Work-related stress among municipal employees in rural northern Sweden

Background: Many rural municipalities in Sweden are facing challenges like depopulation, decreased economy, and difficulties in recruiting staff. Living and working in rural areas may involve adverse working conditions and higher risks of ill-health. Work is generally good for employee health, but various physical and psychosocial aspects of work can also be hazards and cause work-related stress, health problems, reduced productivity, and long-term sick leave. Leadership by managers in the organisation is important for the work environment, work performance, and occupational health of employees. The Swedish municipal sector employs almost 20% of employees in the labour market, where school, preschool and care of older people are the dominating areas. Previous research has shown that there are adverse psychosocial working conditions in Swedish municipal organisations. The municipal sector has the highest rate of long-term sick leave compared to other sectors in the labour market, mainly due to stress-related disorders, such as exhaustion disorder (ED). Therefore, it is important to focus on organisational and psychosocial work environments, work-related stress, and health in the municipal sector of rural northern Sweden. Aim: The overall aim was to explore organisational and psychosocial work environments, work-related stress, and health among municipal employees in rural northern Sweden. Methods: Both quantitative and qualitative methods were used to collect data. Study I and II had a quantitative approach, a cross-sectional design, and used a questionnaire for collecting data. Participants were employees (n =1093) in the municipal sector in two municipalities in rural northern Sweden. The questionnaire was constructed to contain instruments measuring the organisational and psychosocial work environments, perceived stress, self-rated exhaustion disorder (s-ED), and physical activity. Quantitative data were analysed using logistic regression in Study I, and partial least squares regression in Study II. Studies III and IV had a qualitative approach. In Study III, semi-structured individual interviews were conducted with 15 municipal employees with high self-reported stress. In Study IV, semi-structured individual interviews were conducted with 15 managers at different levels in the municipal sector. All qualitative data were analysed using inductive qualitative content analysis. Results: In Study I, results showed that 21.5 % of the municipal employees repor