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  Table of Contents 
Year : 2017  |  Volume : 21  |  Issue : 3  |  Page : 128-131

Effort–Reward Imbalance and its Association with Health among Pluckers in a Tea Plantation in South India

Department of Community Medicine, St. John's Medical College, Bengaluru, Karnataka, India

Date of Web Publication7-Mar-2018

Correspondence Address:
Dr. Chitra Tomy
Department of Community Medicine, St. John's Medical College, Bengaluru, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijoem.IJOEM_141_17

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Context: Work-related stress is associated with cardiovascular diseases, musculoskeletal disorders, psychological ailments, and work-related injuries. Imbalance between high effort and low reward at work can lead to work stress among plantation workers. Aims: To assess the effort–reward imbalance (ERI) among pluckers in tea plantations in South India and its association on chronic health problems, substance abuses, and workplace injuries. Settings and Design: A cross-sectional study was conducted among 346 tea pluckers from May to June 2015 in six selected tea plantations in Anamalai, South India. Patients and Methods: A short version of ERI questionnaire was used to assess the work-related stress among them. Along with ERI questionnaire, sociodemographic details, chronic diseases, substance abuses, and workplace injuries were ascertained. Statistical Analysis Used: Sociodemographic variables were described as frequency and measures of central tendency. Tests of association, such as Chi-square test, were applied. Results: Among the study population, 322 (93.1%) reported more effort, 23 (6.6%) reported more reward, and one (0.3%) had no imbalance between effort and reward. Those in older age group (≥51 years) experienced more effort compared to those in younger age group (≤50 years) (Fisher's exact = 21.905, P = 0.001). Educational status (Fisher's exact = 15.639, P = 0.027) and work experience (Fisher's exact = 23.122, P = 0.003) increased the effort rather than increasing the reward associated with work. No significant association was found between ERI and any chronic diseases, substance abuses, or injuries. Conclusions: Majority of pluckers in tea plantation experienced more effort compared to reward.

Keywords: Effort–reward imbalance, plantation workers, pluckers

How to cite this article:
Tomy C, Ramesh N, Fathima FN, D'cunha RL, Chakravathi KA. Effort–Reward Imbalance and its Association with Health among Pluckers in a Tea Plantation in South India. Indian J Occup Environ Med 2017;21:128-31

How to cite this URL:
Tomy C, Ramesh N, Fathima FN, D'cunha RL, Chakravathi KA. Effort–Reward Imbalance and its Association with Health among Pluckers in a Tea Plantation in South India. Indian J Occup Environ Med [serial online] 2017 [cited 2022 Jul 6];21:128-31. Available from:

  Introduction Top

Plantation industry in India is spread across the states of Assam, Kerala, Tamil Nadu, and West Bengal and is the largest private employer in the country with over 1 million employers. The plantation workforce has been among the most exploited workforce in the organized sector. At the bottom of the tea industry are the tea plantation workers.[1]

Occupational health aims at prevention of disease and maintenance of highest degree of physical, mental, and social wellbeing of workers in all occupations. Job stress can be defined as the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker. There is significant association of stressful work with cardiovascular disease, musculoskeletal disorders, psychological disorders, and workplace injury.[2]

We are using an effort-reward imbalance (ERI) model to assess the adverse health effects of stressful experience at work among pluckers in tea plantation. Effort had an inverse relationship, while reward and overcommitment were positively related to the self-rated health.[3] Efforts were significantly associated with psychosocial health problems.[4] Failed reciprocity between efforts and rewards may enhance the activation of the autonomic nervous system and influence the risk of coronary heart disease.[5] Workers who are stressed are also more likely to be unhealthy, poorly motivated, less productive, and less safe at work. Efforts were positively associated with sickness absenteeism [6] and negatively associated with job satisfaction [4] and performance at workplace.[7]

ERI was used to assess the stressful work environment among audiologist,[8] industrial workers,[9] municipality workers (white collar and blue collar workers),[10] garment factory workers,[4] and health care workers.[11] To our knowledge, this study is the first of its kind among pluckers in tea plantation in India. Hence there is scope to explore this area of research further. Studies of this nature help in developing appropriate preventive measures to reduce the work-related stress.


The objectives are to assess the prevalence of ERI among pluckers in tea plantations in South India and to study the association between ERI and chronic health problems (hypertension, diabetes mellitus, and musculoskeletal disorders), substance use (alcohol, tobacco chewing, and tobacco smoking), and workplace injuries among the study population.

  Patients and Methods Top

A cross-sectional study was conducted among tea pluckers in the age group of 18–70 years, from May to June 2015 in six selected tea plantations in South India. Subjects were selected by consecutive sampling from workers attending outpatient clinics of the Garden (Central) Hospital, Anamalai, Tamil Nadu, India. Workers who were illiterate and had difficulty to comprehend the questionnaire were excluded from the study. Based on a prevalence of ERI of 70% according to a previous study by Vinaya Manchaiah et al.[8] among audiologists, we estimated that a sample size of 322 would be required for our study, at an absolute precision of 10% and at 95% level of confidence interval.

At the start of the individual interviews, the aims and procedures of the study were explained and written informed consent was obtained from 346 pluckers who consented to be part of the study. The 346 pluckers were from six estates of a company. An interview schedule was administered to the subjects by the investigators to assess prevalence of ERI. Interview schedule had the following sections: (a) Sociodemographic details; (b) Morbidity profile – substance use, chronic health problems, workplace injuries; and (c) ERI questionnaire – effort, reward, and overcommitment.

A short version of ERI questionnaire was used to assess the work-related stress among them. ERI questionnaire consists of three scales: Effort (3 items), reward (7 items), overcommitment (6 items). To compute the ER ratio, the effort score is put in the numerator and the reward score in the denominator

For ER = 1, the person reports one effort for one reward; for ER <1, there are less efforts for each reward; and for ER >1, the person reports more efforts for each reward.

The data analysis was done using Statistical Package for the Social Sciences version 16. Sociodemographic variables and morbidity profile were described as frequencies and measures of central tendency. Tests of association such as Chi-square test, t-test, and analysis of variance were applied. A P value <0.05 is considered statistically significant.

  Results Top

A total number of 346 pluckers were asked for ERI at the workplace. Key sociodemographic features of the study population are shown in [Table 1]. Majority of the workers interviewed were females workers (62.7%, 217), majority were married (96.8%, 335), most were Hindu (78.9%, 273), and all of them were permanent workers (100%, 346). More than half of the workers were above the age of 50 years with a mean age of 49.9 ± 6.7 years.
Table 1: Sociodemographic features of study population

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Out of the total study population, 51.4% (178) gave history of any form of substance use. Smoking was present in 6.9% of workers, alcohol use in 11%, and tobacco chewing in 8.7% of workers. Smoking and alcoholism were present in 24.9% of the pluckers.

We asked about chronic diseases such as diabetes mellitus, hypertension, and musculoskeletal diseases. Diabetes mellitus was present in 86.7% of study population, hypertension in 79.2%, and musculoskeletal diseases in 28.9% of study population. Out of 346 pluckers, 288 (83.2%) had some form of injury during work in the past 3 months.

The results of our study showed that ERI was seen in almost all the participants with only one participant reporting no ERI. A large majority of the study participants (93.1%) reported putting in more effort, whereas 6.6% reported more reward. The results of the perceived ERI by the study participants are depicted in [Table 2].
Table 2: Effort–reward imbalance (n=346)

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Those in older age groups (≥51 years) experienced more effort compared to those in younger age group (≤50 years) and it was found to be statistically significant (Fisher's exact = 21.905, P = 0.001). Our study shows that an increase in the educational status was associated with increase in effort rather than increasing the reward (Fisher's exact = 15.639, P = 0.027). Similarly an increase in the work experience was also associated with an increase in effort (Fisher's exact = 23.122, P = 0.003). No significant association was found between ERI and any chronic diseases, substance use, or injuries. The association between ERI and the factors associated with it is depicted in [Table 3].
Table 3: Factors associated with effort–reward imbalance

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  Discussion Top

Our study shows that nearly all the study participants in a tea plantation setting perceived ERI. Majority of them reported more effort, while a few of them perceived more reward.

More effort or unfavorable working environment can cause low self-esteem, increased stress, and sickness absenteeism.[6] In a study done by Chundu S et al. using the ERI among audiologists, it was observed that 72% of the participants experienced unfavorable working situations (high effort and low reward) and only 28% of participants reported favorable working environment (low effort and high reward).[8]

A study done by Lau et al. among municipality workers showed that the ERI ratio did not significantly differ according to gender, age, education, or occupation groups. However, youngest employees have low effort values compared to older employees.[10] In our study also, older age group experienced more effort compared to those in younger age group and this was statistically significant. Young workers are more energetic, enthusiastic, and active compared to older age groups. So they may be feeling less strain or less effort even though the workload is the same.

Educational status and work experience increased the effort rather than increasing the reward associated with work. The type of work done by those with higher education was similar to that of lower education. The work done by them was more but the wages were less compared to their counterparts in other jobs. This may be the reason for them experiencing more effort than others. Even though they were working there for long time, the type of work and the salary are static, keeping them in the same socioeconomic status.

Efforts and overcommitment were the risk factors for occupational injuries.[12] In this study the prevalence of any form of injury during work in the past 6 months was 83% and it was equal in those with more and less effort. No significant association between occupational injuries and ERI was found in this study. ERI was associated with musculoskeletal complaints and poor health. Employees working in a high effort–low reward situation had an elevated risk of cardiovascular diseases and diabetes mellitus.[13],[14] In this study a high rate of diabetes mellitus and hypertension among the pluckers was observed. However, a significant association between ERI and any chronic diseases, substance use, or injuries was not found.

  Conclusions Top

Majority of pluckers in these tea plantations (93.1%) experienced more effort compared to reward. Older and more experienced workers and those with higher educational status had greater ERI. Introduction of equipment/machines or mechanization may help reduce the workload and effort put in by the pluckers to pluck the tea leaves. Identification of good pluckers and rewarding them with incentives not only motivate workers to do well but may also help balance the ERI.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

International Lobour Organization. India: Plantations Labour Act, 1951: Workers' Rights - Worker's activities p. 1951. Available from: [Last accessed on 2017 Aug 26].  Back to cited text no. 1
Stellman JM, International Labour Office. Encyclopaedia of occupational health and safety. International Labor Office; 1998. Available from: [Last accessed on 2017 Aug 26].  Back to cited text no. 2
Magnavita N, Garbarino S, Siegrist J. The use of parsimonious questionnaires in occupational health surveillance: Psychometric properties of the short Italian version of the effort/reward imbalance questionnaire. Sci World J 2012;2012:1-7.  Back to cited text no. 3
Buapetch A, Lagampan S, Faucett J, Kalampakorn S. The Thai Version of Effort-Reward Imbalance Questionnaire (Thai ERIQ): A study of psychometric properties in garment workers. J Occup Health 2008;50:480-91.  Back to cited text no. 4
Siegrist J. Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol 1996;1:27-41.  Back to cited text no. 5
Silva-Junior JS da, Fischer FM, Shipley M, North F, Syme S. Long-term sickness absence due to mental disorders is associated with individual features and psychosocial work conditions. Coyne J, editor. PLoS One 2014;9:e115885.  Back to cited text no. 6
Nakagawa Y, Inoue A, Kawakami N, Tsuno K, Tomioka K, Nakanishi M, et al. Job demands, job resources, and job performance in Japanese workers: A cross-sectional study. Ind Health 2014;52:471-9.  Back to cited text no. 7
Chundu S, Manchaiah V, Easwar V, Boothalingam S, Krishna R. Psychological work environment and professional satisfaction among Indian audiologists. Int J Speech Lang Pathol Audiol 2015;3:20-7.  Back to cited text no. 8
Li J, Loerbroks A, Jarczok MN, Schöllgen I, Bosch JA, Mauss D, et al. Psychometric properties and differential explanation of a short measure of effort-reward imbalance at work: A study of industrial workers in Germany. Am J Ind Med 2012;55:808-15.  Back to cited text no. 9
Lau B. Effort-reward imbalance and overcommitment in employees in a Norwegian municipality: A cross sectional study. J Occup Med Toxicol 2008;3:9.  Back to cited text no. 10
Kikuchi Y, Nakaya M, Ikeda M, Okuzumi S, Takeda M, Nishi M. Relationship between depressive state, job stress, and sense of coherence among female nurses. Indian J Occup Environ Med 2014;18:32-5.  Back to cited text no. 11
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Liu X, Zong Y, Huang G, Wang S, Zhou Y, Guo Z, et al. Association between occupational stress, social support, and occupational unintentional injuries: A case-control study. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2015;33:110-2.  Back to cited text no. 12
Li J, Jarczok MN, Loerbroks A, Schöllgen I, Siegrist J, Bosch JA, et al. Work Stress is Associated with Diabetes and Prediabetes: Cross-Sectional Results from the MIPH Industrial Cohort Studies. Int J Behav Med 2013;20:495-503.  Back to cited text no. 13
Xu W, Hang J, Gao W, Zhao Y, Li W, Wang X, et al. Association between effort–reward imbalance and glycosylated hemoglobin (HbA1c) among Chinese workers: Results from SHISO study. Int Arch Occup Environ Health 2012;85:215-20.  Back to cited text no. 14


  [Table 1], [Table 2], [Table 3]


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