Muñoz-Pino, Natalia; Tibaná-Guisao, Anderson E.; Cardona-Hincapié, Johnatan D.; Hurtado-Aristizábal, Alejandro; Agudelo-Suárez, Andrés A.

doi:10.1590/2177-6709.25.5.23.e1-12.onl

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Online Articles • Dental Press J. Orthod. 25 (05) • Sep-Oct 2020 • https://doi.org/10.1590/2177-6709.25.5.23.e1-12.onl copiar

Factors associated to quality of life of orthodontists graduated from a public university (1993-2016): A mixed-methods approach

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Introdução:

Entre os profissionais da área odontológica, incluindo os ortodontistas, a Qualidade de Vida (QOL) é um tópico de interesse crescente, podendo ser determinada por meio de complexos fatores objetivos e subjetivos.

Objetivo:

O presente estudo analisou fatores que influenciam a QOL dos ortodontistas graduados entre 1993 e 2016 em uma universidade pública (Medelín, Colômbia).

Método:

Foi conduzido um estudo de metodologia mista (pesquisa transversal; 88 participantes; 3 grupos focais, 21 participantes). Análise quantitativa: foram incluídas características sociodemográficas, ocupacionais e de saúde como variáveis independentes e o questionário WHOQOL-BREF como resultado principal para QOL. As frequências foram calculadas e a associação entre QOL e as variáveis independentes foram estimadas por uma análise bivariada (teste qui-quadrado) e uma regressão linear multivariada. Análise qualitativa: análise do conteúdo narrativo de acordo com as categorias temáticas. Metodologia mista: foi desenvolvida uma estrutura conceitual para QOL utilizando a triangulação.

Resultados:

Todas as pontuações ultrapassaram 55 pontos nos 4 domínios do WHOQOL-BREF. Um valor mais baixo foi encontrado na dimensão física (57,1±10,7) e um valor mais alto, na dimensão psicológica (70,8±8,3). As variáveis associadas positivamente à QOL foram as seguintes: contrato permanente, atividades ensino/pesquisa, renda mensal, dias de descanso por semana e sexo. Os fatores associados negativamente foram baixo suporte social, saúde mental e morar de aluguel. O discurso dos participantes permitiu a identificação do conceito de QOL, dos determinantes contextuais e sociais, e os fatores motivacionais.

Conclusão:

A QOL dos ortodontistas é influenciada por fatores sociodemográficos, ocupacionais, ligados ao trabalho e à saúde. Dessa maneira, a QOL se apresenta como um conceito multidimensional, que reconhece o contexto político e socioeconômico, assim como as experiências pessoais e profissionais.

Palavras-chave:
Qualidade de vida; Ortodontistas; Estudos em saúde; Pesquisa odontológica; Pesquisa qualitativa

Variables	n (%)
Sociodemographic
Sex
Males	42 (47.7)
Females	46 (52.3)
Age ^a
Mean (± SD)	42.2 (7.1)
Marital status
Single	26 (29.5)
Married / Cohabited	55 (62.5)
Separate	7 (8.0)
Socioeconomic status
Middle	24 (27.6)
High	63 (72.4)
Housing
Own	69 (78,4)
Rented	11 (12.5)
Other	8 (9.1)
Vehicle
Yes	80 (90.9)
No	8 (9.1)
Type of family ^c
Nuclear	62 (72.1)
Extended	5 (5.8)
Single-parent	3 (3.5)
Assembled	1 (1.2)
Live alone	15 (17.0)
Number of people in charge ^a
Median (IQR)	1.0 (2.0)
Labour conditions
Laboractivity ^b
Teaching/research	27 (30.7)
Clinical assistance	88 (100.0)
Administrative	9 (10.2)
Other	2 (2.3)
Written contract
Yes	57 (64.8)
No	31 (35.2)
Presence of several contracts
Yes	51 (58.0)
No	37 (42.0)
Type of contract ^b
Permanent	9 (10.2)
Temporal	16 (18.2)
Independent	62 (70.5)
Provision of services	52 (59.1)
Percentage rent	53 (59.1)
Percentage rent value ^a
Median (IQR)	60.0 (20.0)
Working hours per week ^a
Mean (± SD)	38.9 (12.0)
Resting days per week ^a
Median (IQR)	2.0 (1.0)
Variables	n (%)
Working geographical regions ^b
Metropolitan area	78 (88.6)
Intermunicipal	63 (71.6)
Interstate	2 (2.3)
Average income (Colombian peso) ^d
3,000.001 - 4,000.000	5 (5.7)
> 4,000.001 - 5,000.000	9 (10.2)
> 5,000.001 - < 7,000.000	16 (18.2)
> 7,000.000	58 (65.9)
Number of work places as an orthodontist ^a
Median (IQR)	4.0 (3.0)
Does your current salary allow you to cover your basic needs, and those of the people who depend on you?
Yes	80 (90.9)
No	8 (9.1)
Does your current salary allow you to cover unforeseen important expenses?
Yes	66 (75.0)
No	22 (25.0)
Training and unformal education ^b
Diploma courses	33 (37.5)
Short courses	78 (88.6)
Congress	86 (97.7)
Conferences	67 (76.1)
Other	4 (4.5)
Annual frequency of participation in events of training and unformal education ^a
Median (IQR)	3.0 (3.0)
Quality of life
Physical ^a
Median (IQR)	57.1 (10.7)
Psychological ^a
Median (IQR)	70.8 (8.3)
Social ^a
Median (IQR)	66.6 (25.0)
Environment ^a
Median (IQR)	68.7 (18.7)
Health
Sport practice
Yes	58 (66.0)
No	30 (34.0)
Body Mass Index (BMI) ^a
Mean (± SD)	24.1 (3.4)
Self-rated health ^c
Good	71 (85,5)
Poor	12 (14.4)
Social support (Duke-UNC-11)
Normal	83 (94.3)
Low	5 (5.7)
Mental health (GHQ-12)
Good	68 (77.3)
Poor	20 (22.7)

Variables	WHOQOL-BREF dimensions
Variables	Physical	Psychological	Social	Environment
Age	0.2	-0.02	0.1	-0.1
Years of graduation as orthodontist	-0.02	-0.04	-0.3*	-0.14
Number of people in charge (family)	-0.12	-0.1	-0.1	-0.3*
Working hours per week	-0.1	-0.02	-0.04	-0.3*
Resting days per week	0.04	0.06	0.2	0.3**
Number of jobs	-0.13	-0.1	-0.05	-0.14
Body Mass Index	-0.07	-0.12	-0.03	-0.2

Variables	WHOQOL-BREF dimensions
	Physical			Psychological			Social			Environment
	Me	IQR	p-value	Me	IQR	p-value	Me	IQR	p-value	Me	IQR	p-value
Sex
Males	55.4	10.7	0.86	70.8	12.5	0.88	66.7	16.7	0.55	68.8	15.6	0.019*
Females	57.1	14.3	0.86	70.8	8.3	0.88	66.7	25.0	0.55	71.9	15.6	0.019*
Marital status
Single	55.4	14.3	0.69	70.8	16.7	0.66	66.7	25.0	0.99	70.3	15.6	0.81
Married /Cohabitated	57.1	14.3		70.8	8.3		66.7	16.7		70.3	15.6
Separate	53.4	10.7		66.7	12.5		66.7	25.0		68.8	10.8
Socioeconomic status
Middle	57.1	10.7	0.62	70.8	12.5	0.99	66.7	20.8	0.73	70.3	20.3	0,45
High	53.6	10.7	0.62	70.8	8.3	0.99	66.7	25.0	0.73	68.8	15.6	0,45
Housing
Own	57.1	14.3	0.06	70.8	8.3	0,07	66.7	25.0	0.25	68.8	18.8	0.031*
Rented	50.0	14.3		66.7	8.3		66.7	16.7		59.4	18.8
Other	57.1	5.4		77.1	10.4		79.2	16.7		73.4	10.9
Sport practice
Yes	55.4	14.3	0.94	70.8	8.3	0.96	66.7	25.0	0.64	71.9	15.6	0.082
No	57.1	14.3	0.94	70.8	8.3	0.96	66.7	16.7	0.64	67.2	18.8	0.082
Labor activity - Teaching/research
No	53.6	10.7	0.019*	70.8	12.5	0.005**	66.7	16.7	0.44	68.8	15.6	0.51
Yes	60.7	14.3	0.019*	75.0	12.5	0.005**	75.0	25.0	0.44	68.8	18.8	0.51
Clinical assistance
No	NC	NC	----	NC	NC	----	NC	NC	----	NC	NC	----
Yes	57.4	12.5	----	70.8	8.3	----	66.7	25.0	----	68.8	17.2	----
Administrative
No	53.6	10.7	0.22	70.8	8.3	0.22	66.7	25.0	0.44	68.8	18.8	0.23
Yes	57.1	7.2	0.22	75.0	12.5	0.22	75.0	16.7	0.44	71.9	3.1	0.23
Other
No	53.6	10.7	0.012*	70.8	8.3	0.32	66.7	16,7	0.81	68.8	18.8	0.49
Yes	64.3	7.1	0.012*	70.8	12.5	0.32	75.0	33.3	0.81	68.8	15.6	0.49
Presence of several contracts
Yes	55.4	14.3	0.67	70.8	8.3	0.43	66.7	25.0	0.35	68.8	15.6	0.5
No	57.1	10.7		68.8	12.5		66.7	16.7		68.8	15.6
Written contract
Yes	57.1	14.3	0.25	70.8	8.3	0.27	75.0	25.0	0.16	68.8	15.6	0.34
No	53.6	10.7	0.25	70.8	16.7	0.27	66.7	16.7	0.16	68.8	15.6	0.34
Type of contract - Independent
No	57.1	10.7	0.76	70.8	8.3	0.996	66.7	8.3	0.9	71.9	15.6	0.62
Yes	53.6	14.3	0.76	70.8	8.3	0.996	66.7	25.0	0.9	68.8	15.6	0.62
Provision of services
No	57.1	12.5	0.16	70.8	10.4	0.31	66.7	16.7	0.55	68.8	20.3	0.65
Yes	53.6	10.7	0.16	70.8	9.2	0.31	66.7	25.0	0.55	68.8	14.1	0.65
Percentage rent
No	57.1	12.5	0,097	68.8	12.5	0.6	70.8	20.8	0.64	70.3	15.6	0.37
Yes	53.6	12.5	0,097	70.8	8.3	0.6	66.7	25.0	0.64	68.8	15.6	0.37
Temporal
No	53.6	10.7	0.037*	70.8	12.5	0.019*	66.7	20.8	0.36	68.8	15.6	0.396
Yes	60.7	12.5	0.037*	75.0	12.5	0.019*	75.0	20.8	0.36	68.8	20.3	0.396
Variables	WHOQOL-BREF dimensions
	Physical			Psychological			Social			Environment
	Me	IQR	p-value	Me	IQR	p-value	Me	IQR	p-value	Me	IQR	p-value
Average income (Colombian peso)
3.000.001- 4.000.000	57.1	3.6	0.31	75.0	0.0	0.16	75.0	25.0	0.71	71.9	6.3	0.63
>4.000.001- 5.000.000	57.1	14.3		70.8	0.0		66.7	16.7		62.5	12.5
>5.000.001-< 7.000.000	58.9	19.6		70.8	12.5		75.0	33.3		67.2	21.9
> 7.000.000	53.6	10.7		68.8	14.6		66.7	16.7		68.8	15.6
Self-rated health
Good	51.8	14.3	0.25	66.7	10.4	0,05*	58.3	12.5	0,16	60.9	14.1	0,013*
Poor	57.1	14.3	0.25	70.8	8.3	0,05*	75.0	25.0	0,16	71.9	15.6	0,013*
Social support (Duke-UNC-11)
Normal	57.1	14.3	0.088	70.8	8.3	0.277	66.7	25.0	0.005**	68.8	15.6	0.02*
Low	42.9	14.3	0.088	66.7	8.3	0.277	33.3	0.0	0.005**	56.3	0.0	0.02*
Mental health (GHQ-12)
Good	57.1	14.3	0.004**	70.8	8.3	<0.001***	75.0	16.7	0.003**	71.9	14.1	0.001**
Poor	50.0	16.1	0.004**	64.6	10.4	<0.001***	58.3	20.8	0.003**	60.9	12.5	0.001**

WHOQOL-BREF dimensions	Variables included in the lineal regression model	Non-standardized Regression Coefficient	Standardized Regression Coefficient	Determination Coefficient (%)
Physical	Mental Health (Poor)	-8.5***	-0.4	21.0
	Rent housing	-8.9**	-0.3
	Permanent contract	7.6*	0.2
Psychological	Mental Health (Poor)	-8.2***	-0.4	25.0
Psychological	Labour activity: Teaching/researcher	6.6***	0.4	25.0
Social	Social support (Low)	-30.0***	-0.4	16.0
Environment	Mental Health (Poor)	-13.28 ***	-0.5	41.0
	Rent housing	-11.33**	-0.3
	Sex (Females)	7.09**	0.3
	Resting days per week	3.96**	0.3
	Labour activity: Teaching/researcher	5.8*	0.2
	Monthly income	5.1*	0.2

Categories	Verbatim extracts from participants
1. Concept of quality of life (QOL)	a) “If someone has professional success, they have all the conditions to have a better quality of life. Professional success does not necessarily mean working from 7 to 7, as I will probably be successful but won’t have a good quality of life. Quality of life encompasses many things” (FDG 2)
	b) (...) “I think that quality of life is like a state of well-being, right? It needs to be differentiated from individual quality of life and that of, say, society or a community or a group of people or a society as the individual has aspirations, desires, anxieties as they say. As long as that is given back, I would say they have a good quality of life. At a social level, there has to be some standards that say which is the quality of life for that society and so each individual will have a way to be integrated into that society in terms of quality of life and in regards to their dreams of quality of life” (FDG 3)
	c) “I consider quality of life is doing everything that makes us happy and having the conditions that allow for it; staying at home if that makes me happy but doing it because I can afford it, or play sports, or travel or study but being at ease with being able to do things and do and achieve what allows me to do it” (FDG 1)
2. Negative and positive determinants/conditionings of Quality of Life (QOL)	a) “I think that anyway that result can be associated to that even though we have greater mental demand -for all we have said, it is not physically that demanding whereas when you work as an orthodontist the physical demand is greater while the mental one is, say, may not be so high. As teachers, anyway, I think we all choose to be here since it gives us a level of satisfaction as we are not expecting further retribution other than being happy with what we do. I also share that being professors demands more time outside the work place” (FDG 3)
	b) “I would love to have social benefits and saying for once in my life that I will have a smooth December. For me December is torture because it means paying all December-related and January expenses without having the money because people chooses not to go to treatments and so I am like “come let’s work until Christmas”( FDG 1)
	c) ”Financially, I don’t think being an orthodontist is profitable these days. To have high income you need to work very hard and long hours, to achieve that balance” (FDG 3)
	d) (...) “we have spoken about muscle-skeletal disorders. We are very exposed to them. Obviously as more patients, greater the risk of having some health issue that will affect work performance and quality of life” ( FDG 3)
	e) (...) “It makes me laugh because one day we met, all the female alumni from Universidad de Antioquia, mostly from orthodontics, and they began to talk… all went to the same therapist! They had to see a therapist because it was hard to cope with day-by-day activities and stress. All, because of their personality type, began a zero-stress program… not stressing over things you cannot control as traffic jams. As they say around here a lot, light one and relax as you arrive, and all that” (FDG 1)
	f) ”I think that for myself, it is just a mystery because when the control body announces a visit everyone is stressed, at least from two months before. For me… I don’t see any more than external pressure; the pressure on the professional” (FDG 2)
	g) ”One thing we have not covered is that the health system is also affecting us, particularly orthodontists. For example, a dentist thinking about opening a practice. From 150 graduating, 10 opened their private practice and most are thinking about finding work. That is also seen in specialists when other entities are beginning to cover specializations of dentistry, they also will absorb the demand and we will obviously see the amount of patients decrease from the private practice. That will impact the level of income because health service providers are absorbing it” (FDG 3)
	h) “I agree with that payment is not the same but satisfactions are greater since we work better each time. Each time we have more experience, because each time we manage people better” (FDG 2)
3. Proposals and strategies for improving QOL in orthodontists	a) “Here is a point I find very important, what he says. Our programs, as I understand, in other countries students up to their 20’s, or the first third of their lives, are taught economics, administration and we are ignorant in those fields. We charge for what we observe but we do not know why. Besides we don’t know how to invest what we make. They are prepared for that so when they go out to the productive life they already know what to do with their money. We don’t have that clear” (FDG 2)
	b) “We talked about it once, as (name of the person) said, doctors saw a way to organize themselves, We do not know how to be organized towards the same goal. If we all fought in the same direction this would be different”. (FDG 2)
	c) (...) “I had to make a bunch of changes in work-hours, pause, join the gym, strengthen my back, abdomen… I even stop exercising for over a month and the body claims it. I begin work and the back feels warm and I know I have to start back exercises”. (FDG 1)

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[1] Contact address: Andrés A. Agudelo-Suárez E-mail: alonso.agudelo@udea.edu.co, oleduga@gmail.com