Article Text

Original research
Turnover intention among primary health workers in China: a systematic review and meta-analysis
  1. Rongxin He1,2,
  2. Jinlin Liu1,2,
  3. Wei-Hong Zhang3,
  4. Bin Zhu1,2,
  5. Ning Zhang1,2,
  6. Ying Mao1,2
  1. 1Department of Social Security, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi, China
  2. 2Research Center for the Belt and Road Health Policy and Health Technology Assessment, Xi'an Jiaotong University, Xi'an, China
  3. 3International Centre for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
  1. Correspondence to Professor Ying Mao; mao_ying{at}


Objectives To analyse the prevalence and determinants of turnover intention (TI) among primary health workers (PHWs) in China to provide evidence for improving retention measures.

Design Systemic review and meta-analysis.

Data sources Four English-language databases (PubMed, EMBASE, Cochrane Library, PsycINFO) and three Chinese databases (CNKI, CSPD, CBM) were searched up to October 2019.

Eligibility criteria Eligible studies were observational or descriptive studies conducted in mainland China. The prevalence of TI among health workers and related factors had to be explicitly reported in each included study.

Data extraction and synthesis Data were extracted by one author and reviewed independently by two other authors. For each factor analysed by a meta-analysis, the factor was required to be the same across different studies, and at least three studies had to include it. The quality of studies was assessed using the Newcastle–Ottawa Scale and heterogeneity was evaluated using the I2 statistic.

Results We identified 16 cross-sectional studies investigating a total of 37 672 PHWs. The prevalence of TI was 30.4%. Subgroup analysis revealed that the highest prevalence was observed in the community primary healthcare institutions and the eastern provinces of China. Meta-analyses indicated that 21 factors were significantly associated with TI, including demographic factors (gender, age, education, marital status), job characteristic factors (title, work seniority, remuneration, social status, organisational affiliation, work stress) and job satisfaction factors (learning and training opportunity, interpersonal relationship, work condition and environment, and so on).

Conclusion This study highlights the problem of TI among PHWs in China. Efforts should be made to improve conditions in both work-related areas and areas outside of work. Policymakers should continue to improve reward systems, the construction of infrastructure and promotion systems, and pay more attention to PHWs’ lives outside of work and meet their living needs.

  • primary care
  • human resource management
  • health policy
  • health services administration & management

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  • Contributors RH and YM conceived this research project. JL and RH developed the search strategy and RH searched the databases. JL, BZ, NZ and RH selected the studies. RH designed and executed the analyses, interpreted the findings, wrote the first draft, revised subsequent drafts, and prepared the manuscript. YM and WHZ revised drafts of the manuscript.

  • Funding This research was funded by the Major Project of National Social Science Fund of China: Research on big health putting prevention first and construction of healthy China (grant number 17ZDA079).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplemental information. No additional data are available from the authors.

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