Introduction

Methods

Results

Discussion

Conclusions

References

Abstract

Background: Health workforce turnover remains a global concern, particularly in rural and remote areas. Western rural areas are the least developed in China, where it faces the serious challenge on the rural health worker (RHW) management. This study aimed to investigate job satisfaction, work stress, and turnover intentions of RHWs, and to explore prominent factors associated with turnover intentions of RHWs in rural western China.
Methods: From June to September 2013, based on a three-stage random sampling method, a cross-sectional survey was conducted among RHWs in 11 western provinces in China. A brief, structured questionnaire filled in by RHWs was used for data collection. A total of 5046 RHWs participated in the study. The response rate was approximately 93.1%. Exploratory factor analyses, Pearson’s chi-squared tests, one-way ANOVA, binary logistic regression analyses, and mediating effect tests were performed for data analyses.
Results: Approximately 29.1% of the 5046 RHWs indicated turnover intentions. Most of the RHWs disclosed low educational levels, income levels, and professional technical titles. The RHWs expressed slight job satisfaction (mean 3. 20) and moderate work stress (mean 3.22). Age, income, medical institution, and job satisfaction (i.e., organizational management, reward, and occupation satisfaction) were significant predictors of the RHWs’ turnover intentions. The RHWs, who were younger (less than 41 years), receiving an income of $326.8–$۴۹۰٫۱ per month, working in township hospitals, and having low job satisfaction, were more likely to have turnover intentions. Work stress had an indirect and positive effect on RHWs’ turnover intentions. Job satisfaction weakened the positive effect of work stress on turnover intentions of RHWs by playing a total mediating role. Reward satisfaction was the strongest mediator.
Conclusions: The turnover intentions of RHWs in western China are significantly associated with job satisfaction, work stress, age, income, and medical institution. Appropriate strategies should be implemented to improve RHWs’ job satisfaction and reduce their work stress. Meanwhile, providing more attractive wages and non-monetary support, improving working conditions, etc. could be effective to reduction in RHWs’ turnover intentions.

Introduction

No health without a workforce has been a universal truth [1]. However, shortage and misdistribution of qualified health workforce have become global concerns affecting nearly all counties, especially the rural and remote areas. The process of attracting additional health workforce to work in these areas has drawn considerable attention from policymakers and researchers. Besides, the retention of qualified health workers who have been working and living in these rural and remote areas has been considered another primary issue that requires attention. Various risk factors, such as low salary, lack of opportunities for career advancement and continuing educational training, and inadequate working and living conditions, etc., have been addressed [2–۴]. In response to these challenges, the World Health Organization (WHO) has proposed a series of evidence-based global policy recommendations to increase access to health workers in remote and rural areas through improved retention [5]. Currently, health workforce turnover is a costly problem, which exists not only in remote rural areas but also in developed urban regions.