Imbalance models on insomnia [21]. It revealed that low social support and effort-reward imbalance at the baseline had a significant association with insomnia at the follow-up. The Effort-reward imbalance is related to the frequency of sickness absence among hospital nurses. According to research among nurses, nurses who are frequently absent perceived poorer health had lower overcommitment scores, and reported a higher ratio (effort/reward) than low frequent absentees [22].
Recently, several research studies have proposed IT solutions to public health problems, in particular, to facilitate communication between health professionals and patients (see Fig. 1). It is through the use of information and communication technologies [23]- [25]. Some research has proposed mobile platforms to assess the level of stress or burnout to prevent psychosocial risks [26,27].

Conclusion and Future Work
The study states that there is an imbalance between the efforts and the rewards received among nurses. The results raise questions about the importance of the better understanding of the effect of psychosocial risks on health through perceived effort/reward imbalance would provide targets for effective coping strategies. The continuation of this research work could also focus on the use of information and communication technologies to accurately identify psychosocial risks at work.