Sex and Employment-Setting Differences in Work-Family Conflict in Athletic Training
Work-family conflict (WFC) has received much attention in athletic training, yet several factors related to this phenomenon have not been examined, specifically a practitioner's sex, occupational setting, willingness to leave the profession, and willingness to use work-leave benefits. To examine how sex and occupational differences in athletic training affect WFC and to examine willingness to leave the profession and use work-leave benefits. Cross-sectional study. Multiple occupational settings, including clinic/outreach, education, collegiate, industrial, professional sports, secondary school, and sales. A total of 246 athletic trainers (ATs) (men = 110, women = 136) participated. Of these, 61.4% (n = 151) were between 20 and 39 years old. Participants responded to a previously validated and reliable WFC instrument. We created and validated a 3-item instrument that assessed willingness to use work-leave benefits, which demonstrated good internal consistency (Cronbach α = 0.88), as well as a single question about willingness to leave the profession. The mean (± SD) WFC score was 16.88 ± 4.4 (range = 5 [least amount of conflict] to 25 [highest amount of conflict]). Men scored 17.01 ± 4.5, and women scored 16.76 ± 4.36, indicating above-average WFC. We observed no difference between men and women based on conflict scores (t244 = 0.492, P = .95) or their willingness to leave the profession (t244 = −1.27, P = .21). We noted differences among ATs in different practice settings (F8,245 = 5.015, P <.001); those in collegiate and secondary school settings had higher reported WFC scores. A negative relationship existed between WFC score and comfort using work-leave benefits (2-tailed r = −0.533, P < .001). Comfort with using work-leave benefits was different among practice settings (F8,245 = 3.01, P = .003). The ATs employed in traditional practice settings reported higher levels of WFC. Male and female ATs had comparable experiences of WFC and willingness to leave the profession.Context
Objective
Design
Setting
Patients or Other Participants
Main Outcome Measures(s)
Results
Conclusions
The ever-changing demographic makeup of the workforce appears to drive scholarly attention toward work and family challenges. Work-family and work-life balance have become predominant concerns for working Americans. Americans work more hours than people in other industrialized countries,1 which affects the time available to address nonwork responsibilities and personal hobbies and interests. Whereas these factors have been cited among all occupations, health care professionals, such as physicians2 and athletic trainers (ATs),3 are susceptible to challenges with work-family balance because of the long work hours, inflexible work schedules, and demands associated with patient care.2,3
Work-family conflict (WFC) appears to be emerging as a greater concern in athletic training because of its association with retention,3,4 particularly of female ATs.4–6 In a recent report, Kahanov and Eberman7 noted that many female ATs leave the profession before they are 30 years old, indicating a relationship between starting a family and incompatibility with a career in athletic training. Hours worked are linked repeatedly to this dichotomy between a lifelong career in athletic training and the demands of parenthood.6,8,9 Dodge et al10 were among the first to report concerns about the time-intensive nature of the profession and longevity, noting that some athletic training students changed majors to more family-friendly career paths. This observation directly links the importance of early socialization and mentoring of students because their results implied that some students decide to leave the profession before serving as ATs. Whereas female ATs appear to make career-setting or occupational-setting changes due to motherhood, limited data exist to support sex differences in the profession. Researchers5,7,9 have postulated that male ATs shift occupational settings to accommodate the need to provide for the family financially, both in the traditional sense and with job security, whereas female ATs make career changes to fulfill their parenting roles. Despite the strong speculation that sex mitigates experiences of WFC mostly because of the traditional ideology that exists about parenting roles and needs, no such differences have been found in athletic training.8 The lack of a sex difference is potentially misleading because the data were based only on a large group of ATs working in the collegiate setting, which provides rationalization for future research.
In addition, a facet of WFC that has not been explored is the use of work-related benefits, including personal time, sick days, and appropriate family-medical leave, that allow a person to attend to necessary family and personal obligations. Many organizations have family-friendly workplace policies to help employees more easily balance and manage their family and work obligations. A variety of policies are commonly offered, including flex time, job sharing, telecommuting, maternity/paternity leave, and child care options.3,9 Researchers3,9 have suggested that these policies are more readily accessible to and are used more often by women because of the gendered nature of the policies. The advantages of workplace benefits that allow for fulfillment of work-family balance include job and life satisfaction, improved workplace productivity, and retention of quality employees.11 Despite these universal workplace benefits, little is known about ATs' comfort levels in using them to address personal and family needs and, thus, to potentially mitigate WFC.
The collegiate setting appears to be an occupational setting that precipitates departure because of the hours worked, along with other demands placed on the ATs employed in that setting.4 Whereas information on WFC in the collegiate and secondary school settings is available, it is limited within emerging practice settings, such as military and industrial. The experiences of ATs working in the National Collegiate Athletic Association Division I-A and secondary school settings cannot be generalized among all athletic training populations, as job demands and responsibilities may differ and affect experiences of WFC. Researchers5–8 have reported that WFC in athletic training is facilitated by many organizational factors; thus, we need to understand occupational-setting differences. Most data that exist on occupational settings and experiences of WFC are qualitative, and although these data are valuable and insightful, transferability is limited. In most cases, the sample sizes are small, and the intended purpose is to gain exploratory knowledge on a particular topic for a holistic understanding. Therefore, the purpose of our study was multifaceted: (1) to investigate if a difference exists in perception of WFC between sexes in athletic training, (2) to determine whether sex differences exist in how WFC affects willingness to leave the profession, (3) to access how occupational settings affect WFC, (4) to examine the comfort level in using work-leave benefits, and (5) to evaluate whether this comfort level differs by practice setting. We hypothesized that female ATs would perceive more WFC than male ATs and that female ATs would be willing to leave athletic training based on WFC. We also hypothesized that a difference would exist among settings for WFC and willingness to leave the profession.
METHODS
Participants
We sent surveys to 1000 of the 31 144 ATs in the National Athletic Trainers' Association (NATA) who allow surveys to be sent to their e-mail addresses. The random sample that NATA Member Services generated included male and female ATs of all ages and experience levels. The sample also included all settings (collegiate, secondary school, clinic/outreach, education, industry, professional sports, performing arts, sales, hospital, and military). Athletic trainers from all districts participated in this study.
A total of 257 surveys were returned, for a 25.7% response rate. Of those returned, 246 respondents completed the entire survey and provided usable data for analysis. Of these 246 participants, 34.6% (n = 85) worked 41 to 50 h/wk, 26% (n = 64) worked 51 to 60 h/wk, and 22.4% (n = 55) worked 31 to 40 h/wk. The total number of participants in each age range is depicted in Table 1, which shows that most of our participants (61.4% [n = 151]) ranged in age from 20 to 39 years old. Of the participants, 59.3% (n = 146) were married, 30.5% (n = 75) were single, 4.9% (n = 12) were engaged, and 4.5% (n = 11) were divorced; 0.8% (n = 2) of participants did not respond to the question. Almost half (48% [n = 118]) did not have children, 17.5% (n = 43) had 1 child, 23.6% (n = 58) had 2 children, and 10.6% (n = 26) had 3 or more children; 1 participant did not respond to the question. Our study population included more single women than single men and more married men than married women (Table 2). In addition, more men than women had children. The clinical settings in which our participants were employed are shown in Table 1. Most of our participants were from the collegiate setting; the fewest participants were from the sales and industry settings. All participants implied their informed consent by completing the survey, and the study was approved by the Institutional Review Board at Montana State University.
Instrument
Work-family conflict was measured using an instrument first created and validated by Netemeyer et al.12 The 5-item scale has been used in the athletic training literature and validated in the collegiate and secondary school settings.6,8,13 The scale was scored on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree) and summed to obtain a WFC score. We summed the scale as prescribed by Netemyer et al12 following the procedures of others.6 The highest possible WFC score was 25 and indicated the highest amount of conflict, whereas a score of 5 indicated the least amount of conflict. A score of 15 indicated an overall neutral response. A score of 16 to 24 represented above-average conflict, meaning the respondent agreed with at least half of the questions.
The 5 WFC items have demonstrated adequate internal consistency with a Cronbach α of 0.88 for working professionals,12 0.89 for ATs in the collegiate setting,6,8 and 0.95 for ATs working in the secondary school setting (Appendix).13 Given that we were specifically investigating family and life interferences, we added several questions to the WFC scale that asked about leaving work for family reasons, taking sick leave, taking personal days, and possibly leaving the profession or current job for family reasons. We also collected demographic and setting information, including primary source of WFC.
To ascertain an AT's comfort in using work-leave benefits (eg, sick leave, personal days), we created a 3-item instrument scored on a 5-point Likert scale that was reverse scored (1 = strongly agree, 5 = strongly disagree; Appendix). The questions reflected common workplace policies that are often offered to full-time employees to address domestic concerns during the work week. The policies selected reflected benefits of paid time off offered to an employee. The items in this instrument were reviewed for face and content validity by a 2-person expert panel (S.M.M., W.A.P.) with expertise in survey research and past research on the work-family interface. As used in this study, these items demonstrated good internal consistency (Cronbach α of 0.87). The ratings of each item were summed to determine a participant's overall comfort score.
Last, we sought to gauge an AT's willingness to leave his or her career if the job interfered with family. We used a single question scored on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree), which was also reviewed by our 2-person expert panel and believed to be suitable for its purpose (Appendix). Whereas other scales are used to determine willingness to leave the profession or organization, we wanted to directly ask about family concerns and an AT's willingness to leave the profession. The inclusion of this question was supported by the literature in athletic training related to parenthood and retention.4–6
Data Collection and Procedures
Data were collected over a 3-week period during the 2013 spring semester. The NATA Member Services Department delivered e-mails containing the SurveyMonkey (Palo Alto, CA) link to 1000 random certified ATs spanning all populations listed in the Participants subsection. A second e-mail was sent 2 weeks after the initial invitation to remind potential respondents to complete the survey. The survey took approximately 10 to 15 minutes to complete. All data were stored on the Web site.
Data Analysis
Independent variables were sex and practice setting, and dependent variables were WFC score and comfort score. We conducted descriptive statistics, inferential t tests, and analyses of variance to compare groups; a Tukey post hoc test was performed to identify the specific groups in which a difference occurred. A Pearson product moment correlation was used to examine the relationship between level of WFC and comfort using work-leave benefits. The α level was set at .05 for each analysis. We analyzed all quantitative data using SPSS statistical software (version 20.0; IBM Corporation, Armonk, NY).
RESULTS
More women (n = 7) than men (n = 2) worked 0 to 20 h/wk, more women (n = 46) than men (n = 18) worked 21 to 40 h/wk, and more women (n = 56) than men (n = 29) worked 41 to 50 h/wk. More men (n = 57) than women (n = 28) worked 51 to 80+ h/wk. Three participants selected “other” for time worked but did not offer explanations.
Mean WFC scores by sex are presented in Table 3. Of 246 respondents, most (n = 140, 56.9%) experienced above-average conflict (score = 16.88), 69 (28.0%) experienced high levels of conflict (score = 19–22), and 24 (9.8%) experienced extremely high conflict (score ≥23). According to 246 respondents, hours worked or traveled (n = 113, 45.9%) and inflexible work schedules (n = 64, 26.0%) were the primary contributors to WFC. We observed no difference between men and women based on conflict scores (t244 = 0.492, P = .95). No differences were observed between men and women for their willingness to leave the profession (t244 = −1.27, P = .21; Table 4).
We found differences in WFC scores for ATs in different practice settings (F8,245 = 5.015, P <.001; Table 5). Our Tukey post hoc analysis revealed differences between the clinic/outreach and collegiate settings (mean difference = −3.73; P < .001) and between the clinic/outreach and secondary school settings (mean difference = −2.40; P = .042). A difference existed between the collegiate and education (eg, teaching faculty) settings (mean difference = 4.72; P = .02). We noted no difference among settings in willingness to leave the profession (P = .66; Table 6).
We found a negative relationship between WFC score and comfort using work-leave benefits (2-tailed r = −0.533, P < .001); that is, when the comfort using work-leave benefits was lower, the WFC score was high. The comfort using work-leave benefits was different among practice settings (F8,245 = 3.01, P = .003), but no difference existed between men and women and their comfort using work-leave benefits (t244 = 1.568, P = .06). Our Tukey post hoc analysis showed a difference in comfort levels for attending to nonwork obligations between the clinic/outreach and collegiate settings (mean difference = 1.91, P = .046) and clinic/outreach and secondary school settings (mean difference = 2.03, P = .02). Athletic trainers in the clinic/outreach setting were more comfortable attending to nonwork obligations than ATs working in the collegiate or secondary school setting.
DISCUSSION
Our purpose was to determine if a difference existed in WFC between the sexes and whether WFC differed by practice setting. In addition, we investigated ATs' comfort in using work-leave benefits and whether this differed by practice setting. We also examined ATs' willingness to leave the profession. No researchers have specifically analyzed WFC in athletic training based on sex differences across all practice settings.
We hypothesized that female ATs would perceive more WFC than male ATs and would be willing to leave athletic training based on WFC. Despite limited support for sex differences in experiencing WFC in athletic training, researchers continue to demonstrate that female ATs find balancing the roles of motherhood and athletic training to be stressful5,7 and often report more burnout and stress.14 Our hypothesis reflected that women tend to perceive more challenges from family responsibilities than men and that motherhood challenges them to find a balance while working as an AT.5,15
We also proposed that a difference would exist among settings for WFC and willingness to leave. Our hypotheses were developed based on the existing literature in which authors have found no sex differences within the National Collegiate Athletic Association Division I setting6,8,16 and anecdotal and empirical suggestions that traditional work settings appear to present more challenges than nontraditional settings regarding WFC.17 As in previous research,6,13 our sample group of ATs appeared to experience moderate levels of WFC, which was likely due to several organization-related factors.
A few key observations emerged from our data. First, our demographic data continued to illustrate a general shift in the number of female ATs in the profession, as our sample of 246 ATs was 55% female and 45% male. Despite the shift in women entering the athletic training workforce, a decline appears to occur after a particular age, as presented by Kahanov and Eberman.7 Interestingly, the field of athletic training appears to remain attractive to women, as the sex breakdown showed that more women than men employed as ATs. A possible explanation for the observed female attrition may be that many preprofessionals have limited knowledge of the role of the AT, and once they are socialized into the profession, they realize the demands and time commitment.10,15 Furthermore, in terms of demographics, our sample included more married men than married women and more men with children than women with children. Therefore, despite not finding any differences as we initially expected, the dichotomy between men and women who had children may have influenced the results. Based on their employment settings, ATs have made decisions regarding their family status,15 and many female ATs have possibly opted not to have children or have left the profession since having children. Many female ATs depart the collegiate setting, specifically the Division I setting, to fully balance parental roles and work responsibilities.6,8,16 Contributing to the departure are likely the stress and burnout that female ATs experience when balancing the demands of the time-intensive roles of parenthood and athletic training.18,19
Second, we demonstrated that no differences existed between the male and female ATs for conflict or willingness to leave the profession. We observed a difference among athletic training settings based on conflict but no difference in willingness to leave the profession. However, given the imbalance in the responses for work settings, no difference was found in willingness to leave the profession due to family-related concerns. Our findings support the work of Mazerolle et al,6 indicating that sex did not affect perceptions of WFC; however, they do not fully support the recent work of Eberman and Kahanov,18 who suggested that sex differences did exist. This discrepancy can be explained partially by the differences in the research agendas; we were concerned with comparing measures of WFC between sexes and among occupational settings, whereas Eberman and Kahanov18 looked at work-life balance and parenting factors. Their findings suggested that women experienced more stress managing family and work challenges than men did, and our findings suggested that men and women did not perceive differences in experiencing conflict between work and family. In addition, we used the WFC scale, which assesses the conflict between the roles, whereas Eberman and Kahanov18 used the work-life balance and parenting scale.
Our observation of no differences between the sexes in willingness to leave the profession is interesting and new to the literature. Parental concerns, burnout, and work-life balance have become primary reasons to depart the profession and have mainly been linked to women,4–6,8,16 yet our results suggest that men also question longevity in the profession. Investigators14 have recently indicated that men reported working more hours and struggling to balance work and domestic life while working clinically. This can possibly influence their perceptions of longevity. In this study, we only measured willingness to leave, and we noted no differences; however, it is possible that women eventually act on their willingness to leave to address domestic responsibilities, whereas men are likely to persist in providing financially for their families. Stereotypically, men tend to embrace the breadwinner role, whereas women embrace the caretaker role, which can influence their decisions about career planning.20,21 Moreover, in several recent publications, authors4–7 have illustrated that the departure of female ATs from athletic training is likely due to a combination of factors, including WFC and burnout. Our mean responses for willingness to leave were neutral, so more research is needed to further investigate this phenomenon in ATs. Investigators may need to closely evaluate the difference between willingness to leave and actual turnover.
Third, we noted differences between experiences of WFC and occupational setting, which was not surprising based on the existing literature. Whereas we are the first to compare experiences of WFC among occupational settings within the same sample, researchers4,6,8,16 examining WFC from the separate occupational settings have suggested, as we did, that working in the collegiate setting presents heightened levels of WFC. Athletic trainers working in the collegiate setting want more time to spend with their families and often believe their personal and family responsibilities are neglected because of their work schedules,18 which can explain why they would report higher levels of WFC than ATs employed in other settings. The secondary school setting has also been reported to create the potential for increased WFC,13 likely because of the lack of organizational support and long hours worked. The clinic/outreach setting has been regarded as a setting that affords a more regular work schedule, enabling the AT to spend more time outside the workplace.17
We found a negative correlation between the ATs' WFC scores and their perceived comfort using work-leave benefits. When the comfort using work-leave benefits was lower, the WFC scores were high, and no difference existed between men and women for comfort. Paid time off for personal reasons has been identified as an important factor in job satisfaction.22 In addition, tangible benefits, such as paid time off, have been linked to reduced turnover among health care professionals23 and a way to reduce WFC.24 In our study, participants in the collegiate and secondary school settings reported higher WFC scores and less comfort using work-leave benefits. These results were not surprising given the perceived lack of organizational support and long hours reported in these settings.13,16
Limitations and Future Research
Whereas our response rate (25%) was fair, it was comparable with that of other Web-based studies conducted and published within the professional literature.25 The sample was generated from a small random sample of 1000 ATs within the NATA Member Services pool. A more robust sample may provide stronger evidence of sex and occupational-setting differences. The continued pursuit of understanding work-family considerations in athletic training will help broaden our knowledge and ability to develop policies and strategies to facilitate improved balance between work and family roles. As suggested by others,4,18 a more global understanding is necessary in athletic training, particularly from those who provide support outside the workplace for ATs. Parents, spouses or partners, and children may provide some insights into managing life with an AT to help promote retention in the profession.
When examining willingness to leave the profession or organization, researchers often use a 3-item scale based on the work of Mobley et al.26 Despite the reliability of the scale, it only assesses general willingness to leave, so we used a single item to determine how family concerns can affect ATs' willingness to leave their profession. In future studies, investigators may use the valid 3-item scale in combination with our single item to fully capture an AT's willingness to leave the position or profession.
Our observations highlighted the need for future validation of an instrument that investigates comfort with and use of work-family workplace policies. We also did not operationalize workplace policies, such as personal days or sick time, so the respondents' interpretations may have influenced responses. Future researchers should systematically examine the use of paid leave to address work-family balance and determine why ATs in some settings are reluctant to use this benefit. Current strategies and policies that ATs use appear to be more informal than formal. However, we have a limited understanding of their use and benefits on WFC, and more research is needed.
CONCLUSIONS
Our results showed that WFC continues to be a substantive employment consideration in athletic training, and the level of perceived WFC did not differ between men and women. Differences are present in the perceived level of WFC in practice settings: ATs in the collegiate and secondary school settings report higher levels than those in the clinic/outreach and education settings. A lack of comfort in using work-leave benefits to address family concerns was negatively correlated with WFC, but more research is needed to explore the role of workplace policies in mitigating WFC.
Contributor Notes