Paparisabet et al.

BMC Health Services Research

BMC Health Services Research (2024) 24:1373
https://doi.org/10.1186/s12913-024-11893-1

RESEARCH Open Access

Investigating the organizational

commitment and its associated factors
among the staff of the health sector:
a cross‑sectional research
Mahdis Paparisabet1, Amir Hossein Jalalpour2,3, Farzaneh Farahi4, Zeinab Gholami5, Fatemeh Shaygani2,3,
Neda Jalili3, Sama Rashid Beigi3, Milad Ahmadi Marzaleh6,8* and Hadis Dastgerdizad Elyaderani7

Abstract
Introduction Organizational commitment (OC) significantly impacts the quality of care provided by healthcare staff.
It reflects employees’ connection to and engagement with their organization, affecting job satisfaction, employee
turnover, and the overall success of the healthcare organization. This research seeks to assess OC levels and identify its
influencing factors among health sector staff in Shiraz, southwestern Iran.
Methods In this cross-sectional study, the staff of the health sector including physicians/family physician (FP), mid-
wives, healthcare workers, psychologists, dentists, and nutritionists were selected through a multi-stage sampling;
they filled out an online 36-item questionnaire (12 demographic items and 24-item Allen and Mayer OC question-
naire). The data were analyzed using SPSS software (version 25). Descriptive statistics of OC scores were provided. Also,
independent samples t-test and analysis of variance were used as statistical tests, and P-value < 0.05 was considered
the significant level.
Results Overall, 289 staff with a mean age of 32 ± 7.6 years participated in this study. The OC total mean score
was higher in the public sector compared with the private sector and higher in the non-FP team compared
with the FP team. The mean score of all types of OC among all job positions was low. Moreover, education level, work-
place, job experience in current job, engagement in other jobs for making money, and FP staff showed a significant
association with the total mean score of OC.
Conclusion According to the results, OC among health sector staff is low. Therefore, policymakers in the health
sector are strongly recommended to implement immediate measures to enhance this critical factor among their
workforce.
Keywords Organizational commitment, Healthcare professionals, Health sector, Family physician

*Correspondence:
Milad Ahmadi Marzaleh
miladahmadimarzaleh@yahoo.com
Full list of author information is available at the end of the article

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Paparisabet et al. BMC Health Services Research (2024) 24:1373 Page 2 of 11

Background guiding approaches to improving organizational effi-

Organizational Commitment (OC) in the health sec- ciency in both sectors.
tor refers to the degree of attachment, loyalty, and The final point addresses the urban family physician
identification that health professionals have with their program (UFPP) in Iran, which has been implemented
organization [1, 2]. It is a crucial factor affecting the only in the two large provinces of Fars and Mazandaran
performance and efficiency of healthcare institutions, since 2012. Notably, no research has been conducted to
as it influences the employees’ motivation, job satisfac- compare OC between FP and non-FP staff. This com-
tion, and overall commitment to the organization [3]. parison is highly advantageous, as the UFPP in Fars
There are three types of OC including affective, con- and Mazandaran serves as an important pilot project
tinuance, and normative commitment [4, 5]. Affective designed to improve healthcare services nationwide. Any
commitment pertains to the emotional attachment, adjustments to the workforce plans are essential for the
identification, and active involvement of an employee success of the upcoming national program.
within the organization [6]. Normative commitment Therefore, this study aimed to assess the level of OC
involves a sense of responsibility that employees feel and its associated factors among the health sector staff in
towards the organization [7]. On the other hand, con- Shiraz, Iran. The research questions are outlined below:
tinuance commitment is linked to the perception of
the costs associated with leaving the organization [8]. • What is the total mean score of OC and its compo-
Based on evidence, various factors such as the work- nents among different job positions of health sector
ing environment, recognition, supportive supervisors, in Shiraz?
workload, leadership styles, and individual and job- • Do public sector staff have a higher level of OC than
related characteristics were identified as the most influ- private sector staff?
ential factors contributing to employees’ commitment • Do staff of the FP team have a higher level of OC
to their organizations [9, 10]. than non-FP team staff?
A high level of employee OC has numerous benefits • What are the factors associated with OC among
for healthcare organizations, including achieving goals, health sector staff in Shiraz?
improved performance, motivation, attachment, effec-
tiveness, efficiency, job satisfaction, reduced turnover,
burnout, and absenteeism [11–13]. Conversely, low OC Methods
increases medical errors and jeopardizes patient safety Setting and participants
[14]. Committed employees have been found to pro- This cross-sectional study was carried out using cluster
vide quality care, exhibit better performance, and ensure sampling from January to June 2024 in Shiraz, Western
patient safety [13]. It is obvious that the health sector has Iran. The health sector staff including physicians/FP, mid-
a great impact on community health promotion and its wives, healthcare workers, psychologists, dentists, and
employees play a crucial role in this regard [15]. nutritionists were eligible to participate in this study.
It is clear that the significance of health sector is at least The target population was selected from both public and
equal to that of care, if not greater, as it promotes a proac- private sectors including comprehensive health cent-
tive lifestyle that can prevent diseases and enhance over- ers, health posts and public clinics, and private clinics
all well-being, but surprisingly, most OC studies in Iran’s and offices. There were no exclusion criteria, except for
healthcare sector primarily focus on hospital employees, unwillingness to participate in this study. According to a
particularly clinical nurses [16–18]. report by Shiraz University of Medical Sciences (SUMS),
Also, from the limited studies conducted in health sec- the total number of staff of health sector was 1158
tor, they examined the healthcare workers in general, but (Table 1).
2 pq
these often did not differentiate between various roles Using the Cochran formula (n= NdNz 2 +z 2 pq ), we calcu-
within the healthcare field and instead analyzed all health lated the sample size as 289 with a confidence level of
professionals collectively. We believe that comparing job 95% and an error of 4.96%; the sample size for each job
positions in this regard can help researchers identify role- displayed in the above table is shown in Table 2.
specific factors influencing OC, which can foster more A multi-stage stratified and cluster sampling was
effective management strategies and enhance employee employed to conduct this study. At first, Shiraz was
satisfaction throughout the sector [19, 20]. divided into five geographical regions (North, South,
Additionally, research comparing public and private Center, East, and West) and allocated an equal sample
sectors of Iran’s health system on OC is lacking. Such size for each region. Then, we defined five public and pri-
research can provide valuable insights into how sector vate centers/clinics in each region to invite their employ-
factor impact employee engagement and commitment, ees to participate in this study.
 Paparisabet et al. BMC Health Services Research

Table 1 The number of staff of the health sector in Shiraz, Iran

Type of Job Physician Midwives and healthcare Psychologists Dentists Nutritionists
(2024) 24:1373

health sector environment workers

Public sector Comprehen- FP and Non- 216 355 47 36 37

sive health FP
centers,
health posts
and public
clinics
Private sector Private clinics Only FP 278 189 - - -
and offices
Page 3 of 11
 Paparisabet et al. BMC Health Services Research

Table 2 The sample size for staff of the health sector in Shiraz, Iran
Type of Job Physician Midwives and healthcare Psychologists Dentists Nutritionists
(2024) 24:1373

health sector environment workers

Public sector Comprehen- FP and Non- 54 89 12 9 9

sive health FP
centers,
health posts
and public
clinics
Private sector Private clinics Only FP 69 47 - - -
and offices
Page 4 of 11
Paparisabet et al. BMC Health Services Research (2024) 24:1373 Page 5 of 11

Initially, the researchers were provided with a contact highly taken into account. Moreover, voluntary partici-
list by SUMS to call the health sector staff and explain the pation was highly considered by asking participants to
objectives of the study to them. Those who agreed to par- willingly participate in this study and written informed
ticipate were included in the study, while those who were consent was obtained from each. Also, they were
unwilling were excluded. Next, the researchers provided assured that they could withdraw from the study at any
an anonymous questionnaire to each participant after stage without providing any justification.
obtaining their written consent and asked them to fill it
out carefully.
Results
Data collection A total of 289 staff members participated in this study.
The data collection tool in this study was a 36-item ques- Their mean age was 32 (SD = 7.6) years, and 185 sub-
tionnaire including demographic characteristics (12 jects (64%) were married. Over half of them were con-
questions) and the Allen and Meyer OC questionnaire tractual employees and worked in the public sector.
(24 items) [21]. In this study, the translated valid and reli- Almost all of them complained that their income did
able version of the Allen and Meyer OC questionnaire not match their expenses which caused over half of
was used (Cronbach’s alpha was reported from 0.77 to them to get a second job to meet their needs (Table 3).
0.91) [22–24]. Additionally, the reliability of the trans- According to Table 2, the OC total mean score in the
lated questionnaire was assessed in the present study, public sector was about 1.1 times higher than in the
with a reported Cronbach’s alpha of 81.3%. private sector. Considering the position of participants
Allen and Meyer OC questionnaire has 24 items in in the public sector, midwives/healthcare workers had
three dimensions: Affective Commitment (AC) (8 items), the highest OC total mean score, followed by physi-
Continuance Commitment (CC) (8 items), and Norma- cians, nutritionists, psychologists, and dentists; how-
tive Commitment (NC) (8 items). The OC questionnaire ever, physicians in the private sector showed a higher
was scored using a five-point Likert scale (1: Strongly OC score compared with midwives/healthcare workers.
disagree; 2: Disagree; 3: Neither agree nor disagree; 4: Also, among the three types of OC, the mean score of
Agree; 5: Strongly agree). The minimum and maximum CC was higher than the other types. Notably, the mean
scores in each dimension of commitment are 8 and 40, score of all types of OC among all positions studied in
respectively. Moreover, the interpretation of the overall this research was lower than 40, indicating poor OC
score for each dimension is as follows: a score of 8 to 18 (Table 4).
indicates low OC, a score of 19 to 29 moderate OC, and a As Table 5 shows, the mean total OC score in the
score of 30 to 40 indicates high OC. FP team was 2.9 times lower than in the non-FP team.
Moreover, in both FP and non-FP teams, physicians
Data analysis had a higher OC score in comparison with midwives/
In this study, the data were analyzed using IBM SPSS Sta- healthcare workers.
tistics software (version 25). Descriptive statistics regard- According to Table 6, age, gender, current living
ing OC and its three types were provided. The normality area, compatibility of the current job with the field of
analysis of the data performed (Sig. value of the Shap- study, employment status, workplace, expenses equal
iro-Wilk Test was greater than 0.05) and then univari- monthly incomes from this job, involvement in other
able analysis was done using independent samples t-test jobs for making money, and employment as the FP staff
and analysis of variance [25]. The tests were two-sided, showed a significant association with the score of AC (p
and P-value less than 0.05 was considered statistically value < 0.05).
significant. Moreover, marital status, education level, involvement
in other jobs for making money, and employment as the
Ethics statement FP staff had a significant association with the score of CC
The proposal of this study was approved by the Eth- (p value < 0.05). Furthermore, age, workplace, job expe-
ics Committee of Shiraz University of Medical Sci- rience in the current job, involvement in other jobs for
ences (SUMS), Shiraz, Iran, with the code of IR.SUMS. making money, and employment as the FP staff were sig-
NUMIMG.REC.1402.080. Also, the Declaration of Hel- nificantly associated with the score of NC (p value < 0.05).
sinki [26], the ethical principles for medical research Finally, education level, workplace, job experience in
involving human subjects, was considered in this study. the current job, involvement in other jobs for making
Additionally, the anonymous nature of the question- money, and employment as the FP staff showed a sig-
naire, possibility of access to the researchers of the nificant association with the total mean score of OC (p
study, and privacy and confidentiality of the data were value < 0.05).
Paparisabet et al. BMC Health Services Research (2024) 24:1373 Page 6 of 11

Table 3 Demographic characteristics of the participants (n = 289)

Variable N (%) Variable N (%)

Age (year) Compatibility of the current job with the field of study
< 25 72 (25) Yes 273 (94.5)
25–40 168 (58.2) No 16 (5.5)
> 40 49 (16.8) Employment status
Mean age 32 ± 7.6 Permanent employment 114 (39.5)
Gender Contractual employment 163 (56.4)
Female 236 (81.7) Manpower planning 12 (4.1)
Male 53 (18.3) Workplace
Marital status Employed in public sector 173 (59.9)
Single 104 (36) Employed in private sector 116 (40.1)
Married 185 (64) Mean years of work experience 11 ± 5.5
Mean number of children 1.1 ± 1.08 Job experience in current job (n)
Ethnicity n<2 39 (13.5)
Fars 133 (46) 2≤n<5 45 (15.6)
Turk 97 (33.6) 5 ≤ n < 10 73 (25.2)
Lor 54 (18.7) 10 ≤ n < 15 65 (22.5)
Kurd 0 (0) 15 ≤ n < 20 38 (13.2)
Other 5 (1.7) 20 ≤ 29 (10)
Education Level Expenses equals monthly incomes from this job
Associate degree 13 (4.5) Yes 27 (9.4)
BSc 118 (40.8) No 262 (90.6)
MSc 26 (9) Having other jobs for making money
PhD/Professional doctorate 132 (45.7) Yes 103 (35.6)
Current living area No 186 (64.4)
In Shiraz city 228 (78.9) Being FP staff (among physicians, midwives and healthcare workers (259))
Around Shiraz city 61 (21.1) Yes 164 (63.3)
No 95 (36.7)

Table 4 The OC scores among health staff (public/private) workplace, job experience in current job, involvement
Position Sector AC CC NC Total OC
in other jobs for making money, and employment as the
FP staff showed a significant association with the total
Physician Public 19.1 ± 1.4 25.2 ± 4.2 20.4 ± 3.6 64.7 ± 7.2 mean score of OC.
Private 14.9 ± 2.3 22.8 ± 5.1 16.6 ± 2.5 54.3 ± 9.7 As previously stated, there are three types of OC:
Midwife / Public 21.3 ± 1.2 27.1 ± 1.6 23.6 ± 3.8 72 ± 5.8 affective, continuance, and normative commitment [4,
Healthcare Private 12.6 ± 2.7 22.4 ± 3.1 13.7 ± 2.1 48.7 ± 7.2 5]. A high level of employee OC had numerous benefits
worker
for healthcare organizations, including achieving goals,
Dentist Public 17.1 ± 1.8 16.2 ± 3.8 17.4 ± 3.6 50.7 ± 8.1
improved performance, motivation, attachment, effec-
Psychologist Public 14.3 ± 3.5 26.4 ± 1.2 13.5 ± 2.8 54.2 ± 6.9
tiveness, efficiency, job satisfaction, reduced turnover,
Nutritionist Public 15.4 ± 1.6 23.9 ± 3.2 15.7 ± 2.1 55 ± 5.7
burnout, and absenteeism [11–13]. Conversely, low OC
All staff Public 17.7 ± 3.5 23.8 ± 5.5 18.9 ± 3.1 60.4 ± 6.3
increased medical errors and jeopardizes patient safety
Private 13.8 ± 2.8 22.6 ± 2.4 15.5 ± 2.7 51.9 ± 4.1
[14].
As mentioned earlier, the OC score was found to be
poor in the employees of the health sector. Similarly,
Discussion two studies in Ethiopia revealed low OC among health-
According to the findings of this study, the OC total care professionals [1, 27]. The below evidence indicated
mean score was higher in the public sector than in the that the level of OC among healthcare professionals
private sector and higher in the non-FP team than in was in the moderate range in the past few years and
the FP team. The mean score of all types of OC among this decline may be attributed to the unstable economic
all job positions was low. Moreover, education level,
Paparisabet et al. BMC Health Services Research (2024) 24:1373 Page 7 of 11

Table 5 The OC scores among FP team and non-FP team

Position FP staff or non-FP staff AC CC NC Total OC

Physician FP 13.1 ± 3.4 24.5 ± 6.1 16.6 ± 4.7 54.2 ± 13.1

non-FP 21.1 ± 4.7 29.2 ± 5.2 27.4 ± 3.9 77.7 ± 13.6
Midwife / Healthcare FP staff 12.9 ± 3.1 25.4 ± 6.5 11.9 ± 4.1 50.2 ± 13.2
worker non-FP staff 21.3 ± 1.2 27.1 ± 1.6 23.6 ± 3.2 72 ± 5.6
All FP team 13 ± 3.2 24.9 ± 6.1 14.2 ± 4.3 52.1 ± 12.1
non-FP team 21.2 ± 2.5 28.1 ± 3.3 25.5 ± 3.4 74.8 ± 7.7

conditions in Iran in recent years, which have been Our findings showed that the OC was higher in the
exacerbated by sanctions. non-FP team than in the FP team. Likewise, a study
Contrary to our results, three Iranian studies showed found that FPs demonstrated lower OC than other phy-
that most of healthcare workers in Gorgan, Marand, and sicians [36]. Also, qualitative study in Fars province,
Sarpol-e Zahab city had a medium level of OC [20, 28, Iran indicated that the Family FP team exhibited low
29]. responsiveness, which may be rooted in their low level
Another study in the west of Iran showed that employ- of OC [37]. This could be attributed to their low income
ees in administrative units of health care centers had a despite having numerous responsibilities. In contrast,
moderate OC [30]. Also a systematic review on Iranian another study noted that FPs exhibited higher OC than
nurses demonstrated that their OC was moderate in the other physician groups [38].
half of studies. It seems that healthcare workers have According to our result, employees aged under 25
worse OC compared to employees in administrative roles and over 40 years were found to have a higher OC.
at healthcare centers and clinical nurses in hospitals. This The reason can be that people under 25 have recently
difference could be further investigated in future com- graduated and have a strong desire for a job. Also, peo-
parative studies. ple over 40 years of age are well-oriented to do their
Also, in contrast to the findings of our research, an Ira- tasks and have a low tendency to leave. Similarly, sev-
nian study, showed that the components of OC among eral studies have shown that older employees tend to
healthcare workers in Marand city were: AC > NC > CC exhibit higher levels of affective commitment as they
[28]. get older; their emotional attachment to the organiza-
The combination of job satisfaction, work environ- tion increases and they are more likely to feel a sense
ment, leadership quality, work-life balance, emotional of belonging and loyalty to their workplace [39]. Con-
well-being, and demographic factors all play a signifi- versely, a study conducted in Marand, Iran indicated
cant role in shaping the OC of healthcare professionals in that there was no significant association between the
the health sector [27, 31–33]. By implementing focused age range of healthcare workers and their OC [28].
interventions in these areas, organizations can boost A systematic review also revealed that personal fac-
commitment levels, ultimately leading to improved effec- tors, such as age, play a significant role in Iranian
tiveness in healthcare services. nurses’ OC levels, with younger nurses frequently
According to our findings, the OC was higher in the reporting lower OC than their older counterparts [18].
public sectors than in the private sectors. Similarly, a Due to our findings, female employees have a higher
study explored OC as a feeling of dedication towards the OC. Similarly, a study revealed that male physicians
employing organization, highlighting significant differ- were more likely to leave their jobs than female phy-
ences in commitment levels between public and private sicians because the latter may feel the need to remain
sector employees [34]. Also, another research suggests in the organization due to concerns about future job
that employees in the public sector experience bet- opportunities and the potential loss of social sta-
ter working conditions that may lead to higher levels of tus [33]. Conversely, a study in Poland demonstrated
commitment, mainly due to factors such as job satisfac- that, when controlling for other factors, women and
tion and internal communication [35]. We believe that men exhibit similar levels of organizational commit-
higher OC of public sector employees may be due to ment. Although women showed a statistically signifi-
the fact that most people who work in the public sector cant higher commitment than men, the effect size was
have a permanent contract and consequently higher job described as trivial in practical terms [40]. Also, a study
security, which affects their level of commitment to the in Marand, Iran showed that male healthcare workers
organization.
Paparisabet et al. BMC Health Services Research (2024) 24:1373 Page 8 of 11

Table 6 Univariable analysis of demographic determinants of OC scores

Demographic variables AC CC NC Total OC

Mean ± SD P-Value Mean ± SD P-Value Mean ± SD P-Value Mean ± SD P-Value

Age (year) < 0.001 0.089 < 0.001 0.052

< 25 21.2 ± 3.1 23.4 ± 3.6 16.8 ± 3.3 61.4 ± 10
25–40 15.9 ± 4.7 25.7 ± 6.4 19.1 ± 4.2 60.7 ± 15.3
> 40 20.6 ± 7.2 28.2 ± 5.1 22.2 ± 1.9 71 ± 14.2
Gender < 0.001 0.077 0.068 0.059
Female 22.8 ± 4.9 24.7 ± 6.2 22.7 ± 5.2 70.2 ± 16.3
Male 13.9 ± 3.1 26.2 ± 3.5 20.1 ± 4.5 60.2 ± 11.1
Marital status 0.093 < 0.001 0.070 0.063
Single 19.9 ± 2.5 21.2 ± 5.6 19.6 ± 2.5 60.7 ± 10.6
Married 16.3 ± 4.3 29.6 ± 3.3 17.4 ± 1.9 63.3 ± 9.5
Ethnicity 0.071 0.054 0.060 0.057
Fars 21.1 ± 2.8 24.1 ± 4.3 20.3 ± 4.5 65.5 ± 11.6
Turk 19.5 ± 2.1 22.4 ± 3.2 22.3 ± 3.5 64.2 ± 8.8
Lor 20.9 ± 3.9 22.9 ± 3.7 21.7 ± 2.4 65.5 ± 10
Other 18.7 ± 5.2 24.0 ± 2.1 23.3 ± 1.1 66 ± 8.4
Education Level 0.064 < 0.001 0.077 < 0.001
Associate degree 18.2 ± 3.7 25.8 ± 3.1 19.7 ± 3.6 63.7 ± 10.4
BSc 15.1 ± 5.8 24.2 ± 2.5 17.1 ± 3.1 56.4 ± 11.4
MSc 15.8 ± 3.3 25.2 ± 3.2 15.6 ± 2 56.6 ± 8.5
PhD/Professional doctorate 14 ± 4.1 16.8 ± 4.2 17.9 ± 3.2 48.7 ± 11.5
Current living area < 0.001 0.096 0.089 0.072
In Shiraz city 19.8 ± 4.9 25.1 ± 6.5 17.5 ± 2.1 62.4 ± 13.5
Around Shiraz city 13.3 ± 5.1 27.2 ± 3.3 15.8 ± 4.5 56.3 ± 12.9
Compatibility of the current job with the field of study < 0.001 0.067 0.081 0.055
Yes 16.5 ± 3.2 24.6 ± 4.5 18.1 ± 1.3 59.2 ± 9
No 21.1 ± 3.5 27.2 ± 3.3 16.9 ± 1.5 65.2 ± 8.3
Employment status < 0.001 0.081 0.065 0.070
Permanent employment 16.2 ± 4.1 22.8 ± 3.4 19.9 ± 5.2 58.9 ± 12.7
Contractual employment 13.5 ± 2.9 23.5 ± 4.1 15.8 ± 1.7 52.8 ± 8.5
Manpower planning 20.2 ± 1.5 25.0 ± 2.6 15.2 ± 2.3 60.4 ± 6.4
Workplace < 0.001 0.074 < 0.001 < 0.001
Employed in public sector 17.7 ± 3.5 23.8 ± 5.5 18.9 ± 3.1 52.1 ± 12.1
Employed in private sector 13.8 ± 2.8 22.6 ± 2.4 15.5 ± 2.7 74.8 ± 7.7
Job experience in current job 0.085 0.062 < 0.001 < 0.001
n<2 17.8 ± 3.3 22.3 ± 4.6 15.2 ± 2.1 55.3 ± 9.8
2≤n<5 13.8 ± 4.1 22.9 ± 4.3 17.6 ± 2.5 54.3 ± 10.5
5 ≤ n < 10 15.2 ± 3.5 23.5 ± 2.8 19.1 ± 3.2 57.8 ± 9.5
10 ≤ n < 15 19.5 ± 4.1 25.8 ± 3.2 21.9 ± 4.2 67.2 ± 11.3
15 ≤ n < 20 19.7 ± 3.8 24.8 ± 6.1 22.4 ± 3.6 66.9 ± 13.3
20 ≤ 17.5 ± 4.3 23.2 ± 4.5 22.9 ± 3.2 63.6 ± 12
Expenses equals monthly incomes from this job < 0.001 0.055 < 0.001 < 0.001
Yes 21.9 ± 3.5 21.8 ± 2.6 20.1 ± 2.9 63.8 ± 8.5
No 12.6 ± 2.8 23.3 ± 3.9 15.3 ± 3.2 51.2 ± 9.7
Having other jobs for making money < 0.001 < 0.001 < 0.001 < 0.001
Yes 16.1 ± 4.5 24.8 ± 2.3 14.1 ± 3.6 55 ± 9.8
No 22.6 ± 1.8 21.7 ± 4.7 19.8 ± 4.2 64.1 ± 10.5
Being FP staff < 0.001 < 0.001 < 0.001 < 0.001
Yes 13 ± 3.2 24.9 ± 6.1 14.2 ± 4.3 52.1 ± 12.1
No 21.2 ± 2.5 28.1 ± 3.3 25.5 ± 3.4 74.8 ± 7.7

Bold values are statically significant

Paparisabet et al. BMC Health Services Research (2024) 24:1373 Page 9 of 11

have the higher level of OC compared with female col- of their employment contracts and the greater job secu-
leagues, which contrasts with the findings of the cur- rity typically found in the public sector. Conversely, a sys-
rent study [28]. tematic review showed that nurses in Iran’s private sector
Our findings show that married employees exhibited express greater job satisfaction attributed to improved
greater OC than their unmarried counterparts. Similarly, pay and working conditions. Nonetheless, this sense of
a study in Shiraz, Iran found that married nurses had a fulfillment may be diminished by concerns over job secu-
higher average score for normative commitment com- rity [44, 47]. This finding may be rooted in the different
pared to those who were single [41]. This is attributed nature of working condition and career promotion and
to the increased family responsibilities and the need for security in these two sectors.
job stability often accompanying. Similarly, a study found In our study, having job experience in the current job
that married employees report higher commitment levels showed a significant association with the total mean
due to their financial burdens and family obligations [42]. score of OC. Similarly, studies by Meyer et al. and Tahere
Conversely, a study in Marand, Iran reported that there et al. revealed a strong link between higher work experi-
was no significant association between health workers’ ence and better OC [48, 49]. Also, a study by Asl IM et al.
marital status and their OC [28]. demonstrated that the relationship between the OC and
According to our study, education level was an impor- job experience was significant [28].
tant factor in the OC, and highly educated employees A systematic review similarly found that work experi-
may have lower OC. Similarly, Bakan et al. asserted that ence has a considerable impact on nurses’ OC as those
the level of education is statistically related to all types of nurses with longer job tenures generally demonstrate
OC [43]. Also, a study by Asl IM et al. showed that the greater levels of commitment to their organizations [18].
relationship between the OC and education level was sig- Conversely, a study in Marand, Iran showed that there
nificant [28]. Moreover, several studies in Iran reported was no significant association between health workers’ OC
that the level of education of healthcare workers and and their job experience [28]. Also, a study by Yağar et al.
nurses is significantly associated with their OC [28, 41]. revealed that as the professional experience of employees
It can be attributed to their perceptions of inadequate increased, their levels of affective commitment decreased
rewards, unmet expectations, poor job fit, and the avail- [38]. The reason for this different result may be explained
ability of alternative employment options. These factors by the fact that although employees get used to their job
create a landscape where commitment is diminished as over time, as their work experience and professional skills
these employees may feel less tethered to their current increase, they see themselves as deserving of a better and
organizations than their less-educated counterparts. higher-level job, and this causes their affective commit-
Our study showed that employees who lived in the city ment to the recent organization to become decreased [49].
had higher OC than those living around the city of their Moreover, another study revealed an opposite result, indi-
workplace. Likewise, a study conducted in Birjand, Iran, cating that individuals who have been working for many
found that residing in the same city as one’s workplace years may reduce their level of OC due to burnout and
had a positive effect on life satisfaction, which subse- being occupied with various responsibilities [27].
quently improved OC [44]. In this study, not being satisfied with the salary of the
A systematic review also highlighted that nurses resid- current job and having to get other jobs to make money
ing nearer to their workplaces generally exhibited greater were found to be important factors impacting the OC
OC, probably because of lower commuting stress and of employees. Likewise, a meta-analysis conducted by
an improved work-life balance [18]. Moreover, evidence Esfahani and Heydari indicated that job satisfaction sig-
revealed that poor living conditions could contribute to nificantly contributes to enhancing employees’ OC in Ira-
role stress and ambiguity, negatively impacting job satis- nian hospitals [50]. Furthermore, a study by Gabrani et al.
faction and organizational commitment [45]. revealed that being satisfied with salary plays a major role
According to the findings of this study, the workplace in determining their level of commitment to their organi-
had a significant association with the OC. Likewise, a zation [51]. Therefore, the managers of organizations are
study by Asl IM et al. indicated that the relationship recommended to pay more attention to their employees’
between the OC and place of employment was significant financial issues which have an important effect on their
[28]. In our study, OC was higher in the public sector quality of life and commitment to the organization [28].
than in the private sector. Similar to our study, Marko-
vits et al. asserted that public sector employees gener- Limitations and recommendations
ally form stronger affective and normative commitment Due to the restricted budget and time, we have to con-
toward their organizations than their private sector duct a cross-sectional study which cannot reflect accu-
counterparts [46]. This could be attributed to the nature rate changes over time and make it difficult to establish
Paparisabet et al. BMC Health Services Research (2024) 24:1373 Page 10 of 11

causal relationships between variables. So, longitudinal Author details

1
Zhengzhou university, Zhengzhou, China. 2 Health Policy Research Center,
studies could help address some of these issues by allow- Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran. 3 Student
ing for a clearer understanding of causality and change Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
over time. Also, in order to reduce the response bias and 4
School of Medical Sciences, Firoozabad Branch, Islamic Azad University,
Firoozabad, Iran. 5 Student Research Committee, Department of Clinical
limited contextual understanding, research with qualita- Nutrition, School of Nutrition and Food Science, Isfahan University of Medical
tive design is highly recommended. Sciences, Isfahan, Iran. 6 Department of Health in Disasters and Emergencies,
Health Human Resources Research Center, School of Health Management
and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
Conclusion 7
Department of Sociology, University of Miami, 5202 University Drive, 120‑G
This study showed that the overall level of OC among Merrick Building, Coral Gables, FL, Florida 3314 Miami, USA. 8 School of Health
Management and Information Sciences, Shiraz University of Medical Sciences,
staff members of the health sector was low. In addition,
Shiraz, Iran.
the main drivers of overall OC were financial factors,
indicating an immediate need for health policymak- Received: 21 August 2024 Accepted: 6 November 2024
ers to review and revise financial policies related to the
staff of the health sector. Improvement of these financial
aspects, along with other associated factors, is critical for
enhancing the quality of healthcare services and patient References
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