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While many reviews of job stress and the stressor–strain relationship have been conducted, such reviews typically focus exclusively on quantitative data. In the current paper, we review qualitative studies on occupational stress that met two criteria: (1) the studies employed qualitative methods; (2) the stressors, strains and/or coping strategies were grouped into identifiable, higher-order categories. Results indicated that the nature of the stressors experienced varied by (a) occupation, (b) country, (c) seniority and (d) gender. The review further revealed that organizational constraints, work overload and interpersonal conflict were relatively universal stressors. Anger and annoyance were the most frequently reported psychological strains in the United States and the United Kingdom, while Chinese workers exhibited tension and anxiety and Indian workers exhibited acceptance. Coping strategies also varied by gender, occupation and country. Research on gender differences suggested that, compared to men, women tended to report more interpersonal stressors. Differences in the ways in which the two types of methodologies are applied, as well as their relative strengths and weaknesses, underline the value of qualitative approaches to the study of occupational stress, especially when used in conjunction with quantitative methods in mixed-methods studies. Copyright © 2011 John Wiley & Sons, Ltd.
Researchers have studied occupational stress for several decades, with a primary focus on the stressor–strain relationship. Stressors refer to environmental conditions or situations that elicit an emotional response such as anger or anxiety (Spector, 1998). Strains are individuals' responses to stressors (Jex & Beehr, 1991) and can be physical (e.g. increased blood pressure), psychological (e.g. anger) or behavioural (e.g. smoking). Researchers hope that by identifying stressors they can recommend steps to prevent or limit the strains that stressors elicit. Accumulated research on occupational stress has generated a wealth of knowledge about the stress process and how stressors affect people in a wide variety of jobs (see reviews by Jex & Beehr, 1991; Kristensen, 1996; Lin, 2003).
The majority of studies on occupational stress have used quantitative methods, which is reflected in the reviews cited above. While studies using quantitative methods have been important to the field, these studies have limitations. One assumption of quantitative research is that the investigator knows what stressors and strains to assess in structured data-collection instruments. This approach may ignore what are the most important stressors and strains for the respondents (Keenan & Newton, 1985). Therefore, qualitative research can play a role in the discovery of stressors, strains and coping behaviours that were not originally thought of by researchers using structured instruments in quantitatively oriented research (Kidd, Scharf, & Veazie, 1996; Schonfeld & Mazzola, in press). Qualitative findings can add depth to quantitative results by detailing the personal experiences of people who work. Compared to quantitative methods, qualitative methods are more difficult to use for the purpose of hypothesis testing, but when carefully structured and paired with complementary methods, they may indeed be useful in testing specific hypotheses (e.g. Grebner, Elfering, Semmer, Kaiser-Probst, & Schlapbach, 2004). Because results from self-report quantitative scales are easy to analyze, research on occupational stress has under-utilized qualitative methods. While not commonly employed, some stress researchers have used qualitative methods to study stressors, strains, coping and other aspects of the stress process (e.g. Keenan & Newton, 1985; Noblet & Gifford, 2002); their findings, however, have rarely been reviewed.
The purpose of this paper is to examine the findings of occupational stress research that employed qualitative methods. One reason we conducted this review is that the studies we targeted were often completed by researchers in a wide variety of fields who publish in a diverse cross section of journals. For example, a qualitative study of job stress in nurses was published in a nursing journal devoted specifically to the care of AIDS patients (Kalichman, Gueritault-Chalvin, & Demi, 2000). It became evident to us that qualitative studies of occupational stress are spread across many journals that occupational stress researchers may not readily encounter (e.g. Health Education Quarterly, The British Journal of Forensic Practice and The Journal of the Association of Nurses in AIDS Care). Moreover, in order to identify patterns in the literature, this paper examines the most prevalent work-related stressors (as well as strains and coping strategies) compiled over a large number of studies in which participants were asked to report stressful incidents, without constraints on the types of work-related events they could describe. Finally, by presenting the findings of studies using qualitative and mixed methods, this paper provides researchers with examples to help them adapt these methods to their own research on job stress.
It is important to note that this review is limited to studies that coded responses by themes and/or placed them into meaningful and comparable categories. Studies that reported only narrative responses, while an integral part of the qualitative research literature on job stress were excluded because they did not contain analyses that permitted higher-order themes to emerge, enabling comparisons across studies. We also advance the view that the open-ended nature of qualitative methods is a major strength, allowing participants to respond as they see fit, based on their personal experience. We present what has been learned about occupational stress directly from the experiences of people who work, which can in turn help researchers tailor interventions to relevant stressors, strains and coping styles.
Qualitative and quantitative researchers often ask very different questions. While the qualitative studies discussed here mainly sought to describe, categorize and report the frequencies of these stressors and strains, quantitative researchers typically look at stressor ‘levels’ (e.g. score on a job demands scale), investigating the relationship of stressor levels to other variables. Part of the appeal of qualitative methods is their applicability to the identification and discovery of stressors (Schonfeld & Farrell, 2010), and thus, most qualitative studies that we reviewed here neither made predictions nor drew firm conclusions. That said, the compilation of these studies allowed us to make some basic predictions on what the combined data would say.
We hypothesized that some stressors would occur more frequently than others. Since frequency of stressors is rarely addressed in quantitative research, this prediction is evaluated in terms of the frequency with which stressors were identified in individual qualitative studies, making it difficult to anticipate which would be most prevalent. However, in at least one quantitative study, workload and organizational constraints (from staffing issues) were found to contribute significantly to stress levels (Lindsay, Hanson, Taylor, & McBurney, 2008). Meanwhile, other stressors, such as role ambiguity and conflict, are not as frequently indicated by participants (Jex & Beehr, 1991). We therefore predicted that workload and constraints would be commonly reported in qualitative research, and role conflict and role ambiguity would not.
We also predicted that stressors would differ depending on the population being investigated. Again, very few studies involving quantitative or qualitative methods compare stressors across occupations (or even organizations), but research on stress levels and frequency suggests that stress experiences differ by job type (Blase, 1986; Lindsay et al., 2008; Narayanan, Menon, & Spector, 1999a). In addition, we examined studies that shed light on cultural differences in stressor and strain frequency. Hofstede (1986) advanced the view that the individualism–collectivism dichotomy reflects pervasive cultural differences that influence human behaviour. We identified qualitative studies that bear on the relation of cultural differences to the occupational stress experience. Finally, we also anticipated that there would be gender differences in stressors. Previous studies using qualitative (Jones & Fletcher, 1996) and quantitative (Antoniou, Polychroni, & Vlachakis, 2006) methods support this contention. However, we did not have any specific a priori expectations regarding the direction of gender differences.
Besides results that bear on the predictions above, many other findings on stressors and the overall stress process were compiled and examined. However, we did not have any prior hypotheses about what would ultimately be found with regard to these other aspects (e.g. strains) of the stress process. Instead, in the spirit of the qualitative researcher, we let the data speak!
We begin with a brief discussion of how studies were chosen for this review and the qualitative research methods that have been used in job stress research. Next, we present some general findings about stressors, followed by a summary of results on the frequencies of different types of stressors in various occupations and nations. Then we present an overview of what qualitative research has found about strains, coping with stressors and gender differences, ending with studies that used mixed methods (qualitative and quantitative methods combined). Finally, we summarize the findings and discuss possible avenues for future stress research related to qualitative and mixed methodology.
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This review has summarized findings from qualitative studies that inform occupational stress research. Stressors at work were reported more frequently than stressors associated with other role areas. An implication of this finding is that work is a major source of stressors for employed people, and that research on occupational stress is especially relevant to efforts aimed at reducing overall stress levels. The one (Swiss) study that examined the overall frequency of stressful events suggests that workplace stress can be an almost daily occurrence. Additional diary research is needed to estimate the number of work-related stressors that occur in a given time frame (i.e. per day, week or year) and further explain how work and non-work stressors interact with each other, different coping strategies and various types of strains within a person's daily life.
Across all occupations, no stressor was found to be more pervasive than interpersonal conflict. Some form of interpersonal conflict was present in almost every occupation summarized here. The sources of these conflicts included customers, patients, co-workers, supervisors, subordinates and students. As hypothesized, organizational constraints and overload were frequently occurring stressors, with role conflict and role ambiguity rarely reported. Organizational constraints are visible in policies that are too stringent or arbitrary and when adequate resources are not available, causing employees to perform less than optimally (Peters & O'Connor, 1980). Employees frequently reported overload, a situation that also makes it difficult to complete all assigned work, especially at high performance levels (Jex & Beehr, 1991).
As expected, the results also show important differences in stressors as a function of occupation, nation and gender. For example, time/effort wasted was found to be a more commonly reported stressor in sales and engineering than in the other occupations. Workers from more collectivist cultures (India and China) experienced more stressors involving evaluation and recognition, organizational constraints and lack of structure (only India). Workers from more individualist cultures were more likely to experience work overload and lack of autonomy. Women routinely reported more interpersonal events than men, and given the importance of interpersonal conflict shown throughout this review, this gender difference may warrant further investigation. Additionally, Guthrie et al. (1999) demonstrated that stressors can also vary by level of experience within the same occupation and organization. It is likely that early in careers, balancing home (and young children) and work and learning the job are the paramount sources of stress, but as workers gain experience and their children grow up, other stressors, such as administrative problems, enter the foreground. Because the study by Guthrie et al. was the only qualitative study to examine within-occupation, seniority-related differences, more research is needed to determine if parallel findings hold for occupations other than psychiatry.
Qualitative research also sheds light on reactions to stressors, including both strains and coping responses. With regard to psychological reactions, anger and annoyance were more common in English-speaking countries. In China, tension and anxiety were more readily found while acceptance was common among Indian participants. Psychological strains were reported by participants relatively more frequently, but qualitative researchers could ask more specific questions regarding physical and behavioural strains. Reported coping strategies varied greatly (e.g. Narayanan et al., 1999a; Shinn et al., 1984) and were affected at least in part by the type of stressor experienced. Talking to someone (social support), dealing directly with the situation (problem-focused coping) and wishful thinking or ignoring the stressor (emotion-focused coping) were all frequently reported strategies. It should be noted that these studies identified the most prevalent reported coping strategies and did not (and could not) determine which were effective.
In some ways, the qualitative findings are consistent with results from quantitative studies (Jex & Beehr, 1991), especially with regard to the importance of workload and organizational constraints as stressors. However, the differences between the quantitative and qualitative results are valuable to researchers. Since the qualitative results showed that a few stressors occur across occupations (e.g. interpersonal conflict, organizational constraints and workload), it may be useful for researchers and practitioners to concentrate on these more prevalent stressors. Nonetheless, researchers and practitioners should exercise caution, and resist the temptation to ignore stressors that are less prevalent, especially if evident in a particular occupation. For example, role ambiguity and role conflict were shown to be fairly uncommon and may not need to be investigated unless sufficient evidence exists to underline their importance in a population of specific interest to researchers or practitioners.
Organizations may have the ability to prevent the occurrence of many of these common stressors and/or mitigate their effects by incorporating certain prevention interventions when possible. Qualitative data are especially helpful in informing researchers and practitioners about workers' thoughts and complaints. Murphy (1995) advanced the principle that successful stress prevention programmes are those designed to specifically address the occupational stressors to which employees on a particular job are exposed. An organization can employ qualitative methods to identify stressors that are most prevalent among its workers. Given the prevalence of workload, organizational constraints and interpersonal conflict, organizations may take steps to ensure that they are properly staffed, supplied with adequate resources, and furnished with proper channels for resolving employee conflicts.
Although we combined information already present in the literature, we could not include results from qualitative studies in which investigators did not code stressors and strains in a manner that enabled comparisons across studies. As with all self-report measures, both qualitative and quantitative, we cannot be certain if the reported behaviours are the enacted behaviours. For example, this could be a problem when examining the coping strategies reported, and whether the participants truly used them in response to the stressors described. However, evidence adduced by Schonfeld and Mazzola (in press) underlines the realism in workers' reports.
Additionally, almost all studies coded only one stressful event into a single stressor category. Several stressors can be present simultaneously in an employee's life, and many stressors reflect more than one thematic category (i.e. an argument with a co-worker, while clearly an incident of interpersonal conflict, may also create an organizational constraint if interactions with that person are necessary for task completion). It is difficult to know exactly how results would differ if more events were collected or stressors were coded into multiple categories.
No method is perfect for all situations, and qualitative methods have limitations that need to be understood and addressed by researchers. Qualitative research is often conducted on unrepresentative convenience samples and is biased towards participants who are willing to devote enough time to describe the details of their experiences. This limitation frequently applies to quantitative studies as well but is nonetheless a concern in qualitative research. In some of the research we reviewed, investigators obtained reasonably large samples (e.g. Liu et al., 2008; Narayanan et al., 1999b). Qualitative research is by its nature interpretative, which could undermine the reliability of qualitative findings, especially in terms of inter-rater agreement. Reliability in the sense familiar to quantitative researchers is not an important part of the qualitative research tradition (Kirk & Miller, 1986), although Schonfeld and Farrell (2010) advanced the view that the coefficient kappa (Fleiss, Levin, & Paik, 2003) should be more widely employed to help ensure the reliability of the thematic categories that emerge in qualitative research. Some confidence in the reliability of the findings is gained because of cross-study convergence in identifying a number of stressors (e.g. interpersonal conflict).
Qualitative findings can not only replicate or extend quantitative results, but can also add depth to quantitative findings by detailing the personal experiences of the participants. Being able to examine job stressors from different perspectives can provide a deeper understanding of the stress process. While this review used mostly categorical qualitative data, qualitative methodologies also provide rich narratives for researchers and practitioners that could not be obtained through the use of quantitative data. Qualitative methods can be particularly informative when investigators set out to understand the nature of stressors in occupations previously not included in job stress research (Kidd et al., 1996).
It would be prudent for future researchers to combine methods when possible so that the weaknesses of one method are complemented by the strengths of the others. For example, qualitative research can be helpful in discovering important stressors within a workplace that have previously gone unrecognized by the research community. Quantitative methods could then be used to measure specific aspects of those stressors, possibly in larger, more representative samples of workers. Given the exploratory nature of qualitative methods, hypothesis testing may be extremely difficult (Schonfeld & Farrell, 2010). However, innovations involving mixed methodologies can pave the way for hypothesis testing (e.g. Elfering et al., 2005; Grebner et al., 2004), and future researchers should look to combine these methods in whole new ways. Mixed methodology allows researchers to examine the stress process in ways not possible using either type of method alone.
There are numerous ways that qualitative methods can be used in the future to improve our understanding of stress in the workplace. One such use is for investigators to continue to collect qualitative data from job incumbents whose jobs differ on any number of characteristics. As previously shown, stressors differ by job, level of experience on the job and cultural or national group; more information is needed to ascertain how these patterns of job stressors may emerge. Additionally, the results regarding gender differences underline gender-related processes in the response to job stressors. Researchers could examine differences in the types of stressors affecting men and women in similar work roles (e.g. do women encounter more interpersonal conflict?) and the coping behaviours in which they engage (e.g. use of direct action strategies). In addition to gender differences, researchers could examine differences related to age, ethnicity, education and other demographic variables. Another avenue of research would entail assessing the frequency of stressful incidents across occupations that differ on some fundamental job characteristic, such as autonomy.
Qualitative research could also be employed in more cross-national and cross-cultural research. Open-ended questionnaires allow workers to report what was stressful to them without being constrained by the structure of pre-existing scales or the investigator's preconceptions. Researchers who conduct cross-national research on occupational stress may not be able to understand specific stress experiences without directly asking probing questions of workers. National and ethnic differences in stressful work experiences could be examined along the dimension of a key cultural value, such as individualism-collectivism or uncertainty avoidance (Hofstede, 1986).
Cohen's (1989) study of California nursing directors was, to our knowledge, the only qualitative study to allow participants to describe multiple coping strategies used in response to a specific work stressor. Using this study as a model, future researchers could conduct qualitative studies in order to identify multiple coping strategies used by job incumbents confronting a critical work stressor that commonly occurs in any one occupation. Qualitative studies using theoretical sampling methods described by Glaser and Strauss (1967) could guide the development of hypotheses, for example, about types of stressors associated with, say, older versus younger employees or between several different demographic groups. With those qualitative studies serving as a starting point for hypothesis generation (Schonfeld & Farrell, 2010), future researchers can develop quantitatively organized studies to assess the capacity of coping strategies to modify the impact of the work stressor on health, well-being and job performance.
To accomplish these goals, researchers need to work further towards a common nomenclature for stressors, strains and coping, as labels often differ between studies. If researchers utilize the stressor categorizations generally reported in the literature (or thoroughly describe the nature of their categories and/or responses for readers), the task of comparing the results of any one study to the findings of other qualitative and quantitative studies would be facilitated, and the structure of the knowledge base of research on job stress enhanced.
In conclusion, qualitative methods are a valuable but underutilized resource in occupational stress research. The results of the current review suggest that there are important benefits to be gained from qualitative research that complement those obtained from quantitative research. Qualitative (and mixed methods) research can and should be a vital part of research on the stress process at work.