Assessment of Turnover Intention and Associated Factors Among Health Information Technology Professionals Working in Public Health Institution, South Gondar Zone, Northwest Ethiopia

Background: Place of work turnover is critical to health information technology professionals (HIT) and health information systems as it indications dropping skilled and competent health information professionals. However, the progress of surviving plans requests a strong acceptance of the place of work variables that either inspire health information staff to persist active or principal them to dispensation their recent working organization. Objective: This study was deliberate to measure intention to leave and associated factors among health information technology professionals working in south institution, Methods: A cross-sectional study was carried out among 122 health information technology professionals. Data were collected using structured pre-tested self-administered questionnaires from September 1 to October 1/2020. The collected data were entered into Epi-info Version 7 and exported to SPSS version 20 software for analysis. Bivariate and multivariable logistic regression was employed to detect influences associated with dependent and independent variables. Odds ratio (OR), with 95% CI and p< 0.05 were computed to determine the level of significance. Results: Based on the operational definition the total score of intent to leave health information technology professionals from the organization was 64.8% [95% CI: 56.6-72.9]. Among the applicant variables for multivariable analysis 3 variables like the marital status of the respondents [OR: 0.49(0.231-1.042)p: value 0.000], performance appraisal of the respondents [OR: 7.0(2.66-18.45) p: value 0.000] and recognition of the respondents [OR: .447(.783-3.513) p: value 0.002] had to have a significant association with intention to leave and performance appraisal of the respondents were significantly associated 8.29 times [AOR: 8.29(3.002-22.889)p: value 0.001] to leave of the respondents from the working organization.


Background
Health information technology (HIT) is discipline practical to health and health care. It maintenances health information management systems through electronic systems and the safe exchange of health information between clients, workers, financiers, and quality monitors [1].
Health IT (health information technology) is the part of IT including the plan, development, creation, use, and maintenance of information systems for the health sector, Automated and interoperable healthcare information systems will continue to improve medical care and public health, lower costs, increase efficiency, reduce errors and improve patient satisfaction, while also optimizing reimbursement for ambulatory and inpatient healthcare providers [1,2].
Regardless of the types of organizations, human resources are important organizational assets in determining core organizational capability, effectiveness, and performance, together with other sorts of resources such as material or intellectual resources [4].
Employee turnover refers to the process of employees leaving an organization and having to be replaced. It is a problem that affects all organizations and has become a focus of healthcare organizations because of high replacement costs [5,6].

Study area and periods
The study was conducted under the south Gondarzonal health department Public health institution (SGZHD), Ethiopia. The study was conducted from March to April /2020.

Study Design
A cross-sectional study design was conducted.

Source population
All health information technology professionals working in south Gondar zone public health institutions were taken as source population.

Study population
The study subjects were all health information technology professionals working in public health institutions for six (6) months and above during the study period.

Inclusion Criteria
 Full-time employees who were working in public health institutions of south Gondar zonal health department.

Exclusion Criteria
 Health information technology professionals who were less than 6 months' work experience.

Sample Size Determination and Sampling Technique
The sample size of the study was the total population of health information technology (HIT) who was working in a public health facility under the south Gondar zone health department and the sampling technique was a total survey.

Data Collection Tools
An English version self-administered questionnaire was adapted from different works of literature were used to collect data on socio-demographic characteristics, job satisfaction, and their intention to leave the organization.
Job satisfaction was measured with a forty-seven-item scale that included twelve subscales adapted and customized into the local context from previous studies [32,34] compensation and benefit, professional opportunities, work environment, supervisor support, relationship and coworker, organizational policy, and strategy, performance appraisal, nature of work, recognition, workload, and autonomy. These items were answered on a five-point Likert scale with response options ranging from 1 (very dissatisfied) to 5 (very satisfied) [35].
The dependent variable, intention to leave the organization was measured by three items. [36].
The respondents were asked to indicate the extent of their agreement using a five-point scale (1=strongly disagree, 5=strongly agree). The total score was obtained by calculating the sum of all items on the scale.

Data collection procedure
Data were collected through a structured self-administered questionnaire by the health information technology (HIT's) from each Woreda health office under the Zonal health department. The principal investigator was distributed and provided a one-hour orientation about the purpose and processes of data collection for a single health information technology (HIT's) of data collector in each health facility. Then the principal investigator were collect completed questionnaires from each participant government health facility found in the south Gondar Zonal health department during the study period.

Operational definitions
Health Information Technician (also known as health information technology Professionals): Anyone who has earned a Diploma and/or bachelor's degree or higher in health information technology from an accredited college or university.
Turnover intention: the intention of an employee to leave their organization in the new future. Respondents who will be scored more than 60% of the sum of all the intention to leave scale items will be considered as showing the Intention to leave Job satisfaction level item score: All items are scored on 5 point liker scale as 1, 2, 3, 4, and 5 to score respondents" satisfaction level on the respective item as very satisfied, satisfied, neutral, dissatisfied, and very dissatisfied respectively.
Work Environment: describes the quality of the working environment both its physical qualities and the degree to which it provides meaningful work. Supervisor support: describes the supervisors' responsibility both in preventing and solving employee problems.

Co-worker Relationship:
Describes the participants' interpersonal relationships within their workplace.
Compensation and benefit describe Employees' expectations of fairness and adequate compensation on a day's pay for a day's work.
Promotion: describes the availability of advancement opportunities for employees within the organization.
Autonomy: reflects participants' autonomy in initiating and continuing their work behaviors and processes such as making decisions about work methods, pace, and effort.
Performance appraisal: describes the participants feeling on the measurement of their actual performance.
Nature of work: describes the type of work the participants do (its Variety, meaningfulness...).
Workload: describes the participant's work requirement, the amount of time, and resources for this requirement.

Data processing and analysis procedures
The collected data were checked for completeness. Then, it was coded, organized, and entered into Epi-info Version 7 and exported to SPSS version 20 software for cleaning, merging, and analysis. Tables and graphs were used to present the result.
Descriptive statistical analyses such as frequencies and percentages were used to describe the study population characteristics and responses to the questionnaire items.
Mean & standard deviation was also computed to explore the dominant turnover intention and satisfaction status of health information technology employees. Binary logistic regression was conducted to identify the factors that associate with the dependent variable (turnover) with a 0.05 Significance level. The model fitness was checked by Homier and Lemeshow test, based on the findings of Homier and Lemeshow test the model was fitted at 69.1% and the chi-square was used to test the association between the dependent and independent variables and there was shown a significant association between dependents and independent variables with p-value <0.046.

Data quality management
To assure the quality of data pre-test was conducted on 10% of the total sample size (13) in Bahirdar Town Health Institutions. Based on the pre-test, the tools were assessed for clarity; understanding ability, flow, and structure. Additionally, all completed questionnaires were collected and examined by the investigator. Twelve data collectors (diploma HIT) and two supervisors (BSc HIT) were assigned for data collection and training was given for one day. Before the data collection, the questionnaire was translated to Amharic and then back to English after data collection to ensure its consistency.

Ethical consideration
Ethical clearance was obtained from the ethical committee of the institute of public health, college of medicine and health science, Debrtabor University. Before communicating the study participants' Official letters were given from Debrtabor University (DTU) and the selected health facilities to get a supportive letter. Then permission from specific hospital management and other relevant managerial hierarchy to conduct the study was obtained. The name was not to be written on the YalgawLibsuyeZimamu Page 20

Assessment of turnover intention and associated factors among health information technology (HIT) professionals
questionnaire and the confidentiality of the data was been kept at all levels of the study.

Job Satisfaction
Based on the operational definition the overall score of intention to leave of health

Factors associated with intention to leave
Findings based on the analytical part ,which results , variables such as sex of the respondents  (table 3).

Discussion
The current study tried to assess the magnitude of intention to leave among health information technology professionals and the overall score of intention to leave of health information technology professionals from the organization in the study area shown an intention to leave their current work within one year respectively, The two studies showed that intention to leave of health professionals among Gondar referral hospital and Gambella region found to be lower than the current study, this may be in the current study area absence of different enforcements to retain those health information technology professionals, lack of motives, bad working environment and the tendency of professionals to leave from this environment and shift their working areas to another environment from the region [19,20]. As shown above, the current study revealed that the overall magnitude of intention to leave among health information technology professionals had been 64.8%. A similar study was done in Southwest Ethiopian, Jimma zone health institutions intention to reveal that 59.4% of the health professionals had intended to leave. The study findings from the Jimma zone and the findings of the current study are in line with each other. The possibility of similarity among the two studies may be due to similarity in payment and other benefits, the similarity in professional development, similarities in family arrangements, and similarities in recognition and rewards [17].

Similar studies in developed countries also showed that no different from studies in
Ethiopia such as studies in Jimma, Gambella, and Gondar University. For instance, the study conducted by Iraqi doctors on the magnitude of intention to leave their organization revealed that 55.2% were actively seeking alternative employment jobs due to intention to leave. The study findings of the current research are higher by intention to leave as compared with the study conducted in Iraqi. The higher intention to leave among the current study participants may be due to a good working environment, scarcity of extra benefits other than salary, conflicts with managers, and dissimilarities among study areas, which means differences in economic status among the two comparing study areas [15].
From the current study majority of the study participant, (93.4%) were satisfied with the co-worker relationship, and (73.8%) of participants were satisfied with organizational Policy and strategy but were dissatisfied with pay and benefit 118 (96.7%), and educational development 103(84.4 %). A similar study conducted in the Gambella region showed that intention to leave was higher for those who were dissatisfied with their salary (78.8%), educational opportunity (76.0%), and working environment (76.3%) [20]. The current study revealed that higher numbers of health

Assessment of turnover intention and associated factors among health information technology (HIT) professionals
information technology professionals were dissatisfied than the above study. The possibility of dissatisfaction would be due to lack of professional development, poor payments and benefits, lack of a comfortable working environment, and lack of motivation and incentives for those who perform better [20].
From this study, about 84.4 % of study participants were dissatisfied with lack of educational development, similarly a study conducted in Sub-Saharan Africa showed that about 28% of study subjects were dissatisfied with lack of professional development and the major reason for leaving the previous job. Higher numbers of the study participants were dissatisfied with the current study than the above study with lack of educational development. The possible reason for dissatisfaction was a lack of opportunity for professional development [27].
Factors like performance appraisal of the respondents were significantly associated 8.29 times to leave but the marriage had 40.35% and is recognized by the organization had 42.1% times reduce the risk of intention to live respectively. A similar study conducted in Bahirdar showed health professionals never married and married 27.58 and 11.45 times more likely to leave the public health sector as compared to Divorced Marital status. The findings of the current study are inversely related to the above study that means marriage is a preventive factor for intention to leave for the current study but a risk factor for the above study. The possible difference may be due to married and stay the two couples in similar residencies from the current study [31].
Generally, the magnitude of intention to leave from the current study is higher and influenced by factors like performance appraisal.

Conclusions
The magnitude of health information professional's intention to leave was found to be high, which can extremely affect the coverage and quality of information management and use of information for decisions in the zone.    [21,32,33] Tables