Occupational balance and stroke impact among community-dwelling stroke survivors 65 years or older: a cross-sectional study.

INTRODUCTION: Occupational balance has been investigated in different populations but less in stroke survivors. Previous studies have focussed on occupational balance among stroke survivors of working age (15-64 years of age), showing they did not perceive they had occupational balance. There is, therefore, a lack of knowledge of how older stroke survivors perceive their occupational balance. The aims of this study were to describe occupational balance in community-dwelling stroke survivors 65 years or older and to investigate if there were any associations between their perceived stroke impact and occupational balance. METHODS: A cross-sectional study was performed with 58 stroke survivors, with a median age of 75 years at stroke onset and a median time since stroke onset of 11 months. The participants were recruited from a local stroke register and answered questionnaires on occupational balance and stroke impact. Data were analysed with descriptive statistics, correlations and logistic regression. RESULTS: The participants had a median score of 29 (min 12 to max 33), indicating a very high occupational balance, a low stroke impact, and a good recovery (median 82.5; min 0 to max 100). An association between participation and occupational balance (OR 1.13; 95% CI 1.04-1.23) was found. CONCLUSION: The stroke survivors perceived a low stroke impact and a high occupational balance. It is possible that older community-dwelling stroke survivors, of whom many have retired, juggle less occupations leaving them with more time to engage in those occupations they want to, leading to a better occupational balance.

A Rasch analysis of the Danish version of the occupational balance questionnaire (OBQ11).

BACKGROUND: OBQ11 was developed in a Swedish context. To evaluate occupational balance, accurate self-rating instruments in the native language are needed. AIM: The aim was to investigate the measurement properties of the Danish version of OBQ11, using the Rasch analysis. METHOD: Data for the analysis of the Danish version of OBQ11 (OBQ11-DK) was gathered online, and all full data records (n 366) were included in the analysis. RESULTS: Three items showed non-significant marginal under- or overfit, suggesting a degree of misfit between the data and the Rasch model. Unidimensionality was not reached, though, since the proportion of persons with different estimates were more than 5% and thus the OBQ11-DK cannot be said to assess a person's perception of occupational balance. CONCLUSION: The present version of the OBQ11-DK shows the need for further development and testing and is not tested for test/retest or in clinical samples. The results and small number of items may after modifications and further studies make it feasible to implement OBQ11-DK into settings where the measuring of occupational balance is needed.

Validity and Reliability of the Occupational Balance Questionnaire (OBQ11) in a U.S. Sample of Adults With Type 1 Diabetes.

IMPORTANCE: Although occupational balance (OB) is a construct of importance to occupational therapy, existing OB assessments have not been validated in clinical populations. OBJECTIVE: To examine the validity and reliability of the 11-item version of the Occupational Balance Questionnaire (OBQ11) in U.S. adults with Type 1 diabetes. DESIGN: Data were analyzed from adults with Type 1 diabetes enrolled in a larger longitudinal study examining the relationships among blood glucose, emotion, and functioning. Dimensionality of the OBQ11 was assessed with item response theory (IRT); convergent validity was tested by examining whether associations between the OBQ11 and other constructs were consistent with a priori hypotheses. SETTING: Three outpatient clinical sites in the United States. PARTICIPANTS: Data from 208 U.S. adults with Type 1 diabetes were included in the analyses (42% Latino, 29% White, 14% African American, 7% multiethnic, and 8% other). OUTCOMES AND MEASURES: Assessments administered include the OBQ11, Patient Health Questionnaire (depression), and Diabetes Self-Management Questionnaire. RESULTS: Overall, results from IRT models and correlational tests supported the reliability and validity of the OBQ11. For instance, higher scores on the OBQ11 were significantly associated with better self-ratings of diabetes management behaviors (r = .28, p < .001), lower depression symptoms (r = -.53, p < .001), and greater positive affect (r = .32, p < .001). A single-factor generalized partial credit model fit the OBQ11 acceptably well, supporting its unidimensionality. CONCLUSIONS AND RELEVANCE: The OBQ11 may be a reliable and valid measure of OB appropriate for use in clinical populations such as adults with diabetes. What This Article Adds: OB is not often formally assessed by occupational therapists in the United States, even though the contributions of OB to health and well-being are core components of the philosophy of occupational therapy. The current evidence supports the validity of the OBQ11 in a clinical population of adults with Type 1 diabetes and demonstrates significant associations between OB and health management behaviors. Study results may encourage greater consideration and assessment of OB in occupational therapy clinical practice in the United States.

Perceptions of and interactions with green neighbourhood environment - A qualitative study.

BACKGROUND: Green environments have been shown to be important for health, although less is known about what, in the environment and the individual, leads to interaction and promotes engagement in activities. AIM: To explore some individuals' perceptions of their green neighbourhood environment and how the interaction with it promotes engagement in activities. MATERIAL AND METHODS: A qualitative approach was used comprising eight semi-structured interviews and directed content analysis based on the Model of Human Occupation. RESULTS: The green neigbourhood environment (GNE) offered opportunities to challenge the participants' performance capacity, develop habits and engage in activities. The GNE also gave stress relief and helped the participants experience balance. Experiences of interacting with green environments earlier in life and the cultural context seemed to be the main reason why the participants interacted with the GNE.Conclusions and significance: Norms and values from the childhood, previous experiences and interests were of particular importance for interaction with the GNE. Green environments gave perspective, a sense of being part of something larger and helped individuals achieve balance. Based on this knowledge, occupational therapists can enable individuals to interact with the green environment.

Designing Virtual Natural Environments for Older Adults: Think-Aloud Study.

BACKGROUND: Spending time in natural environments is beneficial for human health, but many older adults have limited or no access to natural environments. Virtual reality technology may be a means to facilitate nature experiences, and so, there is a need for knowledge on how to design virtual restorative natural environments for older adults. OBJECTIVE: The aim of this study was to identify, implement, and test older adults' preferences and ideas regarding virtual natural environments. METHODS: A total of 14 older adults (mean age 75, SD 5.9 years) participated in an iterative process to design such an environment. We used think-aloud protocols and qualitative content analysis and established questionnaires that targeted usability, affective aspects, and side effects. These data guided the design decisions for incremental implementations of a prototype. RESULTS: The participants' preferences included trueness to reality in terms of rendition and behavior; traces of human activity and natural processes that trigger the imagination and provide believability; the ability to roam, explore, and interact with the environment; and a familiar, relatable environment that evokes memories. The iterative design process resulted in a prototype featuring many of the participants' ideas and preferences, including a seated locomotion technique, animals, a boat ride, the discovery of a boat wreck, and apple picking. The questionnaire results indicated high perceived usability, interest, and enjoyment; low pressure and tension; moderate value and usefulness; and negligible side effects. CONCLUSIONS: We suggested 3 principles for virtual natural environments for older adults: realness, interactivity, and relatedness. Virtual natural environments should also provide a diversity of content and activities to accommodate the heterogeneity in older adults' preferences. These results can contribute to a framework for designing virtual natural environments for older adults. However, these findings need to be tested and potentially revised in future studies.

Quality of life, sense of coherence and occupational balance one year after an occupational therapy intervention for people with depression and anxiety disorders.

BACKGROUND: Quality of life (QOL), sense of coherence (SOC) and occupational balance (OB) have been found to increase after rehabilitation among people living with depression and anxiety. However, these aspects have not been investigated over time in participants with different paid work situations, such as being on sick leave or not. OBJECTIVE: To describe and compare the self-rated QOL, SOC and OB after participation in occupational therapy in three groups of people with depression and anxiety disorders based on their work situation during the study period: continuous sick leave, return to work and continuous work. METHODS: Forty-seven women and seven men, 19-60 years old with depression and anxiety were followed over time. They completed questionnaires on QOL, SOC and OB on four occasions. Data were analyzed with non-parametric statistics. RESULTS: No statistically significant differences between the groups were identified. All groups improved in at least one of the studied areas over time: the sick leave group in OB; the return-to-work group in QOL and OB; and the Work group in QOL and SOC. CONCLUSION: The results indicate variations in QOL, SOC and OB between people with different work situations over time after occupational therapy. Studies with larger samples are, however, warranted.

A Comparison of the Self-Perceived Organisational and Social Work Environment among Swedish Occupational Therapists in Different Job Sectors: An Observational Study.

Sick leave due to mental health problems is increasing, and there is evidence that it is associated with the individual's self-perceived organisational and social work environment. The aim of this study was to compare occupational therapists' self-perceived organisational and social work environments in different job sectors. The goal is to identify the sectors with the most unfavourable work environment and thus where the need to improve the work environment, to prevent mental health problems, is greatest. A web survey was emailed to working members of the Swedish Association of Occupational Therapists in February 2018 (n = 7600). The response rate was 48% (n = 3658). Studied job sectors were somatic specialist health care; elderly care; habilitation; psychiatric health care; primary health care; and university (n = 2648). This sample is representative of Swedish occupational therapists with respect to age, gender, and job sector. The web survey included questions on their sociodemographic characteristics and self-perceived organisational and social work environment regarding workload, control, community in the workplace, reward, justice, and values. Questions on the self-perceived organisational and social work environment were assessed by the QPS mismatch questionnaire. Differences in work environmental conditions between the job sectors were tested with ANOVA and post hoc multiple-group analysis. The results showed that occupational therapists working in psychiatric health care perceived the highest proportion of unfavourable working conditions. Occupational therapists who worked at universities perceived a higher workload than occupational therapists in most of the other studied job sectors. These job sectors need to be specifically addressed with adjustments to prevent mental health problems.

[Translation of the Occupational Balance Questionnaire in French and its Validation]. / Traduction de l'Occupational Balance Questionnaire en français et sa validation.

Background. Questionnaires measuring occupational balance have been created in recent years, but those available in French are limited. Purpose. This study aimed to translate and transculturally adapt the Occupational Balance Questionnaire and to examine the internal consistency, test-retest reliability and convergent validity of the French version. Methodology. A cross-cultural validation was conducted with adults in Quebec (n = 69) and in French-speaking Switzerland (n = 47). Results. Internal consistency was good in both regions (α > 0.85). Test-retest reliability was satisfactory in Quebec (ICC = 0.629; p < 0.001), but a significant difference was found between the two measurement times in French-speaking Switzerland. Significant associations were found between the results of the Occupational Balance Questionnaire and those of the Life Balance Inventory (Quebec, r = 0.47; French-speaking Switzerland, r = 0.52). Implications. These initial results support the use of the OBQ-French in the general population of two French-speaking regions.

Description. Des questionnaires visant à mesurer l'équilibre occupationnel ont été créés ces dernières années, mais ceux disponibles en français sont limités. But. Cette étude visait à traduire et adapter transculturellement l'Occupational Balance Questionnaire et à examiner la cohérence interne, la fidélité test-retest et la validité convergente de la version en français. Méthodologie. Une validation a été effectuée auprès de personnes adultes au Québec (n = 69) et en Suisse romande (n = 47). Résultats. La cohérence interne est bonne dans les deux régions (α > 0,85). La fidélité test-retest est satisfaisante au Québec (ICC = 0,629 ; p < 0,001), mais une différence significative est relevée entre deux passations en Suisse romande. Une relation significative est démontrée entre l'équilibre occupationnel et l'équilibre de vie (Québec r = 0,47 ; Suisse romande r = 0,52). Conséquences. Ces premiers résultats soutiennent l'utilisation de l'OBQ-français auprès de la population générale de deux régions francophones.

Validity and reliability of the Turkish Occupational Balance Questionnaire (OBQ11-T) in mental health.

BACKGROUND: People with psychiatric disabilities often find it difficult to maintain a satisfactory occupational balance. AIMS/OBJECTIVES: This study aimed to investigate the validity and reliability of the Turkish version of the Occupational Balance Questionnaire (OBQ11-T) in mental health. MATERIAL AND METHODS: OBQ11-T was applied to 149 people for construct validity analysis and to 61 of them for reliability analysis. Validity was determined using factor analyses. The reliability of the OBQ between the first and second evaluations was assessed using the intraclass correlation coefficient (ICC) for each item and the total OBQ11-T score. Internal consistency was assessed using Cronbach's alpha. RESULTS: The results of factor analysis revealed one factor that explains 35.94% of the total variance in the model. OBQ11-T item 1 had the lowest and OBQ11-T item 4 had the highest factor loadings. The model fits the data according to the indices of relative fit (RMSEA = 0.087, CMIN/DF = 2.129, CFI = 0.901). There was an excellent correlation between test and retest OBQ11-T total scores (ICC = 0.905). All items of the OBQ11-T showed good reliability. Cronbach's alpha for the OBQ11-T total score was 0.839, indicating acceptable internal consistency. CONCLUSIONS AND SIGNIFICANCE: The current study showed that OBQ11-T is a valid and reliable tool for measuring the self-rated occupational balance of people with mental illness.

Occupational performance problems in people with depression and anxiety.

BACKGROUND: Depression and anxiety often reduce people's ability to cope with everyday occupations. There is a lack of knowledge about such problems in people of working age with depression and anxiety. AIM: To describe which problems people with depression or anxiety disorders experience when performing everyday occupations and which occupations are affected. MATERIALS AND METHODS: Data based on the Canadian Occupational Performance Measure was used in this cross-sectional study. A total of 118 participants aged 18-65 years, with depression or anxiety, were recruited from primary healthcare and general mental healthcare services. The data were analysed with descriptive statistics and directed content analysis. RESULTS: The participants rated a low level of occupational performance, and their satisfaction with performance even lower. They described a great number of problems with their everyday occupations. The most frequent problem areas concerned household management, socialization and personal care. Detailed descriptions of which type of problem they experienced during everyday occupations are included. CONCLUSIONS: This study provides knowledge of which problems people with depression and anxiety disorders experience in everyday occupations within self-care, productivity, as well as leisure. Furthermore, they rate performance and satisfaction with performance of the five occupations they find the most important to change in everyday life.

Occupational balance in parents of pre-school children: Potential differences between mothers and fathers.

BACKGROUND: Parents of young children are a vulnerable group with an increased risk of stress-related health problems compared to adults without children. Low occupational balance has been identified as a risk factor for stress-related disorders. AIM: The study aimed to describe occupational balance in parents of pre-school children and to explore potential differences between mothers and fathers. METHOD: Data were collected by a web-based survey based on the Occupational Balance Questionnaire (OBQ11). A total of 302 working parents (200 mothers and 102 fathers) with at least one child under seven years of age were included in the study. FINDINGS: Mothers reported lower occupational balance than fathers with a median value of 10 for mothers and 12 for fathers (p = 0.029). Mothers rated significantly lower than fathers in three items; 'Balance between work, home, family, leisure, rest and sleep', 'Having sufficient time for doing obligatory occupations' and 'Balance between doing things for others and for oneself'. CONCLUSION: The results indicate that caring for pre-school children may negatively impact both parents, impacting mothers' occupational balance to a greater degree. SIGNIFICANCE: Occupational therapists' knowledge could be utilised to increase awareness of the importance of occupational balance within health services and improve mothers' occupational balance.

Occupational performance issues in a longitudinal perspective in people with depression and/or anxiety on sick leave, returning to work or working.

BACKGROUND: People with depression and anxiety disorder may experience occupational performance issues (OPIs). Further knowledge about these issues longitudinally and about potential differences between people is valuable. AIM: To explore experienced OPIs longitudinally in a sample living with depression and/or anxiety disorder participating in occupational therapy and varying in terms of their work situation. MATERIAL AND METHODS: The Canadian occupational performance measure (COPM) was completed by 54 participants with depression and/or anxiety at four measure-points from baseline to one-year after participation in occupational therapy. The participants constituted three groups: continuously on sick leave (SL), returned to work within a year and continuing working. Descriptive and non-parametric analysis was used. RESULTS: Participants in all groups identified OPIs in all occupational areas in the COPM. All groups increased their occupational performance and satisfaction with their occupational performance in the area socialisation. Each group also made improvements in relation to other occupational areas, varying between the groups. CONCLUSIONS: OPIs and improvements were identified among the participants regardless of them being on SL, returning to work or working. SIGNIFICANCE: The diverse nature of OPIs and improvements in the clients indicate the relevance of occupational therapy.

Work conditions as predictors of Swedish occupational therapists' occupational balance.

BACKGROUND: There is little knowledge of how organizational and social work environmental conditions impact workers' perceptions of occupational balance. The aim of the present study was to investigate organizational and social work environmental conditions as predictors of Swedish occupational therapists' perceptions of occupational balance. MATERIALS/METHODS: This prospective study collected data twice, with a one-year interval, and used a web survey. The present study included 1835 participants. Logistic regression analysis was used to analyze the work predictors of occupational balance. RESULTS: A reasonable workload, high control, and high reward predicted high occupational balance. Having no children living at home, a satisfactory financial situation, and being physically active also predicted high occupational balance. CONCLUSION: A reasonable workload, high control and high reward predicted occupational balance among the occupational therapists. All these factors may be of importance for a sustainable working life for occupational therapists. SIGNIFICANCE: This knowledge can support occupational therapists in the development of interventions at the work place, with focus on the workload and the resources (control and reward), to promote employees' occupational balance.

School Principals' Work Participation in an Extended Working Life-Are They Able to, and Do They Want to? A Quantitative Study of the Work Situation.

The objective of this study is to increase the knowledge regarding school principals' work situations by examining the associations between various factors and the school principals' assessments of their ability or wish to work until 65 years of age or longer. The 1356 participating school principals in this study were aged between 50 and 64 years of age. Individual and work factors were evaluated in relation to two dichotomized outcomes: i.e., can work and want to work beyond 65 years of age, respectively. Generalized Estimating Equations (GEE) models were used to specify bivariate and multivariate cross-sectional logistic regression models that accounted for repeated measurements. The results showed that, both in 2018 and 2019, about 83% of the school principals stated that they could work and about 50% stated that they wanted to work until 65 years of age and beyond. School principals' exhaustion symptoms and experiences of an excessive burden were statistically significantly associated with whether they both could not and did not want to work beyond 65 years of age. Additionally, the school principals' experiences of support from the executive management in the performance of their managerial duties was of primary importance for whether the school principals wanted to work until 65 years of age and beyond. To conclude, it is important that school principals receive sufficient support from the management to cope with their often very stressful leadership tasks so that they have the opportunity to be able and willing to continue working their entire working life. The study strengthens the robustness of the theoretical SwAge model regarding the investigated factors related to determinant factors for a sustainable working life and as a basis for developing practical tools for increased employability for people of older ages.

Outcomes of the Tree Theme Method versus regular occupational therapy: A longitudinal follow-up.

INTRODUCTION: Depression and anxiety disorders affect individuals' everyday lives, and treatments that can help them to perform everyday occupations are needed. Occupational therapy for this group has been evaluated from a short-term perspective but not from a long-term perspective; further research is thus warranted. The aim of the study was to investigate the longitudinal outcomes of the Tree Theme Method (TTM) compared with care as usual, provided by occupational therapists, in terms of everyday occupations, psychological symptoms, and health-related aspects. METHODS: This randomised controlled trial comprised a follow-up 3 and 12 months after an intervention. A total of 118 participants (19-64 years) with depression or anxiety disorders and problems with everyday occupations completed the base line questionnaires, 100 completed the follow-up at 3 months, and 84 completed the follow-up at 12 months. Imputations of missing data were performed using the last observation, and parametric analysis was used. RESULTS: Both groups showed significant improvements (P value ≤ 0.01) in everyday occupations, psychological symptoms and health-related aspects after 3 and 12 months. No significant differences were found between the groups. CONCLUSION: This study contributes with knowledge about the outcomes of occupational therapy for clients living with depression and anxiety disorders. Both TTM and care as usual lead to significant improvements over time concerning everyday occupations, psychological symptoms, and health-related aspects. The fact that both occupational therapy methods were associated with improvements for clients with depression and anxiety supports client-centredness in enabling an occupational therapist to choose the method best suited for the individual.

Exploring the Associations Among Occupational Balance and Health of Adults With and Without Inflammatory Arthritis.

OBJECTIVE: Occupational balance is a person's subjective perception of the amount and variation of their everyday activities. Evidence suggests an association between occupational balance and health. However, the impact of arthritis on occupational balance and its association with health is unclear. This exploratory study was undertaken to examine associations between occupational balance and measures of health and between-group differences in adults with and without inflammatory arthritis (IA). METHODS: In a cross-sectional study, participants completed the 11-item Occupational Balance Questionnaire (OBQ-11) and the Short Form 36 (SF-36) health survey (physical and mental component summary scores) and provided demographic information. Telomere lengths were analyzed from dried blood spots. RESULTS: A total of 143 adults participated (67 with IA, 76 from the healthy comparison [HC] group). Occupational balance was higher in the HC group than in the IA group (mean difference 3.5 [95% confidence interval 1.0, 5.9; P = 0.01]), but this difference was not statistically significant when adjusted for physical health. The association between occupational balance and physical health was stronger in the IA group (R2  = 0.17, P = 0.001) than in the HC group (R2  = 0.05, P = 0.05). Occupational balance was associated with mental health (R2  = 0.26, P < 0.001) but not associated with telomere length (R2  = 0.02, P = 0.24). CONCLUSION: Occupational balance is associated with mental health for all participants and associated with physical health and disease activity in participants with IA. Attention to assessment of and strategies for improving occupational balance in rehabilitation practice and arthritis self-management programs may contribute to sustaining physical and mental health.

Psychosocial Working Conditions and Social Participation. A 10-Year Follow-Up of Senior Workers.

Social participation is important for health, and it is well known that high strain jobs impact negatively on mental and physical health. However, knowledge about the impact of psychosocial working conditions on social participation from a long-term perspective is lacking. The purpose of this study was to investigate the associations between different job types and social participation from a long-term perspective. A comprehensive public health questionnaire "The Scania Public Health Survey", was used, and psychosocial working conditions were measured with a Swedish translation of the Job Content Questionnaire. Based on data from 1098 working respondents aged 55 at baseline and a 10-year follow-up when the respondents were not working, the analyses revealed that social participation varied by job type. Jobs with high decision latitude, as in active and relaxed jobs, seem to predict high social participation, even after cessation of employment. Besides that, the result suggests that high social participation during working life is a predictor of high social participation from a long-term perspective which promotes healthy aging. Incentives for working longer are strongly related to good working conditions. A supportive work environment with possibilities for employees to participate in decision making, i.e., high control, is vital for a sustainable working life. This may contribute to an extended working life and may also support social participation prior to retirement as well as after retirement and thus to healthy aging.

Cultural Adaptation and Psychometric Properties of the Spanish Version of the Occupational Balance Questionnaire: An Instrument for Occupation-Based Research.

Occupational balance (OB) may be a major determinant of health outcomes due to its role in bringing a sense of purpose in the occupations that are personally experienced as a process of getting health and wellness. The Occupational Balance Questionnaire (OBQ) is a reliable instrument for measuring OB, although it has not been adapted and validated in Spain so far; therefore, this study had a double aim: (1) to translate and cross-culturally adapt the original OBQ version into Spanish (OBQ-E); (2) to analyze the psychometric properties for its use in the Spanish population. Standard procedures were used for the cross-adaptation process and pilot testing was carried out using three different samples to extend the applicability of the OBQ-E. Validation measures of the final version of the OBQ-E were conducted in a sample of 219 participants. The OBQ-E showed that items and instructions were culturally appropriate and written clearly. Psychometric testing showed excellent internal consistency (Cronbach's alpha = 0.87; Guttman split-half coefficient = 0.85), good test-retest reliability (rs (Spearman rho) = 0.73), and acceptable convergent validity (overall status, rs = 0.37; Related Quality of Life, rs = 0.42; Satisfaction with Life Scale, rs = 0.54). The findings suggest that the OBQ-E may be a suitable instrument for assessing OB in the Spanish population; hence, it is a promising tool for epidemiological research that will significantly contribute to the understanding of OB as a health-related factor. Nevertheless, further investigation is also warranted to explore the potentiality of this instrument for clinical purposes.

Supportive and demanding managerial circumstances and associations with excellent workability: a cross-sectional study of Swedish school principals.

BACKGROUND: The leadership of principals is important for school, teacher and student related outcomes. To be capable of doing their work (i.e., having sufficient workability), school principals need proper organisational preconditions, motivation, and good health. It is therefore concerning that some studies suggest that principals have a work situation that risks taxing their health and reducing their workability. However, few studies have examined the psychosocial working conditions of principals and no study has gauged principals' workability. Accordingly, we decided to examine Swedish principals' workability and their perceptions of eight demanding and five supportive managerial circumstances as well as the associations between managerial circumstances and reports of excellent workability. METHODS: The participants comprised 2219 Swedish principals (78% women) who completed a cross-sectional web survey in 2018. A brief version of the Gothenburg Manager Stress Inventory (GMSI-Mini) gauged managerial circumstances. Workability was assessed with the workability score (0-10; WAS). Unadjusted and adjusted logistic regression analyses were used to examine associations between managerial circumstances and reports of excellent workability (WAS ≥ 9). Covariates were: length of work experience as a principal, school level, self-rated health, and general self-efficacy. RESULTS: The results showed that circa 30% of the principals reported excellent workability. The GMSI-Mini results showed that role conflicts, resource deficits, and having to harbour co-workers' frustrations were the most frequently encountered managerial demands. Meanwhile, cooperating co-workers, supportive manager colleagues, and a supportive private life were the most supportive managerial circumstances. Adjusted logistic regression analyses showed that role conflicts and role demands were associated with an increased likelihood of reporting less than excellent workability. In contrast, supportive managerial colleagues, a supportive private life and supportive organisational structures were associated with an increased likelihood of reporting excellent workability. CONCLUSION: Circa 30% of the participating principals perceived their workability to be excellent. Reducing role demands, clarifying the principals' areas of responsibility and accountability in relation to other actors in the governing chain (role conflicts), striving for increased role clarity, and striving to find ways to separate work and private life, seem to be promising intervention areas if increasing principals' workability is desired.

Should I Stay or Should I Go? Associations between Occupational Factors, Signs of Exhaustion, and the Intention to Change Workplace among Swedish Principals.

A high turnover among principals may disrupt the continuity of leadership and negatively affect teachers and, by extension, the students. The aim was to investigate to what extent various work environment factors and signs of exhaustion were associated with reported intentions to change workplace among principals working in compulsory schools. A web-based questionnaire was administered twice, in 2018 and in 2019. Part I of the study involved cross-sectional analyses of the associations 2018 (n = 984) and 2019 (n = 884) between occupational factors, signs of exhaustion, and the intention to change workplace, using Generalized Estimating Equations models. Part II involved 631 principals who participated in both surveys. The patterns of intended and actual changes of workplace across two years were described, together with associated changes of occupational factors and signs of exhaustion. Supportive management was associated with an intention to stay, while demanding role conflicts and the feeling of being squeezed between management and co-workers (buffer-function) were associated with the intention to change workplace. The principals who intended to change their workplace reported more signs of exhaustion. To increase retention among principals, systematic efforts are probably needed at the national, municipal, and local level, in order to improve their working conditions.