Abstract
Purpose Increased use of technology, including social media, has led to a new phenomenon of workplace cyberbullying, specifically within the health care professions. The purpose of this study was to measure the prevalence of workplace cyberbullying among clinical dental hygienists and identify relationships between these behaviors and demographic characteristics.
Methods A cross-sectional survey research design was used with a non-probability sample of clinical dental hygienists (n=714) recruited via social media. The validated Workplace Cyberbullying Measure (WCM) survey instrument was used for data collection which included work-related (10 items) and person-related (7 items) subscales. Data analysis included descriptive statistics and correlations.
Results The completion rate was 88.8% (n=634). The prevalence of workplace cyberbullying among participants was 19%, with the highest frequency of negative acts occurring now and then. When comparing the two subscales among different workplace settings corporate dental/Dental Service Organizations (DSOs) had a higher work-related subscale score (M=1.84, SD=0.78) than private practice (p=0.03), but not community/public health clinical settings (p=0.69). Community/public health clinics had a higher work-related subscale score (M=1.78, SD=0.68) than private practice (p<0.001). Corporate dental/DSOs had a higher person-related cyberbullying score (M=1.49, SD=0.59) than private practice (p=0.003) but not community/public health clinics (p=0.37). Corporate dental/DSOs had higher work-related and person-related cyberbullying scores than private practice, however community/public health clinic participants reported a greater incidence of WCB.
Conclusion Dental hygienists (20%) report experiencing workplace cyberbullying in the past 6 months especially in corporate dental/DSOs and community/public health settings. Corporate dental/DSOs may need to investigate educating personnel on WCB. Employers, particularly corporate/DSOs and public health agencies, need to have policies in place to manage WCB.
INTRODUCTION
Technology and social media use has expanded in recent years and become a more accepted and essential modality for both personal and professional communication.1 Workplace stressors have also developed as a result of communicating through the use of technology and a new type of harassment or bullying has emerged known as workplace cyberbullying (WCB).2,3 Previous reports in the literature showed cyberbullying occurring primarily in adolescent and teenage populations, however more recent research shows WCB is often seen in the adult population, including health care workers.2-4
Workplace bullying has been described as any perceived or unwanted behavior in the place of employment that offends, humiliates, sabotages, intimidates or negatively affects someone’s work where there is an imbalance of power.3 When these behaviors are delivered through electronic media platforms the term WCB is used. Types of WCB include unwanted, aggressive online messages from coworkers that may suggest harm to another coworker in the work environment.3,4 Because technology is an essential part of modern communication, WCB can be conducted in different ways including text messages, email, in addition to social media, allowing for unlimited audiences to view the WCB.5,6 Communication technology platforms are easily accessible and can result in ongoing harassment for the victim,7 including private time outside of work.4 Perpetrators of WCB have a history of aggressive behavior which was previously exhibited by face-to-face bullying that continued with cyberbullying.8 Unlike face-to-face bullying, WCB can be distributed through digital technology by faceless perpetrators.9
Workplace cyberbullying is a type of harassment behavior impacting the psychological health and job satisfaction among employees.4 In the United States (US) WCB has been studied in health professionals, including nursing where WCB has been reported in the literature.8 The range of WCB prevalence in nursing varied between 1.5% and 4.3%.7,10 However, these statistics may be misleading due to underreporting and the relatively new phenomenon of WCB. It has been suggested that education about WCB may be needed in order to fully understand its prevalence.7 Cyberbullying in the workplace has negative effects for health care professionals as it relates to self-esteem and job satisfaction. Data collected from studies in nursing indicate that WCB has also been linked to anxiety, depression, and employment turnover intention,11 along with poor physical health.8,10,11
There are limited studies among dental professionals investigating the prevalence of workplace bullying.12,13 However, the evidence suggests that face-to-face workplace bullying is prevalent amongst dental professionals with reported incidences ranging from 21-24%.12,13 Currently, there are no studies exploring WCB in dental professionals, in particular dental hygienists. Therefore, the purpose of this study was to explore the prevalence of workplace cyberbullying among clinical dental hygienists in the US and identify any relationships between WCB and different workplace characteristics and individual demographic variables.
METHODS
A cross-sectional survey research design was used to explore cyberbullying in a convenience sample of dental hygienists using a web-based survey instrument. This study received exempt status from the MCPHS University Institutional Review Board (IRB) in accordance with the revised Common Rule at 45 CFR 46.104 d (2)(ii) and was assigned protocol number IRB 040121B. Participants were recruited from social media groups along with snowball sampling. Inclusion criteria were licensed dental hygienists residing in the US who provided patient care a minimum of 2 days per week. Individuals who did not meet these criteria were excluded from participating. Eligible participants were informed on the nature of the survey; participation and completion of the survey was voluntary.
A priori sample size estimation was conducted using G*Power 3.1.14 The following parameters were used for all estimations: α=0.05 and β=0.8. Based on the previous work using the WCM survey instrument,15 the effect size of this study was expected to be medium according to Cohen’s criteria.16 For the planned ANOVA analysis with three independent groups, the suggested minimum sample size was n=159.
Instrument
A validated questionnaire, Workplace Cyberbullying Measure (WCM), was used with permission.15 The survey presented 17 items relating to negative work-related acts through technology and 1 item of self-labeling WCB for the participants. The instrument used a 5-point Likert scale (1=never, 2 =now and then, 3 =at least weekly, and 5=daily). The 17 items were grouped into work related cyberbullying and person-related cyberbullying. Work related cyberbullying are the questions that involve acts related to a person’s work experience and person-related cyberbullying involving acts of a personal nature.15 Items in the first section measured the frequency of negative work-related acts an individual has experienced. The second section provided a definition of WCB and participants were asked to rate whether they have been cyberbullied at work based on the definition provided.15
The final instrument consisted of 27 items and included demographics (7 items), work characteristics (2 items), WCM (17 items), and a self-labeling question on WCB (1 item).
Procedure
Social media groups in Facebook and Instagram with large numbers of dental hygiene members were selected for recruitment. Permission was requested from group administrators to post the invitation to participate on the selected sites. Snowball sampling was also used to disseminate the invitation to participate in the survey to colleagues. The invitation to participate contained a link to the electronic survey (Qualtrics; Provo, UT, USA) and potential participants were first taken to the informed consent. No incentives were provided for participation; security settings were used to prevent participants from taking the survey more than once. The survey remained open for 4 weeks and weekly reminders to participate were posted on the social media sites.
Data analysis
Results were described using frequencies for categorical variables and measures of central tendency and variance for continuous variables. The Shapiro-Wilk and visual examination of the histograms for the work-related and person-related subscales were used to test for normality. A Cronbach’s alpha was calculated to measure the internal reliability of the work-related (10 items) and person-related (7 items) subscales.
The influence of each demographic variable or workplace characteristics on WCM was evaluated using correlation and the non-parametric alternative to ANOVA, the Kruskal-Wallis. Continuous demographic variables were correlated with each of the WCM subscales. Categorical demographic variables were tested using the demographic characteristic as the independent variable and each of the WCM summed items score as the dependent variable in the Kruskal-Wallis. Post hoc pairwise comparisons using the Mann-Whitney U were calculated to test the difference in subscale score if the Kruskal-Wallis had a p<0.05. A Bonferroni adjustment for familywise error was used for all tests. All reported p-values were adjusted using the Bonferroni method. All analysis were conducted using a statistical software program (SPSS version 26; IBM Corp., Armonk, NY).
RESULTS
Of the 714 participants of the survey, 634 responses were at least 80% complete for demographics and 100% complete for the Workplace Cyberbullying Measure to calculate the total and subscale WCM scores, resulting in an 87.7% completion rate. Eight participants were excluded from the final data analysis due to residency outside of the US. The majority of the participants were female (98.6%) and White/non-Hispanic (87.9%). Age distribution was nearly equally divided between 20-39 years old (44.3%) and 40-59 years old (45.3%) and these groups comprised the majority of participants. Representation from regions in the US was similar for the Northeast (29.3%), Midwest (25.6%), and South (24.3%). Sample demographics are shown in Table I.
Demographics (n= 634)
The WCM responses from participants (n=634) are shown in Table II. The majority of the participants stated they had never experienced workplace cyberbullying (82%), however, within the past 6 months nearly 20% of the participants reported witnessing an act of WCB. Nine percent of participants reported experiencing workplace cyberbullying least once weekly. Participants were more likely to experience workplace cyberbullying at least once a week or daily (7%) as compared to person-related cyberbullying (3%) although both occurred infrequently. The most frequently reported WCB item occurring daily or once a week was “received unreasonable work demands” (9%).
Workplace Cyberbullying Measure (WCM) (n= 634)
The mean score for workplace cyberbullying (range: 1-5) was 1.56 (SD=0.60) and an average of 1.32 (SD=0.44) for person-related cyberbullying. Cronbach’s alpha showed both the workplace (0.91) and the person-related (0.85) cyberbullying subscales had excellent internal consistency. A Shapiro-Wilk test of normality indicated neither work-related (p<0.001) or person-related (p<0.001) were normally distributed. A Spearman’ correlation was performed to measure the relationship of age and hours worked per week with the two WCB subscales. None of the comparisons were statistically significant (p=0.53 and p=0.87, respectively).
For the analysis of employment setting and WCB, practice type was the independent variable and was categorized into three main types (private practice, corporate dental, and community/public health) and subscale scores were the dependent variables. There was a difference for work-related cyberbullying between practice types (p<0.001) and person-related WCB among practice types (p=0.002). Corporate dental/Dental Service Organization (DSO) had a higher work-related subscale score (M=1.84, SD=0.78) than private practice (M=1.49, SD=0.54; p=0.03), but not community/public health clinical settings (M=1.79, SD=0.67; p=0.69). Community/public health clinics had a higher work-related subscale score (M=1.78, SD=0.68) than private practice, p<0.001. Corporate dental/DSOs had a higher person-related cyberbullying score (M=1.49, SD=0.59) than private practice (M=1.28, SD=0.41; p=0.003) but not community/public health clinics (M=1.37, SD=0.43; p=0.37). Community/public health clinics and private practice showed no difference (p=0.19). There were no differences in US region (West, South, Midwest, East) for either work-related (p=0.44) or person-related cyberbullying (p=0.43).
A Kruskal-Wallis also showed a difference in work-related cyberbullying for degree type (associate, bachelor, and master) a Kruskal-Wallis showed a difference in work-related scores (p=0.045) but not person-related cyberbullying (p=0.22). Pairwise comparisons using Mann-Whitney U showed master’s degree holders had a higher score (M=1.80, SD=0.72) than bachelor’s (M=1.55, SD=0.59; p=0.02) and associate (M=1.53, SD=0.58;p=0.01) but no difference between associate and bachelor’s degree holders (p=0.83).
DISCUSSION
Prevalence of workplace cyberbullying among clinical dental hygienists in the US was explored for the first time in this study. Findings showed that even though daily incidences of WCB was rare in this sample of dental hygienists, 20% of participants reported it had occurred now and then. From previous literature, the prevalence rate of WCB in various occupations was 9-21%. and among nurses it ranged from 1.5%-4.6%.7,10,17,18 The prevalence of WCB data among nurses was extracted using a variety of strategies including tweets from Twitter, survey research, and computerized adapting testing (CAT).7,10,17 It is difficult to make a comparison of this study’s results of WCB with the literature because of the different criteria and methods used to assess WCB. However, when using the same instrument to measure WCB in nurses, the subscales mean score can be compared with this study’s outcomes. Nurses work-related cyberbullying experiences (1.17±0.42) were similar to the work-related cyberbullying experiences 1.56 (SD=0.60) identified in the dental hygienist participants in this study. Both nurses (1.12±0.36) and dental hygienists 1.32 (SD=0.44) reported higher work-related cyberbullying than person related cyberbullying.9
Among the employment settings of the clinical hygienist, both corporate dental/DSOs and community/public health clinics had a higher work-related WCB subscale scores than private practice settings. This is a finding not seen in the literature and may be a consequence of private dental practices having a small number of employees where there may be more work engagement and social support, which has been shown to reduce cyberbullying behaviors.4 Corporate dental/DSO settings also had a higher person-related cyberbullying score as compared to private practice settings. Further research is needed among corporate dental/DSO employment settings to explore the potentially higher risks of cyberbullying. The findings suggest that administrators in these settings should address prevention and management of WCB to improve communication among employees and to reduce potential mental distress and/or job dissatisfaction.
When comparing negative acts between nurses and the dental hygienist participants in this study, the experiences were different. In this study, the most frequent negative acts included being unfairly blamed for work problems, sending conflicting information, and unreasonable work demands; with the most frequent response being “now and then.” In the nursing literature where the WCM survey was used, the most frequently occurring negative act was “receiving messages that had a disrespectful tone.”11 Findings in this study included higher scores on work-related bullying for individuals with a master’s degree. It is unknown why this might be the case, but it could relate to being different from the majority of clinical dental hygienists/work colleagues where holding an associate or bachelor’s degree is the norm.
Previous research on workplace bullying in the dental profession can be compared to the current findings of WCB. Previous research has shown that workplace bullying is present among clinical dental hygienists, with about 20% indicating that it occurred “now and then.”12,13 Unreasonable/unmanageable workload/demand was reported as a frequent negative behavior in both WPB and WCB13 in contrast to disrespectful messaging. This study did not explore the mental health effects of WCB on clinical dental hygienists, but this is an area needing further research given the number of respondents reporting experiencing it at least now and then (20%). In particular, WCB has been shown to cause anxiety, depression, poor physical health, and lead to intention to leave in healthcare employees so understanding the impact of WCB on dental hygienists will be important for retention in the workforce.8,10,11
The focus of this study can also address some of the fundamental principles and core values of the American Dental Hygienists’ Association Code of Ethics as they apply in the workplace. With the prevalence of WCB, core values such as individual autonomy and respect for human beings, societal trust and non-maleficence are violated,19 suggesting the need for further education on ethical behaviors in and outside of the workplace. When WCB is present in a dental setting, management to prevent further conflicts in a constructive manner and the promotion of a healthy work environment is needed.
The literature also showed that health care professionals do not fully understand what WCB actually is, due to the lack of clarity in the definition. Conceptual definitions identify WCB as a “faceless” attack, however it is important for health care providers to understand what it is and be aware of when it is taking place.3,9 When WCB has been acknowledged, health care professionals do not know how to address the issue. These are key factors to focus on when conducting future studies to obtain the most accurate data on WCB prevalence and create a platform for further research. In this study, some participants reached out to the investigator via Facebook Messenger to discuss their personal experiences with WCB. There was a need to elaborate on their experiences as there were no open-ended questions on the survey instrument therefore suggesting the need for qualitative research to explore WCB more in-depth among dental hygienists.
This study had limitations. The use of non-probability convenience sampling on social media limits the generalizability of the findings in addition to potential self-selection and self-report bias. The primary recruitment was limited to those who frequently used social media during the time the survey invitation was posted. Also, depending on the device and browser the participants used, there was a potential for technology issues when accessing and completing the survey.20 Future studies can explore alternative sampling methods. However given the nature of cyberbullying, familiarity and use of social media may be the platform of choice for both the perpetrators and the victims.
CONCLUSION
Dental hygienist participants reported experiencing some level of workplace cyberbullying in the past 6 months, with a higher frequency of occurrences in corporate dental/DSOs and community/public health settings than in private practice settings. Corporate dental/DSOs may need to investigate educating personnel on WCB. Employers, particularly corporate/DSOs and public health agencies need to have policies in place to manage WCB improve employee health, retention, and job satisfaction. Findings from this study can provide a basis for future research to explore workplace cyberbullying in more depth in the dental hygiene profession.
ACKNOWLEDGEMENTS
The authors would like express thanks to Dr. S. Farley for granting permission to use the Workplace Cyberbullying Measure instrument.
Footnotes
NDHRA priority area, Professional Development: Occupational Health (determination and assessment of risks)
- Received August 29, 2022.
- Accepted December 15, 2022.
- Copyright © 2023 The American Dental Hygienists’ Association
