|Year : 2020 | Volume
| Issue : 2 | Page : 168-172
Health-related quality of life among dentists in Middle-East countries – A cross-sectional study
Sami S AlAbdulwahab, Shaji John Kachanathu, Abdulelah A Alaulami
Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
|Date of Submission||05-Nov-2019|
|Date of Decision||08-Nov-2019|
|Date of Acceptance||05-Jun-2020|
|Date of Web Publication||24-Jun-2020|
Dr. Shaji John Kachanathu
P. O. Box: 10219, Building #: 24, Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433
Source of Support: None, Conflict of Interest: None
Background: Health-related quality of life (HRQoL) is an essential concept for all health professionals. It is used to assess material, physical, social, emotional, and productive well-being. Health professionals investigate the HRQoL for their patients but rarely for themselves. Aim: To investigate the HRQoL among dentists in Middle-East countries. Materials and Methods: A multicenter and multi-regional stratified sample of 339 dentists (220 females and 119 males) with a mean age of 37 ± 9 years and 13 ± 8 years of experiences in dental practices in Middle-East countries participated in the study. HRQoL was assessed using the short form-8 (SF-8) health survey. The study group was examined based on HRQOL differences in age, gender, income, and overall QoL. The IBM® SPSS Statistics version 21 (IBM Corp., Armonk, USA) statistical software package was used for data analysis. The Spearman correlation coefficient and independent t-tests were used and significance was set at P ≤0.05. Results: The study observed that HRQoL among Middle East dental practitioners were within the published accepted general population range, in both physical component summary and mental component summary summaries of SF-8. The study also observed that gender differences had no role in terms of HRQoL among dental practitioners (P = 0.64). Conclusions: The study concluded that dentists have a positive HRQoL and no gender differences in HRQoL along with their years of dental practice. It is important that rehabilitation specialists have enough HRQoL information on different health-care professionals and geographical distribution to enable them to adopt an appropriate strategy and healthcare polices for a better outcome.
Keywords: Dentist, health-related quality of life, life change events, short form-8 questionnaire
|How to cite this article:|
AlAbdulwahab SS, Kachanathu SJ, Alaulami AA. Health-related quality of life among dentists in Middle-East countries – A cross-sectional study. J Indian Assoc Public Health Dent 2020;18:168-72
|How to cite this URL:|
AlAbdulwahab SS, Kachanathu SJ, Alaulami AA. Health-related quality of life among dentists in Middle-East countries – A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2020 [cited 2020 Oct 28];18:168-72. Available from: https://www.jiaphd.org/text.asp?2020/18/2/168/287626
| Introduction|| |
Quality of life (QoL) of an individual or society is considered to be related to attaining a healthy and productive lifestyle. QoL can be considered in a multidimensional concept, which includes physical, psychological, and other components. However, the World Health Organization defines QoL as individuals' perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns. It is a broad-ranging concept affected in a complex way by the person's physical health, psychological state, level of independence, social relationships, personal beliefs, and their relationship to salient features of their environment. QoL assessment has become an integral part of the evaluation of health programs. Health-related QoL (HRQoL) is a concept that links health and the QoL. The Centers for the Disease Control and Prevention define HRQoL as a multidimensional concept focusing on how a person's health affects his or her physical, mental, social, and emotional functioning.
Surveys in public health have emphasized the need to focus on improving HRQoL among all individuals. Poor HRQoL, particularly concerning perceived general health (GH) and limitations in physical functioning (PF)., In recent years, modernization and the increasing use of advanced technologies in workplaces have become increasingly competitive. Such changes may be associated with adverse HRQoL. It has been observed that the QoL is influenced by work burnout.
Burnout has been defined as a state of physical, emotional, and mental exhaustion that results from the long-term involvement in work situations that are emotionally demanding. Burnout is very common in occupations that have relationships with people face to face and is a result of prolonged stress related to work intensity. The intense physical and cognitive demands of providing high-quality healthcare to a wide spectrum of patients is well known; however, the prevalence of burnout syndrome in established medical professionals has been broadly estimated to range from 25% to 60%. It is considered as a serious potential threat to the overall quality of patient care and positive outcomes to the treatment strategies. The recent literatures observed the prevalence of burnout in many of the human service professions. Moreover, there have been extensive reports regarding burnout and the effects in a variety of professions as teachers, doctors, and nurses.,,
Dentistry is a demanding profession involving the high degree of concentration and precision. Dentists require good visual acuity, hearing, depth perception, psychomotor skills, manual dexterity, and ability to maintain occupational postures over long periods. Diminution of any of these abilities affects the practitioner's performance and productivity. Despite numerous advances in dentistry many occupational health problems still persist in the modern dentistry. Work-related musculoskeletal disorders have been also documented across a range of professions and clinical settings within the health-care industry., Clinically, number of health professionals visit physical therapy department seeking for advice and help to either prevent or minimize work-related musculoskeletal disorders.
Despite the documented prevalence and clinical ramifications of health professional distress, few rigorous studies have tested interventions to address the problem, especially in dental practice. However, to the best of our knowledge, there have been no previous studies in which HRQoL has been investigated with respect to dental professions. Considering the essential role of HRQoL in dental practitioners and the lack of information, this study was conducted to delineate the status of dentist's HRQoL, especially in physical and mental components.
| Materials and Methods|| |
After preparing a list of names and addresses of the general dental practitioners in the different cities of Middle-East countries from their respective dental associations, the questionnaire related to the survey was distributed to them through E-mail. The inclusion criteria were general dentists and dental specialists, who had been employed at their respective workplaces for at least 6 months–15 years. A stratified cluster sampling procedure was employed to collect the representative sample. All the participants were assured about the confidentiality of personal information. A total of 550 questionnaires were distributed between January 2018 and April 2018 with two reminder e-mails and 339 questionnaires were used for analysis, whereas 111 questionnaires omitted due to any form of incomplete data yielded 339 valid samples for an effective response rate of 62%. In the final sample of 339, study participants were 220 females and 119 males, with a mean age of 37 ± 9 years and 13 ± 8 years of experiences. This was a 12-month cross-sectional study in which the data collection period started from January 2018 to December 2018, and used structured questionnaire short form-8 (SF-8) to collect the data using mail-out and mail-back methods. The researcher extracting HRQoL data from SF-8 health survey questionnaire were also blinded to the study. To ensure equity and ethical considerations, this study was approved by the Institutional Review Board (Ethics number: CAMS 111-36/37), and the study details explained to the study participants before a questionnaire distribution and obtained signed consent.
The present study also involved using a structured questionnaire comprising basic personal characteristics, including gender, age, education level, spiritual beliefs, place of work, and total years of experience in dental practice along with SF-8 Health Survey Questionnaire.
Short form-8 health survey
The SF-8 health survey is an 8-item SF designed to provide a HRQoL profile. The questionnaire has the practical advantage of being brief (only 8 questions, rather than 12 or 36), while yielding scores that are directly comparable to the eight scores produced by the standard SF-36 and SF-12 questionnaires. All three SF surveys can be summarized into an 8-scale profile that can be compared across the surveys. They also can be scored to report an overall measure of physical and mental functioning (i.e., physical component summary [PCS] and mental component summary [MCS]) that is comparable among the surveys and higher scores indicating better self-reported HRQoL. Test-retest reliability of the SF-8 survey has previously been investigated and proven to be strong, indicating that the survey is sensitive to change, and can therefore be used to assess the change in HRQoL over time.
Different versions of the SF-8 have been developed and validated for three recall periods: standard (4-week), acute (1-week), and acute (24-h) in which, a 4-week recall was being used for this evaluation. In order to measure the HRQoL, the SF-8 represented eight-dimensional concepts, i.e., PF, role limitation caused by physical problems, bodily pain (BP), GH, vitality, role limitation because of emotional problems, social functioning (SF), and mental health. Two summary measures were also produced, the PCS and MCS (Ware 2008). Both PCS and MCS are continuous variables, normative scores, calculated and summarized (means and standard deviations) by quality metric incorporated, were used in this paper to compare the study population. The SF-8 scale was scored using the 5-point Likert scale (very positive, rather positive, equivocal, rather negative, and very negative). The scores for each dimension were converted into standard scores, and after the conversion, the standard score of each dimension was 100 points. The scores on all the subscales are transformed to a scale from 0 = worst to 100 = best, with high scores representing best function and lower scores worse function.
The IBM® SPSS Statistics version 21 (IBM Corp., Armonk, USA) statistical software package was used for data analysis. The numerical values are presented as mean ± standard deviation, except when otherwise specified. The Spearman correlation coefficient and independent t-tests were used and significance was set at P ≤ 0.05.
| Results|| |
The Spearman correlation coefficient showed no significant change in the HRQoL among dental practitioners along with their years of dental practice (P > 0.56). The HRQoL among dental practitioners, especially PCS and MCS, were of 49 ± 8; 50 ± 8 respectively. Independent t-test showed no statistical significant different between male and female HRQoL (P > 0.64) [Table 1].
|Table 1: Comparison of health-related quality of life among dental practitioners|
Click here to view
| Discussion|| |
The results of the present study observed that a normal rather higher HRQoL among dental practitioners along with their years of dental practice, especially in physical and mental components. Moreover, it also observed that gender among dental practitioners had no effect on HRQoL. HRQoL studies are increasingly used to implement the corrective measures for general population globally; however, dearth of studies have been undertaken on health-care providers, especially dentists who are usually undergoing tremendous physical excretions during their clinical practices. There are evidences that HRQoL scores vary by sociodemographics trend; hence, we assume that the current study would be a regional database of HRQoL for clinically practicing dentists in Middle-East countries.
The result of the present study showed HRQoL, especially PCS and MCS with a mean of 49 ± 8; 50 ± 8, respectively, whereas the subscales scores ranges from 45 to 51. The higher the score is, the higher the HRQoL, and similarly, a lower score indicate a lower HRQoL. Although, there are different reports on the normative values of HRQoL, Tian-hui and Lu (2005) reported that PCS and MCS <39 can be considered as normal <39, whereas >39 can be considered as abnormal HRQoL. Moreover, studies also had been reported if a total score of 50 or more is reached, then it represents a high HRQoL. Based on the previous observations, our study result may also consider as higher HRQoL among dentists.
Musculoskeletal disorders/pain had a particularly negative impact on the physical and mental aspects of HRQoL. Although it has been reported that the prevalence of musculoskeletal problems are high and impact significantly on dentists' daily lives. Hand/wrist complaints are of most importance in terms of occupational-related musculoskeletal disorders in dentist and ergonomic and educational interventions could hold a prominent role in its prevention. However, in the current study, among SF-8, BP component of PCS is related to self-reported pain score. The higher HRQoL of the present study group is that it has higher rates of coexisting healthier conditions of the study group possibly due to well-designed working environment and ergonomic awareness. Moreover, the doctor–patient ratio was well maintained. The study participants were also associated with a medical university and had the opportunity to visit physical therapy clinics whenever they had musculoskeletal disorders/pain.
The highlight of gender difference is important in addressing the various aspects as comprehensively as possible for the life domains of the target health professional group when investigating HRQoL. Studies have been also reported HRQoL and its gender-related differences among the general population., However, the present study observed that no gender differences among dental practitioners. Although we have been unable to find any previous publications that have used this approach in health professional's HRQoL research related to gender differences. The present study is to our knowledge the first attempt to determine the role of HRQoL with gender difference among dentists. However, the question of whether the gender differences in HRQoL vary depending on the culture cannot be answered here.
A recent study on teachers reported that young teachers are the most having the burnout syndrome than the older teachers and also observed 36–45 years' age group is determinate the highest personal achievement score. Based on these observations, the age factor of the present study group, i.e., 37 ± 9 years also might have contributed to the higher HRQoL. Moreover, as medical professionals, the phenomenon of burnout appears to be initiated during the medical school and may be sustained at significantly high rates of occurrence through residency training. Adolescents' unsettled phase can lead to a higher health-related burden. Studies have been tending to indicate the higher values of HRQoL in adolescent males than in adolescent females in the general population. Although the present study group population were at their age of late thirties by this time, the improvement in QoL may be due to professional autonomy and social acceptance even in females also settled with their motherhood stage. Moreover, it has been observed that increasing age was associated with a reduced risk of developing nervousness and depression in dentists. This could be the one of the reasons for the better HRQoL result in the experienced study participants.
However, another important concern about the individuals participated in this study had been chosen dentistry as a professional career, based on a wide range of motivational factors. It may also be argued that dentistry as a professional career was motivated by the multiple categories of influence: “professional” “academic;” “healthcare;” “lifestyle;” the influence of “advisors,” including family, friends, careers advisers, and “work experience., No centralized official data on the social, demographic, and professional aspects of the HRQoL of dental practitioners, hence, we think job satisfaction factor may affect the results our study.
A further point of contention is that, even though the findings are not directly comparable, there is the general agreement on the range of motivating factors; it appears that the dominant motivational factors may vary over time and between countries. For a dental professional, it provides a financially lucrative, contained career in healthcare, with professional status, job security and the opportunity to work flexibly. Long-term professional expectations were closely linked with their personal lives and support a vision of a favorable work/life balance. Features included the nature of dentistry combining science, healthcare and art; the hours of work which can be both regular and flexible; the perception of job availability and security; independence/freedom; and earning a sizeable and flexible income. Professional factors included achieving “continuing job satisfaction” and “career development,” thus “avoiding boredom.” Continuing job satisfaction throughout their career was an important factor. This may influence the HRQoL of dental professionals. This could be the reason for the observation of the better HRQoL among the study participants.
Dentists in the present study inclined toward spiritual belief as noted during the initial interview. Spirituality is considered as a stress-coping mechanism and is widely acknowledged in the general population. A possible explanation might be that the beliefs of religious tended to have the positive effects on the QoL through the provision of hope and optimism, as well as a sense of awe and appreciation for things in nature and their surroundings. This could be the one of the predisposing factors that might be contributed to the present study result. It has been suggested that potential HRQoL improving strategies have been grouped into six broad categories: physical conditioning, organizational strategies, workload and work allocation, work practices, environment and equipment, and education and training.
| Conclusions|| |
It can be concluded that dentists in this study have a positive HRQoL. Dentist's genders have no significant effect on HRQoL along with their years of dental practice. It is important that physical rehabilitation specialists have enough HRQoL information on different health-care service providers and geographical distribution to enable them to adopt an appropriate strategy for a better outcome.
The authors would like to extend their appreciation to the Deanship of Scientific Research, and Research Center, College of Applied Medical Sciences at the King Saud University for constructive scientific support during this research.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Hambleton P, Keeling S, McKenzie M. The jungle of quality of life: Mapping measures and meanings for elders. Australas J Ageing 2009;28:3-6.
Power M, Harper A, Bullinger M. The World Health Organization WHOQOL-100: Tests of the universality of Quality of Life in 15 different cultural groups worldwide. Health Psychol 1999;18:495-505.
Reeves WC, Strine TW, Pratt LA, Thompson W, Ahluwalia I, Dhingra SS, et al
. Mental illness surveillance among adults in the United States. MMWR Suppl 2011;60:1-29.
Manuel DG, Schultz SE. Health-related quality of life and health-adjusted life expectancy of people with diabetes in Ontario, Canada, 1996-1997. Diabetes Care 2004;27:407-14.
Goldney RD, Phillips PJ, Fisher LJ, Wilson DH. Diabetes, depression, and quality of life: A population study. Diabetes Care 2004;27:1066-70.
Pransky G, Robertson MM, Moon SD. Stress and work-related upper extremity disorders: Implications for prevention and management. Am J Ind Med 2002;41:443-55.
Fradelos E, Tzitzikos G, Giannouli V, Argyrou P, Vassilopoulou C, Theofilou P. Assessment of burn-out and quality of life in nursing professionals: The contribution of perceived social support. Health Psychol Res 2014;2:984.
Barutçu E, Serinkan C. Burnout syndrome as one of the important problems of our day and a research in Denizli. Ege Academic Review 2008;8:541-61.
Panagopoulou E, Montgomery A, Benos A. Burnout in internal medicine physicians: Differences between residents and specialists. Eur J Intern Med 2006;17:195-200.
Ptacek R, Stefano GB, Kuzelova H, Raboch J, Harsa P, Kream RM. Burnout syndrome in medical professionals: A manifestation of chronic stress with counterintuitive passive characteristics. Neuro Endocrinol Lett 2013;34:259-64.
Barutçu E, Serinkan C. Burnout syndrome of teachers: An empirical study in Denizli in Turkey. Procedia Soc Behav Sci 2013;89:318-22.
Ayers KM, Thomson WM, Newton JT, Morgaine KC, Rich AM. Self-reported occupational health of general dental practitioners. Occup Med (Lond) 2009;59:142-8.
Leggat PA, Kedjarune U, Smith DR. Occupational health problems in modern dentistry: A review. Ind Health 2007;45:611-21.
Alperovitch-Najenson D, Treger I, Kalichman L. Physical therapists versus nurses in a rehabilitation hospital: Comparing prevalence of work-related musculoskeletal complaints and working conditions. Arch Environ Occup Health 2014;69:33-9.
Barbosa RE, Assunção AÁ, de Araújo TM. Musculoskeletal pain among healthcare workers: An exploratory study on gender differences. Am J Ind Med 2013;56:1201-12.
Ware Jr. JE. SF-36 health survey update. Spine 2000;25:3130-9.
Ware JE Jr., Improvements in short-form measures of health status: Introduction to a series. J Clin Epidemiol 2008;61:1-5.
Tian-hui C, Lu LA. Systematic review: How to choose appropriate health-related quality of life (HRQOL) measures in routine general practice?. J Zhejiang University Science B 2005;6:936-40.
Paananen M, Taimela S, Auvinen J, Tammelin T, Zitting P, Karppinen J. Impact of self-reported musculoskeletal pain on health-related quality of life among young adults. Pain Med 2011;12:9-17.
Alexopoulos EC, Stathi IC, Charizani F. Prevalence of musculoskeletal disorders in dentists. BMC Musculoskelet Disord 2004;5:16.
Vázquez I, Valderrábano F, Fort I, Jofré R, López-Gómez JM, Moreno F, et al
. Differences in health-related quality of life between male and female hemodialysis patients. Nefrologia 2004;24:167-78.
Liu H, Feurer ID, Dwyer K, Speroff T, Shaffer D, Wright Pinson C. The effects of gender and age on health-related quality of life following kidney transplantation. J Clin Nurs 2008;17:82-9.
Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med 2002;136:358-67.
Ptacek R, Stefano GB, Kuzelova H, Raboch J, Harsa P, Kream RM. Burnout syndrome in medical professionals: A manifestation of chronic stress with counterintuitive passive characteristics. Neuroendocrinology Letters 2013;34:259-64.
Bisegger C, Cloetta B, Von Bisegger U, Abel T, Ravens-Sieberer U. Health-related quality of life: Gender differences in childhood and adolescence. Sozial-und Präventivmedizin 2005;50:281-91.
Puriene A, Aleksejuniene J, Petrauskiene J, Balciuniene I, Janulyte V. Self-perceived mental health and job satisfaction among Lithuanian dentists. Ind Health 2008;46:247-52.
Scarbecz M, Ross JA. Gender differences in first-year dental students' motivation to attend dental school. J Dent Educ 2002;66:952-61.
Gallagher JE, Patel R, Donaldson N, Wilson NH. The emerging dental workforce: Why dentistry? A quantitative study of final year dental students' views on their professional career. BMC Oral Health 2007;7:7.
Gallagher JE, Clarke W, Eaton KA, Wilson NH. Dentistry-a professional contained career in healthcare. A qualitative study of Vocational Dental Practitioners' professional expectations. BMC Oral Health 2007;7:16.
Krägeloh CU, Shepherd GS. Quality of life of community-dwelling retirement-aged New Zealanders: The effects of volunteering, income, and being part of a religious community. VOLUNTAS Int J Volunt Nonprofit Organizations 2015;26:2462-78.
McPhail SM, Waite MC. Physical activity and health-related quality of life among physiotherapists: A cross sectional survey in an Australian hospital and health service. J Occup Med Toxicol 2014;9:1.