Medicine®

Observational Study

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Factors associated with kindergarten teachers’
willingness to continue working
Moemi Matsuo, PhDa , Goro Tanaka, PhDb,c, Akiko Tokunaga, PhDb,c, Toshio Higashi, PhDb,
Sumihisa Honda, PhDb, Susumu Shirabe, PhDd, Yuri Yoshida, PhDc,e, Akira Imamura, PhDc,f,∗Izumi Ishikawa, PhDc,e, Ryoichiro Iwanaga, PhDb,c,
Abstract

The turnover rate among kindergarten teachers in advanced countries is extremely high. As such, there is an urgent need todetermine the reasons for this turnover and to identify ways to prevent it. The current study investigates the individual andenvironmental factors that impact kindergarten teachers’ willingness to continue working.
A total of 600 kindergarten teachers in Japan participated in this study. Participants responded to questionnaires regarding their
willingness to continue working, mental health, work engagement, and the availability of social support. Multiple logistic regression
analysis was used to analyze participants’ data, with willingness to continue working for 5 or more years as the dependent variable.
Additionally, Spearman rank correlation was used to examine the correlations between factors associated with willingness tocontinue working.
Factors such as older age, living with a spouse, caring for younger children (up to 2 years old) at work, good mental health, andhigher work engagement were signiﬁcantly associated with teachers’ higher willingness to continue working. Factors such as
marriage, health and family problems, overtime work, issues with workplace childcare, and education policy, working time/day
problems, human relations, and difﬁculties taking care of children were correlated with teachers’ lack of willingness to continue
working.
The ﬁndings of this cross-sectional study suggest that welfare beneﬁts and individual support systems could be key elements toencourage kindergarten teachers to continue working and could lead to their improved job satisfaction and mental health. Balanced
work conditions and workers’ high agreement with their workplace’s overall childcare or educational policies may lead to lower
turnover. Some programs – such as relationship counselling – could have a positive impact on teachers’ mental health and job
satisfaction.
Abbreviations: K6 = The Kessler Screening Scale for Psychological Distress, OR = odds ratios, SSQ = Social Support

Questionnaire, UWES = Utrecht Work Engagement Scale.

Keywords: job satisfaction, mental health, preschool teacher, turnover, work engagement

Editor: Jun-Beom Park.

1. Introduction

All procedures performed in this study were approved by the Ethics Committeeof Nagasaki University and complied with the Declaration of Helsinki.

The turnover rates of kindergarten teachers in advanced
countries such as Japan and Sweden are extremely high; hence,
there is an urgent need to determine the reasons for this turnoverand identify ways to prevent it.[1,2] Moreover, Japan has been
facing a shortage of kindergarten teachers,[3] resulting in children
receiving insufﬁcient care in kindergartens and parents not letting
their children attend, which affects parents’ ability to work. Somehave shown a reduced inclination to have children because of thissocial issue, contributing to the fertility decline in Japan andmaking it imperative to reduce turnover rates according toMinistry of Health, Labour and Welfare, Japan.
Researchers have identiﬁed various factors, including individual and environmental factors that impact kindergarten teachers’
intention to continue working. In a meta-analysis, demographic
and job characteristics, and job satisfaction were signiﬁcantly
associated with the turnover intention of workers in 1 study.[4]Another study conducted by researchers at the authors’ university
investigated factors impacting the turnover rate among kindergarten teachers, showing that gender, age, mental health, social
support, and work engagement were associated with teachers’
willingness to continue working.[3] In terms of individual factors,
higher job satisfaction has been shown to be positively related toteachers’ mental health, and higher job satisfaction and work

The authors have no funding and conﬂicts of interest to disclose.
The datasets generated during and/or analyzed during the current study are notpublicly available, but are available from the corresponding author on reasonable
request.
a
Faculty of Rehabilitation Sciences, Nishi Kyushu University, 4490-9 Ozaki,
Kanzaki, Saga, Japan, b Unit of Medical Science, Nagasaki University Graduate
School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Japan, c Center forChild Mental Health Care and Education, Nagasaki University, 1-7-1 Sakamoto,Nagasaki, Japan, d Organization of Rural Medicine and Resident Education,
Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Japan, e Faculty of
Education, Nagasaki University, 1-14 Bunkyo, Nagasaki, Japan, f Unit of
Neuropsychiatry, Nagasaki University Graduate School of Biomedical Sciences,1-7-1 Nagasaki, Japan.
∗

Correspondence: Ryoichiro Iwanaga, (e-mail: iwanagar@nagasaki-u.ac.jp).

Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.
This is an open access article distributed under the Creative Commons
Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited.
How to cite this article: Matsuo M, Tanaka G, Tokunaga A, Higashi T, Honda S,
Shirabe S, Yoshida Y, Imamura A, Ishikawa I, Iwanaga R. Factors associatedwith kindergarten teachers’ willingness to continue working. Medicine
2021;100:35(e27102).
Received: 20 July 2020 / Received in ﬁnal form: 7 July 2021 / Accepted: 12
August 2021
http://dx.doi.org/10.1097/MD.0000000000027102

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Matsuo et al. Medicine (2021) 100:35

Medicine

engagement have been shown to lower turnover rates.[2,5,6–8]
With regard to environmental factors, monetary rewards[1,9] andsocial support[10] have been found to impact turnover rate,suggesting that a balanced reward system can lower the turnoverrate,[11,12] and strong workplace support contributes to workers’
willingness to continue working.[11,13] These factors have beenshown to be interlinked and inﬂuenced by issues related toworkers jobs and personal lives as well as those related to theorganization itself.[14]Furthermore, other factors that are also associated with theturnover rate, such as those regarding children’s care in thekindergarten, support for children who have developmental
disabilities in the kindergarten, and support from families orcaretakers have not been actively studied. Thus, it is also
imperative to consider the kindergarten teacher’s job speciﬁcity,such as unexpectedly caring for children with developmental
disabilities, as this may also impact the turnover rate. Thus, thisstudy’s primary objective is to investigate the individual andenvironmental factors that impact kindergarten teachers’
willingness to continue working. Based on their responses,
participants were divided into 2 groups: Group 1 consisted ofparticipants willing to work less than 5 years, whereas Group 2
included those who wanted to work for 5 or more years. The
ﬁndings could contribute toward ameliorating the various driversof high turnover rates among kindergarten teachers in Japan,
where a related shortage is a growing problem.

participants, we received 600 completed responses (collection
rate: 53%). The study was conducted from April to December
2017. Prior to conducting the analysis, 132 participants whose
answer to the question about willingness to continue working
was “I do not know” were excluded. Thus, the ﬁnal sample
consisted of 468 participants: 457 female and 10 male teachers;
54%, 22%, 16%, and 8% were in their 20s, 30s, 40s, and over
50, respectively (Fig. 1). Informed consent was obtained from allparticipants before the study. The study was conducted at theCenter for Child Mental Health Care and Education, Nagasaki
University. It was approved by the Ethics Committee of Nagasaki
University (approval No. 17060864) and complied with the
Declaration of Helsinki.[15]2.2. Procedure

2.1. Subjects

Participants were recruited from all kindergartens and authorizedchildcare institutions in Nagasaki, Japan. The study questionnaires took approximately 10 minutes to complete and wereanswered by participants, who all provided informed consent, in
their workplaces. Participants completed the general questionnaire, the Kessler Screening Scale for Psychological Distress (K6),
the Utrecht Work Engagement Scale (UWES), and the Social
Support Questionnaire (SSQ). All questionnaire responses wereself-reported and given anonymously: participants returned theiranswered questionnaires in sealed envelopes. For the purposes ofanalysis, participants were divided into 2 groups, those who
expressed willingness to continue working in their current
position for less than 5 years and those who were willing to workat least 5 years (Fig. 1).

A total of 1137 full-time kindergarten teachers working inkindergartens or authorized childcare institutions in Nagasaki
prefecture, excluding those in managerial positions, wererecruited to participate in the study. We included only full-timeteachers to ensure that part-time workers with ﬁxed-term
contracts would not affect the results. From these potential

2.3. Measures
2.3.1. General questionnaire. The general questionnaire comprised 12 sections: gender, age, family environment, number ofchildren in their families, educational background, work
experience, main responsibilities at work, type of workplace,

2. Methods

Figure 1. Flow chart of the research. The 468 participants who met the research criteria were divided into 2 groups. The ﬁrst group included teachers who werewilling to continue working for 5 or more years, and the second included those who are willing to work for less than 5 years.

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number of colleagues in their workplace, children withdisabilities in their class, children who could have developmental
disabilities in their class, and willingness to continue working intheir present position for 5 years or more. Table 1 reports
comparative data from this questionnaire between participants
willing to continue working for 5 or more years and those willingto continue working for less than 5 years.

The scale has 6 questions related to the frequency of experiencing
psychological distress over a period of 30 days, and theparticipants were asked to answer on a scale of 5 for eachquestion (0: not at all, 1: a little, 2: sometimes, 3: often, 4:
always). High K6 scores indicated a high level of psychologicaldistress. The participants were segregated into 2 categories basedon their scores – K6 < 13 or K6 ≥ 13. Scores in the K6 ≥ 13
category indicated that they frequently faced psychologicaldistress.

2.3.2. Mental health. K6 was used to assess the mental health of
the kindergarten teachers. The scale has been used in annual
government health surveys in the United States, Canada, and theWorld Health Organization World Mental Health Surveys.[16]2.3.3. Work engagement. The UWES was used to assess work
engagement, which is the opposite of burnout. Contrary to those

Table 1Comparison between teachers’ willingness to continue working for 5 or more years and less than 5 years.
Variables
Gender (female/male, n (%))
Age, n (%)
20 to 29
30 to 39
40 to 49
50≧
Family environment, n (%)
Living alone/Transfer without family
Living with a spouse
Living with children
Living with parent
Living with spouse’s parent
Living with brother/sister
Living with others
Number of children in the teachers’ families (mean ± SD)
Educational background, n (%)
Bachelor<
Bachelor≧
Work experience (years, mean ± SD)
Main responsibilities at work, n (%)
0-2 years old childcare or other
3–5 years old childcare or education
Type of workplace, n (%)
Public kindergarten
Private kindergarten
Public authorized childcare institution
Private authorized childcare institution
Number of colleagues in the workplace (have/none, n (%))
Children with disabilities in the class (n, mean ± SD)
Physical disability
Hearing disability
Visual disability
Intellectual disability
Developmental disability
OthersChildren who could have developmental
disabilities in the class (mean ± SD)
Mental health
K6 < 13, n (%)
K6≧13, n (%)
Work engagement (UWES score, mean ± SD)
Available social support (SSQ number/score, mean ± SD)
Amount number, mean ± SD
Satisfaction score, mean ± SD

Willingness to continue working for
5 or more years n = 223

Willingness to continue working for less than
5 years n = 245

P-value

215/8 (96/4)

242/2 (99/1).039

81 (36)51 (23)62 (28)29 (13)174 (71)
51 (21)
12 (5)
8 (3)

<.001

25 (11)
97 (43)89 (40)92 (41)14 (6)
33 (15)
13 (6)
1.97 ± 0.84

32 (13)27 (11)19 (8)
179 (73)3 (1)
77 (31)9 (4)2.00 ± 0.79

.280
.069
∗
<.001
∗
<.001
∗
<.001
∗
<.001
∗
.004
.774

163 (73)59 (26)12.37 ± 9.27

149 (61)
96 (39)5.97 ± 6.11.004

92 (41)131 (59)

65 (27)180 (73).001

28 (13)33 (15)
13 (6)
143 (64)
68/143 (30/64)8 (3)62 (25)
10 (4)
161 (66)
70/167 (29/68)<.001

0.10 ± 0.30
0.06 ± 0.23
0.07 ± 0.26
0.19 ± 0.47
0.80 ± 1.13
0.22 ± 0.46
1.62 ± 2.03

0.18 ± 0.38
0.06 ± 0.25
0.03 ± 0.18
0.17 ± 0.46
0.78 ± 0.94
0.16 ± 0.45
1.59 ± 1.62

.242
.939
.278
.896
.749
.459
.519

213 (96)
10 (4)
63.94 ± 13.50

202 (82)
43 (18)55.08 ± 13.05

<.001
<.001

4.08 ± 1.85
4.98 ± 0.87

3.78 ± 2.17
4.90 ± 0.82

.109
.309

∗
∗

∗
∗

<.001

∗

∗

.538

∗
∗

Willingness to continue working is signiﬁcantly affected by the independent variables – gender, age, living with children, living with parent, living with spouse’s parent, living with brother/sister, living with others,
educational background, main responsibilities at work, type of workplace, work experience, K6 scores, and UWES scores.
K6 = The Kessler Screening Scale for Psychological Distress, SSQ = Social Support Questionnaire, UWES = Utrecht Work Engagement Scale.
∗P < .05 by chi-squared test or Mann–Whitney U test or t test.

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Matsuo et al. Medicine (2021) 100:35

Medicinescores (P < .001), and UWES scores (P < .001), using the chisquared test, Mann–Whitney U test, or t test. There were no
signiﬁcant differences between the other variables (Table 1).
The results of multiple logistic regression analysis with the stepdown procedure indicated that the following factors are
signiﬁcantly associated with a higher willingness to continue
working for 5 or more years – age, family environment, main
responsibilities at work, mental health, and work engagement.
The OR of older participants (≥ 40 years of age) was 3.4 times
higher than that of younger participants (< 30 years of age). The
OR of living with a spouse was 2.4 times higher than that of notliving with a spouse. The OR of responsibilities related to care ofyounger children (up to 2 years old) at work was 2.2 times higher
than that of older childcare responsibilities (care and education ofchildren aged 3–5 years). The OR of good mental health (K6 <13) was 4.5 times higher than high risks of mental health(K6≥13), while that of higher work engagement was 3.4 times
higher than lower work engagement (Table 2).
The factors associated with willingness to continue working
for less than 5 years are shown in Table 3. The main factor stated
was too much overtime work, followed by low salary, and humanrelations. Additionally, the correlation between the factors
associated with working for less than 5 years and factors
associated with higher willingness to continue working for 5

who suffer from burnout, engaged employees are energetic, havea sense of effective connection with their work activities, andbelieve that they can manage the demands of their job well.[17]This segment of the questionnaire had 17 categories, including
vigor items (6), dedication items (5), and absorption items (6).[18]The participants were asked to answer on a scale of 6 (1: feel very
rarely, 2: feel not too often, 3: feel sometimes, 4: feel often, 5: feelvery often, 6: feel always) for each question. High UWES scoresindicated high work engagement.
2.3.4. Available social support. The SSQ was used to assess thesocial support available for kindergarten teachers. The SSQ
investigates 2 aspects of social support: the amount of social
support a person perceived they have in their life and the degree towhich they are personally satisﬁed.[19] The participants wereasked to answer on a scale of 7 (0–5, and more than 6) for aspect,
and a scale of 6 (from highly dissatisﬁed to very satisﬁed) for
aspect. High SSQ numbers and scores indicated that a large
amount of social support was available.
2.4. Statistical analysis
Chi-square tests were used to examine differences in the
categorical variables (gender, age, family environment, educational background, responsibilities at work, type of workplace,
number of colleagues at the workplace) between the 2 groups (ie,those willing to continue working for 5 or more years and thosewilling to continue working for less than 5 years). The
Kolmogorov–Smirnov test was used to examine normality forcontinuous variables. The Mann–Whitney U test was used forvariables that were not normally distributed (ie, number ofchildren in the participants’ families, disabled children in theclass, children who potentially could have developmental
disabilities in the class, and K6 scores). Additionally, independentt tests were used for normally distributed variables (workexperience, UWES scores, and SSQ numbers and scores).
The participants were divided into 2 categories based on the
median for UWES scores. Using the data from the analysis of theparticipants, multiple logistic regression analysis with backward
stepwise selection was performed with the willingness to continue
working for 5 or more years as the dependent variable. P-values,
odds ratios (OR), and 95% conﬁdence intervals were calculated.
While calculating the multivariate OR, gender, age, family
environment (living with a spouse and/or children), main
responsibilities at work, type of workplace, K6 scores, and
UWES scores were set as covariates. Finally, Spearman rankcorrelation was used to examine the correlations between factors
signiﬁcantly associated with willingness to continue working.
The statistical analysis software SPSS (Version 22.0, IBM, Tokyo,
Japan) was used for data analysis. Differences with a P-value of<.05 were considered statistically signiﬁcant.

Table 2Multiple logistic regression analysis between willingness tocontinue working and demographics, K6 scores, and UWES
scores.
Variables
GenderFemaleMale
Age
20 to 29
30 to 39
40 to 49
50≧
Family environment
Not living with spouse or children
Living with a spouse
Living with children
Main responsibilities at work
0 to 2 years old childcare or other3 to 5 years old childcare or education
Type of workplace
Public kindergarten
Private kindergarten
Public authorized childcare institution
Private authorized childcare institution
Mental health
K6 < 13K6≧13Work engagement
UWES < 0.58
UWES≧0.58

3. Results
The results indicated that the dependent variable (willingness tocontinue working for 5 or more years) was signiﬁcantly affectedby the independent variables – gender (P = .039), age (P < .001),
living with children (P < .001), living with parent (P < .001),
living with a spouse’s parent (P < .001), living with brother orsister (P < .001), living with others (P = .004), educational
background (P = .004), main responsibilities at work (P = .001),
type of workplace (P < .001), work experience (P < .001), K6

Multivariate OR
OR (95% CI)

P-value1.00 (referent)
4.81 (0.83–27.90).080

1.00 (referent)
1.25 (0.69–2.26)
3.41 (1.45–8.01)
2.56 (0.97–6.78)

.456
∗
.005
.058

1.00 (referent)
2.44 (1.21–4.93)
2.15 (0.95–4.91)

.013
.068

1.00 (referent)
0.47 (0.28–0.79).004

1.00 (referent)
0.36 (0.12–1.04)
0.67 (0.17–2.69)
0.39 (0.14–1.09)

.060
.570
.071

1.00 (referent)
0.22 (0.09–0.53).001

1.00 (referent)
3.44 (2.15–5.50)

<.001

∗

∗

∗

∗

The following factors are signiﬁcantly associated with higher willingness to continue working for 5 ormore years – age, family environment, main responsibilities at work, mental health, and work
engagement.
CI = conﬁdence interval, K6 = The Kessler Screening Scale for Psychological Distress, OR = odds
ratios, UWES = Utrecht Work Engagement Scale.
∗P < .05 by Multiple logistic regression analysis.

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workplace and oneself, working time/day problems, and healthproblems. Both good mental health and high work engagement
were signiﬁcantly correlated with marriage, while high risks ofmental health and low work engagement were correlated withhuman relations, differences in childcare/education policy
between workplace and oneself, and difﬁculties taking care ofchildren (Table 4).

Table 3
Factors for willingness to continue working for less than 5 years.
Factors for willingness
to continue working for less than 5 years n = 245
Too much overtime work
Low salary
Human relations
Marriage
Too few holidays
Pregnancy/giving birth
Other reasonsDifferences in childcare/education policies between
workplace and oneself
Difﬁculties of procuring childcare/education at work
Difﬁculties in taking care of children
Difﬁculties in taking care of guardian
Unsatisfactory welfare beneﬁts
Inadequate levels of satisfaction at work
Working time/day problems
Health problems
Family problemsn (%)
124 (51)
99 (40)65 (27)62 (25)52 (21)32 (13)29 (12)27 (11)

4. Discussion
The present study analyzed the factors associated with thewillingness of full-time nonmanagerial kindergarten teachers tocontinue working. Factors such as being older, living with aspouse, responsibilities related to the care of younger children atwork, good mental health, and higher work engagement weresigniﬁcantly associated with a higher willingness to continue
working for 5 or more years, while the number of children with
developmental disabilities in the class and the number of children
who potentially could have developmental disabilities did notshow any signiﬁcant association. A previous survey on the
efﬁcacy, self-esteem, social support, and organizational commitment of childcare teachers in Korea suggested that both schools
and families are important in teachers’ lives. Events in school canaffect their personal lives, and events at home can impact school
life.[20] Additionally, a Japanese cross-sectional study suggested
that a supportive work environment allows them to continue
working even under difﬁcult family circumstances. Regardless ofgenerational characteristics or being inﬂuenced by different
domestic economic conditions, the psychosocial work environment factors of effort and monetary rewards are generationcommon factors[21] that impact intention to work. These results
suggest that, in addition to individual factors such as age,teachers’ family and work environment also impact their
willingness to continue working, indicating that individual
factors and environmental conditions interact.

27 (11)26 (11)25 (10)22 (9)
17 (7)
15 (6)
11 (4)
7 (3)The factor with the highest percentage was “too much overtime work” followed by “low salary”, and“human relations.”.

or more years are shown in Table 4. The results show that age orfamily environment were signiﬁcantly correlated with marriage
and health and family problems that indicated a willingness tocontinue working for less than 5 years. Similarly, older age andliving with a spouse were correlated with health and family
problems. Moreover, older childcare responsibilities (care andeducation of children aged 3–5 years) were signiﬁcantly correlated with too much overtime work, while responsibilities related tocare of younger children (up to 2 years old) at work werecorrelated with differences in childcare/education policy between

Table 4
Correlation between factors for willingness to continue working for less than 5 years and factors associated with willingness to continue
working for 5 years or more.
(r)

Factors for willingness to continue working for 5 years or more

Factors for willingness to continue working for less than 5 years

Age

Family environment

Main responsibilities at work

Too much overtime work
Low salary
Human relations
Marriage
Too few holidays
Pregnancy/giving birth
Other reasonsDifferences in childcare/education policies between workplace and oneself
Difﬁculties of procuring childcare/education at work
Difﬁculties in taking care of children
Difﬁculties in taking care of guardian
Unsatisfactory welfare beneﬁts
Inadequate levels of satisfaction at work
Working time/day problems
Health problems
Family problems

0.051
0.073
0.082
∗∗
0.174
0.095
0.068
0.107
0.014
0.046
0.071
0.121
0.069
0.020
0.019
∗∗
0.216
∗
0.138

0.113
0.069
0.005
∗∗
0.145
0.023
0.062
0.032
0.043
0.084
0.072
0.054
0.117
0.006
0.073
∗∗
0.175
∗∗
0.174

0.261
0.104
0.079
0.073
0.050
0.006
0.009
∗
0.143
0.025
0.051
0.050
0.027
0.018
0.001
∗
0.138
0.119

∗∗

K6

UWES

0.043
0.065
∗∗
0.424
∗
0.128
0.019
∗
0.153
0.038
∗
0.148
∗∗
0.203
∗∗
0.204
∗∗
0.210
0.017
∗
0.140
0.052
0.110
0.060

0.027
0.111
∗
0.177
∗∗
0.199
∗
0.146
0.037
∗
0.151
∗∗
0.171
0.072
∗
0.139
0.062
0.057
0.102
0.071
0.054
0.013

The following factors, namely, marriage, health and family problems, too much overtime work, differences of childcare/education policy between workplace and oneself, working time/day problems, humanrelations, and difﬁculties in taking care of children, were correlated with the factors of willingness to continue working for less than 5 years.
K6 = The Kessler Screening Scale for Psychological Distress, UWES = Utrecht Work Engagement Scale.
∗P < .05 by Spearman rank correlation.
∗∗
P < .01 by Spearman rank correlation.

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Matsuo et al. Medicine (2021) 100:35

Medicineold). Furthermore, human relations, differences in childcare/education policies between workplace and teachers, and difﬁculties
with caring for children were correlated with a high risk of mental
health issues and low work engagement. At the same time, lowsalary, which was one of the highest factors cited for willingness tocontinue working for less than 5 years, was not correlated with any
factor. Prior research suggested that, because of the detrimental
impact of heavy workload-related pressures,[14] supervisors shouldattempt to help workers maintain the right balance between work
demands, work pace, and workload.[34] A survey conducted on thepsychosocial risks and occupational functioning among workers in
Poland indicated that greater involvement with their work might
reduce the stress and role conﬂict and could also increase job
satisfaction. Low job satisfaction is considered an emotional
response to job strain.[35] Being part of a workplace provides
workers with good access to social support, which may play animportant role in promoting health.[30] As previous studies havesuggested, efforts should be made to improve conditions in bothwork-related and outside-work areas. Policymakers should
continue to improve reward systems, the construction of
infrastructure, and promotion systems, and should pay more
attention to kindergarten teachers’ lives outside work to ensure
their living needs are met.[4] Accordingly, work supervisors should
control conditions such as workload and overtime and seek
workers’ strong agreement with the childcare/education policies in
the workplace. These initiatives may lead to lower turnover. In
addition, providing counseling support for human relations
factors, including taking care of children and good interpersonal
relationships, can lead to better mental health,[33,35–37] job
satisfaction,[38] and client satisfaction.[14] Some studies havereported that difﬁcult workplace relationships can lead toworkplace stress across occupations.[39] Hence, the developmentof programs – such as offering workplace counselling – may reduce
problems related to human relations, with potentially positiveeffects on the teachers’ mental health and job satisfaction levels.
Additionally, training programs and educational opportunities
may help teachers determine how to best take care of children.

The primary factors associated with willingness to continue
working for less than 5 years were too much overtime, low salary,and human relations. A correlation analysis was performed forfactors signiﬁcantly associated with willingness to continue
working. The results suggest that a willingness to continue
working for less than 5 years was correlated with marriage
among workers who were younger or not living with a spouse,
health and family problems among workers who were older orliving with a spouse, too much overtime among workers witholder childcare responsibilities, and differences in childcare/education policy between workplace and the teacher, andworking time/day problems for teachers who were caring foryounger children. Furthermore, marriage was correlated withgood mental health and high work engagement. In contrast,
human relations, differences in childcare/education policy
between the workplace and teacher, and difﬁculties caring forchildren were correlated with a high risk of mental health issues
and low work engagement. However, low salary, one of thestrongest drivers of willingness to continue working for less than
5 years, was not correlated with other factors. These ﬁndings
indicate the necessity of having different strategies based on eachfactor to lower the turnover rate. Conversely, our results suggestthat willingness to continue working is not inﬂuenced by the
number of disabled children in class but by the perceived
difﬁculties associated with taking care of children.
In terms of individual factors, our results suggest that marriage
is correlated with factors inﬂuencing the willingness to continue
working for less than 5 years among younger teachers, while
health and family problems are correlated with willingness tocontinue working for less than 5 years among older teachers. An
Indian cross-sectional survey suggested that a work-life balancethat helped employees better manage their work and personal
time was a factor that affected job satisfaction.[16] This referred tofamily-friendly work arrangements and alternative work
arrangements, including programs such as ﬂexible work options,paid maternal or paternal leave, and home telecommuting that
could increase workers’ satisfaction levels. Additionally, otherresearchers found that low satisfaction with salaries, decisionmaking, daily tasks, and work-life balance could decrease
workers’ job satisfaction.[22–24] Moreover, a Gambian study
suggested that better implementation of stress management plansby the government could have a beneﬁcial impact on the broader
psychosocial needs of workers.[25] Individual support systems
leading to higher self-esteem and better effort-reward balance forworkers may positively inﬂuence their well-being.[26] In arandomized controlled trial involving Norwegian workers inprivate kindergartens, nondirective social support—which focuses on workers’ intrapsychic challenges (eg, the need forrestoring self-worth feelings)[27–29]–was found to be signiﬁcantly
associated with fewer health problems.[30] Nondirective social
support often leads to improvements in positive health behavior,
health outcomes, life satisfaction, self-esteem, and hope andoptimism.[28–30] Thus, workplace welfare beneﬁts and individual
support services could be key elements that could improve job
satisfaction and mental health and motivate teachers to continue
working after marriage or as problems related to health andfamily care emerge.[31–33]
In terms of environmental factors, our study suggests that too
much overtime work is correlated to workers with older childcare
responsibilities (care and education of children aged 3–5 years),indicating that teachers working with older children have a greater
workload than those caring for younger children (up to 2 years

4.1. Research limitations
In this study, all the participants were recruited from a single
prefecture in Japan, and it is unclear if the results can begeneralized and are applicable to kindergarten teachers in
different prefectures or other countries. Future research should
include participants working in different prefectures or othercountries. Despite these limitations, the ﬁndings regarding factors
responsible for willingness to continue working among kindergarten teachers provide meaningful new insights for addressing
work environment issues and the shortage of kindergarten
teachers in Japanese childcare institutions.

5. Conclusions
The ﬁndings of this cross-sectional study suggest that individual
factors and environmental conditions can inﬂuence the willingness to continue working among kindergarten teachers. The
results suggest that older age, living with a spouse, responsibilities
related to care of younger children at work, better mental health,and higher work engagement are signiﬁcantly associated with ahigher willingness to continue working. Furthermore, marriage,
health, and family problems, too much overtime work, differences in childcare/education policy between workplace and6Matsuo et al. Medicine (2021) 100:35

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teacher, working time/day problems, human relations, anddifﬁculties taking care of children are signiﬁcantly correlated withthese factors. Accordingly, welfare beneﬁts and individual
support systems in the workplace or provided by work
supervisors could be key elements to encourage teachers tocontinue working and improve their job satisfaction, mental
health, and well-being. Balanced work conditions and workers’
high agreement with workplace childcare/education policy may
lead to a reduction in turnover. Programs such as relationshipcounseling could have a positive impact on teachers’ mental
health and job satisfaction. This study’s ﬁndings may contributetoward addressing the high turnover rate among kindergarten
teachers in Japan.

Acknowledgments
This study did not receive any speciﬁc grant from funding
agencies in the public, commercial, or not-for-proﬁt sectors. The
authors would like to express their appreciation to theparticipants of this study.

Author contributions
MM contributed to literature search, data analysis, statisticalanalysis, manuscript preparation, manuscript editing, andmanuscript review. GT, SS, YY, AI, and II contributed to theresearch concept, design, and the deﬁnition of intellectual
content. AT contributed to the research concept, design, anddata acquisition. TH and SH contributed to statistical analysis.
RI contributed to the research concept, design, deﬁnition of
intellectual content, literature search, statistical analysis, manuscript editing, and manuscript review.
Conceptualization: Moemi Matsuo, Goro Tanaka, Akiko
Tokunaga, Susumu Shirabe, Yuri Yoshida, Akira Imamura,
Izumi Ishikawa, Ryoichiro Iwanaga.
Data curation: Moemi Matsuo, Sumihisa Honda.
Formal analysis: Moemi Matsuo, Toshio Higashi, Sumihisa
Honda, Ryoichiro Iwanaga.
Investigation: Moemi Matsuo, Akiko Tokunaga, Ryoichiro
Iwanaga.
Methodology: Moemi Matsuo, Goro Tanaka, Akiko Tokunaga,
Susumu Shirabe, Yuri Yoshida, Akira Imamura, Izumi
Ishikawa, Ryoichiro Iwanaga.
Project administration: Moemi Matsuo.
Software: Toshio Higashi.
Supervision: Ryoichiro Iwanaga.
Writing – original draft: Moemi Matsuo.
Writing – review & editing: Moemi Matsuo, Sumihisa Honda,
Ryoichiro Iwanaga.

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