Associations between effort–reward imbalance and health indicators among school teachers in Chuquisaca, Bolivia: a cross-sectional study

OBJECTIVE: To assess the association between effort–reward imbalance (ERI) and health indicators among Bolivian school teachers. DESIGN: School-based cross-sectional study. SETTING: Sixty randomly selected schools from rural (33) and urban (27) schools in Chuquisaca, Bolivia. PARTICIPANTS: A total of 1062 school teachers were invited to participate, of which 597 answered the questionnaire (response 56.2%). EXPOSURE MEASURE: Psychosocial factors at work were explored through the short version of the Effort–Reward Questionnaire. PRIMARY AND SECONDARY OUTCOME MEASURES: Health outcomes included self-rated overall health, mental distress (12-item General Health Questionnaire ≥5) and the 7-day prevalence of low back pain (LBP) as well as neck or shoulder pain (Nordic Questionnaire). Crude and adjusted ORs and their 95% CIs for each health outcome were calculated using logistic regression models. RESULTS: The median value for the effort–reward ratio was 0.91 (range: 0.3–2.3) with higher values for teachers from rural versus urban schools. Overall, about 43% of the teachers reported their overall health as fair or poor; 45% suffered mental distress, 17% reported LBP and 29% neck or shoulder pain. Prevalences were higher for teachers employed at rural schools compared with those at urban schools. After adjusting for potential confounders and school location, ERI was statistically significantly associated with fair/poor self-rated health (adjusted OR 1.7, 95% CI 1.0 to 2.9); mental distress (1.9; 95% CI 1.2 to 3.1) and LBP (2.3; 95% CI 1.3 to 4.1). CONCLUSION: Our results indicate the urgent need to improve psychosocial working conditions among Bolivian school teachers, in order to promote their health and well-being.