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Work intensification and health outcomes of health sector workers

James Chowhan (School of Human Resource Management, York University, Toronto, Canada)
Margaret Denton (Department of Health, Aging & Society and Gilbrea Centre, McMaster University, Hamilton, Canada)
Catherine Brookman (Catherine Brookman Consulting & Associates, Toronto, Canada)
Sharon Davies (McMaster University, Hamilton, Canada)
Firat K. Sayin (Sobey School of Business, Saint Mary’s University, Halifax, Canada)
Isik Zeytinoglu (McMaster University, Hamilton, Canada)

Personnel Review

ISSN: 0048-3486

Article publication date: 19 February 2019

Issue publication date: 7 March 2019




The purpose of this paper is to examine the mediating role of stress between work intensification and musculoskeletal disorders (MSDs) focusing on personal support workers (PSWs) in home and community care.


The analysis sample of 922 comes from the 2015 survey of PSWs employed in Ontario, Canada. The endogenous variable is self-reported MSDs, and the exogenous variable is work intensification. Stress, measured as symptoms of stress, is the mediating variable. Other factors shown in the literature as associated with stress and/or MSDs are included as control variables. Structural equation model regression analyses are presented.


The results show that stress mediates the effect of work intensification on PSW’s MSDs. Other significant factors included being injured in the past year, facing hazards at work and preferring less hours – all had positive and significant substantive effects on MSDs.

Research limitations/implications

The survey is cross-sectional and not longitudinal or experimental in design, and it focuses on a single occupation in a single sector in Ontario, Canada and, as such, this can limit the generalizability of the results to other occupations and sectors.

Practical implications

For PSW employers including their human resource managers, supervisors, schedulers and policy-makers, the study recommends reducing work intensification to lower stress levels and MSDs.


The findings of this study contribute to the theory and knowledge by providing evidence on how work intensification can affect workers’ health and assist decision makers in taking actions to create healthy work environments.



Ethics approval and consent to participate: this research is reviewed and approved by McMaster Research Ethics Board protocol No. MREB-2014-132. Consent for participation in the study: no individual person’s data are shown in this paper. Only aggregate information is provided. For online survey, survey participants agreed to participate by consenting at the beginning of the survey and “clicking” submit button at the end of the survey. For print-mail-out survey, sending it to researchers was considered as consent and clearly indicated to the participants in the “study information and consent page.” For more see Competing interests: the authors declare that the authors have no competing interests. This study is funded by Ontario Ministry of Labour Research Opportunities Program (Proposal No. 13-R-030). The funder had no role in the design, execution and writing of this study. The authors would like to thank the PSWs who shared their experience with the authors by responding to the survey, co-investigators of the grant Susan VanderBent and Patricia Boucher, the Research Advisory Committee members (Patricia Boucher, Advanced Gerontological Education, St Peter’s Hospital; Brigid Buckingham, SEIU Healthcare; Henrietta Van hulle, Public Services Health and Safety Association; Janitha Joseph, Canadian Union of Public Employees (CUPE), Local Union 3358-01; Margaret McAlister, Home Care Ontario; Wendy Robertson, St Clair West Services for Seniors; Deborah Simon, Ontario Community Support Association; Susan VanderBent, Home Care Ontario; Ronda Dickie, PSW Representative, PSNO; and Stefanie Nucci, PSW Representative, OPSWA) for their advisory role in the design and execution of the project this paper is based on. The Research Advisory Committee assisted in the survey distribution through e-mail blasts, newsletter inserts and a customized health and safety training presentation. Special thanks to Steve De Lisser for graphic design, communications assistance and suggesting the survey title that is also part of the title of this paper as well as the project logo. Special thanks to Bruno Marsala for the design, development and maintenance of the study micro website and contents including the production of the project website promotional video.


Chowhan, J., Denton, M., Brookman, C., Davies, S., Sayin, F.K. and Zeytinoglu, I. (2019), "Work intensification and health outcomes of health sector workers", Personnel Review, Vol. 48 No. 2, pp. 342-359.



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