Tarja Heponiemen (THL) esitys Work2017-konferenssissa Turussa elokuussa 2017.

1. 23.8.2017
Stress due to health information systems
among Finnish and migrant physicians and
nurses
Osaavan työvoiman varmistaminen sosiaali- ja terveydenhuollon murroksessa

2. 23.8.2017 Osaavan työvoiman varmistaminen sosiaali- ja terveydenhuollon murroksessa 2
• Competent workforce for the future (COPE)
– Subproject 3: Optimized utilization of knowledge and skills in
culturally diverse health and social care
– Funded by Strategic Research Council (number 303604)
• Information Systems and Stress in Health Care
(Digityö ja stressi-hanke)
– Funded by the Finnish Work Environment Fund, project 116104

3. Changes in the working life and competence
needed are in focus
23.8.2017
Competence workforce for the future 3

4. Stress due to health information systems
among Finnish and migrant physicians and
nurses
• Health care professionals with migration origin may face
challenges in adjusting to foreign health care culture.
• One particular challenge may be information systems in
health care which have been found to burden native
physicians (Vänskä et al 2010, Heponiemi 2012).
• We examined stress due to information systems in the work
of migrant and native physicians and nurses in the Finnish
health care and how these differences varied according to
working sector and type of employment
23.8.2017 Osaavan työvoiman varmistaminen sosiaali- ja terveydenhuollon murroksessa 4

5. Methods
• The data is based on a survey for physicians (natives: n=3646, 55%
response rate; migrants: n=549, 43% response rate) and registered
nurses (natives: n=1008, 46% response rate; migrants n=515, 45%
response rate).
• The composite scale for stress experienced due to health
information systems (DigiStress) included 2 items: how often had
the respondents been distracted, worried, or stressed about a)
constantly changing information systems and b) difficult to use,
poorly functioning information systems (5-point response scale).
• The results were analyzed by ANCOVA adjusted for background
factors (Age, gender, working sector, full-time employment,
permanent employment and supervisor position for all subgroups
and specialization status for physicians; Additional information
concerning the migrant respondents was country of origin and year
of migrating to Finland)
23.8.2017 Osaavan työvoiman varmistaminen sosiaali- ja terveydenhuollon murroksessa 5

6. Results
• Native physicians (F=42.4, p<0.001) and nurses (F=59.4,
p<0.001) reported higher DigiStress.
23.8.2017 Osaavan työvoiman varmistaminen sosiaali- ja terveydenhuollon murroksessa 6
1
1,5
2
2,5
3
3,5
Physicans Nurses
Natives reported higher
DigiStress Among physicians
(F=42.4 p<.0001) and nurses
(F=59.4, p<.0001)
native
Foreign born

7. • When migrant respondents’ country of origin was taken into
account, Finnish nurses reported more DigiStress compared
to nurses from all other countries except Estonia.
• Estonian nurses reported higher DigiStress compared to
nurses coming from Russia, Asia and Africa (F=56.4,
p<0.001).
23.8.2017 Osaavan työvoiman varmistaminen sosiaali- ja terveydenhuollon murroksessa 7
1
1,5
2
2,5
3
3,5
Native
Finns
Estonian Russian Other EU
country
Other
European/
Midle
East
country
Asia Africa North/
South
America
Native Finns and Estonian nurses reported higher
DigiStress than nurses from Russian, Asian or African
origin (F=56.4, p<.0001)

8. • When the length of the stay in Finland among the migrant
respondents was included in the analysis, native Finnish nurses
reported higher DigiStress than migrant nurses who had moved to
Finland after 1990, but not when compared to those who had moved
to Finland earlier.
• Migrant nurses who had moved to Finland before 1990 reported
higher DigiStress than those migrated to Finland after 2000 (F=16.
98, p0.001). Similar pattern of differences appeared among migrant
physicians (F=6.6, p<0.001).
23.8.2017 Osaavan työvoiman varmistaminen sosiaali- ja terveydenhuollon murroksessa 8
1
1,5
2
2,5
3
3,5
Native Finns before 1990 1990-1999 2000-2005 After 2006
Native nurses and those migrated to Finland
before 1990 reported higher DigiStress
compared to late arrivals (F=16.98, p<.0001)
Foreign born, migrated to Finland ...

9. 23.8.2017 Osaavan työvoiman varmistaminen sosiaali- ja terveydenhuollon murroksessa 9
1
1,5
2
2,5
3
3,5
Native Finns before 1990 1990-1999 2000-2005 After 2006
Native physicians and those migrated to Finland before 1999 reported higher
Digi Stress than late arrivials (F=16,6, p<0.0001)

10. • Among nurses a significant interaction term was found
between native/ migrant status and working sector (F=5.5,
p<0.001).
• The differences between native Finns and migrant nurses in
DigiStress were greatest in specialized care, followed by
primary and elderly care, while no differences were observed
in private sector.
23.8.2017 Osaavan työvoiman varmistaminen sosiaali- ja terveydenhuollon murroksessa 10
1
1,5
2
2,5
3
3,5
Specialized
care
Primary care Private Elderly care
Native nurses reported higher
DigiStress particularly in
specialiced care, no difference
in private sector (interaction
5.54, p<.0001)
Native
Foreign born

11. • Among physicians significant interaction terms were found
between native/ migrant status and having permanent
employment (F=6.9, p<0.01) and native/ migrant status and
being in supervisor position (F=7.1, p<0.01).
• The differences in DigiStress between native and migrant
physicians were greater among physicians working on
temporal contract and in non-leadership position.
23.8.2017 Osaavan työvoiman varmistaminen sosiaali- ja terveydenhuollon murroksessa 11
1
1,5
2
2,5
3
3,5
temporal permanent
Native physicians reported higher
DigiStress among those with Temporal
contract (interaction f=6.9, p<.01)
Native
Foreign
1
1,5
2
2,5
3
3,5
no superv supervisory
Native physicians reported higher Digi
stress among those not in suporvisor
position (interaction F=7.14, p<.01)
Native
Foreign

12. Conclusions
• Stress related to information systems in health care is higher
among native professionals than their co-workers with
migrant origin. Moreover, after having stayed in Finland also
migrants’ stress related to information systems starts to
increase.
• Several potential interpretations for the results may apply.
– Digital skills may actually be more advanced among migrant
professionals. According to the “healthy migrant” hypothesis
postulates that persons who migrate are a selected group in
terms of good health status. Migrated nurses and physicians may
be a selected group also in terms of psychosocial resources to
cope with new situations and technologies.
– Migrant respondents may use different assessment criteria in
responding to stress-related questions. They may also have
different expectations regarding the functioning of information
systems based on their experiences in their country of origin.
23.8.2017 Osaavan työvoiman varmistaminen sosiaali- ja terveydenhuollon murroksessa 12

13. Conclusions
– It is also possible that in health care units the adjustment of
migrant workers is supported by organizing the work so that
migrant workers have less responsibility on tasks that may be
difficult for them, such as dealing with complex information
systems. This interpretation is supported by the fact that native
Finns reported more stress due to information systems compared
to new arrivals but not when compared to those migrant
professionals who have been in Finland longer. This could
indicate successful integration processes in health care
organization. However, a possible counter effect could be the
burden among native professionals (Aalto et all 2014).
23.8.2017 Osaavan työvoiman varmistaminen sosiaali- ja terveydenhuollon murroksessa 13

14. • Twitter: @stncope
• @TarjaHeponiemi
• http://www.slideshare.net/ta
g/cope-hanke
• http://videonet.fi/web/thl/201
6106/
• www.stncope.fi
• www.thl.fi/digityojastressi
23.8.2017 Kaarina Wilskman
Thanks