662616

research-article2016
RCBXXX10.1177/0034355216662616Rehabilitation Counseling BulletinLi et al.

Article
Rehabilitation Counseling Bulletin

Factors Influencing Job

2017, Vol. 61(1) 28­–40
© Hammill Institute on Disabilities 2016
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DOI: 10.1177/0034355216662616

Adults With Multiple Sclerosis rcb.sagepub.com

Jian Li, PhD1, Richard T. Roessler, PhD1,

Phillip D. Rumrill Jr., PhD1, and Emtiaz R. Ahmed, MEd1

Abstract
Given the high unemployment rates of adults with multiple sclerosis (MS) and the importance of job satisfaction as a
predictor of turnover intention and job tenure, this investigation examined the relationship of perceived job satisfaction
to social cognitive career theory and ecological model constructs. Highly compatible, the two formulations suggest that
extent of job satisfaction is a function of personal or demographic, contextual or extrinsic, disability/health status, and
self-perceived vocational situation variables. Based on responses to a national survey by 628 employed adults with MS, a
four-block, hierarchical logistic regression analysis examined the extent to which the four variable groupings contributed
to the prediction of job satisfaction. The following variables were retained in the regression equation: racial/ethnic status,
satisfaction with current financial status, satisfaction with housing accessibility, illness duration, extent of job/person match,
appropriateness of current work hours, and self-rated job performance level. Consequently, job satisfaction is influenced
by multiple factors that counselors must consider in their rehabilitation planning and service delivery.

Keywords
multiple sclerosis, employment, job satisfaction, work adjustment

The purpose of this investigation was to determine how job
satisfaction (dependent variable) is related to four classes of
independent variables: personal or demographic character-
istics, contextual or extrinsic factors, disability/health sta-
tus, and perceived vocational situation variables. Given the
high unemployment rates of adults with multiple sclerosis
(MS; Julian, Vella, Vollmer, Hadjimichael, & Mohr, 2008)
and the importance of job satisfaction as a predictor of turn-
over intention and job tenure (Mahdi, Zinn, Nor, Sakat, &
Naim, 2012; Perry, Hendricks, & Broadbent, 2000), the
study focused on the job satisfaction of adults with MS who
participated in a national survey supported by the National
Multiple Sclerosis Society (NMSS).
This study is a replication of our previous investigation
based on an empirical rather than theoretical rationale that
resulted in a three-stage model of job satisfaction involving
only perceptions of (a) adequacy of wage/salary level, (b)
severity of MS, and (c) job match and expected job tenure
(Roessler, Rumrill, & Fitzgerald, 2004). In this earlier
investigation, perceived adequacy of household income and
perceived job/person match were retained in the multivari-
ate prediction model, resulting in a coefficient of determi-
nation of .38 for the job satisfaction criterion. To expand the
prediction model for the current study, we selected two
theoretical positions, social cognitive career theory (SCCT;
Lent, 2013) and the ecological model (Szymanski, Enright,
Hershenson, & Ettinger, 2010), as the basis for a four-stage
prediction analysis.
Job Satisfaction: Theoretical
Rationales for a Four-Stage Prediction
Analysis
The four classes of variables for this study were identified
as important based on two theoretical models explicating
the predictors of (a) human performance (i.e., SCCT; Lent,
2013) and (b) human outcomes (i.e., ecological model;
Szymanski et al., 2010). SCCT describes how person char-
acteristics such as racial/ethnic background, gender, and
health status influence choices and actions that ultimately
result in performance attainments such as employment. It
also describes the impact that distal (i.e., past educational
opportunities) and proximal (i.e., current wage/salary level,
1
Kent State University, OH, USA
Corresponding Author:
Jian Li, School of Foundations, Leadership, and Administration,
Kent State University, P.O. Box 5190, 316 White Hall, Kent,
OH 44242-0001, USA.
Email: jli42@kent.edu
Li et al. 29
adequacy of finances, and housing accessibility) contextual
or extrinsic influences have on performance attainment.
The ecological model (Szymanski et al., 2010) presents
a similar multivariate explanation for individual outcomes
that even specifies job satisfaction as one example of such
an outcome. Precursors to outcomes include contextual,
individual, and work environment constructs similar to the
independent variables selected for this study. For example,
contextual factors include “aspects of an individual’s cur-
rent or past situation that are external to the person” (p.
108) such as educational opportunities and attainments.
Health status, gender, racial/ethnic status, and marital sta-
tus are examples of individual constructs. Defined in this
study in terms of perceptions of one’s vocational situation,
work environment factors pertain to characteristics such
as task requirements, work reinforcers, and organizational
climate.
Drawing on SCCT (Lent, 2013) and the ecological
model (Szymanski et al., 2010), we investigated the appro-
priateness of a four-stage or step prediction model of job
satisfaction for adults with MS. The rationale for the four-
step model was drawn in part from the multivariate models
previously described and the potential for intervention by
rehabilitation professionals. For example, Lent and Brown
(2013) described how concepts in several stages of the
model are worthy of consideration during counseling to
help individuals increase their work satisfaction and perfor-
mance. Thus, both theoretical models and the rehabilitation
intervention priority support the inclusion of personal char-
acteristics or life statuses in the first step of the prediction
model, for example, gender, racial/ethnic status, past educa-
tional attainment, and marital status. Being somewhat tan-
gential to typical rehabilitation emphases, though no less
important, accessibility of housing, adequacy of transporta-
tion, and current financial status comprised the second step
in the model focusing on contextual or extrinsic factors.
Steps 3 and 4, traditionally considered targets of rehabilita-
tion efforts, included health status (Step 3) and subjective
vocational factors (Step 4). Although health status is an
individual characteristic that could appear earlier in the
stage model, a decision was made to place it later in the
analysis to determine the extent to which it continued to
influence job satisfaction after accounting for other person
or contextual variables. The rationale for viewing health
status as a third stage had to do with its mutability through
medical and other therapy services provided as part of many
rehabilitation programs. Stage 4 of the model consisted of
perceived vocational situation constructs pertaining to the
proximal environment in SCCT and the work environment
in the ecological model. These perceived vocational situa-
tion constructs (i.e., job performance, job match, and pre-
ferred number of hours) are important considerations
throughout the planning, placement, and job retention
phases of vocational rehabilitation services.
The Importance of Job Satisfaction
According to Lent and Brown (2013), job satisfaction and
satisfactory job performance are components of a larger
construct referred to as work adjustment. Thus, it is impor-
tant to study job satisfaction to gauge an individual’s overall
level of work adjustment, which is a critical concern of the
vocational rehabilitation counselor. For the job placement
efforts of counselors to result in work adjustment on the
part of clients and, therefore, higher probabilities of long-
term tenure, they must ensure that clients secure employ-
ment in jobs compatible with both their work preferences
and work skills. The reason for this is that job satisfaction
and satisfactory job performance are in a complementary
relationship in that satisfied workers are more likely to per-
form satisfactorily and satisfactory workers are more likely
to be satisfied (Swanson & Schneider, 2013). Difficulties in
either area are predictive of eventual job loss due to either
the individual choosing to leave the position or being asked
to leave by his or her employer. Consequently, an important
part of rehabilitation counseling is to help clients under-
stand why they are dissatisfied in their jobs and how that is
affecting their performance and vice versa (Lent & Brown,
2013; Swanson & Schneider, 2013; Sypniewska, 2014).
Research Question
Based on comparable constructs in the two theoretical mod-
els underlying this investigation, the following research
question was addressed:
Research Question 1: To what extent do factors at the
demographic, contextual, illness, and work environment
levels contribute to the predictability power for the
dependent variable, job satisfaction?
Findings from this investigation pertain to reasons why
individuals with MS are satisfied in their employment and
what rehabilitation interventions are feasible to enhance job
satisfaction and thus overall work adjustment.
Method
As the four groups of variables (i.e., demographic, contex-
tual, illness-related, work environment) vary from the more
objective to the more subjective, the statistical analysis
addressed the extent to which the more subjective variables
contributed to the differences in the outcome variable, job
satisfaction, over and above the contribution of the more
objective variables. Thus, the statistical analysis involved
entering these groups of variables into a block-wise, hierar-
chical logistic regression analysis in a sequential order and
evaluating the change in explanatory power associated with
the inclusion of each group of variables.
30 Rehabilitation Counseling Bulletin 61(1)
Participants
The sample in this study was extracted from data collected
in a national survey of the employment concerns of
Americans with MS from nine NMSS chapters, represent-
ing 21 states and Washington, D.C., in the United States
(Rumrill, Roessler, Li, Daly, & Leslie, 2015). The survey
instrument included demographic, disease-related, and sup-
port system variables related to employment interventions
that might benefit adults with MS. The sample for this study
consisted of 628 participants with MS who were employed
either part-time or full-time at the time of the survey and
provided complete information on the employment-related
measures. The sample included 511 women (81%) and 117
men (19%). Fifty-eight percent of respondents described
their communities as suburban, whereas 23% lived in urban
areas and 19% resided in rural settings. With an average age
of 49 (SD = 10.55), participants in the sample were well
educated (99% were high school graduates, 58% were col-
lege graduates). Most of the participants were White (77%);
other racial/ethnic groups were represented in the sample
with African Americans and Hispanic groups being overs-
ampled (9% were African American, 12% were Hispanic,
and 2% were Asian, Pacific Islanders, Native Americans, or
Alaskan Natives).
Illness-related symptoms reported by the participants
suggested a mixture from severe to non-severe MS condi-
tions, as well as a wide range of physiological, sensory, and
psychological effects. In descending order of frequency, the
most commonly reported symptoms were fatigue (indicated
by 77% of respondents), tingling (52%), balance/coordina-
tion problems (52%), numbness (46%), cognitive impair-
ment (45%), diminished physical capacity (44%), bowel or
bladder dysfunction (39%), gait/mobility impairment
(38%), pain (32%), spasticity (31%), sleep disturbance
(29%), vision problems (25%), anxiety (24%), depression
(23%), and sexual dysfunction (18%). The mean number of
reported MS symptoms was 6 (SD = 3.40).
Measures
Job satisfaction.  Participants with MS who were employed
either part-time or full-time at the time of the survey
responded to a 5-point scale that measured their job satis-
faction ranging from 1 (very dissatisfied) to 5 (very satis-
fied). Given that the frequency distributions on the five
categories were uneven with some categories having very
low frequencies, the categories were combined, and the
variable was recoded into a dichotomous variable (0 = satis-
fied, 1 = not satisfied, a rating of “undecided” was catego-
rized as not satisfied).
Personal/demographic characteristics.  Four demographic vari-
ables were extracted and adopted for this study to represent
participants’ personal backgrounds. These included gender
(dichotomous; 0 = female, 1 = male), racial/ethnic status
(dichotomous; 0 = White, 1 = non-White), educational attain-
ment (dichotomous; 0 = elementary/secondary/some post-
secondary education, 1 = college graduate or higher), and
marital status (dichotomous; 0 = married or living with sig-
nificant other/partner, 1 = single, divorced, separated, or
widowed).
Extrinsic or contextual factors.  Originally, on 5-point scales
measuring factors related to or facilitating satisfaction with
employment, three contextual variables were investigated
and recoded into dichotomous variables given the uneven-
ness in the categories in the frequency distributions. These
included current financial status (dichotomous; 0 = able to
meet expenses, 1 = difficulty meeting expenses), satisfaction
with the transportation resources needed for daily living
(dichotomous; 0 = satisfied or very satisfied, 1 = undecided,
dissatisfied, or very dissatisfied), and satisfaction with cur-
rent housing accessibility (dichotomous; 0 = satisfied or
very satisfied, 1 = undecided, dissatisfied, or very
dissatisfied).
Illness-related factors.  Again, given the uneven frequency
distributions with some categories having very low fre-
quencies, six variables representing participants’ illness
and disability status were recoded for the analyses in this
study. Self-reported general health status was measured
on a 5-point scale ranging from 1 (poor health) to 5
(excellent health). Cognitive symptoms, originally mea-
sured on a 6-point scale ranging from normal cognition to
total cognitive disability, was recoded into a dichotomous
variable representing the presence of a cognitive impair-
ment (i.e., 0 = no, 1 = yes). Perceived symptom severity,
originally measured on a 5-point scale ranging from no
current symptoms to multiple severe symptoms signifi-
cantly limiting daily functioning, was recoded into a
three-level categorical variable representing (a) no or lit-
tle current symptoms that affect daily functioning, (b)
some symptoms that affect daily functioning, and (c)
multiple severe symptoms significantly limiting daily
functioning. Another estimate of severity of MS using the
Patient-Determined Disease Steps Scale (PDDS; Hohol,
Orav, & Weiner, 1995) measured gait/mobility impair-
ment on a 9-point scale ranging from normal to bedrid-
den. PDDS was recoded into a three-level categorical
variable to represent (a) normal or mild disability, (b)
moderate disability, and (c) severe disability. Two other
continuous variables were collected to measure the self-
reported number of symptoms at the time of the survey
and the respondent’s illness duration in years.
Subjective vocational or work environment factors. Three
variables were used to represent different aspects of the
Li et al. 31
subjective vocational factors related to job satisfaction.
Perceived job/person match was originally measured on a
5-point scale ranging from 1 (complete mismatch) to 5
(perfect match). Given that some of the categories had
very low frequencies, the variable was recoded into a
three-level categorical variable (1 = match perfectly, 2 =
match well, 3 = match to a lesser degree). Participants also
rated their perceived job performance on a 5-point scale
ranging from 1 (very poor performance) to 5 (excellent
performance). For the same reason as for perceived job/
person match, perceived job performance was recoded
into a dichotomous variable (0 = good or excellent perfor-
mance, 1 = very poor to adequate performance) before the
variable was entered into the analysis. Another three-level
categorical variable examined participants’ preferred
number of working hours (i.e., preferred to work fewer
hours than they currently do, more hours than they cur-
rently do, and about the same number of hours that they
currently do). For clearer interpretation, this variable was
recoded into a dichotomous variable with 0 for the prefer-
ence for the same number of working hours or more and 1
for the preference for fewer working hours.
Procedure
The original target sample for the national survey study
included 8,000 people with MS representing the nine NMSS
chapters that provided a strong representation of geographic
areas, rural/urban/suburban settings, and diverse racial/eth-
nic groups. Based on the proportions of clients from diverse
racial/ethnic backgrounds, eight of the participating NMSS
chapters were asked to identify stratified random subsam-
ples of 800 clients and one chapter was asked to draw a
stratified random subsample of 1,600 clients. We oversam-
pled Hispanic/Latino and African American clients within
NMSS chapters that had relatively high proportions of these
two groups on their client registries. The goal of this sam-
pling procedure was to ensure that at least 5% of the overall
respondent sample was comprised of Hispanic/Latino indi-
viduals with MS and that at least 5% were African
Americans; these proportions are consistent with commonly
held estimates of population parameters for people with MS
(Minden et al., 2006).
We implemented several strategies including Dillman,
Smyth, and Christian’s (2009) recommendations to
improve survey return rates. First, NMSS chapter service
directors sent a pre-notice letter to those selected for the
national sample (N = 8,000) 2 weeks prior to mailing the
survey. A package containing the survey and an explana-
tory cover letter was then mailed. The package was fol-
lowed by “reminder/thank you” postcards and an email
from the chapter service director 4 weeks and 10 weeks,
respectively, after it was mailed. In the initial package,
each potential respondent received a paper version of the
survey, in either English or English and Spanish depend-
ing on his or her identified ethnicity. Also enclosed in that
mailing, potential respondents received information per-
taining to accessing the survey in an online or telephone
format, again offered in both English and Spanish. In the
end, 631 surveys were returned to participating chapters as
undeliverable, reducing the available target sample to
7,369 people with MS. Of the target sample, 1,932 NMSS
members returned questionnaires, resulting in a response
rate of 26%. Among the 1,932 respondents, 628 employed
respondents provided complete information on the mea-
sures used in this investigation; these individuals com-
prised the study sample.
Statistical Analysis
Data were analyzed using a block-wise, hierarchical logistic
regression analysis with the variables in the four-stage pre-
diction model (i.e., demographic or personal characteristics,
extrinsic or contextual factors, illness-related factors, and
subjective vocational or work environment factors) entered
into the analysis in a sequential order. To be specific, the
dependent variable was the dichotomous variable job satis-
faction (0 = satisfied, 1 = not satisfied), and the independent
variables were entered into the model in four blocks: (a)
Block 1: gender, racial/ethnic status, educational attain-
ment, and marital status; (b) Block 2: current financial sta-
tus, satisfaction with transportation accessibility needed for
daily living, and satisfaction with housing accessibility; (c)
Block 3: health status, cognitive symptoms, perceived
symptom severity, PDDS, number of symptoms, and illness
duration; and (d) Block 4: perceived job/person match, per-
ceived job performance, and preferred number of working
hours. The categorical independent variables were dummy
coded using the lowest level as the reference group when
they were entered into the analyses.
A modeling procedure was used to ensure the parsimony
of the final model. First, the model started with just the first
block for demographic variables and was built up by adding
the following blocks one at a time in sequential steps. When
a new block was entered into the model, the significance of
the independent variables in the newly entered block was
assessed along with the significant independent variables
from the previous block (if any), and the non-significant
variables in the newly entered block were dropped. The
more parsimonious model with the non-significant vari-
ables removed was rerun and the magnitude of the parame-
ter estimates was compared with those in the model before
the non-significant variable was removed (Hosmer,
Lemeshow, & Sturdivant, 2013). If no critical change was
observed, it was concluded that the removed variables were
not confounders of the relationship between any of the
remaining independent variables and the outcome variable.
As a result, the modeling procedure moved on to add in the
32 Rehabilitation Counseling Bulletin 61(1)
next block and iterate the same assessment process. If con-
founding was observed, the removed variables were added
back into the model and interaction terms with other inde-
pendent variables were explored and examined to identify
the confounding effect before the modeling procedure pro-
ceeded to add in the next block.
To allow the sample to represent the national population
of employed people with MS, a sampling weight variable
was calculated based on the racial/ethnic status information
provided in the NMSS Sonya Slifka Longitudinal Study
(Minden et al., 2006) and used in the estimation process.
Complex survey data present a variety of technical chal-
lenges in the analysis. For example, the maximum likeli-
hood estimation (ML) used in the ordinary logistic
regression was no longer appropriate as the ML assumption
that cases are independent of each other was violated. As a
solution, the logistic regression models were fitted through
an approximate likelihood to incorporate the sampling
weight variable in the analysis (Hosmer et al., 2013). Also,
the assessment of the overall model significance and the
parameter estimates was conducted via the multivariable
F-adjusted Wald tests and the t statistic rather than the tradi-
tional likelihood ratio χ2 tests and Z statistic.
In addition, model fit indices such as pseudo-R2 are not
reported for logistic regression analysis that incorporates
survey design and sampling weight. Pseudo-R2 statistics
were obtained through the ordinary logistic regression when
necessary (Hosmer et al., 2013). Because a variety of
pseudo-R2 statistics can be calculated for the same logistic
regression model, McKelvey and Zavoina’s R2 (McKelvey
& Zavoina, 1975) was chosen in this study due to the fact
that it resembles the closest to the ordinary least square R2
in multiple regression models (Long, 1997; Long & Freese,
2006). The calculation of McKelvey and Zavoina’s R2
assumes a continuous latent variable underlying the
observed dichotomous outcomes, and therefore McKelvey
and Zavoina’s R2 represents the percentage of the variability
of the continuous latent variable explained by the indepen-
dent variables. All the analyses were conducted using the
statistical computer package STATA 12.1 (StataCorp,
2011), and the alpha significance level for the hypothesis
tests was set at .05.
Results
This section first presents descriptive statistics related to
characteristics of the respondents for each independent
variable and then provides a description of the results of
the hierarchical logistic regression analysis for evaluating
the job satisfaction model. Table 1 displays descriptive sta-
tistics related to the categorical independent variables for
each categorical level of the dependent variable, job satis-
faction, whereas Table 2 exhibits statistics related to the
continuous independent variables given the differences in
job satisfaction. The initial stage of analysis with only
Block 1 entered into the model examined the importance of
the four demographic variables in terms of their explana-
tory power for job satisfaction among employed people
with MS. Results of entering Block 1 variables are pre-
sented in Table 3. Only the coefficient for racial/ethnic sta-
tus was found to be significantly different from zero.
As a result, other demographic variables such as gender,
educational attainment, and marital status were removed
from the model, and the model with racial/ethnic status as
the remaining variable in Block 1 was analyzed again.
Racial/ethnic status was found to significantly contribute to
the explanatory power of the model, F(1, 624) = 11.13, p <
.001, and the change of its coefficients was minor when
compared with that in the model with all four demographic
variables. Therefore, the analysis proceeded to the next step
with Block 2 added into the model. The three independent
variables in Block 2 (current financial status, satisfaction
with transportation resources, and satisfaction with current
housing accessibility) were assessed along with the signifi-
cant variable from the previous block (i.e., racial/ethnic sta-
tus), and the variable satisfaction with transportation
resources was the only variable in Block 2 that did not have
a coefficient significantly different from zero. Results of
entering Block 2 variables are displayed in Table 4.
Following the same procedure, the non-significant variable
in Block 2 (satisfaction with transportation resources) was
removed from the model and the more parsimonious model
was analyzed again. The two remaining variables in Block 2
(current financial status and satisfaction with housing acces-
sibility) added significantly to the explanatory power, F(2,
624) = 11.33, p < .001, over and above the contribution made
by Block 1. Next, Block 3 with six variables representing par-
ticipants’ illness and disability status was entered into the
model and results are presented in Table 5. The importance of
Block 3 variables was assessed along with the remaining vari-
ables in the previous two blocks, and only illness duration had
a coefficient significantly different from zero.
When the non-significant variables in Block 3 (health
status, presence of a cognitive impairment, self-perceived
severity of symptoms, number of symptoms, and PDDS)
were removed from the model, illness duration in Block 3
contributed significantly to the explanatory power beyond
what had been contributed by the previous blocks, F(1,
624) = 5.84, p < .05. Finally, Block 4 with three subjective
vocational or work environment variables was entered into
the model. Block 4 continued to add to the explanatory
power over and above the contributions made by the blocks
that had previously been entered into the analysis, F(4,
624) = 22.55, p < .001. In fact, all three variables in Block
4 (perceived job performance, perceived job match, and
preferred number of work hours) had a coefficient signifi-
cantly different from zero. Results of entering Block 4
variables are displayed in Table 6. At every step of the
Li et al. 33

Table 1.  Descriptive Statistics of Respondents for Categorical Independent Variables.

Satisfied Dissatisfied

Characteristic n % n %
Gender
 Female 387 76 124 24
 Male 91 78 26 22
Racial/ethnic status
 White 385 79 101 21
 Non-White 93 65 49 35
Educational attainment
  Elementary/secondary/some post-secondary education 193 73 71 27
  College graduate or above 285 78 79 22
Marital status
  Married/living with other 351 78 97 22
 Single/divorced/separated/widowed 127 71 53 29
Current financial status
  Able to meet expenses 348 81 82 19
  Difficulty meeting expenses 130 66 68 34
Satisfaction with transportation resources
  Satisfied or very satisfied 386 77 117 23
  Undecided or dissatisfied or very dissatisfied 92 74 33 26
Satisfaction with current housing accessibility
  Satisfied or very satisfied 406 80 101 20
  Undecided or dissatisfied or very dissatisfied 72 60 49 40
Health status
 Bad 7 70 3 30
 Fair 91 67 44 33
 Good 208 77 61 23
  Very good 123 80 30 20
 Excellent 49 80 12 20
Presence of a cognitive impairment
 No 117 81 28 19
 Yes 361 75 122 25
Self-perceived severity of symptoms
  No or little current symptoms 251 81 60 19
  Some symptoms that affect daily functioning 193 71 79 29
  Multiple, severe symptoms significantly limiting daily functioning 34 76 11 24
Patient-determined disease steps
  Normal/mild disability 296 77 86 23
  Moderate/gait/early cane 136 72 54 28
  Late cane/bilateral support/wheelchair or scooter/bedridden 46 82 10 18
Perceived job/person match
  Match perfectly 236 93 17 7
  Match well 155 79 40 21
  Match to a lesser degree 87 48 93 52
Preferred number of working hours
  Same number of working hours or more 293 82 64 18
  Fewer working hours 185 68 86 32
Perceived job performance
  Good or excellent 440 80 113 20
  Very poor to adequate 38 51 37 49

model-building procedure, the coefficients in the more par- before the variable removal. The changes of coefficients
simonious model were compared with those in the model were always negligible.
34 Rehabilitation Counseling Bulletin 61(1)
Table 2.  Descriptive Statistics of Respondents for Continuous
Independent Variables.
Satisfied Dissatisfied
Characteristic M SD M SD
Number of symptoms 5.76 3.36 6.42 3.46
Illness duration in years 13.27 9.73 11.05 7.50
All four blocks contributed significantly to the explana-
tory power over and above the contribution attributed to the
blocks that had previously been entered in the model.
However, in hierarchical multiple regression analysis, the
relative importance of each block may vary and can be
judged on the basis of the change in the R2 (ΔR2) statistic
(Wampold & Freund, 1987). As the pseudo-R2 statistic was
not reported for the logistic regression analysis that took the
sampling weight into consideration, an ordinary hierarchi-
cal logistic regression model with the four blocks in the
final model was fitted to the data to obtain the pseudo-R2
statistic for each block. Although these pseudo-R2 statistics
were not exactly accurate, they provided some instrumental
information regarding the relative importance of the blocks.
To be specific, the changes in the pseudo-R2 statistic for
Blocks 1 through 4 were .03, .06, .01, and .26, respectively.
The pseudo-R2 statistic in the final model was .35.
Obviously, the subjective vocational or work environment
variables in Block 4 were relatively more important con-
tributors to job satisfaction when compared with the vari-
ables in other blocks.
Although the greatest focus of hierarchical regression is
on ΔR2 and its corresponding change in F and p value statis-
tics and less attention is paid to the regression coefficients
of independent variables (Courville & Thompson, 2001;
Petrocelli, 2003), a close examination of the coefficients in
the final model yield useful insights and interpretations. In
Table 6, the data presented under “Coefficient” represent
the estimated logistic regression coefficients that predict
job satisfaction in log-odds units for each independent vari-
able included in the final model, the t statistic provides a
test of each of these coefficients, and the odds ratio (OR)
coefficient provides information related to the change in the
odds of being dissatisfied that would be associated with a
one-unit change in a given independent variable. Satisfaction
with current housing accessibility, which had two catego-
ries (i.e., satisfied vs. not satisfied), was significantly related
to job satisfaction (t = 3.72, p < .001). Its OR coefficient
indicates that the odds of being dissatisfied with one’s job
for those who reported dissatisfaction with their housing
accessibility were 3 times greater than the odds for those
who were satisfied with their housing accessibility.
Perceived job/person match was also significantly related to
job satisfaction. The odds of being dissatisfied with their
jobs were 16.3 times greater for those who perceived greater
degrees of job/person mismatch than for those who per-
ceived their jobs to be a perfect match (t = 8.42, p < .001;
OR = 16.33) and 4.4 times greater for those who perceived
their jobs to simply match well than for those who per-
ceived their jobs to be a perfect match (t = 4.46, p < .001;
OR = 4.37). The odds of being dissatisfied with their jobs
for those preferring to work fewer hours were about 2 times
greater than the odds of being dissatisfied with their jobs for
those who preferred to work for the same number of hours
or more (t = 2.52, p < .05; OR = 1.81). In addition, the odds
of being dissatisfied with their jobs among those who per-
ceived their job performance as poor or just adequate were
at least 2 times greater than the odds of being dissatisfied
with their jobs among those who perceived their job perfor-
mance as good or excellent (t = 2.83, p < .01; OR = 2.32).
Although racial/ethnic status, current financial status, and
illness duration all helped explain the variability in job sat-
isfaction, their regression coefficients were not statistically
significant in the final model.
Discussion
Hierarchical logistic regression results confirmed the utility
of the four-stage prediction scheme based on the ecological
(Szymanski et al., 2010) and SCCT models (Lent, 2013).
More than a third of the variability in job satisfaction rat-
ings of the survey respondents was explained by predictors
representing the four sets of independent variables that
were hypothesized to correlate with job satisfaction: per-
sonal or demographic characteristics, contextual or extrin-
sic factors, illness-related or disability/health status factors,
and subjective work environment factors. In other words,
all four blocks of the analysis contributed to the explanatory
power over and above the contribution attributed to the
blocks individually. These findings are consistent with the
observations of others (Chiu, Chan, Bishop, da Silva
Cardoso, & O’Neill, 2013) that one cannot understand the
impact of MS on employment-related issues without con-
sidering the complex interaction of multiple factors in the
personal, functional, financial, and psychosocial realms.
Consequently, in their case planning, rehabilitation counsel-
ors need to think broadly about strategies to counter the
influence of these multiple factors on the vocational and
quality of life outcomes of adults with MS. Keeping in mind
the importance of this notion of interaction, the discussion
points to follow pertain to the interpretation of each of the
variables in the prediction equation.
Demographic Factor: Racial/Ethnic Background
Racial/ethnic status was the only demographic variable sig-
nificantly related to job satisfaction; gender, educational
attainment, and marital status were not retained in the pre-
diction model. Respondents who were people of color (i.e.,
Li et al. 35

Table 3.  Step 1 of Block-Wise Hierarchical Logistic Regression Analysis Including Demographic Characteristics.

Independent variable Coefficient Linearized SE t p OR

Gender −0.04 0.26 −0.17 .865 0.956
Racial/ethnic status 0.70 0.23 3.00 .003 2.008
Education attainment −0.37 0.20 −1.86 .064 0.688
Marital status 0.24 0.22 1.07 .284 1.271
Constant −1.18 0.18 −6.65 .000 0.307

Note. OR = odds ratio.

Table 4.  Step 2 of Block-Wise Hierarchical Logistic Regression Analysis Including Significant Block 1 Variable Combined With
Extrinsic Factors.

Independent variable Coefficient Linearized SE t p OR

Racial/ethnic status 0.54 0.23 2.34 .019 1.713
Current financial status 0.54 0.22 2.50 .013 1.718
Satisfaction with transportation resources −0.20 0.27 −0.75 .452 0.815
Satisfaction with current housing accessibility 0.94 0.26 3.69 .000 2.570
Constant −1.65 0.15 −11.15 .000 0.191

Note. OR = odds ratio.

Table 5.  Step 3 of Block-Wise Hierarchical Logistic Regression Analysis Including Significant Variables in Blocks 1 and 2 Combined
With Chronic Illness or Disability Factors.

Independent variable Coefficient Linearized SE t p OR

Racial/ethnic status 0.46 0.24 1.86 .063 1.578
Current financial status 0.34 0.23 1.45 .148 1.401
Satisfaction with current housing accessibility 0.88 0.25 3.56 .000 2.406
Health status
  Fair vs. bad 0.10 0.84 0.12 .902 1.109
  Good vs. bad −0.21 0.85 −0.25 .802 0.808
  Very good vs. bad −0.35 0.87 −0.40 .687 0.703
  Excellent vs. bad −0.30 0.93 −0.32 .749 0.742
Presence of a cognitive impairment 0.10 0.29 0.36 .716 1.110
Self-perceived severity of symptoms
  Some symptoms versus no or little symptoms 0.55 0.28 1.93 .054 1.730
  Multiple severe symptoms versus no or little 0.65 0.52 1.25 .213 1.915
symptoms
Number of symptoms −0.01 0.04 −0.20 .844 0.992
Patient-determined disease steps
  Moderate/gait/early cane versus normal/mild disability −0.28 0.28 −1.01 .314 0.755
  Late cane/bilateral support/wheelchair or scooter/ −0.76 0.47 −1.61 .108 0.470
bedridden versus normal/mild disability
Illness duration −0.03 0.01 −2.24 .025 0.973
Constant −1.27 0.91 −1.39 .164 0.281

Note. OR = odds ratio.

non-Caucasians) reported lower levels of job satisfaction
than did Caucasians. This finding parallels results from
other studies indicating that workers with MS from tradi-
tionally underrepresented racial and ethnic groups encoun-
ter greater difficulties in the workplace such as higher levels
of unemployment than do Caucasians with MS (Chiu et al.,
2013). Antao et al. (2013) described the ways in which
employment discrimination limits the opportunities of
minority groups. In describing the SCCT model, Lent and
Brown (2013) made similar points regarding the ways in
36 Rehabilitation Counseling Bulletin 61(1)

Table 6.  Step 4 of Block-Wise Hierarchical Logistic Regression Analysis Including Significant Variables in Blocks 1, 2, and 3 Combined
With Subjective Vocational Factors (Final Model).

Independent variable Coefficient Linearized SE t p OR

Racial/ethnic status 0.28 0.31 0.90 .369 1.319
Current financial status −0.07 0.26 −0.27 .788 0.932
Satisfaction with current housing accessibility 1.09 0.29 3.72 .000 2.986
Illness duration −0.01 0.01 −0.96 .340 0.987
Perceived job/person match
  Well match versus perfect match 1.47 0.33 4.46 .000 4.368
  Lesser degrees versus perfect match 2.79 0.33 8.42 .000 16.332
Preferred number of working hours 0.59 0.24 2.52 .012 1.807
Perceived job performance 0.84 0.30 2.83 .005 2.324
Constant −3.30 0.36 −9.09 .000 0.037

Note. OR = odds ratio.

which economic and cultural conditions can limit the ability
of some individuals to find satisfying outcomes in employ-
ment and other life realms. They noted that prejudicial treat-
ment forces some individuals to accept outcomes that are
not entirely consistent with their personal values and inter-
ests. One insight into the operation of discrimination in the
lives of minority group individuals with MS is revealed in
the findings of several studies that indicate that being
treated fairly in the hiring process is one of the most signifi-
cant problems faced by adults with MS, presumably even
more so for minority group individuals with MS (Roessler,
Rumrill, & Hennessey, 2002; Rumrill, Roessler, & Koch,
1999). Moreover, unlawful discharge is the number one
allegation of workplace discrimination filed with the U.S.
Equal Employment Opportunity Commission (EEOC) by
adults with MS, again presumably an issue pertaining even
more to minority individuals with MS (Neath, Roessler,
McMahon, & Rumrill, 2007) given the double disadvan-
tagement that inheres in membership in a racial or ethnic
minority group while experiencing a significant disability
(Smart, 2009). Consequently, rehabilitation counselors
must help minority group individuals with MS anticipate
and cope with the effects of discrimination in their efforts to
seek and maintain employment, which may be all the more
prevalent due to stereotypes held by the general public
regarding both their minority and disability status.
Within the larger group of minority adults with MS, addi-
tional research is needed to identify the specific employment
concerns and experiences of African Americans and
Hispanics/Latinos. Both of these groups are experiencing
higher incidences of MS than ever before (Minden et al.,
2006), and it is possible that they face different issues in
their efforts to seek, secure, and maintain employment.
Contextual Factor: Current Financial Status
Given the financial exigencies faced by adults with MS, it is
no surprise that more satisfying work is associated with a
more comfortable financial situation, a contextual variable
included in the four-stage model. Antao et al. (2013)
stressed that long-term episodic conditions such as MS
present individuals with barriers that can easily result in
poverty status. In a study in England, Hakim et al. (2000)
reported that 37% of their sample (n = 305) indicated that
their standard of living had decreased since their diagnosis
of MS due to high costs associated with treatment of their
condition and to negative life outcomes such as unemploy-
ment. Although not the case for a significant number of
respondents with MS, the high costs associated with MS
treatment may explain why some respondents perceived
their jobs to be more satisfying if they allowed them to have
adequate finances for high priced prescription drugs, health
insurance, child care and support, and medical care.
Rehabilitation counselors should recognize the importance
of Chiu’s et al. (2013) finding that maintenance support for
food, transportation, housing, and clothing was one of the
services of the state-federal vocational rehabilitation pro-
gram that was related to success in the job placement pro-
cess, presumably because wage/salary levels of some jobs
are insufficient to meet basic needs. Findings from the pres-
ent study suggest that a job is satisfying, in part, depending
on the extent to which it helps adults with MS meet the
financial pressures associated with the disease.
Contextual Factor: Satisfaction With the
Accessibility of Current Housing
Although the contextual variable “satisfaction with trans-
portation resources” was not retained in the model, satisfac-
tion with accessibility of current housing was significantly
and positively related to job satisfaction. Some adults with
MS viewed their jobs as more satisfying if they enabled
them to avoid negative life outcomes such as unsuitable
housing. Honan et al. (2012) found that employed adults
with MS who anticipated that financial concerns could
affect their living arrangements were more likely to expect
Li et al. 37
that they would need to reduce their work hours in the
future, possibly reflecting expectations of a worsening con-
dition and higher medical costs. Other research indicates
that concerns about housing are associated with higher rates
of unemployment among adults with MS. For example,
Bishop et al. (2013) reported that individuals who indicated
that they were less likely to need assistance in the home,
less limited by finances to make home renovations, and
more likely to function at high levels in the home were also
more likely to be employed than adults with MS reporting
difficulties in these areas. Rehabilitation counselors’ per-
spectives on vocational planning for adults with MS must
include steps to secure and maintain appropriate housing to
increase the probability of a successful vocational outcome
as noted in Chiu’s et al. (2013) research. Again, a job that
helped to solve one’s housing situation would have a high
probability of being perceived as satisfying.
Illness-Related Factor: Duration of MS
Surprisingly, of the many disability/health status variables
included in the original model, including presence of cogni-
tive limitations, duration of illness was the only health-
related variable significantly related to job satisfaction.
Presence of cognitive impairment, self-perceived MS sever-
ity, number of symptoms, and extent of mobility limitations
were not retained in the model. McGonagle, Fisher, Barnes-
Farrell, and Grosch (2015) offered one theoretical explana-
tion for this outcome in their description of the construct of
“work ability.” They defined work ability as a person’s pre-
diction that he or she would be able to continue working in
his or her current job. This perception is greatly influenced
by the resources that individuals perceive as available to
help them maintain employment such as the nature of fea-
sible job demands (e.g., time pressures), adequate job
resources (e.g., supervisory support), and sufficient per-
sonal resources (e.g., health status and emotional stability).
As workers with MS age, they are likely to have additional
symptoms limiting their functioning (i.e., fewer personal
resources), which might make their jobs less satisfying. If
their performance suffers as a result, they may also experi-
ence less adequate job resources and less compatible job
demands, both of which would decrease perceived work
ability and make working less satisfying.
Research supports the expectation of fewer personal
resources available as one ages while dealing with a severe
chronic illness such as MS. Moore et al. (2013) found that
older adults with MS who changed the nature of their
employment by decreasing work demands and hours
reported higher levels of fatigue, greater memory problems,
and higher pain levels. Other research (Hakim et al., 2000)
provided evidence of a correlation between the age of an
individual with MS and the financial impact of the disease,
suggesting fewer personal resources with time from both
health and monetary standpoints. Thus, if perceived work
ability decreases with age (i.e., duration of disability), then
the satisfaction one experiences from working would
decrease as well given that the job is less able to meet the
personal needs and values of the worker. Rehabilitation
counselors should keep in mind the multiple, complex
health conditions faced by older adults with MS and incor-
porate medical interventions and health maintenance provi-
sions in their vocational programming.
Subjective Work Environment Factors
The importance of the fourth stage in the prediction model
is evident in the fact that all three variables in the work
environment category were retained in the model, even
after accounting for the influence of significant demo-
graphic, contextual, and illness-related health status vari-
ables. The odds of being dissatisfied with their jobs were
significantly greater for participants perceiving greater lev-
els of job/person mismatch, reporting a preference to reduce
current work hours, and believing their job performance to
be poor or inadequate.
Job/person match. Gilbride, Stensrud, Vandergoot, and
Golden (2003) stressed that job/person match “has always
been a key component of quality vocational rehabilitation”
(p. 135). In the Minnesota Theory of Work Adjustment, two
components are considered essential to job match, one being
working in a job that meets one’s personal needs and the
other being working in a position appropriate for one’s work
skills. Considered together, these two components predict
tenure on the job, an outcome warranting the rehabilitation
counselor’s investments of time and money in client services.
Thus, job satisfaction and satisfactoriness are considered
interdependent constructs in that workers who enjoy their
jobs are more likely to perform well and workers who per-
form well are more likely to be satisfied (Lent, 2013; Swan-
son & Schneider, 2013). To ensure job satisfaction, then,
rehabilitation counselors must help individuals find work that
meets their needs and that is compatible with their skills.
To enhance job match and therefore job satisfaction,
Antao et al. (2013) proposed interventions at both the
“micro” and “meso” levels. The “micro” level pertains to
personal attributes of the individual, and the “meso” level
refers to the workplace practices and policies that enable
people with disabilities to find employment in satisfying
work. In interviews with employees with disabilities,
employers, and placement personnel, Gilbride et al. (2003)
found that employers who were open to hiring and retaining
individuals with disabilities were also open to helping them
secure jobs that matched their personal needs, preferences,
aptitudes, and abilities. Unfortunately, adults with MS have
enduring concerns about the lack of support from employ-
ers (Hakim et al., 2000; Rumrill et al., 1999; Rumrill et al.,
38 Rehabilitation Counseling Bulletin 61(1)
2015) with respect to the availability of reasonable accom-
modations, career counseling, and cross-training or retrain-
ing. Rehabilitation counselors can help fill this gap by
providing follow-along career counseling and job training
services to their clients and by working with employers to
increase their understanding of the effects of chronic ill-
nesses such as MS on an individual’s employability.
Preferred number of work hours.  Respondents who reported
satisfaction with their current number of work hours or even
the desire to work more hours were more satisfied with their
jobs than respondents who wished to work fewer hours.
Lack of satisfaction resulting from working too many hours
may reflect tensions arising from difficulties in balancing
current job duties with family and household responsibili-
ties due to increased MS symptom levels. Moore et al.
(2013) reported that individuals with MS who had decreased
their job responsibilities or hours tended to be older and
have higher levels of fatigue, pain, and cognitive limitations
than workers who had made no changes in their job roles.
Smith and Arnett (2005) offered another perspective on
those who wish to cut back on their work hours. They found
that adults with MS who wished to decrease their work hours
or responsibilities had higher levels of fatigue than did non-
working people with MS or employed people with MS who
did not wish to decrease their hours. At the same time, those
wishing to decrease their work hours had higher levels of edu-
cation, financial security, and occupational status, suggesting
that they might have more control over their job situations and
the types of changes they wanted to make. Modifying their
job responsibilities would enable them to enhance their job
satisfaction by accommodating increased fatigue levels, thus
allowing them to remain employed for a longer period of
time. In either scenario regarding the relationship between job
satisfaction and number of preferred work hours, the rehabili-
tation counselor’s role involves exploring accommodations
regarding work hours or responsibilities with both the
employer and employee to determine whether such accom-
modations are reasonable from the employer’s point of view
and appropriate from the employee’s point of view (i.e.,
resulting in enhanced job satisfaction).
Perceived job performance. The Minnesota theory of work
adjustment (Swanson & Schneider, 2013) and the SCCT
(Lent, 2013) both posit that work adjustment is one part job
satisfaction and one part capability to perform well in the
job. In both theories, satisfaction with work and the ability
to perform well in that work role are conceptualized as
reciprocally related. Therefore, one would expect that
respondents who rated their job performance higher would
also rate their job satisfaction higher, which was observed
in this study. Given the confirmation of this hypothesis in
the present findings, the question becomes how to work
with employees with MS and their employers to improve
the level of employees’ work performance. The resulting
improvements in performance would enhance job satisfac-
tion and vice versa. Herein lies a major concern.
To modify his or her work roles, the employee with MS
must initiate a request for an accommodation, which begins
with self-disclosure of his or her status as a person with a
disability under Title I of the Americans With Disabilities
Act (ADA). In qualitative interviews with employees with
MS, Vickers (2012) found high levels of mistrust and fear
regarding the outcomes of such disclosure. Employees with
MS discussed their fears of being viewed as incompetent
and unreliable by their employers. Stressing the stigmatiz-
ing nature of MS, they also felt that employers would see
them as employees who were making unreasonable
demands and requiring high levels of support. In some
cases, interviewees reported somewhat covert discrimina-
tory reactions from employers to try to force them to quit or
retire, such as raising work targets, critiquing performance
more stringently and frequently, and bullying employees to
force them to resign.
Research regarding barriers to employment retention that
adults with MS encounter continues to underscore these
concerns about disclosure and accommodation requests. In a
survey of adults with MS, Roessler, Rumrill, Hennessey,
Neath, and Nissen (2011) found that 30% of the sample had
experienced discrimination on the job and that the most fre-
quent complaint was about the employer’s failure to provide
reasonable accommodations. Findings pertaining to recent
allegations of employment discrimination made by adults
with MS with the U.S. EEOC indicated that the four most
prevalent allegations had to do with unlawful discharge, fail-
ure to provide reasonable accommodations, terms and con-
ditions of employment, and harassment (Neath et al., 2007).
The obvious implication of this situation is the need for reha-
bilitation counselors to intervene at the worksite prior to
unlawful discharge by offering follow-up services. To pre-
vent unlawful discharge, the counselor’s points of interven-
tion could occur when allegations of failure to provide
reasonable accommodations, presence of discriminatory
terms and conditions of employment, and harassment occur.
Limitations
The present study had several limitations that should be
kept in mind when interpreting results. These included the
complete reliance on self-report data, the low response rate
(26%) and associated threats to external validity in the orig-
inal survey from which this study’s data were drawn, the
use of a single-item measure of the job satisfaction crite-
rion, possible bi-directionality in the relationship between
satisfaction with housing accessibility and job satisfaction,
and the restricted range of responses that resulted from the
categorical coding of most independent and dependent vari-
ables. Readers should also note that findings from this study
Li et al. 39
of Americans with MS may not generalize to people with
MS in other countries due to international differences in the
policies and practices that govern health care, human ser-
vices, and workforce development.
Conclusion
Hierarchical logistic regression results support the premises
of the SCCT and ecological models that outcomes in the
lives of adults with severe chronic illnesses are influenced
by multiple factors. In this study, demographic (racial/eth-
nic status), contextual (current financial situation and satis-
faction with current housing accessibility), illness-related
(duration of illness), and subjective work environment
(self-rated job/person match, employment at preferred
number of hours, and perceived adequacy of job perfor-
mance) variables accounted for 35% of the variance in job
satisfaction, an essential client goal for the work of voca-
tional rehabilitation counselors.
To increase the probability of outcomes resulting in job
satisfaction, rehabilitation counselors must carefully con-
sider the impact of each of these variables on vocational
planning efforts with individuals with MS. Counselors
should prepare their clients to cope with discrimination in
job acquisition and maintenance efforts arising from social
stereotypes pertaining to both their minority and chronic ill-
ness statuses. Efforts to provide quality job placements and
adequate maintenance support are also needed to improve
the financial and housing conditions of adults with MS.
Counselors should secure or provide follow-along services
including job retraining and career planning as individuals
with MS age to enable them to counter heightened symptom
levels. Finally, in their vocational counseling efforts, reha-
bilitation counselors must engage clients in problem-solv-
ing discussions of negative self-perceptions regarding
extent of job/person match, number of work hours, and
adequacy of job performance.
Acknowledgments
The authors wish to thank the National Multiple Sclerosis Society,
its participating chapters, and the study participants for their sup-
port and assistance with this research.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support
for the research, authorship, and/or publication of this article:
This research was funded through a Health Care Delivery and
Policy Research grant from the National Multiple Sclerosis
Society, New York, NY.
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