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

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          Abstract

          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.

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          Factor structure of the Maslach burnout inventory: an analysis of data from large scale cross-sectional surveys of nurses from eight countries.

          Job burnout is an important predictor of nurse retention. Reliable and valid measures are required to monitor this phenomenon internationally. To evaluate the applicability of the Maslach burnout inventory (MBI) in international nursing research. Secondary analysis of cross-sectional hospital nurse survey data from eight countries. Hospitals in the U.S., Canada, the U.K., Germany, New Zealand, Japan, Russia and Armenia. 54,738 direct care professional nurses from 646 hospitals in eight countries. Confirmatory and exploratory factor analysis were undertaken to identify the factor structure of the MBI. The internal consistencies of the subscales were investigated. Exploratory factor analysis revealed three factors being extracted from the 22-item Maslach burnout inventory. In nearly all countries the two items (6 and 16) related to the "stress" and "strain" involved in working with people loaded on the depersonalization subscale rather than the emotional exhaustion subscale to which they were initially assigned. The three subscales exhibited high reliability with Cronbach alphas exceeding the critical value of 0.70. The correlation coefficients for the emotional exhaustion and depersonalization subscales were strong and positive. The 22-item Maslach burnout inventory has a similar factor structure and, with minor modifications, performed similarly across countries. The predictive validity of the emotional exhaustion and depersonalization subscales might be improved by moving the two items related to stress and strain from the emotional exhaustion to the depersonalization subscale. Nevertheless, the MBI can be used with confidence as a burnout measure among nurses internationally to determine the effectiveness of burnout reduction measures generated by institutional and national policies.
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            The effects of health worker motivation and job satisfaction on turnover intention in Ghana: a cross-sectional study

            Background Motivation and job satisfaction have been identified as key factors for health worker retention and turnover in low- and middle-income countries. District health managers in decentralized health systems usually have a broadened ‘decision space’ that enables them to positively influence health worker motivation and job satisfaction, which in turn impacts on retention and performance at district-level. The study explored the effects of motivation and job satisfaction on turnover intention and how motivation and satisfaction can be improved by district health managers in order to increase retention of health workers. Methods We conducted a cross-sectional survey in three districts of the Eastern Region in Ghana and interviewed 256 health workers from several staff categories (doctors, nursing professionals, allied health workers and pharmacists) on their intentions to leave their current health facilities as well as their perceptions on various aspects of motivation and job satisfaction. The effects of motivation and job satisfaction on turnover intention were explored through logistic regression analysis. Results Overall, 69% of the respondents reported to have turnover intentions. Motivation (OR = 0.74, 95% CI: 0.60 to 0.92) and job satisfaction (OR = 0.74, 95% CI: 0.57 to 0.96) were significantly associated with turnover intention and higher levels of both reduced the risk of health workers having this intention. The dimensions of motivation and job satisfaction significantly associated with turnover intention included career development (OR = 0.56, 95% CI: 0.36 to 0.86), workload (OR = 0.58, 95% CI: 0.34 to 0.99), management (OR = 0.51. 95% CI: 0.30 to 0.84), organizational commitment (OR = 0.36, 95% CI: 0.19 to 0.66), and burnout (OR = 0.59, 95% CI: 0.39 to 0.91). Conclusions Our findings indicate that effective human resource management practices at district level influence health worker motivation and job satisfaction, thereby reducing the likelihood for turnover. Therefore, it is worth strengthening human resource management skills at district level and supporting district health managers to implement retention strategies.
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              The relationship between job satisfaction, work stress, work–family conflict, and turnover intention among physicians in Guangdong, China: a cross-sectional study

              Objective To investigate the relationship between job satisfaction, work stress, work–family conflict and turnover intention, and explore factors associated with turnover intention, among physicians in Guangdong Province, China. Methods From August to October 2013, physicians completed questionnaires and scales with regard to their job satisfaction, work stress, work–family conflict, and turnover intention. Binary logistic regression and structural equation modelling (SEM) were used in data analysis. Results A total of 3963 physicians were approached, with 3563 completing the questionnaire. The mean score of the overall perception of turnover intention of physicians who worked in Guangdong was 2.71 on a scale ranging from 1 to 6. Hours worked per week, working in an urban/rural area, type of institution, and age significantly impacted on turnover intention. Turnover intention was directly and negatively related to job satisfaction, and it was directly, indirectly and positively related to work stress and work–family conflict. Conclusion Job satisfaction, work stress, work–family conflict, hours worked per week, working in an urban/rural area, types of institution and age are influencing factors of turnover intention. Reducing working hours, raising salary, providing more opportunities for career development and training, supporting and encouraging physicians by senior managers could potentially contribute to the reduction in turnover intention.
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                Author and article information

                Contributors
                beibeiyuan@bjmu.edu.cn
                Journal
                BMC Fam Pract
                BMC Fam Pract
                BMC Family Practice
                BioMed Central (London )
                1471-2296
                15 January 2020
                15 January 2020
                2020
                : 21
                : 12
                Affiliations
                [1 ]ISNI 0000 0004 1761 1174, GRID grid.27255.37, School of Health Care Management, , Shandong University, ; Jinan, 250012 China
                [2 ]ISNI 0000 0004 1761 1174, GRID grid.27255.37, NHC Key Laboratory of Health Economics and Policy Research (Shandong University), ; Jinan, 250012 China
                [3 ]ISNI 0000 0001 2256 9319, GRID grid.11135.37, Department of Global Health, School of Public Health, , Peking University, ; Beijing, 100191 China
                [4 ]ISNI 0000 0001 2256 9319, GRID grid.11135.37, China Center for Health Development Studies, , Peking University, ; Beijing, 100191 China
                [5 ]GRID grid.410585.d, School of Public Administration, , Shandong Normal University, ; Jinan, 250014 China
                [6 ]Health Commission of Weifang, Weifang, 261061 Shandong China
                Article
                1083
                10.1186/s12875-020-1083-8
                6961377
                31941455
                6e64ec2e-79c4-433a-b264-67ef31dbefaa
                © The Author(s). 2020

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 28 July 2019
                : 8 January 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 71403008
                Award Recipient :
                Funded by: Shandong University
                Award ID: IFYT18033
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Medicine
                job satisfaction,burnout,turnover intention,primary care providers,structural equation modeling

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