Tourism is the main economic sector in the Balearic Islands (Spain) and hotel housekeepers (HHs) are a large occupational group, in which stress is becoming a major issue. This study aims at exploring in-depth factors perceived as stressors by HHs and key-informants, and their effects on work-life balance (WLB). A qualitative design with phenomenological approach was used, conducting six focus groups with 34 HHs and 10 individual interviews with key-informants. Results were analyzed adopting the job demands-resources model and a gender perspective. High demands, e.g., work overload, time pressure, physical burden…, lack of enough resources and little control, derived from role conflict, unexpected events…, were the most important factors explaining HHs’ stress. Additionally, this imbalance was perceived as leading to health problems, mainly musculoskeletal disorders. Working schedule was mentioned as a facilitator to WLB, whereas an imbalance between job demands and resources led to work-home conflict, preventing them from enjoying leisure time. Multiple roles at work and at home increased their stress. HHs experienced their job as invisible and unrecognised. Regarding practical implications, our recommendations for hotel organization include reducing workload and increasing resources, which would improve the job demands-resource balance, diminish negative mental and physical outcomes and improve WLB. Tourism accounted for 13.4% of employment in Spain and 25.6% in the Balearic Islands in 2019 , and psySince exposure to psychosocial job hazards may result in a higher risk for HHs’ health status ,16,17,18Tourism is one of the most stressful work settings . ResearcIn the hospitality sector, most of the jobs are unskilled and held mostly by migrant and young women under temporary contracts and with low wages ,31. Thisto draw any firm conclusions regarding the role of gender in the level of workplace stress”   showed tstress” Other authors relate higher levels of stress for women with work-life conflict i.e., “a process whereby contextual demands in one domain drain personal resources, leaving insufficient personal resources to function optimally in the other domain” ; thus, mSeveral theoretical frameworks have explained the development of stress in work settings and described adverse health effects as a result of demands-resources imbalances ,41,42,43The JD-R model classifies working conditions into job demands and job resources. Job demands refer to those “physical, social, or organizational aspects of the job that require sustained physical or mental effort and are therefore associated with certain physiological and psychological costs”; and Job resources refer to the “physical, psychological, social or organizational aspects of the job that may do any of the following: (a) be functional in achieving work goals, (b) reduce job demands at the associated physiological and psychological costs; (c) stimulate personal growth and development”  (p. 501)Furthermore, the JD-R model has been applied to examine interdependencies between work and family life . Women rGiven its strengths, we used the JD-R model as the main theoretical framework for the analysis of the data; it allows identifying not just the demands which have been reported widely ,49,50,51Based on the JD-R model, the main aim of the study is to qualitatively explore HHs’ perceptions and experiences of stress and its consequences on health and work-family life from a gender perspective. The specific objectives of this study are to identify: (i) factors of the work environment perceived as stressors (demands); (ii) factors of the work environment perceived as resources; (iii) the perceived outcomes of the (im)balance between demands and resources; and (iv) how distress affects HHs’ personal and family life.A qualitative design with phenomenological approach was undertaken to explore HHs’ perceptions and experiences of stress. We conducted individual semi-structured interviews and focus groups (FGs). Individual interviews with HHs and a supervisor allowed us to explore the main topics related to their job; interviews with other key informants allowed us to broaden the perspective of the phenomenon and to contrast different explanations and experiences given by HHs. On the other hand, FG was the method to gather information about the experiences of HHs related to work, identify shared experiences and perceptions, and to go in depth in their perceptions and experiences of stress as well as its implications for their personal life.This project was undertaken by the Department of Primary Health Care in the Balearic Islands. HHs participating in FGs were recruited through purposive sampling: GPs in different health care centres identified potential participants according to sociodemographic and labour variables, and informed them about the research. This was the most feasible and effective way to contact them and get their participation. Afterwards, researchers contacted and invited them to participate in FGs and set the date. Selection criteria included being 18 years old or older and having worked as a HH during the last season (2017). Additionally, profiles regarding different variables—age, years working as a HH, hotel star rating, and kind of contract -were included in order to ensure generating rich information.Key informants were selected through purposive sampling to obtain different perspectives and rich information. A code was also assigned to them to guarantee their anonymity.Empirical material was collected through FGs with HHs—conducted in different health care centres—and semi-structured interviews to key informants conducted between January and June 2018. Four FGs were undertaken in Mallorca, one in Menorca and one in Eivissa. FGs ranged from 60 to 90 min and interviews from 25 to 80 min; all of them were conducted by the first author. Interviews were recorded digitally and FGs were video-recorded as well. Data collection was undertaken until saturation of the information.(1)Characteristics and organization of work of HHs.(2)Positive and negative aspects of HHs’ job.(3)Equipment and materials available.(4)Relationships among hotel workers and among HHs.(5)Factors of stress.(6)Health problems.Based on the literature review, we developed a script to explore the areas identified as relevant, and to approach them in a similar way across all FG and interviews. The initial script was completed as the data collection was progressing. Although some areas or questions were adapted according to key-informant profiles, the areas approached in FG and interviews were as follows:FGs and interviews were literally transcribed. An alphanumeric code was assigned to each HH in order to guarantee the anonymity but also to be able to identify the contributions of each person and each FG. Each contribution was identified by “HH” (meaning ‘hotel housekeeper’) and by two numbers separated by a dot: the first number correspond to the FG (and it ranges from 1 to 6) and the second number pertain to the individual who made the contribution.The contents of FGs and interviews were analyzed jointly, aiming at identify both similarities and differences in the narratives. Content analysis was undertaken emphasizing the meaning of the text. First, a code tree was elaborated according to the objectives of the research, inspired by the JD-R model categories and the reading of some FGs transcriptions. This code tree was checked by a second researcher. In order to guarantee internal validity, both researchers encoded and analyzed the transcriptions separately. Finally, analysis of each code was discussed and conclusions were agreed. Software NVivo11  was used to assist this analysis.The study was approved by the Balearic Islands Research Ethics Committee (IB3738/18 PI). An information sheet and informed consent was given to the participants before undertaking the interview or FG. Signed agreement of the forms was compulsory to participate.Six FGs and 10 interviews with key-informants were carried out. A total of 34 HHs participated in FGs—between four and eight in each FG. A total of 64 HHs were invited: 20 of them rejected participation—due to incompatibility of schedules, being abroad, etc. and 10 had agreed to participate but did finally not come to the FG.Socio-demographic characteristics of FGs’ participants are displayed in The results are presented under key thematic headings of the JD-R model: demands perceived, resources identified, outcomes reported of demands-resources imbalance, and consequences over WLB . Links tStress was the most commented job-related negative aspect and it was an issue arising in all FG and interviews conducted with HHs. It emerged mostly when HHs were asked to mention some characteristics of their work and a negative aspect of their job.The main stressor perceived by HHs was work overload: it was related to the number of check-out rooms to clean, the state of the rooms—e.g., untidiness-, unexpected events—e.g., a flood, and the replacement of amenities and shifts.HHs perceived they had to clean too many check-out rooms, which had to be cleaned in depth and be ready at a certain time for the new clients. Regarding the state of the rooms, the director of HR and the head of the occupational health department admitted the fact that untidiness altered the daily work load. However, from the HHs’ perspective, this was not taken into account when calculating working times.HHi4. There are some stipulated times that we really don’t know where they come from. Because nobody has ever come to ask how much time you spend in one room. They calculate that in ten or fifteen minutes you have to finish an apartment no matter how full it is, no matter how much crap there is, whether they are clean or dirty or have kids whose toys are thrown all over the place. You have to leave all of that in a reasonable condition.OHealth. The big problem that we find with the HHs is the diversity of all the activities. In the same hotel, two identical rooms, the workload is different, right? One thing is the family that comes back from the beach with all their things, sand, the toy boats… another thing is the family that didn’t go to the beach that day and their room is completely different.Regarding amenities, some hotels had a mini-bar in rooms; in most cases, HHs were in charge of replacing the products consumed by clients. Most HHs perceived that amenities had increased during the last years and some of them thought that these tasks should be done by a barman.HH5.3. Every single year they increase our workload; now we have to check the mini fridge, in every room check for coca cola, water, juices, crisps, candies, tea… everything. It’s [now all part of] our job [but it didn’t used to be].Prev. They restock the minibar. They have a cart. They have bottles, they restock amenities, papers…Yes.Another factor of workload perception was “rooms’ changing”, a practice that occurred when the reception desk changed the room assigned to clients when they did not like the room they had in the first place. HHs complained because this meant they had to clean a room twice. This practice deteriorated the relationship between the reception desk and housekeeping department.HH6.8. Now since they [hotel management] don’t want to compensate them, they change rooms. (…) Instead of six check-outs, you have ten. And that’s very hard for a HH.(1)The reduction of workforce, which implied having to assume more rooms to clean; not having enough staff to replace HHs on short sick leave; not having their days off when someone was ill; carrying out tasks not of their responsibility such as refilling mini-bars, etc.Some issues identified by HHs and interviewees as causes of the increase of workload during the last years were:PInsp. I think I have only found one who told me they were still the same [number of workers] as always (...). There were 15 [workers], but with the crisis they went down to 10; [but] the work was still completed [even with less staff]. Next year they went down to 8; [but] the work was still completed.OHealth. A long term leave, (…) you get a contract, or go through a temp agency, or temporary contracts (…). Now, for example, it’s 7 in the morning and the director receives the “hey, I don’t feel well” and now there’s no time to-. So now the work that person had has to be divided among all the HHs including the ones from the afternoon shift.(2)The shortening of the length of stay of clients, which increased the number of check-out rooms to clean.HH5.4. Since the crisis, people stay for two days, for three days, there are a lot of check-outs, they come, they go, this one has gone, this one hasn’t left yet… And it’s… besides the work, it’s stressful.Most HHs in FGs and interviews perceived time pressure. The planned time to clean rooms was very tight, and neither displacements between rooms nor unexpected events were taken into account when calculating how many rooms per day HHs were able to clean.Insufficient time was perceived as having negative consequences for their health, such as mental strain and physical exhaustion. Other consequences they reported were not being able to have lunch or use the toilet while working, not being able to use the individual protection equipment properly , not being able to help colleagues and to do tasks as properly as they would like or were required to. Time pressure and work pace, coupled with lack of equipment –i.e., bed linen- were perceived as leading to interpersonal tensions among HHs:HH5.1. I find it very stressful (…) the small amount of time they give you to finish such a complicated task.HHi2. It’s not even an option for a person who’s working to be able to head down to pee because there’s no time. They don’t eat anything, and if I head down to eat, I can’t really eat because of all the stress I have.SUP. While you go to another floor, several minutes have passed. Those minutes are dead time for the company. They don’t figure that in.This point of view was supported by the physician from the government’s inspection service. Additionally, the head of the occupational health department accepted that sometimes HHs told him not having time for lunch. Meanwhile, the head of the occupational risk prevention service stated that the housekeeping department was not the most stressful department in the hotel.PInsp. Some tell you that they aren’t allowed to eat. (…) Come on, if you’re there from 7.30 until 4, at some point you have to eat. “Yes, but that means more of your time at work before you can leave. And you really just want to get home”. That’s what most of them tell me.OHealth. It’s true that they sometimes tell us “I don’t even have time to head down”. (…) It’s also true that we analyze the workload and it’s not too different from the one who does have time to head down to eat.Prev. In the room service department where the HH works alone at her pace, she has to finish 15, 16, 17, 18, however many rooms, but at her pace. I don’t see how that can be as stressful compared to, for example, [kitchen].(1)From the reception desk: sometimes clients were sent to a room that was not ready yet, so HHs had to talk to clients without having nor enough time neither knowledge to explain the situation. Additionally, they thought that giving this kind of explanations was not their responsibility;(2)From clients, who asked for a blanket, for a pillow, for hangers, etc., so HHs had to interrupt their duties and go for them;(3)From the supervisor, who at the same time may receive demands from clients, from the reception desk and the dining hall- asking to clean a certain place.HHs and the supervisor reported some situations where they received demands from different departments or people. These situations were perceived as stressful because HHs had to deal with these demands, sometimes contradictory, in a context of shortage of time, implying to move and undertake tasks not included in their original working plan. Demands received were:HH6.1. The client says: “Hey, clean my room, I’m taking up my child to take a nap”. Okay. You have rooms on another floor. The director: “Hey, the clients on such and such floor want to check-out”. You head over there. You find a client in the hallway: “You haven’t cleaned my room”.SUP. We are very, very, very stressed. Then there’s reception asking if a certain room is ready, and this client who wants a blanket, and this client who wants this, and this client who wants that. You have to go and take those things to them.A consequence of role conflict was the feeling of being maids of other hotel workers and a lack of recognition. HHs stated that their colleagues or supervisors expected or ordered them to clean areas not of their responsibility, such as the dining hall and bar.HH4.3. We’re maids to our own co-workers. They tell you to clean up their own work space.SUP. In any case, management doesn’t tend to appreciate the work that HHs do. Mostly because, of course, when the girls do a good job, they never value that.HH1.2. They don’t really appreciate us. We’re the maid… we’re the nannies for everybody. Because if the kitchen is dirty your own co-workers won’t help you.The issue of receiving different demands was absent from the discourse of the director of HR, the head of the occupational risk prevention service, and the head of occupational health department, showing little awareness about details of the every-day work organization of HHs.Another aspect regarding role conflict was “rigorousness”. Hotel managers and supervisors demanded HHs to do the work properly, but also HHs showed pride and satisfaction in doing their work accurately despite not having enough resources. The combination of direct supervision, the thoroughness demanded, and the lack of time was referred as very stressful.HH1.3. From my point of view and in my experience, which is not very much, they give us a lot of work given what a good job they expect us to do.HHs considered their job as physically demanding. It included pushing the trolley, moving furniture—in order to clean the room properly or to put furniture back in place-, moving beds, carrying bed linen, and cleaning the panes, among others. This physical burden was perceived as cause of some of their physical problems, basically musculoskeletal disorders . Physical burden was also recognised also by key-informants interviewed:HHi4. And we use duvets. (…) imagine in every apartment having to change the covers for five or six duvets. By yourself.OHealth. We know that the work done by the HHs is physical work that requires effort.Sometimes, hotel facilities, furniture and work materials and equipment could increase the physical burden .HH2.2. I had a better cart and they exchanged it for a much smaller one, but nothing fits in it.HRDir: Hotels that have carpet, it’s much harder to move the bed. While hotels that don’t have carpet are better, or where the beds have rollers.Age and physical status were perceived by HHs as factors that prevented them from doing their work properly, to face the workload effectively and to keep up with the work. Moreover, HHs perceived their educational level as a barrier to get another job: they mentioned they could not have many job or career opportunities because many had completed compulsory education only. The combination of these factors made HHs have different expectations regarding their future. The youngest HHs did not see themselves working as HH all their life; the HHs in their 40’s and 50’s were wondering whether they would be able to work until the retirement age; and the oldest HHs were just waiting for their retirement.HH5.4. Psychologically, I’m okay to work. But physically I hurt.In summary, demands perceived by HHs as stressful were related mainly to work overload, work organization , and the physical burden.Most HHs agreed that their wage was acceptable compared to other jobs, but it was not enough in relation to their workload. Thus in economic terms they thought they were not fairly rewarded.HHi3. Financially, we could say a HH earns a decent salary.HH3.5. The salary is not what you’d think. For the work we do, it’s badly paid. (…) We’re the bottom rung of the ladder. Earning less than a technician, earning less than a reception assistant…When talking about training, most participants’ comments referred just to courses on prevention of occupational hazards. HHs highlighted that they already had this kind of knowledge—so, these courses were not necessary anymore- and complained that attending training did not imply a reduction in workload, and thus, involving an increase in time pressure and, consequently, in their stress. Besides, HHs reported that other types of training were not useful or did not exist at all and recognized few possibilities for promotion or improving their skills. This point of view was supported by some key-informants, such as the director of HR and the head of occupational risk prevention service. Thus, training, which is usually a resource, is lacking for this occupational group.HH6.5. I’m stuck in a rut because there aren’t really many opportunities for advancement or to level up or get a promotion. (…) There is no professional development at all.Prev. All departments have their general training for occupational risk prevention and specific training for the job. Minimal, once a year each one. (…) We try to modify it every year or every two years, because the thing in job training (…) is that you are always explaining the same.(1)Possibility of choosing the order in which to clean the rooms.(2)Knowing the habits of clients .(3)Days having less work, they could advance other tasks. The supervisor interviewed supported this practice as well.(4)Having certain rooms assigned to the same cleaner everyday allows them to have more control over the workload throughout the days. The HR director interviewed supported this view:Control over work or autonomy is considered a key resource in the JD-R model and aspects related to it were very mentioned in the discourse of HHs. The most important factors reported as facilitators of control over work and autonomy were as follows:HH4.7. What’s more, you get organized yourself. What I mean is if a client tells me that they don’t want me to clean their room that day and I have a bit more flexibility with my time, I’ll do a little extra in the room I’m cleaning, for tomorrow. To get ahead.HRDir. Because each one likes to have their space and to have it under control.In contrast, some factors already mentioned, such as the role conflict arising from receiving different demands from different departments or clients and the state of the rooms were commented as making their control over work more difficult:HH3.1. Go back to each of the do-not-disturbs, go back to all the ones who told you they were sleeping, go back to all the ones who said “I can’t right now”, “come back later, I’m eating”, “ten minutes, I’m heading down to the beach”. And that puts me behind schedule.HH5.3. Because you really don’t know what you’re going to find when you open the room, if you’re going to be there for fifteen minutes, twenty or thirty.HHs stated that schedule was the most positive feature of their job: it was continuous—7 a.m. to 4 p.m. approx.- and it allowed them to better balance work, family and personal life:HHi2. For me the schedule is the best part of the job because you have afternoon off, even though you’re really tired.Clients were a main source of satisfaction and recognition of HHs’ work. Some clients leave a tip, others tidy up the room to make it easier to clean it, some congratulate them for the work done, etc.HH5.2. It is gratifying because the client knows you and says: “Oh, very nice, very nice, we like you.” And they’re pleased to tell you, you know? And then you feel good about the work you’ve done.Nonetheless, as aforementioned, interactions with clients were not always satisfactory: in a context of shortage of time, these interactions were demands and usually experienced as stressful:HH4.4: When new clients check-in and the card doesn’t work and they cannot open the door and you are like “Oh, don’t look at me, don’t see me.” And you see the old people: “Hey girl, this does not work.” And you are like “Oh, don’t call me.”The feelings of satisfaction stemmed also from the importance and meaning HHs gave to their job and the pride in doing the work accurately. Other positive aspects were relationships with clients and the wage, as aforementioned.Social support includes the relative presence or absence of psychological support resources from other significant people. From narratives from FG and interviews, it can be stated that HHs considered social support important: above all, HHs mentioned instrumental and emotional support.Regarding instrumental support, helping among HHs was mentioned as a quite unusual and informal practice, not explicitly proposed by hotel management. HHs reported that workload prevented them from helping their colleagues. Nevertheless, in most cases they tried to help colleagues when needed—sometimes without informing nor the supervisor neither managers, and some HHs pointed out they would like to work in pairs because some tasks would be easier to perform; so, most HHs would support that working in pairs was a more common practice. The head of occupational risk prevention service mentioned that hotel management hired more HHs when work load was unusually high. However, these “extra HHs” sometimes were not seen by HHs as helpful because they were not permanent employees and did not know how to do the work properly. Finally, HHs reported that in some cases the supervisor decided who was to be helped when a HH finished her work ahead of schedule:HH1.1. We can’t help each other any longer because it’s impossible. Because she’s just as busy as me.SUP. If they see that one of them isn’t doing well because she’s had problems because check-outs went badly, they lend each other a hand.Regarding emotional support, some HHs mentioned that relationship with colleagues was one of the most positive aspects of their job. However, sometimes there were interpersonal tensions due to the high pace work and time pressure:HH4.2. The relationships tend to be good.HH4.4. You fight, argue, laugh, kissHH4.7. But the stress and the exhaustionHH4.4. Why? Because they took your mop away, the mop is mine, the mop is yours, okay fine, you take it.HH4.7. What brings that on? Stress. Exhaustion.Experience working as HHs was the personal resource that helped them to cope with the workload. However, as they were getting more experience they were getting older as well. Thus, age was also perceived as a factor preventing them from doing their job properly:HH4.6. You have many years of experience, you know how to do your job well, but you don’t have the time or the energy to get it done and it produces anxiety where you just can’t take it anymore. You finish and leave work in tears.Summarizing, the most important resources related to work identified by HHs were salary (when compared to similar jobs), recognition from clients, satisfaction with the working schedule, satisfaction with a well-done work, and their experience working as HH. Other resources such as helping among HHs, social support among HHs, and training are important resources, but currently present to a lesser extent in their jobs.Most HHs reported different mental and physical outcomes related to their work. First of all, most HHs reported being nervous or stressed the whole working day because of work overload. This perception of not being able to cope with workload made them feel sad, not wanting to go to work, and psychologically burned out. Another source of stress was having to deal with clients sent to the room before it was ready. Consequently, most HHs described their job as making them “anxious”.A second mental outcome reported was being unable to disconnect from work due to work overload and the anxiety described above. This implied basically difficulties to sleep well and to enjoy leisure time.Third, HHs reported tension among co-workers and a bad work environment. From their point of view, not having enough time to face the workload involved getting angry with co-workers when they needed help, materials, etc.Last but not least, HHs described many physical health problems, mainly musculoskeletal disorders. HHs perceived that these were directly related to the organization of work—e.g., a high working pace, a high workload, and physical burden. One of the most commented strategies towards health problems was self-medication. HHs explained that they were taking anti-inflammatories and analgesics and, to a lesser extent, tranquilizers and anxiolytics. This information was confirmed by health workers and the head of the occupational risk prevention service interviewed:HH4.7. Constant stress. From the moment they give you the paper and you go home thinking about what you have to do the next day. (…) you don’t disconnect: “tomorrow I have so many check-outs, will I be able to get them done?”HHi4. Work overload is taking a toll on our health.HH5.2. I self-medicate (…) with pills, waiting until it really hurts so that I don’t have too much medication in my system. I’m tired of taking medication.Prev. Young workers still don’t take anything. But yes, somebody in their late forties, early fifties who’s been working 20 odd years in the hotel industry has to take some kind of medication.A short working day—from 7 am to 4 pm with 15 min for breakfast and 30 min for lunch-was mentioned as the most positive aspect of their job because it facilitated their WLB. Actually, the working schedule was one of the reasons given by HHs to take this job. It allowed them to take care of the kids—if they had children—without leaving their jobs, to do housework, and to enjoy social life:HH2.4. You have time for yourself, if you have kids you have time for home, for everything. To have a bit of a social life. The people who have a split shift are there almost 24 h.HH3.1. And I started because of the schedule. I had young kids and it worked well for me not to have a split shift. That was the only reason.Negative consequences on WLB reported by HHs were not having enough energy nor to face family demands neither to enjoy their family. Moreover, as aforementioned, HHs reported difficulties for disconnecting from work and resting when being at home, which had negative implications for enjoying personal time. These consequences on WLB were perceived as being caused by work overload and the physical burden of their job. Some reported the hardness of working as HH, being responsible of housework and having children. When arriving home exhausted from work, HHs had to go to the park with their children, cook dinner, tidy up the house, etc.:HH6.5. I have an eleven year old son, a one year old grandson, a thirty-two year old daughter and it’s stressful because I get home and my daughter tells me she’s coming over for lunch with my grandson. I should be happy but I’m not really. And I’m like, damn, now she’s coming over and I’m screwed. Because now I have to prepare food for four, clear the table…Because she’s coming to spend time with her mother, but her mother is thinking about all that she has to do…HHi2. Because for the person who carries such a heavy workload on the outside and inside, it’s hard to have relationships and you can’t do everything with your daughter that you’d like to.The two days-off HHs had per week also had consequences on WLB. Different situations regarding the days-off were identified. Some HHs reported that during the summer they could take just one day off per week due to workload and lack of staff. Others stated that they could enjoy always the same two weekdays-off, while others could not and the days-off changed from one week to another, sometimes unpredictably. The two days-off were perceived as a tool to balance work, family and personal life. When these days were constantly changing, difficulties in WLB increased:HH5.1. Because I went to the director and said: “I want to at least know one day that I’m getting off because if I have to see the doctor, they’re my personal things”.To sum up, the working schedule is perceived as the most positive aspect of HHs’ job for WLB; however, other work factors affect WLB negatively these women. HHs felt exhausted after their working day and had problems to disconnect from work when being at home; consequently HHs did not feel as having enough strength to face family and domestic demands or to enjoy leisure time. Moreover, despite days-off are perceived as a tool for WLB, in some cases hotel management constantly changed them and make WLB more difficult.The summary of the main findings—demands, resources and outcomes-are displayed in Previous research has focused mainly on demands of the HHs occupation ,20,26. DOur main findings see  showed tWork demands. Our results pointed out that work overload, time pressure and work pace, role conflict and the physical burden were perceived by HHs as the main stressors. Workload ,20 and iTime pressure and a high work pace were in part caused by the fact that the housekeeping department receives additional pressure by other departments in order to offer quick and high-quality services . These eRegarding role conflict, it stemmed from receiving requests—sometimes conflicting—from different hotel departments, from colleagues and from clients. Perceptions of occupying an unskilled and ‘servile’ job, performing women’s work and being the lowest rung among hotel workers ,51,57,58Moreover, HHs’ interactions with clients during their workday can become an added pressure —e.g., haOur findings suggest that interpersonal tensions were perceived as a result of stress more than a cause of it: they were experienced by HHs as derived from circumstances such as lack of equipment, time pressure and role conflict.Regarding the impact of demands on their physical status, HHs perceived that high work demands led them to fatigue, relation supported by evidence: similar patterns have been observed in different occupational settings—nurses, teachers, manufacturing and chemical industry, air-traffic controllers, in which unfavourable job demands were positively related to exhaustion ,46,60.Resources. On the positive side, main resources reported by HHs were recognition of clients, social support among HHs, job experience as HH, some control over the work, intrinsic rewards, and, to some extent, salary. HHs reported that clients were the main source of recognition and it was described as very important by HHs in FGs, generating self-pride and satisfaction as reported in Nimri et al. . NeverthBesides, social support from colleagues was mentioned as a positive feature of HHs’ job too. Although helping among HHs was not common due to workload, relationships among them were considered one of the most positive aspects. In this sense, Hunter Powell and Watson  identifiWorking experience as HH was valued as a personal resource, because it implied know-how to do the tasks properly and quicker; this positive attitude was expressed in Nimri et al. as “challenging due to the physicality and the monotony of the room attendants’ daily tasks” . On the HHs valued factors that allowed them to perceive a certain control over the work—e.g., choosing the order to clean the rooms, having certain rooms assigned, etc. These resources raised as strategies in order to counteract to some extent the lack of other important resources in their work setting—such as time.Although salary is considered as a resource, it has been reported as a negative factor in HHs’ work. Yilmaz  and KensOn the other hand, despite the little extrinsic reward HHs received, lack of recognition by bosses and co-workers and an insufficient salary, they felt proud of their job and found it meaningful, an intrinsic reward, as reported by other studies with cleaning staff ,65. ThisRelated to the little recognition and value given to HHs’ work, HHs mentioned insufficient training other than safety instruction, as reported in other studies with hotel workers and HHs ,20,49. ADespite resources commented by HHs, experiences and perceptions about salary, unrecognition from co-workers and unsatisfactory interactions with them, unclear promotion aspects and insufficient training could be factors that reinforced HHs’ feeling of ‘being maids’, being undervalued and being at the lowest rung of the organization.Regarding WLB, various HHs in our study explained that they started working as HH when they had children, because a continued working schedule allowed them to better balance work, family and personal life. However, changes in days-off made WLB more complicated, a situation described also in Cañada . WorkingAdditionally, analysis of HHs’ discourses shows that characteristics of their work and the stress suffered in the workplace have implications for the perceptions of WLB. One of the most immediate and reported effect was the fact that the working conditions leave them with insufficient resources to face domestic and care tasks, as reported in Cañada . BesidesThe interaction between work and family roles has adopted two perspectives: (1.) multiple roles—worker, spouse, mother—may give meaning to one’s life and have positive health outcomes (accumulation or enhancement hypothesis); (2.) multiple roles may lead to negative outcomes on health because they are a source of stress (overload hypothesis) . FindingIn this sense, HHs expressed work-family conflict when admitting difficulties to cope with housework due to their working role. According to our results, research showed that work-family conflict is negatively related to well-being  and, in Further, the social image of the home as a sanctuary, as a place to rest, to recuperate from problems at work, a place where solidarity reigns, etc., has been challenged by feminist studies ,77. HHs’Our research has practical implications both for policy makers and for Human Resources departments in hotels, who may improve organization of work and working conditions. Reducing work overload and psychosocial risk factors to which HHs are exposed would diminish stress levels and work-home conflict and improve HHs’ health status. Following the JD-R model we identify some basic proposals to improve HHs’ work. First, demands and the associated workload should be decreased . Second, resources should be increased . Third, the participation of HHs in decision-making processes related to the design of facilities, furniture acquisition, working materials, etc. would make HHs feel important in the hotel structure and may enhance their satisfaction with work and feelings of recognition. This kind of measures would increase their control over work and would diminish HHs’ perception of stress levels, improve their well-being, and probably their satisfaction and engagement with work. Additionally, practical implications regarding the reduction of the conflict between work and family life are directly related to the implementation of WLB policies and practices such as planning days-off in advance. Overall, reducing demands and increasing resources would have a positive effect on HHs’ well-being.Recruitment of participants in FGs was through general practitioners (GPs). This could introduce a bias related to an over-representation of discourses of HHs with more health problems—those attending the health care centre more frequently—and of those more occupationally stable—GPs would not know HHs who just work and live in the area during the season. We also acknowledge difficulties for recruiting young HHs and HHs with a temporary contract. Thus, we were not able to collect their discourse in a direct way. However, this recruitment method through GPs—without any link to enterprises or unions—gave HHs confidence to report their experiences related to health and work. Further, we believe that our results reflect reality of most HHs, as HHs’ associations  claim that stress and certain health problems—musculoskeletal disorders above all—are generalized in this occupational group.We should note limitations inherent to qualitative studies, such as weakness of external validity of the results and limitations to measure the incidence of stress among HHs. On the other side, qualitative methods allow to go in depth in explanations of the phenomena and getting rich information and shared accounts of facts and experiences. Future research on this area should follow survey-based studies to broaden the results. In fact, a later survey was carried out in a representative sample of HHs living and working in the Balearic Islands and will contribute with quantitative data about HHs’ working conditions, quality of life and levels of stress among others. This qualitative study was useful to design data collection survey and quantitative data will allow us to contrast whether discourses reported in this study are representative among HHs.Also, future research should consider the characteristics of specific work settings and family burden in order to explore how they influence the experience of stress and in their well-being. Different work settings, influenced by the size of hotel, leadership styles, the kind of organization of work, human resources policies of the company, etc. and different family situations  could lead to different experiences of stress. Moreover, and taking into account gender roles, it would be interesting to explore in-depth possible differences between men and women in perceived work demands and resources, family demands and the interaction between work and personal/family spheres.HHs are an occupational group with working conditions known to be physically hard. From HHs’ narratives obtained in our research, we can conclude that their job is also psychologically demanding and very stressful. HHs perceived their job as highly demanding in terms of work overload above all, without enough resources to cope with these demands, and having little extrinsic recognition. The outcomes of these features are not only high levels of mental strain and stress but also physical problems. Moreover, the analysis of this workforce from a gender perspective shows that hotel housekeeping work is an invisible and unrecognised job, and therefore is only visible when it is not done, characteristics shared with domestic work. The analysis also shows that work-home conflict is a relevant additional factor increasing the level of stress of HHs and emphasizing their physical exhaustion; negative outcomes of HHs’ job on WLB are reported, such as not being able to enjoy leisure time or family life. Some improvements should be made in HHs’ working conditions, e.g., reduce workloads, increase control over work, increase staff, etc., in order to diminish negative mental and physical outcomes and improve WLB.


We appreciate the authors’ interest in our article titled, “Evaluation of functional disability after Chikungunya infection”,According to the International Classification of Functioning, Disability and Health (ICF), functionality and disability are related to health conditions based on the organs’ and system’s functions and body structure and limitations to activities and social participation in the environment where an individual lives. Thus, functionality is used as a positive aspect, whereas disability is related to negative aspectsAnother critical point in our study was the assessment instrument used. The Roland-Morris Disability Questionnaire was initially developed to measure physical disability in patients with low back painAdditionally, we used QIRM-g because of psychometric characteristics consistent between our study and the study by Sardá Júnior, Nicholas, and Pimenta


We read with great interest the article entitled “Vesical schistosomiasis and squamous cell carcinoma associated with schistosoma haematobium: A re-emerging neglected tropical disease in Tehran, Iran” by Haghighi et al , publishSchistosoma haematobium wrongly as “schistosoma haematobium”. According to the binomial nomenclature system, each living organism is assigned a scientific name consisting of “genus” and “species”, both of which must be written in italic, with the genus name capitalized  were found together on the bladder wall ”, however, the figure does not show the presence of both or either sexes. More importantly, none of the figures is provided with essential information including scale bar, magnification number and staining method(s). The sizes of eggs in “figure 2 (B and C)” are almost equal despite different magnifications of the micrographs. Furthermore, it seems that the terminal spines of the eggs in “figure 2 (F)” are located at the opposite pole, not at the asterisk.It is also mentioned that “Histopathological examination confirmed It is claimed by the authors that, “During retrograde radiographic evaluations, thickening and linear calcification of the bladder and left unilateral dilation of the ureter were observed (figure 3)”. This is not correct, as thickening of the bladder wall cannot be observed using this technique. Linear calcification can be detected through plain radiography, computerized tomography (CT) scanning and ultrasonography, but not with retrograde radiography (retrograde cystography).In “figure 2 (A)”, the authors have stated: “Squamous cell carcinoma (SCC) , transitional cell carcinoma (TCC) (in deeper layer)”. These lesions look more likely to be granulomatous reactions but not malignancy. Moreover, squamous metaplasia is by definition, different from SCC, although the first condition may be a precursor for the latter one . SimilarIt should be noted that ethics approval for research is a necessity, which must have been included in the text accordingly, especially as inferred from the context, a considerable amount of tissue might have been obtained by vesical biopsy.To conclude, it is principally accepted that individuals with relevant specialties should be involved in every research work, for instance, at least a pathologist or urologist should have been included in the authors’ team to avoid inaccuracies and deficiencies. Moreover, it is of importance that authors of scientific communications always be welcoming comments and critics to their works. Finally, in order to fulfill their mission, the scientific journals for the sake of science, must practice sound and prudent processing of articles, most importantly through proper peer-reviewing of the submitted manuscripts.


Methadone maintenance treatment might be commonly associated with lying for several causes or manipulating psychiatrists and therapists by a number of patients. Deceptive patients tend to manipulate their psychiatrists for multiple causes. This study aims to improve clinicians’ therapeutic decision-making by identifying the reasons for increasing daily methadone maintenance dosage among deceptive patients. One hundred ninety-six patients undergoing the Methadone Maintenance Treatment (MMT) with no statistically significant difference between the overall Addiction Severity Index (ASI) scores at different doses of methadone (< 60 mg/d and ≥ 60 mg/d) and Ahvaz Reality Distortion Inventory (ARDI) scores > 30, were examined in the current qualitative study with multiple semi-structural interviews about the reasons for increasing daily methadone maintenance dosage. The investigation results revealed that the most common reasons for increasing daily methadone maintenance dosage among deceptive patients were opium craving, patient willingness to feel euphoria, fear of the withdrawal signs, earn money through the sale of surplus methadone, improve the symptoms of physical and psychiatric comorbidity, forgetting painful memories, curiosity, the influence of others, sexual issues, feeling of well-being, and appearance changes. Given these reasons, any increase in daily methadone maintenance dosage is not necessarily accompanied by improvement in the clinical condition of patients. However, clinicians can make the most appropriate therapeutic decision by putting the psychological assessments and clinical interviews into play. Methadone maintenance treatment might be commonly associated with lying for several causes or manipulating psychiatrists and therapists by a number of patients. Manipulation means deliberately developing or exaggerating the symptoms. Although psychiatrists are trained to collect the information vigilantly, they are likely to be manipulated. Recent studies have indicated that even experienced psychiatrists may fail to detect malingering in some cases. Patients tend to manipulate their psychiatrists for multiple causes. Sometimes they are motivated by secondary gains such as work exemptions, disability confirmation, or obtaining their interested medications. Others may seek primary gains like the psychological advantages of accepting the patient role . UnfortuUnderstanding the reasons for increasing daily methadone maintenance dosage among deceptive patients is important for two causes. Firstly, during the therapeutic decision-making process, psychiatrists confront two issues of trust and distrust in their deceptive patients’ complaints. These issues may lead to devastating effects by increased and steady constant or decreased daily doses of methadone maintenance. In this regard, knowing the reasons for increasing daily methadone maintenance dosage among deceptive patients can help trust some patients’ complaints and find the most appropriate treatment for them. The increased methadone dosage (particularly higher than 60 mg per day) has led to more complications, including QT interval prolongation, heart conduction disorders, osteoporosis, infertility, overdose, and chronic gastrointestinal complications  , 5. HoweBy investigating the reasons for increasing daily methadone maintenance dosage among deceptive patients, this qualitative study attempts to help improve the patient-physician relationship and obtain a more effective understanding of this patient group’s physical and psychological needs as mitigating the processes of transference and countertransference.In this qualitative study, the convenience sampling technique was used to collect the samples within a one-year period. During that period, after giving the necessary explanations about the purpose and methods, as well as following the principles of the Declaration of Helsinki, all the patients aged 18 to 50 who referred to rehabilitation centers of Zahedan and treated with less than 60 mg of methadone per day during the last month, were evaluated using the Addiction Severity Index (ASI). The exclusion criteria of the current study were: 1) Significant statistical difference between ASI scores of < 60 mg daily methadone consumption and ≥ 60 mg; 2) Illiteracy; 3) Severe physical and psychological diseases (like psychosis and bipolar disorders), which need immediate interventions; 4) Positive urine morphine test, two times in a row within two weeks or more than one week of absence; 5) Being homeless; 6) Intellectual disability; 7) Prisoners or immediate imprisonment; 8) Use of an illegal drug and medication.After evaluating 912 patients undergoing methadone maintenance treatments with ASI, 204 persons who increased methadone maintenance doses from < 60 mg to ≥ 60 mg, but with no significant difference in mean ASI scores with different amounts of methadone (< 60mg or ≥ 60mg), were selected. The Ahvaz Reality Distortion Inventory (ARDI) was used to confirm the deception of these patients. Only patients with ARDI scores > 30 were entered into the study . Then, tThe study started with several general questions on the subject. While designing the questions, previous literature with the comments of experts and faculty members were considered. Some of the questions had previously been designed based on the objective of the study, while other deep and exploratory questions  were devised based on the answers of the participants. The interviews with the patients and their companions were performed in the hospital, rehabilitation centers, or locations selected by them, including the hospital courtyard and the waiting rooms. The interviews were audio-recorded and transcribed verbatim. In order to analyze the obtained data, an analysis framework based on five steps of familiarizing, identifying a thematic framework, indexing, charting, and mapping, as well as interpreting was used. The content of each interview was written down within 24 hours. In this analysis, after familiarization with the range and diversity of the contents, the researchers identified the key concepts and topics based on which a conceptual framework was later designed. Next, all the texts corresponding to the individual interviews were reviewed and revised 2-4 times based on the obtained conceptual framework, followed by organizing the texts according to the most appropriate conceptual source. The concepts, conflicts, theories, experiences, and previous studies were also compared to each other, and the desired patterns and relations were extracted from the findings.Along with the data collection process, the coding process was also performed. The main concepts were defined in the form of initial codes. In the next stage, the codes with similar concepts were put together to create secondary classes using the MAXQDA software, version 18.The truncated version of the ASI scale consists of 106 questions covering six areas, namely the medical, substance use, employment, family, legal, and psychological conditions of the respondent. It measures the professional, family, legal, and psychological conditions of the respondent in the past 30 days, as well as the dosage, term, and severity of substance use. The questions are ranked based on the 5-point Likert scale (0-4). In Iran, Cronbach’s alpha coefficient of this questionnaire was between 0.65 and 0.89 [The ARDI questionnaire consists of 10 questions. Participants should choose one of the four options for each question. The total score of ten materials shows the distortion rate of reality for each subject. Earning more than 30 points in ARDI indicates a higher distortion of reality. Answers to questions take place in a framework of a 4-point Likert scale . Its internal consistency through Cronbach’s alpha coefficient was 0.75 .Based on the view of the interviewees, two categories of personal factors  and social factors , eleven themes of opium craving, patient willingness to feel euphoria, fear of the withdrawal signs, earning money through selling the surplus methadone, improving the symptoms of physical and psychiatric comorbidity, forgetting painful memories, curiosity, the influence of others, sexual issues, feeling of well-being, as well as appearance changes, as well as 21 subthemes were obtained concerning the increase in the daily dose of methadone maintenance among the deceptive patients.Example: “Whenever I went, someone was abusing drugs. There were even some people in the market who whispered prices for various drugs much cheaper than methadone. It seemed that my eyes were only seeing addicts, and my ears were only hearing the name of different drugs. I was always afraid of slipping up again” .Example: “I know that I am a weak person. So far, I have quit drugs many times, but I have always come back to them. I am tired of all of these. I did not want to fell in the trap of drugs once again” .Example: “After quitting drugs, I was so bored and tired that I was not in the mood for doing anything. I tried to feel better by increasing the dose of my methadone” .Example: “The euphoric pleasure after taking a drug was the only reason persuading me to abuse drugs again more than ever before. After quitting drugs, I loved to experience this euphoric feeling, this time with methadone” .Example: “Taking methadone has a pleasure that is temporary, but for reaching that brief pleasure, a man likes to use it more and more” .Example: “I do not like to go back to those days. I mean the days I was in withdrawal. It was so painful that I cannot even experience it one more time. In reality, from the day I quit the drugs and started methadone, I was always afraid of feeling so much pain so that I have to return to the drugs. I didn’t have any other option but to trick my doctor into increasing my dose of methadone” .Example: “The reality is that I wanted to see how much methadone in a day can give more pleasure to an individual” .Example: “When I was an addict, I would spend most of my time abusing drugs; now that I have quit drugs, I do not have any other entertainment but the methadone” .Example: “Abusing drugs messed me up. I have heard from others that taking methadone can increase your weight. I thought if I increased my dose, I would gain more weight quickly because I was totally embarrassed with my appearance” .Example: “My main problem and difficulty is unemployment. If I had a job, I would not be forced to lie to make a living” .Example: “To be honest, the difference between the free-market and the publicly-funded methadone was very high; thus, I realized I could buy the methadone from the government and sell it in the black market. In this way, I could make a living and also pay for my methadone” .Example: “The pressure to study was very high. I was highly stressed. When I increased the dose of methadone, I felt my anxiety decreases and I also felt learning is much easier for me” . Another patient said: “Nothing can improve my headache like methadone; it is like water poured on the fire” .Example: “I have so many bad memories in my life that even recounting them pains me. The beatings I received from my father... being humiliated in front of others. Nothing is important anymore. I only want to take a drug and forget everything” .Example: “When I stop taking methadone, I cannot have sexual relations; I do not have the physical endurance to do it. I have to take more methadone to be able to increase the duration of the sexual relation” .Example: “When my friends were betting on how they can trick their doctor into increasing their dose of methadone, I was too embarrassed to disagree with them” .Example: “I was hiding this from my doctor and my family, but I liked to show my friends that I am responsible for my own life and no one can control it” .Example: “My friends were always encouraging me to consume more methadone. They said consuming a low dose of methadone is not different from not consuming it at all” .Example: “I am a manual worker. In order to increase my physical capability for doing more work, I decided to increase the dose of my methadone. When I consumed more methadone, I did not get tired” .Example: “When I see that all my friends and family members are taking one type of illicit drug, I am free to take as much methadone as I like; nothing is more important for me than having a good mood and enjoying my time” .Example: “In our house, everybody is always fighting. You cannot have any peace of mind. I have to resort to anything to escape this environment” .Example: “When I was an addict, I was under immense pressure from others; now, I think I can take the methadone as much as I like because there is no pressure from others or the law. It seems that you have great support to consume as much methadone as you like and have fun” .The present qualitative study demonstrated increased daily methadone intake of deceptive patients due to two categories of factors: personal  and social , comprising opium craving, patient's desire for euphoria, fearing of withdrawal signs, earning money by selling surplus methadone, improving the symptoms of psychiatric and physical comorbidity, curiosity, forgetting painful memories, sexual issues, the influence of others, well-being feeling, and appearance changes, which is almost in line with the World Health Organization schematic model of drug use and dependence. Based on this model, multiple social factors  and individual factors  are involved. Through developing a neuro-adaptive state, according to the model, chronic substance use creates tolerance and withdrawal symptoms, resulting in gradually increased use of substance due to the reduced drug effect as well as the aversive consequences  Drug side effects , 14; 2) The present study has exposed some limitations, regarded as using a convenience sampling technique for sample collection, the relatively small sample size, and the selection of participants only from Zahedan. Based on the findings, increased daily dosage of methadone maintenance among deceptive patients has represented more contextual and local meaning relative to a general and universal meaning. Moreover, the removal of these limitations would improve the precision of the results.Psychiatrists are inefficiently trained to elicit the information well and be aware of deceptive patients. The optimal methadone dosage can be determined for the methadone maintenance treatment, possibly through psychological assessments and clinical interviews to analyze patients psychiatrically. The daily dosage of methadone can then be calculated based on the results, which prevent possible mistakes by the clinicians. As a consequence, this might minimize the side effects caused by methadone overuse, facilitating withdrawal in the future. Taking everything into account, providing the non-substance-related and comorbid disorders with mental training and pharmaceutical and non-pharmaceutical adoption has been impressive in reducing daily methadone dosage and improving the life quality and performance of patients undergoing the methadone maintenance treatment. Therefore, using the results of this study during the interview process, clinicians can make appropriate treatment decisions.The authors declare that there is no conflict of interest.


The entropy of a pair of random variables is commonly depicted using a Venn diagram. This representation is potentially misleading, however, since the multivariate mutual information can be negative. This paper presents new measures of multivariate information content that can be accurately depicted using Venn diagrams for any number of random variables. These measures complement the existing measures of multivariate mutual information and are constructed by considering the algebraic structure of information sharing. It is shown that the distinct ways in which a set of marginal observers can share their information with a non-observing third party corresponds to the elements of a free distributive lattice. The redundancy lattice from partial information decomposition is then subsequently and independently derived by combining the algebraic structures of joint and shared information content. X and Y, the entropy H satisfies the inequalityFor any pair of random variables From this inequality, it is easy to see that the conditional entropies and mutual information are non-negative,A and B, a measure For any pair of sets Although the entropy is not itself a measure, several authors have noted the entropy is analogous to measure in this regard ,4,5,6,7.ormation  between ormation , amount ormation  or co-inormation ),9)I . Indeed,μ(A∩B∩C) ). Conseqμ(A∩B∩C)  recommensigned measure that is valid for an arbitrary number of random variables. To do this, Yeung defined a signed measure on a suitably constructed However, Yeung ,7 showedmeaning” ,6.In this paper, we introduce new measures of multivariate information that are analogous to measures upon sets and maintain their operational meaning when considering an arbitrary number of variables. These new measures complement the existing measures of multivariate mutual information, and will be constructed by considering the distinct ways in which a set of marginal observers might share their information with a non-observing third party. In X and Y represent their respective observations. Say that Johnny is a third individual who can simultaneously make the same observations as Alice and Bob such that his observations are given by the joint variable x of variable X computed from the probability distribution X. Similarly, Bob’s expected information gain is given by the entropy Suppose that Alice and Bob are separately observing some process and let the discrete random variables  content ,(10)h Thus, X are independent of Bob’s observations Y, which leads Indiana to overestimate her information on average. Indeed, Indiana is so optimistic that the information she expects to get upper bounds the information that Johnny can expect to get,Since Johnny knows the joint distribution  content  and entr content , the non content , but ratSuppose that Eve is another individual who, similar to Indiana, does not make any direct observations, but with whom both Alice and Bob share their knowledge; i.e., Eve knows the joint realisation It seems clear that Eve’s information should always satisfy the following two requirements. Firstly, since Alice and Bob both share their knowledge with Eve, she should have at least as much information as either of them have individually. Secondly, since Eve has less knowledge than Johnny, she should have no more information than Johnny; i.e., in contrast to Indy, Eve should never have more information than Johnny. As the following theorem shows, these two requirements uniquely determine the functional form of Eve’s information:Theorem 1.The unique function Proof. Clearly, the function is lower bounded by union information content. The union information content is the maximum possible information that Eve can get from knowing what Alice and Bob know—it quantifies the information provided by a joint event Eve’s information is given by the maximum of Alice’s and Bob’s information, or the information content of the most surprising marginal realisation. Although we have defined Eve’s information by requiring it to be no greater than Johnny’s information, it is also clear that Eve also has no more information than Indiana. As such, Eve’s information satisfies the inequalityequality  satisfieequality , Eve’s iunique information content from x relative to y, and vice versa, respectively. It is easy to see that, since Eve’s information is either equal to Alice’s or Bob’s information (or both), at least one of these two functions must be equal to zero.Similar to how the conditional information contents  and 16)16) enablintersection information content. The intersection information content is the minimum possible information that Eve could have gotten from knowing either what Alice or Bob know, and is given by the information content of the least surprising marginal realisation.The inequality  also ena content , the comFinally, from  and 23)23)–25),,25), it To summarise thus far, both Alice and Bob share their information with Indiana and Eve, who then each interpret this information in a different way. By comparing X or Y. Similar to how the non-negativity of the entropy =EX entropy —i.e., weSince the expectation value is monotonic, and since the union information content satisfies the inequality , we get X relative to Y, and vice versa, respectively. Crucially, and in contrast to X relativNow, consider how much more information Indiana expects to get relative to Eve,ormation , since tormation  is non-nFinally, similar to , we can trast to , there isynergistic information content, and it quantifies how much more information one gets from knowing the joint probability As discussed at the beginning of the previous section, and as required in Theorem 1, one of the defining features of Eve’s information is that it is never greater than Johnny’s information,This decomposition can be seen in e to Bob  can be de to Bob ,(36)h(39)H(40)HIt also seems reasonable to expect that Eve’s information should not depend on the order in which Alice and Bob share their information, nor should the minimum information that Eve could have received from either individual. Again, since the maximum and minimum operators are commutative, the union and intersection information content both align with our intuition.Property 2.The union and intersection information content are commutative,(Commutativity)Z represent her observations. Say that Dan is yet another individual with whom, similar to Eve, our observers can share their information. Intuitively, it should not matter whether Alice, Bob and Charlie share their information directly with Eve, or whether they share their information through Dan. To be specific, Alice and Bob could share their information with Dan such that his information is given by Now, suppose that Charlie is another individual who, similar to Alice and Bob, is separately observing some process, and let the random variable Property 3.The union and intersection information content are associative,(Associative)Suppose now that Alice and Bob share their information with Dan such the information that he could have gotten from either Alice or Bob is given by Property 4.The union and intersection information content are connected by absorption,(Absorption)Now, say that Daniella is, similar to Eve or Dan, an individual with whom our observers can share their information. Consider the following two cases: Firstly, suppose that Bob and Charlie share their information with Dan such that the information that Dan could have gotten from either Bob or Charlie is given by Property 5.The union and intersection information content are distribute over each other,(Distributivity)n individuals and let n marginal observers directly share their information with Eve, and could clearly be considered for any subset Now, consider a set of Theorem 2.max operator. Separately, the marginal information contents form a meet semi-lattice min operator.The marginal information contents form a join semi-lattices Proof. Properties 1–3 completely characterise semi-lattices ,17. □Theorem 3.The marginal information contents form a distributive lattice  max and min operators.Proof. From Property 4, we have that the semi-lattices  lattice ,17.□n observers can share their information with Eve such that she has distinct information corresponds to an element in partially ordered set, or more specifically the free distributive lattice on n generators [n)th Dedekind number  . By the We now use Properties 1–6 to generalise the results of Theorem 1 and Theorem 4.The marginal information contents are a totally ordered set under the max and min operators.Proof. A totally ordered set is a partially ordered set with the connex property (p. 2 ).□eralises  and 24)n=2 and neralises  using thn. This distributive lattice for entropies can be seen in x, y, z and h with X, Y, Z and H, respectively.Now that we have generalised the union and intersection information content, similar to milar to  and 29)x from X,milar to , we can Crucially, however, Property 6 does not hold for the entropies—it is not true that Eve’s expected information x, y and z, respectively, and say that Alice, Bob and Charlie share their information with Eve such that her information is given by In  content  such thaNow, consider three more observers, Joan, Jonas, and Joanna, who observe the joint marginal realisations Of course, these new ways to share joint information are not just restricted to the union information. If Alice and Joanna share their information, then the information that Eve could have gotten from either is given by With all of these new ways to share joint marginal information, it is not immediately clear how we should decompose Johnny’s information. Nevertheless, let us begin by considering the algebraic structure of joint information content. From the inequality , we know-lattice  which weWe now wish to establish the relationship between this semi-lattice of joint information content sources and denote them by collections of sources which are given by the set Despite the fact that the overall algebraic structure is not a lattice, there is a lattice sub-structure position  , and itand Beer , we callfound in . Informampty set .n marginal observers is also given by the (n)th Dedekind number  . Cramptfound in . Informaand Beer . However3  . From , we havexclusion , we get ) (p. 57 ), and side using  and 76)S⊆A(x), dThe closed-form solution  from The(A22) of . As such(A22) of .Let us now use the closed-form solution  from Theposition  of Johnnn marginal realisations, and then subsequently inserting the results back into  Similai= content , there i content  is non-ni= content  and 86)94)i(x⊔yi(x⊔y(94)Despite lacking the clear interpretation that we had for the information contents, these functions share a similar algebraic structure. For example, by using  and 91)91), we c entropy . Moreove entropy , by usin entropy  and 92)(105)i.).(105)i. To be riable Z ,37,39. Nriable Z ,37. Therormation , which iThe secondary objective of this paper has been to understand and demonstrate how we can use the measures of shared information content to decompose multivariate information. We began by comparing the union information content to the joint information content and used this comparison to define a measure of synergistic information content that captures how much more information a full joint observer, Johnny, has relative to an individual, Eve, who knows which joint realisation has occurred, but only knows the marginal distributions. We showed how one can use this measure, together with the measures of shared information content, to decompose the joint information content. We then compared the algebraic structure of joint information to the lattice structure of shared information, and showed how one can find the redundancy lattice from the partial information decomposition  embeddedTo our knowledge, the only other approach that attempts to provide this pointwise perspective is due to Ince . Ince’s There are several avenues of inquiry for which this research will yield new insights, particularly in complex systems, neuroscience and communications theory. For instance, these measures might be used to better understand and quantify distributed intrinsic computation ,79. It i