Ntjikelane Vinolia, Phiri Bevis, Kaiser Jeanette L, Rosen Sydney, Morgan Allison J, Huber Amy, Mokhele Idah, Tchereni Timothy, Ngoma Stanley, Lumano-Mulenga Priscilla, Pascoe Sophie, Scott Nancy
Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Sunnyside Office Park, 32 Princess Wales Terrace, Parktown, Johannesburg, 2193, South Africa.
Clinton Health Access Initiative-Zambia, Lusaka, Zambia.
Hum Resour Health. 2025 May 26;23(1):25. doi: 10.1186/s12960-025-00993-6.
HIV care providers are often overworked and suffer from burnout and low job satisfaction. Differentiated service delivery (DSD) models for HIV treatment aim to decongest clinics and improve providers' quality of professional life by reducing the client/provider ratio and allowing for more time with clients in need. We investigated current job satisfaction and perceived changes in job satisfaction among HIV care providers in Malawi, South Africa, and Zambia after the adoption of DSD models of care in each country.
We conducted a concurrent, cross-sectional mixed methods survey with clinical and non-clinical HIV care providers between April 2021 and January 2022 at public sector clinics in Malawi (n = 12), South Africa (n = 21), and Zambia (n = 12). Questions investigated the effect of DSD models on provider responsibilities, work burden, time allocation, and job satisfaction. We conducted a principal components analysis of survey responses to create a job satisfaction index and estimated odds ratios (OR) using logistic regression for associations between key variables and low reported job satisfaction. We reported emerging qualitative themes. We used Herzberg's two-factor theory to organize and interpret results, identifying motivating factors (which lead to job satisfaction) and hygiene factors (which we refer to as maintenance factors, that lead to dissatisfaction if lacking).
Providers had generally high job satisfaction. Providers from Malawi were more likely to report lower job satisfaction than those from South Africa or Zambia (adjusted OR (aOR) 4.56; 95% confidence interval (CI) [2.12-9.80]). Providers who believed that their jobs became harder after the introduction of DSD models (2.82; [1.14-6.96]) or that their jobs did not change (6.50; [2.50-16.89]) were more likely to report lower job satisfaction than those who believed their jobs became easier. Qualitatively, providers felt DSD models improved their working conditions by easing clinic congestion and allowing them to spend more time on other tasks. Providers were particularly motivated when they could spend more time with clients.
Findings highlight the importance of DSD models in maintaining or improving healthcare providers' quality of professional life and underscore the need for continued monitoring of the impact of these models on job satisfaction among HIV care providers in resource-constrained settings.
艾滋病护理人员经常工作过度，身心疲惫，工作满意度较低。艾滋病治疗的差异化服务提供（DSD）模式旨在通过降低患者/护理人员比例，让护理人员有更多时间陪伴有需要的患者，从而缓解诊所压力，提高护理人员的职业生活质量。我们调查了马拉维、南非和赞比亚的艾滋病护理人员在采用DSD护理模式后目前的工作满意度以及他们所感知到的工作满意度变化。
2021年4月至2022年1月期间，我们在马拉维（n = 12）、南非（n = 21）和赞比亚（n = 12）的公共部门诊所，对临床和非临床艾滋病护理人员进行了一项同步横断面混合方法调查。问题涉及DSD模式对护理人员职责、工作负担、时间分配和工作满意度的影响。我们对调查回复进行主成分分析，以创建工作满意度指数，并使用逻辑回归估计关键变量与低工作满意度报告之间关联的比值比（OR）。我们报告了新出现的定性主题。我们使用赫兹伯格的双因素理论来组织和解释结果，确定激励因素（导致工作满意度）和保健因素（我们称为维持因素，如果缺乏会导致不满）。
护理人员总体工作满意度较高。马拉维的护理人员比南非或赞比亚的护理人员更有可能报告较低的工作满意度（调整后的OR（aOR）为4.56；95%置信区间（CI）[2.12 - 9.80]）。那些认为引入DSD模式后工作变得更难（2.82；[1.14 - 6.96]）或工作没有变化（6.50；[2.50 - 16.89]）的护理人员，比那些认为工作变得更容易的护理人员更有可能报告较低的工作满意度。从定性角度来看，护理人员认为DSD模式通过缓解诊所拥堵并让他们有更多时间处理其他任务，改善了他们的工作条件。当能够花更多时间陪伴患者时，护理人员尤其受到激励。
研究结果凸显了DSD模式在维持或提高医疗保健人员职业生活质量方面的重要性，并强调需要持续监测这些模式对资源有限环境下艾滋病护理人员工作满意度的影响。
