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Student ERI: Psychometric properties of a new brief measure of effort-reward imbalance among university students

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Highlights

  • Psychosocial stress among university students, particularly medical students, is considered a widely prevalent problem;

  • There is a need for valid measurement of an adverse psychosocial stress environment in university settings;

  • Student-ERI questionnaire is a psychometrically tested tool for assessment of psychosocial stress in university settings.

Abstract

Background

Psychosocial stress among university students, particularly medical students, is considered a widely prevalent problem. There is a need for valid measurement of an adverse psychosocial stress environment in university settings. The aim of this study was to examine the psychometric properties of a newly developed short student version of the effort-reward imbalance (ERI) questionnaire in a sample of medical students.

Methods

A cross-sectional survey with a self-administrated questionnaire containing three scales was conducted among 406 medical students. Item-total correlations and Cronbach's alpha were calculated to assess the internal consistency of the scales. Confirmatory factor analysis was applied to test factorial validity of the questionnaire structure.

Results

The student version of the ERI questionnaire provides acceptable psychometric properties. The Cronbach's alpha coefficients for effort, reward, and over-commitment were 0.67, 0.65, and 0.79, respectively. Confirmatory factor analysis displayed a satisfactory fit of the data structure with the theoretical concept (GFI > 0.94).

Conclusions

This student version of the ERI questionnaire provides a psychometrically tested tool for studies focussing on psychosocial environment in university settings. Further applications of this approach in other student groups are needed, in addition to prospective studies assessing associations with health outcomes.

Introduction

Stressful psychosocial environments are associated with a number of risks. Previous studies suggest that a stressful environment in university settings may affect health, academic performance, and further career development in university students [1], [2], [3], [4], [5], [6]. Providing a theory-based measure of a stressful psychosocial environment in university settings is important in order to assess related risks and develop health-promoting settings.

Several theoretical models of stressful psychosocial work environments have been developed and applied in occupational health research [7], [8], [9], [10], [11], [12]. One of the most widely tested models, ‘effort-reward imbalance’ (ERI), posits that the imbalance between high effort spent and low reward received in turn elicits strong negative emotions and sustained stress responses [11], [12], [13]. These effects may be amplified in the presence of a distinct personal coping characteristic, termed over-commitment. A robust body of epidemiological evidence obtained from employed populations indicates that effort-reward imbalance is associated with elevated risks of poor physical and mental health functioning [14], [15], [16], [17], [18], [19], [20].

Recent studies have extended this work-related model to the context of school work among adolescents by adapting the original ERI questionnaire to the school setting and revealed sound psychometric properties [17], [22]. Furthermore, the studies indicate significant adverse health effects of perceived effort-reward imbalance in school-aged children and adolescents, such as depressive symptoms [22], suicidal ideation [23], fatigue [24], somatic pain [21], and poor self-rated health [17], [21].

Psychological distress among university students is widely prevalent, given highly challenging curricula, an intensive and time-consuming workload, high intellectual and emotional demands, and lack of leisure time and recreation, particularly among medical students. Identifying stressful components within this complex psychosocial environment is crucial not only in scientific terms, but also in terms of developing preventive strategies. There is a need for reliable and valid measures of health-adverse psychosocial conditions in university settings. The intention of this study is to provide a reliable short theory-based measure of a stressful psychosocial environment in university settings, with items reflecting all dimensions of the approved original effort—reward imbalance model. The aim of this investigation was to examine psychometric properties of a newly developed standardized self-administered short version of the ERI questionnaire, using a sample of medical students. In this short report we focus mainly on the criteria of content and construct validity.

Section snippets

Study design and participants

This current investigation is based on a cross-sectional survey which is a part of the prospective cohort study “Healthy Learning in Duesseldorf” (HeLD). HeLD-Study was initiated at the start of a major reform of the curriculum of medical education at the Medical Faculty of Heinrich Heine University Duesseldorf in Germany. All medical students, enrolled at the Heinrich-Heine-University of Dusseldorf during 2012–2013, were invited to participate. In total, 406 students completed our

Results

The mean age of the initial sample of students was 21.1 years (SD = 3.9), 30% were men. 34.4% of participants had both parents without an academic degree while the majority of students came from families with academic background. Mean scores of the scales effort, reward and over-commitment, and the mean value of the effort-reward ratio were 3.09 (SD = 0.51), 2.94 (SD = 0.44), 2.63 (SD = 0.68) and 1.09 (SD = 0.32), respectively.

Discussion

The current findings show that the ERI model, which was initially designed to identify a health-adverse psychosocial environment of paid work, can be effectively adapted to a different working context, as represented by an intense learning and training environment within Universities, and specifically within a Medical Faculty. Using a 14-item questionnaire, we replicated the 3 core theoretical components of the model (effort, reward and over-commitment), where confirmatory factor analysis

Conflicts of interest

None declared.

Acknowledgements

This study is based in part on data from the HeLD (healthy Learning in Düsseldorf) Study, provided by the Institute of occupational und social Medicine, Centre of Health and Society, University of Düsseldorf.

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