Stigma, an important source of dissatisfaction of health workers in HIV response in Vietnam: a qualitative study

Pham et al. BMC Health Services Research 2012, 12:474 http://www.biomedcentral.com/1472-6963/12/474 RESEARCH ARTICLE Open Access Stigma, an important source of dissatisfaction of health workers in HIV response in Vietnam: a qualitative study Ha Nguyen Pham1,2*, Myroslava Protsiv1†, Mattias Larsson1,3†, Hien Thi Ho4, Daniel H de Vries5† and Anna Thorson1† Abstract Background: Like in many other low- and middle-income countries, the recent development of an HIV epidemic in Vietnam has led to a growing need for prevention, treatment, care, and support services for people living with HIV (PLHIV). This puts greater demands on the national HIV services, primarily on health workers, which increases the importance of their job satisfaction and working conditions. This study describes health worker perceptions and explores the factors that influence job satisfaction and dissatisfaction of health personnel working on the HIV response in Vietnam. Spector’s job satisfaction model was used as the theoretical framework for the study design and analysis. Methods: The study employed a qualitative design with 7 focus group discussions and 15 semi-structured interviews with health workers, purposively selected from national and provincial organizations responsible for HIV services in 5 cities and provinces in Vietnam. Data were analyzed using a hybrid approach of theory-driven and data-driven coding and theme development using qualitative analysis software. Results: HIV services are perceived by Vietnamese health workers as having both positive and negative aspects. Factors related to job satisfaction included training opportunities, social recognition, and meaningful tasks. Factors related to job dissatisfaction included unsatisfactory compensation, lack of positive feedback and support from supervisors, work-related stress from a heavy workload, fear of infection, and HIV-related stigma because of association with PLHIV. An adjusted Spector’s model of job satisfaction for HIV service health workers was developed from these results. Conclusion: This study confirmed the relationship between stigmatization of PLHIV and stigma experienced by staff because of association with PLHIV from families, colleagues, and society. The experiencing stigma results in additional work-related stress, low self-esteem, poor views of their profession, and lower income. The study shows the importance of actions to improve staff job satisfaction such as pay raises, supportive supervision, stress management, stigma reduction and workplace safety. Immediate actions could be the provision of more information; education and communication in mass media to improve the public image of HIV services, as well as improvement of workplace safety, therefore making health workers feel that their work is valued and safe. * Correspondence: † Equal contributors 1 Department of Public Health Sciences, Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden 2 Hanoi Medical University, Hanoi, Vietnam Full list of author information is available at the end of the article © 2012 Pham et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Pham et al. BMC Health Services Research 2012, 12:474 http://www.biomedcentral.com/1472-6963/12/474 Background In recent years the perception of health workers has changed from one of almost being completely neglected to recognition as a crucial part of health systems [1]. The health workforce needs to be viewed not as a resource, but rather as a partner in delivering health services. It is thus very important to move one step further by understanding how health workers experience their work in relation to the HIV epidemic [2]. The increasing prevalence of HIV infection every year has led to increased demand for services for people living with HIV (PLHIV) that in turn increases the burden on the health system and the workloads of health workers in HIV service organizations. Response to the HIV epidemic is currently one of the first priorities in public health. Shortages of human resources have been cited as the major barrier for increasing HIV services in lowand middle-income countries [3-5]. The World Health Organization (WHO) has suggested that countries should improve the recruitment process, make the most of their existing workforces, and manage the migration of healthcare personnel to other countries. Therefore, appropriate remuneration, financial and non-financial incentives, promotion of lifelong learning, and creating an enabling work environment are needed [1]. Given the pivotal role that health workers play to achieve good service, it is important to understand what motivates them and the extent to which they are satisfied by the organizations for which they work. Job satisfaction describes how people feel about their jobs—whether they like or dislike their jobs [6]. Job dissatisfaction has been cited as the primary reason for high turnover [6,7] and absenteeism [6,8], which in turn poses a threat to organizations’ capacities to provide quality service and meet the needs of customers [9]. Studies have shown that dissatisfied employees are more likely to quit their jobs or be absent than satisfied employees [7,10]. Therefore, increasing job satisfaction and organizational commitment are potentially good strategies for reducing absenteeism and turnover intentions [10]. However, job satisfaction is not the same as motivation, although they might be clearly linked. In the work context, motivation can be defined as an individual’s degree of willingness to exert and maintain an effort towards organizational goals [11]. Motivation can be divided into two types: intrinsic and extrinsic motivation. Intrinsic motivation exists within the individual and refers to motivation that is driven by an interest or enjoyment in the task itself [12,13]. Extrinsic motivation refers to the performance of an activity to attain an outcome [12,13]. A study by Goetz et al. showed that intrinsic motivators have the most positive impact on job satisfaction of dentists in Germany [14], while Sicsic et al. wanted to send a cautionary message on the Page 2 of 13 potential negative effects of increasing extrinsic motivation among French general practitioners through their pay-for-performance policy [13]. There are several theories on job satisfaction. Hackman and Oldham argued that five core job characteristics (skill variety, task identity, task significance, autonomy, and feedback) affect three psychological states (experienced meaningfulness, responsibility for outcomes, and knowledge of actual results) that, in turn, influence job performance, job satisfaction, motivation, and turnover [6,15]. Herzberg pointed out that certain factor (...truncated)