Abstract
In the mental healthcare field, job satisfaction is a crucial indicator of burnout rate, turnover, well-being, and service quality. Various factors may influence job satisfaction for mental healthcare professionals. In low- and middle-income countries, job satisfaction and its associated factors need to be considered to counteract the critical lack of human resources in the mental healthcare field. A cross-sectional study was conducted through an online survey. The survey included sociodemographic questions, work-related questions, and job satisfaction measurements with the Job Satisfaction Survey. In total, 1121 mental healthcare workers across Vietnam participated in this study. Interestingly, the level of job satisfaction of mental health workers in Vietnam was significantly higher than in the United States. Older age, female gender, higher economic area of living, and stable working contract were found to predict job satisfaction, whereas direct care of psychiatric patients and taking care of child and adolescent patients were inversely associated with job satisfaction. The results of this study are essential to develop strategies to improve mental health workers’ job satisfaction and thus optimize the quality of mental healthcare services and mental health staff job adherence in Vietnam.
Highlights
● A lot of previous evidence suggest factors associated with job satisfaction of healthcare workers such as sociodemographic characteristics, colleagues relationship, organization, opportunities and recognition.
● Low and middle income countries in general and Vietnam in particular has a shortage of human resources in mental healthcare sector, which sparks a demand for a reform in mental healthcare system.
● We found that Vietnamese mental healthcare workers were more satisfied than that of American population, factors associated with higher job satisfaction includes higher age, female gender, rural working area, short term contract and working with child and adolescent patients. Factor negatively associated with job satisfaction is direct care to patient.
Introduction
Job Satisfaction in the Vietnamese Mental Health Workforce
Contemporary mental health systems have evolved to cater to diverse client needs and effective treatment, requiring personnel with varying levels of professional and paraprofessional training. 1 In efforts to increase human resources for mental health sector, job satisfaction is recognized as a crucial factor. 2 Job satisfaction is “a pleasurable or positive emotional state resulting from the appraisal of one’s job or job experiences.”3(p1304) Given the critical shortage of mental health professionals in low-and middle-income countries (LMICs), job satisfaction is paramount. 4
Job satisfaction impacts multiple levels within the health care system. At the personal level, higher job satisfaction among professionals is associated with enhanced teamwork, collaboration with other groups or organizations, effective problem-solving, and better decision-making abilities. 5 For organizations, staff job satisfaction has been shown to reduce absenteeism, employee turnover, and burnout, as well as prevent substance abuse and mitigate mental or physical suffering. 6 Therefore, improving job satisfaction is critical for optimizing healthcare system performance.
Previous research has demonstrated a relationship between job satisfaction and sociodemographic characteristics such as age, urbanicity, occupation, professional education, and working experience. 7 Furthermore, higher job satisfaction among healthcare workers is frequently associated with factors such as efficient teamwork, a sense of belonging to the organization, personal development opportunities, recognition, contribution to patients’ recovery, good relationships with colleagues and superiors, and a clear understanding of the facility’s objectives and plans. However, job satisfaction was also negatively influenced by higher workload, poor communication, excessive administration, low income, increased work stress, and unmet expectations. 8
Although North America, Western Europe and other developed nations have a substantial body of research on job satisfaction among mental health practitioners,9,10 our understanding of this issue in LMICs like Vietnam still needs to be improved. A study showed that Vietnamese healthcare workers in commune health stations expressed the least satisfaction with their salary and incentives, followed by benefits packages, equipment, and work environment. 7 Another study conducted in Vietnam identified age, gender, and educational level as significant predictors of job satisfaction of healthcare workers. 11 However, these studies focused solely on community level.7,11 Therefore, the current study contributes to our understanding of job satisfaction in Vietnam by incorporating national-level psychiatric hospitals, provincial hospitals, and departments of psychiatry in general hospitals. Mental healthcare workers face multiple difficulties, such as stigma, workforce shortages, and insufficient income, resulting in significant treatment gaps and high workloads within the mental healthcare sector. 12 Vietnam’s mental healthcare system currently suffers from a scarcity of human resources, only 0.91 psychiatrists per 100 000 people. 13 Investigating the job satisfaction of Vietnamese mental healthcare workers nationally and exploring associated factors are crucial steps toward improving mental healthcare in Vietnam. This research addresses 2 questions: (1) What is the overall level of job satisfaction among the mental health workforce in Vietnam? and (2) What factors are associated with job satisfaction levels?
Methods
Design
A cross-sectional study was conducted using an online survey administered between April 1, 2021, and June 15, 2021.
Sampling
We used convenience sampling, participants were recruited using Google Forms. The management team of all national-level psychiatric hospitals, provincial-level psychiatric hospitals, and departments of psychiatry at general hospitals were contacted and informed about the study. After obtaining their agreement to participate, information about the online survey was disseminated to staff members of the hospitals. The target participants included all individuals directly involved in caring for patients with mental disorders. Before participation, all potential participants were informed about the study objectives and the use of data. The data collected were stored by our research group under the supervision of the Ethical Review Board and used for scientific publication. Participants who decided to participate in the survey provided their consent by checking a box, a required field in the form. The responses were collected anonymously and sent to the secure Google account of the principal investigator. The inclusion criteria were: (i) willingness to participate, (ii) current employment in the mental health system, and (iii) completing over 95% of the survey. A total of 1121 responses met the inclusion criteria.
Measurements
The survey included the following measures:
i. Sociodemographic factors: This section collected information on age, gender, marital status, educational level, and income (measured with million VND/month and divided into brackets, self-reported). These are basic demographic data used to investigate their relevance to job satisfaction, as they are shown many times before.
ii. Work-related variables: Participants provided information about their type of work, position, institution type, work experience (work duration by year), and working areas (urbanicity). These are occupational characteristics, which can be helpful to determine their working setting.
iii. The Job Satisfaction Survey (JSS): The JSS scale, consisting of 36 items divided into 9 facets, was used to assess employees’ attitudes toward their job and various aspects of it, including payment, promotion, supervision, benefits, contingent rewards, working conditions, coworkers, the work itself, and communication. 14 Each facet was assessed using 4 items, and a total score was calculated by summing all the items. According to the developer of JSS, 15 total scores below 108 indicate dissatisfaction, scores higher than 144 suggest satisfaction, and scores between 108 and 144 can be interpreted as ambivalent. For each facet, scores between 4 and 12 represent dissatisfaction, scores between 16 and 24 indicate satisfaction, and scores between 12 and 16 are considered indifferent or ambivalent. 15 The average job satisfaction score for mental healthcare workers in the American population is reported to be 133.7, suggesting an overall indifferent or ambivalent attitude towards their jobs.16 The JSS has been reliably used in various settings including healthcare.
Analysis
Quantitative data were presented as mean values and standard deviations (SD), while categorical data were presented as frequencies and percentages. A linear stepwise regression analysis was conducted to assess the extent to which the independent variables predicted the variance in the outcome variable, job satisfaction. We chose linear stepwise regression because of the lack of prior model of job satisfaction in Vietnam and the need to explore potential significant factors, however it is difficult to generalize data from the model. Outliers, assumptions of overfitting, homoscedasticity, multicollinearity, and normality were checked prior to further analysis. Group comparisons were made using ANOVA, and post hoc analyses using LSD multiple comparisons were conducted. In cases where Levene’s test for homogeneity of variance reached significance at the specified p-level (P < .05), non-parametric tests were used to confirm the results (parametric tests were reported). All analyses were performed using the Statistical Package for Social Sciences (SPSS) version 25, and two-tailed p-values less than 0.05 were considered statistically significant. Missing data were marked as null and not accounted in the calculation.
Ethical Considerations
This is an observatory study and we keep.
The study was approved by the Ethical Review Board of Hanoi Medical University in Vietnam (Approval No.: 535/GCN-HĐĐĐNCYSH-ĐHYHN).
Results
Socio-Demographic Characteristics
Out of the 1121 respondents, 305 (27.2%) were male, and 816 (72.8%) were female. The largest proportion of participants fell within the age range of 30 to 40 (46.2%). Most participants were married and living with their spouses. Regarding educational attainment, 45% had graduated from college, while 34.9% had completed postgraduate studies. Approximately 33% of participants lived in special-level urban areas, whereas 20.7% lived in rural areas. Regarding income, the majority of the participants earned less than 400 USD monthly. Psychiatric nurses constituted the largest professional group among the respondents, followed by psychiatrists, psychologists, and occupational therapists. Most participants held low-level staff positions (86.8%), whereas 1.2% were directors or vice directors, this makes it difficult to analyze satisfaction across different professional levels. Regular staff accounted for more than 80% of the participants. Almost all the respondents worked in psychiatric hospitals. Regarding work experience, most participants had been in the field for 5 to 20 years (see Table 1).
Characteristics of Respondents.
Level of Job Satisfaction
The sample mean for total job satisfaction was found to be 165.8, suggesting a high level of job satisfaction among the participants (see Table 2). Additionally, a z-test was conducted to compare the Vietnamese sample with the American population norm provided by the JSS. The total satisfaction score was significantly higher than the norm value of the American population (P < .001), with a large effect size (Cohen’s d = 3.86). In addition, the job satisfaction scores for each of the 9 facets were significantly higher in the Vietnamese sample than in the American population (P < .001).
Characteristics of Job Satisfaction.
P < .05.
Predictors of Job Satisfaction
A stepwise multiple regression analysis was conducted to identify the factors associated with job satisfaction (see Table 3). The total score of job satisfaction was entered as the dependent variable. In the first block, sociodemographic variables (age, gender, economic area, marital status, and highest education) were entered into the analysis. The total variance explained by the model was 3.4% (P < .001). In the second block, job-related variables (professional qualification, current position, type of contract, average income, and total years of service) were added. At step 2, the total variance explained by the model was 3.8% (P < .001). In the last block, after the inclusion of work-related factors (direct involvement in patient care, caring for patients in different groups), the total variance explained by the model as a whole was 7.6% (P < .001). In the final model, 6 predictors were found to be statistically significant. Taking care of child and adolescent psychiatric patients had the highest explained variance (β = .208, P < .001). Additionally, gender (β = .131, P < .001), economic area (β = .119, P < .001), age (β = .103, P = .05), type of contract (β = .069, P < .05), and direct involvement in patient care (β = −.081, P < .05) significantly predicted job satisfaction.
Variables Associated with Job Satisfaction: Multiple Linear Regression.
P < .05. **P < .001.
Discussion
The present study aimed to determine job satisfaction and its determinants among the mental health workforce in Vietnam. The results indicated that the Vietnamese mental health workforce exhibited higher levels of job satisfaction in all facets compared to the norms of the American mental health workforce. 16 Perceived work values such as societal recognition may be the underlying reason for the difference. In Vietnamese culture, societal benefits tend to be more prioritized than individual interest, therefore, the appreciation from patients and family members may make up for the unfavorable working conditions.17 -19
Interestingly, our results indicated that older age predicted higher levels of job satisfaction. Previous research found inconsistent findings considering relevance between age and job satisfaction.7,8,11 In Vietnamese culture, seniority is very important and older people are more respected in general, particularly healthcare workers. 20
We found that female gender was significantly associated with higher job satisfaction. This may be attributed to the fact that women are generally more accepting toward mental health and care oriented careers, also it might be due to the social expectation of income to provide for the family placed on their male counterparts.21,22 Interestingly, we found that rurality was a significant positive predictor of job satisfaction. The findings on this matter varied between studies, with some studies supporting this result, 23 while others found the opposite to be true. 24 The difference might be due to the source of satisfaction, while for urban healthcare staff it is often career development opportunities and equipment, it is community recognition for rural workers. 23 This is understandable in Vietnamese culture where the effect of community is very large in rural areas.
Direct contact with patients indicated lower levels of job satisfaction, this may be due to the exposure to complaints, insults, and even the possibility of violence from patients. Such incidents can result in psychological and physical consequences, including missed workdays, post-traumatic stress disorder, and sleep disorders. 25 In Vietnamese context, this is more apparent because of the overwhelming number of patients per mental health staff in compared to neighboring countries. 13
Contract type also influences job satisfaction. Short-term contracts had been found to positively effect job satisfaction. Generally, short-term contracts are associated with lower job satisfaction.26,27 However, in some situations, this type of contract might be favored as it promotes job flexibility, enabling employees to experience in different settings and make career choice appropriately, especially in rural areas, this in turn can reduce burnout significantly. 28
Finally, our study revealed higher levels of job satisfaction among mental healthcare staff working with children and adolescents. This result aligns with a study from Dorothy Stubbe and Thomas highlighting that child and adolescent psychiatrists were generally satisfied with their work thanks to work variety, autonomy and being able to make a difference. 29 Another study showed that higher academic ranks and research career were positively associated with job satisfaction in psychiatrist dealing with children and adolescents. 30
We did not find association between job satisfaction and several factors: marital status, educational level, working position, and income. The findings on the association between marital status and job satisfaction were inconsistent in previous studies. 31 Educational level was found to be a significant factor predicting job satisfaction in several previous studies. 32 As opposed to our results, previous studies found that working position seemed to have a significant impact on job satisfaction. 33 As for income, while numerous studies showed that higher income is associated with higher job satisfaction, 34 some studies found insignificant relevance, it was proposed that emotional exhaustion and work-life balance were more important for psychiatrists. 31 In Vietnam, it is important to consider political and cultural context, it is likely that future prospects, recognition and work-life balance are more highly considered.7,31
Our results have several implications to further improve job satisfaction among mental healthcare workers in Vietnam. Improving the level of job satisfaction in Vietnam is a crucial step when aiming to fill the lack of human resources in the mental healthcare field. It is critical that younger mental health staff are given appropriate career prospects and advancement opportunities, where they are oriented and be able to choose career pathways. 34 Furthermore, gender specific challenges for male mental healthcare workers can be looked into for tailoring programs for this group of workers. Lastly, it is also helpful to improve protocols and guidelines for mental healthcare staff in clinical settings when approaching especially vulnerable patients, such as those with aggressive behaviors. Overall, improving the job satisfaction in the mental healthcare field can promote its reputation among new generations of professionals and improve motivation and well-being of existing staff.
Limitations
Our study results must be interpreted considering several limitations. First, causal implications cannot be drawn due to the cross-sectional study design. Due to the self-report nature of the study, there is a risk of recall bias, non-response bias, selection bias or non-disclosure. The study also limits its understanding of job satisfaction to 1 measurement tool, which cannot account for the multidimensional effects a job has on a persons’ quality of life or mental well being. Also, the Job Satisfaction Survey was not validated in Vietnamese population, which can contribute to incorrect evaluation. Additionally, although this study sample has a considerable size, the results may not be generalizable to the whole Vietnamese mental healthcare staff due to convenience sampling which limits generalization. Finally, our regression analysis model only offered 7.6% of the variance in job satisfaction, which means there are numerous other factors that contributes more to the variance such as violence in workplace, burnout and work-life balance.
Future Research
Future research using representative data with randomized design needs to be conducted to be able to generalize the results to the whole Vietnamese mental healthcare system. Furthermore, qualitative research would be necessary to gain a deeper understanding of job satisfaction in Vietnamese mental healthcare staff. In particular, it would be interesting to determine cultural differences in perceived job satisfaction between Vietnamese and American mental healthcare staff. Additionally, future research such as longitudinal design is important to draw causal relationship between the predictors and job satisfactions and determine specific solutions for healthcare reforms in the future. Some of the results need to be replicated in future studies to have more significant implications such as significant high satisfaction and the superiority of short term contract. Finally, additional predictors should be considered in future research such as role ambiguity, workplace violence, work-life balance.
Conclusion
Our study provides insights into the job satisfaction among mental healthcare workers in Vietnam identifying age, gender, urbanicity, direct involvement in patient care, type of contract, and caring for child and adolescent patients as significant predictors of job satisfaction. These findings contribute to our understanding of job satisfaction among mental healthcare workers in Vietnam and highlight the importance of addressing these factors to enhance job satisfaction and promote the well-being of mental healthcare professionals. Further research and targeted interventions are needed to optimize job satisfaction and ensure the delivery of high-quality mental healthcare services in Vietnam.
Supplemental Material
sj-docx-1-inq-10.1177_00469580251371382 – Supplemental material for Job Satisfaction Among Vietnamese Mental Health Care Staff: A Nationwide Cross-Sectional Study
Supplemental material, sj-docx-1-inq-10.1177_00469580251371382 for Job Satisfaction Among Vietnamese Mental Health Care Staff: A Nationwide Cross-Sectional Study by Van Tuan Nguyen, Van Phi Nguyen, Selin Mavituna, Truong Son Hoang, Thi Thu Ha Tran, Kerem Böge, Thi Hoa Nguyen, Cong Thien Le, Thi Thu Ha Le, Thanh Long Nguyen, Van San Bui, Hoang Yen Nguyen, Thi Hue Doan, Xuan Thang Pham, Luisa Eilinghoff, Sebastian Weyn Banningh, Solveig Kemna, Marco Zierhut, Eric Hahn and Thi Minh Tam Ta in INQUIRY: The Journal of Health Care Organization, Provision, and Financing
Footnotes
Acknowledgements
We would like to express our deepest appreciation to our colleagues at Hanoi Medical University, National Institute of Mental Health, Hanoi, Vietnam. They gave us unwavering support contacting the local sites and recruiting the participants for the project. Furthermore, we are also grateful to the colleagues from Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany for unconditional feedbacks and comments for the manuscript.
Ethical Considerations
The study was approved by the Ethical Review Board of Hanoi Medical University in Vietnam (Approval No.: 535/GCN-HĐĐĐNCYSH-ĐHYHN).
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data Availability Statement
The data that support the findings of this study are available upon reasonable request.
Supplemental Material
Supplemental material for this article is available online.
References
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