1 INTRODUCTION
Work-related stress is defined as the response of individuals when work
demands and pressures do not match their knowledge and ability and their
ability to cope is challenged (World Health Organization, 2020).
Work-related stress is a global concern in all professions and all
countries(International Labour Organization, 2016). Studies show that
workplace stress is a serious risk in health care settings (Maharaj,
Lees, & Lal, 2019; Mark & Smith, 2018; Nowrouzi, Nguyen, Casole, &
Nowrouzi-Kia, 2017). The health care system is a sensitive public
service provider. The results of several studies showed that HCWs
experienced high levels of stress during the coronavirus pandemic
(Benfante, Di Tella, Romeo, & Castelli, 2020; Kisely et al., 2020;
Salari et al., 2020; Zhang et al., 2020).
Prolonged response to chronic stressors in the workplace leads to
overwhelming exhaustion, a sense of ineffectiveness, lack of
accomplishment, feelings of cynicism and detachment from the job, and
eventually burnout (Maslach & Leiter, 2016).
Despite the extensive research in this field, most of the studies
investigated the factors of workplace stress independently, and few
studies investigated the different dimensions (Gheshlagh et al., 2017;
Wiederhold, Cipresso, Pizzioli, Wiederhold, & Riva, 2018). While
workplace stress is an important multi-level, integrated approach
(Wiederhold et al., 2018) .Evidence shows that health interventions in
the workplace are effective in improving the health of HCWs (Brand et
al., 2017). Therefore, a comprehensive and scientific framework is
needed for effective interventions to control stress in the workplace.
The findings of a systematic review revealed that scarcely any studies
have investigated occupational stress with a theoretical approach
(Nowrouzi et al., 2017). So far, several models have been identified in
the field of workplace mental health (Bakker & Demerouti, 2007; J. V
Johnson & Hall, 1988; Karasek Jr, 1979; Siegrist, 1996). However, most
of these models were limited to identifying factors related to workplace
stress and did not have a clear pattern for designing interventions.
While for stressful workplaces such as health care systems, a special
model or framework of occupational stress is needed for interventions.
The PRECEDE-PROCEED model is a planning model for health promotion in
the workplace and appropriate health care environments(Green, L.W.;
Kreuter, 2005). The PRECEDE-PROCEED model has an educational and
ecological approach, so it is a guide and facilitator for identifying
different dimensions of stress and implementing interventions at
different levels. The Job Demands-Resource (JD-R) model is an excellent
theoretical basis for assessing the mental health and well-being of
workers and can be used in various workplaces (Lesener, Gusy, & Wolter,
2019). Therefore, this study was conducted with the aim of developing a
conceptual model for promoting mental health in the workplace in order
to reduce occupational stress among HCWs, based on the perceptions of
employees and superiors, and in line with the PRECEDE-PROCEED model and
the JD-R model.