| BackgroundTuberculosis(TB)is a major infectious disease that endangers human health for a long time,and China has long been in the ranks of countries with a high burden of TB,TB epidemic in Chongqing is more serious especially.Its TB prevention and treatment work still faces many difficulties and challenges,especially in terms of human resources,there are problems of insufficient quantity and low quality.Job burnout or occupational burnout,referred to as burnout,refers to the state of physical and mental fatigue and exhaustion caused by heavy work pressure,and an extreme reaction when an individual is unable to cope with work stress smoothly and negative state of emotion,attitude and behavior accompanied by long-term stress experience,including "emotional exhaustion","depersonalization" and "reduced personal accomplishment" which have a negative impact on human resources resulting in a decline in job satisfaction and reduced work enthusiasm.In addition,TB prevention and treatment medical personnel in a separate containment system and are exposed to a higher risk of infection for a long time,which is particularly the case among health care workers.Therefore,in Chongqing,where the burden of TB is heavy,by studying the job burnout of TB prevention and treatment medical personnel in Chongqing,finding problems in time and put forward targeted countermeasures and suggestions and will help to improve the problems existing in the human resources of TB prevention and treatment in Chongqing,help to achieve the goal of "ending tuberculosis" in Chongqing.ObjectiveThe purpose of this study is to find out the job burnout of TB treatment medical personnel in Chongqing,based on motivation-hygiene theory,analyze the related factors of job burnout in different TB control institutions and put forward countermeasures and suggestions to provide a reference basis for improving the decision-making of TB prevention and treatment in Chongqing.MethodFrom September 2021 to June 2022,From September 2021 to June 2022,a mixed research method combining quantitative and qualitative methods was used to collect data.Quantitative research(questionnaire survey)and qualitative research(in-depth personal interview)were carried out on the TB prevention and treatment personnel in the disease prevention and control institutions(TB prevention and treatment institute / CDC TB section),designated TB hospitals,and primary medical institutions(Community health service centers,Rural hospitals,Village clinics)of the 16 districts and counties finally selected..1、Quantitative studyUsing the method of stratified random cluster sampling,A self-filling questionnaire survey was conducted among the TB prevention and treatment personnel in the selected districts and counties..The main content of the survey consists of four parts: basic situation(age,gender,marital status,professional title,education,job content,etc.);One of the two dimensions of motivation-hygiene theory is hygiene factors(environment and conditions,treatment,training,supervision and assessment,organizational management,doctor-patient relationship,interpersonal relationship),and the other is motivating factors(work burden,personal development and achievement,job support,meaning and responsibility);the job burnout assessment part(Maslach Burnout Inventory-Human Services Survey,MBI-HSS,The scale contains 22 items in 3 dimensions of burnout.The score is Likert7,0 is very inconsistent,6 is very consistent.).Use SPSS22.0 to analyze quantitative data,including descriptive statistics,univariate and multivariate analysis,among which univariate analysis adopts rank sum test(Kruskal-Wallis H test or Mann-Whitney U test)and trend Chi-square test(Trendχ2),spearman rank correlation test,according to the characteristics of independent variables.Multivariate analysis using multiple linear regression,all statistics are P<0.05 two-sided as the statistical significance level.2、Qualitative researchObjective sampling method was adopted to select part of the medical staff and tuberculosism-related leaders engaged in tuberculosis prevention and treatment work as the research objects.The final sample size is determined by the principle of information saturation.conduct personal in-depth interviews using a semi-structured interview outline(including two versions: for medical personnel and for leaders).The thematic framework approach was used to organize and analyze the data based on the motivation-hygiene theory.Result1.Basic information of survey objects1140 valid questionnaires(effective rate 95.47%),female(679,59.6%),aged 40-49(336,29.5%),married(889,78.9%),with 2 or more children(461,40.5%),college education(460,40.4%),primary job title(509,44.6%),medical education(1013,88.9%),major in clinical medicine(407,41.2%)perceived good health(703,61.7%),working in primary healthcare institutions(893 people,78.3%),in low-to-medium epidemic areas(336,29.5%),working ≤3 years(431,37.8%),formally status(526,46.1%)account for the majority.2.The burnout degree and distribution of TB prevention and treatment medical personnel in ChongqingThe overall job burnout rate of TB prevention and treatment personnel in Chongqing was 66.8%(mild,moderate and severe burnout rates were 31.9%,26.2% and 8.6%,respectively).The overall job burnout rate of disease prevention and control institution is55%(mild,moderate and severe burnout rates are 28.0%,16.0% and 11.0% respectively).The overall job burnout rate of designated hospitals is 70.1%(mild,moderate and severe burnout rates are 30.6%,34.0% and 5.4%,respectively).The overall job burnout rate in primary health care institutions is 67.5%(mild,moderate and severe burnout rates are32.6%,26.1% and 8.8%,respectively).Population distribution: the degree of burnout decreased with the increase of age(χ 2=31.67,P < 0.01,correlation coefficient:r = 0.14,correlation P < 0.01),and the burnout degree of unmarried was higher than that of married(χ 2=4.90,P < 0.01)and divorced / widowed(χ 2=3.59,P < 0.01).The degree of burnout in children with no children was higher than that in children with one child(Z=-3.32,P <0.01)and two or more children(Z=-4.20,P < 0.01),and the degree of burnout increased with the increase of educational level(χ 2=29.70,P < 0.01,correlation coefficient: r = 0.07,correlation P=0.02).The degree of burnout decreased with the improvement of conscious health status(χ 2=27.64,P < 0.01,correlation coefficient:r= 0.14,correlation P < 0.01).3.Analysis of related factors in each dimension of job burnoutMultiple linear regression analysis was carried out on the personnel of disease prevention and control institution,designated TB hospitals and primary healthcare institutions,respectively.In disease prevention and control institutions,the worse the interpersonal relationship,the more serious the depersonalization [B(95%CI):-0.89(-1.71,-0.80),P=0.03],and the lower the satisfaction of training,supervision and assessment,personal achievement reduced more seriously [B(95%CI): 2.13(0.91,3.35),P<0.01].In designated TB hospitals,the patients with worse doctor-patient relationship [B(95%CI):-6.63(-12.06,-1.20),P=0.02],those with heavier work burden [B(95%CI):-3.65(-5.74,-1.55),P<0.01] had more serious emotional exhaustion,and those with worse doctor-patient relationship had more serious depersonalization [B(95%CI):-1.77(-3.31,-0.23),P=0.04].In primary healthcare institutions,the worse the environmental condition is,the worse the doctor-patient relationship is [B(95%CI):-0.46(-0.73,-0.19),P<0.01],the worse the doctor-patient relationship is [B(95%CI):-1.23(-2.16,-0.29),P=0.01],the less work support is [B(95%CI):-0.93(-1.46,-0.39),P<0.01],and the less sense of responsibility is[B(95%CI):-0.73(-1.35,-0.10),P=0.02] emotional exhaustion is more serious.The lower the satisfaction of training,supervision and assessment [B(95%CI):-0.55(-0.87,-0.22),P<0.01],and the worse the organization and management [B(95%CI):-0.12(-0.21,-0.03),P=0.01] depersonalization is more serious.The lower the satisfaction of traini ng,supervision and assessment [B(95%CI): 0.65(0.03,1.26),P=0.04] and worse interpersonal relationship [B(95%CI): 0.97(0.15,1.78),P=0.02] personal achievement reduced more seriously.Conclusion1.The level of job burnout of TB prevention and treatment medical personnel in Chongqing is relatively high,especially in designated TB hospitals and primary healthcare institutions,the job burnout of TB prevention and treatment medical personnel is more serious,and the job burnout is more serious in low age group,unmarried,childless,highl y educated and perceived poor health.2.The job burnout of TB prevention and treatment medical personnel in Chongqing is affected by complex factors,and the influencing factors of job burnout of TB prevention and treatment medical personnel are different in different institutions.Disease prevention and control institutions: among the hygiene factors,interpersonal relationship among health factors is related to depersonalization,training,supervision and assessment satisfaction is related to personal achievement.No motivating factors are found to be related to all dimensions of job burnout.Designated TB hospitals: among the hygiene factors,the doctor-patient relationship is related to emotional exhaustion and depersonalization;among the motivating factors,work burden is related to emotional exhaustion.Primary healthcare institutions: among the hygiene factors,the environment and conditions,doctor-patient relationship are related to emotional exhaustion,training,supervision and assessment satisfaction are related to depersonalization and personal achievement,organizational management is related to depersonalization,interpersonal relationship is related to personal achievement;among the motivating factors,job support,meaning and responsibility are related to emotional exhaustion.Countermeasure suggestions:Pay more attention to the job burnout of TB prevention and treatment medical personnel,and to formulate targeted measures to improve the job burnout of different types of TB prevention and treatment medical personnel.Disease prevention and control institutions: cultivate the stress resistance and mature coping style of TB prevention and treatment medical personnel;improve the working methods of training,supervision and assessment to prevent act in a way that defeats one’s purpose.Designated TB hospitals: at the level of hygiene factors,we should pay attention to the work mode and cultivate the communication ability of TB prevention and treatment personnel in designated TB hospitals.At the level of motivating factors,we should strengthen the construction of human resources and psychological support.Primary healthcare institutions: at the level of hygiene factors,we should improve TB hardware facilities and infection control in primary healthcare institutions;make joint efforts to improve training supervision and assessment;optimize organization and management to enhance the sense of organizational support of TB prevention and treatment personnel;reasonably distinguish patients to reduce the pressure of primary healthcare institutions;give psychological support,and cultivate organizational identity.At the level of motivating factors,we should improve the work support from the family,government and social levels;pay attention to publicity and guidance and improve the professional level and enhance the sense of responsibility of TB prevention and treatment personnel. |
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