Work stress, work motivation and their effects on job satisfaction in community health workers: a cross-sectional survey in China

The relationship between teachers' zest for work and teaching motivation: the mediating role of achievement goals

Objective

This study aims to investigate the mediating role of achievement goals in the relationship between teachers' zest for work and teaching motivation.

Method

The research was designed using the relational survey model. The research sample consisted of 518 teachers working in various cities in Turkey in 2023-2024 academic year fall semester. A convenience sampling method was used in sampling. Three Likert-type scales were used as data collection tools. In the data analysis, firstly, the data suitability to normal distributions was examined. As a result of the analysis, kurtosis and skewness values were examined and it was assumed that the data were normally distributed. SPSS Process extension was used to analyze the data.

Results and discussion

According to the research results, teachers' zest for work positively and significantly predicted strong and positive achievement goals. In addition, teachers' achievement goals significantly and positively predicted their teaching motivation. Additionally, teachers' zest for work positively and significantly predicted their teaching motivation. Moreover, it can be inferred that achievement goals for students have a mediating role in the relationship between teachers' zest for work and teaching motivation. In this context, it is suggested that policies that increase teachers' teaching motivation should be prioritized.

Stress Alleviation Methods for community-Based Health ActiVists (SAMBHAV): Development of a digital program for stress reduction for community health workers in rural India

Background

Community health workers (CHWs) face high levels of stress (both professional and personal) and risk of burnout, highlighting the need for efforts to promote their mental health and well-being. This study seeks to develop a digital stress reduction program for CHWs in rural India.

Methods

A stepwise design process was employed to adapt and digitize the evidence-based World Health Organization's Self-Help Plus (SH+) intervention for addressing psychological distress among CHWs in Madhya Pradesh, India. This involved participatory design workshops with CHWs to ensure that the digital stress reduction intervention would be relevant for their needs and the local culture and context. Small groups of CHWs reviewed the adapted program content, allowing the research team to make refinements such as simplifying language, tailoring content to the local setting, and ensuring that program materials are both interesting and relevant. Simultaneously, the research team digitized the content, leveraging a combination of video and graphical content, and uploaded it to the Sangath Learning Management System, a digital platform accessible on a smartphone app.

Results

In total, 18 CHWs contributed to the adaptation of the SH+ content and digital intervention development. Participants commented on finding some terms difficult to follow and recommended simplifying the language and providing detailed explanations. Participants offered positive feedback on the adapted content, expressing that they found the examples covered in the material both relatable and relevant to their own personal experiences at home and in the workplace. By combining participants' insights and comments with feedback from content experts, it was possible to finalize a digital Hindi version of the SH+ intervention for CHWs in rural India.

Conclusions

This study is timely given the continued detrimental impacts of the COVID-19 pandemic, and offers a promising and potentially scalable digital program to alleviate psychological distress among frontline health workers.

Examining Medical Staff Well-Being through the Application and Extension of the Job Demands-Resources Model: A Cross-Sectional Study

For medical staff, job satisfaction is essential for advancement on an individual and organizational level. This study looked into the relationships between challenging job demands, job resources, personal resources, and well-being. Additionally, it examined the potential mediating effects of emotional exhaustion and work motivation within the framework of the job demands-resources (JD-R) model. Results from a cross-sectional study of 267 medical employees at a second-grade comprehensive hospital in Jiangsu, China's mainland, indicated that challenging job demands and job satisfaction were positively correlated and mediated via (decreasing) emotional exhaustion. The relationship between job resources and job satisfaction was found to be mediated via (decreasing) emotional exhaustion and (increasing) work motivation. The investigation also demonstrated that the two regulatory focuses serve different purposes. It was discovered that promotion focus had a favorable effect on work motivation but a negative effect on emotional exhaustion. Conversely, preventive focus only positively predicted emotional exhaustion. Thus, the JD-R model offers a valuable structure for clarifying the job satisfaction of health personnel. The implications for enhancing individual and job outcomes are discussed.

"We are everyone's ASHAs but who's there for us?" a qualitative exploration of perceptions of work stress and coping among rural frontline workers in Madhya Pradesh, India

OBJECTIVE

More than a million female village-level lay providers called 'Accredited Social Health Activists (ASHAs)', who deliver primary care, face high levels of stress due to work demands and low compensation, within the context of poverty and gender inequality. Evidence on ASHAs has focused on workplace challenges from a system perspective, without sufficient probing into individual-level stress. This study aims to gain perspectives into the experiences of work stress, the related health symptoms, and the responses to stress among ASHAs in India.

METHODS

Focus group discussions (FGDs) conducted with ASHAs in Sehore district, Madhya Pradesh, were audio-recorded and transcribed. Grounded theory was used to generate themes under the various domains of ASHAs' work and domestic life. We identified pathways between the conditions that trigger stressful events, experiences of these events, resulting perceptions, effects on health and wellbeing, and approaches used by ASHAs to respond to stress.

RESULTS

Six FGDs with 59 ASHAs generated the following themes: (a) Facility: Workload, undue pressures, unstructured work; ASHAs' relationships with seniors (e.g., feelings of being disrespected, blamed, or targeted), and low access to physical and administrative resources; (b) Home: Feelings of guilt for putting less time for family/child care; disrespect by the elderly for a poorly incentivised job; (c) Community: Low acceptance by the villagers; caste- and gender-bias; difficult community-level relationships (emotional labour, fear/stigma towards her services); (d) Somatic and psychological symptoms: headache, exhaustion, depressive symptoms (to cite a few); and (e) Responses to stress: Motivation (support from peers, family, a sense of identity/pride, incentives), Individual strengths (e.g., social responsibility), and spiritual recourse mechanisms.

CONCLUSIONS

This study will inform the development of a strengths-based coaching intervention to address work stress among ASHAs. The findings are relevant to building the evidence on alleviation of work stress among female frontline cadres in low-resource settings globally.

Study on the determinants of health professionals' performance on diabetes management care in China

BACKGROUND

As the direct providers of diabetes management care in primary health care facilities (PHFs) in China, health professionals' performance on management care of diabetes determines the quality of services and patients' outcomes. This study aims to analyze the key determinants of health professionals' performance on diabetes management care in PHFs in China.

METHODS

We conducted a cross-sectional study in 72 PHFs in 6 cities that piloted the contracted family doctor service (CFDS). Self-developed questionnaire was used to measure three kinds of factors (capacity, motivation and opportunity) potentially influencing the performance of health professionals. The performance of diabetes management care in the study was measured as whether health professionals delivered 7 service items required by the National Basic Public Health Service Guideline with a total of 7 points and was divided into three grades of good, medium and bad. The questionnaire is self-administered by all the health professionals involved in the study with the number of 434. The Chi-square tests were used to compare differences of performance on diabetes management care among health professionals with different characteristics. The ordinal logistic regression was used to analyze the determinants on the performance of diabetes management care.

RESULTS

Health professionals who got higher score on diabetes knowledge test had odds of better performance on diabetes management care (OR = 1.529, P < 0.001). health professionals with higher degree of self-reported satisfaction on training (OR = 1.224, P < 0.05) and perception of decreasing workload (OR = 3.336, P < 0.01) had odds of better performance on diabetes management care. While health professionals with negative feeling on information system support had odds of worse performance on diabetes management care (OR = 0.664, P < 0.01).

CONCLUSIONS

Attention should be paid to the training of health professionals' knowledge on diabetes management capacity. Furthermore, measures to improve training for health professionals could satisfying their needs for self-growth and improve the motivation of health professionals. The information system supporting management care should be improved continuously to improve the health professionals' working opportunities and decrease the workload.

Association of Job Characteristics and Burnout of Healthcare Workers in Different Positions in Rural China: A Cross-Sectional Study

Objectives: Health workers in rural primary care systems are at increased risk of job burnout, but their associations with different positions have received scant attention in the literature. Thus, this study aims to measure job burnout in different positions in rural China and to identify factors associated with it. Methods: A cross-sectional survey was conducted with a total of 15,627 participants from six provinces in China. And job burnout was measured using the Chinese version of the Maslach Burnout Inventory-General Scale (MBI-GS). Multilevel regression analyses were used in examining factors potentially associated with job burnout in different positions. Results: Overall, more than half of providers suffered from moderate burnout. The degree of job burnout varied among different positions. Middle managers showed higher levels personal stress, while general staff showed the lowest interpersonal and self-evaluation dimensions of burnout. Job duty, job capability, job treatment, and career advancement are potential factors affecting these results. Conclusion: Interventions aimed at providing appropriate training and development opportunities, developing relevant career planning and management strategies, and implementing reasonable staffing and job design may be promising strategies for alleviating burnout in different positions and improving health system performance.

Predictors of burnout, compassion fatigue, and compassion satisfaction experienced by community health workers offering maternal and infant services in New York State

Although burnout has been increasingly well studied among medical (nurses, physicians, residents) and mental health providers (psychologists, psychiatrists, social workers), there continues to be a lack of attention on the well-being of community-based providers, such as Community Health Workers (CHWs), within the United States. Using cross-sectional data from 75 CHWs employed in 14 agencies funded through the Maternal and Infant Community Health Collaboratives Initiative (MICHC) in New York, our study examined predictors (anxiety, physical health, adverse childhood experiences, job satisfaction, role certainty, demographic and work characteristics) of burnout, compassion fatigue (CF) and compassion satisfaction (CS). Descriptive statistics were used to characterize our sample and linear regression was employed to investigate the correlates of burnout, CF and CS. Results indicated that CHWs with higher levels of anxiety and lower job satisfaction were more likely to have higher burnout scores. CHWs with higher levels of anxiety, lower job satisfaction and fewer days of poorer health were more likely to report higher CF. Those who worked more than 35 h per week were less likely to report higher CS. The study provides recommendations for organizational-level interventions to address risk factors of burnout and CF and promote CS among CHWs, such as bolstering supervision, encouraging greater communication, offering recognition/appreciation of CHWs and creating opportunities for self-care. Findings should be considered when designing organizational-level preventive measures that mitigate burnout and CF and promote CS.

Workload and emerging challenges of community health workers in low- and middle-income countries: A mixed-methods systematic review

BACKGROUND

Community health workers (CHWs) play an important role in improving access to health services to a broader population; particularly to communities living in remote areas. However, the productivity of CHWs is affected by the workload they have. We aimed to summarize and present CHWs' perceived workload in low-and middle-income countries (LMICs).

METHODS

We searched three electronic databases (PubMed, Scopus, and Embase). A search strategy customized for the three electronic databases was developed using the two key terms of the review (CHWs and workload). Primary studies conducted in LMICs that explicitly measured workload of CHWs and published in English were included, without date restrictions. Methodological quality of the articles was assessed by two reviewers independently using mixed-methods appraisal tool. We applied a convergent integrated approach to synthesize the data. This study is registered on PROSPERO, number CRD42021291133.

RESULTS

Of 632 unique records, 44 met our inclusion criteria, and 43 (20 qualitative, 13 mixed-methods, and 10 quantitative studies) passed the methodological quality assessment and were included in this review. In 97.7% (n = 42) of the articles, CHWs reported that they have a high workload. Having multiple tasks was the most commonly reported subcomponent of workload, followed by lack of transport; which was reported in 77.6% (n = 33) and 25.6% (n = 11) of the articles respectively.

CONCLUSION

CHWs in LMICs reported that they have a high workload; mainly related to having to manage multiple tasks and the lack of transport to access households. Program managers need to make careful consideration when additional tasks are shifted to CHWs and the practicability to be performed in the environment they work in. Further research is also required to make a comprehensive measure of the workload of CHWs in LMICs.

Exploring employment preferences of nurses to improve retention in rural China

BACKGROUND

The scarcity of nurses in rural China deserves serious consideration in light of the widening gap in health outcomes between rural and urban populations. The outflow of primary care nurses suggests the value of examining their employment preferences to identify possible effective incentives for their retention.

METHODS

Our research used discrete choice experiment methodology designed to quantitatively measure the relative importance of various job attributes valued by primary care nurses using conditional logit and mixed logit models. Willingness to pay and uptake rates were also calculated.

RESULTS

A total of 1744 registered nurses in township health centres were surveyed. Participants considered all the job attributes included in the study to be significant, with pay increases demonstrating the greatest potential to improve the retention of nurses. Among the non-monetary aspects of work, nurse-patient relationships, bianzhi (positions allocated to each unit by the Chinese government with special benefits) and educational opportunities ranked highest in importance for respondents. Responses to hypothetical policy proposals suggest that incentive packages are also likely to be effective.

CONCLUSIONS

Policy making regarding rural nurses' retention is an important undertaking that requires an evidence-based approach. Our findings provide a range of policy options that shed light on effective retention strategies. Tailoring policy incentives to primary care nurses is also necessary.

Exploring barriers to dementia screening and management services by general practitioners in China: a qualitative study using the COM-B model

BACKGROUND

Dementia has become a global public health problem, and general practitioners (GPs) play a key role in diagnosing and managing dementia. However, in Chinese primary care settings, dementia is underdiagnosed and inefficiently managed, and dementia screening and management services provided by GPs are suboptimal. The reasons underlying this gap are poorly understood. This study aimed to determine the barriers that hinder GPs from actively promoting dementia screening and management, and thereby provide insights for the successful promotion of dementia screening and management services in primary care.

METHODS

Purposive sampling was used. And focus groups and in-depth interviews were conducted face-to-face among GPs from community health service centers (CHSCs) in South China. Thematic analysis was used to identify barriers to screening and managing dementia and map them to the Capability/Opportunity/Motivation-Behavior model (COM-B model).

RESULTS

Fifty-two GPs were included. The COM-B model found nine barriers to implementing dementia screening and management services in primary healthcare: (1) poor capability: lack of systematic knowledge of dementia and inadequate dementia screening skills; (2) little opportunity: unclear pathways for referral, insufficient time for dementia screening and management, lack of dementia-specific leaders, and no guarantee of services continuity; (3) low motivation: outside of GP scope, worries associated with dementia stigma rooted in culture beliefs, and insufficient financial incentives.

CONCLUSIONS

Our study concluded that GPs were not yet ready to provide dementia screening and management services due to poor capability related to knowledge and skills of dementia, little opportunity associated with an unsupportive working environment, and low motivation due to unclear duty and social pressure. Accordingly, systematic implementation strategies should be taken, including standardized dementia training programs, standardized community-based dementia guidelines, expansion of primary care workforces, development of dedicated leaders, and the eradication of stigma attached to dementia to promote dementia screening and management services in primary care.

Job Satisfaction: Knowledge, Attitudes, and Practices Analysis in a Well-Educated Population

Job satisfaction has a huge impact on overall life quality involving social relationships, family connection and perceived health status, affecting job performances, work absenteeism and job turnover. Over the past decades, the attention towards it has grown constantly. The aim of this study is to analyze simultaneously knowledge, attitudes, and practices toward job satisfaction in a general population in a large metropolitan area. The data acquired from 1043 questionnaires-administered to subjects with an average age of 35.24 years-revealed that only 30% is satisfied by his job. Moreover, among all the tested sample, 12% receive, or often receive intimidation by their superior, and 23% wake up unhappy to go to work. Marital status and having children seem to be an important factor that negatively influences job satisfaction through worst behaviours. The multiple linear regression analysis shows how knowledge is negatively correlated to practices; although this correlation is not present in a simple linear regression showing a mediation role of attitudes in forming practices. On the contrary, attitudes, correlated both to knowledge and practices, greatly affect perceived satisfaction, leading us to target our proposed intervention toward mindfulness and to improve welfare regulation towards couples with children.

The barriers and facilitators of developing clinical competence among master's graduates of gerontological nursing: a qualitative descriptive study

BACKGROUND

Clinical competence development is a main goal of specialized nursing courses. Nonetheless, some master's graduates of gerontological nursing programs have inadequate Clinical competence. The aim of this study was to explore the barriers and the facilitators to clinical competence development among the master's graduates of gerontological nursing.

METHOD

This qualitative descriptive study was conducted in 2020. Participants were twenty nursing master's students, master's graduates, and instructors of gerontological nursing. They were purposively selected from several faculties of nursing and midwifery in Tehran, Isfahan, and Kashan, Iran. Semi-structured interviews were held for data collection and the conventional content analysis proposed by Graneheim and Lundman was used for data analysis. Data were managed using the MAXQDA 10 software.

RESULTS

The main barriers to clinical competence development were students' neglectfulness towards learning, inefficiency of educational system, and ineffective management. The main facilitators to clinical competence development were effective educational planning and management improvement.

CONCLUSION

There are different personal, educational, and managerial barriers and facilitators to clinical competence development among master's graduates of gerontological nursing. Effective educational planning and management improvement are needed for clinical competence development among master's students and graduates of gerontological nursing.

Impact of Job Satisfaction and Social Support on Job Performance Among Primary Care Providers in Northeast China: A Cross-Sectional Study

Background

Primary health care institutions face major challenges in maintaining the accessibility and affordability of health services. This requires primary care providers to change and improve their performance. Therefore, Study on the job performance is conducive to improve the quality of primary health care services and the sense of access of primary care providers.To understand the current status of job performance among primary care providers in Heilongjiang Province, China, and explore the impact of job satisfaction and social support on job performance, further to improve the job performance of primary care providers and ensure the stable development of primary health services.

Methods

A stratified sampling method was adopted to select 1,500 primary care providers from seven cities in Heilongjiang Province, China, using the gross domestic product development level of each city as a basis. A questionnaire survey was conducted (effective response rate was 85.8%) by using sociodemographic factors, job satisfaction scale, social support scale and job performance scale. One-way ANOVA or independent sample t-test was used to analyze the differences of demographic factors on job performance. Pearson correlation analysis was used to measure relationship between job satisfaction, social support and job performance. Hierarchical linear regression was used to analyze the relevant influencing factors associated with job performance among primary care providers.

Results

Among the primary care providers who participated in this survey, the mean job performance score was 22.189 (SD = 7.695). The job performance of primary care providers was positively correlated with job satisfaction (r=0.574, p < 0.001), and was also positively correlated with social support (r = 0.534, p < 0.001). Model 3 showed that job satisfaction (β = 0.299, p < 0.001) and social support (β = 0.149, p <0.001) are positive predictors of job performance, respectively. Moreover, the regression relationship explained that 37.6% for the variation of the dependent variable.

Conclusions

The job performance of primary care providers in Heilongjiang province is relatively low. Job satisfaction and social support are the relevant factors affecting the job performance of primary care providers. It is necessary to provide assistance to primary care providers in terms of family, organization, society, policy, etc., to improve their job performance, and to better provide high-quality health services to the grassroots.

Relationships among thriving at work, organisational commitment and job satisfaction among Chinese front-line primary public health workers during COVID-19 pandemic: a structural equation model analysis

OBJECTIVES

This study aims to explore the mediating effect and influence mechanism of organisational commitment on the association among thriving at work and job satisfaction among frontline primary public health workers (PHWs) in China during the COVID-19 pandemic.

DESIGN

This study is a cross-sectional written survey.

SETTING

We included 20 primary care units in northern provinces of China.

PARTICIPANTS

A total of 601 PHWs who worked in primary organisations and against COVID-19 on the front line were included.

METHODS

We collected the data from the participants' written questionnaire (Minnesota Satisfaction Questionnaire, thriving at work scale and organisational commitment scale), and programmed AMOS V.26.0 to develop a structural equation model (SEM) based on the relationships among the three variables.

RESULTS

The thriving at work scores of the primary PHWs were (M=3.17, SD=0.65), and job satisfaction was (M=3.05, SD=0.69); the scores of their thriving at work, organisational commitment and job satisfaction were all significantly correlated (p<0.01); and the SEM indicated that organisational commitment had a significant partial mediating effect between thriving at work and job satisfaction. The overall effect value was 0.867, and the mediated effect value was 0.422, accounting for 48.7% of the total effect size.

CONCLUSION

The thriving at work and job satisfaction scores of primary PHWs in China are moderate, and thriving at work not only affects job satisfaction directly, but also indirectly through organisational commitment. This study suggests that health policy-makers should promote job satisfaction among PHWs through relative inventions aiming to improve their thriving at work and organisational commitment.

Factors Influencing Medical Personnel to Work in Primary Health Care Institutions: An Extended Theory of Planned Behavior

In China, the primary health care institutions (PHCIs) have difficulty winning the trust of residents because of the shortage of medical personnel and the low level of skills. The government has advocated encouraging qualified doctors to work in PHCIs, but no obvious results are achieved. Based on the theory of planned behavior (TPB), this paper explores the factors affecting medical personnel seeking employment in PHCIs and then putting forward measures to improve the human resources construction of PHCIs. A three-stage survey was conducted to obtain the factors and a structural equation modeling (SEM) was applied to examine the relationship of the factors. We found that the factors affecting medical personnel to work in PHCIs include the specific conditions and work contents of PHCIs, as well as the family life and regional factors. Besides, there is a significant correlation and indirectness between these factors. Therefore, targeted measures can be proposed to improve the intention of medical personnel seeking employment in PHCIs. This study provides theoretical support for encouraging medical personnel to work in PHCIs and improving the primary health care system.

Adapting the depression component of WHO Mental Health Gap Intervention Guide (mhGAP-IG.v2) for primary care in Shenzhen, China: a DELPHI study

Background

Primary care doctors in Shenzhen, China are increasingly expected to identify and prevent depressive disorder; however, they have received limited mental health training and community healthcare centres (CHC) do not provide standardised protocols for the diagnosis and care of depressive disorder. The World Health Organization’s mental health gap intervention guide, version 2 (mhGAP-IG.v2) is a decision support tool for non-specialists for the assessment, management and follow-up of mental, neurological and substance use disorders (including depressive disorder). Given that mhGAP-IG.v2 is a generic tool, it requires adaptation to take account of cultural differences in depression presentation and unique characteristics of China’s emergent mental health system.

Methods

A two-round, web-based, Delphi survey was conducted. A panel of primary care doctors from Shenzhen, were invited to score their level of agreement with 199 statements (arranged across 10 domains) proposing changes to the content and structure of mhGAP-IG.v2 for use in Shenzhen. Consensus was predefined as 80% panelists providing a rating of either “somewhat agree/definitely agree”, or “definitely disagree/somewhat disagree” on a five-point scale for agreement.

Results

79% of statements received consensus with a mean score of 4.26 (i.e. “somewhat agree”). Agreed adaptations for mhGAP-IG.v2 included:- an assessment approach which considers a broader spectrum of depression symptoms and reflects the life course of disease; incorporating guidance for screening tool usage; clarifying physicians’ roles and including referral pathways for intersectorial care with strong family involvement; aligning drug treatment with national formularies; stronger emphasis of suicide prevention throughout all sections of the guide; contextualizing health education; reflecting a person-centred approach to care. Panelists chose to maintain diagnostic and treatment advice for bipolar patients experiencing a depressive episode as in the current guide.

Conclusions

An adapted mhGAP-IG.v2 for depression recognises China’s cultural and contextual needs for assessment guidance; unique primary healthcare system organization, priorities and treatment availability; and diverse psychosocial educational needs. An adapted mhGAP-IG.v2 could both inform the future training programs for primary care in Shenzhen and also offer an additional mental health resource for non-specialists in other countries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13033-022-00523-0.

Satisfaction with Public Hospital Reform and Associated Factors Among Medical Staff: A Cross-Sectional Survey in Wuhan, China

Purpose

To assess whether medical staff are satisfied with public hospital reform and its influencing factors.

Methods

A sample of 2000 medical staff from 13 public hospitals in Wuhan were surveyed with a self-administered questionnaire. Descriptive analysis and binary logistic regression were conducted to identify the status of the medical staff’s attitude to the reform and the influencing factors.

Results

A total of 61.4% of medical staff satisfied with the reform and the main reason was the promotion of their practice environment and social status brought by the reform. The logistic regression model indicated that the attitude to the reform of medical staff was positively associated with 9–11 hours of daily working time (OR = 2.373, as compared with less than 8 hours), higher income (OR = 1.966), the occupation of the nurse and medical technician (OR = 2.196–1.464 as compared with the doctor) as well as negative attitude towards the effectiveness of reform (OR = 3.676).

Conclusion

More than half of medical staff are satisfied with the public hospital reform, while some still hold negative attitude to the reform because of the extra working hours, low salary and high expectations due to professional characteristics and high input costs (education and time). Thus, in the current epidemic of prevention and control, more attention should be paid to the work pressure and enthusiasm of medical personnel. Administrators should pay attention to increasing income and improving the practicing environment and social status to prevent medical staff from treating reforms negatively.

Factors Influencing the Implementation of Foreign Innovations in Organization and Management of Health Service Delivery in China: A Systematic Review

Background: China has been encouraged to learn from international innovations in the organization and management of health service delivery to achieve the national health reform objectives. However, the success and effectiveness of implementing innovations is affected by the interactions of innovations with the Chinese context. Our aim is to synthesize evidence on factors influencing the implementation of non-Chinese innovations in organization and management of health service delivery in mainland China. Methods: A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched seven databases for peer-reviewed articles published between 2009 and 2020. Data were analyzed and combined to generate a list of factors influencing the implementation of foreign innovations in China. The factors were classified in the categories context, system, organization, innovation, users, resources, and implementation process. Results: The 110 studies meeting the inclusion criteria revealed 33 factors. Most supported by evidence is the factor integration in organizational policies, followed by the factors motivation & incentives and human resources. Some factors (e.g., governmental policies & regulations) were mentioned in multiple studies with little or no evidence. Conclusion: Evidence on factors influencing the implementation of foreign innovations in organization and management of health service delivery is scarce and of limited quality. Although many factors identified in this review have also been reported in reviews primarily considering Western literature, this review suggests that extrinsic motivation, financial incentives, governmental and organizational policies & regulations are more important while decentralization was found to be less important in China compare to Western countries. In addition, introducing innovations in rural China seems more challenging than in urban China, because of a lack of human resources and the more traditional rural culture.

Job satisfaction in a group of patients with tinnitus

BACKGROUND

Tinnitus is an auditory impression without any external auditory stimulus. It may cause negative symptoms (anxiety, insomnia, depression) significantly affecting work performance and job satisfaction.

OBJECTIVE

To evaluate the job satisfaction in tinnitus sufferers.

METHODS

Cross-sectional study were conducted and 51 individuals (23-70 years) were recruited. Participants completed two questionnaires: Tinnitus Handicap Inventory and Job Satisfaction Scale.

RESULTS

People affected by tinnitus report higher job satisfaction than healthy people. Job satisfaction was significantly related to age: r = 0.31; p < 0.05 in all tinnitus patients. There was a correlation between job satisfaction and tinnitus severity but only in people with normal hearing (-0.69; p < 0.05).

CONCLUSIONS

The results show that job satisfaction is affected by the level of tinnitus annoyance (from both its emotional and functional aspects), but only in people with normal hearing. In future research it is recommended that additional factors be investigated, both work and non-work related, to thoroughly explore the impact of tinnitus on job satisfaction.

Job Insecurity, Work-Related Flow, and Financial Anxiety in the Midst of COVID-19 Pandemic and Economic Downturn

During the COVID-19 pandemic, every domain of industry has experienced a severe economic downturn with concomitant stress throughout the economy. Employees working in government and private sectors are experiencing different psychological problems. The current study was conducted to investigate the role of work-related flow in the relationship of job insecurity with financial anxiety in the employees working in private and government sectors of Saudi Arabia. The sample comprised 1,195 employees, 886 females, and 309 males. The participants' ages ranged from 25 to 60 years. The Financial Anxiety Scale, Work-Related Flow Inventory, and Qualitative Job Insecurity Measures were found valid and reliable. Structural equation modeling was applied to test the associations. As hypothesized, the results indicated that job insecurity was positively related to financial anxiety, work-related flow was negatively associated with financial anxiety, and work-related flow mediated the relationship between job insecurity and financial anxiety. All these associations were significant regardless of gender, age, marital status, sector of employment, income, self-rated health, and COVID-19 infection status. Further research is needed to understand the impact of job insecurity on financial anxiety in-depth through the paths of work-related flow, especially in the midst of COVID-19.

Stress, anxiety, work-related burnout among primary health care worker: A community based cross sectional study in Kolar

Background:

Because of Primary Health care workers most of the national programmes run efficiently at grass root level. Workplace stress is alteration in one's physical or mental state in response to workplaces. Anxiety related to work among them is increasing and also Burnout.

Objectives of the Study:

To assess stress, anxiety and burnout related to work among ASHA workers and to assess the socio-demographic factors influencing the stress, anxiety and burnout related to work among ASHA workers.

Methodology:

This was a community based cross sectional study carried out for a period of 6 months from January 2019 to July 2019 at Kolar, India. Multistage cluster sampling was applied. From the selected 8 PHC all ASHA workers were part of the study. Sample size was calculated based on previous study with effect size of 1.5 from which final sample size was 150. Ethical clearance was obtained from the Institutional Ethical Committee (IEC) before the start of study. Written Informed consent was taken from the study. All data were entered in excel sheet and analyzed using SPSS version 22.

Results:

150 ASHA workers were interviewed. 75.5% belonged to Nuclear family, 50.7% belonged to age group of 31-40 years, 86.7% perceived that received payment for the work was low, 60.7% had to spend more than 2 hours for walking for the official work, 72% had work experience less than 10 years and 35.3% had working hours more than 8 hours. 45.3% had mild to moderate anxiety, 9.3% had Moderate Anxiety according to Zung Anxiety scale, 54% had moderate stress according to Cohen's perceived stress scale and 23.3% had personal burnout, 33 (22%) had work-related burnout and 4 (2.7%) had Client related Burnout of Moderate levels according to Copenhagen Burnout Inventory scale.

Conclusion:

Socioeconomic status, Training received before joining work, Type of work, perceptions regarding Work was found to be important factors affecting the mental health. Screening regularly for stress, anxiety and work-related burnout at work place is the need of the hour.

Clinical Psychological Assessment of Stress: A Narrative Review of the Last 5 Years

OBJECTIVE

Work-related stress typically occurs due to particularly challenging dynamics, risks and pressure. Prolonged exposure to stress may cause serious consequences on psychophysical well-being. The current study was conducted to reexamine the clinical instruments useful for evaluating the risk factors and to examine two closely linked dimensions, which may constitute protective factors such as coping strategies and satisfaction.

METHOD

Through a narrative review of the scientific literature of the last 5 years, carried out through the PubMed, Web of Science and Scopus databases, the most relevant clinical instruments used in the evaluation of stress, job satisfaction and coping strategies were examined.

RESULTS

Based on the considered inclusion criteria, 142 articles were selected, and 10 of the most used psycho-diagnostic instruments were identified for the evaluation of the three dimensions. The selected assessment instruments were deeply discussed in order to highlight strengths and limitations.

CONCLUSIONS

A variety of studies used a range of psycho-diagnostic tools in order to measure stress, coping strategies and job satisfaction. However, their integration is necessary to guarantee a complete evaluation protocol.

Effects of effort-reward imbalance, job satisfaction, and work engagement on self-rated health among healthcare workers

BACKGROUND

Healthcare workers, who protect and improve the health of individuals, are critical to the success of health systems and achieving national and global health goals. To respond effectively to the healthcare needs of populations, healthcare workers themselves must be in a good state of health. However, healthcare workers face various psychosocial pressures, including having to work night shifts, long working hours, demands of patient care, medical disputes, workplace violence, and emotional distress due to poor interactions with patients and colleagues, and poor promotion prospects. Constant exposure to these psychosocial hazards adversely impacts healthcare workers' health. Consequently, this study aimed to examine the influence of effort-reward imbalance, job satisfaction, and work engagement on self-rated health of healthcare workers. The results would be conducive to providing policy guidance to improve the health of healthcare workers.

METHODS

We analysed the data of 1327 participants from The Chinese Sixth National Health and Services Survey in Sichuan Province that was conducted from August 2018 to October 2018. Structural equation modelling was used to test the hypothesized relationships among the variables.

RESULTS

Only 40.1% of healthcare workers rated their health as 'relatively good' or 'good'. Effort-reward imbalance had a significant negative correlation with self-rated health (β = - 0.053, 95% CI [- 0.163, - 0.001]). The associations of effort-reward imbalance and work engagement with self-rated health were both mediated by job satisfaction (95% CI [- 0.150, - 0.050] and [0.011, 0.022]), and work engagement mediated the relationship between effort-reward imbalance and self-rated health (95% CI [- 0.064, - 0.008]).

CONCLUSION

In order to improve the health of healthcare workers, administrators should balance effort and reward and provide opportunities for career development and training. In addition, health managers should help healthcare workers realize the significance and value of their work and keep them actively devoted to their work through incentive mechanisms.

Understanding the importance of non-material factors in retaining community health workers in low-income settings: a qualitative case-study in Ethiopia

OBJECTIVES

The motivation and retention of community health workers (CHWs) is a challenge and inadequately addressed in research and policy. We sought to identify factors influencing the retention of CHWs in Ethiopia and ways to avert their exit.

DESIGN

A qualitative study was undertaken using in-depth interviews with the study participants. Interviews were audio-recorded, and then simultaneously translated into English and transcribed for analysis. Data were analysed in NVivo 12 using an iterative inductive-deductive approach.

SETTING

The study was conducted in two districts each in the Tigray and Southern Nations, Nationalities and People's Republic (SNNPR) regions in Ethiopia. Respondents were located in a mix of rural and urban settings.

PARTICIPANTS

Leavers of health extension worker (HEW) positions (n=20), active HEWs (n=16) and key informants (n=11) in the form of policymakers were interviewed.

RESULTS

We identified several extrinsic and intrinsic motivational factors affecting the retention and labour market choices of HEWs. While financial incentives in the form of salaries and material incentives in the form of improvements to health facility infrastructure, provision of childcare were reported to be important, non-material factors like HEWs' self-image, acceptance and validation by the community and their supervisors were found to be critical. A reduction or loss of these non-material factors proved to be the catalyst for many HEWs to leave their jobs.

CONCLUSION

Our study contributes new empirical evidence to the global debate on factors influencing the motivation and retention of CHWs, by being the first to include job leavers in the analysis. Our findings suggest that policy interventions that appeal to the social needs of CHWs can prove to be more acceptable and potentially cost-effective in improving their retention in the long run. This is important for government policymakers in resource constrained settings like Ethiopia that rely heavily on lay workers for primary healthcare delivery.

The effect of family doctor policy practice on primary health-care workers' health in Hongkou District of Shanghai, China: varied by occupational divisions?

BACKGROUND

A key component of the 2009 medical reform in China was the change to family doctor (FD) policy practice. However, this led to an increased workload for primary health-care workers (PHCWs) at community health service centres. Their increasing workload may play a significant role in affecting PHCWs' health.

METHODS

A questionnaire survey was conducted in Hongkou district of Shanghai amongst PHCWs including family doctors (FDs), family nurses (FNs), public health doctors (PHDs), and other PHCWs in early 2019. Ordered logistic regression models (Models 1 to 3) were performed to explore the differing health status amongst PHCWs, and their respective influential factors were also tested (Models 4 to 7).

RESULTS

Five hundred sixty-two valid questionnaires were collected with a response rate of 96.4%. Other PHCWs' (OR = 2.03; 95% CI: 1.163-3.560) and FNs' (OR = 1.98; 95% CI: 1.136-3.452) self-rated health (SRH) were significantly better than that of FDs. In terms of FNs, the OR of SRH for those who strongly perceived the extra workload brought by FD-contracted services was only 12.0% (95% CI: 0.018-0.815) of that of the no-pressure group. Similarly, FNs with stronger work pressure had worse SRH, i.e., compared with "no" pressure, the SRH ORs for "neutral," "strong," and "very strong" evaluations of work pressure were 0.002 (95% CI: 0.000-0.055), 0.001 (95% CI: 0.000-0.033), and 0.000 (95% CI: 0.000-0.006), respectively. Information technology (IT) systems and performance incentives were suggested to improve SRH for FNs, while the former was found to be negatively correlated with other PHCWs. After one unit increase in the PHDs' team/department support, their OR was 10.7 times (95% CI: 1.700-67.352) higher. In addition, policy support had a negative effect on SRH for PHDs. The OR of "good" assessments of cultural environments was 25.98 times (95% CI: 1.391-485.186) higher than that of "very poor" for Other PHCWs.

CONCLUSIONS

The influences of FD policy practice on FNs' SRH were the most significant amongst PHCWs, rather than FDs' as expected. The significant factors of SRH were varied over different occupational categories, that is team/department support and policy support (though negative) for PHDs, IT system and incentive for FNs, facility and equipment for FDs, and culture environment for other PHCWs respectively.

A motivational factors assessment instrument for medication management center employees providing medication therapy management services: A Rasch analysis

BACKGROUND

Telephonic medication management centers (MMCs) provide medication therapy management services to help alleviate medication-related issues and improve health outcomes. Motivation factors driving the performance of MMC personnel are key components in achieving these goals. Yet, published literature is limited on how motivation affects MMC personnel performance.

OBJECTIVE

To assess validity and reliability of the employee motivation questionnaire (EMQ), a 19-item measure of barriers and facilitators to motivation associated with MMC employees' work performance.

METHODS

Pharmacist, nurse, pharmacy technician, and intern employees (N = 534) from 5 telephonic-based U.S. MMCs were invited to complete the electronic EMQ. Rasch analysis was conducted in Winsteps software using a rating scale model. Construct and content validity and reliability were analyzed with employee and item separation index (SI) and reliability coefficient (RC). Linear regression was conducted to test the association of employee characteristics with individual work performance motivation.

RESULTS

A total of 319 employees completed the EMQ, 59.7% response rate. Principal components analysis suggested a unidimensional construct. Employee and item infit and outfit mean squared values met recommended fit criteria (0.5-1.5), suggesting that the data fit the model. An item-person map identified items that were easiest (joy of helping patients) and most difficult (motivated to work harder if incentives were tied to goal achievements) to agree with. Mismatch of employee motivation and item difficulty level on the measurement continuum (-1 to 0.92 logits) indicated a need for additional items that employees perceive as more difficult to agree with. The employee RC was 0.81 and the SI was 2.04; whereas, the item RC was 0.97 and the SI was 5.94. None of the variables tested illustrated statistically significant associations with the person motivation measure.

CONCLUSIONS

The EMQ illustrated reasonable content validity, good construct validity, and reliability evidence when used to measure motivation factors among MMC employees. Consideration of employee motivation factors may help to better meet MMC program goals and improve patient outcomes.

Sexual dysfunction and health condition in Chinese doctor: prevalence and risk factors

To our knowledge, little attention has been paid to the sexual function of health workers. The aim of the present study was to assess the frequency of sexual dysfunction among Chinese doctors. In addition, the risk factors for sexual dysfunction were analyzed. This was a questionnaire-based multicenter cross-sectional survey performed in five large academic medical centers in China. A total of 539 male doctors, 547 female doctors were evaluated. We analyzed doctors' demographic characteristics, quality of life, sexual function and attitudes towards sexual problems. Chinese doctors are at high risk of sexual dysfunction and poor health. The prevalence of sexual dysfunction appears to increase with age, and is associated with various social and demographic factors including monthly income, physical exercise, working hours, night shift and health-related quality. The quality of life and sexual health of doctors deserves special attention as a significant public health concern. Alleviating work pressure, increasing income, improving quality of life and therapeutic sexual problems should be considered comprehensively.

The experiences of foreign doctors in Saudi Arabia: A qualitative study of the challenges and retention motives

Background

The Saudi healthcare system is mainly staffed by foreign doctors who constitute about 73% of the total medical workforce. But, the high rate of turnover among these foreigners had deposited an additional unbearable cost and threatens the stability of the provided healthcare services in the country.

Objectives

This study was conducted to explore the professional and personal challenges that were experienced by foreign medical doctors while working in one of the major governmental tertiary-care hospitals in Riyadh city. The study also seeks to explore the factors that could influence or motivate their retention.

Methods

A qualitative study based on semi-structured interviews was conducted on January 2018. A total of 16 foreign doctors were recruited purposefully using a maximum variation sampling strategy. The interviews were recorded, transcribed verbatim, and analyzed using thematic analysis technique.

Results

Three primary themes have been emerged based on the data analysis: (1) Work-related challenges such as; communication and discrimination challenges. (2) Living-related challenges such as; supportive services and restricted movement challenges. (3) Factor motivating retention such as providing good children education, offering flexible traveling regulations, and providing professional development opportunities.

Conclusions

The findings of this study have indicated that there are more important motivators than money for improving the retention of foreign doctors in the country. Several policy actions have been recommended to maintain their essential role. For example; implementing an ethical code to protect them from receiving deceptive hiring information, developing a specialized pocket dictionary to overcome language barriers, embracing "workforce diversity management" techniques to minimize discrimination at institutional level, and finally it is also recommended to include the foreign doctors' family needs and other living related challenges in any future retention strategies.

Job satisfaction, burnout, and turnover intention among primary care providers in rural China: results from structural equation modeling

BACKGROUND

Low job satisfaction, severe burnout and high turnover intention are found to be prevalent among the primary care providers (PCPs) in township health centers (THCs), but their associations have received scant attention in the literature. In light of this, this study aims to examine the relationships between job satisfaction, burnout and turnover intention, and explore the predictors of turnover intention with a view to retaining PCPs in rural China.

METHODS

Using the multistage cluster sampling method, a cross-sectional survey was conducted in Shandong Province, China. 1148 PCPs from 47 THCs participated in this study. Job satisfaction, burnout and turnover intention were measured with a multifaceted instrument developed based on the existing literature, the Maslach Burnout Inventory and the participants' responses to a Likert item drawn from the literature, respectively. The relationships of the three factors were examined using Pearson correlation and structural equation modeling, while the predictors of turnover intention were investigated using multivariate logistic regression.

RESULTS

The subscale that the PCPs were most dissatisfied with was job rewards (95.12%), followed by working environment (49.65%) and organizational management (47.98%). The percentages of the PCPs reporting high-levels of emotional exhaustion, depersonalization and reduced personal accomplishment were 27.66, 6.06, and 38.74%, respectively. About 14.06% of the respondents had high turnover intention. There was a significant direct effect of job satisfaction on burnout (γ = - 0.52) and turnover intention (γ = - 0.29), a significant direct effect of burnout on turnover intention (γ = 0.28), and a significant indirect effect (γ = - 0.14) of job satisfaction on turnover intention through burnout as a mediator. Work environment satisfaction, medical practicing environment satisfaction, and organizational management satisfaction proved to be negative predictors of turnover intention (p < 0.05), whereas reduced personal accomplishment was identified as a positive predictor (p < 0.05).

CONCLUSIONS

Plagued by low job satisfaction and severe burnout, the PCPs in rural China may have high turnover intentions. Job satisfaction had not only negative direct effects on burnout and turnover intention, but also an indirect effect on turnover intention through burnout as a mediator. Targeted strategies should be taken to motivate and retain the PCPs.

Motivating factors on performance of primary care workers in China: a systematic review and meta-analysis

OBJECTIVE

Although China has made remarkable progress in strengthening its primary healthcare system, lack of well-performed primary health workforce is still the bottleneck of deepening the reform. The objective of this review is to understand the current profile of Chinese primary care workers (PCWs) and their motivating factors of performance and propose targeted policy suggestions on improving their work performance.

DESIGN

Systematic review.

METHODS

A systematic search of PubMed and MEDLINE was conducted to identify articles published from January 1, 2000, to June 2, 2018. Quality assessment and data extraction for the studies closely relevant to performance of PCWs in China were conducted by two reviewers independently. A preliminary framework containing different levels of factors influencing PCWs' motivation based on existence, growth and relatedness (ERG) theory guided the synthesis analysis. In addition, we used a random-effects model to pool individual studies on job satisfaction and estimate the overall job satisfaction of PCWs.

RESULTS

A total of 36 articles were included; 16 (23 882 participants) in the meta-analysis. Regarding the individual level of motivation, 3 overarching themes and 12 subthemes were developed. The subthemes of financial incentives, career advancement and work itself were frequently mentioned and have more influences on PCWs' performance. Moreover, the healthcare system reform policies have inevitable and complex impacts on different levels of human needs, and then influences on the motivation and performance of PCWs. Meta-analysis showed that the overall job satisfaction score among PCWs was 3.30, just reaching a satisfied rating and varied in different regions.

CONCLUSIONS

This study suggests low work satisfaction among PCWs in China, with financial incentives and career advancement being two most important motivating factors. Efforts to improve the work performance in PCWs should give priority to these motivating factors and systematically take into account the health policy's impacts on performance of PCWs.

Job satisfaction of the primary healthcare providers with expanded roles in the context of health service integration in rural China: a cross-sectional mixed methods study

OBJECTIVE

Against the backdrop of integrating public health services and clinical services at primary healthcare (PHC) institutions, primary healthcare providers (PCPs) have taken on expanded roles. This posed a potential challenge to China as it may directly impact PCPs' workload, income, and perceived work autonomy, thus affecting their job satisfaction. This study aimed to explore the association between the expanded roles and job satisfaction of the PCPs in township healthcare centers (THCs), the rural PHC institutions in China.

METHODS

A cross-sectional study using mixed methods was conducted in 47 THCs in China's Shandong province. Based on a sample of 1146 PCPs, the association between the proportion of PCPs' working time spent on public health services and PCPs' self-reported job satisfaction was estimated using the logistic regression. Qualitative data were also collected and analyzed to explore the mechanism of how the expanded roles impacted PCPs' job satisfaction.

RESULTS

One hundred eighty-four physicians and 146 nurses undertook increased work responsibilities, accounting for 15.91% and 12.61% of the total sample. For those spending 40-60%, 60-80%, and more than 80% of the working time providing public health services, the time spent on public health was negatively associated with job satisfaction, with the odds ratio being 0.199 [0.067-0.587], 0.083 [0.025-0.276], and 0.030 [0.007-0.130], respectively. Qualitative analysis illustrated that a majority of the PCPs with expanded roles were dissatisfied with their jobs due to the heavy workload, the mismatch between the income and the workload, and the low level of work autonomy. PCPs' heavier work burden was mainly caused by the current public health service delivery policy and the separation of public health service delivery and regular clinical services delivery, a significant challenge undermining the efforts to better integrate public health services and clinical services at PHC institutions.

CONCLUSION

The current policies of adding public health service delivery to the PHC system have negative impacts on PCPs' job satisfaction through increased work responsibilities for PCPs, which have led to low work autonomy and the mismatch between the income and the workload. The fundamental reason lies in the fragmented incentives and external supervision for public health service delivery and clinical service delivery. Policy-makers should balance the development of clinic and public health departments at the institutional level and integrate their financing and supervision at the system level so as to strengthen the synergy of public health service provision and routine clinical service provision.

Job satisfaction among Community-Based Rehabilitation (CBR) workers in caring for disabled persons in the east coast region of Peninsular Malaysia

Background

Job satisfaction influences staff retention, motivation, and performance in providing services. A considerable amount of published studies has reported on the job satisfaction level of healthcare workers, but to date, very few studies focused on Community-Based Rehabilitation (CBR) workers. This study aimed to explore the job satisfaction level among Community-Based Rehabilitation (CBR) workers and associated factors related to their overall job satisfaction.

Methods

A one-year survey was conducted in three states of the east coast region of Peninsular Malaysia involving 204 CBR workers selected through universal sampling method where all CBR staff who fulfilled the inclusion criteria were selected as participants. Self-completed questionnaires consisted of 20 association factors on six-point Likert scale responses were distributed. Total mean satisfaction level and mean associated factors were reported in this study.

Results

The results showed that the majority of the participants were between 20 and 40 years old (72%), female (96%), Malay (99%) and had 1–5 years of working experience. The mean total satisfaction score was 79.8 ± SD = 7.85. The highest mean satisfaction level for the associated factor was 4.6 ± SD = 0.59 with about 95% of the participants were satisfied that “CBR programme is a challenging work”, while the lowest satisfaction level for associated factor was on “salary of community-based rehabilitation staff is acceptable”, with mean score of 2.3 ± SD = 0.97 with about 59% of the participants felt dissatisfied. The results of this study determined that the highest dissatisfied factors among CBR workers were on salary.

Conclusion

These findings provided useful information for policymakers to evaluate this issue for a sustainable CBR programme in the future.

Trial registration

This study has been registered for trial as ‘retrospective registered’ in the Australian New Zealand Clinical Trials Registry (ANZCTR) (registration no.: ACTRN 12618001101279) on 5th October 2018.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6520-z) contains supplementary material, which is available to authorized users.

Perceived job stress among community nurses: A multi-center cross-sectional study

AIM

China is reforming its health care system, which aimed to strengthen primary health care through building community health centers (stations) and assigning a "gate-keeper" role to primary care providers. Community nurses play a key role in the reform. Little is known about the level of job stress among community nurses. Thus, this study aims to explore the level of perceived job stress and its influencing factors among community nurses.

METHOD

A cross-sectional design was used to conduct a survey with 1015 nurses from 56 community health centers in Sichuan province. Job stress was measured by the Community Nurses Stress Scale. Data were collected between March and November 2015.

RESULTS

Community health nurses in China perceived high levels of job stress. The job stress was related to nurses' individual characteristics and work environments. Permanently employed nurses, shift workers, and those older than 45 years age and with less training related to community nursing and involvement in childcare were more likely to experience high levels of stress.

CONCLUSION

Reform is required of the community nursing personnel system, and development of continuing education programs and stress-alleviating measures to reduce community nurses' job stress. The results of this study favour future advanced practice community health nursing practice and education.

Health-personnel recruitment and retention target policy for health care providers in the rural communities: A retrospective investigation at Pudong New Area of Shanghai in China

To tackle the shortage of health personnel in the rural areas of Pudong New Area of Shanghai, the local government issued an incentive policy as one of the medical reforms. The current investigation focused on the relevant incentive measures and their corresponding effects and problems with a view to providing referential and useful experiences for those who are engaged in addressing the same problem at home and abroad. The details of the incentive policy were derived from the government document, and the related data about the flow of the rural community health care providers, from the institutional investigation. As indicated by the current investigation, the incentive policy produced some positive effect in attracting health care providers to work in the rural community health centers, especially general practitioners, nurses, MS/MD degree holders, and intermediate professional title holders to be employed in the farther ones. However, it was turned out that the population of high quality health care providers was still not sufficient enough to cover the whole rural areas, which suggested that it was still hard to draw such qualified medical individuals. To conclude in the current investigation, we made three recommendations for the policymakers to take into account in terms of policy maintenance, benefits for health personnel, and guarantee of their lawful rights and interests.

Workplace violence, job satisfaction, burnout, perceived organisational support and their effects on turnover intention among Chinese nurses in tertiary hospitals: a cross-sectional study

OBJECTIVES

Our aims were to assess the relationship between workplace violence, job satisfaction, burnout, organisational support and turnover intention, and to explore factors associated with turnover intention among nurses in Chinese tertiary hospitals.

METHODS

The purposive sampling method was used to collect data from August 2016 through January 2017. A total of 1761 nurses from 9 public tertiary hospitals in 4 provinces (municipalities) located in eastern (Beijing), central (Heilongjiang, Anhui) and western (Shaanxi) regions of China completed the questionnaires (effective response rate=85.20%). A cross-sectional study was conducted using the Workplace Violence Scale, Chinese Maslach Burnout Inventory General Survey, Minnesota Job Satisfaction Questionnaire Revised Short Version, Perceived Organizational Support-Simplified Version Scale and Turnover Intention Scale.

RESULTS

A total of 1216 of 1706 (69.1%) participants had high turnover intention. During the previous 12 months, the prevalence of physical violence and psychological violence towards nurses was 9.60% and 59.64%, respectively. As expected, the level of turnover intention was negatively correlated with participants' scores on job satisfaction (r=-0.367, p<0.001) and perceived organisational support (r=-0.379, p<0.001), respectively. Burnout was positively associated with turnover intention (r=0.444, p<0.001). Workplace violence was positively associated with turnover intention (β=0.035, p<0.001) in linear regression analysis. The total effect (β=0.53) of workplace violence on turnover intention comprised its direct effect (β=0.36) and its indirect effect (β=0.17).

CONCLUSIONS

Perceived organisational support served as a mediator between workplace violence, job satisfaction, burnout and turnover intention, and it had a significantly negative impact on turnover intention. Therefore, nursing managers should understand the importance of the organisation's support and establish a reasonable incentive system to decrease turnover intention.

Delivery of public health services by community health workers (CHWs) in primary health care settings in China: a systematic review (1996-2016)

BACKGROUND

Community Health Workers (CHWs) have been widely used in response to the shortage of skilled health workers especially in resource limited areas. China has a long history of involving CHWs in public health intervention project. CHWs in China called village doctors who have both treatment and public health responsibilities. This systematic review aimed to identify the types of public health services provided by CHWs and summarized potential barriers and facilitating factors in the delivery of these services.

METHODS

We searched studies published in Chinese or English, on Medline, PubMed, Cochrane, Google Scholar, and CNKI for public health services delivered by CHWs in China, during 1996-2016. The role of CHWs, training for CHWs, challenges, and facilitating factors were extracted from reviewed studies.

RESULTS

Guided by National Basic Public Health Service Standards, services provided by CHW covered five major areas of noncommunicable diseases (NCDs) including diabetes and/or hypertension, cancer, mental health, cardiovascular diseases, and common NCD risk factors, as well as general services including reproductive health, tuberculosis, child health, vaccination, and other services. Not many studies investigated the barriers and facilitating factors of their programs, and none reported cost-effectiveness of the intervention. Barriers challenging the sustainability of the CHWs led projects were transportation, nature of official support, quantity and quality of CHWs, training of CHWs, incentives for CHWs, and maintaining a good rapport between CHWs and target population. Facilitating factors included positive official support, integration with the existing health system, financial support, considering CHW's perspectives, and technology support.

CONCLUSION

CHWs appear to frequently engage in implementing diverse public health intervention programs in China. Facilitators and barriers identified are comparable to those identified in high income countries. Future CHWs-led programs should consider incorporating the common barriers and facilitators identified in the current study to maximize the benefits of these programs.

Job Satisfaction among Health-Care Staff in Township Health Centers in Rural China: Results from a Latent Class Analysis

Background: The lower job satisfaction of health-care staff will lead to more brain drain, worse work performance, and poorer health-care outcomes. The aim of this study was to identify patterns of job satisfaction among health-care staff in rural China, and to investigate the association between the latent clusters and health-care staff’s personal and professional features; Methods: We selected 12 items of five-point Likert scale questions to measure job satisfaction. A latent-class analysis was performed to identify subgroups based on the items of job satisfaction; Results: Four latent classes of job satisfaction were identified: 8.9% had high job satisfaction, belonging to “satisfied class”; 38.2% had low job satisfaction, named as “unsatisfied class”; 30.5% were categorized into “unsatisfied class with the exception of interpersonal relationships”; 22.4% were identified as “pseudo-satisfied class”, only satisfied with management-oriented items. Low job satisfaction was associated with specialty, training opportunity, and income inequality. Conclusions: The minority of health-care staff belong to the “satisfied class”. Three among four subgroups are not satisfied with income, benefit, training, and career development. Targeting policy interventions should be implemented to improve the items of job satisfaction based on the patterns and health-care staff’s features.

Measuring and understanding motivation among community health workers in rural health facilities in India-a mixed method study

Background

Motivated human resource is the key to improve health system performance and retention of health workers. There is scanty literature on measuring motivation of health workers in India. Thus, the objective of this study was to measure and identify important aspects of health workers’ motivation in North India.

Methods

A mixed method study design was adopted. Under the quantitative component, we interviewed randomly selected 62 community health workers (CHWs) in 18 sub-centres in two blocks of District Ambala, Haryana, India using a structured motivation scale. In-depth interviews were also carried out with 18 CHWs to explore the sources of motivation.

Results

The age of respondents and training in the past 12 months were found to be significantly associated with motivation. Job burnout, poor personal health, job insecurity and less career development opportunities were the individual level de-motivators, whereas not being able to fulfil family roles and poor supportive supervision were identified as environmental factors for poor motivation. Love for work, and financial incentives were individual level motivators, while community support and recognition, organizational commitment and pride, regular training were identified as environmental level motivators.

Conclusion

Non-financial motivators such as interpersonal relations, family support, skill and career development opportunities require more attention. Regular need-based training is essential to maintain high levels of motivation.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1614-0) contains supplementary material, which is available to authorized users.

Job satisfaction and associated factors among healthcare staff: a cross-sectional study in Guangdong Province, China

OBJECTIVES

This cross-sectional study aimed to explore job satisfaction among healthcare staff in Guangdong following the health system reforms in 2009, and to investigate the association between job satisfaction and work stress, work-family conflict and doctor-patient relationship.

DESIGN

Cross-sectional survey.

SETTING

The Fifth National Health Service Survey was carried out in Guangdong, China.

PARTICIPANTS

All participants in this study were healthcare staff including physicians, nurses and public health staff from hospitals, health service centres and health clinics. A total of 6583 questionnaires were distributed and collected. After excluding the incomplete questionnaires, 5845 questionnaires were included for the analysis.

OUTCOME MEASURES

Sociodemographic information and scores for evaluating job satisfaction, work stress, work-family conflict and doctor-patient relationship were obtained using the questionnaire developed by the National Health and Family Planning Commission of the People's Republic of China. To assess the significantly associated factors on job satisfaction of the healthcare staff in Guangdong, a binary logistic regression model was used.

RESULTS

Based on the 5845 valid responses of the healthcare staff who worked in Guangdong, the mean score of overall perception of job satisfaction was 3.99 on a scale of 1-6. Among the sociodemographic variables, occupation, educational background, professional status, years of service, annual income and night shift frequency significantly influenced the level of job satisfaction. Work stress, work-family conflict and doctor-patient relationship also had significant effect on job satisfaction.

CONCLUSIONS

The overall job satisfaction exceeded slightly dissatisfied (score 3) and approached slightly satisfied (score 4). Measures to enhance job satisfaction include the reduction of workload, increase of welfare, maintaining moderate stress and balancing work-family conflict. Moreover, relevant laws should be issued to protect the healthcare staff from violent acts.

Occupational Hazards in the Thai Healthcare Sector

Healthcare personnel work in vulnerable conditions that can adversely impact physical and/or mental health. This paper aims to synthesize the state of knowledge on work-related illnesses, injuries, and risks experienced by Thai healthcare workers. We found that Thai healthcare personnel, like others worldwide, are at risk for injury related to needle sticks and sharp instruments; infectious diseases due to biological hazards exposure such as airborne pathogens and patient secretions; muscle pain due to workload and long duration of work; and psychological disorders related to stressful working conditions. Because detailed surveillance data are limited for the Thai healthcare workforce, we recommend that additional surveillance data on Thai healthcare workers' health outcomes be collected. Future research efforts should also focus on evidence-based interventions in order to develop methods to prevent and treat occupational health injuries and illnesses acquired in the workplace for Thai healthcare sector workers.

Determinants of job motivation among frontline employees at hospitals in Tehran

Introduction

Human resources are the most strategic resource and the most significant input for health systems. Their behavior and motivation can strongly affect the overall performance of the health systems. The aim of this study was to determine the factors that affect motivation in frontline employees at teaching hospitals affiliated with Shahid Beheshti University of Medical Sciences (SBMU) in Tehran, Iran.

Methods

This cross-sectional study was conducted in 2015. The participants (nurses, physiotherapists, radiology and laboratory technicians, operating room and pharmacy staff) were 300 employees selected by the stratified random sampling method from two general and teaching hospitals. The data collection instrument was a questionnaire that consisted of 42 questions in the 7 domains of motivational factors. Data analysis was performed using descriptive statistics and independent samples t-test by SPSS software, version 23.

Results

The findings indicated that working relationships (mean of 3.95) were the main determinant of job motivation of frontline employees. Job content (3.76) career development (3.75), social respect (3.75), and autonomy (3.30) were the next four affective factors. Recognition and remuneration had the least influence on the job motivation of frontline employees. The results of the Friedman test indicated that the difference between the mean scores of different dimensions was significant (χ²₍₆₎ = 607.00, p < 0.001).

Conclusion

A hospital that seeks to engender increased motivation of its frontline employees should have in place a human resources strategy that includes facilitating communication between personnel and management, supporting employees in the community, and promoting social respect for health professions, providing educational opportunities and career development, development of appropriate promotional policies, employee participation in goal setting, facilitating a good working environment and job security, job enrichment, and delegation.

Job satisfaction of urban community health workers after the 2009 healthcare reform in China: a systematic review

PURPOSE

In 2009 China introduced a new round of healthcare reform to strengthen primary care networks through the development of Community Health Services (CHS). This study aimed to measure the degree of overall job satisfaction and also satisfaction dimensions and then find common causes of dissatisfaction among Community Health Workers (CHWs) in urban China by conducting a systematic review of relevant studies on CHWs' job satisfaction.

DATA SOURCES

Web of Science, PubMed, Google scholar, Wanfangdata and CNKI were searched.

STUDY SELECTION

Publications about job satisfaction of CHWs were screened and assessed. Finally 18 Chinese articles and 4 English articles were included.

DATA EXTRACTION

Quantitative and qualitative data were extracted for nine themes concerning job satisfaction. Narrative synthesis was employed to analyze the data.

RESULTS OF DATA SYNTHESIS

CHWs were generally neither satisfied nor dissatisfied with their work after 2009. Financial rewards and opportunities for professional development were the most important determinants of job dissatisfaction. Workers were generally satisfied with interpersonal relationships in the workplace. The expanded public health services package and human-resources related regulations, e.g. the professional rank promotion system, government-controlled staffing policy (i.e. staff-quota system) and government-controlled budgetary planning (i.e. the Separation of Revenue and Expenditure), were policies that had an effect on job satisfaction.

CONCLUSION

Financial rewards and professional development were the two main predictors of job satisfaction. To improve CHS in China, policy-makers (especially the central government) need to consider the impact of current policies on job satisfaction in order to reduce job dissatisfaction.

Student nurses' motivation to choose gerontological nursing as a career in China: a survey study

BACKGROUND

The world's population is aging, and the need for nurses is increasing. Working with older adults, however, has always been an unpopular career choice among student nurses. It is important to understand student nurses' motivation for choosing gerontological nursing as a career.

OBJECTIVES

The purpose of this study was to examine the motivation for choosing gerontological nursing as a career and to identify the associated factors among student nurses.

DESIGN

Cross-sectional survey.

SETTINGS AND PARTICIPANTS

Participants were last-semester student nurses from 7 universities offering nursing undergraduate programs in Shandong, China. Of the 1290 student nurses, 916 completed the survey (a response rate of 71.0%).

METHODS

The outcome variable was the motivation to choose gerontological nursing as a career. This was measured using a motivation questionnaire that included expectancy and value subscales. Other instruments included the Chinese version of the Facts on Aging Quiz I, the Geriatrics Attitudes Scale, the Anxiety about Aging Scale, a clinical practice environment questionnaire and a self-administered general information questionnaire.

RESULTS

Student nurses' expectancy and value aspects of motivation for choosing gerontological nursing as a career were both at a moderate level; the highest value they held was of personal interest. Clinical practice environment, anxiety about aging and the attitudes about geriatrics were the main factors influencing student nurses' motivation to choose gerontological nursing as a career in China.

CONCLUSIONS

It is imperative for nurse educators to improve the gerontological nursing clinical practice environment for student nurses. Moreover, cultivating student nurses' positive attitudes about geriatrics and relieving anxiety about aging could be beneficial.

The development of urban community health centres for strengthening primary care in China: a systematic literature review

INTRODUCTION

This review outlines the development of China's primary care system, with implications for improving equitable health care.

SOURCES OF DATA

Government documents, official statistics, and recent literature identified through systematic searches performed on NCBI PubMed.

AREAS OF AGREEMENT

Community health centres (CHCs) are being developed as the major primary care provider in urban China, with laudable achievements. The road towards a strong primary care-led system is promising but challenging.

AREAS OF CONTROVERSY

The effectiveness in improving equitable care through the expansion of primary care workforce and redesign of the social medical insurance system warrants further exploration.

GROWING POINTS

Healthcare disparities exist in the health system wherein universal health coverage and gatekeepers have not yet been established.

AREAS TIMELY FOR DEVELOPING RESEARCH

Future prospective studies should aim to provide solutions for strengthening the leading role of CHCs in providing equitable care in response to population ageing and multimorbidity challenges.