The Relationships Between Structural Empowerment Nursing Essay
Statement of the Problem
Enabling empowerment and community participation is one of the subsystems of the national health system in Indonesia. The policy is one of the Indonesian Government's efforts to increase awareness, willingness and ability for society to live with optimal health. It also aims to extend the reach and improve the quality of basic health services, especially for mothers and children. One of the activities to expand the reach and improving the quality of health care is through an integrated health center (Ministry of Health, 2012).
An Integrated Health Center (Posyandu) is one form of community based health resource that is managed and organized by, for and with communities in health development organizations, to empower the community and make it easier for people to obtain basic health services and to accelerate the decline in maternal and infant mortality (MOH, 2012). The Integrated Health Center (IHC) is expected to be developed on the awareness and efforts to the community, or with the social participation of each community in the village.
Presently, the existence rather than IHC is still very much needed in health promotion and prevention to the community particularly in rural areas. The existence IHC is mainly related to the improvement of the nutritional status of the community as well as maternal and child health efforts. A report by the Ministry of Health of Indonesia (2010), noted that the percentage using IHC in Indonesia for the monitoring of growth of children aged 6-59 months nationally was about 80.6%, in hospitals 3.8%, and in clinics 6.7%. In Bali, using IHC for monitoring growth was 66.3%. This suggests that the use of IHC as a basic service for children is still high. In 2009, the number of IHCs in Indonesia recorded was 266.827 or a ratio of 3.55 IHC per village (MOH, 2011). Based on data from the Bali Provincial Department of Health (2010), the number of IHC in Bali still active is about 64.54% of total of 4.757. However, when viewed from the aspect of quality, there were a number of problems. Among them, incomplete facilities and the inadequate skills of community health volunteers (MOH, 2012).
Although the role and utilization of health integrated centers are fairly good, but there are still many obstacles encountered in implementation. Health integrated center is not effective because the ability of health volunteers is still low (Sukiarko, 2007), community health volunteers are less active and less motivated (Maqbul, 2007 ; Djuhaeni et al., 2010), and funding and infrastructure was less (Maqbul, 2007). Motivation is the most dominant factor affecting the performance of community health volunteers. Community health volunteers had low motivation because their work activity is distracted by IHC activities (Djuhaeni et al., 2010). In a study conducted by Djuhaeni, et al. (2010), it showed a significant correlation between the factors of motivation for health integrated center activities. Based on the results obtained some researchers suggest that community health volunteers play a more active role in both providing counseling and other activities in health integrated centers (Hida, 2011 ; Harahap, 2008 ; Anwar, et al., 2010 ; Maria, 2009). This suggests that the role of the community health volunteers is one important factor in the implementation or sustainability health integrated centers because the motor activities of health integrated centers are community health volunteers.
One of the efforts undertaken by the Government of Indonesia is to increase the role of IHC and motivation of community health volunteers through IHC revitalization and empowerment of community health volunteers (MOH, 2012). Through revitalization IHC with community empowerment, training of community health volunteers, development activities in accordance with the needs of the community, is expected to improve the level of development integrated health center.
Empowerment is the idea of the efforts to provide community health volunteers the skills, resources, authority, and opportunity. It certainly will improve motivation, responsibility for the results of their actions and will contribute to their competence and their satisfaction. In the workplace, there are various perspectives of empowerment. These include structural empowerment that can occur when people have access to information, support, resources, opportunities, as well as psychological empowerment which is a process when a person has a sense of motivation in the workplace environment (Laschinger et al., 2004 ; Manojlovich, 2007 in Stewart, 2010). According to Kanter, work in conditions which encourages empowerment has a positive impact for employees, which increases feelings of self confidence, job satisfaction, and higher motivation (Deborah, 2006).
There were several previous studies linking structural empowerment, psychological empowerment and job satisfaction. Some studies have suggested a link between empowerment and job satisfaction (Kuo et al., 2008 ; Sarmiento et al., 2004 ; Baker et al., 2010 ; Lautizi et al., 2009 ; Cai and Zongkui, 2009 ; Ahmad and Oranye, 2010). Previous studies mostly used nurses at the hospitals, nurse educators, and the employees of a company as a sample. One study of job satisfaction in Taiwanese health volunteers examined the relationship between personal traits and job satisfaction. Lin (2007) found variables correlating with job satisfaction. These variables included gender, educational level, religious preference, participation in training, working to promote community health, the willingness to work, the frequency of participating in job training, and cooperation with other volunteer partners. However, based on the literature review, very few studies have been carried out among community health volunteers on empowerment and job satisfaction.
This study aims to investigate the relationships between structural empowerment, psychological empowerment, and job satisfaction of community health volunteers in Indonesia. Therefore, the results of this study help us to understand the phenomena and may provide alternative solutions that are expected to contribute in solving the problems faced community health volunteers of integrated health centers.
Based upon the limited existing research conducted on community health volunteers and the few published studies examining the variables proposed in this study, the following research questions are proposed:
What are the socio-demographic characteristics (age, sex, marital status, education level, years of experience and training experience) of community health volunteers in Indonesia?
What are the levels of structural empowerment, psychological empowerment, and job satisfaction of community health volunteers in Indonesia?
Are there relationships between the individual socio-demographic characteristic and job satisfaction of community health volunteers?
Is there a relationship between structural empowerment and job satisfaction of community health volunteers?
Is there a relationship between psychological empowerment and job satisfaction of community health volunteers?
1.3 Research objective
1.3.1 General Objective
The general purpose of this study is to explore the relationships between structural empowerment, psychological empowerment, and job satisfaction of community health volunteers.
1.3.2 Specific Objectives
The specific aims of this study are as follows:
To examine the socio-demographic characteristics of community health volunteers in Indonesia.
To examine the level of structural empowerment, psychological empowerment, and job satisfaction of community health volunteers in Indonesia.
To explore the relationships between socio-demographic characteristic of the participants (age, sex, marital status, education level, year of experience, training) and job satisfaction of community health volunteers.
To explore the relationships between structural empowerment and job satisfaction of community health volunteers.
To explore the relationship between psychological empowerment and job satisfaction of community health volunteers.
1.4 Conceptual framework
The conceptual framework of this study is based on the theory of empowerment by Kanter (Sarmiento et al., 2004 ; Laschinger and Finegan, 2005 ; Baker et al., 2010), which aims to predict job satisfaction of community health volunteers in Indonesia.
Independent Variables Dependent Variable
Year of Experience
Figure 1 The relationships between socio-demographic characteristics, structural empowerment, psychological empowerment and job satisfaction.
The integrated health center is a form of community participation in health services, which is managed by the health volunteers and the target is the whole community in Indonesia.
Community health volunteers are a man or a woman chosen by the community and trained to deal with health problems of individuals and communities.
Structural empowerment is based on the concept that giving community health volunteers' skills, resources, authority, opportunity, motivation, in order that responsible for the outcomes of their actions and will contribute to their competence and satisfaction.
Psychological empowerment is a psychological perception or attitude of community health volunteers about their work.
Job satisfaction is the community health volunteers feeling or emotional reflection about their job as community health volunteers.
Age refers to the age of the volunteers at the time of the research carried out and expressed in years. Age of community health volunteers will be grouped into 5 group, including <30 years, 30-40 years, 41-50 years, 51-60 years, > 60 years.
Marital status refers to the marital status of the volunteers were divided into single / unmarried, married, widow or widower.
Education level in this study refers to level of Indonesia school graduations which are primary education, secondary education, high school education and college/university.
Year of experience refers to the length of participation the participants as volunteers and expressed in years.
Training experience refers to the participation of community health volunteers in training associated with the integrated health center program. The training experience will be grouped into none, 1-2 times, and more than 2 times.
Scope of Study
The scope of the study focuses only on the relationship between socio-demographic characteristic, structural empowerment, psychological empowerment and job satisfaction of community health volunteers in Denpasar City, Bali, Indonesia. In fact there are many factors correlating with the empowerment and job satisfaction that were not included in this study such as organizational commitment, occupational stress, job performance, organizational support, job characteristics and turnover.
This study is important because community health volunteers are one of the factors that most influence the success of the program in an IHC. The results of this study can also be used as a reference for decision makers in the process of revitalizing an IHC and empowerment of community health volunteers in Indonesia.
This chapter will explain the various theories, concepts and views as well as a review of the study from variables such as socio-demographic, structural empowerment, psychological empowerment, and job satisfaction. This chapter also will be describe the relationship of each of the above variables.
Concept of Integrated Health Center (Posyandu)
The Integrated Health Center (IHC) is a form of community participation in health, which is managed by the health volunteers and the target is the whole communities. IHC is one form of community based health resources that are managed and organized by, for and with communities in health development organizations, to empower the community and make it easier for people to obtain basic health services and to accelerate the decline in maternal and infant mortality (MOH, 2012).
Integration of basic social services in the IHC is an attempt to synergize the various services required by the community and includes improved health and nutrition, education and child development, family economic improvement, family food security and social welfare. Community empowerment in health is the process of providing information to individuals, families or groups (clients) continually and continuously keep track of clients, as well as the process of helping the client, so the client has changed from not knowing to knowing or being aware of (aspects of knowledge), of knowing to want (aspect attitude), and of want to be able to carry out behavior is introduced (aspects of the act or practice). Efforts to develop the quality of human resource to optimize the potential of growth and development can be implemented in a fair manner, if the system of health services community-based such as IHC can be done effectively and efficiently and able to reach all of the targets that need health care, pregnant women, nursing mothers and postpartum mother.
In terms of quantity, the growing amount of IHC is very encouraging, because it is in every village found about 3-4 IHC. When IHC launched in 1986, the number of registered of IHC around 25,000 IHC and in 2009, rising to 266 827 with a ratio of 3.55 IHC per village. However, when viewed from the aspect of quality, there were many problems, such as completeness of facilities and inadequate skills of community health volunteers.
Primary health care in IHC is health care that includes at least five (5) activities, namely Maternal and Child Health (MCH), Family Planning (FP), immunization, nutrition, and prevention of diarrhea. While the target of the IHC is the entire society with an important focus are babies, children under five, pregnant women, postpartum and breastfeeding women, and infertile couples. The Purpose of IHC is:
Supporting accelerate declines in Maternal Mortality Rate (MMR), Infant Mortality Rate (IMR) and Child Mortality in Indonesia through community empowerment.
The increasing role of the community in the implementation of basic health measures, especially the associated with a reduction in MMR, IMR and Child Mortality.
The increasing role of cross-sector collaboration in the implementation of IHCs, particularly relating to reduction in MMR, IMR and Child Mortality.
Increased coverage and coverage of basic health services, particularly regarding the reduction in MMR, IMR and Child Mortality.
The implementation of activities IHC is determined by the ability of community health volunteers in carrying out its role. The role and tasks of community health volunteers in IHC activities such as:
Informing to the community about the time of IHC activities
Preparing a place and means for IHC activities
Coordinate with the public health center
Carry out health education to the community
Monitor the growth and development of children under five years through weight measurement
Helping health workers provide health care to the community
Update data related to the target of IHC
Follow up on targets that do not come or require further health education
Perform activities that support environmental health and communicable disease control
Concept of Empowerment
The origin of the theory of empowerment can be traced back to that first initiated by Freire (1973). Freire was an influential Brazilian educator and humanitarian. Furthermore the theory of empowerment has gone through many developments. The concept of empowerment is understood as the idea of power, because empowerment is closely related to how to get, remove, reduce or eliminate the power or force (Page & Czuba, 1999 cited in Hur, 2006). Parpart (2003 cited in Hur, 2006) states that empowerment can also be seen as an outcome because it can be measured.
Ahmad and Oranye (2010) explained there are two prominent concepts of empowerment in the literature: structural empowerment (Kanter 1977, 1983), and psychological empowerment (Spreitzer, 1995). Structural empowerment which derives from organizational/management theories and mainly focuses on organizational behavior and lacks individual psychological factors, such as a sense of competence and self-efficacy, which are considered to be important elements for an individual to be empowered. Psychological empowerment, which derives from a social psychological model, is seen as the psychological perception or attitudes of employees about their work and their organizational roles and focuses on intrinsic task motivation and does not incorporate some important elements such as environmental factors.
According to Kanter (1993) an empowering work environment is the availability of access to information, support and resources required of employees in the completion of the work. Empowering work environment can also provide the opportunity to increase their knowledge and skills of the employees. When a person does not have access to information, support, resources and opportunities in their work, they feel powerless. Kanter believes that by giving people the opportunity to share power through empowerment (Kanter, 1993 cited in Tromley & Mainiero, 1994).
Kanter’s concepts of the structural empowerment theory can be divided into four divisions as follows:
Systemic power factors: formal and informal
Formal power is the independence of people to make the decision-making that can be found in high-profile jobs. In high-profile jobs, the power comes from roles that allow flexibility, visibility and creativity. Formal power is also derived from work that is considered relevant, important for the organization and enables independence in decision making. Informal power came from alliances with people at all levels both within and outside the organization. Alliances within the organization such as the relationship with the employer who has higher position (sponsors/ superiors), some friends who have the same level (peers) and subordinates. An alliance outside the organization aims to improve access to opportunities.
Empowerment structures: opportunity, power and proportions structures
Structures are associated with the conditions of employment opportunities that provide individuals with the opportunity to advance, improve knowledge and skills within the organization. The structure is divided into three forces: access to information, support and resources. Access to information means the chance to gain knowledge and information necessary to perform their duties, including information related to the organization. Access support from the feedback received from superiors/ sponsors, peers and subordinates about their performance, including policy decisions. Access to resources means there is the ability to obtain supplies, equipment, money, time, rewards and benefits to achieve the demands of their jobs. Proportions associated with the structure of a balanced division between the duties and responsibilities which, if the balance is created it will produce a harmonious work situation. The harmonious work situation is an important key to empowerment.
Personal impact has a very strong impact and could produce a positive change for everyone in the organization. Some positive changes are expected because they increase self-efficacy, increase organizational commitment, perceived autonomy is increased, increased perceptions of participative management, job satisfaction is increased, motivation becomes higher and burnout levels become lower.
Work effectiveness benefits the organization. Targets or goals of the organization can achieve success. The success of this course will enhance the respect and cooperation in organizations. Finally, client satisfaction will increase because all parts of the organization play its roles properly.
According to Kanter (1993) power within the organization comes from the structural conditions in the workplace, rather than personal characteristics or socialization effects. Power is the ability of people to mobilize existing resources in the completion of a job. Kanter (1993) argues that the growing power of the availability of work empowerment structures enables the achievement of organizational goals. Kanter (1993) divides power into formal and informal power. The next rule affecting access to job is related to empowerment structures. Kanter (1993) divides empowerment structures into three categories: opportunity structures, power structures and proportion structures. Empowerment structures are at the core of Kanter’s SE theory. Empowerment occurs when employees feel working in an environment that provides opportunities for growth and development and access to power structures (resources, information and support) are needed to carry out the demands of work. According to Kanter (1993) people with high formal and informal power have greater access to the structural lines of power and opportunity. Workers are empowered to have access to the structure of employment so that they become more productive, highly motivated and able to motivate others (Brown & Kanter, 1982 cited in Sarmiento, Laschinger & Iwasiw, 2003). Individuals without access to power will feel powerless and less committed to organizational goals. The creation of good empowerment structures is the basis of a strong influence and deliver positive changes for the personnel within the organization. All personnel in the organization feel comfortable with the situation so that the totality of working in harmony and increased job satisfaction and productivity increases. Finally, the end result is work effectiveness. The organization will be more effective because it targets and objectives are achieved and client satisfaction is increased. Accordingly, this conceptual framework is consistent with the objectives of Kanter’s SE theory to explain and identify the powers that influence empowerment structures. Kanter’s examples of the SE theory applied in various applications and lends support for the strength of the theory.
Access to workplace empowerment structures as described by Kanter (1993) is strongly associated with positive outcomes in the nursing work environment, such as staff nurses (Laschinger & Wong, 1999 cited in Ledwell et al., 2006), nurse educators (Sarmiento et al., 2003) and the nurse administrator (Upienieks, 2002 cited in Ledwell, 2006). Sinclair (2000) cited in Ladwell, (2006) identified that the support of instructors and the opportunity to learn are very important in the empowerment of clinical learning. Kanter's theory can also be applied in nursing practice (Armstrong & Laschinger, 2006) and community nursing (DeCicco, Laschinger & Kerr, 2006). Four studies which are Ledwell et al. (2006), DeCicco et al. (2006), Sarmiento et al. (2003) and Armstrong & Laschiner, (2006), focus on nursing education, nursing practice in community nursing homes, nursing educators and nursing practice in hospitals. All the researchers revealed a link between Kanter’s SE theory on their research. Ledwell et al. (2006) examine the experience of the empowerment of nursing students in distance education using computer conferencing (CC) SE accordance with Kanter's theory. In this study, the authors obtain a thorough understanding of the application Kanter SE theory because each relationship is described in detail. For access to the information structure, whole students said that they are able to access all information in the course outline. However, the lack of face to face cause the deficit in communication because it is sometimes difficult to understand instructions from the instructor. This leads to frustration and feelings of powerlessness. While access to the resource structure, the students also said that they need consistent access to the library. To access the support structure, most of students who have worked said that support from employers and families is critical to their success. Instead of students who do not have the support of their superiors feel disappointed that their professional development efforts are not recognized. Distance education with a CC offers many opportunities to enhance self-efficacy and development potential in the learning process. Students are required to develop independence of learning modules that they can get. These things are certainly congruent with Kanter (1993) theory which states that people should have access to empowerment structures (especially access to information, resources and support). It is important for this study are not in accordance with the Kanter SE theory is the emergence of data that personal commitment is needed in this study. Students said that the self-commitment, discipline, time management and determination to succeed is very important. These statements reveal personal predispositions are important in the process of empowerment for nursing students who follow distance education. In three studies by DeCicco et al. (2006), Sarmiento et al. (2003) and Armstrong & Laschiner, (2006) is a quantitative study that also suggests a link between the research results obtained by the Kanter SE theory. Sarmiento et al. (2003) stated that a high level of empowerment associated with low levels of burnout and greater job satisfaction. These findings have important implications for nurse education administrators. DeCicco et al. (2006) conducted research to examine the relationship between nurses perception of structural and psychological empowerment, respect and organizational commitment. The result is a Registered Nurse (RNs) perceived higher level of empowerment and respect than Registered Practical Nurses (RPNs). This indicates that RNs power is greater than the RPNs that make RNs can access empowerment structures more easily. Armstrong & Laschinger (2006) tested a theoretical model, linking the quality of the nursing practice environment to a culture of patient safety. They suggest empowerment particularly strong nursing leadership is an important factor in creating a Magnet-like work environment. Supportive feedback on performance, strong networks of alliances, and opportunities for continuous learning are important conditions for promoting a positive climate of patient safety, supporting the constructs of Kanter (1993) SE theory. Actually the strength of the Kanter SE theory is can be used on most areas of nursing in particular to identify the obstacles encountered in implementing an activity that can generate input for the formulation measures or policies to be taken next.
Psychological empowerment is the process when the workers have a sense of motivation related to the workplace environment (Manojlovich, 2007 cited in Stewart et al, 2010). Spreitzer (1995) stated "Psychological empowerment is defined as a motivational construct manifested in four cognitions: meaning, competence, self determination, and impact".
Meaning is when community health volunteers values, beliefs, and behaviors are congruent with workplace requirements. Confidence in the ability to perform job requirements is competence. Feeling that one has the autonomy to have control over one’s work is self determination. Impact is when community health volunteers feel that they able to have an influence on the organization’s outcomes.
Concept of Job Satisfaction
Job satisfaction is an assessment or reflection of the feelings of the workers on the job (Kuo et al., 2008). Job satisfaction is the extent to which the employee enjoys the job (Lephala et al., 2008). Job satisfaction is an emotional attitude that is reflected from a community health volunteer’s morale, discipline and work performance. Job satisfaction can be derived from the work such as praise, treatment from supervisor, work atmosphere, work equipment. Job satisfaction can also be obtained from the outside of his/her job such as the receiving the correct salary.
Indicators of job satisfaction can be measured by the discipline, morale, and turnover of the staff. If these factors are relatively small then job satisfaction is said to be good. Conversely, if the discipline, morale, and employee turnover is higher then job satisfaction can be reduced. Basically, the more positive towards an attitude of work, the greater the job satisfaction shown. Hence the various indicators of job satisfaction need to be considered in order to continuously improve performance.
One theory of job satisfaction was used as a concept in a study by Herzberg's Motivation-Hygiene Theory. A two-factor theory proposed by Herzberg (1950) distinguishes between motivational factors (satisfiers) are intrinsic to the work and lead job satisfaction, and dissatisfiers (hygiene factors) are extrinsic factors and led to job dissatisfaction. Hygiene factor is referred to as a source of discontent because as extrinsic motivation which is composed of the factors obtained employees from the organization which related to the work environment that can trigger the employee dissatisfaction. Motivator factors referred to as a source of satisfaction because it is an intrinsic motivation that is composed of factors which implanted organization to the employees and associated with the work itself (Graham and Messner, 1998). The motivational factor is a key driver of behavior in a person’s job. Motivational factors include achievement, recognition, the work itself, responsibility, and opportunity for advancement. Motivational factor of CHVs is needed to get serious attention to the achievement of objectives in the activities of IHC. A community health volunteers will be diligent or not diligent, creative or not creative, it can be traced by the motivation that was in them. Dissatisfiers include company policy and administration, supervision, interpersonal relations, working conditions, salary. Herzberg stated that many dissatisfiers have little effect on job satisfaction such as supervision, as well as several factors motivating reduce job dissatisfaction to some extent such as achievement (Dieleman et al., 2003).
In a study conducted by Djuhaeni (2010) about the motivation of community health volunteers in Indonesia state that a sense of responsibility is the biggest contributor of internal motivation. Responsibility is the initial stage for the willingness to act. Responsibility is the obligation to function (work and belief in the potential) as well as possible. The award is the next indicator that has contributed significantly to the internal motivation factor. The award which desired generally is respected and status in various forms such as praise, recognition of achievement, awarding status symbol (power), and the award for their involvement in the activities of IHC. Self-actualization is the most significant contributor to internal motivation. For external motivation, social relationships are the most significant contributor. Salary as part of the external motivation was not so expected by community health volunteers.
The Relationship between Variables
The relationship between socio-demographic characteristics and job satisfaction.
Several studies have found that there are relationships between socio-demographic characteristic with job satisfaction. In a study conducted by Lin et al. (2007) stated that socio-demographic characteristics such as marital status, education level, and frequency of participating in job training significantly influenced job satisfaction among Taiwanese community health volunteers. Community health volunteers who are married and educated junior or lower have higher job satisfaction than community health volunteers with educated high school or higher. High job satisfaction is also shown on the community health volunteers who have experience in training compared with community health volunteers who never received of training. Other studies describing the relationship between demographic characteristics of registered nurses at two hospitals (gender, age, education levels, work experience, work position and work status) with empowerment, job satisfaction and organizational commitment scores was research conducted by Ahmad and Orange (2010). In that study revealed if age and education level linked to structural and psychological empowerment in one hospital but only had a significant relationship with psychological empowerment in other hospitals. The results also showed that there was no significant relationship between demographic characteristics with job satisfaction at both hospitals. Hwang et al. (2009) in a study on the major factor influencing job satisfaction stated significant factors related to job satisfaction were age, job position and department of work. In a study conducted by Ning et al. (2009) about the impact of nurse empowerment on job satisfaction explained that the demographics factors influence empowerment were age and work objective. While demographic factors that influencing job satisfaction were education level and work objective. Another study states that there is a relationship between socio-demographic factors of village health volunteers (age, gender, educational level, marital status, number of children, working duration and training experience) with a performance of village health volunteers in nutrition promotion activities in Vietnam (Nhuyen, 2001). However, according to a study by Nilawati (2008) it noted that training, education levels, marital status did not affect the activeness of community health volunteers in Indonesia.
The relationship between psychological empowerment and job satisfaction.
Psychological empowerment and job satisfaction are closely linked. Some research indicates that there is a significant relationship between psychological empowerment to job satisfaction (Ahmad and Oranye, 2010 ; Casey et al., 2010 ; Chung, 2011 ; Baker, et al., 2010). Chung (2011) in study on job stress, mentoring, psychological empowerment, and job satisfaction among nursing faculty stated that psychological empowerment had a moderate correlation with job satisfaction. Similar results showed through a study by Baker et al. (2010) that psychological empowerment and job satisfaction were moderately strongly correlated.
The relationship between structural empowerment and job satisfaction.
Many studies show links between structural empowerment to job satisfaction. However, more research is done by nurses in hospitals. Almost all previous study showed that structural empowerment was significantly positively associated with job satisfaction (Kuo, et al., 2008 ; Ahmad and Oranye, 2010 ; Casey et al., 2010 ; Lautizi, et al., 2009 ; Cai and Zhou, 2009 ; Baker et al., 2010 ; Sarmiento, et al., 2004 ; Laschinger and Finegan, 2005 ; Ning et al., 2009 ; Cai and Zhou, 2009). This means that the increase in structural empowerment would increase job satisfaction. In a study on empowerment and job satisfaction in associate degree nurse educators by Baker et al. (2010) explained the structural empowerment components of formal power and resources have moderate positive correlation with job satisfaction, while informal power, opportunity to learn and grow, and information have weak positive correlation. The other result showed that structural empowerment, psychological empowerment and critical social empowerment were significant independent predictors of perceived job satisfaction with structural empowerment being the weakest predictor and critical social empowerment being the strongest predictor (Casey et al., 2010). Similar findings, Lautizi et al. (2009) explained that all components structural empowerment had significantly and positively related to job satisfaction, most strongly to access to support and opportunity.
Based on the previous review of the literature, the hypotheses of this study are that:
Structural empowerment is statistically positively significantly correlated with job satisfaction.
Psychological empowerment is statistically positively significantly correlated with job satisfaction.
Socio-demographic characteristic (age, sex, marital status, education, year of experience, training) significantly correlated with job satisfaction
3.1 Study Design
A cross-sectional design with a descriptive correlation approach will be used to examine the relationships between socio-demographic characteristics, structural empowerment, psychological empowerment, and job satisfaction of community health volunteers in Indonesia.
3.2 Population and samples
The populations of this study are community health volunteers of integrated health center at four public health centers in Denpasar City, Bali. To determine the minimum number of samples, the sample size will be calculated by using G-Power formula with Power (1-β err prob) 0.95 and α err prob 0.05. Based on this formula, the minimum required numbers of samples are 115 respondents.
To select the sample, cluster random sampling and simple random sampling technique will be used. The selection of two sub-districts of four sub-districts in Denpasar will be used simple random sampling. From each sub-district will be selected two PHC. The selection of PHC will be used simple random sampling. Finally, selection 15 IHC for each PHC in this study will be used simple random sampling.
The inclusion criteria of the participants are community health volunteers who have experience as community health volunteers for at least 1 year, still active as community health volunteers, willing to be participants in the study. The exclusion criteria are community health volunteers do not come at the time when the integrated health center implemented.
The research location is Denpasar City, Bali. Denpasar city is chosen as the research setting because this area has a fairly low percentage in the level of independence of integrated health center (7.89%) and the number of active integrated health centers (51.75%).
Data will be collected by four questionnaires assessing socio-demographic data, structural empowerment, psychological empowerment, and job satisfaction.
A demographic questionnaire is developed by the researcher. It is composed of questions assessing gender, age, educational level, marital status, years of experience as community health volunteers, and participation in training.
The Conditions for Working Effectiveness Questionnaire II (CWEQ-II), will be used to measure structural empowerment. The CWEQ-II (Kuo et al, 2007), consists of 19 items that measure the 6 components of structural empowerment described by Kanter (opportunity, information, support, resources, formal power, and informal power), and a 2-item global empowerment scale which is used for construct validation purposes. Items on each of the six subscales are summed and averaged to provide a score for each subscale ranging from 1-5. The score of total empowerment derived from adding up all scores at each of the six subscales (score range: 6-30). Higher scores represent higher perceptions of empowerment. The Cronbach’s alpha reliability coefficients from previous studies ranged from 0.76-0.85 (Cai and Zhou, 2009).
Psychological empowerment will be measured using Psychological Empowerment Scale (PES). This instrument develop by Spreitzer’s (1995) study and consists of 12 items that measure 4 components (meaningful work, competence, autonomy, and impact). The items are rated on a seven point Likert scale ranging from 1 (very strongly disagree) – 7 (very strongly agree). The possibility of the total scores of psychological empowerment is ranging from 12-84. From previous study, the Cronbach’s alpha reliability coefficient was .84 (Baker et al., 2010).
Job satisfaction will be measured using the Minnesota Satisfaction Questionnaire (MSQ). The MSQ is a popular measure of job satisfaction that conceptualizes satisfaction as being related to either intrinsic or extrinsic aspects of the job. The MSQ which will be used is an MSQ short form comprising twenty questions. These questionnaires include two domains: one domain measures intrinsic job satisfaction (11 items); the other domain measures extrinsic job satisfaction (nine items). These items are rated on a Likert scale ranging from 1 (extremely dissatisfied) – 5 (extremely satisfied). The possible scores range from 20–100. A Cronbach’s alpha coefficient will be used to assess the internal consistency of this instrument. The Cronbach’s alpha reliability coefficient from previous study was .94 (Ning et al., 2009).
Before using the instruments with the respondents, all of the questionnaire will be translated from English into Indonesian. The questionnaire will be translated by native Indonesia speaker who is an expert in both English and Indonesian languages. The questionnaire in the Indonesian language translated back into the original language (English). The translation in English will be compared with the original instrument and any differences will be discussed together to get the final result and correct translation. Questionnaires in Indonesian version will be tested for reliability by a pilot study. The number of respondents that will be used to test the reliability of the instrument is 30 respondents. Respondents used are the community health volunteers who have characteristics similar to the sample.
3.5 Data Collection Plan
Data collection will be done by using a structured questionnaire that had been prepared. Data will be collected by these steps:
Prior to data collection, the researcher will contact the selected public health centers to get the schedule of activities IHC in each village in the region of the public health center.
Data collection will be done following the schedule of IHC. Data collection will be conducted by researcher and teams who have received training on how to fill the questionnaire.
Questionnaires will be distributed to community health volunteers who come at the time the IHC is implemented. The explanation of the purpose of the study and how charging instrument to participants will be conducted by the researcher or a member of the team who assigned to conduct the data collection.
The time needed to complete all of the questionnaires is about 30 minutes.
The subjects who participate will be told that they can withdraw from the study at any time and that this would not affect their subsequent rights in the workplace. A questionnaire will be answered anonymously.
The researcher collects all completed questionnaires from community health volunteers and then offeres a practical gift to participants, such as a shopping bag.
The data will be collected from March 2013 to April 2013.
Plan for Data Analysis
In this study, the independent variables are structural empowerment, psychological empowerment, and socio-demographic characteristics while the dependent variable is job satisfaction. Descriptive and inferential statistical analyses will be carried out by using the Statistical Package for Social Sciences Program (SPSS). Descriptive statistical analysis will be carried out to understand the individual socio-demographic characteristic, structural empowerment, psychological empowerment, job satisfaction of community health volunteers in Indonesia. To explore relationships between independent variables (structural empowerment, psychological empowerment, year of experience) and job satisfaction among community health volunteers, the Pearson product moment correlation will be used. The Pearson correlation test is one kind of statistical test that's used to measure the magnitude and direction of a linear relationship of two variables in the scale interval/ratio. Two variables are said to be correlated if changes in one variable are accompanied by changes in the other variables. While the relationship between the independent variable which has a measurement scale nominal/ordinal (age, sex, marital status, training experience, education level) with variable job satisfaction will use Spearman’s Rho.
Ethical Issue/Human Subjects Protection
The research proposal will be submitted to the Ethics Committee at Kasetsart University and Badan Kesbanglinmas Province Bali. Each participant will be informed of the purpose of the study. A consent form will be signed by participants and the researcher when the participant is well informed about the requirements of the study. The participants can withdraw at any time without penalty.