STUDY DESIGN, STUDY AREA AND PERIOD
A mixed institution-based cross-sectional study design was used to collect data using both qualitative and quantitative methods. Key informant interviews and in-depth interviews were carried out to collect primary data. The proposed study was conducted to Addis Ababa. Addis Ababa is the capital city of Ethiopia, and it’s situated in the heartland of the country, covering an area of 527 km2 with a population of more than 7 million and lying at an altitude of 2,300 meters above sea level. This study included professionals working in health facilities were conducted from June 2023 through July 2023.
POPULATIONS
The source population was all health professionals working at selected public health facilities in Addis Ababa, Ethiopia. The study population consisted of all sampled health professionals in selected public health facilities that fulfilled inclusion criteria.
SAMPLING PROCEDURE AND SAMPLE SIZE DETERMINATION
A multistage sampling technique was implemented in 11 sub-cities found in Addis Ababa. 30% of the sub cities were selected by a simple random sampling method. Again, from the public health facilities found in each selected sub city, 30% were selected from each sub city randomly. The study participants were allocated proportionally based on the number of health professionals in each health facility using the simple random sampling technique.
The sample size (n) required for the objective was calculated using the formula to estimate a single population proportion by considering the following assumptions:
n= number of sample required for the study
Zα/2 = critical value for normal distribution at 95% confidence level, which equals to 1.96 (Z value at alpha=0.05).
P= (32.9%) level and factors associated with the health professional commitment in public health facilities, Southwest Ethiopia. (4)
d= Desired degree of accuracy (5%).
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)
n=340 and since the sampling method is multistage stratified sampling, by taking 1.5 design effects, 340*1.5 = 510, and by adding 5% non-response rate, 510*0.05 =535. Based on the assumption, the final sample size (n) is 535.
DATA COLLECTION INSTRUMENT AND PROCEDURE
Five sections make up the questionnaires. Part 1: socio-demographic data; Part 2: commitment questions Part 3: Job Satisfaction; Part 4: Perceptions of Health Professional Support; and Part 5: Working Environment Factors for Health Care Professionals. A five-point Likert scale, with response possibilities ranging from 1 (strongly disagree) to 5 (strongly agree), is used for parts 2, 4, 5, and 6. A five-point Likert scale from 1 (very unsatisfied) to 5 (very satisfied) was used for part 3. In order to gather quantitative data, self-administered questionnaires were used. At the time of data collection, the study population was encouraged to participate willingly by describing the purpose of the study. Three trained data collectors were used to distribute structured and pretested questions to the health professionals. Qualitative data were collected concurrently with the quantitative part. The researcher gathered information from both the in-depth interview and the key informant interview. The investigator gathered information via focus group discussions (FGDs) in support of a qualified facilitator. During data collection, data collectors were closely monitored and guided by two supervisors for their completeness, appropriate collection of the data, and reporting on a daily basis.
DATA QUALITY ASSURANCE
A pre-test was conducted on 5% of the sample size using validated tools adapted from previously published literature a week before the actual data collection in a similar study population (12,16,17). Any ambiguity, confusion, difficult words, or differences in understanding were revised and corrected based on the pretest experience. The English-adapted tools were translated to the Amharic version using professionals in linguistics and then back to English to check information consistency. The data collectors and supervisors were trained on the objective of the study and the data collection technique using a standardized tool. Supervision was held regularly during the data collection period. The data was cross-checked for consistency and completeness on a daily basis.
STUDY VARIABLES: Health professional’s commitment
OPERATIONAL DEFINITION
Health professional commitment: is the relative strength of an individual’s linkage to the respective profession. It is beyond a commitment for a particular organization and implies the individuals’ perspective towards their profession and the motivation that they have to stay in their job, which refers to one’s loyalty to the profession and the willingness to strive and uphold the value and goals of the profession to maintain membership in the profession, which can be explained by adherence to principles of ethical practice, effective interactions with patients and with other people working in the healthcare system, reliability, commitment to autonomous maintenance and continuous improvement of competence, pride in the profession, and good behavior outside work. This was measured using 10 items on a 5-point Likert scale, with 1 denoting commitment and 0 denoting uncommitted. A professional commitment score was created, and a higher score indicates higher professional commitment. The mean scores for all scales were reported as percentages of the scale mean score (%SM), and after standardization, the mean was calculated (18,19)
“Good health professional commitment’’ when the study participant scores above mean value and was coded 1
“Poor health professional commitment’’ when the study participant scores equal to and below the mean value of the sample and was coded 0
DATA ANALYSIS AND PRESENTATION
The data was thoroughly cleaned and carefully entered into the computer. During the entry of the data, double-entry verification using Epi-Data version 4.2 is applied and then exported to SPSS version 26 for further analysis. Descriptive statistics were used to summarize the data, and the results were presented using frequency tables and percentages. Bivariate analysis was carried out to identify applicant variables. Those variables in bivariate analysis whose p-value is less than 0.25 were included in multivariate logistic regressions. Then multivariate logistic regression analysis was performed for those factors that showed associations in bivariate analysis to investigate independent predictors by controlling for possible confounders. Finally, variables whose p-value is less than 0.05 were considered statistically significant, and results were presented using text, graphs, and tables.