Discrete Choice Experiment to Elicit Job Preference in Rural of Newly Graduated Nurses

Abstract

           The shortage of nurses in rural areas is a recurring concern in Thailand. Recently, it has been aggravated by two factors, an increase in health demand and inadequate workforce supply. Importantly, the number of newly graduated nurses entering rural health facilities has declined since the compulsory contract with the government has been abolished in 2004. Significant attention is being focused on health workforce strategies to address the problem but it is not clear which policy interventions would be most effective. The overall aim of this research was to identify effective policy interventions to improve the recruitment and retention of nurses in rural areas. This study was to investigate the job preferences of nursing graduates in Thailand using a Discrete Choice Experiment (DCE).

          The DCE has been developed by the researchers. Seven job attributes were identified and designed into a labeled discrete choice experiment where respondents were to choose between hypothetical job in a rural area and another hypothetical job in an urban area. Each nurse was asked to consider 16 pairs of job descriptions and choose one job among each pair. The DCE was administered to 342 newly graduated nurses from 4 nursing colleges together with self-administered questionnaire during March 2008. The results were analyzed using a conditional logistic regression model.

         The results showed that 6 attributes were found to have a statistically significant effect on the utility associated with the employment alternatives, except opportunity for training. These preliminary results suggest that the Thai government has a range of interventions available that would attract newly graduated nurses to public positions in rural areas. In particular, posting them to rural district hospitals is likely to be an effective attraction and retention policy. Moreover, better housing provision, extended medical coverage, accelerated promotion, and salary increase seem equally good policy candidates.

Key words: Discrete Choice Experiment, job preference, health workforce, nurse, rural workplace, incentive measures