Gao Jing, Yin Jia, Sun Qiang
Department of Social Medicine and Health Management, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, China.
BMJ Open. 2025 Jul 22;15(7):e097491. doi: 10.1136/bmjopen-2024-097491.
The special nature of the functional ability of older individuals with disabilities places higher demands on the quantity and quality of long-term care (LTC) services. However, LTC services lag significantly behind, with LTC facilities facing challenges in recruiting and retaining direct care workers (DCWs). Job satisfaction significantly affects turnover rates. To enhance the stability of the care workforce, there is an urgent need for an in-depth analysis of the barriers and challenges that affect job satisfaction from the perspective of DCWs.
This study uses the Herzberg's two-factor theory to explore the barriers and challenges that affect job satisfaction among DCWs in LTC services from their perspective.
A descriptive qualitative study design involving face-to-face semistructured interviews. Thematic framework analysis was used to generate qualitative codes and identify themes.
The study included 31 DCWs from an LTC service institution.
This study was conducted in Shandong Province, China. In each city, 3-4 medium-sized to large-sized facilities that provided LTC care services were selected.
DCWs faced barriers in terms of motivation and hygiene factors. The hygiene factors deficiencies are primarily related to systemic barriers to LTCI policy and the absence of a home care safety system. The main impediments to motivational factors include poor working conditions, discordant interpersonal communication, emotional labour overload and low occupational identity.
DCWs face multiple barriers and challenges related to job satisfaction. This study may provide a framework to guide the improvement of intervening variables in the provision of LTC services. In the future, more emphasis should be placed on service providers as the mainstay of LTC policy practice; this will ensure that both the hygiene and motivation factors among DCWs are addressed and implemented simultaneously. Concurrently, the LTC insurance system should be used as a guarantee to promote the synergistic development of LTC services and the stability of the DCWs.
残疾老年人功能能力的特殊性质对长期护理（LTC）服务的数量和质量提出了更高要求。然而，LTC服务明显滞后，LTC设施在招聘和留住直接护理人员（DCW）方面面临挑战。工作满意度对离职率有显著影响。为提高护理人员队伍的稳定性，迫切需要从DCW的角度深入分析影响工作满意度的障碍和挑战。
本研究运用赫兹伯格双因素理论，从DCW的角度探讨影响LTC服务中DCW工作满意度的障碍和挑战。
采用描述性定性研究设计，进行面对面的半结构化访谈。运用主题框架分析法生成定性编码并确定主题。
该研究纳入了一家LTC服务机构的31名DCW。
本研究在中国山东省进行。在每个城市，选择了3 - 4家中大型提供LTC护理服务的机构。
DCW在激励因素和保健因素方面面临障碍。保健因素的不足主要与长期护理保险（LTCI）政策的系统性障碍以及家庭护理安全系统的缺失有关。激励因素的主要障碍包括工作条件差、人际沟通不和谐、情感劳动过载和职业认同感低。
DCW在工作满意度方面面临多重障碍和挑战。本研究可为指导改善LTC服务提供中的干预变量提供框架。未来，应更加重视服务提供者作为LTC政策实践的主体；这将确保同时解决和落实DCW的保健因素和激励因素。同时，应以LTCI制度为保障，促进LTC服务的协同发展和DCW队伍的稳定。
