Resilience and green spaces: Association with stress among contact centre workers in the Philippines
Abstract
Issue Addressed
Philippine contact centres are rife with factors that contribute to work-related stress; health promotion strategies are needed to mitigate the impacts. With a transactional framework with the environment, this study examined the relationship of stress with resilience and the presence of urban green spaces (UGS) in the environment, while accounting for individual characteristics (ie, age, household income, exercise frequency).
Methods
Participants include employees (Stage 1 N = 186; Stage 2 N = 89) from six contact centres in the capital region of the Philippines. A two-stage online survey included standardised instruments to measure stress (10-item Perceived Stress Scale) and resilience (Connor-Davidson Resilience Scale), customised questions to gather demographic information and probe on participants' insights. Google Earth Pro was used for satellite mapping of UGS, followed by on-site ocular inspection.
Results
Participants' average stress level was categorised as high; primary stressors included client demands and workload. The objectively measured percentages of UGS in the study sites' vicinity were categorised as low. Participants found UGS visible after careful observation, and majority were aware of UGS in their workplace vicinity. Resilience, household income and awareness of UGS in the vicinity significantly predicted stress levels.
Conclusion
Contact centre workers experienced high stress levels and their workplaces had little accessible UGS. Resilience, household income and awareness of UGS are significant contributors to stress levels.
So What?
Health promotion in Philippine contact centres could consider strategies that include building resilience, enhancing income security and promoting the awareness of UGS within the workplace vicinity.
1 INTRODUCTION
Advances in information and communication technologies have accelerated the global coordination of business organisations,1 enabling workplaces to overcome time differences and space constraints.2 This is most evident in business process outsourcing (BPO) in which the responsibility for operational functions is transferred to external service providers that are not necessarily in the same country or region.3 In cases where the service providers are offshore, shift work is required to follow a time zone that is different from that of the workers (ie, increase in night shifts). The Philippines had emerged as one of the leading international BPO providers, particularly for administrative services. A large portion of the Philippine BPO industry is made up of the sub-sector of contact centres, which “provide both inbound and outbound voice services for sales, customer service, technical support and other business processes” (p. 2).4 Despite the low skill level needed for contact centres, the sub-sector attracts a large number of workers, including high-skilled professionals, because of wages that are above the national average.5 However, the International Labour Organization (ILO) identified BPO employees as a group that is exposed to stressful environments and heightened discontent, which had been evident in high employee turnover rates.4
Early on, Lazarus and Folkman defined stress as “a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her wellbeing” (p. 19).6 Such definition adopts a transactional perspective, where individuals are believed to constantly appraise stimuli in their environment and generate emotions that lead to coping processes.7 The environment of Philippine contact centres had been described as stress-inducing due to task-related factors. For instance, high volumes of work need to be completed within limited time, while voice calls were monitored to ensure that workers meet pre-determined daily quotas.5, 8 These situations appear to compromise contact centre workers' wellbeing. Conflicts arising from irate customers, along with unpredictable work schedules also contribute to workers' disturbed sleeping patterns. Moreover, workers routinely take night shift, which is a known risk factor to health and wellbeing.9 Physical and psychosocial symptoms such as muscular tension, insomnia and headaches had also been attributed to stress experienced in the contact centre environment.5, 10 It is not surprising that stress had been considered the leading cause for employee turnover.7
Faced with the challenges of a stressful working environment, employees might still maintain an ability to adapt and maintain psychological stability and focus, which has been referred to as resilience.11 It has also been described as an individual's ability to respond well to stressors with reduced harmful consequences, which has a protective effect for workers in highly stressful environments.12 Resilience and its potential to influence workers' stress levels have yet to be explored in contact centre settings. In the Philippines, resilience had been examined in the context of disasters13, 14 but not in the perspective of promoting health in the workplace. While the value of resilience training in the workplace had become increasingly evident,15 there is a gap in our understanding of how individual resilience interacts with work-related stress in Philippine contact centres.
Looking at the environment, there has been growing interest in the health benefits associated with urban green spaces (UGS) which include stress relief.16 UGS has been described broadly as any green space, public open space, or park in an urban setting,17 which might include sports fields, natural meadows, wetlands and other ecosystems that facilitate physical activity and relaxation.15 Studies have suggested that exposure to UGS is positively correlated to multi-dimensional aspects of wellbeing. UGS provide a venue for activities that benefit the wellbeing of people, as the presence of green spaces contributes to increasing the frequency of physical activity among adults.18 Individuals with a higher percentage of greenery around them also feel less lonely, regardless of age, sex and or presence of disability.19 High-quality green spaces are also linked to an improved sense of social connectedness.20 In workplaces, employees with access to an outdoor natural environment report fewer health concerns compared to those without physical access to the outdoors.21 Even visual access makes a difference in workplaces, with views of green spaces in workplaces found to be associated with positive wellbeing and reduced stress levels.22, 23 Despite the evident value of UGS for promoting workplace wellbeing, this has yet to be examined in developing countries. In the Philippines, the relationship of green spaces and health has yet to be explored in both the workplace, and the wider community context.
Contact centre workers in the Philippines make up a large workforce who are exposed to factors that contribute to work-related stress, and evidence-informed health promotion strategies that could mitigate the impact are needed. Stress depends on the interactions of individual and environmental characteristics,6 and evidence suggests that resilience and UGS present potential mitigating factors. There is currently limited context-specific research in this area that would benefit the contact centre workers in the Philippines. This study therefore aimed to examine the relationship of perceived stress with environmental (ie, UGS) and individual (ie, resilience) factors amongst a sample of contact centre employees in the capital region of the Philippines. It was hypothesised that stress will have negative associations with resilience and the presence of UGS. To understand the context in which the relationships of stress, resilience and UGS exist, this study accounted for other individual factors (ie, age, income, exercise habits) and explored the workers' experiences in relation to work-related stress.
2 MATERIALS AND METHODS
This is a cross-sectional study using a concurrent mixed-methods research design with the quantitative component being the main focus (QUAN + qual).24 All procedures were approved by the institutional ethics review board, and participants provided informed consent.
2.1 Participants
Invitations to participate in the study were sent by email to contact centres located in the national capital region of the Philippines and who were listed in the directory of the national organisation of BPO companies (ie, Information Technology and Business Process Association of the Philippines). A total of 31 emails were successfully delivered (ie, did not bounce back), from which six contact centres responded affirmatively. Employees of these contact centres were invited to participate through a company representative who disseminated the information sheet about the online survey through their official communication channels (ie, work emails). Participation was voluntary, and employees can decline or withdraw without any penalty or negative consequence. They can also answer the questionnaires during their work hours. Eligible participants were those who were (a) working full-time for at least 6 months at the time of recruitment, and (b) and at least 18 years old. Those who were currently prescribed with medications for psychiatric symptoms were excluded. Out of 202 potential participants, 94% (N = 190) completed the first questionnaire that measured their perceived levels of stress. Four individuals were excluded after the first survey indicated extreme levels of perceived stress (see Methods section for the cut-off score); they were subsequently advised to seek professional health consultation. Out of the 186 participants who were invited to respond to the second questionnaire that measured resilience and obtained UGS-related information, 48% submitted complete responses; the others submitted partial responses, which were not included in the subsequent analysis. The final sample in the second stage (n = 89) consisted of 30.3% males and 69.7% females, and their ages ranged from 19 to 53 years (M = 30, SD = 7.47). The sample size met the target (n = 74), which was calculated using G*Power 3.1, based on 80% power, 95% confidence interval and effect size −0.286.25
2.2 Procedures
2.2.1 Questionnaires
Two sets of questionnaires were administered in sequence and online using SurveyMonkey (SurveyMonkey Inc., CA). In the first questionnaire, perceived stress was measured using the 10-item Perceived Stress Scale (PSS-10).26 PSS-10 is a valid instrument and is uniformly reliable across males and females without any risk of bias.27 It had been translated and validated in sub-groups across the globe, including those in Asian contexts.28, 29 In this study, the original version was deemed appropriate because English is an official language in Philippine corporate environments. While no formal validation of PSS-10 in the Philippines had been published, it had been used in a longitudinal study that involved adult samples in this country.30 Using a five-point Likert-type scale (0 to 4), PSS-10 measures the degree to which current life situations are deemed stressful (eg, In the last month, how often have you been upset because of something that happened unexpectedly at work? 0 = Never, 1 = Almost Never, 2 = Sometimes, 3 = Fairly Often, 4 = Very Often). Higher scores indicate higher levels of perceived stress. The scores correspond to stress levels as follows: 0-7 as very low, 8-11 as low, 12-15 as average, 16-20 as high and ≥21 as very high; those who score > 31 are deemed to be in extreme stress.25
The second questionnaire included the 10-item Connor-Davidson Resilience Scale (CD-RISC) which had been shown to be a valid measure of resilience31 and had been used in adult samples in the Philippines.32, 33 CD-RISC uses a five-point Likert-type scale (0 to 4) where higher scores indicate greater resilience capability (eg, I am able to adapt when changes occur; 0 = Not true at all, 1 = Rarely true, 2 = Sometimes true, 3 = Often true, 4 = True nearly all the time). The questionnaire also sought to obtain other individual information that included age, household income category, and frequency of engagement in exercise. It also included items related to UGS, which are described further in the next section. Finally, the questionnaire included open-ended questions to probe on their insights in relation to work-related stress (eg, When you are stressed while working, how do you cope with it?) and UGS (eg, When you visit parks, gardens and other green spaces, what do you usually do?).
2.2.2 UGS assessment
In this study, UGS refers to accessible and open areas of greenery,17 excluding those designated as pathways amongst urban buildings. Participants' interactions with UGS were examined using a 5-point Likert scale to assess visibility (1 = very noticeable, 5 = no green environment) and physical accessibility (1 = accessible and used often, 5 = none that is accessible) of UGS in relation to the participants' workplace.23 A dichotomous item (Yes/No) was used to assess whether the participants were aware of any UGS in the vicinity of their workplace.
2.3 Data analyses
A dependent mixed-methods analysis approach was used,24 such that quantitative data analyses were first performed followed by qualitative analysis to follow up on the findings of the quantitative component. Descriptive and statistics were performed to summarise the variables. Pearson's product-moment correlation was used to assess the associations of PSS-10 scores with CD-RISC scores, %UGS and age. Spearman's rank correlation coefficient was used to test the association of PSS-10 scores with household income category, frequency of exercise and scale responses on interactions with UGS. Independent samples t-tests were used to compare the PSS-10 scores of males and females, and of those who were aware/not aware of UGS in their workplace vicinity. Stepwise linear regression was performed to assess the contribution of associated factors to the variance of PSS-10 scores. All statistical tests were performed using SPSS 25, and statistical significance was set at P < 0.05.
Constant comparison36 was performed to examine the responses to open-ended questions. In this approach, initial analysed responses were reviewed and divided into meaningful parts, each of which constituted a code. Succeeding answers were similarly partitioned and compared to previously identified codes, looking for similarities and differences. New codes were generated as the content analysis progressed; similar codes were grouped together to identify a theme. Two of the researchers performed the constant comparison independently and discussed the codes and themes until a consensus was reached.
3 RESULTS
3.1 Participants' characteristics
Out of 190 respondents who completed the first questionnaire, 121 (64%) were categorized to have high or very high-stress levels. The mean PSS score was 17.45 (SD = 6.09). From the 89 participants who completed the second questionnaire, the mean PSS and CD-RISC scores were 17.26 (SD = 5.32) and 32.49 (SD = 4.86), respectively. The majority (61.8%) of the participants reported household incomes in categories that were above the national poverty line.37 A relatively small proportion of the participants exercised every day (12.4%), while a greater number did not exercise at all (31.5%); the median rating for exercise frequency corresponded to “a few times per month.”
3.2 UGS
The mean percentage of UGS distribution (%UGS) measured through satellite mapping for the sites of the six contact centres was 6.12% (SD = 7.17). The %UGS for each site is presented in Table 1, and a detailed profile of the surveyed sites is available in Data S1. While nearly half of the respondents noted that UGS are noticeable (20.2%) or visible (24.7%), the median rating for UGS visibility was 3 which corresponds to “visible after careful observation.” Majority of the respondents (71.9%) were aware of UGS in the area of their workplaces.
| Contact centre | Total UGS area (m2) | %UGS |
|---|---|---|
| 1 | 9975.85 | 3.53 |
| 2 | 53 698.33 | 19.00 |
| 3 | 27 255.21 | 9.64 |
| 4 | 0 | 0 |
| 5 | 1999.01 | 0.71 |
| 6 | 10 850.60 | 3.84 |
3.3 Factors associated with stress
PSS scores were found to have a significant negative association with CD-RISC scores (r = −.455, P < .001) and age (r = −.251, P = .018). Respondents with higher resilience reported lower stress levels, as did older contact centre workers. The difference in PSS scores between males and females was not significant (t[87] = −.997, P = .322). Significant negative associations with PSS scores were found for household income range (r = −.260, P = .014) and frequency of exercise (r = −.246, P = .020). Those with higher income, and who exercised more frequently tended to have lower stress levels (see Tables 2 and 3).
| Mean | SD | 1 | 2 | 3 | 4 | |
|---|---|---|---|---|---|---|
| 1. PSS-10a | 17.26 | 5.32 | - | |||
| 2. CD-RISCb | 32.49 | 4.86 | −0.455* | - | ||
| 3. %UGSc | 4.96% | 5.10 | −0.058 | 0.052 | - | |
| 4. Age | 30.36 | 7.47 | −0.251* | 0.192 | 0.300 | - |
- a 10-item Perceived Stress Scale (PSS-10).
- b Connor-Davidson Resilience Scale (CD-RISC).
- c Percentage of the area considered as urban green space (UGS) (%UGS).
- * Statistically significant at P < 0.05.
| Median | Minimum - maximum | 1 | 2 | 3 | 4 | 5 | 6 | |
|---|---|---|---|---|---|---|---|---|
| 1. PSS-10a | - | - | - | |||||
| 2. Household income | 2 | 0–6 | 0.260* | - | ||||
| 3. Exercise frequency | 4 | 1–6 | 0.246* | −0.072 | - | |||
| 4. Urban green space (UGS) visibility | 3 | 1–5 | 0.108 | 0.099 | −0.053 | - | ||
| 5. UGS accessibility | 3 | 1–4 | −0.019 | −0.040 | 0.117 | 0.256* | - | |
| 6. UGS frequency of use | 4 | 1–5 | 0.056 | −0.037 | 0.178 | 0.326* | 0.439* | - |
- a 10-item Perceived Stress Scale (PSS-10).
- * Statistically significant at P < 0.05.
PSS scores were not associated with %UGS, visibility, accessibility and frequency of use. Participants who were aware of UGS in the vicinity of their contact centre site reported lower stress levels than those who were not aware (t[87] = −2.737, P = .008). The mean PSS score for those who were aware of UGS was 16.33 (SD = 4.989), and for those who were not aware of UGS was 19.64 (SD = 5.484).
A regression model that included the factors that were identified to have a significant association with PSS-10 scores (ie, CD-RISC, age, household income, exercise frequency, UGS awareness) was found to be significant (F[5, 83] = 9.713, P < .001), and explained 36.9% of the variance in PSS-10 scores. However, regression coefficients showed that age and frequency of exercise were not significant predictors (see Table 4). A model that included CD-RISC score, household income and UGS awareness was found to be significant (F[3, 85] = 14.120, P < .001) and explained 33.3% of the variance in PSS-10 scores. The additional contributions of age (1.2%) and frequency of exercise (2.5%) to explain the variance in PSS-10 scores were not significant (∆F P = .219 and 0.760, respectively).
| Predictor | Unstandardised coefficients | Standardised coefficient | Sig. | 95% Confidence interval for B | ||
|---|---|---|---|---|---|---|
| B | SE | β | Lower bound | Upper bound | ||
| CD-RISCa | −0.444 | 0.099 | −0.406 | < 0.001 | −0.642 | −0.247 |
| Urban green space (UGS) awareness | 2.405 | 1.073 | 0.204 | 0.028 | 0.272 | 4.538 |
| Household income | 0.767 | 0.297 | 0.229 | 0.012 | 0.176 | 1.358 |
| Age | −0.086 | 0.065 | −0.121 | 0.185 | −0.215 | 0.042 |
| Exercise frequency | 0.479 | 0.267 | 0.163 | 0.076 | −0.051 | 1.009 |
- a Connor-Davidson Resilience Scale (CD-RISC).
3.4 Insights on work-related stress and UGS
The content analysis revealed four themes from the qualitative data: (1) sources of work-related stress, (2) coping strategies for work-related stress, (3) activities associated with UGS and (4) participants' feelings evoked by their interactions with UGS. The top five frequently identified codes within each theme are summarised in Table 5. The most frequently coded source of work-related stress was the clients, particularly those who are incensed and demanding. This was followed by workload that included tight deadlines and large work volumes, and competition with co-workers. The other frequently reported codes included competition with co-workers, pressure of performance evaluation and having to do overtime work. Elaborations of their experiences of work-related stress revealed that participants attributed negative effects on social relationships and personal wellbeing to stress. For instance, one participant (P003) mentioned that “failure to connect fully with friends and family” is a consequence of stress at work. In terms of wellbeing, emotional instability was also mentioned as an effect of work-related stress, leading to the participants becoming more irate when they felt that the work pressure was escalating. This is apparent in the following response from another participant (P016)—“I become irritable when I'm too tired.”
| Theme | Code | Frequency (% of total coded responses) |
|---|---|---|
| Sources of work-related stress | Demanding clients | 29.5 |
| Workload (including deadlines and work volume) | 19.6 | |
| Competition with co-workers | 14.7 | |
| Performance evaluation | 9.8 | |
| Overtime work | 8.8 | |
| Coping strategies for work-related stress | Positive mind-set | 16.1 |
| Family support | 15.4 | |
| Stress eating | 14.7 | |
| Engaging in hobbies | 13.3 | |
| Relaxation/Rest | 13.3 | |
| Activities in urban green space (UGS) | Rest | 40.6 |
| Observation of surroundings | 21.8 | |
| Strolling | 12.0 | |
| Eating/Drinking | 6.0 | |
| Spending time with friends | 5.3 | |
| Feelings associated with UGS | Relaxation | 54.9 |
| Happiness | 9.0 | |
| Neutral emotions | 9.0 | |
| Energised | 4.5 | |
| Distracted | 2.3 |
The most commonly reported coping strategies for work-related stress were those that were emotion-focused. Responses under this code included strategies such as positive mind-set and conscious/active self-reminders to keep calm in the presence of stressors. For instance, one participant (P012) noted that they “just have to find time to be alone, think well and be calm and then react as what I think is right for the situation.” The other common approach for coping with stress was leaning on the support and presence of their family (eg, spending time with family members). Stress eating was also reported, followed by engaging in hobbies and planned relaxation activities (eg, short vacations). Some responses referred to positive interpersonal relationships with their supervisors—eg, “We have a decent work rapport even if we don't talk much out of the office” (P009)—but none of the respondents referred to such relationships as a relevant factor for coping. While it was documented that employers offer various programs and facilities for wellbeing (including exercise), the participants did not mention any of such programs as avenues for coping. Instead, the respondents noted that participation in such programs was often presented as a requirement that counts on their performance review scores, thus inadvertently turning into a stressor. The participants expected to cope better with work-related stress if overall employee conditions and incentives are increased. The primary motivators for participants to stay in their positions despite work-related stress were the competitive salary and benefits (eg, health insurance, reward packages).
The most frequently coded activity when visiting UGS was to rest, including passing time during work breaks. For example, one participant (P071) described their time spent in UGS as “I just take time; I just sit, and enjoy the calmness of the moment.” The other activities included passively observing their surroundings including people-watching, strolling to and from their workplaces, eating and drinking and hanging out to chat with friends. The dominant feeling evoked by their interactions with UGS was that of relaxation. For instance, one participant (P037) mentioned that “it feels peaceful and quiet; like I can find my inner self.” However, despite associating UGS with such feelings, no one mentioned UGS in relation to their coping strategies for work-related stress. Two other positive emotions were associated with UGS – feelings of happiness and a sense of being energised. The coded responses also showed that some participants reported neutral emotions, and few had a sense of being distracted from work.
4 DISCUSSION
The work environment of BPOs, especially contact centres in the Philippines, has been shown to be rife with factors that expose employees to stress.4, 5, 8 This current study adds to the evidence that contact centre employees in the country continue to experience high levels of stress. A score of 16 and above on the PSS had been categorised as indicative of a high-stress level26; the average PSS score of the study sample was higher than this cut-off score, and more than half of the respondents reported high to very high levels of stress. Qualitative findings showed that to some extent, participants' work-related stress negatively affected their social relationships and emotional stability. In the context of a low-income and developing country, work-related stress could potentially combine with personal constraints that cascade into health problems. This combination is apparent in the current findings, which showed that those with lower household incomes tended to have higher stress levels. Noting that the experience of stress is a transactional process with the environment,7 it is likely that those with lower income also need to contend with stressors associated with the costs of daily living. Moreover, the relationship between income and stress highlights a greater risk of further health issues for those in low-income environments.
Stress is experienced through reciprocal interactions between the stressors in the environment and the responses of the individual7; thus, potential health problems might be mitigated through a better understanding of both the environmental and individual factors. Age is one such individual factor, and contact centre managers have associated youth with greater resistance to work-related stress.38 On the contrary, this current study revealed that higher stress levels were found in younger respondents. Other research had similarly shown younger workers to be more susceptible to stress and less effective with coping.39 This can be understood through the emotional development theory, which suggests an increase in adaptive coping mechanisms as one ages.40 It is possible that the older respondents had learnt effective coping strategies such as those identified in our qualitative data—that is, positive mind-set and reliance on family members. We did not examine the relationship of stress with the number of years in the workplace, but we acknowledge that this could potentially be a factor that could confound the influence of age.
The ability to cope with stress can be influenced by the individual factor of resilience. Indeed, this current study showed that those with greater resilience tended to report lower stress levels, regardless of age. Resilience is an individual trait but evidence had suggested that attributes of resilience (eg, emotion regulation, impulse control) could be enhanced.11 A review had shown that resilience training interventions improve the individual ability to adapt to workplace demands through enhanced self-efficacy, social skills and overall psychosocial wellbeing.41 Contact centres could consider interventions to promote resilience among their employees.
In this study, physical activity was assessed in terms of self-reported frequency of exercise and only a small portion of participants reported engaging in regular exercise. In low- and middle-income countries like the Philippines, people in urban areas—such as the participants in this study—tend to be less physically active.42 It is well known that the barriers to adherence to regular exercise among adults include factors such as time, costs and venue.43 However, we did not enquire on the factors influencing participants' exercise patterns. We are, therefore, unable to confirm that these are relevant concerns. We are able to confirm that respondents who exercised more frequently reported lower stress levels. Other studies have shown a similar relationship between physical activity and stress levels.44 From a physiologic perspective, exercise is known to stimulate the release of endorphins, which generates feelings of euphoria and analgesia, and induces a sense of self-efficacy or elevated mood45 to counter stressors. However, the qualitative findings suggest that the respondents did not seem to consider exercise as a strategy to cope with stress (ie, only one participant specifically identified exercise as a coping mechanism). Combined with their generally low engagement with exercise, our findings suggest that the contact centre workers in this study might have limited awareness of the mitigating effects of physical activity on stress and its positive relationship with mental wellbeing; deliberate strategies in workplace health promotion could address this limited awareness. It is important, however, that such health promotion strategies not be made mandatory so that workers might not perceive them as additional burden.
UGS represents an environmental factor that could influence work-related stress. While previous studies from developed countries have shown that UGS contributes to reduction of stress in the general community19, 25 and in workplaces,23 this current study showed no direct association between individual stress levels and objectively measured UGS within a 300-meter radius of the workplace. It is noticeable that UGS was found to be generally sparse around the study sites. UGS that fall below 23% of the measured area are considered low,25 and the measurements reported in this current study ranged from nil to 19% (see Table 1). It is possible that the low UGS measured across the study sites comprised a data variance that was too limited to reveal significant associations with stress levels. Given the transactional process of stress, it is also possible that other individual factors that we found to be associated with stress (ie, resilience, household income and awareness of UGS) interact with the relationship of UGS with stress. Follow-up research could explore the potential mediating or moderating roles of individual characteristics in the relationship between stress and the environment.
Green spaces in urban planning and design are generally within the mandate of public governance and private builders.46 The current study findings, therefore, have implications that need to be addressed through policy and investment. While these aspects are beyond the direct influence of contact centre managements, UGS as an environmental factor that could mitigate stress could still be considered by as a corporate health promotion strategy. The findings of this study revealed that participants who were aware, tended to have lower stress levels, compared to those who were not aware of UGS in their vicinity. It is therefore worth considering whether there is value in making the employees aware when UGS is within the vicinity of the workplace. Enhancing workers' UGS awareness could include the promotion of what UGS might be in the context of workplaces (ie, open and accessible green spaces). Enhanced UGS awareness could generate the desired effects because natural settings tend to draw attention. When an onlooker is captivated, conscious thinking processes could be focused away from stressors and negative emotions.47 Gilchrist et al22 noted that not only actual green spaces, but views in workplaces were also associated with positive wellbeing. Nevertheless, we take note that simply promoting visibility of UGS is not optimal because accessibility of UGS is associated with frequency of use. Promoting actual visits to UGS should be considered as some studies have shown that health benefits are gained with at least 2 hours of visits to UGS per week.48 Supportive evidence was also generated from our qualitative findings, where visits to UGS tend to be associated with activities and feelings of relaxation. The low UGS finding in this study needs to be highlighted, as it suggests that the urban areas in the vicinity of contact centres (and possibly other industries) in the capital of the Philippines tend to be designed with limited allocation for accessible green spaces. Low UGS in itself is concerning, and needs to be addressed alongside workplace health promotion strategies.
4.1 Limitations
To obtain reliable and objective data, standardised approaches were taken to measure stress levels, resilience and the percentage of UGS. Nevertheless, some limitations need to be considered when interpreting the findings of this study. First, the measurement of UGS was primarily based on the presence of open and accessible green spaces, which does not account for aspects such as biodiversity, vegetation density and air quality—factors that may have an impact on the health benefits gained from UGS. Future studies could consider alternative UGS measurement strategies such as high-resolution remote sensing data49 and analysis of UGS metrics according to canopy cover or vegetation cover.50 The second limitation relates to the small variance of UGS percentage, which could partially explain the lack of association between UGS and individual stress levels. This study purposefully focused on the capital region where contact centres tend to be located in highly urbanised business districts. Follow-up studies could aim to target sites outside the capital region, which would potentially generate a wider range of UGS percentages. Given the limited access to comprehensive population data of contact centre workers in the Philippines, a purposive sampling approach was utilised in this study, which limits the generalisability of the findings. Should a sampling frame become accessible, further work using randomised sampling could yield more generalisable findings for contact centre workers in the Philippines. A larger sample size could also be sufficiently powered to allow multi-level analyses that would account for other relevant sources of variance (eg, contact centre site, location). Whilst this study had met the a priori target sample size for the intended study design, we cannot rule out the possibility that findings could have been influenced by the large number of participants who did not complete the second questionnaire. We did not systematically enquire on the reasons for the low response rate to the second questionnaire, but we suppose that breaking the task into two stages may have led to participant attrition. Finally, cross-sectional studies have an inherent limitation that does not provide evidence of causal relationships.
4.2 Conclusions
This study revealed that contact centre workers in the capital region of the Philippines experience high-stress levels and contact centres were shown to have little accessible UGS. From a broader policy perspective, it is recommended that urban planning should consider enhancing the visibility and accessibility of green spaces in the vicinity of workplaces. Considering individual and environmental factors, it was found that resilience, household income and awareness of UGS are significant contributors to the contact centre workers' stress levels. Health promotion strategies in contact centres should consider resilience building, enhancing income security and promoting the awareness of UGS within the workplace vicinity.
CONFLICT OF INTEREST
The authors declare that there are no conflicts of interest related to this research.
ETHICS STATEMENT
This work is approved by the institutional ethics review board, and human participants provided informed consent.
