Job satisfaction is an individual's attitude or emotional response to their work (H. Lu et al., 2012). Previous studies have shown that nurses' job satisfaction, stability, and care quality and patients' satisfaction interact with each other. In medical and nursing activities, a decline in nurses' job satisfaction directly affects nurses' work engagement (Z.-Y. Liu et al., 2017), job performance (Hou et al., 2013), and organizational commitment (Zhu et al., 2009), which leads to a decline in nursing quality and patient satisfaction (Kvist et al., 2014; Tervo-Heikkinen et al., 2009). On the other hand, a decline in job satisfaction can also lead to nurses' disobedience of hospital management and increased sick leave, absenteeism (Roelen et al., 2013), and intentions to quit (Choi et al., 2013; Masum et al., 2016).
Because nursing is a stressful occupation, job dissatisfaction can easily occur. Aiken et al. (2011), in a study of nurses from nine countries, reported that the rate of job dissatisfaction varied from 17% in Germany to approximately one third in most countries and up to 60% in Japan. Low job satisfaction of nurses has also been reported in China. A survey of 11,942 nurses from 87 hospitals in China showed that nurses had high job stress and low job satisfaction, and as many as 22.9% of nurses had strong turnover intention in the next year (Y.M. Xu, Wu, Zhang, et al., 2016). In another study of 2,250 nurses from 19 large general hospitals in Shanghai, China, C. Liu et al. (2012) reported that 50.2% of nurses were dissatisfied with their job and 40.4% of nurses had an intention to leave their current job. In addition, the shortage of nurses has always been a major challenge in health care globally, and the situation in China is more serious. At the end of 2015, although there were 3.24 million RNs in China, there were only 23 RNs per 10,000 people, which is considerably lower than the European Union standard (80 RNs per 10,000 people) and much lower than that in many developed countries (World Health Organization, 2019). Therefore, as an important factor affecting the quality of care and the stability of the nursing profession, nurses' job satisfaction should be highly valued by government departments, hospital managers, and researchers.
Mindfulness can be defined as awareness generated by purposeful and nonjudgmental attention to the present (Kabat-Zinn, 2003). Mindfulness is a complex multidimensional concept that can be regarded as not only a method of concentration but also a psychological trait or state. In the current study, mindfulness was treated as a personality trait that refers to the ability and tendency to focus on the present in an open, receptive, and sensitive way. In recent years, mindfulness has attracted increasing attention in the fields of management psychology and organizational behavior, and a growing number of studies have shown that mindfulness has positive effects not only on employees' health but also on working attitudes and behavior (Zhang et al., 2017; Zheng & Ni, 2018). An integrative review indicated that mindfulness is fundamentally connected to many aspects of workplace functioning, including performance (e.g., task, citizenship behaviors, deviance, job performance), relationships (e.g., leadership, teamwork, coordination, communication), and well-being (e.g., emotion, resilience, job satisfaction, work–family conflict) (Good et al., 2016). In the field of nursing, a number of studies have focused on the impact of mindfulness on nurses' health, but few have explored the impact of mindfulness on nurses' working attitudes and behavior, such as job satisfaction, turnover intentions, and work engagement (Guillaumie et al., 2017). As mentioned above, job satisfaction is an important issue in ensuring an adequate nursing workforce and high-quality health care. Therefore, it is of great theoretical and practical significance to explore the relationship between mindfulness and nurses' job satisfaction and the mediating mechanism in this relationship.
Resilience is the ability to bounce back or successfully cope despite adverse circumstances (Connor & Davidson, 2003). Research on resilience was initially aimed at people who faced losses, difficulties, or adversity, but in recent years, it has gradually focused on the professional population. Much evidence has shown that resilience is a key factor for nurses to cope with job stress, and nurses' resilience is closely related to their health, job satisfaction, and turnover intention (Matos et al., 2010; McDonald et al., 2013; Mealer et al., 2012). Notably, resilience is a complex phenomenon influenced by other psychological factors (Rees et al., 2015). Mindfulness has been indicated to be an individual characteristic that has an important impact on resilience (Liang et al., 2016; X. Xu et al., 2016). In line with conservation of resources theory, individuals strive to build and accumulate resources, and “resources tend to generate and activate other resources, thus creating ‘resource caravans,’ which may result in positive outcomes such as better coping and well-being” (Hobfoll, 2002, p. 312). Previous research has indicated that mindfulness is a valuable personal resource, and a key element of mindfulness is acceptance of the present, which enables employees to better adapt to changing work environments by helping them accept the current level of resources and raise their awareness of other resources (Kroon et al., 2015). Therefore, the current authors proposed that mindfulness, as a personal resource, can generate and activate resilience, which is another type of personal resource (Good et al., 2016), and has a positive impact on job satisfaction. Therefore, it was hypothesized that resilience plays a mediating role between nurses' mindfulness and job satisfaction.
Positive affect is the internal mood state associated with the satisfaction of individual needs and is accompanied by the subjective experience of pleasure. Positive affect can also be regarded as a personal resource that can enhance people's cognitive and behavioral abilities and is conducive to the construction of individual physiological, psychological, and social resources (Fredrickson, 2001). Previous studies have found that positive affect is closely related to mindfulness, resilience, and job satisfaction. On the one hand, mindfulness helps increase positive affect (Schroevers & Brandsma, 2010; Waters et al., 2009), and on the other hand, positive affect is an important predictor of resilience (Cohn et al., 2009; Xing & Sun, 2013) and job satisfaction (Connolly & Viswesvaran, 2000; Kafetsios & Zampetakis, 2008). Based on the above analysis, the current authors hypothesized that positive affect plays a mediating role between nurses' mindfulness and job satisfaction. Moreover, it was hypothesized that positive affect and resilience also play a chain mediating role between nurses' mindfulness and job satisfaction.
The main goals of the current study were to: (a) assess the levels of mindfulness, positive affect, resilience, and job satisfaction among Chinese hospital nurses; (b) examine the relationship between mindfulness and job satisfaction; and (c) explore the mediating role of positive affect and resilience in the relationship between mindfulness and job satisfaction. The hypothesized model in Figure 1 guided the study design and analyses.
Hypothesized model for current study.
Study Design and Sample
The current study used a cross-sectional design. A convenience sample of staff nurses (N = 1,043) was recruited from three tertiary hospitals from March to April 2019 in Dongguan, China. Inclusion criteria were RNs with at least 1 year of clinical experience who had signed a formal labor contract with the hospital, understood the study objectives, and provided written informed consent. Exclusion criteria were absence during the survey, such as due to leave, training, or maternity leave.
The research questionnaire comprised five parts: (a) general information questionnaire; (b) Mindful Attention Awareness Scale; (c) Positive and Negative Affect Schedule; (d) Connor–Davidson Resilience Scale; and (e) McCloskey/Mueller Satisfaction Scale.
General Information Questionnaire. This questionnaire was developed by the primary researcher to collect data on the basic demographic characteristics of participants, such as age, gender, marital status, education, and work years.
Mindful Attention Awareness Scale (MAAS). Mindfulness was measured by the MAAS, developed by Brown and Ryan (2003) and revised by Deng et al. (2012). The scale is a one-dimensional scale comprising 15 items used to measure core characteristics of mindfulness related to attention or awareness in the present moment. Items are rated on a 6-point scale from 1 (always) to 6 (never), with higher scores indicating greater mindfulness (Brown & Ryan, 2003). The Chinese version has been suggested to have high reliability and validity (Cronbach's alpha and Guttman's split-half reliability coefficient were 0.85 and 0.81, respectively). The internal consistency (Cronbach's alpha) of the MAAS was 0.90 in the current study.
Positive and Negative Affect Schedule (PANAS). Watson et al. (1988) developed the PANAS, and Huang et al. (2003) developed a Chinese version with satisfactory validity and reliability (Cronbach's alpha was 0.82 for the whole scale, and the Varimax-rotated factor loading for the terms ranged from 0.40 to 0.76). The PANAS is a self-report instrument that measures positive and negative affect. The PANAS comprises a list of 20 adjectives, 10 per subscale, that are rated on a 5-point scale based on the time instructions established by the researcher. In the current study, only the positive affect subscale was used, and Cronbach's alpha was 0.93.
Connor–Davidson Resilience Scale (CD-RISC). The CD-RISC (Connor & Davidson, 2003) was developed in the United States to measure individuals' ability to cope effectively when faced with adversity. The current study used the Chinese version revised by Yu and Zhang (2007), which includes 25 items in three dimensions (tenacity, strength, and optimism). Each item is rated on a Likert scale ranging from 0 (not at all) to 4 (almost always). The range of possible total scores is 0 to 100, with higher scores indicating higher levels of resilience. The revised scale has good reliability and validity (Cronbach's alpha was 0.91 for the whole scale and 0.88, 0.80, and 0.60 for the three dimensions, respectively). In China, the revised version has been widely used in populations including nurses, and it has demonstrated good reliability and validity (Guo et al., 2017; Ren et al., 2013). In the current study, Cronbach's alpha of the CD-RISC was 0.895.
McCloskey/Mueller Satisfaction Scale (MMSS). Mueller and McCloskey (1990) developed the MMSS, and Zheng and Liu (2010) developed a Chinese version with satisfactory validity and reliability (Cronbach' s alpha was 0.95 for the whole scale, and the average content validity index was 0.94). The MMSS is a 31-item scale that measures hospital nurses' job satisfaction. The scale measures eight types of satisfaction (satisfaction with extrinsic rewards, scheduling, family/work balance, coworkers, interaction, professional opportunities, praise/recognition, and control/responsibility) and includes one item for “overall job satisfaction of nurses.” The responses are indicated on a Likert scale ranging from 1 (very dissatisfied) to 5 (very satisfied). The possible total score ranges from 31 to 155, with higher scores indicating greater job satisfaction. In the current study, Cronbach's alpha of the MMSS was 0.934.
Ethical Considerations and Data Collection
The research was approved by the Ethics Committee of Xiangya Nursing School at Central South University (China). Prior to the survey, the primary researcher contacted the head of the Nursing Department of each hospital and obtained permission to distribute questionnaires to nurses at their meetings. On the day of investigation, nurses were told of the purpose of the study and were asked whether they were willing to participate. Nurses were also told that their participation was entirely voluntary, that no names or personal information would be requested, and that the questionnaires were anonymous. After signing the informed consent, the researchers sent a questionnaire link through the Questionnaire Star website; nurses completed the online questionnaire on site and submitted the questionnaire immediately after completion. There was no financial incentive for participants.
All data were analyzed using SPSS 22.0. Descriptive statistics were used to present the study variables. Pearson's correlation analysis was used to identify the relationships among mindfulness, positive affect, resilience, and job satisfaction among participants. The mediation hypotheses were tested using the bias-corrected bootstrap method (5,000 bootstrap resamples; Model 6) with the PROCESS macro in SPSS (Hayes, 2013). Bias-corrected bootstrapping is the most effective and reasonable method of obtaining confidence limits for specific indirect effects under most conditions, and it allows the strength of indirect effects to be compared when multiple mediators are included in the model tested (Preacher & Hayes, 2008).
A total of 1,122 questionnaires were completed anonymously online, and 1,043 valid questionnaires were returned, for an effective response rate of 93%. There were 1,032 women and 11 men who were aged between 19 and 52 (mean age = 30.21 years [SD = 7.44 years]); nurses' working years ranged from 1 to 30 years, with an average duration of 9.41 years (SD = 7.71 years). Approximately 58% of participants were married, and more than one half of participants had children (n = 549, 52.6%). Most participants had an Associate degree (n = 473, 45.3%) or Bachelor's degree (n = 491, 47.1%); only 9.3% (n = 97) were head nurses. Nurses participating in the survey had the following titles: 46.8% (n = 488) were primary nurses, 26.7% (n = 279) were junior nurses, and 26.5% (n = 276) were senior nurses.
Levels of Mindfulness, Positive Affect, Resilience, and Job Satisfaction
Table 1 presents the descriptive statistics for the study variables. Mindfulness of participants was at a medium-high level (i.e., above the intermediate item score of 3.5). Nurses had a medium level of positive affect, resilience, and job satisfaction (i.e., slightly fluctuated in the intermediate item score of 3, 2, and 3, respectively). Among the three dimensions of resilience, the level of strength was the highest. Among the three dimensions of job satisfaction, the score of satisfaction with extrinsic rewards was the highest, followed by coworkers, and the score of scheduling and family/work balance was the lowest.
Levels of Mindfulness, Positive Affect, Resilience, and Job Satisfaction (N = 1,043)
Relationships Among Mindfulness, Positive Affect, Resilience, and Job Satisfaction
Pearson's correlation was used to examine the relationships among mindfulness, positive affect, resilience, and job satisfaction. The results revealed that the total MAAS, positive affect subscale, CD-RISC, and MMSS scores were significantly positively correlated with each other (p < 0.01). In addition, the scores of the dimensions of the MAAS (a single dimension), positive affect subscale (a single dimension), CD-RISC (three dimensions), and MMSS (eight dimensions) were also significantly positively correlated with each other (p < 0.01). Details on the correlations among all variables are presented in Table 2.
Relationships of Mindfulness, Positive Affect, Resilience, and Job Satisfaction (N = 1,043)
Mediating Roles of Positive Affect and Resilience
Based on the correlation analysis, the bias-corrected bootstrap method was used to further explore the mediating effects of positive affect and resilience on nurses' mindfulness and job satisfaction. The mediation model examined mindfulness as the independent variable, positive affect and resilience as the mediators, and job satisfaction as the dependent variable. The resampling size was 5,000, and the mediation effect was considered to be statistically significant if the 95% confidence interval (CI) did not contain zero.
The results showed that mindfulness had a significant direct effect on job satisfaction among nurses (β = −0.258, 95% CI [0.172, 0.343]) and a significant indirect effect on job satisfaction through the mediating effects of positive affect and resilience (β = 0.209, 95% CI [0.163, 0.258]). The direct effect of mindfulness on job satisfaction was 0.258, and the total indirect effect of mindfulness on job satisfaction was 0.209, accounting for 44.72% of the total effect of mindfulness on job satisfaction and indicating that positive affect and resilience play partial intermediary roles between mindfulness and job satisfaction. Specifically, this mediation effect included three indirect effects: Mindfulness → positive affect → job satisfaction (indirect effect 1); mindfulness → resilience → job satisfaction (indirect effect 2); and mindfulness → positive affect → resilience → job satisfaction (indirect effect 3). The 95% CI of each path did not contain zero, indicating that the indirect effects were statistically significant. However, there were no significant differences in the indirect effects of the three paths (Table 3 and Figure 2).
Mediating Effects of Positive Affect and Resilience on Nurses' Mindfulness and Job Satisfaction
Final model with coefficients.
**p < 0.01.
The results show that nurses' job satisfaction was at a medium level, which was similar to the results of a recent nationwide survey of hospital nurses in China (Dan et al., 2018). This large sample survey found that nurses had average job satisfaction, and their lowest level of satisfaction corresponded to extrinsic rewards and family/work balance. In the current study, nurses were least satisfied with their family/work balance but were most satisfied with extrinsic rewards. This discrepancy in results may be due to the different study regions. Dongguan City, where the current survey was conducted, is located in the most developed area of China; therefore, nurses' income and benefits in this area are higher than those in most other areas. Moreover, as it is a prefecture level city in Guangdong Province, Dongguan does not have high house prices and consumption compared to other cities, such as Beijing, Shanghai, Guangzhou, and other first-tier cities.
Nurses' mindfulness was at a medium-high level, which was slightly lower than that of psychiatric nurses (Q.-H. Lu, 2019; F. Xu & Sun, 2018) but higher than that of oncology nurses (Feng et al., 2017) and maternal and child specialist nurses (Zeng et al., 2017), indicating that nurses' mindfulness levels may vary with different specialties. However, participants in the current study are nurses in general hospitals, which involve many specialties, and the sample size of nurses in each specialty is not balanced. Therefore, the level of mindfulness of nurses with different specialties was not compared and needs to be further studied in the future.
The results of the current study revealed that nurses' positive affect was at a medium level, which was consistent with that in a previous study (F. Lu et al., 2019), indicating that nurses' emotions can be further improved. In addition, nurses also experienced a moderate level of resilience, which was similar to the result of Guo et al.'s (2017) survey of nurses in tertiary hospitals. However, the level of nurses' resilience in the current study and Guo et al.'s (2017) study were significantly lower than that of the Chinese community population (X. Yu et al., 2009). Findings suggest that nurses' resilience has been weakened in Chinese hospitals, and nursing managers should take effective measures to enhance nurses' personal resilience.
In the current study, nurses' mindfulness was positively correlated with the total score and all dimension scores of job satisfaction, and mindfulness directly and positively predicted job satisfaction in the mediation model. There have been few studies on the relationship between mindfulness and job satisfaction in nurses. Lu, Wang, et al. (2019) found that mindfulness was closely and positively related to job satisfaction in psychiatric nurses. In addition, Gauthier et al. (2015) suggested that mindfulness interventions could increase job satisfaction of pediatric nurses. Mindfulness is the awareness that emerges through purposefully and nonjudgmentally paying attention to the present moment. Mindfulness helps enhance the quality of experience through receptive attention to activities so that individuals become happily immersed in them (Brown & Ryan, 2003); in addition, mindfulness has a positive impact on job satisfaction by promoting self-determined behavior (Hulsheger et al., 2013). Mindfulness can improve the quality of internal awareness (i.e., mindfulness increases the perception of one's own emotions, thoughts, and behaviors), which helps people clearly identify their basic values and needs and promotes self-determination behaviors in line with individual needs and values, whereas self-harmony and value realization are closely related to job satisfaction.
The current study also found that nurses' mindfulness had not only direct but also indirect effects on job satisfaction. First, positive affect played a partial mediating role between mindfulness and job satisfaction, which indicates that mindfulness can improve nurses' job satisfaction by enhancing positive affect. Previous studies have shown that mindfulness was positively related to positive affect and that mindfulness-based intervention could effectively increase positive affect (Chen et al., 2011; Wang et al., 2017). In addition, positive affect has always been considered an important antecedent variable of job satisfaction (Connolly & Viswesvaran, 2000; Kafetsios & Zampetakis, 2008). These results are consistent with the current results. Second, resilience played a partial mediating role between mindfulness and job satisfaction, which indicates that mindfulness can improve nurses' job satisfaction by enhancing resilience. A growing number of studies have proposed that mindfulness is an important characteristic of a resilient individual and that resilience is a key factor in coping with job stress, which influences the occurrence of adverse consequences in the workplace (Rees et al., 2015). The current research results are in line with this theoretical assumption. Finally, positive affect and resilience played a chain mediating role between mindfulness and job satisfaction, which indicates that mindfulness can enhance resilience by increasing positive affect and ultimately improve job satisfaction. Previous studies have shown that positive affect is closely related to resilience (Cohn et al., 2009; Xing & Sun, 2013). Positive affect not only reflects resilience but also promotes the development of resilience. Nurses with high levels of mindfulness have more positive affect, which supports their development of higher levels of resilience in the workplace, thereby preventing negative experiences and burnout and enhancing their well-being and job satisfaction. Notably, the chain mediating effect of positive affect and resilience is not higher than the independent mediating effects of positive affect and resilience, which indicates that positive affect and resilience play important roles in the influence of mindfulness on job satisfaction. In addition, the effect of mindfulness on resilience may also be affected by other mediating factors.
The current study had the following limitations. First, the hospitals in the study are urban tertiary hospitals, and they were selected through convenience sampling, which affected the representativeness of the sample to a certain extent. Second, cross-sectional designs do not permit conclusions regarding causal pathways. Third, previous studies have shown that cognitive appraisal is an important psychological mechanism through which mindfulness plays a role in the workplace (Good et al., 2016). Therefore, cognitive appraisal may also play a mediating role between nurses' mindfulness and job satisfaction and may indirectly affect nurses' job satisfaction through resilience. Future research should focus on identifying other mediating variables and paths to more systematically and clearly reveal the mechanism of mindfulness in improving nurses' job satisfaction.
Implications for Nursing Management
Based on the current study findings, nurses' mindfulness has positive direct and indirect impacts on job satisfaction, and positive affect and resilience play mediating roles between the two variables. Findings suggest that mindfulness is related to nurses' better workplace function and results in positive work outcomes. However, mindfulness in work settings, especially in nursing work, remains an emerging area, and more studies are needed to explore the impact of mindfulness on nurses' work attitudes and behaviors, such as leadership and job performance. In addition, mindfulness is an innate human ability that can be cultivated and improved through training. Therefore, nurse managers should recognize the importance of mindfulness and incorporate mindfulness training into health promotion and employee management plans for hospital nurses. Traditional mindfulness training (e.g., mindfulness-based stress reduction) requires a high time commitment from trainees, which affects its practicability to a certain extent, especially for busy occupational groups such as nurses (Morrison Wylde et al., 2017). Managers should adopt modified or brief versions of training programs to benefit from the value of mindfulness training.
Considering the mediating roles of positive affect and resilience between mindfulness and job satisfaction, strategies and methods to increase positive affect and resilience are also important for nursing managers and organizations. Job satisfaction is a complex phenomenon that is not only affected by personal factors but also affected by job characteristics and environmental factors. For example, scheduling and family/work balance were the dimensions of jobs with the lowest levels of satisfaction in the current study, which seems to be a problem strongly related to staffing and organizational culture. Therefore, nurse administration and managers should develop and implement strategies from psychological, professional, and environmental points of view. However, making changes in job characteristics and environmental factors is often not easy, especially those involving social background, policy orientation, hospital management, and other aspects; from this perspective, mindfulness is indeed a flexible, practical, and effective method of helping nurses enhance resilience and improve job satisfaction at the personal level.
The current study demonstrates the relationships among mindfulness, positive affect, resilience, and job satisfaction among hospital nurses. These findings highlight the importance of mindfulness in increasing nurses' job satisfaction. Furthermore, mindfulness can enhance job satisfaction by mediating the positive affect and resilience of nurses. The application of these findings could contribute to nurses' job satisfaction, which is desirable for managers and administrators.
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Levels of Mindfulness, Positive Affect, Resilience, and Job Satisfaction (N = 1,043)
|Variable||Item Score (Mean [SD], Range)||Total Score (Mean [SD])|
|Mindfulness||4.02 (0.76) (1 to 6)||60.42 (11.47)|
|Positive affect||2.83 (0.59) (1 to 5)||28.27 (5.90)|
|Resilience||2.15 (0.55) (0 to 4)||53.77 (13.70)|
|Tenacity||2.05 (0.59) (0 to 4)||26.60 (7.77)|
|Strength||2.38 (0.59) (0 to 4)||19.05 (4.73)|
|Optimism||2.03 (0.61) (0 to 4)||8.13 (2.44)|
|Job satisfaction||3.10 (0.54) (1 to 5)||96.24 (16.75)|
| Satisfaction with extrinsic rewards||4.20 (0.81) (1 to 5)||12.60 (2.45)|
| Scheduling||2.89 (0.78) (1 to 5)||17.36 (4.70)|
| Family/work balance||2.87 (0.79) (1 to 5)||5.74 (1.59)|
| Coworkers||3.63 (0.64) (1 to 5)||7.25 (1.27)|
| Interaction||3.20 (0.68) (1 to 5)||12.82 (2.71)|
| Professional opportunities||3.05 (0.64) (1 to 5)||12.19 (2.55)|
| Praise/recognition||3.38 (0.57) (1 to 5)||13.53 (2.27)|
| Control/responsibility||3.19 (0.62) (1 to 5)||15.94 (3.09)|
Relationships of Mindfulness, Positive Affect, Resilience, and Job Satisfaction (N = 1,043)
|2. Positive affect||0.35||1|
|7. Job satisfaction||0.32||0.35||0.42||0.39||0.41||0.34||1|
|8. Satisfaction with extrinsic rewards||0.74||0.22||0.32||0.30||0.32||0.20||0.26||1|
|10. Family/work balance||0.16||0.16||0.20||0.18||0.20||0.14||0.61||0.17||0.50||1|
|13. Professional opportunities||0.20||0.24||0.27||0.27||0.26||0.20||0.77||0.15||0.50||0.43||0.38||0.66||1|
Mediating Effects of Positive Affect and Resilience on Nurses' Mindfulness and Job Satisfaction
|Dependent Variable||Independent Variable||Regression Coefficient||β||Bootstrap SE||95% CI|
|Job satisfaction||Mindfulness||c (total effect)||0.467||0.043||[0.382, 0.551]|
|Positive affect||Mindfulness||a1||0.180||0.015||[0.151, 0.210]|
|Positive affect||d21||1.284||0.059||[1.167, 1.401]|
|Job satisfaction||Positive affect||b1||0.312||0.100||[0.117, 0.508]|
|Mindfulness||c′ (direct effect)||0.258||0.044||[0.172, 0.343]|
|a1×b1 (indirect effect 1)||0.056||0.019||[0.020, 0.094]|
|a2×b2 (indirect effect 2)||0.070||0.015||[0.044, 0.103]|
|a1×d21×b2 (indirect effect 3)||0.083||0.014||[0.059, 0.114]|
|Total indirect effect||0.209||0.024||[0.163, 0.258]|