DOES ORGANIZATION MATTER - A MULTILEVEL ANALYSIS OF THE DEMAND-CONTROL MODEL APPLIED TO HUMAN-SERVICES

The demand-control model (DC model) in occupational epidemiology sugge sts that health, an individual attribute, is partly determined by work organization, via the interplay of demand and control, job strain. Th e objective of this study was empirical assessment of the model's tene t of an organizational determination of individual health. An emerging analytic method, multi-level modelling, permits such an assessment Th e study encompasses two large Swedish human service organizations. It was based on a nationally representative sample of 291 local organizat ional units (level 2) with 8296 employees (level 1), a median of 18 em ployees per unit. 5730 persons (69.1%) completed the questionnaire. Li stwise deletion of missing data left a net study base of 4756 individu als in 284 units. Missing data were largely random. Demand and control were measured by standard questions and combined into a job strain in dex. Two such indices were calculated, one for quantitative demands an d one for emotional demands. Individual attributes included age, gende r, marital status, having children, social anchorage, and education. T here were two dependent variables, self-assessed psychovegetative symp toms (worry, anxiousness, sadness, sleep difficulties, restlessness, a nd tension) and exhaustion (fatigue, feelings of being used up and ove rworked), both measured as summative indices. For psychovegetative hea lth, a null model yielded 2.2% level 2 variance, unchanging when indiv idual attributes were included in a random intercepts model. Inclusion of the strain variables rendered level 2 variance non-significant, de creasing level 1 variance by 23% and level 2 variance by 62%. For exha ustion, level 2 variation was 8.3% in the null model and 1.6% in the f inal model, with strain variables. The strain variables utilized in th e DC-model thus draw a substantial part of their variation from the or ganizational level. It is concluded that the claim of the DC model to rely on organizational factors receives support. Copyright (C) 1997 El sevier Science Ltd