Scientific Papers

Job adjustment predictive factors of healthcare midwives in health system reform in Iran | Archives of Public Health


There were 362 links sent to healthcare midwives to complete a questionnaire; 323 were completed, while the remaining 39 were not. Exclusions were made from the primary study because three participants had less than a year of work experience, and ten participants did not answer all of the questions correctly on the questionnaires. In the end, 310 surveys’ worth of data were analyzed.

The participants’ mean age was 37.67 (7.1) years, their mean length of service was 10.26 (6.91) years, and they worked 43.20 h per week. In addition, approximately 84.6% of midwives were married, the majority had one or two children, 69% held a bachelor’s degree, 93.2% worked in their native residences, and the majority owned their own homes. Furthermore, 40% of the participants were employed in healthcare units, and 44.5% held full-time contractual positions. Furthermore, 76.1% held the organizational position of health care midwife, and approximately 40.6% had previously worked as midwives in health centers. Most were highly interest with their new profession as midwives and desired to remain in it for a long time (Table 1).

Table 1 Absolute and relative frequency of demographic and occupational characteristics of healthcare midwives participating in the study in West Azarbaijan province in 2022 (n = 310)

Regarding socioeconomic factors, approximately 41.3% of respondents felt their income was insufficient to cover their living expenses, while 73.9% described their economic status as average. Among those who did not own their own homes, 64.9% stated they could not afford one (Table 1).

According to the findings of the primary analysis, 58.1% of the participants experienced moderate job adjustment. The mean raw score for job adjustment was 49.81 on a scale from 0 to 100. The values of altruism and autonomy were related to the highest and lowest levels of job adjustment, respectively (Table 2).

Table 2 Job adjustment and its domains in healthcare midwives participating in the study in West Azarbaijan province in 2022 (n = 310)

Based on the study results, “external factors” were the most influential domain in determining job satisfaction for the participants (health factors). Salary and job security sub-structures had the greatest impact on job satisfaction, while workplace conditions sub-structure had the least impact. From the participants’ perspectives, the sub-structures of job responsibility and work itself and achievement received the highest and lowest scores, respectively, among the “internal factors” (motivational factors). Moreover, most healthcare midwives (55.8%) demonstrated a strong organizational commitment. Emotional and normative commitment domains exhibited the highest and lowest organizational commitment levels, respectively (Table 3).

Table 3 The level of factors affecting job satisfaction and organizational commitment and their domains in healthcare midwives participating in the study in West Azarbaijan province in 2022 (n = 310)

The mean job satisfaction score of healthcare midwives was 106.25 (14.44), representing a moderate level. Regarding job satisfaction, they received a mean score of 119.68 (28.51), and 72% of respondents believed that all the items introduced in this domain were essential for achieving job satisfaction. In addition, the study participants’ mean organizational commitment score was 100.61 (20.62), indicating a high level of organizational commitment.

According to the results of Pearson’s test, job adjustment was significantly correlated with age, population covered, job satisfaction, and organizational commitment (p < 0.05). In addition, based on the results of Spearman’s test, job adjustment was significantly correlated with the variables of desire to remain in the profession, interest in the profession, adequate income, economic class, and housing price evaluation (p < 0.05) (Figs. 1 and 2).

Fig. 1
figure 1

Scatter plot of highly correlated residuals in the regression model of job adjustment with job satisfaction in healthcare midwives participating in the study in West Azarbaijan province in 2022 (n = 310)

Fig. 2
figure 2

Scatter plot of highly correlated residuals in the regression model of job adjustment with organizational commitment in healthcare midwives participating in the study in West Azarbaijan province in 2022 (n = 310)

Furthermore, a one-way ANOVA and independent t-test revealed that workplace structure (p < 0.001), employment status (p = 0.001), organizational position (p = 0.002), and previous job type (p = 0.05) had a significant impact on job adjustment (p < 0.05). This difference, however, was not statistically significant for the variables of marital status, housing status, and employment in the city of residence (p < 0.05).

Multiple regression (the enter method) was used to investigate the simultaneous effect of several significant individual, demographic, and occupational variables on the level of job adjustment. The enter type was used to enter variables in the SPSS main window. In this method, all independent variables are entered concurrently into the model to determine the effect of all significant and nonsignificant variables on the dependent variable.

The model’s R2 value was 0.48. In this regard, the desire to remain in the position of healthcare midwife was the most accurate predictor of job adjustment (p < 0.000). The proportion of income to expenses (p < 0.05), the structure of the midwife’s working environment in comprehensive rural health service centers or healthcare units (p = 0.021 and p = 0.009, respectively), and the presence or absence of severe work problems during the period of employment in this profession (p = 0.008) were among the significant predictors of job adjustment in the healthcare role. Moreover, job satisfaction and organizational commitment were identified as strong predictors of job adjustment for healthcare midwives (p = 0.013 and p < 0.001, respectively).

This model had no significant predictive relationship between job adjustment and age, covered population, interest in the profession, economic class, housing price assessment, type of employment, organizational position, or previous job (Table 4).

Table 4 Evaluation of the effect of individual and job variables on the level of job adjustment using multiple linear regression model in healthcare midwives participating in the study in West Azarbaijan province in 2022 (n = 310)

Path analysis was used to determine the direct and indirect effects of the factors on job adjustment levels. The variables of housing price, economic class, age, and covered population were not significantly correlated with job adjustment in the model derived from regression analysis. These four variables were therefore eliminated from the path analysis diagram. The results indicated that the model’s fit was satisfactory. Thus, an indirect path was drawn from adequate income to interest in the profession to obtain better-fitting indices, and a better model fit was achieved. The fit indices for the initial and final models are presented in Table 5 and Fig. 3, respectively.

Table 5 Fit indices of the initial and final models
Fig. 3
figure 3

Path analysis of the factors affecting job adjustment with standard coefficients in healthcare midwives participating in the study in West Azarbaijan province in 2022 (n = 310), (*:p < 0.05)

In the final model, the ratio of the chi-square statistic to the degree of freedom was less than 1; therefore, the model provided an excellent fit. When the CFI and GFI are closer to 1, the model fits better, whereas the model fit is rejected at critical values of 0.9. In this study, in the final model, the model fit was less than 0.001, indicating that the model fit was excellent. While values of < 0.08 are acceptable for the RMSEA, values of < 0.05 are preferable. This value was 0.001 in the final model, indicating that the final model exhibited a very good fit.

The direct path of the effect of the variables of adequate income to expenses, organizational commitment, desire to remain in the profession, and job satisfaction is statistically significant (p < 0.05), according to the results of the table. The relationship between income and expenses, interest in the profession, and organizational commitment in drawing paths significantly impacted the desire to remain in the profession. However, the variable of desire to remain in the profession had the greatest effect on job adjustment (β = 0.361), and interest in the midwifery profession had the greatest direct effect on the desire to remain in the healthcare midwifery profession (β = 0.617). (Table 6).

Table 6 Standard and non-standard path coefficients of the path analysis model of the variables affecting job adjustment in healthcare midwives participating in the study in West Azarbaijan province in 2022 (n = 310)

According to the results of the path analysis, interest in the profession had an indirect effect on job adjustment via job satisfaction, desire to remain in the profession, and organizational commitment. The results indicated that an increase of one unit in interest in a profession increased job adjustment by 34% when compiling the direct and indirect effects. The variable of desire to remain in the profession directly affected job adjustment, with a 36% increase per unit increase in the variable of desire to remain in the profession. The ratio of income to expenses influenced job adjustment directly and indirectly through job satisfaction, organizational commitment, and desire to remain in the profession.

In general, an increase of one unit in income sufficiency increased job adjustment by 22%. Job satisfaction had both direct and indirect effects on job satisfaction by influencing organizational commitment and desire to remain in the profession; therefore, a one-unit increase in job satisfaction and desire to remain in the profession increased job satisfaction by 18%. Organizational commitment had a significant direct effect on job adjustment and an indirect effect on job adjustment via the desire to remain in the profession. Since higher scores indicate greater organizational commitment, increased organizational commitment may increase one’s desire to remain in the profession and, as a result, job adjustment. In addition, an increase of one unit in organizational commitment increased job adjustment by 36% via the mediating effect of the desire to remain in the profession.

Generally, organizational commitment and desire to remain in the profession impacted job adjustment most among the study variables. Job satisfaction, interest in midwifery, and adequate income were significant factors influencing job adjustment (Table 7).

Table 7 Direct, indirect and general effects of factors affecting job adjustment in healthcare midwives participating in the study in West Azarbaijan province in 2022 (n = 310)



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