Assessment of work environment factors influencing job satisfaction among mortuary staff in Nairobi City County, Kenya

INTRODUCTION

The topic of job satisfaction has been widely assessed by scholars among various categories of healthcare workers and presented on published accounts. In many instances, job satisfaction has been seen to influence organizational variables such as productivity, quantity and quality of work.¹ While many scholars have worked on investigating and ascertain job satisfaction levels across various cadres of healthcare workers in the world, one notable category that has been largely overlooked are the mortuary staff.² The mortuary staff and the funeral industry at large is highly ignored by researchers in part because of the stigma surrounded in the topic of death.³ Additionally, very few people are willing to undertake profession in the funeral industry, hence those who are willing are overworked and their job satisfaction level is affected negatively.⁴

Despite the progress made by African countries regarding studies on job satisfaction models, they are mostly based on theoretical grounds heavily borrowed from High Income Countries (HIC) including the US, UK and Asia.⁵ Additionally, majority of the existing literature on mortuary staff narrowly focus on their occupational safety aspect, and few on their job satisfaction levels.⁶ In many LMIC settings, mortuary staff are largely neglected and work in deplorable conditions that may result to low morale while performing their duties.⁷ Similarly, when it comes to priority setting in healthcare institutions, majority of the resources, which are still limited, are allocated for curative services, leaving out departments such as the mortuary. This was ascertained in a study carried out viewing the conditions in the public mortuary facilities in Uganda.⁸

Within the Kenyan setting, mortuary staff have been one of the highly understaffed categories of health workers. According to the Funeral Service Association of Kenya (FSAK), the current number of qualified mortuary attendants stands at approximately 200 against the targeted 1000 countrywide.⁹ Additionally, mortuary staff, especially those in public facilities, operate in poor working environment with lack of proper equipment exposing them to health hazards and reducing their levels of job satisfaction.¹⁰ With the global healthcare landscape undergoing rapid transitions and countries striving to achieve Universal Healthcare Coverage (UHC), it is pertinent that they look for efficient and effective ways of delivering their health services and utilisation of their human resources.¹¹ One of the studies carried out across 29 African countries indicated that workforce inadequacy was the top tier health workforce drawback.¹² Therefore, the mere availability of mortuary attendants is not enough, it additionally calls for their occupational satisfaction and empowerment for them to deliver their services efficiently and effectively.¹³

METHODS

For this study, descriptive cross sectional study design was applied since it gives an image of a population at the time and makes it possible to draw conclusions.¹⁴ Additionally, a mixed method of qualitative and quantitative data collection techniques was used to complement and enhance the quality of data collected for analysis. The study was done in Nairobi City County which has the highest population in the Country of 4,397,073.¹⁵ The study’s time frame was between September 2021 to September 2022. The study population included 193 mortuary staff working in the selected public and private mortuaries in Nairobi City County for more than six months who were present during the time of the study and had given informed consent. These mortuaries were selected due to their high-level capacity of operation. The study excluded mortuary staff working in public, private and institutional mortuaries in Nairobi City County who had worked for less than six months or were unwilling to take part in the study. Stratified sampling was applied to ensure representativeness with each mortuary facility, and further staff gender, constituting a stratum. Using the lists obtained from each of the facility, a sample was randomly drawn from each stratum to ensure that they stood an equal chance of being picked. Additionally, ten Key Informant Interviews were carried out targeting one mortuary superintendent from each of the ten facilities in order to obtain additional information that was used to inform the study.

Quantitative data analysis was done using SPSS statistical software for analysis, version 2.0. Chi-square was used to calculate inferential statistics at a confidence interval of 95% and p value of 0.05. Results were presented using frequency tables and percentages. The analysis of qualitative data from Key Informant Interviews (KII) drew on the Framework Approach and the entire dataset was coded using NVIVO. The coded sections were later organised into thematic charts to facilitate identification of patterns in responses. All participants were approached for interview only after authorization from the institution authorities and informed consent was sought from the mortuary staff recruited for the study.

RESULTS

Socio-demographic characteristics of respondents

Regarding the gender of the respondents, the study found that majority were male 99 (65.1%), while the females were 53 (34.9%). These results corroborated with that of the key informants, majority of whom indicated that the profession is majorly dominated by men. “A lot of workers in this profession are men, even though the previous years have witnessed ladies warming up to the profession, majority of workers, especially at the morgues are men-Key Informant 5, Public Facility.”

The study further indicated that most of the respondents were aged between 30-39 55(36.2%), followed closely by those between the ages of 20-29 47 (30.9%). In terms of level of education, majority of the respondents had reached certificate level 50 (32.9%). Concerning the years of experience, most of the respondents had between 6-10, 56 (36.8%). The results depicted that majority of the workers at 91 (59.9%) were married (Table 1).

Influence of work environment on job satisfaction

Those who were interviewed felt that the work environment plays a key role in the job satisfaction level with some making a comparison between the public and private sectors. One respondent said; “There is a saying that you are the product of your immediate environment. The physical setting has a high impact on your productivity and ultimately job satisfaction. There is a stark difference in some of our public and private mortuaries or funeral homes, and you can even see this reflecting from the workers-Key informant 6, Public Facility.”

To further establish the influence of work environment on job satisfaction, respondents were asked a series of questions. When asked whether the management provides the right tools and resources, there was an almost mixed view from respondents with 49 (32.2%) disagreeing and 45 (29.6%) agreeing with the statement. Majority of the respondents at 53 (34.9%) also disagreed with the statement that the management is keen on providing and even replacing their work gear. The results showed that majority of the respondents 48 (31.6%) agreed that cleanliness level and ventilation of the buildings was well done. This was however followed by those who disagreed at 39 (25.7%). One of the respondents from a private facility who agreed with the statement illustrates; “For us you cannot even tell you are in a morgue. We thoroughly clean the facility at regular intervals and after every procedure. The preservation of bodies is also up to international standards-Key Informant 12, Private Facility”. 55 (36.2%) of the respondents agreed that the work environment is also free from hazardous materials that may cause injuries. However, in a sharp contrast, 69 (45.4%) respondents strongly disagreed with the appropriateness of the workload and the working hours at their facilities. Similarly, majority of the respondents felt that the level of staffing was not relevant to the workload, with 65 (42.8%) strongly disagreeing. Regarding the general solidarity among the employees, majority of the respondents at 51 (33.6%), strongly agreed that this was the case (Table 2).

Association between work environment factors and job satisfaction

From the bivariate analysis between work environment factors and job satisfaction among the mortuary staff, majority of the respondents from those who were satisfied disagreed that the institution provided the right tools and the right protective gear for them to carry out their duties efficiently and effectively, 21 (30.9%). While majority of the respondents 22 (32.4%) who were satisfied agreed that the buildings were clean and well ventilated, there was an almost equal tie between those who agreed and those who disagreed with the effort that their organizations put in place to eliminate workplace hazards, at 21 (30.9%) and 18 (26.5%) respectively.

The results showed that from the respondents who were satisfied, majority of them strongly disagreed with the appropriateness of their workload 26 (38.2%), as well as the level of staffing in relation to the workload 24 (35.3%). However, there was no correlation between these two factors and job satisfaction (p=0.265) and (p=0.264) respectively. However, there was a significant relationship between workplace solidarity and job satisfaction (p=0.024), majority of the respondents 20 (29.4%) from those who were satisfied strongly agreed that there was solidarity among the employees working within the mortuary department (Table 3). One of the key informants interviewed also shared the same thoughts, they illustrate; “This profession forces you to act as a family. We have various welfares and social groups just to encourage each other since we go through similar experiences. This largely helps us to cope with our situation and the work environment-Key Informant 13, Private Facility”.

DISCUSSION

This study sought to assess influence of work environment on job satisfaction among mortuary staff. From the analysis, the study revealed that most of the respondents were male. This can be attributed to the fact that there is still high level of segregation based on gender and the mortuary attendant profession is majorly male dominated. These results were consistent with two studies done in the United States of America (USA) that sought to analyze the gender stereotyping in the funeral industry; even though the Civic Right Act forbid employment discrimination based on age, gender and race, the funeral industry still did not meet these employment standards.^{16 17} Similarly, the situation in Kenya displays the stark difference of male versus female employees in the funeral industry through its healthcare workforce report.¹⁸ The study revealed that there was no significant relationship between gender and job satisfaction. However, different results were observed in a study that was analyzing occupation segregation based on gender where men were more satisfied.¹⁹ In terms of age, the study showed that most respondents were between 30-39 years. This can be attributed to the fact that the later years have witnessed more people warming up to the mortuary profession unlike in the past years where the profession was heavily discriminated. These results have also been depicted in the workforce report in Kenya.¹⁸ There was no statistically significant association between age and job satisfaction as per the study. However, literature denotes different findings with some indicating that there is no correlation between age and job satisfaction ²⁰, while others show that older professionals are more satisfied. ²¹ Satisfaction in older professionals was linked to factors such as increased benefits and renumeration packages as well as an established relationship with the management.

The study showed that majority of the respondents felt that the management did not provide the right tools and resources for their work. However, there was no significant relationship between provision of the right tools and resources and job satisfaction. These results were however different to that of a study done in Nigeria with the aim of ascertaining factors that highly influence the job satisfaction among physicians.²² The results showed that workers tend to be more satisfied with their workplace if they are given the right resources since it promotes efficiency and effectiveness in operation. Besides getting the right tools for operation, a key factor that would affect workers in occupations where there is high rate of infections is getting the right working gear. The results portrayed that the management lagged in provision and even replacement of their work gear. Despite this, there was no significant relationship between provision of the right working gear and overall job satisfaction. Although, a study done in Jordan showed that employees were more satisfied if they had the right working gear and as a result, they treated and interacted with the customers better.²³

Critical to job satisfaction is the provision of good working conditions including cleanliness and well-ventilated buildings. The results however showed no correlation between job satisfaction and working conditions. Arguments have been brought forth by studies such as one done in Indonesia which linked industrial unrest with poor working conditions.²³ However, giving a different point of view, some studies have shown that if working conditions are “too favourable”, some employees may take advantage of this and lower their productivity levels.²³ The results showed that majority of the respondents felt that their workload was inappropriate since they worked for long hours. The results were further supported by views from most of the respondents who felt that they were understaffed. Further to this, there was no correlation between workload, staffing levels and job satisfaction. Studies done in other countries have however revealed different results, owing to the fact that there is still stigma around mortuary staff especially in African setting.^24,9

Solidarity and social support among employees was seen to have a statistically significant relationship with their job satisfaction. The results additionally showed that majority of the respondents agreed that there was solidarity amongst them. Healthcare workers especially in high stress occupation such as mortuary attendants have been seen to benefit largely from support from their management and even more from their colleagues.²⁵ Additionally, such support has been argued to create a sense of togetherness and identity among these workers hence promoting their job satisfaction levels.²⁶ Critical to this would be management of healthcare organizations setting environments that provide room for social support.²⁶

Limitations

One of the limitations was that accessibility to the hospital premises and morgues was a challenge due to formalities that are required before carrying out a study as well as the emergence of the COVID-19 pandemic, resulting to delays in acquiring information. There was also lack of effective communication and interaction with most respondents due to the nature of their work this is because they were busy most of the time while others were on night duty hence little time for interacting one on one and filling the questionnaires. Due to time and resource constraints, the study was limited to mortuary staff working in public and private facilities in Nairobi City County hence there was no comparative study done with other counties and countries.

CONCLUSION

In conclusion, the study revealed that mortuary staff in Nairobi County are experiencing low levels of job satisfaction. This study emphasizes the necessity for facility administrators and policymakers to gain a deeper understanding of the factors affecting job satisfaction among mortuary staff. This understanding is crucial for shaping future policies and making informed decisions regarding effective intervention strategies.

ACKNOWLEDGEMENTS

Authors would like to express their sincere thanks to mortuary staff who participated in this study. Authors would also like to thank the contributions of the respective authorities from the public and private mortuaries in Nairobi City County.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

1. 1. Tharikh SM, Ying CY, Saad ZM. Managing Job Attitudes : The Roles of Job Satisfaction and Organizational Commitment on Organizational Citizenship. Procedia Econ Financ. 2016;35:604-11.
2. 2. Ba KW. A missing link ? The role of mortuary staff in hospital-based bereavement care services. Breave Care. 2013;3:127-30.
3. 3. Laan S Van Der, Moerman LC. An Investigation of Death Care and the Funeral Industry in Australia An Investigation of Death Care and the Funeral Industry in Australia. Available at: https://ro.uow.edu.au/. Accessed on 20 February 2023.
4. 4. Ganesh K. Foreseeing a Need for Counselling Practices for Mortuary Workers Foreseeing a Need for Counselling Practices for Mortuary Workers. IJIP. 2019.
5. 5. Blaauw D, Ditlopo P, Maseko F, Chirwa M, Mwisongo A, Bidwell P, Thomas S, Normand C. Comparing the job satisfaction and intention to leave of different categories of health workers in Tanzania, Malawi, and South Africa. Glob Health Action. 2013;6:192.
6. 6. Douglas KE, Peterside SS. Assessment of workplace hazards in mortuaries in Port. PHMJ. 2016;10(3):32-9.
7. 7. Papathanasiou IV, Kleisiaris CF, Tsaras K, Fradelos EC, Kourkouta L. General Satisfaction Among Healthcare Workers: Differences Between Employees in Medical and Mental Health Sector. Mater Sociomed. 2015;27(4):225-8.
8. 8. Kazungu J, Nanyingi M, Katongole SP, Ddm AR. The State of Mortuary and Mortuary Services in Public Health Facilities of South Western Uganda. Int J Public Health Res. 2015;3(2):23-8.
9. 9. Mwangi W. Skilled workers needed in morgues, but few takers-Daily Nation. Available at: https://mobile.nation.co.ke/business/Skilled-workers-needed-in-morgues/1950106-5354494-14s47rez/index.html. Accessed on 20 February 2023.
10. 10. Simiyu S. Assesment of Occupational Hazards facing Mortuary Attendants in Nairobi County. Pan Afr Med J. 2014;23:12-8.
11. 11. Cometto G, Boerma T, Campbell J, Dare L, Evans T. The Third Global Forum: Framing the health workforce agenda for universal health coverage. Lancet Glob Heal. 2013;1(6):e324-5.
12. 12. Hryshchenko AA. International coordination of national economies’ development as a condition for preventing global financial and economic crises. Actual Probl Econ. 2010;(9):3-10.
13. 13. Alnıaçık Ü, Alnıaçık E, Akçin K, Erat S. Relationships Between Career Motivation, Affective Commitment and Job Satisfaction. Proced Soc Behav Sci. 2012;58:355-62.
14. 14. Kothari E. Research Methodology and Techniques. 2nd ed. India: New Age International Publishers. 2009.
15. 15. Kenya National Bureau of Statistics. Available at: https://www.knbs.or.ke/?wpdmpro=2019-kenya-population-and-housing-census-volume-i-population-by-county-and-sub-county. Accessed on 20 February 2023.
16. 16. Diah M. The Overtaking of Undertaking: Feminization and the Changing Gender Type of Funeral Directing. Available at: https://core.ac.uk/download/pdf/20522639.pdf. Accessed on 20 February 2023.
17. 17. Penepent DR. Gender role differences between funeral professionals and nurses. Available at: http://faculty.waldenu.edu/User/Default.aspx?ReturnUrl=%2FFacultyHome%2Fdefault.aspx. Accessed on 20 February 2023.
18. 18. Kenya Health Workforce Report : The Status of Healthcare Professionals in Kenya. Available at: https://taskforce.org/wp-content/uploads/2019/09/KHWF_2017Report_Fullreport_042317-MR-comments.pdf. Accessed on 20 February 2023.
19. 19. Wright DB, Eaton AA, Skagerberg E. Occupational segregation and psychological gender differences: How empathizing and systemizing help explain the distribution of men and women into (some) occupations. J Res Pers. 2015;54:30-9.
20. 20. Concialdi C. The role of gender, age, occupational position and job performance on employees job satisfaction. Psychol Spec. 2014;12:32-8.
21. 21. Carrillo-García C, Solano-Ruíz M del C, Martínez-Roche ME, Gómez-García CI. Job satisfaction among health care workers:the role of gender and age. Rev Lat Am Enfermagem. 2013;21(6):1314-20.
22. 22. Bello S, Dt A, Mc A. Determinants of job satisfaction among physicians in public hospitals in Calabar, Nigeria. J Community Med Prim Heal Care. 2018;30(1):19-33.
23. 23. Abuhashesh M, Al-Dmour R, Masa’deh R’. Factors that affect Employees Job Satisfaction and Performance to Increase Customers’ Satisfactions. J Hum Resour Manag Res. 2019;2019:23.
24. 24. Leandra K. The Psychological Stressors and Coping Strategies of Corpse Handlers in Windhoek State Mortuaries. Master Diss. 2018;10:12-8.
25. 25. Flynn BW, McCarroll JE, Biggs QM. Stress and resilience in military mortuary workers: care of the dead from battlefield to home. Death Stud. 2015;39(5):92-8.
26. 26. Aklilu M, Warku W, Tadele W, Mulugeta Y, Usman H, Alemu A, et al. Assessment of Job Satisfaction Level and Its Associated Factors among Health Workers in Addis Ababa Health Centers: A Cross-Sectional Study. La Torre G, editor. Adv Public Heal. 2020;2020:108.