BMJ Open 3:e002297 doi:10.1136/bmjopen-2012-002297
  • Health services research
    • Research

Job strain and supervisor support in primary care health centres and glycaemic control among patients with type 2 diabetes: a cross-sectional study

  1. Sakari Suominen6,2,3
  1. 1Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland
  2. 2Department of Public Health, Folkhälsan Research Center, Helsinki, Finland
  3. 3Department of Public Health, University of Turku, Turku, Finland
  4. 4Unit of Expertise in Work and Organizations, Finnish Institute of Occupational Health, Helsinki, Finland
  5. 5Department of Psychology, Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland
  6. 6Department of Public Health, Nordic School of Public Health, Göteborg, Sweden
  1. Correspondence to Dr Anne Koponen; anne.m.koponen{at}
  • Received 2 November 2012
  • Revised 20 March 2013
  • Accepted 21 March 2013
  • Published 2 May 2013


Objectives This study investigates associations between healthcare personnel's perceived job strain, supervisor support and the outcome of care in terms of glycaemic control among patients with type 2 diabetes.

Design A cross-sectional study from 2006.

Setting 18 primary care health centres (HCs) from five municipalities in Finland.

Participants Aggregated survey data on perceived job strain and supervisor support from healthcare personnel (doctors, n=122, mean age 45.5 years, nurses, n=300, mean age 47.1 years) were combined with registered data (Electronic Medical Records) from 8975 patients (51% men, mean age 67 years) with type 2 diabetes.

Outcome measure Poor glycaemic control (glycated haemoglobin (HbA1c) ≥7%).

Results The mean HbA1c level among patients with type 2 diabetes was 7.1 (SD 1.2, range 4.5–19.1), and 43% had poor glycaemic control (HbA1c ≥7%). Multilevel logistic regression analyses, adjusted for patient's age and sex, and HC and HC service area-level characteristics, showed that patients’ HbA1c-levels were less optimal in high-strain HCs than in low-strain HCs (OR 1.44, 95% CI 1.12 to 1.86). Supervisor support in HCs was not associated with the outcome of care.

Conclusions The level of job strain among healthcare personnel may play a role in achieving good glycaemic control among patients with type 2 diabetes.

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