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

Abstract

BackgroundIn 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.MethodsA 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.ResultsEight 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).ConclusionsJob 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.

Midwives’ Professional Satisfaction and the Quality of Obstetric Care in Developing Country

“…This tool, created from theinstruments "Measure of Job Satisfaction" (MJS) [25] and "Job Descriptive Index" (JDI) [26] was validated on a sample of 937 care providers who worked in reproductive health facilities inMali and Senegal. It has been shown to have good validity and satisfactory reliability [22]. The questionnaire also included some questions about midwives' characteristics such as age, seniority in the profession and in the facility, level of education, trade union membership and marital status.…”

“…A questionnaire was developed and validated to measure the degree of job satisfaction in obstetric services in Senegal and Mali [22]. This work aims to study the effect of midwives' job satisfaction on the technical quality of emergency obstetric care in Senegal.…”

An Employee Engagement Instrument and Framework Building on Existing Research

“…Moreover, measurement instruments developed among populations of workers in Westernised countries are difficult to apply to populations in low-income countries as they fail to take into account certain dimensions of the construct that may be specific to a country, continent or culture -(such as the value of work, social organisation and religion), thereby compromising their validity (Faye, Fournier, Diop, Philibert, Morestin & Dumont, 2013;Klassen et al, 2012). The available instruments measuring some or other dimension of engagement all consist of numerous items, illuminated in Table 1, which will thus be impractical to use in the South African context.…”

Frontline health worker motivation in the provision of maternal and neonatal health care in Ghana

“…Secondly the teaching hospitals, which are the training institutions that feed public hospitals with doctors, retain most of the doctors they train. 43 The skewed distribution of doctors in low resource countries including Ghana has been noted elsewhere (Agyepong et al 2001;Chen et al 2004;Dovlo 1998;Faye et al 2013;Mbindyo et al 2009a;Mutale et al 2013;Snow et al 2012 -Denkyira et al 2011;Larbi 1998Larbi , 2005. Secondly per the Ghana Health Service and Teaching Hospitals' Act 525 (Government of Ghana 1996), the regional health directorate and the Ghana Health Service, have no authority over doctors in the teaching hospitals, which are a major source of recruitment of doctors and other frontline workers.…”

“…Interventions to improve quality and responsiveness in healthcare have centred on professionals and frontline workers without recourse to a total system reform (Agyepong et al 2001;Agyepong et al2004). Yet, low health worker motivation and discontent continue to be cited as major causes of poor healthcare quality and outcomes in Sub Saharan Africa including Ghana (Adzei and Atinga 2012;Agyepong et al 2004;Agyepong et al 2012;Alhassan et al 2013;Chandler et al 2009;Faye et al 2013;Luoma 2006). Worker motivation can be defined as the degree of willingness of the worker to maintain efforts towards achieving organizational goals (Franco et al 2002;Kanfer 1999).…”