Professor Shereen Hussein recently completed an RfPB funded project focused on developing a scale of care work-related quality of life. The project ran from September 2019 to December 2021, led by Professor Hussein, collaborating between the London School of Hygiene and Tropical Medicine and the University of Kent.

Long-term care (LTC) work is characterised by unfavourable working conditions, including poor wages, insecure contracts and increasingly fragmented working arrangements. A significant number of workers leave their jobs every year, and levels of stress and burnout are concerning. While some scales measure well-being at work, they do not examine the impact of care work on workers’ own quality of life, which seems critical to workers’ well-being and motivation. 

LTC describes a range of activities to support people who need personal and social care including older people and adults living with disabilities. LTC roles include social work, personal care and practical support for adults with a physical disability, a learning disability, or physical or mental illness, as well as support for their careers. The sector has been experiencing many long-standing challenges, which have been exacerbated during the COVID-19 pandemic. These challenges include limited access to publicly funded services, a fragmented care market, demographic trends increasing demands and the inability to attract and retain a sufficient supply of care workers.

A body of literature highlights the emotional nature of social care work with potential implications on the quality of life of workers. More generally, staff quality of life at work has been recognised in organisational studies as a key influencer on individuals’ health and work performance and organisational functioning. For care staff, their wellbeing is perceived to be further associated with the delivery and quality of care. Social care staff are particularly vulnerable to low levels of quality of life (QoL) at work, due to both the nature of the work as well as situational factors such as unfavourable working conditions. Care work is emotionally taxing and is linked to both emotional and physical stress and burnout. Additionally, how social care is generally structured and delivered includes increased fragmentation of work and persistently low wages. QoL at work is also linked in the literature as one of the factors that contribute to the social care sector’s high turnover and vacancy rates.

QoL at work, as a concept, has been extensively explored in the organisational psychology and management literature. It comprises various elements such as affective, behavioural and cognitive components, and includes positive and negative emotion, competence, integrative functioning and autonomy. There are various scales developed to measure these components, with particular attention in the organisational psychology literature to the ‘affective’ QoL at work. Despite these developments and attempts to measure QoL at work, there is a lack of validated, applicable, and sensitive scales to measure care work-related quality of life (CWRQoL). Such measure would recognise the common aspect of care work with other sectors as well as the specific nature of social care, such as the time needed to build relations. This gap in knowledge is due to several factors but paramount among them is the complex nature of care work itself. This requires a holistic scale that captures both the positives and the negatives of care work with adults and older people within specific organisational and delivery arrangements and structures. 

Aims

The aim of the research is to begin the development of a work-related quality of life scale that is specific to the nature and context of adult social care. To develop this new tool, the first stage and the focus of this project, is to determine the constructs of a scale measure of care work-related quality of life that are relevant to staff working in long-term care.

The objectives of this research are:

RQ1. Develop a conceptual framework for the scale through a deductive process – review and appraising current wellbeing at work scales – and an inductive process through primary data collected from care workers, managers, care users and other stakeholders. 

RQ2. Identify and content validate key domains and items necessary to construct a care work-related quality of life tool that is specific to the adult social care workforce in England.

RQ3. Identify potential ‘at work’ supporting mechanisms that are likely to improve care staff wellbeing.

RQ4: Investigate the benefits and challenges in the use of the scale in practice.

Methods

The research project adopted a multi-method approach, using deductive and inductive approaches, with the following activities: 

1. A systematic review of published studies and assessment scales of care staff wellbeing (drawing on formal and family carer quality of life measures) and organisational support mechanisms to enhance wellbeing at work. 

2. Interviews (n=16), focus groups (3 groups with n=11 participants) and written responses (n=2) gathering the views of frontline care workers (n=10), managers (n=7) and key social care stakeholders and policymakers (n=12) and explore the utility of a care work-related quality of life scale. 

3. An online survey (n=35) to explore the content validity of the proposed domains and items and reach a consensus on what would be important to include. 

Findings

Through the iterative stages in this study, we have identified domains, and items, that hold significance for participants in making sense of the concept CWRQoL. The domains of CWRQoL and their contained sub-domains and items vary, from those that are concrete and objective (such as employer characteristics) to abstract, subjective experiences (such as emotional wellbeing). Through their own effect and interactions, these domains formulate care workers’ CWRQoL. Drawing on findings from this study, we propose theoretical links that unite the domains of care workers’ CWRQoL within a dynamic construct; that is, one which varies with vary with time and experience:

At a particular time, a care worker’s work-related quality of life corresponds to their experiences of work tasks and interactions, determined by and rewarded within an employment context in which interacting emotional, physical, social and financial components of wellbeing are impacted in work life and non-work life, and potentially shape their engagement with care.

This definition integrates concrete aspects of the work while acknowledging the subjectivity of the overall construct and the inseparable relationship between wellbeing at work, wellbeing outside work, and possible impact on the work itself. It has the potential to distinguish between individuals within the same employment context and performing related job roles. We expand on this definition through a theoretical model constructed through an analysis of findings across the three study stages. The hypothetical paths commence with concrete employment and individual job factors, which are in a relationship with subjective factors of how the care worker experiences the work and the impacts it might have on them, with consequences for their QoL at work, in turn impacting on wellbeing in their non-work life. These paths do not assume positive or negative relationships; instead, they have the potential to vary between individuals and within individuals’ experiences. Furthermore, we identified two more areas of wellbeing that have been briefly discussed by the participants but might have further implications: social and environmental wellbeing.

Existing scales might be used to capture some of the domains related to the ‘care work organisation. However, tailored questions need to be developed to capture the specific nature of care work and how care is (or perceived to be) recognised. Furthermore, the manifestation of the three broad factors on workers’ quality of life at work appears to be specific to the context of care work.

Outputs

Hussein, S., Towers, A-M., Palmer, S., Brookes, N., Silarova, B., Mäkelä, P. (2022). Developing a Scale of Care Work-Related Quality of Life (CWRQoL) for Long-Term Care Workers in England. International Journal of Environmental Research and Public Health. 19(2): 945. https://doi.org/10.3390/ijerph19020945

Silarova, B.,  Brookes, N.,  Palmer, S.,  Towers, A.-M., &  Hussein, S. (2022).  Understanding and measuring the work-related quality of life among those working in adult social care: A scoping review. Health & Social Care in the Community,  00,  1– 28. https://doi.org/10.1111/hsc.13718

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Professor of Health and Social Care Policy, the London School of Hygiene and Tropical Medicine, UK

Shereen Hussein is a Professor of Health and Social Care Policy at the Department of Health Services Research and Policy (HSRP) at the LSHTM. She is a Co-Director of the PRUComm policy research unit. She is also an Honorary Professor at the University of Kent and King’s College London in the UK and the University of Southern Queensland in Australia.

Shereen is a demographer with expertise in labour-migration, sociology and economics. Her primary research revolves around ageing, family dynamics, migration and long-term care. Shereen has previously worked with the United Nations, the Population Council, the World Bank, and the League of Arab States. Her current research focuses on ageing demographics, long term care demand and migration within the UK and Europe and the implications on policy and practice.

Shereen has conducted extensive research on population ageing and its impact on long term care and health policy and practices in the UK, internationally and in the Middle East and North Africa (MENA) region. She has contributed to recent United Nations’ policy response to ageing in the region through collaboration with UN-ESCWA and directly providing expert consultations to several countries in the region including Turkey, Oman and Egypt. Shereen leads many large research projects on ageing and long-term care in the UK and contributes to a large project addressing responses to dementia in developing countries STRiDE. Shereen is the founder and lead of the MENARAH network.