title: Identifying factors influencing the recruitment and retention of primary care doctors in Kuwait
Creators: name: Alhenaidi, Abdulaziz Saleh
Publisher: name: University of Glasgow
Year: 2021

description: Background and aim: Primary care is widely considered the cornerstone of health systems. Stronger primary care services have been shown to improve the population’s health and improve health service delivery. Increasing the availability, quality, and accessibility of the primary care workforce is considered a milestone to improving primary care services. This thesis aims to understand the factors influencing recruitment and retention of primary care doctors and their career intentions in Kuwait. This aim was fulfilled by reviewing the existing literature and understanding the factors at play internationally affecting recruitment and retention, and by exploring the intentions and motivators for leaving clinical practice among current practising primary care doctors in Kuwait. Methods: This research adopted a mixed-methods approach, integrating the results of a systematic review, quantitative, and qualitative studies. The Systems Theory Framework for Career Development (STF) was used as a theoretical model. The systematic review of the literature concerning the recruitment and retention of primary care doctors was conducted from 2000 to 2019 and analysed using thematic analysis guided by the STF. In the second study, a cross-sectional survey was distributed in twenty-five randomly selected primary care centres in Kuwait. In addition to descriptive analysis, Chi-Square tests and logistic regression analyses were conducted, and the STF was used to analyse the open question answers. In the qualitative study, participants were recruited from respondents to the quantitative study and purposeful sampling was used to select twenty primary care doctors for interview. The interviews were analysed using thematic analysis guided by the STF. Results: In the systematic review, almost 15,000 articles were screened and 65 papers were eligible for qualitative synthesis. The cross-sectional survey was returned by 191 participants giving a response rate of 80.9%. All three studies showed that increase in age is associated with leaving or intending to leave primary care. In the systematic review and qualitative interviews, ill health was linked to leaving primary care. Some values, including those related to the doctor-patient relationship, can have a dual effect of improving recruitment but jeopardising retention. The systematic review showed that work-life balance has a significant effect on both recruitment and retention. While the systematic review showed that job autonomy could improve recruitment and retention, the interviews found a mixed effect of job autonomy on retention. Both the systematic review and the cross-sectional study showed that increased job satisfaction could positively affect retention. The qualitative study also identified that medical school experiences influence recruitment; however, the systematic review yielded mixed evidence about the role of medical schools. Continuing professional development (CPD) activities were shown to improve retention in both the systematic review and qualitative study. The survey’s results demonstrated that having a family medicine or primary care qualification was associated with the intention of working for more than five years in primary care. While the systematic review and interviews showed that the perception that primary care is compatible with family life and family opinion could affect recruitment, both studies also showed that retention could be negatively affected by family responsibilities. The systematic review showed that both recruitment and retention could be affected by peer relationships and opinions, but the interviews demonstrated mixed evidence for the effect of peers. All of the studies showed that the perceived high workload was associated with leaving primary care, and the systematic review and interviews reported that working hours could positively or negatively affect GPs’ recruitment. In the systematic review, the work environment had both positive and negative effects on recruitment and retention; in the interviews, work environment had a negative effect on retention. Although both the systematic review and qualitative interviews showed doctors' passion for interacting with patients could improve recruitment, the increase in patient demands was an influencing factor for leaving primary in the systemic review. Both the systematic review and interviews showed the impact of political decisions on recruitment and retention. All of the studies demonstrated evidence related to geographical location and its effect on retention. Conclusion: The findings show that the recruitment and retention of primary care doctors is a multi-factorial phenomenon, in which personal, social, and societal-environmental factors can all have an effect. This PhD contributes to the evidence by giving a perspective on the factors affecting recruitment and retention in Kuwait. It concludes with implications for policy to improve recruitment and retention in Kuwait which may have international relevance, and with recommendations for future research.