Job demands and resources and their association with employee well-being in the healthcare sector: a systematic review and meta-analysis of prospective studies

Research goals and background: At European level, the healthcare sector is considered one of the most at-risk contexts for employee well-being. Healthcare employees are exposed to a wide range of straining work characteristics. Despite this, a comprehensive overview of the major job characteristics experienced by the European healthcare employees, and a metaanalytic investigation of their long-term relationships with well-being, is lacking. Guided by the JD-R model (Bakker & Demerouti, 2017), we investigated which job demands and resources have been prospectively explored in literature in the European healthcare sector. Second, we quantified the prospective associations between these job demands and resources and employee well-being. Third, we tested if the relationships between job demands and resources and well-being were moderated by generic or healthcare-specific job demands and resources, source (Nielsen et al., 2017), time lag, gender, and age. Methods: We followed PRISMA guidelines (Moher et al., 2009) to retrieve eligible publications. We limited our search to European longitudinal studies published between 2008 and the date of search (March 2019). We assumed a random-effects model and performed univariate and multivariate analyses (Cheung & Chan, 2005). Moderator analysis was performed using subgroup analysis and mixed-effects meta-regressions. Publication bias and the presence of outliers were finally inspected. Results: 50 independent samples were selected for inclusion. Demands, lack of control, lack of support, negative relationships, and role stress emerged as generic job demands; work schedule, interaction with patients, emotional demands, work-life conflict, physical demands, organizational unfairness, lack of development, and straining work environment as contextual demands. We identified control, support, positive relationships, and role clarity as generic job resources; opportunities for development, organizational fairness, staff adequacy, work environment and equipment, and work-life balance as contextual resources. Univariate and multivariate analyses showed that the prospective effects on well-being for job demands and resources were significant. We found evidence for reciprocal effects between JD-R and wellbeing, with perception of demands and resources predicting well-being, and vice versa. No significant differences in well-being between generic and specific job characteristics, and between multiple-level job demands and resources, were found. Conclusions: Our results suggest that accurate psychosocial risk assessment should consider both generic and occupation-specific job demands and resources to better catch the specificities of high-risk sectors such as the healthcare, and to design effective interventions. These may be focused on reducing job demands and building resources at different levels to successfully improve well-being.