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Assessment of quality of life among
the health workers of primary health
centers managed by a nongovernment
organization in Karnataka, India:
A case study
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www.ijhas.in

DOI:
10.4103/ijhas.IJHAS_128_17 Rajeshwari Bangalore Sathyananda, Usha Manjunath1

Abstract:
BACKGROUND: Quality of life (QOL) is the general well‑being as experienced and perceived by
individuals and communities. Measuring QOL has a number of implications in a wide variety of contexts
including healthcare. Studies have shown that World Health Organization (WHO) QOL‑BREF is a
quick and an effective tool (as the WHO QOL‑100) in capturing the results with respect to key four
domains. Healthcare services, in general, are human intensive in terms of emergencies, emotionality,
and relationships which could affect grass root health worker’s QOL negatively, especially in
challenging working environments.
OBJECTIVES: To evaluate the QOL among health workers of primary health centers (PHCs) managed
by public private partnership in Karnataka State.
MATERIALS AND METHODS: An exploratory study was carried out by applying WHO QOL‑BREF
to 70 health workers from 24 PHCs in 21 Districts of Karnataka and the results were analyzed.
Pearson’s correlation was conducted to assess the agreement level; paired t‑test and ANOVA to
compare differences between the domains.
RESULTS: Analysis of domain‑specific results and gender differences showed that women were
more satisfied with physical health domain and men more satisfied with psychological health domain.
The least satisfaction was seen in their opportunity for leisure activities and the highest satisfaction
was with their ability to perform daily living activities.
CONCLUSIONS: The study indicated moderate levels of QOL among the respondents. WHO
QOL‑BREF is a useful measure to assess, monitor and improve employees’ QOL.
Keywords:
Primary health centres, public private partnership, quality of life BREF

Introduction when scoring. The World Health

Department of Public Organization (WHO) defines QOL as an

A
Health, State Institute happy and healthy care provider leads “Individual’s perception of their position in
of Health and Family
Welfare, 1Healthcare to good quality of care, increased life in context of culture and value systems in
Management, Institute patient satisfaction and health outcomes, which they live and in relation to their goals,
of Health Management in turn leading to healthy population.[1] expectations, standards and concerns.”[2]
Research, Bengaluru, The quality of life (QOL) is a holistic way of WHO has developed a questionnaire to
Karnataka, India
measuring one’s health status as individuals assess the QOL consisting of four domains,
Address for consider their experiences with expectations with 100 questions and later came up with a
correspondence: standard WHO QOL‑BREF equally effective
Dr. Rajeshwari Bangalore This is an open access article distributed under the terms with twenty six questions. The four domains
Sathyananda, of the Creative Commons Attribution-NonCommercial-
State Institute of Health ShareAlike 3.0 License, which allows others to remix, tweak, How to cite this article: Sathyananda RB,
and Family Welfare, and build upon the work non-commercially, as long as the Manjunath U. Assessment of quality of life among
Magadi Road, Bengaluru, author is credited and the new creations are licensed under the health workers of primary health centers managed
Karnataka, India. the identical terms. by a nongovernment organization in Karnataka, India:
E‑mail: rjbsmerc@gmail. A case study. Int J Health Allied Sci 2017;6:240-4.
com For reprints contact: reprints@medknow.com

240 © 2017 International Journal of Health & Allied Sciences | Published by Wolters Kluwer ‑ Medknow
[Downloaded free from http://www.ijhas.in on Friday, February 16, 2018, IP: 117.247.109.91]
Sathyananda and Manjunath: Assessment of QOL among Health workers of PHCs
are D1‑physical health, D2‑psychological, D3‑social
relationships, D4‑environment along with general
questions on the QOL (Q1) and general health (Q2).[2‑5]
WHO QOL BREF has been applied in India among
different settings and has been found to be useful.[6,7]
QOL BREF was mostly used to assess patient’s wellbeing
and to rate the success of care delivery in relation to
different diseases.[8‑10] Studies on QOL among healthcare
personnel, in particular, primary healthcare centre (PHC)
workers at grass root levels are limited.
In 1996, the Government of Karnataka piloted an
early adopter of public private partnership (involving
nongovernment organizations [NGOs] and private
medical colleges for running PHCs) and contracted
out 1st PHC at Gumballi, Chamarajnagar district to
Karuna Trust. Later to realize its health goals, launched
Arogya Bandhu Scheme in 2008 by contracting out 51
PHCs.[11‑15]
The Karuna Trust was established in 1986 to enable
treatment and rehabilitation of Leprosy patients in
Yelandur Taluk, Chamarajanagar District, Karnataka.
Currently, the trust is managing around eighty PHCs
in seven states of India, including some regions affected
by Maoists and insurgency. It manages thirty six PHCs
including twenty seven rural centers in twenty two
backward districts of Karnataka. The Trust wanted to
understand the status of the wellbeing of its grass root
health workers and the first line of managers as part
of performance improvement and establish a baseline
of QOL.
Materials and Methods
An exploratory study was conducted among
the health workers of rural PHCs managed by
Karuna Trust, an NGO. The NGO managed 253
health workers (223 exclusive health workers and
30 administrators‑health workers with additional
administrative responsibilities) in the PHCs and
172 were from rural PHCs. The study was conducted in
the months of June and July 2015. All the health workers
from the rural PHCs were approached to participate in
the study and participation was voluntary.
A set of study brief consent forms and WHO QOL‑BREF
were sent to all the health workers. They were requested
to send the completed forms by post or submit
directly when the administrators came to the office
for the monthly review. The participants were briefed
about the study purpose and its usefulness through
telephone calls or in person when they visited the
main office during the period of the study. Informed
consent was obtained for participation and privacy and
International Journal of Health & Allied Sciences - Volume 6, Issue 4, October‑December 2017
confidentiality of personal information were strictly
adhered to. Participants were informed that the data
would be processed as a whole and that no part of
individual scores would be released with identifiable
personal information. Participants contacted the
researcher if they had any queries in completing the
questionnaire.
The QOL was assessed using WHO QOL‑BREF.
The instrument was translated into the local
language (Kannada), pre‑tested and necessary changes
were made in wordings without changing the original
meaning.[16] Each item was scored on the Likert scale of one
to five. “One” represented “very dissatisfied” and “five”
was “very satisfied.” Four domains of WHO QOL‑BREF
namely, D1‑physical health, D2‑psychological, D3‑social
relationships, D4‑environment along with general
questions on the QOL (Q1) and general health (Q2)
were included in the study. All the items were used
to calculate raw domain scores as per protocol; these
raw scores were transformed into 4‑20 and 0‑100 as
per the guidelines. The domain scores of individuals
so calculated were used to derive the mean domain
scores for the group; higher Domain scores represented
higher QOL.[17]
Data analysis
The domains of the QOL‑BREF questionnaire
were considered as the dependent variable. The
data on gender and profession were considered
as independent variables. SPSS version 16 was
used for data analysis. Descriptive analysis was
performed and internal consistency of the data was
assessed using Cronbach’s alpha and the value >0.65
was considered acceptable. Pearson’s correlation
coefficient was performed to assess the correlation
between the domains (positive/negative correlation;
correlation >0.65 was considered significant). Paired
t‑test was used to assess the difference between the
means of the domains.
Results
Of the 172 persons contacted at PHCs, 70 responded
(response rate of 40.64%): 21 administrators (male
health workers with additional administrative duties)
and 49 Health Workers (32 females and 17 males) from
24 PHCs in 21 districts. Table 1 presents the details of
the participants. All the workers were employed on a
contractual basis and drawing salary as per norms of
the Government of Karnataka. Female health workers
were trained in auxiliary nurse midwifery and male
health workers with diploma health inspector. All the
administrators (health workers with administrative
duties) were postgraduates. Seven percent of the
respondents reported having chronic illnesses such
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Sathyananda and Manjunath: Assessment of QOL among Health workers of PHCs

as hypertension (1 person for last 2 months), diabetes with their sleep, were more satisfied with their ability to
(3 persons for 1, 10 and 15 years each) and epilepsy perform daily activities and capability to work. Men were
(1 person for 3 years). more impressed with their body image and appearances,
had less negative feelings, better self‑esteem, enjoyed
The results show that the general QOL and satisfaction more in life, felt that they had a meaningful life, were
with the health of the subjects can be considered good able to concentrate better and were more satisfied with
at 3.94 and 3.97 respectively. The satisfaction with themselves.
physical health, psychological wellbeing and social
relationships can be considered average with scores of Time for leisure activities was rated lowest (2.46) and
63.31, 66.19 and 64.59 respectively. The satisfaction with the highest score was in the satisfaction with their
their environment can be considered below average at bodily appearance (4.30). Though mean scores were
59.86 [Table 2]. different among the subgroups and the domains
scores showed no statistically significant difference
Women scored the satisfaction with their environment of opinions between groups, unlike the study by
the lowest and satisfaction with physical health the Dongre and Deshmukh (2015). [17] ANOVA was
highest; men scored psychological domain the highest. conducted with the job type (administration/clerk and
From this we can say that women perceived they were Fieldwork) as the independent variable. The statistically
more capable of performing daily activities; were less significant difference of opinion was found between
dependent on medical aid; had enough energy for daily groups in environmental domain. The mean score of
activities and able to get around, were more satisfied clerk/administrators was 65.90 and that of fieldworker
was that of 57.27, indicating that administrators
Table 1: Characteristics of respondents (n=70) weremore satisfied with their environment. This can
Characteristics n (%) be justified by the fact that the physical environment,
Sex transport, and physical safety are a challenge in the field
Male 38 (54) where health workers serve, unlike administrators who
Female 32 (46) were mostly working in the PHCs.
Education
>12 years 70 (100) The Cronbach’s alpha was conducted for all the items;
Marital Status the coefficient was adequate with the score of 0.651
Married 38 (54) and 0.679 (standardized items). Pearson’s correlation
Unmarried 30 (43) coefficient between general questions and all the
Widow/widower/divorced 2 (3) domains showed weak correlation indicating clarity of
Children domain boundaries. Paired t‑test showed statistically
Yes 30 (43) significant difference in the perception of physical and
No 40 (57)
Psychological domain; physical and environmental
Employment type
domain; psychological and environmental domain at
Contractual 70 (100)
95% confidence interval [Table 3].
Chronic disease
No 65 (93)
Yes 5 (7)
Discussion
Residence
The health workers are the trained grass root workers of
Rural 69 (99)
the Indian healthcare system. They assess the needs of the
Urban 1 (1)
community to develop the yearly plan for the delivery of
Characteristics Range Average all the preventive health care and the National Programs
Age (years) 22-68 33 at the community level. Their wellbeing is essential for
Work experience the success of the Healthcare system. QOL being an
Total experience in years 0.5-45 8.4 effective measure to assess the overall wellbeing of an
Experience at trust in 0.2-23 4.9 individual was considered for the study. QOL acts as a
years guide for providing intervention and follow‑up.

Table 2: Comparison of World Health Organization quality of life domain scores of various studies
Domains Health workers in Karnataka, Healthcare staff, Anganwadi workers, Maharastra, Traffic police, Mumbai,
India (2015) Iran (2013) India (2014) India (2014)
Physical health (D1) 63.31 70.49 69 63
Psychological (D2) 66.19 60.6 69 56
Social relationships (D3) 64.59 63.48 81 69
Environment (D4) 59.86 56.94 56 56

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Sathyananda and Manjunath: Assessment of QOL among Health workers of PHCs

The environmental domain was scored the least among
all domains, the phenomenon noted by other authors.[18‑20]
Figure 1 presents the results from various studies. In our
study, the Q1 and Q2 were scored 3.94 and 3.97, whereas
in the study of healthcare staff they were scored 3.64 and
3.67[18] respectively.
The lower scores in the environmental domain among
the healthcare workers were further explored. Table 4
shows the items of the environmental domain and its
correlation. The individual items of the environmental
domain were compared and analyzed. Though the
scores were similar among the health workers in
India and healthcare staff of Iran,[18] the statistically
significant difference of opinion existed in six items
and opportunities for leisure activities was scored least
among all the items in both the studies. The satisfaction
with the money to meet the ends was scored better
68
66
64
62
60
58
56
54
D1 (0-100) D2 (0-100) D3 (0-100) D4 (0-100)
Figure 1: Mean Score for the Domains
in Iran and other items were scored better by the
respondents.
Since all the health workers in this study are
employed on a contract basis it is possible that their
QOL could differ from those of regular employees
of PHCs. A government job offers “job security” and
that it may impact the perceptions of QOL of health
workers positively. This, however, needs to be further
examined by studying QOL among health workers of
government run PHCs. Therefore, it is strongly felt
that this study fulfills the purpose of exploring QOL
and provides future directions for understanding
and improving QOL among health workers for better
performance.
Conclusions
The health workers of PHCs managed by Karuna
Trust have moderate overall QOL. They have good
satisfaction with their psychological health and they
are fairly satisfied with physical health and social
relationships. The environmental domain was scored
the least. WHO QOL‑BREF is found to be a useful
Male tool and further research should be done will all the
Female employees of the organization for programmatic
Total
intervention to enhance QOL. Considering the
criticality of the QOL and its relation to employee
performance, future studies on health workers in
Government run PHCs are indicated.
Financial support and sponsorship
Nil.

Table 3: Paired sample t‑test for the four domains of World Health Organization quality of life‑bref
Pairs Paired Paired samples t‑test
Dimension Mean SD SEM 95% CI of the t df Significant
Difference (two‑tailed)
Lower Upper
Pair 1 D1–D2 −2.871 9.478 1.133 −5.131 −0.612 −2.535 69 0.014
Pair 2 D1–D3 −1.271 19.384 2.317 −5.893 3.351 −0.549 69 0.585
Pair 3 D1–D4 3.457 11.400 1.363 0.739 6.175 2.537 69 0.013
Pair 4 D2–D3 1.600 19.788 2.365 −3.118 6.318 0.676 69 0.501
Pair 5 D2–D4 6.329 11.441 1.367 3.601 9.057 4.628 69 0.000
Pair 6 D3–D4 4.729 21.574 2.579 −0.415 9.873 1.834 69 0.071
CI = Confidence Interval, SD = Standard deviation, SEM = Standard error of mean

Table 4: Description of environment domain‑comparison of studies

Description Health workers in Karnataka, India Healthcare staff, Iran Pearson’s R
Feel safe in daily life (8) 3.54 3.54 1
Have healthy physical environment (9) 3.56 3.46 0.000
Have enough money to meet the needs (12) 2.64 2.89 0.000
Have enough information for day to day life (13) 3.69 3 0.000
Have opportunity for leisure activities (14) 2.46 2.44 0.000
Satisfied with condition of living place (23) 3.77 3.51 0.000
Satisfied with access to health service (24) 4.01 3.61 0.000
Satisfied with transport (25) 3.23 3.23 1

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Sathyananda and Manjunath: Assessment of QOL among Health workers of PHCs
Conflicts of interest
There are no conflicts of interest.
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