Health Education Research Advance Access originally published online on July 31, 2006
Health Education Research 2007 22(2):248-260; doi:10.1093/her/cyl073
Occupational well-being of school staff members: a structural equation model
1 Department of Nursing Science, University of Kuopio, PO Box 1627, 70211 Kuopio, Finland
2 Information Technology Centre, University of Kuopio, Neulaniementie 1, 70210 Kuopio, Finland
3 Cancer Society of Finland, Liisankatu 21 B, 00170 Helsinki, Finland
* Correspondence to: T. Saaranen. E-mail: terhi.saaranen{at}uku.fi
 |
Abstract |
|---|
 Top Abstract IntroductionMethodsResultsDiscussionConclusions and challenges for...Conflict of interest statementAcknowledgementsReferences |
|---|
This study aimed to develop a theoretical basis for the promotion of school staff's occupational well-being. The ‘Content Model for the Promotion of School Community Staff's Occupational Well-being’ describes the four aspects of the promotion of occupational well-being (‘working conditions’, ‘worker and work’, ‘working community’ and ‘professional competence’) as well as the functionality and structure of the model. The content model was examined empirically by means of a structural equation model. The project was developed with school staff and occupational health nurses and implemented in 2001–2004. The target group consisted of the staff of 12 comprehensive schools in Eastern Finland in 2002 (n = 211) and 2004 (n = 266). The data were collected using a ‘well-being at your work index’ questionnaire at both times. A structural equation model for the school staff's occupational well-being, i.e. the ‘Occupational Well-being of School Staff Model’ (baseline OWSS Model: Study I in the year 2002), was produced. The model was tested with the 2004 data. Based on this, the model was further developed into the final OWSS Model (Study II). The theoretical Content Model for the Promotion of School Community Staff's Occupational Well-being can be used as a framework for planning, implementing and evaluating school staff's occupational well-being.
|
Introduction |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionConclusions and challenges for...Conflict of interest statementAcknowledgementsReferences |
|---|
Students' well-being at schools has been studied and defined from multi-disciplinary and broad points of view [e.g. 1–3], whereas the occupational well-being of teachers and school support service staff [4], such as cleaners and cooks, has received less attention or has been dealt with rather briefly [cf. 5]. There is research information on teachers' stress, exhaustion and satisfaction with work [6–10, see also 11], which is based on the mental workload associated with teaching. Teachers' workload is not, however, merely mental. For example, aging female physical education teachers and male teachers of vocational subjects has encountered difficulties in maintaining their physical ability to work [12]. The reasons for the workload of teaching in school communities are therefore diverse, depending on the nature of the teachers' role (e.g. role ambiguity, role conflict and role overload) [8] and the working environment [7]. This line of research has been criticized for its conceptual narrowness and lack of psychometric rigor [10].
This being the case, the efforts to attain and promote occupational well-being in schools do not aim merely to eliminate teachers' stress and exhaustion or to establish occupational well-being (i.e. affective well-being) [5]. Even though the interventions to promote occupational well-being have been notable both healthwise and economically (e.g. the impacts on health behavior, employee absenteeism, productivity and health care costs) [13, see also 14, 15], few development projects and intervention studies aimed at school staff's occupational well-being have been reported or else the staff's well-being has been reported as a part of more comprehensive school development programs [e.g. 12, 14, 16, 17]. In order to develop school staff's occupational well-being, intervention studies are therefore needed [cf. 18] along with broad (involving physical, mental and social parameters) multi-disciplinary approaches [19] to conceptualize and model occupational well-being. They will provide assistance for occupational health service professionals and school staff in planning, implementing and evaluating occupational well-being development projects [cf. 5].
This article relates to a development project titled Promotion of School Community Staff's Occupational Well-being in Co-operation with Occupational Health Nurses (2001–2004), which was carried out in 12 comprehensive schools in Eastern Finland. The project was part of a broader international European Network of Health Promoting Schools program, in which the aim is to promote school staff's occupational well-being. In this development project, the staff's occupational well-being was developed in collaboration with the schools' staff and occupational health nurses by activities to maintain their ability to work from the viewpoint of the individual, the working community, professional competence and the working conditions [20, 21]. In many Finnish working communities, actions to maintain work ability and evaluations of these actions have been carried out for a long time [20, 21]. However, the promotion of occupational well-being by actions to maintain work ability in the school community has not been studied much in either Finland or other countries.
This study aimed to develop a theoretical basis for the promotion of school staff's occupational well-being. A structural equation model was used in the study to examine empirically the functionality and structure of the theoretical ‘Content Model for the Promotion of School Community Staff's Occupational Well-being’ (Fig. 1) in explaining school staff's occupational well-being. The developed content model was based on the previous literature and research data focusing on the activities to maintain ability to work [e.g. 20, 21] and school staff's well-being [e.g. 4, 5, 9, 12, 19, see also 22] and the previous results of a qualitative study at the planning phase of this project [23, 24]. This content model was then used as a theoretical framework for planning, implementing and evaluating school staff's occupational well-being by activities to maintain their work ability.
|
The Content Model for the Promotion of School Community Staff's Occupational Well-being pertains to the promotion of four aspects of school staff's occupational well-being [cf. maintenance of work ability; 20, 21]. Occupational well-being is assumed to be affected by the working conditions (e.g. the physical working environment; physical, biological and chemical factors and safety at work; working postures and equipment) and the workers' health together with resource and workload factors (e.g. personal health and physical and mental fitness) in relation to the work itself (e.g. the mental and physical strain of work). The working community and its functionality (e.g. work management and organization, leadership, social support, information) and professional competence (e.g. in-service education) are further essential factors.
The school staff's occupational well-being, as outlined in the model, consists of the individual and communal resource and workload factors of these four aspects [20, 23]. Resources are defined as factors that decrease the number of situations increasing workload and reduce the experience of workload by producing more efficient methods of control [25]. Teachers' good health and good relations within the working community [12] and administrative support [9] are examples of resource factors in a school community. Workers' good professional competence and a possibility to further develop themselves in that respect also create resources to work [26]. Workload factors here refer to mental and physical factors, which are affected by job description and working environment [23]. A reasonable workload as well as adequate job demands combined with sufficient job control [cf. 27] is positive and necessary factors for occupational well-being. However, when the mental or physical workload is prolonged or excessive or physically too low or too high in relation to the available resources, harmful strain is created [25].
The individual-based interpretation of the model emphasizes the worker's own responsibility for his/her health, development of resources and management of workload factors both in the school community and during leisure time [cf. 28]. The community-based interpretation emphasizes the significance of the whole school community and its structures, such as leadership at workplace, workplace atmosphere and working conditions, in the creation and promotion of occupational well-being. Thus, the occupational well-being of school community staff is amenable to individual- and community-based interpretations (cf. Fig. 1).
Consequently, based on the previous literature and research data concerning activities to maintain the ability to work and school staff's occupational well-being, the present study addressed the following hypotheses:
- (1) The factors of the different aspects of occupational well-being (‘working conditions’, ‘worker and work’, ‘working community’ and ‘professional competence’) affect directly either the school staff's personal well-being (=the school staff member's subjective occupational well-being at a given workplace compared with the best level) or/and the working community's occupational well-being (=the working community's general staff well-being in the worker's working community) (see Fig. 1).
- (2) In addition, the factors of the different aspects of occupational well-being are assumed to be correlative.
- (2) In addition, the factors of the different aspects of occupational well-being are assumed to be correlative.
In the year 2002, the content model was employed empirically as a theoretical framework for outlining the best potential structural equation model compatible with the hypothesis (Study I), which was tested and further developed in view of its functionality and structure in 2004 (Study II). Although structural equation modeling cannot provide final proof of causality, this approach gives a preliminary insight into the order of relationships between concepts.
|
Methods |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionConclusions and challenges for...Conflict of interest statementAcknowledgementsReferences |
|---|
Study populations and variables
Altogether, 211 persons (N = 271) in the year 2002 and 266 persons (N = 320) in the year 2004 from 12 comprehensive schools in Eastern Finland participated in this study. At both times, data were collected using the ‘well-being at your work index’ questionnaire, which was developed in this project. The occupational health nurses wanted a tool that could be used to estimate school staff's occupational well-being relative to the activities to maintain their ability to work from the viewpoint of the individual, the working community, professional competence and the working conditions. It was designed based on the previous literature and research data and the qualitative research carried out at the planning phase of this project. Thus, the Content Model for the Promotion of School Community Staff's Occupational Well-being (Fig. 1) also served as the theoretical frame for the well-being at your work index questionnaire.
The questionnaire was evaluated by the project research group and the participating occupational health nurses (n = 12). The actual preliminary testing was done by the staff of one junior high school (n = 14) who did not participate in the actual study. Afterwards, at both times, the questionnaires were personally delivered to the occupational health nurses, who passed them on to the school staff. The occupational health nurses also collected the anonymous questionnaires in the response envelopes and returned them to the researcher. The questionnaire includes questions relating to the school staff's background. In addition, the questionnaire was used to investigate both the school staff member's subjective occupational well-being at this workplace compared with the best possible level, i.e. personal occupational well-being and the general well-being of the staff in the worker's working community with five-step Likert-scale variables (1 = very poor, 2 = quite poor, 3 = moderate, 4 = quite good and 5 = very good). Both the background information and the level of personal and community well-being in 2002 and 2004 are presented in Table I.
|
Furthermore, the questionnaire included items relating to the different aspects of occupational well-being, i.e. working conditions, worker and work, working community and professional competence. They were also evaluated with five-step Likert-scale variables (1 = totally disagree, 2 = quite disagree, 3 = neither agree nor disagree, 4 = quite agree and 5 = totally agree). Sum variables of each aspect were formed in order to summarize the school staff's opinions (see Table II). The formation of these sum variables was based on the results of a factor analysis made on the 2002 material, which has been described in more depth in another article [22]. As a summary of that, the loading of each single variable correlated well with the particular factor, and the reliability of the sum variables was also tested. The alpha coefficient values of the sum variables of the structural equation model can be considered good in the years 2002 and 2004 (see Table II) [cf. 29].
|
Construction of the model
Structural equation models constitute a general group of highly diverse models [30]. The recursive path model employed here is a structural equation model that assumes the relationship between the endogenic (explained) and exogenic (explaining) variables to be linear [cf. 31]. The special feature of the model is its recursiveness, i.e. unidirectional causality [30, 32, 33]. The structural equation model was formulated using the analysis of moment structures (AMOS) software [34, 35]. The software specializes in analyzing covariance structures and can be used to flexibly test structural equation models.
The ‘Occupational Well-being of School Staff Model’ (OWSS Model) was constructed through the normal phases of a structural equation model: model specification, examination of identification, estimation of parameters, testing of hypotheses related to the model and other adequacy tests of the model [cf. 36]. Based on the 2002 material, the structural equation model for school staff's occupational well-being (OWSS Model in the basic phase = Model 1) was produced, for which the theoretical framework was obtained from the Content Model for the Promotion of School Community Staff's Occupational Well-being. The endogenic variables in the structural equation model were the school staff member's subjective occupational well-being at this workplace compared with the best possible level and the working community's general staff well-being in the worker's working community (five-step Likert scale). The sum variables of the different aspects of occupational well-being (working conditions, worker and work, working community and professional competence) served as exogenic variables (see Table II). According to the recursive path model, the relations between the endogenic and exogenic variables were unidirectional, i.e. not reciprocal [30, 31]. The 2002 model (Model 1) was tested with the 2004 material (Model 2), after which the model was further developed (OWSS Model in the final phase = Model 3).
The OWSS models (Models 1 and 3) were formulated to be identifiable, and the parameters were estimated using the AMOS software. The estimates are presented graphically (see Figs 2 and 3) as standardized estimates, which include correlations (standardized covariance) and path coefficients. Standardized estimates are interpreted as having a small effect if their value is <0.10. Estimates with a medium effect have values 
0.30, and those with a major effect have values >0.50 [30].
|
|
The compatibility of each OWSS Model (=testing of the statistical hypotheses related to the model) with the material was tested by comparing the theoretical and empirical covariance matrices using the
2 test. The hypothesis was that the OWSS Model fits the material, i.e. the theoretical and empirical covariance matrices are equal. The adequacy of the model was ensured using the indexes Normed Fit Index (NFI), Comparative Fit Index (CFI) and Root Mean Square Error of Approximation (RMSEA) [30, 31, 36]. |
Results |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionConclusions and challenges for...Conflict of interest statementAcknowledgementsReferences |
|---|
Study I in 2002
In determining school staff's occupational well-being empirically using the structural equation model (Fig. 2), the endogenic variables were the school staff member's subjective occupational well-being at this workplace compared with the best possible level and the working community's general staff well-being in the worker's working community, which were explained with the sum variables of the different aspects of occupational well-being (see Table II). In Model 1 (OWSS Model in the basic phase), in particular, the positive effect of the working atmosphere and appreciation of others' work explained the working community's well-being, which could also be seen as the model's highest standardized path coefficient (0.56) (see Fig. 2). Working spaces, postures and equipment also had some effect on the working community's well-being (0.10).
The most significant factor explaining subjective occupational well-being consisted of the working atmosphere and appreciation of others' work (0.37). Subjective occupational well-being was also explained, with medium values, by workload (0.17) as well as substantive competence and interaction (0.17).
Workload, working atmosphere and appreciation of others' work as well as substantive competence and interaction also correlate with each other (see Table III; Covariances), and their standardized estimates had medium effects (0.19–0.27; see Fig. 2). In addition, working spaces, postures and equipment as well as workload also correlated (0.14).
|
The factors of Model 1 (OWSS Model in the basic phase) accounted for
33% of the variance related to the working community's general well-being and 27% of the variance related to subjective occupational well-being (see Table III; squared multiple correlations). The model's compatibility with the 2002 material was tested using the 2 test (estimate 5.861, df = 5, P = 0.320), and its adequacy was tested with the indexes NFI (0.973), CFI (0.996) and RMSEA (0.029), all of whose values supported the model's suitability (Table III). The statistical significance (P values) of the model's factors can also be seen in Table III.
Study II in 2004
The OWSS structural equation model (Model 1) based on the 2002 material was tested with the 2004 (n = 266) material. This model (Model 2) was shown to be incompatible by the 2 test (estimate 27.643, df = 5, P = 0.000) and inadequate by the indexes NFI (0.868), CFI (0.880) and RMSEA (0.131). After this, the model was supplemented by adding workload (Model 3) as a factor explaining the working community's general well-being, which factor actually explained the working community's general well-being with a medium effect (0.19) (see Fig. 3). In addition, working spaces, postures and equipment were found to correlate with working atmosphere and appreciation of others' work (0.21) as well as with substantive competence and successful interaction (0.16), and the 2002 model (Model 1) was hence supplemented with these covariances (see Model 3; Fig. 3). The compatibility of the supplemented model was ensured with the 2 test (estimate 2.011, df = 2, P = 0.366) and its adequacy with the indexes NFI (0.990), CFI (0.996) and RMSEA (0.029), all of whose values were good (see Table III).
The factors of Model 3 (OWSS Model in the final phase) account for 23% of the variance related to the working community's general well-being and 17% of the variance related to subjective occupational well-being (see Table III; squared multiple correlations and Fig. 3). Working atmosphere and appreciation of others' work explain the working community's occupational well-being most effectively (0.35), and they also have a role in subjective occupational well-being (0.14). Workload, however, has the largest effect on subjective occupational well-being (0.25) (Fig. 3).
|
Discussion |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionConclusions and challenges for...Conflict of interest statementAcknowledgementsReferences |
|---|
Reliability and ethicality
Reliability issues of structural equation models are associated with the study material and its collection, the formulation of the model and the visual representation of the models. The study material should contain a minimum of 200 observations for complex models and >100 observations even in the case of simpler models [cf. 30]. In this study, the size of the material was considered appropriate (n = 211 in the year 2002 and n = 266 in the year 2004). In addition, the materials give a broad view of the situation and the experiences of the school staff involved in the project, because the response percentages at the two points of data collection were 78 and 83%. The well-being at your work index questionnaire and the formulation of the sum variables are reported in more detail in another article [22]. The reliabilities of the sum variables used in the path models are presented in Table II, and they are sufficient (0.62–0.88).
A researcher who is building a model must be well acquainted with the phenomenon under study and justify the choice of the variables and the reciprocalities included in the model [30]. The model underlying this study (Content Model for the Promotion of School Community Staff's Occupational Well-being) is based on previous literature and research [e.g. 22]. Therefore, the construction of the path model required a lot of preparatory work. The content model provided a clear-cut framework for building and testing the path models empirically in the years 2002 and 2004. The construction of the path models proceeded according to the normal development of a structural equation model [cf. 36]. The compatibility of the model was ensured by performing the 2 test and adequacy examinations on the model (cf. Table III). The structural equation does not completely explain the content model, but this method confirmed the functionality and structure of the Content Model for the Promotion of School Community Staff's Occupational Well-being.
The visuals and graphical layout of the path models were based on the graphics of the AMOS software. Standardized values (path coefficients and correlations) were used in the figures. The use of standardized values was justified because it enabled the estimates to be interpreted on the same scale [30].
Examination of results
The Content Model for the Promotion of School Community Staff's Occupational Well-being served as a frame for building the recursive path model for school staff's occupational well-being in the year 2002 (Fig. 2; OWSS Model 1 in the basic phase). This model was tested with the 2004 data, and based on this, the model was further developed into the final OWSS Model (Fig. 3; OWSS Model 3 in the final phase). In both OWSS models focusing on the hypothesis (Model 1, 3; see Figs 2 and 3), the exogenic variables (working spaces, postures and equipment, workload, working atmosphere and appreciation of others' work, substantive competence and interaction) were the same and pertained to the different aspects of occupational well-being (working conditions, worker and work, working community, professional competence, see Table II and Fig. 1), but in Model 3, workload was found out to be a statistically significant factor in explaining the working community's general well-being (Table III). The addition of this direct effect to the OWSS Model 3 may be due to various reasons, and to confirm these reasons, more research is required. One reason may be the ever-changing workload pressures inherent in the teacher's role [cf. 8]; when the workload becomes excessive, it is first reflected on the worker's subjective occupational well-being (cf. Fig. 2), and if the strain persists, it has a negative effect on the general well-being of the working community as well (cf. Fig. 3).
In addition, all exogenic variables in Model 3 correlate with a medium effect [see the hypothesis (2)], which shows that the aspects of occupational well-being influence one another. Occupational well-being and its development should therefore be addressed as a broader phenomenon than mere stress, exhaustion or satisfaction with work [5]. The results obtained from the formulation (Model 1), testing (Model 2) and further development (Model 3) of the OWSS Model reinforce the perception that the Content Model for the Promotion of School Community Staff's Occupational Well-being is a broad four-aspect model that can be used as a framework for planning, implementing and evaluating development projects for school staff's occupational well-being from the viewpoints of both an individual and the entire working community. This project has also proved that the content model is a practical and unambiguous instrument for the promotion of occupational well-being for schools staff and occupational health nurses. Planners of development projects, however, should realize that rather long follow-up studies are required to establish advantageous effects, such as reduced health care costs [13, 15].
The OWSS Model 3 supports the view that, even though occupational well-being and its promotion at schools are broad concepts, the path coefficients of the explanatory factors in the model have somewhat different intensities (see Fig. 3). Based on the results, particular attention should be paid to the workers' workload as well as the working atmosphere and appreciation of others' work when promoting occupational well-being. These two factors have a medium effect on both the working community's general well-being and the worker's subjective (=own) occupational well-being. Often, as the staff's job descriptions are broadened, for example, when the teacher's role is diversified [8], an overload situation develops where job demands exceed job control [cf. 27]. The increased job demands can be better controlled when the workers themselves together with the entire school community take responsibility for adequate further or in-service education, which helps them to maintain and develop their professional competence. The school community must be seen as an entity, where individuals, groups and the whole organization are continuously learning and able to develop their learning skills. The importance of promoting professional competence can also be seen in the OWSS Model 3: ‘substantive competence and interaction’ account directly for subjective occupational well-being, but also correlate with other exogenic variables.
Based on the present results, good working atmosphere and appreciation of others' work are important factors regarding the promotion of both the working community's and the worker's own occupational well-being [cf. 9, 12, 23]. However, a school community cannot attain a good working atmosphere and a high level of reciprocal staff support out of thin air. School communities must consciously pursue a more conversational culture by creating supportive infrastructure, such as regular teaching staff meetings, where the staff can feel that their work is appreciated. At the same time, it is possible to develop teaching and to find solutions for stressful situations in teaching and educational work by appreciating the workers with their own characteristics [4, 23].
Working spaces, postures and equipment explain occupational well-being least well in the OWSS Model 3 (see Fig. 3). However, working conditions as an aspect of occupational well-being (variable working spaces, postures and equipment) directly explain the working community's general well-being. Working spaces, postures and equipment also correlate with all exogenic variables. This being the case, physical working conditions (e.g. adequate working spaces and good ergonomics) and their need for development should also be considered in promoting school staff's occupational well-being.
|
Conclusions and challenges for further research |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionConclusions and challenges for...Conflict of interest statementAcknowledgementsReferences |
|---|
The OWSS Model 3 in the final phase confirms the view that the Content Model for the Promotion of School Community Staff's Occupational Well-being is a feasible framework for planning, carrying out and evaluating development projects for school staff's occupational well-being from the viewpoint of both the individual and the whole working community. In promoting school staff's subjective and the working community's general occupational well-being, attention should be given to the four aspects of occupational well-being, i.e. working conditions, worker and work, working community and professional competence. The content model is suited to practical actions and evaluations by school staff, occupational health nurses, researchers and other co-operative teams in the promotion of school staff's occupational well-being. However, to increase the reliability of the content model and to further develop it, the model should be tested in other school development projects both nationally and internationally.
|
Conflict of interest statement |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionConclusions and challenges for...Conflict of interest statementAcknowledgementsReferences |
|---|
None declared.
|
Acknowledgements |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionConclusions and challenges for...Conflict of interest statementAcknowledgementsReferences |
|---|
This study has been financially supported by the Finnish Ministry of Social Affairs and Health (the European Network of Health Promoting Schools program), Academy of Finland (the Finnish Post-Graduate School in Nursing Science) and the Department of Nursing Science of the University of Kuopio, Finland to whom we are gratefully appreciative.
|
References |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionConclusions and challenges for...Conflict of interest statementAcknowledgementsReferences |
|---|
1. Konu A, Alanen E, Lintonen T, et al. Factor structure of the School Well-being Model. Health Educ Res 2002 17:732–42.
2. Konu A, Lintonen TP, Autio VJ. Evaluation of well-being in schools—a multilevel analysis of general subjective well-being. Sch Eff Sch Improv 2002 13:187–200.
3. Engels N, Aelterman A, Van Petegem K, et al. Factors which influence the well-being of pupils in Flemish secondary schools. Educ Stud 2004 30:127–43.
4. Savolainen A. Koulu työpaikkana. Työolojen itsearviointi ja kehittämistarpeet oppilaiden ja henkilöstön näkökulmasta. [School as a Worksite. Self-Assessment of and Development Needs for Working Conditions as Experienced by Students and School Personnel.].Tampere, Finland: Tampereen Yliopistopaino Oy Juvenes Print, Acta Universitatis Tamperensis 2001.
5. Horn JE, Taris TW, Schaufeli WB, et al. The structure of occupational well-being: a study among Dutch teachers. J Occup Organ Psychol 2004 77:365–75.
6. Pedrabissi L, Rolland JP, Santinello M. Stress and burnout among teachers in Italy and France. J Psychol 1993 127:529–35.[Web of Science][Medline]
7. McCormick J. Occupational stress of teachers: biographical differences in a large school system. J Educ Adm 1997 35:18–38.
8. Conley S and Woosley SA. Teacher role stress, higher order needs and work outcomes. J Educ Adm 2000 38:179–201.
9. Dick R and Wagner U. Stress and strain in teaching: a structural equation approach. Br J Educ Psychol 2001 71:243–59.[CrossRef][Web of Science][Medline]
10. Scott C and Dinham S. The development of scales to measure teacher and school executive occupational satisfaction. J Educ Adm 2003 41:74–86.
11. Taris TW, Schreurs PJG, Van Iersel-Van Silfhout IJ. Job stress, job strain, and psychological withdrawal among Dutch university staff: towards a dual-process model for the effects of occupational stress. Work Stress 2001 15:283–96.
12. Parkatti T, Kinnunen U, Rasku A. Work, well-being and health among ageing teachers. In Ilmarinen J and Louhevaara V (Eds.). FinnAge—Respect for the Aging: Action Programme to Promote Health, Work Ability and Well-being of Aging Workers in 1990 –96.People and Work, Research Report 26. Helsinki, Finland: Finnish Institute of Occupational Health, Nykypaino Oy 1999 pp. 163–70.
13. Pelletier KR. A review and analysis of the clinical and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: 1995 –1998 update (IV). Am J Health Promot 1999 13:333–45.[Web of Science][Medline]
14. Allegrante JP. School-site health promotion for faculty and staff: a key component of the coordinated school health program. J Sch Health 1998 68:190–5.[Web of Science][Medline]
15. Aldana SG, Merrill RM, Price K, et al. Financial impact of a comprehensive multisite workplace health promotion program. Prev Med 2005 40:131–7.[CrossRef][Web of Science][Medline]
16. James G. A seven-year follow-up comparing attendees and nonattendees at a statewide, school employee wellness conference. J Sch Health 2001 71:127–31.[Web of Science][Medline]
17. Kolbe LJ. A framework for school health programs in the 21st century. J Sch Health 2005 75:226–8.[CrossRef][Web of Science][Medline]
18. M
koma W and Flisher AJ. Evaluations of health promoting schools: a review of nine studies. Health Promot Int 2004 19:357–68.
19. Freude G, Seibt R, Pech E, et al. Assessment of work ability and vitality—a study of teachers of different age groups. Int Congr Ser 2005 1280:270–4.
20. Peltomäki P, Hussi T, Julin H, et al. Introduction. Maintaining and promoting work ability in Finland. In Peltomäki P, Hussi T, Julin H, Launis K, Liira J, Räsänen K (Eds.). Maintenance of Work Ability Research and Assessment: Summaries.Vammala, Finland: Ministry of Social Affairs and Health, Finnish Institute of Occupational Health, Social Insurance Institution, Vammalan Kirjapaino Oy 2002 pp. 7–16.
21. Peltomäki P and Husman K. Occupational health services and maintenance of work ability at workplace. Arg hig Rada Toksikol 2002 53:263–74.
22. Saaranen T, Tossavainen K, Turunen H, et al. Development of occupational wellbeing in the Finnish ENHP Schools. Health Educ 2006 106:133–54.
23. Saaranen T, Tossavainen K, Turunen H, et al. Työhyvinvoinnin rakentuminen kouluyhteisössä—henkilöstön ja työterveyshoitajien arviointia. [Basis of occupational well-being in school communities—evaluation by staff and occupational health nurses.]. Työ ja ihminen 2004 18:328–41.
24. Saaranen T, Tossavainen K, Turunen H. School staff members' and occupational health nurses' evaluation of the promotion of occupational well-being—with good planning to better practice. J Interprof Care 2005 19:465–79.[CrossRef][Medline]
25. Mäkinen K. Opetustyön kuormittavuus ja sen seuraamuksia ammatillisessa koulutuksessa. [The Load of School Teaching and Its Implications to Vocational Education.].Vammala, Finland: Vammalan kirjapaino, Acta Universitatis Tamperensis 1998 pp. 634.
26. Ma X and MacMillan RB. Influences of workplace conditions on teachers' job satisfaction. J Educ Res 1999 93:39–47.
27. Karasek R and Theorell T. Healthy Work: Stress, Productivity and the Reconstruction of Working Life.New York: Basic Books 1990.
28. Ho JTS. Stress, health and leisure satisfaction: the case of teachers. Int J Educ Manag 1996 10:41–48.
29. Nunnally JC and Bernstein IH. Psychometric Theory. 3rd edn New York: McGraw-Hill 1994.
30. Kline RB. Principles and Practice of Structural Equation Modeling.New York: Guidford Press 1998.
31. Musil CM, Jones SL, Warner CD. Structural equation modeling and its relationship to multiple regression and factor analysis. Res Nurs Health 1998 21:271–81.[CrossRef][Web of Science][Medline]
32. Polit DF and Hungler BP. Nursing Research. Principles and Methods. 6th edn Philadelphia: Lippincott 1999.
33. Burn N and Grove SK. The Practice of Nursing Research. Conduct, Critique, & Utilization. 4th edn Philadelphia: W.B. Saunders Company 2001.
34. Arbuckle JL and Wothke W. Amos 4.0 User's Guide.Chicago, IL: SmallWaters Corporation 1999.
35. Arbuckle JL. Amos 5.0 Update to the Amos User's Guide.Chicago, IL: SmallWaters Corporation 2003.
36. Bollen K. Structural Equations with Latent Variables.New York: John Wiley & Sons 1989.
Received on October 21, 2005; accepted on June 19, 2006
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||