Factors influencing health profession students’ willingness to practice in rural regions of Bosnia and Herzegovina: a cross-sectional study

Early Abstract:

Introduction: The literature indicates different factors influencing recruitment of health professional students to work in rural areas. The purpose of this study is to explore the willingness of health profession students in Faculty of Medicine Foca, University of East Sarajevo, Bosnia and Herzegovina towork in a rural area following graduation andthe factors influencing incentives to pursue a rural career.

Methods: The cross-sectional study included first-year through sixth-year students 18 years of age or older enrolled in one of three study programs at Faculty of Medicine; medicine, dentistry, and nursing. The questionnaire was distributed at the beginning of the winter semester during the first required lecture for each year and study program class. Data was analyzed using Student t-test, Analysis of variance when appropriate, Kruskal-Wallis test andmultivariate logistic regression analysis.                                                                               

Results: A total of 519 students participated, an 88.3% response rate. Three hundred and ninety-nine (77%) participants responded positively to the question ““When you complete your studies, would you be inclined to accept job in rural region?” Factors associated with willingness to practice in rural areas included being female (p=0.027) and having rural upbringing (p=0.037). Significant difference between medicine, nursing and dentistry students were found in expressing the opinion that willingness to work in rural practice depends greatly on the possibility to get residency more easily (p=0.001). Compared to their peers, nursing students scored higher opportunities to attend national courses cost-free(p=0.027) and to beinvolved in the education of new generations of health profession students (p=0.001). Getting the post in the urban area after a work period in a rural area was most valued as incentives by dentistry students (p=0.037).The multivariate logistic regression model was used to analyze predictors of willingness to practice in rural areas. Students who have been raised in the rural community (p=0.042)as well as female students (p=0.016) were more likely to acceptrural practice. Statistical significance at an α (alpha) level of 0.05 was not reached for study program and year of study.

Conclusions: The results of the study showed a high willingness of medicine, dentistry and nursing students to work in rural areas following graduation. Female students and students who were raised in a rural community were more likely to choose a rural career. Stakeholders should be committed to strengthening the rural deployment of health professionals by creating a more attractive, rural environment.