Discrete choice analysis of health worker job preferences in Ethiopia: Separating attribute non-attendance from taste heterogeneity.
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SUBMITTER: Arora N
PROVIDER: S-EPMC9305885 | biostudies-literature | 2022 May
REPOSITORIES: biostudies-literature
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Discrete choice analysis of health worker job preferences in Ethiopia: Separating attribute non-attendance from taste heterogeneity.
Arora Nikita N Quaife Matthew M Hanson Kara K Lagarde Mylene M Woldesenbet Dorka D Seifu Abiy A Crastes Dit Sourd Romain R
Health economics 20220217 5
When measuring preferences, discrete choice experiments (DCEs) typically assume that respondents consider all available information before making decisions. However, many respondents often only consider a subset of the choice characteristics, a heuristic called attribute non-attendance (ANA). Failure to account for ANA can bias DCE results, potentially leading to flawed policy recommendations. While conventional latent class logit models have most commonly been used to assess ANA in choices, the ...[more]
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Project description:BackgroundHuman resource is one of the health system's building blocks, which ultimately leads to improved health status, equity, and efficiency. However, human resources in the health sector are characterized by high attrition, distributional imbalance, and geographic inequalities in urban and rural settings.MethodsAn discrete choice experiment (DCE) with 16 choice tasks with two blocks containing five attributes (salary, housing, drug and medical equipment, year of experience before study leave, management support, and workload) were conducted. A latent class and mixed logit model were fitted to estimate the rural job preferences and heterogeneity. Furthermore, the relative importance, willingness to accept and marginal choice probabilities were calculated. Finally, the interaction of preference with age and sex was tested.ResultsA total of 352 (5632 observations) final-year medical students completed the choice tasks. On average, respondents prefer to work with a higher salary with a superior housing allowance In addition, respondents prefer a health facility with a stock of drug and medical equipment which provide education opportunities after one year of service with supportive management with a normal workload. Young medical students prefer lower service years more than older students. Besides age and service year, we do not find an interaction between age/sex and rural job preference attributes. A three-class latent class model best fits the data. The salary was the most important attribute in classes 1 and 3. Contrary to the other classes, respondents in class 2 do not have a significant preference for salary. Respondents were willing to accept an additional 4271 ETB (104.2 USD), 1998 ETB (48.7 USD), 1896 ETB (46.2 USD), 1869 (45.6 USD), and 1175 ETB (28.7 USD) per month for the inadequate drug and medical supply, mandatory two years of service, heavy workload, unsupportive management, and basic housing, respectively.ConclusionRural job uptake by medical students was influenced by all the attributes, and there was individual and group-level heterogeneity in preference. Policymakers should account for the job preferences and heterogeneity to incentivize medical graduates to work in rural settings and minimize attrition.
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Project description:BackgroundPsychiatric nurses are instrumental in enhancing accessibility to care and addressing the mental health care needs of individuals. However, the field faces a significant shortage of nurses coupled with a high turnover rate. Developing policies to attract or retain psychiatric nurses is imperative, but little is known about the preferences of psychiatric nurses regarding the economic and non-economic attributes of work. Here, a discrete choice experiment (DCE) was used to explore psychiatric nurses' job preferences.MethodsA survey instrument was developed adhering to the design-principles of DCE. Psychiatric nurses were surveyed nationwide based on convenience sampling. A mixed logit model was used to estimate the psychiatric nurses' preferences. Willingness to pay was calculated and the change in the probability of psychiatric nurses accepting a job when attribute levels changed was simulated.ResultsThe attribute level most valued by respondents was 'violent coping strategies-impeccable' (coefficient = 1.002, p < 0.01) and willingness to pay for it is 4476.5323 CNY. The most important attribute level for psychiatric nurses living in cities was 'respect-high' (coefficient = 0.505, p < 0.01), and for psychiatric nurses living in town is 'study assistance for children-thorough' (coefficient = 0.620, p < 0.01). Notably, psychiatric nurses with less than ten years of work experience exhibited significant preferences for 'opportunity to upgrade-sufficient' (coefficient = 0.417, p < 0.01), whereas this preference was insignificant among those with ten years or more of experience (p > 0.05). Changing 'violence coping strategies' from 'without' to 'impeccable' increased the probability of psychiatric nurses accepting the job by 37.04%. The optimal job increased the probability of psychiatric nurses accepting the job by 86.06%.ConclusionPsychiatric nurses would prefer jobs with higher income, more respect, better coping strategies with violence, better opportunities for promotion, and a good working atmosphere. Psychiatric nurses with different seniority and residence had different preferences.
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Project description:Although the number of medical workers has increased rapidly, its scarcity in rural areas remains a serious problem in China. This study aimed to investigate medical students' stated preferences when choosing a job, so as to assist policy makers with designing alternative interventions to address the unbalanced distribution of the health workforce in China.A discrete choice experiment (DCE) was conducted to elicit the job preferences of final year medical students. Attributes include work location, hospital type, monthly income, bianzhi (which can be loosely regarded as state administrative staffing), work environment, Training and career development opportunity. This study was carried out during April to June 2017 in 4 medical universities in Shandong Province, China. Mixed logit models were used to analyze the relative importance of job attributes.A total of 519 medical students participated in the survey. All 6 attributes were statistically significant with the expected sign and demonstrated the existence of preference heterogeneity. In the main effects mixed logit model, working in the city and a superior working environment were most strongly associated with job preference. A relatively unexpected finding was the relatively lower utility of offering bianzhi in job preferences. Subgroup analysis showed that females and those who have an urban background were significantly willing to pay more for working in the city. The most preferred scenario for medical students was to select a better work environment job in a tertiary hospital in the city, which could offer 9000 CNY monthly, with sufficient training and career development opportunities and bianzhi.Both monetary and nonmonetary intervention could be considered by policy makers to attract medical students to work in rural areas in China. There exists preference heterogeneity on medical students' job preferences, which should also be taken into account in developing more effective policy incentive packages.
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| S-EPMC8259344 | biostudies-literature
Project description:BACKGROUND:There is a deficiency of healthcare administrators in China as compared with other countries; furthermore, the distribution is unequal. To inform an effective policy intervention, it is crucial to understand healthcare administration students' career decision-making. This study aims to investigate the undergraduate students' stated preferences when choosing a job. METHODS:A discrete choice experiment (DCE) was conducted among a population-based multistage sample of 668 final year undergraduate healthcare administration students during April to June 2017 in eight universities of China to elicit their job preferences. Attributes include location, monthly income, bianzhi (which refers to the established posts and can be loosely regarded as state administrative staffing), training and career development opportunity, working environment and workload. Conditional and mixed logit models were used to analyze the relative importance of job attributes. RESULTS:All six attributes were statistically significant with the expected sign and demonstrated the existence of preference heterogeneity. Monthly income, workload and working environment were of most concern to healthcare administration students when deciding their future. Among the presented attributes bianzhi was of the least concern. Sub-group analysis showed that students who have an urban background and/or with higher annual family incomes were willing to pay more for working in the city. In addition, students from western and middle universities valued bianzhi higher than students from eastern universities. CONCLUSIONS:This is the first study focusing on the career decision-making of Chinese healthcare administration students at a critical career decision-making point. Both monetary and non-monetary interventions could be considered by policy-makers to attract students to work in health institutions, especially in rural and remote health institutions in China. There exists preference heterogeneity on healthcare administration students' job preferences, which should also be taken into account in developing more effective policy incentive packages.
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Project description:BackgroundShortage and mal-distribution of nursing human resources is an intractable problem in China. There is an urgent need to explore the job preferences of undergraduate nursing students. The main aim of this study is to investigate the stated preferences of nursing students when choosing a job.MethodsA discrete choice experiment (DCE) was conducted to assess job preferences of the final year undergraduate nursing students from four medical universities/colleges in Shandong Province, China. Job attributes include location, monthly income, bianzhi (which refers to the established posts and can be loosely regarded as state administrative staffing), career development and training opportunity, work environment and working strength. Mixed logit models were used to analyze the DCE data.ResultsA total of 445 undergraduate nursing students were included in the main DCE analysis. They demonstrated higher preference for a job with higher monthly income, and the probability of choosing a rural job would increase to 92.8% if monthly income increased from RMB 2000 (US$ 296) to RMB 8000 (US$ 1183). They expressed higher stated preferences for a job which required light working strength and with excellent work environment over other non-economic attributes. Among all attributes, location was the least important attribute. Subgroup analysis showed that students who came from city or county and whose family income was more than RMB 50 000 (US$ 7396) were significantly willing to pay more monthly income for a job in city.ConclusionsThis study confirmed that economic and non-economic factors both affected the job choices of the students. These results may be more effective for policymakers to perfect the employment policies and design strategies to attract more nursing students taking jobs in rural areas.
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Project description:BackgroundIn Iran, the issue of the nursing shortage and unequal distribution exist simultaneously. The shortage of healthcare workers is one of the most important concerns of the health systems. In addition, the disparity in the distribution of healthcare workers between large metropolises and remote or non-capital areas has become a serious concern and a top priority to address. We conducted this study to identify and create a sufficient understanding of the different financial and non-financial preferences of nurses for working in deprived areas.MethodsThis research was carried out in June and April 2022. It was carried out in three major phases. The factors influencing the nurses' job preferences were first discovered using qualitative methods. The second phase was conducting a pilot study and determining the best design for discrete choice experiment scenarios. The last phase involved publishing the questionnaire to gather information. Data were analyzed (discrete choice analysis) using JMP Pro 16 software.ResultsA desirable job for the participants (nurses) in this study would have a higher salary, work in a city, the Rasmi employment contract, a low workload, adequate workplace facilities, an appropriate work schedule, and 1 to 3 years spent on the assigned job to promote to a higher position. Willingness to pay (WTP) and the probability of selecting different attribute levels were also calculated and reported. For example, the highest amount of money that a nurse expected to be paid was for changing the geographical location of the workplace from a city to a deprived area. In this case, a nurse tends to receive 91.87 million IRR more to move from a city to a deprived area to work. This amount of money was by far the most among other WTPs.ConclusionThe results of this study indicated that nurses are willing to forego net income in exchange for other favorable characteristics of their working environment and conditions. This shows that a variety of actions are accessible to policymakers that can greatly enhance the working conditions for nurses. The WTP and the probability of selecting various attributes may help policymakers plan more effectively.
| S-EPMC10680310 | biostudies-literature
Project description:BackgroundPrimary-level Traditional Chinese Medicine (TCM) healthcare institutions are currently facing a severe shortage of TCM professionals, highlighting the urgent need to explore the job preferences of TCM clinical graduates. This study aimed to investigate the stated job preferences of TCM clinical graduates when seeking employment.MethodsA discrete choice experiment (DCE) was conducted to assess the employment preferences of TCM clinical graduates from 16 TCM universities across China. The job attributes examined included the monthly income, work location, hospital tier, job stability (position tenure), work intensity, opportunities for mentorship under renowned practitioners, and career advancement prospects. A mixed logit model was employed to obtain the main effects model. Based on the results of the main effects model, analyses of relative importance and willingness to pay (WTP) were conducted. Additionally, heterogeneity analysis and scenario simulation analysis were performed.ResultsA total of 2,402 valid questionnaires were included in the primary DCE analysis. Monthly income was the most important factor (RIS = 52.58%). Among non-economic factors, participants expressed the strongest willingness to reduce workload, being willing to forgo 2,367.5 yuan in monthly income to transition from high to low work intensity. Other significant factors included formal establishment (RIS = 11.32%), mentorship opportunities (RIS = 7.44%), and hospital level (RIS = 4.63%), with job location being the least important (RIS = 3.44%). Subgroup analysis showed that male graduates were more willing than female graduates to forgo formal establishment for mentorship opportunities. Graduates from the eastern region valued lower work intensity and formal establishment more than those from the central and western regions. Postgraduates were more likely than undergraduates to give up monthly income for jobs in higher-tier cities. Scenario analysis revealed that graduates had a 43.0% probability of choosing third-tier cities under baseline conditions. Comprehensive improvements (e.g., higher income and formal establishment) increased this probability to 84.8%, rising to 87.3% with better promotion opportunities.ConclusionThis study demonstrates that the monthly income has the most significant impact on employment preferences. The work intensity and mentorship opportunities also play crucial roles, with the influence of the work intensity surpassing those of other non-economic factors. In contrast, the hospital tier and work location have a relatively smaller impact on graduates' preferences. In addition, a combination of certain non-economic measures can enhance students' willingness to choose hospitals in third-tier cities. Based on these findings, it is recommended that recruitment and career development strategies focus on the salary, work intensity, and mentorship opportunities, while providing stable job positions and favorable work environments, so as to meet the primary needs of TCM clinical graduates. A novel contribution of this study is its identification of the significant influence of mentorship opportunities, which are one of the distinctive features of TCM, on the employment choices of TCM graduates, filling a gap in the existing research. Future studies should integrate online questionnaires with offline interviews to gain deeper insights into the decision-making processes of graduates in real-world work environments.
| S-EPMC11841246 | biostudies-literature