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Associations between effort–reward imbalance and health indicators among school teachers in Chuquisaca, Bolivia: a cross-sectional study
  1. Maria Teresa Solis-Soto1,2,
  2. Anabel Schön3,
  3. Manuel Parra3,
  4. Katja Radon3
  1. 1 Instituto de Ciencias de la Salud, Universidad de O’Higgins, Rancagua, Chile
  2. 2 Doctoral Academic Committee, Universidad San Francisco Xavier de Chuquisaca, Sucre, Bolivia
  3. 3 CIHLMU@Occupational Social and Environmental Medicine, Klinikum der Universitat Munchen, Munich, Bayern, Germany
  1. Correspondence to Dr Maria Teresa Solis-Soto; maritesolissoto{at}


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.

  • psychosocial
  • subjective health
  • musculoskeletal pain
  • mental disorders
  • school teachers
  • Bolivia

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  • Contributors MTS-S participated in the design of the study acquisition of data, performed the statistical analysis and wrote the paper. AS participated in the design of the study and acquisition of data. KR and MP participated in the design of the study and helped to draft the manuscript. All authors revised the manuscript critically for important intellectual content and approved the final manuscript.

  • Funding This study was supported by the Network Funds 2015 through the Center for International Health of the University Hospital Munich (LMU) within the Higher Education Excellence in Development Cooperation (Exceed) program of the German Academic Exchange Service (DAAD) and the Federal Ministry for Economic Cooperation and Development (BMZ)—Germany.

  • Competing interests None declared.

  • Ethics approval The study protocol was approved by the Bioethics Committee of the medical faculty of San Simón University, Cochabamba–Bolivia, the Regional Education Office in Chuquisaca and the authorities of every school.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The datasets used in this study are available from the corresponding author on reasonable request.

  • Patient consent for publication Not required.

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