A Cross-sectional Study on the Level of Perceived Stress and Self-reported Morbidity

among Call Handlers Working in Call Centres in Delhi NCR

• Upadhyay P 1, Khokhar A 2, Talwar R 3

1 Junior resident, Dept. of community medicine, VMMC &SJH

2 Professor, Dept. of community medicine , VMMC &SJH

3 Professor, Dept. of community medicine , VMMC &SJH

INTRODUCTION • Call centre: More than 500 business process outsourcing

companies1

• High rate of absenteeism and turnover2

• STRESS: Night shifts, long hours of continuous work, extremely high work targets, loss of identity 3

• Musculoskeletal disorders, gastric upset, metabolic disorders, psychiatric disturbances, and disturbed relationships

• Only few studies in India have focused on stress and morbidity in call handlers specifically

1 nasscom.org/quick-facts

2 Batt R, Doellgast V, Kwon H, Nopany M, Nopany P, and Da Costa A. The Indian Call Centre Industry

3 Tripathi K. A Study on the Worklife of BPO Employees and the various Human Resource Practices in a BPO - A Case Study of Convergys

OBJECTIVES

• To measure the level of perceived stress among call handlers working in call centers in Delhi National Capital Region (NCR)

• To study the self-reported morbidity among call handlers working in call centers in Delhi NCR.

MATERIALS & METHODS

Study setting: Domestic and international call centres situated in three areas of Delhi and National Capital Region (NCR): Delhi, Noida (Uttar Pradesh) and Gurgaon (Haryana)

Study population:

INCLUSION CRITERIA:

• Working as call handler for at least 1 year

• Working for at least one shift per day

EXCLUSION CRITERIA:

• Subjects who refuse to participate in study

MATERIALS & METHODS

Sample size: Taking a relative precision of 15%, a non-response rate of 10% and prevalence of stress to be 40%, the sample size was calculated to be 300.

Sampling design:

• A complete list of call centers was prepared

• One call centre from each area by simple random method

• Request for permission from the administrative head

• In case of refusal, next call center was picked by simple random method from that area only

• If number of call handlers were less than 100, then another call center was included (by simple random method) till a total of 100 call handlers were covered

MATERIALS & METHODS

• If the number of call handlers was more than 100 per call center then depending on the actual number of call handlers who participated, our study was planned.

STUDY INSTRUMENTS: • Cohen’s Perceived Stress Scale *

• A questionnaire regarding socio-demographic profile

and medical history (including history of drugs)

• For BMI: ‘The International Classification’ by World Health Organization

*(PSS; Cohen, Kamarck, & Mermelstein, 1983; Cohen & Williamson, 1988)

Data collection:

• Using Self-administered, pre-tested, semi-structured questionnaire in English

• Provided by hand and were collected after they were filled in the presence of researcher

• For incomplete questionnaires: Participants were asked to fill it completely.

• This methodology was followed till the final sample size of 100 from each of the three areas was achieved

• Scores were then calculated

Ethical issue:

• Ethical clearance was taken from the Institutional ethical committee

Statistical analysis:

• Statistical analysis was done with statistical significance level set at p < 0.05.

• Independent t-test, Chi-square test and ANOVA test were used to test statistical difference between different parameters.

RESULTS General characteristics:

• Out of a total of 300 call handlers studied, the mean age of call handlers was 24. 4 years (S.D=3.1)

• Males constituted 65.7% of population

• Majority 210(70%) of call handlers belonged to Hindu religion

• As many as 230(76.7%) of them were unmarried

• Most of the call handlers 177(59%) had their native state outside Delhi NCR

• The average numbers of working hours was 8.94 and the mean job duration was 2.5(SD=1.6) years.

• The average monthly income was Rs.16586 (SD=6383.5, Range: 4750-40000).

RESULTS • Prevalence of perceived stress: 37.3% (Perceived Stress Score >20).

• With medical illness Vs. Without medical illness (46.5% vs. 33.6%; p= 0.03) were stressed

• Those using drugs or medicines not prescribed by doctor Vs. those using drugs or medicines prescribed by doctor (50% vs. 34.9%; p= 0.048)

• Mean perceived scores : No statistically significant difference was found by comparing the mean score within the sub-groups of socio-demographic profile.

• Mean perceived scores : Call handlers with present medical illness Vs. those who did not complaint of medical illness (19.8 Vs 18.2; p=0.019, 95% CI).

RESULTS • A statistically significant high mean stress score (20.4) was

found in call handlers who reported taking illicit drugs and un-prescribed medicines (p=0.033) than non-users(16.2)

• 190 (63.3%) call handlers availed sick leave during last year.

• The mean number of days absent due to illness was 7.9(SD=7.3, Range: 1-60) days during the last year.

• Family history of diabetes 50(16.6%) followed by hypertension 48(16%), heart disease 30(10%), asthma 10(3.3%), psychiatric illness 9(3%), tuberculosis 6(2%) and stroke 6(2%).

• 22% of subjects were found to be pre-obese and obese

Distribution of present self-reported medical complaints among call handlers (N=300)

S.no. Present medical complaints Number (%)

Yes 86* (28.7)

1. Musculoskeletal disorder 24(8.0)

2. Gastrointestinal disorder 17(5.7)

3. Headache/migraine 16(5.3)

4. Eye problems 15(5.0)

5. Respiratory disorder 11(3.7)

6. Cardiovascular (including Hypertension) 6(2.0)

7. Psychiatric disorder 5(1.7)

8. Others 15(5.0)

No 214(71.3)

* Multiple responses

Distribution of call handlers according to current use of medicines/drugs* (N=300)

S. no. Use of medicines or drugs by call handlers Number (%)

1. Current use of medicine prescribed by doctor 45(15.0)

2. Current use of medicine not prescribed by

doctor

36(12.0)

3. Current use of illicit drug 23(7.7)

4. Not using any medicine or drug at present 214(71.3)

* Multiple responses

DISCUSSIONS Author Place of study Key findings Our findings

Charbotel B et al

in 2007 France Psychological distress (39.4%),

Musculoskeletal complaints (59%), visual fatigue (77.3%), auditory fatigue (50%) Psychoactive medication: 24%

Stressed:37.3% Medical illness: 28.7% Musculoskeletal disorders :24(8.0%) Gastrointestinal: 17(5.7%) Illicit drug: 7.7%

Sadia Aziz Ansari in 2010

Pakistan 55%: extremely stressed, 25%: moderately stressed, 20 %: low stress

E-SAT BPO (2010) report

India Multiple stressors and 34% were stressed mainly due to travel time

DISCUSSIONS

Author Place of study Key findings Our findings

Superna et al Delhi NCR (IT company)

Stress to be more in males (40.2%) than females (22.9%) MSDs: 77% & Eye problems:76%

Stressed:37.3% Medical illness: 28.7% Musculoskeletal disorders :24(8.0%) Gastrointestinal: 17(5.7%)

Bhuyar et al Pune and Mumbai

Stress: 46.9% of females in comparison to 19.6% of males Backache:58.6%, disturbed sleep in 29%. 22% were pre-obese and 2% were obese.

DISCUSSIONS

Author Place of study Key findings Our findings

Monisha Vaid in 2006

Gurgaon Illicit drugs: 23.3%males and 4.4% females.

Stressed:37.3% Medical illness: 28.7% Musculoskeletal disorders :24(8.0%) Gastrointestinal: 17(5.7%) Illicit drug use: 7.7%

Sudhashree VP et al

Bengaluru Sleeping disorders-83% digestive disorders-14.9% voice loss-8.5% , ear problems 8.5%, and eye sight problems 10.6%

Lin YH et al in 2006

Taiwan 33.5% of outbound operators and 27.1% of inbound operators were stressed More perceived stress have multiple health problems

STRENGTHS AND LIMITATIONS

First of its kind which has tried to assess both stress and health status

Different call centres engaged in different businesses

Highly reliable and validated scale

• Self-reported questionnaire based study

• Health complaints were also self-reported (no check ups)

• Main stressors were not considered

CONCLUSIONS Stressed call handlers (37.3%): Need stress management

86 (28.7%) of call handlers complained of medical illness.

Musculoskeletal disorder and gastrointestinal disorders

Irrespective of a large proportion of them reporting family history

of diabetes and hypertension, there was less inclination towards a healthy lifestyle

45(15%) of call handlers were currently using medicines prescribed by doctor & 38(12.7%) of call handlers were using either illicit drugs or medicines not prescribed by doctor.

Stress was significantly associated with presence of medical illness

RECOMMENDATIONS • Early intervention in the form of health program activities and

healthy lifestyle workshops

• Gym facility and yogic management programme

• Full time counsellors • Length and frequency of breaks should be adequate

• Employers need to apply a systematic risk management

framework

• More comprehensive, fully structured and relevant regulations

• A longitudinal multicentre study

THANK YOU

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