Vol.5, No.10, 1659-1666 (2013) Health
Moderators of occupational pressure in female health
professionals—Individual differences and coping
Siew Yim Loh*, Kia Fatt Quek
Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; *Corresponding Author: syloh@um.edu.my
Received 8 July 2013; revised 8 August 2013; accepted 8 September 2013
Copyright © 2013 Siew Yim Loh, Kia Fatt Quek. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Individual differences and coping skills have
influential impacts on stress process by influ-
encing the eventual outcomes of the stressors,
contributing to either wellbeing, or illness and
negative experiences. The aim of this paper is to
explore the individual differences and coping
strategies of a cohort of women w ith health pro-
fessionals’ occup ational pressure. This is a cross-
sectional survey, informed by the transactional
model of stress and coping framework, and car-
ried out on women health professionals (n = 203)
from the Kuala Lumpur Hospit al. Multiple regres-
sions were conducted to examine the potential
moderators of stress. Women Health Profes-
sionals reported stress with six out of eight or-
ganizational sources of pressure, with relation-
ship being a key stressor. Their individual dif-
ferences (mean + SD) were characterised by low
drive (7.6 + 1.9 - 8.2 + 2.0), low personal influ-
ence (10.8 + 2.0 to 11.7 + 2.3), moderate control
(13.4 + 3.4 to 16.3 + 2.4), and high impatience
behaviour (19.1 + 3.8 to 20.4 + 3.3). With Coping
strategy, the Life-work-balance coping is a sig-
nificant positive predictor for five out of the nine
outcomes of occupational pressure [state of
mind (p < 0.001), level of resilience (p = 0.01),
level of confidence (p = 0.003), physical symp-
toms (p = 0.001) and energy level (p < 0.001)].
The findings show relationship as a key stres-
sor, with a less favourable pattern of individual-
differences and an over-reliance on lifework ba-
lance coping. Female health professionals, stre-
ssed at work, have an undesirable profile of in-
dividual difference and a coping strategies, sug-
gestive of attempts to balance the demands of
their dual work role. The increasing female into
the workforce, warrants more research to inform
stress management guideline to ameliorate stress
amongst those vulnerable workers. Future stu-
dies to examine individual differences of these
female-dominated professions across health
setting are needed to better inform the pressure-
at-work issues for the increasing Asian women
health professionals.
Keywords: Occupational Pressure; Women;
Individual Differences; Coping
Stress at work has been the number one reason behind
sickness from work, with more than two thirds of people
suffering from work-related stress [1]. Stress literature
showed that specific, enduring work-related stressful
experiences contribute to depression [2,3], predicted as
one of the three leading causes of burden of disease
worldwide [4-6]. Individual differences and variability
and/or reactivity may be an appropriate concept to un-
derstand and ameliorate work pressure and reduce its
debilitating effects [7]. The study uses the Transactional
Model of Stress and Coping framework to understand the
multi-factorial causes of work stress. Stress is mediated
by people’s appraisal of the stressor and, by the so-
cial-cultural resources at their disposal [7,8]. Significant
differences exist in terms of physical and psychological
wellbeing amongst the male and female workers [9,10].
Comic et al. [11] explain that role demands such as that
of being wife, mother and professional provoke role con-
flicts for female workers. In order to help female health
professionals manage work stress, an understanding of
their social and occupational role and the individual dif-
ferences is fundamental. These individual differences (i.e.
type-behaviour, level of patience, perception of control
and personal-influence) and coping strategies (i.e. prob-
Copyright © 2013 SciRes. OPEN ACCESS
S. Y. Loh, K. F. Quek / Health 5 (2013) 1659-1666
lem-focus and life-work balance) are influential in the
stress process. These explanatory variables should be
examined to inform individuals about their self-manage-
ment de-stressing skills. There are relatively less paper
describing these variables and/or how they impacted the
stress relationships, or what their key features are within
a certain organizational climate. This paper examines the
four variables within the individual differences, two cop-
ing strategies and social support of the female health
professional, and its relationship with the nine measures
of effect of occupational pressure.
2.1. Study Design and Sampling
Respondents for this survey were selected using clus-
ter sampling of all women professionals from the seven
health care professions in Kuala Lumpur Hospital (KLH),
a tertiary referral, government hospital under the Malay-
sian Ministry of Health. There were 233 females out of
the total 331 health professionals from the seven disci-
plines, which make up about 73% of the health profes-
sions workforce during the time this audit was carried
out. KLH is considered to be one of the biggest hospitals
in Asia, with 2502 beds and 7000 workers with almost
100 professions in various disciplines.
2.2. The Survey Instrument
The Pressure Management Inventory (PMI), a se-
cond-generation tool developed from the Occupational
Stress Inventory is a copyrighted tool for measuring
pressure at work [12]. It is based on a transactional
model of the stressor-strain relationship that identifies
three components of stress-sources, effect and compo-
nent of relationship (i.e. individual differences and cop-
ing strategies). The 145 items PMI requires about 20
minutes to complete, and covers all aspects of the pres-
sure-strain relationship (Figure 1). In the PMI, the eight
sources of pressure interact with the moderators (i.e. type
of behaviour, control, coping and support), with the
eventual occupational outcomes. The individual differ-
ences includes: 1) Type A Behaviour, as measured by a)
drive—to succeed and achieve results, and b) patience-
impatience—pace of life and ability to cope with the
need for urgency); 2) Influence and control, as meas-
ured by a) control—the extend one feel able to control
events) and b) personal Influence—how much influence
one has over work and are able to exercise discretion in
one’s job.
Sour ces o f Pr essur e
Organisational climate
Personal responsibility
Managerial role
Home work balance
Daily Hassles
Individual differences
1.Typ e A Behavi our
2. Influence and control
-Personal Influence
Problem Focus coping
Life-Work Balance coping
Social Support
- Job Satisfaction
- Organisational Satisfaction
- Organisational Security
- Organisational Commitment
Mental wellbeing:
- State of Mind
- Resilence
- Confidence level
Physi ca l w ellbeing:
- Physical Symptoms
- Energy Levels
Figure 1. The Pressure Management Inventory: transactional view of the processes; Adapted from Resource Systems, Harro-
gate, UK (1996).
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S. Y. Loh, K. F. Quek / Health 5 (2013) 1659-1666 1661
The Coping Strategies consist of two types: 1) Prob-
lem Focus coping—the extend one is able to plan ahead
and manage time to deal with problems) and 2) Life-
Work Balance coping—the extend one is able to separate
home from work and not let things gets to oneself). So-
cial Support refers to the help one gets by discussing
problems or situations with other people. The instrument
have been validated and showed good internal consisten-
cies (alpha < 0.7) for most subscales. The test-retest cor-
relation coefficients were significant at the level of p <
0.001 for almost all scale. The ICC coefficients were also
high (>0.7) particularly for Pressure, Health and Coping
Scales (Loh, 2004).
2.3. Data Collection
Upon ethical approval from the Kuala Lumpur Hospi-
tal Ethics Committee, briefings were conducted on the
key representatives of seven health disciplines (Occupa-
tional Therapy, Physiotherapy, Medical Laboratory
Technology, Medical Dispenser, Radiotherapy and Ra-
diography and Counselling, and Social work), to explain
the purpose of the study. Confirmation of the where
about of the health professionals were checked with the
census obtained from the human resource office of each
individual department. From the list, the female health
professionals were identified and those servicing outside
the Hospital premise were excluded to ensure the pres-
sure was within the organisation. The women were in-
formed of the study and were given the consent form.
Those who signed the consent form were followed up
with the PMI questionnaire.
2.4. Data Analyses
Data analysis was performed using the SPSS version
16 (SPSS Inc., Ill., Chicago, USA. Statistical tests such
as descriptive statistic, analyses of variance, independent
t tests, correlations and analyses of variance (ANOVA)
were used. Multiple linear regressions were performed to
examine the variables on the individual differences as
predictors of the effect of occupational pressure as (Fig-
ure 1).
3.1. Psychometrics of PMI
All items on the stressors, and outcome were found to
be statistically significant. In the influential item vari-
ables variable, only individual differences (r = 0.12, p >
0.05) was not found to be significant. The Cronbach Al-
pha (internal consistencies) of 0.7 and above was noted
for most scales (except for job satisfaction, α = 0.61, type
A drive, α = 0.62; patience-impatience, α = 0.21; social
support, α = 0.59) suggesting the reliability of most of
the scales are acceptable. This supports most subscales
met the required coefficient of 0.7 and above [13]. Items
such as social support (0.59), type A (0.62), patient im-
patience (0.21) and control (0.64) were all below 0.7, and
thus have to be interpreted with caution. The panel of six
psychiatrists provided the consensus that the PMI has
face validity. However, in terms of content, the panel
concurred that the PMI may pose some difficulty for the
average Malaysian because of some of the ambiguous
and difficult wordings in the PMI. This was the reason
why PMI was supplemented with a Malay version. In
addition, in term of appropriateness for measuring occu-
pational pressure of female, the panel also highlighted
some women-specific health-related issues and home-en-
vironment issues that were not highlighted in the PMI.
However, this was not included in this study where PMI
was used.
3.2. Socio-Demographic Characteristic of
Female Health Professionals
Table 1 showed the response rate of the various pro-
fessions this study, while Table 2 showed the demo-
graphic background of the women. The seven profes-
sions comprising of 330 workers, out of which, 72% are
female workers. The response rate for this survey was
84% (Table 1). Non respondents also included those
who were on leave and those servicing outside the HKL
premise. About 68% were within the age range of 20 - 39
years old. Almost 80% were assigned to the lowest grade
-basic entry grade (U8) within the profession. Thus, only
20% are holding the higher managerial tasks of oversee-
ing these 80% workforce. In terms of ethnic group, the
majority (82%) were Malays followed by the Chinese,
Indians, Sikh, Eurasians and Others. About 60% were
married and about half of these married women have
children. Overall, only 27% claimed to engage in some
form of regular exercise at least three days a week.
3.3. The Occupational Pressure of Women
Health Professionals
Tabl e 3 shows the mean scores for all the five group-
ings of profession. Three stressors-relationship, per-
sonal responsibility and organizational climate were
rated consistently as the highest stressors across these
professions. Standardization of mean-score of the stress-
sor over the number of items within the scale, were
computed to describe the ranking of stressors within the
seven professions. The top three work stressors within
the five clusters of professionals were presented in Table
3. Three stressors (relationship, personal responsibility
and organizational climate) were rated consistently high
across the various professions. There were significant
differences in five of the eightsources of pressure, across
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S. Y. Loh, K. F. Quek / Health 5 (2013) 1659-1666
Table 1. Response rate of the various professions.
Profession Total (Male & female) Female (n) % female in professionEligible female
% Response rate
within profession
Medical dispensers 63 46 73% 43 94%
Medical technologists 109 70 64% 66 94%
Radiotherapist 42 27 64% 27 100%
Radiographer diagnostic 60 43 72% 25 58%
Physiotherapists 38 35 92% 28 80%
Occupational/ Social
Welfare/Counsellors 18 15 83% 14 93%
Total 330 238
72% 203 Overall response
rate 84%)
Table 2. Background of Female health professionals (n = 203).
N = 203 n %
20 - 29 91 44.8
30 - 39 50 24.6
40 - 49 52 25.6
Age Group
50 - 59 10 4.9
U5 (Supervisor) 7 3.5
U6 (Section supervisor) 7 3.4
U7 (senior therapist) 28 13.8
Job Grade
U8 (junior therapist) 160 78.8
Malay 147 72.4
Chinese 36 17.7
Indian 14 6.9
Others 6 3.0
Married 118 58.1
Single 81 39.9
Marital status
Others 4 2.0
<12 yrs only 49 24.1
>12 yrs only 19 9.4
No of Children
Both age groups 27 13.3
Yes 55 27.1
Exercise Status No 148 72.9
the profession. These were recognition (p < 0.001), or-
ganisational climate (p = 0.001), personal responsibility
(p = 0.002), managerial role (p = 0.016) and daily hassle
(p = 0.007). The Occupational therapists, social welfare
and counsellor cluster reported the highest significant
pressure from recognition, personal responsibility and
managerial role, whilst the radiographers reported the
highest significant pressure from organisational climate
and daily hassles. Post hoc test showed that the radiog-
rapher-therapy group had significantly higher stressors
compared to the medical laboratory technologists for
recognition (p < 0.001), and daily hassles (p = 0.007),
and compared to medical dispenser for stressor with or-
ganisation climate (p = 0.002).
In terms of demographics, between the exercisers (n =
54) and non-exercisers (n = 148)—the sources of pres-
sure were significantly lower for exercisers compared to
non exercisers for all sources except for relationship and
personal responsibility. Between the married (n = 118)
and single (n = 85)—sources of pressure were signifi-
cantly different only for personal responsibility (p =
0.043) and for home-work balance (p = 0.004). There
were, however, no significant difference between those
with children and those without children.
3.4. Individual Differences
Table 4 showed the differences in the mean-scores of
individual differences and coping strategies of the five
professions. The differences across professions was sig-
nificant on job-control (p = 0.001), a key item of indi-
vidual differences. The Occupational therapist, counsel-
lor and social worker cluster recorded the highest mean
score for job control (16.3 + 2.4) whilst the medical dis-
pensers (13.4 + 3.4) and radiographer and radiotherapist
(14.7 ± 3.0) had the lowest scores for job control.
Among the demographic variables, job grades, age and
marital status were found to be statistically significant in
the effect of occupational pressure. Between the lower
and higher job grades, there were higher ratings for those
with higher job-grade on items like personal influence (p
= 0.013) and life work balance (p = 0.03). Between
age-groups, there were significant difference in the level
of impatience (p = 0.013) and problem focus copings (p
= 0.034). The younger group displayed higher scores on
impatience and lower scores on problem-focus copings.
With marital status, there were significant difference in
drive (p = 0.016), personal influence (p = 0.001) and
problem focus coping (p = 0.03). The means scores
showed that the divorcee had higher control, personal
influence and problem focus coping compared to either
the married or the single group. Post hoc analysis
showed personal influence to be statistically significant
amongst the divorcees compared to single women (p =
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S. Y. Loh, K. F. Quek / Health 5 (2013) 1659-1666 1663
Table 3. Occupational stressor of female health professionals (n = 203) (Mean and SD).
Individual cluster of Professions Sig*
[Mean ± SD]
RG/RT (n = 53)
[Mean ± SD]
MD (n = 43)
[Mean ± SD]
PT (n = 26)
[Mean ± SD]
OT, SW & C (n = 15)
[Mean ± SD] ANOVA
Workload 17.8 ± 5.1 19.3 ± 5.3 17.3 ± 6.2 19.2 ± 6.2 18.9 ± 6.8 0.360
Relationship 29.0 ± 7.5 32.1 ± 6.1 30.2 ± 7.7 28.7 ± 7.1 29.5 ± 8.7 0.001*
Recognition 11.6 ± 3.8 14.4 ± 4.0 12.7 ± 3.2 14.3 ± 2.9 15.2 ± 4.1 0.002*
Personal Responsibility 13.5 + 3.8 16.0 ± 3.7 13.4 ± 5.2 15.4 ± 4.1 16.3 ± 4.0 0.016*
Managerial role 7.0 + 2.8 8.4 ± 3.8 7.2 ± 4.1 9.1 ±3.2 9.3 ± 4.5 0.001*
Organisation Climate 13.6 + 4.0 15.8 ± 3.3 13.0 ± 3.8 13.6 ±3.3 15.7 ± 3.6 0.016*
Home-work balance 16.3 + 5.8 17.8 ± 5.1 17.4 ± 6.2 18.4 ±5.6 18.3 ± 5.8 0.458
Daily Hassles 11.8 + 3.0 13.7 ± 3.0 12.2 ± 3.0 13.4 ±3.1 12.3 ± 3.4 0.007*
MLT = Medical technologist; RG-RT = radiographers-radiotherapists; MD = medical dispensers; PT = physiotherapists; OT, SW & C + Occupational therapists,
social workers and counsellor; * = significant.
Table 4. Descriptive influential item variables variables (Mean and SD) across the professions.
(n = 203) Individual cluster of Professions Sig*
Influential item
variables Mean ± SD MLT (n = 66)
Mean ± SD
RG & RT (n = 53)
Mean ± SD
MD (n = 43)
Mean ± SD
PT (n = 26)
Mean ± SD
OT, SW & C
(n = 15)
Mean ± SD
(bet’ groups)
Individual differences
Type A Drive 7.9 ± 2.2 8.2 ± 2.0 8.0 ± 2.3 7.6 ± 1.9 8.0 ± 1.8 7.8 ± 3.3 0.64
Patience-impatience 19.6 ± 3.4 19.3 ± 3.2 19.1 ± 3.8 20.2 ± 3.5 20.4 ± 3.3 19.7 ± 2.3 0.35
Control* 14.8 ± 3.1 15.3 ± 2.7 14.7 ± 3.0 13.4 ± 3.4 15.3 ± 3.2 16.3 ± 2.4 0.01*
Personal Influence 11.1 ± 1.9 10.8 ± 2.0 11.2 ± 1.8 11.1 ± 2.0 11.3 ± 1.8 11.7 ± 2.3 0.58
Coping scales
Problem focus 24.7 ± 3.8 24.8 ± 4.0 24.4 ± 3.1 24.1 ± 3.9 25.3 ± 4.1 25.7 ± 4.9 0.54
Lifework balance 17.6 ± 3.1 17.4 ± 3.0 18.1 ± 2.9 17.1 ± 3.3 17.7 ± 3.3 17.7 ± 2.8 0.65
Social support 11.9 ± 2.5 11.7 ± 2.3 12.1 ± 2.0 11.4 ± 3.0 12.3 ± 2.0 12.7 ± 2.9 0.32
MLT = Medical technologist; RG & RT = radiographers-radiotherapists; MD = medical dispensers; PT = physiotherapists; OT, SW & C + Occupational thera-
pists, social workers and counsellor * = significant.
Table 5 showed result of multiple linear regression
analyses on variables conducted on each of the nine ef-
fects of pressure. Overall, the variables account for 20%
- 30% variation of the combined variables for each of the
eight effects of pressure. Only the “physical symptoms”
variable have the lowest (14%) variation accounted for
the outcome.
Of the four individual differences items, the item
“Control” was found to be statistically significant and
has a positive relationship with three out of nine effect of
occupational pressure [i.e. organisational satisfaction,
organisational security, and energy level (p < 0.007)].
The variable, “impatience” was significantly and nega-
tively associated with job satisfaction, state of mind and
level of confidence (p < 0.007).
Across the three coping scales, the ‘life-work-balance’
coping was found to be an key factor for four out of the
nine outcomes of occupational pressure amongst these
female cohort. This item was a significant predictor of
state-of-mind (B = 0.326, p < 0.001), level of confidence
(B = 0.226, p = 0.003), physical symptoms (B = 0.259, p
= 0.001) and energy level (B = 0.374, p < 0.001). The
other coping style, the problem-focus coping was a sig-
nificant predictor of level of resilience (B = 0.356, p <
0.001), and of organisational commitment (B = 0.193, p
< 0.001). Personal influence was the only positive sig-
nificant predictor for organisational commitment (B =
0.32, p = 0.002).
The survey unravelled the occupational pressure of
female health professionals (mid level positions) in a
large medical-model hospital-based organisation. Two
out of the five groups of health professions surveyed
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S. Y. Loh, K. F. Quek / Health 5 (2013) 1659-1666
Table 5. Unstandardised (B) and standardised (β) regression coefficients: explanatory and effect.
Unstandardized Coefficients
variables/(IV) B 95%CI for B SE
  t P value** Effect of Pressure DV
Impatience 0.203 0.35; 0.02 0.087 0.159 2.31 0.0017 Job satisfaction R2 = 0.240
Control 0.572 0.35; 0.76 0.106 0.372 5.41 0.001
Organisation Satisfaction
R2 = 0.22
Control 0.390 0.26; 0.53 0.068 0.374 5.76 0.000
Organisation Security
R2 = 0.30
Personal influence 0.19 0.07; 0.31 0.51 0.06 3.32 0.001 Organisation Commitment
R2 = 0.24
Problem focus Coping 0.32 0.12; 0.51 0.10 0.22 3.17 0.002
Impatience 0.366 0.54; 0.21 0.086 0.284 4.25 0.000 State of Mind
Life-work balance Coping 0.464 0.26; 0.66 0.104 0.326 4.46 0.000 R2 = 0.28
Problem focus Coping 0.252 0.16; 0.38 0.057 0.356 4.39 0.000 Level of Resillience R2 = 0.23
Impatience 0.218 0.03; 0.13 0.060 0.30 4.46 0.003 Level of Confidence
Life-work balance Coping 0.197 0.06; 0.31 0.065 0.209 2.83 0.001 R2 = 0.22
Life-work balance Coping 0.284 0.12; 0.45 0.085 0.259 3.34 0.001 Physical symptoms R2 = 0.14
Control 0.337 0.17; 0.51 0.085 0.265 3.948 0.007 Energy Level
Life-work balance Coping 0.478 0.29; 0.66 0.093 0.374 5.134 0.000 R2 = 0.24
β = Standardized coefficients; **p < 0.007 (with Bronferonni adjustment).
demonstrated consistent highest scores suggesting high
stress. The first group, the Occupational therapist so-
cial-worker and counsellor group reported highest pres-
sure from recognition, personal responsibility and man-
agerial role, whilst the second group, i.e. the radiogra-
phers (RG-RT) reported highest pressure from organ-
isational climate and daily hassles. The OSC group
showed high rating for personal-control (16.3, p = 0.001)
and personal-influence, and the RG-RT group showed
high reliance on life-work balance coping. The OSC
group are younger in the history of the Malaysian Health
care delivery system and it also has the lowest number of
personnel. This scenario of a bottle neck situation in
terms of lack of job promotion, where only an over-
whelmingly few can attain the higher grade suggest a
lack of career advancement which may contribute to the
pattern of unfavourable individual differences found in
this cohort. With two-thirds of Malaysian civil servants
being women [14], and as the number of female workers
is still on the rise, the organisation must look at ways to
advance the career of the female workers, and minimise
stress from this source.
Overall, the profile of group individual-differences are
characterised by low drive and high impatience. These
individual differences suggest a type-A disposition of
high impatience which aggravates work stress and a low
drive which promotes burnt out [15]. Hostility, a trait of
type A, has been linked to coronary heart disease [16],
whilst individual differences relating to coping (or use of
emotional, cognitive, and/or behavioural strategies to
manage one’s stress) can reduce harmful impact on psy-
chological adjustment [8,17,18]. Research evidence show-
ed that high levels of satisfaction, commitment, security
(reflecting high control and influence) were negatively
correlated with high pressure and the impatience dimen-
sion of Type A [12]. A low job-control has been demon-
strated by Karasek (1985) to cause pressure at work and
contributes to low mental well-being. Thus, it would au-
gur well for health organisations to consider organiza-
tional strategies that can provide more job control and
personal influence to these mid-level health professionals
whose professional autonomy seems violated within the
medical model delivery in Asia.
In this study, three general coping types—problem fo-
cus, life-work balance and social support were studied
here. Specific coping strategies such as problem-focused
coping or emotion-focused coping have been used to
facilitate lifestyle practices of stress management [19,20].
It has been found that the use of coping strategies is in-
fluenced by personality [21], and also by the type of en-
Copyright © 2013 SciRes. OPEN ACCESS
S. Y. Loh, K. F. Quek / Health 5 (2013) 1659-1666 1665
vironment [22]. This study found that the female profes-
sionals rely a lot on life-work balance coping which has
a significant positive relationship with four out of the
nine outcomes of work pressure.
This study found that women professionals with low
confidence, low resilience and low energy level are in-
clined to resort to high social support strategy. Studies
have showed that in self perceived stress is an indicator
of psychosocial impairment at the workplace [7]. Also,
in times of stress, women tend and befriend rather than
fight or flight [23], whereby the use of social support is a
critical coping resource for women [24]. Evidence sug-
gest that social support with qualities of hardiness
(commitment and control) can moderate the relationship
between stress and depression [25]. Drawing from recent
finding on women and stress, researchers suggest that
women displayed a “tend and befriend” rather than
“fight-or-flight” behaviour [26,27]. This finding have
implications on intervention program to ensure that skills
on getting support and maintaining support should be
incorporated into the stress management program par-
ticularly for women with low confidence, low resilience
and low energy level. A strategy to increase organisa-
tional commitments is to improve the personal influence
of these women health professionals; whilst to increase
organisational satisfaction, organisational security and
energy levels, women perceived themselves as having
high job control over their work do perform better.
There is an unfavourable pattern of individual differ-
ences (characterized by low-drive or low desires to suc-
ceed and achieve results), and this does not augur well
for the occupational performance of the workers nor of
the hospital organization. Job reorganizations involving
increasing employee influence and increased job-control
were less frequently practice for women and older work-
ers [28], but may be so pertinent in Asian health care
organisations, a sector largely led by male medical clini-
cians who are predominantly, the hierarchical and auto-
cratic decision makers.
Lastly, this paper raises other interesting questions re-
garding items of stress response, such as social support
which showed a tendency towards significance item
pressure for four outcomes of pressure. The critical query
remains, do women fair better with social support be-
cause of the tend-and-befriend stress response [23], since
it has a negative relationship to four of the outcomes of
pressure. As more and more women today need to bal-
ance home and work roles, rehabilitation strategies
should be put in place to ameliorate women stressed at
work, and to identify which subgroup are most vulner-
able in order to provide preventive strategies? The find-
ing support the view that individual differences play a
role in the function of job control [28,29], although the
role of self efficacy and its relationship to the de-
mands-control model needs to be further studied. Future
studies should look at comparison with males staff even
thought there are relatively fewer males in this mid
management jobs. It would also be interesting to do mul-
tisite studies on various hospitals to determine if stress is
significantly different.
Occupational pressure may be a characteristic burden
in the middle management positions that needs to incor-
porate strategies directed at individuals, or at the organi-
sation as a whole. Individual differences (particularly the
level of perceived job-control) and the use of coping
strategies (particularly life-work balance) were signifi-
cant items of occupational pressure of female health
professionals. The findings suggest that individual dif-
ference act as key correlate to work pressure, with an
unfavourable pattern of individual-differences found in
these middle management health professionals. Regular
audit of Occupational Pressure should be set up so that
any evaluation can be carried out immediately or annu-
ally for detecting, monitoring and intervening occupa-
tional pressure of these middle management health
workers. A comprehensive understanding of the transac-
tional process of stress is needed to understand the spe-
cific pressure of female health employees within the
healthcare delivery system, in order to implement user-
friendly policy to enhance occupational and organisa-
tional performance and wellbeing at work
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