STRENGTHS AND LIMITATIONS OF THIS STUDY

The study used the gold standard (simple random) sampling technique.

It is not generalisable for health professionals working in private health facilities.

It lacks causality and there may be recall bias.

This study is also subjective to self-response bias.

There may be a possibility of introducing social desirability bias.

Introduction

Work-related stress (WRS) is a pattern of reactions that occurs when workers are presented with work demands not matched to their knowledge, skills or abilities and which challenge their ability to cope.1 2 WRS is a major problem throughout the world and has negative emotional, physical and psychological effects on health professionals.3–5 Globally at least 3 million employees have occupational stress problems and one in three employees was estimated to be affected by WRS and also, the cost related to WRS reached around $5.4 billion per year in estimation.6 WRS has a potential effect both on the employees and employers. For the employer, it results in disorganisation, disruption in normal operations and decrease in productivity.7 WRS on health professionals would lead to absenteeism and turnover, which would affect the quality of care and further result in increased mortality among patients, failure to rescue and patient dissatisfaction.8 WRS also affects the quality of life including social relationships and family life. Mental health illness outcomes like depression, metabolic syndrome, cardiovascular diseases and physical injuries can happen in individuals exposed to WRS for a longer period of time.9 WRS can occur in all sectors; however, its impacts are higher in the health sector due to the complexity of the working environment.10 Studies conducted in Ethiopia among healthcare professionals also showed that 37.8%–68.2% of healthcare professionals had occupational stress.11 12 Even though little focus is given to WRS in Ethiopia, previous studies conducted show that the magnitude is high among working groups including the health sector.5 Different studies reported that sex, age, religion, ethnicity, marital status, child rearing, professional qualification, monthly salary and work experiences were identified as factors significantly associated with WRS.5 9 12–15 Almost all studies conducted in Ethiopia on the magnitude and factors associated with WRS were more focused on specific working group of health professionals and at the same level of health facility especially at hospital level. Therefore, the aim of this study is to assess WRS and its associated factors among health professionals working in Ambo town governmental facilities and the result of this finding would help to fill those information gaps.

Methods and materialsStudy area

The study was conducted in Ambo town, West Shoa Zone, Oromia region. The town is located at a distance of 114 km south-west of Addis Ababa on the main road from Addis to Nekemte. The town has two governmental hospitals and two health centres and there are 602 health professionals working in this health facility consisting of medical doctors, health officers, nurses, midwifery, laboratory technologists, pharmacists and others.

Study design and period

An institutional-based cross-sectional study was conducted from 15 July 2021 to 15 August 2021.

Source population

All the health professionals working in Ambo town governmental health facilities.

Study population

All the health professionals working in Ambo town governmental health facilities at the time of data collection.

Inclusion criteria

All the healthcare professionals working in Ambo town governmental health facilities who were available during the data collection period and serving one and above years at current health facility.

Exclusion criteria

Health professionals who were not present during data collection and who were not permanent employees at the institutions were excluded.

Sample size determination

The sample size for this study was determined by using a single population proportion formula by considering the prevalence of WRS as 53.3% which was obtained from a previous study conducted on WRS in Addis Ababa.16 Hence, assuming a 95% level of confidence and a 5% margin of error, the sample size for the first objective was calculated as follows:

Therefore, .

By allowing 10% contingency for non-response rate, the total sample size for this study was 420.

Sampling procedures

All governmental health facility in Ambo town was included. Accordingly, the town has two governmental hospitals namely Ambo University Referral Hospital and Ambo General Hospital and two health centres namely Ambo health centre and Awaro health centre consisting of 377, 181, 21 and 23 health professionals, respectively. Proportional allocation of study population was distributed for each of the health facilities and simple random sampling method was used to select study participants from the Ambo town governmental health facilities by using the payroll of each health facility as a sampling frame.

Study variablesDependent variable

Work-related stress.

Independent variables

Sociodemographic factors (age, sex, marital status, religion, profession, educational level, experience, salary/income), working conditions (managerial position, working hours, work unit, work shift, work load, job insecurity and violence), job satisfaction (supportive manager, promotion, clarity of work, recognition, availability of supply, training, interpersonal relationship), life-threatening events, behavioural conditions and life style.

Operational definitionsWork-related stress

WRS is the physical and emotional reactions that occur when health professionals’ abilities/skills and resources imbalance with their demands and requests of their work.

Stressed

It is described as participants who score the mean and above the score in the workplace stress scale (WSS).

Not stressed

Participants who score below the mean score of the WSS.

Data collection tools and procedures

Data were collected by a structured self-administered questionnaire. The questionnaire included three parts. Part I is on sociodemographic parts derived from the Ethiopian Demographic Health Survey, part II measures job satisfaction of health professionals while part III is a tool to measure WRS. The magnitude of job satisfaction was measured with a multi-item scale derived from Satisfaction of Employees in Health Care (SEHC) which has a possible range of scores from 1 to 72. SEHC is a survey established to measure staff satisfaction in healthcare settings in low-income countries like Ethiopian country. Overall job satisfaction was measured on a 4-point Likert scale with the value ranging from 1 (strongly disagree) to 4 (strongly agree). The average/mean value was used as the cut-off point to determine whether the respondents were satisfied with their job or not.

WRS was measured by WSS which was developed by the Marlin Company, North Haven, CT, USA, and the American Institute of Stress, Yonkers, NY, USA.

The WSS consists of eight items describing how often a respondent feels an aspect of his or her job and each item was rated on a 5-point scale ranging from never (1) to very often (5) or having possible response from 1 to 5 response for each item and ranging from never, almost never, sometimes, fairly often and very often, respectively. Positively worded items were reversely scored, and the ratings were summed, with higher scores indicating more stress. The possible range score of WSS ranges from 8 to 40 and the degree of association between dependent and independent variables was computed.

The range of WSS scores was divided into stratified quartiles and upper two and lower two quartiles were combined and labelled as stressed and not stressed, respectively. Before they started the practical data collection, a letter from ERC was secured and three nurses and one midwifery were trained on how to approach the study participants, privacy and rights of the study participants, consent issues and were briefed about the study and supervised by the researcher.

Data quality management

The designed structured self-administered questionnaire was prepared first in English and then translated into Afan Oromo and retranslated back to English by an independent translator to check for consistency. Pretest was done among 5% of study participants out of the study and unclear questions were restated in a way that a participant could easily understand. Training was given for two midwives and four nurses before data collection. The collected data were checked for completeness and for its consistencies by the investigator and supervisor every day.

Data analysis and management procedures

Data were entered by using EPI-data V.4.6 and exported into SPSS-25 for analysis. Descriptive statistics was expressed by using frequencies, mean, SD and percentages. Binary logistic regression analysis was done to identify variables candidate for multi-logistic regression analysis. Those variables with p value <0.25 in binary logistic regression were entered into the multivariate logistic regression models. OR with 95% CI was computed to identify factors that are statistically significant with WRS. The statistical significance level was declared at p value <0.05 in multi-logistic regression. Hosmer-Lemeshow was checked to determine the goodness of fitness of the model.

Patient and public involvement

None.

ResultsSociodemocratic characteristics of study participants

From the total of 420 health professionals, 407 were involved in the study making the response rate 96.9%. The age of the respondents ranged from 20 to 52 with the mean age of 29 years (SD=4.8) and majority 204 (50.1%) of them were between 25 and 29 years. Out of total respondents male accounts for 261 (64.1%) (table 1).

Table 1

Sociodemocratic characteristics of health professionals in Ambo town health facilities, west Shoa, Oromia, Ethiopia, 2021 (n=407)

Assessment of work condition of study participants

The respondents were predominantly on shift rotation 375 (92.1%) whereas about 60 (14.7%) were working in the outpatient department. Almost more than half 281 (69%) worked for long hours while about 138 (33.9%) intended to change their current job and 161 (39.6%) stated to continue their current career (table 2).

Table 2

Assessment working conditions of healthcare workers of health facilities in Ambo town, 2021 (n=407)

Assessment of behavioural, physical health and life events of study participants

Among the total 407 study participants, 258 (63.4%) had never taken alcohol in their life time whereas the rest 149 (36.6%) took alcohol sometimes. Regarding chat chewing, 344 (84.5%) had never consumed it while only 63 (15.5%) respondents used to chew partly. Likewise, only 32 (7.9%) of the respondents were used to smoking cigarettes whereas the remaining 375 (92.1%) stated no to smoking cigarettes (table 3).

Table 3

Assessment of behavioural, physical health and life events factors among health professionals working in governmental health facilities in Ambo town, 2021 (n=407)

Prevalence of WRS of study participants

WRS among the study participants was assessed by using WSS-8. Based on the tool, the total score for the study participants ranged from 8 to 40 and the mean score was 22. Sixty-five (SD=3.569). Out of 407 respondents 213 (52.33%) and 194 (47.67%) respondents scored equal/greater than and less than the mean, respectively. Accordingly, 213 (52.33%), 95% CI 0.475, 0.572 participants were stressed.

Multivariate logistic regression analysis

Bivariate logistic regression analysis was conducted to screen possible factors that associated with WRS. Accordingly, sociodemographic variables like sex, marital status, religion, profession, academic levels and work experience showed an association with WRS. Additionally, working unit, job insecurity (those who plan to change current job and continuing current job), job satisfaction, major life events (serious illness or injury to close family, death of close family or friends/relatives, being violated by others and anything seriously upset) and job satisfaction also showed association with WRS. After computing the multi-collinearity diagnostic test, tolerance test was greater than 0.2 while variance inflation factors for independent variables ranged from 1.13 to 1.4 which was acceptable. Variables those have an association with outcomes variable with p value <0.25 in the bivariate logistic regression were entered into multivariate logistic regression for further analysis. Statistical significance was delcared at p<0.05. Accordingly, sex, home-work interface, job insecurity (tendency to continue current career), major life events (serious injury to close relatives, death of close family/relatives, being violated by others and anything else seriously upset in the last 6 months) was independently associated with WRS.

Female health professionals were about 1.73 times (adjusted OR (AOR)=1.73, 95% CI 1.06, 2.81) more likely to report WRS than male health professionals. Study participants who reported home-work interface were about two times (AOR=1.93, 95% CI 1.19, 3.14) more likely to develop WRS than those opposite one. The odds of reporting WRS among study participants those who did not determine their idea to continue their career within the next couple of years were threefold compared with study participants those who like to continue their career within the next couple of years (AOR=3.22, 95% CI 1.87, 5.56).

Study participants those report serious injury to close relatives in the last 6 months were about three times (AOR=3.13, 95% CI 1.68, 5.84), death of close relatives in the last 6 months were about two times (AOR=2.09, 95% CI 1.16, 3.77), violence towards them by others in the last 6 months were about three times (AOR=3.10, 95% CI 1.65, 5.83) and anything else seriously upset in the last months were about 2.6 times (AOR=2.63, 95% CI 1.60, 4.32) more likely report WRS than their counterparts (table 4).

Table 4

Multivariate logistic regression analysis of factors associated with work-related stress among health professionals working in governmental health facilities in Ambo town, Oromia, Ethiopia, 2021 (407)

Discussion

This study employed as an institution-based cross-sectional design to investigate WRS and associated factors among health professionals. The findings from this study indicated that the overall prevalence of WRS was 52.33% (47.5, 57.2). This finding is consistent with the results from Bahirdar (48.6%).17 The finding of the current study was lower than the study findings reported in western Ghana (69.5%),13 Gurage Zone (78.3%)18 and Harar Ethiopia (66.2%).5 This difference might be due to the study setting, tools used, sample size, time difference and the study population. This finding is higher as compared with the results from Mekelle (46.9%)19 and Addis Ababa (37.8%).11 The possible reasons for the difference might be due to differences in tools used, study population, study period and setting and differences in individual coping strategies. The study conducted in Addis Ababa was conducted in 2012 which has a great time variation as compared with our study. Due to time variation, there may be existence of different factors facilitating WRS like high workload due to high patient flow. Our study included all health professionals whereas the study conducted in Addis Ababa was conducted among nurses only.

Sex was significantly associated with WRS. Female workers were more likely to be stressed than male health workers. This finding is in line with the studies done in Worabe,20 Iran21 and Japan.22 However, the finding is inconsistent with the study done in Nigeria.22 This difference could be a result of variation in sociocultural and study population and tools used. Females had multiple roles outside their work place than males and also gender discrimination in roles played at home may be able to add to the burden of stress at work place for females.

Work-family interference was significantly associated with WRS. Participants who reported that their job interfered with their family/social life were more likely to develop WRS as compared with their counterparts. This finding is in line with the result reported from China.23 This can be due to the fact that home-work interface may reduce job satisfaction and result in increased WRS as a result of lack of time for family care and fear that arise from work place acquired transmitted disease.

Health professional’s job insecurity which is escalated by long working hours, poor promotion and other management related factors is significantly associated with WRS.

Those participants who felt insecure about their job were more likely to report WRS as compared with their counterparts. This finding is similar to the studies done in Iran and China.21 23 However, this finding is not in line with the study findings reported in Mekelle, Bahir Dar and Addis Ababa, Ethiopia.17 19 24 This difference can be due to the variation in, tool used and study setting. The reason might be health professionals who do not determine their idea on their future job may put in dilemma and more thought and become restless which induce tension, anxiety and stress.

Occurrence of major life events was significantly associated with WRS among health professionals. Participants who reported major life events in the last 6 months were more likely report WRS than their counterparts. This finding is similar to the finding from Addis Ababa.24 The reason might be life stressors that occur outside the work may result in disturbance, unable to fix their idea on the work, depression and unable to control their emotion and finally stress at their workplace.

Conclusion

The prevalence of WRS among health professionals working in Ambo town public health facilities was high as compared with other studies. Sex, job insecurity, home-work interface, occurrence of major life events like reporting serious injury to close relatives, death of close family/relatives, violence from others and anything else seriously upset in the last 6 months were factors that positively related to WRS and make the work of health professionals stressful. Therefore, this study recommended that health facilities, programme managers and policy makers should consider those identified factors while designing public health interventions to reduce WRS among health professionals. Moreover, longitudinal research is needed to ensure temporal association between the independent variables and WRS.

Data availability statement

Data are available upon reasonable request. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Ethics statementsPatient consent for publication

Not applicable.

Ethics approval

This study involves human participants and ethical clearance was obtained from ethical review board of Ambo University, College of Medicine and Health Sciences. An official letter of cooperation was given to Dandi district administrative and health offices. Permission letter was obtained from administrative and health offices of Dandi district. After the purpose and objective of the study was informed, written informed consent was obtained from each study participant. All participants were informed that participation was on a voluntary basis and they could withdraw from the study at any time if they were not comfortable with the questionnaire. To maintain confidentiality data were collected and analysed anonymously. All methods were carried out in accordance with Declaration of Helsinki. Participants gave informed consent to participate in the study before taking part.

Acknowledgments

We would like to express our deepest appreciation to Ambo University, College of Medicine and Health, Department of Public Health for providing this opportunity. Our heartfelt appreciation also goes to West Shoa Zone, Zonal Health Department for their cooperation in conveying us all the necessary information regarding Ambo town public health facilities and administrative structures cooperation. Finally, our special thanks would go to the study participants, data collectors and supervisors.