Factors Predicting Disclosure of Chronic Illness Status in the Workplace for Individuals with Inflammatory Bowel Disease - Research Paper Example

Factors Predicting Disclosure of Chronic Illness Status in the Workplace and General Well-Being for Individuals with Inflammatory Bowel Disease COURSE SCHOOL Table of Contents I.Methodology 1 A.Sample Size and Method 1 B.Study Instrument 1 C.Operationalizing the Key Variables 1 II.Research Questions 3 III.Hypothesized Explanatory Factors 3 IV.Findings 4 A.Demographic Profile 4 B.Presenting Condition 5 C.The Variable Characteristics and Correlates of Disclosure 5 D.The Variable Characteristics and Correlates of General Well-Being 8 E.The Relationship Between Workplace Disclosure and Well-Being 9 I. Methodology A. Sample Size and Method In order to augment the base of 108 patients covered by the occupational Inflammatory Bowel Disease (IBD) study series of Dr. Sara Cox in the Institute of Work, Health and Organisations at the University of Nottingham, UK, solicitations to join a mailed survey were posted to 300 NACC members carefully balanced by gender and for presenting with either Crohn’s or colitis. Reply rate by the closing date for fieldwork was 36.7% or 110 returns. B. Study Instrument The questionnaire booklet consisted of several questionnaires. Sections were divided into personal details consisting of demographic and disclosure questions, coping questionnaire, social support questionnaire and general well-being questionnaire. C. Operationalizing the Key Variables The Personal Details section recorded demographic details such gender and age, and specific personal details including illness status and employment history. For the purposes of this study, only age, gender and IBD status are considered. Participants were asked to rate their severity of illness experienced since the start of current employment. This question was rated on the 7-point Likert scale. In the Disclosure segment, participants were asked to think about the extent of disclosure to significant others (e.g. employer, colleague, line manager or subordinate) in their organisation in terms of whether they have just mentioned the illness or they have gone into more detail in discussing how the condition may affect their work performance. Participants performed a self-report rating on a 5-point scale ranging from ‘1 = I have not disclosed’ to ‘5 = Disclosed performance-related effects of illness’. High scores indicate a deeper level of disclosure and are more indicative of someone who has disclosed more about their illness to the organisation. Coping styles were measured with the COPE Inventory developed by Carver and colleagues (Carver et al., 1989). This inventory was used to tap into a wide variety of coping styles patients employ since starting where are currently employed. The COPE inventory consists of 60 statements describing particular behaviours and participants were required to rate the frequency with which they exhibit these behaviours. The options range from 1 ‘I haven’t been doing this at all’ to 4 ‘I have been doing this a lot’. There are 15 overall coping styles assessed by this inventory; some are ‘positive’ or ‘functional’ and others adjudged ‘negative’ or ‘dysfunctional’. For brevity’s sake, only the five top coping styles shown below were analysed in this study: 1. Positive reinterpretation and growth 2. Active coping 3. Seeking emotional support 4. Acceptance 5. Planning Social support was measured with the short version of the Significant Others Scale (Power et al., 1988). This scale was used here to tap into the perceived amount of social support received by an individual from various significant others since the start of current employment. Social support is further dichotomized into emotional and practical. The SOS version employed in this study required participants to choose the key people that will be rated. This gave the opportunity to encompass significant others at work. For each of the chosen key people, participants had to answer 4 questions: 2 for emotional and 2 for practical support. Each question was divided into two parts, asking to first rate the support available and then the ideal level of support. All ratings were done on a 7-point Likert scale. The discrepancy between support received and ideal support was calculated for each for the “significant others” identified by each participant. The average support discrepancy for each participant was then calculated for both emotional and practical support. A higher average discrepancy score indicated a larger discrepancy between the level of support received compared to the participant’s desired level of support. To measure general well-being, the General Well-Being Questionnaire (GWBQ) was used (Cox et al., 1983). This section of the study instrument consisted of 24 statements, each describing a symptom, for each of which participants were required to rate frequency of occurrence over a prior six-month period. The response possibilities ranged from 0 ‘never’ to 4 ‘all the time’. The GWBQ has two underlying factors: the ‘worn-out’ factor (factor1) which includes items such as ‘how often have you become easily tired?’ and the ‘up-tight’ factor (factor2) which includes items such as ‘how often have you been tense or jittery?’. II. Research Questions A. Which factors predict disclosure (to employer, colleagues, line manager subordinate) of Inflammatory Bowel Disease (IBD) at work? B. Which factors predict general well-being of IBD sufferers? C. Is there a relationship between workplace disclosure and well-being? III. Hypothesized Explanatory Factors Part of the answer to the first research question may lie with the finding (Faust, Halpern, Danoff-Burg & Cross, 2012) that there is greater disengagement coping as the disease progresses, suggesting that IBD sufferers are less likely to voluntarily disclose their condition as their physiological state deteriorates. Reinforcing such a hypothesis are the findings of a prospective study among Norwegian IBD patients (140 with ulcerative colitis (UC) n = 92, Crohns disease (CD) n = 48 and mean age 46.9 and 40.0-year old, respectively, administered the Norwegian Rating Form of IBD Patient Concerns (RFIPC) three times in the course of a year) by Jelsness-Jørgensen, Moum and Bernklev (2011). In this earlier study, the authors also found that the extent of worry increased, logically enough, as IBD symptoms proliferated. Even when the condition was ameliorated, “…worries about undergoing surgery or having an ostomy bag seem to persist…” (p. 12). Such persistent anxiety again militates against disclosure. In respect of the second research question, there is evidence from a study of 80 adult patients that quality of life is inversely related with social constraint, coping, anxiety symptoms, depression symptoms (Faust, Halpern, Danoff-Burg & Cross, 2012). The research team had taken these findings to mean that counselling or other mental health therapy is crucial for IBD sufferers. IV. Findings A. Demographic Profile Counting only participants for whom demographic and morbidity data was complete, one notes first of all a distinct female skew. Males were underrepresented at 45.9% of net participants versus 54.1% for females. This is a sex ratio of 0.85 males/females whereas the general working-age population 15 to 64 years old hews closer to 1.03 males/females (Index Mundi, 2011). By age, 9.3% of the IBD sample was 25 and below (minimum age 19), 51.9% was aged 26 to 45 and 38.9% of the sample was 46 and above (maximum age 64). B. Presenting Condition IBD status broke down into one-third (38.5 %) diagnosed with Crohn’s and the majority (61.5 %) presenting with colitis. C. The Variable Characteristics and Correlates of Disclosure Figure 1 below shows that all but 15% of the patients have disclosed their condition to colleagues at work in varying degrees. Figure 1: Distribution of Disclosure at Work Variable More often than not, IBD patients reveal the symptoms of their disease. A further 39% disclosed their ailment either because they needed some adjustments to their work settings or performance-related standards. Table 1: Statistically Significant Correlations with Disclosure     Rating of disclosure to work colleagues IBD STATUS SEVERITY AT CURRENT JOB AVERAGE PRACTICAL SUPPORT discrepancy Rating of disclosure to work colleagues Pearson Correlation 1 -.254** .309** -.192* Sig. (2-tailed) .008 .001 .048 N 110 109 107 106 IBD STATUS Pearson Correlation -.254** 1 -.078 -.009 Sig. (2-tailed) .008 .429 .926 N 109 109 106 105 SEVERITY AT CURRENT JOB Pearson Correlation .309** -.078 1 -.225* Sig. (2-tailed) .001 .429 .022 N 107 106 107 103 AVERAGE PRACTICAL SUPPORT discrepancy Pearson Correlation -.192* -.009 -.225* 1 Sig. (2-tailed) .048 .926 .022 N 106 105 103 106 As to the descriptive statistics, the mean and standard deviation for disclosure are 3.1363 and 1.29592, respectively. This means that around two-thirds of the distribution falls between scale values of 1.84 and 4.43 on the five-point scale of disclosure (an ordinal variable). Further, the 90% confidence interval is 1 and 5 (both values rounded off), which embraces the entire scale (Rosner, 2010). At α = 0.05, the statistically significant correlates of disclosure are IBD status, severity at current job and average practical support discrepancy. This means that the propensity for more detailed disclosure: Varies together with the self-rated (seven-point scale) severity of the disease, from “Very mild” to “Very severe”. Varies inversely with the nominal variable “IBD status”. This means that disclosure is more likely when one has Crohn’s disease, the IBD variety characterized by diarrhoea, abdominal pain and cramping, bloody stool, ulcers in the mouth and the inner lining of the intestine (that can also perforate), poor appetite and weight loss, fever, fatigue, arthritis, eye inflammation, skin disorders, inflammation of the liver or bile ducts, and delayed growth or sexual development in children Varies inversely with the discrepancy between practical support expected and received from significant others (family, friends and colleagues at work). Results showed that the average discrepancy varied from 0 to 7 on the 7-point scale. The above findings suggest that for disclosure as Y (the response variable), the logic of predictor variable selection is as follows: Predictor Variable Anticipated Sign Reasoning ILLC (Severity at current job) >0 The more severe the symptoms of IBD on the job, the more the pressure to disclose. Status Read More