I I LIBRARY Michigan State Unlversity PLACE IN RETURN BOX to remove this checkout from your record. TO AVOID FINES return on or before date due. DATE DUE MTE DUE MTE DUE M 1/93 mus-nu COMMUNICATION, STRESS AND BURNOUT: USE OF RESOURCE REPLACEMENT STRATEGIES IN RESPONSE TO CONDITIONAL DEMANDS IN COMMUNITY-BASED ORGANIZATIONS BY Mary K. Casey A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Communication 1998 ABSTRACT COMMUNICATION, STRESS AND BURNOUT: USE OF RESOURCE REPLACEMENT STRATEGIES IN RESPONSE TO CONDITIONAL DEMANDS IN COMMUNITY-BASED ORGANIZATIONS BY Mary K. Casey This study posits a model of human service workers use of communication behaviors in response to chronic stressors as a means of preventing or alleviating job burnout. Using Hobfoll’s (1989) conservation of resources framework, it was hypothesized that demands of human service work in community-based organizations (CBOs) would prompt the use of resource replacement strategies to mediate the relationships between demands and the three dimensions of burnout. Personal resources of tolerance for ambiguity and personal control were hypothesized to moderate the relationships between the demands and replacement strategies. Telephone interviews were conducted with the executive directors of 104 organizations in the Midwest providing HIV prevention programs to verify organizational status as community-based and to identify full-time service providers. Forty-six CBOs with a total of 136 HIV prevention educators were identified via the telephone survey. Eighty-two HIV prevention service providers from 46 CBOs representing four Midwestern states completed a written questionnaire surveying their personal resources, normative communication behaviors, job characteristics, andperceptions of conditional demands and burnout. Results did not support the conservation of resources framework. The demands of role conflict and ambiguity of work outcomes did not prompt use of communication resource replacement strategies as a means of decreasing the experience of burnout (i.e., emotional exhaustion, depersonalization, and diminished personal accomplishment). Many hypotheses could not be tested due to measurement structures which demonstrated that organizational target of communication resource replacement behavior (i.e., supervisor or coworker) had a stronger influence on communication behavior than replacement strategy type (i.e., feedback seeking, reification of the meaningfulness of work, and social support seeking). Post hoc analyses revealed that communication resource replacement strategies, personal resources, and task characteristics act as independent variables, and the demands as mediators in the process of burnout. Study results suggest that communication behaviors can both attenuate and exacerbate demands. Findings imply that enhancing service providers’ personal control, relationship with supervisor, and access to feedback from the client can decrease the experience of conditional demands, and consequently, burnout. To the memory of F. Dennis Casey, for his unwavering belief in me. iv ACKNOWLEDGEMENTS I owe this accomplishment to the support and efforts of many individuals throughout my education. To the many friends, colleagues and teachers who have shared their knowledge and friendship with me over the years, I owe thanks. To my chair and mentor, Dr. James Dearing, for his insight, guidance, friendship, and frankly, endurance, I am gratefully indebted. To him I owe thanks for his example and for providing invaluable experiences which have helped me to develop as a scholar. To my committee member and longtime advisor, Dr. Vernon Miller, for his instruction, encouragement, faith, and friendship throughout my education, I owe eternal gratitude. To him I owe thanks for recognizing my potential, teaching me how to develop it, and pushing me to use it. To my committee members, Drs. Kim Witte and Charles Salmon, for their direction and support throughout the dissertation process, I owe thanks. To my respondents, for taking their valuable time to participate in this project, I am indebted. I gratefully acknowledge their participation, and their contributions to our community. To my friends and colleagues, Dr. Gary Meyer, for truly being my coach and showing me "how things should really get done," and Dr. Judy Berkowitz, for being my ready reference and sounding board, I owe thanks. To my friend, Mr. Daniel Weissbein, for the innumerable Venn diagrams he drew, and his assistance in clarifying the data analysis, I owe thanks. To him I owe gratitude for his continual support and faith in me. To my friend, Mr. Jon Frederickson, for his support and love through these last trying months, I owe my gratitude. To him I owe thanks for both his persistent encouragement and his patience to see me through to the end. To my family, especially my parents, for their enduring guidance, support and love, I am forever indebted. To them I owe thanks for teaching me life’s greatest lessons: how to love, laugh, work, and share. I could not have accomplished this without them. vi TABLE OF CONTENTS LIST OF TABLES LIST OF FIGURES CHAPTER 1: STATEMENT OF THE PROBLEM Introduction Purpose of Study Predisposition for Burnout in Human Service Work Unique Attributes of Human Service Organizations Characteristics of H80 Service Providers Alternative HSOs: Community-Based Organizations Characteristics of CBOs Providing HIV Prevention Services Characteristics of CEO HIV Prevention Service Providers Burnout and HIV Prevention Service Providers Need for Research Community-based Organizations The Role of Communication in the Burnout Process CHAPTER 2: REVIEW OF THE LITERATURE Burnout Nature of Burnout Relationship to Stress Overview of Empirical Findings in Burnout Research Role Properties Job Design and Organizational Characteristics Personal Characteristics and Resources Attitudinal and Behavioral Outcomes Summary and Critique of Empirical Work The Role of Communication in Burnout Processes Social Support As a Coping Resource Structural Social Support Functional Social Support Review and Critique of Social Support Literature Conservation of Resources Theory of Stress Explication of the Theoretical Model Conditional Demands Ambiguity of Work Outcomes Role Conflict Relationships Between Demands and Resource Replacement Strategies Resource Replacement Strategies Role Modification Feedback Seeking Reification of the Meaningfulness of Work Social Support Seeking vii xii KOONIbUJNI—‘H 10 ll 12 13 13 14 16 l6 l6 19 26 27 27 30 33 34 36 37 39 40 46 47 53 53 53 55 58 61 62 63 64 66 Influence of Personal Resources Personal Control Tolerance for Ambiguity Relative Effectiveness of Resource Replacement Strategies CHAPTER 3: METHODOLOGY Sample Selection Questionnaire Procedures Operationalization of Variables Ambiguity of Work Outcomes Role Conflict Role Modification Feedback Seeking Reification of the Meaningfulness of Work Social Support Seeking Burnout Tolerance for Ambiguity Personal Control Characteristics of the Job Demographic Information Analyses CHAPTER 4: RESULTS Participants Psychometric Properties of Instruments Preliminary Analysis Tests of the Hypotheses Relationships Between Demands and Resource Replacement Strategies Relationships Between Strategies and the Dimensions of Burnout Influence of Personal Resources and Replacement Strategy Use Relative Effectiveness of Resource Replacement Strategies Post Hoc Analyses Exploration of Demographic, Personal and Job Characteristics Exploratory Path Model Analyses CHAPTER 5: DISCUSSION Overview of Study Limitations of Study Overview of Results Discussion of Key Findings Burnout Intensity Lack of Support for COR Hypotheses Influence of Strategy Target Predictors of Burnout Emotional Exhaustion Depersonalization Diminished Personal Accomplishment viii 67 68 69 69 71 71 73 74 74 75' 75 76 76 77 77 78 79 79 80 68 82 82 84 87 89 89 90 92 93 94 94 96 97 98 101 104 105 106 108 110 112 112 116 117 Relationships Amongst Dimensions of Burnout Implications Directions for Future Research APPENDIX A: TABLES APPENDIX B: FIGURES APPENDIX C: MATERIALS SENT TO EXECUTIVE DIRECTORS APPENDIX D: TELEPHONE PROTOCOL APPENDIX E: LETTER TO SERVICE PROVIDERS REFERENCES ix 120 121 125 129 152 155 158 160 162 Table Table Table Table Table Table Table Table Table Table Table Table Table Table Table 10. 11. 12. 13. 14. 15. LIST OF TABLES Definitions of role conflict types Role conflict dimensions represented in Rizzo, House, and Lirtzman's instrument Scale items and factor loadings for ambiguity of work outcomes Scale items and factor loadings for role conflict Scale items and factor loadings for role modification Scale items and factor loadings for personal control Scale items and factor loadings for tolerance for ambiguity Scale items and factor loadings for feedback seeking-supervisor Scale items and factor loadings for feedback seeking-coworker Scale items and factor loadings for general feedback seeking Scale items and factor loadings for reification of the meaningfulness of work-supervisor Scale items and factor loadings for reification of the meaningfulness of work—coworker Scale items and factor loadings for reification of the meaningfulness of work-external Scale items and factor loadings for social support seeking-supervisor Scale items and factor loadings for social support seeking-family and friends 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 List of Tables continued Table Table Table Table Table Table Table 16. 17. 18. 19. 20. 21. 22. Scale items and factor loadings for social support seeking-coworker Scale items and factor loadings for emotional exhaustion Scale items and factor loadings for depersonalization Scale items and factor loadings for diminished personal accomplishment Variable means and standard deviations Correlations between original variables and targeted behaviors Path model correlations, means and standard deviations xi 145 146 147 148 149 150 151 LIST OF FIGURES Figure 1. Conservation of resources conceptual model 153 Figure 2. Post hoc path model 154 xii CHAPTER 1: STATEMENT OF THE PROBLEM Introduction Burnout is a pervasive problem in modern organizations, consistently being related to the physical and psychological well-being of workers and valued organizational outcomes, such as commitment, satisfaction and intention to remain in the organization. The vast literature on work stress and burnout, which accounts for thousands of articles, speaks to the prevalence of this problem, particularly in human service organizations. Maslach and Schaufeli (1993) describe burnout as prolonged job stress, wherein employees’ resources are depleted by continual workplace demands. Cherniss (1980) states that burnout also refers to "negative changes in work-related attitudes and behaviors in response to job stress" (p. 6). The descriptions of burnout are numerous, but most reflect that burnout: (a) occurs over time; (b) occurs in response to exposure to chronic work demands (stressors); (c) manifests itself in negative physical, psychological and behavioral effects; and, (d) results in professional, social and financial costs for individuals, their interpersonal networks, and their organizations. Here, burnout is defined as a pattern of emotional exhaustion, depersonalization, and diminished personal accomplishment in response to chronic workplace demands. In the 1980's and 1990’s great strides in burnout research have been made in terms of (a) the identification of key antecedents and consequents of burnout, (b) the relationship of burnout to stress, and (c) conceptualization and Operationalization of burnout. Additionally, identification of a common occupational context, namely, human services, established itself in the burnout literature (Schaufeli, Maslach, and Marek, 1993). The emphasis of burnout research in human service occupations is historically grounded in Freudenberger’s (1974) conceptualization of the phenomenon he witnessed in alternative human service institutions (i.e., free clinics). Freudenberger attributed the phenomenon to both characteristics of the organization and to the characteristics of individuals who sought employment within them. Purpose of the Study Here, employing Hobfoll’s (1989) conservation of resources (COR) framework, a model of communication, stress and burnout among CBO service providers is delineated, focusing on the use of communication replacement strategies to cope with workplace demands. This study offers a test of the theoretical relationships between two workplace demands thought to be pervasive in CBOs (i.e., ambiguity of work outcomes and role conflict), use of communication replacement strategies (i.e., role modification, feedback seeking, reification of the meaningfulness of work, and social support seeking), and the experience of burnout (i.e., emotional exhaustion, depersonalization, and diminished personal accomplishment). Further, the proposed moderating roles of two personal resources (i.e., personal control and tolerance for ambiguity) in the burnout process are examined. Pragmatically, this study strives to identify efficacious and cost-effective strategies that CBO members can use to combat the everyday demands that characterize their work lives. It is hoped that the lessons learned from this exploration of the burnout process can result in practical strategies for reducing the impact of chronic workplace demands on CBC service providers, thereby improving their organizational lives and, in turn, the lives of their clients. Predisposition For Burnout In Human Service Work The "helping" professions, as human service occupations are commonly called, grew from a need to counteract increasing social individualization and the loss of care previously provided by church, family and community (Cherniss, 1980). In an age of increased alienation in work processes, fluctuating employment status, chronic substance use and aging populations, the need for public human services is likely to increase. As such, research efforts directed at gaining a greater understanding of burnout processes and preventing its occurrence are of great social importance. In order to fully understand the burnout processes and its pervasiveness in human service occupations, it is necessary to address the unique characteristics that Freudenberger identified. Unique Attributes of Human Service Organizations Hasenfield and English (1974; as cited in Kouzes and Mico, 1979, p. 453) define human service organizations as those, "whose primary function is to define or alter the person's behavior, attributes, or social status in order to maintain or enhance his well being." Examples of human service organizations (HSOs) include hospitals, police departments, educational facilities and social service agencies, though the reader should note that the literature reviewed in this document focuses on social service and health care occupations. HSOs differ from classical bureaucracies in a number of organizational attributes (Kouzes & Mico, 1979). Key differences are in relation to profit as motive, intended beneficiaries and resource base, as well as goal clarity, professional versus instrumental orientation of workforce, transformation processes and means-ends relation (Kouzes and Mico, 1979). Goals in HSOs tend to be ambiguous and problematic as they are greatly influenced by complex and differentiated environmental entities which are influential in terms of governance and policy issues (Weisbord, 1976). The workforce in HSOs, such as medical centers and universities, consist of recognized professionals socialized and responsive to their discipline (Mullen & Leifer, 1982; Rutherford, 1990; Weisbord, 1976), whereas the workforce in business and industry is regarded as being instrumental in completing tasks within a bureaucratic setting. Business and industry transformation processes involve the creation of a tangible product and as such focus on the interaction between the employee and the product. The "product" of an HSO is conceived of as an effectual process, one which is intangible and is achieved via staff-client interaction. Lastly, the means-ends relation in HSOs is characterized as relatively indeterminant. Conversely, business and industry pride themselves in determinant means-ends relation which legitimates their existence and ensures their survival. Human service organizations do not differ from business and industry solely in terms of the tasks that they perform, rather the differences are pervasive in the legitimacy, functioning, funding, structure and coordination of the organization. HSOs are not merely a modified form of the technocratic bureaucracy, but are an alternate form in their own right which entails alternate conceptualization. While Cordes and Dougherty (1993) recently argued that the incidence of burnout is not limited to the human service occupations, individuals employed in human service work are particularly vulnerable to burnout given substantial differences in organizational and task characteristics. Schaufeli, Maslach, and Marek (1993) speak to this vulnerability: What is special about their work is that their tools are their own social skills, attitudes, and personality characteristics in addition to their professional technical abilities. The professionals’ relationship with the recipient is the vehicle for change and hence the source of accomplishment (or of failure). At the same time, this relationship is demanding and exhausting by its very nature - recipients are troubled or suffering, and they are asking for assistance of some kind. Thus, in contrast to other types of occupational strain, burnout results from interpersonal processes with recipients as well as from an interplay of individual and organizational factors (p. 255). Characteristics of H80 Service Providers The emotional nature of the work of those employed in the helping professions increases their vulnerability, as does the psychosocial orientation of the work force. Individuals attracted to human service occupations tend to possess great empathy for the suffering of others, often have experienced situations similar to those of their prospective clients, and embrace humanitarian values (Pines, Aronson & Kafry, 1981). They are client-centered and committed to enhancing the quality of their clients’ lives to such an extent that the service provider’s role is defined by the clients needs (Pines, Aronson & Kafry, 1981). Human service workers see themselves as agents to evoke change in the world, minimally in the lives of their clients. As Farber (1983, p. 4) asserts: People who go into human service work want to help others, sometimes desperately so. Some of these individuals may base their self-esteem too exclusively on the attainment of unrealistic, albeit humane goals. Thus, the motivation for joining human service occupations lies in the desire to help others and to bring about positive change in client lives. The role of service- provider or "helper" becomes interwoven with the provider’s sense of self. So, chronic stressors which directly threaten the enactment of the "helper" role are most influential on the provider’s psychological well-being, what Thoits (1991) describes as "identity-relevant" stressors. Unfortunately, these identity-relevant stressors persevere and the attainment of this idealistic state is impeded by bureaucratic formalization, the service providers often unrealistic expectations for intrinsic rewards to result from provider-client interactions, and the emotional taxation of the work itself. As Heifetz and Bersani (1983) assert "burnout must be preceded by commitment...Metaphorically, one must be "fired up" before one can burnout" (p. 59). Therefore, burnout can be conceived of as a disease of overcommitment, of identification with an idealized role which cannot be enacted. As Pines, Aronson and Kafry (1981) assert, "Tragically, burnout impacts precisely those individuals who had once been among the most idealistic and enthusiastic" (p. 3). Freudenberger (1975) illustrates what occurs when the overcommitted service provider experiences these impediments: It is at this point, that the dedicated worker’s guilt, his feelings that he is a super—being helper, his desire for being of genuine help, pushes him ever onward to work even harder, because such a person believes that the only way to stem the flood of demands upon him is to put in more hours and more effort. What happens is that the harder he works, the more frustrated he becomes; and the more frustrated he is, the more exhausted, the more bitchy, the more cynical in outlook and behavior - and of course, the less effective in the very things he so wishes to accomplish (p. 74). Having addressed the organizational and task factors, as well as, the psychosocial orientation of the human service worker which presumably makes him or her more susceptible to burnout, the focus will be placed on a particular type of H80, namely, the community-based organization. Given the variance of organizational features of human service organizations, from hospitals and universities to free community clinics, a conscious decision to limit this variance by focusing on the organizational constraints of one type of H80 and one functional type of service provision (i.e., Human Immunodeficiency Virus disease prevention) was made for this research endeavor. HIV prevention was chosen as the functional type of service provision given the relative success of community—based efforts targeted to HIV prevention and the lack of empirical research exploring the problem of burnout in this service context. Following a general discussion of community-based organizations, the characteristics of community-based organizations and service providers offering HIV prevention services are addressed. Alternative HSO§: Communitv-ba§§g_ggganiga§iggg Community-based organizations (CBOs) are nonprofit human service organizations that can serve a variety of functions and provide a variety of services to their clients, the members of the community. Mico (1985) defines CBOs in detail, as follows, (p. 3): A community-based organization is a formalized social structure that enables many people to work together in pursuit of a common goal. It is controlled by the people in the neighborhood or community. It is not a charter or an affiliate of a national or state organization, operating within the constraints, bylaws, or control of another authority. It may receive grants or contracts from private or governmental sources, and abide by funding guidelines, but these do not control the organization. Mico (1985) continues his definition of a typical CBO as private, nonprofit organizations which are defined by a particular function, such as economic development, community action or social and physical support, and operate programs or activities in line with that particular function. The community-based organizations to be addressed below are functionally defined as HIV/AIDS service providers. As there is little information on CBOs as an organizational entity aside from that provided above, the following discussion of community-based organizations and staff members stems from lessons learned via survey and interview data collected during a two-year study of organizations which provide HIV prevention education to individuals in San Francisco, California (Dearing, Rogers, Meyer et al., 1996). Characteristics of CBOs providing HIV prevention services. Community—based organizations are non-profit organizations that serve a defined target population or area. Alperin & Richie’s (1989) study of 108 HIV/AIDS service CBOs across the United States found most to be voluntary, non-profit, secular, independent organizations that began as an informal AIDS support group. CBOs are highly dependent on funding sources and opportunities typically operating with scarce resources. The scarci of resources entails the use of programmatic strategies :3 identify their own market niche in the form of targeting specific populations for certain programs. Specified target populations are often those which cannot be reached by standard communication or health education methods, such as African American IDUs or runaway youth who engage in survival sex as a means to support themselves (Dearing et al., 1996). Identifying market niches by targeting unique and or difficult to reach populations in the community prevents the overlap of services and allows the CEO to demonstrate their utility to the funding agency. While providing HIV prevention services and resources to the client population, CBOs act as intermediaries for governmental and health institutions. Community-based organizations are viewed as credible institutions by their clients given their establishment in the community 10 infrastructure. The philosophy driving these CBOs is to provide HIV prevention information in a safe, non— evaluative and confidential context (Broadhead & Fox, 1990; Dearing et al, 1996). This philosophy, coupled with a high degree of homophily with the client population, creates a climate in which these organizations and their staff members are perceived as non—threatening to target population members and are accepted as sources of knowledge and services in a safe and familiar environment. Service interactions take place on the client’s turf, or at the client’s request by visiting the CBO. Characteristics of CBO HIV prevention service providers. CBO service providers are often drawn from the populations that they provide prevention services for, they play a dual role of publicly representing the community which they serve and act as role models for the clients they reach (Broadhead & Fox, 1990, Dearing et al., 1996). Given their investment in the community, the allegiances of the staff are geared toward community rather than organizational or political entities. This high degree of homophily with and commitment to the target population assists in the establishment of credible and trusting relationships, thus breaking through many of the social and psychological barriers that other professional and non- similar staff members may bring to the interaction (Dearing et al., 1996). Former prostitutes, transgenders and recovering IDUs are examples of CBO service providers who 11 share common experiences and cultural backgrounds with the client population in San Francisco (Dearing et al., 1996). As homophilous and committed change agents operating within the linguistic and cultural norms of the community, CBO staff members are allowed access to and status with the opinion leaders of hidden and unique populations (Casey, 1995). Burnout and HIV prevention service providers. To date, few research endeavors have explored the nature and prevalence of burnout in HIV prevention service providers. The bulk of the burnout literature in the HIV/AIDS context has focused on AIDS caregivers and counselors. The AIDS caregiver burnout literature has explored AIDS-specific issues, such as, homophobia, discrimination against marginalized individuals, fear of contagion and issues related to terminal illness (Ross, 1993). Janz, Wren and Israel (1993) explored service provider stress in 26 HIV prevention projects, 14 HIV/AIDS service projects, and 11 combination projects funded by the Robert Wood Johnson Foundation, some of which were housed in community-based organizations. Project directors of the HIV prevention projects rated quantitative work overload, staff retention, burnout, rapid organizational growth, and staff recruitment as the most serious staff problems. While burnout was rated a serious problem in the prevention only projects, it was not rated as seriously in service only or combination projects. This difference was attributed to the greater 12 ambiguity of goals in prevention work, greater difficulty in quantifying and measuring outcomes, and unpredictability of desired outcomes regardless of work effort or quality (i.e., recognizing that increases in knowledge do not always translate into behavior change). Need for Research While substantial progress has been made in the burnout literature, Schaufeli, Maslach, and Marek (1993) identify the following shortcomings: (a) a lack of theoretical grounding; (b) self-selected, non- representative samples; (c) a lack of method triangulation, involving objective and subjective measures; (d) minimal cross-national validation of findings; (e) few longitudinal research designs; and, (f) a lack of base rate and criterion levels of burnout. The majority of these shortcomings address methodological and design weaknesses, which clearly influence the confidence one can have in empirical results. Additional weaknesses, which will be addressed in this study include a lack of attention to (g) the demands (stressors) of alternative human service organizations, and (h) to the role of communication in the burnout process. Community-based Organizations As an alternative to bureaucratic or governmental human service organizations, the community-based organization has received scant attention in terms of unique work demands which likely influence service provider 13 perceptions of stress and experience of burnout. Yet, a community-based approach to providing health and human services has gained credence and import in the last decade. Specifically, community-based initiatives have been identified by the 0.8. Department of Health and Human Services (1990) and health experts (Bracht, 1990) as an efficacious strategy for health promotion and disease prevention. For example, the vital role of CBOs in the prevention of the spread of the Human Immunodeficiency Virus (HIV) in the United States has been acknowledged in public health, health psychology and health communication literatures. As governmental budget-cutting practices increase and the Federal push for service provision at the local and community levels increases, the community-based organization is going to play a central role in the provision of human services. Efforts to identify efficacious and cost-effective means for the management of workplace demands (stressors) and for the prevention of CEO service provider burnout need to be on the research agenda for the new millennium. The Role of Communication in the Burnout Process Communication scholars have primarily focused on the role of social support in the burnout process, though some research has explored communication network roles (Ray, 1991), participation in decision making (Miller, Ellis, Zook & Lyles, 1990) and empathic communication (Miller, 14 Birkholt, Scott & Stage, 1995). Interestingly, social support has typically been cast as a resource that significant others (e.g., supervisors, co-workers, friends) provide for the individual experiencing stress, not a strategy that individuals employ to cope with demands. Additionally, few studies have explored the role of organizational communication behaviors, such as, feedback seeking and role modification in the burnout process. The strategic use of organizational communication behaviors as a means to cope with chronic workplace demands may be an efficacious and cost-effective option for mediating the influence of workplace demands on burnout. For instance, Casey, Miller and Johnson (1997) found that the survivors of organizational downsizing altered their information seeking behaviors in response to high uncertainty following a workforce reduction. While a reduction in workforce is an example of an acute workplace demand, the general lesson is that employees can be strategic in their use of communication behaviors in adjusting to organizational phenomena. As such, the role of strategic communication behaviors in the burnout process is deemed a question worthy of exploration. 15 CHAPTER 2: REVIEW OF THE LITERATURE As indicated in the previous chapter, the literature examining and theorizing about burnout is vast. As such, this literature review is focused on work which is directly relevant to the research at hand. To assist the reader, this chapter is divided into two main sections. The first reviews relevant burnout literature, beginning with a discussion of the nature and symptoms of burnout and it’s relationship to stress embedded in a general adaptation syndrome (Selye, 1993) framework. An overview of burnout research exploring key antecedents and outcomes, with attention explicitly directed to the role of communication in the burnout process follows. The second section provides an explanation of the conservation of resources theory of stress framework (Hobfoll, 1989), an explication of the proposed theoretical model, and lastly, an elaboration of hypothesized relationships. Bprpppt Th n The term "burnout" was first coined by the psychoanalyst Herbert Freundenberger in 1974 based on his own experiences and through observation of volunteers who were working with him in a community-based organization. Freundenberger (1974) used the denotative meaning of the verb burn-out to define the phenomena, "to fail, wear out, or become exhausted by making excessive demands on energy, 16 strength, or resources" (p. 159). Since 1975, numerous definitions of burnout have evolved, some of the most popular of those from the 19803 work of Ayala Pines, Christine Maslach and Cary Cherniss. Pines, Aronson and Kafry (1981) define burnout as a state of physical, mental and emotional exhaustion, resulting from "constant or repeated emotional pressure associated with an intensive involvement with people over long periods of time" (p. 15). Maslach and Jackson (1986) define burnout operationally as a "syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment that can occur among individuals who do ’people’ work of some kind" (p. 1). Cherniss (1980) states that burnout "refers to a process in which the [human service] professional’s attitudes and behavior change in negative ways in response to job strain" (p. 5, brackets added). Common among these definitions are the characterizations that: (a) burnout is a process; (b) burnout is a social-psychological concept, an interaction between the individual and the environment; (c) burnout is multi-dimensional; and, (d) burnout is a distinctly negative phenomenon. Here, burnout is defined, reflecting the work of Maslach and her colleagues, as a pattern of emotional exhaustion, depersonalization, and diminished personal accomplishment in response to chronic workplace demands. The work of Maslach and others lead to the development of the multi-dimensional Maslach Burnout Inventory (M81) 17 which reflects the nature of burnout (Maslach & Jackson, 1981). The MBI is a conceptual and operational tool which defines three inter-related dimensions of the state of burnout; (a) depersonalization, which involves a distancing of oneself from others and regarding others, particularly clients, as objects, (b) diminished personal accomplishment, which involves a negative evaluation of oneself and one’s performance on tasks and, (c) emotional exhaustion, which involves perceptions of feeling psychologically "drained," and general fatigue. Leiter (1991) asserts that emotional exhaustion is the defining feature of burnout, as "workers who are not emotionally exhausted, but who express an impersonal view of clients or diminished assessments of their own accomplishment have a job-related problem other than burnout" (p. 125). Leiter continues that emotional exhaustion is central to the burnout process because it through that lens that individuals appraise themselves and their environment. Lee and Ashforth (1996) provide substantiation of the centrality of emotional exhaustion in their meta-analytic study of correlates of the three burnout dimensions; emotional exhaustion was significantly associated with more demands and resources than either depersonalization or diminished personal accomplishment. Symptomatically, burnout may manifest itself in cognitive, affective, interpersonal, behavioral and psychosomatic dimensions. While the MBI is considered to be 18 a rich measure of the state of burnout, symptoms have otherwise been defined or identified. Horst’s (1986) review of 55 articles revealed 87 symptoms. Those reported most often included: (cognitively) cynicism/negativism, rigidity, and dehumanizing clients; (affectively) irritability, helpless/hopeless feelings, emotional detachment and depression; (interpersonally) withdrawal and isolation from clients, co-workers and family, and martial problems; (behaviorally) poor work performance, substance abuse, and absenteeism; and (physically), chronic fatigue, physical exhaustion, sleep disorders and headaches. While Horst (1986) did not provide sufficient information regarding what constitutes a symptom, it should be noted that the majority of burnout research has utilized correlational or descriptive analyses, thus blurring the lines between antecedents, correlates, symptoms, and consequences of the burnout process. MW By definition, burnout is a process which occurs over time in response to chronic workplace demands. In the words of Farber (1983), "burnout can be regarded as the final step in a progression of unsuccessful attempts to cope with a variety of negative stress conditions" (p. 15). Farber (1983) argues it is the condition of chronic unmediated stress that leads to burnout, rather than the mere advent of stress that leads to burnout. But, one cannot 'meaningfully discuss burnout processes without a general 19 understanding of stress. Here, burnout will be discussed in relation to stress and the broader concept of human adaptation processes. From a historical perspective, scientific attention to stress began in the early 19005 with a focus on physiological reactance to certain conditions or elements. As such, modern approaches to stress and burnout are grounded in the early adaptation research by Selye and others. Selye’s work, which began in the 19308, on the general adaptation syndrome (GAS) (the elicitation of an altered physical state in the presence of demands posed on the body), precipitated interest in the study of stress phenomena. The GAS process flows from an entity’s initial alarm reaction to the stressor stimuli, to a stage of resistance against the stimuli, and finally to a stage of exhaustion if the demand is severe and lasts for a sufficient period of time to deplete resistance resources (Selye, 1993). These stressor stimuli (demands) can be physical, environmental, emotional or cognitive in nature. Selye (1993) likens the tripartite process to stages of development, "these three stages are reminiscent of childhood (alarm reaction), with its characteristic low resistance and excessive response to any kind of stimulus, adulthood (stage of resistance), during which the body has adapted to most commonly encountered agents and resistance is increased, and senility (stage of exhaustion), characterized by loss of adaptability and eventual 20 exhaustion, ending with death" (p. 10, parens added). Selye (1993) continues that the body’s adaptability or adaptation energy is finite, in that while adaptive resources can be replenished, they can never be completely restored, thus adaptation events accumulate to constitute the signs of aging. Selye’s adaptation framework provides a useful heuristic for illustrating the relationships between stress and burnout. Stress occurs during the first two stages, alarm reaction and stage of resistance (the locus of coping) and burnout occurs in the last stage, the stage of exhaustion. As there exists little agreement about a formal definition of stress, Lazarus and Folkman (1984) offer the term "stress" as an organizing concept for the field of interest focusing on human and animal adaptation processes. Therefore, individual researchers often make unique distinctions between types of stress based on it’s nature (i.e., psychological, physical), it’s persistence (i.e., acute, chronic, intermittent), it’s locus (i.e., internal, external, context specific) and it’s magnitude (i.e., cataclysmic, distressing, annoying). Using these distinctions, burnout research is the study of chronic psychological stress which occurs in the workplace that is assumed to be distressing. A generic model of the stress process indicates that any salient stressor generates either eu-stress or distress, which in turn, can lead to either positive or 21 negative outcomes (Golembiewski and Munzenrider, 1988). In this model, a stressor is a heightened feature present in one’s life, and which can range from a coveted promotion, to role ambiguity, to a stolen parking spot. Stress is said to occur when there is an imbalance (real or perceived) between the environmental stressors and an individual’s ability to adequately respond to them (Farber, 1983). Stress itself is neither positive or negative, but can lead to either eu-stress, a energizing and motivating force or distress, a force which strains or disrupts individuals. Eu—stress is a positive phenomenon, potentially leading to physical health or high productivity, whereas, distress is a negative occurrence which can accumulate to lead to absenteeism, disease and low productivity. As the distress imbalance becomes greater (greater environmental demands or a lessor ability to respond occurs), the likelihood that stress will eventually lead to burnout increases (Farber, 1983). Much of the focus of the organizational stress literature has been on delineating the process of stress leading to distress in the workplace. Kahn and Byosiere’s (1992) review of the post-1976 literature on organizational stress highlights numerous theoretical frameworks which have been employed to study the stress process. Upon review of the frameworks, the authors conclude that there exists a common sequence in conceptualization of the stress process, namely, "(a) the imposition of a damaging or taxing stimulus (stressor), 22 (b) a set of psychological responses triggered by that stimulus (reactance/coping), and (c) a more or less complex array of consequences in which the well-being of the individual is involved (strain/outcomes)" (p. 593, parens added). Further, Kahn and Byosiere note that there is partial agreement amongst the frameworks that various individual and contextual characteristics and resources moderate the stress process. Thus, the convergence of these conceptualizations illustrate what Lazarus and Folkman (1984) call a relational definition of stress, meaning that stress can only occur through the interaction of the characteristics of the individual with the characteristics of the environment. Dewe, Cox and Ferguson (1993) summarize three themes of relational (also known as transactional) definitions of psychological stress, "(a) stress as a dynamic cognitive state, (b) representing a disruption in homostatis or ’imbalance’ and (c) giving rise to a requirement for resolution of that imbalance or restoration of homostatis" (p. 6). Implicit in these themes is Lazarus and Folkman’s (1984) notion of cognitive appraisal, which states that an individual must perceive a stressor as threatening or challenging to his or her well-being or resources in order for the stressor to act as a catalyst. It is this threatening or challenging stressor which leads to alarm reaction then to coping attempts, or what Selye (1993) terms the stage of resistance. Hobfoll’s (1989) 23 conservation of resources theory of stress, which is the theoretical grounding for this study, employs a transactional definition of stress. Stress research has primarily explored the following relationships; (a) the influence of stressors on strains, (b) the influence of strains on individual, organizational and social outcomes, (c) the role of individual and contextual factors as moderators in the stress-strain relationship, (d) the means by which individuals attempt cope with perceived stress, and (e) the effectiveness of said coping attempts. Additionally, as Kahn and Byosiere (1992) note, research has focused on stressors as the independent variable with little attention directed to environmental features which may contribute to the production of stressful stimuli. A great deal of effort has been expended exploring the first three relationships posed above, as is evident in Holt’s (1993) review of the organizational stress literature which identifies approximately 50 stressors (i.e., independent variables), a similar number of strains/outcomes (i.e., dependent variables) of stress, and approximately 40 contextual or individual characteristics (i.e., moderating variables). Another significant portion of the literature has focused on the latter two questions by exploring cognitive appraisal and coping processes and their relative affects. One criticism of the stress literature is the presence of confounds in conceptualization and measurement, wherein 24 the stressor (i.e., independent variable) is not conceptually or empirically distinct from the measured strain (i.e., dependent variable). Lazarus and Folkman (1984, p. 49) relate Kasl’s (1978, p. 14) assertion that some stress research is, "about as illuminating as correlating ’How often do you have a headache?’ type of item with ’How often are you bothered by headaches?’ form of question." This conceptual and operational indistinction and a general reliance on subjective measures of stress often renders the actual stressor unremarkable from its subjective appraisal by the individual, and at times indistinguishable from consequent strains (Kahn & Byosiere, 1992; Lazarus & Folkman, 1984). In sum, burnout is a unique type of stress wherein unsuccessful attempts to cope with chronic stress lead to a state of emotional exhaustion, depersonalization and diminished personal accomplishment. The processual nature of burnout reflects the sequence of the stress process, but goes a stage further in the general adaptation sequence. To this end, many researchers have not conceptualized the process of burnout as being substantially different, rather the focus has been placed on burnout’s nature and consequences. As such, popular frameworks of burnout processes (Cherniss, 1980; Leiter, 1991; Maslach & Jackson, 1981; Pines, Aronson & Kafry, 1981) either subsume or reflect theoretical frameworks of stress. However, it should be noted that this practice is not without criticism 25 (Burish, 1993; Hallsten, 1993). Overview pf Empirigal Findings in Bprnput Research This summary of empirical findings will focus on burnout research which utilized the MBI as the measure of burnout. As mentioned above, much of the empirical work has been correlational, computed from cross-sectional data, so some descriptions of variables as either antecedents or consequents has been ascribed, rather than empirically verified. Given the multidimensional nature of burnout, the correlates are often differentially related to the three components of burnout and these relationships are so noted. As much of the literature has focused on human service providers, research which focuses on that population is reflected here, with the inclusion of some work conducted outside of this population. Similar to the stress literature, numerous correlates of burnout have t —n studied, so only those relationships which have m-st often been substantiated or are of interest to this study will be addressed. A separate section devoted to the role of communication in burnout processes will follow. As discussed in Chapter 1, burnout as a disease of overcommitment implies that when individual, contextual, organizational or societal demands consistently interfere with the realization of humanitarian goals and ideals of the human service worker, burnout is more likely to occur. Accordingly, research has focused on role properties, job design characteristics, organizational characteristics, 26 personal resources, and attitudinal and behavioral outcomes. Each category will be addressed below, with particular attention placed on the literature relevant to role conflict, ambiguity of work outcomes, tolerance for ambiguity and personal control in a subsequent section. Rple prppertigs. Properties of the service provider’s role, namely, ambiguity/clarity, conflict, and overload are some of the most widely researched antecedents to burnout. Role ambiguity and clarity have been associated with depersonalization and role clarity has been found to be negatively related to emotional exhaustion according to Lee and Ashforth’s (1996) meta-analysis. Role stress (a combined measure of conflict and ambiguity), role conflict and quantitative role overload have been found to be significantly related with both emotional exhaustion and depersonalization over a number of studies (Lee & Ashforth, 1996). Interestingly, Maslach and Jackson (1984) found a curvi-linear relationship between service provider caseload and the dimensions of burnout, implying that work underload can be as taxing on the individual as work overload. Similarly, Burke and Greenglass (1995) found a lack of stimulation for school-based educators to be predictive of burnout. 1gp desigp and Qrganizapipnal gharagperispigs. Research examining the relationships between job design characteristics and burnout has found the following to be consistently negatively associated with emotional 27 exhaustion (innovation, participation, skill utilization, and efficient and well-planned task orientation), and depersonalization (innovation, participation, skill utilization, and task orientation) (Lee & Ashforth, 1996). Lee and Ashforth (1996) do not report any significant correlations between the above variables and diminished personal accomplishment. Golembiewski and his colleagues work on the relationships between job characteristics, work environment and eight phases of burnout based on the MBI has been pervasive and informative. Golembiewski, Munzenrider and Carter’s (1983) eight—phase model of burnout dichotomizes the MBI components and various combinations of the three components then comprise the progressive phases. For example, Phase I consists of low emotional exhaustion, depersonalization and diminished personal accomplishment, whereas, Phase VI consists of high emotional exhaustion and depersonalization and low diminished personal accomplishment. This model has been used to explore relationships between the ten facets of Hackman & Oldham’s Job Diagnostic Survey, six variables from Smith, Kendall & Blood’s Job Descriptive Index, and variables from Smith’s Index of Organizational Reactions, Deckard and Rountree's Psychological Sense of Community Scale, and Insel and Moos’ Work Environment Scale. These measures of job characteristics and work environment significantly changed in the expected direction 28 across the eight phases in a series of studies (Golembiewski & Munzenrider, 1988). For example, Deckard, Rountree and Golembiewski (1986) found that as the phases of burnout became more advanced, care retirement community employees’ assessments of the five components of Smith’s Index of Organizational Reactions (i.e., perceptions of satisfaction of supervision, the kind of work, financial rewards, co-worker relationships and amount of work) became increasingly negative. Primarily employing analysis of variance and paired comparison techniques on cross- sectional data, Golembiewski et al. cannot conclude that certain job characteristics and aspects of the work environment cause burnout. However, the basic pattern of their results across samples from 33 organizations and over 12,000 individuals clearly indicate that job and organizational characteristics influence burnout. Tennis (1989) and Brookings, Chacos, Hightower, Howard and Weiss (1985) explored the relationships between perceived work environment and the dimensions of burnout. Employing factor analytic techniques, Brookings et al. (1985) derived two measures of the work environment; Work Supports and Administrative Control. Work Supports was negatively correlated with each of the burnout measures, suggesting that a supportive work environment leads to less frequent perceptions of emotional exhaustion and depersonalization and more frequent perceptions of personal accomplishment. Administrative Control, which reflects 29 supervisor support and autonomy, work pressure and control, was not significantly related to any of the burnout components. Tennis (1989) similarly reported that more positive assessments of the work environment and workplace processes were negatively associated with the components of burnout, and the independent indices of trust, mutual influence and organizational leadership provided the strongest predictions of the burnout components. Specifically, trust was the strongest predictor of emotional exhaustion and organizational leadership was the strongest predictor of personal accomplishment. Perspnal gharacteristigs and respprces, Golembiewski and others work on the eight phase model of burnout have found 11 demographic variables (e.g., sex, age, compensation, status, ethnicity, organizational tenure, marital status) to be significantly associated with burnout across the phases, however the variables explained negligible variance (Golembiewski & Munzenrider, 1988). Cordes and Dougherty’s (1993) review of job burnout research states that sex, age, marital status and having children have been found to relate to the components of burnout. While age has consistently been found to be negatively associated with burnout, the influence of sex in the process is not as clear (Cordes & Dougherty). One relationship that appears to be solid across studies considering sex is the relationship between sex and depersonalization, specifically men experience greater or 30 more frequent depersonalization than women (Cordes & Dougherty, 1993; Maslach & Jackson, 1984; Russell, Altmaier & Van Velzen, 1987). Communal orientation and involvement are two other personal resources that have been found to influence degree of burnout in human service workers. Taking an equity theory framework, Vaaneren (1995) describes the nurse- client relationship as a one-sided communal relationship wherein the norm is to provide benefits to the client in response to their needs or to demonstrate concern for the client’s well-being. Perceived underbenefit on behalf of the provider is a central characteristic of the provider- client relationship and therefore was not perceived as excessive to two-thirds of the nurses sampled. However, the remaining third perceived a substantial imbalance in benefits of the relationships, which interacted with degree of communal orientation, to predict emotional exhaustion and depersonalization. In other words, in perceived inequitable relationships, nurses high in communal orientation (i.e., the desire to give and receive out of concern for another) are less likely to experience emotional exhaustion and depersonalization. While the interaction between perceived imbalance and communal orientation was not significant for diminished personal accomplishment in this study, a direct negative association between communal orientation and diminished personal accomplishment was revealed. 31 Degree of job involvement has most often been conceptualized as an attitudinal outcome of burnout (Lee & Ashforth, 1996). Lee and Ashforth’s (1996) meta-analysis revealed insignificant negative relationships between job involvement and the three components of burnout. However, Koeske and Kelly’s (1995) test of their client overinvolvement model, which poses overinvolvement leading to burnout (MBI’s emotional exhaustion) leading to job dissatisfaction, identified social workers’ client involvement to be strongly predictive of emotional exhaustion. Overall, they found support for emotional exhaustion as a mediator between overinvolvement and intrinsic and global job satisfaction. Eisenstat and Felner (1984) similarly found client involvement to be positively related to emotional exhaustion, whereas general job involvement was negatively related to emotional exhaustion. This client involvement research provides empirical support for the long-standing assertion that human service providers’ commitment to helping others makes them more susceptible to burnout. Limited support for job involvement as an antecedent comes from Frone, Russell and Cooper’s (1995) stress research employing identity theory, which poses that the psychological importance of the job role (role—identity) intensifies the relationships between job stressors and individual outcomes, such as employee health. 32 Aggitudinal and pehavipral putgpmes. Golembiewski and colleagues have conducted research on the relationships between employees’ health, performance and productivity and their eight-phase model of burnout (Golembiewski & Munzenrider, 1988). They conclude that assessments of poor job and organizational characteristics are associated with increases in burnout which are associated with increased physical symptoms, decreased performance and decreased productivity (Golembiewski and Munzenrider, 1988). More commonly researched attitudinal and behavioral outcomes of burnout are employee intention to turnover, organizational commitment and job satisfaction. Lee and Ashforth (1996) report that intention to turnover is positively related to all three burnout components, although the association is strongest with emotional exhaustion, followed by depersonalization, then diminished personal accomplishment. Organizational commitment has been found to be negatively correlated with both emotional exhaustion and depersonalization across seven studies. Leiter’s (1991) recent structural equation model indicated that skill utilization, supervisor support and emotional exhaustion predicted organizational commitment. In regards to job satisfaction, Lee and Ashforth (1996) found job satisfaction to be significantly negatively related to depersonalization across twelve studies. However, a recent study of community mental health staff revealed that aspects of the job and the work environment lead to 33 perceptions of work satisfaction, which in turn predicted emotional exhaustion (Schulz, Greenley & Brown, 1995). a n ri i f m ir' 1 work. In sum, properties of the service provider role, job design and work environment characteristics, and personal characteristics and resources have a significant influence on burnout phenomena, which in turn can have profound affects on employees, organizations, and clients. This review also provides support for the multidimensional nature of burnout, such that the components have empirically distinct qualities. For example, stressors associated with role properties are consistently related to emotional exhaustion, but not diminished personal accomplishment. Conversely, characteristics of a supportive work environment are related to all three components, as Brookings et al. (1985) and Tennis’ (1989) findings indicate. These differential relationships also have implications for burnout research and interventions, as Leiter (1988, p. 113) notes: Both personal and environmental factors contribute to the development of burnout, but research evidence suggests that the characteristics of the work environment provide a more promising direction than such personal factors as demographic and personality variables...Not only is burnout more strongly related to environmental factors...but aspects of the work setting are generally more amenable to change than are personality or demographic characteristics. 34 While burnout is purported to be a more pervasive phenomena in the field of human service work, much of the research has focused on "generic" job and organizational demands and resources. In point, a great deal of research has been conducted in the context of human service work, yet the unique characteristics of human service work which make it fertile ground for burnout are not proportionately addressed in the literature. Clearly, research on client involvement, communal orientation, severity of client problems and some job design characteristics pertinent to human service work (i.e., significance of the task, knowledge of results, and performance feedback, etc.) has made strides in this direction, but a great deal of emphasis is still placed on generic issues such as satisfaction with pay, promotion, security, and trusting and supportive relations with supervisors and co-workers. This criticism is not meant to imply that "generic" features of the job and workplace are not salient to burnout phenomenon, but rather to highlight that the unique features of human service work and workers deserve greater attention in order to understand the higher prevalence of burnout. Recall that burnout is thought to evolve from unmediated or uncontrollable chronic work stress, but the stressors themselves, and in turn, the process of burnout may be qualitatively different in the human service environment. This difference has been identified in Miller’s comparative work on patterns of communication and 35 burnout across organizational roles (Miller, Birkholt, Scott & Stage, 1995; Miller, Ellis, Zook & Lyles, 1990; Miller, Zook and Ellis, 1989). This study seeks to redress this inattention by exploring two of these unique demands, role conflict and ambiguity of work outcomes in the burnout process. The Rple pf Communicagign in Bprnpp; Prgcesses While Cordes and Dougherty (1993) and Maslach and Jackson (1984), among others, emphasize the frequency and intensity of provider-recipient interactions as influential antecedents to burnout, the communication literature has not focused on provider-recipient interactions. Rather, communication researchers have attended to the role of supportive communication in the burnout process. The supportive communication literature is vast, explores a variety of contexts and can be characterized as pursuing two primary tracks; structural social support and functional social support. The separation of empirical work taking a communication perspective or focusing on communication variables, from the remainder of burnout research literature, is a convenient extraction for purposes of this study. Much of the job design and work environment literature discussed above addresses the influence of a supportive communication climate, and some of the literature to be discussed below explores psychological and organizational correlates of burnout. However, given the 36 size and diversity of the social support literature, this overview will rely on review articles by Cohen and Wills (1985) and Thoits (1995), as well as, selected communication articles which focus on either social support or the relationship of social support to burnout (assessed with the MBI). Sggial sppppr; as a gpping resourge. Social support has been conceptualized in sociological terms (i.e., network integration), psychological terms (i.e., a state of acceptance or support, perceived social support) and communication terms (i.e., supportive messages and interactions) (Burleson, Albrecht, Goldsmith & Sarason, 1994). The definitions of social support are numerous but most reflect social support as a psychosocial coping resource, or in the words of Thoits (1995) as, "a social ’fund’ from which people may draw when handling stressors" (p. 64). The communication literature has adopted the sociological or structural social support conceptualization, as well as, psychological and communication perspectives in the form of functional conceptualizations. While there is growing recognition of the need for research on supportive communication behaviors and interactions (Burleson et al., 1994; Hobfoll & Vaux, 1993), most of the organizational stress and burnout literature employs a structural or psychological functional conceptualization. 37 The topic of social support typically evokes a controversy over its relationship to stress and burnout. Both main effects and moderating or buffer effects have been found in the literature. Cohen & Wills’ (1985) review of social support literature found that social support from friends, family and co-workers can act as; (a) a buffer against adversely stressful events, and (b) an overall beneficial effect on psychological well-being. Support for the buffering hypothesis was evident where measures of social support were operationalized to assess the perception that available social resources were responsive the needs bought on by stressors, thereby implying a functional Operationalization. Conversely, evidence for the main effect of social support was found for social support measures with a structural Operationalization (e.g., an individual’s degree of network integration in a large community network). Unfortunately, only three articles in Cohen and Wills’ (1985) review considered organizational stressors, and most of the other studies utilized life events measures of stress. Thus, we cannot be confident that these relationships translate to the organizational context where the characteristics of demands and available resources may be considerably different. Further, Hobfoll and Vaux (1993) assert that the buffer and direct effect models have serious limitations and call for more complex models which, "address the fit of support to stressor— related needs, that examine the process by which support 38 influences the stress process, and that take context into account" (p. 696). Spppppp;§l_§pgial_§pppppp. Ray (1983; 1991) and Leiter and colleagues (Leiter, 1988; Leiter and Meechan, 1986) have explored the influence of network integration and network role structure in relationship to burnout. Unfortunately, Ray (1991) operationalized burnout using Kafry and Pines’ Tedium Scale, making comparisons to the multidimensional MBI measure difficult (in her earlier piece, Ray used the MBI, but found the MBI factor structure unsatisfactory, and computed a total MBI score). In regards to degree of network integration (frequency of total contacts across networks), Ray (1983) found no significant relationship to the total unidimensional MBI score. Leiter’s (1988) research indicates that a greater number of reciprocal links with co-workers in the work-related network predicted increased feelings of personal accomplishment and greater emotional exhaustion, whereas, the greater number of links with co-workers in the informal network was associated with increasing feelings of personal accomplishment. Similar findings for emotional exhaustion were identified in Leiter and Meechan’s (1986) study, wherein the more that an individual’s informal network was concentrated in the formal network, the greater emotional exhaustion and depersonalization the individual experienced. 39 Leiter (1988) concludes that co-worker interactions both aggravate and alleviate burnout. Taking into account Ray’s (1991) work on network structure and tedium (i.e., physical, mental and emotional exhaustion), one may interpret these structural support findings to indicate that biplex or multiplex networks may lead to emotional exhaustion because it can be stressful to maintain complex relationships, but the resulting support has benefits for the individual (i.e., personal accomplishment). The structural literature reviewed here supports Thoits’ (1995) conclusion that social integration is often found to have a direct positive effect, rather than a buffering effect, on mental and physical health. Epngpipnal social sppporp. The functional support literature will be addressed in terms of; (a) the influence of perceived general support from various organizational sources on the burnout process, and (b) the functions of different types of supportive communication behaviors in the process. As Thoits (1995) notes, "the effects of pgppgiyed social support have most frequently been examined in the literature, especially the effects of perceived emotional support" (p. 64, emphasis added). Miller and colleagues (Miller, Ellis, Zook & Lyles, 1990; Miller, Zook & Ellis, 1989) and Leiter (1991) have conducted some interesting work on the role of perceived social support in the burnout process. Leiter’s (1991) structural equation model of stressors, social support, 40 coping strategies and burnout identified direct causal links from co-worker support to depersonalization and diminished personal accomplishment, whereas Miller et al.’s (1990) caregiver model indicated no relationships between co-worker support, supervisor support and the dimensions of burnout. In Miller et al.’s (1990) study, participation in decision making (an indicator of communication climate) was found to have direct negative links to role stress and diminished personal accomplishment. Given a strong association between participation in decision making and supervisor support (Pearson’s r = .70), multicollinearity makes it difficult to disentangle the relationships between supervisor support, participation in decision making and the endogenous variables. Of course, neither of the above studies tested the buffering hypothesis given the constraints of structural equation modeling. Miller, Zook and Ellis’ (1989) correlational analysis of occupational differences in perceptions of communication, stress and burnout revealed significant associations between some sources of perceived social support and the burnout components for nurses. Specifically, they looked at associations between perceived support from supervisor, co- workers, and friends/family, as well as, participation in decision making and burnout. Only co-worker and supervisor support were significantly correlated with burnout: (a) co- worker support was negatively related to emotional exhaustion and depersonalization; and, (b) supervisor 41 support was negatively correlated with depersonalization and personal accomplishment. The supervisor support relationship with personal accomplishment was in the unexpected direction, as the negative correlation indicites that as nurses perceptions of supervisor support increase, their feelings of personal accomplishment decrease. Miller et al. (1989) suggest that perceptions of high supervisor support may indicate that the nurses are not performing as well as they could be. Employing multiple regression techniques, Russell, Altmaier and Van Velson (1987) examined the predictive utility of support from supervisor, co-workers, spouses, and friends/relatives on the burnout components for school- based educators. Only perceived supervisor support was significantly related to emotional exhaustion, depersonalization and diminished personal accomplishment. However, the interaction between supervisor support and stress significantly predicted depersonalization, thus providing evidence of a supervisor support buffering effect for depersonalization. While only the Russell et al. (1987) article explored the buffering hypothesis for perceived social support from various sources and provided little evidence of its presence, it would be irresponsible to conclude that the buffering hypothesis has not been substantiated by the perceived social support literature. However, in light of the findings presented here it can be argued that perceived 42 social support is a psychosocial measure which may reflect the communication climate of the organization, rather than specific supportive relationships. As such, perceived social support may function like a contextual state of support, thereby directly affecting the appraisal of demanding or threatening situations. Additionally, it is interesting to note that neither Miller et al. (1989) or Russell et al. (1987) found significant relationships between family/friend support and burnout, giving credence to Cohen’s (1992) assertion that the appropriateness of a source of support is contingent on the nature of the stressful event, its impact on the individual and the source’s relevance for the event. Thus, the important source distinction may not lie in differentiation of supervisors and co-workers, but rather in the source domain, work contacts versus nonwork contacts. Ray (1991) speaks to the importance of organizational relationships in explaining the role of social support in stress-reduction processes (p. 92): Because they understand the overt and subtle stresses in the workplace...organization members share common organizational referents that nonmembers do not, enabling a shared code and value system...As a result, these relationships can provide interactants with a vehicle for reducing stress by sharing perceptions with those who share the same interpretive context. The second stream of functional social support research explores the influences of supportive behaviors. Research on supportive behaviors examines the functions of various types of supportive behaviors in the burnout 43 process, in particular, the relative impact of various types of supportive behavior. House and Cottington’s (1986) typology of supportive behaviors (i.e., informational, instrumental and emotional) was used by Ellis and Miller (1994) in their study of co—worker supportive behaviors, burnout and intent to remain in sample of hospital nurses. Informational, instrumental and emotional co-worker behaviors were negatively associated with emotional exhaustion and depersonalization. Informational and emotional support were significantly negatively correlated with diminished personal accomplishment. Emotional support was also positively correlated with intention to remain and organizational commitment. Ellis and Miller (1994) conclude that emotional support (i.e., the expression of empathy, caring, and trust) is a critical type of co-worker communication. Metts, Geist and Gray (1994) explored the relationships between types of supportive behaviors, type of relationship and perceived support effectiveness with a random sample of nurses using Cutrona and Suhr’s (1992) Social Support Behavior Code. The Social Support Behavior Code subsumes House and Cottington’s typology and adds two additional types of support; esteem and network. Tangible aid (i.e., instrumental support) was the most frequently identified type of support received at work and also the most effective for dealing with work-related difficulties. Additionally, emotional support from work sources was more 44 effective than informational and esteem support, but not more effective than tangible aid. Network support was barely evident from both work and non-work sources. Emotional, esteem, tangible aid and additional characteristics of supportive relationships predicted support episode effectiveness from non-work sources. Metts, Geist and Gray (1994) conclude that "aggregate and global measures of social support availability and effectiveness may be misleading" (p. 244). Russell, Altmaier and Van Velzen’s (1987) study of types of social support and educator burnout found direct effects for assurance of worth (i.e., esteem, emotional support) for emotional exhaustion, depersonalization and diminished personal accomplishment. Assurance of worth and reliable alliance (i.e., general network support) interacted with job-related stress to predict depersonalization. The authors conclude that "acknowledgement of the teacher’s skills and abilities by supervisory personnel would appear to be an important component to include in programs designed to prevent teacher burnout" (p. 272). Given the diverse findings of these three supportive behavior studies, it is difficult to draw general conclusions about the influence of various types of supportive behaviors. Overall, emotional support appears to directly influence the burnout process, particularly the emotional exhaustion component. However, it should be noted 45 that the buffering hypothesis was only explored by Russell et al. (1987). Review end erieigee pf eeeiel egppor; lieerepure. In general, the research reviewed here leads to three descriptive conclusions: (a) both structural and functional operationalizations reveal social support to be a coping resource which can both aggravate and alleviate burnout; (b) perceived emotional support appears to have a significant influence in the burnout process; and, (c) social support from work sources appear to have a greater influence on burnout than social support from non-work sources. These conclusions are asserted cautiously given that the literature reviewed here may or may not be truly representative of the research on social support and burnout, as many of the articles are atheoretical and/or methodologically limited (small samples, non-representative samples), and not all used the MBI measure. Regardless, it is evident that contrary findings do exist and more research needs to be done to disentangle the findings, particularly in the area of supportive behaviors. Additionally, research examining supportive interactions with methods that contextualize the phenomena is needed (Burleson et al., 1994; Miller & Ray, 1994; Zimmerman & Applegate, 1994). Broadly, the communication literature on workplace burnout is lacking. The focus of this overview was on social support simply because the bulk of burnout studies 46 in communication have focused on perceived or received social support and network integration. As such, we have adopted the psychosocial construct in lieu of exploring the communicative actions of the individual facing chronic stress. As Thoits’ (1994) argues, individuals are often activists on their own behalf, engaging in behaviors to attempt to protect threats to their role-identities and self-esteem. Further, organizational communication scholars have adopted the interpersonally grounded conceptualization of supportive behaviors while virtually ignoring organizational communication behaviors. This study seeks to explore the organizational behaviors of human service workers in their attempts to cope with chronic stress in the workplace. Specifically, role modification, feedback seeking, reification of the meaningfulness of work, and social support seeking behaviors of CEO service providers are explored. geneervation of Resources Theopy of Stress Hobfoll’s (1989) initial conceptualization of conservation of resources (COR) theory was in response to a perceived lack of theory-based research on stress phenomena and the inadequacies of extant frameworks of stress. Hobfoll, Lilly, and Jackson (1992) describe COR as a "general theory of human motivation that is especially relevant to the process of coping with stress" (p. 125). COR postulates that individuals are motivated to gain resources, regardless of the current level of stress, in 47 order to protect themselves against potential future losses by creating sustained gain cycles (Hobfoll & Freedy, 1993). The basic tenet of COR is that individuals, "strive to retain, protect and build resources and that what is threatening to them is the potential or actual loss of these valued resources" (Hobfoll, 1989, p. 516). Therefore, Hobfoll (1989) defines psychological stress as, "a reaction to the environment in which there is (a) the threat of a net loss of resources, (b) the net loss of resources, or (c) a lack of resource gain following the investment of resources (p. 516). Further, stress is not just produced by the actual loss of resources, as a perceived loss or lack of gain is also proposed to be sufficient to induce stress. According to COR, resources are valued objects, personal characteristics, conditions or energies. Resources may be valued on their own merits or due to their utility in acquiring other resources. Object resources, such as a car, are valued because of a physical characteristic or a characteristic attributed to them on the basis of their extrinsic value. Self-esteem, low trait anxiety, and other personal dimensions are valued personal characteristic resources. Conditions, such as marriage, employment or tenure, are considered to be resources to the extent that they are desired and valued. Lastly, energies, such as time or knowledge, are valued for their ability to assist in acquiring other resources. Hobfoll (1989) asserts that while social relations may not fit into any single resource 48 category, "social relations are seen as a resource to the extent that they provide or facilitate the preservation of valued resources, but they can also detract from individuals’ resources" (p. 517). Resource loss is viewed to be important to people in that resources have instrumental value, and symbolic value tied to individuals’ identities. From the COR framework, Hobfoll (1989) draws two primary hypotheses. First, "when confronted with stress (i.e., a loss or lack of resources), individuals will strive to minimize net loss of resources" (p. 517). This situation requires the employment of other resource reserves or use of resources available from the environment to counteract loss. Other means of conservation may entail either reinterpreting the threat as an opportunity for change, or resources may be conserved by re-evaluating the value of the lost resource. However, Hobfoll (1989) cautions that, "although minor reappraisals may allow individuals to buffer the brunt of stressors, reappraisal of the more basic aspects of self and the environment are more likely to backfire against the individual...than they are to have stress-moderating effects" (p. 520). So, COR further predicts that given resource loss, individuals seek to replace resources, either directly, indirectly or symbolically. Individuals with few resources are particularly disadvantaged by potentially depleting small resource reserves when faced with real or perceived 49 resource loss, thereby entering a loss spiral. The second primary hypothesis states, "when not currently confronted with stress, individuals strive to develop resource surpluses in order to offset the possibility of future loss through investment" (p. 517). For example, energy resources (i.e., time and money) may be. invested in activities to increase conditional resources (i.e., tenure) to protect from future loss (i.e., unemployment). Investing resources to increase resource reserves is motivated by the desire to have reserve protection from future losses as well as contributing to positive well-being, or eu-stress. However, if the resource investment does not pay off, individuals will perceive a loss, in terms of a lack of the expected gain of the investment. COR has primarily been applied to traumatic or acute situational stress (i.e., natural disasters, war, birth delivery, and children’s illnesses). While support for COR is evident in these contexts (Freedy, Shaw, Jarell & tasters, 1992; Hobfoll & Lerman, 1989; Hobfoll & Leiberman, 1987; Hobfoll, Lomarz, Eyal, Bridges & Tzemach, 1989), the utility of the theory for explaining and predicting chronic stress phenomena in the form of burnout awaits empirical validation. In a recent conceptual piece, Hobfoll and Freedy (1993) delineate the application of COR to burnout phenomena. They assert that most stress theories do not account for perceptions of stress when a taxing stressor is 50 not readily apparent. Burnout is said to occur when "demands are made over time in a way that tax individuals without proper rewards or resources for addressing demands" (Hobfoll & Freedy, p. 116). COR postulates that individuals are more sensitive to loss than they are to gain, a sensitivity which is heightened during the experience of physical and psychological overload. Thus chronic stressors, which may be lower in intensity than many acute stressors, are never-the-less taxing on an individual, particularly in those individuals experiencing overload. COR further states that loss induces individuals to engage in coping more actively. However, coping involves the use of existing resources and can lead to resource depletion. So, for employees with weak resource reserves, chronic stress can lead to resource depletion, consequent increased vulnerability, and eventually lead to loss spirals evincing an employee’s inability to cope. In an earlier piece, Hobfoll (1989) postulated that those with weak reserves will engage in loss-control strategies which may be useful in the short run, but self-defeating in the long run. Conversely, employees with strong and diverse resource reserves are better able to cope with demands. Strong resource reserves allow some depletion without creating vulnerable conditions and diverse reserves may enable an employee to substitute one resource for another. For example, tenure in an organization may allow an employee to take additional vacation time to re-invest in 51 personal and social resources. Citing some substantiation from Leiter’s (1990) unpublished work, Hobfoll and Freedy (1993) assert that there exists, "a causal process whereby those possessing greater resources are not only less likely to experience burnout but are more likely to recover if they encounter burnout" (p. 126). In addition to Leiter’s (1990) work with COR and burnout, Lee and Ashforth (1996) applied COR post hoc as the theoretical framework for their MBI meta-analysis. Overall, they found some evidence supporting the COR framework. In regards to CORs primacy of loss corollary, five of the eight demand correlates examined were strongly associated with emotional exhaustion (i.e., correlations greater than or equal to .40) and only two of the eighteen resource correlates (e.g., community bond) were as strongly correlated, thus indicating that loss is more important than gain. Further, depersonalization was found to be strongly correlated with the demands of role stress, stressful events and the community bond resource. However, personal accomplishment was only strongly associated with one resource, that of work friend support. Aside from Leiter’s (1991) exploration of demands, resources, coping strategies and burnout, no other published study known to this researcher has applied and tested COR hypotheses apriori in application to burnout phenomena. The COR framework does not operate on hedonistic principles feeding into tit-for-tat exchanges, rather it 52 describes human cognition and behavior as purposive and strategic to the extent that resources are available to enact long-term conservation plans. The COR framework is attractive due to its ability to explain and predict responses to both chronic and acute stress. A test of the first primary COR hypothesis (i.e., conservation via replacement of resources when faced with loss and a lack of resource gain following an investment) will be explicated below in reference to the workplace demands of ambiguity of work outcomes and role conflict faced by CEO service providers. Explication of ghe Theoretical Model Using a COR framework, it is proposed that workplace demands of ambiguity of work outcomes and role conflict prompt the use of resource replacement strategies (i.e., role modification, feedback seeking, social support seeking, and reification of the meaningfulness of work) in order to counteract the effects of long-term resource loss (i.e., burnout). Personal resources, namely, tolerance for ambiguity and personal control are hypothesized to moderate the demand-replacement strategy process. See Figure 1 for depiction of the conceptual model. n ' i e n Ampigni;y_ef_yerk_pppepme§. Ambiguity of work outcomes is defined as a lack of situational clarity and factual information regarding client outcomes following provider— client service interactions. Based on Hackman and Oldham’s 53 (1975) theory underlying their Job Diagnostic Survey, knowledge of work results is identified as one of the three critical psychological states necessary for successful personal and work outcomes. Operationally, knowledge of results is contingent on feedback from the task itself and feedback from supervisors, co-workers and other stakeholders (Hackman & Oldham, 1975). Research has verified a link between knowledge of outcomes and burnout. Golembiewski and others utilizing their eight-phase model of burnout demonstrated that as knowledge of results decreased, emotional exhaustion, depersonalization and diminished personal accomplishment increased (Golembiewski and Munzenrider, 1988). Similarly, Maslach and Jackson (1979, as cited in Horst, 1986) report negative relationships between knowledge of work results and feedback from the task itself and the three dimensions of burnout, though the former relationship to diminished personal accomplishment is somewhat questionable. Here, ambiguity of work outcomes is framed as a conditional demand because insufficient clarity and inadequate information is not likely to be under a service provider’s volitional control or an organization’s control, but rather is an artifact of the nature of service provision in community-based organizations. More simply put, mechanisms may not exist to obtain the information needed clarify work outcomes, given provider-client relational boundaries variably defined in terms of timing, 54 frequency and duration of service interactions. Approximately thirty years ago, Locke, Cartledge and Koeppel asserted, "the facilitative effect of knowledge of results upon learning and performance is one of the best established findings in the research literature" (1968, p. 474). Given the presence of the Job Diagnostic Survey in job design and motivation literature today, knowledge of results is still considered to be a prime incentive for modern employees. However, knowledge of work results becomes murky in the human services, as tasks are often processual and the means-end relation in service provision lacks determination. CBO service providers face ambiguity daily, as they may be able to garner little feedback from or about clients (i.e., performance outcome ambiguity), and there is a always a question of whether or not perfect service performance will bring about desired outcomes (i.e., procedural outcome ambiguity). This ambiguity of work outcomes should motivate CBO service providers to engage in resource replacement strategies to provide the feedback and effectual reassurance needed. Role eonfliee. Role conflict is generally regarded as the degree of incongruence between various expectations for role behavior (Schuler, Aldag & Brief, 1977). This incongruence occurs when pressures from one or more sources (e.g., organizational policy, standardized procedures, supervisor, co-workers) make compliance to other pressures from other sources more difficult to obtain (Kahn, Wolfe, 55 Quinn, Snoek & Rosenthal, 1964). This conflict or inability to meet the expectations of members of one’s role set, creates stress for the employee striving to comply with these pressures. Research has shown that this type of role conflict is associated with emotional exhaustion (Beehr, King & King, 1990; Jackson, Schuler & Schwab, 1986; Leiter & Maslach, 1988; Starnaman & Miller, 1992) and depersonalization (Beehr, King & King, 1990; Starnaman & Miller, 1992). Lee and Ashforth’s (1996) meta-analysis indicates that significant associations have been shown between role conflict and emotional exhaustion and depersonalization across 11 studies. Leiter and Maslach (1988) argue that the role conflict stems from interpersonal disagreements about work procedures, multiple demands, and organizational policies or intra-individual sources, such as the focal person’s values, which are incongruent with competing pressures. This assertion reflects Kahn et al.’s multidimensional conceptualization of role conflict, however, common means of operationalizing role conflict (i.e., Rizzo, House and Lirtzman’s scale) do not adequately reflect the multidimensional nature of role conflict (see Table 1 for definitions of the types of role conflict). It is argued here that Rizzo, House and Lirtzman’s (1970) instrument focuses on inter-sender conflict as described in the proceeding paragraph. Close examination of the eight-item scale reveals (see Table 2) that (a) three items (#3, #5, 56 #6) tap into inter-sender role conflict; (b) two items purported to reflect intra-role conflict (#2, #7) may actually be reflecting overload (i.e., inadequate capacity); (c) two items reflect person-role conflict (#1, #8), (d) and one item likely taps into inter-role conflict (#4). Further, Smith, Tisak and Schmieder’s (1993) examination of the discriminant validity of the Rizzo et al. (1970) role conflict and ambiguity scales indicates that item number 8 loads on both the role conflict and ambiguity scales and has suspect reliability. Unlike other criticisms of the psychometric properties of Rizzo et al.’s (1970) role conflict scale (House, Schuler & Levanoni, 1983; Kelloway & Barling, 1990; McGee, Ferguson & Seers, 1989; Tracy & Johnson, 1981), the point of concern here is not the adequacy of it’s measurement qualities, as Smith et al., (1993) provide convincing evidence of it’s discriminant validity and reliability, but rather it’s construct validity is called to question. Instruments such as Rizzo et al’s (1970) and those operationalized in studies by Starnaman and Miller (1990), reflect inter-sender conflict more so than other types of role conflict. Conceptually, inter-sender conflict reflects tension in the employee’s work context, whereas, person- role conflict, and to some extent inter—role conflict, reflects tension within the employee. Kahn et al. (1964) conceptualized inter-role conflict as sent role conflict (conflict in the environment of the person), however, 57 tension between two personally valued roles (i.e., service provider and wife or service provider and community member) are more central to the individual’s identity, thus inter- role conflict may be within the person as he or she struggles with various role identities. At issue is the manner in which inter-role and person- role conflict influences burnout. An underlying assumption of role theory is that an individual has an occupational self-identity and is "motivated to behave in ways which affirm and enhance the valued attributes of that identity" (Kahn et al., 1964, p. 17). Thus, conditional demands in the form of person-role and inter-role conflict should motivate individuals to engage in resource replacement strategies. CBO service providers can experience role conflict due to tensions between work and community memberships (inter-role) or tensions between the completion of specific job tasks and a holistic orientation to assisting a human being (person-role). R l 'on ' b tween d m n n urce re lacement eegepegiee. Ambiguity of work outcomes and role conflict are conditional demands to the extent that knowledge of work outcomes and role consonance are desired and valued by service providers. According to COR, the lack of conditional resources is threatening and motivates individuals to reduce stress through either reappraisal or replacement to minimize net loss of resources. These two strategies are more widely known in the stress and coping 58 literature as appraisal-focused coping and problem-focused coping [see Latack & Havlovic (1992) for a review of job stress coping behaviors]. Appraisal-focused coping involves a re—evaluation of stressful situation, whereas problem- focused coping involves altering the stressful situation (Latack & Havlovic, 1992). A third coping strategy, emotion-focused coping, involves efforts to cope with negative emotions which concurrently arise from stressful situations (Latack & Havlovic, 1992). While subject to empirical verification, it is assumed that individuals value and desire intrinsic rewards of work, such as knowing in general that their efforts have resulted in positive outcomes and that the manner in which they enact their tasks or role is appropriate and reflective of their values and beliefs. As such, Hobfoll (1989) maintains that reappraisal is likely to be more stressful as it would necessitate re-evaluation or de- valuation of the role and of the self as an effective service provider, resulting in loss of personal characteristics resources, such as self-esteem or self— efficacy. Further, COR does not address emotion-focused coping strategies per se as the theory focuses on strategies which maintain, replace or bolster resources. For the convenience of conceptual congruence with the established coping literature, resource replacement strategies are problem-focused coping strategies in that they are directed at loci of resource loss and gain. So, a 59 problem-focused approach, such as resource replacement, is likely to be triggered by conditional demands. Thus, in order to conserve resources, CBO service providers experiencing these conditional demands will engage in replacement strategies to offset the loss. Hypothesis 1: Perceived ambiguity positively associated with the use replacement strategy. Hypothesis 2: Perceived ambiguity positively associated with the use replacement strategy. Hypothesis 3: Perceived ambiguity positively associated with the use of of of of of of work outcomes will be the role modification work outcomes will be the feedback seeking work outcomes will be the reification of the meaningfulness of work replacement strategy. Hypothesis 4: Perceived ambiguity of work outcomes will be positively associated with the use of the social support seeking replacement strategy. Hypothesis 5: Perceived role conflict will be positively associated with the use of the role modification replacement strategy. 60 Hypothesis 6: Perceived role conflict will be positively associated with the use of the feedback seeking replacement strategy. Hypothesis 7: Perceived role conflict will be positively associated with the use of the reification of the meaningfulness of work replacement strategy. Hypothesis 8: Perceived role conflict will be positively associated with the use of the social support seeking replacement strategy. Resppree Replecement Sereeegiee As discussed above, ambiguity of work outcomes and role conflict are conditions or artifacts of CEO service provision, so full replacement is not feasible if one remains in the same condition. Given these conditional demands, CBO service providers will be motivated to engage in replacement strategies which offset loss by enhancing energy and personal characteristics, thereby giving credence to their investment in their occupation and workplace. Stated another way, when CBO service providers’ resource investment is threatened by conditional demands, they will seek to minimize net loss by re—investing in the position through replacement or will experience high net loss (i.e., the experience of burnout). So, it is proposed here that use of resource replacement strategies will 61 mediate the relationships between conditional demands and the burnout dimensions. Thus, as attempts to replace resources increase, perceptions of the dimensions should decrease. Four replacement strategies which offer replacement potential are the communication strategies of role modification, feedback seeking, reification of meaningfulness of work and social support seeking. Each of the four strategies is elaborated on below. Role mpdificetion. Role modification is direct means of replacing conditional resources through negotiated re- structuring of the actual work role (Hall, 1972). Hall (1972) asserts that, "coping through structural role definition permits a person to change the external reality of role demands and make them more congruent with one’s own interests and goals. This strategy attempts to eliminate conflict where it originates-in the environment" (p. 475). For example, a CEO service provider could seek out alternate means of service provision or to limit role activities and attempt to negotiate role changes. Through modification of the work role (i.e., resource replacement), CBO service providers can likely reduce the demands of role conflict and ambiguity of work outcomes, thereby reducing the experience of burnout. Limited support for the effectual nature of role modification in reducing the demands of role conflict comes from an unpublished study of the insurance company 62 employees’ role negotiation abilities (Miller, Johnson, Hart, Peterson, Su & Zhao). The authors found role negotiation ability to directly and negatively influence role conflict demands. Hypothesis 9: Use of role modification will be negatively associated to the dimensions of burnout. Feedbaek eeeking. Feedback seeking is a relatively direct means of replacing conditional resource loss through active seeking of information regarding job performance from supervisors and co-workers. Herein the feedback sought includes referent information, which identifies appropriate behaviors to enact, and appraisal information regarding how well an individual is performing role behaviors (Ashford & Cummings, 1983). Feedback seeking behavior has been found to be motivated by uncertainty during newcomer socialization (Morrison, 1993a). And feedback from the task and feedback from others has consistently been found to be negatively related to role conflict, as operationalized by Rizzo et al. (Jackson & Schuler, 1985). Burnout research conducted by Eisenstat and Felner (1984) revealed that performance feedback from staff was significantly negatively related to emotional exhaustion. Through the use of feedback seeking replacement strategies, CBO service providers can decrease the experience of the dimensions of burnout. Socialization 63 research conducted by Morrison (1993b) indicates that newcomers target their feedback seeking behaviors differentially given the type of feedback desired. At issue is the effectiveness (i.e., resource replaceability) of the communication behavior and the target in diminishing the experience of burnout. This evokes exploration of whether the target of feedback seeking behavior will differentially influence the intensity of service provider burnout. Hypothesis 10: Use of feedback seeking will be negatively associated to the dimensions of burnout. Research Question 1: Will there be differences in strength of association between feedback sought from supervisors and feedback sought from co-workers? ' ' ' n f h meanin ln s f w r . Reification of the meaningfulness of work is a relatively indirect means of replacement through engaging others (i.e., organizational members, members of occupational/professional organizations, work friends, affected population members) in discussions of occupational values, goals, and progress as a means of enhancing occupational identification. Reification behaviors should enhance occupation (i.e., role-relevant) identification through identify-enhancing events (Thoits, 1991) or affiliation and discourse with members holding a similar 64 sense of community (i.e., membership, participation and identification) regarding the occupation (Klein & D’Aunno, 1986). Thus, CBO service providers may indirectly replace conditional demands by enhancing their identity with and commitment to the goals and values of HIV prevention. Limited empirical support for the efficacy of reification behaviors in reducing the intensity of the burnout experience is found in Beehr, King and King’s (1990) work. The authors’ study of registered nurses communication with their supervisors found positive communication with supervisors (i.e., reflections of the rewards of nursing, positive impact of the work, and positive aspects of the hospital) to be significantly negatively related to emotional exhaustion, depersonalization, and role conflict. Unfortunately, Beehr et al. (1990) did not measure diminished personal accomplishment. Reification of the meaningfulness of work strategies may be targeted to numerous others, those inside and outside of the organization with a similar identification, in this case, with the cause of HIV prevention. Given the similar identification amongst targets of reification attempts, it is unknown as to whether or not some targets of reification behaviors may be more influential than others in decreasing the felt intensity of burnout. 6S Hypothesis 11: Use of reification of the meaningfulness of work will be negatively associated to the dimensions of burnout. Research Question 2: Will there be differences in strength of association given locus of reification attempts? Soeiel eppper; eeeking. Social support seeking is a highly indirect means of replacing conditional resource loss by seeking supportive communication to increase personal characteristic resources, such as self-esteem and self—efficacy, from supervisors, co-workers, family and friends. As Hobfoll, Freedy, Lane and Geller (1990) note, "social support is the major vehicle by which individuals’ resources are widened outside the limited domain of resources that are contained in the self...[and] these personal and social resources are two integral aspects of people’s identities...Thus, people will strive to maintain social support both to protect their resources and in order to protect their identity" (p. 467). Specific to the organizational setting, characteristics of role, communication structure, communication climate, and organizational culture should influence which sources of support will be most salient and efficacious. As discussed earlier, work members may be more effective sources of support than non-work members due to their investment and understanding of the work context. 66 However, the incongruence within the social support source literature, as well as, the supportive behavior literature begs further exploration of the relationships between targets of social support seeking and burnout. Hypothesis 12: Use of social support seeking will be negatively associated to the dimensions of burnout. Research Question 3: Will there be differences in strength of association given target of social support seeking attempts? Influence pf Personal geseerees COR predicts that greater resources, personal or otherwise, have a positive effect on the stress process regardless of the level of stress. Further, under high stress conditions, individuals with greater resource reserves should engage in more positive coping (i.e., problem-focused coping) (Hobfoll, Lilly and Jackson, 1992). As Hobfoll and Vaux (1993) assert, "In general, it has been shown that those who possess strong personal resources have greater access to a supportive network and activate and utilize support from others more successfully than do those who lack these personal resources" (p. 690). In other words, CBO service providers with greater personal resource reserves are less susceptible to experiencing net loss and when faced with loss are in a better position to inhibit 67 loss or replace resources. Persgnal generol. Personal control is conceptualized as a sense of control in or influence over one’s work situation. The greater the sense a CEO service provider has that he or she can effect the work situation, the more direct the attempts will be to effect resource loss. Thus, relationships between the conditional demands and the use of resource replacement strategies will be moderated by individual perceptions of his or her control over the work environment and his or her position. Hypothesis 13: Individuals with high personal control will be more likely to engage in role modification and feedback seeking than reification of meaningfulness of work or social support seeking, given conditional demands. Hypothesis 14: Individuals with low personal control will be more likely to engage in reification of the meaningfulness of work and social support seeking than role modification and feedback seeking, given conditional demands. W Tolerance for ambiguity is defined as the degree of tolerance one has for a lack of feedback and situational clarity in the workplace. CBO service providers with a high tolerance for ambiguity are less likely to perceive ambiguity of work outcomes as a 68 demand or resource loss. Thus, the relationships between ambiguity of work outcomes and resource replacement strategies will be moderated by individual tolerance for ambiguity. Hypothesis 15: The strength of the relationships between ambiguity of work outcomes and the use of resource replacement strategies will be significantly weaker for individuals with a high tolerance for ambiguity. Reletive Effeepiveness pf Respdrce Replecement Strategies As Freedy and Hobfoll (1994) assert, "The COR stress model maintains that coping behavior effectively reduces psychological distress when such behavior results in the gain of deeded resources" (p. 323, emphasis added). In this case, resource replacement strategies which most effectively (i.e. directly or specifically) replace the lost resource will be most useful in minimizing net loss. This directness of replacement assertion reflects Cutrona’s idea of domain specific matching, in that the "nature of the loss is presumed to affect the nature of the required replacement" (Cohen, 1992, p. 113). So, CBO service providers will only be efficacious in replacing resources if there is a fit of the resource sought to the need imposed by the conditional demand (Hobfoll & Vaux, 1993). Thus, given the variability in the directness of replacement across the replacement strategies and 69 differences in needs elicited by the two conditional demands, certain strategies will be more efficacious in mediating the effects of certain conditional demands than others. Hypothesis 16: Role modification, feedback seeking and reification of the meaningfulness of work will be more efficacious in mediating the effect of ambiguity of work outcomes on the dimensions of burnout than will social support seeking. Hypothesis 17: Role modification and reification of the meaningfulness of work will be more efficacious in mediating the effect of role conflict on the dimensions of burnout than will feedback and social support seeking. 70 CHAPTER 3: METHODOLOGY This chapter outlines the methodology and procedures used in this study. First, the sampling procedures for the questionnaire respondents are discussed. Second, procedures for administering the questionnaire are presented. Then, the operationalization of the variables is addressed. Finally, the analyses used to examine the proposed hypotheses are discussed. Sample Selection Four comprehensive lists of community-based organizations providing HIV prevention services in four Midwestern states were obtained from the CDC National AIDS Clearinghouse. The four lists were collapsed into a master list of 365 organizations. For each organization, a one-to- two page description of organizational activities, affiliations, sponsoring organizations and target populations was provided by the CDC National AIDS Clearinghouse. A set of four selection criteria were then applied to the master list. Only those organizations which met the following criteria were retained in the sample: (a) operate independently from a larger organization; (b) are not under the control of any private or governmental funding source; (c) employ full-time staff who provide HIV prevention services on a regular basis; and, (d) provide primary HIV prevention services directly to clients. Based on the descriptions, 104 of the 365 organizations met these 71 criteria and were retained in the sample. Many of the 261 organizations that were excluded from the study focused on secondary HIV prevention, meaning care or support for HIV—positive individual who have not been diagnosed as having AIDS. These organizations offered care, housing, food or legal assistance to HIV-positive individuals. Organizations providing general hotlines, newsletters, research and technical assistance services, and volunteer—based organizations were similarly excluded given the above criteria for inclusion. The executive directors of the 104 community-based organizations were mailed a letter of introduction which specified the purpose of the study and a copy of the statement of confidentiality that was sent to service providers (See Appendix C). This letter requested participation in a brief telephone interview. Approximately one week after the anticipated receipt of the letter, executive directors were telephoned and asked to confirm organizational status as a CEO and to forward names of adult, full—time staff members who provide HIV prevention services directly to clients (See Appendix D). In instances where an alternate person was identified as having responsibility for HIV prevention staff, that individual was designated the spokesperson for the organization, in lieu of the executive director. A second sampling cut was conducted on the basis of the telephone interview. Forty-seven organizations were 72 disqualified for the following reasons: (a) 12 organizations were disqualified from further participation on the basis that they were not independent, non-profit community-based organizations; (b) 12 organizations were disqualified on the basis that they no longer provided primary HIV prevention services; (c) 16 organizations were disqualified because they had only part-time or volunteer prevention service providers; (d) 6 organizations were no longer in existence; and, (e) 1 organization refused to participate. An additional 11 organizations were disqualified because the researcher was unable to make contact with the executive director after four or more attempts. As such, a resultant sample of 46 organizations and 136 service providers was compiled. Questionnaire Procedpres The contact information obtained via the telephone interview was used to communicate with the service providers directly so as not to reveal their participation intentions to their executive directors. The identified service providers were mailed a questionnaire packet. This packet included a letter of introduction which specified the purpose of the study (See Appendix E), a statement of confidentiality, a questionnaire booklet and an addressed, postage-paid return envelope. Directions for self- administration were incorporated into the paper-and-pencil questionnaire booklet. 73 Approximately one week following the anticipated receipt of the questionnaire packet, service providers were sent a postcard reminder to complete and return the survey. This postcard reminder also served as a thank you for those who returned the survey. Approximately three weeks following the anticipated receipt of the original questionnaire packet, service providers were mailed a letter appealing for participation as well as a replacement survey and postage-paid return envelope. All correspondence with respondents was conducted via U.S. mail except for respondents who wished to directly contact the researcher via telephone. Operationalization of Variables As the majority of the hypotheses require assessment of service providers’ perceptions of their job-related beliefs, feelings, work environment and work relationships, self-report measures were derived to measure the variables. Ambiguity of Work Outcomes A nine-item measure was created to measure service providers’ perceptions of ambiguity regarding the outcomes of their work. The measure consists of two sub-scales, knowledge ambiguity and procedural ambiguity. The knowledge ambiguity sub-scale reflects a lack of factual knowledge and situational clarity about outcomes of service provision for the clients. The procedural ambiguity sub—scale taps into a lack of factual knowledge and situational clarity regarding the efficacy of the services provided. 74 Respondents answered using a five-point Likert scale ranging from "strongly disagree" to "strongly agree." W A nine-item measure was derived to measure service providers’ perceptions of conflict in enacting their work roles. This measure was driven by Kahn, Wolfe, Quinn and Snoek’s (1964) definitions of inter—role and person-role conflict. The measure contains two sub-scales, inter-role and person-role conflict. The inter-role sub—scale reflects conflict between allegiance to the CBC and other identifications, such as community members or the greater cause of HIV prevention. The person-role conflict sub-scale was created to measure tensions between performing mandated tasks and care for an individual in a holistic manner. One item on the person-role sub-scale, "I have to do things that I think should be done differently," was extracted from Rizzo, House and Lirtzman’s (1970) scale. Respondents answered using a five-point Likert scale ranging from "strongly disagree" to "strongly agree." Role Modification Built on the work of Hall (1972) and Ashford and Slat (1996), an eight-item, single-factor measure was created. The items indicate various behavioral approaches to role re-structuring enacted by service providers. For example, "Try to negotiate with your supervisor for a change in the amount of tasks you perform," reflects direct role re- structuring, whereas, "Seek to establish collaborative 7S relationships with other groups with HIV prevention interests," taps into changing societal role definition (Hall, 1972). Respondents will answer using a five-point metric ranging from "to a very little extent" to "to a very great extent." Mark—Seem The work of Ashford (Ashford, 1986; Ashford & Black, 1996) and Morrison (1993a) was drawn upon for the creation of this 14-item scale. Two sub-scales were derived to measure feedback seeking behavior, one referencing supervisor and one referencing co-workers. Each sub-scale contains items which reflect a direct inquiry approach (e.g., "Ask your supervisor for feedback on your effectiveness as a service provider") and items tapping into an observational strategy of obtaining feedback (e.g., "Watch which behaviors your co-workers are rewarded for"). Respondents answered using a five-point metric ranging from "to a very little extent" to "to a very great extent." Reification of the Meaningfulness of Work This 13-item scale was created on the basis of Cherniss and Krantz’s (1983) work on the features of ideological community identification. The measure was designed to reflect the extent to which service providers engage in discourse and seek affiliation with other individuals invested in the HIV prevention cause. Attempts at reification both inside the workplace (e.g., "Talk to your co—workers about the importance of HIV prevention 76 work") and outside the workplace (e.g., "Seek out others involved in HIV prevention to talk about the progress being made") are indicated by the scale. Internal organizational attempts are further specified in terms of referents, namely, supervisors and co-workers. Respondents answered using a five-point metric ranging from "to a very little extent" to "to a very great extent." Social Support Seekinq This 18-item scale was based on the seeking social support sub—scale embedded in Lazarus and Folkman’s (1984) Ways of Coping instrument. The items were modified for applicability to assessing social support seeking in the workplace. Further, the scale was designed to primarily assess emotional support seeking behaviors, as opposed to instrumental or informational support. Six of the items are directed at social support seeking from one’s supervisor, six items are directed at co-workers and the remaining six items are directed at family and friends. Respondents answered using a five-point metric ranging from "to a very little extent" to "to a very great extent." Burnout The three dimensions of burnout were measured using 21 of the 25 items in the Maslach Burnout Inventory (MBI) (Maslach & Jackson, 1981). Additionally, one item from the MBI was modified for current purposes and three other items were created, for a total of 25 items. The three sub-scales measure the extent to which service providers experience 77 the following dimensions; perceptions of emotional exhaustion, depersonalization of clients, and diminished personal accomplishment in their work. The MBI instrument has been widely used and validated in a number of contexts (Golembiewski & Munzenrider, 1988; Lee & Ashforth, 1996; Maslach & Jackson, 1981; Miller, Ellis, Zook and Lyles, 1990; Schaufeli, Enzmann & Girault, 1993). Respondents answered using a five-point metric ranging from "to a very little extent" to "to a very great extent," thus assessing intensity of burnout. Tolerance For Ambiguity Tolerance for ambiguity was measured by a five-item instrument derived from the work of Norton (1975) and Johnson, Bernhagen, Miller and Allen (1996). This scale was designed to measure an individual’s tolerance for a lack of feedback and situational clarity in the work setting. Three items were pulled from Norton’s (1975) job—related sub- scale of the Measure of Ambiguity Tolerance (MAT-50) and two items were pulled from Johnson et al.’s (1996) Need for Feedback scale. Respondents answered using a five-point Likert scale ranging from "strongly disagree" to "strongly agree." Personal Conprol A six-item measure of personal control was derived from the work of Ashford, Lee and Bobko (1989) and Greenberger (1982). Two items from Ashford et al.’s (1989) powerlessness scale were modified for the current context 78 (e.g., "I have enough influence in this organization to control events that might effect my job"). Two items based on Greenberger’s (1982) scale were similarly modified for inclusion (e.g., "I have little control over the policies used in this organization"). And two additional items were created based on Greenberger’s (1982) conceptualization of personal control. Respondents answered using a five-point Likert scale ranging from "strongly disagree" to "strongly agree." Characteristics of the Job A series of single-item, open-ended measures were created to assess organization, position, and occupation tenure, as well as various characteristics of service provision and time spent at work. The above characteristics were selected for inclusion due to their potential moderating effect on the hypothesized relationships. Demogrephic Information Lastly, a series of multiple choice questions were written to assess demographic characteristics of the respondents. Specifically, multiple choice questions were derived to measure gender, age, ethnicity, education level, socioeconomic status and HIV serostatus. The above demographic characteristics were included as they are indicative of personal resource availability which may influence the hypothesized relationships. 79 Analyses Here, the proposed statistical procedures for analyzing the nature of the variables and the hypothesized relationships between them are briefly addressed. First, all scales were assessed to determine their psychometric properties through a series of central tendency, variance, reliability estimation and factor analytic assessment techniques commonly used in social science research. SPSS For Windows (Version 6.0), Hamilton and Hunter’s (1988) PACKET 1.0, and Lanning and Miller’s (1993) Tests of Homogeneity and Heterogeneity software programs were used to assess psychometric properties of the scales. Next, Hypotheses 1-8, which propose positive associations between the conditional demands and the resource replacement strategies, were tested by computing a series of Pearson correlations. Hypotheses 9-12 were similarly tested to assess associations between the resource replacement strategies and the dimensions of burnout. Hypotheses 13-15, propose moderating effects of personal control and tolerance for ambiguity on the relationships between conditional demands an resource replacement strategies. The moderating influence of the personal resources were assessed using the regression moderator technique set forth by Baron and Kenny (1986), wherein the main effects are first entered in the regression equation, followed by the interaction to 80 determine the effect of the interaction while controlling for the main effects. Hypotheses 16 and 17, which propose substantive differences in the mediation effects of the resource replacement strategies between the conditional demands and two dimensions of burnout were initially assessed by computing regression models wherein all replacement strategies are entered into the regression equation in a single block. This technique extracts the variables relative to the amount of variance they account for in the dependent variable. In essence, the technique ranks the variables according to their predictive strength. This technique was also used to explore the inquiries set forth in Research Questions 1-3. Lastly, to test the mediation influence of resource replacement strategies on the dimensions of burnout (as proposed in Hypotheses 16 and 17), while taking into account the moderating influence of the personal resource variables, the combined mediated moderation technique described by Baron and Kenny (1986) was used. 81 CHAPTER 4: RESULTS This chapter reports the information regarding the study participants and characteristics of their positions, tenure and client contacts. Second, psychometric properties of the measurement instruments defined in Chapter 3 and preliminary analyses are reported. Third, the results of the hypothesized relationships are provided. Lastly, post hoc analyses reveal key relationships between the conditional demands, resource replacement strategies, personal resources, job characteristics and the dimensions of burnout. Participants Eighty-three surveys out of 136 were returned, representing CBO service providers from 46 organizations. One participant was disqualified because his/her job did not include a service provision element. As such the resultant sample of 82 participants out of 135 candidates yielded a satisfactory response rate of 60 percent. Descriptive items revealed that 57 percent (N = 47) of the respondents classified themselves as female, 34 percent (N = 34) as male, and 1 percent (N = 1) as transgender. Sixty-four percent (N = 52) of the respondents were between the ages of 25 and 44, with approximately 95 percent (N = 76) of the respondents falling in the range of 19 to 54 years of age. The sample of participants was ethnically diverse: thirty-nine percent (N = 32) identified as 82 White/Non-Hispanic; thirty-seven percent (N = 31) Black/African American; seventeen percent (N = 14) as Hispanic/Latino; four percent (N = 3) as Asian/Pacific Islander; and the remaining individual identified his or herself as Native American. The majority of the respondents had completed some college work (N = 78), with about 50 percent of the sample holding at least an undergraduate degree. The household income range for participants went from less than $20,000 to over $60,000, with fifty-four percent (N = 43) having household incomes of $30,000 or less. The final demographic item tapped into HIV serostatus, wherein 69 respondents (84%) reported being seronegative, eight reported being seropositive (10%), and four respondents were unaware of their status. Forty-five of the respondents (55%) were employed 1 non-supervisory positions and 31 in supervisory positions (38%), with the status of the remaining six percent of the respondents unknown. Respondents had been employed in their current CBO for an average of 2 years and 9 months (M = 32.9, sd = 30.0, N = 80) and in their present position an average of just under two years (M = 24.0 months, sd = 24.9, N = 78). The average number of hours worked during a typical week was 42 (M = 42.1, sd= 10.8, N = 80), with a range from four to 80 hours per week. They spent an average of 24 hours per week (M = 23.9, sd = 12.0, N = 75) in direct contact with clients, with a range from one to eighty hours per week. The number of clients they worked 83 with during a typical week ranged from one to 400 (M = 48.3, sd = 64.8, N = 71). The percentage of on-going client relationships, meaning that service providers met with the client three or more times, ranged from zero to 100 percent (M = 42.0, Sd = 35.2, N = 72). Psychometric Properties of Instruments Prior to instrument validation procedures, the data was visually explored to determine extent of missing information for the entire data set. There were 142 perceptual items and 82 cases, yielding a total of 3544 items. Six percent (225/3544) of the data were missing across the entire data set, which is considered to be low (Anderson, Basilevsky & Hum, 1983). A pairwise deletion technique was used in the instrument validation procedures and subsequent analyses. As stated in Chapter 3, all instruments were assessed to determine their psychometric properties through a series of reliability estimation and factor analytic assessment techniques. Confirmatory factor analysis tests (Hunter, 1980) were performed on the following instruments: Ambiguity of Work Outcomes, Role Conflict, Role Modification, Feedback Seeking, Reification of the Meaningfulness of Work, Social Support Seeking, Personal Control, Tolerance for Ambiguity, Emotional Exhaustion, Depersonalization, and Diminished Personal Accomplishment. The factor analytic technique entails assessment of face validity, item loadings, internal consistency, and 84 parallelism. Following numerous iterations the resulting scales demonstrated (a) face validity; (b) minimum primary factor loadings of .40, with few exceptions; (c) internal consistency, as less than 5% of the errors were significant (at p < .05); and (d) parallelism, given non-significant chi-squares showing no deviation from the hypothesized unidimensional model. It should be noted that internal consistency errors were carefully examined, particularly for instruments with few items. As such, interpretation of Lanning and Miller's internal consistency output considered size of error prior to deletion of items. The psychometric properties of the scales will be briefly addressed below. Five instruments yielded expected factor solutions with sufficient evidence of validity and reliability. Ambiguity of Work Outcomes yielded a seven-item solution (see Table 3 for items and loadings) with sufficient reliability (alpha = .79) and internal consistency (Chi- square(21) = 10.08). The five-item Role Conflict instrument was similarly internally consistent (Chi~square(10) = 3.04) with adequate reliability (alpha = .69) (See Table 4). Role Modification revealed a seven-item solution (See Table 5) with evidence of sufficient reliability (alpha = .76) and internal consistency (Chi-square(21) = 18.64). Personal Control yielded a reliable (alpha = .77) and internally consistent (Chi—square(15) = 10.54) six-item solution (See Table 6). Lastly, the four—item Tolerance for Ambiguity scale met the criteria for internal consistency 85 (Chi—square(6) = .94), but evinces suspect reliability (alpha = .64) (See Table 7). The analysis of three resource replacement strategies which incorporated various targets for behavior revealed distinct factor solutions given said targets. Thus, Feedback Seeking Behavior revealed two dimensions; Feedback Seeking-Supervisor (See Table 8) and Feedback Seeking- Coworker (See Table 9). Both scales demonstrate sufficient reliability (alpha for supervisor = .85; alpha for coworker .83) and internal consistency (Chi—square supervisor(lS) 4.22; Chi-square coworker(lO) = 1.34). A general Feedback Seeking scale was produced which met the factor analysis test criteria (See Table 10), but was discarded given its unsatisfactory face validity. Analysis of the Reification of Meaningfulness of Work instrument produced a three factor solution based on behavioral target; Supervisor, Coworker and External targets. The four—item Reification of Meaningfulness-Supervisor and Coworker scales (See Tables 11 and 12) both revealed sufficient reliability (alpha for supervisor = .84; alpha for coworker = .82) and internal consistency (Chi-square supervisor(6) = 2.11; Chi-square coworker(6) = .80). The three—item Reification of Meaningfulness-External (see Table 13) scale was just identified, found have few internal deviations, and an adequate reliability (alpha = .68). The Social Support Seeking instrument revealed three scales based on target of behavior, namely supervisor, coworkers and family/friends. 86 The Supervisor scale, composed of four items demonstrated sufficient reliability (alpha = .83) and internal consistency (Chi—square(6) = .83) (See Table 14). The Family/Friends scale revealed it’s four items to be reliable (alpha = .81) and consistent (Chi-square(6) = .81) (See Table 15). The three-item Coworker scale yielded a reliable solution (alpha = .82) and the just identified model indicated few discrepancies between observed and expected scores (See Table 16). The three expected dimensions of the Maslach Burnout Inventory (Maslach & Jackson, 1981) did not successfully come to fruition. Factor analytic techniques revealed the three dimensions, but with suspect characteristics. Emotional Exhaustion produced a satisfactory five-item solution of sufficient reliability (alpha = .85) and internal consistency (Chi-square(10) = 2.82) (See Table 17). The Depersonalization scale consists of two-items with a suspect reliability coefficient (alpha = .50) (See Table 18). A four-item Diminished Personal Accomplishment solution was produced, demonstrating internal consistency (Chi-square(6) = 1.18) but with suspect reliability (alpha = .62). (See Table 19). Preliminapy Apalysis Variables were computed on the basis of the confirmatory factor and reliability analyses, wherein missing data were replaced with the variable mean in instances where a minimum of 66 percent of the scale items 87 were available. Next, estimates of central tendency, kurtosis, skewness and frequency were computed to determine scale means and normal distribution (See Table 20 for variable means and standard deviations). As is evident in Table 20, the dimensions of burnout are skewed, indicating a restriction in range or responses. This restriction is particularly problematic for DEP and DPA, thus relationships with these two dimensions of burnout should be interpreted with caution. Next, Pearson correlations were computed which revealed low to moderate significant intercorrelations amongst behavior specific scales, for example SSS.S correlated moderately with SSS.C (r = .38, N = 80, p = .000). While these intercorrelations given common behavioral strategies were not surprising, the high intercorrelations amongst target specific items, for example SSS.S with FSB.S (r = .83, N = 81, p = .000), were unexpected. Suspecting second-order unidimensionality of the target specific resource replacement strategies, the confirmatory factor analytic techniques described above were employed. Results indicate that two second-order factor structures were operating, one for behavioral strategies which targeted supervisors and one which targeted coworkers. Thus, a composite measure of FSB.S, SSS.S and REIFY.S was created, namely supervisor directed behaviors (S-BEH; alpha = .91). Similarly, a composite measure (C-BEH) was created by averaging the FSB.C, SSS.C 88 and REIFY.C variables for coworker directed behavior (alpha = .87). All correlations with significance information are presented in Table 21. Tests of the Hypotheses Many of the hypotheses and research questions could not be tested, or tested as stated. This difficulty is due to the lack of unidimensional structure for the feedback seeking, social support seeking, and reification of the meaningfulness of work scales. In other words, the relationships proposed with these variables were untestable given the composite measures based on strategy target. Subsequent resource replacement strategy hypotheses were tested where applicable using the following five variables: ROLEMOD, S-BEH, C-BEH, REIFY. E, and SSS.F. Relationships Between Demands and Resource Replacement Strategies Hypotheses 1-4 proposed positive associations between ambiguity of work outcomes and the four resource replacement behavior strategies. Hypothesis 1 was not supported given a nonsignificant relationship between ambiguity of work outcomes and role modification. Hypothesis 2 could not be tested because a valid measure of feedback seeking behavior no longer existed. Hypothesis 3 was assessed by examining the correlation between ambiguity of work outcomes and external reification of the meaningfulness of work. A significant relationship exists, but in the unexpected direction (r = -.28, N = 78, p = 89 .006). Hypothesis 4 was not supported given a nonsignificant association between ambiguity of work outcomes and social support seeking with family and friends. Neither supervisor or coworker targeted behaviors were significantly related to ambiguity of work outcomes. Hypotheses 5—8 stated that there would be positive associations between perceived role conflict and the four resource replacement strategies. Hypothesis 5 was supported given a significant relationship between role conflict and role modification (r = .19, N = 79, p = .046). Hypothesis 6 could not be tested because a valid measure of feedback seeking behavior no longer existed. A positive relationship between external reification of the meaningfulness of work and role conflict provided support for Hypothesis 7 (r = .25, N = 79, p = .013). Role conflict was positively associated with social support seeking from family and friends (r = .37, N = 77, p = .001), thus providing support for Hypothesis 8. Lastly, supervisor targeted behaviors was significantly negatively associated with role conflict (r = -.24, N = 79, p = .015), whereas coworker directed behavior was unrelated to role conflict. Relationships Bepween Strategies and the Dimensions of Bernopp Hypotheses 9-12 proposed negative associations between the resource replacement strategies and the three dimensions of burnout. Additionally, Research Questions 1-3 queried as to whether there would be differences in 90 strength of these associations given target of behavioral strategy. The research questions could no longer be tested as stated due to invalid measures. Role modification was found to be positively associated with emotional exhaustion (r = .25, N = 79, p = .014), and unrelated to depersonalization and diminished personal accomplishment. Thus, there is one significant relationship to support Hypothesis 9, but it is in the unpredicted direction. Hypothesis 10 could not be tested because a valid measure of feedback seeking no longer existed. Hypothesis 11 predicted a negative relationship between reification of the meaningfulness of work and the three dimensions of burnout. This hypothesis was not supported as external reification strategies were unrelated to the burnout dimensions. The test of Hypothesis 12 revealed a positive association between social support seeking from friends and family and emotional exhaustion (r = .32, N = 79, p = .002), which was opposite of the direction posited. Lastly, coworker targeted behavior was found to be positively associated with emotional exhaustion (r = .23, N = 79, p = .022). Overall, there were no relationships, predicted or otherwise, between any resource replacement strategies and the burnout dimensions of depersonalization and diminished personal accomplishment. Further, all significant relationships between resource replacement strategies and emotional exhaustion were positive (i.e., unpredicted). 91 Influence of Personal Resources and Resource Replacement Strate Use Hypotheses 13 and 14 proposed that personal control would moderate the relationships between the conditional demands and resource replacement strategies. Specifically, individuals with high personal control would be more likely. to engage in role modification and feedback seeking given conditional demands (Hypothesis 13) and individuals with low personal control would be more likely to engage in reification of meaningfulness and social support seeking given role conflict and ambiguity of work outcomes (Hypothesis 14). Moderator regressions were computed to assess the interaction of personal control and ambiguity of work outcomes on the five existing resource replacement variables. There were no significant interactions for ambiguity of outcomes and personal control in relation to the resource replacement variables. However, personal control was found to moderate the relationship between role conflict and supervisor targeted behavior, given a significant interaction [F(3,74) = 4.85, p = .0039; Beta = .97, t(77) = 2.49, p = .015]. Thus, when faced with role conflict, individuals with low personal control are significantly less likely to engage in resource replacement strategies targeted to their supervisor than individuals with high personal control. Overall, Hypothesis 13 and 14 were not supported as stated. 92 Hypothesis 15 proposed that tolerance for ambiguity would moderate the relationships between ambiguity of work outcomes and the resource replacement strategies. Moderator regressions revealed no evidence of tolerance for ambiguity as a moderator, thus Hypothesis 15 was not supported. Relative Effectiveness of Resource Replacement Strategies Hypothesis 16 stated that role modification, feedback seeking, and reification of the meaningfulness of work would be more efficacious in mediating the effect of ambiguity of work outcomes on the dimensions of burnout than would social support seeking. As role modification, social support seeking from family and friends, and coworker targeted behavior were the only resource replacement strategies related to a burnout dimension (i.e., emotional exhaustion), their roles as mediators were assessed. Using mediator regression tests, none of the above were found to mediate the relationship between role conflict and emotional exhaustion. Thus Hypothesis 16 was not supported. Hypothesis 17 stated that role modification and reification of the meaningfulness of work would be more efficacious in mediating the effect of ambiguity of work outcomes on the dimensions of burnout than would feedback seeking and social support seeking. Hypothesis 17 was not tested given an absence of potentially supporting relationships. 93 Post Hoc Analyses While there was a lack of support for the hypothesized relationships, the statistical analyses indicated that there were some systematic relationships amongst the variables. Namely, resource replacement strategies, personal resources and job characteristics act as independent variables in the burnout process, and the conditional demands as the mediators in this process. Theoretical liberty was taken at this stage of analysis as the goal was to identify key variables and processes which may illuminate our understanding of the role of communication behaviors in the burnout experience. Exploration of Demographic, Personal and Job Characteristics First, demographic and job characteristics were examined to identify their potential influence in the process. Unfortunately, due to the nominal and unequal ordinal measurement of the demographic variables, analyses were extremely limited. Specifically, there were no differences for any of the aforementioned variables given gender of the service provider. Service providers in supervisory positions were less likely to seek social support for family and friends (supervisory M = 1.95, sd = .68, N = 31; non-supervisory M = 2.47, sd = 1.04, N = 44; t(72.72) = -2.61, p = .011), and reported feelings of greater personal control in the work environment (supervisory M = 3.62, sd = .74, N = 31; non-supervisory 94 M = 2.81, Sd = .72, N 44; t(72) = 4.75, p = .000). Further, service providers who reported being HIV-positive (N = 8) were more likely to engage in external reification attempts (HIV-positive M = 3.95, sd = .81; HIV-negative M = 3.11, Sd = .92, N = 69; t(75) = -2.49, p = .015) and supervisor targeted behaviors (HIV-positive M = 3.55, sd = .45), than those who reported being HIV-negative (HIV- negative M = 2.87, sd = .93; t(15.47) = -3.49, p = .003). The remaining demographic variables (e.g., age, income, ethnicity and education) were measured in uneven ordinals or nominally with small categorical representation, thus making any inferences suspect. Given the small representation of those in supervisory positions and those reporting HIV infection, these analyses were regarded as merely descriptive in nature. Two job characteristics, the percentage of on-going client relationships (ONGOING) and average number of hours worked per week (HRSWEEK), and one personal characteristic, tenure in human service work (TENURE) were examined in this exploratory phase. The percentage of on-going client relationships and months of tenure in human service work were selected given their pragmatic relationships to ambiguity of work outcomes. Both variables represent the resources of knowledge and experience gained either through tenure in the occupation and/or in specific client relationships. It follows that knowledge and experience resource reserves would lessen perceptions of ambiguity 95 regarding work outcomes. The average number of hours worked per week, an assessment of quantitative workload, was explored given its presence in the literature as an influential job demand. Specifically, Lee and Ashforth (1996) found workload to be significantly positively related to emotional exhaustion across six studies and to depersonalization across five studies. Exploratory Path Model Analyses Relationships between the conditional demands, resource replacement strategies, targeted communication behaviors, personal and job resources and burnout dimensions were explored via path model analyses using Hunter and Hamilton’s (1992) PATH.BAS software. All correlations, means and standard deviations used in the analyses are presented in Table 22. Beginning with a model based on the results of the hypothesis tests, the third iteration revealed a parsimonious model which best fit the data [chi-square (30, n 80) = 5.68, p < .001]. Figure 2 depicts the post hoc path model, wherein all path coefficients are significant (at p < .05). Multiple regression analyses indicate that the model accounts for a satisfactory amount of the variance in role conflict (R— squared = .33), emotional exhaustion (R-squared = .29), and ambiguity of work outcomes (R-squared = .28), but only a limited amount of the variance for depersonalization (R- squared = .05) and diminished personal accomplishment (R- .06). squared 96 CHAPTER 5: DISCUSSION Perhaps a case for the study of burnout need no longer be made; its prevalence and ravaging effects are globally documented (Golembiewski, Boudreau, Munzenrider & Luo, 1996). Fifteen years ago, it was estimated that stress- related outcomes cost organizations in the tens of billions of dollars each year (Wallis, 1983; as cited in Ray, 1991); one can only imagine the inflation of those expenses in the 1990s given the rise in health care costs. Negative physical, psychological, and behavioral manifestations and their associated consequences for individuals, their interpersonal relations, and organizations have been empirically verified. Approximately, 2500 books, journal articles, and dissertations were devoted to the topic during the period from 1974-1990 (Maslach & Schaufeli, 1993). Thus, it can be said that the academy has explored and the academy has learned. Concurrently, this plethora of activity has revealed conceptual, methodological, and empirical limitations and queries. This research sought to respond to one of these queries: To what extent and in which manner do human service workers’ use of normative organizational communication behaviors influence the experience of burnout. 97 Overview of Study Employing Hobfoll’s (1989) conservation of resources framework, it was proposed that human service workers experiencing chronic workplace demands who engage in communication behaviors, in an attempt to meet or replace said demands, will experience burnout less intensely. Specifically, it was hypothesized that: (a) role conflict and ambiguity of work outcomes (i.e., conditional demands) would be positively associated with the use of role modification, feedback seeking, reification of the meaningfulness of work, and social support seeking behaviors (i.e., communication resource replacement strategies); (b) use of communication resource replacement strategies would be negatively associated with emotional exhaustion, depersonalization, and diminished personal accomplishment (i.e., dimensions of burnout); (c) level of personal resources (i.e., personal control and tolerance for ambiguity) would intervene in the relationships between conditional demands and communication resource replacement strategies; and, (d) certain types of communication resource replacement strategies would be more efficacious in mediating the relationships between the conditional demands and the dimensions of burnout. Lastly, exploratory questions sought to identify differences given the target of communication resource replacement strategies. This research demonstrates several conceptual and methodological strengths. Conceptually, this study 98 integrates the stress, burnout, social support, and dyadic organizational communication literatures to explore the relationships between workplace stress, burnout, and normative organizational communication behavior. Extant supportive communication literature does not capture the mundane nature of employee communication behaviors enacted to clarify and/or modify task behaviors, results, and meaningfulness. For example, the organizational assimilation literature indicates that employees desiring to maintain organizational membership continually seek to individualize and clarify their roles and task behaviors through feedback seeking behaviors and, perhaps more dramatically, via role modification behaviors. Moreover, human service work entails interactions with external stakeholders, such as, clients, funding agencies, community groups, school districts, governmental entities, and other community-based organizations. To decontextualize these behaviors and frame them as different types of social support behaviors devalues, and likely misspecifies, their normative function in the workplace. Further, much of the social support literature has explored perceived or received social support, rather than casting the human service worker as an activist on his or her own behalf. Additionally, this study provided a direct test of the COR framework to a unique form of chronic stress, namely, workplace burnout. To date, only Leiter’s (1991) research has posited a COR framework to burnout phenomena a priori. 99 Thus, this current project furthers our knowledge of the applicability of COR to workplace burnout and perhaps other forms of chronic, low intensity stress. Third, in regards to conceptual contributions, this study sought to disentangle the common and complex role conflict variable. Assessments of role properties and their influences on organizational and communicative phenomenon are commonplace in the communication, managerial and psychological literature, yet the distinctiveness of various types of role conflict may be suppressed by typical operationalization which combines the various types and loci of this conflict. Specifically, person-role and inter- role conflict were assessed herein to capture role—identity stress that human service workers face, as opposed to assessments of intra-sender or inter-sender conflict which reflect diverse viewpoints within or between workgroups or employees. Methodologically, this field survey utilized sound sampling techniques to increase confidence in the generalizability of the results. A random sampling technique was used to gain insights into the understudied population of non-profit, non-governmental, community-based organization employees. The resultant sample is demographically diverse and is representative of full-time HIV prevention service providers employed by CBOs in four Midwestern states. However, given the geographic clustering and dispersion of HIV disease, one must consider the 100 prevalence estimates of HIV when making inferences from this population to another, as work demands may differ given the prevalence of the disease. Limitations of Study This exploration is bounded by the limitations of cross-sectional, survey methodology which was further constrained by a desire to be both parsimonious and concise so as not to overburden participants. Consequently, there are methodological and conceptual shortcomings herein which will be addressed below and which should be considered in future research designs. Thus, the results presented here should be interpreted in light of five primary limitations of this study, namely, (a) a cross-sectional view of a process, (b) suspect reliability of some instruments, (c) a lack of statistical power, (d) reliance on self-report measures, and (e) the potential influence of unspecified variables. The cross-sectional survey technique employed is limited in terms of fidelity, depth and breadth of assessing employee experiences and behaviors. The very definition of burnout as psychological and behavioral responses to chronic stress conveys the centrality of time in this phenomena. While the conditional demands of work are persistent, they no doubt vary in their intensity, and subsequently, individual responses likely covary. This snapshot of the burnout process highlights the importance of time and experience through the substantiation of tenure 101 in human service work and percentage of on—going client relationships as key variables influencing felt ambiguity of work outcomes and, in turn, perceptions of personal accomplishment. Thus, this study adds credence to characterization of burnout as a social-psychological process, however, it does not capture the dynamic flux of this process which could only be garnered by a longitudinal study. The instability of three of the scales utilized signal a cautious interpretation of the results, as this measurement error attenuates relationships among variables. Specifically, Tolerance for Ambiguity and two of the MBI dimensions, Depersonalization and Diminished Personal Accomplishment, yielded alpha coefficients of .65 or less. The Depersonalization scale is the most concerning, as factor analysis indicated only two items held together to reflect a common factor. Previous psychometric analysis of the MBI has produced equivocal findings, with most researchers concluding that Emotional Exhaustion is the defining dimension of burnout, and Depersonalization the least consistent in samples of human service workers (Schaufeli, Enzmann & Girault, 1993). Koeske and Koeske (1989) recognize the conceptual soundness of the MBI, but recommend an overhaul of the instrument, such that each dimension have an equal number of items and a balance of positively- and negatively—worded items. Strengthening the measurement of the above variables would provide a more 102 accurate depiction of the identified relationships. While the sample is representative of the defined population, the size of the sample limits the power of the statistical procedures and generalizability of the results. As significance tests are driven by the size of the effect and the size of the sample, a small sample coupled with some instruments of suspect reliability increases confidence in significant findings while decreasing confidence that all true relationships were revealed. Designing studies with access to larger samples will prove useful in confirming or redefining the results of this study. The survey methodology employed here used self-report measures, as opposed to observation of communication behaviors. As such, the data may reflect social desirability bias and be comprised by recall and reporting inaccuracies. Further, the sole use of survey methodology may have resulted in common method variance which would be expected to inflate relationships among the variables. Using different methodologies and triangulating appropriate measures would strengthen future studies. Lastly, as the focus of this study was on the service provider as a communication activist seeking to replace resources, numerous personal, task, and organizational correlates of burnout were not assessed. Further, the COR perspective adopted here focused on the use of communication strategies directed at problem-solving, to 103 the neglect of appraisal, emotion, and escape-focused strategies, as well as, other coping mechanisms under the control of the organization or supervisor. For example, weekly meetings which allow service providers to vent frustrations and receive support in lieu of a specific request would be an organizationally supported coping mechanism. Additionally, within the COR framework, there are other variables appropriate for inclusion in future research. More specifically, variables such as individual discomfort in seeking social support or the quality of the relationship with various targets of replacement strategies may intervene in the resource replacement process, as suggested in previous research by Hobfoll and Lerman (1988) and Metts, Geist and Gray (1994) and as addressed below. Overview of Results Eighty-two full-time HIV prevention service providers representing 46 community-based organizations in four Midwestern states were surveyed via a paper-and-pencil questionnaire distributed through the U.S. Postal Service. The respondents self-identified demographic and situational characteristics revealed a sample diverse in gender, age, ethnicity, educational background, socioeconomic status, and supervisory status. On average, they had been employed in some form of human service work for just over 4 years and in their current position for just under three years. The respondents spent an average of 24 hours per week in direct contact with clients, and worked with approximately 104 fifty clients during a typical 42-hour work week. Results revealed that communication resource replacement strategies were distinctive on the basis of the target of communication, rather than the type of communication behavior, thereby yielding many untestable hypotheses based on type of communication resource replacement strategy. Depersonalization was predicted by the level of emotional exhaustion. Emotional exhaustion was strongly predicted by level of role conflict and less so by individual tolerance for ambiguity and communication behaviors targeted to coworkers. Diminished personal accomplishment was predicted by ambiguity of work outcomes. Role conflict and ambiguity of work outcomes were predicted by a variety of individual and situational characteristics, as well as, external communication behaviors. Pertinent to the scholar here is the causal ordering of the variables, wherein the conditional demands did not prompt the use of resource replacement strategies, rather they directly influenced the experience of emotional exhaustion and diminished personal accomplishment. These results are addressed in greater detail below. Discussion of Key Findings The body of literature on burnout portrays a pessimistic view of human service work given its focus by definition on those employees who are "burnt out," and experiencing it’s harmful physical, emotional and behavioral effects. This focus is expected given the desire 105 to learn from this phenomena in order to prevent it’s occurrence and promote healthier work experiences. Fortunately, the findings of this study depict a population of CEO HIV prevention service providers who are not "burnt out" and identify individual, organizational and task resources which are fruitful in diminishing the experience and influence of conditional demands and burnout. This section shall proceed by addressing key findings and elaborating on predictors of the dimensions of burnout. Burnout Intensity Unexpectedly, burnout was not prevalent in this population, as mean scores on the three dimensions were skewed well below the scale means. Examination of the means and standard deviations of the three dimensions laid against the scale metric, shows the majority of the respondents perceived depersonalization between "to a very little extent" and "to a little extent," and both diminished personal accomplishment and emotional exhaustion between "to a very little extent" and "to some extent." These findings can be interpreted to mean that HIV prevention service providers experienced little to no sense of depersonalization and little to modest feelings of diminished personal accomplishment and emotional exhaustion. However, interpretation of these findings in comparison to other studies becomes murky. While diagnostic criteria for burnout has yet to be established, the general heuristic applied is a third-split, wherein the individuals 106 in the top third of the overall dimension scores are characterized as "burnt out" (Schaufeli, Enzmann & Girault, 1993). However, adopting this heuristic for interpretation of these results seems inappropriate given the low incidence and minimal variance in responses. Further, this approach has been criticized as a critical burnout point (i.e., the intensity or frequency experienced that precipitates negative consequences) has yet to be clinically established (Schaufeli, Enzmann & Girault, 1993). Further comparison to other burnout studies (randomly selected) reveals that this low incidence may reflect the norm, given low to midpoint means and normal variance. For example, Koeske and Kelly (1995) report a mean intensity score of 2.57 for emotional exhaustion on a 5-point (1-5) scale for a sample of 107 social workers. Schulz, Greenley and Brown (1995) report a mean frequency score.of 2.2 for emotional exhaustion on a 7-point (0-6) scale for a sample of 311 service providers in community mental health facilities. Beehr, King and King’s (1990) study of 225 nurses report a mean frequency score of 2.2 for emotional exhaustion and 1.25 for depersonalization on 7-point (0-6) scale. Similarly, Miller et al. (1990) report intensity means for emotional exhaustion, personal accomplishment (reflected), and depersonalization which are well below the scale means for a sample of over 200 caregivers at a private psychiatric hospital. 107 Comprehensive comparison to the burnout literature reviewed in this study is not possible given differences in computation, a lack of information regarding scaling procedures or the absence of univariate analysis reporting. As such, the conclusion that this sample is not "burnt out" is based on the low incidence and restriction in range of responses reported by this sample. Based on previous work looking at attitudinal and behavioral outcomes, one might also surmise that those employees who experienced the burnout dimensions more intensely have exited the organization and thus are not included in this sample. Lack of Support for COR Hypotheses The hypotheses driven by the COR framework were generally unsupported. Many of the hypotheses framed around the various types of communication resource replacement strategies were untestable given the second-order factor structure of the responses based on strategy target. The relevance of the second-order unidimensionality finding will be addressed in greater detail below. Where appropriate, the composite measures of coworker targeted and supervisor targeted behaviors were substituted in the tests of the hypotheses. In the final analysis, only three of the original hypotheses were supported, identifying positive associations between role conflict and the resource replacement strategies of role modification, reification behaviors with external stakeholders, and social support seeking with family and friends. As such, 108 the general COR framework which posited that conditional demands would prompt the use of communication resource replacement strategies contingent on personal resources, which in turn, would lessen the intensity of perceptions of burnout, was not supported by the data. Post hoc analysis revealed that resource replacement strategies, personal resources and task characteristics ac: as independent variables in the process of burnout and the conditional demands as intervening variables in this process. Retrospectively, it logically follows that low intensity, chronic stress would not prompt the stimulus- response reaction predicted by COR. Theoretically, COR makes time-bound predictions based on the onset of acute or traumatic demands which do not clearly transfer to burnout phenomena. The difference may be as simple as reaction versus adaptation, where the mystery lies in the identification of the critical point where adaptation is no longer feasible and exhaustion ensues. To frame it another way, stress in a burnout framework is normative, thus the process of adaptation to chronic stress may not be distinct from mundane communication and task behaviors until some limitation or critical point is reached. From this perspective, chronic, unmediated stress is a natural part human service work and its presence does not act as the strong catalyst for resource replacement that COR predicts. 109 Influence of strategy target. The strong intercorrelations between the resource replacement strategies based on the target of communication behavior was both unexpected and interesting. Hypotheses based on the variable directness of the resource replacement could not be tested as stated. However, the finding that feedback seeking, reification of the meaningfulness of work, and social support seeking collapsed into factors based on who the behavior was targeted to greatly contributes to the lessons learned in this work. It had been expected that there would be moderate associations between types of behavior, for example, that some individuals may be more disposed to seeking social support and would do so from different communication targets. However, the second—order factor structure indicates that an employee chose to engage in resource replacement strategies based on target, thus the choice focused on the target, more so than the type of behavior itself. For instance, if an employee is likely to seek feedback from his or her supervisor, then he or she is also likely to seek social support and engage in reification communication with his or her supervisor. This finding suggests that the focus of communication resource replacement strategies should be extended to include the relationship between the service provider and the target, rather than solely focused on the service provider’s choice of communication behavior. As seeking resources can be socially costly, it follows that employees 110 would be predisposed to seek resources from targets with whom they have open, trusting, and supportive relationships. This is not to advocate that the personal relationship should take precedence over the organizational role relationship, as supervisors and coworkers clearly have access to different resources in this context, but the quality of the personal relationship with the target needs to recognized and explored for its influence on resource replacement behaviors. In striving to frame this work in an organizational context, the relational level was admittedly, and unfortunately, overlooked. Examination of the correlations between supervisor and coworker targeted behaviors and the other variables of interest provides insight into the differential resources these behaviors provide. For example, supervisor targeted behavior was negatively associated with role conflict and positively associated with perceptions of personal control, whereas coworker targeted behavior was unrelated to either. Further, coworker targeted behavior was positively associated with emotional exhaustion. As personal control was a key predictor of role conflict and role conflict was a key predictor of emotional exhaustion, those employees engaging in supervisor targeted behaviors may have a distinct advantage in reducing the experience of role conflict and burnout. As a caveat, the latter assertion requires further empirical exploration as a significant interaction effect for personal control on the relationship 111 between role conflict and supervisor targeted behavior suggests a complex relationship involving individual, relational and contextual influences. However, one can infer from these findings and previous research on social support, that the quality of relationships with supervisors and coworkers is a critical element in an employee’s decision to and ability to mobilize needed resources. Predictors of Burnout The question driving this study was: To what extent and in which manner do human service workers’ use of normative organizational communication behaviors influence the experience of emotional exhaustion, depersonalization and diminished personal accomplishment? The findings reveal that communication behaviors do influence the three dimensions of burnout in a complex array of relationships between task characteristics, personal resources, and conditional work demands. The key predictors of the dimensions of burnout revealed by causal modeling are addressed per dimension below. Emotional exhaustion. Emotional exhaustion is the core dimension of burnout, characterized by feelings of fatigue and being mentally and emotionally depleted. Emotional exhaustion was directly predicted by individual tolerance for ambiguity, coworker targeted behavior, and most strongly by the conditional demand of role conflict. The relationship between role conflict and emotional exhaustion is well established in the literature and is, in fact, one 112 of the most consistent predictors of emotional exhaustion (Cordes & Dougherty, 1993; Lee & Ashforth, 1996). However, it should be reinforced that this study measured person— role and inter-role conflict, thus reflecting role-identity conflict and opposed to conflict within the individual’s environment or role set. As such, this findings adds credence to Thoits’ (1991) assertion that identity-relevant stressors are powerful predictors of psychological distress. Role conflict, in turn, was most intensely experienced by CEO service providers with lower perceptions of personal control and those who engage in more extensive reification behaviors with external stakeholders. So, service providers who perceive that they are not influential in their organizations and who seek resources from extra- organizational individuals may exacerbate perceptions of role conflict by highlighting role distinctions. To elaborate, personal control reflects an employee’s assessment of his or her influence over organizational policies, procedures and the nature of service provision. As such, role conflict is the manifestation or felt tension that ensues when an employee feels ineffectual in the ability to bring about changes that are more aligned with his or her role-identity. For example, a service provider who perceives his or her role as a "helper" to assist the client in any means possible, but has no sense of control over designing service procedures to meet additional client 113 needs, is more likely to experience conflict. Similarly, feelings of role conflict will be more salient for service providers who engage external stakeholders in discussions of the values, goals and progress of HIV prevention work, wherein those discussions reveal diverse viewpoints or limitations regarding HIV prevention work and progress. The more extensively service providers engaged in coworker targeted resource replacement strategies, the more intensely they experienced emotional exhaustion. In line with previous research on structural social support (Leiter, 1988; Leiter & Meechan, 1986; Ray, 1991), complex relationships (i.e., those which reflect job, social and/or innovation content) with co-workers may lead to emotional exhaustion because these relationships can be stressful to maintain. La Gaipa’s (1990) theorizing about negative consequences of informal support systems (e.g., friendships) frames support in terms of dialectic tensions, specifically autonomy versus dependence. In any social relationship there is a tension between autonomy and dependence. In this instance, coworkers enmeshed with each other in the provision of social resources may experience a lack of autonomy (e.g., resulting in feeling obligated or resentful) and a sense of dependence (e.g., resulting in helplessness, increased need for social resources) which can be taxing (La Gaipa, 1990). This tension will be heightened in cases where the informal (e.g., friend in social network) and formal (e.g., coworker in job network) 114 networks overlap. Additionally, this may be confounded by limitations on peers to accessing resources which may assist in the alleviation of role conflict or emotional exhaustion, as discussed above. CBO service providers with a higher tolerance for ambiguity experienced emotional exhaustion less intensely. Tolerance for ambiguity is an assessment of an individual’s need for feedback and situational clarity in the workplace, and is assumed to be a fairly stable personal resource. As such, it was hypothesized to moderate the relationships between ambiguity of work outcomes and resource replacement strategies. Interestingly, tolerance for ambiguity neither interacted with nor had a direct effect on the conditional demand of ambiguity of work outcomes. This finding may be due to differences in specificity of the constructs. Tolerance for Ambiguity reflects global job-related uncertainty, whereas Ambiguity of Work Outcomes focuses more specifically on ambiguity related to service provision (i.e., service procedures and outcomes). Conception of tolerance for ambiguity as a stable trait reflecting the capacity of an individual to deal with job-related uncertainty with little to no adverse effect does align with COR predictions in relation to emotional exhaustion. COR asserts that individuals with stronger resource reserves are less likely to be as affected by demands, and when faced with demands are more likely to recover or reduce net loss. In this instance, CBO service 115 providers with a higher tolerance for ambiguity likely experience less job-related uncertainty and are more resilient to demands, resulting in less exhaustion. Depersonalization. Depersonalization refers to a dehumanization of clients to the point of treating them as objects. Intensity of depersonalization was predicted by the intensity of emotional exhaustion. This finding implies that as CEO service providers’ emotional energies depleted, they were more likely to detach themselves from their clients, psychologically distancing themselves from their clients and treating them more impersonally or less conscientiously. In point, service providers had fewer resources to share with their clients. Previous research has found intensity of emotional exhaustion to be significantly positively correlated with intensity of depersonalization (Lee & Ashforth, 1996), thus providing precedence for the significant, but weak, relationship found here. The causal ordering indicates that chronic stress leads to intra-personal consequences (i.e., emotional exhaustion), then to interpersonal consequences (i.e., depersonalization), as would be expected given knowledge of the stress process, and the centrality of emotional exhaustion in burnout phenomena (Maslach, 1993). However, in this study, measurement of depersonalization may not fully capture the depersonalization construct and the resultant two-item scale reliability is merely a correlation between said items. Thus, while the results are 116 in alignment with previous research and theorizing, these findings should be viewed with caution. Diminished personal accomplishment. Diminished personal accomplishment reflects a negative assessment of oneself and one’s performance. Diminished personal accomplishment was predicted by the extent of ambiguity of work outcomes, which, in turn, was predicted by reification of the meaningfulness of work behaviors with external stakeholders, tenure in the field of human service, and percentage of on-going relationships with clients. Ambiguity of work outcomes reflects a lack of situational clarity and factual information regarding client outcomes from service interactions, both in terms of procedural outcomes (i.e., whether or not service procedures produce desired outcomes) and performance outcomes (i.e., the actual outcomes for clients). Ambiguity of work outcomes was framed as a conditional demand as the nature of human service work in CBOs may provide few venues for receiving feedback and obtaining knowledge regarding work outcomes, and thus is a constant feature of the work environment. Continual ambiguity and lack of feedback on work outcomes produces the perception of being less effectual than desired or previously believed to be. Hackman and Oldham (1975) identify knowledge of work results as one of the three psychological states necessary for successful outcomes for both the employee and the organization, and it is a necessary component for setting and achieving 117 performance goals (Locke, Cartledge & Koeppel, 1968). As such, CBO service providers experiencing ambiguity do not receive adequate information to reinforce their sense of efficacy or modify their service behaviors in an attempt to provide more effective service (Cusella, 1980). This lack of information likely leads to a reduction in self— assessments of competence and self-determination and can lead to an actual decrease in the quality of service provision (Cusella, 1990; Hackman & Oldham, 1975). While the above discussion is framed in negative terms to highlight the salience of ambiguity of work outcomes for employees and organizations, this study identified three means by which CBO service providers garner information and feedback to enhance knowledge of work outcomes, namely via occupational and client experience and communication behaviors. CBO service providers with longer tenure in human service work experienced less ambiguity regarding procedural and performance outcomes. Simply put, with time comes the resource of experience. As an individual’s professional expertise increases, the fewer procedural and performance cues they may need to evaluate work outcome: In addition to requiring fewer cues to make judgements this finding likely reveals an acceptance of a lack of direct feedback and hard indicants of outcomes, and a recognition that social change is slow and cumulative. Client experience in the form of individual provider- client relationships can provide pertinent information to 118 reduce ambiguity. The extent to which feedback from the client is available is dependent on the credibility and intimacy of the relationship. Thus, the task characteristic of on-going relationships (i.e., relationships in which the provider and client meet three or more times), provides additional time necessary to develop trust and intimacy for an open exchange of information. Relational development is critical for this type of service work, as human service work revolves around sensitive, and potentially stigmatizing issues, particularly in reference to HIV prevention where issues of sexual orientation and behaviors are pertinent. Designing tasks such that service interactions occur at multiple points in time is mutually beneficial. Multiple service interactions have been documented to contribute to HIV prevention service effectiveness, thus benefitting the client. Concomitantly, the service provider receives more information and feedback to tailor assistance to the needs of the client (i.e., procedural feedback) and garner information regarding client outcomes (i.e., performance feedback), thereby lessening ambiguity of work outcomes. Engaging in discussions which reinforce the meaningfulness of work is a means of increasing occupational identification and the sense that one is making a contribution to society. CBO service providers who engage in reification behaviors with extra-organizational stakeholders can gather information about the efficacy and 119 progress of HIV prevention efforts on a community or societal level. External reification behaviors appear to be an indirect means of replacing the conditional demand of ambiguity of work outcomes, as evidenced by the significant negative association between the two. Conversely, these discussions with outside HIV prevention service providers and infected and affected individuals contributes to providers sense of role conflict. It is plausible that while these discussions celebrate HIV prevention accomplishments and goals on a societal level, they may also highlight ineffectiveness and inadequacies in service provision and results on a local level, thus exacerbating inter-role and person-role conflict within individual service providers. Relationships amongst dimensions of burnout. Diminished personal accomplishment has been theorized by Leiter (1993) to develop in parallel with emotional exhaustion and depersonalization developing in sequence. Leiter (1993) argues that demands in the work environment lead to emotional exhaustion, which leads to feelings of depersonalization, whereas, resources contribute to feelings of personal accomplishment (conversely, a lack of resources contribute to feelings of diminished personal accomplishment). This general causal pattern of the burnout dimensions is clearly supported by the results of this study. Specifically, diminished personal accomplishment developed in parallel to the emotional exhaustion- 120 depersonalization component of burnout. W The results of the post hoc analyses substantiate many previous findings in the burnout literature, namely, (a) individuals with greater personal resources are more resilient when faced with demands and less susceptible to burnout, (b) role conflict is an influential demand which leads to emotional exhaustion, (c) emotional exhaustion is at the core of burnout phenomena, and (d) a lack of knowledge regarding work outcomes reduces one’s sense of personal accomplishment. Concurrently, this work makes some unique theoretical and pragmatic contributions to the literature. Five of these key lessons are detailed below. Burnout processes reflect unsuccessful adaptation, not reaction. COR principles may have been too strictly applied to the study of burnout. As Hobfoll (1989) conceptualized COR in light of reactions to traumatic and acute stress, it is not surprising that demands do not elicit replacement responses given the lower intensity of chronic stress associated with burnout. In the case of work burnout, many "replacement" strategies may be enacted on fairly regular basis in response to general organizational and job uncertainty, thus the time-ordered predictions that COR makes are not appropriately applied to burnout. Alternatively, individuals may engage in "replacement" behaviors based on other motivations, such as seeking feedback to manage impressions with supervisors or engaging 121 in reification behaviors with other HIV prevention service providers as a means to develop collaborative relationships. Resource replacement behaviors are normative behaviors that employees engage in during the course of adapting to or coping with typical work life. This is not to assert that these are ineffectual in coping with conditional demands, rather, the point is they are normative, not responsive in relation to persistent, low intensity demands. Communication behaviors can both attenuate and exacerbate conditional demands. Reification of the meaningfulness of work behaviors with extra-organizational individuals predicted greater role conflict and lessor ambiguity of work outcomes. Service providers who engaged in discussions of the progress, goals and values of HIV prevention work with external stakeholders developed a clearer picture of the nature and effectiveness of HIV prevention work while experiencing a greater amount of role-identity conflict. Reification behaviors with external stakeholders may reinforce identification with the cause of HIV prevention, while creating a tension between devotion to assisting others in the name of the cause and the specific requirements of their job. Relationship quality needs to be examined in conjunction‘with relationship type to predict communication behavior. Target of communication behavior was more influential in predicting service providers communication 122 behaviors than was type of communication resource replacement strategy. The overriding influence of target masked any differences in choice based on directness of replacement in relation to the other variables of consideration. Based on these findings and previous research it is assumed that the quality of relationship with the target (i.e., degree of trust, openness and supportiveness) contributed to service providers communication choices. Given supervisors and coworkers differential access to resources, service providers relationships with these targets can have a significant influence on the efficacy of their communication behaviors in coping with conditional demands. This difference in efficacy is substantiated by the finding that greater coworker targeted behavior lead to greater emotional exhaustion. This suggests that human service workers who have high quality relationships with their supervisors have greater access to and are more likely to access needed resources to cope with conditional demands. A sense of personal control in one’s organization and regarding one’s role reduces role-identity conflict. In absence of other predictors, personal control accounted for 26 percent of the variance in role conflict, which, in turn, accounted for 18 percent of the variance in emotional exhaustion. Service providers who perceive they are influential in affecting policies and work procedures in their CBOs experience less conflict between their personal 123 role expectations and the role expectations of their CEO and other groups with which they identify. Pragmatically, enhancing service providers’ sense of personal control is an effective means of reducing role conflict and consequently, emotional exhaustion— depersonalization. As research by Greenberger, Strasser, Cummings and Dunham (1989) found sense of personal control to predict both job satisfaction and performance in nursing services employees, it appears that bolstering service providers’ sense of personal control leads to positive individual and organizational outcomes. Adopting a managerial style which allows for greater employee latitude in decision making, such as participative management, is one way in which CBOs can attempt to enhance employees’ sense of personal control. Task design conducive to building provider-client relationships is an effective means to reduce ambiguity regarding work outcomes. Designing service provision interactions such that the provider-client relationship has the opportunity to develop over time is an effective means of reducing service providers’ ambiguity about work outcomes. Percentage of on-going client relationships (i.e., those that meet three or more times) accounted for 14 percent of the variance in ambiguity of work outcomes in this study. Service provision designed to be delivered over time allows for a greater exchange of information, the development of trust and openness in the relationship, and 124 creates greater opportunities for direct feedback regarding service procedures and outcomes. Additionally, feedback from the task itself (i.e., service interactions) may be more salient for service providers’ assessments of their performance than feedback from their role set. For example, Greller and Parsons (1992) found both positive and negative feedback from the task to be the stronger predictors of police officers self- evaluation of their performance when compared to feedback from supervisors and coworkers. As such, to the extent feasible, service provision should be designed to be delivered at multiple points in time. This will increase providers’ knowledge of work results, and consequently, enhance their sense of personal accomplishment. The client similarly benefits, given that feedback can be used to tailor service provision to his or her needs. Directions for Future Research Workplace burnout has received an astonishing amount of attention in social science research over the course of the last two decades, but many questions remain in regards to the processes and factors involved and the manner in which interventions should be designed to prevent and alleviate this costly problem. This study revealed that normative organizational communication behaviors are influential in the process of burnout. However, this study may have raised more questions for empirical study than it answered. In addition to addressing the limitations of this 125 research as discussed above, this study highlights three areas that should be addressed by future research on burnout. First, given the nature of human service work, there will always be some degree of chronic stress. The work process is emotionally taxing and outcomes are contingent on human behaviors which are complex and probabilistic, not deterministic. Burnout is a dynamic process, based on personal and work factors which fluctuate over time. But how "burnt out" is too "burnt out?" While burnout is a distinctly negative phenomenon, it is not clear at what magnitude or duration burnout becomes individually and organizationally unhealthy. As such, it is crucial that a critical value or diagnostic criterion for burnout be established. Golembiewski and others have taken strides in identifying various phases of burnout and patterns of movement between those phases, but they do not provide critical values for comparison across populations. Future research needs to focus on the creation of criterion for use in diagnosis, prevention and intervention. Second, task characteristics of service provision (i.e., on-going client relationships versus single interactions), should be revisited in burnout literature. It behooves communication scholars to examine task characteristics which structure work relationships and interactions. Anecdotal evidence, from a larger study of which this is part, indicates that other characteristics of 126 service provision may influence conditional demands, resource replacement behaviors and the dimensions of burnout. For example, individuals who engaged in outreach HIV counseling and testing tasks experienced less ambiguity of work outcomes and less emotional exhaustion than those who did not. Additionally, service providers who engaged in HIV prevention street outreach tasks engaged in more supervisor targeted behaviors than providers that did not engage in street outreach. Lastly, future research needs to employ methods which capture actual behaviors, most likely in the form of field observation. Only by observing actual behavior, and inquiring about said behavior, can it be discerned how relational quality, the context and structure of the interaction, and the content and function of communication interplay to replace resources. Clearly, adaptation to chronic, low intensity stress is a complex process in which communication has a significant influence. Observation of communication behaviors is requisite to learning more about the nature and characteristics of that influence. 127 APPENDICES 128 APPENDIX A TABLES 129 Table 1 Definitions of Role Conflict Types Type Definition Intra-sender When different prescriptions and proscriptions from a single member of the role set may be incompatible. Inter-sender When pressures from one role sender opposes pressures from one or more other senders. Inter—role When role pressures associated with membership in one organization are in conflict with pressures stemming from membership in other groups. Person—role When the needs and values a person has and the demands of his/her role set conflict. Role overload When expectations from one or more role senders exceed the capacity of the individual or the individual’s resources . Note. Definitions were drawn from Kahn et al., (1964, pp. 19-20) 130 Table 2 Role Conflict Dimensions Represented in Rizzo, House and Lirtzman’s Instrument Item Role Conflict Dimension 1. I have to do things that should be done differently. 2. I received an assignment without the manpower (staff) to complete it. 3. I have to buck a rule or policy in order to carry out an assignment. 4. I work with two or more groups who operate quite differently. 5. I receive incompatible (conflicting) requests from two or more people. 6. I do things that are apt to be accepted by one person, but not another. 7. I receive an assignment without adequate resources and materials to execute it. 8. I work on unnecessary things. person-role overload inter-sender inter-role inter-sender inter-sender overload person-role 131 Table 3 Scale Items and Factor Loadings for Ambiguity of Work Outcomes _ -d-O”..‘_. v- _\ - I don’t know if I make a difference in what my clients think or do. It’s difficult to tell what impact I make on my clients. Once my service relationship with a client ends, I have no idea what s/he does. There are ways that I can find out how a former client is doing. [r] I know that my job helps clients to remain seronegative. [r] I don’t know if what I do helps clients to engage in low-risk behaviors. I’m not sure if providing HIV prevention services makes a difference in client lives. .67 .61 .54 .52 .64 .79 .38 132 Table 4 Scale Items and Factor Loadings for Role Conflict My loyalty to my organization is in conflict with my loyalty to the greater cause of HIV prevention. I experience conflict between what my organization expects me to do and what other groups want me to do. I feel caught between taking care of clients and performing the specific tasks of my job. My job gives me all the freedom I need in how I choose to assist clients. [r] I cannot do what I think is best to help a client because of the boundaries of my job. 133 Table 5 Scale Items and Factor Loadings for Role Modification Try to change your supervisor’s expectations of your role as a service provider. Try to change your job to better fit your needs and abilities. Try to negotiate with your supervisor for a change in the types of tasks you perform. Try to negotiate with your supervisor for a change in the amount of tasks that you perform. Seek out other ways to change your job (e.g., apply for a grant, seek additional training or education, etc.). Seek to establish collaborative relationships with other groups with HIV prevention interests (i.e., other CBOs, government agencies, community groups, etc.). Seek out alternative ways that current services could be provided. .61 .46 .60 .65 .51 .45 .61 134 Table 6 Scale Items and Factor Loadings for Personal Control I have enough influence in this organization to control events that might affect my job. In this organization, I can prevent negative things from affecting my work situation. I have little control over the policies in this organization. [r] I can influence how my organization provides services to clients. In general, I have a great deal of control over work and work-related factors. I don’t have much say about how things are done in my organization. [r] .71 .54 .53 .55 .46 .81 135 Table 7 Scale Items and Factor Loadings for Tolerance for SW I function very poorly whenever there is a serious lack of communication in a job situation. If I am uncertain about the responsibilities of a job, I get very anxious. In a situation where people evaluate me, I feel a great need for clear and explicit evaluations. I need to know what is going on in order to do a job correctly. .84 .56 .42 .42 136 Table 8 Scale Items and Factor Loadings for Feedback Seeking- Supervisor Ask your supervisor for feedback on your overall performance. Ask for comments on how you dealt with a particular situation. Ask your supervisor for feedback on your effectiveness as a service provider. Ask your supervisor for her/his opinion about how you handle difficult situations. Ask your supervisor for specific ways in which you can improve your performance. Pay attention to the feedback that your supervisor gives to your co-workers. .64 .72 .75 .83 .74 .49 137 Table 9 Scale Items and Factor Loadings for Feedback Seeking -Coworkers Ask for comments on how you dealt with a particular situation. Ask your coworkers for feedback on your effectiveness as a service provider. Ask your coworkers what they have heard about your work performance. Ask your coworkers for their opinion about how you handle difficult situations. Ask your coworkers for specific ways in which you can improve your performance. .75 .66 .54 .78 .79 138 Table 10 Scale Items and Factor Loadings for General Feedback See—hm. Ask your supervisor for feedback on your overall performance. Ask your supervisor for feedback on your effectiveness as a service provider. Ask your supervisor for her/his opinion about how you handle difficult situations. Ask your supervisor for specific ways in which you can improve your performance. Ask your coworkers for feedback on your effectiveness as a service provider. Ask your coworkers for their opinion about how you handle difficult situations. Watch how your coworkers interact with clients and compare it with your own style. .69 .70 .78 .72 .43 .54 .59 139 Table 11 Scale Items and Factor Loadings for Reification of the Meaningfulness of Work-Supervisor Talk to your supervisor about the values of HIV prevention work. Talk to your supervisor about the importance of HIV prevention work. Talk about the impact of your work with your supervisor. Engage in discussions that reinforce the meaningfulness of your work. .88 .82 .64 .70 140 Table 12 Scale Items and Factor Loadings for Reification of the Meaningfulness of Work-Coworker Talk to your co-workers about the values of HIV prevention work. Talk to your co—workers about the importance of HIV prevention work. Talk about the impact of your work with your co—workers. Engage in discussions that reinforce the meaningfulness of your work. .88 .77 .69 .59 141 Table 13 Scale Items and Factor Loadings for Reification of the Meaningfulness of Work— External Seek out HIV prevention service providers outside of your organization to discuss the contributions your work makes. .57 Interact with infected and affected people on your own time to reinforce the meaning of your work. .70 Seek out others involved in HIV prevention to talk about the progress being made. .68 142 Table 14 Scale Items and Factor Loadings for Social Support Seeking-Supervisor Ask your supervisor for advice about work. Seek encouragement from your supervisor about work. Seek understanding from your supervisor about work. Seek out your supervisor because talking to him or her about work makes you feel better about yourself. .82 .82 .64 .70 143 Table 15 Scale Items and Factor Loadings for Social Support Seeking-Family and Friends Ask your family/friends for advice about work. Seek sympathy from your family/friends about work. Seek understanding from your family/friends about work. Seek out your family/friends because talking to them about work makes you feel better about yourself. .59 .77 .69 .84 144 Table 16 Scale Items and Factor Loadings for Social Support Seeking-Coworker Ask your coworkers for advice about work. Seek encouragement from your co-workers about work. Seek out your co-workers because talking to them about work makes you feel better about yourself. .77 .83 .73 145 Table 17 Scale Items and Factor Loadings for Emotional Exhaustion I feel I feel I feel I feel I feel emotionally drained from my work. used up at the end of the workday. burned out from my work. very frustrated by my job. like I’m at the end of my rope. .75 .86 .71' .62 .68 146 Table 18 Scale Items and Factor Loadings for Depersonalization I feel uncomfortable about the way I have treated some clients. I feel I treat some clients as if ,they were impersonal "objects." .59 .59 147 Table 19 Scale Items and Factor Loadings for Diminished Personal Accomplishment I deal very effectively with the problems of my clients. [r] I can easily create a relaxed atmosphere with my clients. [r] I have accomplished many worthwhile things in this job. [r] In my work, I deal with emotional problems very calmly. [r] .49 .71 .42 .53 148 Table 20 Variable Means and Standard Deviations Scale Variable M sd Females Ambiguity of Work Outcomes AMBIG 2.38 .67 Role Conflict ROLECON 2.48 .81 Resource Replacement Strategies Role Modification ROLEMOD 3.02 .72 Feedback Seeking-Supervisor FSB.S 2.95 .89 Feedback Seeking-Coworker FSB.C 2.80 .91 Reification of Meaningfulness —Supervisor REIFY.S 3.11 1.01 Reification of Meaningfulness -Coworker REIFY.C 3.43 .93 Reification of Meaningfulness —External REIFY.E 3.15 .98 Social Support Seeking -Supervisor SSS.S 2.80 1.00 Social Support Seeking -Coworker SSS.C 2.80 1.06 Social Support Seeking —Family/Friends SSS.F 2.28 .96 Personal Resources Personal Control PERCON 3.16 .80 Tolerance for Ambiguity TOLER 2.67 .75 Targeted Resource Replacement Strategies Supervisor Behavior S-BEH 2.95 .89 Coworker Behavior C-BEH 3.01 .86 Burnout Dimensions Depersonalization DEP 1.30 .52 Diminished Personal Accomplishment DPA 2.05 .60 Emotional Exhaustion EE 2.15 .82 Note. 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Hmcofluoem 1. me. uoflamcoo oaom emf mmf Soasmflnse pom monopmaoe HOHDGOU Hmcompmm 154 APPENDIX C MATERIALS SENT TO EXECUTIVE DIRECTORS 155 Dear [Executive Director]: Never before has there been such recognition of the effectiveness of community-based organizations (CBOs) in meeting the health and social service needs of communities throughout the United States. And nowhere is this recognition stronger than in the area of HIV prevention service provision, as evidenced by an on-going effort to move health and social service planning and prevention activities to the community level. However, given the high rate of job stress and burnout that occurs in these 0805, it is critical to identify ways in which the efforts of community-based service providers can be supported. The goal of this endeavor is to identify cost-effective strategies that service providers and their supervisors can use to help alleviate feelings of job stress and burnout. Your community-based organization is one of a few randomly chosen from four Midwestern states in which service providers are being asked to complete a questionnaire. The questionnaire focuses on job-related feelings, attitudes and behaviors in order to ascertain how service providers respond to typical work life in 0808. As such, I am interested in obtaining contact information for the HIV prevention service providers that your CBO employs in order to directly request their participation in this study. Your role in the present study will involve participation in a brief telephone call, wherein I will request the names of your full-time HIV prevention service providers that work directly with clients. You may be assured of complete confidentiality. Your name and the identity of your organization and service providers will remain anonymous in any report of the research findings. Please see the enclosed statement of confidentiality that will be sent to your service providers. I will phone you during the week of April let, and will be happy to answer any questions you may have at that time. I anticipate that the telephone call will take less than 5 minutes to complete. You may receive a summary of the _ results of the study by requesting one during our telephone conversation. In the meanwhile, I would be pleased to answer any questions that you might have. Please write or call. The telephone/fax number is (517) xxx-xxxx. Thank you for your assistance. Sincerely, Mary K. Casey PhD. Candidate 156 STATEMENT OF CONFIDENTIALITY FOR PARTICIPATION IN THE "TYPICAL WORK LIFE FOR HIV PREVENTION SERVICE PROVIDERS IN COMMUNITY-BASED ORGANIZATIONS" STUDY Descnmion The purpose of this study is to explore your job-related attitudes, feelings and behaviors as HIV prevention service providers working in community-based organizations. Specifically, the ways in which the challenges of working in community-based organizations influence job stress and burnout are of great interest and importance. The goal of this project is to identify effective ways of dealing with everyday work stressors in community-based organizations through the use of communication and other cost-effective strategies. Espectations for Your Participation I am asking HIV prevention service providers in community-based organizations, such as yourself, to respond to a questionnaire about your job-related attitudes. feelings and behaviors. The questionnaire will take approximately 35 minutes to complete. In return, I will send you a report of the results at your request. How YA: Were Selected Lists of 0805 which provide HIV prevention services in four Midwestern states were obtained from the CDC National AIDS Clearinghouse. Your organization was randomly chosen from the four-state list for inclusion in the study. The executive director of your 030 was contacted to obtain a list of HIV prevention service providers in your organization so that I could contact you directly. All future correspondence will be with you directly, not with your superiors. Your superiors will have no indication of whether or not you chose to participate or what your responses are. Confidentisl Voluntag Participation Completion of the enclosed questionnaire indicates your voluntary agreement to participate in this research project. You may decline to answer any questions, or choose not to participate at all without any concern of negative consequences. All of your responses will be kept strictly confidential and your identity will remain anonymous in any report of research findings. That is, your identity will only be known by Mary K. Casey and your name will never be placed on the questionnaire. At the completion of the full research endeavor, the record of participant names and contact information will be destroyed. Cont_apt lnforrnation If you have any questions or concerns, please feel free to contact me at the phone number or address provided below: [contact information] 157 APPENDIX D TELEPHONE PROTOCOL 158 TELEPHONE PROTOCOL FOR CBO EXECUTIVE DIRECTORS Name: Address: Address: Phone: Hello, is this ? Hi, this is Mary K. Casey, calling from Michigan State University. I sent you a letter last week which outlined a study that I am conducting on feelings of stress and burnout in HIV prevention service providers in 0805. To refresh your memory...Your organization was randomly chosen from a list of 0805 providing HIV prevention services in the Midwest. This list was obtained from the CDC National AIDS Clearinghouse. In terms of your participation in the study, I would like a list of your full-time HIV prevention service providers that work directly with clients. I will then contact them directly through the mail and request their participation in the study. In this way, you do not have to feel responsible for their participation, nor do they feel that they have to participate. I expect that this phone call will take less than 5 minutes to complete. Do you have any questions of me at this time? Any information that you provide is strictly confidential. Your name, the name of your organization and your service providers will be known only to me, and will never appear in any report of the results. Of course, your service providers will be aware that you have provided a list of their names to me. Your participation is strictly voluntary and you can refuse to answer any questions or discontinue participation at any time. Do you have any questions about this confidentiality agreement? Do you agree to voluntarily participate in this study? yes no First, I would like to confirm your organization's status as a 080. Is your organization an affiliate of a national or state organization? yesno Is your organization under the control of any private or governmental funding source? yesno How many full-time, adult, HIV prevention service providers that interact directly with clients does your organization have? Could you please spell each of their names? Thank you for your contribution to this study. Would you like me to send you a summary of the results? yes no If you have any questions, please don’t hesitate to phone me at (517) nor-moor. 159 APPENDIX E LETTER TO SERVICE PROVIDER 160 Dear [Service Provider]: Never before has there been such recognition of the effectiveness of community-based organizations (0805) in meeting the health and social service needs of communities throughout the United States. And nowhere is this recognition stronger than in the area of HIV prevention service provision, as evidenced by an ongoing effort to move health and social service planning and prevention activities to the community level. However, given the high rate of job stress and burnout that occurs in these 0805, it is critical to identify ways in which the efforts of community-based service providers can be supported. The goal of this endeavor is to identify cost-effective strategies that service providers and their supervisors can use to help alleviate feelings of job stress and burnout. Your community-based organization is one of a few randomly chosen from four Midwestern states in which service providers are being asked to complete a questionnaire which focuses on job-related feelings, attitudes and behaviors. All full-time HIV prevention service providers in your organization are being invited to participate in this study. l-ask that you complete and return the enclosed questionnaire in the stamped return envelope that has been provided. In order that the results will truly represent the feeling, attitudes, and behaviors of C80 HIV prevention service providers, it is important that each questionnaire be completed and returned. You may be assured of complete confidentiality. Your name and the identity of your organization will remain anonymous in any report of the research findings. Your specific answers will only be known to me. Please read the enclosed statement of confidentiality for greater detail. I would like to thank you in advance for your participation and encourage you to complete the survey at your earliest convenience. Please return the survey in the stamped envelope that has been provided for you. 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