Turnover intention among primary health workers in China: a systematic review and meta-analysis

Rongxin He; Jinlin Liu; Wei-Hong Zhang; Bin Zhu; Ning Zhang; Ying Mao

doi:10.1136/bmjopen-2020-037117

Turnover intention among primary health workers in China: a systematic review and meta-analysis

BMJ Open. 2020 Oct 16;10(10):e037117. doi: 10.1136/bmjopen-2020-037117.

Authors

Rongxin He^{1

2}, Jinlin Liu^{1

2}, Wei-Hong Zhang³, Bin Zhu^{1

2}, Ning Zhang^{1

2}, Ying Mao^{4

2}

Affiliations

¹ Department of Social Security, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
² Research Center for the Belt and Road Health Policy and Health Technology Assessment, Xi'an Jiaotong University, Xi'an, China.
³ International Centre for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium.
⁴ Department of Social Security, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi, China mao_ying@mail.xjtu.edu.cn.

Abstract

Objectives: To analyse the prevalence and determinants of turnover intention (TI) among primary health workers (PHWs) in China to provide evidence for improving retention measures.

Design: Systemic review and meta-analysis.

Data sources: Four English-language databases (PubMed, EMBASE, Cochrane Library, PsycINFO) and three Chinese databases (CNKI, CSPD, CBM) were searched up to October 2019.

Eligibility criteria: Eligible studies were observational or descriptive studies conducted in mainland China. The prevalence of TI among health workers and related factors had to be explicitly reported in each included study.

Data extraction and synthesis: Data were extracted by one author and reviewed independently by two other authors. For each factor analysed by a meta-analysis, the factor was required to be the same across different studies, and at least three studies had to include it. The quality of studies was assessed using the Newcastle-Ottawa Scale and heterogeneity was evaluated using the I² statistic.

Results: We identified 16 cross-sectional studies investigating a total of 37 672 PHWs. The prevalence of TI was 30.4%. Subgroup analysis revealed that the highest prevalence was observed in the community primary healthcare institutions and the eastern provinces of China. Meta-analyses indicated that 21 factors were significantly associated with TI, including demographic factors (gender, age, education, marital status), job characteristic factors (title, work seniority, remuneration, social status, organisational affiliation, work stress) and job satisfaction factors (learning and training opportunity, interpersonal relationship, work condition and environment, and so on).

Conclusion: This study highlights the problem of TI among PHWs in China. Efforts should be made to improve conditions in both work-related areas and areas outside of work. Policymakers should continue to improve reward systems, the construction of infrastructure and promotion systems, and pay more attention to PHWs' lives outside of work and meet their living needs.

Keywords: health policy; health services administration & management; human resource management; primary care.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

China / epidemiology
Cross-Sectional Studies
Humans
Intention*
Job Satisfaction
Personnel Turnover*