Sivri, Kalliopi
(2019)
Investigating the relationship between job insecurity and health in Europe: a focus on cardiovascular disease.
PhD thesis, University of Nottingham.
Abstract
Background: The economic crisis, which commenced in 2008, had several negative consequences for both nations and individuals. The overall economic situation of nations affected growth, development and employment opportunities. Consequently, unemployment levels and job insecurity for those employed both increased. This thesis aims to explore the impact of job insecurity on a specific group of employees: those affected by cardiovascular disease. Specifically, the thesis aims to explore the interactions between job insecurity and other work-related factors and add knowledge on how employees who had a heart attack and returned to work experience employment protection and social support at work. The thesis also aims to explore the role of work-related factors and employment protection in these employees’ recovery and transition back to work while managing their cardiovascular disease.
Methods: The current thesis is based on the biopsychosocial model of health by Engel (1977) that includes biological, psychological and social elements. Additionally, the thesis incorporates the job demands-control-support (JDCS) model, which aims to explain how job insecurity is affected by other work-related factors that, consequently, directly and indirectly, affect health-related outcomes. The current thesis uses a mixed-methods approach, with qualitative findings complementing quantitative findings through an integrative process. The proposed model of job insecurity and health, which is developed based on the literature, is quantitatively tested on a sample (N= 1,584) retrieved from the European Working Conditions Survey (2010). The quantitative study employed exploratory factor analysis, hierarchical multiple regression (HMR), moderation and mediation analyses (Hayes, 2013), confirmatory factor analysis and multilevel structural equation modelling (MSEM). The qualitative study was based on semi-structured interviews with 30 employees (15 English and 15 Greek) who had a heart attack between 2008 and 2016 and returned to work. It adds cognizance of employees’ experience of employment protection, support and job insecurity. The qualitative study also highlights similarities and differences between the samples in these two countries that were differently affected by the 2008 financial crisis.
Results: In the quantitative part of this thesis, the proposed model was partially confirmed with key structures working as expected, and some sub-hypotheses not being confirmed. Separate HMRs indicated significant results for most hypothesised relationships. However, the results were slightly different when all interactions were tested at the same time with MSEM. Focusing on the MSEM results, JDCS had the expected function in the model, and was associated with job insecurity, financial security/confidence, health, wellbeing and work-related stress. Job insecurity was negatively associated with health and work-related stress as expected, but not wellbeing, presenteeism and work-life balance. Presenteeism and work-life balance were associated with work-related stress, and wellbeing was positively associated with financial security/confidence. The qualitative part of this thesis yielded five key themes: employment rights and security after a heart attack, economic situation, health after a heart attack, self at work after a heart attack, and resources and support after a heart attack. Findings from the interviews showed that employment protection provisions are not always clear to employees, and perceptions of job insecurity are affected by organisational culture, work experience and expertise, business relationships and networks, and job role flexibility.
Conclusion: The integration of quantitative and qualitative findings indicates that workplace social support and job insecurity had an important impact on employees’ health, recovery and transition back to work after a heart attack. EPL and policies affect how employees experience job insecurity, demands and control at work upon their return after sick leave. However, it seems that employment protection and support are not always clear and officially communicated by employers. Lack of adequate inspection of employers’ and managers’ practices is causing inconsistent support provision to employees, consequently affecting levels of job control and security. Further action and research are necessary to encourage the comprehensive implementation of both employment protection and health and safety legislation and policies, requiring employers to implement effective risk assessments for employees’ return to work after a heart attack.
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