1.Background
The world health organization (WHO) has defined quality of life (QOL) as “an individual’s perception of his/her 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” (1). Recently, many general instruments have been used to measure QOL in different groups (i.e., population, patients, workers, etc). One of such instruments is the SF-36 questionnaire, a generic instrument translated and validated in Iran by Montazeri (2). In this regard, QOL of people with a health problem (i.e., cancer, diabetes, hypertension, etc) was evaluated in many studies (3-29); But there are few studies that have evaluated the QOL of health care workers, for example nurses, who provide health care services for patients.
Nurses are among the greatest providers of services in the health care system and in their work settings, they may be exposed to a wide array of chemical, biological, psychosocial (i.e., stress, depression, etc) and physical hazards (i.e., injuries, transmission of infectious diseases, etc). Consecutively, such conditions may affect the QOL of nurses. It is noteworthy that nurses provide higher quality services for their patients when they are healthy and possess desirable QOL. Therefore, it is important to pay particular attention to nurses’ general health conditions and QOL.
2. Objectives
The objective of this study was to assess the QOL in nurses working in Neyshabur hospitals and some factors associated with it, with the use of the SF-36 scale.
3. Materials and Methods
In this cross-sectional study, data were collected from February to April 2012 in Neyshabur hospitals (22 Bahman and Hakim) in Neyshabur (A city in Northeast of Iran). Of all nurses (n = 220), 22 were excluded because they refused to participate in the study. Therefore, 198 questionnaires were collected (response rate = 90%). All of participants provided informed consent after the purpose of study was explained for them. Inclusion criteria for participating in the study included the nurses who work in Neyshabur hospitals in addition to their agreement for participation.
3.1. Procedure and Study Instrument
In this study, questionnaires have been filled out by participants and for enhancing the accuracy, participants were explained that their responses would remain confidential. A trained person explained how to complete the questionnaires for each participant. We used the Iranian version of the SF-36 questionnaire in this study that was validated in Iran by Montazeri (2). This questionnaire contains 36 items that are divided into eight subscales: physical functioning (PF), role limitations due to physical problems (RP), bodily pain (BP), vitality (VT), general health (GH), social functioning (SF), role limitations due to emotional problems (RE) and mental health (MH). Three subscales (MH, RE, and SF) correlate most highly with the mental aspect of QOL and are associated with subscale of VT, contribute most to the scoring of mental component summery (MCS) measure (30). The physical aspect of QOL correlates most highly with the subscales including PF, RP, and BP, which are associated with sub-scale of GH, contribute most to the scoring of physical component summery (PCS) measure (31). This study also focuses on analyzing and reporting PCS and MCS. The SF-36 was scored according to the recommendations by Ware et al (31). The scores of each item are transformed to a 0–100 scale, where 100 is the best and zero is the worst score.
3.2. Dependent and Independent Variables
Eight subscales of SF-36 questionnaire were considered as dependent variables. Other collected data including sex, age, marital status, employment status, income level (per month), years in occupation, existence of any chronic disease morbidity, family size, number of children, shift type and house ownership were considered as independent variables. The age of participants was classified into two categories of ≤ 35 years and > 35 years. Nurses were also categorized into two groups of single/divorced and married according to marital status. Employment status was categorized into two categories including official and contractual. Income level was classified into two categories including ≤ 5 million Rials and > 5 million Rials per month. Also, years in occupation was divided into two categories including < 10 years and ≥ 10 years. Family size was divided into two categories including ≤ 4 and > 4 . Number of children was divided into two categories including 1 and ≥ 2 . Shift type was categorized into two categories including fixed and circular. House ownership was categorized into two categories including tenant and private house.
3.3. Statistical Analyses
Descriptive analyses were performed including the frequencies, percentages, ranges, means, and standard deviations (SD). Pearson’s correlation coefficient was used to determine the level of agreement between eight subscales of SF-36. To investigate the association between participants’ characteristics and their QOL, t-independent test was performed. Multiple Linear Regression model with backward method was performed to control confounding effects. Transformed scores were used for statistical analyses in all subscales. SPSS software, version 16 was used to analyze the collected data. P values less than 0.05 were considered statistically significant.
4. Results
In total, 198 nurses filled out the SF-36 questionnaire in this study. Ten questionnaires had more than 20% of missing data and thus were excluded from the study. The analysis was restricted for the remaining 188 respondents. Some of the characteristics of study population are shown in Table 1. The mean age of female and male participants was 29.5 and 36.2 years respectively and this difference was statistically significant (P < 0.001) .
Table 1Characteristics of Study Population (n = 188)
| Characteristics | No. | % |
|---|---|---|
| Sexa | ||
| Male | 42 | 22.3 |
| Female | 146 | 77.7 |
| Marital Status | ||
| Single/Divorced | 43 | 22.9 |
| Married | 145 | 77.1 |
| Employment Statusa | ||
| Official | 35 | 18.8 |
| Contractual | 151 | 81.2 |
| Mean ± SD Age, y | 31.02 ± 6.74 | |
| Mean ± SD Years in Occupation | 6.1 ± 6.31 |
aSome data were missing
Table 2 presents correlations between eight subscales of SF36; as observed, there were statistically significant correlations between all subscales (P < 0.05). There was also relations between all subscales (P < 0.05). There was also a significant correlation between PCS and eight subscales in addition to MCS and eight subscales of SF36. As Table 3 shows, the total mean score of SF-36 was 64.7 and among the different subscales of SF-36, the lowest and the highest mean scores were found for RE subscale (Mean = 55.9) and PF subscale (Mean = 77.3 ), respectively. The mean scores of the PCS, MCS, eight subscales and total of SF-36 according to sex, age, marital status, employment status, income level, years in occupation, chronic disease existence, family size, number of children, shift type and house ownership are presented in Table 3. As Table 3 shows, there were significant differences between different states of some variables (age, marital status, employment status, years in occupation, chronic disease existence and house ownership) in six subscales of SF-36 (P < 0.05) . Table 4 presents the results of Backward Multiple Linear Regression model; variables with significant relations were as follows: years in occupation, employment status and house ownership. Table 4 shows the positive and negative relations in this study. Positive relations included: between RP subscale and employment status, between the PCS and employment status. Negative relations included: between PF, VT, SF, BP, GH subscales and years in occupation, between the MCS and years in occupation, between RP subscale and house ownership. We did not observe any significant relation between various factors and RE or MH subscales after use of regression model.
Table 2Correlation Coefficients for the PCS, MCS and Eight Subscales of SF-36
| PF | RP | RE | VT | MH | SF | BP | GH | PCS | MCS | |
|---|---|---|---|---|---|---|---|---|---|---|
| PF | ||||||||||
| CC | 1 | 0.433 | 0.203 | 0.422 | 0.361 | 0.379 | 0.503 | 0.454 | 0.750 | 0.367 |
| Sig | <0.001 | 0.005 | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | |
| RP | ||||||||||
| CC | 1 | 0.387 | 0.315 | 0.312 | 0.417 | 0.458 | 0.274 | 0.826 | 0.440 | |
| Sig | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | ||
| RE | ||||||||||
| CC | 1 | 0.538 | 0.548 | 0.556 | 0.336 | 0.361 | 0.438 | 0.899 | ||
| Sig | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | |||
| VT | ||||||||||
| CC | 1 | 0.759 | 0.523 | 0.404 | 0.556 | 0.528 | 0.790 | |||
| Sig | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | ||||
| MH | ||||||||||
| CC | 1 | 0.528 | 0.388 | 0.448 | 0.479 | 0.494 | ||||
| Sig | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | |||||
| SF | ||||||||||
| CC | 1 | 0.510 | 0.490 | 0.584 | 0.759 | |||||
| Sig | <0.001 | <0.001 | <0.001 | <0.001 | ||||||
| BP | ||||||||||
| CC | 1 | 0.407 | 0.765 | 0.470 | ||||||
| Sig | <0.001 | <0.001 | <0.001 | |||||||
| GH | ||||||||||
| CC | 1 | 0.624 | 0.525 | |||||||
| Sig | <0.001 | <0.001 | ||||||||
| PCS | ||||||||||
| CC | 1 | 0.588 | ||||||||
| Sig | <0.001 | |||||||||
| MCS | ||||||||||
| CC | 1 | |||||||||
| Sig |
Abbreviations: BP, bodily pain; CC, Correlation coefficients; GH, general health; MCS, mental component summery; MH, mental health; PCS, physical component summery; PF; physical functioning; RE, role limitations due to emotional problems; RP, physical problems; SF, social functioning; Sig, Significant. (2-tailed); VT, vitality
Table 3Comparison of the Mean Scores in the PCS, MCS, Eight Subscales and Total of SF-36 According to Nurses’ Characteristics
| Subscales | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PF Mean(SD) | RP Mean(SD) | RE Mean(SD) | VT Mean(SD) | MH Mean(SD) | SF Mean(SD) | BP Mean(SD) | GH Mean(SD) | PCS Mean(SD) | MCS Mean(SD) | Total Mean(SD) | ||
| Total | 77.3(21.4) | 59.8(39.8) | 55.9(44.9) | 57.7(18.4) | 62.6(17.6) | 69.4(19.8) | 70.1(23.4) | 65 (18.9) | 68 (19.7) | 61.4 (21) | 64.7 (18.1) | |
| Sex | ||||||||||||
| Male | 75.8(24.2) | 62.5(41) | 62.7(46.7) | 60.9(21) | 67.1(16.7) | 70.5(18.3) | 72.4(21.1) | 62.1(20.7) | 68.2(19.1) | 65.3(21.5) | 67.4 (17.5) | |
| Female | 77.8(20.6) | 59.1(39.5) | 53.9(44.3) | 56.8(17.5) | 61.3(17.7) | 69.1(20.2) | 69.4(24.1) | 65.8(18.3) | 68 (19.9) | 60.3(20.8) | 64.3 (18.2) | |
| P-value | 0.606 | 0.624 | 0.263 | 0.191 | 0.060 | 0.678 | 0.469 | 0.276 | 0.951 | 0.168 | 0.341 | |
| Age | ||||||||||||
| ≤ 35 yr | 79.6(20.9) | 62.8(38.4) | 56.2(44.6) | 59 (16.6) | 62.7(16.4) | 69.4(18.7) | 71.2(23.5) | 67.6(16.9) | 70.3 (19) | 61.8(19.5) | 66.1 (16.8) | |
| > 35 yr | 71.8(20.5) | 51.8(41.5) | 54.8(45.3) | 53 (22.2) | 60.1(20.1) | 69.9(21.9) | 66.6(23.8) | 58.8(20.6) | 62.2(19.5) | 59.4(59.4) | 60.8 (19.9) | |
| P-value | 0.036 | 0.113 | 0.855 | 0.111 | 0.403 | 0.883 | 0.271 | 0.006 | 0.018 | 0.562 | 0.095 | |
| Marital Status | ||||||||||||
| Single/Divorced | 86.4(16.6) | 75 (35.4) | 65.9 (42) | 62.9(18.3) | 65.7(18.3) | 77.1(17.7) | 79.7(20.1) | 74.5(16.7) | 78.9(16.8) | 67.9(19.2) | 73.4 (15.7) | |
| Married | 75.1(21.6) | 55.9(39.9) | 53.3(45.4) | 56.3(18.2) | 61.7(17.5) | 67.4(19.8) | 67.4(23.7) | 62.3(18.6) | 65.2(19.2) | 59.7(21.1) | 62.4 (17.9) | |
| P-value | 0.002 | 0.006 | 0.099 | 0.041 | 0.197 | 0.005 | 0.003 | <0.001 | <0.001 | 0.025 | <0.001 | |
| Employment Status | ||||||||||||
| Official | 67.6(21.3) | 47.9(41.7) | 61.9(45.1) | 53.6(21.7) | 63.8(21.5) | 71.4 (22) | 64.5(21.9) | 59.1 (20) | 59.8(19.2) | 62.7(23.4) | 61.2 (19.5) | |
| Contractual | 80.1(20.4) | 62.8(38.7) | 54.5(44.8) | 58.7(17.5) | 62.1(16.6) | 69 (19.2) | 71.3(23.2) | 66.4(18.4) | 70.1(19.1) | 61.1(20.4) | 65.6 (17.6) | |
| P-value | 0.001 | 0.045 | 0.382 | 0.135 | 0.673 | 0.520 | 0.123 | 0.40 | 0.004 | 0.692 | 0.194 | |
| Income Level (mo) | ||||||||||||
| ≤ 5000000 Rial | 79.2(26.2) | 63.9(40.4) | 59.3(46.5) | 60.6 (20) | 64 (19.6) | 72.9(15.6) | 69.3(20.3) | 72.8(17.6) | 71.3(22.3) | 64.2(21.7) | 67.7 (21) | |
| > 5000000 Rial | 76.8(76.8) | 56.8(39.2) | 55.8(44.8) | 57.2(18.6) | 61.3(18.1) | 68.9(19.6) | 70 (22.8) | 64.9(19.1) | 67.1 (19) | 60.8(20.9) | 64 (17.5) | |
| P-value | 0.668 | 0.472 | 0.762 | 0.476 | 0.559 | 0.413 | 0.897 | 0.100 | 0.396 | 0.525 | 0.406 | |
| Years in occupation | ||||||||||||
| < 10 yr | 80.5(20.7) | 62.1 (40) | 56.1(45.2) | 60.2(18.6) | 63.5(16.7) | 72.9(19.8) | 72.6(24.7) | 67.9(19.3) | 70.8(20.8) | 63.2(20.8) | 67 (18.8) | |
| ≥ 10 yr | 65 (22.3) | 55.7(40.8) | 42.4(43.9) | 49.3 (18) | 56.2(22.1) | 58.5(20.2) | 56.9(28.2) | 52.3 (21) | 57.5(19.3) | 51.6(22.3) | 54.5 (18.9) | |
| P-value | 0.003 | 0.508 | 0.207 | 0.015 | 0.090 | 0.003 | 0.011 | 0.001 | 0.008 | 0.024 | 0.007 | |
| Chronic Disease | ||||||||||||
| No | 68.2(22.8) | 45.5(37.5) | 63.6(43.5) | 52.7(17.8) | 59.6(20.4) | 67.6(22.4) | 56.1(23.6) | 54.6(23.6) | 56.1(17.1) | 60.9(21.8) | 58.5 (17.5) | |
| Yes | 79.2(20.5) | 62.3(39.1) | 54.2(45.1) | 58.1(18.6) | 62.8(17.5) | 69.6(19.3) | 71.5(22.9) | 66.7(18.1) | 69.9(19.1) | 61.2(20.9) | 65.6 (17.8) | |
| p-value | 0.021 | 0.058 | 0.358 | 0.203 | 0.431 | 0.654 | 0.004 | 0.004 | 0.001 | 0.952 | 0.082 | |
| Family size | ||||||||||||
| ≤ 4 | 74.4(21.2) | 55.2(39.2) | 53.6(45.2) | 56 (17.5) | 61.2(17.4) | 68.2(20.6) | 67 (23.8) | 62.4(18.8) | 64.7(18.8) | 59.7(21.1) | 62.2 (17.7) | |
| > 4 | 80 (26.5) | 73.2(39.8) | 61.9 (45) | 59.6(26.4) | 61.7(20.8) | 69.6(18.2) | 72.7(24.6) | 70.4(16.7) | 74.1(20.8) | 63.2(24.8) | 68.1 (21) | |
| P-value | 0.365 | 0.108 | 0.518 | 0.627 | 0.910 | 0.796 | 0.399 | 0.133 | 0.086 | 0.569 | 0.212 | |
| Children number | ||||||||||||
| 1 | 73.5(20.6) | 66.1 (37) | 50.8(46.1) | 54.1 (19) | 57.9(19.1) | 64 (20.9) | 67.3(25.5) | 58.8(20.3) | 66.4(20.7) | 56.7(22.6) | 61.5 (19.6) | |
| ≥ 2 | 71 (23.2) | 56.7(40.4) | 54.1(46.8) | 55.1(20.8) | 63.5(19.5) | 70.3(18.5) | 66.6(23.7) | 60.7(18.8) | 63.7(17.4) | 60.7(22.7) | 62.2 (17.5) | |
| P-value | 0.605 | 0.261 | 0.743 | 0.804 | 0.184 | 0.140 | 0.894 | 0.658 | 0.514 | 0.407 | 0.863 | |
| Shift type | ||||||||||||
| Fix | 71.7 (24) | 52.1 (42) | 61 (42.5) | 59.4(16.5) | 63 (17.4) | 68.1(19.1) | 68.4(22.6) | 64.6(19.9) | 64.2(21.6) | 62.9(19.6) | 63.5 (18.1) | |
| Circular | 79.7(20.1) | 63 (38.7) | 53.8(45.9) | 57.1(19.2) | 62.3(17.7) | 69.8 (20) | 70.3(23.9) | 65.3(18.5) | 69.6(18.7) | 60.8(21.5) | 65.2 (18) | |
| P-value | 0.430 | 0.108 | 0.349 | 0.474 | 0.808 | 0.606 | 0.626 | 0.831 | 0.133 | 0.555 | 0593 | |
| House ownership | ||||||||||||
| Private house | 78.9(19.8) | 63 (39.8) | 53.6(44.5) | 55.9(17.4) | 62.3(16.9) | 68.6 (20) | 69.3(24.2) | 63.5 (19) | 68.7(18.9) | 60.1(20.4) | 64.4 (17.2) | |
| Tenant | 72.5(22.4) | 45.7(37.3) | 56.4(44.5) | 57.4(19.2) | 58.7(18.2) | 68.8(18.9) | 66.8(21.8) | 64.9(17.2) | 62.5(19.2) | 60.3(21.1) | 61.4 (17.9) | |
| P-value | 0.064 | 0.009 | 0.708 | 0.610 | 0.220 | 0.961 | 0.524 | 0.644 | 0.052 | 0.947 | 0.306 | |
Table 4Comparison of the Mean Scores in the PCS, MCS, Eight Subscales and Total of SF-36 According to Nurses’ Characteristics a
| Variables | Unstandardized Coefficients | Standardized Coefficients | t | P value | |
|---|---|---|---|---|---|
| B | SE | Beta | |||
| PF Subscale | |||||
| Years in occupation | - 12.13 | 5.37 | - 0.227 | - 2.26 | 0.026 |
| RP Subscale | |||||
| Employment Status | 19.29 | 7.55 | 0.196 | 2.56 | 0.012 |
| House Ownership | - 20.92 | 6.56 | - 0.244 | - 3.19 | 0.002 |
| VT Subscale | |||||
| Years in occupation | - 10.92 | 4.42 | S | - 2.47 | 0.015 |
| SF Subscale | |||||
| Years in occupation | - 14.42 | 4.76 | - 0.283 | - 3.03 | 0.003 |
| BP Subscale | |||||
| Years in occupation | - 15.05 | 6.12 | - 0.236 | - 2.46 | 0.016 |
| GH Subscale | |||||
| Years in occupation | - 15.60 | 4.45 | - 0.337 | - 3.51 | 0.001 |
| PCS | |||||
| Employment Status | 14.94 | 5.50 | 0.264 | 2.72 | 0.008 |
| MCS | |||||
| Years in occupation | - 11.58 | 5.05 | - 0.218 | - 2.29 | 0.024 |
| Total | |||||
| Years in occupation | -12.44 | 4.51 | -0.260 | -2.76 | 0.007 |
Abbreviations: BP, bodily pain; GH, general health; MCS, mental component summery; PCS, physical component summery; PF; physical functioning; RP, physical problems; SF, social functioning; VT, vitality
5. Discussion
The present study was designed to assess the QOL in nurses working in Neyshabur hospitals and some factors associated with it, with the use of the SF-36 scale. According to our findings, the total mean score of SF-36 was 64.7 that indicates a relatively moderate QOL in Neyshabur’ nurses. In a study conducted by Assarrodi, which was conducted to investigate the relation between spiritual well-being and QOL in nurses, they observed that the mean score of QOL was 64.38 (32). In another study conducted by Allaf Javadi in order to compare the QOL in nurses of special care and internal surgical wards, they observed that mean scores of QOL were 69.66 and 62.17, respectively (33).
Among the different subscales of SF-36, the lowest mean score was found for RE subscale (55.9%), implying that more than 44% of Neyshabur’ nurses, had problems with their work or other regular daily activities as a result of emotional problems (such as feeling depressed or anxious) in the last four weeks. Moreover, the highest mean score was shown for PF subscale (77.3%) indicating that lower than 23% of physical activities of Neyshabur’ nurses, was limited a lot or limited a little. In a study conducted by Aghamolaei in order to investigate the determinants of health-related quality of life (HRQOL) in general population living in Bandar Abbas, the lowest and the highest mean scores were found for GH and RE subscales, respectively (34). Additionally, assarrodi showed that the lowest and the highest mean scores were observed for RE and RP subscales, respectively (32). Daher et al performed another study to assess the HRQOL among Iraqis living in Malaysia, and they observed that the lowest and the highest mean scores were found for VT and PF subscales, respectively (35). In this study, we observed that the mean score of PCS is more than the mean score of MSC, implying that participants in this study had fewer problems in physical component in compare with mental component. This findings confirm the results of Assarrodi, Allaf Javadi and Daher’ studies (32, 33, 35). But the report of Aghamolaei showed that the mean score of PCS is lower than the mean score of MSC (34).
As Table 3 shows, single/divorced participants reported higher QOL in compare to married participants in the PCS, MCS and eight subscales of SF-36, and the differences were statistically significant (except in RE and MH sub-scales). In the report of Aghamolaei, they observed that marital status could not significantly decrease the scores of SF-36 in both mental and physical aspects (34). But in Tajvar’s report married participants had higher HRQOL in compare to single people (36).
As Table 4 shows, years in occupation was the most important factor affecting the QOL of study population in total and also in MCS and five subscales (PF, VT, SF, BP and GH) of SF-36. Years in occupation was negatively related to MCS and subscales such as: PF, VT, SF, BP and GH. This subject indicates that having more work experience reduced QOL in some physical and mental subscales. Employment status was the other factor that was associated with PCS and RP subscales. Such results indicate that employment status was related only with physical subscale. House ownership was another factor that was associated with RP subscale. In the study conducted by Aghamolaei, sex, age, education and employment status were significantly related to the PCS and MCS (34). Sex was significantly associated with PCS and marital status was associated with MCS in the study conducted by Daher (35). Thumboo observed that educational level and housing type (markers of socio-economic status) were also associated with SF-36 scores (37).
This study has several limitations: First, causality between the compared variables could not be concluded due to the cross-sectional design of the study. Second, most variables were assessed by self-report and desirable responses might have been given. Third, 22 persons were excluded from the study because of refusal to participate in the study and 10 persons were also excluded because their questionnaires had more than 20% of missing data.
From the findings of this study, it appears that Neyshabur’ nurses have SF-36 scores that might indicate a relatively moderate QOL and the findings also confirm that years in occupation is the major factor that affects their QOL. Thereby, interventional programs should be designed and implemented by Neyshabur Faculty of Medical Science, in order to help nurses to improve their QOL and general well-being, especially among nurses with more work experience.
