The Impact of Work/Family Conflict (WFC) and Workplace Social Support on Mental Distress in Home Health Workers

Background and Purpose: With the aging of the population, the demand of direct care work has been substantially increased. As the members of the fastest growing direct care occupation, home health workers provide personal care services to frail older adults and enable them to live independently in their homes and communities. Despite their important contribution, home health workers have shown to be challenged by many job-related stressors. Among them, the present study focused on work/family conflict (WFC). Based on the stress buffering hypothesis (Cohen & Wills, 1985), we conceptualized WFC as a major stressor, mental distress as an outcome, and workplace social support as a coping resource. Various types of workplace social support, including support from clients, peers, supervisors, and an organization, were considered, and they were hypothesized to reduce the negative mental health consequences of WFC.    

Methods: Surveys with home health workers were conducted in a home care service agency located in Central Texas. Using both English and Spanish versions of the questionnaire, self-administered surveys were completed by 150 home health workers (response rate = 60.4%). Descriptive and bivariate analyses were conducted to examine the characteristics of the sample and explore associations among study variables. Multivariate regression model of depressive symptoms included testing of the direct impact of WFC and workplace social support, as well as their interactions. In order to maintain the sufficient ratio between the number of predictors and the sample size, each interaction term was entered separately.    

Results: The result of multivariate analysis showed that WFC increased mental distress (β = .46, p < .001). Among four different types of workplace social support variables, client support (β = -.24, p < .01) and organizational support (β = -.29, p < .01) emerged as significant factors. In addition to the direct effects, the interaction between WFC and client support (β = -.15, p < .05) was found to be significant. To further analyze the moderating effect, the sample was divided into low and high groups in terms of the level of client support. While the correlation between WFC and mental distress was substantial in the low client support group (r = .54, p < .001), no significance was observed in the high client support (r = .11, p > .05). The difference in the correlation coefficients between the groups (z = 3.00, p < .01) supports the proposed buffering hypothesis.          

Conclusions and Implications:  Findings confirm that WFC is a critical stressor that poses a risk to home health workers’ mental health. Previous studies suggest that specific types of supervision and leadership such as family-supportive supervision and transformational leadership can help reduce WFC. Such practice is called for in home health agencies. Given the importance of workplace support, management practices that can promote relationship with clients (e.g., communication training, supervision on the relationship with clients) are recommended. Finally, various strategies to provide organizational support that embraces various facets of the work conditions should be sought for mental well-being of the workers.