Developing a tool to measure satisfaction among health professionals in sub-Saharan Africa

Human Resources for Health

Alexandre Dumont²  Florence Morestin¹  Aline Philibert⁴  Idrissa Diop³  Pierre Fournier⁴  Adama Faye⁴ 

[1] Institut National de Santé Publique du Québec, Montreal, QC, Canada;Institut de Recherche Pour le Développement, UMR 216, Université Paris Descartes, Sorbonne Paris Cité, Paris, France;HYGEA, Dakar, Senegal;University of Montreal Hospital Research Centre (CRCHUM), 3875 Saint-Urbain St., 2nd Floor, Montreal, QC H2W 1V1, Canada

关键词: Measurement;    Health workers;    Sub-Saharan Africa;    Job satisfaction;   

Others  :  822471
DOI  :  10.1186/1478-4491-11-30

 received in 2012-09-19, accepted in 2013-05-30,  发布年份 2013

【 摘 要 】

Background

In sub-Saharan Africa, lack of motivation and job dissatisfaction have been cited as causes of poor healthcare quality and outcomes. Measurement of health workers’ satisfaction adapted to sub-Saharan African working conditions and cultures is a challenge. The objective of this study was to develop a valid and reliable instrument to measure satisfaction among health professionals in the sub-Saharan African context.

Methods

A survey was conducted in Senegal and Mali in 2011 among 962 care providers (doctors, midwives, nurses and technicians) practicing in 46 hospitals (capital, regional and district). The participation rate was very high: 97% (937/962). After exploratory factor analysis (EFA), construct validity was assessed through confirmatory factor analysis (CFA). The discriminant validity of our subscales was evaluated by comparing the average variance extracted (AVE) for each of the constructs with the squared interconstruct correlation (SIC), and finally for criterion validity, each subscale was tested with two hypotheses. Two dimensions of reliability were assessed: internal consistency with Cronbach’s alpha subscales and stability over time using a test-retest process.

Results

Eight dimensions of satisfaction encompassing 24 items were identified and validated using a process that combined psychometric analyses and expert opinions: continuing education, salary and benefits, management style, tasks, work environment, workload, moral satisfaction and job stability. All eight dimensions demonstrated significant discriminant validity. The final model showed good performance, with a root mean square error of approximation (RMSEA) of 0.0508 (90% CI: 0.0448 to 0.0569) and a comparative fit index (CFI) of 0.9415. The concurrent criterion validity of the eight dimensions was good. Reliability was assessed based on internal consistency, which was good for all dimensions but one (moral satisfaction < 0.70). Test-retest showed satisfactory temporal stability (intra class coefficient range: 0.60 to 0.91).

Conclusions

Job satisfaction is a complex construct; this study provides a multidimensional instrument whose content, construct and criterion validities were verified to ensure its suitability for the sub-Saharan African context. When using these subscales in further studies, the variability of the reliability of the subscales should be taken in to account for calculating the sample sizes. The instrument will be useful in evaluative studies which will help guide interventions aimed at improving both the quality of care and its effectiveness.

【 授权许可】

   
2013 Faye et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Dussault G: The health professions and the performance of future health systems in low-income countries: support or obstacle? Soc Sci Med 2008, 66(10):2088-2095.
• [2]Chaguturu S, Vallabhaneni S: Aiding and abetting - nursing crises at home and abroad. N Engl J Med 2005, 353(17):1761-1763.
• [3]Vujicic M, Zurn P, Diallo K, Adams O, Dal Poz MR: The role of wages in the migration of health care professionals from developing countries. Hum Resour Health 2004, 2(1):3. BioMed Central Full Text
• [4]Mullan F: The metrics of the physician brain drain. N Engl J Med 2005, 353(17):1810-1818.
• [5]Gerein N, Green A, Pearson S: The implications of shortages of health professionals for maternal health in sub-Saharan Africa. Reprod Health Matters 2006, 14(27):40-50.
• [6]Miller S, Cordero M, Coleman AL, Figueroa J, Brito-Anderson S, Dabagh R, Calderon V, Cáceres F, Fernancez AJ, Nunez M: Quality of care in institutionalized deliveries: the paradox of the Dominican Republic. Int J Gynaecol Obstet 2003, 82(1):89-103. Discussion 87–88
• [7]Parkhurst JO, Penn-Kekana L, Blaauw D, Balabanova D, Danishevski K, Rahman SA, Onama V, Ssengooba F: Health systems factors influencing maternal health services: a four-country comparison. Health Policy 2005, 73(2):127-138.
• [8]Kanfer R: Measuring Health Worker Motivation in Developing Countries. Major Applied Research 5, Working Paper 1. Bethesda, MD: Partnerships for Health Reform Project, Abt Associates Inc.; 1999.
• [9]Franco LM, Bennett S, Kanfer R, Stubblebine P: Determinants and consequences of health worker motivation in hospitals in Jordan and Georgia. Soc Sci Med 2004, 58(2):343-355.
• [10]Herzberg F, Mausner B, Snyderman BB: The Motivation to Work. New York: Wiley; 1959.
• [11]Siu OL: Predictors of job satisfaction and absenteeism in two samples of Hong Kong nurses. J Adv Nurs 2002, 40(2):218-229.
• [12]Rouleau D, Fournier P, Philibert A, Mbengue B, Dumont A: The effects of midwives’ job satisfaction on burnout, intention to quit and turnover: a longitudinal study in Senegal. Hum Resour Health 2012, 10(1):9. BioMed Central Full Text
• [13]Haas JS, Cook EF, Puopolo AL, Burstin HR, Cleary PD, Brennan TA: Is the professional satisfaction of general internists associated with patient satisfaction? J Gen Intern Med 2000, 15(2):122-128.
• [14]Tzeng HM, Ketefian S: The relationship between nurses’ job satisfaction and inpatient satisfaction: an exploratory study in a Taiwan teaching hospital. J Nurs Care Qual 2002, 16(2):39-49.
• [15]Kazanjian A, Green C, Wong J, Reid R: Effect of the hospital nursing environment on patient mortality: a systematic review. J Health Serv Res Policy 2005, 10(2):111-117.
• [16]Prytherch H, Leshabari MT, Wiskow C, Aninanya GA, Kakoko DC, Kagoné M, Burghardt J, Kynast-Wolf G, Marx M, Sauerborn R: The challenges of developing an instrument to assess health provider motivation at primary care level in rural Burkina Faso. Ghana and Tanzania. Glob Health Action 2012, 5:1-18.
• [17]Huang X, Van De Vliert E: Where intrinsic job satisfaction fails to work: national moderators of intrinsic motivation. J Organ Behav 2003, 24(2):159-179.
• [18]Inglehart R: Modernization and Postmodernization: Cultural, Economic, and Political Change in 43 Societies. Princeton: Princeton University Press; 1997.
• [19]Roe RA, Zinovieva IL, Dienes E, Ten Horn LA: A comparison of work motivation in Bulgaria, Hungary, and the Netherlands: test of a model. J Appl Psychol 2000, 49(4):658-687.
• [20]Garcia-Zamor J-C: Workplace spirituality and organizational performance. Public Adm Rev 2003, 63(3):355-363.
• [21]Holland JL: Making Vocational Choices: A Theory of Vocational Personalities and Work Environments. 3rd edition. Odessa, FL: Psychological Assessment Resources; 1997.
• [22]Wilensky HL: Work, careers, and social integration. Int Soc Sci J 1960, 12(4):543-560.
• [23]McAuliffe E, Manafa O, Maseko F, Bowie C, White E: Understanding job satisfaction amongst mid-level cadres in Malawi: the contribution of organizational justice. Reprod Health Matters 2009, 17(33):80-90.
• [24]Mathauer I, Imhoff I: Health worker motivation in Africa: the role of non-financial incentives and human resource management tools. Hum Resour Health 2006, 4:24. BioMed Central Full Text
• [25]Agyepong IA, Anafi P, Asiamah E, Ansah EK, Ashon DA, Narh-Dometey C: Health worker (internal customer) satisfaction and motivation in the public sector in Ghana. Int J Health Plann Manage 2004, 19(4):319-336.
• [26]Dieleman M, Toonen J, Toure H, Martineau T: The match between motivation and performance management of health sector workers in Mali. Hum Resour Health 2006, 4:2. BioMed Central Full Text
• [27]Nabirye RC, Brown KC, Pryor ER, Maples EH: Occupational stress, job satisfaction and job performance among hospital nurses in Kampala, Uganda. J Nurs Manag 2011, 19(6):760-768.
• [28]Pillay R: Work satisfaction of professional nurses in South Africa: a comparative analysis of the public and private sectors. Hum Resour Health 2009, 7:15. BioMed Central Full Text
• [29]Mbindyo PM, Blaauw D, Gilson L, English M: Developing a tool to measure health worker motivation in district hospitals in Kenya. Hum Resour Health 2009, 7:40. BioMed Central Full Text
• [30]Fournier P, Dufresne C, Zunzunegui MV, Haddad S: Réformes des systèmes de santé et satisfaction du personnel: le cas du Mali. In Proceedings of CERDI 2ème Colloque International, ‘Financement de la santé dans les pays en développement’: 1–2 December 2005. Clermont-Ferrand, France: CERDI; 2005:9.
• [31]Spector PE: Measurement of human service staff satisfaction: development of the Job Satisfaction Survey. Am J Community Psychol 1985, 13(6):693-713.
• [32]Gregson T: Measuring job satisfaction with a multiple-choice format of the job descriptive index. Psychol Rep 1990, 66:787-793.
• [33]Willis-Shattuck M, Bidwell P, Thomas S, Wyness L, Blaauw D, Ditlopo P: Motivation and retention of health workers in developing countries: a systematic review. BMC Health Serv Res 2008, 8:247. BioMed Central Full Text
• [34]van Saane N, Sluiter JK, Verbeek JH, Frings-Dresen MH: Reliability and validity of instruments measuring job satisfaction–a systematic review. Occup Med (Lond) 2003, 53(3):191-200.
• [35]Dumont A, Fournier P, Fraser W, Haddad S, Traore M, Diop I, Gueye M, Gaye A, Couturier F, Pasquier J-C, Beaudoin F, Lalonde A, Hatem M, Abrahamowicz M: QUARITÉ (quality of care, risk management and technology in obstetrics): a cluster-randomized trial of a multifaceted intervention to improve emergency obstetric care in Senegal and Mali. Trials 2009, 10:85. BioMed Central Full Text
• [36]Tremblay MA, Blanchard CM, Taylor S, Pelletier LG, Villeneuve M: Work extrinsic and intrinsic motivation scale: its value for organizational psychology research. Can J Behav Sci 2009, 41(4):213-226.
• [37]Bentler PM: Comparative fit indexes in structural models. Psychol Bull 1990, 107(2):238-246.
• [38]Browne MW, Cudeck R: Alternative ways of assessing model fit. In Testing Structural Equation Models. Edited by Bollen KA, Long JS. Newbury Park, CA: Sage Publications; 1993:136-162.
• [39]Mittal R: Cross-cultural orientation inventory: development and measure of a new instrument. Int J Contemp Bus Stud 2012, 3(5):32-48.
• [40]Crocker LM, Algina J: Introduction to Classical and Modern Test Theory. Mason, OH: Cengage Learning; 2008.
• [41]Tso IF, Ng SM, Chan CL: The development and validation of the concise outpatient department user satisfaction scale. Int J Qual Health Care 2006, 18(4):275-280.
• [42]Weir JP: Quantifying test-retest reliability using the intraclass coefficient correlation and the SEM. J Strength Cond Res 2005, 19(1):231-240.
• [43]Fleiss JL: The Design and Analysis of Clinical Experiments. New York: John Wiley & Sons; 1986.
• [44]Traynor M, Wade B: The development of a measure of job satisfaction for use in monitoring the morale of community nurses in four trusts. J Adv Nurs 1993, 18(1):127-136.
• [45]Manongi RN, Marchant TC, Bygbjerg IC: Improving motivation among primary health care workers in Tanzania: a health worker perspective. Hum Resour Health 2006, 4:6. BioMed Central Full Text
• [46]Stringhini S, Thomas S, Bidwell P, Mtui T, Mwisongo A: Understanding informal payments in health care: motivation of health workers in Tanzania. Hum Resour Health 2009, 7:53. BioMed Central Full Text
• [47]Mbilinyi D, Daniel ML, Lie GT: Health worker motivation in the context of HIV care and treatment challenges in Mbeya Region, anzania: a qualitative study. BMC Health Serv Res 2011, 11:266. BioMed Central Full Text
• [48]Bradley S, McAuliffe E: Mid-level providers in emergency obstetric and newborn health care: factors affecting their performance and retention within the Malawian health system. Hum Resour Health 2009, 7:14. BioMed Central Full Text
• [49]Lephoko CS, Bezuidenhout MC, Roos JH: Organizational climate as a cause of job dissatisfaction among nursing staff in selected hospitals within the Mpumalanga Province. Curationis 2006, 29(4):28-36.
• [50]Ndiaye P, Seye AC, Diedhiou A, Deme BS, Tal-Dia A: Perceptions and motivations of public sector physicians in Dakar (Senegal). Sante 2007, 17(4):223-228.
• [51]Chandler CI, Chonya S, Mtei F, Reyburn H, Whitty CJ: Motivation, money and respect: a mixed-method study of Tanzanian non-physician clinicians. Soc Sci Med 2009, 68(11):2078-2088.
• [52]Tabachnick BG, Fidell LS: Using Multivariate Statistics. Fourth edition edition. Boston; Toronto: Allyn and Bacon; 2001.
• [53]Leshabari MT, Muhondwa EP, Mwangu MA, Mbembati NA: Motivation of health care workers in Tanzania: a case study of Muhimbili National Hospital. East Afr J Public Health 2008, 5(1):32-37.
• [54]Kwansah J, Dzodzomenyo M, Mutumba M, Asabir K, Koomson E, Gyakobo M, Gyakobo M, Agyei-Baffour P, Kruk ME, Snow RC: Policy talk: incentives for rural service among nurses in Ghana. Health Policy Plan 2012. Epub ahead of print
• [55]Ebuehi OM, Campbell PC: Attraction and retention of qualified health workers to rural areas in Nigeria: a case study of four LGAs in Ogun State, Nigeria. Rural Remote Heal 2011, 11(1):1515.
• [56]Tabak N, Orit K: Relationship between how nurses resolve their conflicts with doctors, their stress and job satisfaction. J Nurs Manag 2007, 15(3):321-331.
• [57]Zangaro GA, Soeken KL: A meta-analysis of studies of nurses’ job satisfaction. Res Nurs Health 2007, 30(4):445-458.