Background
Midwifery is one of the key professions responsible for safeguarding community health, playing a critical role in maternal and child healthcare, and, reproductive health services, preventing complications, and ultimately reducing mortality rates in women and children [1]. Midwives provide more than 80% of women’s healthcare services [2]. Work is a significant aspect of every individual’s life, and the level of satisfaction or dissatisfaction with one’s job can affect different aspects of personal life and, ultimately, the effectiveness of the care provided [3]. Healthcare organizations, responsible for prevention, care, and treatment have a special position in society. However, undesirable and challenging work environments, along with strenuous tasks, can lead to both physical and mental disorders and job dissatisfaction among healthcare providers, which can have serious consequences [4]. This, in turn, affects the quality of the services provided to patients. As a high-risk profession, midwifery faces numerous occupational hazards and challenges [5, 6]. Some of these challenges arise from the complex nature of the work itself, which places significant pressure on midwives, while others stem from the strenuous nature of the job and exposure to occupational hazards [7, 8]. In the midwifery profession, job-related stress is due to the heavy workload and long hours, the emotional demands of the job, dealing with women who require complex care, working in traditional environments with a shortage of midwives, fear of punishment related to negative outcomes, lack of recognition, and financial burdens, especially when women are unable to afford their care. These are among the many challenges that midwives face in their work [5, 9, 10]. From the point of view of working midwives, the difficulty of midwifery plays a significant role in the occurrence of midwifery errors [11]. According to researchers, midwifery has been introduced as an emotionally demanding job, where caring for women and their families amidst social complexities exposes midwives to anxiety, pain, fear, and grief. Working in such challenging situations creates problems for midwives, and it is not surprising that low morale and job-related stress are significant concerns in the midwifery workforce [8, 12].
Today, work-related stress has become a common and costly problem in the workplace [13]. Dealing with multiple challenges leads to increased stress, dissatisfaction, lack of motivation, despair, and job burnout among midwives, which reduces their involvement in providing optimal care [8, 14, 15]. Studies have shown that stressful working conditions lead to increased absenteeism, misconduct, and employee turnover [16]. On the other hand, healthcare providers also face multiple occupational hazards, including biological, chemical, physical, ergonomic, and psychological risk factors [17]. According to reports, midwives experience physical and medical limitations and problems, including the risk of hospital-acquired infections, often due to the lack or improper use of personal protective equipment [1]. Research findings indicate that job dissatisfaction among midwives is primarily related to their work environment, job security, and benefits, and in some regions, different strategies have been implemented to improve motivation, such as improving working conditions, continuous monitoring, and offering more educational opportunities [1, 13].
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Finally, Healthcare workers facing heavy workloads and emotional stress, coupled with stressful or unsafe work environments, may experience increased tension among colleagues and decreased cooperation and positive interactions. Additionally, occupational hazards and job insecurity can negatively impact workers’ mental health [18, 19]. These factors directly and indirectly affect the physical and mental health of employees, leading to burnout and decreased job satisfaction, ultimately impacting job performance and quality of work-life [20, 21].
A review of the literature highlights the importance of addressing the challenges and risks associated with midwifery to design appropriate strategies to prevent accidents and job burnout, which impact the health of individuals. Addressing these issues is an organizational necessity [6]. To achieve organizational health, it is essential to focus on the quality of work life for employees, providing a suitable environment that fulfills personal aspirations and creates a motivating space for the execution of tasks. Understanding the work conditions and challenges faced by those providing care to women and newborns is crucial for improving care. This study was conducted to examine the occupational hazards and factors related to the quality of work life of midwives working in healthcare centers.
Methods
This study was a descriptive-analytical cross-sectional study conducted in 2023 in Iran, focusing on midwives working in hospitals and healthcare centers. The study population consisted of all midwifery personnel employed at healthcare and treatment centers in two cities, Ahvaz and Tabriz. The inclusion criteria included midwives with at least one year of work experience in hospitals and healthcare centers and, the absence of any physical or mental illnesses. The exclusion criteria were lack of consent to participate in the study and incomplete responses (over 10%) in the questionnaire.
Sampling method and sample size
The sampling was conducted in multiple stages. In each city, educational hospitals (3 in Tabriz and 2 in Ahvaz) and one non-educational (private) hospital were selected for sampling. For selecting healthcare centers in each city, clusters were first defined (5 clusters in Tabriz and 4 clusters in Ahvaz), and 3 healthcare centers from each cluster were randomly selected using the Randomizer software. Midwives working in these centers were recruited into the study based on availability, following the division of the initial sample size between hospitals and healthcare centers until, the calculated sample size was reached.
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According to the study’s objectives, the largest sample size was calculated based on the information from the study by Zarrini et al. [6], focusing on the chemical hazards dimension of the Occupational Hazards Questionnaire, yielding a sample size of 177 participants. Considering a design effect of 1.5 and a 10% increase in study precision, the final sample size was calculated as 290 participants for each city.
Study parameters: alpha = 0.05, power = 0.90, CI = 95%, m = 2.38, SD = 0/95, d = 6%M
$$\:\varvec{n}=\frac{{({\varvec{Z}}_{1}-\frac{\varvec{\alpha\:}}{2})}^{2}\:\times\:{\varvec{s}}^{2}}{{\varvec{d}}^{2}}$$
Data collection tools
1.
Demographic and Social Information Questionnaire: This questionnaire included the demographic variables of the study participants to complete the research data. The questions covered age, educational qualification, marital status, employment status, years of employment, shift status, workplace, and job position.
2.
OSIPOW Occupational Stress Questionnaire: The Osipow Job Stress Questionnaire [22] is based on a five-point Likert scale and consists of three parts. It was developed by Osipow in 1987 to assess individual stress from six dimensions: (1) Role Overload, (2) Role Insufficiency, (3) Role Ambiguity, (4) Role Boundary, (5) Responsibility, and (6) Physical Environment. Scoring is based on a five-point Likert scale, with options ranging from “Never” (1 point) to “Most of the time” (5 points). The total score ranged from 60 to 300, with higher scores indicating higher levels of stress. The overall stress levels are categorized into four groups: low stress (50–99), low to moderate stress (110–149), moderate to severe stress (150–199), and severe stress (200–250). The validity and reliability of the questionnaire have been evaluated in studies conducted in Iran [23, 24].
3.
Work-Related Quality of Life Questionnaire (WRQoL-2): This scale was designed by Van Laar et al. to be used in the healthcare sector (22). The questionnaire consists of 34 Likert-scale questions (1 = Strongly Disagree, 5 = Strongly Agree). Lin et al. reported that Cronbach’s alpha for all dimensions of the Chinese version ranged between 0.71 and 0.88 [25]. Mazloumi et al. in Iran evaluated the validity and reliability of this questionnaire, with the reliability for various dimensions reported between 0.63 and 0.929 [26].
4.
Minnesota Job Satisfaction Questionnaire (MSQ): The MSQ consists of 19 items and six subscales: payment system (3 questions), type of job (4 questions), opportunities for advancement (3 questions), organizational climate (2 questions), leadership style (4 questions), and physical conditions (3 questions). It is used to assess job satisfaction. Scoring is done on a Likert scale, where the options “Strongly Disagree,” “Disagree,” “Neutral,” “Agree,” and “Strongly Agree” are assigned 1, 2, 3, 4, and 5 points, respectively [27]. The total score of the MSQ is obtained by summing up the points for all items. Scores between 19 and 38 indicate low job satisfaction, 38 and 57 indicate moderate satisfaction, and scores above 57 indicate high job satisfaction. In a study by Jafarjalal et al., the reliability of the MSQ was determined with a Cronbach’s alpha of 0.88 [28].
5.
Occupational Hazards Questionnaire: This questionnaire was developed by Arab et al. (2014) [29] and contains 58 questions on a 5-point Likert scale (1–5 points) in five categories: physical hazards (9 questions), biological hazards (6 questions), chemical hazards (6 questions), ergonomic hazards (8 questions), and psychological, organizational, and social hazards (29 questions). A score between 1 and 2.2 indicates low hazard levels, a score between 2.2001 and 3.4 indicates moderate hazard levels and a score above 3.4001 to 5 indicates high hazard levels. The overall score for each category was calculated by dividing the total score by the number of questions, and the overall occupational hazards score was obtained by dividing the total score by the number of dimensions.
After obtaining approval from the university ethics committee and permission from hospital and healthcare center officials, sampling was initiated by the researchers. Researchers visited midwives at their workplaces, recruited participants based on availability, and after explaining the study objectives and obtaining informed consent, the questionnaires were distributed to the participants for self-reporting.
Data analysis
Data analysis was conducted using Statistical Package for the Social Sciences version 24 software and included descriptive statistics such as mean, standard deviation (SD), frequency, and percentage. Regarding occupational hazards, the mean (SD) of each question in different dimensions was calculated, and then the total score for each dimension was reported separately. The independent t-test and the analysis of variance (ANOVA) were used to assess the association between the study’s demographic variables (as an independent variable) and dependent variables (MSQ, OSIPOWO occupational Stress, and WRQoL-2). The normal distribution of the data was evaluated using the Kolmogorov-Smirnov test, skewness, and kurtosis. Although the data were slightly skewed, the data were considered normal because skewness and kurtosis were 1 to − 1. Furthermore, Pearson’s correlation test was used to assess the association between the study’s main variables (MSQ, OSIPOW Occupational Stress, with WRQoL-2); finally, independent variables including (MSQ, OSIPOW Occupational Stress) and sociodemographic variables with P ≤ 0.05 as control variables were inserted into the univariate and multivariate linear regression model (enter method) to predict their effect on the independent variables. Model 1 examined the individual predictive power of MSQ and OSIPOW occupational Stress on quality of work life. Model 2 assessed the combined predictive power of MSQ and OSIPOW occupational stress on the quality of work-life through a multivariate analysis. Model 3 investigated the predictive power of stress and job satisfaction on quality of work life while controlling for demographic factors in a multivariate regression analysis. There were 10% missing data that were imputed with the mean substitution method. P-values < 0.05 were considered significant.
Results
In this study, 580 midwives from Ahvaz and Tabriz participated. The findings indicated that the mean age of the participants was 39.21 years, with a standard deviation of 9.09 years.
In terms of education, 83.3% of the participants held a bachelor’s degree. The majority were married (69%) and worked in hospitals (64.7%). The most common work experience ranged between 16 and 20 years (25.3%). Most participants had rotating shifts (60.3%). A statistically significant difference in demographic characteristics between the two cities was only observed regarding marital status and employment type.
Initial statistical analysis results between demographic and work characteristics and quality of work-life showed that the mean quality of work-life was higher among individuals aged 20–29 compared to other age groups and, higher among single individuals compared to married and divorced midwives. The mean work-life quality score was significantly lower for the divorced participants compared to the other two groups. Additionally, the mean quality of work-life score decreased with increasing years of work experience. For instance, those with 5 to 10 years of experience had higher scores than those with longer work experience. Furthermore, the mean quality of work-life score was significantly higher for those with temporary employment compared with the other groups. Finally, there was a statistically significant difference in the mean quality of work-life score between participants with fixed shifts and those with rotating shifts (97.48 vs. 93.93) (Table 1).
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Table 1
Sociodemographic characteristics of the participants in two cities and their relation with the main variables
Variable | N (%) | Tabriz (n = 290) N (%) | Ahvaz (n = 290) N (%) | Minnesota Job Satisfaction Mean (SD) | Osipow Occupational Stress Mean (SD) | Work-Related Quality of Life Mean (SD) |
|---|---|---|---|---|---|---|
Age (year) Mean (SD) 39.21 (9.09) [22–60] | ||||||
20–29 | 113 (19.5) | 58 (20.0) | 55 (19.0) | 52.03 (14.39) | 227.78 (42.60) | 107.48 (21.54) |
30–39 | 168 (29.0) | 83 (28.6) | 85 (29.3) | 39.64 (12.51) | 231.39 (39.88) | 92.80 (21.14) |
40–49 | 235 (40.5) | 122 (42.1) | 113 (39.0) | 38.30 (11.49) | 233.04 (41.86) | 92.03 (18.69) |
≥ 50 | 64 (11.0) | 27 (9.3) | 37 (12.8) | 35.86 (8.90) | 240.38 (30.75) | 92.72 (16.48) |
P- valuea | 0.570 | < 0.001 | 0.248 | < 0.001 | ||
Educational status | ||||||
Bachelor | 483 (83.3) | 238 (82.1) | 245 (84.5) | 40.81 (13.16) | 235.00 (38.76) | 94.83 (20.34) |
Master | 82 (14.1) | 46 (15.9) | 36 (12.4) | 40.94 (22.47) | 218.78 (45.29) | 97.66 (21.95) |
Ph.D. | 15 (2.6) | 6 (2.1) | 9 (3.1) | 51.13 (18.91) | 221.13 (49.79) | 99.00 (22.43) |
P- valuea | 0.383 | 0.012 | 0.002 | 0.406 | ||
Marital status | ||||||
Married | 400 (69.0) | 219 (37.8) | 181 (31.2) | 39.24 (12.44) | 233.54 (41.92) | 92.92 (19.77) |
Single | 156 (26.9) | 55 (9.5) | 101 (17.4) | 46.95 (14.11) | 226.46 937.19) | 102.76 (20.41) |
Divorced or widow | 24 (4.1) | 16 (2.8) | 8 (1.4) | 33.96 (9.50 ) | 250.71 (25.99) | 87.46 (24.03) |
P- valuea | < 0.001 | < 0.001 | 0.013 | < 0.001 | ||
Job environment | ||||||
Hospitals | 375 (64.7) | 188 (64.8) | 187 (64.5) | 40.19 (12.28) | 233.86 (38.61) | 93.70 (19.96) |
Healthcare centers | 205 (35.3) | 102 (35.2) | 102 (35.5) | 42.76 (14.91) | 229.59 (43.45) | 98.34 (21.50) |
P- valuea | 0.931 | 0.240 | 0.036 | 0.009 | ||
Work experience | ||||||
1–5 | 131 (22.6) | 67 (23.1) | 64 (22.1) | 51.18 (14.77) | 225.13 (43.33) | 107.93 (20.72) |
6–10 | 72 (12.4) | 40 (13.8) | 32 (11.0) | 46.64 (13.56) | 211.39 (40.51) | 99.11 (20.30) |
11–15 | 107 (18.4) | 48 (16.6) | 59 (20.3) | 36.99 (9.89) | 239.10 (34.86) | 89.61 (20.30) |
16–20 | 147 (25.3) | 82 (28.3) | 65 (22.4) | 35.77 (10.89) | 240.61 (40.18) | 91.73 (20.72) |
21–25 | 77 (13.3) | 37 (12.8) | 40 (13.8) | 36.07 (10.03) | 240.82 (32.76) | 89.53 (17.88) |
≥ 25 | 46 (7.9) | 16 (5.5) | 30 (10.3) | 41.09 (13.32) | 229.39 (41.98) | 88.11 (14.90) |
P- valuea | 0.134 | < 0.001 | < 0.001 | < 0.001 | ||
Type of employment | ||||||
Temporary | 88 (15.2) | 50 (17.2) | 38 (13.1) | 51.67 (15.31) | 237.35 (39.89) | 105.82 (19.93) |
Contractual | 234 (40.3) | 102 (35.2) | 132 (45.5) | 36.59 (11.71) | 246.83 (31.18) | 88.78 (18.79) |
Lifetime | 258 (44.5) | 138 (47.6) | 120 (41.4) | 41.57 (11.79) | 217.50 (42.86) | 97.71 (20.51) |
P- valuea | 0.034 | < 0.001 | < 0.001 | < 0.001 | ||
Type of shift | ||||||
Day shifts only | 230 (39.7) | 116 (40.0) | 114 (39.3) | 41.97 (14.39) | 227.62 (43.63) | 97.48 (21.69) |
Day & night shifts | 350 (60.3) | 174 (60.0) | 176 (60.7) | 40.52 (12.54) | 235.45 (37.88) | 93.93 (19.79) |
P- valueb | 0.865 | 0.215 | 0.027 | 0.042 | ||
The results showed that 314 (54.1%) participants had completed a course on occupational hazards, while 266 (45.9%) had not received this training. According to reports, 366 (63.1%) participants experienced musculoskeletal problems. According to Table 2, the study found that the level of occupational hazards among the midwives surveyed was high, with a mean (SD) score of 3.76 (0.87). Among the dimensions of occupational hazards, ergonomic and biological hazards were identified as the most significant, with mean scores of 4.22 and 4.10, respectively. The mean scores for chemical and physical hazards were also reported to be high, at 3.82 and 3.66, respectively. Psychological, social, and organizational hazards were recognized as the least significant sources of occupational injury among the other dimensions.
Table 2
Information about occupational hazard
Risk type | Items | The mean (SD) score of each question | The Mean (SD) total score of dimensions |
|---|---|---|---|
Biological hazards | Skin contact with blood or other fluids of the patient | 4.45 (1.14) | 4.10 (1.09) |
Injury with sharp objects | 4.32 (1.24) | ||
Plunging the head of the needle into the body | 4.32 (1.25) | ||
Infectious diseases | 4.28 (1.33) | ||
Splashing of blood and body fluids in the eyes and mucous membranes | 4.30 (1.30) | ||
Broken slides or glass containers containing the body fluids of the patient | 2.94 (1.06) | ||
Chemical hazards | Respiratory problems | 4.04 (1.49) | 3.82 (1.30) |
Skin sensitivity (dermatitis) | 4.08 (1.40) | ||
Breathing vapors of disinfectants/sterilizers | 4.04 (1.44) | ||
Eye contact with vapors of disinfectants/sterilizers | 3.98 (1.53) | ||
Splashing chemicals in the eyes | 3.97 (1.53) | ||
Drug/chemical poisoning | 2.90 (1.52) | ||
Physical hazards | Workplace noise pollution | 4.35 (1.19) | 3.66 (1.05) |
Improper ventilation of the workplace | 4.31 (1.24) | ||
Collision with a bed or stretcher | 4.26 (1.24) | ||
Inadequate lighting and lighting of the workplace | 4.13 (1.36) | ||
Radiation hazards | 3.24 (1.39) | ||
Slip and fall | 3.00 (1.43) | ||
Hitting due to heavy objects falling on a part of the body | 2.86 (1.18) | ||
Being hit or injured by patients or clients | 3.87 (1.53) | ||
A foreign object entering the eye | 3.02 (1.17) | ||
Ergonomic hazards | Standing too much to perform activities related to job duties | 4.41 (1.09) | 4.22 (0.95) |
Improper posture while performing tasks | 4.37 (1.15) | ||
Foot pain | 4.51 (0.96) | ||
Back pain | 4.52 (0.99) | ||
wrist pain | 4.37 (1.23) | ||
shoulder pain | 4.53 (2.38) | ||
Arthritis of the neck | 4.41 (1.18) | ||
Lifting and carrying heavy objects/patients | 2.72 (1.03) | ||
Psychological-social and organizational risks | Disrespect from the patient and the patient’s companions | 3.05 (1.30) | 2.98 (0.54) |
Chronic fatigue due to work activity | 3.82 (1.08) | ||
Job stress | 4.54 (0.96) | ||
Occurrence of job-related depression | 4.27 (1.26) | ||
Being under the control of the working relationship with doctors | 3.54 (1.28) | ||
Uncomfortable feelings due to caring for non-same-sex patients | 1.32 (0.84) | ||
Inappropriate communication with colleagues in the work department (conflict with colleagues) | 1.48 (0.91) | ||
Inappropriate communication flow with different management levels of the hospital and the health center | 1.57 (1.03) | ||
sleep disorders | 3.61 (1.25) | ||
Isolation, bad mood, and despair | 3.27 (1.38) | ||
Addiction to sedatives and psychotropic drugs | 1.30 (0.86) | ||
Imposing unrelated tasks | 1.68 (1.20) | ||
Excessive expectations of patients and their families | 3.78 (1.18) | ||
Involvement of the patient’s relatives in providing care measures | 3.60 (1.19) | ||
Lack of job independence in performing professional duties | 4.08 (1.32) | ||
The disproportion of the workload of the work department with the number of personnel | 3.67 (1.12) | ||
Lack of job independence in performing professional duties | 3.54 (1.23) | ||
Employment discrimination in the workplace | 3.01 (0.94) | ||
Occurrence of concerns related to the care and education of children due to work | 4.24 (1.24) | ||
Incompatibility of assigned responsibilities with job description | 1.75 (1.21) | ||
Feeling unappreciated by managers | 2.39 (1.43) | ||
Not benefiting from job opportunities according to your abilities | 1.89 (1.30) | ||
Non-observance of maximum working hours | 3.22 (1.12) | ||
Uniformity and repetition of the work environment (absence of tone in the work environment) | 1.93 (1.35) | ||
Lack of support from external organizations (midwifery system, university, etc.) in your job | 4.43 (1.05) | ||
Negative societal perception of midwifery | 1.82 (1.21) | ||
Interference between work and personal life | 4.26 (1.20) | ||
The negative view of your spouse and first-class family members towards your work | 3.69 (1.56) | ||
The negative impact of interacting with end-stage patients on your mood | 1.86 (1.33) |
In the biological hazards category, aside from exposure to “broken glass or containers containing body fluids,” which was classified as a medium hazard, the main occupational injuries reported included skin contact with blood or other bodily fluids, injuries from sharp and cutting objects, needle-stick injuries, infectious diseases, and splashing of fluids into the eyes. In the chemical hazard’s domain, the mean score for drug toxicity was at a medium level, while the other options received high scores. Regarding physical hazards, all options received high scores and were considered significant hazards. Noise pollution and inadequate ventilation scored the highest, with averages of 4.35 and 4.31, respectively. Regarding ergonomic hazards, which were identified as the most important factor, high scores were noted for pain in various body areas, including the shoulders, back, and legs, as well as prolonged standing for job-related tasks and poor posture. Finally, in the psychological, social, and organizational hazards domain, although most items scored above the mean, the highest scores were associated with occupational stress and lack of external support.
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The descriptive statistics for occupational stress, job satisfaction, and quality of work life are presented in Table 3. The mean scores obtained were 232.35, 41.9, and 95.34, respectively. In terms of occupational stress, the score was in the severe range, while the mean score for job satisfaction was at a moderate level.
Table 3
Descriptive statistics and correlations among primary study variables (N = 580)
variables | Mean (SD) | Range | Correlation coefficient | ||
|---|---|---|---|---|---|
1 | 2 | 3 | |||
1- Minnesota Job Satisfaction | 41.09 (13.32) | 21–77 | 1 | -0.556 | 0.534 |
2- Osipow Occupational Stress | 232.35 (40.40) | 124–287 | 1 | -0.375 | |
3- Work-Related Quality of Life | 95.34 (20.62) | 39–170 | 1 | ||
The results of the Pearson correlation test among the main study variables are also shown in Table 3. According to the Pearson correlation analysis, the relationship between occupational stress and the overall quality of work life was found to be significant, negative, and moderate (r = -0.375, P < 0.001). Additionally, the results indicated a positive and significant correlation between job satisfaction and the quality of work life of the midwives. Furthermore, a negative and significant relationship was observed between occupational stress and job satisfaction.
According to Model 1, the results of the univariate regression analysis showed a statistically significant relationship between stress and job satisfaction with the quality of work life. These variables individually predicted 13.9% and 28.4% of the changes in the quality of work life, respectively. Specifically, for each standard deviation increase in occupational stress, the quality of work life decreased by 0.375 standard deviations (P = 0.020, β = -0.375). Conversely, for each standard deviation increase in job satisfaction, the quality of work life increased by 0.534 standard deviations (P < 0.001, β = 0.534).
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Multivariate regression analysis in Model 2 indicated that 29.2% of the changes in quality of work life could be explained by the two variables of stress and job satisfaction, with job satisfaction having the greatest impact on quality of work life (P < 0.001, β = 0.471).
Finally, in Model 3, when all variables were included in the regression model using the inter method, the results showed that 31.3% of the changes in the quality of work life could be explained by the variables entered in the model (R²_adj = 0.313, P < 0.001). The variables of job satisfaction, age, and work experience had significant relationships with the quality of work life, with job satisfaction having the most substantial effect (P < 0.001, β = 0.376). This indicates that as job satisfaction increases, the quality of work life also increases. However, work experience harmed the quality of work life, such that an increase in work duration was associated with a decrease in the quality of work life (P < 0.001, β = -0.296) (Table 4).
Table 4
Univariate and multivariate linear regression analysis of WRQoL-2
Predictors | R | R2 | R2adj | P-Value | B | S.E | β | 95%CI | F |
|---|---|---|---|---|---|---|---|---|---|
Model 1 | |||||||||
MSQ | 0.534 | 0.285 | 0.284 | < 0.001 | 0.827 | 0.054 | 0.534 | 0.720 to 0.934 | 230.90 |
OSIPOW Occupational Stress | 0.375 | 0.141 | 0.139 | < 0.001 | -0.192 | 0.020 | -0.375 | -0.230 to -0.153 | 94.78 |
Model 2 | |||||||||
0.543 | 0.294 | 0.292 | < 0.001 | 120.34 | |||||
MSQ | < 0.001 | 0.730 | 0.065 | 0.471 | 0.602 to 0.858 | ||||
OSIPOW Occupational Stress | 0.007 | -0.058 | 0.021 | -0.113 | -0.100 to -0.016 | ||||
Model 3 | |||||||||
0.568 | 0.322 | 0.313 | < 0.001 | 33.914 | |||||
MSQ | < 0.001 | 0.667 | 0.072 | 0.431 | 0.526 to 0.809 | ||||
OSIPOW Occupational Stress | 0.066 | -0.044 | 0.024 | -0.086 | -0.091 to 0.003 | ||||
Marital status | 0.196 | -1.823 | 1.409 | -0.045 | -4.591 to 0.944 | ||||
Age | 0.021 | 0.387 | 0.167 | 0.171 | 0.716 to -0.229 | ||||
Job environment | 0.636 | 1.410 | 2.978 | 0.033 | -4.440 to 7.260 | ||||
Work experience | < 0.001 | -3.865 | 0.992 | -0.296 | -5.813 to -1.917 | ||||
Type of employment | 0.102 | -2.034 | 1.241 | -0.071 | 0.403 to 0.036 | ||||
Type of shift | 0.857 | -0.5183 | 2.865 | -0.012 | -6.1442 to 5.109 |
Discussion
The results of the present study, conducted to examine the status of occupational hazards and the relationship between stress levels and job satisfaction with the quality of work life of midwives working in various health-care sectors, revealed that there is no desirable status regarding occupational hazards, work stress, job satisfaction, and quality of work life among midwives in both cities.
Status of midwifery occupational hazards
The status of occupational hazards was first assessed to achieve the study’s objectives, with findings indicating high scores in various dimensions of occupational hazards. According to the reports from the participating midwives, they experience different occupational hazards at a high level. The investigations showed that ergonomic and biological hazards were reported as the most significant occupational hazards, while psychological, social, and organizational hazards were mentioned as secondary sources of occupational hazards. Among the biological hazards, skin contact with blood or other patient fluids, injuries from sharp objects, needle stick injuries, contracting infectious diseases, and splashes of fluids into the eyes were reported as the most important occupational injuries. In the category of chemical hazards, only the mean score for drug toxicity was moderate; the other options received high scores. Regarding physical hazards, noise pollution, and inadequate environmental ventilation received the highest scores. In connection with ergonomic hazards, which were identified as the most significant, pain in various body areas including shoulders, back, and legs, standing for prolonged periods during job-related activities, and poor physical posture were also mentioned as high risks. Finally, despite most psychological, social, and organizational hazards obtaining scores above the mean, the highest scores pertained to work stress and lack of external support. present study’s findings align with other studies that have assessed occupational hazards in groups of nurses and midwives. Numerous studies have reported occupational hazards that health care providers may encounter, with ergonomic hazards like musculoskeletal problems and physical hazards such as inadequate ventilation and noise pollution being identified as the primary risks [29, 30]. Common ergonomic risk factors include prolonged standing for job-related activities and awkward posture during work [29]. In studies involving nurses working in educational hospitals, biological hazards such as exposure to blood and other fluids were reported as high [31]. Other studies have also indicated that skin contact with blood and other bodily fluids is an occupational hazard faced by midwives and nurses [6, 31, 32]. In a systematic review, Fereidooni and colleagues reported that the most common occupational hazards include needle stick injuries, contact with infectious materials, and transmission of diseases such as hepatitis and AIDS, which can also lead to psychological harm [33]. Additionally, Bianchi et al. mentioned factors such as infection risk, post-traumatic stress, and musculoskeletal problems as part of the occupational hazards in midwifery [34]. Leinweber and colleagues, in their study on Australian midwives, indicated that harsh working conditions and post-traumatic stress symptoms among midwives may have significant consequences, such as reducing empathetic abilities and emotional care, potentially contributing to feelings of lack of support among women during childbirth [35]. Adatara and colleagues, through a qualitative study on the challenges faced by midwives in Ghana, referred to various themes, one of which was the lack of necessary physical infrastructure [36]. Based on the study results, issues such as the risk of infections, musculoskeletal problems, and psychological and physical discomfort due to night shifts and traumatic events during childbirth are challenges faced by midwives, and unfortunately, occupational hazards in midwifery are often underestimated.
Status of stress and job satisfaction of midwives
Another finding of this study indicated that the scores obtained from the work stress and job satisfaction of the participants were in the severe and moderate ranges, respectively. Furthermore, the mean score for the quality of work life among participants was also at a moderate level. The results of other studies related to work stress and job satisfaction in Iran align with the present findings [37, 38]. The results of a study by Kordi and colleagues in Iran indicated that the mean score for work stress and work capability was 149 and 38.81, respectively, with a negative correlation between work stress and work capability; midwives experiencing higher work stress showed poorer work capability. They concluded that preventive measures should be taken to eliminate or reduce work stress and increase the work capability of Iranian midwives, although identifying the sources of work stress is essential for adopting appropriate stress management strategies [39]. A study examining the relationship between organizational citizenship behavior and job satisfaction and work stress among midwives who work in health care centers indicated a significant direct correlation between organizational behavior and job satisfaction and an inverse correlation with work stress [40]. Midwives and all health personnel who work night shifts or at unconventional hours or in rotating shifts are considered sensitive occupations, and given the role of midwives in providing quality services to mothers and children, evaluating their working conditions is crucial. Special attention must be given to these individuals to ensure that work stress does not negatively impact their performance and abilities. By reducing and managing stress, they can enhance their job satisfaction and improve their work quality. In a study by Peter and colleagues [41] on midwives working in a maternity ward and women’s department of a public hospital in Switzerland, it was reported that compared to other health professions, the desire to leave the profession is higher among younger generations of midwives. This finding has been corroborated in other studies, where researchers indicated that work stress, inadequate working conditions, and insufficient rewards for individuals working in health care centers, especially in midwifery and nursing settings, which are heavily influenced by work-related stress and have higher emotional demands—lead to a greater likelihood of premature departure from the job [42, 43]. This is an important finding for heads of institutions and policymakers, who must implement strategies to reduce work stress among midwives to retain them in their workplaces. In addition, broader studies should design and implement interventions to reduce work-related stress and increase job satisfaction among midwives. It has been shown that training stress coping skills, including stress management, can effectively reduce the levels of work stress. However, reducing stress without addressing professional, occupational, organizational, and environmental factors will not lead to job satisfaction [44]. Therefore, it is recommended to create a supportive environment and appropriate welfare conditions to reduce work stress, and by holding relevant training courses on stress management and enhancing communication skills, psychological support can be provided to help reduce stress. Furthermore, creating career advancement opportunities and recognizing good performance can also be effective. It should be noted that all measures that lead to improved working conditions, enhanced psychological and social support, and increased professional support can lead to increased job satisfaction, ultimately contributing to increased productivity in healthcare organizations and improved service quality for mothers and children.
Status of quality of work life of midwives
Finally, another finding of the study regarding the factors affecting the quality of work life of midwives indicated the need for appropriate measures to improve this variable, given the moderate overall score for quality of work life among participants. Overall, other studies have also shown that the quality of work life for healthcare providers, particularly midwives, is not very favourable [4, 45]. Therefore, paying attention to the factors is essential, as it closely relates to the quality and capability of organizations in delivering health services to clients. Addressing the quality of work life of employees fosters positive attitudes toward their work and organization, enhancing productivity, internal motivation, and organizational effectiveness [46]. The examination of the relationship between this quality of work life with demographic characteristics, stress status, and job satisfaction revealed that the quality of work life among midwives aged 20 to 29 years, single individuals, and those with temporary employment status were higher compared to those of older ages, married individuals, and those with formal employment status. Additionally, with increasing work experience (length of service), the mean score of quality of work life decreased, such that the mean score of this variable in the group with 5 to 10 years of work experience was higher than that of individuals with more extended work experience, and a statistically significant difference was also found in the mean score of the quality of work life among participants with fixed shifts compared to those with rotating shifts. In another study in Iran, the score obtained for the quality of work life of midwives was low, and a correlation was found between quality of work life and the mean weekly working hours and satisfaction with workload in shifts, but no relationship was observed between quality of work life and demographic characteristics such as age, education, marital status, or number of children [4].
Additionally, considering the low quality of work-life scores among married individuals, it can be said that married people may experience lower work quality due to stress from other family responsibilities and increased workload. Shift work can disrupt family and social life, leading to a decline in work-life quality. Furthermore, according to various studies and what we extracted from our study, midwives working in delivery rooms reported lower work quality and job satisfaction, along with higher job stress compared to midwives employed in health centers and clinics [38, 47, 48]. This could be due to midwives in delivery rooms facing conditions such as dealing with emergency and unpredictable situations, excessive noise in the workplace, rotating shifts, long working hours, wages that are disproportionate to their responsibilities, and pressure from heavy workloads, which can all affect their perception of work-life quality. In a study by Talasaz and colleagues, the mean work-life quality score for midwives in healthcare centers was 18.67, while for those in delivery rooms, it was 16.62, indicating lower work quality among the staff. According to them, efforts to enhance work-life quality lead to greater commitment among employees and contribute to the growth and dynamism of the organization [47]. A study by Rouleau and colleagues, conducted on midwives working in Senegal, found that their greatest dissatisfaction was related to aspects of the work environment [48]. Given these working conditions, it is evident that job factors significantly affect work-life quality; high work pressure in midwifery reduces work-life quality. Our study also indicated that there were statistically significant inverse and direct relationships between the main variables of stress and job satisfaction with midwives’ work-life quality. Specifically, as job stress perception increases, work-life quality decreases, and as job satisfaction increases, work-life quality improves. Ultimately, in the regression model presented, examining various variables revealed that job satisfaction, age, and work experience (length of service) had significant relationships with work-life quality, with job satisfaction having the greatest impact. The next influential variable, work experience, harmed work-life quality, such that as the duration of employment increased, work-life quality decreased. Enhancing work-life quality can contribute to economic, social, and cultural development and improve individuals’ health levels. The more control an individual has over events, the lower their stress levels will be, which in turn will increase their efficiency. Researchers believe that work-life quality is related to an individual’s attitude toward their job; the more mutual trust, attention, appreciation, and suitable opportunities for employees are provided by managers in the workplace, the more belief in better job performance individuals will develop, which will also help reduce job-related stress [49, 50]. Given the relationship between job conditions, such as stressful environments, and job satisfaction with the quality of life, the recommendations made for reducing stress and increasing job satisfaction can contribute to improving quality of life. These activities include creating a safe working environment, promoting physical health, addressing mental health by providing psychological support and encouraging teamwork, establishing a work-life balance such as flexible working hours and appropriate leave, providing educational and professional development opportunities, increasing wages and benefits, creating a regular reward system, implementing stress reduction programs, and periodically assessing work-life quality through regular surveys. Implementing all these suggestions will require proper policy-making and planning.
Implications of the study
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Individualized support programs are essential for improving midwives’ quality of work life.
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Management plans should account for individual differences to enhance midwives’ job satisfaction.
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To improve the quality of work life for midwives, it is imperative to implement robust programs aimed at reducing occupational hazards, especially ergonomic and biological risks.
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To enhance midwives’ quality of work-life, programs aimed at boosting job satisfaction are crucial. This includes improving working conditions, increasing compensation, and fostering professional growth.
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Rotating shifts and long working hours can negatively impact the quality of life of midwives. Therefore, creating a work-life balance is crucial for midwives.
Limitations
The current study, which assessed the existing situation through a questionnaire, may have limitations; conducting qualitative studies and observing job conditions could provide a better analysis of the current state. Furthermore, other influencing variables on stress, job satisfaction, and quality of work life should also be considered, and their simultaneous effects should be examined in studies designed with path analysis.
Conclusion
Overall, based on the results obtained, midwives work in an environment with many occupational hazards, and ergonomic and biological risks are important to them. This group of healthcare providers experienced high occupational stress and had moderate job satisfaction and quality of life. Considering the impact of factors such as stress, job satisfaction, age, and duration of service of midwives on their quality of work life, actions such as regular assessments of the quality of work life and appropriate policy-making to improve job conditions—such as stress management, attention to mental health, increasing professional support, optimizing the work environment, and establishing incentive systems—can lead to an enhancement of midwives’ quality of work life.
Acknowledgements
We thank all the midwives who participated in the study. We also appreciate the support from the Islamic Azad University of Tabriz Medical Sciences.
Declarations
Ethics approval and consent to participate
Written informed consent was obtained from each participant before the completion of the survey. This study was approved by the Ethics Committee of the Azad University of Tabriz Medical Sciences, Iran (code number: IR.IAU.TABRIZ.REC.1400.113). All the methods were carried out under relevant guidelines and regulations.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Clinical trial number
Not Applicable.
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