Study area and period
The study was conducted in selected public health facilities of Bench Sheko Zone, Southrn Nations Nationalities and Peoples Regional State (SNNPR) state, south west Ethiopia, from March 20– April 30, 2020. Bench sheko Zone is one of the 15 zones of SNNR State of Ethiopia. Mizan Aman Town, is the capital of the Zone, which is located 585km away from Addis Ababa. The total estimated population of the zone is 625345. The zone has 8 districts, 6 rural and 2 town administration with 25 public health centers and one teaching hospital. There were 904 health professionals working in these public health facilities of Bench Sheko Zone.
Study design: Facility-based cross-sectional study.
Sample size and sampling technique
Fourteen public health facilities (thirteen health center and one hospital) were randomly selected from the 25 public health facilities found in Bench Sheko Zone. A total of 630 health professionals who worked for six month and above in the selected health facilities were included in the study. Those health professionals who had been on sick leave and steady leave during data collection were excluded from the study.
Variable of the study
Dependent variable
Organizational commitment
Independent variables
1. Socio-demographic variables: Gender, age, education level, marital status, type of profession, working health facility, year of service, having managerial position, residence, net monthly salary and housing condition.
2. Job satisfaction 3. Perceived organizational support 4. Perceived leadership style 5. Perceived psychological empowerment
Operational definitions and measurements
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Public health facilities are hospitals and health centers that are owned by government were considered as public health facilities.
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Organizational commitment means the relative strength of an individual’s linkage to the organization. It was measured with 16 items in 5-point Likert scale (1=strongly disagree to 5=strongly agree). The mean score (level of organizational commitment) was reported as the percentages of scale mean score (%SM) after calculation of standardized mean value. This value ranges from “0%” to “100%”. It was calculated using the formula %SM = (Actual score –Potential minimum score/Potential maximum–Minimum) *100(19). Composite scale of organizational commitment score was created from the four factors emerged on factor analysis of organizational commitment items. This score was used as continuous dependent variable on linear regression.
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Job satisfaction means positive or pleasurable emotional state resulting from the appraisal of one’s job or job experience. It was measured with 2 scales (perceived conducive work climate and perceived recognition).
Perceived conducive work climate refers to situations to health professionals’ work in facilities where there were good work atmosphere among professionals and between professionals and their facilities. It was measured using 3 items in 5 point Likert scale (1=very dissatisfied to 5=very satisfied). Perceived conducive work climate scale was created on factor analysis and higher score indicate higher job satisfaction.
Perceived recognition scale denotes career development and educational promotion opportunity in once organization. It was measured with 11 items in 5-point Likert scale (1=very dissatisfied to 5=very satisfied). Perceived recognition score was created on factor analysis and higher scores indicate higher job satisfaction.
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Perceived organizational support denotes the extent to which employees see that organizations recognizes their contribution and cares about their well-being. Perceived organizational support was measured using 2 scales; perceived value and care for employee and perceived concern for employee. Perceived value and care for employee defines job characteristic where the organization acknowledges the effort of health professionals and care for their wellbeing. This was measured using 3 items in 5-point Likert scale (1=strongly disagree to 5 =strongly agree). Perceived value and care for employee score was created on factor analysis and higher score indicate higher perceived organizational support.
Perceived concern for employee is the way how the organization is being open to the needs and questions of health professionals. This was measured with 4 items in 5-point Likert scale (1=very dissatisfied to 5=very satisfied). Perceived concern for employee score was created on factor analysis and higher score indicate higher perceived organizational support.
Perceived leadership style refers to perception of health professionals about leadership style of their immediate leader. It was measured with 2 scales; perceived transformational leadership style and perceived transactional leadership style.
Perceived transformational leadership style measures individual’s opinion about how their immediate leaders were motivating and inspiring to them and how they involve in setting good relationship. It was measured with 5 items in 5-point Likert scale (1=strongly disagree to 5=strongly agree). Perceived transformational leadership style was created on factor analysis and higher score indicate higher perceived leadership style.
Perceived transactional leadership style scale denotes perception of individual health professionals about how their leader manage or respond to situations or changes. It was measured with 2 items in 5-point Likert scale (1=strongly disagree to 5=strongly agree). Perceived transactional leadership style was created on factor analysis and higher score indicate higher perceived leadership style.
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Perceived psychological empowerment denotes the extent to which organizations give authority and freedom for their employees in order to do formal tasks. It was measured with 3 scales; perceived impact, perceived self-confidence and perceived self-determination.
Perceived impact denotes individual’s perception about their impact and influence in their organization or working department. Perceived impact was measured using 3 items in 5-point Likert scale, which ranges from (1=strongly disagree to 5 =strongly agree). Perceived impact score was created on factor analysis and higher scores indicate higher perceived psychological empowerment.
Perceived confidence scale measures health professionals’ opinion about their ability and competence in order to fully execute their job. It was measured with 3 items in 5-point Likert scale (1=strongly disagree to 5=strongly agree). Perceived confidence score was created on factor analysis and higher score indicate higher perceived psychological empowerment.
Perceived self-determination scale measure health professionals’ freedom and authority in the work place. It was measured with 2 items in 5-point Likert scale (1=strongly disagree to 5 =strongly agree). Perceived self-determination score was created on factor analysis and higher score indicate higher perceived psychological empowerment.
Data collection tool
Data were collected using structured questionnaire adapted from related literatures. The questionnaires had six parts. Part one contained socio-demographic characteristics which had 12 questions, part two comprised of job satisfaction questions with 23 items, part three was on perceived organizational support having 8 items, part four was on organizational commitment questionnaires having 24 items, part five was on perceived leadership style measures with 9 items and part six was on perceived psychological empowerment questionnaires with 12 items.
Tools from part one up to part three were adapted from related study conducted in Gurage zone southwest Ethiopia (SWE) (15) . Tool for part four was adapted from organizational commitment questioners of studies of Jaros which was initially developed and validated by Meyer and Allen(20). Tool for part five was adapted from Multi factor Leadership Questionnaire (MLQ) of studies of Mora C. and Ticlau T., which was firstly developed and validated by Bass and Avolio(21). Lastly, a tool for part six was adapted from studies of Ambad S and Bahron, which was initially developed and validated by Spreitzer(22). After running factor analysis the following scales were emerged as part of the tools.
Organizational commitment is a composite scale that was created from four factors each with Eigen value ≥ 1, which totally explained 66.88% of the variability, which facilitated the treatment of organizational commitment as a single continuous dependent variable on linear regression. The composite scale was labeled as organizational commitment. It had sixteen items, which had a reliability coefficient (Cronbach’s alpha) of 0.833. The first factor was loaded with the following seven items.
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One of the few serious consequences of leaving this organization would be the scarcity of available alternatives,
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I feel that I have very few options to consider leaving this organization,
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Too much in my life would be disrupted if I decided to leave my organization now,
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One of the major reasons I continue to work for this organization is that leaving would require considerable personal sacrifice and besides this another organization may not match the overall benefit I have here,
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Right now, staying with my organization is a matter of necessity as much as desire,
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It would be very hard for me to leave my organization right now even if I wanted to,
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If I got another offer for a better job elsewhere, I would not feel it was right to leave my organization.
The items have reliability coefficient (Cronbach’s alpha) of =0.869. This factor was named as continuance commitment scale. It explained, 24.84% of the total variability in the organizational commitment of health professionals.
The second factor has four items;
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Jumping from organization to organization does not seem at all unethical to me,
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I think that I could easily attach myself to another organization as I am to this one(R),
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I do not believe that a person must always be loyal to his or her organization(R),
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I think that people these days move from company to company too often(R).
This factor was labeled as normative commitment scale. The items loaded in this scale have reliability coefficient (Cronbach’s alpha) of = 0.769. The scale explained 15.63% of the total variability in the organizational commitment of health professionals.
Three items were loaded on the third factor;
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I do not feel ‘emotionally attached’ to this organization(R),
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I do not feel like ‘part of the family’ at my organization and I do not feel a ‘strong’ sense of belonging to my organization.
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I do not feel a ‘strong’ sense of belonging to my organization
This scale was identified as affective commitment. It has reliability coefficient (Cronbach’s alpha) of 0.766. It explained 13.47% of the total variability in the organizational commitment of health professionals.
Lastly, two items were loaded on the fourth factor
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I really feel as if this organization’s problems are my own,
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I enjoy discussing about my organization with people outside it.
These items have Cronbach’s alpha of = 0.70. The factor was named as perceived proud and concern scale. It explained around 10% the variability in the organizational commitment of health professionals.
Job satisfaction: Two factors each with Eigen value ≥ 1, which explained 66.18 % of the total variability in job satisfaction of health professionals were extracted.
Three items were loaded on the firs factor
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I have good working relationship with my colleagues,
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There is a clear channel of communication at my workplace,
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I can depend on my colleagues for support.
This scale was named as perceived conducive work climate. The items have reliability coefficient (chronbachs alpha of 0.845). Perceived conducive work climate scale explained 49.12% of the total variability in the job satisfaction of health professionals.
The second factor was loaded with 11 items
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I have enough support for continuing education,
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I have sufficient opportunity for professional growth,
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I get support for personal growth and development through education and training,
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I receive recognition for the tasks well done,
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I don’t experience frustration in my workplace due to limited supply,
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I have support to be fully accountable for those decisions,
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My work has more advantages than disadvantage,
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Adequate consideration is given to my opinion and suggestion for change in the work setting,
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My income is the reflection of the work I do,
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Adequate recognition is given to my personal needs,
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There are training opportunities available to me.
This scale was denoted as perceived recognition. The items have reliability coefficient (Cronbach’s alpha) of 0.941. Perceived recognition explained 17.05% of the total variability in the job satisfaction of health professionals.
Perceived organizational support: Two factors each with Eigen value ≥ 1, which together explained 58.53% of the total variability in perceived organization support of health professionals were extracted. The following four items were loaded on the first factor
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The organization fails to appreciate any extra effort from me(R),
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The organization ignores any compliant that I raise (R),
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Even if I did the best job possible, the organization would fail to notice(R),
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The organization shows very little concern for me(R). This factor was labeled as perceived concern for employee scale. Perceived concern for employee had reliability coefficient (Cronbach’s alpha) of 0.723. It explained 31.3% of the total variability in the perceived organization support of health professionals. The second factor was loaded with 3 items
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The organization values my contribution to its wellbeing,
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The organization really cares about my wellbeing,
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The organization cares about my general satisfaction at work.
The scale was identified as perceived value and care for employee scale. The items of this scale had reliability coefficient (Cronbach’s alpha) of 0.692. It explained 27.22% of the total variability in the perceived organizational support of health professionals.
Perceived leadership style: Two factors each with Eigen value ≥ 1 which cumulatively explained 77.67% of the total variability in perceived leadership style of health professionals were extracted.
The first factor was loaded with the following five items
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My manager talks optimistically about the future,
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My manager spends time teaching and coaching me,
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My manager reexamines critical assumptions in order to question whether they are appropriate,
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My manager instills pride in me for being associated with him/her,
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My manager avoids making decisions(R).
This factor was labeled as perceived transformational leadership style. The items of this scale have reliability coefficient (Cronbach’s alpha) of 0.908. Perceived transformational leadership style explained 50.42% of the total variability in the perceived leadership style of health professionals.
Two items were loaded on the second factor
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My manager fails to interfere until problems become serious(R),
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My manager concentrates his/her full attention on dealing with mistakes, complaints and failures(R).
This scale was identified as perceived transactional leadership style. It explained 27.24 % of the total variability in the perceived leadership styles of health professionals. Perceived transactional leadership style items have Cronbach’s alpha of 0.862.
Perceived psychological empowerment: Three factors each with Eigen value ≥ 1, which in combination explained 80.81 % of the total variability in the perceived psychological empowerment of health professionals were extracted.
The first factor was loaded with three items
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My impact on what happens in my department is large,
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I have a great deal of control over what happens in my department,
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I have significant influence over what happens in my department.
This factor was named as perceived impact. Perceived impact explained 30.02% of the total variability in the perceived psychological empowerment of health professionals. Perceived impact items had reliability coefficient (Cronbach’s alpha) of 0.873.
The second factor was loaded with three items
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I am confident about my ability to do my job,
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I have mastered the skills necessary for my job,
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I am self-assured about my capabilities to perform my work activities.
The scale was named as perceived self-confidence. Perceived self-confidence explained 28.43% of the total variability in perceived psychological empowerment of health professionals. Perceived self-confidence items had reliability coefficient (Cronbach’s) alpha of 0.835.
Data quality control
The questionnaire firstly prepared in English was translated into the local language (Amharic) which was back translated into English to ensure consistency. The study tools were pre-tested on 66 health professionals (10% of the sample size) who were not actual study participants working in a nearby public health facilities. Seven BSc. Degree holder health professionals (4 health officers and 3 nurses) employed as data collectors. One masters of public health student (MPH) and two assistant lecturers of public health were supervisors of the data collection. Prior to actual data collection process two days training was given for data collectors and supervisors about; general overview of organizational commitment, its effect on health care service delivery, aim of the study, data collection tools, process of data collection and the role of each data collector and supervisor from the beginning of data collection to the end.
Data processing and analysis
Data were entered into Epi-data Version 3.1 and exported to SPSS version 24.0 for analysis. The frequency distribution of all the variables was examined to check for data entry errors. Assumptions of factor analysis and linear regression were checked. Simple and multiple linear regression were done. Variables with p- value ≤ .25 on simple linear regression were candidate for multiple linear regression model. Hierarchal linear regression with enter method were done to build the final multiple regression model. Predictors of organizational commitment were declared in the final model at a significance level of p-value ≤0.05. Independent sample t-test and one-way ANOVA were done to check the presence of significant mean difference in organizational commitment between and among categories of categorical sociodemographic variables respectively. Finally, findings were presented using; figures, raw means, standard deviations, percentage mean scores and summary tables.
Ethical considerations
The current study was conducted in accordance with declaration of Helsinki. Ethical clearance letter was obtained from institutional review board of Institute of health of Jimma University. In addition, support and permission letter were obtained from Zonal, Woreda health departments. Prior to starting data collection process written informed consent was taken from each study participants. Participant’s right to participate and withdraw from the study was assured.