The Mediating Role of Organizational Commitment in the Work Performance Grape Effect of Organizational Stress Perceived by Teachers

Yıl 2020, Cilt: 2 Sayı: 2, 115 - 137, 27.07.2020

Gökben Bayramoğlu Emre Uysal Ahmet Karkı

Öz

Many factors that cause anxiety and lead to negative organizational results for people in their work places culminates to organizational stress. The teaching profession is a stressful activity. Besides many factors, the commitment of teachers to the institution they work affects their reactions to stress or the techniques they use to overcome stress. The aim of this study is to examine the role of organizational commitment as a mediator role in the effect of organizational stress perceived by teachers on job performance. In the research, a survey was conducted with 305 teachers working in Çorum. Factor analysis, correlation/regression analysis and SPSS Process module/model 4 were used to analyze the data. A low, negative and significant relationship was detected between perceived organizational stress and job performance. A low, negative and significant relationship was detected between perceived organizational performance and organizational commitment. A low, positive and statistically significant relationship was found between organizational commitment and performance. When perceived organizational stress and organizational commitment variables were included in the regression model, it was seen that the stress-performance relationship became meaningless. In addition, the mediator role was confirmed with the help of the SPSS Process module. The results obtained support the research findings made in the national literature. However, the very low relationship between organizational stress and performance necessitates a review of stress-related discourses. In this respect, it is thought that it will be effective to focus on stress studies to determine the contradictions between human biological structure and modern life.

Anahtar Kelimeler

Perceived organizational stress, job performance, organizational commitment, teacher

Öğretmenlerin Algıladıkları Örgütsel Stresin İş Performansı Üzerindeki Etkisinde Duygusal Bağlılığın Aracılık Rolü

Öz

Örgütsel Stres; “çalışanlar için anksiyeteye ve olumsuz sonuçlara yol açan örgütsel faktörlerin yarattığı stres” olarak tanımlanabilir. Öğretme, stresli bir faaliyet olması nedeniyle detaylı olarak incelenmesi gerekmektedir. Ayrıca öğretmenlerin kuruma olan bağlılıkları, stresin üstesinden gelmek için kullandıkları teknikleri etkilemektedir. Bu çalışmada öğretmenlerin algıladıkları örgütsel stresin iş performansı üzerindeki etkisinde duygusal bağlılığın aracılık rolü araştırılmıştır. Araştırmada Çorum’da görev yapan 305 öğretmenle anket çalışması yapılmıştır. Verilerin analizinde faktör analizi, korelasyon, regresyon analizi ve SPSS Process modülü kullanılmıştır. Algılanan örgütsel stres-iş performansı arasında düşük, negatif yönlü ve anlamlı; algılanan örgütsel performans-örgütsel bağlılık arasında ise düşük, negatif yönlü ve anlamlı bir ilişki tespit edilmiştir. Örgütsel bağlılık-performans arasında düşük, pozitif yönlü ve anlamlı bir ilişki tespit edilmiştir. Algılanan örgütsel stres-örgütsel bağlılık regresyon modeline birlikte dahil edildiğinde stres-performans ilişkisinin anlamsızlaştığı görülmüştür. Ayrıca SPSS Process modülü yardımıyla aracılık rolü teyit edilmiştir. Elde edilen sonuçlar özellikle ulusal literatürde yapılmış olan araştırma bulgularını destekler niteliktedir. Ancak örgütsel stres-performans arasındaki ilişkinin çok düşük olması, stresle ilgili söylemlerin yeniden gözden geçirilmesini getirmektedir. Bu bağlamda, insan biyolojisi-modern yaşam arasındaki çelişkilerin stres üzerindeki etkilerine yönelik çalışmaların arttırılması gerekmektedir.

Anahtar Kelimeler

Algılanan Örgütsel Stres, İş performansı, Örgütsel Bağlılık, Öğretmen

Kaynakça

• Abdullah, A., & Ismail, S. (2019). A Structural Equation Model Describes Factors Contributing to Teachers’ Job Stress in Primary Schools. International Journal of Instruction, 12(1), 1251-1262. https://files.eric.ed.gov/fulltext/EJ1201236.pdf
• Adaramola, S. S. (2012). Job Stress and Productivity Increase. Work, 41, 2955-2958. DOI:10.3233/WOR-2012-0547-2955
• Akman, Y. (2017). Öğretmenlerin Algılarına Göre İş Motivasyonu ve Örgütsel Özdeşleşme Arasındaki İlişki. Hasan Ali Yücel Eğitim Fakültesi Dergisi, 14-1(27), 71-88. https://dergipark.org.tr/tr/download/article-file/324452
• Alıcı, B., & Yalçınkaya, M. (2019). Öğretmenlerin Mesleki Doyum ve ÖB Düzeylerinin İş Stresi Düzeylerine Göre İncelenmesi. Folklor/edebiyat, 25(97-1). doi:10.22559/folklor.939
• Allen, N. J., & Meyer, J. P. (1996). Affective, Continuance, and Normative Commitment to the Organization: An Examination of Construct Validity. Journal of Vocational Behavior, 252-276.
• Ashforth, B. E., & Mael, F. (1989). Social Identity Theory and the Organization. Academy of Management, 14(1), 20-39. http://www.jstor.org/stable/258189
• Baron, R. M., & Kenny, D. A. (1986). The Moderator-Mediator Variable Distinction in Social Psychological Research: Conceptual, Strategic, and Statistical Considerations. Journal of Pe~nality and Social Psychology, 51(6), 1173-1182. doi:http://www.public.asu.edu/~davidpm/classes/psy536/Baron.pdf
• Becker, T., Billings, R., Eveleth, D., & Gilbert, N. (1996). Foci and Bases of Employee Commitment: Implication for Job Performance. Academy of Management Journal, 39(2), 464-482.
• Bilgili, H., & Tekin, E. (2019). ÖS, ÖB ve Öğrenilmiş Güçlülük İlişkisi Üzerine Bir Araştırma. Uluslararası Toplum Araştırmaları Dergisi, 11(18). doi:10.26466/opus.557530
• Boswell, W., Olson-Buchanan, J., & LePine, M. (2004). Relations between Stress and Work Outcomes: The Role of FElt Challange, Job Control, and Psychological Strain. Journal of Vocational Behavior, 64, 165–181. doi:10.1016/S0001-8791(03)00049-6
• Cavanaugh, M., Boswell, W., Roehling, M., & Boudreau, J. (2000). An Empirical Examination of Self-Reported Work Stress Among U.S. Managers. Journal of Applied Psychology, 85(1), 65-74. doi:10.1037//0021-9010.85.1.65
• Chen, M., & Miller, G. (1997). Teacher Stress: A Review of the International Literature. ERIC Database. https://files.eric.ed.gov/fulltext/ED410187.pdf
• Cheney, G., & Tompkins, P. K. (1987). Coming to Terms with Organizational Identification and Commitment. Central States Speech Journal, 38(1), 1-15. doi:10.1080/10510978709368225
• Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A Global Measure of Perceived Stress. Journal of Health and Social Behavior, 24(4), 385-396. https://www.jstor.org/stable/2136404
• Colquitt, J. A., Lepine, J. A., & Wesson, M. J. (2014). Organizational Behavior: Improving Performance and Commitment in the Workplace. New York: McGraw- hill Education.
• Cranwell-Ward, J., & Abbey, A. (2005). Organizational Stress. New York: Palgrave Macmillan.
• Çöl, G. (2008). Algılanan Güçlendirmenin İşgören Performansı Üzerine Etkileri. Doğuş Üniversitesi Dergisi, 35-46. http://journal.dogus.edu.tr/index.php/duj/article/view/77/92
• Drucker, P., & Maciariello, J. (2012). Yönetim. İstanbul: Optimist Yayınları .
• Edwards, J. R., & Cooper, C. L. (1990). The Person-Environment Fit Approach to Stress: Recurring Problems and Some Suggested Solutions. Journal of Organizational Behaviour, 11, 297-307. https://link.springer.com/chapter/10.1057/9781137310651_5
• Eskin, M., Harlak, H., Demirkıran, F., & Dereboy, Ç. (2013). Algılanan Stres Ölçeğinin Türkçeye Uyarlanması: Güvenirlik ve Geçerlik Analizi. New/Yeni Symposium Journal, 51(3), 132-142.
• Funch, S. (2012). Understanding Psychological Bonds between Individiuals and Organizations: The Coalescence Model of Organizational Idenficitaion. New York: Pagrave Macmillan.
• Gedik, A., & Üstüner, M. (2017). Eğitim Örgütlerinde ÖB ve İş Doyumu İlişkisi: Bir Meta Analiz Çalışması. E-Ulusararası Eğitim Araştırmaları Dergisi, 41-57.
• Gilboa, S., Shirom, A., Fried, Y., & Cooper, C. L. (2013). A Meta- Analysis of Work Demand Stressors and Job Performance: Examining Main and Moderating Effects. C. L. Cooper (Dü.) içinde, From Stress to Wellbeing Volume 1: The Theory and Research on Occupational Stress and Wellbeing (s. 188-231). New York: Palgrave Macmillan. doi:10.1007/978-1-137-31065-1
• Göçen, A. (2019). Öğretmenlerin Anlam, Meslek Sürdürme, Stres ve Tükenmişlik. Kastamonu Eğitim Dergisi, 27(4), 1383-1395. doi:10.24106/kefdergi.2479
• Griffith, J., Steptoe, A., & Cropley, M. (1999). An Investigation of Coping Strategies associated with Job Stress in Teachers. British Journal of Educational Psychology, 517-531. doi: https://doi.org/10.1348/000709999157879
• Guglielmi, S., & Tatrow, K. (1998). Occupational Stress, Burnout, and Health in Teachers: A Methodological and Theoretical Analysis. American Educational Research, 68(1), 6199. https://www.jstor.org/stable/1170690
• Harish, K., & Prabha, B. (2019). Performance on the Work-related Stress and Job contentment of Primary School Teachers of Government and Private Sectors. International Journal of Recent Technology and Engineering, 143-148. doi:10.35940/ijrte.B1027.0782S219
• Hartney, E. (2008). Stress Management fot Teach. London, New York: Continuum International Publishing Group.
• Haslam, S., O’Brien, A., Jetten, J., Vormedal, K., & Penna, S. (2005). Taking the Strain: Social Identity, Social Support and the Experience of Stress. British Journal of Social Psychology, 44, 355–370. doi:10.1348/014466605X37468
• Hechl, C. (2017). Affective Commitment to Organizations: A Comparative Study of Reverse Mentoring Versus Traditional Mentoring among Millennials. Binus Business Review, 8(2), 157-165. doi:10.21512/bbr.v8i2.3666
• Hellriegel, D., & Slocum, J. W. (2011). Organizational Behavior (13. b.). South-Western: Thomson Learning Publication.
• Herman, K., Prewett, S., Eddy, C., & Savala, A. (2020). Porfiles of Middle School Teacher Stress and Coping: Concurrent and Prospective Correlate. Journal of School Psychology, 78, 54-68. doi:https://doi.org/10.1016/j.jsp.2019.11.003
• Huguet, P., Galvaing, M., Monteil, J., & Dumas, F. (1999). Social Presence Effects in the Stroop Task: Further Evidence for an Attentional View of Social Facilitation. Journal of Personality and Social Psychology, 77(5), 1011-1025. https://www.researchgate.net/profile/Pascal_Huguet2/publication/12727120_Social_presence_effects_in_the_Stroop_Task_Further_evidence_for_an_attentional_view_of_social_facilitation/links/577d415808aed807ae75faaa.pdf
• Hunter, L. W., & Thatcer, S. M. (2007). Feeling The Heat: Effects of Stress, Commitment and Job Experience on Job Performance. Academy of Management Journal, 50(4), 953-968. https://gmdconsulting.eu/nykerk/wp-content/uploads/2019/06/AMJ-Effects-of-stress-on-job-perf-2007.pdf
• İhtiyaroğlu, N. (2018). Analysis of Relationship between Teachers’ Coping Styles with Stress and the Level of Organizational Commitment. International Online Journal of Educational Sciences, 10(2), 192-206. doi:https://doi.org/10.15345/iojes.2018.02.013
• Irving, P., & Coleman, D. (2003). The Moderating Effect of Different Forms of Commitment on Role Ambiguity-Job Tension Relations. Canadian Journal of Administrative Sciences, 20(2), 97-106.
• Jex, S., Sliter, M., & Britton, A. (2014). Employee Stress and Well-Being. B. Schneider, & K. Barbera (Dü) içinde, The Oxford Handbook of Organizational Climate and Culture (s. 177-193). Oxforf Library of Psychology.
• Kang, X.-L., & Liu, L. (tarih yok). Discussion of the Relationship between Perceived Job Characteristics and Organizational Commitment of University PE Teachers-from the Aspect of Job Stress. Journal of Interdisciplinary Mathematics, 21(2), 317-327. doi:10.1080/09720502.2017.1420562
• Keoh, C. F. (2002). Occupational Stress, Organizational Commitment Career Commitment, Job Satisfaction and Withdrawal Cognition among School Teachers. Thesis Submitted to the School of Graduate Studies. Universiti Putra Malaysia. 02 11, 2020 tarihinde http://psasir.upm.edu.my/id/eprint/9280
• Kesen, M. (2016). Çalışan Katılımı, Yönetimin Açıklığı, Örgütsel Özdeşleşme ve Çalışan Performansı Arasındaki Etkileşimleri Belirlemeye Yönelik Amprik Bir Çalışma. EKEV Akademik Dergi, 20(66), 463-484. doi:10.17753/Ekev605
• Khurshid, F. (2010). The Relationship of Personality Factors with Occupational Role Stress and Organizational Commitment Among University Teachers. Pakistan Journal of Social Issues, 2, 1-11. http://103.226.217.101/jspui/bitstream/1/117875/1/pjsi%20vol.2.pdf#page=3
• Kim, J., Shin, Y., Tsukayama, E., & Park, D. (2020). Stress Mindset Predicts Job Turnover among Preschool Teachers. Journal of School Psychology, 78, 13-22. doi:doi.org/10.1016/j.jsp.2019.11.002
• Kim, J., Shin, Y., Tsukayama, E., & Park, D. (2020). Stress Mindset Predicts Job Turnover among Preschool Teachers. Journal of School Psychology, 78, 13-22. doi:https://doi.org/10.1016/j.jsp.2019.11.002
• Kırımoğlu, H., Yıldırım, Y., & Temiz, A. (2011). İlk ve Ortaöğretim Okullarında Görev Yapan Beden Eğitimi ve Spor Öğretmenlerinin Stresle Başaçıkma Tarzlarının İncelenmesi(Aydın İl Örneği). Niğde Üniversitesi Beden Eğitimi Ve Spor Bilimleri Dergisi, 5(2), 144-156. http://eds.a.ebscohost.com/eds/pdfviewer/pdfviewer?vid=0&sid=8711979c-e522-492e-85bb-00cf28fb85bc%40sdc-v-sessmgr03
• Klassen, R., & Chiu, M. (2010). Effects on Teachers’ Self-Efficacy and Job Satisfaction: Teacher Gender, Years of Experience, and Job Stress. Journal of Educational Psychology, 102(3), 741-756. doi:10.1037/a0019237
• Kline, R. B. (2011). Principles and Practice of Structural Equation Modelling (3. b.). New York, London: The Guilford.
• Kurniawan, R. B., Sularso, R., & Titisari, P. (2018). The Effect Of Work Conflict And Job Stress On Employees Performance With Organizational Commitment As Intervening Variable. Journal Manajemen & Kewirausahaan, 6(1), 1-8. http://jurnal.unmer.ac.id/index.php/jmdk/article/viewFile/1985/1522
• Kyriacou, C. (2001). Teacher Stress: Directions for Future Resarch. Educational Review, 53(1), 27-37.
• Lapointe, É., Vandenberghe, C., & Boudrias, J.-S. (2013). Psychological contract breach, affective commitment to organization and supervisor, and newcomer adjustment: A three-wave moderated mediation model. Journal of Vocational Behavior, 83, 528-538. doi:https://doi.org/10.1016/j.jvb.2013.07.008
• Lazarus, R. S., & Folkman, S. (1984). Stress, Appraisal, and Coping. New York: Springer Publishing Company.
• Manning, D., & Preston, A. (2003). Organizational Stress: Focusing on Ways to Minimize Distress. CUPA-HR Journal, 54(2), 15-18. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.515.1538&rep=rep1&type=pdf
• Masihabadi, A., Rajaei, A., Koloukhi, A., & Parsian, H. (2015). Effects of Stress on Auditors' Organizational Commitment, Job Satisfaction, and Job Performance. International Journal of Organizational Leadership, 4, 303-314. https://ijol.cikd.ca/article_60353_cb6d14cdb2d998fbc073c88f15590bdc.pdf
• Mathieu, J., & Zajac, D. (1990). A Review and Meta-Analysis of the Antecedents, Correlates, and Consequences of Organizational Commitment. Psychological Bulletin, 108(2), 171-194.
• McCraty, R., & Atkinson, M. (2012). Resilience Training Program Reduces Physiological and Psychological Stress in Police Officers. Global Advances in Health and Medicine, 1(5), 44-66. doi:10.7453/gahmj.2012.1.5.013
• Mirela , B., & Mădălina-Adriana, C. (2011). Organizational Stress and Its Impact on Work Performance. Annals of the University of Oraddea, Economi Science Series, 333-337. Morrow, P. (1983). Concept Redundancy in Organizational Research:The Case of Work Commitment. Academy of Management Review, 8, 486-500. https://lib.dr.iastate.edu/cgi/viewcontent.cgi?article=1045&context=management_pubs
• Nagar, K. (2012). Organizational Commitment and Job Satisfaction among Teachers during Times of Burnout. VIKALPA, 37(2), 43-61. https://journals.sagepub.com/doi/pdf/10.1177/0256090920120205
• Nart, S., & Batur, Ö. (2014). The Relationship between Work-familiy Conflict, Job Stress, Organizational Commitment and Job Performance: A Study on Turkish Primary Teachers. International Association of Social Science Research, 2(2), 72-81. doi:10.15527/ejre.201426250
• Nikolaou, I. (2002). Emotional Intelligence in the Workplace: Exploring its Effects on Occupational Stress and Organizational Commitment. The International Journal of Organizational Analysis, 10(4), 327-342. http://eds.a.ebscohost.com/eds/pdfviewer/pdfviewer?vid=2&sid=8de6db62-32c9-4e6a-81b1-404802865181%40sdc-v-sessmgr03
• O'Reilly III, C., & Chatman, J. (1986). Organizational Commitment and Psychological Attachment: The Effects of Compliance, Identification, and Internalization on Prosocial Behavior. Journal of Applied Psychology, 71(3), 492-499. https://pdfs.semanticscholar.org/1eef/c51ff886acd6f2c317f8f25a3f42fe984ddb.pdf
• Özsoy, E. (2019). Örgütlerde Stres ve Stresle Başa Çıkma Yolları. E. Kaygın, & G. Kosa (Dü) içinde, Olumsuz Boyutlarıyla Örgütsel Davranış. Konya: Eğitim Yayınevi.
• Parasuraman, S. (1982). Predicting Turnover Intentions ans Turnover Behavior: A Multivariate Analysis. Journal of Vocational Behavior, 21, 111-121.
• Parveen, H., & Bano, M. (2019). Relationship Between Teachers’ Stress and Job Satisfaction: Moderating Role of Teachers Emotions. Pakistan Journal of Psychological Research, 34(2), 353-366. https://doi.org/10.33824/PJPR.2019.34.2.19
• Riketta, M. (2005). Organizational identification: A meta-analysis. Journal of Vacational Behavior, 66, 358-384. doi:10.1016/j.jvb.2004.05.005
• Riketta, M., & Van Dick, R. (2005). A meta-analytic Comparison of the Strength anf Correlates of Workgroup Versus Organizational Identitification and Commitment. Journal of Vocational Behavior, 67, 490-510. doi:10.1016/j.jvb.2004.06.001
• Seyhan, H. (2015). Kimya Öğretmenlerinin İş Doyumları, Öz-yeterlik Algıları, ÖBları ve İş Streslerinin Çeşitli Değişkenler Açısından İncelenmesi. Turkish Journal of Education, 4(2). https://dergipark.org.tr/en/download/article-file/160549
• Silverthorne, C. (2005). Organizational Psychology in Cross-Cultural Perspective. New York, London: New York Universtity Press. Siu, O.-L., & Cooper, C. L. (1998). A Study of Occupational Stress, Job Satisfaction anf Quitting Intention in Hong Kong Firms: The Role of Locus of Control and Organizational Commintment. Stress Medicine, 14, 55-66. doi:https://doi.org/10.1002/(SICI)1099-1700(199801)14:1<55::AID-SMI764>3.0.CO;2-X
• Sökmen, A. (2019). Örgütsel Özdeşleşme, ÖB ve İş Tatmini İlişkisi: Otel İşletmelerinde Bir Araştırma. Journal of Tourism and Gastronomy Studies, 7(2), 980-990. doi:10.21325/jotags.2019.403
• Suandi, T., Ismail, I. A., & Othman, Z. (2014). Relationship Between Organizational Climate, Job Stress And Job Performance Officer At State Education Department. International Journal of Education & Literacy Studies, 2(1). http://journals.aiac.org.au/index.php/IJELS/article/view/234
• Sullivan, S. E., & Bhagat, R. S. (1992). Organizational Stress, Job Satisfaction and Job Performance: Where Do We Go From Here? Journal of Management, 18(2), 353-374. doi:https://doi.org/10.1177/014920639201800207
• Şahin, B. (2014). SEyahat Acentesi Çalışanlarında ÖSin ÖBla İlişkisi Üzerine Bir Araştırma: İstanbul Örneği. The Journal of Social Sciences Institute, 17(32), 193-211. http://sbe.balikesir.edu.tr/dergi/edergi/c17s32/193-210.pdf
• Tetteh, S. D., Osafo, J., Ansah-Nyarko, M., & Amponsah-Tawiah, K. (2019). Interpersonal Fairness, Willingness-to-Stay and Organisation-Based Self-Esteem: The Mediating Role of Affective Commitment. Frontiers in Psychology, 10, 1-10. doi:10.3389/fpsyg.2019.01315
• Turhan, M., Erol, Y. C., Demirkol, M., & Özdemir, T. Y. (2018). ÖB, İş Doyumu ve İş Stresi Arasındaki İlişki. Turkish Studies, 13(27). doi:10.7827/TurkishStudies.14328 Uğurlu, C. T., & Üstüner, M. (2011). Öğretmenlerin ÖB Düzeylerinin Etik Liderli ve Örgütsel Adalet Davranışlarının Etkisi. Hacettepe Üniversitesi Eğitim Fakültesi Dergisi, 41, 434-448. https://dergipark.org.tr/tr/download/article-file/87417
• Uzun, Ö., & Yiğit, E. (2011). ÖS ve ÖB İlişkisi Üzerine Orta Kademe Otel Yöneticileri Üzerinde Yapılan Bir Araştırma. Eskişehir Osmangazi Universitesi İİBF Dergisi, 6(1), 181-213. http://www.acarindex.com/dosyalar/makale/acarindex-1423880303.pdf
• van Gils, S., Hogg, M., Van Quaquebeke, N., & van Knippenberg, D. (2017). When Organizational Identification Elicits Moral Decision-Making: A Matter of the Right Climate. J Bus Ethics, 155–168. doi: 10.1007/s10551-015-2784-0 van Knippenberg, D., & van Schie, E. (2000). Foci and Correlates of Organizational Identification. Journal of Occupational and Organi:(aHonal Psychology, 73, 137-147. http://eds.b.ebscohost.com/eds/pdfviewer/pdfviewer?vid=3&sid=009af7ad-5e85-4e27-a3e8-bbcbf8dd576a%40pdc-v-sessmgr01
• Wasti, S. A. (2003). Organizational Commitment, Turnover Intentions and the Influence of Culturel Values. Journal of Occupational and Organizational Psychology, 76, 303-321. https://doi.org/10.1348/096317903769647193
• Wegge, J., Van Dick, R., Fisher, G., Wecking, C., & Moltzen, K. (2006). Work Motivation, Organizational Identification, and Well-being in Call Center Work. Work & Stress, 20(1), 60-83. doi:10.1080/02678370600655553
• Wittig-berman, U., & Lang, D. (1990). Organizational Commitment and its outcomes: Differing Effects of Value Commitment and Continuance Commitment on Stress Reactions, Alienation and Organization-serving Behaviors. Stress& Work, 4(2), 167-177. http://dx.doi.org/10.1080/02678379008256978
• Yang, T., Guo, Y., Ma, M., Li, Y., Tian, H., & Deng, J. (2017). Job Stress and Presenteeism among Chinese health care workers: The Mediating Effects of Affective Commitment. International Journal of Environmental Research and Public Health, 14(978). doi:10.3390/ijerph14090978