Pudpong Nareerut, Suphanchaimat Rapeepong, Batra Bipin, Hou Jianlin, Vu Lan T H, Dipika Paul
Healthcare Accreditation Institute (Public Organization), Nonthaburi, Thailand.
International Health Policy Program (IHPP), Ministry of Public Health, Nonthaburi, Thailand.
BMC Nurs. 2017 Mar 21;16:13. doi: 10.1186/s12912-017-0208-4. eCollection 2017.
Shortages and maldistribution of nurses remain significant problems in many countries. Having appropriate intervention strategies to retain nurses in underserved areas, where they are most needed, are crucial for health system strengthening. This study aimed to quantify attitudes to working in rural areas, perceived competencies, and intention to work among final-year nursing students, and to analyze the associations between those factors and their background characteristics across five countries in the Asia-Pacific Network for Health Professional Education Reforms (ANHER), namely Bangladesh, China, India, Thailand, and Vietnam.
A descriptive comparative cross-sectional survey was conducted between July 2012 and July 2013, using a self-administered questionnaire to assess students' attitudes towards working in rural areas, their perceived competencies, and their intended job choices. A total of 10,169 final-year nursing students in five countries were selected. Bivariate models were constructed to compare students' characteristics. Statistically significant variables were further analyzed using multivariate models.
Most nursing students in five countries had rural backgrounds. Students in India (67.1%) and Thailand (65.1%) held more positive attitudes towards working in rural areas. Students in Bangladesh (78.8%) and India (62.6%) believed that their schools prepared them well, and inspired them, to work in rural areas. The 'Lifelong learning' competency was ranked highest by students in all five countries, ranging from 76.2 to 91.7%. Their perceived competencies were significantly related to their background of having graduated from rural high schools and being admitted to study through rural recruitment. Rural upbringing and rural recruitment were significantly associated with more positive attitudes towards rural areas (-value < 0.5). A majority of students in China (83.8%), Thailand (67.7%) and Vietnam (86.5%) intended to work in the public sector immediately after graduation.
These findings from five Asian countries confirm that nursing students with rural upbringing and recruitment had more positive attitudes toward rural areas and were more likely to choose working in rural areas after graduation. This study provides additional evidence from country implementation to support the value of WHO recommendations of effective strategies to address issues of rural retention by focusing on the recruitment of students with a rural background.
护士短缺和分布不均在许多国家仍是重大问题。制定适当的干预策略以留住最需要护士的服务欠缺地区的护士，对于加强卫生系统至关重要。本研究旨在量化亚太地区卫生专业教育改革网络（ANHER）的五个国家（即孟加拉国、中国、印度、泰国和越南）的护理学专业最后一年学生对在农村地区工作的态度、感知能力以及工作意愿，并分析这些因素与他们背景特征之间的关联。
2012年7月至2013年7月期间进行了一项描述性比较横断面调查，使用自填式问卷评估学生对在农村地区工作的态度、他们的感知能力以及他们预期的工作选择。在五个国家共选取了10169名护理学专业最后一年学生。构建双变量模型以比较学生的特征。对具有统计学意义的变量使用多变量模型进一步分析。
五个国家的大多数护理学专业学生有农村背景。印度（67.1%）和泰国（6（65.1%）的学生对在农村地区工作持更积极的态度。孟加拉国（78.8%）和印度（62.6%）的学生认为他们的学校为他们在农村地区工作做好了充分准备并给予了激励。“终身学习”能力在所有五个国家的学生中排名最高，范围从76.2%到91.7%。他们的感知能力与毕业于农村高中以及通过农村招生录取的背景显著相关。农村成长经历和农村招生与对农村地区更积极的态度显著相关（-值<0.5）。中国（83.8%）、泰国（67.7%）和越南（86.5%）的大多数学生打算毕业后立即在公共部门工作。
来自五个亚洲国家的这些研究结果证实，有农村成长经历和农村招生背景的护理学专业学生对农村地区有更积极的态度，并且毕业后更有可能选择在农村地区工作。本研究从国家实施层面提供了更多证据，以支持世界卫生组织关于通过关注招收有农村背景的学生来解决农村地区留用问题的有效策略的建议的价值。
