Temporal relationships among role stress, staff burnout, and residents’ behavioral problems: A 2-year longitudinal study in child care homes in Hong Kong

Ted C. T. Fong; Rainbow T. H. Ho; Joyce C. Y. Fong

doi:10.1371/journal.pone.0270464

Peer Review History

Original SubmissionFebruary 9, 2021
20 Apr 2021 Decision Letter - Gabriela Topa, Editor PONE-D-21-04372 Effects of role ambiguity and role conflict on staff burnout and residents’ behavioral problems: A 2-year longitudinal study in child care homes in Hong Kong PLOS ONE Dear Dr. Fong, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Jun 04 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Gabriela Topa, Ph. D. Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf This is cross sectional observational study, as such, we do not feel that any conclusions on the effects of role ambiguity and conflict can be supported; thus, we ask that you revise the text (especially, but no limited to, the title) to avoid unsupported statements. Please provide additional information regarding the considerations made for the children in care included in this study during the informed consent procedure. 4. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments (if provided): [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This is an interesting topic; however, I have some critical concerns and provide some comments that might help the authors to develop their paper. About the theoretical introduction: The manuscript contains several statements that need to be supplemented with references, e.g.: line 49: …..and could result in depersonalized working attitudes towards the clients. In fact, there is some research missing related to its foundation and model and that should be mentioned in the theory section. In my opinion, one of the main concerns is that the authors do not sufficiently elaborate their main ideas and hypotheses. A clear theoretical perspective is lacking, especially regarding the assumptions of the effects of role ambiguity and role conflict on staff burnout on resident behavior problems. Method: In your current participants and procedures section it would be nice to have more description about if incentives were offered to the participants. Finally, it would nice to report the total response rate across the time points. Adding a table with descriptive demographic statistics would make it easier for the reader. Discussion: You must explain the reasons for some results of your research, for example: “The significant inter-individual variations in the temporal changes denote the existence 256 of diverging trajectories of role stress and burnout among the workers. Some workers 257 reported increasing levels of role stress while others reported declining levels of role stress 258 over the study period”.You should discuss the results of your research and compare them with previous research, providing references and explanations for the differences between the results. The concern is that it most of the section discusses how the current study confirms already established relationships which leaves the reader wondering what is the unique contribution of this study. It should be noted that the mediating role of burnout in the relationship between role stress and the well-being of residents was not possible in the present study. I am not a native English speaker; however my impression is that the manuscript would benefit from a substantial editing in terms of grammar, syntax, and wording by a native English speaker. Reviewer #2: Dear authors, Thank you so much for submitting your interesting work. It is a very well-conducted investigation within one emotionally vulnerable work sector. The children and adolescents' behaviour problems are related to undesirable processes like role ambiguity, role conflict, and burnout. However, I would like to ask some questions which appeared in my mind, and I hope you find them interesting: - The authors describe the scales used in the investigation, supplying necessary information such as levels of reliability or the scoring system. Concerning this, I wonder if some of these questionnaires define levels based on the scores (e.g. high role ambiguity over X points) - L271-L277. The authors mention some interventions for residents, but I am not sure if those are present in the residential care homes in Hong Kong or are just a reference about alternative ways to enhance the participants' behaviour. More information about residents (e.g. which kind of cares offered to them) could be useful and may be presented in the introduction. It would make the introduction and conclusions (like L271-L274 more linked). Thank you so much, Best wishes ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0270464.r001
Revision 1
31 May 2021 Author Response Response to Reviewers [PONE-D-21-04372.R1] Thank you very much for the valuable comments on the manuscript. We have studied all of the comments carefully and revised the manuscript accordingly. Please refer to the point-by-point response (underlined and starting with “>>”) below to each point. The major changes in the manuscript have been highlighted in red, blue, and green for the journal requirement, reviewer 1, and reviewer 2, respectively, for easier reference. Journal Requirements: 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf >> We have formatted the manuscript to the PLOS ONE’s style requirement. 2. This is cross sectional observational study, as such, we do not feel that any conclusions on the effects of role ambiguity and conflict can be supported; thus, we ask that you revise the text (especially, but not limited to, the title) to avoid unsupported statements. >> Thank you for the remarks. Please note that the present study actually has a 2-year longitudinal design. However, since all of the study variables were assessed simultaneously in this study, we agree that there could be reciprocal effects from staff burnout and residents’ behavioral problems to role stress. We have revised the text (especially the title and abstract) to avoid focusing on the “effects” of role stress. 3. Please provide additional information regarding the considerations made for the children in care included in this study during the informed consent procedure. >> We have provided more detailed information regarding the ethical considerations for the child residents in terms of informed consent under the “Ethical considerations” in page 7. 4. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. >> We have reviewed the reference list to ensure that it is complete and correct. No retracted articles have been cited in this manuscript. 5. Review Comments to the Author Reviewer #1: This is an interesting topic; however, I have some critical concerns and provide some comments that might help the authors to develop their paper. About the theoretical introduction: The manuscript contains several statements that need to be supplemented with references, e.g.: line 49: …..and could result in depersonalized working attitudes towards the clients. In fact, there is some research missing related to its foundation and model and that should be mentioned in the theory section. >> We have added several more references in the Introduction and in line 49 about the statement on depersonalized working attitudes to give a broader background of the context in child care services. The added references include (Whittaker, 2016), (Kim & Lee, 2009), (Demerouti et al., 2001), (Kim, 2011), (Boyas, Wind & Ruiz, 2015). In my opinion, one of the main concerns is that the authors do not sufficiently elaborate their main ideas and hypotheses. A clear theoretical perspective is lacking, especially regarding the assumptions of the effects of role ambiguity and role conflict on staff burnout on resident behavioral problems. >> We have elaborated more on the main ideas regarding the assumptions of the effects of role stress (role ambiguity and role conflict) on staff burnout in the third paragraph in page 4 and for residents’ behavioural problems in the fifth paragraph in page 5. We have reorganized the Introduction section with the following flow: 1st paragraph: Context of child care services in Hong Kong; 2nd paragraph: Job demands and burnout in child care workers; 3rd paragraph: The Job Demands-Resources model and role ambiguity and role conflict 4th paragraph: Associations between role stress and burnout and research gap 5th paragraph: Potential association between role stress and residents’ behavioural problems 6th paragraph: Research objectives and hypotheses Method: In your current participants and procedures section it would be nice to have more description about if incentives were offered to the participants. Finally, it would be nice to report the total response rate across the time points. Adding a table with descriptive demographic statistics would make it easier for the reader. >> We have clarified in Ethical considerations section in page 7 that no incentives were offered to the participants. A new table (Table 1) has been added to report the retention rates of the participants across the time points in the “Attrition analysis” section under Results. Discussion: You must explain the reasons for some results of your research, for example: “The significant inter-individual variations in the temporal changes denote the existence 256 of diverging trajectories of role stress and burnout among the workers. Some workers 257 reported increasing levels of role stress while others reported declining levels of role stress 258 over the study period”. You should discuss the results of your research and compare them with previous research, providing references and explanations for the differences between the results. >> Thank you for the comment. We have added a reference of (Fong et al, 2016) to compare our results of inter-individual variations with the previous findings in the end of the first paragraph in the Discussion section. The concern is that it most of the section discusses how the current study confirms already established relationships which leaves the reader wondering what is the unique contribution of this study. >> Apart from discussions on how the current findings compare to established relationships, we have delineated the contribution of this study. The main contributions are 1) an intensive multi-wave panel design which leads to better understanding of the developmental trajectories of role stress and burnout in child care workers and behavioral problems of child residents over the 2-year period, 2) empirical support to longitudinal relationships between role stress and burnout, 3) original investigation of the linkage between workers’ role stress and child residents’ behavioural problems. It should be noted that the mediating role of burnout in the relationship between role stress and the well-being of residents was not possible in the present study. >> Thank you for the comment. We have noted that the mediating role of burnout in the relationship between role stress and residents’ well-being could not be examined in the present study in the 3rd paragraph of the Discussion section. I am not a native English speaker; however my impression is that the manuscript would benefit from a substantial editing in terms of grammar, syntax, and wording by a native English speaker. >> Thank you for the advice. The revised manuscript has been sent to academic editing by a native English speaker for editing of grammar and syntax. Reviewer #2: Thank you so much for submitting your interesting work. It is a very well-conducted investigation within one emotionally vulnerable work sector. The children and adolescents' behaviour problems are related to undesirable processes like role ambiguity, role conflict, and burnout. However, I would like to ask some questions which appeared in my mind, and I hope you find them interesting: - The authors describe the scales used in the investigation, supplying necessary information such as levels of reliability or the scoring system. Concerning this, I wonder if some of these questionnaires define levels based on the scores (e.g. high role ambiguity over X points) >> Thank you for the advice. There are no known cutoff scores for role ambiguity and role conflict of the workers and total behavioral problems of the child residents. We have added the cutoff criteria for high degree of burnout for the CBI under the Measure section in page 9, the Results section in page 13, and the beginning of the Discussion section in page 15. - L271-L277. The authors mention some interventions for residents, but I am not sure if those are present in the residential care homes in Hong Kong or are just a reference about alternative ways to enhance the participants' behaviour. More information about residents (e.g. which kind of cares offered to them) could be useful and may be presented in the introduction. It would make the introduction and conclusions (like L271-L274 more linked). >> Those interventions are currently not present in residential care homes in Hong Kong. They are provided as a reference about and alternative ways of interventions. We have moved these sentences to the 2nd paragraph “Practical implications” section in page 18, which has been revised to describe the context of residential care offered to the child residents in Hong Kong. Attachments Attachment Submitted filename: Response to Reviewers.doc https://doi.org/10.1371/journal.pone.0270464.r002
13 Jun 2022 Decision Letter - Muhammad A. Z. Mughal, Editor Temporal relationships among role stress, staff burnout, and residents’ behavioral problems: A 2-year longitudinal study in child care homes in Hong Kong PONE-D-21-04372R1 Dear Dr. Ho, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Muhammad A. Z. Mughal, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: I have reviewed the suggested changes to the authors of the paper. The changes have been resolved successfully. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No ******** https://doi.org/10.1371/journal.pone.0270464.r003
Formally Accepted
13 Jul 2022 Acceptance Letter - Muhammad A. Z. Mughal, Editor PONE-D-21-04372R1 Temporal relationships among role stress, staff burnout, and residents’ behavioral problems: A 2-year longitudinal study in child care homes in Hong Kong Dear Dr. Ho: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Muhammad A. Z. Mughal Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0270464.r004

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .