A qualitative study of work-related stress among male staff in Hong Kong's social welfare sector.
Article Type: Report
Subject: Stress management (Case studies)
Social service (Case studies)
Job stress (Case studies)
Authors: Wang, Gary C.T.
Chan, Zenobia C.Y.
Pub Date: 09/22/2010
Publication: Name: International Journal of Men's Health Publisher: Men's Studies Press Audience: Academic; Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 Men's Studies Press ISSN: 1532-6306
Issue: Date: Fall, 2010 Source Volume: 9 Source Issue: 3
Topic: Event Code: 200 Management dynamics Computer Subject: Company business management
Organization: Organization: World Health Organization
Accession Number: 241277018
Full Text: The social welfare sector is a female-dominated environment. Thus, the needs of male staff are usually overlooked. This study aims to describe the stress experienced by male staff in Hong Kong's social welfare sector. A qualitative research approach was adopted using multiple case studies. Forty participants were recruited by convenience sampling. Personal essays developed from guide questions were used in data collection, and content analysis was carried out. The results suggest the need for planning stress management programmes in this sector. Further research on the topic using triangulation and purposive sampling would be useful to confirm the results and compare the experience of stress among male social workers in Eastern and Western cultures.

Keywords: occupational stress, social service, men's health, masculinity, gender

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Mental health is a major public health concern in the twenty-first century. According to the World Health Organization, at the turn of the millennium, approximately 450 million people have been diagnosed with mental illness worldwide (World Health Organization, 2001a). Prolonged and high levels of stress may affect mental health, leading to psychological problems and even psychiatric disorders. Stress is one of the most significant mental health problems in the workplace. It is associated with insomnia, depression and anxiety (Tang, Lee, Leung, Tsang, Ho, & Choy, 2006). At the organisational level, high levels of stress increase operating costs (medication, treatment, compensation). Indirect costs include absenteeism, productivity loss, high staff turnover, early retirement and low morale in the work environment (Coffey, Dugdill, & Tattersall, 2004; Tang, Lee, Leung, Tsang, Ho, & Choy, 2006; World Health Organization, 200 lb).

Hong Kong is one of the world's largest trading economies, with a major service sector. Employees suffer stress as a result of high work demands, job insecurity, long working hours, and competition for wealth as well as social status. Moreover, strong organisational commitment at work is emphasised in the Chinese culture (Department of Health, 2003a; Siu & Cooper, 1998). This traditional value imposes additional pressures on employees.

The Hong Kong government's implementation of a subvention system in the social service sector in the twentieth century placed a financial burden on social service agencies. To cope, these agencies tended to hire contract-based or temporary staff, which caused job insecurity among employees and negatively affected employer-employee relationships. In addition, following the worldwide trend, expectations from the government, clients, and the public became much higher. Additional service output and tailor-made services became essential to satisfy the needs of the public, and this created more work for service staff, Research has shown that the influence of stress in the workplace has been increasing over the past two decades (Danny, Subadra, & Clara, 2004; Gellis, 2002; Margaret, Lindsey, & Andy, 2004).

Gender roles as defined by both the ethnic culture and the dominant culture plays an important role in shaping individuals' health beliefs, their patterns of help-seeking, and their well-being (Chang & Subramaniam, 2008; Mussap, 2008) Following the masculinity gender role, men in Hong Kong adapt socially produced gender behaviors, by receiving the least health attention, including occupational health support. The concern for men's health is commonly viewed as being limited to diseases such as prostate disease or erectile dysfunction (Disease Prevention and Control Division, 2002). The men's mental health problems due to poor lifestyle and limited health-seeking practices are often overlooked, and these should be emphasized in health promotion.

Studies on the promotion of men's mental health, especially in the context of Hong Kong's social welfare sector, are limited. This study was therefore undertaken to explore work-related stress among male staff in Hong Kong's social welfare sector.

OVERVIEW

Being mentally healthy is viewed as having a positive sense of well-being and being able to develop and sustain good interpersonal relationships (Tang et al., 2006). People with optimum mental health know their strengths and weaknesses, are able to cope with stress and lead productive lives (World Federation for Mental Health, 2001). Mental illness problems cover a wide range of psychological, neurological, and behavioural disorders. They are the results of interactions between biological, psychological, and social factors (World Health Organization, 2001 a).

Over 6 million people live in Hong Kong, of whom 3.62 million are in the labour force (Government of the Hong Kong Special Administrative Region, 2007). In 2005, it was estimated that over 15,000 people in Hong Kong suffered from mental illness. Depression, distress or anxiety, schizophrenia, and suicidal tendencies are the more common mental and behavioural problems (Department of Health, 2003b). Previous studies revealed that nearly half of the working population in Hong Kong felt tense or under great pressure, with a majority of the pressure caused by their work (Centre for Social Policy Study, 2000; Lingnan University, 2001; World Health Organization, 2001 a). Long working hours, heavy workload, excessive work demands, conflict between work and family roles, anxiety, and job dissatisfaction are major job stressors (Myung, Sang, Bong, Jong, Soon, & Sei, 2005; Siu & Cooper, 1998; Tang, Lee, Leung, Tsang, Ho, & Choy, 2006). Work-related stress can disrupt family and social life, and increase the risk of accidents. As stress is associated with mental illness, it is important to be concerned with work-related stress in the Hong Kong population.

The perception of stress in men is influenced by socio-cultural factors. Traditional Chinese values, typically place the men higher in the family hierarchy and emphasize among men and women his position as economic provider. In addition, appearing physically adequate, suppressing emotions, being superior to women, being intellectually superior, and being able to perform in their work and sex life, are viewed as masculinity (Chang & Subramaniam, 2008; Das & Kemp, 1997; Lee & Saul, 1987). Masculinity is recognized as a fixed socially produced gendered "performance" (Mussap, 2008). The traditional masculinity gender roles shape men in Hong Kong suppress help-seeking behaviors. Some men view help-seeking as a personal affront to their masculinity, and to avoid being stereotyped as a sign of femininity they mask their stress in work. This led to the gender specific stressors (Gough & Flanders, 2009; Kolmet, Marino, & Plummer, 2006; Plummer, 1999).

Men in Hong Kong may attempt to overcome negative stereotypes of them by trying to meet the ideals of the dominant cultural masculinity. This involves masking their problems faced in work and family in front of others. Many men may become disempowered and compensate for it by the pursuit of risky behaviours such as smoking and heavy alcohol consumption. Both strategies can lead to a denial of real health problems (Chang & Subramaniam, 2008; Nagurney, 2007).

Work significantly impacts the physical, mental, and social health of men. Work provides not only financial security but also self-efficacy in supporting a family-Compared with women, men generally work longer hours and are expected to have a stronger commitment to work. Earlier studies have found that full-time male workers work more hours per week than their female counterparts (Australian Bureau of Statistics, 2002; Kolmet, Marino, & Plummer, 2006). In Hong Kong, 37 percent of men worked more than 10 hours a day. Among those who had not slept well in the past 12 months, 45 percent reported that their work caused sleep problems (Disease Prevention and Control Division, 2002; Family Planning Association, 2001). These indicate men in Hong Kong adopt stressful lifestyles.

There are 370 social service agencies in Hong Kong, providing services and support for 57 million client hours per year. The social welfare sector has over 40,000 personnel, the majority of whom are women working in different positions in social work and health care (Hong Kong Council of Social Service, 2007). Men in the social welfare sector are a minority population. In a female-dominated working environment, men feel the need to suppress their stress. The difficulty of voicing this in front of women colleagues creates additional stress.

Besides stress from socially produced gender behaviors, it is known that social welfare sector personnel in general suffer a high level of stress. Previous studies classify the stressors into three main categories: (a) those related to the nature of the worker's role (task-related stressors), (b) those related to the organisational framework (organisational stressors), and (c) those referring to personal issues (personal stressors) (Centre for Health Protection, 2006; Chiu & Ho, 2006; Posen, 1995; Stokols, 1992; Warr, 1994).

Stress affects individuals at the emotional, physiological, and behavioural levels. When under stress, people tend to experience unpleasant emotions, including annoyance, anger, anxiety, fear, dejection, and grief (Weiten, 1998). Chronic and prolonged everyday stress contributes to psychological problems and mental disorders such as depression, schizophrenia and anxiety disorder (Goldberg & Breznitz, 1993; Tang, Lee, Leung, Tsang, Ho, & Choy, 2006).

Stress may also cause psychosomatic diseases such as hypertension, ulcers, asthma, skin disorders and headache. Research identifies heart disease, stroke, tuberculosis, arthritis, diabetes, leukaemia, cancer, various types of infectious diseases, and common colds have also been related to stress (Cheren, 1989; Elliott & Eisdorfer, 1982; Kaplan & Sadock, 1989).

People adopt various coping strategies to deal with stress, depends on their personality. Those who are optimistic employ constructive coping strategies, while some adopt negative coping strategies such as aggression, giving up and defensive coping (Vaillan, 1994; Weiten, 1998), which tend to diminish the quality of work and life.

From an organisational perspective, the high level of stress affects the organisation's socioeconomic environment. One of the direct costs is medical compensation. Indirect costs include absenteeism, reduced productivity and job satisfaction, high staff turnover and early retirement (Chiu & Ho, 2006; Gellis, 2002; World Health Organization, 2001 a).

STRESS MANAGEMENT

To effectively manage stress, the first step is to identify the internal and external sources of the stressors. Internal stressors are psychological and psychosocial aspects such as relationships with co-workers, and external stressors may include sociological aspects of the working environment such as the hours worked, shift work, and the person's socio-economic status (Kaeasek & Theorell, 1990). Both internal and external stressors can be assessed through quantitative as well as qualitative methods (e.g., questionnaires and in-depth interviews respectively).

Heaney and van Ryn (1990) have developed a model to identify stress management strategies. When the stressor is present among subgroups or a few individual employees, it is better to influence the individual-level stressor. At the individual level, education, relaxation training and cognitive structuring are recommended to train individuals to effectively cope with stressors.

When a majority of employees in an organization feel stressful, it requires modifying organisational level stressors. Suggestions include senior staff mentoring new staff and improving the level of communication between supervisors and their staff. However, organisational-level stressors may be related to the organisational culture and management style, which requires the organisation to develop good management practices (Chiu & Ho, 2006).

This study focuses on work-related stressors and stress management strategies among men in the Hong Kong social welfare sector* It employs a qualitative approach and aims to fill the knowledge gap between men's health and the perception of stress in Hong Kong's social welfare sector.

THE PRESENT STUDY

This study has the following objectives:

* To identify the sources of stressors among male staff in Hong Kong's social welfare sector

* To explore the roles of male staff in the sector

* To identify the effects of stress on men's health

* To identify stress management strategies adopted among male staff

Research questions were categorised into three areas: (a) work-related stressors; (b) gender role on stress and health; and (c) stress management strategies. The research questions were:

a) Work-related stressors

* What were the sources of stress among male staff in Hong Kong's social welfare sector?

b) Gender role on stress and health

* What were the roles of male staff in Hong Kong's social welfare sector?

* How did stress affect men's health?

c) Stress management strategies

* How did the male staff relieve their stress?

METHODS

Study Design

A multiple case study design for a qualitative research approach was used in this study to examine multiple dimensions of the complicated, yet little understood phenomenon (Polit & Beck, 2004) of work stress in the social welfare sector. Male staff in the field were asked to describe their experience in their own words, and the researchers of such narratives were invited to enter into and experience their world (Hipsky, 2006; Hsieh, Spaulding, & Riney, 2004)* An exploratory type of case study was adopted to enable the researchers to identify the problems or discrepancies behind the phenomenon, and to provide a certain degree of flexibility* Case studies are a good way of investigating in depth the thoughts of individuals, groups or communities, allowing researchers to develop intimate knowledge of the participants' conditions, thoughts, feelings, and environment (Polit & Beck, 2004; Yin, 1993).

Participants

As this was an exploratory type of study that aimed at describing experiences, a convenience sample was recruited for easier access to participants. Sixty invitations were sent and 40 participants volunteered for the study, yielding a response rate of 66%. The participants were from six major Hong Kong social service agencies providing services for the elderly, families, youth, and people with disabilities. All participants were male Chinese, with 25 of them (63%) between the ages of 21 and 29. On average, the participants had seven years of experience in the social welfare sector. Twenty-seven participants were frontline staff (68%) providing direct service to users, while 13 were either at the professional grade or management staff providing consultation or supervisory services. Nineteen participants had a monthly salary below HKD$10,000 (USD$1,282). Twenty-eight participants (70%) rated their stress level at 5 on a Likert scale of 0 to 10, indicating a moderate level of stress. Table 1 shows the demographic information of the participants.

Instrument

The personal essay, a semi-structured data collection method, was employed to collect ideas from the participants (Ausband, 2006). The personal essay was designed as a question sheet divided into two parts. In the first part, demographic information including gender, age, salary, years of work experience in the field, marital status, number of family members, and the nature of work were obtained. An item to measure self-perceived stress level, rated on an 11-point Likert scale of 0 (no stress) to 10 (highest stress) was used.

In the second part, eight guided questions were used to assist participants in focusing their thoughts. Participants wrote essays expressing their views on work-related stress, their roles in the social welfare sector, and stress management strategies. The guided questions were open-ended, and participants were encouraged to write 50-100 words for each question using a narrative format (Andrews & Ridenour, 2006). This gave them the freedom to elaborate on the issues (Andrews & Ridenour; Yin, 1994). The completed question sheets were sealed and mailed to the researcher directly.

Procedure

Participants were recruited from six social service agencies in Hong Kong. Question sheets with guided questions for the personal essay were mailed to the agencies to invite participant. The participants volunteered to participate by completing the question sheets and sending them back to the researcher.

Data Analysis

Content analysis, which consists of examining, categorising, tabulating, or otherwise recombining the evidence to address the initial propositions of a study, (Polit & Beck, 2004; Yin, 1994) was used. The results were first analysed by the researchers, and relayed to the representatives of the six social service agencies for comments.

RESULTS

The participants identified communications with colleagues, the lack of resources and service restructing were the most common sources of stressors. Other sources, namely, were rising expectations from society, complicated work environment, feeling of incompetence, and irregular work schedule.

Communication Problems with Colleagues

Communication problems were the most common among the participants. Over half of the participants (n = 23) faced difficulties in communicating with supervisors, colleagues, and service users. One participant responded. "It is stressful to handle relationships with seniors in the agency, because we have different point of views. I think social services should have a mission to help the public. When I have completed my routine work, why can't I help others? For example, I have initiated a project to help the poor, and I think it is meaningful. But my seniors always think that I am troublesome in creating this extra work. I think this violates the mission of the agency." The participant's view reflects teamwork is highly emphasized in social welfare sector, and effective communications are essential. The different modes of communications among management and frontline staff create stress.

The Lack of Resources

Participants commonly viewed the lack of resources led to stress. A number of them (n = 16) faced workforce reduction despite the workload increase, and they found it difficult to adapt to the demanding work environment. Financial support from the government or other funders were cut back to enhance cost-effectiveness. Resources in Hong Kong's social welfare sector became insufficient to meet rising demands. One participant reported, "Many service units are facing the problem of long-term insufficient resources. Mental stress among staff is rising. It is hard to provide high output under limited resources. The work causes (me) fatigue and exhaustion."

Service Restructuring

The rapid change in Hong Kong's socio-cultural environment resulted in a concomitant restructuring of the social welfare sector, and this become a significant stress among participants (n = 10). They pointed out that they needed extra time and effort to develop new skills and to adapt to the new work environment. A participant observed that, "Adding new elements in work causes a certain stress. It is good, because I think stress is a pushing power. However, stepping forward too much, such as commercializing the social welfare sector, creates a huge amount of stress." The comments indicated that when facing new and challenging environments, they sometimes feel harmed and threatened (Balloch, Jan, & Mclean, 1998; Taylor, 2006).

Other Sources of Stress

Ten participants indicated that the service users and the society have high expectations on them. This created an extra workload, and they felt somewhat incompetent to carry out their duties. One participant in our study made statements such as, "The public has expectations in my work. It doesn't want the quality of service to deteriorate because of the increasing workload. They want service users to receive good quality services." Some participants (n = 10) felt that the work environment in the social welfare sector was complicated. They were required to handle emergencies such as emotional burnout and behavioural problems. Six participants felt that they were incompetent to provide quality service, while four Participants who work on shift basis, they felt that this irregular work pattern affected their daily lives.

Stressors Specific to Men in the Social Welfare Sector

The majority of the participants (n = 27) felt that men in the social welfare sector faced more stress. Among them, the most significant men's stressor is dealing with women's service users. Other common stressors include extra workload and the effects of gendered socially produced behaviors on work.

Dealing with Women's Service Users

Most participants (n = 12) viewed the men had the responsibility to protect women's service users; they also needed to monitor the inappropriate behaviours of women's service users. Men were hesitant to contact women's service users. They needed to pay extra attention in communicating or in any kind of contact with women's service users as they ran the risk of being accused of sexual harassment. One participant noted that

Extra Workload

Some participants (n = 4) expressed that they were required to do extra work compared with women, which was stressful. They viewed in a numerically women's dominated work environment; men were expected to handle situations that demanded physical strength, such as handling violence among service users. As a result, men in the sector were more likely to experience violence and stress than their women's counterparts.

Effects of Men's Socially Produced Gender Behaviors on Work

Some participants (n = 8) held the view that the working pattern of men were influenced by the socially produced gender behaviors. They felt that men were socially viewed as more active, casual, and humorous, while women were more attentive and patient with service users. This difference in gendered socially constructed differences has led to different perceptions at work, causing communication problems. One participant pointed out, "The points of view of men and women are different. Women are more impressionable and affective. The different working styles cause constraints and lower efficiency in a women-dominated work environment. This is my work stress."

Role of Men in Social Welfare Sector

Participants wrote different roles of men in the sector. The most common role suggested by the participants (n = 12) were leaders. They were expected to be highly competent in organisational management. Some participants' comments were controversial as they expected men were often expected to be more decisive than women. Men would have a clear focus, and were socially expected to be more comprehensive in their judgment and more objective in decision-making. When facing an unjust situation, men would unite their power to fight for resources.

One participant held that men were socially expected to be the leaders in the social welfare sector. A careful attention is required to understand the negative and stereotypical values:

As influenced by the traditional Chinese culture, men are stereotyped to take up masculine figures. This stereotype is typical in social welfare sector. The participants (n = 8) viewed men as adopting a masculine figure in a female-dominated working environment. Men are responsible for challenging tasks and duties where some violence may be encountered to represent an authority role.

A participant explained his masculine role at work:

It is worth notice that in a women-dominant working environment, a number of participants (n = 10) thought that they were marginalised in the organisation. They have negative and stereotypical comments that women were more appreciated, while men usually took on assistant roles. Some of them (n = 2) viewed men were the subordinates of women and thus needed to be obedient, even though they sometimes had disagreements. Others felt that women were more impressionable in making decisions, and were thus more likely to have conflicts with others. As a result, men faced more distress, which commented:

Besides the above major roles, a few participants (n = 3) thought men were the key staff to handle male service users, because they are easily able to develop rapport.

EFFECTS OF STRESS ON HEALTH

The effects of stress on health among participants could be viewed from physiological and psychological perspectives. Physiologically, headache and insomnia were the most common problems faced among participants (n = 16). Others (n = 4) reported fatigue, dizziness, pain, elevated blood pressure, diarrhoea, stomach ache, and skin allergy. These cause a lack of energy and motivation to work during the daytime. Due to the physiological discomfort, participants presented low job satisfaction and commitment to the organisation. The low work commitment in turn affects productivity and efficiency.

Psychologically, the great majority of the participants (n = 35) reported being short-tempered when faced with stress, as well as fatigued, depressed, and nervous. Some participants (n = 5) even had the tendency to have negative thoughts, lacking the confidence to try new things, and worrying about failure at work. They also noted the effects of stress on their daily lives. The most common problem is the disturbance of work-rest schedule, as half of the participants (n=20) needed to work overtime. The meal time and lesiure time were lessened. Even on holidays, some were still anxious. One participant pointed out particularly, "Even if I do not bring the work home, it is still on my mind. Therefore, the holiday is useless."

Other effects of stress on daily lives were the relationships with family and friends. A number of participants (n = 5) had little time to spend with their families and friends. Even during their free time, they preferred to be alone rather than join social activities. Some participants (n = 4) worked in shifts. They had difficulty meeting friends because of their irregular working hours.

Stress Management Strategies

Participants used various strategies to manage work stress. Common strategies were seeking social and spiritual support, engaging in physical and sensory-based activities, self-reflections, and rearranging work schedules. Others suggested an innovative idea of establishing support groups for the well-being of male staff in the social welfare sector.

Social Support

One participant responded, "I relieve stress by finding family and friends with whom to air out my dissatisfaction with work. They may not agree with my views, or provide solutions. But my dissatisfaction is eased after I have ventilated my feelings." Another explained, "Better communication with service users and maintaining good relationships with them are important to relieve work stress. I also apologize to them if I do something wrong." The participants (n = 18) highlighted by gathering with friends and their families, they could shift their attention away from stress. Support from the family, partner, or spouse could act as a buffer to reduce work stress.

Spiritual Support

Besides supports from families and friends, a number of participants (n = 16) sought spiritual support. Some were able to achieve stress relief through different religious activities such as reading the Bible, praying, singing hymns, listening to religious music and participated in church activities.

Physical Activities

Physical activities helped some participants (n = 18) to reduce stress. They played ball games and sports, such as basketball, football, swimming, and jogging in their leisure time. Some engaged in outdoor activities such as hiking and going to the countryside or the seaside. They indicated that they could forget unpleasant things by engaging in physical activities.

Sensory-Based Activities

It was surprising to know that some participants (n = 13) engaged in sensory-based activities to relieve stress. They enjoyed playing video games, watching films and television, eating snacks or their favourite food, listening to music, shopping, and even shouting and using foul language to ventilate the emotions caused by their work stress. One participant described eating as a means to relieve stress in work, "I am in the habit of eating my favourite food to reduce work stress; it causes my body weight to increase." This view indicated some sensory-based stress management strategies led to health problems, causing another stress.

Self-Reflection

One participant responded, "Taking time to undergo self-reflection is important. Upon recovery, I can develop new ideas. It brings out my best capacities." Self-reflection helped to relieve work stress in some of the participants (n = 10). Through reflection, they found methods of improving work performance and overcoming their difficulties. This also allowed participants to forget unpleasant things at work and restructure their thoughts. A participant described: "I think the best way to handle work stress is to put down one's duties, then observe and think about how to work accurately and smoothly before picking up the task again."

Rearrange the Work Schedule

Some participants (n = 12) pointed out to reduce work stress by rearranging their work schedules. If they completed their work within office hours and refrained from working during holidays, work stress did not affect their daily lives. Participants were positive towards their work, in accordance with the traditional Chinese saying, "respect the job, enjoy the job." From this point of view, stress was seen as a motivating force for an individual to learn and improve their work (Taylor, 2006).

Setting Up Support Groups

Some participants (n = 4) suggested stress management strategies from the organisational perspective. Social service agencies might consider organising "staff support groups" to facilitate staff leisure activities and improve social relationships at work. One participant particularly believed that joining the social service union could relieve stress because it would enable his directly to voice out their stress and difficulties to policymakers.

Other stress management strategies adopted by the participants (n = 9) included sleeping, reading, keeping pets, travelling, housework, helping neighbours, and seeking help from professionals such as clinical psychologists.

DISCUSSION

Implications for Health Education and Health Promotion

The findings from this study could serve as a reference in exploring the directions of health education and promotion in Hong Kong's social welfare sector. The results of the present study are consistent with those of previous studies in terms of major work-related stressors, effects of stress on health, and stress management strategies. Our findings are consistent with those of Fischer and Good (1997) that the influence of masculine gender role affect men to communicate with colleagues effectively. Our findings are also consistent with those of Miller, Cohen, and Ritchey (2002); Kolmet, Marino, and Plummer (2006); Shaver, Johnston, Lentz, and Landis (2002); and Taylor (2006), which suggest that long-term work stress can affect men's health. Finally, our findings are also consistent with Balloch, Jan, and Mclean (1998), Barak, Nissly, and Levin (2001), and Lechner (1993), who suggested that support from families, friends, and social service agencies, could act as a buffer to reduce work stress, and is health-protective for men.

Several results in this study are interesting and noteworthy. A number of participants revealed that stress came from communications with women's supervisors and colleagues, as well as contact with women's service users. The masculine gender role views men to be superior to women. However, men are often the minority in the sector and this suppresses masculinity. Job satisfaction is reduced when employees feel emotional strains (Lechner, 1993). Our results highlight the experiences of effects of stereotyped gender roles of men on the social welfare sector, and help fill the knowledge gap in men's health and stress in the social welfare sector.

On the level of clinical practice, we explored work-related stressors to develop stress management programmes for men in the sector, as men usually refuse to address their stress and its impact on their health (O'Brien, Hart, & Hunt, 2007). Participants identified communications with colleagues, dealing with women service users, and extra workload due to masculine gender role as common stressors. These issues could become the focus in stress management programmes for male staff in the sector. Furthermore, some participants relied on sensory-based activities to relieve stress, such as watching television, playing video games, and eating. These strategies may have negative health consequences and create extra stress. Sharing groups may be a useful stress management strategy for facilitating peer learning of appropriate methods. Assertiveness training, adoption of healthy lifestyles, and the social support from sharing groups could also relieve work-related stress (Lechner, 1993; Taylor, 2006).

Some participants perceived stress as a catalyst to improve work performance. This positive effect of stress is often overlooked, and it may be useful to highlight such positive effects of stress to male staff in the social welfare sector (Taylor, 2006).

Some participants view men work issues are negative and stereotypical values. This shows that although the majority of men adopt problem-focused strategies to cope with stress, some are emotion-focused (Ptacek, Smith, & Dodge, 1994; Pugliesi, 1999). Further improvement in gender relationships in the sector could enhance the harmonious working environment. Policymakers in the social service agencies can provide effective communication channels for men and women staff to understand the stress of each other. Study indicates that men's stress is more related to work and finance, while women's stress is more related to family and health (Billings & Moose, 1984). Policymakers could let men and women understand the stress of each other, and develop stress management programmes for them. Based on our findings, effective communications with supervisors and colleagues can relieve stress at work. Participants also indicated that sharing groups and recreational activities could relieve stress. Staff support groups with both genders involved could also be formed to plan different social activities.

Although the social welfare sector is female-dominated, it is surprising to learn that some of the participants expected themselves to take on the leadership roles. Policymakers might develop clear and objective measures in assigning decision-making duties to staff. This help men understand the appointment is based on relevant experience and education, and both genders have equal opportunities.

LIMITATIONS AND FUTURE DIRECTIONS

There are several limitations in the study. First, the transferability of our results is limited since participants were recruited by convenience sampling and may not be representative of the true situation in Hong Kong. Future studies could consider using purposive sampling to include participants with specific knowledge on the topic and with atypical experience. This would also provide broad and specific ideas about the participants to enrich the findings (Ausband, 2006). Second, although the personal essay has several advantages, it is difficult to obtain comprehensive information from the participants. The personal essay also requires adequate literacy skills and a high level of participant cooperation (Polit & Beck, 2004). As a result, some potential participants who were illiterate or not interested in writing were not inclined to participate in the study. Some participants preferred interviews rather than writing. Future studies might consider adding an interview component in the data collection. Third, it is interesting to note that most participants wrote less in the latter parts of the personal essay, possibly reflecting a drop in their attention. To enhance the transferability of the data, it is recommended to use a triangulation design (Hsieh, Spaulding, & Riney, 2004) with multiple and different references to form categories and themes, and draw conclusions (Denzin & Lincoln, 1998; Golafshani, 2003; Polit & Beck, 2004). Finally, since the study took place in the context of Hong Kong's social welfare sector, the results were influenced by the unique mix of Eastern and Western cultures in Hong Kong. Further research comparing the Western and Eastern contexts may be valuable to explore any culture-specific factors related to men's stress in the social welfare sector.

In conclusion, this study identified the work-related stress facing male staff in Hong Kong's social welfare sector, its effects on their health, and stress management strategies. It is hoped that based on this information, stress management programmes may be developed by the various social service agencies to address the needs of this special group. Further research is needed to examine men's stress in social welfare sectors in the Western and Eastern contexts for a comparative perspective.

DOI: 10.3149/jmh.0903.221

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Gary C.T. Wong (a) and Zenobia C.Y. Chan (b)

(a) Hong Kong.

(b) School of Nursing, The Hong Kong Polytechnic University.

Correspondence concerning this article should be addressed to Zenobia C.Y. Chan, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, HKSAR. Email: hszchan@inet.polyu.edu.hk
[I]t is risky for a male staff member to serve a woman's service
   user. For example, women staff can have visual contact with or even
   touch the body of a man's service user in order to help him perform
   daily functions, but a man's staff cannot do the same for women's
   clients and cannot help them even when help is needed. Men need to
   be very careful when dealing with women's service users, and so
   will try to avoid such situations. It is risky for men's staff to
   serve women's service users with mental illness, because they
   sometimes have delusions and accuse men's staff of abuse. This puts
   the men's staff at a big disadvantage.


I think men need to rise up! Because men are leaders and women are
   followers. Although women are more caring in their attitudes, they
   are slower than men in leadership, and not decisive enough. Also,
   men consider different perspectives before making decisions, while
   women make decisions based on moods. Men consider a wider scope in
   their work.


Due to the traditional concepts of our society, men are treated as
   authority figures. Sometimes, although I may be incompetent, I am
   needed to handle challenging tasks like handling violence of
   service users because I am the only male staff member in the
   organisation.


Women in general focus on the minor issues and always change their
   mind. They do not accept different ideas are prejudiced against
   men, especially those who are competent. They prefer hiring female
   staff.


Table 1
Demographic Information of Participants
                                            Number of
Variable                                   participants     %

Gender
  Male                                          40         100
  Female                                         0           0
Age Range
  21-29                                         25          63
  30-39                                          3           8
  40-49                                          6          15
  50-55                                          3           8
  Others                                         3           8
Post
  Management staff                               4          10
  Frontline staff                               27          68
  Professional staff                             9          23
Salary
  Below HKD$ 10,000 (USD$ 1,282)                19          48
  HKD$ 10,001-20,000 (USD$ 1,283-2,564)         11          28
  HKD$ 20,001-30,000 (USD$ 2,565-3,846)          2           5
  HKD$ 30,001-40,000 (USD$ 3,847-5,128)          4          10
Marital Status
  Single                                        27          68
  Married                                       13          32

Note. The total number of participants was fewer than 40 owing to
missing data. Total exceeded  100% as percentages were rounded
off.
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