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Effects of Dental Hygienists Job Stress on Somatization in an Area
J Dent Hyg Sci 2020;20:59-66
Published online March 31, 2020;  https://doi.org/10.17135/jdhs.2020.20.1.59
© 2020 Korean Society of Dental Hygiene Science.

Mi-Jeong Kim †, Hyeon-Sun Kim , and Cha-Young Lim

Department of Dental Hygiene, Vision College of Jeonju, Jeonju 55069, Korea
Correspondence to: Mi-Jeong Kim, https://orcid.org/0000-0002-5309-1853
Department of Dental Hygiene, Vision College of Jeonju, 235 Cheonjam-ro, Wansan-gu, Jeonju 55069, Korea
Tel: +82-63-220-4101, Fax: +82-63-220-4109, E-mail: kimmj@jvision.ac.kr
Received February 19, 2020; Revised March 10, 2020; Accepted March 20, 2020.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: This study aims to analyze the job stress of dental hygienists and the factors affecting somatization and to provide basic data for effectively managing job stress and somatization of dental hygienists.
Methods: In this study, the data collected from 208 dental hygienists working in Jeollabuk-do Province were analyzed. Job stress was investigated using a questionnaire with 43 questions. In addition, the degree of somatization was evaluated through a simplified psychotherapy examination (Symptom Check List-90-Revision).
Results: Age, employment history, position, average monthly income, night duty execution status, and perceived health status were significantly associated with job stress (p<0.05). The job stress sub-items scores based on general characteristics showed significance in ‘workload’ for those working a five-day workweek and perceived health status (p<0.05). Age, average monthly income, and perceived health status were noted in ‘role conflict as a professional’. In ‘lack of expertise and skill’, it was noted that age, employment history, position, income, and night clinic were implemented. In ‘improper treatment and interpersonal issues’, level of education and perceived health status were significant (p<0.05). The higher the job stress, the higher the somatization symptom score (p<0.05), and the higher the job stress component, the higher the somatization symptom score (p<0.01).
Conclusion: The job stress of dental hygienists should be reduced, and the symptoms of somatization should be mitigated. To improve the quality of medical services and the work efficiency of dental hygienists, proper treatment and compensation systems should be implemented for them to take pride as professional. Further, programs and regulations on mitigating job stress and somatization symptoms should be developed.
Keywords : Dental hygienist, Job stress, Somatic symptom
Introduction

With the emergence of the fourth Industrial Revolution, the medical service industry is growing rapidly along with advancements in medical technology. Developments in medical technology require professionalism in humanistic care for not only providing treatment but also interactive service based on integrity and expertise to guarantee a better quality of life for people1). The quality of medical service is expected to continue improving as the national economic level increase2), including the dental health industry. Dental hygienists provide an important dental service while taking a crucial role in determining the quality of dental health services3); thus, they are expected to have more expertise in carrying out professional tasks4). As expected by the society, the dental health industry is specialized and compartmentalized, in which the tasks and roles of dental hygienists are expanded and the required levels of technique and knowledge have also increased. Dental clinics are becoming larger while the services are more specialized, where the scope of work has expanded from treatment assistance to overall dental procedures, thus generating an overwhelming workload and competition between dental clinics5). Accordingly, dental hygienists are highly stressed and face constant pressure of improving self-competence. Nevertheless, dental hygienists are experiencing a high level of work stress, as they are expected to handle an overwhelming workload6). Work stress refers to harmful physical and psychological reactions caused when the ability, resources, and demands of a worker do not correspond with their duty7). Furthermore, high work stress has a significantly negative effect on the organization and its members8). Being constantly exposed to high work stress has been reported to cause somatization9), wherein an individual develops physical discomfort or symptoms without a reasonable cause and seeks medical help by considering it as a physical illness10). Chronic work stress commonly causes various somatization symptoms such as headache, abdominal pain, indigestion, and fatigue. Somatization symptoms can easily become chronic if appropriate treatment is not given early, which eventually makes treatment difficult and causes a decrease in the ability to perform job-related duties11-13). Somatization leads to a reduced efficiency of an organization due to the high turnover rate and the absence rate of employees at the organization level and increased job dissatisfaction, alcohol and drug abuse, and other physical problems at the individual level14). Moreover, stress of the workers in medical services directly influences service provision in the healthcare industry, ultimately affecting the quality of healthcare services provided to patients15).

Job stress in dental hygienists is currently an emerging issue owing to their need to acquire new skills, overwhelming workload, uncertain division of duties, complicated workplace relationships or working conditions, and the diverse service demands of their patients16). In this study, therefore, by analyzing the factors affecting somatization with regard to job stress among dental hygienists, we provide basic data for effectively managing job stress and somatization of dental hygienists.

Materials and Methods

1. Research subjects

The subjects of this study were selected by convenience sampling among licensed dental hygienists currently working in Jeollabuk-do. The study period was from January 28 to February 28, 2019. Using G*POWER 3.1, minimum sample size was calculated as 204, based on a significance level of 0.05, effect size of 0.15, and statistical power of 0.95. To minimize standard error and considering sampling bias or a 10% withdrawal rate, a total of 220 subjects who provided informed consent to participate were finally selected. The subjects completed a structured survey using Google in a self-reporting manner. Excluding 12 surveys containing numerous missing values, a total of 208 surveys were selected for final analysis.

2. Research tools

To measure the level of job stress among dental hygienists, the tool for measuring job stress, as used for Koreans and developed by Chang et al.17), was revised to be appropriate for dental hygienists by referring to the survey developed by Oh18). For this study, job stress in dental hygienists was subdivided into four subcategories including 10 items on ‘overwork,’ 6 items on ‘role conflict as a professional,’ 10 items on ‘lack of expertise and skill,’ and 17 items on ‘improper treatment and interpersonal issues,’ for a total of 43 items. Reliability was tested for internal consistency of the tool, in which Cronbach’s a was 0.950. Values of Cronbach’s a for each of the four subcategories of job stress were as follows: 0.796 for ‘overwork,’ 0.835 for ‘role conflict as a professional,’ 0.916 for ‘lack of expertise and skill,’ and 0.927 for ‘improper treatment and interpersonal issues.’

To identify the severity of somatization symptoms, the Symptom Checklist-90-Revision19) was used, in which only 12 items associated with the somatization scale were used in this study. A reliability analysis revealed a Cronbach’s a of 0.865.

Both job stress and somatization symptoms were scored based on a 5-point Likert scale. As items are negatively formulated, a higher score indicates a higher stress level and more severe somatization symptoms.

As for the general characteristics of the subjects, age, level of education, employment history, position, five-day workweek, night duty execution status, average monthly income, and perceived health status were examined.

3. Data analysis

An independent t-test and a one-way analysis of variance were performed to examine differences in job stress and somatization symptoms according to general characteristics, and the Scheffé test was conducted as a post-hoc test. Pearson’s correlation coefficients were analyzed to examine the correlation between job stress and somatization symptoms. Furthermore, multiple linear regression analysis was performed with set variables to analyze factors influencing somatization symptoms. The collected data were analyzed using PASW Statistics ver. 18.0 (IBM Corp., Armonk, NY, USA). The significance level (a) of statistical tests was set at 0.05.

Results

1. Job stress and somatization symptoms according to general characteristics

The differences in job stress and somatization symptoms according to general characteristics are shown in Table 1.

Job Stressand Somatization according to Demographic Variable

Item Job stress Overwork Professional role conflict experience Lack of expertise and skill Improper treatment and interpersonal issues Somatization
Total 180 196 200 198 188 198
161.00±24.05 38.40±5.56 21.61±4.39 35.46±7.26 65.90±11.45 47.53±8.01
Age (y)
23∼25 60 62 62 60 60 62
168.57±20.88b 39.55±5.16 23.19±3.90b 38.60±6.80b 66.70±10.65b 47.68±8.35a
26∼30 62 66 66 66 62 68
156.45±23.45a 37.85±5.98 20.64±4.21a 34.30±5.88ab 64.71±11.92ab 47.26±8.31a
31∼35 44 42 46 46 44 46
163.85±27.42b 38.90±5.89 21.48±4.99ab 34.91±8.36ab 69.00±11.45b 47.26±8.49a
36∼40 10 12 12 12 10 10
147.00±27.85a 34.83±4.28a 20.33±4.42a 31.50±7.28a 62.40±13.82ab 46.40±4.35a
41∼50 12 14 14 14 12 12
147.33±9.64a 37.43±3.67 20.71±3.54a 32.71±7.29ab 59.67±7.74a 50.17±4.69ab
p 0.003 0.059 0.010 0.001 0.068 0.804
Level of education
College 124 126 130 128 124 132
160.43±26.37 38.92±6.09 21.60±4.47 35.39±8.07 64.71±12.13 47.35±8.10
≥University 64 70 70 70 64 66
162.03±19.31 37.46±4.34 21.63±4.26 35.60±5.52 68.22±9.67 47.88±7.89
p 0.067 0.077 0.965 0.847 0.046 0.662
Employment history (y)
1∼3 72 76 76 72 74 76
165.28±22.19 38.71±5.14b 22.34±4.35b 38.36±6.42b 65.24±10.94ab 46.53±8.45a
4∼6 38 42 44 44 38 44
158.33±26.52ab 38.10±6.43b 21.77±3.99b 34.55±6.46ab 65.74±13.36ab 47.86±9.00ab
7∼9 22 22 24 24 22 22
159.00±24.52ab 35.82±4.74a 21.08±4.42a 33.92±7.64ab 68.64±10.79b 46.55±10.37a
≥10 38 38 40 40 38 38
150.83±24.68a 38.21±5.79b 20.25±4.58a 31.80±7.95a 62.53±11.31a 48.21±4.33b
p 0.034 0.205 0.092 <0.001 0.260 0.677
Position
Intern, contract worker 20 20 20 20 20 20
164.73±16.93b 38.20±5.08b 22.60±4.31b 38.10±5.76b 65.80±8.62ab 44.70±5.79a
Regular (worker) 116 126 126 124 116 126
164.96±23.91b 38.95±5.53b 21.90±4.26ab 36.73±7.02b 67.33±11.79b 47.94±8.57b
Person in charge head of a department 52 50 54 54 52 52
150.21±23.99a 37.08±5.69a 20.56±4.59a 31.59±6.93a 62.77±11.19a 47.62±7.20b
p 0.001 0.129 0.094 <0.001 0.057 0.244
Average monthly income
≤200 80 84 86 86 80 84
166.56±21.05b 39.14±4.79b 22.65±3.95b 37.81±6.62a 66.85±10.56b 46.98±8.20a
201∼250 76 78 78 76 76 80
157.14±26.25a 37.92±6.39a 20.77±4.73a 33.13±7.31ab 65.34±12.25ab 48.20±7.77b
≥251 34 36 36 32 34 36
155.80±23.63a 37.64±5.21a 20.94±4.17a 34.78±7.07b 64.88±11.82a 47.29±8.22ab
p 0.023 0.261 0.013 <0.001 0.613 0.612
The five-day workweek
Existence 140 144 146 146 140 144
160.48±25.25 37.85±5.58 21.36±4.37 35.92±7.04 65.81±11.91 46.97±8.37
Nonexistence 48 52 54 52 48 54
162.52±20.35 39.92±5.27 22.30±4.39 34.19±7.78 66.17±10.08 49.00±6.82
p 0.062 0.021 0.179 0.142 0.855 0.113
Night duty
Absence 50 58 56 56 50 58
157.84±20.26a 38.62±4.77b 21.82±4.27b 33.29±7.16a 64.40±10.74a 47.55±6.70a
8:00 pm∼8:30 pm 100 102 106 106 100 104
163.60±26.72b 38.57±6.16b 21.74±4.59b 36.68±7.92ab 67.26±11.56b 47.65±8.42a
9:00 pm∼9:30 pm 38 36 38 36 38 36
158.29±20.75a 37.56±4.98a 20.95±4.01a 35.28±3.97b 64.32±11.91a 47.11±8.91a
p 0.030 0.604 0.584 0.017 0.224 0.941
Perceived health status
Poor 60 66 68 68 60 66
167.55±17.59b 39.73±4.68b 23.03±3.02b 35.88±6.68b 69.30±10.04b 52.03±5.78c
Normal 100 106 104 102 100 104
160.57±25.32ab 38.53±5.57b 21.31±4.85ab 35.55±7.44b 65.16±11.56ab 46.29±7.81b
Good 28 24 28 28 28 28
146.92±26.75a 34.17±5.88a 19.29±4.28a 34.14±8.03a 61.29±12.17a 41.50±7.87a
p 0.002 <0.001 <0.001 0.560 0.005 <0.001

Values are presented as n or mean±standard deviation.

The same characters are not significant by Scheffe multiple comparison (p<0.05).



In terms of the general characteristics, the subjects’ age, employment history, position, income, night duty execution status, and perceived health status were significantly associated with job stress (p<0.05). Subjects between 23 and 25 years of age had the highest job stress scores, whereas those between 36 and 40 years of age had the lowest job stress scores. Job stress scores were higher among subjects with short employment history, while those in a lower position had a high level of job stress. Subjects with a lower income had a higher level of job stress, and those with night duty for 8:00 pm to 8:30 pm also had a high level of job stress. The level of job stress was high for subjects with a poor perceived health status.

A five-day workweek and perceived health status were significantly associated with ‘overwork’ (p<0.05); age, income, and perceived health status with ‘role conflict as a professional’; age, employment history, position, income, night duty execution status with ‘lack of expertise and skill,’ and level of education and perceived health status with ‘improper treatment and interpersonal issues’ (p< 0.05).

With regard to ‘overwork,’ subjects who did not have a five-day workweek and with a poor perceived health status had a higher stress score. Subjects between 23 and 25 years of age who had 2 million Korean won or less of monthly income or who had a poor perceived health status had a high score for ‘role conflict as a professional.’ Subjects between 23 and 25 years of age had the highest scores for ‘lack of expertise and skills.’ Subjects with a poor perceived health status also had high scores for emotional disharmony and damage in customer service. Subjects at lower positions and with short employment history, 2 million Korean won or less of monthly income, and night duty for 8 to 8.5 hours had a high score for ‘lack of expertise and skill.’ Subjects with a University or with a poor perceived health status had a high score for ‘improper treatment and interpersonal issues.’

Perceived health status was significantly associated with somatization symptoms (p<0.05). The score for somatization symptoms was high among subjects with a poor perceived health status.

2. Correlation between job stress and somatization symptoms

The correlation data between job stress and somatization symptoms are shown in Table 2.

Correlation between Job Stress and Somatization

Item Job stress Overwork Professional role conflict experience lack of expertise and skill Improper treatment and interpersonal issues
Somatization 0.417*** 0.430*** 0.271*** 0.234*** 0.394***

p<0.001 by pearson’s correlation analysis.



Overall job stress and all subcategories of job stress exhibited significant correlations (p<0.001).

As the scores for job stress and its subcategories increased, so did the score for somatization symptoms.

3. Factors influencing somatization symptoms in terms of job stress and sociodemographic characteristics

The factors influencing somatization symptoms in terms of job stress and sociodemographic characteristics are shown in Table 3.

Effects of Job Stress, Demographic Variable on Somatization

Item Model 1 Model 2 Model 3



β p β p β p
Overwork 0.178 0.155 0.152 0.108
Professional role conflict experience −0.090 0.425 −0.131 0.175
Lack of expertise and skill −0.148 0.278 0.054 0.584
Improper treatment and interpersonal issues 0.407 0.050 0.230 0.021
Age −0.167 0.200 −0.232 0.090
Level of education −0.085 0.253 −0.055 0.494
Employment history −0.038 0.797 0.079 0.625
Post position 0.148 0.153 0.180 0.084
Average monthly income 0.225 0.033 0.071 0.568
The five-day workweek 0.169 0.025 0.148 0.053
Night duty 0.063 0.410 −0.010 0.901
Perceived health status −0.519 <0.001 −0.482 <0.001
R2 0.212 0.312 0.397
Adjusted R2 0.194 0.269 0.336

Model 1: subcategories of job stress, Model 2: demographic variable, Model 3: subcategories of job stress+demographic variable.



In Model 1, where the subcategories of job stress were input as independent variables, a high score for ‘improper treatment and interpersonal issues’ led to more severe somatization symptoms.

In Model 2, where the sociodemographic characteristics were input as independent variables, subjects who had a higher income, worked for more than five days a week, and had a poor perceived health status had more severe somatization symptoms.

In Model 3, where the subcategories of job stress and sociodemographic characteristics were input as independent variables, subjects with high scores for ‘improper treatment and interpersonal issues’ and poor perceived health status had more severe somatization symptoms. The explanatory power of the model was 39.7%.

Discussion

Medical service environments are rapidly changing with increasing level of knowledge and skills to be acquired due to advancements in medical technology. As medical institutions grow, competition intensifies, consumer demands increase, and duties become more specialized and compartmentalized5). Such changes have become part of daily life for dental hygienists. These circumstances cause extreme stress, beyond the usual responsibilities and pressure. When individuals are overly exposed to stress, their physical and psychological health are at risk and job satisfaction is reduced, and so job stress management is significantly important14). This study was conducted to provide basic data for effectively managing job stress and somatization of dental hygienists by analyzing factors affecting somatization with regard to the job stress of dental hygienists.

In this study, subjects between 23 and 25 years of age in lower positions, with shorter employment history, lower income, and who had night duty had a high level of job stress. In several previous studies18,20-22), individuals with a higher income had a higher job satisfaction, which corresponds to the findings of the study by Lee et al.23), wherein those with a lower income had a higher level of job stress. Accordingly, a compensation system for personal competence should be established such that individuals can develop a sense of pride for their duty and role, thereby reducing job stress. In the study by Lee et al.23), subjects between 24 and 26 years of age with a short employment history had a high level of job stress, which corresponds to the results of this study. Subjects with a longer employment history have better work proficiency and judgment skills, thus having a lower level of job stress. In contrast, younger subjects with a shorter employment history tend to have a higher level of job stress due to mental and physical stress caused by lack of experience and increased workload. Lower income was also associated with a higher level of job stress. This may be due to an association between employment history and age, in which younger subjects with a shorter employment history in turn generated a lower income. Out of a possible 60 points in the score for somatization symptoms in this study, the average score of the subjects was 47.53 points, which is fairly high. Hence, a measure for alleviating somatization symptoms is needed.

The results of this study showed that poor perceived health status and the presence of somatization symptoms caused a high level of job stress, which corresponds with the findings of Hong et al.6) Differences in levels of job stress affect perceived health status, which eventually leads to somatization symptoms; hence, an effective stress management strategy is needed. When the subcategories of job stress and sociodemographic characteristics were input as independent variables to examine their effects on somatization symptoms, those with a higher score for improper treatment and interpersonal issues had more severe somatization symptoms. This implies that dental hygienists should be encouraged and acknowledged for performing their duties to help them feel a sense of achievement. Moreover, appropriate treatment and compensation should be provided to give them a sense of pride as professionals. When sociodemographic characteristics were input as independent variables, those who worked more than five days a week and had poor perceived health status had more severe somatization symptoms, thus interfering with efficiently performing their duties. Jeong et al.24) reported that a five-day workweek improves job satisfaction while reducing the level of stress. Therefore, dental clinics should change working environments by adopting a five-day workweek to improve the performance of dental hygienists. When the subcategories of job stress and sociodemographic characteristics were input as independent variables, those with a poor perceived health status had more severe somatization symptoms, which corresponds to the findings by Hong et al.6) Job stress has a negative effect on psychological health as well as physical health; hence, job stress is closely related to the overall health of a person. These problems can eventually bring decreased productivity and a loss of workforce. In the study by Lee and Yoon25), job stress has been reported to deteriorate mental and physical health while negatively affecting enthusiasm for work, which is similar to the results of this study.

The limitation of this study is that the data were collected from dental hygienists in a certain region, and so the study results cannot be generalized. Furthermore, this research was a cross-sectional study through which the causal relationship between the variables could not verified. In future studies, more systematic results and the correlation between job stress of dental hygienists and somatization symptoms should be further examined by using various sampling methods. Nonetheless, the results of this study can be used as basic data for developing programs for mitigating job stress and somatization symptoms by identifying factors causing stress and somatization symptoms in dental hygienists, who are the core part of medical services.

Currently, there is lack of regulations or restrictions for managing job stress and somatization symptoms in dental hygienists, let alone the awareness of the risk of such problems. A high level of job stress and lasting somatization symptoms in dental hygienists will reduce the quality of service and care provided to patients as well as the management of dental clinics, while negatively affecting the mental, physical, and social health of dental hygienists. Accordingly, programs and regulations on mitigating job stress and somatization symptoms in dental hygienists, who are vulnerable to emotional labor, should be developed to improve the quality of medical service and work efficiency. Proper treatment and compensation systems should also be provided so as to help dental hygienists develop a sense of pride as professionals.

Notes

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Ethical approval

This study was approved by the institutional review board of Won Kwang University (IRB No. WKIRB-201901-SB-006).

Author contributions

Conceptualization: Mi-Jeong Kim, Hyeon-Sun Kim. Data acquisition: Cha-Young Lim. Formal analysis: Cha-Young Lim. Funding: Mi-Jeong Kim. Supervision: Mi-Jeong Kim. Writing-original draft: Cha-Young Lim. Writing-review & editing: Mi-Jeong Kim, Hyeon-Sun Kim.

Acknowledgements

This study was supported by research fund from, Vision College of Jeonju, 2019.

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  • Vision College of Jeonju