Part I: Factors inflencing professional functioning 49 loss is not the underlying factor explaining the moderate correlation between LE and NFR. In the directed acyclic graph, two factors show moderate correlations with both LE and NFR, specifically ‘feeling that something should change at work’ and PA. Apparently, the way employees perceive their hearing difficulties and how they cope with their hearing loss influence their LE and the fatigue experienced after a day of work. Likewise, subjective measures of perceived hearing difficulties were found to be strongly associated with fatigue and vigor, whereas there was no significant association with degree of hearing loss (Hornsby &Kipp, 2016). It would be interesting to compare our findings of (self-reported) LE with other measures of listening effort, such as measuring reaction time or pupil responses during speech reception tasks in noise (McGarrigle et al., 2014). In linewithDeVries et al. (2015) andMachinandHoare (2008), we found a significant correlation between coping behavior and NFR. Specifically, we have explored two variables for coping behavior distinguishing the communication strategies that were used and the PA that were made. Although these scores showed a moderate correlation between themselves (r = 0.399), the PA score was directly related to LE and NFR, but the communication strategy score was not. Other studies report an association between communication strategies used and NFR (De Vries et al., 2015; Machin & Hoare, 2008). Having a passive reaction coping style explained 26 percent of the variance in NFR in employees with major depression in remission (de Vries et al., 2015). In a population of bus drivers, maladaptive driver coping behaviors were shown to be associated with NFR (Machin & Hoare, 2008). To our knowledge, previous studies have not focused on the association between NFR and PA, including self-acceptance, acceptance of loss, and stress and withdrawal. A qualitative study reported that self-acceptance facilitates work ability (Detaille et al., 2003). Distinguishing communication strategies and PA would be of interest in future studies with hearing-impaired employees to gain further understanding of the influence of coping behavior on NFR. In addition to explore the influence of coping behavior, several other questions were included to assess the influence of PA. We observed that the factor ‘feeling that something should change at work’ was moderately associated with NFR, as well as with LE. The question ‘Do you feel something should change in your work situation’ may grasp a feeling of frustration at the workplace, that was earlier associated with NFR in seafarers (Bridger et al., 2010). Feeling frustration at the workplace might
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