Understanding and measuring the work‐related quality of life among those working in adult social care: A scoping review

Abstract The main aim of this scoping review was to understand how work‐related quality of life (WRQoL) in adult social care has been defined and measured in the literature and to map key components of WRQoL among those working in adult social care and similar contexts. The scoping review included studies that: 1‐ focused on WRQoL/work‐related wellbeing (and their synonyms); and 2‐ included adult social care or community health care. We searched existing evidence from November 2019 until July 2020 through an electronic literature search of eight major databases complemented by the grey literature, searching the reference lists and by contacting our existing network of experts in the field. In addition, we repeated the searches to identify any relevant literature published in 2021. Reporting followed the PRISMA Extension for Scoping Reviews (PRISMA‐ScR) checklist. In total, we included 68 publications. These publications indicate that there is an absence of agreement on a definition and measurement of WRQoL in adult social care. Based on a thematic analysis we identified six key components of WRQoL: organisational characteristics; job characteristics; mental wellbeing and health; physical wellbeing and health; spill‐over from work to home; and professional identity. In summary, at the moment, there is no agreement on what WRQoL is and how to measure it in adult social care. As a result, there is very limited evidence on how to improve WRQoL among people working in adult social care. However, this scoping review suggests that there are six key components of WRQoL that researchers may consider to include in their future studies.

example, limited access to publicly funded adult social care services, a fragmented social care market (services provided through local authorities, for-profit and voluntary home care and residential care providers and directly employed individuals), demographic trends (e.g. people are living longer with multiple or complex needs and therefore requiring more social care services) and a workforce crisis including the inability to attract and retain a sufficient supply of care workers (Bottery et al., 2018;Skills for Care, 2020;The King's Fund, 2019). It has been estimated that in 2019/2020, 1.52 million people worked in adult social care in England with a vacancy rate of 7.3% and turnover rate of 30.4% for the 12 month period (Skills for Care, 2020). Given the projections that increasing numbers of people will require some form of social care support over the next decades (Bottery et al., 2018), it is essential to understand how to ensure that the adult social care sector can become an attractive and rewarding sector to work in.
Work-related quality of life (WRQoL) has become an important concept internationally across different professions (Brauchli et al., 2017;Mokarami et al., 2016;Somsila et al., 2015;Vander Elst et al., 2012), including adult social care (André et al., 2014;Eustis et al., 1993b;Vermeerbergen et al., 2017) and is one of the factors associated with higher retention rates (Ricardo Rodrigues and Leichsenring, 2018;Scanlan et al., 2013). In addition, research shows that WRQoL is associated with the individual's physical and emotional wellbeing and with organisational and work outcomes, such as turnover and quality of work (Carr, 2014;Edwards et al., 2000;Maben, 2012). More importantly, in adult social care, similar to health care, WRQoL is linked to the quality of services provided and outcomes related to patients and service users (Boorman, 2009;Carr, 2014;Maben, 2012;Paparella, 2015).
While several studies examined WRQoL in adult social care and similar settings (André et al., 2014;Eustis et al., 1993a;Vermeerbergen et al., 2017) there is no agreement on what WRQoL is, and in turn how this concept should be measured (Rai, 2015). The lack of consensus on both the definitions and measurement raises several challenges, including an inability to compare and synthesise quantitative evidence on WRQoL. Without a clear understanding of what WRQoL is and how to measure it, development of any interventions and recommendations to the sector and policymakers on how to improve WRQoL among those working in adult social care remains challenging.
The existing international evidence syntheses in social care only focused on a subset of adult social care settings and workforce such as nursing homes (André et al., 2014;Vermeerbergen et al., 2017) and home help services Eustis et al., 1993a). As such, a comprehensive evidence synthesis covering different as-

| ME THODS AND ANALYS IS
We conducted the scoping review following the updated guidance by the Joanna Briggs Institute (Peters et al., 2017) and a pre-defined study protocol (available from the corresponding author). Reporting followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR) checklist (Tricco et al., 2018).

| Eligibility criteria
The full eligibility criteria are described in Table S1. We included studies that: 1-focused on WRQoL/work-related wellbeing (and their synonyms) where the concept is defined as a multidimensional construct consisting of several components (at least two); and 2included adult social care or community health care and individuals working in those contexts as participant groups (such as direct care workers, managers or supervisors, occupational therapists, safeguarding and review officers, nurses, nursing aides, nursing and health care assistants, other allied health care professionals and registered professionals). As our preliminary search did not return a sufficient number of results when focusing only on adult social care

What is known about this topic
• Adult social care in England has been experiencing a workforce crisis.
• Work-related quality of life (WRQoL) is one of the factors that may help us to understand how adult social care can become an attractive sector to work in.
• A comprehensive evidence synthesis of understanding WRQoL across different adult social care settings and workforce is lacking.

What the paper adds
• There is an absence of agreement on the definition of WRQoL in adult social care and how to measure it.
• We have identified seven measures of WRQoL used in adult social care.
• Based on the evidence we conclude that WRQoL in adult social care is a complex concept including six key components.
context, we expanded our search to include community health care settings. The search expansion was to ensure we were able to understand what constitutes key components of WRQoL among people who work in adult social care by learning from other professions that are as close as possible to those working in social care settings.

| Search strategy
We developed the search strategy with input from a research librarian from the Academic Liaison Services, Information Services, University of Kent. We searched existing evidence from November 2019 until July 2020. We performed an initial electronic literature search of three major databases (PubMed; CINAHL Plus with Full Text through EBSCO and Social Care Online) followed by an analysis of the title and abstract of retrieved papers, and of the index terms used to describe the articles to check whether our search strategy needed any refinement. As a next step, we replicated our literature search across an additional five databases (APA PsychINFO through EBSCO; Web of Science Core collection; Cochrane Library; Abstracts in Social Gerontology through EBSCO; Social Policy and Practice through Ovid). The grey literature was searched through the following databases: PROSPERO; OpenGrey; EThOS e-theses online service; and ProQuest Dissertations & Theses Global. In addition, we repeated the searches as described above to identify any relevant evidence published in 2021 (until September including). We complemented these electronic searches by searching the reference lists of included full-text reports and articles. Additionally, we contacted our existing network of 15 international experts to identify unpublished studies and interim findings from ongoing research. We did not contact authors of primary studies for further information as this was not required.
Examples of search strategies for electronic databases are included as Table S2.

| Study selection
All the citations identified were downloaded into EndNote.
Duplicates were auto-removed in a combined library. Study selection was a challenging task as the social care sector has changed over time and varies between different countries including the use of terminology. To ensure that all relevant studies were correctly included, at the title and abstract identification level, only studies clearly not relevant were excluded. Each paper assessed as a full text was screened by at least two reviewers. To be more specific, first, titles and abstracts of the complete list of identified papers were divided equally and assessed by BS and NB. Both authors then met on several occasions to discuss all studies that were selected for inclusion as well as publications where the decision was unclear. The inclusion of studies for the full-text stage was agreed during the discussions, and those not relevant were rejected. For publications where a decision to exclude could not be reached based on the title and abstract alone, the full paper was obtained for detailed assessment. Next, at least two reviewers BS and NB/SP independently assessed the full-text articles for inclusion in the scoping review. Papers identified as not meeting the inclusion criteria by two researchers were excluded. Another researcher (SH/A-M T) reviewed any papers where an agreement was not reached between BS, NB and SP. Reviewers were not masked to the author or journal name.

| Quality of studies
We did not assess the quality of studies included in the scoping review.

| Presentation of results
We present the results in Tables and Figures to describe the key   characteristics of the publications included and key components of WRQoL. Where possible, we conducted a narrative synthesis using thematic analysis to summarise information following Popay's framework (Popay et al., 2006). First, the key definitions of WRQoL, its components and measures were tabulated and combined into groups. After a process of familiarisation with the data, each group was qualitatively coded by one reviewer (BS) and discussed with NB and SP. These coded groups then formed preliminary themes/key components of WRQoL that were reviewed by BS, NB and SP and agreed upon.

| Selection of sources of evidence
The PRISMA diagram ( Figure 1) summarises the total number of studies identified and screened, assessed for eligibility, and included in the review, with reasons for exclusions. After removing duplicates across all electronic databases and grey literature, we (BS and NB) identified and assessed at the title and abstract level 8002 records.
Out of those, we (BS, NB and SP) evaluated 250 full-text articles for eligibility and included 51 studies. We identified 17 further papers through reference lists of eligible full-text articles and our network of experts. In total, we included 68 publications in the current qualitative synthesis.
Examples of definitions include: p13: "quality of working life is not a distinct concept, but can be associated with aspects such as job satisfaction, job involvement, motivation, productivity, health, safety, and wellbeing" ; p110 and p328 respectively: "professional quality of life consists of compassion, satisfaction, burnout, and compassion fatigue" (Durkin et al., 2016;Itzick et al., 2018), and p35: "quality of work life is a management philosophy that enhances personnel's dignity through the creation of favourable working conditions, initiating changes in the culture of the organisation, improving the physical and emotional wellbeing of employees and creating opportunities for growth and development in an environment that promotes job satisfaction" (Malherbe & Hendriks, 2014).

| Key components of WRQoL
We conducted a thematic analysis of definitions of WRQoL, measures, and factors associated with WRQoL or general wellbeing and identified six key components: organisational characteristics; job characteristics; mental wellbeing and health; physical wellbeing and health; spill-over from work to home; and professional identity.
Each key component consists of several sub-themes. For example, job characteristics include job-person match; autonomy/control at work; time; responsibility for people; learning and growth opportunities/self-actualisation; meaningful work and feedback from work.
The full list of key components, description and examples of corresponding items are presented in Table 2. Table 1 shows each study and its corresponding key component of WRQoL and Table S3 includes a full list of items that were coded in the thematic analysis (some items were assigned to more than one component of WRQoL).

| Measures of WRQoL
The overview of measures of WRQoL is included in   and its adaptation ; the Nordcare survey (Szebehely et al., 2017); the 15-item version of the Social Production Function Instrument for the Level of Well-being (Nieboer et al., 2005); the Work-related quality of life scale (Van Laar et al., 2007); and the Job-Related Affective Wellbeing Scale (Warr, 1990 (P. G. Warr, 1990) Abbreviations: JC, job characteristics; MWaH, mental wellbeing and health; OC, organisational characteristics; PI, professional Identity; PWaH, physical wellbeing and health; S, spill-over from work to home. Providing individuals with tools and skills to perform their role; fulfilment of one's potential.

Meaningful work
The degree to which a job has a substantial impact on the lives or work of other people.
Getting a lot out of working with the clients Feedback from work The degree to which carrying out the work activities required by the job results in the employee obtaining information about the effectiveness of their performance. The feeling of doing a good/bad job and being appreciated (or not) for their work.

| Strategies implemented and evaluated in adult social care that addressed social care staff's WRQoL
We identified only two randomised controlled trials that measured social care staff's WRQoL ( (Coffey et al., 2009). Another study (Kemper et al., 2008) conducted among staff working at US skilled nursing facilities, assisted living facilities, and home care agencies recommended the following to improve their job: increased compensation, improved work-relationships, improved staffing, and improved management systems. Next, care workers from private, for-profit care homes and domiciliary (or community) care providers in England (Hay, 2015) wanted: initiatives that would offer workers a greater level of security in their lives outside work (e.g. paying the Living Wage, assistance with childcare, paid sick leave etc.); initiatives intended to make care workers feel better supported at work (e.g. more time at work, better work-related training, more involvement in decision-making and a more supportive working environment) and

TA B L E 2 (Continued)
lastly initiatives aimed at enhancing workers' financial security such as pensions, financial assistance and financial advice. Lastly, a study conducted in Belgium among homecare workers and departmental directors gave similar suggestions: to set up more participation and specific meetings to discuss well-being at work, work organisation adjustment, and sense of innovation; humanisation of work relations; having more social support, listening, trust, and recognition from the hierarchy and management (Bensliman et al., 2021).  (Karasek, 1979), job characteristics model (Hackman & Oldham, 1976), salutogenetic model of health (Antonovsky, 1996), Watson's philosophy of human caring (Watson, 2006), and theory of reasoned action (Martin, 1980)).

| DISCUSS ION
However, based on the thematic analysis of the evidence gathered for this study we conclude that WRQoL in adult social care is a complex concept including six key components: organisational characteristics, job characteristics, mental wellbeing and health, physical wellbeing and health, spill-over from work to home, and professional identity.  (Vendrig & Schaafsma, 2018), social sciences (Cummins, 2005;Cummins et al., 2004)); 2. interchangeable use of terms describing the concept of WRQoL (e.g. work psychosocial characteristics (Iecovich, 2011), job characteristics (Willemse et al., 2012), work environment (Dutcher & Adams, 1994) etc.); 3. lack of empirical testing of proposed models (Cummins, 2005); and 4. the need for new models of WRQoL that reflect changes in the workplace (Loscocco & Roschelle, 1991 (Sirgy et al., 2001), the Professional Quality of Life (ProQOL) Scale (Stamm, 2009) and its revised version, the Professional Quality of Life Scale-Revised (ProQOL) (Stamm, 2005)); Leiden Quality of Work Questionnaire (LQWQ) (van der Doef & Maes, 1999) and its adaptation ; the Nordcare survey (Szebehely et al., 2017); the 15-item version of the Social Production Function Instrument for the Level of Well-being (Nieboer et al., 2005); the Work-related quality of life scale (Van Laar et al., 2007) and the Job-Related Affective Well-being Scale (Warr, 1990). Interestingly, the Professional Quality of Life (ProQOL) Scale (Stamm, 2009) and its revised version (Stamm, 2005) (Rai, 2013(Rai, , 2015 and more recently used in a study focusing on health and WRQoL and coping among health and social care staff while working during the COVID-19 pandemic in the UK . Before new measures are developed, we recommend a systematic review of the psychosocial properties of the identified measures of WRQoL. Such review would help to understand whether these measures are valid and reliable measures of WRQoL and whether they are feasible to be used in adult social care either in their existing forms or with some adaptations. One of the key research questions of this scoping review was to identify strategies implemented and evaluated in adult social care that addressed social care staff's WRQoL. We identified only two randomised controlled trials Bielderman et al., 2021) addressing this question. While in the studies included in this scoping review different suggestions were raised by participants on how different components of WRQoL may be improved, these have not been further empirically tested. This indicates a considerable gap in the present evidence.
Finally, the results of this study have to be interpreted in light of its limitations. Firstly, while we screened almost 8000 articles from variety of resources, given the variety of terms used to describe WRQoL it is possible that there are additional studies of relevance that we did not include. Given the number of articles screened and the breadth of literature resources, it is however unlikely that these would change our findings. Secondly, the social care sector has changed over time and varies between different countries, including terminology and work content. This made it a challenging task to determine the exact nature of the job of participants of included studies and to ensure that all relevant studies were correctly identified.
Again, however, our systematic and broad approach to identifying literature minimised this risk. Lastly, we only included studies written in English, potentially excluding relevant non-English evidence.

| CON CLUS ION
The scoping review itself highlights several key messages for researchers. Firstly, researchers should provide explicit definition of WRQoL and/or its components with the justification for its choice-either to link it to an existing concept or to an existing empirical evidence. If it is clear that they measure the same concept/ component, researchers could compare the results from different studies. Secondly, while we cannot recommend a specific tool to measure WRQoL in adult social care, this scoping review provides a catalogue of existing tools measuring different components of WRQoL in different contexts of adult social care. Lastly, given the inconsistency in definition of WRQoL and its measurement, and lack of strategies aiming to improve WRQoL and/or its components, it is not possible to provide robust recommendations to policy makers or national organisations on how to improve WRQoL among their staff.

CO N S E NT FO R PU B LI C ATI O N
Not applicable.

ACK N OWLED G M ENTS
We would like to thank to Abigail Heath, an Academic Liaison

CO N FLI C T O F I NTE R E S T
The authors have no relevant financial or non-financial interests to disclose.

AUTH O R S ' CO NTR I B UTI O N S
The initial idea for a scoping review on the topic came from SP,

E TH I C S A PPROVA L
This work did not involve human participants or animals and so no ethical approval was required.