Indicators Associated With Job Morale Among Physicians and Dentists in Low-Income and Middle-Income Countries

Sabitova, Alina; McGranahan, Rose; Altamore, Francesco; Jovanović, Nikolina; Windle, Emma; Priebe, Stefan

doi:10.1001/jamanetworkopen.2019.13202

Cited by 25 publications

(44 citation statements)

References 135 publications

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“…1 Moreover, although geography was found to make some contribution to study heterogeneity, the phrasing of the geographic metaregression comparisons is technically somewhat ambiguous, and the interested reader may wish to refer to the supplementary forest plots, analytic tables, and computer code for a fuller understanding. 1 These concerns do not diminish the authors' significant accomplishment in what in many respects is an exemplary and useful systematic review. But the formal meta-analysis illustrates how…”

Section: + Related Articlementioning

confidence: 99%

“…When heterogeneity is very high and between-study variation dominates, random-effects meta-analyses weight studies nearly equally, regardless of sample sizes, yielding a meta-analytic summary close to the more easily calculated arithmetic mean of the individual study results. [2][3][4][5][6][7] In this context, consider the first meta-analytic summary reported by Sabitova et al 1 within large geographic regions. 1 If the meta-analytic assumptions are correct and these were the respective true SDs, then true target burnout prevalences for one-third of studies would be outside the range of 17% to 47% and, for 10%, outside the range of 7% to 57%.…”

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confidence: 99%

“…[2][3][4][5][6][7] In this context, consider the first meta-analytic summary reported by Sabitova et al 1 within large geographic regions. 1 If the meta-analytic assumptions are correct and these were the respective true SDs, then true target burnout prevalences for one-third of studies would be outside the range of 17% to 47% and, for 10%, outside the range of 7% to 57%. Thus, the 32% average provides only very modest guidance on what to expect for any given situation because the studies are so heterogeneous.…”

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confidence: 99%

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Limitations of Meta-analyses of Studies With High Heterogeneity

2020

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Sabitova et al 1 have performed an important service in compiling and summarizing 2 decades of studies on job burnout and satisfaction among physicians and dentists in middle-income countries and a few low-income countries. The authors followed a standard approach to performing a systematic review and meta-analysis to analyze studies that assessed job-related morale among physicians and dentists working in these countries, using levels of job burnout, job satisfaction, and job motivation as indicators of job morale. Data were extracted independently by several investigators following the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines. The authors assessed the quality of the included studies for bias and conducted random-effects meta-analyses, planned subgroup analyses, and metaregression analyses. The study included results from 79 studies with 45 714 participants. The authors reported that, in their analysis of Downloaded From: https://jamanetwork.com/ on 08/01/2020 high, unexplained heterogeneity limits meta-analytic results. Contributors to this unexplained heterogeneity may include variability in social environment and conditions of survey administration, which may not be discernible from published results and which may contribute to differences in response rates. In the end, despite exhaustive analyses, precise answers to broad meta-analytic questions about subjective issues may be difficult to achieve when there are important limitations in the studies and data included in the analyses.

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confidence: 99%

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Limitations of Meta-analyses of Studies With High Heterogeneity

2020

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“…It is important to note that the findings of the current review apply only to the studies that explicitly used the term job morale. As it was shown in a recent systematic review and meta-analysis [ 11 ], there are a number of studies on physicians working in LMICs assessing job-related variables encompassed by the term job morale, including job motivation, job satisfaction and burnout. Whilst some of these are quantitative in nature, there are also some qualitative studies in this area [ 80 ].…”

Section: Discussionmentioning

confidence: 99%

“…In 1978, the concept of morale was reintroduced to the Index of Psychological Abstracts after being delisted in 1973 [ 10 ] as equal to job satisfaction, causing a resurgence in the topic of morale in both job and non-job-related contexts. A recent systematic review and meta-analysis into the job morale of physicians and dentists in low- and middle-income countries (LMIC) [ 11 ] indicated a substantial methodological heterogeneity across studies measuring job morale. This heterogeneity compromises attempts to justify its importance and to evaluate the impact of job morale on performance and make comparisons across different contexts and countries.…”

Section: Introductionmentioning

confidence: 99%

Job morale: a scoping review of how the concept developed and is used in healthcare research

2020

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Background: The job morale of healthcare staff is widely seen as an important factor for the quality of care. Yet, there are different understandings of what constitutes job morale, which hinders systematic research and comparisons. We therefore conducted a scoping review of how the concept of job morale has developed over time and how it is used in healthcare research. Methods: A scoping review was conducted to identify relevant literature. Data were gathered on study design and context, objectives, definitions of morale, outcome measures and key findings. Data was synthesised using a descriptive analytical framework. Results: Ninety-three unique studies met eligibility criteria for the present review. The literature outlines four main periods of the evolution of the concept of job morale: The First World War and the interwar years; Second World War; Aftermath of the Second World War; and Contemporary period. The concept of job morale originated in a military context and was later applied to and specified in the healthcare literature. The concept has been applied to individuals and groups. The understandings used in healthcare vary, but overlap. Methods for assessing job morale in healthcare include quantitative scales, indirect measurements of consequences and predictors of morale, and qualitative approaches. Existing studies have mainly focused on the job morale of general practitioners, nurses and mental health professionals in high-income countries. Conclusions: Although the understandings of job morale in healthcare are heterogeneous and inconsistent, the concept appears to have been useful over longer periods of time and in different contexts. Which precise understanding of job morale is useful, depends on the given research purpose, and studies should make explicit which exact understanding they apply. Systematic research on job morale is required to facilitate measures to improve and maintain high levels of morale across different professional groups, including professionals in low-and middle-income countries.

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