The association between job strain and psychological well-being in national health insurance pilot clinics.
Ackerman, Dianne Megan.
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A review of literature revealed that South Africa is faced with a quadruple burden of disease that is exacerbated by the high incidence of co-morbid depression amongst chronic patients. In a country where mental disorders are still highly stigmatised, providing integrated care becomes a challenge. Dealing with mental health requires caregivers to provide a service that they are not sufficiently trained for or comfortable providing. With the introduction of the National Mental Health Care policy framework and action plan in South Africa, through Primary Care 101 (PC101) which is an integrated set of chronic care guidelines, nurses are receiving additional training on mental health in order to facilitate the process of integration. In the context of all these changes, the aim of this study was to establish the association between job strain and its constructs with psychological well-being. In addition, the study aimed to investigate the relationship between self-efficacy and psychological well-being. The study made use of a quantitative measure in the form of a cross-sectional survey. The study was conducted at the National Health Insurance (NHI) pilot clinics in Klerksdorp, in the North West province as part of the Programme for Improving Mental Health Care (PRIME-SA) project. The sample consisted of professional nurses (n=137). Data was analysed using SPSS 22.0 through frequencies, descriptives and correlations between job strain, psychological job demands, decision latitude, self-efficacy and psychological well-being, and finally multiple regression analysis was conducted. The study findings indicated that nurses who experienced high levels of job strain would be more likely to possess low levels of psychological well-being. Furthermore, nurses who reported higher levels of control over their environments were likely to have higher levels of psychological well-being. Additionally, an increase in levels of self-efficacy was associated with an increase in the levels of psychological well-being. The relationship, however, between psychological job demands and psychological well-being indicated that increased psychological job demands was associated with a decrease in the levels of psychological well-being. Multiple regression analysis showed that self-efficacy was the only construct which made a unique positive predictive contribution to psychological well-being. The results of this study suggest that possible interventions to enhance decision latitude and self-efficacy of nurses may help enhance psychological well-being of nurses. Self-efficacy, making the only unique positive predictive contribution to psychological well-being, will have important implications for future interventions; hence the focus of this study is on self-efficacy when suggesting interventions. Such interventions may help attract and retain nurses and ultimately contribute to the success of the re-engineering of primary health care and the NHI.