[Megathread] Riset JDN terkait kesejahteraan PPDS seluruh Indonesia
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Thread ini merupakan wadah diskusi umum untuk mempersiapkan riset JDN terkait kesejahteraan PPDS seluruh Indonesia. Dalam thread ini, akan dibahas beberapa aspek persiapan riset, mulai dari kerangka teori, kerangka konsep, definisi operasional, sampai formulasi metode. Poin-poin penting dalam diskusi akan diangkat kembali dalam post pertama ini.
Topik pembahasan
- Apa definisi operasional dari kesejahteraan?
- Apakah kesejahteraan dianggap sebagai welfare atau well-being?
- Bagaimana kerangka teori dari kondisi kesejahteraan PPDS?
- Apa saja variabel penelitian terkait dan definisi operasionalnya?
Synchronous discussion logs
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Welfare vs. well-being
- Well-being and welfare are seemingly subject to conceptual confusion.
- It is established that well-being encompasses three dimensions: happiness, meaning in life, and psychological wellness.
- The paper introduces welfare as the fourth dimension of well-being.
- Welfare is represented into three distinct streams:
- Objective observation, e.g., affluence, health, housing, employment.
- Subjective rating of own welfare.
- Subjective rating of capabilities or opportunities to attain welfare, including Sen’s classic capability approach.
- This article endorses the third stream to define welfare.
- A correlation between a subjective well-being measure and certain variables is often used to validate the measure.
- At the same time, that correlation is also used to back the claim that particular interventions on certain variables have welfare consequences.
- The article indicated that these issues complicate the interpretation of well-being on more concrete variables.
- Easterlin paradox: There’s a positive effect of income on life evaluation and on happiness, but there appears to have been little effect of national economic growth on the average measure of life evaluation and on happiness.
Happy but Unequal: Differences in Subjective Well-Being across Individuals and Space in Colombia:
- There are inequalities of well-being representations.
- Top 20% of the population: Well-being is associated with standard-of-living improvements, housing affordability, and civic engagement.
- Bottom 20% of the population: Well-being is associated with having education, a job, sufficient income, economic security, and digital connectivity.
Concept summary
Concept Focus Main Indicators Typical Assessments Perspective Well-being Subjective life satisfaction, happiness Psychological, emotional, Self-reported surveys, quality of life scales Individual-centric, meaning, fulfillment Welfare Material and social conditions Income, access to resources, health, education Income, living conditions, government support Society/institution-centric -
Formulasi pertanyaan penelitian
Brief research deck - Original research questions:
- What is the distribution and demographic profile of medical residents across Indonesia?
- What is the current welfare status of medical residents?
- How adequate is legal and institutional protection for medical residents?
- What forms of bullying, overwork, or psychological stress do residents experience?
- How do medical residents and experts perceive the structural and cultural factors influencing welfare and protection?
Prof. Titin menilai pertanyaan penelitian di atas masih kurang terarah dan belum sepenuhnya mengambarkan aspek apa dari welfare/well-being yang akan diangkat. Setelah diskusi terakhir, kupikir pertanyaan penelitian kita bisa lebih mengerucut untuk membahas aspek2 subjective welfare.
Dalam artikel Individuals’ Assessments of Their Own Wellbeing, Subjective Welfare, and Good Life: Four Exploratory Studies, subjective welfare dinilai menggunakan pendekatan Sen’s capability framework:
Rate from a scale from 1 (not at all important) to 10 (very important)
How important is [the following aspect in] your life[?]- welfare
- economic security
- capability for good health
- access to what I need
- opportunity to do what I want
Phrasing dari pertanyaan2 dlm artikel ini sebetulnya terdengar agar janggal, dan author ga memberikan supplementary materials utk kuisioner yang mereka pakai. Biarpun begitu, yang penting di sini justru formulasi awal dari item2 welfare. Sbg konteks, author dalam artikel ini berargumen bahwa item2 welfare memiliki korelasi positif dengan subjective well-being, namun dengan factor loading yang berbeda. Artinya, item welfare dan item well-being itu memiliki konstruk yang berbeda, namun tetap saling berkaitan.
Artikel tersebut merujuk ke artikel The Development of Capability Indicators (full text is available here) dalam penentuan item2 welfare. Dalam Tabel 1 dari artikel ini terdapat 48 variabel untuk mengukur welfare secara konkret. Dalam Tabel 3, variabel yang memiliki korelasi positif bermakna dengan subjective well-being adalah:
- Bodily health: Adequate shelter (standardized coefficient = 0.23)
- Bodily integrity: Sexual satisfaction (0.22)
- Emotions: Expresses feelings (0.10)
- Practical reasons: Plan of life (0.11)
- Practical reasons: Useful role (0.37)
- Affiliation: Respects others (0.11)
- Affiliation: Takes holidays (0.20)
- Affiliation: Feels worthless (0.31)
- Personality: Emotionally stable (0.12)
Catatan: Korelasi positif bermakna memiliki p < 0.05 dan standardized effect size coefficient >= 0.1.
Mempertimbangkan tabel 4 dan tabel 5, variabel yang tetap konsisten di seluruh subgroup adalah:
- Practical reasons: Plan of life (0.11)
- Practical reasons: Useful role (0.37)
- Affiliation: Feels worthless (0.31)
- Personality: Emotionally stable (0.12)
Menurutku, welfare dapat kita kerucutkan menjadi 4 variabel tersebut. Pertanyaan untuk mengukur keempat variabel berdasarkan rujukan utama adalah:
- Practical reasons: Plan of life
Please indicate how strongly you agree or disagree with the following statement:
’I have a clear plan of how I would like my life to be’
Agree strongly=7, Agree moderately=6, Agree a little=5, Neither agree nor disagree=4, Disagree a little=3, Disagree moderately=2, Disagree strongly=1 - Practical reasons: Useful role
Outside of work, have you recently felt that you were playing a useful part in things?
More so than usual=4, Same as usual=3, Less so than usual=2, Much less than usual=1 - Affiliation: Feels worthless (note that this is an item with inverted responses, i.e., higher score implies lower worthlessness)
Have you recently been thinking of yourself as a worthless person?
Not at all=4, No more than usual=3, Rather more than usual=2, Much more than usual=1 - Personality: Emotionally stable
Use the 10-item personality inventory to measure openness, conscientiousness, extraversion, agreeableness, and neuroticism. Assessment untuk emotional stability diambil dari dimensi neuroticism, direpresentasikan dalam dua pertanyaan berikut:- I see myself as anxious, easily upset (inverted responses)
- I see myself as calm, emotionally stable
Disagree strongly = 1, Disagree moderately = 2, Disagree a little = 3, Neither agree nor disagree = 4, Agree a little = 5, Agree moderately= 6 Agree strongly = 7
Mempertimbangkan aspek welfare tersebut, kita bisa memformulasikan ulang tiga pertanyaan penelitian berikut:
- What is the current welfare status of medical residents?
- What forms of bullying, overwork, or psychological stress do residents experience?
- How do medical residents and experts perceive the structural and cultural factors influencing welfare and protection?
Setelah reformulasi menggunakan Sen’s capability approach:
- To what extent do medical residents report having a clear plan for their life goals?
Pertanyaan penelitian ini dapat kita evaluasi scr kuantitatif melalui dua item berikut:- How strongly do you agree that you have a clear plan for how you would like your life to be?
- To what degree do you feel that you have recently played a useful part in activities outside residency?
- To what extent do medical residents experience psychological stress related to the work culture?
Pertanyaan penelitian ini dapat kita evaluasi scr kuantitatif melalui tiga item berikut:- How frequently have you recently thought of yourself as worthless? (inverted responses)
- Which specific forms of the work culture do you think correspond with higher emotional distress?
- Pertanyaan dimensi neuroticism dari 10-item personality measure.
- How do medical residents and domain experts assess the structural and cultural factors in training environments that expand or constrain residents’ capabilities to plan their lives, maintain a useful social role, preserve emotional stability, and avoid internalized worthlessness?
Pertanyaan penelitian ini dapat kita evaluasi secara kualitatif melalui FGD dan interview dalam dua pertanyaan tematik berikut:- [Mention four capabilities as stated above] Which institutional practices (e.g., duty hours, supervision, reporting mechanisms) are perceived to enhance or restrict these capabilities?
- Which cultural norms (e.g., hierarchy, stigma around help-seeking, expectations of endurance) are perceived to influence residents’ sense of agency, role usefulness, emotional stability, and self-worth?
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Theoretical Background
Culture, Burnout, and Engagement: A Meta-Analysis on National Cultural Values as Moderators in JD-R Theory
Implied research question:
To what extent, and in what specific ways, do national cultural values moderate the established relationships between job demands/resources and the outcomes of burnout/engagement as described by the Job Demands-Resources (JD-R) theory?
Key findings:
- Job demands are strongly and positively linked to burnout.
- Job resources are strongly and positively linked to engagement.
- Five out of the six cultural dimensions from Hofstede’s framework moderated the relationships between job demand/job resource and burnout/engagement.
- The Masculinity/Femininity and Tightness/Looseness dimensions only influenced relationships involving job demands.
- Power Distance, Individualism/Collectivism, and Long-Term/Short-Term Orientation only influenced relationships involving job resources.
- Highly Masculine and/or Tight cultures exacerbated the negative effect of job demands on burnout and decreased engagement.
- High Power Distance, Collectivism, and Long-Term Orientation weakened the effects of job resources on engagement.
- Many of the moderating effects were only partly stable and require further research across other national contexts.
Burnout in medical students before residency: A systematic review and meta-analysis
Implied research question:
What is the global prevalence of burnout and its constituent dimensions (emotional exhaustion, depersonalization, and low personal accomplishment) among medical students prior to their residency training?
Key findings:
- Worldwide prevalence of burnout before residency is 44.2% (95% CI: 33.4%–55.0%):
- Emotional Exhaustion: 40.8% (95% CI: 32.8%–48.9%).
- Depersonalization: 35.1% (95% CI: 27.2%–43.0%).
- Reduced Personal Accomplishment: 27.4% (95% CI: 20.5%–34.3%).
- No significant gender difference in overall burnout prevalence.
- Observed slight differences across various countries and continents.
Burnout syndrome among medical residents: A systematic review and meta-analysis
Implied research question:
What is the prevalence of burnout syndrome among medical residents, and how does this prevalence differ across various medical and surgical specialties?
Key findings:
- The overall burnout prevalence is 35.1% across all specialties.
- Three tiers of burnout prevalence based on medical specialty:
- High Prevalence Group (42.5%): General surgery, anesthesiology, obstetrics/gynecology, and orthopedics.
- Moderate Prevalence Group (29.4%): Internal medicine, plastic surgery, and pediatrics.
- Low Prevalence Group (23.5%): Otolaryngology and neurology.
Interventions to reduce physician’s burnout
Sources:
- Organizational strategies to reduce physician burnout: a systematic review and meta-analysis
- Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis
Implied research question:
What is the overall effectiveness of interventions designed to reduce physician burnout, and how do organization-directed strategies compare in efficacy to individual-directed strategies?
Key findings:
- Interventions are proven to cause clinically meaningful reductions in physician burnout, with a decrease in overall burnout prevalence from 54% to 44%.
- Organization-directed interventions are significantly more effective at reducing burnout (Standardized Mean Difference [SMD] = -0.446) than individual-focused interventions (SMD = -0.178).
- Organizational strategies were more effective at reducing depersonalization and improving feelings of personal accomplishment compared to individual strategies.
- Effective intervention per approach:
- Individual-focused: Mindfulness programs, stress management training, and small group curricula.
- Organization-focused: Changes to workload and schedules (e.g., duty hour requirements, shift rotation) and improvements in teamwork and communication.
Resident duty hours and resident and patient outcomes: Systematic review and meta-analysis
Implied research question:
Based on evidence from randomized controlled trials, what is the impact of resident duty hour restrictions on key resident-centered outcomes (like burnout and well-being) and patient-centered outcomes (like medical errors and length of stay)?
Key findings:
- Shorter resident duty hours were associated with significantly less emotional exhaustion (Standardized Mean Difference [SMD] = -0.11) and less dissatisfaction with overall well-being (Odds Ratio [OR] = 0.61).
- Shorter shifts were also linked to a significant increase in sleep duration for residents.
- No statistically significant association between shorter duty hours and key patient outcomes, including hospital length of stay, serious medical errors, and preventable adverse events.
A Meta-Analysis of the Relationship between Role Stress and Organizational Commitment: the Moderating Effects of Occupational Type and Culture
Implied research question:
What is the relationship between different forms of role stress (ambiguity, conflict, and overload) and the components of organizational commitment (affective and continuance), and are these relationships moderated by occupational type and culture?
Key findings:
- Role ambiguity, conflict, and overload) are significantly and negatively related to affective commitment/employee’s desire to stay.
- Role ambiguity, conflict, and overload) are not significantly related to continuance commitment/employee’s need to stay.
- Role ambiguity has the strongest negative relationship with affective commitment (corrected correlation ρ = -0.40).
- The negative relationships of role ambiguity and role conflict with affective commitment are stronger in Western cultures compared to non-Western cultures.
A systematic review including meta-analysis of work environment and burnout symptoms
Implied research question:
What are the associations between a wide range of working conditions and the development of burnout symptoms?
Key findings:
- Associated with emotional exhaustion:
- Low job control (OR=1.63; evidence grade 3).
- Low workplace support (OR=1.81; grade 3).
- High workload/demand (OR=2.53; grade 2).
- Low reward (OR=1.86; grade 2).
- Job insecurity (OR=1.39; grade 2).
- Workplace justice (OR=0.35; grade 2; OR<1 implies that this factor is negatively associated with emotional exhaustion).
- Associated with depersonalization:
- Low workplace support (OR=1.59; grade 2).
- Unspecified psychological demands (OR=2.37; grade 2).
- High workload (OR=2.52; grade 2).
- Associated with reduced personal accomplishment: Low reward (OR was not calculated because the results in the included studies were inconsistent).
