Turnover intention of primary health workers in China: a systematic review

Abstract

BackgroundPrimary health workers have great meaning for the whole health-care system. However, China faces a serious shortage of primary health workers in rural areas and urban communities because of their high turnover rates. We aimed to analyse the prevalence and determinants of turnover intention (the intent to change or leave current employment) in a systemic review and meta-analysis, to provide evidence for improving retention measures. MethodsIn this systemic review and meta-analysis, we searched five English language databases (PubMed, EMBASE, Cochrane Library, PsycINFO, and ASC) and three Chinese databases (CNKI, CSPD, and CBM) for studies published between Jan 1, 2000, and May 1, 2018. We used a combination of the terms “(Turnover Intention, Departure Intention, Demission Intention, or Leave Intention), (Primary, Community, Rural, Countryside, or Grass roots), (Health worker, Health Manpower, Health Personnel, Doctor, or Nurse), and (China, or Chinese)” to conduct the search. Eligible studies were observational or descriptive studies done in mainland China, with human participants. Number or percentage related to turnover intention of health workers and related exposures (potential risk factors) had to be explicitly reported in each included study. If it was not feasible to make a quantitative synthesis and conduct a meta-analysis with the data, we used a narrative approach and descriptive statistics by grouping studies that reported the same exposures, to compare their associations with turnover intention of health workers. We did all statistical analyses using Stata (version 13.0) and RevMan (version 5.3). FindingsWe identified 21 articles investigating a total of 21 466 workers in Chinese primary health institutions. The prevalence of turnover intention ranged from 11·80% to 78·40%. On the basis of our meta-analysis, age (younger vs older odds ratio [OR] 2·04, 95% CI 1·62–2·60), location (rural vs city 2·33, 1·85–2·68), position (junior job title vs senior job title 1·73, 1·45–2·16), salary (low salary vs high salary 2·37, 1·98–2·83), and working time (more than 8 h per day vs less than 8 h per day 2·20, 1·98–2·43) were significantly associated with turnover intention. Other risk factors including sex, attitude towards future career, education of children, and degree of education were identified using the narrative approach. InterpretationThe prevalence of turnover intention was relatively high among primary health workers in China. The determinants of turnover intention can be contained by the job embeddedness model, including two layers (on-the-job, [determinants directly related to the job] and off-the-job [determinants related to the family and community]) and three dimensions (links, fits, and sacrifices). More measures should be taken towards retaining primary health workers. FundingThe National Social Science Fund of China (grant number 17ZDA079).