Willingness to work in rural areas and associated factors among graduating health students at the University of Gondar, northwest Ethiopia, 2021

PLoS ONE, Volume 17, No. 10 October, Year 2022

Ukuhunyushwa

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.

I-AI Digest

Study Justification:

– Many rural areas in developing countries lack access to quality healthcare services.
– Understanding the barriers that prevent healthcare providers from working in rural areas is crucial for achieving universal health coverage.
– This study aims to assess the willingness to work in rural areas among health students at the University of Gondar in Ethiopia.

Highlights:

– The study found that 78.4% of health students at the University of Gondar were willing to work in rural areas.
– Factors associated with willingness to work in rural areas included being male, having the intention to continue with their profession, having a favorable attitude towards working in rural areas, and having a mother with no formal education or completed primary education.

Recommendations:

– Create a conducive environment for male and female students to engage in rural areas without hesitation.
– Ensure that students are willing to work in rural areas voluntarily, rather than due to a lack of employment.

Key Role Players:

– University of Gondar, College of Medicine and Health Sciences
– Registrar’s office
– Data collectors and supervisors
– Institutional Review Board (IRB)

Cost Items for Planning Recommendations:

– Training for data collectors and supervisors
– Data collection tools and materials
– Data entry and analysis software
– Administrative and ethical clearance fees
– Publication and dissemination of study findings

Amandla Obufakazi

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a cross-sectional study conducted at the University of Gondar in Ethiopia. The study used a stratified random sampling technique and a self-administered questionnaire to collect data. Multivariable logistic regression analysis was performed to identify factors associated with students’ willingness to work in rural areas. The study found that 78.4% of health students were willing to work in rural areas, and several factors were significantly associated with this willingness. The abstract provides a clear description of the study methods and results. However, the evidence could be strengthened by including information on the limitations of the study, such as potential biases or confounding factors. Additionally, the abstract does not mention the sample size calculation in detail, which could be included to provide transparency. To improve the evidence, future studies could consider using a longitudinal design to assess the long-term willingness of health students to work in rural areas and explore additional factors that may influence their decision.

Abstract

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.

Izinto zokwakha

Emisha

Based on the provided information, here are some potential innovations that can be used to improve access to maternal health:

1. Telemedicine: Implementing telemedicine services can improve access to maternal health by allowing pregnant women in rural areas to consult with healthcare providers remotely. This can help address the shortage of healthcare providers in rural areas and provide timely and convenient access to prenatal care.

2. Mobile health (mHealth) applications: Developing mobile health applications specifically designed for maternal health can provide pregnant women with important information, reminders, and access to healthcare services. These applications can also facilitate communication between pregnant women and healthcare providers, enabling remote monitoring and support.

3. Community health worker programs: Establishing community health worker programs in rural areas can improve access to maternal health by training and deploying local community members to provide basic prenatal care, education, and support to pregnant women. Community health workers can bridge the gap between healthcare facilities and remote communities, ensuring that pregnant women receive the necessary care and guidance.

4. Transportation solutions: Improving transportation infrastructure and implementing innovative transportation solutions, such as mobile clinics or ambulances, can help overcome geographical barriers and ensure that pregnant women can access healthcare facilities in a timely manner. This can be particularly beneficial for women living in remote rural areas.

5. Public-private partnerships: Collaborating with private healthcare providers and organizations can help expand access to maternal health services in rural areas. Public-private partnerships can leverage the resources and expertise of both sectors to establish and maintain healthcare facilities, train healthcare providers, and ensure the availability of essential maternal health services.

6. Health education and awareness campaigns: Conducting targeted health education and awareness campaigns in rural areas can help improve knowledge and understanding of maternal health issues. By empowering women and their families with accurate information, they can make informed decisions and seek appropriate care during pregnancy and childbirth.

It is important to note that the implementation of these innovations should be context-specific and consider the local healthcare infrastructure, cultural norms, and resources available in the target area.

AI Innovations Description

Based on the study titled “Willingness to work in rural areas and associated factors among graduating health students at the University of Gondar, northwest Ethiopia, 2021,” there are several recommendations that can be developed into innovations to improve access to maternal health. These recommendations include:

1. Creating a Conducive Environment: The study found that students’ willingness to work in rural areas was optimal. To capitalize on this willingness, it is important for concerned bodies to create a conducive environment for both male and female students to engage in rural areas without hesitation. This can be achieved by providing necessary infrastructure, resources, and support systems in rural healthcare facilities.

2. Addressing Gender Disparities: The study found that being male was significantly associated with willingness to work in rural areas. To ensure equal access to maternal health services, it is important to address gender disparities and encourage more female students to consider working in rural areas. This can be done through targeted recruitment efforts, scholarships, and mentorship programs.

3. Promoting Positive Attitudes: The study found that having a favorable attitude towards working in rural areas was significantly associated with willingness to work in rural areas. To improve access to maternal health, it is crucial to promote positive attitudes among health students towards rural practice. This can be achieved through awareness campaigns, training programs, and exposure to rural healthcare settings during their education.

4. Involving the Community: The study found that having a mother with no formal education and completed primary education was significantly associated with willingness to work in rural areas. To improve access to maternal health, it is important to involve the community in the decision-making process and empower them to take ownership of their healthcare services. This can be done through community engagement programs, health education initiatives, and collaboration with local leaders.

5. Voluntary Engagement: The study emphasized the importance of ensuring that students are willing to work in rural areas voluntarily, instead of working in rural areas due to a lack of employment. To achieve this, it is crucial to provide attractive incentives, career development opportunities, and a supportive work environment in rural healthcare facilities.

By implementing these recommendations, it is possible to develop innovative strategies that improve access to maternal health in rural areas. These strategies should focus on creating a conducive environment, addressing gender disparities, promoting positive attitudes, involving the community, and ensuring voluntary engagement of healthcare professionals.

AI Innovations Methodology

Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Increase incentives for health students to work in rural areas: Providing financial incentives, such as higher salaries or loan forgiveness programs, can motivate health students to choose rural areas for their practice. This can help address the shortage of healthcare providers in rural areas.

2. Improve infrastructure and resources in rural healthcare facilities: Investing in the infrastructure of rural healthcare facilities, including equipment, supplies, and technology, can attract health students to work in these areas. Access to necessary resources can make rural practice more appealing and effective.

3. Enhance training and education on rural healthcare: Incorporating rural health training and education into the curriculum of health programs can prepare students for the unique challenges and opportunities of working in rural areas. This can include rotations or internships in rural healthcare facilities.

4. Strengthen mentorship and support systems: Establishing mentorship programs and support networks for health students working in rural areas can provide guidance, encouragement, and professional development opportunities. This can help alleviate concerns and challenges associated with rural practice.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the indicators: Identify key indicators that reflect access to maternal health, such as the number of healthcare providers in rural areas, the number of maternal health services available, and the maternal mortality rate.

2. Collect baseline data: Gather data on the current state of access to maternal health in the target area, including the number of healthcare providers, the availability of maternal health services, and maternal health outcomes.

3. Implement the recommendations: Introduce the recommended interventions, such as increasing incentives, improving infrastructure, enhancing training, and establishing support systems. Implement these interventions over a specified period of time.

4. Monitor and collect data: Continuously monitor the implementation of the recommendations and collect data on the indicators identified in step 1. This can include tracking the number of healthcare providers in rural areas, assessing the availability and quality of maternal health services, and monitoring maternal health outcomes.

5. Analyze the data: Analyze the collected data to assess the impact of the recommendations on access to maternal health. Compare the baseline data with the data collected after the implementation of the interventions to identify any improvements or changes.

6. Evaluate the impact: Evaluate the impact of the recommendations by assessing the changes in the indicators identified in step 1. This can involve conducting statistical analyses and interpreting the results to determine the effectiveness of the interventions.

7. Adjust and refine: Based on the evaluation results, make any necessary adjustments or refinements to the recommendations. This can involve modifying the interventions or implementing additional strategies to further improve access to maternal health.

By following this methodology, it is possible to simulate the impact of the recommendations on improving access to maternal health and make informed decisions on how to address the barriers and challenges in rural areas.

Umbhali

Dima Health

Identifiers:

DOI: 10.1371/journal.pone.0276594

Research Areas:

Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants

Study Countries:

Ethiopia

Study Design:

Case-Control Study, Cross Sectional Study, Grounded Theory

Study Approach:

Quantitative

Participants Gender:

Male & Female

Yabelana ngalokhu: