literature review on factors affecting job satisfaction

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• Published: 24 April 2023

The factors associated with teachers’ job satisfaction and their impacts on students’ achievement: a review (2010–2021)

• Kazi Enamul Hoque 1 ,
• Xingsu Wang 1 ,
• Yang Qi 1 &
• Normarini Norzan 2  

Humanities and Social Sciences Communications volume  10 , Article number:  177 ( 2023 ) Cite this article

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The success of any educational organization depends heavily on the effectiveness of its teachers, who are tasked with transferring knowledge, supervising students, and enhancing the standard of instruction. Teachers’ job satisfaction has a significant impact on the lessons they teach since they are directly involved in transferring knowledge to students. In order to determine the effect of teachers’ job satisfaction (TJS) on students’ accomplishments, the researchers sought to analyze the empirical studies conducted over the previous 12 years (SA). To determine the characteristics that link to instructors’ job satisfaction and their effect on students’ achievement, thirty-two empirical studies were examined. The analysis of world-wide empirical research findings shows four types of results: (i) In some countries, teachers’ job satisfaction is low, but students’ achievement is high (Shanghai, China, South Korea, Japan, Singapore) (ii) In some countries, teacher job satisfaction is high, but student achievement is low (Mexico, Malaysia, Chile, Italy). (iii) In some countries, teachers’ job satisfaction is high, and so is student achievement (Finland, Alberta, Canada, Australia). (iv) In some countries, teacher job satisfaction is low, which has a negative impact on student achievement (Bulgaria, Brazil, Russia). In sum, irrespective of countries, highly satisfied teachers give their best to their students’ success, not only by imparting knowledge but also by giving extra attention to ensure the better achievement of each student. The review of this study makes it even more worthwhile to reflect on the need to avoid stereotypical considerations and assessments of any objective presentation of the phenomenon and to reflect more deeply on the need to assess the validity of the relationship study.

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Introduction.

Teachers are the main part of the school education system. The factors affecting students’ achievement (SA) should be multifaceted. Among them, teachers are one of the important factors that affect students’ academic performance (Ma, 2012 ). Teacher job satisfaction (TJS) refers to teachers’ satisfaction with their current work, which can be divided into internal satisfaction and external satisfaction (Wang, 2019 ). TJS inquiry and analysis can help managers not only comprehend teachers’ professional attitudes and avoid burnout but also provide some guidance for management decision-making. Improving TJS will assist instructors in maintaining a high level of passion and enthusiasm for their profession for a long time, allowing them to play even better in the lesson and ensuring consistent teaching quality (Zong, 2016 ). Teachers must have proper work satisfaction in order to be fully ready to transmit knowledge and skills important for learners to develop in SA. Teachers have been revered as “nation builders”. More specifically, teachers who teach in colleges and train students into elites and have talents in different disciplines are the key to a nation. Low TJS may lead to lower levels of education (Borah, 2016 ).

Many studies show that TJS has a significant positive correlation with job performance. As an example, Hayati & Caniago ( 2012 ) found that higher job satisfaction is conductive to higher job performance, while Ejimofor’s ( 2015 ) finding shows triadic relationships in which it indicates that TJS improves teaching quality, and teaching quality has the direct effect of improving students’ quality. One of the most important topics in every academic organization is TJS and SA. TJS not only increases productivity but also helps promote a productive teaching and learning environment. Based on this, both school administrators and the government should give more attention to meeting the needs of teachers to improve their motivational level to achieve educational goals so as to improve student academic performance (Ihueze et al., 2018 ). Surprisingly, though some researchers did not find a substantial link between TJS and SA (Ejimofor, 2015 ; Borah, 2016 ), the intuition and popular expectation is that TJS affects SA significantly and directly (Fisher, 2003 ). Moreover, Lopes & Oliveira ( 2020 ), utilizing information from the 2013 Teaching and Learning International Survey, demonstrated that teacher job satisfaction is a vital element of teachers’ and schools’ performance as well as students’ academic and educational attainment (TALIS). They also discovered that aspects of interpersonal relationships are the most effective predictors of job happiness. They advised schools to improve by addressing interpersonal problems, especially in the classroom, where the majority of perceived job satisfaction tends to reside. The findings demonstrated that, (1) among the personal traits of teachers, teacher efficacy had significant effects on job satisfaction (You et al., 2017 ). As the factors affecting teachers’ job satisfaction vary depending on the context of different countries, this review included studies from different regions to give a comprehensive scenario of findings based on different regional factors. The review results have revealed the associated factors of teachers’ job satisfaction and their impacts on student achievement. The findings can be the subject of further exploration. The review study set out to accomplish the following objectives:

Objectives:

to find whether teachers’ job satisfaction (TJS) has an impact on student achievement (SA)

to find the factors that have a positive impact on TJS and SA

to find the factors that influence the effect of TJS on SA and that manifest differently in different countries

Theoretical background

Between 2010 and 2021, the number of studies examining the impact of TJS on SA increased significantly.

Conceptualization of teachers’ job satisfaction

Job satisfaction is one of the important topics in the fields of occupational psychology, organizational behavior, and human resource management to explore employee productivity and organizational effectiveness (Fisher, 2003 ). With the development of humanistic thinking and the concept of lifelong education, this concept has been generally accepted by people, and the academic community has increasingly paid attention to the work-related emotional experiences of different professional or occupational groups such as teachers, nurses, etc.

Generally speaking, TJS refers to a teacher’s overall emotional experience and cognitive expression of their occupation, working conditions, and state. The international community generally believes that, as a variable of emotional attitude, TJS itself not only covers different dimensions but, more importantly, TJS has an important and direct impact on teachers’ enthusiasm and commitment to teaching. Daily work efficiency and effectiveness are also powerful predictors of SA. In addition, from the perspective of organizational commitment, improving TJS is an important way to enhance teachers’ sense of identity and belonging to the school, as well as to improve teachers’ professional attractiveness.

From the perspective of logical inference, according to the important phenomenon of the mentoring effect in the rise of talent chains and talent groups in the history of scientific development, as well as the practical experience that “the greatest happiness of teachers comes from the extraordinary achievements of students,” and even the word “teacher” often used when praising teachers, judging from the phrases such as “famous teachers produce master apprentices” and “peaches and plums fill the world,” in practical work, SA should also be one of the important sources of TJS (Wang & Zhang, 2020 ).

Factors affecting the teachers’ job satisfaction

Different studies have used different elements that have direct, indirect, or even no impacts on the job satisfaction of teachers. In their research on college teachers’ job satisfaction, Shi et al. ( 2011 ) revealed that work treatment, job pressure, leadership behavior, gender, age, etc. have more or less influence on the job satisfaction of college teachers. Existing research usually divides the factors that affect TJS into four levels: individual, school, work, and others. The influencing factors at the individual level can be grouped into objective factors and subjective factors. Among them, objective factors include teachers’ educational background, teaching years (experience), gender, professional title, monthly income and workload, teaching subjects, etc.; subjective factors include occupational preference and work engagement.

The two main influencing variables at the school level are students and management. While the management aspect comprises the institutional culture of the school and student management, the student aspect includes the student’s learning environment. The professional growth environment, work pressure, learning exchange possibilities, etc. are examples of workplace factors. The location of the school (eastern, central, or western) and whether it is located in an urban or rural area are examples of other levels (Beijing Normal University Teachers’ Labor Market Research Group et al., 2021 ).

These elements can be categorized into three groups when considered collectively: the elements of the college professors themselves, the elements of the institutions, and the level of compatibility between individuals and roles. The author’s research focuses on the connection between these three variables and college professors’ job satisfaction (Shi et al., 2011 ).

Professional title, educational background, and job satisfaction are among the factors that teachers can control for themselves, but these variables have very weak correlations and cannot be used as explanatory variables in the regression equation. Age, on the other hand, has a weak correlation with job satisfaction but can be used as a variable to explain job satisfaction. Salary level is the school component that has the greatest impact on TJS. The primary output that teachers receive from the organization is compensation, which is also a key component that teachers demand from the organization. The degree of alignment between instructors’ expectations and their compensation is the most significant element determining TJS in terms of the matching of people to roles.

Student achievement

Defining a student’s grades is not an easy task. The most common metric of achievement is undoubtedly student performance on achievement exams in academic disciplines like reading, language arts, math, science, and history. The quality of schools and teachers, students’ backgrounds and situations, and a host of other variables all have an impact on academic attainment (Cunningham, 2012 ). The researchers looked at academic levels, achievement gaps, graduation and dropout rates, student and school development over time, and student success after high school.

Academic achievement is the ability to complete educational tasks. Such achievements can be general or topic-specific. Academic achievement refers to students’ scores in courses, curriculums, courses, and books that they have studied, expressed in the form of marks, percentages, or any other scale of marks (Borah, 2016 ). It is important to highlight that academic performance encompasses not only students’ achievement in tests and exams, but also their participation in social events, cultural events, entertainment, athletics, and other activities in academic institutions and organizations.

Conceptual framework of the study

How to improve the academic performance of students is a popular topic in the field of education. After all, the purpose of education is to train students to become talents in society. Between 2010 and 2021, scholars from many different countries studied the relationship between TJS and SA. Many scholars’ studies have shown that there is a significant positive correlation between TJS and SA (McWherter, 2012 ; Crawford, 2017 ; Andrew, 2017 ; Iqbal et al., 2016 ). In these studies, the effects of TJS on SA were investigated, suggesting that it is fairly common in the literature to study the relationship between the two as a theme (Ejimofor, 2015 ; Borah, 2016 ).

Specifically, some districts have high SA but lower TJS than average schools. While some districts had high TJS, this did not improve SA. Therefore, it makes sense to understand the findings of these studies as a whole. What’s more, it is necessary to sort out the reasons for this divergence among numerous studies and make comparisons. The following questions serve as a guide for this study’s analysis of the findings in the literature on the effect of TJS on SA.

Does research show that TJS has an impact on SA?

What factors will have positive impact on tjs and sa.

What factors influence the effect of TJS on SA that manifests differently in different countries?

By examining previous research, this work seeks to characterize teacher motivation and assess the evaluation criteria and processes that account for student performance. The research method is systematically summarizing and analyzing based on a literature review, which helps us research and analyze the topic from a dialectical perspective. This study refers to the model of PSALSAR. The process of selecting documents starts with analyzing the topic, searching and classifying relevant documents, screening relevant documents from different sources according to the selection criteria, and finally extracting the most relevant documents for sorting out. Analysis (Bearman et al., 2012 ). The scope of this review also followed four criteria as outlined in the review work of Wayne & Youngs ( 2003 ).

Data sources

The data for this literature review was extracted from three major data sources: Web of Science, Scopus, Google Scholar, and HowNet. The review intended to take into account all recognized and relevant sources reporting on studies that are in English and falls within the duration of the study, which is a 12-year period from 2010 to 2021. The aim of the search is to locate all appropriate literature without expanding the search too much and retrieving a huge number of unrelated results. After applying an analytical inclusion/exclusion criterion to the 721 papers that were found, 32 papers were found to be applicable to the study’s objectives.

Data screening

The databases were searched using the following terms: “career management of teachers,” “teacher job satisfaction,” “student achievement,” and “teacher job satisfaction and student achievement.”

There is much literature on the relationship between TJS and SA, many of which use TJS as a mediator, or TJS is just one of the variables to promote SA. Since the focus of this review was on the impact of TJS on SA, the literature search consisted of two phases to ensure that all relevant literature on the relationship between the two was included. In the first phase, which focused on TJS, the following search terms were used: “teacher job satisfaction”, “teacher work satisfaction” and “teacher satisfaction”, combined with the search term “SA”. In the second stage, the focus is on the effect of TJS on the SA selected from the first stage choices. After screening for keywords and selecting the year interval as 2010–2021, 26 documents were finally extracted for research. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) is an evidence-based framework that clearly defines the bare minimum of items to be included in systematic reviews and meta-analyses (Moher et al., 2009 ).

Inclusion and exclusion criteria

In order to check on the quality and validity of the data obtained, the most recent journals available on the topic were chosen. Also, a high priority was given to reading the findings and extracts of every journal before it was selected for review. Literature analysis adopts the selected research selected by narrative methods so that the author can understand the literature and find the mode by carefully reading and interpreting the research results (De Rijdt et al., 2013 ).

Next, each article is completely reread to determine the important part. Based on the content analysis method, the paragraphs of important information containing the answer to the hypothesis research question are encoded. In this literature review, as mentioned in an earlier section, the PRISMA is applied to the inclusion and exclusion criteria for the review. The table below depicts the details (Table 1 ).

The review results of 32 empirical studies have revealed the following answers to formulated research questions. The answers are organized according to research questions.

From 2010 to 2021, most studies from different countries have shown that TJS has a positive impact on students SA (McWherter, 2012 ; Crawford, 2017 ; Farooqi & Shabbir et al., 2016 ) The morale of teachers is closely related to the academic achievements of students (Sabin, 2015 ). This is because when the teacher is dissatisfied with their work, they will transfer it to students in many ways, including the absence of classes. When this happens, students will suffer, and their academic performance will inevitably be negatively affected.

The research results also show that the more teachers believe that teaching is a valuable occupation, the more satisfied they are (Armstrong, 2009 ), and the better the students’ outcomes. A study in two sub-Saharan African nations examined the degree of teacher satisfaction in Uganda and Nigeria, its causes, and how it affects the quality of instruction and learning (Nkengne et al., 2021 ). According to research, teachers who are satisfied with their jobs are more likely to teach effectively, which should help their pupils learn more in the classroom. In order to make employees play a greater role, the work itself must have satisfactory characteristics. If it is interesting, it has good income and work safety. A teacher with high work satisfaction usually puts more effort into teaching and learning (Ihueze et al., 2018 ). However, whether it is based on the conclusions of existing mainstream theoretical research or on practical experience, low job satisfaction will not only affect teachers’ teaching enthusiasm but also cause teachers to have a teaching attitude problem of “not happy to teach”, as a result, it may even lead to the problem of “poor teaching” ability and ultimately have a negative impact on students’ academic performance; at the same time, it will also have a negative effect on the organizational commitment of in-service teachers and the professional attractiveness of teachers (Wang and Zhang, 2020 ).

The results of several earlier investigations likewise show the opposite. The intuition and general expectations of the work satisfaction of teachers will affect the students’ grades (Fisher, 2003 ). TJS lacks a significant relationship with student grades, which is in line with the findings of Banerjee et al. ( 2017 ). According to their longitudinal study of young children between kindergarten and fifth grade, student reading growth has no association with teacher job satisfaction, but there is a slight but favorable relationship between the two. Although this seems to be a violation, it is consistent with the previous 41 research (Iaffaldano & Muchinsky, 1985 ; Fisher, 2003 ). Studies lack significant relationships between TJS and children’s academic achievements (Ejimofor, 2015 ). The relationship between TJS and SA can be ignored, which is to say that teachers’ job satisfaction has no significant impact on SA (Borah, 2016 ). Despite such findings, most of the scholars agree with the notion that job satisfaction concerning school teachers reflects their strong motivation towards their dedication to students’ performance (Manandhar et al., 2021 ).

TJS has a positive impact on the quality of education; therefore, affecting teacher job satisfaction can affect the quality of education. However, because multiple factors have a significant effect on TJS and SA, not all things that improve TJS also improve academic performance. In many circumstances, the aims of increasing job happiness and enhancing student accomplishment are antagonistic rather than complimentary (Michaelowa, 2002 ).

System control factors and incentive structures, in particular, due to a complete lack of job protection, have been found to have a significant positive impact on teacher performance, although they tend to be strongly opposed by the instructors involved. According to a study (Tsai & Antoniou, 2021 ) conducted in Taiwan with 113 teachers and 2,334 students to examine the relationships between teacher attitudes toward teaching mathematics, teacher self-efficacy, student achievement, and teacher job satisfaction, teacher attitudes toward teaching mathematics, efficacy in the classroom, and student achievement in mathematics could, to some extent, explain variations in teacher job satisfaction. The majority of the variation in teacher job satisfaction, which may translate into improved teacher efficacy and student achievement, was explained by teacher attitudes about teaching mathematics. It suggests that improving the quality of education for children is a complex process for which variables like instructors’ attitudes, their level of self-efficacy, and their pleasure and satisfaction at work may be responsible (Khalid, 2014 ). According to a study by Rutkowski et al. ( 2013 ) on 81 elementary school teachers from a sizable metropolitan school district in the United States, the PD program improved teachers’ pedagogical topic knowledge and subject-matter expertise. The teachers that participated in the professional development program showed a greater level of topic and instructional strategy understanding.

In fact, only a few variables had a clear positive effect on both goals. One was related to classroom equipment, which had a clear positive effect on teachers’ well-being. By accessing the material support of a supportive and satisfying working environment, teachers are more likely to be more actively involved in their teaching activities, which in turn is an important factor in how this leads to the creation of relevance for students’ teaching practice (Benevene et al., 2020 ). Among the device variables, many variables do not have any significant effect on SA and therefore do not even appear in the regressions. However, the situation is different for students’ teaching materials, which are highly correlated with SA and positively correlated with teacher job satisfaction. Therefore, improving the supply of textbooks is certainly a relevant policy option (Hee et al., 2019 ). In terms of class size, however, it does have a significant impact on teacher work satisfaction (Hee et al., 2019 ). TJS can be improved by reducing class size. Increasing class size is clearly the best answer to high student numbers for both teachers and kids. The disadvantages of double-shifting are so severe that they are applicable to classes of up to 100 pupils. Teacher efficacy has been shown to correlate with the presence of classroom processes and procedures, and the presentation of good classroom processes may contribute to better outcomes for students (Perera et al., 2022 ). At the same time, good teacher efficacy will also enable teachers to provide more effective pedagogical support, resulting in better outcomes for students in teaching and learning.

The commonly held belief that low salaries and large class sizes are the key reasons for low teacher job satisfaction and low SA has no support in this study. This had no discernible impact on SA. As a result of this research, an extraordinarily costly endeavor to enhance teacher compensation does not appear to be a suitable policy option in general.

What factors influence the effect of TJS on SA that manifest differently in different countries?

In their study, Dicke et al. ( 2020 ) found that the working context item was associated with student accomplishment for both teachers and principals; however, only the general and working environment factors of teacher job satisfaction were related to the disciplinary climate observed by students. International Student Evaluation Projects (PISA) and the Teaching and Learning International Survey (TALIS) found that in countries and regions with outstanding academic performance of students, their teachers showed lower work satisfaction (OECD, 2016 ; TALIS, 2013). For example, for two consecutive years in the PISA test, it is hailed by the World Bank as Shanghai, China, which has the highest education system in the world, shows that the teacher’s work satisfaction is significantly lower in the Talis 2013 survey results (Liang et al., 2016 ). In fact, Shanghai is not a special case. PISA (2015) data shows that, as a whole, despite the outstanding performance of students, the work satisfaction and occupational satisfaction of East Asian countries and regions are lower than the international average (Chen, 2017 ). At the same time, in those countries or regions that are less ideal in the PISA test, their teachers’ work satisfaction and occupational satisfaction are often significantly higher than the international average (Wang and Zhang, 2020 ). Data from 1,539 teachers at 306 secondary schools in the two Indian metropolises of New Delhi and Kolkata supported the notion that instructional leadership has indirect effects on teaching and learning and that the social and affective climate of the classroom has direct effects on teacher job satisfaction, which in turn affects student achievement (Dutta & Sahney, 2016 ). De Vries et al. ( 2013 ) conducted a study on teacher professional development (PD) in the context of inquiry-based science education (IBSE). The study aimed to investigate the effects of a long-term PD program on teachers’ knowledge, attitudes, and behavior. A total of 62 primary school teachers from the Netherlands participated in the trial and were randomized to either the PD program or a control group. Surveys, interviews, and classroom observations were used to gauge the teachers’ awareness of, attitudes about, and behavior with regard to IBSE. The outcomes demonstrated that the PD program had a favorable impact on teachers’ attitudes and knowledge to IBSE. IBSE knowledge was higher among the teachers in the PD program group, and they were more enthusiastic about advantages for their pupils.

Australia, Chile, Czech Republic, Germany, Italy, Korea, Portugal, Spain, USA, Brazil, China, Colombia, Dominia, Peru, Arab, Netherlands Combining the survey and test data of TALIS 2013 and PISA 2012, it is found that there are four main correspondences between teachers’ job satisfaction index and students’ test scores in different countries (regions) (OECD, 2016 ; TALIS, 2013). Countries (regions) with better test performance, such as Finland, Canada (Alberta), Australia, the Netherlands, etc. The second is countries (regions) where teachers’ job satisfaction is high but students’ performance is significantly worse, such as Mexico, Malaysia, Chile, Italy, etc.; the third is countries (regions) where teachers’ job satisfaction is significantly lower than the international average level, but students’ test scores are significantly higher than the international average or even among the best, such as Shanghai (China), South Korea, Japan, Singapore, and other East Asian countries and regions; the fourth is countries with low teacher job satisfaction and low student test scores, such as Bulgaria, Brazil, Russia, etc.

There is a clear correlation between cultural differences in different countries (regions) and teachers’ job satisfaction. Firstly, teachers’ job satisfaction in countries (regions) with a high power distance index is generally lower; secondly, individualism is different in different countries (regions), and there is a potential positive correlation between the index and teacher job satisfaction; furthermore, countries with a high long-term orientation index tend to have lower teacher job satisfaction and vice versa; and lastly, countries with a high indulgence index score. In other regions, teachers’ job satisfaction is generally higher (Wang and Zhang, 2020 ).

Combined with the analysis results, it can be determined to a large extent that national (or regional) culture has a potential impact on teachers’ job satisfaction that cannot be ignored, and compared with the usual experience of “good SA, TJS should also be high”. From the perspective of stereotyped thinking, the degree of influence of cultural differences on teachers’ job satisfaction, or at least the degree of correlation between the two, is more obvious and stronger. Therefore, it seems that a more reasonable explanation can be made for the puzzling differences in teacher job satisfaction in different countries (regions) shown by the TALIS 2013 survey data (Sims, 2017 ; Wang and Zhang, 2020 ). In order to highlight areas for development and to wrap up the section, Kravarušić ( 2021 ) can be quoted. He looked at the fundamental components of the structure of factors in the Republic of Serbia. He discovered that the status of society, the immediate social context, the quality of the study program, the professional environment, continuous professional development, pedagogical practice, the personal characteristics of educators, job satisfaction, and private life all influence the level of competence of teachers. As a result, the setting is a key factor in determining how satisfied teachers are with their work, which in turn influences student progress.

Limitations & recommendations

This review summarizes and analyzes the existing literature on teacher job satisfaction and student achievement, which will help improve student performance from the perspective of teachers’ job satisfaction in the future. However, there are still some limitations in the research process, which can be considered in the follow-up research.

First of all, it is about theoretical research. Although the research on teachers’ job satisfaction theory has been refined and divided into three stages for discussion and definition, the influencing factors obtained from the experimental analysis based on this definition have also been proved to be effective. However, this method of definition has not been widely accepted, which does not mean that researchers have not paid enough attention, precisely because job satisfaction theory involves too much content and there is not enough practice to demonstrate that the theory is true and effective. In addition, due to the repetition and contradiction of different types of theories caused by too many related studies, it has seriously affected the research on the classification and influencing factors of teachers’ job satisfaction at different stages. As the working lives of teachers cannot be simply divided into pre-service teachers and in-service teachers, such as teachers before retirement, teachers in private schools, etc., these can be the basis for classification, and the factors that affect teachers’ satisfaction are also different. At this stage, the theoretical knowledge of teachers’ job satisfaction is simply divided into stages, but teaching is a process, and its complexity and variability cannot be explained clearly by existing theories. The research at this stage cannot realize the analysis of teachers in terms of process. Therefore, future research can focus on defining teachers job satisfaction from different aspects through practice and strive to obtain the most accurate factors that affect teacher satisfaction so as to achieve the adjustment of students’ achievement.

Secondly, the articles chosen for this study include a reasonably high proportion of quantitative research, which is the primary method for studying the theory of teacher satisfaction and examining its affecting elements. However, this means that the research method is single, and the research results mainly come from the results of questionnaires and data analysis. The research results on the influencing factors to improve teachers’ job satisfaction promote the development of teachers’ personal professional abilities, and thus students’ achievement have been confirmed. However, some researchers said that relying too much on questionnaires and data made them ignore the complexity of the research content, and the validity of the research results also weakened their in-depth research ideas to a certain extent. In order to gain a deeper understanding of teachers’ job satisfaction, a qualitative investigation should be used to truly understand the source of teachers’ satisfaction and provide more possibilities for research on influencing factors (Fig. 1 ).

An overview of the overall screening procedures as well as the workflow associated with selecting relevant material. At the beginning of the process, a total of 2188 records were discovered from the databases. After eliminating gray literatures, duplicated papers, book and book chapters and conference papers, the number of articles maintained for further title reading and abstract review was decreased to 632. Following this, only 159 papers met the eligibility requirements for additional abstract reading and main body skimming. Out of that, 67 remained to be read in their entirety. During the main body reading, articles 32 without content pertaining either to teachers’ professional development or student achievement were excluded manually. At last, 32 papers met eligibility requirements for SLR study remained.

Concluding remarks

In the past 12 years, most studies from different countries have paid much attention to the effect of teachers’ job satisfaction on student achievement. Most research shows that TJS will have a positive impact on students achievement (McWherter, 2012 ; Crawford, 2017 ; Andrew, 2017 ; Iqbal et al., 2016 ). Although there is still a small subset of studies showing no significant relationship between TJS and SA, the number of these studies is far lower than the number of studies that believe that TJS has a positive effect on SA (Ejimofor, 2015 ; Borah, 2016 ). There are many factors that affect TJS, but only work treatment, work pressure, co-worker relationships, etc. However, research shows that only classroom equipment and classroom size have a positive effect on both. Research shows that it is largely certain that national (or regional) culture has a non-negligible potential impact on teacher job satisfaction. Moreover, compared with the usual experience and stereotyped thinking that “students have good grades, so teachers’ job satisfaction should also be high”, the degree of influence of cultural differences on teachers’ job satisfaction, or at least the degree of correlation between the two, is more obvious and relevant. The review of this study makes it even more worthwhile to reflect on the need to avoid stereotypical considerations and assessments of any objective presentation of the phenomenon and to reflect more deeply on the need to assess the validity of the relationship study. As in the case of measuring teacher job satisfaction, the extent to which cultural differences affect teacher job satisfaction cannot be ignored. This is why it is important for scholars to develop a framework for measuring teachers’ job satisfaction according to cultural contexts and specific social needs and to give more dimensions to reflection and further measurement. Only on this basis can the overall level of teacher satisfaction be improved, thus increasing the overall level of teacher effectiveness and well-being, and better motivating students to engage in teaching and learning activities that lead to better quality learning outcomes.

Data availability

Data sharing is not applicable to this research as no data were generated or analyzed

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Hoque, K.E., Wang, X., Qi, Y. et al. The factors associated with teachers’ job satisfaction and their impacts on students’ achievement: a review (2010–2021). Humanit Soc Sci Commun 10 , 177 (2023). https://doi.org/10.1057/s41599-023-01645-7

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Job Satisfaction: Knowledge, Attitudes, and Practices Analysis in a Well-Educated Population

Paolo montuori.

1 Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy

Michele Sorrentino

Pasquale sarnacchiaro.

2 Department of Law and Economics, University “Federico II”, 80131 Naples, Italy

Fabiana Di Duca

Alfonso nardo, bartolomeo ferrante, daniela d’angelo, salvatore di sarno, francesca pennino, armando masucci, maria triassi, antonio nardone, associated data.

The data that support the findings of this study are available upon reasonable request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Job satisfaction has a huge impact on overall life quality involving social relationships, family connection and perceived health status, affecting job performances, work absenteeism and job turnover. Over the past decades, the attention towards it has grown constantly. The aim of this study is to analyze simultaneously knowledge, attitudes, and practices toward job satisfaction in a general population in a large metropolitan area. The data acquired from 1043 questionnaires—administered to subjects with an average age of 35.24 years—revealed that only 30% is satisfied by his job. Moreover, among all the tested sample, 12% receive, or often receive intimidation by their superior, and 23% wake up unhappy to go to work. Marital status and having children seem to be an important factor that negatively influences job satisfaction through worst behaviours. The multiple linear regression analysis shows how knowledge is negatively correlated to practices; although this correlation is not present in a simple linear regression showing a mediation role of attitudes in forming practices. On the contrary, attitudes, correlated both to knowledge and practices, greatly affect perceived satisfaction, leading us to target our proposed intervention toward mindfulness and to improve welfare regulation towards couples with children.

1. Introduction

Job satisfaction has been defined as a “pleasurable or positive emotional state, resulting from the appraisal of one’s job experiences” [ 1 ]. Job satisfaction reflects on overall life quality involving social relationships, family connection and perceived health status, affecting job performances, work absenteeism and job turnover, leading, in some cases, to serious psychological condition such as burnout [ 2 , 3 , 4 , 5 , 6 ].

The recent Gallup statistics on job satisfaction indicated that a very large portion of the world’s 1 billion full-time workers is disengaged, more precisely, only 15% of workers are happy and production in the workplace, the remaining 47% of workers are “not engaged,” psychologically unattached to their work and company [ 7 ]. In the EU, approximately one in five residents (16.9%) currently in employment expressed low levels of satisfaction with their job, on the other hand approximately one in four (24.6%) expressed high levels of satisfaction, the remaining residents (58.5%) declared medium levels of satisfaction with their job [ 8 ]. Characteristics such as age, sex, education, occupation, commuting time and difficulty as inadequate income, seems to be related to job satisfaction as they tent to influence expectation and preferences of individuals’ reflection on their perceived working condition [ 9 , 10 ]; however, as assessed in Eurofound, European Working Conditions Surveys [ 11 ] the relation between age and job satisfaction is very weak, although a slight increase in low satisfaction prevalence was found in elder population, it does not increase significantly with age even though expectations change during lifetime; educational attainment and income seem to play a significant role in job satisfaction as they grow in parallel, leading to better positions and a higher wages, along with power and more decisional autonomy. Sex is a factor as women seems to be overall more satisfied by their job in despite of the worst general conditions [ 11 , 12 , 13 , 14 ]. Job satisfaction also relates to marital status as single subjects’ results as the most satisfied by their work in some European Countries [ 15 ]. In Italy, the overall perceived job satisfaction seems to be similar to other regions in EU, and social relations as well as family composition appear to play a relevant role [ 16 ].

Job satisfaction has been studied mostly over a specific category of workers [ 17 , 18 ], as some types of works seems to be more related to pathological conditions such as burnout [ 19 , 20 ] and job-related stress [ 21 , 22 , 23 ]; however, as reported by those authors, this kind of selection method could lead to selection biases. According to van Saane [ 24 ], although many studies were carried as since Job Satisfaction broke out in the last 70’s as a central topic of interest, nor a mathematical instrument as reliable as desired nor a comparative method were found, usually those studies were based on single components of job satisfaction, taken out from extra working environment, and without analysing the consequences on behaviours in day life [ 25 , 26 , 27 ]. The literature research demonstrated that practices are the results of knowledge, attitudes, or their interaction. The KAP Survey Questionnaire [ 28 ] can be applied to highlight the main features of knowledge, attitude, and practice of a person, and to assess that person’s views on the matter. The purpose, when using the KAP Survey Model, is to measure a phenomenon through the quantitative collection method of a large amount of data through the administration of questionnaires and then statistically process the information obtained. Through a questionnaire, however, seems to be easier to quantify job satisfaction. In addition to that, studying broader populations’ consent to explore different components, both personal and environmental, which concur to influence it [ 29 , 30 ].

In the recent literature, a KAP model was used only once to analyse behaviours toward job satisfaction. In his work, Alavi [ 31 ] conducted a survey based cross-sectional study on 530 Iranian radiation workers; although it comprehends simultaneously knowledge, attitude, and practices, it was conducted on a specific category of workers and on a narrower population. Therefore, since to the best of our knowledge none of the studies presented in the literature are carried out on a broader population relating both knowledge and attitudes to behaviours on job satisfaction, the aim of this study is to analyse simultaneously knowledge, attitudes, and behaviours toward job satisfaction in a large metropolitan area. It is important to investigate this phenomenon to evaluate the condition and develop health education programs and community-based intervention to increase job satisfaction and knowledge and positively orienting attitudes.

2. Material and Methods

2.1. participants and procedure.

This cross-sectional study was conducted from November 2021 to February 2022 in the large metropolitan area of Naples, southern Italy, among working places, universities, and community centres. No specific category of participants was selected. In the questionnaire, respondents indicated their occupation by choosing from the following options: lawyer, architect, engineer, doctor, accountant, entrepreneur, teacher, law enforcement, trader, student, employee, worker, unemployed, other. Table 1 shows the categories indicated by the participants. The criteria for inclusion in the study required that respondents of a general population were over 18 years old, belonging to one of the categories of employment listed in Table 1 , and resided in the metropolitan area of Naples. Every participant directly received a questionnaire (available upon request from the corresponding author) and at the time of filling out the questionnaire, the aim of the study and the anonymity and privacy of the data collecting method being used was explained, both in written form, as an introduction part of the questionnaire, and verbally to each of the participants. The questionnaire consisted of basic information about participants (age, gender, children, civil state, education level, profession, smoke habits) and three pools of questions divided in knowledge, attitudes and behaviours concerning their job satisfaction for a total number of 37 questions. The construction of the questionnaire was carried out as recommended by the KAP Model [ 28 ], briefly was divided into four phases: (1) Constructing the survey protocol; (2) Preparing the survey; (3) Course of the KAP survey in field; (4) Data analysis and presentation of the survey report. To develop the questionnaire, research questions based on the “Objectives of the study” were first carried out to develop the research questions, according to KAP Survey Model [ 28 ], the knowledge was considered as a set of understandings, knowledge, and “science” while Attitude as a way of being, a position. After, the research questions were reduced in number by removing those questions that require unnecessary information. When the above step is also done, the difficult questions have been changed/removed (closed questions have been used because one of the most important things that will increase the relevance of the questions is that the questions must be closed questions). Knowledge and attitudes were assessed on a three-point Likert scale with options for “agree”, “uncertain”, and “disagree”, while inquiries regarding behaviours were in a four-answer format of “never”, “sometimes”, “often”, and “yes/always”. A pilot study was also carried out to test the questionnaire and to verify the reliability of questions. Finally, all the collected questionnaires were digitalized submitting the codified answers in an Excel worksheet (MS Office).

Study population characteristics.

2.2. Statistical Analysis

Data reported by the study were analysed using IBM SPSS (vers. 27) statistical software program. The analysis was carried out in two stages. In the first stage, a descriptive statistic was used to summarize the basic information of the statistical units. In the second stage, a Multiple Linear Regression Analysis (MLRA) was used to model the linear relationship between the independent variables and dependent variable.

The dependent variables (Knowledge, Attitudes and Behaviours) had been obtained by adding the scores obtained in the corresponding questions (questions with inverse answers have been coded inversely). The independent variables were included in all models: sex (1 = male, 2 = female); age, in years; education level (1 = primary school, 2 = middle school, 3 = high school, 4 = university degree); civil state (1 = Single; 2 = In a relationship; 3 = Married; 4 = Separated/Divorced; 5 = Widowed).

The main results from a MLRA contains the statistical significance of the regression model as well as the estimation and the statistical significance of the beta coefficients ( p -value < 0.05) and the coefficient of determination (R-squared and adjusted R-squared), used to measure how much of the variation in outcome can be explained by the variation in the independent variables. Three MLRA were developed:

• (1) Knowledge about job satisfaction (Model 1);
• (2) Attitudes toward resilience and mindfulness (Model 2);
• (3) Actual behaviours regarding Job and Job-related life (Model 3).

In Model 2, we added Knowledge to the independent variables, and in Model 3, we added Knowledge and Attitudes to the independent variables. In the analysis, we considered Attitudes and Knowledge as indexes rather than a scale, which means that each observed variable (A1, …, A13 and K1, …, K12) is assumed to cause the latent variables associated (Attitude and Knowledge). In other terms, the relationship between observed variables and latent variables is formative. Therefore, inter-observed variables correlations are not required. On the contrary, the relationship between the observed variables (B1, …, B14) and latent variable Behaviour could be considered reflective (Cronbach’s alpha = 0.825). All statistical tests were two-tailed, and the results were statistically significant if the p -values were less than or equal to 0.05.

3. Results and Discussion

Out of the 1057 participants, 1043 anonymous self-report surveys were returned, resulting in a response rate of 98.7%. Table 1 shows the characteristics of the study population: the mean age of the study population is 35.24 years; in 18–70 age range, the main group of distribution was 18–30 representing 44.6% of the sample; sex distribution shows that: 427 are men, 616 are woman. A large majority (73.5%) does not have children, while 26.5% of the sample has them. Most of the participants have a post graduate degree, while 29.1% are high school graduates. Among them, 22.2% are physicians, 15.1% teachers and 14.0% students ( Table 1 ).

Respondent’s knowledge about job satisfaction is presented in Table 2 . While a large majority of the sample population (91.7%) has a well-defined knowledge about job satisfaction main characteristics such as mains definitions, both of work-related stress and mobbing, most of them does not know or are not aware which risks are specifically related as only 31.4% knows that job related stress and mobbing are a threat to their cardiovascular health. Only 28.7% of the population knows that “Only 15% of worker, globally, are satisfied by their work” demonstrating that while knowledge regarding job related stress is well spread, the sample does not know how diffused it is and what kind of risks it involves, and that state provide a compensation for job related stress.

Knowledge of respondents toward job satisfaction.

* INAIL: Istituto Nazionale Assicurazione Infortuni sul Lavoro (National Institute for Occupational Accident Insurance).

In Table 3 are described attitudes toward job satisfaction. Most of the participants think that working out is relaxing and spending time is regenerating, showing a good attitude to copy with work related stress. According to 93.4% of the sample, workload plays a key role in job satisfaction, as well as adequate wages and a clear task schedule. Several studies have enlightened that when workers lack a clear definition of the tasks which are necessary to fulfil a specific role, their levels of job satisfaction are likely to be negatively affected [ 32 , 33 , 34 ]. Interestingly, most of the population sees challenges as a motivation to do better (80.2%) and are motivated by career opportunities (90.7%); however, 50.5% of the population has a negative attitude about changes. In confirmation of that, when asked if “Changes lead to stress”, only a small fraction of the sample (14.6%) disagreed. This allowed us to assume that, although most of the population sees problems as an opportunity to learn, improve and progress in their work, they are aware of the difficulties connected to changing scenarios. About 27.2% of the sample does not have a positive attitude toward sharing their feeling about problems at work talking out loud. Bad interpersonal relationships with co-workers are another reason for job dissatisfaction. Poor or unsupportive relationships and conflicts with colleagues and/or supervisors lead to negative psychological intensions, resulting in job dissatisfaction [ 35 , 36 ].

Attitude of respondents toward job satisfaction.

Behaviours of respondents are listed in Table 4 : A consistent part of the sample responded positively to the group of question toward behaviours regarding their coping level of stressful situation (B2, B4, B8, B9, B10) showing a reported good resilience. Commuting seems to be a problem for at least a third of the sample, also in a metropolitan area served by 2 subways, full bus service, car sharing services and a speedway. Job satisfaction is associated negatively with constraints such as commuting time. This dead time, mostly unpaid, is mandatory for workers to reach workplace. Although this is not considered as working time, and only a specific class is refunded, from the employers’ perspective, it is time dedicated to work and a strong determinant for low satisfaction levels. EU workers were much more likely to be highly (37.9%) or moderately satisfied (41.7%) with their commuting time compared to their job satisfaction. Most of the sample responded to not having experienced mobbing; although even a “low” result, such as a cumulative, summing both “yes/always” and “often”, of 11.8% is alarming and pushes us to study more about this phenomenon. Interestingly, 30.9% of respondents are satisfied about their work, reaching a total of 59.5%. In addition, with a “often” response showing a large appreciation of their jobs, 22.9% of the respondents “wake up unhappy to go to work”, and feel “stuck in a job with no career opportunities” (27.7%). The sample has no problems managing their work and social life (48.3%); however, only a complex of 35% of the sample usually spend their time with colleagues outside the office.

Behaviour of respondents toward job satisfaction.

Table 5 illustrates results of linear multiple regression in three models: in Model I Knowledge, as dependent variable, correlate, with a p -value < 0.001; with “sex”, interestingly, woman seem to have a higher overall score of knowledge in disagreement with Gulavani [ 37 ] whose study was conducted among a sample of nurses and found no significant relation between sex and knowledge on job satisfaction. Al-Haroon [ 38 ] evidenced that among health workers, men had a better overall level of knowledge. These results, however, were collected over specific categories of employees, in a narrower sample; whereas our study was represented by a general population of a metropolitan area. No statistically significant correlation between knowledge and age, civil status, children, and education levels was encountered.

Results of the linear multiple regression.

Previous research asses that attitude plays a key a role in job satisfaction, as some attitudinal characteristics of the subject influence perspective, coping skills and stressful situation management [ 39 , 40 , 41 ]. In Model II ( Table 5 ) we correlated, through MLRA, attitudes with age, sex, civil state, having children, education, and overall knowledge score. With a p -value < 0.001, two correlations were found with education and overall knowledge score, both positively. Those results reflect, in accordance with Alavi [ 31 ], who found that higher level of education was among 3 factors that predicted job satisfaction and attaining a higher university degree compared to lower degrees contributes to a feeling of coherence, success at work, personal growth and self-respect, self-realization and intrinsic motivation, that education level and therefore a higher level of knowledge contributes to generating a sense of job satisfaction. In the questionnaire we tried to collect all those propension and as a result: in agreement with Hermanwan [ 42 ], Andrews [ 43 ] and Choi [ 44 ], subjects with better knowledge and high levels of education tent to have better attitudes.

In Model III, behaviours taken as a dependent variable are correlated to age, sex, civil state, children, education, knowledge, and attitudes. The results of linear multiple regression in this model assess that behaviours are negatively correlated to civil state, sons, and knowledge, and positively correlated to attitudes. Our findings show that there is a positive correlation between behaviours and attitudes, in agreement with previous literature [ 45 , 46 , 47 ], demonstrating that people with better attitudes tent to have a better overall behaviour. Surprisingly, in Model III, knowledge also has a statistically significant correlation to behaviours but in a negative way. This correlation, however, is not present when we correlate those variables alone in a Pearson’s correlation between knowledge, attitudes, and behaviours ( Table 6 ). This evidence, therefore, suggests that attitude mediates the effect of knowledge on behaviours, assessing an important relation between those two determinants. People with a better overall score in behaviours tend to have a higher score in knowledge and attitude. In this sample, those who have a lower score in knowledge also has a higher behaviour score in accordance with a part of the previous literature [ 48 , 49 ]. This enlightens the importance of high levels of knowledge in order to form better attitudes in the pursuit of job satisfaction. Civil state and having children seem to play a key role in performing a better behaviour about job satisfaction; which is also evident in one specific question about behaviour: Question “B14” enlightens the social practices of subjects with colleagues outside the work environment, and the statistical analysis on this topic shows that subject with a more stable sentimental situation or with child tend to hang out with their colleagues less, likely worsening their relationships at work and getting a worse overall behaviour score and worse attitude toward the topic in agreement with Sousa-Poza [ 50 ] and Armstrong [ 51 ]. Job satisfaction has a strong correlation to family characteristics: Subjectst who have families with children have less positive behaviours towards their job satisfaction, directly affecting their overall behaviour score; this evidence is in contrast with Alavi [ 31 ], who states that job satisfaction is positively affected by family, assessing that “married employees have opportunities to receive support or advice from their family to mediate job conflicts,” Although he admits that in the literature, this result is controversial as some authors, such as Clark [ 52 ], found that “married employees experienced a higher level of job satisfaction than their unmarried co-workers”, and Booth and Van Ours’ [ 53 ], study did not find a statistically relevant correlation with the presence of children. Those results, therefore, suggest creating targeted educational programs, community-based intervention, and legal regulation, to improve self-awareness and resilience among workers, and a more practical intervention could be directed to families with child.

Pearson’s correlation between knowledge, attitudes, and behaviours.

4. Conclusions

This study shows that the metropolitan population has general good knowledge about job satisfaction as well as a positive attitude. Job satisfaction, however, is reflected accordingly only with attitudes. While it has a negative relation to civil state and having children, this means that the experimental results of this study may be used to create targeted educational programs, community-based intervention, and legal regulation, to improve self-awareness and resilience among workers. A more direct intervention could be directed to families with children. Social networking with colleagues has an important impact on job satisfaction, as the part of the sample who responded positively to the specific question, had an overall better behaviour. Although, in this case, having children seems to be, as they negative correlate, a huge limitation to this practice. Considering that, as previously stated, the impact of job satisfaction on the population has a strong impact in terms of life balance, health, and economics, and it is well known that only a small fraction of workers are fully satisfied. It might be important to promote welfare regulation to allow a larger part of the population to conciliate work and family. Results of this paper could be an indicator of how to establish an educational program more efficiently. It is mandatory to strengthen specific knowledge about job satisfaction through the general population toward the importance of job satisfaction and the benefits related to a correct approach to work-life. The impact of a public health intervention could be even more effective by integrating another program to orient and define attitudes, which in turn will influence people to practice a mindfulness mental setting toward job satisfaction. In conclusion, a training program based on fundamental practices of job satisfaction should be improved in the young population, in early stage of family life, or before they have children, in order to achieve a double objective: “training family and spreading the practice to a future generation”.

Funding Statement

This research received no external funding.

Author Contributions

Data curation: P.M., M.S., P.S., F.D.D., A.N. (Alfonso Nardo), B.F., D.D., S.D.S., F.P., A.M. and M.T.; Formal analysis: M.S., F.D.D., A.N. (Alfonso Nardo), B.F., D.D., S.D.S. and F.P.; Resources: P.M. and M.T.; Software: P.S.; Supervision, P.M., M.T. and A.N. (Antonio Nardone); Writing—original draft: M.S., F.D.D., A.N. (Alfonso Nardo), B.F., D.D. and S.D.S.; Writing—review and editing: P.M., M.S., P.S., F.P., A.M., M.T. and A.N. (Antonio Nardone). All authors have read and agreed to the published version of the manuscript.

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Factors affecting allied health faculty job satisfaction: a literature review

Affiliation.

• 1 University of Medicine and Dentistry of New Jersey, School of Health Related Professions, 65 Bergen Street, Newark, NJ 07101-1709, USA. [email protected]
• PMID: 21399846

Evidence in the literature suggests job satisfaction can make a difference in keeping qualified workers on the job, but little research has been conducted focusing specifically on allied health faculty. In order to attract and retain top quality faculty, colleges and universities should understand the variables impacting faculty satisfaction and develop a plan to enhance satisfaction. An integrative literature review (CINHAL, ERIC, Journal of Allied Health, Chronicle of Higher Education, Research in Higher Education, and current books on job satisfaction) of faculty job satisfaction and dissatisfaction produced a variety of publications presenting the key determinants of job satisfaction by allied health faculty in the United States. The purpose of the analysis was to examine the various factors that influence job satisfaction, especially by allied health faculty, in institutions of higher education in the U.S. The procedure used for this analysis consisted of reviewing allied health and higher education faculty studies to identify factors influencing job satisfaction, research questions, sample size reported, instruments used for measurement of job satisfaction, and job satisfaction results. While the theoretical models of allied health and higher education faculty job satisfaction exist separately in the literature, their remarkable similarities permit the prospect of a contemporary framework of the essential components of job satisfaction. Potential opportunities for continuing research on the personal and professional variables impacting job satisfaction of allied health faculty and similar disciplines are presented.

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JOB SATISFACTION: A LITERATURE REVIEW

Job satisfaction represents one of the most complex areas facing today's managers when it comes to managing their employees. Many studies have demonstrated an unusually large impact on the job satisfaction on the motivation of workers, while the level of motivation has an impact on productivity, and hence also on performance of business organizations.Unfortunately, in our region, job satisfaction has not still received the proper attention from neither scholars nor managers of various business organizations.

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The objective of this paper is to investigate the relationship between these three variables namely: Job performance, job satisfaction and motivation with the help of theoretical models and literatures. Although many studies had already been conducted on job satisfaction and job performance, its relationship is still subject to much hated debates to specifically determine the extent of its relationship. With regards to motivation, results showed that, monetary consideration is by far more important than other motivation strategies which emphasized the aspect of addressing the economic needs of the individuals. However motivation like that of Herzberg had proven that pay is not the sole indicator of employee motivation. Furthermore, it was also proven that job satisfaction, job performance and motivation interact with each other and functioned interdependently such that the process is circular rather than linear. When job satisfaction and performance is linked with group performance, the outcome revealed that higher job satisfaction leads to higher performance although it is not always the case. Working together is the key to achieve desirable outcomes which means that employees should not be kept in isolation but should be encouraged to work together to effectively achieve the goals and success whether in group or the organization as a whole.

RSIS International

Employee Job satisfaction is the outcome of individual response or feelings towards his or her job, culture, policies and environment. The level of satisfaction is closely correlated with the motivation provided in organization which measures. In this paper the employee satisfaction has been studied by comparing the motivational theory namely Maslow's Hierarchy need and Herzberg two factor theory. As measurement of employee satisfaction is a behavioral study depending on the state of mind and situation in which employees work. The results derived from research will help to understand the employee's perception and redesign the HR Polices for improving the work relations, communication, motivation and career planning.

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Challenges affecting migrant healthcare workers while adjusting to new healthcare environments: a scoping review

• Asem Al-Btoush 1 , 2 &
• Charbel El-Bcheraoui   ORCID: orcid.org/0000-0003-3117-9966 1  

Human Resources for Health volume  22 , Article number:  56 ( 2024 ) Cite this article

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Introduction

Shifting demographics, an aging population, and increased healthcare needs contribute to the global healthcare worker shortage. Migrant Health Care Workers (MHCWs) are crucial contributors to reducing this shortage by moving from low-and middle-income countries (LMICs) to high-income countries (HICs) for better opportunities. Economic factors and health workforce demand drive their migration, but they also face challenges adapting to a new country and new working environments. To effectively address these challenges, it is crucial to establish evidence-based policies. Failure to do so may result in the departure of Migrant Healthcare Workers (MHCWs) from host countries, thereby worsening the shortage of healthcare workers.

To review and synthesize the barriers experienced by MHCWs as they adjust to a new country and their new foreign working environments.

Methodology

We followed the PRISMA guidelines and conducted a search in the PubMed and Embase databases. We included cross-sectional studies published after the year 2000, addressing MHCWs from LMIC countries migrating to high-income countries, and published in English. We established a data extraction tool and used the Appraisal tool for Cross-Sectional Studies (AXIS) to assess article quality based on predetermined categories.

Through a targeted search, we identified fourteen articles. These articles covered 11,025 MHCWS from low- to medium-income countries, focusing on Europe, the USA, Canada, Australia, New Zealand, and Israel. Participants and respondents’ rates were diverse ranging from 12% to 90%. Studies encompassed various healthcare roles and age ranges, mainly 25–45 years, with a significant female presence. Participants resided in host countries for 3–10 years on average. Results are categorized based on the Riverside Acculturation Stress Inventory (RASI) and expanded to include bureaucratic and employment barriers, Gender differences, Natives vs. non-natives, and orientation programs.

Conclusions

The findings emphasize the importance of cultural competence training and tailored support for MHCWs integration and job satisfaction. Time spent in the new healthcare setting and the influence of orientation programs are key factors in shaping their intentions to stay or leave. Despite limitations, these studies provide valuable insights, emphasizing the ongoing need for holistic strategies to facilitate successful integration, ultimately benefiting healthcare systems and well-being for all stakeholders.

Peer Review reports

Introduction and background

In 2020, the worldwide healthcare workforce comprised 29.1 million nurses, 12.7 million medical doctors, 3.7 million pharmacists, 2.5 million dentists, 2.2 million midwives, and 14.9 million other healthcare professionals, totaling 65.1 million. However, this distribution was far from equal, with a staggering 6.5-fold difference in density observed between high-income and low-income nations [ 1 , 2 ]. Insufficiently regulated international migration of health workers can worsen existing disparities, intensifying shortages in countries already grappling with a scarcity of healthcare professionals. This impact is particularly pronounced in low- and middle-income Countries (LMICs), where the loss of skilled healthcare workers exacerbates the strain on already fragile health systems, limiting access to essential services for their populations. In contrast, high-income countries (HICs) may experience challenges due to increased demand for healthcare services, but they often have greater resources to attract and retain healthcare workers from both domestic and international sources, mitigating the impact to some extent [ 1 ].

According to a Global Burden of Disease Study conducted in 2022, it was projected that a minimum of 20.7 doctors, 70.6 nurses and midwives, 8.2 dental professionals, and 9.4 pharmaceutical personnel per demographic trends, a progressively aging population, and heightened healthcare requirements have collectively played a role in the persistent shortage of healthcare workers on a worldwide scale [ 3 ]. The International Centre on Nurse Migration has estimated that around 10.6 million fresh nursing professionals will be required within the next 10 years to confront the current nursing deficit and to fill the void left by an anticipated 4.7 million retiring nurses [ 4 ].

International Medical Graduates (IMGs), also known as Migrant Healthcare Workers (MHCWs), are physicians who practice medicine in a country different from where they obtained their primary medical qualification [ 5 ]. Approximately 40% of active physicians in the United Kingdom are IMGs [ 6 ]. This percentage exceeds 25% in the USA and Canada [ 8 ], and it surpasses 40% in countries like Australia, New Zealand, and Norway [ 7 ]. MHCWs, including doctors, nurses, therapists, and technicians, are a dynamic and crucial segment of the global healthcare workforce, relocating from LMIC countries to HICs for better opportunities and improved living conditions [ 8 ]. Their migration is driven by economic factors, career prospects, and the demand for skilled healthcare personnel in destination countries [ 9 ]. While their presence addresses healthcare workforce shortages and enhances service delivery, MHCWs encounter various challenges and barriers when transitioning to new countries and working environments [ 7 ]. A comprehensive two-phased literature review analysis underscores the challenges encountered by migrant healthcare workers, such as language barriers, difficulties with slang and medical terminology, and perceived differences in cultural, social, and professional norms. These challenges contribute to uncertainties in their interactions with colleagues and patients [ 10 ].

MHCWs constitute a vital and dynamic segment of the global healthcare workforce [ 2 ], contributing significantly to the provision of medical services across borders. Insufficiently regulated international migration of health workers can worsen existing disparities, intensifying shortages in countries already grappling with a scarcity of healthcare professionals [ 11 ]. This impact is predominantly felt by HICs (HICs) rather than LMIC Countries (LMICs) [ 1 ]. This study aims to identify the challenges MHCWs face when integrating into new countries and healthcare environments, with a focus on quantitative data from cross-sectional surveys. It contrasts with previous reviews that relied on qualitative data from interviews and discussions. The findings can inform evidence-based policies to retain MHCWs, preventing a worsening shortage if such policies are lacking.

In this scoping review, we adhered to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines to enumerate the barriers experienced by migrant and foreign healthcare workers during their transition to a new country and new working environments [ 12 ].

Data search

Our data search was initiated on June 20th, 2023, utilizing the PubMed database, and subsequently extended on June 25th, 2023, to include the Embase database, which incorporates Medline. To construct an effective search strategy, we conducted a preliminary literature review to identify relevant keywords and Mesh terms. Specifically, we focused on examining articles that address the challenges encountered by migrant healthcare workers during their transition to a new healthcare environment. As a result, we identified three key concepts—Barriers, Adjustment, and foreign healthcare worker—to formulate a search string that yielded a precise and pertinent literature on the subject matter, the final search string used is as follows:

("Barrier*"[All Fields] OR "experience*"[All Fields] OR " perspectiv*"[All Fields] OR " percept*"[All Fields] OR "Obstacle*"[All Fields] OR "challenge*"[All Fields] OR "limitation*"[All Fields] OR "factor*"[All Fields] OR "strateg*"[All Fields] OR "Social Support"[MeSH Terms] OR "Communication Barriers"[MeSH Terms]) AND ("adjust*"[All Fields] OR "adapt*"[All Fields] OR "transition*"[All Fields] OR "integrat*"[All Fields] OR "wellbeing*"[All Fields] OR "Attitude of Health Personnel"[MeSH Terms] OR "Personnel Turnover"[MeSH Terms] OR "Occupational Health"[MeSH Terms] OR "adaptation, psychological"[MeSH Terms] OR "Personal Satisfaction"[Mesh] OR "Job Satisfaction"[MeSH Terms] OR "work/psychology"[MeSH Terms] OR "occupational stress/psychology"[MeSH Terms] OR "workplace/psychology"[MeSH Terms]) AND ("Migrant healthcare worker*"[All Fields] OR "migrant care worker*" [All Fields] OR "International medical graduate*"[All Fields] OR "Foreign medical graduate*"[All Fields] OR "Healthcare worker migration*"[All Fields] OR "care worker migration*"[All Fields] OR "migrant physician*" [All Fields] OR "migrant nurse*" [All Fields] OR "Foreign medical"[All Fields] OR "internationally educated healthcare professional*" [All Fields] OR "internationally educated physician*" [All Fields] OR "internationally educated nurse*" [All Fields] OR "overseas qualified*"[All Fields] OR "International trained*"[All Fields] OR "Foreign Medical Graduates/psychology"[Mesh] OR "Foreign Professional Personnel"[MeSH Terms] OR "Foreign Medical Graduates"[MeSH Terms]).

We refined the study results by including only original research articles, while excluding preprints, conference abstracts, editorials, letters to editors, commentaries, interviews, and correspondence. We began the search process by developing a search string and applying it to the PubMed database. Then, we screened titles and abstracts. We conducted a full-text analysis on the filtered results, following the specified eligibility criteria. We conducted the same process for the Embase and Medline databases. To identify additional relevant articles, we employed snowballing and reference harvesting techniques. We eliminated duplicate articles and saved the title and abstract screening of the literature using the software EndNote X73. To stay updated during the writing process, we set a notification alarm for database updates, utilizing the same methodology for results analysis and filtering as previously described (see Table 1 ).

Data extraction

We developed a comprehensive data extraction tool encompassing the following data points: PubMed identification number and Embase identification number for PubMed and Embase (Medline) respectively, Title, Author, Journal, aims, Type of study, study design, year, number of participants contacted, number of participants responded, response rate, country of origin of migrant healthcare worker, country immigrated to, inclusion criteria of participants, Survey content development, Questionnaire topics, Type of analysis, Analysis Measures categorized Results, Conclusions and recommendations, and Limitations. The detailed data extraction tool can be accessed in Appendix S1.

Quality assessment

To assess the quality of the selected articles, we employed the Appraisal tool for Cross-Sectional Studies (AXIS). AXIS Quality Assessment tool is specifically designed for Observational Cohort and Cross-Sectional studies. We used this tool to assess the reliability of the included studies, examining aspects like study design, sampling methods, reliability and validity measures, statistical techniques, and the overall quality of reporting. The main goal was to assess the studies’ methodological rigor and how well they addressed potential biases [ 13 ]. We employed a 20-point scoring system to evaluate article quality across predefined categories. The scoring ranged from excellent and good quality to fair quality, and in some cases poor quality. This system helped us assess and categorize the articles. The detailed quality assessment tool can be accessed in Appendix S2.

We conducted a thorough search, following PRISMA guidelines [ 12 ], initially identifying 20 articles for potential inclusion in the review. Out of these, we retrieved 18 from systematic databases—13 from PubMed and five from Embase (including Medline). We removed duplicate entries in PubMed, combined the refined dataset with Embase results, and acquired an additional five articles through snowballing related articles. After a thorough screening process, we excluded nine articles: four for duplicating data, four for conference abstracts, and one for focusing on medical fellows’ post-residency, which did not align with our Eligibility criteria. This process resulted in our final selection of 14 articles (see Fig. 1 ).

Preferred reporting items for systematic reviews and meta-analyses (PRISMA) [ 12 ] flow chart of article selection for the scoping review on challenges affecting migrant healthcare workers while adjusting to new healthcare environment

General characteristics

Of the fourteen reviewed studies, seven were deemed high quality, with the majority employing cross-sectional survey designs. Collectively these studies encompassed 11,025 MHCWs. The average response rate across most studies was moderately high, ranging from 40% to 90%, except for one study in Ireland with a response rate of 12% [ 14 ]. The studies covered a range of scenarios, including involvement of IMGs in training, during the examination process, and in permanent posts. Respondent diversity was notable, with participants originating from various LMIC countries such as Nigeria, India, the Philippines, Nepal, China, Egypt, and Pakistan, and relocating to high income countries like the USA, Canada, Australia, New Zealand, Finland, Sweden, Israel, and Ireland. The studies covered a range of healthcare occupations from 9 studies covering doctors (65%), 4 studies covering nurses (28%), and 1 study covering migrant care workers in Australia (7%) [ 15 ]. Participant ages fall between 25 and 45 years. Most of the studies focused on Gender not sex, while gender ratios varied, with more apparent considerable proportion were female. Participants had an average host country residence of 3–10 years.

Main barriers

We will be highlighting the results based on The Riverside Acculturation Stress Inventory (RASI), an acculturation scale developed by Benet-Martínez and Haritatos in 2005 [ 16 ]. It comprises 15 items, which focus on culture-related challenges in five life domains. These are (1) language skills; (2) work challenges; (3) intercultural relations; (4) discrimination; and (5) cultural isolation; in addition, we will be highlighting Bureaucratic and employment barriers.

Language problems

Language problems were identified as a significant challenge faced by MHCWs across multiple studies. In various contexts, such as IMGs in the USA, foreign-born physicians in Finland, migrant nurses in Australia and the USA, and migrant care workers in Australian aged care facilities [ 15 , 17 , 18 , 19 ], Language barriers were found to exert a detrimental influence on the experiences of migrant care workers within Australian residential aged care facilities. Adebayo et al. identified ethnicity and self-reported English proficiency as significant factors contributing to acculturation stress [ 15 ]. Language and communication difficulties were prominent challenges for MHCWs in the USA, with 7% of respondents expressing concerns in this area [ 17 ]. Language barriers were among the top barriers experienced by non-English speaking psychiatry IMGs who participated in a web-based questionnaire in Canada (Median Score: 2.5 vs. 2; p  = 0.002) [ 20 ]. Linguistical barriers and communication issues affected their interactions with colleagues and patients, making it difficult to provide the best possible care and integrate into their work environment effectively.

Work challenges, new healthcare settings

MHCWs often encounter unique challenges when adapting to healthcare systems and working environments in countries such as the USA and Canada, where understanding healthcare team dynamics and roles, as well as the legal and ethical aspects specific to the new system, is crucial for integration [ 17 , 21 ]. Likewise, migrant nurses in Australia noted disparities in work practices and patient care approaches compared to their home countries [ 18 ]. In the USA, MHCWs faced barriers due to differences in professional practices, MHCWs may encounter differences in the use of medical equipment, treatment approaches, or patient management strategies. These disparities can lead to confusion, uncertainty, or inefficiency in their work, potentially impeding their learning and adaptation process within the new healthcare environment [ 17 ]. The understanding of the Canadian healthcare system (Median Score: 4 vs. 2; p = 0.020) was mentioned as second choice among psychiatry IMGs who are in Canada for less than 12 months [ 22 ]. In another study in Canada, mean scores of challenges faced by IMGs and program directors were for Knowledge of the Canadian Healthcare System as follows: IMGs: 3.93 (SD: 1.097), Program Directors: 3.55 (SD: 0.852) [ 20 ]. Some MHCWs also reported insufficient workplace support, affecting their overall well-being and job satisfaction [ 19 ]. Therefore, support at work, including providing assistance in areas such as language and cultural adaptation, professional development, social integration, psychosocial well-being, and recognition for MHCWs, plays a vital role in helping them overcome these challenges and succeed in their new healthcare roles.

Discrimination

Discrimination poses a significant challenge for MHCWs worldwide, stemming from factors like ethnicity, language, and cultural differences. This discrimination is linked to struggles adapting to new healthcare systems, potentially leading to workforce talent loss [ 23 ]. Female MHCWs often face gender-related discrimination, impacting their integration and career intentions. Male respondents primarily expressed concerns related to logistical challenges, such as family issues (80%), adjusting to American diets (72%), visa and immigration matters (64%), finding adequate housing (59%), and managing finances (57%). In contrast, female respondents were more focused on personal issues, including mental health concerns (65%), duty hours (57%), self-sufficiency (54%), workplace discrimination (53%), and lack of support at work (52%). These differences indicate that while male IMGs were mainly worried about bureaucratic hurdles, female IMGs were more concerned about personal challenges like discrimination and mental well-being [ 17 ]. Workplace discrimination is particularly detrimental, affecting job satisfaction and integration among MHCWs in the USA [ 17 ].

Beyond the USA, MHCWs in various countries confront discrimination challenges. In Sweden, a significant portion of respondents (29%), reported instances of perceived discrimination during their job-seeking endeavors. Gender differences were evident in the types of discriminatory experiences recounted. Barriers to employment included feelings of competence undervaluation attributed to factors such as foreign ethnicity, religion, language proficiency, and limited work experience or references in Sweden. Notably, respondents with a background of growing up or residing in Sweden reported fewer instances of discrimination or undervalued competence, amounting to 6% of the sample size (n = 16) [ 24 ]. Citizenship and perceptions regarding career opportunities emerged as pivotal factors influencing decision-making among respondents in Ireland. Those intending to remain perceived more abundant career prospects, while those planning to migrate onward expressed disagreement with this perception [ 14 ]. Similarly, foreign-born physicians in Finland encounter discrimination linked to language difficulties and employment barriers, affecting their intentions to stay in the country, 59% of foreign-born public sector GPs intended to leave their jobs, while 52% of Finnish public GPs had the same intention [ 25 , 26 ]. Overseas-qualified nurses in Australia experience discrimination due to language barriers and advocate for more cultural diversity education [ 18 ]. In Ireland, migrant doctors struggle with communication difficulties and discrimination based on dialects and accents [ 14 ]. Canadian MHCWs contend with acculturation stress due to limited communication training, language barriers, and discrimination tied to cultural backgrounds [ 21 ]. In Australia, migrant care workers report discrimination related to ethnicity, impacting their mental health and well-being [ 15 ].

Intercultural relations and cultural isolation

The study by Symes [ 17 ] in the USA revealed significant challenges faced by MHCWs. Intercultural barriers, affecting both professional practices and individual experiences, were a major concern for 18% of respondents. The study also highlighted the USA' healthcare system as a substantial hurdle for MHCWs, along with the emotional strain of being far from their support network; family, and friends (11%). Social Isolation was among the top barriers experienced by non-English speaking psychiatry IMGs (Median Score: 3 vs. 3.5; p  = 0.043) [ 22 ].

Meanwhile, Finland saw MHCWs encountering competence undervaluation based on factors, such as foreign ethnicity, religion, and language skills [ 25 , 26 ]. In Israel and the USA, migrant nurses faced challenges concerning work practices and communication issues, underscoring the need for enhanced cultural education [ 19 ]. In addition, Australian aged care facilities reported that weak associations were found between cultural isolation and DASS-depression, anxiety, and stress, as well as intercultural relations and DASS-depression, anxiety, and stress [ 15 ]. These experiences underscored the need for enhanced cultural education to aid integration and maximize the utilization of their skills [ 27 ].

Bureaucratic barriers

The articles shed light on challenges faced by MHCWs in different countries, encompassing bureaucratic and employment barriers that affect their integration and well-being. These challenges encompass work-related difficulties, interrelationships with colleagues, bureaucratic obstacles, visa issues, and financial constraints. Notably, Sweden and Finland encountered integration challenges for foreign-born physicians, including discrimination, undervaluation of competence, and language difficulties [ 24 , 25 , 26 ].

Bureaucratic barriers were a significant issue, particularly in the USA, the study by Symes [ 17 ] in the USA revealed significant challenges faced by MHCWs. Bureaucratic barriers, affecting both professional practices and individual experiences, were a major concern for 9% of study respondents where recent travel restrictions to specific countries delayed visa applications, causing stress and hindrances to MHCWs' successful adjustment. Employment barriers, including visa-related challenges and a lack of orientation support, impacted integration and raised concerns related to mental health, work–life balance, workplace discrimination, and support [ 17 ]. In Finland, standardized beta weights for significant variables used in the study indicated a P value of 0.085, reflecting the impact on migrant healthcare workers' intentions to remain in the country. Among these variables, employment barriers were associated with increased turnover intentions among migrant healthcare workers [ 25 , 26 ], while in Australia, the length of stay was linked to job satisfaction among immigrant nurses, indicating the need to address bureaucratic and employment-related challenges for MHCWs' successful integration and well-being [ 18 ].

The duration spent in a new healthcare setting significantly shapes healthcare professionals' career choices and migration intentions. Studies across the fourteen articles consistently demonstrate that the length of time spent in the new environment is intricately linked to these decisions. Longer stays in the host country are associated with stronger intentions to stay, as seen in MHCWs in the USA, who report higher job satisfaction and reduced turnover intentions [ 17 ]. Similarly, migrant doctors in Sweden with lengthier average durations have greater career stability and advancement in the medical labor market [ 24 ].

Conversely, shorter periods in the new healthcare setting often express higher intentions to leave or migrate onward. MHCWs in Australia with shorter durations experience higher acculturation stress, which is associated with intentions to leave [ 15 ]. MHCWs in Finland who have shorter contracts are more likely to express intentions to leave their positions [ 25 ].

Support and orientation programs

Support programs and orientation programs are integral in addressing the challenges faced by MHCWs in various healthcare and professional settings. An increase in perceived quality of orientation reduced the odds of experiencing organizational-level turnover by 36% among Asian Foreign-Educated Nurses in their 1st year of US employment [ 28 ]. In Australian residential aged care facilities, support programs alleviate acculturation stress for migrant care workers [ 15 ].

In Canada, approximately 75% of all participants, including 93% of Program Directors and 63% of IMGs, expressed the need for an orientation program for International Medical Graduates (IMGs). These findings underscore Canada's recognition of the importance of resources and orientation programs to facilitate the integration of MHCWs into the Canadian healthcare system [ 20 ]. Moreover, communication skills training and cultural orientation are identified as essential components of support programs to IMGs, especially for those dealing with language barriers and unfamiliar healthcare systems [ 21 ]. These programs do not only assist individuals in overcoming cultural and language challenges but also provide them with the necessary tools to navigate the complexities of their new professional environments effectively.

This paper provides a nuanced understanding of the unique challenges faced by migrant healthcare workers (MHCWs) when transitioning to new countries and healthcare environments. Unlike previous reviews that predominantly utilized qualitative data, this scoping review focuses on quantitative data from cross-sectional surveys, offering a broader, data-driven perspective on the integration of MHCWs. The study highlights significant barriers, such as language difficulties, cultural differences, and acculturation stress [ 8 ], emphasizing their impact on communication, job satisfaction, and overall integration into the healthcare system. Notably, the review underscores the importance of the temporal dimension, revealing how the duration of stay in a new environment influences MHCWs' adaptation and retention.

Furthermore, this review extends the existing literature by providing concrete recommendations for healthcare systems to improve the integration of MHCWs. It suggests implementing cultural competence training, diversity and inclusion policies, and support networks to address cultural and language barriers. The study also highlights the pivotal role of effective orientation programs in enhancing MHCWs’ confidence, competence, and sense of belonging, ultimately leading to reduced turnover intentions. By addressing these challenges through tailored strategies, the paper aims to foster a more inclusive and supportive healthcare environment, enhancing both patient care and the well-being of migrant healthcare professionals [ 2 ].

Language difficulties affected interactions with patients, colleagues, and supervisors, leading to miscommunications, misunderstandings, and potential risks in patient care. MHCWs reported struggling with English language skills, including comprehension of medical terminology, idioms, and nuances, which hindered effective communication and patient-centered history taking. For some, this also influenced their ability to understand and adhere to local healthcare protocols, ethical standards, and legal requirements. Inadequate language proficiency can hinder patient–physician interactions, potentially compromising the quality of care provided [ 29 ]. The consequences of language impacted MHCWs’ confidence, job satisfaction, and overall integration into the healthcare system.

The literature on cultural aspects as barriers to integration and intercultural relations among MHCWs underscores the importance of cultural competence, effective communication, and a supportive work environment. Comparative studies have offered valuable insights into how cultural factors vary across different countries and healthcare systems, highlighting the need for tailored strategies to address these barriers and promote successful integration and positive intercultural relations within the healthcare profession [ 30 , 31 ].

Cultural differences have a significant impact on the experiences of healthcare professionals, as highlighted in the analyzed articles. These differences encompass various aspects, including communication styles, power distance, and healthcare practices. For instance, MHCWs often face language barriers as mentioned before, making it challenging to effectively communicate with colleagues and patients [ 29 , 32 ]. In addition, variations in cultural norms and values can influence how healthcare professionals perceive and respond to specific situations, potentially leading to misunderstandings or conflicts in clinical settings. These cultural disparities can also affect power dynamics within healthcare teams, with MHCWs sometimes feeling marginalized or undervalued [ 23 , 33 ].

This scoping review goes along with existing literature that highlights the significance of the temporal dimension in healthcare professionals' career decisions and intentions [ 34 ]. A longer duration in the new healthcare environment provides professionals with the opportunity to adapt, integrate, and establish themselves, leading to a higher likelihood of staying. On the other hand, those who are relatively new to the setting may grapple with acculturation stress, language barriers, and the challenges of adjusting to a new healthcare system, potentially influencing their decisions to leave or seek opportunities elsewhere.

Overall, the time frame serves as a crucial context for understanding the complexities of professionals' intentions to either stay, return home, or migrate onward in their healthcare careers. Recognizing the dynamic interplay between time spent in the new healthcare setting and career intentions is pivotal for designing effective interventions and support mechanisms that address the evolving needs of healthcare professionals at various stages of their migration journey. The scoping review reveals several implications for further research and identifies gaps in the existing literature. One important avenue for future investigation is the in-depth exploration of the specific factors influencing the time frame healthcare professionals spend in new healthcare settings and its connection to their intentions to stay or leave.

To address highlighted challenges and provide a more inclusive and supportive healthcare environment, healthcare systems should implement several strategies. First, cultural competence training should be a fundamental component of medical education and professional development programs [ 28 , 35 ]. This training equips MHCWs with the skills to navigate cultural differences effectively, resulting in better communication and collaboration [ 36 ]. Second, healthcare systems should establish diversity and inclusion policies that promote equality and respect for all staff, regardless of their cultural background. These policies can help create a more welcoming and accepting workplace culture [ 8 ].

Furthermore, healthcare organizations should offer support networks for MHCWs [ 8 ]. These networks can provide emotional support, guidance on cultural adaptation, and opportunities for social interaction. In addition, interprofessional education programs can enhance teamwork and collaboration among healthcare professionals from diverse backgrounds [ 37 ]. Language support services, such as interpreters or language courses, are crucial in overcoming language barriers [ 29 ]. Cultural liaisons within healthcare organizations can serve as valuable resources for IMGs, helping them navigate the healthcare system and address cultural challenges effectively.

Orientation programs have been mentioned many times in numerous studies. They play a significant role in shaping the experiences, attitudes, and intentions of healthcare professionals in the various studies [ 38 ]. These programs are designed to facilitate the integration of foreign-trained healthcare workers into their new healthcare settings, providing them with essential information, skills, and support [ 8 ]. By actively addressing cultural differences and implementing these measures, healthcare systems can create a more inclusive and culturally competent environment that enhances patient care, promotes job satisfaction, and supports the well-being and integration of healthcare professionals from diverse cultural backgrounds. Quality cultural orientation experiences are linked to reduced turnover intentions and increased job satisfaction [ 38 ].

Orientation programs also contribute to the acculturation and integration of healthcare professionals into the new healthcare system. Effective orientation programs provide newcomers with a clear understanding of their roles, responsibilities, and expectations, helping them feel more confident and competent in their positions [ 39 ]. Effective orientation equips professionals with the necessary skills for effective communication and cultural understanding, promoting a smoother transition and a sense of belonging in the new environment [ 28 ]. Effective orientation equips professionals with the knowledge and skills needed to navigate the complexities of the host country's healthcare system, communicate effectively with colleagues and patients, and understand cultural norms and practices [ 40 ].

Further research can focus on policies around cultural competence training, diversity and inclusion, support networks, interprofessional education, language support services, and orientation programs in healthcare systems. For example, some countries like the United States and Australia have implemented policies on cultural competence training as part of medical education, established diversity and inclusion policies to promote equality and respect, created support networks for healthcare workers, and offered interprofessional education programs to enhance teamwork [ 15 , 28 ]. In addition, language support services and effective orientation programs have been introduced to aid in overcoming language barriers and facilitating the integration of foreign-trained healthcare workers [ 29 ]. However, further research is needed to understand the impact of these policies on creating a more inclusive and supportive healthcare environment, improving patient care, job satisfaction, and the integration of healthcare professionals from diverse cultural backgrounds.

Retention and turnover intentions are influenced by a complex interplay of factors. Positive experiences, such as effective orientation, supportive team climates, and ample career opportunities, are associated with reduced turnover intentions [ 23 , 30 ], while barriers and dissatisfaction contribute to higher intentions to leave or migrate. Personal demographics, nationality, career motivations, and the quality of professional experiences intersect to shape migration intentions. The reviewed studies add to existing literature and highlight the importance of addressing discrimination, providing support, and creating inclusive work environments to optimize the integration and well-being of migrant healthcare professionals [ 23 , 33 ]. Enhanced preparation, orientation programs, and communication skills training emerge as valuable strategies to facilitate successful transitions and mitigate challenges.

Limitations

While this scoping review provides a comprehensive exploration of the challenges and barriers faced by MHCWs in unfamiliar healthcare environments, it is important to acknowledge certain limitations that warrant consideration when interpreting its findings and implications. The diverse range of MHCWs, including doctors and nurses, from various countries of origin and experience levels, introduces sample heterogeneity. Some countries of origin were vast and versatile, not neatly fitting into the LMIC countries classification like Saudi Arabia or Estonia. However, this diversity serves as a strength, enriching insights and offering a holistic understanding of the phenomenon. Similarly, while the predominantly cross-sectional design restricts the ability to establish causal relationships, the utilization of cross-sectional surveys across the studies enhances methodological rigor by providing valuable statistical insights.

In addition, the reliance on self-reported data within the studies raises concerns about potential biases. However, this limitation can be mitigated by the scoping review's consideration of gender and ethnic differences within the analysis. By doing so, it offers valuable insights into the subtle ways in which MHCWs experiences may vary based on these factors, enriching the conclusions, and enhancing applicability across diverse contexts. Furthermore, the variability in response rates across studies, which could introduce non-response bias, is balanced by the review's comprehensive scope, capturing a wide range of perspectives from different healthcare settings, professional groups, and countries of origin.

One limitation of the scoping review conducted for this research pertains to the language barrier encountered during the literature search process. The review aimed to comprehensively explore existing studies on the experiences of MHCWs, encompassing a broad range of sources to ensure inclusivity. However, the search was primarily conducted in English, which may have inadvertently excluded relevant studies published in other languages. As a result, there is a possibility that valuable insights and perspectives from non-English language sources were not captured in the review. This limitation could potentially introduce bias into the findings, as it may overlook important research conducted in languages other than English. In addition, the reliance on English-language publications may limit the generalizability of the findings, particularly in contexts where English is not widely used or where research is predominantly published in other languages. Therefore, it is important to acknowledge the language limitation as a potential constraint in the scope and comprehensiveness of the scoping review findings. Future research endeavors may benefit from employing multilingual search strategies to mitigate this limitation and ensure a more comprehensive and inclusive exploration of the topic.

In summary, while the limitations should be acknowledged, they are counterbalanced by the scoping review's strengths. This review's inclusivity, methodological rigor, and synthesis of findings contribute to its credibility and effectiveness in shedding light on the multifaceted challenges and experiences of MHCWs navigating unfamiliar healthcare environments. Addressing these limitations in future research, through more focused samples, longitudinal designs, and consideration of additional contextual factors, would further refine our understanding of this complex phenomenon.

This paper sheds light on the multifaceted barriers of MHCWs while adjusting to a new country and healthcare system in various countries, while many of these barriers, such as language skills, discrimination, and work challenges, have been well-documented in existing literature, our review has identified additional nuances and new barriers. For example, we found that intercultural relations and cultural isolation were less frequently highlighted in previous studies but emerged as significant issues in our review to inform evidence-based policies that can address these challenges. Without effective policies, MHCWs may face significant challenges that could lead to their departure from the host country, exacerbating healthcare worker shortages there. While our review is focused on MHCWs in host countries, we also recognize that their migration may also worsen healthcare shortages in their source countries. Therefore, it's crucial to implement and evaluate strategies that support the integration and well-being of MHCWs in host countries. It is equally important to address the reasons that lead to MCHWs leaving their country of origin, a topic that goes beyond the scope of our review. This paper offers a detailed examination of the unique challenges encountered by MHCWs as they adapt to new countries and healthcare settings. Unlike prior reviews that mainly relied on qualitative data, this scoping review leverages quantitative data from cross-sectional surveys, providing a comprehensive, data-driven perspective on MHCWs' integration. This study also underscores the temporal dimension’s importance, highlighting how the duration of stay in a new environment influences MHCWs’ adaptation and retention, which adds a new layer of insight compared to prior research. Findings reveal the complex interplay between Language barriers, cultural differences, Discrimination, employment barriers, work environment, and personal well-being. The findings underscore the significance of cultural competence training and support programs to enhance the integration and job satisfaction of MHCWs. The role of time spent in the new healthcare setting emerges as a crucial factor in shaping intentions to stay or leave. Retention and turnover intentions in migrant healthcare professionals are influenced by a complex interplay of factors, with positive experiences and support reducing turnover intentions. Addressing discrimination, promoting inclusive work environments, and enhancing preparation programs are crucial for their successful integration and well-being. Further research should explore the impact of policies on cultural competence, diversity, support networks, interprofessional education, language services, and orientation programs. These measures, implemented in some countries, aim to create inclusive healthcare environments. Despite limitations of this scoping review on Sample Heterogeneity, Variability in Response Rates, and self-reported data, this study contributes valuable insights and emphasize the ongoing need for comprehensive strategies to facilitate the successful integration of MHCWs in diverse contexts. Ultimately, addressing these dynamics can lead to improved healthcare systems and the well-being of both healthcare providers and patients alike.

Availability of data and materials

Not applicable.

Abbreviations

• Migrant healthcare worker
• International medical graduate

Foreign-educated nurse

High income countries

Low- and middle-income Countries

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Al-Btoush, A., El-Bcheraoui, C. Challenges affecting migrant healthcare workers while adjusting to new healthcare environments: a scoping review. Hum Resour Health 22 , 56 (2024). https://doi.org/10.1186/s12960-024-00941-w

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