Perceptions of wellness and burnout among certified athletic trainers: sex differences

Wellness Among Interventional Radiologists: Results From a Multidimensional Survey

RATIONALE AND OBJECTIVES

To evaluate wellness among interventional radiologists using a multidimensional survey.

MATERIALS AND METHODS

An anonymous 53-item survey, including 36 Perceived Wellness Survey (PWS) prompts, was created in Qualtrics (an online survey tool) to assess wellness among interventional radiology attendings and residents. The survey was open from June to September, 2022, 2 years into the COVID-19 Pandemic. The survey was distributed via Society of Interventional Radiology Forums, social media (Twitter, LinkedIn, and Facebook), and personal correspondence. PWS scores were categorized into Wellness Composite and subscores (physical, emotional, intellectual, psychological, social, and spiritual).

RESULTS

367 surveys were completed. 300 (81.7%) respondents were male and 67 (18.3%) were female. Respondents included attending physicians (297; 81.0%) and residents (70; 19.0%). Practice settings included academic (174; 47.4%), private (114; 31.0%), private-academic hybrid (62; 16.9%), and others (17; 4.7%). Mean Wellness Composite at academic centers (14.74 ± 3.16; range: 5.42-23.50) was significantly lower than at private (15.22 ± 3.37; range: 6.13-23.51) and hybrid (16.14 ± 2.47; range: 10.20-23.50) practices (p = 0.01). Respondents < 40 years old had significantly lower emotional wellness subscores compared to those ≥ 40 years old (4.34 ± 0.86 vs. 4.60 ± 0.87; p = 0.006). There were no significant differences between geographic regions in the United States, however, International respondents had significantly lower social and intellectual wellness (INT) subscores. Physical wellness subscore (4.00 ± 0.9) was significantly lower than the other subscores (4.59 ± 0.81) (p < .001). Overall mean Wellness Composite was 15.11 ± 3.13 (range: 5.42-23.51).

CONCLUSION

Overall self-reported wellness was lower among interventional radiologists practicing at academic centers. Interventional Radiologists < 40 years old and residents had lower emotional wellness, while international respondents had lower social and INT. Overall wellness scores were lower than prior PWS studies.

Energy Availability, Mental Health, and Sleep Patterns of Athletic Trainers

CONTEXT

Engaging in exercise and appropriate nutritional intake improves mental health by reducing anxiety, depression, and sleep disturbances. However, few researchers have examined energy availability (EA), mental health, and sleep patterns in athletic trainers (ATs).

OBJECTIVE

To examine ATs' EA, mental health risk (ie, depression, anxiety), and sleep disturbances by sex (male, female), job status (part time [PT AT], full time [FT AT]), and occupational setting (college or university, high school, or nontraditional).

DESIGN

Cross-sectional study.

SETTING

Free living in occupational settings.

PATIENTS OR OTHER PARTICIPANTS

A total of 47 ATs (male PT ATs = 12, male FT ATs = 12; female PT ATs = 11, female FT ATs = 12) in the southeastern United States.

MAIN OUTCOME MEASURE(S)

Anthropometric measurements consisted of age, height, weight, and body composition. Energy availability was measured through energy intake and exercise energy expenditure. We used surveys to assess the depression risk, anxiety (state or trait) risk, and sleep quality.

RESULTS

Thirty-nine ATs engaged in exercise, and 8 did not exercise. Overall, 61.5% (n = 24/39) reported low EA (LEA); 14.9% (n = 7/47) displayed a risk for depression; 25.5% (n = 12/47) indicated a high risk for state anxiety; 25.5% (n = 12/47) were at high risk for trait anxiety, and 89.4% (n = 42/47) described sleep disturbances. No differences were found by sex and job status for LEA, depression risk, state or trait anxiety, or sleep disturbances. Those ATs not engaged in exercise had a greater risk for depression (risk ratio [RR] = 1.950), state anxiety (RR = 2.438), trait anxiety (RR = 1.625), and sleep disturbances (RR = 1.147), whereas ATs with LEA had an RR of 0.156 for depression, 0.375 for state anxiety, 0.500 for trait anxiety, and 1.146 for sleep disturbances.

CONCLUSIONS

Although most ATs engaged in exercise, their dietary intake was inadequate, they were at increased risk for depression and anxiety, and they experienced sleep disturbances. Those who did not exercise were at an increased risk for depression and anxiety. Energy availability, mental health, and sleep affect overall quality of life and can affect ATs' ability to provide optimal health care.

Work-Family Conflict and Family Role Performance Among Collegiate Athletic Trainers

CONTEXT

Work-life balance continues to be a focal point of athletic training research, particularly due to the job challenges and demands of health care providers. Despite a large body of literature, much is still unexplored, especially in the area of family role performance (FRP).

OBJECTIVE

To examine the relationships between work-family conflict (WFC), FRP, and various demographic variables among athletic trainers employed in the collegiate setting.

DESIGN

Cross-sectional online survey.

SETTING

Collegiate setting.

PATIENTS OR OTHER PARTICIPANTS

A total of 586 collegiate athletic trainers (females = 374, males = 210, sex variant or nonconforming = 1, preferred not to answer = 1).

MAIN OUTCOME MEASURE(S)

Data were collected through an online survey (Qualtrics) in which participants responded to demographic questions and previously validated WFC and FRP scales. Demographic data were reported and analyzed for descriptive information and frequencies. Mann-Whitney U tests were performed to identify differences among groups.

RESULTS

Participants' mean scores were 28.19 ± 6.01 and 45.86 ± 11.55 for the FRP and WFC scales, respectively. Mann-Whitney U tests revealed differences between men and women for WFC scores (U = 344 667, P = .021). The FRP score was moderately negatively correlated with the WFC total score (rs[584] = -0.497, P < .001) and predicted the WFC score (b = 72.02, t582 = -13.30, P = .001). The Mann-Whitney U test demonstrated that married athletic trainers (47.20 ± 11.92) had higher WFC scores than those who were not married (43.48 ± 11.78; U = 19847.00, P = .003). Mann-Whitney U analysis (U = 32 096.00, P = .001) also revealed a difference between collegiate athletic trainers with children (48.16 ± 12.44) and those without children (44.68 ± 10.90).

CONCLUSIONS

Collegiate athletic trainers experienced more WFC with marriage and having children. We propose that the time required to raise a family and build relationships may cause WFC due to time incongruencies. Athletic trainers want to be able to spend time with their families; however, when such time is highly limited, then WFC increases.

Physical Activity and the Link Among Stress, Burnout, and Well-Being in Athletic Trainers

CONTEXT

Stress is a leading cause of burnout in working professionals, including athletic trainers (ATs). One consequence of burnout for ATs is lower perceptions of well-being, which have implications for mental and physical health. Physical activity is known to help reduce stress. Thus, activity may help reduce stress and burnout in ATs while enhancing well-being.

OBJECTIVE

To examine a theoretically based mediating model whereby leisure time physical activity was linked to subjective well-being by way of ATs' perceived stress and burnout.

DESIGN

Cross-sectional study.

SETTING

Online survey during the fall sports season.

PATIENTS OR OTHER PARTICIPANTS

Practicing certified ATs (N = 163; mean age = 30.5 ± 6.7 years).

MAIN OUTCOME MEASURE(S)

Via a secure link, participants completed a survey that measured leisure time planned physical activity, work-related stress, burnout, and perceived life satisfaction. Latent variable analysis was used to examine the hypothesized mediating model.

RESULTS

Minutes spent in moderate or vigorous activity were not associated with stress. Minutes spent walking were negatively associated with perceived stress (β = -0.18, P < .001). Stress was positively associated with exhaustion (β = 0.89, P < .001), negatively associated with personal accomplishment (β = -0.70, P < .001), and positively associated with depersonalization (β = 0.71, P < .001). Exhaustion was negatively associated (β = -0.57, P < .001) and personal accomplishment was positively associated (β = 0.31, P = .013) with well-being. Minutes spent walking were positively linked to well-being via stress and exhaustion. The negative relationship between stress and well-being was mediated by exhaustion and personal accomplishment.

CONCLUSIONS

Leisure time walking was indirectly and positively linked to well-being. Walking could be a strategy to reduce stress and burnout in ATs and thereby improve well-being.

Perceived Stress, Work–Family Conflict, and Burnout in Irish Certified Athletic Therapists

Burnout and its associated factors are a concern for U.S. athletic trainers, but no research has investigated it from an international perspective. We examined perceived stress, work–family conflict, burnout, coping, and self-care practices in Irish certified athletic therapists. Low burnout (41.0 ± 12.1) and moderate perceived stress levels (17.8 ± 6.2) were observed. Certified athletic therapists with children had significantly higher work–family conflict (p = .02, ) and time-based conflict (p < .001, ) than those without. Moderate resilient coping was noted (14.7 ± 2.5). Low burnout was found, likely due to the use of resilient coping strategies. Time was a limiting factor for both self-care and experiences of work–family conflict.

Age, Sex, and Years of Experience: Examining Burnout Among Secondary School Athletic Trainers

CONTEXT

Burnout is occurring in the athletic training profession. Although data on burnout are growing, the secondary school employment setting is often overlooked in research. With the employment of athletic trainers in the secondary school setting growing rapidly, a better understanding of burnout is warranted, as it has been linked to attrition.

OBJECTIVE

To better understand burnout among secondary school athletic trainers using the Copenhagen Burnout Inventory (CBI), with a particular focus on differences between men and women.

DESIGN

Cross-sectional survey.

SETTING

Secondary school athletic trainers.

PATIENTS OR OTHER PARTICIPANTS

Athletic trainers who work in the secondary school setting were recruited via email to participate in the online survey. A total of 572 (373 women, 195 men, and 4 unreported) responses were included after we filtered out incomplete responses.

MAIN OUTCOME MEASURE(S)

Participants were asked to complete an online survey, which consisted of demographic and workplace questions along with 3 scales (ie, Perceived Stress Scale, CBI, and Work-Family Conflict Scale). Nonparametric analysis was used to investigate the differences in scale scores between groups.

RESULTS

Participants reported a mean score of 40.1 (± 16.28) on the CBI scale. Women's scores were higher on the personal burnout subscale (t570 = 24.501, P ≤ .001), work-related burnout subscale (t570 = 11.347, P ≤ .001), and total CBI (t570 = 9.423, P = .002). Participants who were ≤30 years of age scored higher on the personal burnout subscale (t515 = 5.53, P = .019), work-related subscale (t515 = 7.812, P = .005), and total CBI (t515 = 4.194, P = .041). Those with ≤3 years of experience scored higher on the personal burnout subscale (t570 = 11.213, P ≤ .001), work-related burnout subscale (t570 = 6.557, P = .010), and total CBI (t570 = 4.722, P = .030).

CONCLUSIONS

Low levels of burnout are being reported among secondary school athletic trainers. Female athletic trainers experienced greater levels of burnout, as well as personal and work-related burnout. Early-career athletic trainers also reported higher levels of burnout, suggesting the need for more support during this time.

Work-Addiction Risk in Athletic Trainers and Its Relationship to Work-Family Conflict and Burnout

CONTEXT

Individual factors can affect numerous work-life interface outcomes, including work-family conflict and burnout. Recently, the concept of work addiction has been investigated as an individual factor that could affect numerous outcomes. Despite the large body of literature investigating work-family conflict and burnout in athletic training, little is known about the incidence of work addiction or its potential effect on these outcomes.

OBJECTIVE

To gather descriptive data on the work-addiction risk and examine the effect work addiction may have on work-life interface outcomes in athletic training.

DESIGN

Cross-sectional study.

SETTING

Online web-based survey.

PATIENTS OR OTHER PARTICIPANTS

Athletic trainers (ATs) employed in all work settings were recruited to participate via social media and email distribution lists. Data from 226 (n = 65, 28.8% males; n = 161, 71.2% females) ATs, currently employed in more than 13 work settings, were included in data analysis.

MAIN OUTCOME MEASURE(S)

The online questionnaire consisted of 4 main sections: demographic questions, work-family conflict scale, Copenhagen Burnout Inventory, and the Work Addiction Risk Test. We calculated Mann-Whitney U and Kruskal-Wallis tests to determine if group differences existed. Simple linear regressions were used to assess if work-addiction risk scores predicted burnout and work-family conflict.

RESULTS

The ATs experienced moderate levels of personal (55.0 ± 19.1) and work-related (50.0 ± 16.0) burnout and were at medium risk for work addiction (58.3 ± 11.2). No demographic differences were observed in burnout or work-family conflict scores, but these scores differed based on the work-addiction risk. Women were more at risk for compulsive tendencies than were men. Work-addiction risk scores predicted both burnout and work-family conflict, but only a relatively small percentage of the variability was explained.

CONCLUSIONS

Those ATs at higher risk for work addiction reported higher levels of burnout. Because of the medium risk for work addiction among ATs, work-addiction mitigation strategies should be implemented by individuals and organizations.

Perceived Stress as an Indicator of Work–Family Conflict and Burnout Among Secondary School Athletic Trainers

Burnout and work–family conflict (WFC) are stressors faced by secondary school athletic trainers, however, the concept of perceived stress and its relationship to burnout or WFC is not well understood. The purpose of this study was to investigate perceived stress’ relationship with burnout and WFC. Participants reported a WFC score of 40.36 (±15.63), low burnout (40.1 ± 16.28), and moderate stress (15.99 ± 7.02). Perceived stress predicted WFC, but not burnout (b = 1.13, t572 = 14.132, p ≤ .001). One’s level of perceived stress impacts WFC, which indicates higher stress will equal greater work–family conflict.

Energy Balance, Eating Disorder Risk, and Pathogenic Behaviors Among Athletic Trainers

CONTEXT

Research exists on energy balances (EBs) and eating disorder (ED) risks in physically active populations and occupations by settings, but the EB and ED risk in athletic trainers (ATs) have not been investigated.

OBJECTIVE

To assess ATs' energy needs, including the macronutrient profile, and examine ED risk and pathogenic behavioral differences between sexes (men, women) and job statuses (part time or full time) and among settings (college or university, high school, nontraditional).

DESIGN

Cross-sectional study.

SETTING

Free-living in job settings.

PATIENTS OR OTHER PARTICIPANTS

Athletic trainers (n = 46; male part-time graduate assistant ATs = 12, male full-time ATs = 11, female part-time graduate assistant ATs = 11, female full-time ATs = 12) in the southeastern United States.

MAIN OUTCOME MEASURE(S)

Anthropometric measures (sex, age, height, weight, body composition), demographic characteristics (job status [full- or part-time AT], job setting [college/university, high school, nontraditional], years of AT experience, exercise background, alcohol use), resting metabolic rate, energy intake (EI), total daily energy expenditure (TDEE), exercise energy expenditure, EB, macronutrients (carbohydrates, protein, fats), the Eating Disorder Inventory-3, and the Eating Disorder Inventory-3 Symptom Checklist.

RESULTS

The majority of participants (84.8%, n = 39) had an ED risk, with 26.1% (n = 12) engaging in at least 1 pathogenic behavior, 50% (n = 23) in 2 pathogenic behaviors, and 10.8% (n = 5) in >2 pathogenic behaviors. Also, 82.6% of ATs (n = 38) presented in negative EB (EI < TDEE). Differences were found in resting metabolic rate for sex and job status (F1,45 = 16.48, P = .001), EI (F1,45 = 12.01, P = .001), TDEE (F1,45 = 40.36, P < .001), and exercise energy expenditure (F1,38 = 5.353, P = .026). No differences were present in EB for sex and job status (F1,45 = 1.751, P = .193); χ2 analysis revealed no significant relationship between ATs' sex and EB ({\rm{\chi }}_{1,46}^2= 0.0, P = 1.00) and job status and EB ({\rm{\chi }}_{1,46}^2 = 2.42, P = .120). No significant relationship existed between Daily Reference Intakes recommendations for all macronutrients and sex or job status.

CONCLUSIONS

These athletic trainers experienced negative EB, similar to other professionals in high-demand occupations. Regardless of sex or job status, ATs had a high ED risk and participated in unhealthy pathogenic behaviors. The physical and mental concerns associated with these findings indicate a need for interventions targeted at ATs' health behaviors.

Work-Family Conflict of Collegiate and Secondary School Athletic Trainers Who Are Parents

CONTEXT

The work-life interface has been a much discussed and researched area within athletic training. The National Athletic Trainers' Association position statement on work-life balance highlighted the profession's interest in this topic. However, gaps in the literature remain and include the roles of time-based conflict and social support.

OBJECTIVE

To compare work-family conflict (WFC) and social support among athletic trainers (ATs) employed in the 2 most common practice settings.

DESIGN

Cross-sectional observational survey.

SETTING

Collegiate and secondary school settings.

PATIENTS OR OTHER PARTICIPANTS

A total of 474 (females = 231, males = 243) ATs who were employed in the collegiate (205, 43.2%) or secondary school (269, 56.8%) setting.

MAIN OUTCOME MEASURE(S)

Data were collected through a Web-based survey designed to measure conflict and social support. Likert responses were summed. Demographic information was analyzed for frequency and distribution. Independent t tests and Mann-Whitney U tests were calculated to determine group differences. Linear regression was used to determine if social support predicted WFC.

RESULTS

Social provisions and WFC were negatively correlated, and the social provisions score predicted WFC. No WFC differences (P = .778) were found between collegiate and high school ATs even though collegiate ATs worked more hours (63 ± 11) during their busiest seasons compared with those in the high school setting (54 ± 13, P < .001). Similarly, no difference (P = .969) was present between men and women, although men worked more hours. Our participants scored highest on time-based WFC items.

CONCLUSIONS

Work-family conflict was experienced globally in 2 of the most common athletic training settings and between sexes. This indicates WFC is universally experienced and therefore needs to be addressed, specifically with a focus on time-based conflict. In addition to time-management strategies, ATs need support from coworkers, peers, and family members.

Intention to Leave Emergency Medicine: Mid-career Women Are at Increased Risk

INTRODUCTION

Burnout is prevalent among emergency physicians and may cause physicians to consider leaving the practice of emergency medicine (EM). This study sought to determine whether there is a gender difference in reporting burnout and seriously considering leaving the specialty of EM, and secondarily to explore the factors reported as contributing to burnout.

METHODS

This was a secondary analysis of the 2014 American Board of Emergency Medicine Longitudinal Survey of Emergency Physicians. We used multiple logistic regression to determine which factors were associated with reporting serious consideration of leaving EM, when stratified by years in practice and adjusting for individual, departmental, and institutional factors.

RESULTS

The response rate was 82%, (n = 868); 22.6% (194) were female and 77.4% (664) were males; and 83.9% (733) White. The mean age of men responding was significantly higher than women (52.7±11.9 vs. 44.9±10.4, p<0.001). Overall, there were no significant gender differences in reporting having had serious thoughts of leaving EM in either unmatched or age-matched analyses. More women reported that burnout was a significant problem, while men more often were equivocal as to whether it was a problem. When stratified by years in practice, mid-career women had a seven-fold increase in the odds ratio (OR) of seriously considered leaving EM, compared to men of similar years in practice (OR 7.07, 95% confidence interval, 2.45-20.39). Autonomy at work, control over working conditions, fair compensation, personal reward, and a sense of ownership were factors associated with a lower rate of reporting considering leaving EM.

CONCLUSION

Our findings suggest that the intention to leave EM is not more prevalent in women. However, mid-career women more often reported seriously considering leaving the specialty than mid-career men. Further research on the factors behind this finding in mid-career women in EM is needed.

An Examination of Athletic Trainers' Occupational Recovery Experiences During Time After Work

CONTEXT

Although researchers have directed scholars toward investigating the effectiveness of the nonwork personal time of athletic trainers (ATs), no one has characterized the occupational recovery experiences of ATs.

OBJECTIVE

To examine the reliability and validity of the Recovery Experience Questionnaire (REQ) for use in AT populations.

DESIGN

Cross-sectional study.

SETTING

Web-based survey.

PATIENTS OR OTHER PARTICIPANTS

A total of 144 ATs (71 men, 73 women) working in a variety of National Collegiate Athletic Association sports across all levels of competition.

MAIN OUTCOME MEASURE(S)

The REQ was administered to assess the AT recovery experience.

RESULTS

Preliminary evidence emerged for the reliability (ω = 0.80-0.90) and validity of the REQ for use in AT populations. Weak linear relationships were identified between stress and perceptions of psychological detachment (r = -0.314, P < .001), mastery (r = -0.179, P = .32), control (r = -0.284, P = .001), and relaxation (r = -0.157, P = .06).

CONCLUSIONS

Our results support measuring and applying occupational recovery for AT stress and work-life balance. Given that occupational recovery as a construct was only weakly related to stress, it is clearly a unique and distinct variable worth considering within the work-life balance line of inquiry.

Athletic Trainer Burnout: A Systematic Review of the Literature

OBJECTIVE

To identify the causes, effects, and prevalence of burnout in athletic trainers (ATs) identified in the literature.

DATA SOURCES

EBSCO: SPORTDiscus and OneSearch were accessed, using the search terms athletic trainer AND burnout.

STUDY SELECTION

Studies selected for inclusion were peer reviewed, published in a journal, and written in English and investigated prevalence, causes, effects, or alleviation of AT burnout.

DATA EXTRACTION

The initial search yielded 558 articles. Articles that did not specifically involve ATs were excluded from further inspection. The remaining 83 full-text articles were reviewed. Of these 83 articles, 48 examined prevalence, causes, effects, or alleviation of AT burnout. An evaluation of the bibliographies of those 48 articles revealed 3 additional articles that were not initially identified but met the inclusion criteria. In total, 51 articles were included in data collection.

DATA SYNTHESIS

Articles were categorized based on investigation of prevalence, causes, effects, or alleviation of burnout. Articles were also categorized based on which subset of the athletic training population they observed (ie, athletic training students, certified graduate assistants, high school or collegiate staff members, academic faculty).

CONCLUSIONS

Burnout was observed in all studied subsets of the population (ie, students, graduate assistants, staff, faculty), and multiple causes of burnout were reported. Suggested causes of burnout in ATs included work-life conflict and organizational factors such as poor salaries, long hours, and difficulties dealing with the "politics and bureaucracy" of athletics. Effects of burnout in ATs included physical, emotional, and behavioral concerns (eg, intention to leave the job or profession).

National Athletic Trainers' Association Position Statement: Facilitating Work-Life Balance in Athletic Training Practice Settings

OBJECTIVE: 

To illustrate the concept of work-life balance and those factors that influence it and to provide recommendations to facilitate work-life balance in athletic training practice settings. To present the athletic trainer with information regarding work-life balance, including those factors that negatively and positively affect it within the profession.

BACKGROUND: 

Concerns for work-life balance have been growing within the health care sector, especially in athletic training, as it is continuously linked to professional commitment, burnout, job satisfaction, and career longevity. The term work-life balance reflects those practices used to facilitate the successful fulfillment of the responsibilities associated with all roles one may assume, including those of a parent, spouse, partner, friend, and employee. A host of organizational and individual factors (eg, hours worked, travel demands, flexibility of work schedules, relationship status, family values) negatively influence the fulfillment of work-life balance for the athletic trainer, but practical strategies are available to help improve work-life balance, regardless of the practice setting.

RECOMMENDATIONS: 

This position statement is charged with distributing information on work-life balance for athletic trainers working in a variety of employment settings. Recommendations include a blend of organizational and personal strategies designed to promote work-life balance. Establishing work-life balance requires organizations to have formal policies that are supported at the departmental and personal level, in addition to informal policies that reflect the organizational climate of the workplace. Individuals are also encouraged to consider their needs and responsibilities in order to determine which personal strategies will aid them in attaining work-life balance.

Prevalence and Outcomes of Exposure to Catastrophic Events Among Athletic Trainers

CONTEXT

Little is known about the prevalence of exposure to catastrophic events or how caring for athletes exposed to catastrophic events can influence burnout in athletic trainers (ATs).

OBJECTIVE

To assess (1) the prevalence of exposure to catastrophic events, (2) the levels of burnout among ATs who have been exposed to catastrophic events, and (3) the coping strategies they used.

DESIGN

Cross-sectional study.

SETTING

Online survey.

PATIENTS OR OTHER PARTICIPANTS

We invited 9881 certified members of the National Athletic Trainers' Association to participate in this study; 1007 surveys were completed, for a response rate of 10.2% (433 men, 572 women, and 2 who preferred not to answer the question).

MAIN OUTCOME MEASURE(S)

Participants completed an online survey to assess demographic information, exposure to a catastrophic event, and scores on the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and the Coping Inventory for Stressful Situations (CISS). Scores on the MBI-HSS (personal accomplishment, depersonalization, and emotional exhaustion subscales) and CISS (avoidance, task, and emotion-oriented subscales) were determined. Two multivariate analyses of variance (one for MBI-HSS and one for CISS) were conducted using the independent variable of group (catastrophic event and no catastrophic event). The α level was set at P < .05 for all analyses.

RESULTS

A total of 518 ATs (51.4%) reported providing care to athletes exposed to a catastrophic event and 489 (48.6%) did not. The group that reported providing care for athletes exposed to a catastrophic event had a significantly worse personal accomplishment score (46.1 ± 6.7) than the group that had never provided such care (44.6 ± 7.7; P < .05). The emotion-oriented score for those who had provided care for athletes exposed to a catastrophic event was 14.3 ± 4.8 versus 14.9 ± 4.2 for those who had not ( P < .05), indicating less use of emotion-oriented coping strategies.

CONCLUSIONS

The ATs who provided care to athletes exposed to a catastrophic event could be more likely to suffer from a lack of personal accomplishment and exhibit task and emotion-oriented coping behaviors.

Serotonin transporter gene (5-HTT) rs6354 polymorphism, job-related stress, and their interaction in burnout in healthcare workers in a Chinese hospital

OBJECTIVE

Many studies have reported that long-term exposure to job-related stress can lead to burnout, which may be influenced by genetic and environmental factors. Burnout correlates with depression. This study investigated whether one tag polymorphism rs6354 in 5-HTT gene modulated the influence of job-related stress on burnout in the medical professionals in a Chinese Han population, which to our best knowledge has not been explored.

METHODS

Seven hundred twelve subjects were recruited from a general hospital and measured for burnout symptoms using the Maslach Burnout Inventory (MBI), the stress using the House and Rizzo's Work Stress Scale, and the stressors using the Evers, Frese, and Cooper's Sources of Pressure Scale. The 5-HTT rs6354 polymorphism was genotyped in 376 subjects.

RESULTS

The majority of correlations between the work stress score or the six stressor scores and three burnout subscores were significant (all p < 0.05). There was no significant main effect of the 5-HTT rs6354 genotype on burnout symptoms; however, there was a statistically significant interaction between 5-HTT rs6354 and work stress on burnout (F = 5.08, df = 2, 369, p = 0.007). In the low stress group, G allele carriers had significantly higher burnout level than TT homozygote (F = 11.60, df = 1, 48, p < 0.001). On the contrary, in the high stress group, G allele carriers exhibited significantly lower burnout level compared to TT homozygote (F = 3.86, df = 1, 103, p = 0.025).

CONCLUSIONS

Our findings suggest that the 5-HTT rs6354 polymorphism may modulate the influence of job-related stress on burnout by adjusting serotonin transporter function and neurotransmission, showing that individuals with TT genotype displayed a greater susceptibility to both the detrimental effects of higher stress and the beneficial effects of lower stress compared to those with G allele, which supports the differential-susceptibility hypothesis.

Initial Validation of a Multilevel Model of Job Satisfaction and Career Intentions Among Collegiate Athletic Trainers

CONTEXT

  The constructs of job satisfaction and career intentions in athletic training have been examined predominantly via unilevel assessment. The work-life interface is complex, and with troubling data regarding attrition, job satisfaction and career intentions should be examined via a multilevel model. Currently, no known multilevel model of career intentions and job satisfaction exists within athletic training.

OBJECTIVE

  To validate a multilevel model of career intentions and job satisfaction among a collegiate athletic trainer population.

DESIGN

  Cross-sectional study.

SETTING

  Web-based questionnaire.

PATIENTS OR OTHER PARTICIPANTS

  Athletic trainers employed in National Collegiate Athletic Association Division I, II, or III or a National Association of Intercollegiate Athletics college or university (N = 299; 56.5% female, 43.5% male). The average age of participants was 34 ± 8.0 years, and average experience as an athletic trainer was 10.0 ± 8 years.

MAIN OUTCOME MEASURE(S)

  A demographic questionnaire and 7 Likert-scale survey instruments were administered. Variables were responses related to work-family conflict, work-family enrichment, work-time control, perceived organizational family support, perceived supervisor family support, professional identity and values, and attitude toward women.

RESULTS

  Exploratory factor analysis confirmed 3 subscales: (1) individual factors, (2) organizational factors, and (3) sociocultural factors. The scale was reduced from 88 to 62 items. A Cronbach α of 0.92 indicated excellent internal consistency.

CONCLUSIONS

  A multilevel examination highlighting individual, organizational, and sociocultural factors is a valid and reliable measure of job satisfaction and career identity among athletic trainers employed in the collegiate setting.

An Examination of Relationships Among Resiliency, Hardiness, Affectivity, and Work-Life Balance in Collegiate Athletic Trainers

CONTEXT:

A multilevel model has been used to describe the complex nature of work-life balance in sport organizations. Organizational aspects such as work scheduling, hours worked, job demands, and decreased perceived value have been reported as factors that can positively or negatively affect work-life balance. However, the individual factors that contribute to this balance have not been well studied.

OBJECTIVE:

To better understand the individual factors (emotional stability and coping) that may facilitate or inhibit work-life balance among athletic trainers (ATs).

DESIGN:

Cross-sectional online survey.

SETTING:

National Collegiate Athletic Association athletic training setting.

PATIENTS OR OTHER PARTICIPANTS:

A total of 423 (193 men, 230 women) ATs employed in the National Collegiate Athletic Association setting.

MAIN OUTCOME MEASURE(S):

Data were collected via a Web-based survey instrument consisting of demographic and Likert-scale questions related to resiliency, hardiness, affectivity, work-family conflict (WFC), and work-family enrichment (WFE). Likert responses were summed and demographic information was analyzed for frequency and distribution. Independent t tests, analysis of variance, and Spearman correlations were calculated to evaluate the relationships among variables.

RESULTS:

Participants exhibited moderate hardiness scores of 3.9 ± 4.0 (range, -9 to 15). Positive affectivity was weakly negatively correlated with WFC ( r = -0.212, P < .001) and moderately positively correlated with WFE ( r = 0.448, P < .001). Resiliency was weakly negatively correlated with WFC ( r = -0.25, P < .001) and weakly positively correlated with WFE ( r = 0.228, P < .001). Additionally, individuals with less than 10 years of experience had lower positive affectivity scores than those with more than 10 years of experience. Men scored higher than women only in resiliency.

CONCLUSIONS:

Collegiate ATs demonstrated moderate levels of coping behaviors that allow them to manage their personal and professional lives. Athletic trainers with more years of experience displayed a more positive affect.

Barriers to the Role of the Head Athletic Trainer for Women in National Collegiate Athletic Association Division II and III Settings

CONTEXT

Very few women assume the role of head athletic trainer (AT). Reasons for this disparity include discrimination, motherhood, and a lack of interest in the position. However, data suggest that more women seek the head AT position in National Collegiate Athletic Association Division II and III settings.

OBJECTIVE

To examine the barriers female ATs face as they transition to the role of head AT.

DESIGN

Qualitative study.

SETTING

Divisions II and III.

PATIENTS OR OTHER PARTICIPANTS

In total, 77 female ATs participated in our study. Our participants (38 ± 9 years old) were employed as head ATs at the Division II or III level.

DATA COLLECTION AND ANALYSIS

We conducted online interviews with all participants. They journaled their reflections to a series of open-ended questions pertaining to their experiences as head ATs. Data were analyzed following a general inductive approach. Credibility was secured by peer review and researcher triangulation.

RESULTS

Organizational and personal factors emerged as the 2 major themes that described challenges for women assuming the role of the head AT. Organizational barriers were defined by gender stereotyping and the "good old boys" network. Personal influences included a lack of leadership aspirations, motherhood and family, and a lack of mentors.

CONCLUSIONS

Female ATs working in Divisions II or III experienced similar barriers to assuming the role of the head AT as those working in the Division I setting. Stereotyping still exists within collegiate athletics, which limits the number of women in higher-ranking positions; however, a lack of desire to assume a higher position and the desire to balance work and home inhibit some women from moving up.

Navigating Motherhood and the Role of the Head Athletic Trainer in the Collegiate Setting

CONTEXT

Motherhood has been identified as a barrier to the head athletic trainer (AT) position. Role models have been cited as a possible facilitator for increasing the number of women who pursue and maintain this role in the collegiate setting.

OBJECTIVE

To examine the experiences of female ATs balancing motherhood and head AT positions in the National Collegiate Athletic Association Division II and III and National Association of Intercollegiate Athletics settings.

DESIGN

Qualitative study.

SETTING

National Collegiate Athletic Association Divisions II and III and National Association of Intercollegiate Athletics.

PATIENTS OR OTHER PARTICIPANTS

A total of 22 female head ATs (average age = 40 ± 8 years) who were married with children completed our study. Our participants had been certified for 15.5 ± 7.5 years and in their current positions as head ATs for 9 ± 8 years.

DATA COLLECTION AND ANALYSIS

We conducted online interviews with all participants. Participants journaled their reflections on a series of open-ended questions pertaining to their experiences as head ATs. Data were analyzed following a general inductive approach. Credibility was confirmed through peer review and researcher triangulation.

RESULTS

We identified 3 major contributors to work-life conflict. Two speak to organizational influences on conflict: work demands and time of year. The role of motherhood, which was more of a personal contributor, also precipitated conflict for our ATs. Four themes emerged as work-life balance facilitators: planning, attitude and perspective, support networks, and workplace integration. Support was defined at both the personal and professional levels.

CONCLUSIONS

In terms of the organization, our participants juggled long work hours, travel, and administrative tasks. Individually and socioculturally, they overcame their guilt and their need to be present and an active part of the parenting process. These mothers demonstrated the ability to cope with their demanding roles as both moms and head ATs.

Personality Traits and Burnout Among Athletic Trainers Employed in the Collegiate Setting

CONTEXT

Burnout, a psychological state of mental weariness that occurs when work stresses become overwhelming, has frequently been documented in athletic trainers and has been hypothesized to affect professional retention. Experiences of burnout may be influenced by individual-level factors such as gender or personality, though few researchers have investigated such interactions in athletic trainers.

OBJECTIVE

To investigate the relationship between personalities, as measured by the Big Five Personality Inventory, and burnout.

DESIGN

Cross-sectional study.

SETTING

Online Web-based survey.

PATIENTS OR OTHER PARTICIPANTS

A total of 189 athletic trainers working in the collegiate setting, 65 men (34.4%) and 124 women (65.6%), with an average of 5 ± 3 years certified and 2.5 ± 2 years working in their current position.

MAIN OUTCOME MEASURE(S)

Data were collected using a Web-based survey instrument consisting of 3 sections: (1) demographics, (2) burnout survey, and (3) Big Five Personality Inventory. Likert responses for the burnout score were summed. Independent t tests, Pearson correlations, and multiple regressions were calculated to evaluate the relationships between demographics and burnout and between burnout and personality.

RESULTS

This group of athletic trainers experienced moderate burnout, regardless of gender. A weak negative correlation was present between burnout score and both agreeableness and extraversion. A weak positive correlation existed between burnout and neuroticism. These variables did not predict burnout scores; only neuroticism added significantly to the weak predictive value. Personality explained only 17.3% of the variability in burnout scores.

CONCLUSIONS

Our study confirms the findings of previous researchers highlighting moderate burnout in athletic trainers employed in the collegiate setting. We did not find that personality significantly predicted burnout, though it did account for a small amount of the variance in burnout scores. Thus, organizational-level factors may play a greater role in determining burnout in athletic trainers than individual-level factors such as personality.

Sex and Employment-Setting Differences in Work-Family Conflict in Athletic Training

CONTEXT

Work-family conflict (WFC) has received much attention in athletic training, yet several factors related to this phenomenon have not been examined, specifically a practitioner's sex, occupational setting, willingness to leave the profession, and willingness to use work-leave benefits.

OBJECTIVE

To examine how sex and occupational differences in athletic training affect WFC and to examine willingness to leave the profession and use work-leave benefits.

DESIGN

Cross-sectional study.

SETTING

Multiple occupational settings, including clinic/outreach, education, collegiate, industrial, professional sports, secondary school, and sales.

PATIENTS OR OTHER PARTICIPANTS

A total of 246 athletic trainers (ATs) (men = 110, women = 136) participated. Of these, 61.4% (n = 151) were between 20 and 39 years old.

MAIN OUTCOME MEASURES(S)

Participants responded to a previously validated and reliable WFC instrument. We created and validated a 3-item instrument that assessed willingness to use work-leave benefits, which demonstrated good internal consistency (Cronbach α = 0.88), as well as a single question about willingness to leave the profession.

RESULTS

The mean (± SD) WFC score was 16.88 ± 4.4 (range = 5 [least amount of conflict] to 25 [highest amount of conflict]). Men scored 17.01 ± 4.5, and women scored 16.76 ± 4.36, indicating above-average WFC. We observed no difference between men and women based on conflict scores (t244 = 0.492, P = .95) or their willingness to leave the profession (t244 = -1.27, P = .21). We noted differences among ATs in different practice settings (F8,245 = 5.015, P <.001); those in collegiate and secondary school settings had higher reported WFC scores. A negative relationship existed between WFC score and comfort using work-leave benefits (2-tailed r = -0.533, P < .001). Comfort with using work-leave benefits was different among practice settings (F8,245 = 3.01, P = .003).

CONCLUSIONS

The ATs employed in traditional practice settings reported higher levels of WFC. Male and female ATs had comparable experiences of WFC and willingness to leave the profession.

A Longitudinal Examination of Work-Life Balance in the Collegiate Setting

CONTEXT

The literature regarding work-life balance (WLB) is plentiful, particularly in the National Collegiate Athletic Association Division I collegiate setting due to its demanding nature as defined by work hours and travel. Despite the comprehensive understanding of factors contributing to WLB for athletic trainers (ATs) in this setting, the effect of time of year has yet to be investigated.

OBJECTIVE

To determine the influence sport season timing (ie, preseason, in-season, off-season) can have on perceptions and experiences of WLB for ATs.

DESIGN

Qualitative, case-study design.

SETTING

Division I collegiate practice setting.

PATIENTS OR OTHER PARTICIPANTS

Six ATs employed in the Division I college setting (3 women, 3 men) volunteered and completed our study over 1 year. The average age of participants was 31.0 ± 3 years, and they had 9.0 ± 3 years of experience.

DATA COLLECTION AND ANALYSIS

We conducted semistructured one-on-one phone interviews with each participant at 4 points during the year (August, November, February, June). All interviews were transcribed verbatim. Data were analyzed inductively, and we used peer review, multiple-analyst triangulation, and member checks for credibility.

RESULTS

Time of year (eg, competitive in-season), organizational demands (eg, hours and travel), and life stage (eg, roles assumed) were factors that influenced WLB for ATs in the collegiate setting. Having a positive and adaptable mind-set; having coworker, supervisor, and personal support; and engaging in personal or family time were factors that counterbalanced the inhibitors.

CONCLUSIONS

Our results indicate that a career as an AT in the collegiate setting can create WLB concerns; these concerns, however, seem to peak during the competitive in-season for the AT's primary coverage team. Additionally, conflict that arises for ATs seems to be stimulated by time, as work roles are often less accommodating due to the athletic atmosphere.

Work-Based Social Interactions, Perceived Stress, and Workload Incongruence as Antecedents of Athletic Trainer Burnout

CONTEXT

Burnout is an important psychological health concern for working professionals. Understanding how psychological stress and markers of workload contribute to athletic trainers' (ATs') perceptions of burnout is highly valuable. Both positive (social support) and negative social interactions should be considered when examining relationships among markers of ATs' health and wellbeing.

OBJECTIVE

To examine the potential effects of social interactions on the relationships between (1) burnout and perceived stress and (2) burnout and workload incongruence in ATs.

DESIGN

Cross-sectional study.

SETTING

Participating ATs completed a computer-based survey during the fall sports season.

PATIENTS OR OTHER PARTICIPANTS

Responding participants were ATs randomly sampled from the National Athletic Trainers' Association membership (N = 154; men = 78, women = 76; age = 36.8 ± 9.5 years).

MAIN OUTCOME MEASURE(S)

Participants completed self-report assessments (Perceived Stress Scale, Social Support Questionnaire, Positive and Negative Social Exchanges, Maslach Burnout Inventory-Human Services Survey) via a secure e-mail link. Workload incongruence was calculated by subtracting anticipated work hours from actual current work hours (6.0 ± 9.6 hours). We used hierarchical multiple regression analyses to examine hypothesized relationships among study variables.

RESULTS

Social interactions did not affect the relationships between burnout and perceived stress or workload incongruence at the global or dimensional level. However, perceived stress (β = .47, P < .001), workload incongruence (β = .12, P < .05), and social support (β = -.25, P < .001) predicted global AT burnout. Negative social interactions trended toward significance (β = .12, P = .055). Our findings suggest that stress perceptions and social support drive the dimensional AT burnout experience, whereas workload incongruence (emotional exhaustion) and negative social interactions (depersonalization) were linked to specific burnout dimensions.

CONCLUSIONS

Social interactions and markers of stress and workload should be considered when seeking to understand ATs' experiences with burnout and to design workplace interventions.

Staffing Levels at National Collegiate Athletic Association Football Bowl Subdivision-Level Institutions

CONTEXT

The "Appropriate Medical Coverage for Intercollegiate Athletics" (AMCIA) document was created to support assessment and calculation of athletic training personnel requirements. However, little is known regarding disparities between current and recommended staffing practices.

OBJECTIVE

To identify the staffing and employment characteristics of athletic health care services at Football Bowl Subdivision-level institutions.

DESIGN

Cross-sectional study.

SETTING

Web-based survey.

PATIENTS OR OTHER PARTICIPANTS

Head athletic trainers and athletic training staff members who were knowledgeable about budget and staff.

MAIN OUTCOME MEASURE(S)

The survey, Assessment of Staffing Levels at National Collegiate Athletic Association Football Bowl Subdivision-Level Institutions, was used to evaluate personal, university, and staff demographics; staffing and employment topics; and AMCIA variables and use.

RESULTS

The survey was accessed and partially completed by 104 individuals (response rate = 84.6%). A total of 79 athletic trainers (response rate = 76%) completed the entire survey. One-third of the respondents (34.2%, n = 26) met the recommended number of full-time equivalents (FTEs) for football, two-thirds of the respondents (65.7%, n = 50) failed to meet the recommendation, and 26.2% (n = 27) were missing data needed for FTE calculation. Among those who did not meet the recommended FTEs (n = 50), 38.0% (n = 19) were within 1 FTE of being compliant, 26.0% (n = 13) were within 2 FTEs, and 24.0% (n = 12) were within 3 FTEs. About one-third of respondents (35.9%, n = 37) reported not using the AMCIA, citing lack of funding (29.7%, n = 11), lack of administrative support (21.6%, n = 8), and other reasons (37.8%, n = 14).

CONCLUSIONS

The majority of institutions that used the AMCIA were able to provide justification for staffing. For most of the institutions that failed to meet their recommendation, adding 1-3 FTE athletic trainers for football would change their compliance status. A uniform definition of the term FTE within collegiate athletics is needed to allow for structured assessment and allocation of staffing and workloads.

Perceptions of National Collegiate Athletic Association Division I Female Athletic Trainers on Motherhood and Work-Life Balance: Individual- and Sociocultural-Level Factors

CONTEXT

A multilevel model of work-life balance (WLB) has been established in the sports management literature to explain interactions among organizational/structural, individual, and sociocultural factors and their effects on individual responses and attitudes toward WLB. These factors influence experiences and outcomes related to WLB.

OBJECTIVE

To examine individual and sociocultural factors that may influence perceptions of female athletic trainers (ATs) employed in the National Collegiate Athletic Association Division I setting, particularly any sex-specific influences.

DESIGN

Qualitative study.

SETTING

National Collegiate Athletic Association Division I.

PATIENTS OR OTHER PARTICIPANTS

A total of 27 women (14 single with no children, 6 married with no children, 7 married with children) currently employed as full-time ATs in the Division I setting participated.

DATA COLLECTION AND ANALYSIS

Participants responded to a series of open-ended questions via reflective journaling. Data were examined using a general inductive approach. Trustworthiness was established by multiple-analyst triangulation, member interpretive review, and peer review.

RESULTS

Participants recognized that their sex played a role in assessing WLB and a long-term career as an AT. In addition, they identified various individual- and sociocultural-level factors that affected their perceptions of WLB and attitudes toward a career goal.

CONCLUSIONS

Our data suggested that female ATs may hold traditional sex ideologies of parenting and family roles, which may influence their potential for career longevity.