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. 2025 Jun 6;15(1):20036.
doi: 10.1038/s41598-025-05533-9.

The effect of Effort-Reward imbalance on job performance among primary healthcare professionals: the mediating roles of social support and resilience

Chengxin Fan #  1 , Cuiyu Li #  2 , Xiaochun Li  1 , Ruixuan Wang  1 , Jing Song  1 , Zhongming Chen  3 , Wenqiang Yin  4
Affiliations

The effect of Effort-Reward imbalance on job performance among primary healthcare professionals: the mediating roles of social support and resilience

Chengxin Fan et al. Sci Rep. .

Abstract

In light of the ERI exacerbated by health emergencies, stabilizing the working conditions of primary healthcare professionals and ensuring the consistent operation of the public health system has become a focal point of research. This study was designed to investigate the mechanisms by which ERI affects job performance among primary healthcare professionals in the context of health emergencies, as well as the mediating role of perceived social support and resilience. Participants were recruited from 54 primary healthcare institutions, with a total of 1,050 primary healthcare professionals included in the study. Data were collected using the Effort-Reward Imbalance Scale, Perceived Social Support Scale, Individual Resilience Scale, and Job Performance Scale to assess key variables. Hayes' serial mediation model was applied to examine the interrelationships between these variables. The effects of the Effort-Reward-Imbalance and Job Performance were negatively correlated (P < 0.01). ERI influences job performance through three pathways: the mediating role of perceived social support, the mediating role of individual resilience, and the chain mediating role of both perceived social support and individual resilience. Perceived social support and individual resilience moderates the association between Effort-Reward-Imbalance and job performance among primary healthcare professionals.

Keywords: Effort-Reward-Imbalance; Individual resilience; Job performance; Perceived social support; Primary healthcare professionals.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: All methods were carried out in accordance with relevant guidelines and regulations. The Medical Ethics Committee of Shandong second Medical University reviewed and approved the protocol of the study in compliance with the Declaration of Helsinki. (ref: 2021YX067). Informed consent was obtained from all subjects and/or their legal guardian(s).

Figures

Fig. 1
Fig. 1
Hypothesized relationships between Effort-Reward imbalance, perceived social support, individual resilience and job performance. *a, b, c, and d represent path coefficients.
Fig. 2
Fig. 2
The Pearson correlation matrix of study variables. ** P < 0.01.
Fig. 3
Fig. 3
The chain mediating effect of perceived social support and individual resilience between ERI and job performance. ***P < 0.001.
See this image and copyright information in PMC

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