|Year : 2017 | Volume
| Issue : 4 | Page : 240-244
Assessment of quality of life among the health workers of primary health centers managed by a nongovernment organization in Karnataka, India: A case study
Rajeshwari Bangalore Sathyananda1, Usha Manjunath2
1 Department of Public Health, State Institute of Health and Family Welfare, Bengaluru, Karnataka, India
2 Healthcare Management, Institute of Health Management Research, Bengaluru, Karnataka, India
|Date of Web Publication||12-Dec-2017|
Dr. Rajeshwari Bangalore Sathyananda
State Institute of Health and Family Welfare, Magadi Road, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
BACKGROUND: Quality of life (QOL) is the general well-being as experienced and perceived by individuals and communities. Measuring QOL has a number of implications in a wide variety of contexts including healthcare. Studies have shown that World Health Organization (WHO) QOL-BREF is a quick and an effective tool (as the WHO QOL-100) in capturing the results with respect to key four domains. Healthcare services, in general, are human intensive in terms of emergencies, emotionality, and relationships which could affect grass root health worker's QOL negatively, especially in challenging working environments.
OBJECTIVES: To evaluate the QOL among health workers of primary health centers (PHCs) managed by public private partnership in Karnataka State.
MATERIALS AND METHODS: An exploratory study was carried out by applying WHO QOL-BREF to 70 health workers from 24 PHCs in 21 Districts of Karnataka and the results were analyzed. Pearson's correlation was conducted to assess the agreement level; paired t-test and ANOVA to compare differences between the domains.
RESULTS: Analysis of domain-specific results and gender differences showed that women were more satisfied with physical health domain and men more satisfied with psychological health domain. The least satisfaction was seen in their opportunity for leisure activities and the highest satisfaction was with their ability to perform daily living activities.
CONCLUSIONS: The study indicated moderate levels of QOL among the respondents. WHO QOL-BREF is a useful measure to assess, monitor and improve employees' QOL.
Keywords: Primary health centres, public private partnership, quality of life BREF
|How to cite this article:|
Sathyananda RB, Manjunath U. Assessment of quality of life among the health workers of primary health centers managed by a nongovernment organization in Karnataka, India: A case study. Int J Health Allied Sci 2017;6:240-4
|How to cite this URL:|
Sathyananda RB, Manjunath U. Assessment of quality of life among the health workers of primary health centers managed by a nongovernment organization in Karnataka, India: A case study. Int J Health Allied Sci [serial online] 2017 [cited 2021 Mar 5];6:240-4. Available from: https://www.ijhas.in/text.asp?2017/6/4/240/220518
| Introduction|| |
A happy and healthy care provider leads to good quality of care, increased patient satisfaction and health outcomes, in turn leading to healthy population. The quality of life (QOL) is a holistic way of measuring one's health status as individuals consider their experiences with expectations when scoring. The World Health Organization (WHO) defines QOL as an “Individual's perception of their position in life in context of culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.” WHO has developed a questionnaire to assess the QOL consisting of four domains, with 100 questions and later came up with a standard WHO QOL-BREF equally effective with twenty six questions. The four domains are D1-physical health, D2-psychological, D3-social relationships, D4-environment along with general questions on the QOL (Q1) and general health (Q2).,,,
WHO QOL BREF has been applied in India among different settings and has been found to be useful., QOL BREF was mostly used to assess patient's wellbeing and to rate the success of care delivery in relation to different diseases.,, Studies on QOL among healthcare personnel, in particular, primary healthcare centre (PHC) workers at grass root levels are limited.
In 1996, the Government of Karnataka piloted an early adopter of public private partnership (involving nongovernment organizations [NGOs] and private medical colleges for running PHCs) and contracted out 1st PHC at Gumballi, Chamarajnagar district to Karuna Trust. Later to realize its health goals, launched Arogya Bandhu Scheme in 2008 by contracting out 51 PHCs.,,,,
The Karuna Trust was established in 1986 to enable treatment and rehabilitation of Leprosy patients in Yelandur Taluk, Chamarajanagar District, Karnataka. Currently, the trust is managing around eighty PHCs in seven states of India, including some regions affected by Maoists and insurgency. It manages thirty six PHCs including twenty seven rural centers in twenty two backward districts of Karnataka. The Trust wanted to understand the status of the wellbeing of its grass root health workers and the first line of managers as part of performance improvement and establish a baseline of QOL.
| Materials and Methods|| |
An exploratory study was conducted among the health workers of rural PHCs managed by Karuna Trust, an NGO. The NGO managed 253 health workers (223 exclusive health workers and 30 administrators-health workers with additional administrative responsibilities) in the PHCs and 172 were from rural PHCs. The study was conducted in the months of June and July 2015. All the health workers from the rural PHCs were approached to participate in the study and participation was voluntary.
A set of study brief consent forms and WHO QOL-BREF were sent to all the health workers. They were requested to send the completed forms by post or submit directly when the administrators came to the office for the monthly review. The participants were briefed about the study purpose and its usefulness through telephone calls or in person when they visited the main office during the period of the study. Informed consent was obtained for participation and privacy and confidentiality of personal information were strictly adhered to. Participants were informed that the data would be processed as a whole and that no part of individual scores would be released with identifiable personal information. Participants contacted the researcher if they had any queries in completing the questionnaire.
The QOL was assessed using WHO QOL-BREF. The instrument was translated into the local language (Kannada), pre-tested and necessary changes were made in wordings without changing the original meaning. Each item was scored on the Likert scale of one to five. “One” represented “very dissatisfied” and “five” was “very satisfied.” Four domains of WHO QOL-BREF namely, D1-physical health, D2-psychological, D3-social relationships, D4-environment along with general questions on the QOL (Q1) and general health (Q2) were included in the study. All the items were used to calculate raw domain scores as per protocol; these raw scores were transformed into 4-20 and 0-100 as per the guidelines. The domain scores of individuals so calculated were used to derive the mean domain scores for the group; higher Domain scores represented higher QOL.
The domains of the QOL-BREF questionnaire were considered as the dependent variable. The data on gender and profession were considered as independent variables. SPSS version 16 was used for data analysis. Descriptive analysis was performed and internal consistency of the data was assessed using Cronbach's alpha and the value >0.65 was considered acceptable. Pearson's correlation coefficient was performed to assess the correlation between the domains (positive/negative correlation; correlation >0.65 was considered significant). Paired t-test was used to assess the difference between the means of the domains.
| Results|| |
Of the 172 persons contacted at PHCs, 70 responded (response rate of 40.64%): 21 administrators (male health workers with additional administrative duties) and 49 Health Workers (32 females and 17 males) from 24 PHCs in 21 districts. [Table 1] presents the details of the participants. All the workers were employed on a contractual basis and drawing salary as per norms of the Government of Karnataka. Female health workers were trained in auxiliary nurse midwifery and male health workers with diploma health inspector. All the administrators (health workers with administrative duties) were postgraduates. Seven percent of the respondents reported having chronic illnesses such as hypertension (1 person for last 2 months), diabetes (3 persons for 1, 10 and 15 years each) and epilepsy (1 person for 3 years).
The results show that the general QOL and satisfaction with the health of the subjects can be considered good at 3.94 and 3.97 respectively. The satisfaction with physical health, psychological wellbeing and social relationships can be considered average with scores of 63.31, 66.19 and 64.59 respectively. The satisfaction with their environment can be considered below average at 59.86 [Table 2].
|Table 2: Comparison of World Health Organization quality of life domain scores of various studies|
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Women scored the satisfaction with their environment the lowest and satisfaction with physical health the highest; men scored psychological domain the highest. From this we can say that women perceived they were more capable of performing daily activities; were less dependent on medical aid; had enough energy for daily activities and able to get around, were more satisfied with their sleep, were more satisfied with their ability to perform daily activities and capability to work. Men were more impressed with their body image and appearances, had less negative feelings, better self-esteem, enjoyed more in life, felt that they had a meaningful life, were able to concentrate better and were more satisfied with themselves.
Time for leisure activities was rated lowest (2.46) and the highest score was in the satisfaction with their bodily appearance (4.30). Though mean scores were different among the subgroups and the domains scores showed no statistically significant difference of opinions between groups, unlike the study by Dongre and Deshmukh (2015). ANOVA was conducted with the job type (administration/clerk and Fieldwork) as the independent variable. The statistically significant difference of opinion was found between groups in environmental domain. The mean score of clerk/administrators was 65.90 and that of fieldworker was that of 57.27, indicating that administrators weremore satisfied with their environment. This can be justified by the fact that the physical environment, transport, and physical safety are a challenge in the field where health workers serve, unlike administrators who were mostly working in the PHCs.
The Cronbach's alpha was conducted for all the items; the coefficient was adequate with the score of 0.651 and 0.679 (standardized items). Pearson's correlation coefficient between general questions and all the domains showed weak correlation indicating clarity of domain boundaries. Paired t-test showed statistically significant difference in the perception of physical and Psychological domain; physical and environmental domain; psychological and environmental domain at 95% confidence interval [Table 3].
|Table 3: Paired sample t-test for the four domains of World Health Organization quality of life-bref|
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| Discussion|| |
The health workers are the trained grass root workers of the Indian healthcare system. They assess the needs of the community to develop the yearly plan for the delivery of all the preventive health care and the National Programs at the community level. Their wellbeing is essential for the success of the Healthcare system. QOL being an effective measure to assess the overall wellbeing of an individual was considered for the study. QOL acts as a guide for providing intervention and follow-up.
The environmental domain was scored the least among all domains, the phenomenon noted by other authors.,, [Figure 1] presents the results from various studies. In our study, the Q1 and Q2 were scored 3.94 and 3.97, whereas in the study of healthcare staff they were scored 3.64 and 3.67 respectively.
The lower scores in the environmental domain among the healthcare workers were further explored. [Table 4] shows the items of the environmental domain and its correlation. The individual items of the environmental domain were compared and analyzed. Though the scores were similar among the health workers in India and healthcare staff of Iran, the statistically significant difference of opinion existed in six items and opportunities for leisure activities was scored least among all the items in both the studies. The satisfaction with the money to meet the ends was scored better in Iran and other items were scored better by the respondents.
Since all the health workers in this study are employed on a contract basis it is possible that their QOL could differ from those of regular employees of PHCs. A government job offers “job security” and that it may impact the perceptions of QOL of health workers positively. This, however, needs to be further examined by studying QOL among health workers of government run PHCs. Therefore, it is strongly felt that this study fulfills the purpose of exploring QOL and provides future directions for understanding and improving QOL among health workers for better performance.
| Conclusions|| |
The health workers of PHCs managed by Karuna Trust have moderate overall QOL. They have good satisfaction with their psychological health and they are fairly satisfied with physical health and social relationships. The environmental domain was scored the least. WHO QOL-BREF is found to be a useful tool and further research should be done will all the employees of the organization for programmatic intervention to enhance QOL. Considering the criticality of the QOL and its relation to employee performance, future studies on health workers in Government run PHCs are indicated.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Alonazi WB, Thomas SA. Quality of care and quality of life: Convergence or divergence? Health Serv Insights 2014;7:1-2.
Skevington SM, Lotfy M, O'Connell KA, WHOQOL Group. The World Health Organization's WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial. A Report from the WHOQOL Group. Qual Life Res 2004;13:299-310.
Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychol Med 1998;28:551-8.
Saxena S, Carlson D, Billington R, WHOQOL Group. World Health Organisation Quality Of Life. The WHO quality of life assessment instrument (WHOQOL-Bref): The importance of its items for cross-cultural research. Qual Life Res 2001;10:711-21.
Saxena S, Chandiramani K, Bhargava R. WHOQOL-hindi: A questionnaire for assessing quality of life in health care settings in India. World health organization quality of life. Natl Med J India 1998;11:160-5.
Agnihotri K, Awasthi S, Chandra H, Singh U, Thakur S. Validation of WHO QOL-BREF instrument in Indian adolescents. Indian J Pediatr 2010;77:381-6.
Meena UK, Sen RK, Behera P, Tripathy SK, Aggrawal S, Rajoli SR, et al.
WHOQOL-BREF Hindi questionnaire: Quality of Life assessment in acetabular fracture patients. Indian J Orthop 2015;49:323-8.
] [Full text]
Folasire OF, Iabor AE, Folasire AM. Quality of life of people living with HIV and AIDS attending the antiretroviral clinic, university college hospital, Nigeria. Afr J Primary Health Care Fam Med 2011;4:8.
Sathvik BS, Parthasarathi G, Narahari MG, Gurudev KC. An assessment of the quality of life in hemodialysis patients using the WHOQOL-BREF questionnaire. Indian J Nephrol 2008;18:141-9.
] [Full text]
Arogya Bandhu Scheme for Involving Private Medical Colleges and Other Agencies in the Management of PHCs under Partnership Agreement; August, 2008. Government of Karnataka. Available from: http://www.karhfw.gov.in/PDF/AROGYA%20BANDHU-PPP%20.pdf
. [Last accessed on 2015 Feb 06].
Pandke HT, Pandve TK. Primary healthcare system in India: Evolution and challenges. Int J Heatlh Syst Disaster Manag 2013;1:123-8.
Evidence of Regional Disparities in Health Infrastructure in Karnataka, Based on Performance Evaluation of NRHM in Karnataka; 2013. Available from: http://www.graam.org.in
. [Last accessed on 2016 Jan 19].
Deshmukh PR, Dongre AR, Rajendran K, Kumar S. Role of social, cultural and economic capitals in perceived quality of life among old age people in Kerala, India. Indian J Palliat Care 2015;21:39-44.
] [Full text]
Gholami A, Jahromi LM, Zarei E, Dehghan A. Application of WHOQOL-BREF in measuring quality of life in health-care staff. Int J Prev Med 2013;4:809-17.
Phadke SD, Gupta AA. Application of WHOQOL-BREF in measuring quality of life in traffic police. Int J Sci Res 2014;3:1580-3.
Sheethal MP, Harish BR, Vinay M. Assessment of quality of life among anganwadi workers of Mandya City. Int J Med Sci Public Health 2015;4:386-8.
[Table 1], [Table 2], [Table 3], [Table 4]