Examining the Predictive Validity of Moral Distress Theory in the Context of Social Work in Times of National Crisis: An Explanatory Model on a Nation-Wide Representative Sample

Background and Purpose: Social workers' health is an essential factor of service quality. Literature concerning social workers' stress and health focused mainly on personal and organizational-level predictors, while studies on the contribution of contextual factors are scarce. The present study aims to address this research gap by examining the predictive validity of moral distress theory in the context of a national crisis caused by the COVID-19 pandemic. The innovative aspect of the estimated model is examining moral distress predictors with contextual factors that were only limitedly examined in moral-distress research to predict work-related health problems. This study is one of the first attempts to incorporate multi-leveled factors within one explanatory theoretical model to predict work-related health problems among social workers.

Methods­ The nationwide sample included 2,542 active social workers between the ages of 22-57. The majority were women (91.3%) and union members (87%). The sample representatively included all types of social work services in Israel. Using closed and open-ended questions, we assessed work-related health problems, perceived stress, the impact of the COVID-19 pandemic on the provision of social services, job satisfaction, and the emotional impact of the COVID-19 outbreak on social workers. Quantitative data were analyzed using structural equation modeling analysis (SEM) and accelerated bias-corrected bootstrap analyses. Qualitative data provided in 1,443 text responses were analyzed using HebEmo algorithm to detect the emotions expressed in participants' answers. Frequencies of text fragments with emotion detections above a confidence score of .5 were analyzed.

Results: The variables explained 32% of the variance in work-related health problems. SEM provided support for the model: χ2 = .023, df = 2, p = .879, RMSEA = .016, NFI = .99, CFI = .99, and TLI = 1.0. Accelerated bias-corrected bootstrap analyses showed that perceived stress partially mediated the association between the negative impact of the COVID-19 pandemic on the provision of social services and work-related health problems (.097, 95% CI: .080, .113). Perceived stress also mediated the association between job satisfaction after the COVID-19 outbreak and work-related health problems (1.908, 95% CI: 1.368, 2.582), and the association between age and work-related health problems (-.143, 95% CI: -.185, -.104). Both job satisfaction and perceived stress mediated the association between the negative impact of the pandemic on the provision of social services and work-related health problems (.004, 95% CI: .002, .007). HebEMO generated a dataset of 10,265 text fragments indicative of one of the six emotions with a confidence score above 0.5. The dominant emotions were fear (26.5%), disgust (25.6%), and sadness (23.5%).

Conclusions and implications: The current study uncovers the contribution of contextual factors to social workers' moral distress and highlights the relationship of personal, organizational and contextual predictors in explaining social workers' job-related health problems. High levels of moral distress may jeopardize social workers’ ability to respond adequately to the needs of service users. Therefore, policymakers and employers should implement practical screening tools to monitor workers' exposure to job-related stress and provide readily available sources of support during times of national crisis.