title: Stress, motivation and professional satisfaction among health care workers in HIV/AIDS care and treatment centers in urban Tanzania: a cross-sectional study.
abstract: BACKGROUND
  Shortages of health care workers (HCWs) represents a serious challenge to ensuring effective HIV care in resource-limited settings (RLS). Stress, motivation, and job satisfaction have been linked with HCW retention and are important in addressing HCW shortages. In this cross-sectional study HCW stress, motivation and perceived ability to meet patient needs were assessed in PEPFAR-supported urban HIV care and treatment clinics (CTCs) in Tanzania.
  
  
  METHODS
  A self-administered questionnaire measuring motivation, stress, and perceived ability to and meet patient needs was given to HCWs at 16 CTCs. Scales measuring HCW satisfaction, motivation, and stress were developed using principle components analysis. Hierarchical linear models were used to explore the association of HCW and site characteristics with reported satisfaction, stress, motivation, and ability to meet patients' needs.
  
  
  RESULTS
  Seventy-three percent (279) of HCWs completed the questionnaire. Most (73%) HCWs reported minimal/no work-related stress, with 48% reporting good/excellent motivation, but 41% also reporting feeling emotionally drained. Almost all (98%) reported feeling able to help their patients, with 68% reporting work as rewarding. Most reported receipt of training and supervision, with good availability of resources. In the multivariate model, direct clinical providers reported lower motivation than management (p < 0.05) and HCWs at medium-sized sites reported higher motivation than HCWs at larger sites (p < 0.05). HCWs at small and medium sites were more likely to feel able to help patients than those from larger sites (p < 0.05 and p < 0.001 respectively).
  
  
  CONCLUSIONS
  Despite significant patient loads, HCWs in these PEPFAR-supported CTCs reported high levels of motivation, job satisfaction, ability to meet patients' needs, low levels of stress but significant emotional toll. Understanding the relationship between support systems such as strong supervision and training and these outcomes is critical in designing interventions to improve motivation, reduce stress and increase retention of HCWs.
authors: MUHAS-Harvard School of Public Health, Dar es Salaam City Council (MDH) HIV/AIDS Care and Treatment Program, 477A Mindu street, Dar es Salaam, Tanzania.
authors: Hellen
authors: H
authors: Siril
authors: Lisa R
authors: LR
authors: Hirschhorn
authors: Claudia
authors: C
authors: Hawkins
authors: Maria E
authors: ME
authors: Garcia
authors: Michelle S
authors: MS
authors: Li
authors: Shabbir
authors: S
authors: Ismail
authors: Sarah Geoffrey
authors: SG
authors: Mdingi
authors: Guerino
authors: G
authors: Chalamilla
authors: Wafaie
authors: W
authors: Fawzi
authors: Sylvia
authors: S
authors: Kaaya
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000458:organization & administration; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000451:nursing; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D009042:Motivation; D012931:Social Environment; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D013636:Tanzania; D016526:Workload / Q000523:psychology; D055815:Young Adult