Influence of well-being and quality of work-life on quality of care among healthcare professionals in southwest, Nigeria

The Nigerian healthcare industry is bedevilled with infrastructural dilapidations and a dysfunctional healthcare system. This study investigated the influence of healthcare professionals' well-being and quality of work-life (QoWL) on the quality of care (QoC) of patients in Nigeria. A multicentre cross-sectional study was conducted at four tertiary healthcare institutions in southwest, Nigeria. Participants' demographic information, well-being, quality of life (QoL), QoWL, and QoC were obtained using four standardised questionnaires. Data were summarised using descriptive statistics. Inferential statistics included Chi-square, Pearson's correlation, independent samples t-test, confirmatory factor analyses and structural equation model. Medical practitioners (n = 609) and nurses (n = 570) constituted 74.6% of all the healthcare professionals with physiotherapists, pharmacists, and medical laboratory scientists constituting 25.4%. The mean (SD) participants' well-being = 71.65% (14.65), QoL = 61.8% (21.31), QoWL = 65.73% (10.52) and QoC = 70.14% (12.77). Participants' QoL had a significant negative correlation with QoC while well-being and quality of work-life had a significant positive correlation with QoC. We concluded that healthcare professionals' well-being and QoWL are important factors that influence the QoC rendered to patients. Healthcare policymakers in Nigeria should ensure improved work-related factors and the well-being of healthcare professionals to ensure good QoC for patients.

Pattern and perception of wellbeing, quality of work life and quality of care of health professionals in Southwest Nigeria

BACKGROUND

Personal wellbeing (PW) including quality of life and work life is a very complex concept that influences health professionals' commitment and productivity. Improving PW may result in positive outcomes and good quality of care. Therefore, this study aimed to assess the pattern and perception of wellbeing, quality of work life (QoWL) and quality of care (QoC) of health professionals (HPs) in southwest Nigeria.  METHODS: The study was a convergent parallel mixed method design comprising a cross-sectional survey (1580 conveniently selected participants) and a focus group interview (40 purposively selected participants). Participants' PW, quality of life (QoL), QoWL, and QoC were assessed using the PW Index Scale, 5-item World Health Organization Well-Being Index, QoWL questionnaire, and Clinician QoC scale, respectively. The pattern of wellbeing, QoWL and quality of care of HPs were evaluated using t-test and ANOVA tests. Binary regression analysis was used to assess factors that could classify participants as having good or poor wellbeing, QoWL, and quality of care of HPs. The qualitative findings were thematically analyzed following two independent transcriptions. An inductive approach to naming themes was used. Codes were assigned to the data and common codes were grouped into categories, leading to themes and subthemes.

RESULTS

Of 1600 administered questionnaires, 1580 were returned, giving a 98.75% response rate. Only 45.3%, 43.9%, 39.8% and 38.4% of HP reported good PW, QoL, QoC and QoWL, respectively; while 54.7%, 56.1%, 60.2% and 61.6% were poor. There were significant gender differences in PW and QoC in favor of females. With an increase in age and years of practice, there was a significant increase in PW, QoWL and QoC. As the work volume increased, there was significant decrease in QoWL. Participants with master's or Ph.D. degrees reported improved QoWL while those with diploma reported better QoC. PWI and QoC were significantly different along the type of appointment, with those who held part-time appointments having the least values. The regression models showed that participant's characteristics such as age, gender, designation, and work volume significantly classified health professionals who had good or poor QoC, QoWL, PW and QoL. The focus group interview revealed four themes and 16 sub-themes. The four themes were the definitions of QoC, QoWL, and PW, and dimensions of QoC.

CONCLUSION

More than half of health professionals reported poor quality of work life, quality of life and personal wellbeing which were influenced by personal and work-related factors. All these may have influenced the poor quality of care reported, despite the finding of a good knowledge of what quality of care entails.

Anthropometric determinants of lung function in apparently healthy individuals

Background

Forced vital capacity (FVC) and peak expiratory flow rate (PEFR) are used to assess and monitor the management of lung pathology.

Objectives

Our study documented spirometry reference values for apparently healthy Nigerians and developed predictive equations for pulmonary function.

Method

A cross-sectional survey involving healthy adult Nigerians included anthropometric measurements of weight, height, waist, hip circumference (HC), sagittal abdominal diameter (SAD) and percentage body fat. Anthropometric indices (body mass index [BMI] and waist-to-hip ratio [WHR]) were estimated and pulmonary function tests (FVC, forced expiratory volume in 1 s [FEV1], PEFR, FEV1/FVC ratio) measured. The association amongst selected anthropometric and socio-demographic variables and pulmonary function test parameters were established using t-tests and Pearson’s product moment correlation tests. The predictors of pulmonary function were established using stepwise multiple linear regression models.

Results

Four hundred and forty-four adults (156 [35.1%] men) were included, mean age 37.3 ± 8.25 (range 22–25) years. Male participants had significantly higher lung volumes than females (p < 0.05). Age, height, weight and percentage body fat had significant low correlations with lung function test parameters (p < 0.05). Fat-free mass (FFM), fat mass (FM), SAD, height and age of participants were main predictors of FVC and FEV1 (R² = 0.43 and 0.41, respectively). Fat-free mass and SAD were main predictors of PEFR (R² = 0.53). Sagittal abdominal diameter and age were main predictors of FEV1/FVC ratio (R² = 0.34).

Conclusion

Fat-free mass, FM, height, age and SAD are important determinants of lung volumes and key variables for predictive equations of pulmonary function.

Clinical implications

An accurate documentation of pulmonary function values for apparently healthy Nigerian adults may be useful in identifying deviations from normative values thereby giving an index of suspicion for the diagnosis of pulmonary dysfunction.

Keywords

anthropometric; lung function; spirometry; fat-free mass; apparently healthy.