The route to well-being at workplace: examining the role of job insecurity and its antecedents

Sumera Saeed (Department of Commerce, Faculty of Commerce Law and Business Administration, Bahauddin Zakariya University, Multan, Pakistan)
Ibne Hassan (Department of Commerce, Faculty of Commerce Law and Business Administration, Bahauddin Zakariya University, Multan, Pakistan) (College of Business, University of Hail, Hail, Saudi Arabia)
Ghulam Dastgeer (College of Business, University of Hail, Hail, Saudi Arabia)
Tehrim Iqbal (COMSATS Institute of Information Technology, Islamabad, Pakistan)

European Journal of Management and Business Economics

ISSN: 2444-8494

Article publication date: 30 April 2021




The current study focuses on the role of antecedents to prevent perceived job insecurity and mitigate its negative impacts on work-related well-being. The study examined variables of the resourceful environment (effective organizational communication and involvement), conserved resources (perceived employability and emotional exhaustion) and resource loss (job insecurity) by drawing on the Conservation of Resources (COR) theory for predicting the work-related well-being adding the moderating role of boundaryless career orientation.


A sample of 306 salespersons of pharmaceutical companies working in Pakistan was obtained. The hypothesized relationships were tested through structural equation modeling in SmartPLS.


The results confirmed showed that the organizational communication, employee involvement and perceived employability reduce the perceived job insecurity; however, the emotional exhaustion was positively related. It also confirmed the moderating effect of boundaryless career orientation on relationship of job insecurity and well-being.

Practical implications

To make employees engaged, the organizations are required to involve employees by sharing knowledge, information and power to make decisions, value their opinion and ensuring the employability. Further, salespersons having a preference of a boundaryless career proved to mitigate negative impact of job insecurity on work-related well-being.


Many empirical studies have identified that the perceived job insecurity is one of the major concerns affecting employee's well-being. However, few studies simultaneously have sought to prevent the perceived job insecurity among employees. The findings are important in developing the understanding that how salespersons perceive their capabilities and the work environment of the organization, this perception; resultantly, can influence their behaviors particularly the work engagement dimension of well-being.


本研究的焦點為探討導致僱員感到缺乏職業安全的成因, 對防止該感覺的產生扮演著什麼角色,並研究導致缺乏職業安全感的成因,就減少缺乏職業安全感給和工作有關的幸福感所帶來的負面影響方面扮演著什麼角色。研究應用了可預測與工作相關的幸福感的資源保留理論 (COR) ,來探討資源豐富的環境 (有效的機構溝通及參與) 、節約資源 (感知的受僱能力與情緒耗竭) 及資源耗損 (缺乏職業安全) 這些變數,並加入了無邊界職業生涯定向的調節角色。






過去許多實證研究均已證實缺乏職業安全感是影響僱員幸福感的一個主要因素,唯很少研究會同時透過探討資源豐富的環境 (有效的機構溝通及參與) 和節約資源 (感知的受僱能力和情緒耗竭) 等變數,來嘗試防止僱員產生職業不安全的感覺。本研究的結果至為重要、因它使我們更了解營業員對自己的能力及機構的工作環境的看法、最終會影響他們的工作行為,特別是幸福感的工作投入層面。







Saeed, S., Hassan, I., Dastgeer, G. and Iqbal, T. (2021), "The route to well-being at workplace: examining the role of job insecurity and its antecedents", European Journal of Management and Business Economics, Vol. ahead-of-print No. ahead-of-print.



Emerald Publishing Limited

Copyright © 2021, Sumera Saeed, Ibne Hassan, Ghulam Dastgeer and Tehrim Iqbal


Published in European Journal of Management and Business Economics. Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at

1. Introduction

In the past few years, there has been a constant rise in the studies on workplace well-being (Kowalski and Loretto, 2017; Diener et al., 2018). The surge in this trend is based on the findings that happy employees are more productive employees (Miller, 2016; Warr and Nielsen, 2018). Health and well-being have also been adopted by the United Nations as the third Goal out of seventeen “Goals of Sustainable Development” (United Nations, 2015), which calls for healthy lives and well-being for all and at all ages. It is recognized that the good health and well-being of individuals depend on and contribute to the other Goals of Sustainable Development such as sustaining social justice, economic growth and environmental protection. The current investigations have become more relevant especially after the coronavirus disease 2019 (COVID-19) outbreak against which the individuals in organizations are facing limited social and work support, increased work pressure and asymmetrical working hours (Blake et al., 2010; International Labor Organization, 2020).

In an organizational milieu, well-being embraces the worker's physical, mental, emotional and spiritual health (Mirabito and Berry, 2015). Researchers have proposed the factors such as psychological capital, job satisfaction, organizational commitment and role of leader/supervisor to contribute to well-being at work in any given organizational and cultural context (Avey et al., 2010; Kumar and Giri, 2009; Chughtai et al., 2015). At the same time, job insecurity is consistently proven to damage both the mental and physical health and well-being of employees (Richter et al., 2014; De Witte et al., 2016). At the individual level, perceptions of job insecurity affect the physical health and well-being negatively, whereas at the organizational level it results in reduced work engagement and poor work behaviors (Richter, 2011; Vander Elst et al., 2012; Nella et al., 2015; Jiang and Lavaysse, 2018). Researchers in the field have almost unanimously affirmed that the perceptions of job insecurity must be reduced and ultimately prevented for the betterment of individual employees and the organization's health. Sjöberg (2018) has regarded perceived job insecurity as the disease of the 21st century. Growing research has documented its detrimental effects on employee's health and well-being (Cheng et al., 2012; Jiang and Probst, 2016; Witte, 2016).

However, most job insecurity research is conducted in the Western context (Wang et al., 2014). As perceived job insecurity has become a worldwide concern (Cheng et al., 2012), Pakistan has no exemption to it. Job insecurity is a subjective perceptual experience and perceptions largely arise from the work environment of employees (Qureshi and Khan, 2016). In Pakistan where the majority of people are facing unemployment, persons having jobs, are facing tough competition at one hand and threats of job loss on the other hand. There exists empirical evidence that job insecurity has been experienced as a common phenomenon in the private sector organizations of Pakistan (Awan and Salam, 2014; Qureshi and Khan, 2016). Drawing on the sample of private college teachers, Awan and Salam (2014) concluded that there exists a negative relationship among age, performance and job insecurity. In response to the call of filling in the gaps in the meta-analysis by Shoss (2017), who recommended additional studies to expand knowledge of antecedents as well as the consequences of job insecurity, the current study investigates whether organizational communication, employee involvement, perceived employability and emotional exhaustion are associated with job insecurity perception among the salespersons in pharmaceutical companies as job insecurity is the major concern in many industries; including pharmaceuticals employ salespersons (Chaker et al., 2016). Vander Elst et al. (2010) recognized through a broad study that organizational communication and participation relate negatively to job insecurity. Likewise, Huang et al. (2012) disclosed that employment involvement practices of information sharing, inclusion in decision-making as well as group goals reduce perceptions of job insecurity. Likewise, exhausted employees possess little emotional and physical resources (Maslach et al., 2001), which reduce employees' control and may raise negative emotions and attitudes (Jiang and Probst, 2016). Another variable which Shoss (2017) suggested in meta-analysis is perceived employability. Workers who experience job insecurity due to lack of perceived employability have increased risk of deviant behaviors and intentions to leave (De Cuyper et al., 2009; Huang et al., 2017). Additionally, these variables have buffering effects on several negative effects of job insecurity (Jiang and Probst, 2014; Schreurs et al., 2012; Wang et al., 2015). If not mitigated these variables can ultimately harm well-being and job attitudes (De Cuyper et al., 2014; Hewlin et al., 2016). Additionally, little is known about mitigating the negative effects of perceived insecurity on work-related well-being (Cheung et al., 2016). Therefore, it is suggested that by taking “boundaryless career orientation” like pursuing educational opportunities, the negative effect of job insecurity can be mitigated (Klehe et al., 2012; Shoss, 2017). Hence, the study examines boundaryless career orientation as a moderator on the job insecurity well-being association. To the best of our knowledge, this study is the first to investigate the effect of job insecurity on well-being, particularly in a sales context as well as its original to examine boundaryless career orientation as a moderator between perceived job insecurity and work-related well-being.

2. Literature review

Well-being is viewed as the first and foremost goal in every society. Human well-being remained the goal of all human activities (Diener et al., 1999). The literature review synthesizes that interest in employee well-being at work is growing globally (Kowalski and Loretto, 2017). Following the stream of positive psychology (Seligman and Csikszentmihalyi, 2000), there is a surge in organization behavior–related scholarship (Luthans, 2002; Cameron et al., 2003; Cameron and Spreitzer, 2012; Simmons and Nelson, 2007) focusing on positive attitude and experiences at work. Since this development our understanding related to happiness and well-being at workplace has enhanced. Ample of constructs, including job satisfaction, job involvement, organizational commitment, work engagement, emotions and moods, intrinsic motivation, thriving and vigor have been measuring different forms and aspects of well-being (Fisher, 2010). The well-being of employees is a broad construct as it includes the physical, emotional, mental and spiritual health of employees (Mirabito and Berry, 2015). It describes the level of their work involvement, intrinsic motivation, engagement and meaning in work (Fisher, 2014). While well-being at work is multi-dimensional (Grant et al., 2007; Page and Vella-Brodrick, 2009; Warr, 2013), its measurement and conceptualization vary in timeframe and range (Warr, 2013). For instance, Bakker and Oerlemans (2011) have proposed five frequently used indicators; engagement, job satisfaction, workaholism, burnout and happiness to measure affect based hedonic well-being at work. They ranked engagement in high pleasantness, while burnout in the low pleasantness low arousal quadrant. Finally, happiness as an emotion is considered to be high pleasantness and moderate arousal. Consequently, Fisher concluded that the scholars have defined construct in “many and inconsistent ways.” He also noted that definition of well-being whether broad and or specific depends on the research questions being asked. He suggested that if the other constructs in the research model are specific and narrow, then specific and narrow measures of aspects of well-being might be most appropriate. If the other constructs in the model are broad, then general measures of well-being may be most suitable. Hence, he recommended the construct of job engagement to measure the intrinsic engagement and enjoyment aspect of the work-related well-being. He further acknowledged that the inclusive scale on work-related well-being measuring the entirety of the concept does not exist as the existing scale omits either subjective well-being aspects or social well-being items.

The current study focuses on “work-related” well-being. In the academic tradition, the construct of work-related well-being is measured by the concept of burnout, work engagement, occupational stress level and job satisfaction level. These measures estimate the vigor-fatigue, enthusiasm-depression and anxiety-comfort dimension of well-being (Warr, 2002). In the similar vein, Maslach et al. (2012) conceive that employees' psychological relationship to their work is like a continuum between the negative experience of burnout and the positive experience of engagement. Besides, in the context of well-being the term engagement has become very popular though many scholars have defined it differently (Macey and Schneider, 2008). Some have conceptualized it in eudaimonic well-being domain focusing more on meaning and intrinsic motivation, and flow experiences while the other for instance Kahn (1990, 1992) coined the term “personal engagement” to denote to the physical, emotional and cognitive devotion to work. In the literature, the construct of well-being is defined in line with the hedonic perspective of happiness (Ryan and Deci, 2001), which connotes to the presence of positive mood and absence of negative mood (Diener et al., 1998). Work engagement is the positive, fulfilling and affective motivational state of work-related well-being (Warr and Inceoglu, 2012) which is characterized by the concept of vigor, dedication and absorption (Bakker and Demerouti, 2008). Vigor denotes the extraordinary level of drive and mental resilience where one is ready to invest energy in execution of tasks while facing obstacles. Dedication refers to involvement in work such that it gives you sense of worth, pride and challenge, while absorption symbolizes full focus and of being joyfully immersed in activities (Bakker et al., 2008; Schaufeli et al., 2004; Narainsamy, 2013). In conformity with the previous related studies “work engagement” is employed as the indicator of work-related well-being (De Cuyper et al., 2008; Vander Elst et al., 2012). Work engagement is a significant indicator of occupational well-being for both employees and organizations (Bakker et al., 2011). Just as Buitendach et al. (2016) used work engagement, happiness and job satisfaction as positive aspects whereas burnout as the negative aspect of employee well-being. In a recent study Vander Elst et al. (2012) on a heterogeneous sample of 3,185 Flemish employees measured the work-related well-being through vigor construct of engagement using Utrecht Work Engagement Scale (UWES; Schaufeli and Bakker, 2004). Work-specific well-being of Finnish dentists were determined by the burnout and work engagement constructs (Hakanen and Schaufeli, 2012). Besides, Kanste (2011) considers work engagement and work commitment as essential, positive components of work-related well-being. As Hakanen and Schaufeli (2012) argued, work engagement has temporal precedence over well-being. Dissimilar to the symptoms of burnout those who are engaged employees have a sense of robust and effective connection with their work (Schaufeli et al., 2006), this engagement is characterized by the properties of “vigor, dedication and absorption” (Schaufeli et al., 2002). Schaufeli et al. (2008) through the sample of 587 telecom managers concluded that workaholism, burnout and engagement are three different kinds of employee well-being. Moreover, burnout akin to job demands (e.g. role stress) (Bakker et al., 2003, 2004), while engagement is associated to personal resources (Bakker et al., 2005; Hakanen et al., 2006; Langelaan et al., 2006; Mauno et al., 2007; Xanthopoulou et al., 2007).

According to the World Health Organization (WHO), well-being of workers comprised of conditions whereby an employee understands his/her potential and ability to handle the pressures in working productively and contributing toward the whole society. Previous research suggested that happy and engaged employees are more likely to be productive (Saks, 2006; Reio and Rocco, 2011; Warr and Nielsen, 2018). This study takes Conservation of Resources (COR) theory (Hobfall, 1989) as the theoretical base that explained the relationship between perceptions of insecurity and work-related well-being. According to the basic credence of the COR theory, all individuals seek to acquire, retain, foster and protect those resources they consider valuable and that the individuals are threatened by the actual or potential loss of those resources (Hobfoll, 1989). He views “resources” as personal (skills, self-esteem), conditions (e.g. being employed, autonomy, performance feedback), energies (time, money and knowledge) and objects of value.

This study is investigating organizational communication, employee involvement, perceived employability and emotional exhaustion as antecedents of job insecurity using the theory of COR. Resources can be categorized as job related and person related (Del Libano et al., 2012). Personal resources reflect a sense of strength and refer to the individuals' capability to control as well as influence their environment (Hobfoll et al., 2003). Perceived employability is a useful resource for active adaptability to labor market changes (De Cuyper et al., 2011). Froehlich et al. (2015) confirm how perceived employability influences the relationship between job insecurity and job satisfaction. The COR theory considers emotional intelligence as a resource and for many years the emotional exhaustion has affected resource investment strategies tied to performance at work (Demerouti et al., 2014; Halbesleben and Bowler, 2007). In literature, positive organizational communication efforts are proposed as a resource that might serve as a buffer in times of job insecurity (Jiang and Probst, 2013). Following sections present the theoretical review of each antecedent and its proposed influence on job insecurity and well-being.

2.1 Job insecurity and well-being

Job insecurity is considered as the common stressor having unfavorable consequences for employees (Cheng et al., 2005). Job insecurity is the disease of the 21st century (Sjöberg, 2018). Greenhalgh and Rosenblatt (1984, p. 438) defined it as “a sense of powerlessness' to maintain desired continuity in the threatened job situation”. De Witte (2005) has defined job insecurity as a perceived risk of losing the current job. It reflects the current situation of a job not the overall career of a person. Later, Vander Elst et al. (2016) described job insecurity as a subjective experience to feel the risk of potential job loss. Perceived job insecurity contributes to reducing job satisfaction, job involvement and trust in an organization (Richter and Naswall, 2019); soars organizational stress, anxiety and depression (Chirumbolo and Areni, 2010); ascends absenteeism (Jiang and Lavaysse, 2018; Karatepe et al., 2020) and increases turnover (Hellgren et al., 1999).

The COR theory (Hobfoll, 2002) explains the negative outcomes that job insecurity generates. From the COR theory’s (Hobfoll, 2001) perspective, job security is also a resource as it guarantees access to other resources like salary to fulfill economic needs (Sjöberg, 2018). According to the COR theory, when the valued resources go under threat of loss it creates anxiety and stress. People get stressed when they fail to invest resources that are essential for their goals (Hobfoll, 1989). Taking note of the COR theory, we can conclude that the possible or actual job loss presents a threat to the valuable resource or resources that would, in turn, lead toward impaired well-being. The potential job loss would generate stress reactions, i.e. less engagement in work that eventually goes toward the loss spiral. Consistent with the COR theory, we can say that the possible or actual job loss of employees be it job features presents a threat to the valuable resource or resources. Employees simultaneously start searching for other jobs during work time instead of concentrating on their present job (König et al., 2010). Likewise, when employees experience the threat of resource (job) loss, they invest less energy in their current job to prevent further resource losses (Cheng et al., 2012).

Findings of various studies proposed that job insecurity has a negative link with job attitude, as well as the well-being of employees (Cheng et al., 2005; Otto et al., 2011, 2016; Jiang and Probst, 2016; Huang et al., 2017; Getahun Asfaw and Chang, 2019). People having more resources may perceive the less risk job loss, however, those with fewer resources may perceive their jobs insecure and become less engaged (Holmgreen et al., 2017). Studies confirmed that job insecurity is related to a separate dimension of work engagement and job insecurity predicted low dedication (Mauno et al., 2007; Xanthopoulou et al., 2007; Vander Elst et al., 2010). That is, engaged employees are working enthusiastically (vigor), are concerned about their work (dedication) and are fully focused and happily immersed in their work (absorption) (Bakker et al., 2008). Thus, the study tested the following hypothesis for the salespersons:


Perceived job insecurity has a negative relationship with work-related well-being.

2.2 Employee involvement

Employee involvement creates a setting that connects employees in all levels of organizational decision-making, giving them information, and involving them in problem-solving activities (Riordan et al., 2005). Therefore, employee involvement policies are globally practiced (Su and Wright, 2012; Smith et al., 2018). Employee involvement can be an important resource at work to achieve success (Hobfoll, 1988, 1989). The basic assumption of the COR theory is that individuals in all contexts strive to retain, protect and gain resources for maintaining well-being (Hobfoll, 2001). When employees possess resources, they develop the ability to protect the future loss of resources (Hobfoll et al., 2018). Previous literature provides the evidence that employee involvement is positively related with work engagement (Macky and Boxall, 2008; Rana, 2015). Similarly, more engaged employees are less likely to feel insecure about their job.

In the same way, involved employees are less likely to feel insecure about a job. Similarly, Huang et al. (2012) revealed that employee involvement practices that include decision-making, information sharing would increase perceptions of control in employees; hence, minimizing the perceived job insecurity. This is because the participation of employees provides opportunities for networking with supervisors that may increase the perception of security (Vander Elst et al., 2010). The COR theory suggests that a person when gaining more resources will move to well-being (Hobfoll, 2002). It can be hypothesized that:


Employee involvement is positively related with work-related well-being


The relation between employee involvement and work-related well-being is mediated by perception of job insecurity.

2.3 Organizational communication

Organizational communication is the extent to which workers have an adequate amount of information about the organization and their tasks (Stoter, 1997). Organizational communication reinforces the worker's understanding and control over their work situation and conditions (DeWitte, 2005), as it offers clarity and certainty in one's employment setting and is related with higher well-being (Vander Elst et al., 2010). Previous studies reported a positive relationship of organizational communication and work engagement (May et al., 2004; Lieke et al., 2012). Adkins et al. (2001) suggested the negative association of organizational communication with perceived job insecurity. That is, when employees have information about their roles such as expectations, performance ratings and conditions of employment, it helps workers to feel secure (Huang et al., 2012). However, poor organizational communication creates unclear expectations and enhances employee's perceptions of job insecurity (Keim et al., 2014). Likewise, rumors also create confusion, enhancing the perception of job insecurity among employees (Smet et al., 2016). The COR theory (Hobfoll, 2001) conceptualizes organizational communication as a key resource for employees to gain insights about work situations. Well-being is influenced by the extent to which the resources are pooled by employees in understanding and controlling the job insecure situations. It can be hypothesized that:


Organizational communication is positively related to work-related well-being.


The relationship between organizational communication and work-related well-being is mediated by perceived job insecurity

2.4 Perceived employability

Perceived employability is defined as the perceptions of an individual's ability to find alternate employment (McQuaid and Lindsay, 2005). It is been evaluated by objective indicators such as education, skills, training and occupational or market position (Van Dam, 2004; De Jong and Schalk, 2017). Several studies described perceived employability as a “potential antecedent of job insecurity” (Forrier and Sels, 2003; Berntson et al., 2007). Previous studies also confirmed a negative association between perceptions of job insecurity and employability (Kalyal et al., 2010). This study conceptualized the perceived employability as the personal resource from the COR perspective. According to the COR theory, individuals with resources can gain more means as well as have less risk of resource loss. The characteristics which are tied to an individual as resources include feelings about being able to influence its environment and situation (Hobfoll et al., 2003). Researchers have found a positive relation of perceived employability with employees' general and work-related well-being (Silla et al., 2009; De Cuyper et al., 2008). It can be hypothesized that:


Perceived employability is positively related to work-related well-being.


The relation between perceived employability and work-related well-being is mediated by perceived job insecurity

2.5 Emotional exhaustion

It is observed that exhausted workers express very little energy, and they also have reduced resources, hence reduced personal accomplishment. Emotional exhaustion is mostly demonstrated by physical fatigue and the feeling of psychologically and emotionally drained sensations (Wright and Cropanzano, 1998). Emotional exhaustion arises when workers feel that they do not have sufficient physical and emotional resources in coping with different stressors (Hobfoll, 1989). Emotional exhaustion is found to initiate perceived job insecurity because the exhausted workers exhibit poor performance. So, emotional exhaustion with poor performance spurs feelings of job insecurity. Work engagement is essentially regarded as energy and thereby a resource, consistent with the COR theory. The COR theory conceptualizes emotional exhaustion as the depletion of energy resources (Halbesleben, 2010; Zijlstra et al., 2014) that ultimately reduces the work engagement. Most of the research has reported a negative relationship between work engagement and emotional exhaustion (Schaufeli and Bakker, 2004; Hakanen et al., 2018). In a study of 1,314 employees of Finnish universities, De Cuyper et al. (2012) found the positive relation of emotional exhaustion and perceived job insecurity which ultimately affects the work-related well-being. Therefore, it can be hypothesized that:


Emotional exhaustion is negatively related to work-related well-being.


The relation between emotional exhaustion and work-related well-being is mediated by perceived job insecurity.

2.6 Moderating role of boundaryless career orientation

The boundaryless career orientation is defined as the career paths wherein employees respond to reduced organizational resources by seeking opportunities and resources from outside the current employer, by changing employers or building an external professional network (Arthur and Rousseau, 1996). It encourages flexibility, the development of knowledge and networks, and the taking of responsibility for one's career (Cartwright and Cooper, 2008). Sullivan and Arthur (2006) proposed a boundaryless career orientation as physical or psychological mobility. Physical mobility refers to the actual movement across organizations and industries, whereas psychological mobility is the psychological orientation toward making those movements. This study adopted Briscoe and Hall's (2006) idea of boundaryless career orientation as the preference of employees to move across different employers/organizations. Boundaryless career orientation provides the shift in control of careers from organizations to individuals. By using the COR theory (Hobfoll, 2001), the study conceptualizes boundaryless career orientation as a personal resource; therefore, the employees who possess resources, develop the ability to protect their resources (Hobfoll et al., 2018). Personal resources in work environment refer to an individual's sense of capability to manage his or her surroundings. When an individual takes account of one's career, they perceive their work as significant, meaningful and valuable (Rosso et al., 2010). Employees who have personal resources have confidence in their capabilities and are optimistic about their future. This allows them to be more engaged in their jobs (Xanthopoulou et al., 2007; Ngo and Hui, 2018). Individuals while gaining resources and opportunities for developing new skills and competencies may better adapt to the current work environment and move toward well-being (Hobfoll, 2002). From the COR theory and the above discussion, it can be hypothesized that:


Boundaryless career orientation will be positively related to the work-related well-being.

Several studies suggest that individuals with high boundaryless career orientation are characterized by high mobility. Conversely, persons with low boundaryless career orientation choose to do an existing job with the same employer (Volmer and Spurk, 2011). Boundaryless career orientation allows individuals to continue to thrive even in uncertain conditions and explore alternative opportunities, while maintaining capabilities in their existing employment at the same time (Briscoe et al., 2012). The COR theory states that resource investment is more evident during the time of possible loss (Hobfoll, 2001). It is therefore assumed that the salespersons with a high presence of boundaryless career advance their resources to develop more resources. Moreover, boundaryless career orientation provides the basis of career success by understanding one's competencies, opportunities in the wider economic environment and likely development in future jobs. From the COR theory and the above discussion, it can be hypothesized that:


Boundaryless career orientation buffers the negative association between perceived job insecurity and work-related well-being (Figure 1).

3. Research methodology

The present study employed a quantitative design and deductive approach as the objective is to examine the factors to reduce the perceptions of job insecurity among salespeople. The study takes the COR theory by Hobfoll (1989, 1998) as the deductive argument that sets the foundation for establishing the hypotheses of the research.

3.1 Data collection

Cross-sectional data were collected from salespersons of pharmaceutical companies in Pakistan where job insecurity is a reality (Chaker et al., 2016). Furthermore, the literature review synthesized scarcity of well-being related empirical studies on this sector. The self-reported questionnaire was personally distributed to 350 salespersons using simple convenience sampling. This method of sampling is recommended when the sample meets the objectives of research and is willing to participate in the study, sample is easily accessible, is at proximity and accessible on time (Dörnye, 2007). Convenience sampling technique is appropriate to both qualitative and quantitative design of studies as this method underscores generalizability of the findings on the population (Etikan et al., 2016; Suen and Lee, 2014). In total, 306 filled questionnaires were obtained, yielding the rate of response 87% approximately. The standard statistical analysis including structural equation modeling “recommends a sample of 200 as fair and 300 as good” sample for such studies (Tabachnick and Fidell, 1996). The current study followed the suggestion of Hair et al. (2008) to choose a sample that is five times the number of items in the questionnaire. Therefore, a sample size of 310 was required for this study. The demographic characteristics of the sample are shown in Table 1.

3.2 Measures

The questionnaire comprised of 62 items, 12 items measured employee involvement using the scale of Vandenberg et al. (1999), employee's perceptions of involvement on four components such as sharing of power, information, reward and knowledge was assessed. For example, items included “I have sufficient authority to fulfill my job tasks,” “Company policies and procedures are communicated to employees,” “Generally, I feel this company rewards employees who make an extra effort,” “I am given a real opportunity to improve my skills at this company through education and training programs.” Similarly, 11 items of the scale proposed by Smidts et al.'s (2001) assessed organizational communication (e.g. “I have received information about the goals of our organization”; “I have received information about how well I fulfill my task”; “I have received information about ongoing management decisions”). A six-item scale for emotional exhaustion by Maslach et al. (1996) was used. Burnout inventory measures how often an individual feels emotionally exhausted by his job. The items were rated on a seven-point Likert scale ranges from 0-never to 6-everyday. Sample items include “I feel emotionally drained from my work,” “I feel tired when I get up in the morning and face another day of work,” and “I feel I'm working too hard on my job.” perceived employability was measured with four items from De Witte (1992). It has items as: “I am confident that I could quickly get another job,” rated on a 5-point Likert-type scale ranges from 1-(totally disagree) to 5-(totally agree), and 7-items of perceived job insecurity was lent from Hellgren et al. (1999) such as: “I am worried that I will have to leave my job before I would like to,” “I worry about being able to keep my job.” 17-item scale of work-related well-being was lent through the Utrecht Work Engagement Scale (Schaufeli et al., 2002). It measured vigor (6 items), dedication (5 items) and absorption (6 items) and were rated on a 7-point Likert-type scale ranges from 0-never to 6-everyday. Boundaryless career orientation is measured through Briscoe et al.'s (2006) subscale of organizational mobility. It was rated on a 5-point Likert-type scale ranging from 1 (to a little or no extent) to 5 (To a great extent). The items of organizational mobility were reversely coded. The sample items include “I would feel very lost if I could not work for my current organization,” “I prefer to stay in a company I am familiar with rather than look for employment elsewhere,” “In my ideal career, I would work for only one organization.” Demographic information such as gender, education level and years in service was treated as control variables.

4. Analysis and results

The preliminary analysis of data was conducted with Statistical Package for Social Sciences (SPSSs), version 20.0. The analysis includes the screening of data, descriptive statistics and normality. The descriptive analysis including means and standard deviation (SD) of the sample is shown in Table 2. The table also includes the skewness and kurtosis values of variables demonstrating that the normality of data is ensured. Structural equation modeling was employed with SmartPLS 3.0. to test the measurement and structural model. The following is the detailed evaluation of both measurement and structure model.

4.1 Assessment of measurement model

The assessment of the outer model determines the fit among the proposed theory and data collected (Hair et al., 2014). The confirmatory factor analysis was used to evaluate the measurement model. The outer loadings of every item used in this study are generated in partial least squares (PLS) calculation. Table 4 shows that each item has a loading of above 0.50, the items below 0.40 loading were deleted for further analysis (Hair et al., 2014). It ensures that only valid and reliable constructs should be used to measure the relationships among variables. The reliability of instruments is evaluated with Cronbach's alpha. The Cronbach's alpha evaluates the internal consistency of the instrument, and Sekaran (2006) recommends the value of 0.5 as poor, 0.6 is satisfactory and 0.7 as good. For this study, Cronbach's alpha of all constructs is greater than a satisfactory level (See Table 3). The composite reliability indicates the internal consistency and its value should be 0.6 (Bagozzi and Yi, 1988; Awang, 2015). Composite reliability values displayed a satisfactory level (See Table 3). Construct validity is defined as the degree to which measured items characterize the underlying construct (Saunders et al., 2016, p. 193). The validity of the construct is measured by convergent and discriminant validity. For establishing convergent validity, the factor loadings (See Table 4) and “average variance extracted” (AVE) are higher than 0.5 as recommended by Hair et al. (2014). Table 3 exhibits AVE values thus establishing the convergent validity of all variables. Discriminant validity evaluates that every construct to be distinct and unique from all other constructs and the correlation matrix in Table 1 exhibit the square root of the AVE for every variable is higher than their correlation with other variables as recommended by Fornell and Larcker (1981).

4.1.1 Control variable:

Control variables like gender education level and years in service were assessed to eliminate alternative explanations for the obtained results in SPSS. As such coding for gender is 1 = male; 2 = female. For education level (1 = masters; 2 = graduation; 3 = other) and years in service is coded as (1 = 1–10 years; 2 = 10–20 years; 3 = 20–30 years). An independent sample t-test was conducted to compare the mean difference between males and females. The reported result was insignificant; hence, there is no statistical significance difference between gender male and female with respect to work-related well-being. To check the significant mean differences among different education levels and years in service with respect to the dependent variable, we run the one-way Analysis of Variance (ANOVA) test in SPSS, but we did not find the significant result of the test, justifying that there is no mean statistical difference in education and years in service concerning work-related well-being.

4.1.2 Common method variance:

Data were collected through a self-reported questionnaire. Thus, to avoid common method variance, several measures were adopted. First, the study adopted procedural recommendations by Podsakoff et al. (2003) such as using different scale types for the independent and outcome variable; adopted the validated measures and used reverse-coded items on a scale. Next, Harman's one-factor test was conducted to examine common method variance. This has ensured that all measurement items were subjected to factor analysis by applying the extraction method of the principal component of one fixed factor with no rotation method (Podsakoff, 2003). Common method variance exists when a single factor accounts for more than 50% variance independent variable. The first factor explained 34.14% of the variance, demonstrating that there is no single factor accounting the variance in this study.

4.2 Assessment of structure model

The partial least squares structural equation modeling (PLS-SEM) technique was employed for hypotheses testing. The bootstrapping analysis estimated the β-coefficients that reflect the strength of relations among dependent and independent variables. The hypothesis is accepted if t ≥ 1.96 at the 0.05 level of significance (Peng and Lai, 2012; Hair et al., 2014). Table 5 demonstrates the results of path estimates. All paths are significant except for the direct relationship of perceived employability and work-related well-being (β 0.047, p 0.432) (See Table 5). Our first hypothesis (H1) examined the negative relationship of perceived job insecurity with work-related well-being. The results demonstrated negative significant paths from work-related well-being and perceived job insecurity (β −0.335, p 0.00); hence, H1 is accepted (See Table 5). First, we tested the direct relationships of work-related well-being with employee involvement (H2a), organizational communication (H3a), perceived employability (H4a) and emotional exhaustion (H5a). Except perceived employability (H4a) all direct hypothesis are accepted (See Table 5).

4.2.1 Mediation analysis

Mediation refers to the existence of a third variable or mechanism which influences the effect of the independent variable on the consequence or outcome variable (Aguinis et al., 2017). The researcher used bootstrap analysis (Preacher and Hayes, 2008) to test the mediation. Bootstrapping is a robust method to conduct mediation analysis (Hayes, 2013). In this method, sampling distribution is computed by intensive repeated iterations. First, the path model was assessed using the bootstrapping technique, without the mediator (See Table 6). We tested the mediating role of perceived job insecurity between work-related well-being and employee involvement (H2) organizational communication (H3), perceived employability (H4) and emotional exhaustion (H5). From that sampling distribution, the effects of the direct and indirect paths are evaluated (Awang, 2015) with SmartPLS. Table 6 demonstrates the significant results of the mediation analysis.

To check the strength of mediation, Hair et al. (2014) suggest mediation strength VAF (variance accounted for) score which was calculated in MS Excel. According to Hair et al. (2014) if the value of VAF is above 80% it is called full mediation. If the value of VAF lies in-between 20 to 80%, it is called partial-mediation and VAF below 20% accounted as no mediation. Table 6 also demonstrates the calculated VAF score. The indirect path (EI → JIS → WB) has a t-value of 3.17412; hence, H2 is accepted. The VAF value of indirect path is 32% accounted for as partial mediation. H3 is confirmed as the indirect path (OC → JIS → WB) has t-value, 2.4839, and the VAF score of this path is 22% accounted as partial mediation. The indirect path (EE → JIS → WB) with t-value, −4.2991 also confirms the H5. The VAF accounted for this path is 33.96% all the above scores are between 20 and 80% it is established that perceived job insecurity partially mediates these relationships (See Table 6). However, the study revealed an indirect path (PE → JIS → WB) as insignificant with t-value 1.088; hence, H4 is rejected (See Table 6).

4.2.2 Moderating role of boundaryless career orientation

It was assumed that a positive relation between boundaryless career orientation and work-related well-being exists. The results demonstrated positive significant paths from work-related well-being and boundaryless career orientation (β 0.260, p 0.00). Thus, hypothesis H6 and H7 both are supported. The results confirmed the hypothesis 15 (β 0.230, p 0.00) which proposed that the relationship of perceived job insecurity and work-related well-being will be weaker when boundaryless career orientation will be high as compared to low. High boundaryless career orientation among salespersons has buffered the negative association between perceived job insecurity and work-related well-being. Figure 2 indicates the direction of the boundaryless career orientation and perceived job insecurity interaction with relationship to work-related well-being. It exhibits that the slope in the graph is steeper in case of low boundaryless career orientation. Moreover, individuals with low boundaryless career preferences appeared not to alleviate the negative relationship between perceived job insecurity and work-related well-being.

5. Discussion

Though many studies have brought the importance of organizational communication, employee involvement (De Witte, 2005; Vander Elst et al., 2010; Shoss, 2017), perceived employability (Bernstrøm et al., 2019) and other personal resources to prevent the perceived job insecurity, yet very few studies have investigated these relationships to reduce perceptions of job insecurity among employees (Huang et al., 2012). The current study aspires to investigate the factors that contribute to prevent the perceived job insecurity and mitigate its negative impacts on the work-related well-being of salespersons.

Our first objective was to examine how organizational communication, employee involvement at the organization level and individual factors (perceived employability and emotional exhaustion) contribute toward well-being by reducing the perceptions of job insecurity among pharmaceutical salespeople in Pakistan. The empirical results confirmed the role of the salespersons' involvement and effective communication to reduce the perceptions of job insecurity (see Table 5). Our finding is consistent with the previous study of Vander Elest et al. (2010) who by engaging a sample of service and industrial workers in Belgium found that communication reduces the worker's perception of job insecurity. Keim et al. (2014) also found that greater communication makes the work environment less ambiguous, provide clarity in role and job duties, reduce conflicts, and thus, minimize the perceptions of job insecurity. Similarly, a longitudinal study of Huang et al. (2012) also found that organizational practices of employee involvement and communication reduce job insecurity by creating clarity and certainty in the work situation. Recent studies on the topic verified that organization which involve employees in strategic decisions can make them feel more secured, safe and attached with the organization (Pham et al., 2020; Vinodkumar and Bhasi, 2010).This is also in alignment with the arguments of the COR theory that individuals having more resources perceive the less risk of job loss; however, those with fewer resources may perceive their jobs insecure (Holmgreen et al., 2017). Thus, effective communication and employee involvement in terms of shared knowledge, involvement in decisions and reward compensation provide the opportunity to reduce the perceptions of job insecurity among salespersons.

Our finding validates a significant positive relationship between emotional exhaustion and job insecurity (see Table 5). Support for this relationship comes from Piccoli and De Witte (2015) who proposed that exhausted workers are less likely to show desired performance, hence, experience more job insecurity. Finally, we also confirmed perceived employability as a personal resource prevents the feelings of job insecurity. This result simulated the findings of De Cuype et al. (2012) who also found the negative association of perceived employability to job insecurity among Finnish workers. Peiró et al. (2012) using the data of 3,000 Spanish employees also found that employability reduces job insecurity. Our finding proved the argument of the COR theory (Hobfoll, 1989, 2001) that employees who perceive themselves as employable are less vulnerable to resource loss in the form of job insecurity. Specifically, the salespeople having more personal resources perceive themselves as less insecure (Aybas et al., 2015)

Next, the results of the mediation analysis confirmed job insecurity as a mediator as most (3 out of 4) mediation paths were significant (see Table 6). One of the significant effects is related to the partial mediation of job insecurity between employee involvement and their work-related well-being. As such when employees are involved in their work policies and procedures, they consider their job less insecure and engage more toward their work. Further, the relationship between organizational communication and well-being is mediated by job insecurity, so that effective communication prevents job insecurity, which, in turn, associates with well-being. Job insecurity also mediates the relationship between emotional exhaustion and well-being as emotionally exhausted salespersons perceive more insecurity that impairs their engagement toward work. The non-significant effect is related to the mediating role of job insecurity on perceived employability and work-related well-being. Thus, highly employable salespersons feel less job insecurity and are motivated to engage in their work. On the other hand, Bernstrøm et al. (2019) found that highly employable workers leave insecure jobs. Our finding is inconsistent with the previous study that salespersons having a will and the means to fulfill the requirements of work and achieve their goals move toward higher well-being (Bouzari and Karatepe, 2018).

Another objective was to mitigate the effects of perceived job insecurity by using boundaryless career orientation among salespersons. The study confirmed the moderating role of boundaryless career orientation on the association between perceived job insecurity and well-being that salespeople having high boundaryless career orientation are less likely to feel insecure about their job. Our finding is following the COR theory that resourceful employees possess relevant skills and expertise and become less vulnerable to job loss. Similarly, the relevant resources of work enable flexibility and reduce the negative effects of perceived job insecurity by lowering expectations for security (Klehe et al., 2012). Salespersons with more resources, possessing the relevant skills and expertise in their field are less vulnerable to job loss, and this resource gain (being able to get employed) will buffer the negative reactions of perceived job insecurity. Moreover, salespersons with a high presence of boundaryless career advance their resources to develop more resources such as knowledge, experience and professional networks across organizations.

6. Conclusion and implications

Thus far, there is little empirical research directed on the effects of job insecurity on work-related well-being using the lenses of the COR theory (Lee et al., 2018).

Further, the study introduced and examined the buffering role of boundaryless career orientation by using the COR theory. Boundaryless career orientation is conceptualized as a personal resource moderating the association between perceived job insecurity and employee well-being and its outcomes. Furthermore, the study tested the extent to which boundaryless career orientation (BCO) operates as a buffer that weakens negative effects. The results revealed that employees having high BCO are less likely to feel insecure about their job.

This study examined the ways to prevent and mitigate the negative effects of perceived job insecurity on the work-related well-being of pharmaceutical salespersons. To make employees engaged, the organizations are required to involve employees by sharing knowledge, information, and power to make decisions, value their opinion and ensuring employability. Such salespersons, in turn, contribute to the organization by offering solutions to customer problems and making suggestions for increasing their sales performance. BCO proved to moderate the relationship between job insecurity and work-related well-being. Salespersons having a preference of a boundaryless career are motivated to advance their resources and develop more resources such as knowledge, experience and professional networks across organizations. This conclusion fills in the gap of current literature on moderating variables in the association of perceived job insecurity and well-being which was one of the objectives of this research.

This investigation makes meaningful theoretical implications in the existing literature of well-being. The study proposed that the utilization of organizational and personal resources will reduce the perceptions of job insecurity among salespersons using the lens of the COR theory which was less investigated. Further, using the COR theory, this study spearheaded future research by examining BCO mitigating the negative impact of job insecurity on the well-being of salespersons. The finding attached the importance of work environment and work practices (involvement and communication) to reduce perceptions of insecurity among pharmaceutical salespersons.

COVID-19 has recently transformed the demand and supply side of labor market. This mega crisis has influenced the wage rates and downsizing has become a panacea. Consequently, the employees feel threatened and their job quality is compromised (Frone, 2018; Meyer et al., 2018). Niesen et al. (2018) acknowledged that downsizing increase employees' job insecurity. Economic indicators and company reports indicate “service mega-disruptions” due to COVID-19 for businesses, in particular for the services sector (Kabadayi et al., 2020). In this background, our findings provide several useful implications for administrators, pharmaceutical salespersons and managers. It is noted that in uncertain conditions like COVID-19, the employees feel less engaged toward work and exhaust emotionally; therefore, the employers and managers should minimize the effects of perceived job insecurity to win the commitment of employees. A recent meta-analysis on organizational resilience during the turbulent times like pandemics concluded that communication and openness along with contact frequency with employee will have a positive influence on the overall well-being of employees (Bui et al., 2019). This communication must contain the element of hope and continuity of services during the crisis. An organization may engage employees in their decisions which may reduce their concerns over potential job loss. It will enable organizations to create an engaged and loyal salesforce. Further by providing the feeling of employability to pharmaceutical salespersons, the insecurity perception may reduce, and it will send signals to employees that management is willing to invest in developing their skills and knowledge. Our support theory of COR maintains that effective response of organization during the uncertainty like pandemics reduces the psychological and physiological strain associated with a depletion of resources tempted by a pandemic (Vo-Thanh et al., 2020). The moderating role of high BCO suggests the need for individual workers to develop new skills and opportunities as job insecurity is influenced by one's subjective perceptions. With this recognition, the corporate strategy must revolve around the continuous training for enhancing the motivation level as well as to improve the professional and emotional skills for career advancement in the organization. At the management level, this can be done through strong internal recruitment systems that enable the employees to upgrade their current position through internal mobility.

7. Limitations

There are some limitations related to this research. The first limitation of the study is the cross-sectional design thereby the researcher has collected data at one point in time. Some researchers argued that job insecurity persists overtime which may affect the future well-being. Therefore, future studies must consider longitudinal designs so that the underlying process is investigated further. Another limitation of this study is the selection of the sample, pharmaceutical salespersons. Future research may be commissioned to consider other sets of salespersons which will lead to the validity of results. Future research needs to uncover additional moderators like psychological contract fulfillment to mitigate the negative impact of perceived job insecurity on employee's well-being.

The third limitation is the use of a self-report questionnaire. Employees reporting their perceptions about predictor and criterion variables can be a reason for common method variance that in turn affects the findings. Therefore, the study adopted procedural recommendations by Podsakoff et al. (2003) such as using different scale types for the independent and outcome variable; used reverse-coded items in scale; adopted the validated measures; ensuring that there was no single factor accounting for the majority of the variance. Besides, to prevent the effect of social desirability in data, the respondents were asked to participate voluntarily, and anonymity was ensured by the researcher. Additional research on the outcomes of the job insecurity among salespeople may illuminate this field of research. For instance, career adaptability dimension could be studied as the moderator or different components of work-related well-being may be measured through burnout and job dissatisfaction dimensions. Another interesting study could be the investigation on our antecedents on different career stages as employees face different set of challenges related to their well-being. For in-depth and holistic understanding of how pandemics are shaping individuals’ short-term and long-term career choices, this research could be extended by employing BCO and turnover intent as an antecedent.


Proposed research framework

Figure 1

Proposed research framework

Moderating effect of boundaryless career orientation

Figure 2

Moderating effect of boundaryless career orientation

Demographic information of sample

VariablesCharacteristicsFrequencyPercentage (%)
Experience1–10 years28191.8
11–20 years216.8
21–30 years41.3

Descriptive statistics and correlations of studied variables

MeanSt. deviationSkewnessKurtosisBCOEEEIOCPEWWBJIS
Boundaryless career orientation2.390.7190.014−0.7770.725
Emotional exhaustion2.921.112−0.584−0.285−0.3170.728
Employee involvement3.050.6938−0.219−1.147−0.054−0.0620.674
Organizational communication3.120.638−0.406−0.431−0.2490.1360.4910.652
Perceived employability2.890.702−0.6650.259−0.2800.2430.3230.4090.733
Work-related well-being3.690.732−0.8390.650−0.1370.410−0.0010.2240.2720.660
Perceived job insecurity2.650.732−0.082−0.263−0.3190.5740.2150.3060.4910.3090.720

Note(s): Square root of AVE values diagonally in bold established discriminant validity

Cronbach's alpha, composite reliability and average variance extracted of all variables

VariablesCronbach's alphaComposite reliabilityAVE
Employee involvement0.7390.8020.504
Organizational communication0.6680.7860.501
Perceived employability0.7110.8210.537
Emotional exhaustion0.7800.8490.530
Perceived job insecurity0.7670.8430.519
Work-related well-being0.7450.8210.436
Boundaryless career orientation0.7080.8150.526

Outer loadings of items used in this study

OC1 0.713
OC11 0.802
OC2 0.782
OC5 0.827
OC6 0.700
OC9 0.686
PE1 0.804
PE2 0.840
PE3 0.767
PE4 0.835
EE1 0.630
EE2 0.767
EE3 0.570
EE5 0.554
EE6 0.830
JIs1 0.747
JIs2 0.859
JIs3 0.724
JIs5 0.870
JIs6 0.629
JIs7 0.630
BCO1Rev 0.656
BCO2Rev 0.815
BCO3Rev 0.686
BCO4Rev 0.842
BCO5Rev 0.860
WWB1 0.736
WWB2 0.782
WWB3 0.781
WWB4 0.677
WWB5 0.547
WWB6 0.704
WWB10 0.577
WWB16 0.610
WWB17 0.809

Path estimates of model

Without mediatorEmployee involvement → Work-related well-being0.3653.4930.00
Organizational communication → Work-related well-being0.3814.4090.000
Perceived employability → Work-related Well-being0.0470.7860.432
Emotional exhaustion → Work-related well-being−0.3008.3910.000
Boundaryless career orientation → Work-related well-being0.2603.5510.000
Moderating effect → Work-related well-being0.2303.6760.000
With mediatorEmployee involvement → Work-related well-being0.2792.9560.003
Organizational communication → Work-related well-being0.3544.8230.000
Perceived employability → Work-related well-being0.0710.7970.428
Emotional exhaustion → Work-related well-being−0.3018.3910.000
Job insecurity → Work-related well-being−0.3354.9430.000
Employee involvement → Job insecurity−0.3794.3840.000
Organizational communication → Job insecurity−0.3043.1510.003
Perceived employability → Job insecurity−0.2542.3120.021
Emotional exhaustion → Job insecurity0.4627.9120.000

Results of mediation analysis



Direct effects

Indirect effect

Total effects




























No mediation









Note(s): p < 0.05. VAF >80% = Full mediation, 20% ≤ VAF 80% = Partial mediation, and VAF <20% = No mediation; VAF, variance accounted for; N/A, not applicable


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Further reading

Jiang, L., Probst, T. and Sinclair, R.R. (2013), “Perceiving and responding to job insecurity: the importance of multilevel contexts”, The Psychology of the Recession on the Workplace, Edward Elgar Publishing.

Narainsamy, K. and Van Der Westhuizen, S. (2013), “Work related well-being: burnout, work engagement, occupational stress and job satisfaction within a medical laboratory setting”, Journal of Psychology in Africa, Vol. 23 No. 3, pp. 467-474.

Rothmann, S. (2008), “Job satisfaction, occupational stress, burnout and work engagement as components of work-related well-being”, SA Journal of Industrial Psychology, Vol. 34 No. 3, pp. 11-16.

Schaufeli, W.B., Taris, T.W. and Van Rhenen, W. (2008), “Workaholism, burnout, and work engagement: three of a kind or three different kinds of employee well‐being?”, Applied Psychology, Vol. 57 No. 2, pp. 173-203.

Suen, L.J., Huang, H.M. and Lee , H.H. (2014), “A comparison of convenience sampling and purposive sampling”, Vol. 61 No. 3, pp. 105-111, doi: 10.6224/JN.61.3.105. PMID: 24899564.

Corresponding author

Ibne Hassan can be contacted at:

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