Donning the mask: effects of emotional labour strategies on burnout and job satisfaction in community healthcare

Emotional labour involves management of one's emotions to match the demands of their roles. This emotion display involves just expression (surface-level emotional labour) or experience in addition to expression (deep-level emotional labour) of the desired emotions. Emotional labour is required in the effective, efficient and successful healthcare service delivery. Burnout associated with emotional labour is an important factor that decides how satisfied frontline service providers with their job are. This empirical study investigates the link between surface and deep-level emotional labour, burnout and job satisfaction in women community health workers from India. Our results from the structural equation modelling of 177 accredited social health activists (ASHAs) indicate a negative relation between surface and deep-level emotional labour, clearly demarcating them as two different strategies for performance of emotional labour in community health care setting. Surface-level emotional labour is associated with higher job satisfaction, and burnout partially mediates this relation. Deep-level emotional labour is associated with lower job satisfaction; burnout fully mediates this relation. Qualitative post hoc analysis based on interviews of 10 ASHAs was done to understand the findings of the quantitative study. Surface-level emotional labour was found to be a more desirable strategy for community health care workers for the effective and efficient performance of their work roles. Our results have a significant contribution to design, redesign, and improvement of employment practices in community healthcare. This study brings forth the neglected issues of emotions and their implications for these healthcare workers in low and middle-income countries who are a vital link that delivers healthcare to weaker section of the society. The findings have relevance not merely for the individual providing this service but the beneficiary and the organization that facilitates this delivery. Interventions based on demographic, community, national and occupational factors have also been presented.