Dental Hygienists in Israel: Employment Evaluation, Job Satisfaction, and Training Implications

Transcription

1 International Dental Education Dental Hygienists in Israel: Employment Evaluation, Job Satisfaction, and Training Implications Nirit Yavnai, M.P.H., D.M.D.; Leon Bilder, D.M.D., Ph.D.; Harold Sgan-Cohen, M.P.H., D.M.D.; Avi Zini, M.P.H., D.M.D. Abstract: Fundamental changes have occurred in dental services for children in Israel that are likely to affect workforce needs for dental hygienists. The aim of this study was to describe the employment situation and job satisfaction of a sample of dental hygienists in Israel, to estimate associated variables, and to discuss corresponding possible implications for training programs after these changes. An ed questionnaire sent to all dental hygienists in the Israeli Dental Hygienists Association list included questions about respondents demographic background, years of experience, working hours, desire to work in an alternative occupation, and sense that they were valued within the dental community. The response rate was 20.7 percent. The responses showed that dental hygienists worked, on average, in 2.11 different working venues, hours/week, and hours in the private sector. Almost 63 percent of the respondents were willing to add working hours as a dental hygienist, preferably in the private sector. Also, 38.2 percent of the respondents worked in an extra non-dental hygienist job (mean=7.05 hours/week). These dental hygienists reported a high level of job satisfaction. After regression analysis, a high number of working venues, years of experience, and hypothetically choosing again to be a dental hygienist were found to be significant indicators of job satisfaction (R 2 =0.491). It is important that dental hygienists be satisfied and willing to expand their activities. Legislative changes may require reorientation and refocusing of dental hygiene education programs. Dr. Yavnai is a specialist in public health dentistry, Department of Community Dentistry, Hadassah School of Dental Medicine, Hebrew University, Jerusalem; Dr. Bilder is a specialist in public health dentistry, Department of Community Dentistry, Hadassah School of Dental Medicine, Hebrew University, Jerusalem; Prof. Sgan-Cohen is a full Professor and a specialist in public health dentistry, Department of Community Dentistry, Hadassah School of Dental Medicine, Hebrew University, Jerusalem; and Dr. Zini is a lecturer and a specialist in public health dentistry, Department of Community Dentistry, Hadassah School of Dental Medicine, Hebrew University, Jerusalem. Direct correspondence and requests for reprints to Dr. Nirit Yavnai, Department of Community Dentistry, Hadassah School of Dental Medicine, Hebrew University, P.O. Box 12272, Ein Kerem, Jerusalem, Israel 91120; phone; fax; nirityavnai@gmail.com. Keywords: dental hygiene, dental hygienists, dental hygiene education, women in dental education, career satisfaction, Israel Submitted for publication 7/21/11; accepted 12/3/11 A dental hygienist is a licensed dental professional who focuses on prevention and oral hygiene. A variety of training programs prepare dental hygienists to practice in regions around the world. Some programs include a bachelor s degree in dental hygiene, while others, as in Israel, terminate with a registered diploma or certificate. 1-3 Dental hygienists working practices, job satisfaction, and employment status are important research issues and have attracted increasing attention in the recent literature. 4,5 One of the main reasons this subject arouses interest is the necessity of considering the influence of changing work patterns on human resource planning 4 and training programs. There is currently only minimal information about Israeli dental hygienists workforce maintenance, daily working circumstances, and job satisfaction. 6-8 The ratio of dental hygienists to general dentists in Israel was 1:6 in 2009, 9,10 considerably lower than the reported ratio of 1:1 in the United States, Canada, and Japan A low ratio of 1:33 has been reported in Australia, Germany, and Italy. 11,13,14 In a survey from 1994, 62 percent of dental hygienists in Israel reported underemployment. 6 A fundamental transformation occurred in dental services for children in Israel in The National Health Insurance Bill (NHIB), which was enacted in 1994, excluded oral health, 15 so most oral health care had been financed with private means. 16,17 However, after many years of effort, as of July 2010, October 2012 Journal of Dental Education 1371

2 all Israeli residents up to the age of eight years became eligible to receive comprehensive preventive and restorative dental services within the framework of the National Health Insurance. As a next step, the age range was expanded to the age of ten years. This universal coverage will be extended over the coming three years (until 2013), and the eligible cohort will include all children up to the age of fourteen years. 18 In addition, public funding for primary prevention (dental education and distribution of toothbrushes and dentifrices) for children has tripled since 2009 and is now directed toward the entire population of schoolchildren up to the ninth grade. Much of this program is intended to be carried out by dental hygienists. The changes in oral health services for children as a part of the NHIB and a universal primary prevention program in schools require logistical solutions, estimation, the development of dental hygiene training programs, and human resource forecasts. It is not yet known how these changes will affect dental hygienists job availability. There is only minimal current information on Israeli dental hygienists workforce maintenance, daily working circumstances, and job satisfaction. Thus, it is important to investigate dental hygienists working practices, job satisfaction, and employment status. Collecting updated employment and job satisfaction data is critical for human resource planning. The aim of this study was thus to describe the employment situation and job satisfaction of a sample of dental hygienists in Israel, to estimate associated variables, and to discuss possible implications for training programs after the legislative change. Methods The questionnaire developed for this study was based upon questions used in recent studies of working practices and job satisfaction of dental hygienists. 12,19 The Hebrew-translated questionnaire was validated by a pilot study on a sample of dental hygienists following minor modifications intended to improve its content. 20 According to the Israeli Dental Hygienists Association (IDHA), there are 1,593 registered dental hygienists in Israel. The study questionnaire was sent by to all 943 dental hygienists listed in the IDHA database during 2010, not all of whom were IDHA members. Eight percent (n=75) had faulty addresses, and these s were returned automatically. Dental hygienists were asked to return the full self-completed questionnaire by fax or . Follow-up reminder s with attached questionnaires were repeatedly sent two, four, and six weeks after the initial mailing, and dental hygienists were requested to complete the questionnaires if they had not done so previously. In addition, questionnaires were distributed at two dental hygienist conventions during the survey period, and participants were again asked to fill these in if they had not done so previously. To ascertain the potential response bias, fifty dental hygienists were randomly sampled from the nonrespondent list, and they completed a short telephone questionnaire. In order to keep the responses anonymous, all completed questionnaires returned by were printed and numbered by an independent secretary and were inserted into a spreadsheet with numbers only. The questionnaires that were returned at the dental hygienist conventions were anonymous as well. The group of nonrespondents was coded by numbers and was chosen randomly by the secretary, who made the phone calls and filled in the spreadsheet anonymously, coded by numbers. The researchers received the database without any names. Questions sought information about respondents demographic characteristics (year of birth, country of origin, religion, and family status), work demographics (school, place of work, place of residence, years of dental hygienist experience, working sectors, and working hours), postgraduate studies, and job satisfaction. Using a validated job satisfaction scale, 19 respondents were asked to rate their satisfaction from working as a dental hygienist on a scale from one to ten, in which 1=not satisfied and 10=maximal satisfaction. The independent variables were demographic variables, years of experience in the dental hygiene profession, hypothetically choosing again to be a dental hygienist, willingness to work in another occupation, and feeling valued within the dental community. The dependent variable was job satisfaction. The data collected were entered into an Excel spreadsheet and transferred to SPSS 16.0 for further analysis. For job satisfaction, the scale was operationally divided into 1 5=low job satisfaction and 6 10=high job satisfaction. Pearson chi-square tests were used for testing the statistical significance of differences between categorical variables and job satisfaction categories, and an independent t-test was used to detect differences between numeric variables 1372 Journal of Dental Education Volume 76, Number 10

3 and job satisfaction. Backward stepwise logistic regression was conducted to eliminate potential confounders and mediators among all the variables tested. The level of significance was set at p<0.05. The study was approved by the board of ethics in Hebrew University, Jerusalem. Results One hundred and eighty completed questionnaires were returned (20.7 percent response level). No significant difference was observed between the groups of nonrespondents and respondents. All of the participants were females, 62.2 percent were born in Israel, and 96.5 percent were Jewish. Table 1 presents the associations of demographic variables, working in another occupation, willingness to add hours as a dental hygienist, choosing the profession again, perceived value within the dental community, and job satisfaction. Most of the sample were married (68.0 percent), worked in the private sector (70.1 percent), worked only as a dental hygienist (61.8 percent), and were members of the IDHA (80.0 percent). According to the responses, 61.0 percent were willing to add more working hours as a dental hygienist, 67.1 percent would choose their profession again, and 75.1 percent perceived that they were highly valued within the dental community. The mean age of the sample was 36.35±11.18 years, with a mean of 8.94±8.80 years of experience in a mean of 2.11±1.16 different workplaces, 23.64±10.81 hours per week. Table 2 presents the numerical descriptive results. These dental hygienists reported a mean of 7.00±2.36 and a median of 8.00 in job satisfaction. High job satisfaction ( 6) was found among 76.4 percent of the respondents. Satisfaction was significantly higher among those dental hygienists who worked near home (81.8 versus 56.0 percent; p=0.004), who worked in the private sector Table 1. Distribution of demographic and professional variables for total participants and divided into those indicating high and low satisfaction with their job High Job Low Job Total Satisfaction Satisfaction Variable n (%) n (%) n (%) p-value Country of birth Israel 107 (62.2%) 81 (75.7%) 26 (24.3%) Other 65 (37.8%) 50 (76.9%) 15 (23.1%) Family status Single 47 (27.3%) 35 (74.5%) 12 (25.5%) Married 117 (68.0%) 91 (77.8%) 26 (22.2%) Other 8 (4.7%) 5 (62.5%) 3 (37.5%) Place of work Near residency 143 (85.1%) 117 (81.8%) 26 (18.2%) 0.004* Far from residency 25 (14.9%) 14 (56.0%) 11 (44.0%) Membership in the IDHA Yes 136 (80.0%) 108 (79.4%) 28 (20.6%) No 34 (20.0%) 23 (67.6%) 11 (32.4%) Working in private sector Yes 122 (70.1%) 102 (83.6%) 20 (16.4%) 0.001* No 52 (29.9%) 31 (59.6%) 21 (40.4%) Working in another occupation Yes 66 (38.2%) 45 (68.2%) 21 (31.8%) 0.033* No 107 (61.8%) 88 (82.8%) 19 (17.8%) Willing to add hours as dental hygienist Yes 105 (61.0%) 75 (71.4%) 30 (28.6%) 0.039* No 67 (39.0%) 57 (85.1%) 10 (14.9%) Would choose the profession again Yes 112 (67.1%) 104 (92.9%) 8 (7.1%) <0.001* No 55 (32.9%) 26 (47.3%) 29 (52.7%) Perception of high value within the Always and mostly 130 (75.1%) 116 (89.2%) 14 (10.8%) <0.001* dental community Sometimes, seldom, and never 43 (24.9%) 16 (37.2%) 27 (62.8%) Total n (%) 180 (100.0%) 133 (76.4%) 41 (23.6%) Note: High job satisfaction reflects respondents rating of 6 10 on a scale of 1 to 10 in which 1=not satisfied and 10=maximal satisfaction. Low job satisfaction reflects a rating of 1 5 on the same scale. Pearson chi-square was used to determine p-value. *Statistically significant at p<0.05 October 2012 Journal of Dental Education 1373

4 (83.6 versus 59.6 percent; p=0.001), and who did not also work in another occupation (82.8 versus 68.2 percent; p=0.033). The dental hygienists who did not want to add working hours in the profession reported significantly higher job satisfaction (85.1 versus 71.4 percent; p=0.039). Almost 93 percent of the respondents who would have chosen the profession again and 89.2 percent who perceived themselves as highly valued in the dental community had higher job satisfaction when compared with those who would not choose the profession again and perceived their value within the dental community as low (Table 1). The responding dental hygienists who had high job satisfaction were significantly older (37.54 versus years; p=0.013) and had more job experience (9.75 versus 6.11 years; p=0.024), a higher number of workplaces (2.29 versus 1.50; p<0.001), with fewer hours working in another occupation (5.50 versus 11.99; p=0.014) and more weekly hours in the private sector (13.33 versus 8.61; p=0.036) (Table 2). The results of the multivariate regression analysis indicated that a high number of workplaces (OR=2.034), years of experience (OR=1.109), and hypothetically choosing again to be a dental hygienist (OR=13.663) were the main predictors of high job satisfaction (R 2 =0.491) (Table 3). Discussion Dental hygienists are a major dental human resource in all countries, including Israel. Over the last year, fundamental changes in dental treatment coverage for children and increased funding for primary prevention have offered a unique opportunity to enhance and expand the utilization of dental hygiene care. In accordance with this aim, it is imperative that we evaluate dental hygienists job satisfaction and practice patterns. Our study found that dental hygienists work satisfaction in Israel was relatively high and comparable to satisfaction levels in a survey conducted in the United Kingdom in The median level of job satisfaction found in our study was 8 on a scale from 1 to 10 with 10=highest Table 2. Mean and standard deviation on demographic and professional variables for total respondents and divided into those indicating high and low satisfaction with their job High Job Low Job Total Satisfaction Satisfaction Variable Mean±SD Mean±SD Mean±SD p-value Age (years) 36.35± ± ± * Experience (years) 8.94± ± ± * Number of children 1.61± ± ± Number of working places 2.11± ± ±1.13 <0.001* Weekly working hours as a dental hygienist 23.64± ± ± Weekly working hours in another occupation 7.05± ± ± * Hours weekly in private sector 12.34± ± ± * Number of hours willing to add as a dental hygienist 9.37± ± ± Note: High job satisfaction reflects a rating of 6 10 on a scale of 1 to 10 in which 1=not satisfied and 10=maximal satisfaction. Low job satisfaction reflects a rating of 1 5 on the same scale. Independent t-test was used to determine p-value. *Statistically significant Table 3. Stepwise multiple logistic regression for effects of independent variables on job satisfaction among a sample of dental hygienists in Israel Variable B Sig. OR 95% CI Number of working places Years of experience Again choose dental hygiene profession Yes < No Constant Note: Number of working places and years of experience are continuous variables Journal of Dental Education Volume 76, Number 10

5 satisfaction; this level of satisfaction is comparable to results found in the United States and Denmark. 4 The ratio of dental hygienists to dentists in Israel is considerably lower than other Western countries, such as the United States, Canada, Germany, and Australia. 14 In contrast, dental hygienists in Israel report their willingness to add more working hours. This may indicate an underemployment in this country. This finding is consistent with the previous dental hygienist satisfaction survey conducted in Israel. 6 The legislative change in Israel can theoretically add more available positions in the public sector. It is therefore possible and hoped that the recent legislative changes may contribute to an increase in jobs available for dental hygienists. The increase in the budget of the primary prevention program for children may result in more jobs for dental hygienists. Therefore, dental schools should update dental hygiene education programs and emphasize active methods for oral health education as part of the expanded scope of the primary prevention program. At the present time, for instance, only 4 percent of the curriculum for a recognized dental hygiene program 1 is mandated to include training in and instruction about the implementation of community prevention programs and fieldwork. The results of our study might indicate that we should reconsider this part of the dental hygiene training program. While the new legislation is innovative in placing increased priority on health issues and including oral health as one of the components in the NHIB s medical services basket, it may result in a different distribution of dental health services. This phenomenon may alter dental hygienists job satisfaction and employment and should be monitored and regulated by the Ministry of Health. A high number of workplaces was found to be significantly associated with dental hygienist job satisfaction in our study. It might be assumed that a dental hygienist who works clinically, provides dental health education in schools, or works as a health promoter in other institutes would be more satisfied and motivated, as long as the work remains within (and not outside) the limits of the profession. It can therefore be implied that focusing the dental hygiene training program on a wider spectrum of disciplines, such as dental health education, health promotion, planning and conducting community projects, and administration of dental health clinics, in addition to predominantly clinical work, might influence dental hygienists perceptions, motivation, and satisfaction. Dental hygiene training programs should provide a greater variety of tools that dental hygienists will employ in the different disciplines within their own profession. Expanding the dental hygiene training program might also promote advancing the dental hygiene curriculum toward an academic profession, as is the case, for example, in the United States and Australia. 2,3 One possible limitation of our study may result from the way we distributed the questionnaire. It is documented in the scientific literature that ed questionnaires have faster returns but lower response rates than postal mail questionnaires. 21 Overall response rates for surveys are known to be somewhat lower than hard copy surveys. 22 Attention to possible bias as a result of the distribution method is therefore critical in our study. 23 The data generated from our survey can nevertheless serve as a baseline prior to implementation of the new public health programs. Further additional surveys should be conducted within two to three years for comparison and evaluation purposes. These future results should be taken into account when deliberating about the opening of new dental hygiene programs. Conclusions Dental hygienists are an important human resource for effective implementation of dental care reform in Israel. It is not yet known how these changes will affect job availability for dental hygienists. The changes in the NHIB currently occurring in Israel might require reorientation and refocusing of dental hygiene education programs. It is imperative that dental hygienists be satisfied with their profession and willing to expand their activities. Policymakers should consider the present survey results while planning dental hygiene training programs and community prevention programs and expanding primary prevention services that employ this important resource. Acknowledgments The authors would like to acknowledge the IDHA for working with us on the questionnaire and providing updated data on its members. REFERENCES 1. Ministry of Health in Israel. At: download/forms/a3847_3.5_ pdf. Accessed: July 21, October 2012 Journal of Dental Education 1375

6 2. Australian university directory. At: study-in-australia/heath-science/dental-hygiene-oralhealth-degree-at-australian-universities/. Accessed: July 21, United States universities authoritative guide. At: www. universities.com/edu/bachelor_degrees_in_dental_ Hygiene_Hygienist.html. Accessed: July 21, Gibbons DE, Corrigan M, Newton T. A national survey of dental hygienists: working patterns and job satisfaction. Br Dent J 2001;190: Naidu R, Newton JT, Ayers K. A comparison of career satisfaction amongst dental health care professionals across three health care systems: comparison of data from the United Kingdom, New Zealand, and Trinidad and Tobago. BMC Health Serv Res 2006;6: Mann J, Stabholz A, Achinoam T. Employment of dental hygienists in Israel. Isr J Dent Med 1994;11: Sgan-Cohen HD, Mann J, Greene J. Expected functions of dental hygienists in Jerusalem: perceptions of dentists and dental hygiene students. Dent Hyg (Chic) 1987;59(12): Mann J, Call RL, Greene J, Sgan-Cohen H. The future of dental hygiene in Israel. Dent Hyg (Chic) 1987;61(3): Braunstein N, Mann J, Sela M. Professional relationship between dentists and hygienists in Israel. Adkan 2009;103: Manpower in health professions. Jerusalem: Israel Ministry of Health, Abadi N, Mann J, Sela M, Zusman SP. Professional relationship between dentists and dental hygienists in Israel. Isr Dent Hyg Assoc J 2008;31: Hopcraft M, McNally C, Ng C, Pek L, Pham TA, Phoon WL, et al. Working practices and job satisfaction of Victorian dental hygienists. Aust Dent J 2008;53: Johnson PM. International profiles of dental hygiene : a nineteen-nation comparative study. Int Dent J 2001;51: Johnson PM. International profiles of dental hygiene : a twenty-one-nation comparative study. Int Dent J 2009;59: Chernichovsky D, Chinitz D. The political economy of health system reform in Israel. Health Econ 1995; 4(2): Horev T, Mann Y. Oral and dental health: the nation s responsibility to its residents [in Hebrew]. Jerusalem: The Taub Center for Social Policy Studies, Report of the state committee of inquiry on the functioning and efficiency of the health care system in Israel [in Hebrew]. Jerusalem: The Netanyahu Committee, Kaidar N, Horev T, Rosen B. Public insurance for dental care for children. Jerusalem: The Myers, JDC, Brookdale Institute, Ayers KMS, Meldrum AM, Thompson WM, Newton JT. The working practices and job satisfaction of dental hygienists in New Zealand. J Public Health Dent 2006;66: Yavnai N, Zini A. Validity and reliability of a Hebrew version of a questionnaire for evaluation of job satisfaction and working patterns among dental hygienists in Israel. Unpublished manuscript. 21. Tse ACB. Comparing the response rate, response speed, and response quality of two methods of sending questionnaires: versus mail. J Mark Res Soc 1998;40: Yun GW, Trumbo CW. Comparative response to a survey executed by post, , and web form. J Comput Mediat Commun 2000;6(1). 23. Asch DA, Jedrziewski MK, Christakis NA. Response rates to mail surveys published in medical journals. J Clin Epidemiol 1997;50: Journal of Dental Education Volume 76, Number 10