Occupational Burnout And Its Associated Factors Among Health Workers In Clinics Of Methadone Maintenance Treatment In Yunnan Province

ObjectiveTo assess the prevalence and to analyze associated factors of occupational burnout among health workers in clinics of methadone maintenance treatment(MMT)in Yunnan Province.MethodsBetween September and October of 2016,health workers were selected by random cluster sampling from 33 clinics in 6 prefectures and cities.The information about staff‘s demographic characteristics,job-related attributes,incentive factors,and Maslach Burnout Inventory(Version Human Services Survey)were collected through internet-based electronic questionnaire.Descriptive analysis,Chi-square test,and multivariate logistic regression analysis were conducted to assess risk factors for burnout and sorting analysis were conducted on incentive factors.Qualitative study took the form of face-to-face interview.Health workers of the clinic staff were invited to take part in one-to-one in-depth interviews.The objectives of qualitative interview were to understand associated factors that influenced the occupational burnout of the staff and to find the commonness and characteristics of clinic service.Finally,the audio recordings were encoded,transcribed into the text,and analyzed.Results1.Quantitative studyOf the 313 staff,the overall occupational burnout was 70.9%.Three dimensions of the burnout,i.e.,Emotional Exhaustion,Depersonalization,and low Personal Accomplishment were 37.4%,22%,and 51.8%,respectively.Multivariate logistic regression of emotional exhaustion indicated that staff over 40(OR=0.563,95%CI: 0.327~0.969)and staff‘s family support(OR=0.304,95%CI: 0.175~0.530)were associated with decreased risk of emotional exhaustion.However,clients arrested by the police near the clinic(OR=2.967,95%CI: 1.193~7.380),having high occupational exposure(OR=1.749,95%CI: 0.962~3.181),monotonous working content(OR=2.234,95%CI: 1.264~3.950),and having high clients/staff ratio(OR=3.285,95%CI: 1.935~5.578)were associated with increased risk of emotional exhaustion.Multivariate logistic regression of depersonalization showed that staff over 40(OR=0.536,95%CI: 0.276~1.041),nearby community residents‘ support(OR=0.387,95%CI: 0.162~0.922),clients‘ respect(OR=0.357,95%CI: 0.176~0.723),and more training opportunities(OR=0.426,95%CI: 0.206~0.880)would decrease the risk of depersonalization.On the contrary,clients arrested by the police near the clinic(OR=4.169,95%CI: 1.363~12.755),fearing of the contact with HIV positive drug users(OR=1.899,95%CI: 0.945~3.815),having high occupational exposure(OR=2.383,95%CI: 1.116~5.087),and monotonous working content(OR=2.917,95%CI: 1.504~5.657)would increase the risk of depersonalization.Multivariate logistic regression of low personal accomplishment revealed that being willing to accept drug addicts(OR=0.402,95%CI: 0.243~0.666),clients‘ respect(OR=0.411,95%CI: 0.246~0.685),more career promotion opportunities(OR=0.124,95%CI: 0.015~1.022),and staff‘s family support(OR=0.532,95%CI: 0.320~0.885)were associated with decreased risk of low personal accomplishment.On the other hand,monotonous working content(OR=1.689,95%CI: 0.972~2.935)were associated with increased risk of low personal accomplishment.Sorting analysis on incentive factors illustrated that top 5 psychological needs of health workers in MMT clinics were clients‘ respect,welfare,incomes,training opportunities,and clients‘ compliance(order from large to small).Health workers of different roles had diverse psychological needs,while both clients‘ respect and welfare were of greater needs of them all.2.Qualitative studyBy interviewing 32 health workers of different roles in 12 MMT clinics,we found there were still many difficulties on clients‘ management,harsh work environment,too many contract staff,intense relationship between staff and clients,little career promotion opportunities,clients‘ disrespect,poor welfare,insufficient operating funds,poor social support,small training chance,etc.All these problems directly or indirectly influenced staff‘s working enthusiasm and occupational burnout.ConclusionsOccupational burnout and low personal accomplishment are widespread among health workers of MMT clinics in Yunnan Province.Job-related factors have more significant impacts than the demographic characteristics do.Staff with older age,family support,and nearby community residents‘ support will decrease the risk of burnout,while clients arrested by the police near the clinic,havinghigh occupational exposure,monotonous working content,having high clients/staff ratio,small training chance,little promotion opportunities,stigma toward drug addicts and HIV positive clients,and clients‘ disrespect will increase the risk of burnout.In order to fully play the value of MMT clinic,it is necessary to enhance the cooperation of related departments,to speed-up the exploration and development of relevant policies,to strengthen professional training in medical personnel,to improve the comprehensive working ability,to strive for the support of the family and the public,and to build up mutual respect and trust between clients and health workers.