The applicability of the Theory of Planned Behaviour to choosing a career as a rural physician in South Africa

Abstract

The public health system of South Africa faces a number of serious human resources challenges. The shortages, inequity and maldistribution of physicians across various geographical areas and health employment sectors are aggravated by the migration of skills within and from South Africa to urban areas, the private medical sector and to other countries which are perceived to be offering better career prospects and quality of living. Rural health facilities in South Africa experience particular challenges to attract and retain health professionals, as very few physicians choose careers in rural medicine. This scenario gave rise to the problem statement of the study which set out to explore the complex process of career intentions and decision making by medical graduates with a specific focus on choosing a career as rural physician. Many studies have investigated the factors that influence the attraction and retention of physicians in rural areas, both internationally and in South Africa, however, a comprehensive literature review revealed that none of these research studies employed a theoretical model to interrogate career decision making. In this study, the Theory of Planned Behaviour (TPB) was applied to investigate and compare the intentions of two research groups to choose a career as a rural physician in the South African public service. The study involved an interpretive qualitative research method which is uncommon in typical research applied to test the TPB. Data was collected from undergraduate medical students (n=22) and qualified general practitioners (n=21) to determine the following aspects: their beliefs regarding the outcomes of choosing a career as rural physician, as well as the importance and associated benefits of these outcomes; to determine the impact of demographic variables and TPB background factors in the prediction of a career choice as a rural physician; to establish whether the core and extended variables of the TPB account for differences in the career choice to become a rural physician between the two research groups; and to determine whether the TPB can be applied using a qualitative research methodology. ATLAS.ti was utilised for the purposes of data analysis which involved open and axial coding and the generation and evaluation of research findings. In this study, open codes typically represented the "salient beliefs" of study participants regarding the expected outcomes, expectations or feelings related to background or informational variables of the TPB. The "groundedness" concept of ATLAS.ti was used as a proxy to determine the subjective value of salient beliefs. Criteria for credibility, transferability, dependability and confirmability were applied and demonstrated. The study contributes to the fields of vocational and social psychology by demonstrating that the TPB can be applied in a qualitative research design. In addition, the study offers a viable and objective method to test TPB constructs for the purposes of career theory development in a diverse and complex South African context, thus enhancing the body of knowledge in career and social psychology. The constructs of the TPB in its extended form contributed to the development of a practical framework that creates a better understanding of beliefs and behaviour of medical students and physicians as well as inform interventions aimed at influencing or changing their behaviour, particularly with regard to choosing a career in rural health. Themes for future research include expanding the boundaries of the "career" concept; unpacking careers in medicine and current perceptions of South African medical students regarding future career prospects and expanding TPB studies to include more background factors such as emotions, personality traits, value systems and media exposure, particularly exploring the impact of social media on career decision-making.