Associations Analysis of Work-related Quality of Life，Professional Identity and Presenteeism among Family Doctors Based on PLS-SEM

doi:10.12114/j.issn.1007-9572.2018.28.006

Abstract

Abstract: Objective　To explore the associations between work-related quality of life，professional identity and presenteeism，providing a reference for improving the working efficiency of family doctors.Methods　By cluster sampling，we enrolled all the family doctors（n=400） from 33 community health centers（CHCs） delivering family doctor services sampled representatively from Yunlong District，Quanshan District，Gulou District，Tongshan District，Pizhou City，Pei County and Feng County of Xuzhou City （4-6 CHCs were selected from each district/county/county-level city）．Then，from November 2017 to March 2018，we conducted a survey in the sampled family doctors with a self-developed questionnaire consisting of demographic characteristics，Chinese version of Work-related Quality of Life（C-WRQoL） Scale，Professional Identity Scale（PIS），Chinese version of Stanford Presenteeism Scale （C-SPS-6）．Totaled 324（81.0%） returning responsive questionnaires were finally included.Multiple linear regression and partial least squares structural equation modeling （PLS-SEM） were used to investigate the associations between work-related quality of life，professional identity and presenteeism and construct the model，respectively.Results　The subscale scores of the C-WRQoL Scale and the CIS were negatively linearly correlated with the total score of C-SPS-6 （P<0.01）．The subscale scores（except the score of stress at work） of the C-WRQoL Scale were positively linearly correlated with the total score of PIS （P<0.01）．Scores of 4 subscales of the C-WRQoL Scale （job and career satisfaction，home-work interface，stress at work，control at work），and scores of 3 subscales of the PIS（tendency of professional behaviors，professional value，professional belongingness） were the factors influencing the total score of C-SPS-6.The work-related quality of life had a positive effect on professional identity with a path coefficient of 0.629，but had a negative effect on the presenteeism with a path coefficient of -0.343；the professional identity produced a negative effect on presenteeism，with a path coefficient of -0.431；the work-related quality of life affected the presenteeism through the intermediary role of professional identity，with an overall effect of -0.614.Conclusion　Family doctors have a high subjective evaluation of work-related quality of life，which has a positive impact on improving their professional identity，and further reduces their productivity loss due to presenteeism.

Key words: Family doctor, Work-related quality of life, Professional identity, Presenteeism, Partial least squares structural equation modeling

摘要： 目的　探讨家庭医生工作生活质量、职业认同与隐性缺勤的关系，为提高家庭医生的在岗工作效率提供参考。方法　首先，采用典型抽样法，于徐州市云龙区、泉山区、鼓楼区、铜山区、邳州、沛县、丰县各选取4~6个已开展家庭医生服务的社区卫生服务中心，共33家；然后整群纳入各社区卫生服务中心的全部家庭医生，共400例。采用自行设计的调查问卷，于2017年11月—2018年3月进行调查。问卷的主要内容包括家庭医生一般情况调查表以及工作生活质量量表、职业认同问卷、斯坦福隐性缺勤问卷（SPS-6）中文版。共发放问卷400份，回收有效问卷324份，问卷的有效回收率为81.0%。采用多元线性回归与最小二乘结构方程模型（PLS-SEM）分析家庭医生工作生活质量、职业认同与隐性缺勤之间的关系并建构模型。结果　工作生活质量量表各维度得分、职业认同问卷各维度得分与斯坦福隐性缺勤问卷（中文版）得分呈直线负相关（P<0.01）。除工作压力维度得分外，工作生活质量量表各维度得分与职业认同问卷得分呈直线正相关（P<0.01）。工作满意度得分、家庭工作关系得分、工作压力得分、工作控制得分、职业行为倾向得分、职业价值观得分、职业归属感得分是斯坦福隐性缺勤问卷（中文版）得分的影响因素。家庭医生工作生活质量对职业认同具有正向作用，路径系数为0.629；对隐性缺勤具有负向作用，路径系数为-0.343；职业认同对隐性缺勤具有负向作用，路径系数为-0.431；工作生活质量通过职业认同的中介作用对隐性缺勤产生影响，总效应为-0.614。结论　家庭医生拥有较高的工作生活质量评价对提高其职业认同具有积极影响，进而可降低他们因隐性缺勤所导致的生产力损失。

关键词: 家庭医生, 工作生活质量, 职业认同, 隐性缺勤, 最小二乘结构方程模型

LU Huimin,YANG Dandan,MIAO Chunxia, et al. Associations Analysis of Work-related Quality of Life，Professional Identity and Presenteeism among Family Doctors Based on PLS-SEM[J]. Chinese General Practice, 2018, 21(28): 3436-3442. DOI: 10.12114/j.issn.1007-9572.2018.28.006.
卢慧敏,杨丹丹,苗春霞等. 基于PLS-SEM的家庭医生工作生活质量、职业认同与隐性缺勤的关系研究[J]. 中国全科医学, 2018, 21(28): 3436-3442. DOI: 10.12114/j.issn.1007-9572.2018.28.006.

References

［1］GOETZEL R Z，LONG S R，OZMINKOWSKI R J，et al.Health，absenee，disability，and presenteeism cost estimates of certain physical and mental health conditions affecting U.S. employers［J］．J Occup Environ Med，2004，46（4）：398-412.3441
［2］LETVAKS A，RUHM C J，GUPA S N.Nurses' presenteeism and its effects on self-reported quality of care and costs［J］．Am J Nuts，2012，112（2）：30-38，48.3441
［3］JOHNS G.Presenteeism in the workplace：a review and research agenda［J］．J Organ Behav，2010，31（4）：519-542.3441
［4］BAKERMCCLEARN D，GREASLEY K，DALE J，et al．Absence management and presenteeism：the pressures on employees to attend work and the impact of attendance on performance［J］．Hum Resour Manag J，2010，20（3）：311-328.3441
［5］KARANIKAMURRAY M，PONTES H M，GRIFFITHS M D，
et al.Sickness presenteeism determines job satisfaction via affective-motivational states［J］．Soc Sci Med，2015，139：100-106.3441
［6］宋云鹏.医生全科职业认知与择业意愿：收入预期与职业认同的中介效应［J］．中国卫生政策研究，2017，10（4）：77-82．DOI：10.3969/j.issn.1674-2982.2017.04.013.3441
SONG Y P.Career cognition and career intention among general practitioners in China：the mediating effect of income expectation and career identity［J］．Chinese Journal of Health Policy，2017，10（4）：77-82．DOI：10.3969/j.issn.1674-2982.2017.04.013 3442
［7］VAN LAAR D，EDWARDS J A，EASTON S.The Work-Related Quality of Life Scale for healthcare workers［J］．J Adv Nurs，2007，60（3）：325-333.3442
［8］郝玉芬.提升护生职业认同、职业自我效能的自我教育模式研究［D］．上海：第二军医大学，2011.3442
HAO Y F．Research on the self education mode of improving the professional identity and career self efficacy of nursing students
［D］．Shanghai：The Second Military Medical University，2011.3442
［9］魏淑华.教师职业认同研究［D］．重庆：西南大学，2008.3442
WEI S H.A research on teacher's professional identity［D］．Chongqing：Xinan University，2008.3442
［10］KOOPMAN C，PELLETIER K R，MURRAY J F，et al．Standford Presenteeism Scale：health status and employee productivity［J］．J Occup Environ Med，2002，44（1）：
14-20.3442
［11］RANTANEN I，TUOMINEN R.Relative magnitude of presenteeism and absenteeism and work：related factors affecting them among health care professionals［J］．Int Arch Occup Environ Health，2010，84（2）：225-230.3442
［12］胡蓓，陈建安.脑力劳动者工作满意度实证研究［J］．科研管理，2003，24（4）：139-144．DOI：10.3969/j.issn.1000-2995.2003.04.023．3442
HU B，CHEN J A.Empirical research on working satisfaction of mental worker［J］．Science Research Management，2003，24（4）：139-144．DOI：10.3969/j.issn.1000-2995.2003.04.023.3442
［13］施志勇.高承诺人力资源管理与组织绩效研究：以H公司为例［D］．上海：上海交通大学，2012.3442
SHI Z Y.High commitment human resource management and organizational performance：a case study of H company［D］．Shanghai：Shanghai Jiao Tong University，2012.3442
［14］唐雪华，高月霞，仲亚琴，等．医务人员职业倦态、工作满意度及离职意愿与隐性缺勤关系研究［J］．江苏卫生事业管理，2017，28（4）：45-49.3442
TANG X H，GAO Y X，ZHONG Y Q，et al．Associations analysis of burnout，job satisfaction and turnover intention with presenteeism among medical staffs［J］．Jiangsu Healthcare Administration，2017，28（4）：45-49.3442
［15］YANG T，ZHU M，XIE X.The determinants of presenteeism：a comprehensive in vestigation of stress-related factors at work，health，and individual factors among the aging workforce［J］．Journal of Occupational Health，2016，58（1）：25-35.3442
［16］杨添安，马名旭，郭义娜，等．北京市公立医院与私立医院医务人员工作压力及其影响的对比分析［J］．中国卫生事业管理，2017，33（8）：622-625.3442
YANG T A，MA M X，GUO Y N，et al．Comparative analysis of job stress and its influence among medical staffs in public hospitals and private hospitals in Beijing［J］．Chinese Health Service Management，2017，33（8）：622-625.3442
［17］袁立，周昌明，江萍，等．上海市“长宁模式”下的家庭医生工作现状和职业满意度调查研究［J］．中国全科医学，2014，17（28）：3391-3398．DOI：10.3969/j.issn.1007-9572.2014.28.027.3442
YUAN L，ZHOU C M，JIANG P，et al．Investigation of the current working condition and career satisfaction of the family doctors in "Changning Model" in Shanghai［J］．Chinese General Practice，2014，17（28）：3391-3398．DOI：10.3969/j.issn.1007-9572.2014.28.027.3442
［18］徐振海.某市护士工作生活质量现状及影响因素的研究［D］．蚌埠：蚌埠医学院，2011.3442
XU Z H.A Study on the quality of work life status and influence factors of the nurses［D］．Bengbu：Bengbu Medical College，2011.3442
［19］EFRATY D，SIRGY M J.The effects of quality of work life（QWL） on employee behavioral responses［J］．Social Indications Research，1990，22（1）：31-47.3442
［20］骆鹤飞.护士职业认同与工作绩效的关系研究：以精神薪酬满意度为中介变量［D］．长春：吉林大学，2017.3442
LUO H F.A study on the relationship between professional identity and work performance of nurse：psychological reward satisfaction as mediating variable［D］．Changchun：Jilin University，2017.3442
［21］陈曲，刘旭，孟开. 北京市三级甲等医院青年医护人员职业倦怠现状及其影响因素分析［J］. 中国全科医学，2018，21（2）：223-231.DOI：10.3969/j.issn.1007-9572.2017.00.005.3442
CHEN Q，LIU X，MENG K.Job burnout and associated factors among young health care providers in tertiary grade A hospitals in Beijing［J］.Chinese General Practice，2018，21（2）：223-231.DOI：10.3969/j.issn.1007-9572.2017.00.005.3442
［22］穆桂斌，张春辉.大学教师人格特质、职业认同与工作绩效的关系研究［J］．河北大学学报，2012，37（5）：136-140.3442
MU G B，ZHANG C H.A study on the relationship among university teachers' personality，professional identity and work performance
［J］．Journal of Hebei University，2012，37（5）：136-140.3442

[1]	HAO Aihua, ZENG Weilin, LI Guanhai, XIA Yinghua, CHEN Liang. Current Situation of the Construction of Family Doctor Team: an Investigation Based on the Perspective of General Practitioners [J]. Chinese General Practice, 2023, 26(34): 4261-4268.
[2]	YIN Zhaoxia, MAO Lidong, ZHANG Baoshuang, HUANG Yin, FENG Yang, WANG Yunfei. Spectrum of Outpatient Illnesses in Children Contracting Family Doctor Services in Shenzhen's Community Settings and Related Implications for Standardized Residency Training of General Practitioners [J]. Chinese General Practice, 2023, 26(33): 4218-4224.
[3]	LIU Rui, CAO Yu, CHU Aiqun, WU Huanyun. Current Situation of Community Pharmacy Services and the Integration of Pharmacists into Family Doctor Team in Shanghai [J]. Chinese General Practice, 2023, 26(31): 3922-3929.
[4]	PAN Wen, FENG Jing, ZHENG Yanling, LEI Zihui, GAN Yong. Relationship between Psychological Capital and Intention to Stay among General Practitioners in China: the Mediating Role of Professional Identity [J]. Chinese General Practice, 2023, 26(25): 3127-3132.
[5]	YIN Zhaoxia, KONG Chongyu, ZOU Xianhui, LI Chuang, HUANG Yin, FENG Yang, WANG Yunfei, GONG Weijie. Traditional Chinese Medicine Disease Spectrum Analysis in Outpatient Clinics of Contracted Residents by Family Doctors in Shenzhen Community Health Service Centers [J]. Chinese General Practice, 2023, 26(25): 3112-3117.
[6]	GUO Yahong, GUO Haoqian, NING Yanhua, JIANG Ting, LI Meiman, LYU Xiongxiong, KONG Weijuan, LIU Haiyan. Construction of "Internet+" Family Nursing Management Model for the Elderly Based on Contracted Family Doctor Services [J]. Chinese General Practice, 2023, 26(23): 2876-2881.
[7]	ZHAO Linlin, SHAO Shuang, LUO Qi, CHEN Xiaolei, DU Juan. Practice Strategy of Treatment-prevention Integration of Family Doctor Team in China [J]. Chinese General Practice, 2023, 26(22): 2715-2719.
[8]	PAN Shasha, MA Chengcheng, CUI Lu, LI Chanjiao, NI Ziling. Development, Reliability and Validity of the Chinese Version of Primary Care Team Dynamics Scale [J]. Chinese General Practice, 2023, 26(16): 2047-2054.
[9]	XU Jiayu, YAN Hua, FANG Junbo, WANG Haiqin, GUO Pei, SHEN Fulai, WANG Xingsong. Standardized Workload-based Analysis of the Services Delivered by a Family Doctor Team in a Community Health Institution [J]. Chinese General Practice, 2023, 26(13): 1641-1647.
[10]	MENG Wenqi, LIU Songyi, JIANG Xiaoli, PENG Haibo, LI Zixin, YU Qianqian, YIN Wenqiang, SUN Kui, CHEN Zhongming, GUO Hongwei. Mechanisms Affecting the Effectiveness of Contracted Family Doctor Services: a Grounded Theory Analysis [J]. Chinese General Practice, 2023, 26(10): 1192-1197.
[11]	ZHOU Qiru, LI Jushuang, HAO Chun, WANG Yonggang, SHEN Rui, ZHU Minxian, CHENG Xin. Impact of Appointment Service on the Quality of Family Doctor Contract Service Outcomes [J]. Chinese General Practice, 2023, 26(10): 1198-1204.
[12]	MA Zhiqiang, WU Xianglan. The Doctor-patient Trust in General Practice Service and Its Countermeasure Suggestions Based on Trusted Source Model [J]. Chinese General Practice, 2023, 26(10): 1172-1178.
[13]	XU Pingping, ZHAO Jing, LI Chunxiao, LI Linfeng, LIU Senyuan. Quantitative Evaluation of Chinese Central Government's Family Doctor Contract Service Policy Based on PMC Index Model [J]. Chinese General Practice, 2023, 26(04): 440-446.
[14]	MA Zhiqiang, GUO Le, LI Zhao, GE Bailin. Development of the General Practitioner Competency Model Using Grounded Theory for Assessing General Practitioners' Competencies in Delivering Contracted Care Services [J]. Chinese General Practice, 2023, 26(04): 460-466,485.
[15]	LIU Zhimin, FENG Lei. Content Analysis and Optimization Path Exploration of Family Doctors' Contracting Service Agreements [J]. Chinese General Practice, 2023, 26(04): 453-459.