Mediating Effects of Coping Strategies Between Activation for Self-Management of Back Pain and Work Engagement: A Cross-Sectional Study of Cardiac Catheterization Laboratory Nurses

Mediating Effects of Coping Strategies Between Activation for Self-Management of Back Pain and Work Engagement: A Cross-Sectional Study of Cardiac Catheterization Laboratory Nurses | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Mediating Effects of Coping Strategies Between Activation for Self-Management of Back Pain and Work Engagement: A Cross-Sectional Study of Cardiac Catheterization Laboratory Nurses Liping She, Jinju Wang, Yafeng Wu, Shaoman li, Juanjuan Zhou, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4480305/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Work engagement is a critical factor in improving the quality of care, nurses' job satisfaction, and hospital profitability. However, nurses, especially those in cardiac catheterization labs, face significant physical demands such as lower back pain from prolonged use of lead personal protective equipment, impacting their work engagement. To examine the back pain self-management activation, work engagement, and role of coping strategies among nurses in the cardiac catheterization laboratory. Methods This was a cross-sectional study design. A convenience sampling recruited 296 participants from 18 hospitals in Jiangsu and Anhui provinces of China from February to March 2023. The Demographics questionnaire, Participant Activation for Management of Back Pain Questionnaire, Simplified Coping Skill Questionnaire, and the Utrecht Work Engagement Scale were used to survey participants. A Pearson correlation analysis was conducted to determine the relationship between positive self-management of back pain, coping strategy, and work engagement. Bootstrap method was used to analyze the mediating effect of coping strategies. Results Work engagement and back pain self-management activation among cardiac catheterization laboratory nurses were moderate and influenced by various sociodemographic factors. Activation for self-management of back pain directly impacted work engagement, partially mediated by positive coping strategies, which accounted for 25.96% of the total effect. Conclusion Activation of self-management of back pain and positive coping strategies promote work engagement among cardiac catheterization laboratory nurses. Nursing managers should integrate individual and organizational interventions to increase nurses' self-management activation and work engagement. Back pain Coping strategies Mediation effect Cardiac catheterization laboratory Nurses Participant activation Self-management Work engagement Figures Figure 1 Figure 2 1. Background Work engagement refers to a positive, fulfilling, work-related psychological state characterized by vigor, dedication, and absorption [ 1 ]. Numerous studies have demonstrated that work engagement is crucial in improving patients’ quality of care, prognosis, nurses’ job satisfaction, and retention rates [ 2 – 4 ]. In addition, work engagement is vital for nurses’ initiative and hospital operations profitability [ 5 ]. However, nurses face significant occupational risks, complex nurse-patient relationships, and heavy workloads, leading to a direct or indirect decline in their work engagement [ 6 ]. Therefore, identifying relevant factors that may influence nurses’ work engagement is crucial to establish a safe and effective nursing practice environment for patients [ 5 ]. According to the Nursing Job Demands Resource (NJD-R) theory [ 7 ], physical demands are essential for job engagement. Pericak et al. (2020) developed a nurse work engagement model in which the influencing factor was physical health symptoms [ 8 ]. Back pain is a prevalent health issue in the nursing profession, with 55–84% of lower back pain prevalent worldwide and a leading cause of nursing staff quitting or missing work due to poor health [ 9 , 10 ]. Cardiac catheterization laboratory (CCL) nurses, who are exposed to X-ray radiation for extended periods due to cardiac interventional procedures, must wear heavy lead personal protective equipment (PPE) to reduce the radiation exposure. However, prolonged use of heavy lead protective equipment makes CCL nurses more susceptible to lower back pain than nurses in other departments [ 11 , 12 ]. Back pain affects the health of nurses and their motivation at work, impacting the quality of care they provide to patients [ 13 , 14 ]. The Chronic Care Theory model suggests that individuals who are more active in self-management manage their health more actively and experience better health outcomes [ 15 ]. Activation for self-management is important in relieving back pain symptoms and the impact of pain on one’s physical and psychological functioning, reducing the disruption of back pain at work [ 16 – 18 ]. In addition, nurses’ work attitudes and motivation will be enhanced, potentially increasing the work engagement of CCL nurses. Consequently, it is crucial for nurses and clinical workers to reduce the pain associated with back pain. Coping strategies are deliberate and consistent psychological and behavioral strategies individuals use in response to environmental challenges and pressures, and they significantly influence work engagement [ 19 ]. Coping strategies are classified as positive or negative [ 20 ]. Individuals who adopt a positive coping strategy actively adjust their cognition and behavior to adapt to internal and external environmental demands when confronted with stressful situations, demonstrating greater work engagement [ 21 ]. A positive coping strategy can help alleviate stress and anxiety, thereby promoting mental health. And good mental health can provide individuals with stronger coping resources[ 22 , 23 ]. In contrast, negative coping is an emotion-centered and palliative strategy, where individuals focus on negative thoughts and attempt to escape stressful situations (such as avoidance, denial, and wishful thinking) to minimize distress [ 24 ]. Negative coping strategies correlate negatively with nurses’ work engagement [ 25 ]. Previous research has found that coping strategies are a crucial factor influencing nurses' health, productivity, and patient care quality[ 26 – 28 ]. Given this evidence, coping strategies could influence the impact of CCL nurses' back pain self-management activation on work engagement. Positive back pain self-management activation may help to change an individual's assessment of a stressful event, allowing the individual to face the stressor positively and thus participate in clinical care more effectively. Previous research has established a relationship between coping strategies and job engagement[ 19 ]. However, research on the activation for self-management of back pain among CCL nurses and its impact on work engagement remains unclear. This study hypothesized that efficient activation of back pain self-management might alter an individual’s perception of stressful events, enable positive confrontation of stressors and effective engagement in clinical care, and affect CCR nurses' work engagement through positive coping strategies. 1.1 Aims and hypotheses The main goals of this study were to: (1) Ascertain the current level of back pain self-management activation and work engagement among nurses in the catheterization laboratory. (2) Explore the association between back pain self-management activation, work engagement, and coping strategies among CCL nurses. In addition, examine the mediating effect of coping strategies. This study established the following hypotheses (Fig. 1 ): H1: Work engagement and back pain self-management activation among CCL nurses are associated with certain demographic variables. H2: Back pain self-management activation positively influences work engagement (Path c). H3: Back pain self-management activation influences Coping strategy positively (Path a, a’). H4: Coping strategy positively impacts work engagement (Path b, b’). H5: Coping strategy partially mediates the back pain self-management activation on work engagement (Path c’). 2. Method 2.1 Design This cross-sectional survey-based study used convenience sampling. Reporting observational studies is guided by the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. 2.2 Participants Participants were recruited from February 2023 to March 2023 from 18 hospitals (seven tertiary and 11 secondary hospitals) in Jiangsu and Anhui provinces, China. The inclusion criteria for this study were: (1) nurses who were age ≥ 18 years and had ≥ 1 year of clinical nursing work in the cardiac catheterization laboratory; (2) registered nurses with a license to practice; (3) suffered from back pain in the past year (Back pain was defined by the question, "Within the past year, have you had any work-related back pain? Include dull, sharp pain, cramps or tension, etc."); (4) voluntarily participated in this study. The exclusion criteria were nurses: (1) in the menstrual or gestation period; (2) suffering from pathological back pain; (3) in internship, training, or rotation; (4) who did not work in the catheterization laboratory during the survey period for various reasons (e.g., leave of absence, administrative work, and study away). 2.3 Data Collection This study distributed the questionnaires through the Questionnaire Star platform ( https://www.wjx.cn ), with the study purpose and notes explained clearly. The questionnaires were completed anonymously. All data were obtained from participant self-reports. Floyd et al. [ 29 ] stated that the sample size should be 5–10 times the number of items. Therefore, 280 participants were required to respond to the 56 items in the questionnaire. Participants with response times of less than three minutes were disqualified, and each IP could respond once to ensure the quality of the questionnaires. Consequently, 318 questionnaires were collected, of which 296 were valid (response rate of 93.08%). 2.4 Measurement 2.4.1 Demographics questionnaire The demographics questionnaire was self-designed through literature review and included items such as age, gender, work experience, childbearing, professional titles, participation in household chores, daily lead PPE wear time, and hospital rank. 2.4.2 Participant Activation for Management of Back Pain Questionnaire (PAMQ) This study used the Activation for Self-management of Back Pain scale developed by Nkhata et al. [ 17 ] and translated into Chinese by S. Guo et al. [ 30 ]. The PAMQ had 11 entries and included three dimensions of self-management beliefs, self-management awareness, and knowledge related to back pain. A Likert 5-point scale was used, with scores ranging from 1 (completely disagree) to 5, for a total score of 11–55, with higher scores indicating higher activation of nurses’ back pain self-management. Cronbach’s alpha coefficient for the Chinese version of the PAMQ scale and for each item were 0.82 and 0.797–0.833 in this study, respectively. 2.4.3 Simplified Coping Skill Questionnaire (SCSQ) The Simplified Coping Skill Questionnaire, translated and revised by Xie Yaning [ 31 ], had 20 entries with two latitudes of positive (12 entries) and negative (8 entries) coping strategies. A Likert 4-point scale ranging from 0 (not taken) to 3 (often taken) was used to rate the frequency of use of each coping strategy. Positive and negative dimensions ranged between 0–36 and 0–24, respectively. The difference between the mean scores of the positive and negative coping dimension entries determined the individual’s coping tendency; the difference of > 0 and < 0 indicated that the study subject’s coping tendency was positive and negative coping strategies, respectively [ 32 ]. Numerous studies in China have demonstrated that the SCSQ has excellent reliability and consistency [ 33 ]. In this study, the Cronbach's alpha coefficients for the total SCSQ scale and the positive and negative coping subscales were 0.90, 0.89, and 0.78, respectively. 2.4.4 Utrecht Work Engagement Scale (UWES) The Utrecht Work Engagement Scale (UWES) in Chinese, translated by Zhang and Gan, was used to measure work engagement [ 1 , 34 ]. UWES included three dimensions, vigor (six entries), dedication (five entries), and absorption (six entries). A 5-point Likert scale ranging from 1 (completely disagree) to 5 (completely agree) was utilized, yielding a total score of 17–85, with higher scores indicating greater levels of nurse engagement. The scale’s Cronbach’s alpha coefficient for the nurse population and each entry was 0.93 and 0.81–0.91, respectively. 2.5 Ethical considerations The Ethics Committee of Nanjing Hospital of Nanjing Medical University approved the study. All participants in the study gave informed consent. 2.6 Data analysis This study used the SPSS (version 26.0) software for all analyses, and all statistical tests were two-sided ( P = 0.05). The independent t -test and one-way ANOVA were utilized to evaluate for differences in demographic characteristics. The Pearson correlation coefficient was utilized to analyze the association between activation of self-management of back pain, coping strategies, and work engagement. Mediation analysis was used to test the mediating effect of coping strategy between back pain self-management activation and work engagement by using the bootstrap method for resampling with the number of replicates set to 5000. In addition, the demographic variables were identified as covariates based on the previous t -test and ANOVA results. The covariate effects were controlled in the mediation model. 3. Results 3.1 The demographics of the study subjects In this study, 296 nurses participated, with 86.8% female (n = 257) (Table 1 ). The average age of the participants was 33.78 years (SD = 7.68). More than 50% of the participants (n = 205, 69.2%) worked in a tertiary hospital and wore lead protective equipment for more than five hours per day (n = 162, 54.7%). 3.2 Demographic distribution of back pain self-management activation, work engagement, and coping strategies Nurses over the age of 40 had the most activation for self-management of back pain ( Mean = 4.85, SD = 0.62). Nurses with senior titles had higher activation levels for self-management of back pain ( Mean = 4.34, SD = 0.34). Nurses who wore PPE for more than five hours daily had better activation for self-management of back pain ( Mean = 3.83, SD = 0.75). Nurses who did moderate housework had higher work engagement ( Mean = 3.68, SD = 0.91). Nurses with more than five years of work experience were more engaged at work and more likely to use a positive coping strategy ( Mean = 3.76, SD = 0.60; Mean = 2.09, SD = 0.64). Females were more likely than males to adopt a negative coping strategy ( Mean = 1.24, SD = 0.77) (Table 2 ). 3.3 Correlation of back pain self-management activation, work engagement, and coping strategies The Pearson correlation analysis results (Table 3 ) showed that back pain self-management activation and positive coping were positively related to work engagement ( r = 0.582, p < 0.01; r = 0.553, p < 0.01). In contrast, negative coping was negatively related to work engagement ( r = − 0.654, p < 0.01). Activation for back pain self-management was positively correlated with positive coping ( r = 0.414, p < 0.01) and negatively correlated with negative coping ( r = − 0.438, p < 0.01). 3.4The mediating effect of coping strategies between Activation for self-management of back pain and Work engagement In this study, gender, age, work experience, professional title, childbearing status, and participation in household chores were set as covariates. The results of the mediation analyses are presented in Table 4. Specifically, activation for self-management of back pain was positively correlated with positive coping (β = 0.596, p < 0.01)(see Fig. 2 a). Positive coping presented as a partial mediator on the relationship between activation for self-management of back pain and work engagement, with an indirect effect of 0.088 and a bootstrap BC (95% CI of 0.035 to 0.149), with the mediating effect accounting for 25.96% of the total effect. 4. Discussion In this study, CCL nurses demonstrated a moderate work engagement (3.50 ± 0.84), lower than nurses in other hospital departments [ 35 ], possibly attributed to the high risk of cardiac interventional procedures and the frequent need for rescue. High work pressure requires nurses to constantly focus on their tasks, causing job stress to indirectly affect nurses’ work engagement through burnout [ 36 , 37 ]. Previous research has shown that work engagement increases with age [ 38 ]. This study also demonstrated that work engagement was higher among nurses who had worked for > five years or were over 30. Cardiac interventional procedures are complicated and variable, necessitating close monitoring of complications and rescue. Senior nurses with extensive clinical experience have more developed practical skills with greater feelings of responsibility and mission in their nursing work. In addition, the current study discovered that high-intensive housework negatively affected nurses’ work engagement, increasing the likelihood of adopting negative coping strategies, consistent with prior research which indicated that after-hours activities (e.g., leisure, socializing, work, and housework) significantly impact the following day’s work engagement [ 39 ]. Activities outside work hours can consume nurses’ time and energy, affecting their mood and state of mind and decreasing productivity. This study’s mean score for nurses’ back pain self-management activation was 3.63 ± 0.89, lower than a previous study [ 40 ] that surveyed all hospital nurses without distinguishing between departments. In contrast, the present study surveyed only CCL nurses; therefore, the difference within the study population may account for this variance. Furthermore, different regions and hospital types may also lead to this variance. In addition, nurses with more extensive work experience and higher titles were more activated to self-manage back pain, suggesting that nurses became more aware of back pain prevention and management as clinical work time increased. Wearing PPE for a long time may cause a burden on the back of CCL nurses, as this equipment increases the weight load on their backs during work. In our study, nurses who wore protective gear for more than five hours daily had higher levels of activation of self-management of back pain because prolonged wear of such gear increased the risk of back pain [ 11 ], motivating nurses to take proactive measures to prevent or alleviate back pain discomfort. Previous studies have shown that abdominal exercise has a positive effect on improving the quality of life, reducing disability risk, and reducing pain for nurses with back pain[ 41 ]. Therefore, we speculate that this strategy also has a positive impact on reducing the burden on the back when CCL nurses wear lead aprons. Thus, in the future, we will investigate whether the use of abdominal exercise by CCL nurses can alleviate their back pain. The nurses’ work engagement is based on their physical fitness and health status [ 42 ]. Back pain reduces caregiver efficiency and causes a nursing workforce shortage [ 43 ]. Self-management, psychotherapy, and other complementary treatments for back pain are prioritized over medication and surgery, according to the guidelines for the prevention and treatment of back pain [ 44 ]. This study discovered that the higher activation of back pain self-management significantly influenced CCL nurses’ work engagement and improved their back pain symptoms and overall health more significantly [ 45 ]. Activation is the willingness and ability to take independent action to manage one's health and is consistent with self-management behavior and health-related outcomes[ 46 ]. This positive behavior enhances the nurses’ knowledge and skills to manage their back pain [ 47 ], giving them a sense of empowerment and control in the workplace and promoting increased work engagement [ 48 , 49 ]. Consequently, improving activation for back pain self-management helps nurses cope with work-related stress and improve health-related quality of life. Furthermore, coping strategies had a direct impact on work engagement. CCL nurses are repeatedly engaged in prolonged back weight-bearing work, which increases their sense of self-protection and self-efficacy in dealing with pain [ 50 ] and encourage them to use active coping strategies to maintain healthy back function. Moreover, nurses who respond positively are more likely to employ problem-focused strategies to lessen stress and unpleasant feelings [ 51 ], encourage them to succeed at work, and raise their level of engagement. After adjusting for covariates, positive coping partially mediated the association between back pain self-management activation and work engagement. Self-management activation is a significant back care strategy [ 46 ]. Individuals with higher activation of self-management are more likely to adopt healthy coping strategies to maintain or improve their health, which can reduce the negative impact of work demands and increase job engagement[ 17 , 52 ]. Therefore, promoting a positive coping strategy may enhance work engagement among nurses in the cardiac catheterization laboratory. 5. Limitations This study has some limitations. First, this was a cross-sectional study, so causality cannot be inferred. Second, the scope of this study was limited to two provinces; research is needed in other parts of China. Third, all scales are self-reported and may contain bias. Fourth, we still need to consider other factors affecting back pain, work engagement, and coping. 6. Conclusion Some demographic factors may impact the activation of back pain self-management and work engagement of CCL nurses. This study demonstrated that back pain self-management activation was positively correlated with CCL nurses’ work engagement, and positive coping partially mediated this relationship. Higher levels of activation for self-management of back pain were associated with positive coping strategies and greater work engagement among nurses. Nursing managers should consider self-management activation and coping strategies to improve the self-management activation of nurses in the cardiac catheterization laboratory. This outcome can be achieved by integrating individual and organizational interventions, providing regular education and training in the self-management of back pain, creating a positive work environment, and providing nurses with the necessary support and encouragement to increase self-management positivity. Declarations Ethics approval and consent to participate The Ethics Committee of Nanjing Hospital of Nanjing Medical University approved the study. All participants in the study gave informed consent. Consent for publication Not applicable. Conflicts of Interest The authors declare no conflict of interest. Funding Project supported by Nanjing medical science and technology development fund YKK22120. Author Contribution LS: Writing – original draft; Project administration.JW: Writing – original draft.Y W: Investigation.SL: Data curation.JZ: Methodology; Supervision.XZ: Writing – review & editing; Supervision. Acknowledgements: The authors thank all the nurses who participated in the study. Data Availability The datasets analyzed during the current study are available on reasonable request from the corresponding author. References Schaufeli WB, Salanova M, González-romá V, Bakker AB. The Measurement of Engagement and Burnout: A Two Sample Confirmatory Factor Analytic Approach. J Happiness Stud. 2002;3(1):71–92. Gou L, Wang G, Feng L, Zhang Y. A multilevel analysis of the impact of group organisational citizenship behaviour on nurse–patient relationship: The mediating effect of work engagement and the moderating effect of emotional intelligence. J Nurs Adm Manag. 2021;29(2):342–50. Yildiz B, Yildiz T. A systematic review and meta-analytical synthesis of the relationship between work engagement and job satisfaction in nurses. Perspect Psychiatr Care. 2022;58(4):3062–78. Zhang X, Bian L, Bai X, Kong D, Liu L, Chen Q, Li N. The influence of job satisfaction, resilience and work engagement on turnover intention among village doctors in China: a cross-sectional study. BMC Health Serv Res. 2020;20(1):283. Bargagliotti LA. Work engagement in nursing: a concept analysis. J Adv Nurs. 2012;68(6):1414–28. Ulrich B, Cassidy L, Barden C, Varn-Davis N, Delgado SA. National Nurse Work Environments - October 2021: A Status Report. Crit care nurse. 2022;42(5):58–70. Keyko K, Cummings GG, Yonge O, Wong CA. Work engagement in professional nursing practice: A systematic review. Int j nurs stud. 2016;61:142–64. Pericak A, Hogg CW, Skalsky K, Bourdeanu L. What Influences Work Engagement Among Registered Nurses: Implications for Evidence-Based Action. Worldviews Evid Based Nurs. 2020;17(5):356–65. Dressner M. Occupational injuries and illnesses among registered nurses. Monthly labor review / US Department of Labor, Bureau of Labor Statistics 2018. Van Hoof W, O'Sullivan K, O'Keeffe M, Verschueren S, O'Sullivan P, Dankaerts W. The efficacy of interventions for low back pain in nurses: A systematic review. Int j nurs stud. 2018;77:222–31. Orme NM, Rihal CS, Gulati R, Holmes DR, Lennon RJ, Lewis BR, McPhail IR, Thielen KR, Pislaru SV, Sandhu GS, et al. Occupational health hazards of working in the interventional laboratory: a multisite case control study of physicians and allied staff. J am coll cardiol. 2015;65(8):820–6. Khalid S, Nicholas B, Shoaib K, Gilbert-Roy K. The Prevalence of Low Back Pain and Evaluation of Prevention Strategies among the Electrophysiology and Catheterization Laboratory Community (Physicians, Nurses, Technicians) in Rural Hospitals. In: Rural Health. edn. Edited by Umar B. Rijeka: IntechOpen; 2021: Ch. 8. Diana Nørregaard Rasmussen C, Karstad K, Søgaard K, Rugulies R, Burdorf A, Holtermann A. Patterns in the Occurrence and Duration of Musculoskeletal Pain and Interference with Work among Eldercare Workers-A One-Year Longitudinal Study with Measurements Every Four Weeks. Int J Environ Res Public Health. 2019;16(16):null. McCabe PJ, Stuart-Mullen LG, McLeod CJ, O Byrne T, Schmidt MM, Branda ME, Griffin JM. Patient activation for self-management is associated with health status in patients with atrial fibrillation. Patient Prefer Adherence. 2018;12:1907–16. Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004;39(4 Pt 1):1005–26. Du S, Hu L, Bai Y, Dong J, Jin S, Zhang H, Zhu Y. The Influence of Self-Efficacy, Fear-Avoidance Belief, and Coping Styles on Quality of Life for Chinese Patients with Chronic Nonspecific Low Back Pain: A Multisite Cross-Sectional Study. Pain Pract. 2018;18(6):736–47. Nkhata LA, Brink Y, Ernstzen D, Louw QA. Nurses back pain beliefs, coping strategies and factors associated with participant activation for self-management of back pain. J Adv Nurs. 2021;77(9):3772–83. Oberlinner C, Yong M, Nasterlack M, Pluto RP, Lang S. Combined effect of back pain and stress on work ability. Occup med-oxford. 2015;65(2):147–53. Piotrowski A, Sygit-Kowalkowska E, Hamzah I. Work Engagement among Prison Officers. The Role of Individual and Organizational Factors in the Polish and Indonesian Penitentiary Systems. Int J Environ Res Public Health 2020, 17(21). Lazarus RS, Folkman S. Transactional theory and research on emotions and coping. Eur J Pers. 1987;1(3):141–69. Lazarus RS, Folkman S. Stress, Appraisal and Coping. Children's Health Care 2010, 29(4). Wang Q, Zhang J, Wang R, Wang C, Wang Y, Chen X, Mi G, Chen X, Cheng X, Wang L, et al. Sleep quality as a mediator of the association between coping styles and mental health: a population-based ten-year comparative study in a Chinese population. J Affect Disord. 2021;283(null):147–55. Fu M, Huang N, Hall BJ, Shi Q, Shahid M, Guo J. Does the attribution of responsibilities modify the relationship between coping styles and mental health? A survey of Chinese adults during the COVID-19 pandemic. J Health Psychol. 2022;27(9):2211–26. Ding Y, Yang Y, Yang X, Zhang T, Qiu X, He X, Wang W, Wang L, Sui H. The Mediating Role of Coping Style in the Relationship between Psychological Capital and Burnout among Chinese Nurses. PLoS ONE. 2015;10(4):e0122128. Yan Q, Liu L, Ren K, Kou D. Mediating effects of coping styles between adversity quotient and work engagement in nurses of grade-A tertiary hospitals in Shaanxi Province. Occupation Health. 2022;38(21):2917–22. In Chinese. Chen R, Fang P, Tan L, Li J, Yu L. Factors associated with sleep quality among nurse managers during regular prevention and control of the COVID-19 in China: a cross-sectional study. BMC Nurs. 2022;21(1):363. Li H, Chang H, Tao Z, Zhang D, Shi Y, Li X. Mediating effect of coping style on the relationship between clinical leadership and quality of work life among nurses in tertiary-level hospitals in China: a cross-sectional study. BMJ Open. 2021;11(2):e041862. Bekelepi N, Martin P. Experience of violence, coping and support for nurses working in acute psychiatric wards. S Afr J Psychiatr. 2022;28:1700. Floyd F, Widaman J, Keith F. Factor analysis in the development and refinement of clinical assessment instruments. Psychol Assess. 1995;7(3):286–99. Guo S, Zhang D, Ma F, Lu H, Wang Y, Mi G. Cross-cultural adaptation of the Participant Activation for Management of Back Pain Questionnaire and its reliability and validity test in clinical nurses. Chin Nurs Manage. 2022;22(7):1074–8. In Chinese. Xie YN. A preliminary study of the reliability and validity of the Simplified Coping Style Scale. Chin J Clin Psychol. 1998;6(2):114–5. Liang J, Tian L, Yang Y, Li QH. Mediating role of coping style between social support and burnout in ICU nurses. Chin Nurs Manage. 2022;22(01):106–10. In Chinese. Fan X, Li H, Lai L, Zhou X, Ye X, Xiao H. Impact of internet plus health education on urinary stoma caregivers in coping with care burden and stress in the era of COVID-19. Front Psychol. 2022;13:982634. Zhang YW, Gan YQ. The Chinese version of Utrecht work engagement scale: an examination of reliability and validity. Chin J Clin Psychol. 2005;13(3):268–81. In Chinese. Szilvassy P, Širok K. Importance of work engagement in primary healthcare. BMC Health Serv Res. 2022;22(1):1044. Debets M, Scheepers R, Silkens M, Lombarts K. Structural equation modelling analysis on relationships of job demands and resources with work engagement, burnout and work ability: an observational study among physicians in Dutch hospitals. BMJ Open. 2022;12(12):e062603. Liao H, Liang R, He H, Huang Y, Liu M. Work stress, burnout, occupational commitment, and social support among Chinese pediatric nurses: A moderated mediation model. J pediatr nurs. 2022;67:16–23. Alkorashy H, Alanazi M. Personal and Job-Related Factors Influencing the Work Engagement of Hospital Nurses: A Cross-Sectional Study from Saudi Arabia. Healthc (Basel). 2023;11(4):572. ten Brummelhuis LL, Bakker AB. Staying engaged during the week: the effect of off-job activities on next day work engagement. J occup health psych. 2012;17(4):445–55. Guo SP, Zheng DL, Wang Y, Ma FZ, Mi GL. Activation for self-management of back pain and its influencing factors among clinical nurses. J Nurs Sci. 2022;37(23):63–6. In Chinese. Noormohammadpour P, Kordi M, Mansournia MA, Akbari-Fakhrabadi M, Kordi R. The Role of a Multi-Step Core Stability Exercise Program in the Treatment of Nurses with Chronic Low Back Pain: A Single-Blinded Randomized Controlled Trial. Asian Spine J. 2018;12(3):490–502. Ikegami K, Ando H, Eguchi H, Tsuji M, Tateishi S, Mori K, Muramatsu K, Fujino Y, Ogami A. Relationship among work-treatment balance, job stress, and work engagement in Japan: a cross-sectional study. Ind Health. 2023;61(1):56–67. El-Soud AMA, El-Najjar AR, El-Fattah NA, Hassan AA. Prevalence of low back pain in working nurses in Zagazig University Hospitals: an epidemiological study. Egypt Rheumatol Rehabilitation. 2014;41:109–15. Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, Ferreira PH, Fritz JM, Koes BW, Peul W, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018;391(10137):2368–83. Linton S, KatjaBoersma. MichalTraczyk, WilliamShaw, MichaelNicholas: Early Workplace Communication and Problem Solving to Prevent Back Disability: Results of a Randomized Controlled Trial Among High-Risk Workers and Their Supervisors. J Occup Rehabil. 2016;26(2):150–9. Greene J, Hibbard JH. Why does patient activation matter? An examination of the relationships between patient activation and health-related outcomes. J Gen Intern Med. 2012;27(5):520–6. Zhang Y, Guan C, Jiang J, Zhu C, Hu X. Mediating effect of resilience on the relationship between perceived social support and burnout among Chinese palliative nurses. J Clin Nurs 2022, 0(0). Buruck G, Tomaschek A, Wendsche J, Ochsmann E, Dörfel D. Psychosocial areas of worklife and chronic low back pain: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2019;20(1):480. Mazzetti G, Biolcati R, Guglielmi D, Vallesi C, Schaufeli WB. Individual Characteristics Influencing Physicians' Perceptions of Job Demands and Control: The Role of Affectivity, Work Engagement and Workaholism. Int J Environ Res Public Health. 2016;13(6):567. Jackson T, Wang Y, Wang Y, Fan H. Self-Efficacy and Chronic Pain Outcomes: A Meta-Analytic Review. J Pain. 2014;15(8):800–14. Kupcewicz E, Jóźwik M. Positive Orientation and Strategies for Coping with Stress as Predictors of Professional Burnout among Polish Nurses. Int J Environ Res Public Health. 2019;16(21):4264. Galanakis MD, Tsitouri E. Positive psychology in the working environment. Job demands-resources theory, work engagement and burnout: A systematic literature review. Front Psychol. 2022;13:1022. Tables Table 1. Participant demographics (n = 296). Demographics N % Gender Male 39 13.2 Female 257 86.8 Age ≤ 29 79 26.7 30-39 155 52.4 ≥ 40 62 20.9 Number of children 0 96 32.4 1 182 61.5 ≥ 2 18 6.1 Work experience ≤ 5 163 55.1 ＞ 5 133 44.9 Professional titles Junior 122 41.2 Intermediate 140 47.3 Senior 34 11.5 Participation in housework Low intensity (Within 5 hours per week） 78 26.4 Moderate intensity (Within 5 to 10 hours per week） 172 58.1 High intensity (10 hours or more per week） 46 15.5 Average hours of wearing PPE in a day Over 5 hours 162 54.7 2-5 hours 126 42.6 Under 2 hours 8 2.7 Hospital grade Tertiary hospitals 205 69.3 Non-tertiary hospitals 91 30.7 PPE: personal protective equipment. Table2 UWES,coping strategies and PAMQ based on demographic characteristics(n=296) PAMQ score UWES score Positive coping Negative coping Variables Mean（SD） t( P ) Mean（SD） t( P ) Mean（SD） t( P ) Mean（SD） t( P ) Gender Male 3.76(0.58) 1.309(0.195) 3.65(0.56) 1.714(0.091) 1.86(0.66) 0.114(0.910) 0.80(0.55) -4.305(0.000) Female 3.61(0.93) 3.47(0.88) 1.84(0.77) 1.24(0.77) Work experience ≤5 3.45(0.99) -4.149(＜0.001) 3.28(0.95) -5.279(＜0.001) 1.64(0.78) -5.396(＜0.001) 1.31(0.83) 3.498(0.001) ＞5 3.86(0.69) 3.76(0.60) 2.09(0.64) 1.01(0.62) Number of children 0 3.41(1.00) 9.221(＜0.001) 3.19(0.91) 20.973(＜0.001) 1.67(0.79) 7.209(＜0.001) 1.29(0.86) 3.596(0.029) 1 3.68(0.82) 3.57(0.75) 1.89(0.73) 1.17(0.72) ≥2 4.32(0.29) 4.44(0.32) 2.35(0.41) 0.77(0.49) Hospital grade Tertiary hospitals 3.74（0.87） 1.383（0.168） 3.59(0.81) 1.239(0.216) 1.93（0.69） 1.391（0.166） 1.15（0.73） -0.466(0.642） Non-tertiary hospitals 3.58（0.90） 3.46(0.82) 1.81（0.78） 1.19（0.78） Age F ( P ) F ( P ) F ( P ) F ( P ) ≤29 3.27(1.07) 9.731(＜0.001) 3.20(1.02) 9.130(＜0.001) 1.51(0.75) 13.411(＜0.001) 1.34(0.85) 3.994(0.019) 30-39 3.73(0.84) 3.53(0.82) 1.91(0.75) 1.18(0.79) ≥40 4.85(0.62) 3.79(0.44) 2.12(0.61) 0.98(0.47) Professional titles Junior 3.35(0.96) 19.083(＜0.001) 3.25(0.94) 15.558(＜0.001) 1.68(0.80) 8.279(＜0.001) 1.35(0.84) 5.467(0.005) Intermediate 3.70(0.81) 3.58(0.66) 1.89(0.68) 1.07(0.66) Senior 4.34(0.34) 4.09(0.84) 2.24(0.72) 1.03(0.72) Participation in housework Low intensity （Within 5 hours per week） 3.65(0.66) 1.471(0.231) 3.81(0.41) 7.490(0.001) 1.93(0.58) 2.48(0.086) 1.01(0.54) 4.265(0.015) Moderate intensity （Within 5 to 10 hours per week） 3.68(0.91) 3.39(0.88) 1.76(0.77) 1.19(0.79) High intensity （10 hours or more per week） 3.43(1.13) 3.38(1.09) 2.00(0.90) 1.42(0.76) Average hours of wearing PPE in a day Over 5 h 3.83（0.75） 18.390(＜0.001) 3.66（0.68） 10.163(＜0.001) 1.96（0.68） 6.710(0.001) 1.09（0.70） 6.775(0.001) 2-5h 3.47（0.94） 3.36（0.94） 1.74（0.81） 1.24（0.82） Under 2 h 2.18（1.08） 1.27（0.45） 1.17（0.78） 2.05（0.62） Table 3 Correlations between variables (n = 296) Variables Mean±SD 1 2 3 4 (1) Activation for self-management of back pain 3.63±0.89 1 (2) Positive coping 1.84±0.75 .414** 1 (3) Negative coping 1.18±0.76 -.438** -.322** 1 (4) Work engagement 3.50±0.84 .582** .553** -.654** 1 *P＜0.05,**P＜0.01. Table 4 Mediating effects of coping strategies on the relationships between back pain self-management activation and work engagement (n = 296) Bootstrapping (BC 95%CI) Mediating Effect ratio（%） Indirect effect a Effect of X on M Effect of M on Y Direct effect Indirect effect Total effect Lower Upper Activation for self-management of back pain →Positive coping→Work engagement 0.596** 0.147** 0.251** 0.088 0.339** 0.035 0.149 25.96 Activation for self-management of back pain →Negative coping→Work engagement 0.106 0.515 0.334** 0.006 0.339 -0.002 0.022 - Abbreviations: M, Positive coping/Negative coping; X, Activation for self-management of back pain; Y, Work engagement. a Adjusted for gender, age, work experience, professional title, childbearing status, and participation in household chores. * p< 0.05; **p< 0.01. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4480305","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":311518098,"identity":"9411179b-5bdf-449b-8ea4-2868cb978455","order_by":0,"name":"Liping She","email":"","orcid":"","institution":"Nanjing First Hospital, Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Liping","middleName":"","lastName":"She","suffix":""},{"id":311518099,"identity":"3850c114-7065-4af5-86f9-edaef85d21cf","order_by":1,"name":"Jinju Wang","email":"","orcid":"","institution":"Nanjing First Hospital, Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jinju","middleName":"","lastName":"Wang","suffix":""},{"id":311518100,"identity":"defbc75f-536a-47da-83f2-15c2f931d821","order_by":2,"name":"Yafeng Wu","email":"","orcid":"","institution":"Nanjing First Hospital, Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yafeng","middleName":"","lastName":"Wu","suffix":""},{"id":311518101,"identity":"7cf2b90a-06f0-478f-8f4d-4c5e701195e5","order_by":3,"name":"Shaoman li","email":"","orcid":"","institution":"Nanjing First Hospital, Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Shaoman","middleName":"","lastName":"li","suffix":""},{"id":311518103,"identity":"31b7d36d-524c-4f3b-96f0-f45ec42a953c","order_by":4,"name":"Juanjuan Zhou","email":"","orcid":"","institution":"Nanjing First Hospital, Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Juanjuan","middleName":"","lastName":"Zhou","suffix":""},{"id":311518105,"identity":"7ee30ae7-7dae-4c23-95b5-2cd4e3d1b013","order_by":5,"name":"Xuemei Zheng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAt0lEQVRIiWNgGAWjYHACNhAhx8befoA0LcZ8PGcSSNOSOE/CwYA49QbXjj978HFHbXqbBEMCw4+KbYS1SM5OSDeceeZ4bpt04wHGnjO3CWvhl044Js3bdiy3TeZAAjNjGxFa2KQT26T/th1LZ5NIMCBOC790Mps0Y1tNAvFaJGensUn2th0wbAMG8kGi/GJwO/2ZxM+2Onn59vaDD35UEKEFCg6DyQNEqweCOlIUj4JRMApGwUgDAKmtOhsK+hjeAAAAAElFTkSuQmCC","orcid":"","institution":"Nanjing First Hospital, Nanjing Medical University","correspondingAuthor":true,"prefix":"","firstName":"Xuemei","middleName":"","lastName":"Zheng","suffix":""}],"badges":[],"createdAt":"2024-05-26 13:54:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4480305/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4480305/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":59033797,"identity":"ebc8f235-7fe0-452a-8455-f33909336a05","added_by":"auto","created_at":"2024-06-25 14:38:22","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":33830,"visible":true,"origin":"","legend":"\u003cp\u003eHypothesized mediation model.\u003c/p\u003e","description":"","filename":"Figure1.Hypothesizedmediationmodel..png","url":"https://assets-eu.researchsquare.com/files/rs-4480305/v1/3de0734103b6bedbb79fccf6.png"},{"id":59033798,"identity":"a212d83f-b27b-41d0-9343-2a74a73283db","added_by":"auto","created_at":"2024-06-25 14:38:22","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":37164,"visible":true,"origin":"","legend":"\u003cp\u003eMediating effects of (a) Positive coping (b)Negative coping on the relationship between activation for self-management of back pain and work engagement.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4480305/v1/f4f873738e91ce3019377fc6.png"},{"id":92570701,"identity":"026b5959-210e-4f67-9d7a-cf81cf74382e","added_by":"auto","created_at":"2025-10-01 07:39:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1221956,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4480305/v1/882232ef-b6fc-4448-b308-3310daa39cee.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Mediating Effects of Coping Strategies Between Activation for Self-Management of Back Pain and Work Engagement: A Cross-Sectional Study of Cardiac Catheterization Laboratory Nurses","fulltext":[{"header":"1. Background","content":"\u003cp\u003eWork engagement refers to a positive, fulfilling, work-related psychological state characterized by vigor, dedication, and absorption [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Numerous studies have demonstrated that work engagement is crucial in improving patients\u0026rsquo; quality of care, prognosis, nurses\u0026rsquo; job satisfaction, and retention rates [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In addition, work engagement is vital for nurses\u0026rsquo; initiative and hospital operations profitability [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, nurses face significant occupational risks, complex nurse-patient relationships, and heavy workloads, leading to a direct or indirect decline in their work engagement [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Therefore, identifying relevant factors that may influence nurses\u0026rsquo; work engagement is crucial to establish a safe and effective nursing practice environment for patients [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to the Nursing Job Demands Resource (NJD-R) theory [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], physical demands are essential for job engagement. Pericak et al. (2020) developed a nurse work engagement model in which the influencing factor was physical health symptoms [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Back pain is a prevalent health issue in the nursing profession, with 55\u0026ndash;84% of lower back pain prevalent worldwide and a leading cause of nursing staff quitting or missing work due to poor health [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Cardiac catheterization laboratory (CCL) nurses, who are exposed to X-ray radiation for extended periods due to cardiac interventional procedures, must wear heavy lead personal protective equipment (PPE) to reduce the radiation exposure. However, prolonged use of heavy lead protective equipment makes CCL nurses more susceptible to lower back pain than nurses in other departments [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Back pain affects the health of nurses and their motivation at work, impacting the quality of care they provide to patients [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The Chronic Care Theory model suggests that individuals who are more active in self-management manage their health more actively and experience better health outcomes [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Activation for self-management is important in relieving back pain symptoms and the impact of pain on one\u0026rsquo;s physical and psychological functioning, reducing the disruption of back pain at work [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In addition, nurses\u0026rsquo; work attitudes and motivation will be enhanced, potentially increasing the work engagement of CCL nurses. Consequently, it is crucial for nurses and clinical workers to reduce the pain associated with back pain.\u003c/p\u003e \u003cp\u003eCoping strategies are deliberate and consistent psychological and behavioral strategies individuals use in response to environmental challenges and pressures, and they significantly influence work engagement [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Coping strategies are classified as positive or negative [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Individuals who adopt a positive coping strategy actively adjust their cognition and behavior to adapt to internal and external environmental demands when confronted with stressful situations, demonstrating greater work engagement [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. A positive coping strategy can help alleviate stress and anxiety, thereby promoting mental health. And good mental health can provide individuals with stronger coping resources[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In contrast, negative coping is an emotion-centered and palliative strategy, where individuals focus on negative thoughts and attempt to escape stressful situations (such as avoidance, denial, and wishful thinking) to minimize distress [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Negative coping strategies correlate negatively with nurses\u0026rsquo; work engagement [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Previous research has found that coping strategies are a crucial factor influencing nurses' health, productivity, and patient care quality[\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Given this evidence, coping strategies could influence the impact of CCL nurses' back pain self-management activation on work engagement.\u003c/p\u003e \u003cp\u003ePositive back pain self-management activation may help to change an individual's assessment of a stressful event, allowing the individual to face the stressor positively and thus participate in clinical care more effectively. Previous research has established a relationship between coping strategies and job engagement[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. However, research on the activation for self-management of back pain among CCL nurses and its impact on work engagement remains unclear. This study hypothesized that efficient activation of back pain self-management might alter an individual\u0026rsquo;s perception of stressful events, enable positive confrontation of stressors and effective engagement in clinical care, and affect CCR nurses' work engagement through positive coping strategies.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Aims and hypotheses\u003c/h2\u003e \u003cp\u003eThe main goals of this study were to:\u003c/p\u003e \u003cp\u003e(1) Ascertain the current level of back pain self-management activation and work engagement among nurses in the catheterization laboratory.\u003c/p\u003e \u003cp\u003e(2) Explore the association between back pain self-management activation, work engagement, and coping strategies among CCL nurses. In addition, examine the mediating effect of coping strategies.\u003c/p\u003e \u003cp\u003eThis study established the following hypotheses (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e):\u003c/p\u003e \u003cp\u003eH1: Work engagement and back pain self-management activation among CCL nurses are associated with certain demographic variables.\u003c/p\u003e \u003cp\u003eH2: Back pain self-management activation positively influences work engagement (Path c).\u003c/p\u003e \u003cp\u003eH3: Back pain self-management activation influences Coping strategy positively (Path a, a\u0026rsquo;).\u003c/p\u003e \u003cp\u003eH4: Coping strategy positively impacts work engagement (Path b, b\u0026rsquo;).\u003c/p\u003e \u003cp\u003eH5: Coping strategy partially mediates the back pain self-management activation on work engagement (Path c\u0026rsquo;).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"2. Method","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Design\u003c/h2\u003e \u003cp\u003eThis cross-sectional survey-based study used convenience sampling. Reporting observational studies is guided by the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Participants\u003c/h2\u003e \u003cp\u003e Participants were recruited from February 2023 to March 2023 from 18 hospitals (seven tertiary and 11 secondary hospitals) in Jiangsu and Anhui provinces, China. The inclusion criteria for this study were: (1) nurses who were age\u0026thinsp;\u0026ge;\u0026thinsp;18 years and had\u0026thinsp;\u0026ge;\u0026thinsp;1 year of clinical nursing work in the cardiac catheterization laboratory; (2) registered nurses with a license to practice; (3) suffered from back pain in the past year (Back pain was defined by the question, \"Within the past year, have you had any work-related back pain? Include dull, sharp pain, cramps or tension, etc.\"); (4) voluntarily participated in this study. The exclusion criteria were nurses: (1) in the menstrual or gestation period; (2) suffering from pathological back pain; (3) in internship, training, or rotation; (4) who did not work in the catheterization laboratory during the survey period for various reasons (e.g., leave of absence, administrative work, and study away).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Data Collection\u003c/h2\u003e \u003cp\u003eThis study distributed the questionnaires through the Questionnaire Star platform (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.wjx.cn\u003c/span\u003e\u003cspan address=\"https://www.wjx.cn\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), with the study purpose and notes explained clearly. The questionnaires were completed anonymously. All data were obtained from participant self-reports. Floyd et al. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] stated that the sample size should be 5\u0026ndash;10 times the number of items. Therefore, 280 participants were required to respond to the 56 items in the questionnaire. Participants with response times of less than three minutes were disqualified, and each IP could respond once to ensure the quality of the questionnaires. Consequently, 318 questionnaires were collected, of which 296 were valid (response rate of 93.08%).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Measurement\u003c/h2\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.4.1 Demographics questionnaire\u003c/h2\u003e \u003cp\u003eThe demographics questionnaire was self-designed through literature review and included items such as age, gender, work experience, childbearing, professional titles, participation in household chores, daily lead PPE wear time, and hospital rank.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.4.2 Participant Activation for Management of Back Pain Questionnaire (PAMQ)\u003c/h2\u003e \u003cp\u003eThis study used the Activation for Self-management of Back Pain scale developed by Nkhata et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] and translated into Chinese by S. Guo et al. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The PAMQ had 11 entries and included three dimensions of self-management beliefs, self-management awareness, and knowledge related to back pain. A Likert 5-point scale was used, with scores ranging from 1 (completely disagree) to 5, for a total score of 11\u0026ndash;55, with higher scores indicating higher activation of nurses\u0026rsquo; back pain self-management. Cronbach\u0026rsquo;s alpha coefficient for the Chinese version of the PAMQ scale and for each item were 0.82 and 0.797\u0026ndash;0.833 in this study, respectively.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e2.4.3 Simplified Coping Skill Questionnaire (SCSQ)\u003c/h2\u003e \u003cp\u003eThe Simplified Coping Skill Questionnaire, translated and revised by Xie Yaning [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], had 20 entries with two latitudes of positive (12 entries) and negative (8 entries) coping strategies. A Likert 4-point scale ranging from 0 (not taken) to 3 (often taken) was used to rate the frequency of use of each coping strategy. Positive and negative dimensions ranged between 0\u0026ndash;36 and 0\u0026ndash;24, respectively. The difference between the mean scores of the positive and negative coping dimension entries determined the individual\u0026rsquo;s coping tendency; the difference of \u0026gt;\u0026thinsp;0 and \u0026lt;\u0026thinsp;0 indicated that the study subject\u0026rsquo;s coping tendency was positive and negative coping strategies, respectively [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Numerous studies in China have demonstrated that the SCSQ has excellent reliability and consistency [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. In this study, the Cronbach's alpha coefficients for the total SCSQ scale and the positive and negative coping subscales were 0.90, 0.89, and 0.78, respectively.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003e2.4.4 Utrecht Work Engagement Scale (UWES)\u003c/h2\u003e \u003cp\u003eThe Utrecht Work Engagement Scale (UWES) in Chinese, translated by Zhang and Gan, was used to measure work engagement [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. UWES included three dimensions, vigor (six entries), dedication (five entries), and absorption (six entries). A 5-point Likert scale ranging from 1 (completely disagree) to 5 (completely agree) was utilized, yielding a total score of 17\u0026ndash;85, with higher scores indicating greater levels of nurse engagement. The scale\u0026rsquo;s Cronbach\u0026rsquo;s alpha coefficient for the nurse population and each entry was 0.93 and 0.81\u0026ndash;0.91, respectively.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Ethical considerations\u003c/h2\u003e \u003cp\u003e The Ethics Committee of Nanjing Hospital of Nanjing Medical University approved the study. All participants in the study gave informed consent.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Data analysis\u003c/h2\u003e \u003cp\u003eThis study used the SPSS (version 26.0) software for all analyses, and all statistical tests were two-sided (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.05). The independent \u003cem\u003et\u003c/em\u003e-test and one-way ANOVA were utilized to evaluate for differences in demographic characteristics. The Pearson correlation coefficient was utilized to analyze the association between activation of self-management of back pain, coping strategies, and work engagement. Mediation analysis was used to test the mediating effect of coping strategy between back pain self-management activation and work engagement by using the bootstrap method for resampling with the number of replicates set to 5000. In addition, the demographic variables were identified as covariates based on the previous \u003cem\u003et\u003c/em\u003e-test and ANOVA results. The covariate effects were controlled in the mediation model.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1 The demographics of the study subjects\u003c/h2\u003e\n \u003cp\u003eIn this study, 296 nurses participated, with 86.8% female (n\u0026thinsp;=\u0026thinsp;257) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). The average age of the participants was 33.78 years (SD\u0026thinsp;=\u0026thinsp;7.68). More than 50% of the participants (n\u0026thinsp;=\u0026thinsp;205, 69.2%) worked in a tertiary hospital and wore lead protective equipment for more than five hours per day (n\u0026thinsp;=\u0026thinsp;162, 54.7%).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2 Demographic distribution of back pain self-management activation, work engagement, and coping strategies\u003c/h2\u003e\n \u003cp\u003eNurses over the age of 40 had the most activation for self-management of back pain (\u003cem\u003eMean\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.85, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.62). Nurses with senior titles had higher activation levels for self-management of back pain (\u003cem\u003eMean\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.34, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.34). Nurses who wore PPE for more than five hours daily had better activation for self-management of back pain (\u003cem\u003eMean\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.83, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.75). Nurses who did moderate housework had higher work engagement (\u003cem\u003eMean\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.68, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.91). Nurses with more than five years of work experience were more engaged at work and more likely to use a positive coping strategy (\u003cem\u003eMean\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.76, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.60; \u003cem\u003eMean\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.09, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.64). Females were more likely than males to adopt a negative coping strategy (\u003cem\u003eMean\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.24, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.77) (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003ch2\u003e3.3 Correlation of back pain self-management activation, work engagement, and coping strategies\u003c/h2\u003e\n \u003cp\u003eThe Pearson correlation analysis results (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e) showed that back pain self-management activation and positive coping were positively related to work engagement (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.582, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01; \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.553, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). In contrast, negative coping was negatively related to work engagement (\u003cem\u003er\u003c/em\u003e = \u0026minus;\u0026thinsp;0.654, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Activation for back pain self-management was positively correlated with positive coping (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.414, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and negatively correlated with negative coping (\u003cem\u003er\u003c/em\u003e = \u0026minus;\u0026thinsp;0.438, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n \u003ch2\u003e3.4The mediating effect of coping strategies between Activation for self-management of back pain and Work engagement\u003c/h2\u003e\n \u003cp\u003eIn this study, gender, age, work experience, professional title, childbearing status, and participation in household chores were set as covariates. The results of the mediation analyses are presented in Table\u0026nbsp;4. Specifically, activation for self-management of back pain was positively correlated with positive coping (\u0026beta;\u0026thinsp;=\u0026thinsp;0.596, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01)(see Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003ea). Positive coping presented as a partial mediator on the relationship between activation for self-management of back pain and work engagement, with an indirect effect of 0.088 and a bootstrap BC (95% CI of 0.035 to 0.149), with the mediating effect accounting for 25.96% of the total effect.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIn this study, CCL nurses demonstrated a moderate work engagement (3.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84), lower than nurses in other hospital departments [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], possibly attributed to the high risk of cardiac interventional procedures and the frequent need for rescue. High work pressure requires nurses to constantly focus on their tasks, causing job stress to indirectly affect nurses\u0026rsquo; work engagement through burnout [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Previous research has shown that work engagement increases with age [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. This study also demonstrated that work engagement was higher among nurses who had worked for \u0026gt;\u0026thinsp;five years or were over 30. Cardiac interventional procedures are complicated and variable, necessitating close monitoring of complications and rescue. Senior nurses with extensive clinical experience have more developed practical skills with greater feelings of responsibility and mission in their nursing work. In addition, the current study discovered that high-intensive housework negatively affected nurses\u0026rsquo; work engagement, increasing the likelihood of adopting negative coping strategies, consistent with prior research which indicated that after-hours activities (e.g., leisure, socializing, work, and housework) significantly impact the following day\u0026rsquo;s work engagement [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Activities outside work hours can consume nurses\u0026rsquo; time and energy, affecting their mood and state of mind and decreasing productivity.\u003c/p\u003e \u003cp\u003eThis study\u0026rsquo;s mean score for nurses\u0026rsquo; back pain self-management activation was 3.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89, lower than a previous study [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e] that surveyed all hospital nurses without distinguishing between departments. In contrast, the present study surveyed only CCL nurses; therefore, the difference within the study population may account for this variance. Furthermore, different regions and hospital types may also lead to this variance. In addition, nurses with more extensive work experience and higher titles were more activated to self-manage back pain, suggesting that nurses became more aware of back pain prevention and management as clinical work time increased. Wearing PPE for a long time may cause a burden on the back of CCL nurses, as this equipment increases the weight load on their backs during work. In our study, nurses who wore protective gear for more than five hours daily had higher levels of activation of self-management of back pain because prolonged wear of such gear increased the risk of back pain [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], motivating nurses to take proactive measures to prevent or alleviate back pain discomfort. Previous studies have shown that abdominal exercise has a positive effect on improving the quality of life, reducing disability risk, and reducing pain for nurses with back pain[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Therefore, we speculate that this strategy also has a positive impact on reducing the burden on the back when CCL nurses wear lead aprons. Thus, in the future, we will investigate whether the use of abdominal exercise by CCL nurses can alleviate their back pain.\u003c/p\u003e \u003cp\u003eThe nurses\u0026rsquo; work engagement is based on their physical fitness and health status [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Back pain reduces caregiver efficiency and causes a nursing workforce shortage [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Self-management, psychotherapy, and other complementary treatments for back pain are prioritized over medication and surgery, according to the guidelines for the prevention and treatment of back pain [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. This study discovered that the higher activation of back pain self-management significantly influenced CCL nurses\u0026rsquo; work engagement and improved their back pain symptoms and overall health more significantly [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Activation is the willingness and ability to take independent action to manage one's health and is consistent with self-management behavior and health-related outcomes[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. This positive behavior enhances the nurses\u0026rsquo; knowledge and skills to manage their back pain [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e], giving them a sense of empowerment and control in the workplace and promoting increased work engagement [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Consequently, improving activation for back pain self-management helps nurses cope with work-related stress and improve health-related quality of life.\u003c/p\u003e \u003cp\u003eFurthermore, coping strategies had a direct impact on work engagement. CCL nurses are repeatedly engaged in prolonged back weight-bearing work, which increases their sense of self-protection and self-efficacy in dealing with pain [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e] and encourage them to use active coping strategies to maintain healthy back function. Moreover, nurses who respond positively are more likely to employ problem-focused strategies to lessen stress and unpleasant feelings [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e], encourage them to succeed at work, and raise their level of engagement. After adjusting for covariates, positive coping partially mediated the association between back pain self-management activation and work engagement. Self-management activation is a significant back care strategy [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Individuals with higher activation of self-management are more likely to adopt healthy coping strategies to maintain or improve their health, which can reduce the negative impact of work demands and increase job engagement[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Therefore, promoting a positive coping strategy may enhance work engagement among nurses in the cardiac catheterization laboratory.\u003c/p\u003e"},{"header":"5. Limitations","content":"\u003cp\u003eThis study has some limitations. First, this was a cross-sectional study, so causality cannot be inferred. Second, the scope of this study was limited to two provinces; research is needed in other parts of China. Third, all scales are self-reported and may contain bias. Fourth, we still need to consider other factors affecting back pain, work engagement, and coping.\u003c/p\u003e"},{"header":"6. Conclusion","content":"\u003cp\u003eSome demographic factors may impact the activation of back pain self-management and work engagement of CCL nurses. This study demonstrated that back pain self-management activation was positively correlated with CCL nurses\u0026rsquo; work engagement, and positive coping partially mediated this relationship. Higher levels of activation for self-management of back pain were associated with positive coping strategies and greater work engagement among nurses. Nursing managers should consider self-management activation and coping strategies to improve the self-management activation of nurses in the cardiac catheterization laboratory. This outcome can be achieved by integrating individual and organizational interventions, providing regular education and training in the self-management of back pain, creating a positive work environment, and providing nurses with the necessary support and encouragement to increase self-management positivity.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e \u003cp\u003eThe Ethics Committee of Nanjing Hospital of Nanjing Medical University approved the study. All participants in the study gave informed consent.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eConflicts of Interest\u003c/h2\u003e \u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eProject supported by Nanjing medical science and technology development fund YKK22120.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eLS: Writing \u0026ndash; original draft; Project administration.JW: Writing \u0026ndash; original draft.Y W: Investigation.SL: Data curation.JZ: Methodology; Supervision.XZ: Writing \u0026ndash; review \u0026amp; editing; Supervision.\u003c/p\u003e\u003ch2\u003eAcknowledgements:\u003c/h2\u003e \u003cp\u003eThe authors thank all the nurses who participated in the study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets analyzed during the current study are available on reasonable request from the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSchaufeli WB, Salanova M, Gonz\u0026aacute;lez-rom\u0026aacute; V, Bakker AB. The Measurement of Engagement and Burnout: A Two Sample Confirmatory Factor Analytic Approach. J Happiness Stud. 2002;3(1):71\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGou L, Wang G, Feng L, Zhang Y. A multilevel analysis of the impact of group organisational citizenship behaviour on nurse\u0026ndash;patient relationship: The mediating effect of work engagement and the moderating effect of emotional intelligence. J Nurs Adm Manag. 2021;29(2):342\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYildiz B, Yildiz T. A systematic review and meta-analytical synthesis of the relationship between work engagement and job satisfaction in nurses. Perspect Psychiatr Care. 2022;58(4):3062\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang X, Bian L, Bai X, Kong D, Liu L, Chen Q, Li N. The influence of job satisfaction, resilience and work engagement on turnover intention among village doctors in China: a cross-sectional study. BMC Health Serv Res. 2020;20(1):283.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBargagliotti LA. Work engagement in nursing: a concept analysis. J Adv Nurs. 2012;68(6):1414\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUlrich B, Cassidy L, Barden C, Varn-Davis N, Delgado SA. National Nurse Work Environments - October 2021: A Status Report. Crit care nurse. 2022;42(5):58\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKeyko K, Cummings GG, Yonge O, Wong CA. Work engagement in professional nursing practice: A systematic review. Int j nurs stud. 2016;61:142\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePericak A, Hogg CW, Skalsky K, Bourdeanu L. What Influences Work Engagement Among Registered Nurses: Implications for Evidence-Based Action. Worldviews Evid Based Nurs. 2020;17(5):356\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDressner M. Occupational injuries and illnesses among registered nurses. \u003cem\u003eMonthly labor review / US Department of Labor, Bureau of Labor Statistics\u003c/em\u003e 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan Hoof W, O'Sullivan K, O'Keeffe M, Verschueren S, O'Sullivan P, Dankaerts W. The efficacy of interventions for low back pain in nurses: A systematic review. Int j nurs stud. 2018;77:222\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrme NM, Rihal CS, Gulati R, Holmes DR, Lennon RJ, Lewis BR, McPhail IR, Thielen KR, Pislaru SV, Sandhu GS, et al. Occupational health hazards of working in the interventional laboratory: a multisite case control study of physicians and allied staff. J am coll cardiol. 2015;65(8):820\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhalid S, Nicholas B, Shoaib K, Gilbert-Roy K. The Prevalence of Low Back Pain and Evaluation of Prevention Strategies among the Electrophysiology and Catheterization Laboratory Community (Physicians, Nurses, Technicians) in Rural Hospitals. In: \u003cem\u003eRural Health.\u003c/em\u003e edn. Edited by Umar B. Rijeka: IntechOpen; 2021: Ch. 8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDiana N\u0026oslash;rregaard Rasmussen C, Karstad K, S\u0026oslash;gaard K, Rugulies R, Burdorf A, Holtermann A. Patterns in the Occurrence and Duration of Musculoskeletal Pain and Interference with Work among Eldercare Workers-A One-Year Longitudinal Study with Measurements Every Four Weeks. Int J Environ Res Public Health. 2019;16(16):null.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcCabe PJ, Stuart-Mullen LG, McLeod CJ, O Byrne T, Schmidt MM, Branda ME, Griffin JM. Patient activation for self-management is associated with health status in patients with atrial fibrillation. Patient Prefer Adherence. 2018;12:1907\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004;39(4 Pt 1):1005\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDu S, Hu L, Bai Y, Dong J, Jin S, Zhang H, Zhu Y. The Influence of Self-Efficacy, Fear-Avoidance Belief, and Coping Styles on Quality of Life for Chinese Patients with Chronic Nonspecific Low Back Pain: A Multisite Cross-Sectional Study. Pain Pract. 2018;18(6):736\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNkhata LA, Brink Y, Ernstzen D, Louw QA. Nurses back pain beliefs, coping strategies and factors associated with participant activation for self-management of back pain. J Adv Nurs. 2021;77(9):3772\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOberlinner C, Yong M, Nasterlack M, Pluto RP, Lang S. Combined effect of back pain and stress on work ability. Occup med-oxford. 2015;65(2):147\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePiotrowski A, Sygit-Kowalkowska E, Hamzah I. Work Engagement among Prison Officers. The Role of Individual and Organizational Factors in the Polish and Indonesian Penitentiary Systems. Int J Environ Res Public Health 2020, 17(21).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLazarus RS, Folkman S. Transactional theory and research on emotions and coping. Eur J Pers. 1987;1(3):141\u0026ndash;69.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLazarus RS, Folkman S. Stress, Appraisal and Coping. Children's Health Care 2010, 29(4).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang Q, Zhang J, Wang R, Wang C, Wang Y, Chen X, Mi G, Chen X, Cheng X, Wang L, et al. Sleep quality as a mediator of the association between coping styles and mental health: a population-based ten-year comparative study in a Chinese population. J Affect Disord. 2021;283(null):147\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFu M, Huang N, Hall BJ, Shi Q, Shahid M, Guo J. Does the attribution of responsibilities modify the relationship between coping styles and mental health? A survey of Chinese adults during the COVID-19 pandemic. J Health Psychol. 2022;27(9):2211\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDing Y, Yang Y, Yang X, Zhang T, Qiu X, He X, Wang W, Wang L, Sui H. The Mediating Role of Coping Style in the Relationship between Psychological Capital and Burnout among Chinese Nurses. PLoS ONE. 2015;10(4):e0122128.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYan Q, Liu L, Ren K, Kou D. Mediating effects of coping styles between adversity quotient and work engagement in nurses of grade-A tertiary hospitals in Shaanxi Province. Occupation Health. 2022;38(21):2917\u0026ndash;22. In Chinese.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen R, Fang P, Tan L, Li J, Yu L. Factors associated with sleep quality among nurse managers during regular prevention and control of the COVID-19 in China: a cross-sectional study. BMC Nurs. 2022;21(1):363.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi H, Chang H, Tao Z, Zhang D, Shi Y, Li X. Mediating effect of coping style on the relationship between clinical leadership and quality of work life among nurses in tertiary-level hospitals in China: a cross-sectional study. BMJ Open. 2021;11(2):e041862.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBekelepi N, Martin P. Experience of violence, coping and support for nurses working in acute psychiatric wards. S Afr J Psychiatr. 2022;28:1700.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFloyd F, Widaman J, Keith F. Factor analysis in the development and refinement of clinical assessment instruments. Psychol Assess. 1995;7(3):286\u0026ndash;99.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuo S, Zhang D, Ma F, Lu H, Wang Y, Mi G. Cross-cultural adaptation of the Participant Activation for Management of Back Pain Questionnaire and its reliability and validity test in clinical nurses. Chin Nurs Manage. 2022;22(7):1074\u0026ndash;8. In Chinese.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXie YN. A preliminary study of the reliability and validity of the Simplified Coping Style Scale. Chin J Clin Psychol. 1998;6(2):114\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiang J, Tian L, Yang Y, Li QH. Mediating role of coping style between social support and burnout in ICU nurses. Chin Nurs Manage. 2022;22(01):106\u0026ndash;10. In Chinese.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFan X, Li H, Lai L, Zhou X, Ye X, Xiao H. Impact of internet plus health education on urinary stoma caregivers in coping with care burden and stress in the era of COVID-19. Front Psychol. 2022;13:982634.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang YW, Gan YQ. The Chinese version of Utrecht work engagement scale: an examination of reliability and validity. Chin J Clin Psychol. 2005;13(3):268\u0026ndash;81. In Chinese.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSzilvassy P, Širok K. Importance of work engagement in primary healthcare. BMC Health Serv Res. 2022;22(1):1044.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDebets M, Scheepers R, Silkens M, Lombarts K. Structural equation modelling analysis on relationships of job demands and resources with work engagement, burnout and work ability: an observational study among physicians in Dutch hospitals. BMJ Open. 2022;12(12):e062603.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiao H, Liang R, He H, Huang Y, Liu M. Work stress, burnout, occupational commitment, and social support among Chinese pediatric nurses: A moderated mediation model. J pediatr nurs. 2022;67:16\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlkorashy H, Alanazi M. Personal and Job-Related Factors Influencing the Work Engagement of Hospital Nurses: A Cross-Sectional Study from Saudi Arabia. Healthc (Basel). 2023;11(4):572.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eten Brummelhuis LL, Bakker AB. Staying engaged during the week: the effect of off-job activities on next day work engagement. J occup health psych. 2012;17(4):445\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuo SP, Zheng DL, Wang Y, Ma FZ, Mi GL. Activation for self-management of back pain and its influencing factors among clinical nurses. J Nurs Sci. 2022;37(23):63\u0026ndash;6. In Chinese.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNoormohammadpour P, Kordi M, Mansournia MA, Akbari-Fakhrabadi M, Kordi R. The Role of a Multi-Step Core Stability Exercise Program in the Treatment of Nurses with Chronic Low Back Pain: A Single-Blinded Randomized Controlled Trial. Asian Spine J. 2018;12(3):490\u0026ndash;502.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIkegami K, Ando H, Eguchi H, Tsuji M, Tateishi S, Mori K, Muramatsu K, Fujino Y, Ogami A. Relationship among work-treatment balance, job stress, and work engagement in Japan: a cross-sectional study. Ind Health. 2023;61(1):56\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl-Soud AMA, El-Najjar AR, El-Fattah NA, Hassan AA. Prevalence of low back pain in working nurses in Zagazig University Hospitals: an epidemiological study. Egypt Rheumatol Rehabilitation. 2014;41:109\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFoster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, Ferreira PH, Fritz JM, Koes BW, Peul W, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018;391(10137):2368\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLinton S, KatjaBoersma. MichalTraczyk, WilliamShaw, MichaelNicholas: Early Workplace Communication and Problem Solving to Prevent Back Disability: Results of a Randomized Controlled Trial Among High-Risk Workers and Their Supervisors. J Occup Rehabil. 2016;26(2):150\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGreene J, Hibbard JH. Why does patient activation matter? An examination of the relationships between patient activation and health-related outcomes. J Gen Intern Med. 2012;27(5):520\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang Y, Guan C, Jiang J, Zhu C, Hu X. Mediating effect of resilience on the relationship between perceived social support and burnout among Chinese palliative nurses. J Clin Nurs 2022, 0(0).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuruck G, Tomaschek A, Wendsche J, Ochsmann E, D\u0026ouml;rfel D. Psychosocial areas of worklife and chronic low back pain: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2019;20(1):480.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMazzetti G, Biolcati R, Guglielmi D, Vallesi C, Schaufeli WB. Individual Characteristics Influencing Physicians' Perceptions of Job Demands and Control: The Role of Affectivity, Work Engagement and Workaholism. Int J Environ Res Public Health. 2016;13(6):567.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJackson T, Wang Y, Wang Y, Fan H. Self-Efficacy and Chronic Pain Outcomes: A Meta-Analytic Review. J Pain. 2014;15(8):800\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKupcewicz E, J\u0026oacute;źwik M. Positive Orientation and Strategies for Coping with Stress as Predictors of Professional Burnout among Polish Nurses. Int J Environ Res Public Health. 2019;16(21):4264.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGalanakis MD, Tsitouri E. Positive psychology in the working environment. Job demands-resources theory, work engagement and burnout: A systematic literature review. Front Psychol. 2022;13:1022.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"317\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eTable 1. \u0026nbsp;Participant demographics (n = 296).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003eDemographics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003e257\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e86.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026le; 29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e26.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;30-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003e155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e52.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026ge; 40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e20.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e32.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003e182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e61.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026ge; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003eWork experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026le; 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003e163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e55.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;＞ 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003e133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e44.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003eProfessional titles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Junior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e41.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Intermediate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e47.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Senior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003eParticipation in housework\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Low intensity (Within 5 hours per week）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e26.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Moderate intensity (Within 5 to 10 hours per week）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003e172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e58.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;High intensity (10 hours or more per week）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e15.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003eAverage hours of wearing PPE in a day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003eOver\u0026nbsp;5\u0026nbsp;hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e54.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003e2-5 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e42.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003eUnder 2 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003eHospital grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003eTertiary hospitals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003e205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e69.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.09433962264151%\" valign=\"top\"\u003e\n \u003cp\u003eNon-tertiary hospitals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.29559748427673%\" valign=\"top\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.61006289308176%\" valign=\"top\"\u003e\n \u003cp\u003e30.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ePPE: personal protective equipment.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"917\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"9\" valign=\"top\"\u003e\n \u003cp\u003eTable2 UWES,coping strategies and PAMQ based on demographic characteristics(n=296)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.653971708378673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.58650707290533%\" colspan=\"2\"\u003e\n \u003cp\u003ePAMQ score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.58650707290533%\" colspan=\"2\"\u003e\n \u003cp\u003eUWES score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.58650707290533%\" colspan=\"2\"\u003e\n \u003cp\u003ePositive coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.58650707290533%\" colspan=\"2\"\u003e\n \u003cp\u003eNegative coping\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\"\u003e\n \u003cp\u003eMean（SD）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\"\u003e\n \u003cp\u003et(\u003cem\u003eP\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\"\u003e\n \u003cp\u003eMean（SD）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\"\u003e\n \u003cp\u003et(\u003cem\u003eP\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\"\u003e\n \u003cp\u003eMean（SD）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\"\u003e\n \u003cp\u003et(\u003cem\u003eP\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\"\u003e\n \u003cp\u003eMean（SD）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\"\u003e\n \u003cp\u003et(\u003cem\u003eP\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.76(0.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e1.309(0.195)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.65(0.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e1.714(0.091)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.86(0.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e0.114(0.910)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e0.80(0.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e-4.305(0.000)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.61(0.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.47(0.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.84(0.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.24(0.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003eWork experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026le;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.45(0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e-4.149(＜0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.28(0.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e-5.279(＜0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.64(0.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e-5.396(＜0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.31(0.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e3.498(0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; ＞5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.86(0.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.76(0.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e2.09(0.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.01(0.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.41(1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e9.221(＜0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.19(0.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e20.973(＜0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.67(0.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e7.209(＜0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\"\u003e\n \u003cp\u003e1.29(0.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e3.596(0.029)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.68(0.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.57(0.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.89(0.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\"\u003e\n \u003cp\u003e1.17(0.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026ge;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e4.32(0.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e4.44(0.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e2.35(0.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\"\u003e\n \u003cp\u003e0.77(0.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003eHospital grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003eTertiary hospitals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.74（0.87）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e1.383（0.168）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.59(0.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e1.239(0.216)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.93（0.69）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e1.391（0.166）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.15（0.73）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e-0.466(0.642）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003eNon-tertiary hospitals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.58（0.90）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.46(0.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.81（0.78）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.19（0.78）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\"\u003e\n \u003cp\u003eF (\u003cem\u003eP\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\"\u003e\n \u003cp\u003eF (\u003cem\u003eP\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\"\u003e\n \u003cp\u003eF (\u003cem\u003eP\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\"\u003e\n \u003cp\u003eF (\u003cem\u003eP\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026le;29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.27(1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e9.731(＜0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.20(1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e9.130(＜0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.51(0.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e13.411(＜0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.34(0.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e3.994(0.019)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 30-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.73(0.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.53(0.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.91(0.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.18(0.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026ge;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e4.85(0.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.79(0.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e2.12(0.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e0.98(0.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003eProfessional titles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Junior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.35(0.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e19.083(＜0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.25(0.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e15.558(＜0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.68(0.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e8.279(＜0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.35(0.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e5.467(0.005)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Intermediate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.70(0.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.58(0.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.89(0.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.07(0.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Senior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e4.34(0.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e4.09(0.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e2.24(0.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.03(0.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003eParticipation in housework\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Low intensity\u003c/p\u003e\n \u003cp\u003e（Within 5 hours per week）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.65(0.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e1.471(0.231)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.81(0.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e7.490(0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.93(0.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e2.48(0.086)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.01(0.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e4.265(0.015)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Moderate intensity\u003c/p\u003e\n \u003cp\u003e（Within 5 to 10 hours per week）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.68(0.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.39(0.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.76(0.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.19(0.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; High intensity\u003c/p\u003e\n \u003cp\u003e（10 hours or more per week）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.43(1.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.38(1.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e2.00(0.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.42(0.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003eAverage hours of wearing PPE in a day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003eOver\u0026nbsp;5\u0026nbsp;h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.83（0.75）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e18.390(＜0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.66（0.68）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e10.163(＜0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.96（0.68）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e6.710(0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.09（0.70）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e6.775(0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003e2-5h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.47（0.94）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e3.36（0.94）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.74（0.81）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.24（0.82）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.701199563794983%\" valign=\"top\"\u003e\n \u003cp\u003eUnder 2 h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e2.18（1.08）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.27（0.45）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25081788440567%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e1.17（0.78）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.269356597600872%\" valign=\"top\"\u003e\n \u003cp\u003e2.05（0.62）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.359869138495092%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"724\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003eTable 3 \u0026nbsp; \u0026nbsp; Correlations between variables (n = 296)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.685082872928177%\" valign=\"top\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.259668508287293%\" valign=\"top\"\u003e\n \u003cp\u003eMean\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.265193370165747%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.883977900552486%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.265193370165747%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.640883977900552%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.685082872928177%\" valign=\"top\"\u003e\n \u003cp\u003e(1)\u0026nbsp;Activation for self-management of back pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.259668508287293%\" valign=\"top\"\u003e\n \u003cp\u003e3.63\u0026plusmn;0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.265193370165747%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.883977900552486%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.265193370165747%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.640883977900552%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.685082872928177%\" valign=\"top\"\u003e\n \u003cp\u003e(2)\u0026nbsp;Positive coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.259668508287293%\" valign=\"top\"\u003e\n \u003cp\u003e1.84\u0026plusmn;0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.265193370165747%\"\u003e\n \u003cp\u003e.414**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.883977900552486%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.265193370165747%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.640883977900552%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.685082872928177%\" valign=\"top\"\u003e\n \u003cp\u003e(3)\u0026nbsp;Negative coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.259668508287293%\" valign=\"top\"\u003e\n \u003cp\u003e1.18\u0026plusmn;0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.265193370165747%\"\u003e\n \u003cp\u003e-.438**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.883977900552486%\"\u003e\n \u003cp\u003e-.322**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.265193370165747%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.640883977900552%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.685082872928177%\" valign=\"top\"\u003e\n \u003cp\u003e(4)\u0026nbsp;Work engagement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.259668508287293%\" valign=\"top\"\u003e\n \u003cp\u003e3.50\u0026plusmn;0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.265193370165747%\"\u003e\n \u003cp\u003e.582**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.883977900552486%\"\u003e\n \u003cp\u003e.553**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.265193370165747%\"\u003e\n \u003cp\u003e-.654**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.640883977900552%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e*P＜0.05,**P＜0.01.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" \u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"90.37037037037037%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eTable 4\u0026emsp;Mediating effects of coping strategies on the relationships between back pain self-management activation and work engagement\u0026nbsp;(n = 296)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.62962962962963%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.502645502645503%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.899470899470899%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.687830687830688%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.100529100529101%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.206349206349206%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.465608465608465%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.50793650793651%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBootstrapping (BC 95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.62962962962963%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eMediating Effect ratio（%）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.220140515222482%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndirect effect\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.06088992974239%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect of X on M\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.826697892271662%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect of M on Y\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.070257611241217%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDirect effect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.187353629976581%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndirect effect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.36768149882904%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal effect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.782201405152225%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.484777517564403%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUpper\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.502645502645503%\" valign=\"top\"\u003e\n \u003cp\u003eActivation for self-management of back pain\u0026nbsp;\u0026rarr;Positive coping\u0026rarr;Work engagement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.899470899470899%\"\u003e\n \u003cp\u003e0.596**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.687830687830688%\"\u003e\n \u003cp\u003e0.147**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.100529100529101%\"\u003e\n \u003cp\u003e0.251**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.206349206349206%\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.465608465608465%\"\u003e\n \u003cp\u003e0.339**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.936507936507937%\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.571428571428571%\"\u003e\n \u003cp\u003e0.149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.62962962962963%\"\u003e\n \u003cp\u003e25.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.502645502645503%\" valign=\"top\"\u003e\n \u003cp\u003eActivation for self-management of back pain\u0026nbsp;\u0026rarr;Negative coping\u0026rarr;Work engagement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.899470899470899%\"\u003e\n \u003cp\u003e0.106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.687830687830688%\"\u003e\n \u003cp\u003e0.515\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.100529100529101%\"\u003e\n \u003cp\u003e0.334**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.206349206349206%\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.465608465608465%\"\u003e\n \u003cp\u003e0.339\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.936507936507937%\"\u003e\n \u003cp\u003e-0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.571428571428571%\"\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.62962962962963%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"90.37037037037037%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eAbbreviations: M, Positive coping/Negative coping; X, Activation for self-management of back pain; Y, Work engagement.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.62962962962963%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"90.37037037037037%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003e\u003csup\u003ea\u003c/sup\u003eAdjusted for gender, age, work experience, professional title, childbearing status, and participation in household chores.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.62962962962963%\" valign=\"top\"\u003e\n \u003cp\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"90.37037037037037%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003e* p\u0026lt;\u0026thinsp;0.05; **p\u0026lt;\u0026thinsp;0.01.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.62962962962963%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Back pain, Coping strategies, Mediation effect, Cardiac catheterization laboratory Nurses, Participant activation, Self-management, Work engagement","lastPublishedDoi":"10.21203/rs.3.rs-4480305/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4480305/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eWork engagement is a critical factor in improving the quality of care, nurses' job satisfaction, and hospital profitability. However, nurses, especially those in cardiac catheterization labs, face significant physical demands such as lower back pain from prolonged use of lead personal protective equipment, impacting their work engagement. To examine the back pain self-management activation, work engagement, and role of coping strategies among nurses in the cardiac catheterization laboratory.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis was a cross-sectional study design. A convenience sampling recruited 296 participants from 18 hospitals in Jiangsu and Anhui provinces of China from February to March 2023. The Demographics questionnaire, Participant Activation for Management of Back Pain Questionnaire, Simplified Coping Skill Questionnaire, and the Utrecht Work Engagement Scale were used to survey participants. A Pearson correlation analysis was conducted to determine the relationship between positive self-management of back pain, coping strategy, and work engagement. Bootstrap method was used to analyze the mediating effect of coping strategies.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eWork engagement and back pain self-management activation among cardiac catheterization laboratory nurses were moderate and influenced by various sociodemographic factors. Activation for self-management of back pain directly impacted work engagement, partially mediated by positive coping strategies, which accounted for 25.96% of the total effect.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eActivation of self-management of back pain and positive coping strategies promote work engagement among cardiac catheterization laboratory nurses. Nursing managers should integrate individual and organizational interventions to increase nurses' self-management activation and work engagement.\u003c/p\u003e","manuscriptTitle":"Mediating Effects of Coping Strategies Between Activation for Self-Management of Back Pain and Work Engagement: A Cross-Sectional Study of Cardiac Catheterization Laboratory Nurses","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-25 14:38:17","doi":"10.21203/rs.3.rs-4480305/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c12dcc40-5e84-46be-9eae-d92ec6341767","owner":[],"postedDate":"June 25th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-01T07:38:29+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-25 14:38:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4480305","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4480305","identity":"rs-4480305","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}