[Validation of scale to evaluate the relationship between family-work in family physicians]. / Validación de escala para evaluar la relación familia-trabajo en médicas y médicos de familia.

BACKGROUND: Studying the work-family relationships is important because it affects the personal and professional life. Women increases in medicine without redistribute domestic tasks and responsibilities. The purpose of this study was to create and validate a scale of work-family relations in women and men family physician (FP) in Andalusia. METHODS: Cross sectional and multicenter study. The study population were FP of urban primary care centres, sample=500FP (50% by sex). We studied: sex, age, postgraduate family medicine specialty, care burden (2 variables), and family burden (7 variables). We design, and included in self-administered questionnaires, a scale of 13 questions on work-family relations. Bivariate analysis, exploratory factor and multiple regressions to test the convergent validity was performed. RESULTS: The response rate was 73.6%. We identified two dimensions, Overloading and Family Support Deficit (OFSD) (5 questions), and Work-Family Conflict (WFC) (6 questions), in both, female FP score higher than their peers. There are more family variables associated with both dimensions in female FP, it expresses differences in the complexity of the causes of OFSD and WFC by sex. CONCLUSION: The scale obtained is valid, reliable and gives two empirical dimensions of family-work relationships.

Validación de escala para evaluar la relación familia-trabajo en médicas y médicos de familia / Validation of scale to evaluate the relationship between family- work in family physicians

Fundamentos: Estudiar las relaciones familia-trabajo es relevante porque afectan a la vida personal y profesional. Elnúmero de mujeres aumenta en medicina sin que se redistribuyan las tareas y responsabilidades domésticas. El objetivo fueelaborar y validar una escala sobre las relaciones familia-trabajo en médicas y médicos de familia (MF) de Andalucía. Métodos: Estudio transversal y multicéntrico. La población de estudio fueron MF de los centros de salud urbanos de Andalucía, muestra=500 MF, 50% por sexo. Estudiamos: sexo,edad, formación postgraduada en medicina de familia, carga asistencial (2 variables) y carga familiar (7 variables). Diseñamos un cuestionario postal para ser autoadministrado con una escala de 13 preguntas sobre las relaciones familia-trabajo. serealizó análisis bivariante, factorial exploratorio y regresión múltiple para probar la validez convergente. Resultados: La tasa de respuesta fue del 73,6%. Se identificaron dos dimensiones: Sobrecarga y Déficit de Apoyo Familiar (SDAF) (5 preguntas) y Conflicto Familia-Trabajo (CFT)(6 preguntas). En ambas las médicas puntúan más alto que sus compañeros. Hay más variables familiares asociadas a ambasdimensiones en las médicas que en los médicos, lo que expresa diferencias en la complejidad de las causas de SDAF y CFT por sexo. Conclusiones: La escala obtenida es válida, fiable y recoge dos dimensiones empíricas de las relaciones familia-trabajo(AU)

Bakcground: Studying the work-family relationships is important because it affects the personal and professional life.Women increases in medicine without redistribute domestic tasks and responsibilities. The purpose of this study was to create and validate a scale of work-family relations in women and men family physician (FP) in Andalusia. Methods: Cross sectional and multicenter study. The studypopulation were FP of urban primary care centres, sample= 500FP (50% by sex). We studied: sex, age, postgraduatefamily medicine specialty, care burden (2 variables), and family burden (7 variables). We design, and included in self-administered questionnaires, a scale of 13 questions on work-family relations. Bivariate analysis, exploratory factor and multiple regressions to test the convergent validity was performed. Results: The response rate was 73.6%. We identified two dimensions, Overloading and Family Support Deficit (OFSD)(5 questions), and Work-Family Conflict (WFC) (6 questions),in both, female FP score higher than their peers. There are more family variables associated with both dimensions in female FP,it expresses differences in the complexity of the causes of OFSD and WFC by sex. Conclusion: The scale obtained is valid, reliable and givestwo empirical dimensions of family-work relationships(AU)

Patient psychosocial factors and primary care consultation: a cohort study.

BACKGROUND: The combined influence of psychological distress, family dysfunction and social support on primary care consultation (PCC) remains unclear. OBJECTIVE. To build an explanatory model of PCC concerning users' psychosocial factors. METHODS: We undertook a multicentre, prospective cohort study of a random sample of 1141 persons assigned to 113 GPs, belonging to 11 urban health centres in four Spanish cities (Seville, Malaga, Jaen and Granada), of whom 955 (84%) were interviewed in their homes. They were followed up for 1 year and then contacted again. After the second interview, 70 (7.3%) patients were excluded; accordingly, we measured the number of PCC of 885 valid patients using their medical charts. RESULTS: A multilevel analysis was developed. The null model with three levels showed that 93.29% of the variability was explained by the patients, 1.56% by the GPs and 5.15% by the health centres. We selected a two-level model (patients and health centres) with random effects. The variables used in the multilevel analysis explained 48% of PCC, 36% at the patient level and 12% at the health centre level. Poor mental health (GHQ-28, partial correlation coefficient=0.28) and family dysfunction (Family APGAR index, partial correlation coefficient=0.26) were the most predictive variables, whereas social support (Duke-UNC-11, partial correlation coefficient=-0.14) lost significance in the multivariate analysis. Chronic illness seemed less relevant in our study, and only two predisposing factors were included in the equation: age and satisfaction with their doctor. CONCLUSIONS: Mental health and family function were the most important psychosocial factors predicting PCC. More comprehensive identification of psychosocial factors may enhance our understanding of PCC.

[The dimensions of the organisational climate as seen by general practitioners]. / Las dimensiones del clima organizacional percibidas por los médicos de familia.

OBJECTIVE: To create and validate a tool to assess the organizational climate (OC) perceived by general practitioners (GP). DESIGN: Descriptive, cross-sectional, and multi-site, study. SETTING: Health centres (HC) in Jaén and Málaga province Spain. PARTICIPANTS: Random sample of 38 HCs and 387 GPs. MAIN MEASUREMENTS: A self-administered questionnaire in March 2001, with the personal variables of sex, age, graduation date, specialty, kind of contract, time worked in primary care teams, time in current job, list size, case load, tutor of residents and academic qualification. HC variables: urban/rural, team structure, accreditation for teaching residents, service portfolio, out-patient care, and an OC scale of 40 Likert-like questions. We analysed the content validity of the scale by factorial analysis; and its reliability, by Cronbach's alpha and corrected scale-item correlation coefficients. RESULTS: Reply rate was 89.8%, 71% of the GPs were male, mean age was 44, 76% had tenure, and 37% were specialists in family medicine and 28% tutors, 17% with 3rd-year residents, 9% with doctors; 50% of HCs were rural and the mean team structure had 13 GPs and 4 paediatricians. We obtained 12 factors that explained 60% of variance, and 7 factors with reliability coefficients >0.50. We made an OC-positive scale (alpha=.82) with the dimensions for team-work, cohesion and social life; and another OC-negative scale (alpha=.78) composed of team conflict, perceived team failure, excess autonomy, authoritarian management, and GP-nurse tension. CONCLUSIONS: We found a questionnaire with good validity and reliability, which was useful for evaluating the OC perceived by GPs.

Las dimensiones del clima organizacional percibidas por los médicos de familia / The dimensions of the organisational climate as seen by general practitioners

Objetivo. Crear y validar un instrumento para medir el clima organizacional percibido por los médicos que trabajan en atención primaria. Diseño. Estudio descriptivo, transversal y multicéntrico. Emplazamiento. Equipos básicos de atención primaria (EBAP) de las provincias de Málaga y Jaén. Participantes. Muestra aleatoria de 38 EBAP y 387 médicos de familia (MF). Mediciones principales. Cuestionario autoadministrado en marzo de 2001 con variables personales: sexo, edad, año de licenciatura, especialidad, tipo de adscripción-contrato, tiempo trabajado en equipos de atención primaria y tiempo en la plaza actual, población asignada, frecuentación, tutor de residentes y grado de doctor; variables del centro: distribución urbano/rural, composición del equipo, acreditación docente para el sistema MIR, cartera de servicios y dispensación de cuidados, y escala de clima organizacional (CO) con 40 preguntas de tipo Likert. Analizamos la validez de contenido de la escala de CO mediante un análisis factorial, la fiabilidad de los factores con el alfa de Cronbach y los coeficientes de correlación ítem-escala corregidos. Resultados. Tasa de respuesta del 89,8%; el 71% de los médicos era varones, con 44 años de media; un 76%, propietario; un 37%, especialista MIR en medicina familiar; un 28%, tutor acreditado; un 17%, médico residente y un 9%, doctor. De los EBAP, 50% eran urbanos, con 13 MF y 4 pediatras de media. Obtuvimos 12 factores que explican el 60% de la varianza, y quedan 7 con coeficientes de fiabilidad > 0,50. Construimos una escala de CO positivo (alfa = 0,82) con las dimensiones trabajo en equipo, cohesión y vida social, y otra de CO negativo (alfa = 0,78) integrada por conflicto en el equipo, percepción de fracaso, exceso de autonomía, dirección autoritaria y tensión médico-enfermera. Conclusiones. Cuestionario con validez de contenido y buena fiabilidad, útil para evaluar el CO percibido por los MF en atención primaria

Objective. To create and validate a tool to assess the organizational climate (OC) perceived by general practitioners (GP). Design. Descriptive, cross-sectional, and multi-site, study. Setting. Health centres (HC) in Jaén and Málaga province Spain. Participants. Random sample of 38 HCs and 387 GPs. Main measurements. A self-administered questionnaire in March 2001, with the personal variables of sex, age, graduation date, speciality, kind of contract, time worked in primary care teams, time in current job, list size, case load, tutor of residents and academic qualification. HC variables: urban/rural, team structure, accreditation for teaching residents, service portfolio, out-patient care, and an OC scale of 40 Likert-like questions. We analysed the content validity of the scale by factorial analysis; and its reliability, by Cronbach's alpha and corrected scale-item correlation coefficients. Results. Reply rate was 89.8%, 71% of the GPs were male, mean age was 44, 76% had tenure, and 37% were specialists in family medicine and 28% tutors, 17% with 3rd-year residents, 9% with doctors; 50% of HCs were rural and the mean team structure had 13 GPs and 4 paediatricians. We obtained 12 factors that explained 60% of variance, and 7 factors with reliability coefficients >0.50. We made an OC-positive scale (*=.82) with the dimensions for team-work, cohesion and social life; and another OC-negative scale (*=.78) composed of team conflict, perceived team failure, excess autonomy, authoritarian management, and GP-nurse tension. Conclusions. We found a questionnaire with good validity and reliability, which was useful for evaluating the OC perceived by GPs

Las dimensiones del clima organizacional percibidas por los médicos de familia

Objetivo. Crear y validar un instrumento para medir el clima organizacional percibido por los médicos que trabajan en atención primaria. Diseño. Estudio descriptivo, transversal y multicéntrico. Emplazamiento. Equipos básicos de atención primaria (EBAP) de las provincias de Málaga y Jaén. Participantes. Muestra aleatoria de 38 EBAP y 387 médicos de familia (MF). Mediciones principales. Cuestionario auto administrado em marzo de 2001 con variables personales: sexo, edad, año de licenciatura, especialidad, tipo de adscripción-contrato, tiempo de trabajo en equipos de atención primaria y tiempo en la paza actual, población asignada, frecuentación, tutor de residentes y grado de doctor; variables del centro: distribución urbano/rural, composición del equipo, acreditación docente para el sistema MIR, cartera de servicios y dispensación de cuidados, y escala de clima organizacional (CO) con 40 preguntas de tipo Likert. Analizamos la validez de contenido de la escalade CO mediante un análisis factorial, la fiabilidad de los factores con el alfa de Cronsbach y los coeficientes de correlación ítem-escala corregidos. Resultados. Tasa de respuesta del 89,8 por ciento; el 71 por ciento de los médicos eran varones, con 44 años de media; un 76 por ciento, propietario; un 37 por ciento especialista MIR en medicina familiar; un 28 por ciento tutor acreditado; un 17 por ciento médico residente y un 90 por ciento, doctor. De los EBAP, 50 por ciento eran urbanos, con 13 MF y 4 pediatras de media. Obtuvimos 12 factores que explican el 60 por ciento de la varianza, y quedan 7 con coeficientes de fiabilidad > 0,50. Construimos una escala de CO positivo (alfa=0,82) con las dimensiones trabajo en equipo, cohesión y vida social, y otra de CO negativo (alfa=0,78) integrada por conflicto en equipo, percepción de fracaso, exceso de autonomía, dirección autoritaria y tensión médico-enfermera. Conclusiones. Cuestionario con validez de contenido y buena fiabilidad, útil para evaluar el CO percibido por los MF en atención primaria.(AU)