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Background Many of the rural areas in developing countries are still in need access to quality healthcare services. To ensure the fair distribution of a high-quality health workforce and the availability of health services, there is a need to assess the background barriers that explain why healthcare providers are not interested to work in rural areas, thereby setting strategies to achieve universal health coverage. Therefore, this study is aimed to assess the willingness to work in rural areas and associated factors among health students at the University of Gondar. Methods An institution-based cross-sectional study was conducted at the University of Gondar from August 15 to 25, 2021. A total of 422 study participants were selected using a stratified random sampling technique. A pretested self-administered questionnaire was employed to collect the data. Data were entered into EPI DATA 4.6 and exported to SPSS 25 for further analysis. Multivariable logistic regression analysis was performed to identify factors associated with students’ willingness to work in rural areas. The level of significance was decided based on the 95% confidence interval at a p-value of ≤ 0.05. Results In this study, it was found that health students’ willingness to work in rural areas was 78.4% (95% CI: 74.3, 82.4). Being male (AOR = 2.15; 95% CI: 1.17, 3.94), having intention to continue with their profession (AOR = 2.5; 95% CI: 1.28, 4.86), having a favorable attitude towards working in rural areas (AOR = 7.32; 95% CI: 5.71, 18.65), and having a mother with no formal education (AOR = 2.23; 95% CI: 1.02, 4.85) and completed primary education (AOR = 2.69; 95% CI: 1.1, 6.61) were significantly associated with willingness to work in rural areas. Conclusion The willingness of students to work in rural areas was optimal. This calls for concerned bodies to create a conducive environment for male and female students to engage in rural areas without hesitation. It is also important to ensure that students are willing to work in the rural areas voluntarily, instead of working in rural areas due to a lack of employment.
An institution-based cross-sectional study was conducted from August 1 to 25, 2021. The study was conducted at the University of Gondar, College of Medicine and Health Sciences, which is found in Gondar city, northwestern Ethiopia. The college was established in 1954 and is considered one of the oldest and most famous Universities in Ethiopia. There are 12 fields of study in health and medicine such as Nursing, Midwifery, Clinical laboratory, Pharmacy, Anesthesia, Psychiatry, Health informatics, Physiotherapy, Optometry, Environmental and occupational health, Public health officer (HO), and Medicine. Currently, there are 1068 graduating students from the 12 departments by September 2021. All graduating health students during the study period were the study population. The sample size for this study was calculated based on the assumptions of the single population proportion formula by considering the following assumptions. Since there is no similar study, we used the proportion of student’s willingness to work in the rural area-50% (p = 0.5), level of significance- 5% (α = 0.05), Z α/2–1.96, and margin of error—5% (d = 0.05). Therefore, the sample size was calculated as follows After adding a 10% non-response rate, the minimum adequate sample size was found to be 422. There are 12 departments at the University of Gondar, college of medicine, and health sciences. All departments were included in the study. The lists of students were obtained from the registrar’s office and the sampling frame was prepared by ordering the lists of students. Then, the total sample size was distributed proportionally to each department. Finally, the participants were selected using a stratified random sampling technique using a table of random generation (Fig 1). The willingness of students to work in the rural areas was the outcome variable, whereas age, sex, place of origin, religion, professional category, paternal and maternal educational status, paternal and maternal occupation, and personal behaviors like exposure to addictive substances, attitude to work in the rural area, and plan to emigrate were the independent variables. Students were asked whether they are willing to work in rural areas or not. A “yes” response was considered as willing to work in the rural areas [19]. Students’ attitude toward working in rural areas was assessed using 11 questions: 1) Working in rural areas provide opportunities to use various skills 2) There is a supportive environment when working in a rural environment 3) Working in rural areas limits communication with professional peers 4) Working in rural areas provide opportunities to work independently 5) There is lack of amenities and entertainment in rural areas 6) People in rural areas are friendly 7) Working in these areas causes isolation from family and friends 8) Working as a health care provider in hospitals or health centers in rural areas is the most important contribution to the health of the population 9) Health science college prepared me well to work in rural areas 10) Working in rural hospitals areas is the most challenging 11) Working in rural hospitals provide opportunities for real-life problem-solving. Each question has five points Likert scale (1- strongly disagree, 2- disagree, 3- neutral, 4- agree, and 5- strongly agree). The minimum and maximum scores were 11 and 55, respectively. Thus, students who answered above the mean value are considered as having a favorable attitude [17]. The data collection tool was developed by reviewing the literature [16, 17, 19, 20] and data were collected using a structured, pretested, and self-administered questionnaire. The questionnaire was evaluated by experts before data collection. The questionnaire contains socio-demographic characteristics and academic-related characteristics. Six BSc in midwifery graduating students and 1 MSc in Midwifery holder were recruited for data collection and supervision, respectively. To ensure consistency and understandability, the questionnaire was initially prepared in English and translated to the local Amharic language and back to English. A pretest was done on 5% of the calculated sample size at Bahir Dar University to check the response, language intelligibility, and relevance of the questionnaire. The data collectors and supervisors were trained for a day regarding the overall data collection process. At the time of actual data collection, the collected data was checked daily by the supervisor for completeness. Data were entered into EPI DATA 4.6 and exported to SPSS version 25 for further cleaning and analysis. Tables, figures, mean, and proportions are used to state the descriptive statistics of the study participants. The chi-square assumption was tested. Binary logistic regression was fitted to identify independent predictors. Variables with a p-value of less than 0.25 in the bivariable logistic regression were included in the multivariable logistic regression to identify the final independent predictors. Hosmer-Lemeshow was used to test the model’s goodness of fit. In addition, variance inflation factor (VIF), and standard error were used to screen multi-collinearity among independent variables. In the multivariable logistic regression analysis, a p-value of ≤ 0.05 and 95% CI for the adjusted odds ratio (AOR) were used to determine the significance and degree of association between willingness to work in rural areas and the explanatory variables. The ethical clearance letter was obtained from the School of Midwifery under the delegation of the Institutional Review Board (IRB) of the University of Gondar. A formal administrative approval letter was gained from the college of medicine and health sciences. After clearly explaining the purpose of the study to the students, anonymous written informed consent was obtained from each study participant. Interviewees were given the right to refuse and withdraw from the study at any time.
