Most of the participants were nurses/midwives (62%). Approximately two-thirds of respondents were men (65.2%), 56.7% were younger than 40, and 86.9% were married. Mostly physicians, 47.3% of participants were Syrians with Turkish citizenship (Table 1). Although most of the healthcare workers had an undergraduate degree or higher, for 28.8% of nurses, the highest education level was high school. Almost half (41.2%) of study participants had five or less years of work experience in Syria, and 64.5% had worked in Turkish healthcare services for two years or less.
Table 1. Sociodemographic and occupational characteristics of respondents
Characteristic
|
General physician (n = 259)
|
Specialist physician (n = 77)
|
Nurse/midwife (n = 555)
|
Total (n = 891)
|
n
|
%
|
n
|
%
|
n
|
%
|
n
|
%
|
Sex
|
|
|
|
|
|
|
|
|
Male
|
209
|
80.7
|
58
|
75.3
|
314
|
56.6
|
581
|
65.2
|
Female
|
50
|
19.3
|
19
|
24.7
|
241
|
43.4
|
310
|
34.8
|
Age group (years)
|
|
|
|
|
|
|
|
|
20–29
|
41
|
15.8
|
0
|
0.0
|
127
|
22.9
|
168
|
18.9
|
30–39
|
100
|
38.6
|
24
|
31.2
|
213
|
38.4
|
337
|
37.8
|
40–49
|
56
|
21.6
|
34
|
44.2
|
159
|
28.6
|
249
|
27.9
|
≥ 50
|
62
|
23.9
|
19
|
24.7
|
56
|
10.1
|
137
|
15.4
|
Nationality
|
|
|
|
|
|
|
|
|
Syrian
|
111
|
42.9
|
31
|
40.3
|
328
|
59.1
|
470
|
52.7
|
Syrian with Turkish citizenship
|
148
|
57.1
|
46
|
59.7
|
227
|
40.9
|
421
|
47.3
|
Education
|
|
|
|
|
|
|
|
|
High school
|
0
|
0.0
|
0
|
0.0
|
160
|
28.8
|
160
|
18.0
|
Undergraduate degree
|
166
|
64.1
|
16
|
20.8
|
386
|
69.5
|
568
|
63.7
|
Masters/postgraduate degree
|
93
|
35.9
|
61
|
79.2
|
9
|
1.6
|
163
|
18.3
|
Profession in Syria
|
|
|
|
|
|
|
|
|
General physician
|
184
|
71.0
|
0
|
0.0
|
0
|
0.0
|
184
|
20.7
|
Specialist physician
|
75
|
29.0
|
77
|
100.0
|
0
|
0.0
|
152
|
17.1
|
Nurse/midwife
|
0
|
0.0
|
0
|
0.0
|
555
|
100.0
|
555
|
62.3
|
Years worked in Syria
|
|
|
|
|
|
|
|
|
0–5
|
134
|
51.7
|
20
|
26.0
|
213
|
38.4
|
367
|
41.2
|
6–10
|
53
|
20.5
|
21
|
27.3
|
123
|
22.2
|
197
|
22.1
|
> 10
|
72
|
27.8
|
36
|
46.8
|
219
|
39.5
|
327
|
36.7
|
Years worked in Turkeya
|
|
|
|
|
|
|
|
|
0–2
|
172
|
66.4
|
42
|
54.5
|
361
|
65.0
|
575
|
64.5
|
> 2
|
87
|
33.6
|
35
|
45.5
|
194
|
35.0
|
316
|
35.5
|
a In the Ministry of Health project.
Work characteristics and work environment
Almost half of the nurses/midwives (46.1%) reported seeing an average of 21–40 patients per day; in comparison, the highest proportions of both general and specialist physicians reported seeing more than 61 patients per day (46.7% and 39.0%, respectively) (Table 2). Most participants reported having access to the resources required for their work and knowing how to use the equipment and materials at their disposal. Among all participants, 88.2% rated the level of teamwork as good. A slightly lower proportion of all participants (77.7%) rated their team management as good; the lowest proportion of participants giving this assessment were general physicians (68.0%). Of the three professional groups, nurses were the most positive about their teamwork and team management. Overall, 46.1% of participants rated their income as average; this rating was reflected among the specialist physicians and nurses, while the highest proportion of general physicians assessed their income as poor.
Table 2. Work characteristics and work environment of respondents
Characteristic
|
General physician (n = 259)
|
Specialist physician (n = 77)
|
Nurse/midwife (n = 555)
|
Total (n = 891)
|
n
|
%
|
n
|
%
|
n
|
%
|
n
|
%
|
Type of health centre
|
|
|
|
|
|
|
|
|
RHTC
|
23
|
8.9
|
11
|
14.3
|
42
|
7.6
|
76
|
8.5
|
RHC
|
215
|
83.0
|
56
|
72.7
|
491
|
88.5
|
762
|
85.5
|
Extended RHC
|
21
|
8.1
|
10
|
13.0
|
22
|
4.0
|
53
|
5.9
|
Average number of patients/day
|
|
|
|
|
|
|
|
|
< 21
|
3
|
1.2
|
3
|
3.9
|
68
|
12.3
|
74
|
8.3
|
21–40
|
40
|
15.4
|
18
|
23.4
|
256
|
46.1
|
314
|
35.2
|
41–60
|
95
|
36.7
|
26
|
33.8
|
153
|
27.6
|
274
|
30.8
|
≥ 61
|
121
|
46.7
|
30
|
39.0
|
78
|
14.1
|
229
|
25.7
|
Access to resources needed for work
|
|
|
|
|
|
|
|
|
Yes
|
196
|
75.7
|
49
|
63.6
|
489
|
88.1
|
734
|
82.4
|
No
|
63
|
24.3
|
28
|
36.4
|
66
|
11.9
|
157
|
17.6
|
Know how to use equipment/other materials
|
|
|
|
|
|
|
|
|
Yes
|
256
|
98.8
|
77
|
100.0
|
551
|
99.3
|
884
|
99.2
|
No
|
3
|
1.2
|
0
|
0.0
|
4
|
0.7
|
7
|
0.8
|
Teamwork
|
|
|
|
|
|
|
|
|
Poor
|
11
|
4.2
|
2
|
2.6
|
8
|
1.4
|
21
|
2.4
|
Average
|
34
|
13.1
|
7
|
9.1
|
43
|
7.7
|
84
|
9.4
|
Good
|
214
|
82.6
|
68
|
88.3
|
504
|
90.8
|
786
|
88.2
|
Team management
|
|
|
|
|
|
|
|
|
Poor
|
34
|
13.1
|
8
|
10.4
|
27
|
4.9
|
69
|
7.7
|
Average
|
49
|
18.9
|
15
|
19.5
|
66
|
11.9
|
130
|
14.6
|
Good
|
176
|
68.0
|
54
|
70.1
|
462
|
83.2
|
692
|
77.7
|
Income
|
|
|
|
|
|
|
|
|
Poor
|
118
|
45.6
|
23
|
29.9
|
73
|
13.2
|
214
|
24.0
|
Average
|
111
|
42.9
|
43
|
55.8
|
257
|
46.3
|
411
|
46.1
|
Good
|
30
|
11.6
|
11
|
14.3
|
225
|
40.5
|
266
|
29.9
|
Job satisfaction
Nurses/midwives reported the highest level of general job satisfaction, followed by specialist physicians and then general physicians (Table 3). Kruskal–Wallis analysis provided a strong support that job satisfaction levels differed between the three professional groups (p< 0.001); a follow-up Dunn's pairwise test revealed that job satisfaction scores were significantly higher in nurses than in physicians, both general and specialist (p < 0.001). Further analysis revealed that physicians who had worked as specialists in Syria but were now working as general physicians in Turkey had the lowest satisfaction levels (Fig. 1). However, the difference in job satisfaction between sub-groups of physicians was not significant.
Table 3. Job satisfaction by profession
Profession
|
Participants (n)
|
Mean
|
SD
|
95% CI
|
Range
|
General physician
|
259
|
63.3
|
14.6
|
61.5–65.1
|
20.0–100.0
|
Specialist physician
|
77
|
65.9
|
13.2
|
63.2–69.0
|
29.0–88.0
|
Nurse/midwife
|
555
|
74.9
|
11.0
|
74.0–75.8
|
20.0–100.0
|
Total
|
891
|
70.8
|
13.4
|
69.9–71.7
|
20.0–100.0
|
As there was no significant difference in job satisfaction between general and specialist physicians, data for both groups were combined in the analysis of satisfaction on the items of the MSQ. Levels of satisfaction on the 20 items on the MSQ also varied among the different groups of participants (Fig 3 and 4). Responses for the five-point Likert scale were combined into three categories: satisfied (satisfied and very satisfied), neutral and dissatisfied (dissatisfied and very dissatisfied). Physicians were most satisfied with the co-workers, authority and social service items and least satisfied with the compensation, workplace policy/practice and moral values items. Nurses were most satisfied with the social services, professional ability utilization, and co-workers and least satisfied with the moral values, compensation, and independence items. Overall, physicians were more dissatisfied than nurses with compensation.
Factors affecting job satisfaction
Sociodemographic factors
Sociodemographic factors included age, gender, education, and Turkish citizenship. A statistically significant difference was found in the mean general job satisfaction score between age groups (p < 0.003), education levels (p < 0.001), and citizenship categories (p = 0.002). The mean general job satisfaction score was highest among those aged 40–49 yrs. When analyzed by education level, job satisfaction was highest among those with high school education. Job satisfaction scores were higher for healthcare workers without Turkish citizenship than those with Turkish citizenship (p = 0.002).
Work characteristics
The work characteristics assessed in this study were the number of patient consultations per day, access to resources (e.g. equipment and supplies) needed for, work and knowing how to use the available equipment and other materials. Job satisfaction scores were significantly different according to the number of consultations per day. Scores were highest among health workers who saw fewer than 21 patients per day (p < 0.001). There was a significant inverse relationship between the number of patients seen per day and job satisfaction scores (p < 0.001). Participants who reported having access to necessary resources also had significantly higher job satisfaction scores (p < 0.001).
Work environment
The factors used to assess the work environment of Syrian physicians and nurses were type of health center and the participants' perceptions of teamwork and team management. Job satisfaction scores were significantly influenced by all three factors. The mean job satisfaction score was significantly lower for those working in extended RHCs (p = 0.007) and significantly higher among those who rated teamwork and team management as good. Those who rated teamwork as poor had job satisfaction scores 13 points lower than those who rated it as good and three points lower than those who rated it as average (p < 0.001).
Profession, experience and income
The mean job satisfaction scores were significantly higher in nurses than in the physicians. (p < 0.001). Job satisfaction scores also differed significantly by the number of years they worked in Syria (p < 0.001) but not by the number of years working in Turkey (p = 0.190). Compared with the other categories for years worked in Syria, participants with over 10 years of experience had the highest mean job satisfaction scores. The mean job satisfaction score was directly associated with the perception of income earned from working in the RHCs (from poor to good; p < 0.001). Compared with those who rated their income as good, the job satisfaction score was 7.7 points lower among those who rated it as poor and 3.4 points lower among for those who rated it as average.
Multiple linear regression analysis was used to determine which factors likely affected job satisfaction. Variables included in the analysis were age group, nationality, number of patients per day, type of health center, teamwork, team management, job in Turkey, number of working years in Syria and income. Out of these factors, only profession in Turkey and perception of income, teamwork and team management were significantly associated with job satisfaction (Table 4).
Table 4. Multiple regression analysis of factors associated with the general job satisfaction score
Variable
|
B
|
95% CI
|
SE
|
P value
|
Lower bound
|
Upper bound
|
Age group (years) (ref. ≥ 50)
|
|
20–29
|
−4.32
|
−7.53
|
−1.12
|
1.634
|
0.008*
|
30–39
|
−4.61
|
−7.28
|
−1.94
|
1.361
|
0.001*
|
40–49
|
−0.48
|
−2.59
|
1.62
|
1.070
|
0.651
|
Nationality (ref. Syrian with Turkish citizenship)
|
0.32
|
−0.97
|
1.61
|
0.655
|
0.626
|
Education (ref. High school)
|
|
|
|
|
|
Undergraduate degree
|
−0.52
|
−2.45
|
1.42
|
0.984
|
0.600
|
Masters/postgraduate degree
|
−0.31
|
−3.12
|
2.50
|
1.432
|
0.829
|
Number of patients/day (ref. < 20)
|
|
|
|
|
|
21–40
|
−0.81
|
−3.26
|
1.63
|
1.247
|
0.515
|
41–60
|
−0.45
|
−2.97
|
2.07
|
1.285
|
0.725
|
≥ 61
|
−1.52
|
−4.19
|
1.15
|
1.361
|
0.265
|
Type of health centre (ref. RHTC)
|
|
|
|
|
|
RHC
|
−1.65
|
−3.93
|
0.63
|
1.161
|
0.156
|
Extended RHC
|
−2.00
|
−5.38
|
1.38
|
1.721
|
0.245
|
Teamwork (ref. Good)
|
|
|
|
|
|
Poor
|
−13.44
|
−18.11
|
−8.77
|
2.379
|
0.000*
|
Average
|
−3.82
|
−6.13
|
−1.51
|
1.178
|
0.001*
|
Team management (ref. Good)
|
|
|
|
|
|
Poor
|
−15.85
|
−18.63
|
−13.08
|
1.412
|
0.000*
|
Average
|
−9.31
|
−11.27
|
−7.35
|
0.998
|
0.000*
|
Profession (ref. Nurse/midwife)
|
|
|
|
|
|
General physician
|
−6.84
|
−8.81
|
−4.88
|
1.000
|
0.000*
|
Specialist physician
|
−6.60
|
−9.59
|
−3.62
|
1.522
|
0.000*
|
Years worked in Syria (ref. > 10)
|
|
|
|
|
|
0–5
|
1.99
|
−0.37
|
4.35
|
1.202
|
0.099
|
6–10
|
2.26
|
0.05
|
4.48
|
1.130
|
0.045*
|
Income (ref. Good)
|
|
|
|
|
|
Poor
|
−7.79
|
−9.77
|
−5.81
|
1.009
|
0.000*
|
Average
|
−3.24
|
−4.77
|
−1.72
|
0.777
|
0.000*
|
*: P < 0.05.