Rural Primary Health Care Workers Research Articles

Professional burnout in primary health care workers of the Republic of Kazakhstan

Background/objectivesEmotional exhaustion is the most common feature of overall burnout among primary care physicians. The purpose of our study is to identify professional burnout among doctors and nurses of the highest level. MethodsThe data were obtained using a social survey of doctors and nurses in primary health care organizations. Using the MBI questionnaire. The study locations were medical centers in urban and rural areas in eight regions of Kazakhstan. A total of 612 urban and 244 rural primary health care workers took part. ResultsMean score ±standard deviation on the exhaustion subscale was 32.6 ± 13.5, on the depersonalization subscale — 14.4 ± 6.1, on the personal achievement subscale — 42.2 ± 7.5. Overall, the high prevalence of emotional exhaustion, depersonalization, and personal achievement was 57.4%, 64.6%, and 65.0%, respectively. Statistically significant predictors for emotional burnout were such as the location of work, urban or rural (OR = 1.973; p < 0.050, as well as who the employee was a doctor or nurse (OR = 2.137 p < 0.001). Work for a quieter job was a significant factor for personal achievement (OR = 4.709 p < 0.016), (OR = 9.341 p < 0.001), respectively. Statistically significant predictors for depersonalization was the status of the employee, namely, whether his work was permanent or not full -time (OR = 1.542 p < 0.001). Gender (OR = 0.350 p < 0.018), job location urban or rural (OR = 1.918 p < 0.050), and alcohol consumption (OR = 4.493 p < 0.021) were statistically significant for personal achievement. ConclusionMental and psychological health issues have become an increasingly important research topic in recent years. In our study, more than half of the study population reported professional burnout, namely exhaustion, depersonalization, and lack of personal achievement. We found a statistically significant relationship between emotional exhaustion and job location, as well as employee status, Depersonalization, and employee status and position. Personal achievements and gender with work location. To change my job to a more calm one was in all three parameters. Doctors have higher emotional exhaustion than nurses.

Effect of depression awareness and management training on the attitudes of rural primary health care workers.

To measure the effect of depression awareness and management training on the attitudes of rural primary health care workers. A repeated measures design in which participants acted as their own controls. The training program occurred in 6 locations across rural South Australia. The study enrolled primary care workers in general practitioner surgeries, Aboriginal Community Controlled Health Organisations, community health centres, public hospitals, regional health services and non-government organisations. A six-session training workshop that was informed by the National Institute for Health and Care Excellence guidelines for the treatment and care of people with depression. The 22-item Revised Depression Attitude Questionnaire comprised the main outcome measure. Participants were assessed 12weeks before the training, again on the day of commencement of the training and after the training. Seventy-two primary health workers completed the training program in depression awareness, building therapeutic relationships, working with ambivalence, and goal setting. Between the 2 pre-training assessments mean scores showed no significant difference. There were statistically significant improvements on the overall attitudes and the subscales therapeutic optimism and professional confidence between pre-training and post-training. Training rural primary health care workers in depression may improve their attitudes to working with people living with depression.

Could the connectedness of primary health care workers involved in social networks affect their job burnout? A cross-sectional study in six counties, Central China

BackgroundThis study aimed to reveal the effects of the connectedness of primary health care (PHC) workers in social networks on their job burnout.MethodsCross-sectional survey data of rural PHC workers in China were analyzed. A total of 663 respondents were enrolled. Chi-square and cumulative logistic regression were used to determine the effects of the connectedness of PHC workers in social networks on their job burnout.ResultsPHC workers in rural China had high levels of emotional exhaustion (24.1%), depersonalization (15.7%), and lack of personal accomplishment (34.7%). More than half of the participants were in the middle connectedness level in terms of their advisory (70.4%) and friendship (70.3%) networks. The degree of emotional exhaustion seemed to increase when participants had a low connectedness in their friendship networks (β = 0.769, 95% CI = 0.080–1.458, P = 0.029). Respondents with the middle level of connectedness in advisory networks had higher levels of depersonalization (β = 0.739, 95% CI = 0.130–1.348, P = 0.017) and lack of personal accomplishment (β = 0.583, 95% CI = 0.111–1.055, P = 0.015) than those with the high degree of connectedness in advisory networks.ConclusionsThe connectedness of PHC workers in social networks influenced their job burnout. Thus, organizations should establish an informal communication platform and information feedback mechanism, promote and manage friendship networks, and help PHC workers overcome emotional exhaustion. Managers should also encourage individuals with a high level of connectedness in advisory networks play the role of “opinion leader” so that they can help others mitigate burnout.

Challenges impeding integration of oral health into primary health care.

The primary healthcare (PHC) services in the Islamic Republic of Iran have succeeded in addressing high levels of communicable diseases; however, they seem less able to deal with maternal and paediatric oral diseases. The aim of this study was to examine problems in integrating oral health services into PHC. This was a qualitative research study comprising focus group discussions and interviews. Five focus-group discussions were held with midwives, family healthcare practitioners, rural PHC workers, duty-service dentists, and public health dentists. Also, individual interviews were organized with experts of faculty members in related fields, informant managers and policy makers, and in-depth interviews were done with pregnant women in four PHC centres. Audiotapes were transcribed following each session, and then a qualitative thematic analysis was carried out on gathered data. Data analysis resulted in 4 main themes relating to the challenges: environmental, educational, organizational and school-based programme factors. This study provides a clearer understanding of the challenges of integrating oral health services into PHC.

Quality of life among postmenopausal women in rural Minia, Egypt

This study aimed to determine the prevalence and severity of menopausal symptoms and their effect on the quality of life of postmenopausal women in rural Minia. A cross-sectional study was conducted among 1 100 postmenopausal women aged 45-60 years selected by multistage random sampling. The menopause rating scale (MRS) was used to assess the menopausal symptoms. The mean age at menopause was 48.9 (SD 4) years. The most frequent symptoms were joint and muscle pain (82.1%), physical and mental exhaustion (69.6%) and hot flushes and sweating (49.2%). The mean MRS somatic score was 4.12 (SD 2.22), the psychological score was 2.86 (SD 2.50) and urogenital score was 2.13 (SD 1.04). The total MRS score indicated that the symptoms were of moderate severity [9.11 (SD 5.76)]. Education, marital status, occupation, parity and postmenopausal duration were significantly associated with MRS score. Rural primary health care workers should be aware of this critical stage of life in women to help women deal with symptoms that may affect their quality of life.

How decentralisation influences the retention of primary health care workers in rural Nigeria

BackgroundIn Nigeria, the shortage of health workers is worst at the primary health care (PHC) level, especially in rural communities. And the responsibility for PHC – usually the only form of formal health service available in rural communities – is shared among the three tiers of government (federal, state, and local governments). In addition, the responsibility for community engagement in PHC is delegated to community health committees.ObjectiveThis study examines how the decentralisation of health system governance influences retention of health workers in rural communities in Nigeria from the perspective of health managers, health workers, and people living in rural communities.DesignThe study adopted a qualitative approach, and data were collected using semi-structured in-depth interviews and focus group discussions. The multi-stakeholder data were analysed for themes related to health system decentralisation.ResultsThe results showed that decentralisation influences the retention of rural health workers in two ways: 1) The salary of PHC workers is often delayed and irregular as a result of delays in transfer of funds from the national to sub-national governments and because one tier of government can blame failure on another tier of government. Further, the primary responsibility for PHC is often left to the weakest tier of government (local governments). And the result is that rural PHC workers are attracted to working at levels of care where salaries are higher and more regular – in secondary care (run by state governments) and tertiary care (run by the federal government), which are also usually in urban areas. 2) Through community health committees, rural communities influence the retention of health workers by working to increase the uptake of PHC services. Community efforts to retain health workers also include providing social, financial, and accommodation support to health workers. To encourage health workers to stay, communities also take the initiative to co-finance and co-manage PHC services in order to ensure that PHC facilities are functional.ConclusionsIn Nigeria and other low- and middle-income countries with decentralised health systems, intervention to increase the retention of health workers in rural communities should seek to reform and strengthen governance mechanisms, using both top-down and bottom-up strategies to improve the remuneration and support for health workers in rural communities.

Effectiveness of diabetes and hypertension management by rural primary health-care workers (Behvarz workers) in Iran: a nationally representative observational study

Non-communicable diseases and their risk factors are leading causes of disease burden in Iran and other middle-income countries. Little evidence exists for whether the primary health-care system can effectively manage non-communicable diseases and risk factors at the population level. Our aim was to examine the effectiveness of the Iranian rural primary health-care system (the Behvarz system) in the management of diabetes and hypertension, and to assess whether the effects depend on the number of health-care workers in the community. We used individual-level data from the 2005 Non-Communicable Disease Surveillance Survey (NCDSS) for fasting plasma glucose (FPG) and systolic blood pressure (SBP), body-mass index, medication use, and sociodemographic variables. Data for Behvarz-worker and physician densities were from the 2006 Population and Housing Census and the 2005 Outpatient Care Centre Mapping Survey. We assessed the effectiveness of treatment on FPG and SBP, and associations between FPG or SBP and Behvarz-worker density with two statistical approaches: a mixed-effects regression analysis of the full NCDSS sample adjusting for individual-level and community-level covariates and an analysis that estimated average treatment effect on data balanced with propensity score matching. NCDSS had data for 65,619 individuals aged 25 years or older (11,686 of whom in rural areas); of these, 64,694 (11,521 in rural areas) had data for SBP and 50,202 (9337 in rural areas) had data for FPG. Nationally, 39·2% (95% CI 37·7 to 40·7) of individuals with diabetes and 35·7% (34·9 to 36·5) of those with hypertension received treatment, with higher treatment coverage in women than in men and in urban areas than in rural areas. Treatment lowered mean FPG by an estimated 1·34 mmol/L (0·58 to 2·10) in rural areas and 0·21 mmol/L (-0·15 to 0·56) in urban areas. Individuals in urban areas with hypertension who received treatment had 3·8 mm Hg (3·1 to 4·5) lower SBP than they would have had if they had not received treatment; the treatment effect was 2·5 mm Hg (1·1 to 3·9) lower FPG in rural areas. Each additional Behvarz worker per 1000 adults was associated with a 0·09 mmol/L (0·01 to 0·18) lower district-level average FPG (p=0·02); for SBP this effect was 0·53 mm Hg (-0·44 to 1·50; p=0·28). Our findings were not sensitive to the choice of statistical method. Primary care systems with trained community health-care workers and well established guidelines can be effective in non-communicable disease prevention and management. Iran's primary care system should expand the number and scope of its primary health-care worker programmes to also address blood pressure and to improve performance in areas with few primary care personnel. None.

Accessibility of Primary Health Care Workforce in Rural China

This study aims to develop an accessibility index to illustrate the status of the accessibility of primary health care workers in remote and rural areas in China. Relevant county-level data were used to analyze the number and distribution of primary health care workforce in rural China, and relevant provincial-level data were used to analyze the accessibility index. The study found that the development of rural primary health care workers is suboptimal. The rural Primary Health Care Worker Accessibility index shows that the accessibility to primary health care workers in western rural areas is poor. The correlation between PHCWA index and maternal mortality rate is more significant than that between primary health care workers density and maternal mortality rate. In addition to increasing the number of primary health care workers, strategies addressing the challenge of distance are also required.