Working Conditions of Occupational Therapists in Jordan

Transcription

1 RESEARCH ARTICLE Working Conditions of Occupational Therapists in Jordan Hashem Salman Abu Tariah 1 *, Sana M.N. Abu Dahab 2, Razan T. Hamed 2, Rawan A. AlHeresh 2 & Huda Abed Arahim Yousef 2 1 Department of Occupational Therapy, The Hashemite University, Amman 11171, Jordan 2 Department of Occupational Therapy, The University of Jordan, Amman 11942, Jordan Abstract The purpose of this study was to investigate the working conditions and factors related to job satisfaction among Jordanian occupational therapists. A self administered survey consisting of several questions about the participants jobs was developed for this study. The inclusion criteria included occupational therapists who worked in the field of occupational therapy (OT) in Jordan and who had at least six months of experience. The survey was distributed to 120 occupational therapists in different OT settings. One hundred and one occupational therapists from different hospitals, centres, schools and universities responded to the survey. Salaries of the participants were low in comparison with the salaries of the rest of healthcare practitioners in Jordan. Chi square analysis revealed significant relationship between participants perceived job satisfaction and the administration of the setting, and between the choice of studying OT and the salary that the participant makes. Most occupational therapists in Jordan are young, have modest experience and work in general OT services in government owned facilities or paediatric centres. A sense of dissatisfaction was obvious among the participants. Further studies are needed to explore reasons of work satisfaction and dissatisfaction among occupational therapists in Jordan. Copyright 2011 John Wiley & Sons, Ltd. Received 23 September 2010; Revised 2 April 2011; Accepted 7 April 2011 Keywords working conditions; occupational therapists; survey study; Jordan *Correspondence Hashem Salman Abu Tariah, Department of Occupational Therapy, The Hashemite University, PO Box , Amman 11171, Jordan. hashemsalman@hotmail.com Published online 25 May 2011 in Wiley Online Library (wileyonlinelibrary.com) DOI: /oti.319 Introduction The first occupational therapy (OT) programme established in Jordan was a three year diploma programme that started in 1989 at the King Hussein Medical Center (Busuttil, 1991). Ten years later, in 1999, three bachelor s level OT programmes were established in three public universities in Jordan, which are all accredited by the World Federation of Occupational Therapists (2010; Since 1999, about 600 occupational therapists graduated from these universities and currently work in Jordan, other countries in the region and worldwide. The number of admitted students to OT programmes is increasing on an annual basis. More than 350 OT students are currently enrolled in OT programmes in Jordan. This predicts a larger number of occupational therapists in the future. However, until now, no studies were conducted to evaluate the working conditions or general job satisfaction of these therapists. 187

2 Working Conditions of Occupational Therapists in Jordan Abu Tariah et al. Akroyd et al. (1994) investigated the perception of general working conditions and found that it was a strong predictor of work satisfaction among a sample size of 413 occupational and physical therapists in the ambulatory care and hospital setting. Using a hermeneutical phenomenological approach study, Moore et al. (2006) reported that job satisfaction can contribute positively towards the recruitment and retention of staff. Managers behaviours and actions were found to play a key role in influencing occupational therapists job satisfaction (Moore et al., 2006). Similarly, Scanlan et al. (2010) studied recruitment and retention issues among 38 occupational therapists working in mental health area. Factors that foster the participants retention in their workplace were related to the nature of the work, the supportive team members and the opportunity to use OT skills. On the other hand, factors such as the desire for new and different types of work, the desire to work closer to home, insufficient time or high workloads, feeling bored, working in unsupportive teams and family, or other personal factors were behind participants consideration of leaving their positions (Scanlan et al., 2010). Rodwell et al. (2009) reported that the additive demand control support model predicts the outcome variables of job satisfaction, organizational commitment and psychological distress among 113 allied health professionals who participated in the study. Results of the study by Rodwell et al. (2009) also revealed that organizational justice variables predicted organizational commitment and psychological distress. Factors that influence occupational therapists job satisfaction (n =332) according to Eklund and Hallberg (2000) were general satisfaction with work, communication and cooperation among team members, managerial feedback, patients influence on care and relatives influence on care. Autonomy as well was found to be positively related to overall job satisfaction in another study (Davis and Bordieri, 1988). On the other hand, job satisfaction was found to be affected negatively by poor or inadequate salary and inadequate career advancement among 433 environmental health professionals (Zontek et al., 2009). According to Davis and Bordieri (1988), occupational therapists who participated in their survey study (n = 249) perceived achievement, interpersonal relationships with co workers and nature of work itself as incentives; and lack of organizational support for training, opportunity for advancement and working conditions were seen as job disincentives. Job stress and job satisfaction among 406 health team members working in a cancer care area was studied by Sehlen et al. (2009). The study revealed that physicians and nurses had the highest level of job stress that stemmed from structural conditions such as underpayment and ringing of the telephone, and a stress by compassion such as long suffering of patients. Professional group, working night shifts, age group and free time compensation gained significance for total stress questionnaire score (Sehlen et al., 2009). The purpose of this study was to investigate the working conditions and factors related to job satisfaction among Jordanian occupational therapists. Methods Participants A survey was developed to address the working conditions of Jordanian occupational therapists. A convenient sample of Jordanian occupational therapists from different OT and clinical settings were targeted. The inclusion criteria were the following: occupational therapists working in the field of OT in Jordan a formal OT education (diploma, undergraduate, graduate) six or more months of experience. Approval by the Institutional Review Board of the Hashemite University was obtained before the beginning of data collection. One hundred and twenty mail surveys were distributed across Jordan. Two occupational therapists were recruited to help in the process of data collection. A formal letter asking to facilitate the data collection process was sent to hospitals, special education centres, health centres, schools and universities. A cover letter attached to the survey explained the purpose of the study and the voluntary nature of participation to this study by the occupational therapists. The cover letter also provided instructions to the participants regarding the time expected to complete the survey and directed them not to write their names on the survey for confidentiality reasons. Data collection A draft of the survey was developed by the principal investigator of this study and was sent to four 188

3 Abu Tariah et al. Working Conditions of Occupational Therapists in Jordan experienced occupational therapists as well as OT academicians for review. Feedback from the reviewers was taken into account, and needed modifications to the survey were carried out. The survey consisted of several parts. The first part is the demographic data part, which inquired about the participant s gender, age, years of experience and academic level. The second part inquired information regarding the participant s area of OT practice, type of administration at the work place where the therapist practices (i.e. whether the work place is governmental or nongovernmental organization [NGO], private, etc.), salary, the length of time it took each therapist to find a job in the field of OT after graduation, and whether the therapist was involved in any research activity. The last part consisted of Likert scaled questions regarding practitioner s perception and satisfaction about OT in Jordan from different perspectives. Data analysis Data analysis was conducted using the Statistical Package for the Social Sciences (SPSS version 16 for Windows statistical software; SPSS, Inc., Chicago, IL, USA). Descriptive statistics were conducted on all survey questions. Chi square analyses were conducted to explore the relationship between salary, areas of practice and administration at the work place in relation to job satisfaction and the question if you went back in time would you still study OT? Results One hundred and twenty surveys were sent to eight hospitals (two of them are psychiatric hospitals, and the rest of them are general hospitals), twenty one special education centres that provide OT services, four schools that provide OT services and all three universities that offer an OT programme. One hundred and one surveys were returned (response rate 83%). Women represented 61.4% of the participants (n = 62). More than half of the participants were years old, and about 87% of the participants were less than 31 years old (Table I). Fifty two percent of occupational therapists who participated in this study had an experience of six months to two years in the field of OT, 34% had an experience of two to five years and the rest of the participants (14%) had an experience of over five years. Academically, the vast majority of the participants held a bachelor s degree in Table I. Sample characteristics Demographic characteristics n (%) Number of participants (101) Women 62 (61.4) Men 39 (38.6) Age (in years) (55.4) (31.7) (7.9) (2) (1) >45 2 (2) Years of experience (51.5) > (33.7) > (6.9) > (5) >15 3 (3) Academic preparation Diploma 1 (1) Bachelor s degree 92 (91.1) Master s degree 5 (5) PhD 3 (3) OT (91.1%), five percent held a master s degree, three percent held a PhD degree and only one participant held a two year diploma in OT (Table I). Regarding the area of practice, the results showed that forty three participants (42.6%) worked in general OT practice areas (more than one domain of OT practice), thirty (29.7%) worked in paediatric areas, eight (7.9%) worked in the academic field (teaching in OT programmes), seven (6.9%) worked in psychosocial area of practice, five (5%) worked mainly in physical disability area of practice, another five (5%) worked in school area and only one (1%) participant worked in community based rehabilitation. One of the participants who selected other area of practice reported working in the rehabilitation of juvenile offenders, and another participant reported working in the field of OT administration. Forty six participants (45.5%) worked in the private sector, and 16 of them (15.8%) worked in the governmental sector, 13 (12.9%) worked in NGOs, 13 (12.9%) worked in public universities and the same number of participants worked at the Royal Medical Services (Table II). The salary of 31 participants (30.7%) was JD (USD ) per month; 27 participants (26.7%) had a salary of JD (USD ) (Table II). However, according to the 2008 report of the Jordanian Ministry of Labour, 2008, the salary of a new graduate 189

4 Working Conditions of Occupational Therapists in Jordan Abu Tariah et al. Table II. Occupational therapy working conditions of the participants OT work related information n (%) Area of practice School 5 (5) CBR 1 (1) Physical disability 5 (5) Paediatrics OT 30 (29.7) Psychosocial OT 7 (6.9) Academic 8 (7.9) General 43 (42.6) Others 2 (2) Administration at the work place Governmental 16 (15.8) NGO 13 (12.9) Private 46 (45.5) Royal Medical Services (Military) 13 (12.9) University 13 (12.9) Salary (in JD) <100 1 (1) (26.7) (30.7) (15.8) (18.8) (1) (4) > (1) Volunteer 1 (1) Time it took you to find a job (in OT) (in years) <1 83 (82.2) (14.9) >2 3 (3) Involvement in conducting research a Yes 38 (37.6) No 62 (61.4) If you went back in time would you still study OT? Yes 47 (46.5) No 54 (53.5) CBR, community based rehabilitation; NGO, non governmental organization; OT, occupational therapy. a One missing value. nurse and physician in Jordan is JD 320 (USD 460) and JD 600 (USD 860) per month, respectively (www. mol.gov.jo). For 83 participants (82.2%), finding a job in the field of OT did not take them longer than a year (Table II). Sixty two participants (61.4%) reported that they were involved at some point in conducting research. When we asked the question if you went back in time would you still study OT?, only 47 participants (46.5%) answered yes (Table II). Eighty eight percent of the participants agreed or strongly agreed that they would do their best to increase public awareness about OT. Just over a half of the participants agreed or strongly agreed that the health team members whom they worked with highly appreciate and value the importance of OT services. About 85% of the participants agreed or strongly agreed that they always update their information about OT. About 70% of the participants agreed or strongly agreed that they are required to document the OT process for their clients. Eighty nine percent agreed or strongly agreed that OT services are very important to their clients. Only half of the participants agreed or strongly agreed that they are satisfied with their work as registered occupational therapists (Table III). Chi square analysis revealed a significant relationship between participants perceived job satisfaction and the administration at the work place, χ 2 (16, n = 100) = 32.17, p = Other significant relationships were found between the participants response to the question if you went back in time would you still study OT? and the salary, χ 2 (8, n = 101) = 17.71, p = (Table IV). Those who worked at the universities and at the Royal Medical Services were more satisfied than those who worked at the private Table III. Participants perspective about occupational therapy in Jordan Strongly do not agree Do not agree Undecided Agree Strongly agree n (%) n (%) n (%) n (%) n (%) I do all my best to increase public awareness about OT 2 (2) 4 (4) 6 (5.9) 51 (50.5) 38 (37.6) Health team members that I work with highly value the 6 (5.9) 20 (19.8) 20 (19.8) 39 (38.6) 16 (15.8) importance of OT services I always update my information about OT 0 5 (5) 10 (9.9) 48 (47.5) 38 (37.6) I document the OT process of my clients a 6 (5.9) 8 (7.9) 14 (13.9) 34 (33.7) 38 (37.6) I believe that OT services are very important to the clients 2 (2) 2 (2) 7 (6.9) 32 (31.7) 58 (57.4) I am satisfied with my work as an OT a 8 (7.9) 21 (20.8) 20 (19.8) 29 (28.7) 22 (21.8) a One missing value. 190

5 Abu Tariah et al. Working Conditions of Occupational Therapists in Jordan Table IV. Relationship between job satisfaction and response to the question if you went back in time would you still study OT? and relationship between salary, area of practice and administration at the work place Job satisfaction If you went back in time would you still study OT? Chi square p value (two sided) Chi square p value (two sided) Salary Area of practice Administration at the work place Table V. Relationship between perceived job satisfaction and administration at the work place Area type Job satisfaction Total Strongly do not agree Do not agree Undecided Agree Strongly agree n (%) n (%) n (%) n (%) n (%) Governmental 5 (31.25) 2 (12.5) 2 (12.5) 5 (31.25) 2 (12.5) 16 NGO 1 (8.3) 2 (16.6) 4 (33.3) 4 (33.3) 1 (8.3) 12 Private 0 (0) 14 (30) 11 (24) 11 (24) 10 (22) 46 Royal Medical Services 2 (15.38) 2 (15.38) 2 (15.38) 5 (38.48) 2 (15.38) 13 University 0 (0) 1 (7.69) 1 (7.69) 4 (30.77) 7 (53.84) 13 Total sector, at NGOs and at the governmental sector (Table V). Most of those with higher salaries were in favour of still studying OT if they went back in time compared with those with lower salaries. Relationship between the gender of the participants and their job satisfaction, and the gender of the participants and their salaries was analysed as well. However, no significant relationship was found between gender and job satisfaction, χ 2 (4, n = 100) = 3.5, p = 0.478; and no significant relationship was found between gender and salary, χ 2 (8, n = 101) = 7.17, p = Discussion The purpose of this study was to investigate the working conditions and factors related to job satisfaction among Jordanian occupational therapists. As a new profession in Jordan, OT had and continues to face challenges in getting a better establishment among other medical disciplines. The number of the participants is believed to be a large number of Jordanian occupational therapists practicing in Jordan because of the following reasons: 1) the OT profession in Jordan is still relatively new, with only about 600 occupational therapists who graduated from all OT programmes in Jordan; 2) most Jordanian occupational therapists are working abroad (mainly in the Gulf Area), with less than 150 occupational therapists practicing in Jordan, according to the Jordanian Society for Occupational Therapy; and 3) the survey was sent to all places where Jordanian occupational therapists are practicing. The majority of those in the OT practice (87%) are from the young generation (less than 30 years old). Additionally, they have less than two years of experience and are predominantly women. Hence, the lack of senior occupational therapists and the unpopularity of the profession in men are noticeable factors that may have influenced the professional and cultural image of OT in Jordan. The majority (91%) of occupational therapists in Jordan have a bachelor s degree in OT, with only a small proportion (8%) with higher education degree. This may be due to the lack of post graduate programmes in Jordan. Most of the occupational therapists who participated in this study reported that they work in general OT area of practice. That is, they are expected to provide OT services for different groups of clients, such as adults and children with physical, neurological and mental disabilities. The OT departments that are affiliated with the government (mainly by the Ministry of Health) and those that are affiliated with the Royal 191

6 Working Conditions of Occupational Therapists in Jordan Abu Tariah et al. Medical Services provide general OT services. Therefore, the OT practitioners who work in these facilities are expected to take care of different clients groups. When it comes to specialized OT areas in Jordan, the focus is mainly on paediatrics, which was confirmed by the results. Most of those who work in a specialized area reported working in paediatric areas. The results also show that most of the participants are working in the private sector. The majority of these private centres where occupational therapists are working are not specialized OT centres. Those centres are mainly special education centres, which expanded their services and started proving OT for their clients. A sense of dissatisfaction among the participants of this study was obvious (Table III). Several factors may have contributed to this dissatisfaction as revealed by the results. First of all, most of the salaries of the occupational therapists are low compared with the salaries of the rest of healthcare practitioners in Jordan (Table II). According to the 2008 report of the Jordanian Ministry of Labour, 2008, the average wage per employee in the Jordanian public health sector was JD 343 (USD 490) per month ( However, the results showed that more than half of the participants salaries were less than JD 300 (USD 429) per month. Although the relationship between salaries and job satisfaction was not significant, salaries affected the participants willingness to study OT if they have the choice. Albeit lack of statistics, most of Jordanian OT graduates are apt to work outside Jordan (mainly in the Gulf Area) where salaries are significantly higher compared with salaries in Jordan. However, no studies were conducted before in Jordan to support this result. Experienced occupational therapists leaving Jordan may have significantly contributed to the struggle of developing the profession in Jordan. The correlation between poor salary and the lack of job satisfaction was also supported by other studies that found underpayment or poor salaries to affect job satisfaction negatively (Sehlen et al., 2009; Zontek et al., 2009). Furthermore, the participants perceived that some of the health team members that the occupational therapists work with do not value the importance of OT services (Table III). As suggested by Scanlan et al. (2010), certain factors in the workplace can affect staff retention. Therefore, the lack of job satisfaction among occupational therapists can negatively affect the progress of this new profession in Jordan. The significant relationship between the participants job satisfaction and the job setting need further investigation to explore reasons behind OT practitioners sense of dissatisfaction in the private sector, the governmental sector and the NGOs in Jordan. Furthermore, poor salary was behind occupational therapists response that they were not in favour of studying OT if they went back in time. Therefore, improving working conditions including salaries is important to improve OT job satisfaction (Davis and Bordieri, 1988; Akroyd et al., 1994; Eklund and Hallberg, 2000; Moore et al., 2006; Rodwell et al., 2009; Sehlen et al., 2009; Zontek et al., 2009). The gender of the participants is not one of the factors that influence the participants job satisfaction or their salaries as revealed by the results. Professionally, the participants reported that they are updating their knowledge about their profession (through attending professional workshops, conferences, lectures and self study), they do their best to increase public awareness about OT and most of them, at one point, involve in conducting research studies. However, this did not help improve their job satisfaction. There are no data available about the unemployment rate among Jordanian OT practitioners. However, the results revealed that high percentage of the participants were able to find a job in the field of OT in less than one year after graduation. We can conclude based on this study that the working conditions of Jordanian registered occupational therapists in general are not satisfactory to most of them. This conclusion is supported by the results that most OT practitioners are not satisfied with their work and that they prefer that they did not study OT. The connection between the working condition and its relation with the job satisfaction was also supported by Akroyd et al. (1994). Further studies are required to explore in more details and from the Jordanian occupational therapists perspectives the reasons behind their job dissatisfaction, the reasons behind their job satisfaction and why they selected this profession. Factors such as the humanistic nature of OT profession, workplace related factors and the lack of public awareness about OT can also play a role in affecting OT job satisfaction. The study should also focus on finding out the main issues that faces the OT profession in Jordan from the practitioners points of view (such as academic related issues, workplacerelated issues and the lack of job opportunities), the 192

7 Abu Tariah et al. Working Conditions of Occupational Therapists in Jordan ways to solve these issues and the implications for the future of the profession. Limitations of the study include the convenience sampling of occupational therapists, which limits the generalizability of the results. Acknowledgements This research was funded by the Hashemite University (Jordan). We would like to thank all occupational therapists who participated in this study. Special thanks also go to Abdullah Al Omari, OTR, who assisted in the data collection process. REFERENCES Akroyd D, Wilson S, Painter J, Figuers C (1994). Intrinsic and extrinsic predictors of work satisfaction in ambulatory care and hospital settings. Journal of Allied Health 23(3): Busuttil J (1991). Setting up an occupational therapy college in the Middle East. British Journal of Occupational Therapy 54(11): Davis G, Bordieri E (1988). Perceived autonomy and job satisfaction in occupational therapists. The American Journal of Occupational Therapy 42(9): Eklund M, Hallberg I (2000). Factors influencing job satisfaction among Swedish occupational therapists in psychiatric care. Scandinavian Journal of Caring Sciences 14: Moore K, Cruickshank M, Haas M (2006). The influence of managers on job satisfaction in occupational therapy. British Journal of Occupational Therapy 69(7): Rodwell J, Noblet A, Demir D, Steane P (2009). The impact of the work conditions of allied health professionals on satisfaction, commitment and psychological distress. Health Care Management Review 34(3): Scanlan JN, Still M, Stewart K, Croaker J (2010). Recruitment and retention issues for occupational therapists in mental health: balancing the pull and the push. Australian Occupational Therapy Journal 57(2): Sehlen S, Vordermark D, Schafer C, Herschbach P, Bayerl A, Pigorsch S, Rittweger J, Dormin C, Bolling T, Wypior HJ, Zehentmayr F, Schulze W, Geinitz H, DEGRO Quality of Life Work Group (2009). Job stress and job satisfaction of physicians, radiographers, nurses, and physicists working in radiography: a multicenter analysis by the DEGRO Quality of Life Work Group. Radiation Oncology 4: 1 9 Jordanian Ministry of Labour (2008). (Available at: QuQ64%3d&tabid=337) (Accessed 5 September 2010). World Federation of Occupational Therapists. (2010) (Available at: Jordan&id=20) (Accessed 5 September 2010). Zontek T, DuVernois C, Ogle B (2009). Job satisfaction and issues related to the retention of environmental health professionals in North Carolina. Journal of Environmental Health 72(3):