We analyzed 430 respondents, of which 50.2% were male. The majority of the respondents were within the age range of 36 to 45 years. The perception levels of role stressors were: role ambiguity 1.76 M (95% CI: 1.69-1.83), role conflict 3.40 M (95% CI: 3.32-3.49) and role overload 3.18 M (95% CI: 3.09-3.27) (Table 1).
Role ambiguity was significantly high in respondents with the following demographic characteristic: female respondents 14.25 M (95% CI: 13.53-14.76, p= .020), JCE holders 14.38 M (95% CI: 13.47-17.63, p = .008), clinical roles 14.87 M (95% CI:13.59-14.87) and HSAs resident in urban areas 14.14 M (95% CI: 13.53-14.76, p= .000). Role conflict was significantly slightly high in female HSAs 24.20 M (95% CI: 23.40-25.00, p= .004), PSLCE 24.88 M (CI: 20.60-29.15, p.001), clinical roles 23.87 M (CI: 23.23-24.51, p=.001), HSAs in urban areas 24.84 M (95% CI: 23.48-26.20, p= .000) and years at service post 11-19 years 24.42 M (95% CI: 23.54-25.41, p= .000). Role overload was significantly slightly high in Diploma holders 32.75 M (95% CI: 29.22-36.28, p= .000), clinical roles 28.76 M (95% CI: 27.87-29.66, p= .000), HSAs in rural areas 28.77 M (95% CI: 27.86-29.69, p= .000) and 11-19 years at service post M (95% CI: 27.49-29.89 (Table 2). Table 3 shows HSAs tasks were significantly related to the role stressors. In terms of role ambiguity, it was only drug dispensing that was not related to role ambiguity. Role conflict was related to all the HSAs job tasks while role overload was related to all except water chlorination.
Table 4 shows a PCA analysis carried out aimed at identifying factors for the role stressors. Three factors contributing to role ambiguity were extracted. The first factor explained 45.26% of the total variance while all the three components explained 73.63% of the total variance (Table 4). The extraction was done with a loading factor value of 0.7 and all factors with an eigen value above 1.00 were eligible for selection. Component 1 loaded on three items which reflected on the ‘Supervisor’ with an eigenvalue of 3.62, Component 2 loaded on three items which reflected on ‘role clarity’ with an eigenvalue of 1.27 and Component 3 loaded on one item which reflected on ‘work guidelines’ with an eigenvalue of 1.00 (Table 4).
Two factors contributing to role conflict were extracted after conducting the PCA analysis. The first factor explained 33.19% of the total variance while all the two factors combined explained 54.64% of the total variance (Table 4). The extraction was carried out with a factor loading value of 0.7 and loaded three items on Component 1 with an eigenvalue of 2.32 which reflected on ‘incompatibility’ and two items on Component 2 with an eigenvalue of 1.50 which reflected on ‘time & person values’ (Table 4).
Three factors contributing to role overload were extracted after conducting the PCA. The first factor explained 45.26% of the total variance while all the three factors when combined explained 63.04% of the total variance. In this analysis, Component 1 loaded 2 items, Component 2 loaded 2 items and Component 3 loaded 1 item. Component 1 items reflected on issues of ‘time pressure’ with an eigenvalue of 3.37 while, Component 2 reflected on the issue of ‘task overload’ with an eigenvalue of 1.20 and Component 3 reflected on issues of ‘work prioritization’ with an eigenvalue of 1.11 (Table 4).
Table 5 shows social demographic characteristics of the participants that were factors for role stressors after multiple linear regression. In terms of role ambiguity location, clinical work, antenatal care (ANC), growth monitoring (GM), HIV/AIDS and malaria rapid diagnostic testing (MRDT) were predictors for role ambiguity. The predictors for role conflict were location, gender, GM, MRDT, Village Health Committee (VHC) meetings, Family Planning and home-based care (HBC) while education level was the only predictor for role overload.
Table 1: Frequency of HSAs by degree of role stressor (low, moderate, and high) with 95% CI in each of the three role stressors
|
|
RA (M=1.76, Std. Dev=0.74, (95% CI:1.69-1.83)
|
|
RC (M=3.40, Std. Dev =0.89, 95%CI: 3.32-3.49)
|
|
RO (M=3.18, Std. Dev = 0.94, 95%CI:3.09-3.27)
|
Variables
|
N
|
%
|
N
|
%
|
N
|
%
|
Low
|
356
|
82.80
|
53
|
12.30
|
105
|
24.40 (22.44-26.36)
|
Moderate
|
61
|
14.20
|
156
|
36.50
|
114
|
26.50
|
High
|
13
|
3.00
|
221
|
51.20
|
211
|
49.00
|
Abbreviations: RA Role Ambiguity, RC Role Conflict, RO Role Overload
Table 2 Role stressor score according to socio-demographic characteristics with 95% CI in each dimension
|
Role Ambiguity
|
|
Role Conflict
|
|
Role Overload
|
|
|
|
|
|
|
95% CI
|
|
|
|
95% CI
|
|
|
|
95% CI
|
|
Variable
|
N
|
%
|
M
|
SD
|
LB
|
UB
|
p
|
M
|
SD
|
LB
|
UB
|
p
|
M
|
SD
|
LB
|
UB
|
p
|
Age
|
|
|
|
|
|
|
.235
|
|
|
|
|
.301
|
|
|
|
|
.308
|
26-35
|
154
|
35.8
|
13.86
|
5.51
|
12.98
|
14.74
|
|
24.3
|
6.5
|
23.26
|
25.34
|
|
28.56
|
8.31
|
27.24
|
29.89
|
|
36-45
|
221
|
51.4
|
13.87
|
5.78
|
13.1
|
14.64
|
|
23.83
|
6
|
23.03
|
24.63
|
|
29
|
8.62
|
27.85
|
30.14
|
|
46-55
|
52
|
12.1
|
15.52
|
7.57
|
13.41
|
17.63
|
|
22.32
|
6.2
|
20.6
|
24.05
|
|
26.4
|
8.32
|
24.09
|
28.72
|
|
56-60
|
3
|
0.7
|
11.33
|
2.1
|
6.16
|
16.5
|
|
22
|
2.65
|
15.43
|
28.57
|
|
31
|
4
|
21.06
|
40.94
|
|
Gender
|
|
|
|
|
|
|
.023
|
|
|
|
|
.004
|
|
|
|
|
.120
|
Male
|
216
|
50.2
|
13.84
|
6.02
|
13.03
|
14.65
|
|
23.41
|
6.46
|
22.54
|
24.28
|
|
28.5
|
8.72
|
27.32
|
29.67
|
|
Female
|
214
|
49.8
|
14.25
|
5.84
|
13.46
|
15.04
|
|
24.2
|
5.94
|
23.4
|
25
|
|
28.59
|
8.24
|
27.47
|
29.7
|
|
Education
|
|
|
|
|
|
|
.008
|
|
|
|
|
.001
|
|
|
|
|
.000
|
PSLCE
|
8
|
1.9
|
14.25
|
7.1
|
8.35
|
20.17
|
|
24.88
|
5.11
|
20.6
|
29.15
|
|
29.75
|
11.54
|
20.11
|
39.39
|
|
JCE
|
193
|
44.9
|
14.38
|
6.39
|
13.47
|
15.28
|
|
23.62
|
5.95
|
22.77
|
24.47
|
|
27.4
|
8.72
|
26.15
|
28.64
|
|
MSCE
|
217
|
50.7
|
13.98
|
5.53
|
13.24
|
14.73
|
|
23.99
|
6.54
|
23.11
|
24.87
|
|
29.28
|
8.14
|
28.19
|
30.38
|
|
Diploma
|
12
|
2.8
|
9.83
|
1.99
|
8.57
|
11.1
|
|
22.75
|
5.1
|
19.51
|
25.99
|
|
32.75
|
5.56
|
29.22
|
36.28
|
|
Clinical roles
|
|
|
|
|
|
|
.010
|
|
|
|
|
.001
|
|
|
|
|
.000
|
Yes
|
350
|
81.6
|
14.23
|
6.11
|
13.59
|
14.87
|
|
23.87
|
6.11
|
23.23
|
24.51
|
|
28.76
|
8.51
|
27.87
|
29.66
|
|
No
|
79
|
18.4
|
13.23
|
4.98
|
12.11
|
14.35
|
|
23.5
|
6.67
|
21.99
|
25
|
|
27.54
|
8.29
|
25.67
|
29.41
|
|
Location
|
|
|
|
|
|
|
.000
|
|
|
|
|
.000
|
|
|
|
|
.000
|
Rural
|
330
|
76.7
|
14.14
|
5.73
|
13.53
|
14.76
|
|
23.54
|
6.14
|
22.88
|
24.19
|
|
28.77
|
8.6
|
27.86
|
29.69
|
|
Urban
|
100
|
23.3
|
13.67
|
6.67
|
12.25
|
15.09
|
|
24.84
|
6.39
|
23.48
|
26.20
|
|
27.63
|
7.92
|
25.94
|
29.32
|
|
District of Work
|
|
|
|
|
|
|
.235
|
|
|
|
|
.995
|
|
|
|
|
.785
|
Mangochi
|
95
|
22.1
|
14.74
|
6.37
|
13.44
|
16.03
|
|
23.98
|
6.37
|
22.68
|
25.28
|
|
28.28
|
8.72
|
26.51
|
30.06
|
|
Lilongwe
|
278
|
64.7
|
13.86
|
5.88
|
13.16
|
14.56
|
|
23.69
|
6.16
|
22.96
|
24.41
|
|
28.18
|
8.39
|
22.96
|
24.42
|
|
Mzimba
|
57
|
13.3
|
13.81
|
5.43
|
12.37
|
16.03
|
|
24.07
|
6.25
|
22.41
|
25.73
|
|
30.7
|
8.29
|
28.5
|
32.9
|
|
Yrs at Serv. Post
|
|
|
|
|
|
|
.065
|
|
|
|
|
.000
|
|
|
|
|
.016
|
<10 years
|
300
|
80.6
|
14.5
|
6.12
|
13.08
|
15.92
|
|
23.18
|
6.53
|
21.66
|
24.69
|
|
27.5
|
9.52
|
25.29
|
29.7
|
|
11-19 years
|
63
|
16.9
|
13.73
|
5.92
|
12.91
|
14.55
|
|
24.42
|
6.38
|
23.54
|
25.31
|
|
28.69
|
7.52
|
27.49
|
29.89
|
|
≥20 years
|
9
|
2.4
|
14.1
|
5.55
|
12.93
|
15.22
|
|
22.75
|
5.31
|
21.66
|
23.85
|
|
28.04
|
7.52
|
26.49
|
29.59
|
|
Abbreviations: PSLCE Primary School Leaving Certificate, JCE Junior Certificate of Education, MSCE Malawi School Certificate of Education
Table 3 Role stressor score according to job tasks with 95% CI in each dimension
|
|
Role Ambiguity
|
|
Role Conflict
|
|
Role Overload
|
|
|
|
|
|
|
CI: 95%
|
ꭕ2, p
|
|
CI: 95%
|
ꭕ2, p
|
|
CI: 95%
|
ꭕ2, p
|
Task
|
|
N
|
%
|
M
|
L
|
B
|
|
M
|
L
|
B
|
|
M
|
L
|
B
|
|
Vaccination
|
|
430
|
85.6
|
14
|
13.39
|
14.62
|
.ꭤ
|
23.9
|
23.27
|
24.52
|
.ꭤ
|
28.73
|
27.86
|
29.6
|
.ꭤ
|
IEC
|
|
430
|
85.6
|
14
|
13.39
|
14.62
|
.ꭤ
|
23.9
|
23.27
|
24.52
|
.ꭤ
|
28.73
|
27.86
|
29.6
|
.ꭤ
|
Sanitation
|
|
430
|
85.6
|
14
|
13.39
|
14.62
|
.ꭤ
|
23.9
|
23.27
|
24.52
|
.ꭤ
|
28.73
|
27.86
|
29.6
|
.ꭤ
|
Chlorination
|
|
430
|
85.6
|
14
|
13.39
|
14.62
|
15.81 (1.00)
|
23.9
|
23.27
|
24.52
|
95.84 (.000)
|
28.73
|
27.86
|
29.6
|
50.23 (.964)
|
ANC
|
|
369
|
91.6
|
14.17
|
13.53
|
14.81
|
51.86 (.001)
|
23.84
|
23.2
|
24.49
|
56.84 (.001)
|
28.56
|
27.66
|
29.46
|
124.22 (.000)
|
Salt testing
|
|
396
|
88.4
|
13.83
|
13.21
|
14.45
|
86.84 (.000)
|
24.03
|
23.43
|
24.72
|
49.34 (.004)
|
28.85
|
27.95
|
29.74
|
103.94 (.000)
|
GM
|
|
413
|
87.2
|
13.83
|
13.21
|
14.44
|
277.95 (.000)
|
23.74
|
23.11
|
24.37
|
102.59 (.000)
|
28.54
|
27.66
|
29.42
|
95.88 (.000)
|
TB Work
|
|
336
|
94
|
14.09
|
13.43
|
14.75
|
49.77 (.002)
|
24.03
|
23.36
|
24.7
|
69.80 (.000)
|
28.84
|
27.92
|
29.77
|
90.51 (.000)
|
HIV/AIDS
|
|
325
|
91.1
|
14.06
|
13.35
|
14.76
|
71.51 (.000)
|
23.66
|
22.98
|
24.34
|
73.49 (.000)
|
28.57
|
27.58
|
29.56
|
74.50 (.000)
|
DD
|
|
310
|
89.4
|
14.41
|
13.7
|
15.12
|
51.86 (.401)
|
23.79
|
23.04
|
24.54
|
73.49 (.000)
|
28.71
|
27.68
|
29.75
|
150.17 (.000)
|
iCCM
|
|
187
|
89.3
|
14.17
|
13.17
|
15.18
|
146.89 (.002)
|
23.2
|
22.22
|
24.19
|
144.36 (.005)
|
27.13
|
25.83
|
28.44
|
242.66 (.000)
|
MRDT
|
|
200
|
88
|
13.94
|
13
|
14.88
|
102.85 (.031)
|
23.3
|
22.4
|
24.19
|
129.53 (.000)
|
28.57
|
27.34
|
29.8
|
182.65 (.000)
|
VHC Meetings
|
|
400
|
86
|
13.94
|
13.29
|
14.58
|
101.81 (.000)
|
23.97
|
23.32
|
24.61
|
84.55 (.003)
|
28.42
|
27.51
|
29.34
|
68.20 (.539)
|
FP
|
|
283
|
91.5
|
14.34
|
13.61
|
15.06
|
46.18 (.006)
|
24.18
|
23.43
|
24.93
|
64.00 (.000)
|
29.17
|
28.09
|
30.25
|
66.92 (.001)
|
HBC
|
|
385
|
91.7
|
14.06
|
13.44
|
14.68
|
40.83 (.012)
|
23.78
|
23.11
|
24.38
|
63.55 (.000)
|
28.75
|
27.87
|
29.64
|
104.77 (.000)
|
Nutrition
|
|
389
|
89.5
|
14.21
|
13.57
|
14.85
|
75.13 (.012)
|
23.82
|
23.17
|
24.48
|
111.19 (.000)
|
28.65
|
27.75
|
29.54
|
102.45 (.007)
|
Abbreviations: GM growth monitoring, VHC Village Health Committees, iCCM Intergrated community case management, MRDT malaria rapid diagnostic testing, ANC antenatal care, DD Drug Dispensing, IEC Information Education and Communication
Table 4: Summarized results for Principal Component Analysis
Variable
|
EV
|
% of Var
|
Cum. Tot.
|
Role Ambiguity
|
|
|
|
Supervisor
|
3.62
|
45.26
|
30.3
|
Role clarity
|
1.27
|
15.84
|
60.05
|
Guidelines
|
1
|
12.53
|
73.63
|
Role Conflict
|
|
|
|
Incompatibility
|
2.32
|
33.19
|
32.78
|
Time & personal values
|
1.5
|
54.64
|
54.64
|
Role Overload
|
|
|
|
Time pressure
|
3.37
|
45.26
|
26.03
|
Task overload
|
1.2
|
21.36
|
47.39
|
Prioritization
|
1.11
|
15.65
|
63.04
|
Key: EV= eigenvalue, % of Var= Percentage of variance, Cum. Tot. = Cumulative total
Table 5 Multiple linear regression analysis for the association factors with the high level of role stress and their principal components among HSAs 430
|
|
RA
|
|
CI: 95%
|
|
RC
|
|
CI: 95%
|
|
|
RO
|
CI: 95%
|
|
B
|
SE
|
P value
|
L
|
B
|
B
|
SE
|
P value
|
L
|
B
|
B
|
SE
|
p value
|
L
|
B
|
(Constant)
|
1.799
|
.034
|
.000
|
1.733
|
1.866
|
3.135
|
.778
|
.000
|
1.605
|
4.666
|
1.907
|
.962
|
.048
|
.015
|
3.798
|
District
|
.001
|
.002
|
.582
|
-.003
|
.006
|
-.054
|
.052
|
.294
|
-.156
|
.047
|
-.057
|
.064
|
.373
|
-.182
|
.068
|
Location
|
.018
|
.006
|
.004
|
.006
|
.031
|
.350
|
.144
|
.016
|
.066
|
.634
|
-.011
|
.179
|
.950
|
-.362
|
.340
|
Age
|
.002
|
.003
|
.418
|
-.003
|
.008
|
-.131
|
.069
|
.059
|
-.266
|
.005
|
-.037
|
.085
|
.666
|
-.204
|
.131
|
Gender
|
.005
|
.004
|
.203
|
-.003
|
.012
|
.197
|
.083
|
.018
|
.034
|
.361
|
.153
|
.103
|
.137
|
-.049
|
.355
|
Education Level
|
-.002
|
.003
|
.463
|
-.009
|
.004
|
-.064
|
.077
|
.411
|
-.216
|
.088
|
.201
|
.095
|
.036
|
.013
|
.389
|
Experience at work
|
.002
|
.003
|
.469
|
-.004
|
.008
|
-.016
|
.071
|
.816
|
-.155
|
.122
|
.006
|
.087
|
.942
|
-.165
|
.178
|
Clinical work
|
.013
|
.005
|
.014
|
.003
|
.024
|
.023
|
.122
|
.848
|
-.217
|
.264
|
-.210
|
.151
|
.166
|
-.507
|
.088
|
Chlorination
|
-.003
|
.023
|
.906
|
-.048
|
.043
|
-.260
|
.529
|
.624
|
-1.301
|
.781
|
.464
|
.654
|
.479
|
-.823
|
1.750
|
ANC
|
-.033
|
.008
|
.000
|
-.048
|
-.018
|
-.338
|
.177
|
.057
|
-.687
|
.011
|
.410
|
.219
|
.062
|
-.021
|
.841
|
Salt testing
|
-.001
|
.010
|
.899
|
-.020
|
.017
|
-.277
|
.217
|
.203
|
-.705
|
.150
|
-.274
|
.269
|
.308
|
-.803
|
.254
|
GMP
|
-.051
|
.017
|
.003
|
-.084
|
-.017
|
1.432
|
.392
|
.000
|
.661
|
2.203
|
.246
|
.485
|
.612
|
-.707
|
1.199
|
TB work
|
.005
|
.006
|
.439
|
-.008
|
.018
|
-.029
|
.148
|
.844
|
-.319
|
.261
|
.082
|
.182
|
.655
|
-.277
|
.440
|
HIV/AIDS
|
.011
|
.005
|
.039
|
.001
|
.021
|
.000
|
.121
|
.999
|
-.238
|
.239
|
-.056
|
.150
|
.707
|
-.351
|
.239
|
Drug Dispensing
|
-.006
|
.004
|
.148
|
-.015
|
.002
|
.077
|
.098
|
.431
|
-.115
|
.269
|
-.021
|
.121
|
.862
|
-.258
|
.216
|
ICCM
|
-.005
|
.003
|
.052
|
-.010
|
.000
|
.019
|
.059
|
.754
|
-.098
|
.135
|
.059
|
.073
|
.425
|
-.086
|
.203
|
MRDT
|
.019
|
.004
|
.000
|
.012
|
.027
|
.182
|
.083
|
.030
|
.018
|
.346
|
-.012
|
.103
|
.906
|
-.215
|
.191
|
Sputum collection
|
-.006
|
.004
|
.171
|
-.014
|
.003
|
-.043
|
.099
|
.665
|
-.238
|
.152
|
.067
|
.123
|
.586
|
-.174
|
.308
|
VHC meetings
|
.005
|
.009
|
.609
|
-.013
|
.022
|
-.822
|
.205
|
.000
|
-1.224
|
-.419
|
.277
|
.253
|
.273
|
-.220
|
.775
|
Family Planning
|
-.004
|
.004
|
.396
|
-.012
|
.005
|
-.422
|
.099
|
.000
|
-.617
|
-.227
|
-.168
|
.123
|
.171
|
-.409
|
.073
|
HBC
|
-.021
|
.011
|
.052
|
-.042
|
.000
|
.798
|
.245
|
.001
|
.316
|
1.280
|
-.244
|
.303
|
.422
|
-.840
|
.352
|
Nutrition
|
.002
|
.007
|
.742
|
-.012
|
.016
|
-.112
|
.161
|
.489
|
-.429
|
.206
|
.104
|
.199
|
.603
|
-.288
|
.496
|
Abbreviations: RA Role Ambiguity, RC Role Conflict, RO Role Overload, GM growth monitoring, VHC Village Health Committees, iCCM intergrated community case management, MRDT malaria rapid diagnostic testing, ANC antenatal care