The Moderating Role of Health Centre Characteristics in the Relationship between Psychosocial Work Environment and Quality of Health Care in Health Centre IVs in South Western Uganda
Abstract
This study examined the moderating role of health centre characteristics in the relationship between psychosocial work environment and quality of health care in Health Centre IVs in South Western Uganda. The study adopted a mixed-methods cross-sectional design grounded in a critical realist philosophical orientation. Data were collected from 35 Health Centre IVs in Southwestern Uganda, involving 238 healthcare workers, 172 health service recipients, and six District Health Officers. Quantitative data were analyzed using descriptive statistics, Pearson correlation analysis, hierarchical regression, and Structural Equation Modelling (SEM), while qualitative data were analyzed using thematic content analysis. Pearson correlation analysis revealed a positive and statistically significant relationship between psychosocial work environment and quality of health care (r = .496**, p < .01). SEM results indicated that psychosocial work environment was positively and significantly associated with quality of health care (? = .507, p < .001), while health centre characteristics were also positively and significantly associated with quality of health care (? = .161, p < .001). More importantly, the interaction between psychosocial work environment and health centre characteristics was positive and statistically significant (? = .235, p < .001), indicating that favorable health centre characteristics strengthened the positive relationship between psychosocial work environment and quality of health care. These findings suggest that improving workplace conditions alone may not achieve optimal service quality unless supported by favorable organizational and structural conditions within Health Centre IVs. This study extends the literature by demonstrating that health centre characteristics significantly moderate the relationship between psychosocial work environment and quality of health care.
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Aiken, LH., Sloane, DM., Barnes, H., Cimiotti, JP., Jarrín, OF. & McHugh, MD. (2018). Nurses' And Patients' Appraisals Show Patient Safety in Hospitals Remains A Concern. Health Aff (Millwood). 37(11), 1744-1751. doi: 10.1377/hlthaff.2018.0711. PMID: 30395515; PMCID: PMC6325635.
Aust, B., Møller, J. L., Nordentoft, M., Frydendall, K. B., Bengtsen, E., Jensen, A. B., Garde, A. H., Kompier, M., Semmer, N., & Rugulies, R. (2023). How effective are organizational-level interventions in improving the psychosocial work environment, health, and retention of workers? A systematic overview of systematic reviews. Scandinavian Journal of Work, Environment & Health, 49(5), 315
Apiyo, R., Okeyo, I., & Wanjala, C. (2022). Workplace environment and health worker motivation in East African public health facilities. BMC Health Services Research, 22(1), 1124.
Atumanya, P., Taremwa, I. M., & Mugisha, J. (2024). Occupational stress, emotional exhaustion and health worker performance in public health facilities in Uganda. BMC Health Services Research, 24(1), 518.
Aust, B., Rugulies, R., Finken, A., & Jensen, C. (2023). Psychosocial work environment and employee well-being: Current evidence and future directions. International Journal of Environmental Research and Public Health, 20(5), 4123.
Bakker, A. B., & Demerouti, E. (2017). Job Demands–Resources Theory: Taking stock and looking forward. Journal of Occupational Health Psychology, 22(3), 273–285.
Baruch, Y., & Holtom, B. C. (2008). Survey response rate levels and trends in organizational research. Human Relations, 61(8), 1139–1160. https://doi.org/10.1177/0018726708094863
Brand, C. A., Barker, A. L., Morello, R. T., Vitale, M. R., Evans, S. M., Scott, I. A., Cameron, P. A., & Stoelwinder, J. U. (2012). A review of hospital characteristics associated with improved performance. International Journal for Quality in Health Care, 24(5), 483–494.
Donabedian, A. (1988). The quality of care: How can it be assessed? JAMA, 260(12), 1743–1748.
Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2019). Multivariate data analysis (8th ed.). Cengage Learning.
Hategeka, C., Shoveller, J., Tuyisenge, L., & Kenyon, C. (2020). Improving the quality of health care in low- and middle-income countries: A systematic review. BMJ Global Health, 5(8), e002882.
Hussein, M., Pavlova, M., Ghalwash, M., & Groot, W. (2021). The impact of hospital accreditation on the quality of healthcare: A systematic literature review. BMC Health Services Research, 21(1), 1057.
Kline, R. B. (2016). Principles and practice of structural equation modeling (4th ed.). Guilford Press.
Krejcie, R. V., & Morgan, D. W. (1970). Determining sample size for research activities. Educational and Psychological Measurement, 30(3), 607–610.
Kruk, M. E., Gage, A. D., Arsenault, C., Jordan, K., Leslie, H. H., Roder-DeWan, S., Adeyi, O., Barker, P., Daelmans, B., Doubova, S. V., English, M., Elorrio, E. G., Guanais, F., Gureje, O., Hirschhorn, L. R., Jiang, L., Kelley, E., Lemango, E. T., Liljestrand, J., ... Pate, M. (2018). High-quality health systems in the Sustainable Development Goals era: Time for a revolution. The Lancet Global Health, 6(11), e1196–e1252.
McCullough, M. B., Zimmerman, F. J., & Fielding, J. E. (2023). Revisiting the Donabedian framework for health care quality assessment. Health Services Research, 58(2), 245–257.
Meath, T. H. A., Lin, X., & Zhao, J. (2022). Organisational context and quality improvement in health care: A systematic review. International Journal for Quality in Health Care, 34(2), mzac018.
Ministry of Health Uganda. (2023). Annual health sector performance report 2022/2023. Ministry of Health.
Ministry of Health Uganda. (2024). Annual health sector performance report 2023/2024. Ministry of Health.
Rosen, M. A., DiazGranados, D., Dietz, A. S., Benishek, L. E., Thompson, D., Pronovost, P. J., & Weaver, S. J. (2018). Teamwork in healthcare: Key discoveries enabling safer, high-quality care. American Psychologist, 73(4), 433–450.
Salas, E., Reyes, D. L., & Woods, A. L. (2018). The assessment of team performance: Observations and needs. Current Opinion in Psychology, 16, 34–40.
Schaufeli, W. B. (2017). Applying the Job Demands–Resources model: A 'how to' guide to measuring and tackling work engagement and burnout. Organizational Dynamics, 46(2), 120–132.
Silvera, G. A. (2017). The moderating effect of hospital size on the relationship between patient experience and patient safety. Health Care Management Review, 42(3), 202–211.
Tossaint-Schoenmakers, R., Versluis, A., Chavannes, N. H., Talboom-Kamp, E., & Kasteleyn, M. J. (2021). The challenge of integrating the Donabedian model into modern healthcare quality improvement. International Journal for Quality in Health Care, 33(4), mzab128.
Vanichchinchai, A. (2021). Hospital characteristics, lean implementation and service quality in Thai hospitals. International Journal of Lean Six Sigma, 12(6), 1205–1224.
Vaughn, V. M., Saint, S., Krein, S. L., Forman, J., Meddings, J., Ameling, J., & Chopra, V. (2019). Characteristics of healthcare organisations struggling to improve quality: A systematic review. BMJ Quality & Safety, 28(1), 74–84.
World Health Organization. (2021). Global strategy on human resources for health: Workforce 2030. World Health Organization.
World Health Organization. (2022). Quality health services: A planning guide. World Health Organization.
Yang, X., Li, Y., & Chen, H. (2025). Organisational factors and quality improvement in primary healthcare: A multilevel analysis. International Journal for Quality in Health Care, 37(1), mzae001.
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