Factors affecting intent to immigration among Iranian health workers in 2016

Analysis of Iranian health workforce emigration based on a system dynamics approach: a study protocol

BACKGROUND

Emigration of health workers has emerged as a significant obstacle in Iran, compelling policymakers to implement a diverse range of interventions and reforms to enhance healthcare services. It is imperative to comprehend the efficacy of emigration control interventions. To explore the intricate dynamics of elite emigration, this study employs a system dynamics modeling approach. The objective is to scrutinize Iranian health workers' emigration, examine the relationships, and evaluate the impact of various factors involved.

OBJECTIVES

The general purpose of this study is to analyze the policy interventions affecting the emigration of human resources in the field of health in Iran based on the system's dynamic approach.

METHOD

The research consists of four phases including analyzing the emigration status of health workers in developing countries, studying health personnel emigration in Iran, developing a System Dynamics (SD) model, and determining evidence-based policy interventions to address health worker emigration. These phases involve realist review, document analysis, qualitative interviews, data integration, and policy scenario planning. The primary objective is to gain a profound understanding of the underlying causes, mechanisms, and consequences of migration, as well as assess the impact of policies, in order to prioritize effective interventions.

RESULTS

It seems that the SD model developed in this study can highlight the interconnectedness of various factors that influence health worker emigration, including demographic changes, economic conditions, and characteristics of healthcare systems.

CONCLUSION

This study uses a systems dynamics approach to analyze health worker emigration from Iran, focusing on policies that promote retention and explore the implications of emigration on the healthcare system. By examining interrelationships and feedback loops within the healthcare system and socioeconomic factors, the study aims to identify effective policy interventions that can mitigate the negative effects of emigration.

Cultural Intelligence and Migration Intentions Among Nursing and Midwifery Students in Southeastern Region of Turkey: A Correlational Study

AIM

This study explores the relationship between cultural intelligence and attitudes towards the intention to migrate among nursing and midwifery students.

METHODS

Using a correlational design, data were collected from 804 students through the Student Descriptive Form, The Attitude Scale for Brain Drain in Nursing Students and the Cultural Intelligence Scale. The analysis was conducted using IBM SPSS Statistics and AMOS, employing structural equation modelling and analysis of variance.

RESULTS

The majority of participants were female (84.8%) and Turkish citizens (89.1%). The findings showed that both cultural intelligence levels and attitudes towards brain drain were above average. A positive correlation was identified between cultural intelligence and attitudes towards the intention to migrate.

CONCLUSION

Enhancing cultural intelligence through intercultural education, overseas experiences and multilingual proficiency is essential. The study underscores the critical need for policy reforms aimed at improving working conditions in low-income countries and addressing the challenges posed by the intention to migrate.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Incorporating cultural intelligence training into nursing and midwifery curricula is essential for preparing students to work in multicultural healthcare settings. Educational reforms are needed to equip future healthcare professionals with the skills required for diverse patient care. Additionally, policy interventions aimed at improving working conditions and offering better incentives in low-income regions are critical to mitigating brain drain by addressing the root causes of migration among skilled healthcare workers.

IMPACT

The study underscores the role of cultural intelligence in shaping the migration intentions of nursing and midwifery students. It highlights how higher levels of cultural intelligence correlate with more positive attitudes towards migration, suggesting that culturally adept healthcare professionals may be more inclined to seek international opportunities.

REPORTING METHOD

This study adhered to the STROBE guidelines for reporting observational studies.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Original Research: Nurses' Attitudes Toward Brain Drain and the Associated Factors

BACKGROUND

Brain drain refers to the emigration of scientists and other educated professionals from a low- or middle-income country to a high-income country for work. In recent years, this trend has increased, particularly in the health care arena. Prior studies among nurses and nursing students indicate that migration mainly occurs from low- and lower middle-income countries to high-income countries. This study aimed to explore the attitudes of Turkish nurses, nurse academics, and nursing students toward brain drain and the factors associated with these attitudes.

METHODS

The study used a mixed-methods research design. The quantitative part of the study was conducted with 1,018 participants. The qualitative part was conducted with 26 participants from the larger sample who volunteered for focus group interviews. Data were collected from June through August 2022 using an online survey, the Attitude Scale for Brain Drain, and a semistructured interview guide.

RESULTS

Of all participants, 84.3% indicated that they wanted to work and live abroad. Nearly 95% stated that there was a risk of brain drain in the nursing profession, with economic factors given as the most significant reason. As age and years of professional experience increased, brain drain tendency decreased. Nurses and nursing students had higher brain drain tendencies than nurse academics. In focus group interviews, participants reported concern that the brain drain might lead to losses in the qualified nursing workforce and increase the workload for the remaining nurses in the migrant-sending country, while cultural adaptation issues can be difficult for nurses in the migrant-receiving country.

CONCLUSIONS

Brain drain in the nursing profession continues to be a current, crucial problem. This study showed that among Turkish nurses, nursing students, and nurse academics, the desire to work abroad was quite high, and all three groups had high brain drain tendency scores. Brain drain has serious consequences for both migrant-receiving and migrant-sending countries. These findings can help inform the development of initiatives aimed at preventing or mitigating nursing brain drain.

The factors that are associated with nurse immigration in lower- and middle-income countries: An integrative review

AIM

This study aims to synthesize the factors associated with nurse emigration from lower and middle-income countries.

DESIGN

Integrative review.

METHODS

An in-depth search of registries and five databases yielded 9466 records. Using the PRISMA guidelines, 11 were chosen after screening by two authors independently. The mixed methods appraisal tool (MMAT) was used to assess the risk of bias.

RESULTS

The destination countries were Europe and North America, with an inclination for nurse migration of 14.3%-85%. Emigration factors were poor salary, working conditions, poor quality  healthcare infrastructure; outdated healthcare technologies, lack of employment opportunities, younger age, relationship status (single), living environment, social pressure, urban residence, work experience, insecurity, high crime rates, political corruption and foreign language skills.

PUBLIC CONTRIBUTION

Healthcare authorities and nursing leaders must implement practical measures to minimize nurse emigration.

Drivers of health workers' migration, intention to migrate and non-migration from low/middle-income countries, 1970-2022: a systematic review

BACKGROUND

The migration of healthcare workers (HWs) from low/middle-income countries (LMICs) is a pressing global health issue with implications for population-level health outcomes. We aimed to synthesise the drivers of HWs' out-migration, intention to migrate and non-migration from LMICs.

METHODS

We searched Ovid MEDLINE, EMBASE, CINAHL, Global Health and Web of Science, as well as the reference lists of retrieved articles. We included studies (quantitative, qualitative or mixed-methods) on HWs' migration or intention to migrate, published in either English or French between 1 January 1970 and 31 August 2022. The retrieved titles were deduplicated in EndNote before being exported to Rayyan for independent screening by three reviewers.

RESULTS

We screened 21 593 unique records and included 107 studies. Of the included studies, 82 were single-country studies focusing on 26 countries, while the remaining 25 included data from multiple LMICs. Most of the articles focused on either doctors 64.5% (69 of 107) and/or nurses 54.2% (58 of 107). The UK (44.9% (48 of 107)) and the USA (42% (45 of 107)) were the top destination countries. The LMICs with the highest number of studies were South Africa (15.9% (17 of 107)), India (12.1% (13 of 107)) and the Philippines (6.5% (7 of 107)). The major drivers of migration were macro-level and meso-level factors. Remuneration (83.2%) and security problems (58.9%) were the key macro-level factors driving HWs' migration/intention to migrate. In comparison, career prospects (81.3%), good working environment (63.6%) and job satisfaction (57.9%) were the major meso-level drivers. These key drivers have remained relatively constant over the last five decades and did not differ among HWs who have migrated and those with intention to migrate or across geographical regions.

CONCLUSION

Growing evidence suggests that the key drivers of HWs' migration or intention to migrate are similar across geographical regions in LMICs. Opportunities exist to build collaborations to develop and implement strategies to halt this pressing global health problem.

Iranian medical students' tendency to migrate and its associated factors

BACKGROUND

Medical staff migration is one of the challenges for both developed and developing countries affecting society's health and welfare, which limits access to equity. Therefore, this study was designed and conducted to investigate the tendency to migrate and the factors affecting it among medical students of the Tehran University of medical sciences, Tehran, Iran, in 2019.

METHODS

This cross-sectional study was performed among 472 medical students using a valid questionnaire which was designed after reviewing the literature and using the opinions of experts. The tendency to migrate and its associated factors were analyzed and reported using the Pearson correlation test, independent t-test, one-way ANOVA test, Tukey post-hock test, and Kruskal-Wallis non-parametric test.

RESULTS

According to this study, the tendency to migrate was 6.13 ± 2.82 out of 10. While there was no significant relationship between age, marital status, medical educational phase and the tendency to migrate (p > 0.05); There was a significant relationship between willingness to migrate with variables of gender (p = 0.027), pre-university study region (p < 0.001), father's academic degree (p = 0.007), mother's academic degree (p < 0.001), having the relative abroad (p < 0.001), foreign trip experience (p < 0.001), foreign language skills (p < 0.001), number of published articles (p = 0.005) and Iran's National Elite Foundation membership (p = 0.039).

CONCLUSIONS

Females, elites, and those with higher socioeconomic state, previous exposure to foreign countries, the ability to speak foreign languages, and research activity are more likely to migrate. Considering the high tendency to migrate among Iranian medical students, urgent and severe strategies must be undertaken to solve this social and health problem.

Career future perceptions and attitudes towards migration of nursing students: A cross-sectional multicenter study

BACKGROUND

It is important to understand the perceptions of career plans and attitudes towards migration of nursing students so that it can be possible to review the education programs in this direction and plan an effective health workforce.

AIM

To determine nursing students' career future perceptions and attitudes towards migration.

DESIGN

Descriptive and cross-sectional online survey.

METHODS

The study was completed with 3053 students from 52 universities located in seven different regions of Turkey who agreed to participate in the study. The data were collected using the "Student Information Form", "Attitude Scale for Brain Drain (ASBD)" and "Career Futures Inventory (CFI)" with an online questionnaire. Descriptive statistics, independent samples t-test, one-way analysis of variance and correlation were used to analyze the data.

RESULTS

Mean age of the students was 20.29 ± 2.28 and most were females. Students' mean total scores of ASBD, and CFI were 56.64 ± 12.22 and 91.32 ± 11.71 respectively. There was a statistically significant difference between the total mean scores of ASBD and the region of the university where the students studied, gender, being multilingual, desire to work abroad after graduation and experience of participating in student exchange programs and between the total mean scores of CFI and experience of participating in an exchange program. There was a positive and statistically significant relationship between ASBD and CFI total mean scores (p < 0.05).

CONCLUSION

Nursing students' attitudes towards migration and perceptions of career future were positive and there was a positive relationship between attitudes towards migration and perceptions of career future.

Attitude towards migration of psychiatric trainees and early career psychiatrists in Iran

INTRODUCTION

Migration of medical professionals has been rapidly increasing in the past decades and it strongly affects origin and destination countries.

OBJECTIVES

We aimed to explore the extent and the reasons of migration among psychiatric trainees and early career psychiatrists in Iran.

METHODS

Our semi-structured 61-items questionnaire inquired participants' demographics, experiences of short-term mobility (from 3 months to 1 year), long-term migration (more than 1 year) and attitudes towards migration (current and future plans).

RESULTS

A total of 184 responses were received. Most (73.4 %) participants were female, and within the age range of 25-65 (Mean: 34.9). Only 15.2 % had a short-term mobility experience, mostly due to academic reasons (35.7 %). Most (75 %) stated that this short-term mobility experience influenced them in favor of migration. The majority (83.7 %) had 'ever' considered leaving Iran, and more than half (57.3 %) stated they 'strongly agree' or 'agree' to leaving the country 'now' (at the time of the study). The main reason to migrate from Iran was first political, followed by work, financial, social, religious, academic, and cultural reasons, and the least ranked were personal reasons. In relation to their 5-year plans, 67.3 % saw themselves in the country they currently live in, Iran. The main features reported for an attractive job were 'pleasant work environment' (97.3 %), 'good welfare and social security' (96.7 %) and 'high salary '(96.2 %).

CONCLUSIONS

This study calls for more support of psychiatric trainees and early career psychiatrists in Iran. Improvements in the political context, work conditions and finances might lower the rate of migratory intention and brain drain.

Does the mutual recognition agreement on nursing services accelerate nurse migration in member countries of the Association of Southeast Asian Nations?

Aim

To clarify the situations of nursing education and activity, its affecting factors and the nursing educators' views on nurse migration relating Mutual Recognition Agreement on Nursing Services in the Association of Southeast Asian Nations. Design: Descriptive qualitative research.

Methods

The individual semi-structured interviews with 11 nursing educators, analysed using thematic analysis.

Results

Nursing educators acknowledged that the change in nursing was mainly due to the creation and amendment of laws, acts and regulations regarding nursing and improvements in nursing education systems. Some of these improvements occurred by this mutual agreement. The conceptualization of the progress indicated an improvement in the quality of nursing. Nurse migration to the outside of Southeast Asian countries might be accelerated due to concurrent improvements in the quality of nursing. New trends among nurses working as caregivers in surrounding countries such as China, South Korea and Japan to deal with demographic ageing should be considered.