Unit for Social and Community Psychiatry, World Health Organization Collaborating Centre for Mental Health Development, Queen Mary University of London, London, United Kingdom.
Department of Public Health, Astana Medical University, Nur-Sultan, Kazakhstan.
JAMA Netw Open. 2020 Jan 3;3(1):e1913202. doi: 10.1001/jamanetworkopen.2019.13202.
Improving health care in low- and middle-income countries (LMICs) requires a workforce with positive job morale. However, the level of job morale in this population remains unclear.
To analyze studies measuring the job morale of physicians and dentists working in LMICs, using levels of job burnout, job satisfaction, and job motivation as indicators of job morale.
A comprehensive search of Scopus, PubMed, PsycINFO, EMBASE, Web of Science, and the Cochrane Library, from database inception to October 30, 2018, and gray literature was performed.
Studies were eligible if at least 50% of the sample were qualified physicians and/or dentists working in public health care settings in LMICs. Three indicators of job morale in this population were used: job burnout, job satisfaction, and job motivation. Of 12 324 records reviewed, 79 studies were included in the systematic review and 59 were eligible for the meta-analysis.
Data were extracted independently by several investigators in accordance with the Meta-analyses of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Random-effects meta-analyses, planned subgroup analyses, and metaregression were performed. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess bias.
Levels of job burnout, job satisfaction, and job motivation as indicators of job morale.
Overall, 12 324 records were identified. Of them, 80 records, representing 79 studies and involving 45 714 participants across 37 LMICs, met the inclusion criteria for the review; however, only 3 were from low-income countries. In 21 studies with 9092 participants working mainly in middle-income countries, 32% (95% CI, 27%-38%; I2 = 95.32%; P < .001) reported job burnout, and in 20 studies with 14 113 participants, 60% (95% CI, 53%-67%; I2 = 98.21%; P < .001) were satisfied with their job overall. Sufficient data were not available for a meta-analysis of job motivation.
The findings suggest that, among physicians and dentists working mainly in middle-income countries, more than half reported having positive job morale. Positive job morale among physicians and dentists may help with recruitment and retention and thus support programs for improving health care in LMICs.
要改善低收入和中等收入国家（LMICs）的医疗保健，就需要有一支工作士气高昂的医疗队伍。然而，该人群的工作士气水平仍不清楚。
分析使用职业倦怠、工作满意度和工作动机水平作为工作士气指标来衡量在 LMICs 工作的医生和牙医的工作士气的研究。
从数据库建立到 2018 年 10 月 30 日，全面检索了 Scopus、PubMed、PsycINFO、EMBASE、Web of Science 和 Cochrane Library 的文献，并检索了灰色文献。
如果至少 50%的样本是在 LMICs 公共医疗保健环境中工作的合格医生和/或牙医，则研究合格。该人群的工作士气的三个指标是：职业倦怠、工作满意度和工作动机。在审查的 12324 条记录中，有 79 项研究被纳入系统评价，59 项研究符合荟萃分析的条件。
多名研究人员根据观察性研究的荟萃分析（MOOSE）报告指南独立提取数据。进行了随机效应荟萃分析、计划的亚组分析和元回归。使用观察性队列和横断面研究的质量评估工具来评估偏倚。
职业倦怠、工作满意度和工作动机作为工作士气的指标。
总共确定了 12324 条记录。其中，有 80 条记录代表 79 项研究，涉及 37 个 LMIC 中的 45714 名参与者，符合审查标准；然而，只有 3 项来自低收入国家。在 21 项主要在中等收入国家开展的研究中，有 32%（95%CI，27%-38%；I2=95.32%；P<.001）报告职业倦怠，在 20 项研究中，有 14113 名参与者对他们的工作整体满意度为 60%（95%CI，53%-67%；I2=98.21%；P<.001）。由于没有足够的数据，无法进行工作动机的荟萃分析。
研究结果表明，在主要在中等收入国家工作的医生和牙医中，超过一半的人报告工作士气良好。医生和牙医的积极工作士气可能有助于招聘和留用，从而支持改善 LMICs 医疗保健的计划。
