The retention of health human resources in primary healthcare centers in Lebanon: a national survey

BACKGROUND: Critical shortages of health human resources (HHR), associated with high turnover rates, have been a concern in many countries around the globe. Of particular interest is the effect of such a trend on the primary healthcare (PHC) sector; considered a cornerstone in any effective healthcare system. This study is a rare attempt to investigate PHC HHR work characteristics, level of burnout and likelihood to quit as well as the factors significantly associated with staff retention at PHC centers in Lebanon. METHODS: A cross-sectional design was utilized to survey all health providers at 81 PHC centers dispersed in all districts of Lebanon. The questionnaire consisted of four sections: socio-demographic/ professional background, organizational/institutional characteristics, likelihood to quit and level of professional burnout (using the Maslach-Burnout Inventory). A total of 755 providers completed the questionnaire (60.5% response rate). Bivariate analyses and multinomial logistic regression were used to determine factors associated with likelihood to quit. RESULTS: Two out of five respondents indicated likelihood to quit their jobs within the next 1–3 years and an additional 13.4% were not sure about quitting. The top three reasons behind likelihood to quit were poor salary (54.4%), better job opportunities outside the country (35.1%) and lack of professional development (33.7%). A U-shaped relationship was observed between age and likelihood to quit. Regression analysis revealed that high levels of burnout, lower level of education and low tenure were all associated with increased likelihood to quit. CONCLUSIONS: The study findings reflect an unstable workforce and are not conducive to supporting an expanded role for PHC in the Lebanese healthcare system. While strategies aiming at improving staff retention would be important to develop and implement for all PHC HHR; targeted retention initiatives should focus on the young-new recruits and allied health professionals. Particular attention should be dedicated to enhancing providers’ role satisfaction and sense of job security. Such initiatives are of pivotal importance to stabilize the workforce and ensure its longevity

Outcome of Depression and Anxiety After War: A Prospective Epidemiologic Study of Children and Adolescents

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106884/1/jts21895.pd

Prevalence and predictors for post-traumatic stress disorder, depression and general health in a population from six villages in South Lebanon

Objective To determine the prevalence and predictors of psychiatric disorders in a general population from South Lebanon, an area that was under military occupation for more than 20 years. Method This study assessed post-traumatic stress disorder (PTSD) and depression thresholds along with general health (GHQ) among 625 citizens in six villages in South Lebanon using a cross-sectional design through random sampling. Results The prevalence ranged from 17.6 to 33.3% for PTSD and from 9.2 to 19.7% for depression. GHQ total score was found to be 6.7 significantly greater than the internationally established mean score of 5.0. Social support, financial resources, gender, and war exposure were significantly related to PTSD and depression thresholds. Conclusion The results strongly suggest that the general population in South Lebanon suffer from mental health disorders calling for appropriate psychiatric interventions and development planning

TRUSTING THE PHARMACIST IN DELIVERING MEDICATION INFORMATION: A COMMUNITY-BASED PERSPECTIVE

Objective: Optimal disease management is influenced by a solid patient-health provider relationship; which includes trust in the provider. The study compares respondents’ trust in pharmacists and physicians for the delivery of drug information. Methods: Residents of 3 rural communities in Lebanon, aged 40 and above, were invited to participate in the study, 760 accepted. Participants were asked who they trust the most with information about their medication: their physician or their pharmacist. Results: Of the total sample, 154 chose the pharmacist as their most trusted source of medication information (20%). Characteristics associated with choosing the pharmacist were: being a male (29.3% vs 16.2% p<.001), of younger age (31.5% among<50 y, 18.8% among 50-64 y, and 14.6% among 65+years p<.001), single (31.6% vs 21.9% married and 9.3 others, p=0.023), working (39.2% vs15.7% p<.001), and insured (2.3% vs 16.4% p=0.048). The multivariate logistic regression model revealed that having a family member with hypertension (OR=1.86 95% 1.23-2.82), or cardiovascular (OR=3.39 95%CI 1.55-7.45) increased the likelihood of trusting pharmacists over medical doctor. On the other hand, a self-report of cardiovascular disease (OR=0.34 95% CI 0.12-0.95) and taking medication (OR=0.41 95% CI 0.25-0.67) were associated with a decrease in the trust in the pharmacist in favor of the physician. Conclusion: Although pharmacists are the drug specialists, the majority of the Lebanese rural community residents reported higher trust in their physicians with information about their medication(s)

A national cross-sectional study on nurses' intent to leave and job satisfaction in Lebanon: implications for policy and practice

<p>Abstract</p> <p>Background</p> <p>Lebanon is perceived to be suffering from excessive nurse migration, low job satisfaction, poor retention and high turnover. Little is known about the magnitude of nurse migration and predictors of intent to leave. The objective of this study is to determine the extent of nurses' intent to leave and examine the impact of job satisfaction on intent to leave. Intent to leave was explored to differentiate between nurses who intend to leave their current hospital and those intending to leave the country.</p> <p>Methods</p> <p>A cross-sectional design was used to survey nurses currently practicing in Lebanese hospitals. A total of 1,793 nurses employed in 69 hospitals were surveyed. Questions included those relating to demographic characteristics, intent to leave, and the McCloskey Mueller Satisfaction Scale. Univariate descriptive statistics were conducted on sample's demographic characteristics including gender, age, marital status and educational level. Bivariate associations between intent to leave and demographic characteristics were tested using Pearson Chi-square. Differences in satisfaction scores between nurses with and without intent to leave were tested using t-test and ANOVA f-test. A multinomial logistic regression model was created to predict intent to leave the hospital and intent to leave the country.</p> <p>Results</p> <p>An alarming 67.5% reported intent to leave within the next 1 to 3 years, many of whom disclosed intent to leave the country (36.7%). Within nurses who reported an intent to leave the hospital but stay in Lebanon, 22.1% plan to move to a different health organization in Lebanon, 29.4% plan to leave the profession and 48.5% had other plans. Nurses reported being least satisfied with extrinsic rewards. A common predictor of intent to leave the hospital and the country was dissatisfaction with extrinsic rewards. Other predictors of intent to leave (country or hospital) included age, gender, marital status, degree type, and dissatisfaction with scheduling, interaction opportunities, and control and responsibility.</p> <p>Conclusion</p> <p>Study findings demonstrate linkages between job satisfaction, intent to leave, and migration in a country suffering from a nursing shortage. Findings can be used by health care managers and policy makers in managing job satisfaction, intent to leave and nurse migration.</p

Understanding Post-Conflict Mental Health: Assessment of PTSD, Depression, General Health and Life Events in Civilian Population One Year after the 2006 War in South Lebanon

Assessing the psychological impact of war is crucial to meet the needs of communities following conflict. To date, mental health in Lebanon’s southern civilians has not been assessed in relation to the 2006 War. In 2007, face-to-face interviews were conducted in ten villages in South Lebanon. The sample, consisting of 991 adults, was chosen through random sampling using a crosssectional design. The study evaluated PTSD, traumatic events, depression and general health status. Of the total sample, 17.8% met threshold criteria for PTSD, 14.7% for depression and the average GHQ score was 4.31. Significant differences were observed across villages. This study revealed that war-related life events and exposure are highly associated with psychiatric problems one year following a violent conflict

Perspectives on palliative care in Lebanon: Knowledge, attitudes, and practices of medical and nursing specialties

Objective: Our objective was to determine the knowledge, attitudes, and practices of physicians and nurses on Palliative Care (PC) in Lebanon, across specialties. Method: We performed a cross-sectional descriptive survey using a self-administered questionnaire; the total number of completed and returned questionnaires was 868, giving a 23% response rate, including 74.31%nurses (645) and 25.69% physicians (223). Results: Significant differences were found between medical and surgical nurses and physicians concerning their perceptions of patients' and families' outbursts, concerns, and questions. Knowledge scores were statistically associated with practice scores and degree. Practice scores were positively associated with continuing education in PC, exposure to terminally ill patients, and knowledge and attitude scores. Acute critical care and oncology were found to have lower practice scores than other specialties. Significance of results: Formal education in palliative care and development of palliative care services are very much needed in Lebanon to provide holistic care to terminally ill patients

Development and validation of an Arabic questionnaire to assess psychosocial determinants of eating behavior among adolescents: a cross-sectional study

Background: There is a scarcity of studies that evaluate the psychosocial determinants of eating behavior among adolescents in the Eastern Mediterranean region. The availability of such data is limited by the lack of valid culturally appropriate tools. The current study aims to develop and validate an Arabic questionnaire that measures psychosocial determinants of eating behavior among adolescents. Methods: A cross-sectional study was carried out to validate a five-scale questionnaire developed to measure nutrition-related knowledge, attitude, practices, and self-efficacy and social norms. Content validity was assessed by Lawshe\u2019s method, factor analysis was used to assess construct validity, and Cronbach\u2019s \u3b1 was used to test internal consistency. Temporal stability was assessed by test\u2013retest reliability. A random sample of public and private school students participated in the validation study. Results: All the five scales demonstrated excellent content validity (content validity ratio, CVR 650.778). Factor analysis revealed several dimensions for each scale. Cronbach\u2019s \u3b1 for the identified dimensions or subscales ranged between 0.495 and 0.809 indicating acceptable internal consistency. Cronbach\u2019s \u3b1 for the total scales ranged between 0.759 and 0.836. Test\u2013retest analysis revealed good temporal stability (intraclass correlation, ICC &gt;0.7). Conclusions: A psychometrically valid tool to measure psychosocial determinants of eating behavior was developed. This tool can serve as a potential instrument for pretest and impact evaluation of ongoing nutrition education interventions and curricula. Based on results obtained from this tool, efficacious modifications can be instilled for nutrition policies and interventions

A national cross-sectional study on nurses' intent to leave and job satisfaction in Lebanon: implications for policy and practice

Background: Lebanon is perceived to be suffering from excessive nurse migration, low job satisfaction, poor retention and high turnover. Little is known about the magnitude of nurse migration and predictors of intent to leave. The objective of this study is to determine the extent of nurses' intent to leave and examine the impact of job satisfaction on intent to leave. Intent to leave was explored to differentiate between nurses who intend to leave their current hospital and those intending to leave the country. Methods: A cross-sectional design was used to survey nurses currently practicing in Lebanese hospitals. A total of 1,793 nurses employed in 69 hospitals were surveyed. Questions included those relating to demographic characteristics, intent to leave, and the McCloskey Mueller Satisfaction Scale. Univariate descriptive statistics were conducted on sample's demographic characteristics including gender, age, marital status and educational level. Bivariate associations between intent to leave and demographic characteristics were tested using Pearson Chi-square. Differences in satisfaction scores between nurses with and without intent to leave were tested using t-test and ANOVA f-test. A multinomial logistic regression model was created to predict intent to leave the hospital and intent to leave the country. Results: An alarming 67.5% reported intent to leave within the next 1 to 3 years, many of whom disclosed intent to leave the country (36.7%). Within nurses who reported an intent to leave the hospital but stay in Lebanon, 22.1% plan to move to a different health organization in Lebanon, 29.4% plan to leave the profession and 48.5% had other plans. Nurses reported being least satisfied with extrinsic rewards. A common predictor of intent to leave the hospital and the country was dissatisfaction with extrinsic rewards. Other predictors of intent to leave (country or hospital) included age, gender, marital status, degree type, and dissatisfaction with scheduling, interaction opportunities, and control and responsibility. Conclusion: Study findings demonstrate linkages between job satisfaction, intent to leave, and migration in a country suffering from a nursing shortage. Findings can be used by health care managers and policy makers in managing job satisfaction, intent to leave and nurse migration