Study On Job Satisfaction Of Community Health Workers In Anhui Province

BackgroundIn health service sector, job satisfaction (JS) is highly associated with staffs’ turnoverintention, quality and efficiency of services, and patients’ satisfaction. Reports indicatethat doctors with higher job satisfaction are more likely to provide more satisfactoryservices and produce better therapeutic effect than those with lower ones. However, fora long time, health service managers failed to pay enough attention to JS of communityhealth workers (CHWs).The objective of this study was to identify JS levels and theirinfluencing factors among CHWs employed at community health service institutions, inorder to provide policy suggestions for human resource manegement of communityhealth service (CHS), to maintain and promote CHWs’JS and improve the quality ofCHS.ObjectivesBased on quantitative measurement of CHWs’JS, the paper aims to find out the levelof CHWs’JS and the key influencing factors of the community health service personnel,to explore the relationship between CHWs’JS and demographic characteristics, and tocompare CHWs’JS before and after Anhui Province basic medical and health systemreform(LCMR), so as to provide policy suggestions for human resource manegement oflocal health service institutions.MethodsIn2009,57community health service centers (CHCs) were randomly selected in12cities in Anhui province by systematic and cluster sampling. A cross-sectional survey was conducted among813CHWs (including clinical medicine, clinical nursing,medicaltechnology,and public health staff) of57CHCs (response rate:94.1%) by the jobsatisfaction scale (JSS). After two years’implementation of the LCMR (2012),30CHCswere randomly selected from57CHCs which were selected in2009. A total of536anonymous questionnaires were handed out to the participants. Finally,495validquestionnaires were available, with an overall response rate of92.4%.Statistical and analyzing methods include descriptive statistics, t-test, One-WayANOVA, Logistic regression, Nonparametric Tests and Univariate Analysis of Variance,α=0.05.Results(1)The average score of total JS of CHWs was110.06±17.874, which was in“moderate” status;17.0%CHWs were satisfied with total JS, while70.7%CHWs werein “moderate” status. The average score of JS with coworkers (14.71±2.072) and natureof work (14.50±2.679) was the highest, which were both in “satisfied” status;77.6%CHWs were satisfied with JS with coworkers and70.3%CHWs were satisfied withnature of work. While the average score of JS with pay (10.00±2.861), benefits(10.25±3.070), and promotion (10.84±2.919) was the lowest, which were all in“dissatisfied” status;58.6%CHWs were dissatisfied with pay,55.8%CHWs weredissatisfied with benefits, and44.4%CHWs were dissatisfied with promotion.(2)The average score of senior CHWs in total JS (114.57±14.473) were higher thanthose with junior title and middle title (p<0.05); the average score of public health staffin total JS (114.51±21.490) were higher than clinical, nursing andmedico-technique(p<0.05). Logistic regression suggested: age is the protective factor(OR=0.887, p<0.05), and tenure was the risk factor (OR=1.107, p<0.05) for“dissatisfied” with total JS.(3)The average score of CHWs with senior title in pay (10.62±2.439) was higher than those with junior and middle title (p<0.05); the average score of public health staff inpay (10.78±3.391) were higher than clinical, nursing and medico-technique (p<0.05).Logistic regression suggested: job type was the risk factor for “dissatisfied” with pay(ORclinical=2.493, p<0.05; ORnursing=2.310, p<0.05;ORmedico-technique=3.049, p<0.05).(4)The average score of CHWs who have secondary school and below in promotion(11.20±2.713) was higher than the CHWs with educational level of over junior college(p<0.05); the average score of CHWs with senior title in promotion (12.67±3.055) washigher than those with junior and middle title (p<0.05). Logistic regression suggested:educational background (OR=1.480, p<0.05), tenure (OR=1.06, p<0.05) andMedico-technique job type(OR=2.473, p<0.05) were the risk factor for “dissatisfied”with promotion.(5)Gender, age, educational background, professional titles, job type and tenure (years)had no significant influence on job satisfaction with supervision (P>0.05). Logisticregression suggested: there were no relationship between demographic characteristic ofCHWs and “dissatisfied” with supervision (P>0.05).(6)The average score of CHWs with “no technical title” in benefits was higher thanthose with junior title, middle and senior title (p<0.05). Logistic regression suggested:age is the protective factor for “dissatisfied” with benefits (OR=0.897, p<0.05), whiletenure (OR=1.104, p<0.05) and clinical job type (OR=2.126, p<0.05) were the riskfactors.(7)The average score of CHWs whose age is50over in contingent rewards(12.37±2.805) was higher than other age groups (p<0.05); the average score of CHWswith senior title in contingent rewards (12.86±2.414) was higher than those with juniorand middle title (p<0.05). Logistic regression suggested: there were no relationshipbetween demographic characteristic of CHWs and “dissatisfied” with contingentrewards (P>0.05).(8)The average score of female in operating procedures (11.75±2.213) was higher than male (p<0.05); the higher the degree, the lower the average score in operatingprocedures (F=7.398, p=0.007). Logistic regression suggested: educational background(OR=1.449, p<0.05) and tenure (OR=1.066, p<0.05) were the risk factors for“dissatisfied” with operating procedures.(9)The average score of public health staff (15.33±2.126) in coworkers was higher thanclinical, nursing and medico-technique job type (p<0.05). Logistic regression suggested:medico-technique job type was the risk factors for “dissatisfied” with coworkers(OR=10.671, p<0.05).(10)The younger the age, the lower the average score in nature of work (F=7.759,p=0.005); the public health staff had the highest score (15.06±2.739) compared to theother jobs (p<0.05); tenure with16-20years had the highest score (15.04±2.323)compared to the other tenures (p<0.05). Logistic regression suggested: there were norelationship between demographic characteristic of CHWs and “dissatisfied” withnature of work (P>0.05).(11)Tenure with over30years had the highest score in communication (13.20±2.735)compared with other tenures (p<0.05). Logistic regression suggested: age (OR=0.932,p<0.05) and educational background (OR=0.705, p<0.05) are the protective factors for“dissatisfied” with communication.(12)After two years’implementation of the LCMR, the average score of total JS ofCHWs (112.74±23.157) was higher than the of the baseline survey (p<0.05); theaverage score of satisfaction with pay(10.88±4.147), contingent rewards (13.47±3.908),operating procedures(12.26±3.711) and communication(13.46±4.419) in the effectevaluation survey were higher than that of the baseline survey (P<0.05); However, theaverage score of satisfaction with promotion (10.20±4.030) was lower than that of thebaseline survey (p<0.05);there were no significant differences in the dimensions ofsupervision, benefits, coworkers and nature of work between the two surveys (p>0.05).(13)After two years’implementation of the LCMR,27.1%CHWs were satisfied with pay,51.5%CHWs were satisfied with contingent rewards,38.4%CHWs were satisfiedwith operating procedures, and51.7%CHWs were satisfied with communication, whichwere all higher than those of the baseline survey (p<0.05);62.4%CHWs were satisfiedwith coworkers and57.6%CHWs were satisfied with nature of work, which were bothhigher than those of the baseline survey (p<0.05).Conclusions(1)The total JS of CHWs was not high, which was in “imoderate” status.By comparison,the JS of CHWs in coworkers and nature of work was relatively high, which were bothin “satisfied” status; while the JS of CHWs in pay, benefits and promotion wasrelatively low, which were both in “dissatisfied” status.(2) Age and tenure were associated with CHWs’“dissatisfied” with total JS; Job typewas associated with the “dissatisfied” status of pay, promotion, benefits and coworkers;Educational background was associated with the “dissatisfied” status of promotion,operating procedures and communication; Age was associated with the “dissatisfied”status of benefits and communication.(3)After two years’implementation of the LCMR, The total JS of CHWs have a smallimprovement. However, CHWs have lower satisfaction in the dimensions of pay,promotion and benefits dimensions before and after the LCMR. Pay, promotion andbenefits are the key factors that are affecting the CHWs’JS presently. Policy-makersshould take corresponding measures to raise work reward of CHWs and pay moreattention to CHWs’professional development to increase their JS.(4)After two years’implementation of the LCMR, the proportion of CHWs “satisfied”with coworkers and nature of work significantly declined, with reason worthy of furtherstudy.