Abstract
BACKGROUND:
While CRCs play a crucial role in clinical trials, their job satisfaction has not received enough attention.
OBJECTIVE:
To assess the job satisfaction of CRCs and to explore the relevant factors.
METHODS:
The survey was programmed into an online questionnaire platform and distributed to CRCs in China for self-evaluation. The Minnesota Satisfaction Questionnaire (MSQ) was used to assess job satisfaction, and data on demographic characteristics, working situations, burnout and social support also were collected to identify factors associated with job satisfaction. Data analysis was performed using the R software program. Factors associated with job satisfaction were explored using ordinal logistic regression models.
RESULTS:
2,840 participants were included in this survey, and the mean value of overall job satisfaction was characterized as “moderate to not fully satisfied”. Additionally, both burnout and overall social support were reported at moderate levels. Ordinal logistic regression analysis revealed that age, monthly income, sleep duration per day, weekly working time, a fixed workplace, subjective support, utilization of support, emotional exhaustion, depersonalization and reduced personal accomplishment were significantly associated with all types of job satisfaction (p < 0.05). Among all the factors, a fixed workplace was more strongly associated with job satisfaction than the other factors (OR = 0.596, p < 0.001).
CONCLUSIONS:
Implementing the fixed-point CRC mode to promote the provision of a fixed workplace, improving the CRC career development path, increasing income, subjective support and utilization of support, reducing weekly working time, job burnout will help to predict job satisfaction in CRCs.
Keywords: Clinical trial, social support, burnout, research, working conditions, workplace
1. Introduction
Clinical research coordinators (CRCs) collaborate with physicians, sponsors, and institutions to ensure adherence to legal and regulatory requirements, facilitate budget preparation and financial management, oversee quality assurance measures, and manage databases [1, 2]. They play a pivotal role in standardizing and streamlining the development of clinical trials [3], while their inclusion in research teams significantly enhances patient recruitment efforts and improves overall study efficiency. In the 1970s, the United States took the lead in pioneering CRC, while Japan first explicitly proposed the concept of CRC during the revision of Good Clinical Practice (GCP) in April 1997. They defined CRC as an integral component of the clinical trial support system and distinguished it from monitoring roles. In China, CRC only began to emerge in the late 1990s [4]. Currently, the existing laws and regulations issued by Chinese clinical trial regulatory authorities provide a sound definition of the responsibilities held by researchers, sponsors and clinical research associate (CRA). However, they fail to address or define the specific responsibilities of CRCs. CRCs in China lack recognized industry regulations, certification plans, comprehensive training programs, and effective supervision [5]. Several professional associations are actively formulating industry standards and certifications for CRC professionals. For instance, the Clinical Trial Professional Committee in Guangdong has proposed the ‘Guangdong Consensus on CRC Management’ [6], while the Alliance of Pharmaceutical Clinical Trial Institutions has released field-specific guidelines for clinical research coordination [7]. However, despite these efforts, none of these initiatives have gained widespread popularity or recognition. Currently, CRC lacks adequate attention and holds a relatively low social status in China.
In recent years the number of clinical trials initiated in China has increased rapidly [8], and an increasing number of international multi-center clinical trials have been conducted in China. Most investigators of the clinical trials are clinicians, who must spend the majority of their time seeing and treating patients and have less time available for clinical trials because of the large population and the shortage of doctors in China [9]. The Chinese drug supervision authorities have determined to carry out “The Most Stringent” verification of drug clinical trial data since July 22, 2015, and the quality of clinical trials without CRCs could hardly meet the verification requirements [10]. As a result, the demand for CRC has increased sharply, and higher requirements have been put forward for the CRC’s working ability. Furthermore, Clinical trial protocols are becoming increasingly difficult, a significant investment in time and training is necessary for a new CRC to perform job responsibilities properly [11]. A stable and experienced CRC is very important for the quality of clinical trials. However, the turnover rate of CRCs in our current work has been found to be high, as evidenced by survey results indicating an alarming 52.5% resignation rate among CRCs at a specific research center [12].
Many studies have found that job satisfaction is a significant predictor of retention with professional employees [13–15]. Job satisfaction is defined as an evaluation of the staff’s emotional state, whether they like the job or not [16]. As an important indicator for evaluating the sense of belonging of employees, job satisfaction has received increasing attention of enterprises. Higher job satisfaction indicates that employees have a strong sense of belonging to their jobs and will be more motivated to work. In contrast, lower job satisfaction can weaken employees’ sense of belonging and motivation to work and increase the turnover rate of employees [16]. Job satisfaction is very significant in field studies of occupational wellbeing. The working conditions and status of CRCs have not received adequate attention, and there is a dearth of research on their job satisfaction levels, leading to limited understanding in this area. The ‘CRC Home’, the earliest and largest industry organization for CRC in China, has conducted continuous research on its member units; however, their publication output remains relatively limited. Li Shutin et al. comprehensively described the ecological environment of CRC in China based on survey data from 2014 to 2017 [10]. Nevertheless, their work satisfaction survey scale was overly simplistic and failed to analyze the underlying factors influencing satisfaction. The primary objective of this study is to accurately evaluate job satisfaction among CRCs using a professional scale, and investigate factors associated with job satisfaction in order to comprehend the current state of CRCs in China and provide insights for mitigating turnover rates and fostering the advancement of clinical research.
2. Methodology
2.1. Participants
In this study a hybrid sampling method that included convenience sampling and snowball sampling was applied. The questionnaire was initially published online through the Wenjuanxing platform and then distributed to participants via social platforms like WeChat as a website link. “CRC Home” is China’s earliest and largest CRC industry organization, which includes a WeChat group consisting of core members who are heads of member units. The questionnaire was first shared within this core members’ WeChat group, where they were invited to fill it out and subsequently forward it to other in-service CRCS within their teams. The survey was conducted using self-administered methods from November to December in 2019. A total of 3,139 respondents finished the questionnaire and finally the effective sample size was 2,840 participants, which with missing values on some items, logical questions answered incorrectly, and answer time less than 2 minutes were excluded from analyses, with an effective response rate of 90.05%.
2.2. Questionnaire
Assessment of demographic characteristics. The demographic characteristics of the questionnaire included age, gender, education level, major, marital status, weekly exercise, and daily sleep duration.
Assessment of working situation. The working situation questionnaire included working city, job title, type of employment, monthly income, working years, weekly working time, workplace and workload. Workplace was defined as ‘yes’ if there was a fixed working space. Workload was determined with the question ‘how many projects do you manage’.
Assessment of job satisfaction. The Minnesota Satisfaction Questionnaire (MSQ)that is a well-designed measure of employees’ job satisfaction, [17] is widely used in China and has demonstrated good reliability and validity [18, 19]. In this questionnaire job satisfaction is divided into intrinsic job satisfaction and extrinsic job satisfaction and overall job satisfaction includes both of these components. Intrinsic job satisfaction evaluates the work task itself, such as career development opportunities and other similar factors, whereas extrinsic job satisfaction evaluates the working conditions, such as salary, benefits, and so on. Overall job satisfaction reflects employees’ overall satisfaction with the work environment, interpersonal relationships, and internal and external satisfaction of various items [20, 21]. The 20-question MSQ used a 5-point Likert scale (from 1 = very dissatisfied to 5 = very satisfied). Intrinsic job satisfaction includes 12 items (questions 1–4, 7–11, 15–16 and 20) and extrinsic job satisfaction includes 6 aspects (questions 5–6, 12–14 and 19). Overall job satisfaction in these 20 questions was considered as a composite of all the aspects of job satisfaction. The score of overall job satisfaction ranges from 20 to 100 given the numerical scores assigned to each Likert-scale response, and they are categorized as either very dissatisfied or dissatisfied with their jobs (scores of 40 and below), dissatisfied to moderate (scores of 41 to 59), moderate (score of 60), moderate to not fully satisfied (scores of 61 to 79) and very satisfied or satisfied (scores of 80 and above) [18, 22]. In our study, values of Cronbach’s alpha for total job satisfaction, intrinsic job satisfaction and extrinsic job satisfaction of the MSQ were 0.94, 0.91 and 0.89, respectively.
Assessment of burnout. The Chinese version of the Maslach Burnout Inventory-General Survey (MBI-GS), translated and improved by Chaopin Li, is a widely used tool for measuring burnout in all occupations and has shown good reliability and validity in previous studies in China [23, 24]. MBI-GS measures three dimensions of job burnout: (1) emotional exhaustion (5 items), feelings of being emotionally overextended and depleted of one’s emotional resource; (2) depersonalization (4 items), a negative, callous or excessively detached response to other people; and (3) reduced personal accomplishment (6 items), a decline in one’s feelings of competence and successful achievement in one’s work [23, 24]. Each item of the 15-item MBI-GS questionnaire consists of a 7-point Likert scale ranging from 0 (“never”) to 6 (“every day”). A positive score was used for emotional exhaustion and depersonalization, and the reduced personal accomplishment adopted reverse scoring. Higher scores on the emotional exhaustion, depersonalization or reduced personal accomplishment indicate burnout. We calculated a weighted burnout sum score as follows: sum score of burnout = 0.4 * emotional exhaustion + 0.3 * depersonalization + 0.3 * reduced personal accomplishment [25]. For descriptive purposes the burnout was grouped as follows: no burnout (sum score 0–1.49), moderate burnout (sum score 1.50–3.49), and severe burnout (sum score 3.50–6.00). In our study Cronbach’s alpha of the MBIGS was 0.91. The values of Cronbach’s alpha for the subscales ‘emotional exhaustion’, ‘depersonalization’ and ‘reduced personal accomplishment’ were 0.92, 0.93 and 0.94, respectively.
Assessment of social support. Social support was assessed through the Social Support Rating Scale (SSRS), which was developed by Xiao [26] and has been widely applied in China with excellent validity and reliability [27, 28]. The SSRS consists of ten items of three domains in total: objective support, subjective support, and social support utilization. Subjective support refers to an individual’s emotional experience of being respected, supported, and understood by their social group. Objective support refers to objective, visible, or actual support, including direct material support, support from social networks, and the existence and participation of group relationships, etc. The degree of utilization of social support refers to differences in the use of social support by individuals [29]. Individual responses were provided as a 4-point Likert scale. Overall score of all items ranges from 12 to 66, with higher scores reflecting stronger social support. The total score has been divided into three levels: low (12–22), moderate (23–44), and high (45–66) [30]. In our study Cronbach’s alpha of the scale was 0.73.
2.3. Statistical analysis
All data were collected by the survey platform and were checked by the professional data processors to eliminate unqualified questionnaires. All of the qualified data were analyzed using the R software program (version 4.1.2). Descriptive analyses about demographic characteristics, working situations, job satisfaction, burnout and social support of the participants were conducted. Demographic characteristics and working situations were shown as numbers (N) and percentages (%). The numerical levels of job satisfaction, burnout and social support were shown as mean (SD) and median (range). Factors associated with job satisfaction, including demographic characteristics, working situations, burnout and social support were explored using ordinal logistic regression models with random effects to account for heterogeneity in responses among participants.
3. Results
3.1. Demographic characteristics and working situations of the participants
The demographic characteristics and working situations of the total 2840 participants were both listed in Table 1. The study found that 2,694 (94.9%) were female; 2,449 (86.2%) were under 30 years old; 1,007 (35.5%) were married; 2,199 (77.4%) held bachelor’s degrees; 554 (19.5%) graduated from junior college; and 87 (3.1%) held master’s degree or above. The main majors of the participants were Pharmacy (50%) and Nursing (37.5%), and 1,975 (69.5%) had not done any regular exercise every week.
Table 1.
Demographic characteristics and working situations of the participants
| Demographic characteristics | working situations | ||||
| Variable | N (%) | Variable | N (%) | ||
| Gender | Male | 146 (5.1) | Working city | First-tier cities | 692 (24.4) |
| Female | 2,694 (94.9) | Non-first-tier provincial capital cities | 1,726 (60.8) | ||
| Age(years) | ≤25 | 1,272 (44.8) | Other | 422 (14.9) | |
| 26–30 | 1,177 (41.4) | Monthly income (yuan) | ≤5,000 | 769 (27.1) | |
| >30 | 391 (13.8) | 5,001–7,000 | 1,280 (45.1) | ||
| Education Level | Associate | 554 (19.5) | > 7,000 | 791 (27.9) | |
| Bachelors | 2,199 (77.4) | Job title | CRC | 2,491 (87.7) | |
| Masters and above | 87 (3.1) | project manager | 127 (4.5) | ||
| Major | Medicine | 183 (6.4) | Personnel manager | 164 (5.8) | |
| Pharmacy | 1,421 (50.0) | Other | 58 (2.0) | ||
| Nursing | 1,064 (37.5) | Working years | <1 | 971 (34.2) | |
| Bioscience | 73 (2.6) | ≥1 and <2 | 820 (28.9) | ||
| Other | 99 (3.5) | ≥2 and <5 | 854 (30.1) | ||
| Marital status | Single | 1,823 (64.2) | ≥5 | 195 (6.9) | |
| Married and other | 1,017 (35.8) | Weekly working time (hours) | ≤40 | 814 (28.7) | |
| Weekly exercise number (times) | 0 | 1,975 (69.5) | >40 and ≤48 | 1,324 (46.6) | |
| 1–2 | 752 (26.5) | >48 | 702 (24.7) | ||
| 3–4 | 83 (2.9) | Workload | 0–4 | 2,161 (76.1) | |
| ≥5 | 30 (1.1) | 5–8 | 591 (20.8) | ||
| Sleep duration per day (hours) | ≤6 | 305 (10.7) | ≥9 | 88 (3.1) | |
| >6 and ≤7 | 1,647 (58.0) | Workplace | No | 1,099 (38.7) | |
| >7 and ≤8 | 816 (28.7) | Yes | 1,741 (61.3) | ||
| >8 | 72 (2.5) | ||||
The working situations of the participants are summarized as following: 63.1% of the respondents had worked for less than 2 years, only 6.9% worked for more than 5 years; 46.6% worked 40–48 hours every week, and 24.7% worked more than 48 hours weekly; 61.3% of the participants had no fixed workplace; 45.1% earned 5,001–7,000 yuan monthly, and 27.9% earned more than 7,000 yuan.
3.2. The levels of job satisfaction, burnout and social support
The proportion of the participants whose job satisfaction was moderate to not fully satisfied was 63.2%, and the proportion whose overall job satisfaction was moderate to very dissatisfied was 11.4%. The mean value of overall job satisfaction was 72.15±10.97, which was in the range of “moderate to not fully satisfaction” (Table 2). The mean value of burnout and overall social support was 2.93±0.89 and 34.10±7.78 respectively, which were both moderate.
Table 2.
Numerical scores for job satisfaction, burnout and social support
| Scale | Mean (SD) | Median (Range) | |
| Job satisfaction | |||
| Intrinsic | 40.37 (5.86) | 24.00 (11,55) | |
| Extrinsic | 20.97 (4.02) | 29.00(6,30) | |
| Overall | 72.15 (10.97) | 73.00(20,100) | |
| Burnout | |||
| Emotional Exhaustion | 11.72 (5.64) | 10.00 (0,30) | |
| Depersonalization | 6.65 (4.77) | 6.00 (0,24) | |
| Reduced Personal Accomplishment | 15.79 (6.62) | 18.00 (0,36) | |
| Sum sore of burnout | 2.93(0.89) | 2.90(0.70,6.70) | |
| Social support | |||
| Objective | 6.93 (3.34) | 7.00(1,22) | |
| Subjective | 19.19 (4.56) | 17.10 (5,35) | |
| Utilization | 7.98 (1.80) | 8.00(3,12) | |
| Overall | 34.10(7.78) | 34.00(13,65) |
3.3. Factors associated with overall job satisfaction
The model of factors associated with overall job satisfaction were based on demographic characteristics, working situations, social support and job burnout. The results of ordinal logistic regression analysis were shown in Table 3. The effects of age, marital status, sleep duration per day, monthly income, weekly working time, workplace, subjective support, utilization of support, emotional exhaustion, depersonalization and reduced personal accomplishment were statistically significant (p < 0.05).
Table 3.
Ordinal logistic regression analysis of overall job satisfaction
| Predictor | OR | 95% Confidence Interval | P | ||
| lower | upper | ||||
| Gender | Male | 1.285 | 0.982 | 1.681 | 0.068 |
| Female | 1a | ||||
| Age (years) | ≤25 | 1.444 | 1.142 | 1.825 | 0.002** |
| 26–30 | 1.266 | 1.039 | 1.542 | 0.019* | |
| >30 | 1a | ||||
| Education Level | Associate | 1.242 | 0.864 | 1.786 | 0.242 |
| Bachelors | 1.053 | 0.750 | 1.478 | 0.766 | |
| Masters and above | 1a | ||||
| Major | Medicine | 1.199 | 0.823 | 1.747 | 0.344 |
| Pharmacy | 1.145 | 0.837 | 1.566 | 0.396 | |
| Nursing | 1.142 | 0.831 | 1.569 | 0.412 | |
| Bioscience | 1.124 | 0.706 | 1.79 | 0.623 | |
| Other | 1a | ||||
| Marital status | Single | 1.262 | 1.064 | 1.498 | 0.008** |
| Married and other | 1a | ||||
| Weekly exercise number (times) | 0 | 0.757 | 0.44 | 1.304 | 0.316 |
| 1–2 | 0.852 | 0.492 | 1.476 | 0.567 | |
| 3–4 | 0.839 | 0.447 | 1.577 | 0.586 | |
| ≥5 | 1a | ||||
| Sleep duration per day (hours) | ≤6 | 0.799 | 0.536 | 1.19 | 0.270 |
| >6 and ≤7 | 0.685 | 0.477 | 0.984 | 0.041* | |
| >7 and ≤8 | 0.71 | 0.491 | 1.026 | 0.068 | |
| >8 | 1a | ||||
| Working city | First-tier cities | 0.846 | 0.693 | 1.033 | 0.101 |
| Non-first-tier provincial capital cities | 0.939 | 0.796 | 1.108 | 0.459 | |
| other cities | 1a | ||||
| Monthly income (yuan) | ≤5,000 | 0.773 | 0.616 | 0.969 | 0.026* |
| 5,001–7,000 | 0.866 | 0.728 | 1.03 | 0.105 | |
| >7,000 | |||||
| Job title | CRC | 0.672 | 0.441 | 1.023 | 0.064 |
| project manager | 1.335 | 0.824 | 2.162 | 0.240 | |
| Personnel manager | 1.188 | 0.746 | 1.893 | 0.468 | |
| Other | 1a | ||||
| Working years | <1 | 0.964 | 0.692 | 1.343 | 0.827 |
| ≥1 and <2 | 0.994 | 0.728 | 1.357 | 0.970 | |
| ≥2 and <5 | 0.905 | 0.686 | 1.194 | 0.481 | |
| ≥5 | 1a | ||||
| Weekly working time (hours) | ≤40 | 1.44 | 1.214 | 1.708 | 0.000*** |
| >40 and ≤48 | 1.321 | 1.139 | 1.532 | 0.000*** | |
| >48 | 1a | ||||
| Workload | 0–4 | 0.962 | 0.684 | 1.351 | 0.821 |
| 5–8 | 0.913 | 0.642 | 1.297 | 0.611 | |
| ≥9 | 1a | ||||
| Workplace | No | 0.596 | 0.529 | 0.672 | 0.000*** |
| Yes | 1a | ||||
| Objective support | 1.01 | 0.990 | 1.031 | 0.310 | |
| Subjective support | 1.075 | 1.057 | 1.093 | 0.000*** | |
| Utilization of support | 1.084 | 1.047 | 1.123 | 0.000*** | |
| Emotional exhaustion | 0.975 | 0.959 | 0.991 | 0.002** | |
| Depersonalization | 0.901 | 0.885 | 0.919 | 0.000*** | |
| Reduced personal accomplishment | 0.938 | 0.930 | 0.947 | 0.000*** | |
Note: OR denotes odds ratio. a: This superscript identifies the referent that was assigned to a categorical predictor of 2 or more levels. So, the odds ratio of a referent equals 1.0 by definition. *: p < 0.05, **: p < 0.01, ***: p < 0.001.
Compared with those aged more than 30 years, CRCs who were under 25 years (OR = 1.444, p = 0.002) and 26–30 years (OR = 1.266, p = 0.019) had higher overall job satisfaction. Single (i.e., unmarried) CRCs had higher job satisfaction (OR = 1.262, p = 0.008) than married CRCs. Sleeping < 6 hours and ≤7 hours showed lower overall job satisfaction (OR = 0.685, p = 0.041) than sleeping over 8 hours. CRCs who earned less than 5,000 yuan every month had a lower satisfaction (OR = 0.773, p = 0.026). Compared with those who worked more than 48 hours per week, CRCs who worked less than 48 hours per week had higher overall job satisfaction (<40 hours group: OR = 1.440, p < 0.001; ≥40 hours and <48 hours group: OR = 1.321, p < 0.001). Compared with CRCs who have a fixed workplace, CRCs without a fixed workplace had less overall satisfaction with their jobs (OR = 0.596, p < 0.001). Subjective support (OR = 1.075, p < 0.001) and Utilization of support (OR = 1.084, p < 0.001) were positively correlated with overall job satisfaction, whereas emotional exhaustion (OR = 0.975, p = 0.002), depersonalization (OR = 0.901, p < 0.001) and reduced personal accomplishment (OR = 0.938, p < 0.001) were negatively correlated with overall job satisfaction. It is noteworthy that objective support was not significantly associated with overall satisfaction.
3.4. Factors associated with extrinsic job satisfaction
The results of ordinal logistic regression analysis for the factors associated with extrinsic job satisfaction were shown in Table 4. The results were very similar to those of overall job satisfaction. In addition to the factors significantly associated with overall satisfaction, the extrinsic job satisfaction of CRCs who worked in first-tier cities was lower (OR = 0.759, p = 0.016) than those who worked in the cities other than first-tier cities or capital cities.
Table 4.
Ordinal logistic regression analysis of extrinsic job satisfaction
| Predictor | OR | 95% Confidence Interval | P | ||
| lower | upper | ||||
| Gender | Male | 1.314 | 0.971 | 1.778 | 0.077 |
| Female | 1a | ||||
| Age (years) | ≤25 | 1.497 | 1.15 | 1.947 | 0.003** |
| 26–30 | 1.354 | 1.085 | 1.689 | 0.007** | |
| >30 | 1a | ||||
| Education Level | Associate | 1.220 | 0.809 | 1.841 | 0.343 |
| Bachelors | 1.085 | 0.738 | 1.595 | 0.679 | |
| Masters and above | 1a | ||||
| Major | Medicine | 1.269 | 0.829 | 1.942 | 0.273 |
| Pharmacy | 1.149 | 0.806 | 1.638 | 0.443 | |
| Nursing | 1.173 | 0.819 | 1.681 | 0.384 | |
| Bioscience | 1.005 | 0.596 | 1.696 | 0.985 | |
| Other | 1a | ||||
| Marital status | Single | 1.337 | 1.103 | 1.622 | 0.003** |
| Married and other | 1a | ||||
| Weekly exercise number (times) | 0 | 0.663 | 0.352 | 1.25 | 0.204 |
| 1–2 | 0.734 | 0.387 | 1.392 | 0.344 | |
| 3–4 | 0.703 | 0.339 | 1.457 | 0.343 | |
| ≥5 | 1a | ||||
| Sleep duration per day (hours) | ≤6 | 0.722 | 0.458 | 1.138 | 0.161 |
| >6 and ≤7 | 0.617 | 0.408 | 0.932 | 0.022* | |
| >7 and ≤8 | 0.674 | 0.443 | 1.026 | 0.066 | |
| >8 | 1a | ||||
| Working city | First-tier cities | 0.759 | 0.607 | 0.95 | 0.016* |
| Non-first-tier provincial capital cities | 0.871 | 0.723 | 1.050 | 0.148 | |
| other cities | 1a | ||||
| Monthly income (yuan) | ≤5,000 | 0.717 | 0.723 | 1.050 | 0.010* |
| 5,001–7,000 | 0.847 | 0.556 | 0.925 | 0.095 | |
| >7,000 | 1a | ||||
| Job title | CRC | 0.728 | 0.452 | 1.173 | 0.192 |
| project manager | 1.484 | 0.858 | 2.566 | 0.158 | |
| Personnel manager | 1.267 | 0.746 | 2.151 | 0.381 | |
| Other | 1a | ||||
| Working years | <1 | 1.264 | 0.871 | 1.834 | 0.218 |
| ≥1 and <2 | 1.097 | 0.773 | 1.556 | 0.605 | |
| ≥2 and <5 | 1.012 | 0.742 | 1.382 | 0.939 | |
| ≥5 | 1a | ||||
| Weekly working time (hours) | ≤40 | 1.533 | 1.265 | 1.857 | 0.000*** |
| >40 and ≤48 | 1.349 | 1.142 | 1.594 | 0.000*** | |
| >48 | 1a | ||||
| Workload | 0–4 | 1.200 | 0.817 | 1.761 | 0.352 |
| 5–8 | 0.997 | 0.67 | 1.482 | 0.988 | |
| ≥9 | 1a | ||||
| Workplace | No | 0.524 | 0.458 | 0.599 | 0.000*** |
| Yes | 1a | ||||
| Objective support | 1.007 | 0.985 | 1.030 | 0.542 | |
| Subjective support | 1.073 | 1.053 | 1.093 | 0.000*** | |
| Utilization of support | 1.102 | 1.059 | 1.146 | 0.000*** | |
| Emotional exhaustion | 0.963 | 0.946 | 0.981 | 0.000*** | |
| Depersonalization | 0.910 | 0.890 | 0.929 | 0.000*** | |
| Reduced personal accomplishment | 0.954 | 0.944 | 0.964 | 0.000*** | |
Note: OR denotes odds ratio. a: This superscript identifies the referent that was assigned to a categorical predictor of 2 or more levels. So the odds ratio of a referent equals 1.0 by definition.*: p < 0.05,**: p < 0.01,***: p < 0.001.
3.5. Factors associated with intrinsic job satisfaction
The results of ordinal logistic regression analysis for the factors associated with intrinsic job satisfaction were shown in Table 5. The most significant factors of intrinsic job satisfaction were generally similar to those of overall and extrinsic job satisfaction, and the impacts of these factors also were similar. The differences were that marital status was not a significant factor (OR = 1.187, p = 0.063) for intrinsic satisfaction; the intrinsic job satisfaction of CRCs engaged in basic daily work was not as high as those of project managers and personnel managers (OR = 0.622, p = 0.039), while the job title was not a significant factor for overall and extrinsic job satisfaction.
Table 5.
Ordinal logistic regression analysis of intrinsic job satisfaction
| Predictor | OR | 95% Confidence Interval | P | ||
| lower | upper | ||||
| Gender | Male | 1.242 | 0.936 | 1.649 | 0.133 |
| Female | 1a | ||||
| Age (years) | ≤25 | 1.430 | 1.117 | 1.83 | 0.005 |
| 26–30 | 1.243 | 1.01 | 1.531 | 0.040* | |
| >30 | 1a | ||||
| Education Level | Associate | 1.224 | 0.831 | 1.804 | 0.306 |
| Bachelors | 1.020 | 0.71 | 1.468 | 0.913 | |
| Masters and above | 1a | ||||
| Major | Medicine | 1.102 | 0.738 | 1.645 | 0.634 |
| Pharmacy | 1.127 | 0.807 | 1.573 | 0.483 | |
| Nursing | 1.091 | 0.778 | 1.53 | 0.612 | |
| Bioscience | 1.184 | 0.723 | 1.937 | 0.502 | |
| Other | 1a | ||||
| Marital status | Single | 1.187 | 0.991 | 1.423 | 0.063 |
| Married and other | 1a | ||||
| Weekly exercise number (times) | 0 | 0.781 | 0.426 | 1.433 | 0.425 |
| 1–2 | 0.896 | 0.486 | 1.651 | 0.724 | |
| 3–4 | 0.867 | 0.432 | 1.737 | 0.687 | |
| ≥5 | 1a | ||||
| Sleep duration per day (hours) | ≤6 | 0.778 | 0.507 | 1.194 | 0.251 |
| >6 and ≤7 | 0.665 | 0.45 | 0.982 | 0.040* | |
| >7 and ≤8 | 0.674 | 0.453 | 1.001 | 0.051 | |
| >8 | 1a | ||||
| Working city | First-tier cities | 0.869 | 0.704 | 1.072 | 0.191 |
| Non-first-tier provincial capital cities | 0.969 | 0.814 | 1.154 | 0.728 | |
| other cities | 1a | ||||
| Monthly income (yuan) | ≤5,000 | 0.777 | 0.612 | 0.986 | 0.038* |
| 5,001–7,000 | 0.859 | 0.715 | 1.031 | 0.103 | |
| >7,000 | 1a | ||||
| Job title | CRC | 0.622 | 0.397 | 0.975 | 0.039* |
| project manager | 1.257 | 0.749 | 2.107 | 0.387 | |
| Personnel manager | 1.160 | 0.704 | 1.911 | 0.561 | |
| Other | 1a | ||||
| Working years | <1 | 0.771 | 0.543 | 1.094 | 0.145 |
| ≥1 and <2 | 0.900 | 0.647 | 1.251 | 0.532 | |
| ≥2 and <5 | 0.826 | 0.616 | 1.107 | 0.200 | |
| ≥5 | 1a | ||||
| Weekly working time (hours) | ≤40 | 1.379 | 1.152 | 1.651 | 0.000*** |
| >40 and ≤48 | 1.311 | 1.121 | 1.533 | 0.001*** | |
| >48 | 1a | ||||
| Workload | 0–4 | 0.781 | 0.543 | 1.124 | 0.183 |
| 5–8 | 0.837 | 0.575 | 1.220 | 0.355 | |
| ≥9 | 1a | ||||
| Workplace | No | 0.629 | 0.555 | 0.714 | 0.000*** |
| Yes | 1a | ||||
| Objective support | 1.011 | 0.99 | 1.033 | 0.294 | |
| Subjective support | 1.076 | 1.057 | 1.095 | 0.000*** | |
| Utilization of support | 1.074 | 1.035 | 1.115 | 0.000*** | |
| Emotional exhaustion | 0.983 | 0.966 | 1.000 | 0.044* | |
| Depersonalization | 0.888 | 0.871 | 0.906 | 0.000*** | |
| Reduced personal accomplishment | 0.926 | 0.916 | 0.935 | 0.000*** | |
Note: OR denotes odds ratio.a: This superscript identifies the referent that was assigned to a categorical predictor of 2 or more levels. So the odds ratio of a referent equals 1.0 by definition.*: p < 0.05,**: p < 0.01,***: p < 0.001.
4. Discussion
The job satisfaction of CRCs in China was ranked as “moderate to not fully satisfied”, which was similar to the overall job satisfaction level of other health workers in country. The mean overall MSQ score of Psychiatrists in China was 71.6±14.3 [31]; the averages of overall job satisfaction score of Chinese community health workers were 67.17 in Shenyang and 69.95 in Benxi [18]. The job satisfaction of China’s CRC is considered to be suboptimal, and there exists substantial potential for enhancement. The impact factors of overall satisfaction, internal satisfaction, and external satisfaction were individually analyzed, revealing that the significant influencing factors for all three dimensions were similar. Age, sleep duration per day, weekly working hours, monthly income, fixed workplace, subjective support, utilization of support, emotional exhaustion, depersonalization and reduced personal accomplishment were identified as common significant determinants.
Among all the respondents 86.2% were under the age of 30, and undergraduates accounted for 77.4%. The CRC group in China was relatively young and highly educated, similar to the survey results of Zhu et al. The completion of a formal academic degree program enhances a graduate’s perception of their own competence in performing routine and advanced clinical research functions, surpassing the level attained through years of practical experience [33]. A higher level of education contributes to the advancement of the CRC industry in its later stages, while a younger team also injects dynamism into the industry. However, despite years of development, the proportion of CRC professionals aged 30 and above in China stands at a mere 13.8%. Furthermore, only 6.9% of CRCs possess over 5 years of work experience, which is relatively low compared to countries such as the United States and South Korea where there is a higher prevalence of seasoned senior professionals [34, 35]. The massive attrition of experienced CRCs poses a significant challenge to the growth of the industry, because the successful completion of clinical research necessitates highly specialized and standardized management, as well as research personnel who have undergone systematic training [36]. Our survey findings also indicate that job satisfaction levels are lower among CRCs aged 30 and above compared to their younger counterparts. The correlation between job satisfaction and turnover rate underscores the significance of comprehending the present state of job satisfaction among CRC employees, along with its underlying determinants.
A prevalent issue in China’s CRCs is the absence of dedicated office spaces and substandard working environments, which may be attributed to deficiencies in their management and operational models. In this survey, the majority of CRCs are employed by Site Management Organizations (SMOs), which typically oversee multiple research centers simultaneously. These CRCs do not hold regular positions within the research institutions and their work schedules can be adjusted at any time based on actual workload demands, posing challenges for providing them with a fixed workplace. The survey findings suggest that, in comparison to CRCs who possess a fixed workplace, CRCs lacking a fixed workplace exhibit lower job satisfaction, and 61.3% of the respondents had a relatively fixed workplace. Having a fixed workplace is beneficial to a sense of belonging, and Li et al pointed out that hospital conditions, i.e. the woking conditions of CRCs, are one of the key needs to be improved [10]. Recently the fixed-point CRC model, that is a CRC only working in one research center, has been promoted increasingly by research institutions and SMOs. The model not only reduces the time for CRCs to go back and forth among different research institutions to improve the work efficiency, but also prompts CRC personnel relatively fixed in a research institution, which facilitates the provision of a relatively fixed place for CRCs by research institutions. Moreover, under this model the research institutions can also effectively manage CRCs and may provide professional training with institutional characteristics. The joint training and management by SMOs and research institutions will greatly improve the professional capacity of the CRCs. This model may be a solution to improve the working conditions of CRCs, especially to provide a fixed place for them.
Consistent with the majority of research findings, our study demonstrates that individuals who work fewer weekly hours, maintain sufficient daily sleep duration, and earn higher monthly incomes tend to exhibit elevated levels of job satisfaction [37–39]. The workload of CRCs was evidently substantial, with 46.6% of the respondents working between 40–48 hours per week and 24.7% working over 48 hours per week. However, the monthly income of CRCs falls below expectations, as nearly half of the respondents (45.1%) earn a monthly income ranging from 5,001 to 7,000 yuan. This is in contrast to the average monthly salary of employees in enterprises which stands at 6,269 yuan [40]. Additionally, a significant proportion of individuals earn less than the national average wage. Therefore, it may be beneficial to increase job satisfaction by giving the CRCs reasonable working hours and increasing the monthly salary.
Studies[41] have shown that employees who have access to better social support have less occupational stress and are able to attain a higher level of personal achievement. CRCs have complex social relationships in the workplace, including CRC-researcher relationship, CRC-research institution relationship, CRC-clinical subject relationship and CRC-leadership relationship. Buchanan et al [42] found that CRCs who felt respected and engaged by the principal investigators were more likely to have higher job satisfaction, and the investment in time to build genuine relationships with the study staff was just as likely to increase long-term retention as better compensation. The present study is the first to explore the impact of social support on job satisfaction with CRCs. The results suggested that CRCs had moderate levels of social support and subjective social support and utilization of support were significantly and positively correlated with job satisfaction (p < 0.001). The social support may be an important factor contributing to the job satisfaction.
Job burnout refers to a long-term reaction caused by an individual’s inability to cope effectively with the constant pressure at work, including emotional exhaustion, depersonalization, and reduced personal accomplishment. Many studies have shown that job burnout and job satisfaction are mutually influential [18, 43, 44]. In the present study the burnout of CRCs in China was moderate. The ordinal logistic regression analysis in this present study proved that the depersonalization and reduced personal accomplishment exhibit a stronger and more negative correlation with job satisfaction (p < 0.001), as compared to emotional exhaustion (p < 0.05). Burnout was a key predictor of job satisfaction and was helpful in improving job satisfaction by reducing job burnout. The study of burnout among CRCs reveals that inadequate support and respect from researchers, an ambiguous understanding of CRC’s developmental prospects, and a sense of detachment from the affiliated organization are significant risk factors for burnout [45]. Therefore, enhancing the working environment for CRCs, fostering humanistic care and professional training initiatives, as well as promoting a stronger sense of professional identity and belonging within the CRCs can partially alleviate the prevailing issue of burnout while concurrently increasing job satisfaction among CRCs.
5. Conclusion
This study made a comprehensive and multidimensional measurement of the job satisfaction in CRCs and found that implementing the fixed-point CRC mode to promote the provision of a fixed workplace, establishing and improving the CRC career development path, increasing income, subjective support and utilization of support, reducing weekly working time, job burnout, will help to predict job satisfaction in CRCs, which can reduce withdrawal rates of CRCs and promote the better development of clinical research. The CRC industry in China holds immense potential for development, yet it necessitates sustained efforts from all stakeholders to undertake systematic construction.
5.1. Limitations
There were two main limitations in the present study. First, the measurements were administered via self-administration, and bias in the common method and bias in self-administration may have influenced the results. Second, the influential factors of the MSQ included in the study may not contain all related factors that can influence the job satisfaction of a CRC. Additional study should consider more influential factors that may affect CRC job satisfaction.
Ethics approval and consent to participate
The protocol of the study and waiver of signed consent were approved by the Ethics Committee of Children’s Hospital, Zhejiang University School of Medicine (Reference No. 2019-IRB-145). Respondents agreed to participate in the study by continuing to fill out the questionnaire. The research adhered to the tenets of the Declaration of Helsinki.
Conflict of interests
The authors declare that they have no conflict of interests.
Acknowledgments
We would express our gratitude for Dr. Robert M. Dorazio’s guidance on this article. He has given us a lot of inspiration on statistics, including some insightful ideas on statistical methods, and added informative odds ratio plots to make the statistics clearer and more readable.
Funding
This work was supported by Basic Public Welfare Research Project of Zhejiang Province (No. LGF19H310004).
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