School of Public Health, Weifang Medical University, Weifang, China.
School of Public Affairs, Zhejiang University, Hangzhou, China.
Hum Resour Health. 2023 Jan 26;21(1):3. doi: 10.1186/s12960-023-00791-y.
Family doctors in rural China are the main force for primary health care, but the workforce has not been well stabilized in recent years. Surface acting is an emotional labor strategy with a disparity between inner feelings and emotional displays, provoking negative effects such as emotional exhaustion, occupational commitment reduction, and, consequently, increasing turnover rate. With the Conservation of Resources theory, this study explores how the surface acting of rural family doctors affects turnover intention through emotional exhaustion and investigates what role occupational commitment plays in this relationship.
With a valid response rate of 93.89%, 953 valid data were collected by an anonymous self-administered questionnaire survey in December 2021 in Shandong Province, China. Cronbach's Alpha and confirmatory factor analysis (CFA) were used to estimate reliability and construct validity, respectively. The PROCESS macro in SPSS was performed to analyze the mediating and moderated mediation effects of surface acting, emotional exhaustion, occupational commitment, and turnover intention.
Reliability and validity indicated that the measurement instruments were acceptable. Surface acting had a direct positive effect on turnover intention (β = 0.481, 95% CI [0.420, 0.543]). Emotional exhaustion partially mediated the effect of surface acting on turnover intention (indirect effect: 0.214, 95% CI [0.175, 0.256]). Occupational commitment moderated the effect of emotional exhaustion on turnover intention (β = - 0.065, 95% CI [- 0.111, - 0.019]), and moderated the indirect effect of surface acting on turnover intention via emotional exhaustion (index of moderated mediation: - 0.035).
Emotional exhaustion partially mediates the relationship between surface acting and turnover intention among family doctors in rural China, and occupational commitment moderates the direct effect of emotional exhaustion on turnover intention and further moderates the mediating effect. Policymakers should pay more attention to the effects of emotional labor and emotional resource depletion on the stability of rural health human resources.
中国农村家庭医生是基层卫生保健的主要力量，但近年来队伍一直不稳定。表面行为是一种情绪劳动策略，存在内心感受和情绪表现之间的差距，会引发情绪耗竭、职业承诺降低等负面影响，从而导致离职率增加。本研究以资源保存理论为基础，探讨农村家庭医生的表面行为如何通过情绪耗竭影响离职意愿，并研究职业承诺在这种关系中扮演的角色。
2021 年 12 月，采用匿名自填式问卷调查法，在中国山东省对 953 名有效数据进行调查，有效应答率为 93.89%。采用 Cronbach's Alpha 和验证性因素分析（CFA）分别估计可靠性和构建效度。采用 SPSS 的 PROCESS 宏程序分析表面行为、情绪耗竭、职业承诺和离职意愿的中介和调节中介效应。
可靠性和有效性表明测量工具是可以接受的。表面行为对离职意愿有直接的正向影响（β=0.481，95%置信区间[0.420，0.543]）。情绪耗竭部分中介了表面行为对离职意愿的影响（间接效应：0.214，95%置信区间[0.175，0.256]）。职业承诺调节了情绪耗竭对离职意愿的影响（β=-0.065，95%置信区间[-0.111，-0.019]），并进一步通过情绪耗竭调节了表面行为对离职意愿的间接效应（调节中介效应指数：-0.035）。
情绪耗竭部分中介了中国农村家庭医生的表面行为与离职意愿之间的关系，职业承诺调节了情绪耗竭对离职意愿的直接影响，并进一步调节了情绪耗竭的中介效应。决策者应更加关注情绪劳动和情绪资源消耗对农村卫生人力资源稳定性的影响。
