Development and psychometric properties of Iranian midwives job satisfaction instrument (MJSI): A sequential exploratory study.

BACKGROUND: Job satisfaction refers to a person's attitude toward his/her job and its various aspects. Job satisfaction improves the quality of service and employees' physical and mental health. The present study aimed to design a valid and reliable instrument to assess Iranian midwives job satisfaction instrument (MJSI).
METHODS: This is a sequential exploratory study for tool design. This study in two phases; (qualitative and tool's psychometric evaluation) was conducted in Ilam, Iran, 2019 years. In the first phase, a qualitative content analysis was carried out by in-depth and semi-structured individual interviews with 10 experts. Then, the pool of items extracted from the qualitative phase was completed by reviewing the existing texts and tools. The second phase of the study involved reducing the overlapping items and validating the tool. In order to investigate the construct validity, a cross sectional study was conducted with the participation of 121 midwives with census sampling. Data analysis was performed by SPSS-19 software using exploratory factor analysis and reliability tests (Cronbach's alpha).
RESULTS: In the qualitative phase and after reviewing the existing texts and tools by the research team, a 58-item questionnaire was developed and then entered into the psychometric phase. Then, the tool was finalized with five factors, including: 1) communication features, 2) professional features, 3) responsibility aspects, 4) physical-mental aspects and 5) social aspects, respectively. After the psychometric process, by removing the items in different stages, a specific questionnaire was developed to measure the midwives' job satisfaction with 25 items which explained a total of 49.95% of the total variance. Reliability of the tool was approved by Cronbach's alpha = 0.71 and test-retest with 2-weeks intervals, indicating an appropriate stability for the scale (ICC = 0.898).
CONCLUSION: The 25-item self-reporting midwives job satisfaction tool had acceptable validity and reliability. We recommend the use of this tool for evaluating the job satisfaction of midwives, as well as management and research purposes.

Background

Job satisfaction refers to a person’s attitude toward his/her job and its various aspects. It is one of the important issues that service organizations should consider [1]. Certainly, increased job satisfaction improves the quality of service. In addition to improving organizational service, job satisfaction is also linked to employees’ physical and mental health and increase to the quality of service [1, 2].

So far, several factors have been identified as influencing factors in job satisfaction [3, 4]. Job satisfaction is more important in the medical professions. Midwives have a special place in the medical profession for several reasons. Firstly, midwives as an important component of health care system, play a key role in delivering services to two vulnerable groups of society such as mothers and children. Secondly, midwifery services are offered on a large scale from prevention in health care to advanced medical services in hospital [5].

Given the importance of mothers and children as the main target groups in midwifery services around the world, it is essential to identify midwives’ job satisfaction. Therefore, various studies have been carried out so far and different results have been reported [5, 6]. A high rate of job satisfaction has been reported in Australian midwives. The results of one study reported the 81% job satisfaction among Australian midwives. However, the job satisfaction rate is very low in Iranian midwives (1.6%), [1].

On the other hand, various studies have reported many related factors to job satisfaction. In some studies, welfare and management aspects have been investigated as main factors that affect job satisfaction. In other studies, the job security, income level, and work environment are the most important factors in job satisfaction [7, 8].

The measurement of job satisfaction plays an important role in the promotion of health care systems. Also, variety of factors that affect job satisfaction and their impact level in various countries and cultures highlights the need to design and standardize a tool for measuring satisfaction in different cultures and jobs. In this regard, there has been an efforts to design and standardize job satisfaction assessment tools for Iranian physicians and nurses, but no such tool has been designed for Iranian midwives. Since midwives are one of the most essential components of service delivery to the two vulnerable groups of society (mothers and children), the midwives’ job satisfaction is a concern to health service organizations in both developed and developing countries [9]. Considering that, the studies conducted in the field of midwives’ job satisfaction have used non-specific tools [10-12]) and also, due to the importance of this issue, we decided to take a qualitative approach and use content analysis to examine the job satisfaction of Iranian midwives and accordingly, develop a questionnaire with psychometric characteristics. It should be noted that the main researchers in this study have experience in instrument design and psychometrics[13, 14]. The present study aimed to design a valid and reliable tool to assess the job satisfaction in Iranian midwives.

Methods

Design

A mix method study (sequential exploratory study) was conducted from April to December 2019. This research started with a qualitative study and continued with a quantitative study. This method was introduced by Creswell and Plano Clark as one of the five main types of mix method studies [15]. The sequential exploratory study is divided into two types of theory design and instrument design. The present study is a tool design study [16]. To build a tool, we need to understand the concept of health literacy by using the experience of participants. Having a conceptual framework is the first step in designing a tool. Therefore, the qualitative part of the study was designed and implemented to design the tool, and then its psychometric property was confirmed in a quantitative study.

Both quantitative and qualitative studies were applied studies. To develop a tool, it was necessary to know the concept of job satisfaction through the experiences of study participants, because having a conceptual framework is the first step to building tools. Therefore, the qualitative part of the study was implemented to design a tool, and then in a quantitative study, the psychometric properties such as validity and reliability of the tool were confirmed. the tool’s validity was obtained by face validity, content validity and factor analysis methods. The internal consistency and test–retest reliability methods were used to confirm the reliability of the tool.

Phase 1: Development of job satisfaction tool

In the this phase, a qualitative content analysis was carried out by in-depth and semi-structured individual interviews with 10 experts. The inclusion criteria were; being a faculty member or a midwife with at least five years of experience in health centers, hospitals, and counseling centers who were key informants. The interview was conducted by agreement between the researcher and the participant in any place where the participants could more easily share their experiences. The first question to start interview was: “What comes to mind when you hear the word job satisfaction?. As the study progressed, additional questions or new questions were asked from the interviewees. Exploratory questions such as: "What do you mean?" or "If you can please explain more" or Please explain to me? or Please tell me about your experience were also used in the interviews as needed (The Questions guide in qualitative phase is attached in the S1 File section). At the end of each interview, participants were asked to add if there was anything left to say. The interview was conducted by the researcher. The duration of each interview was between 45 to 110 minutes, depending on the amount of information, participation, and cooperation of the participants.

Qualitative analysis was performed using contract content analysis and MAXQDA-10 software.

After analyzing the findings of qualitative phase and reviewing the existing texts and tools, a pool of item was created. After reviewing the items by the members of research team, the initial format of the midwives’ job satisfaction questionnaire with 58 items was formed. The midwives’ job satisfaction questionnaire consisting of five sections: 1) communication features, 2) professional features, 3) responsibility aspects, 4) physical -mental aspects and 5) social aspects. Then the research entered the psychometric stage.

Phase 2: Psychometric evaluation

We used face validity, content validity and factor analysis as the main methods of the tool’ validity assessment. Face validity conducted with qualitative and quantitative methods. In the quantitative face validity, the level of difficulty, relevance and ambiguity of the items were investigated by face to face interview with 10 midwives (faculty member and midwife working in health centers, hospitals, and counseling centers). Then, to determine the quantitative face validity, the impact score method was used. An item with a score equal to or greater than 1.5 was retained and other items were deleted. A 5-point Likert scale was used for determining the importance of items. The classification of very important (5), important (4), relatively important (3), slightly important (2), and unimportant(1) was considered [17]. Therefore, 10 midwives were asked to rate the importance of each item. For content validity, we used both quantitative and qualitative methods, as one of the most important steps of tool’s validity. In qualitative content validity, 10 expert members were consulted and asked to carefully study the tool, and their corrective views and suggestions regarding content coverage, grammar, use of appropriate phrases and the appropriate location of the items were considered. For quantitative content validity, we used Content Validity Ratio (CVR) and Content Validity Index (CVI). A 3-point Likert scale was used to determine CVR by an expert panel. The calcification of “not essential, useful but not essential, essential” was used at this stage, so that higher level of content validity showed the agreement between greater number of experts(faculty member and midwife working in health centers, hospitals, and counseling centers) in the experts’ panel. In the present study, according to 10 specialists and based on the Lawshe table, if the CVR coefficient was more than 62%, the item was retained.

Then a content validity index (CVI) was computed for the instrument. In this section we asked the expert panel to rate each item in terms of clarity and relevancy in a 4-point ordinal scale (1 = not relevant, 2 = somewhat relevant, 3 = quite relevant, 4 = highly relevant). CVI was calculated for I-CVIs and the scale-level (S-CVI). The I-CVI expressed the proportion of agreement on the relevancy of each item, which was between 0 and 1. If the validity index of each item was higher than 0.79, the validity of that item would be accepted. The exploratory factor analysis was applied to determine the construct validity. So, the questionnaires were completed by 121 midwives with census sampling in a cross-sectional study(A minimal set of data for the study is attached in the S2 File section). Therefore, the inclusion criteria were; all faculty member and all midwife working in health centers, hospitals, and counseling centers that would like to participate in the study, with any level of work experience.

In this study, considering that the number of items in the midwives’ job satisfaction questionnaire was 25 items, the sample size for performing exploratory factor analysis was estimated to be 5 samples per item. Kaiser-Meyer-Olkin (KOM) and Cruet-Bartlett’s test and principal component analysis, as well as Varimax rotation. The “Eigen Value” and “Scree Plot” were used to determine the number of factors. A minimum of 40% load was required to keep each factor extracted from factor analysis. Eigen Value of more than 1 was considered. We used internal consistency and test–retest reliability methods to confirm the reliability of the questionnaire. In the present study, Cronbach’s alpha was performed using SPSS-19 software with a minimum coefficient of 0.7. To determine the stability of the questionnaire, 10 midwives (faculty member and midwife working in health centers, hospitals, and counseling centers). were asked to complete the final questionnaire twice, at an interval of 2 weeks.

Ethical considerations

This study was carried out with the approval of the Ethical Committee of Ilam University of Medical Sciences (N: 22.52.98.1572). The aim of the study was explained to all participants before their enrollment in the study. All personal data such as names were anonymized. Paper based data (consent) was stored securely in a locked cupboard and electronic data (interview and transcripts, quantitative data) was stored in secure server with password (The consent form used is attached in the S3 File section).

Results

In qualitative phase, in total, 10 expert person aged 27–45 years participated in this study. The lowest work experience was five years and the highest work experience was 26 years. The participants’ current tasks of the participants were included two supervisors, two staff, two Training, two health service provider, one gynecologist assistant and one clinic staff.

In the present study, we used literature review and interview with the participants in qualitative phase to develop the tool. At this stage, 58 items were obtained, which indicated the midwives’ job satisfaction. The participant´s level of attitude was determined using a 5-point Likert scale, ranking from; totally agree = 4, agree = 3, no comment = 2, disagree = 1 and strongly disagree = 0.

In the qualitative and quantitative face validity, 9 items had the item impact of less than 1.5 and were excluded from the questionnaire. In the content validity section, 24 items did not obtain the necessary score based on Lawshe formula, so they were excluded from the questionnaire.

The exploratory factor analysis was used to determine the construct validity. For this purpose, the questionnaires were completed by 121 midwives in a cross-sectional study. Demographic data for the sample are presented in Table 1. The factor analysis was done on 25 items based on principal component analysis. Items’ validity was determined by KMO index and Bartlett’s test, which were carried out on 25 Items. In this study, the value of KMO index was 0.64 (Table 2).

Table 1

Demographic characteristics and other factors related to job satisfaction in midwives.

Variable	Category	N(%)
Age (years)	Less than 25	29(24)
	26–30	19(16)
	31–35	9(8)
	36–40	17(14)
	More than 40	47(38)
	Total	121(100)
Marital status	Single	35(29)
	Married	85(70.2)
	divorced	1(0.8)
	Total	121(100)
Work experience (years)	Less than 5	47(38.8)
	6–10	9(7.5)
	11–15	21(17.3)
	More than 16	44(36.4)
	Total	121(100)
Current task	Supervisor	3(2.3)
	Staff	10(8.3)
	Therapist	56(46.3)
	Training	8(6.6)
	Health service provider	25(20.7)
	Clinic staff	5(4.1)
	Gynecologist assistant	4(3.3)
	Administrative department	10(8.4)
	Total	121(100)

Table 2

Kaiser-Meyer-Olkin Measure and Bartlett’s Sphericity test of Sampling Adequacy of the questioner of the job satisfaction among Iranian midwives.

KMO and Bartlett’s Test
Kaiser-Meyer-Olkin Measure of Sampling Adequacy.		0.640
Bartlett’s Test of Sphericity	Approx. Chi-Square	845.696
	Df	300
	Sig.	.000

The scree plot and eigenvalue methods were used to determine the number of questionnaire’s constituents Based on the scree plot, five factors were proposed for extraction in exploratory factor analysis of Iranian midwives’ job satisfaction instrument which are shown in Fig 1. After calculating the correlation matrix between the variables, factor extraction was performed by analyzing the main components using orthogonal rotation with eigenvalues >1.

Fig 1

Scree plot.

Based on the Scree plot, five factors were proposed for extraction in exploratory factor analysis of Iranian midwives’ job satisfaction instrument.

Overall, 9 factors were extracted by factor analysis. However, 49.95% of the total variance was explained by 6 factors, and other factors explained the remaining total variance. Totally, 9.12% of rotation variance was explained by first factor and 8.71% by the second factor (Table 3).

Table 3

The total variance explained by factors of the job satisfaction tool among Iranian midwives.

Component	Initial Eigen values			Extraction Sums of Squared Loadings			Rotation Sums of Squared Loadings
	Total	% of Variance	Cumulative %	Total	% of Variance	Cumulative %	Total	% of Variance	Cumulative %
1	3.934	15.738	15.738	3.934	15.738	15.738	2.280	9.122	9.122
2	3.128	12.512	28.250	3.128	12.512	28.250	2.178	8.714	17.836
3	1.823	7.292	35.542	1.823	7.292	35.542	2.143	8.573	26.408
4	1.671	6.684	42.226	1.671	6.684	42.226	2.061	8.243	34.652
5	1.581	6.326	48.552	1.581	6.326	48.552	2.000	8.000	42.651
6	1.438	5.751	54.303	1.438	5.751	54.303	1.825	7.300	49.951
7	1.219	4.877	59.180	1.219	4.877	59.180	1.677	6.708	56.659
8	1.171	4.683	63.863	1.171	4.683	63.863	1.525	6.101	62.760
9	1.029	4.116	67.979	1.029	4.116	67.979	1.305	5.219	67.979
10	.895	3.580	71.559
11	.850	3.399	74.958
12	.779	3.115	78.073
13	.706	2.825	80.899
14	.642	2.570	83.469
15	.588	2.351	85.819
16	.515	2.062	87.881
17	.496	1.983	89.864
18	.454	1.814	91.678
19	.413	1.651	93.329
20	.365	1.458	94.787
21	.330	1.318	96.106
22	.280	1.120	97.226
23	.240	.961	98.187
24	.232	.930	99.116
25	.221	.884	100.000
Extraction Method: Principal Component Analysis.

Based on the rotation matrix components, the first factor was composed of 7 items and the second factor was composed of 10 items. The third and fourth factors had 2 and 3 items, respectively. Other factors were composed of 1 item, therefore, this item was transferred to other factors according to the face validity and the opinion of researchers. Eventually, the items were combined into 5 factors, which included communications (7-item, questions 1 to 7), professional features (10-item, questions 8 to 17) responsibility (2-item, questions 18 and 19), physical, mental (4-item, questions 20 to 23) and social aspects (2-item questions 24 and 25), respectively (Table 4). To determine internal consistency, after ensuring construct validity, Cronbach’s alpha coefficient in a sample of 121 midwives was 0.71 for the whole tool with 95% confidence intervals. However, this value varied from 0.73 to 0.98 in different dimensions include communications dimension (α = 0.73), Professional dimension (α = 0.85), Responsibility dimension (α = 0.96), Physical-Mental dimensions (α = 0.98), Social dimension (α = 0.88). In order to determine the consistency of questionnaire in the repeatability dimension, in a group of 10 midwives with 2 weeks’ interval, the intra-cluster correlation coefficient (ICC) for the whole tool was 0.898. Finally, The 25-item self-reporting midwives job satisfaction tool had acceptable validity and reliability (The final Persian and English version of the Iranian midwives job satisfaction instrument and the scoring of instrument is attached in the S4–S6 Files section).

Table 4

The 5-factor construct, factor load of each item and the scores of Cronbach’s alpha coefficient.

Factors name	Items		Factor Loadings	α
Communications dimension	1	How is your relationship with the midwifery team (faculty, trainers, and faculty members)?	0.734	0.73
	2	How is your relationship with midwife colleagues at other health care centers, organizations, etc.?	0.667
	3	How is your relationship with midwives working in the NGO sector?	0.661
	4	How is your relationship with GPs?	0.591
	5	How is your relationship with gynecologists?	0.587
	6	How is your relationship with pediatricians?	0.551
	7	How do you relate to those around you and ordinary people?	0.476
Professional dimension	1	Does midwifery meet the economic needs of a middle-aged person?	0.597	0.85
	2	How is job security in the midwifery profession in terms of the labor market?	0.597
	3	What is midwifery occupational safety? (Protecting employees from wage and salary fluctuations and eventually losing their jobs)	0.552
	4	What is the flexibility of a midwife’s work hours?	0.537
	5	Do you think it is possible to improve practical skills in the midwifery profession?	0.536
	6	How much can you use your knowledge and skills in service delivery?	0.522
	7	In your opinion, how much is your workload compared to the working time during each shift?	0.510
	8	How useful is the midwifery profession’s usefulness in a midwife’s life?	0.481
	9	How much time can you upgrade your professional knowledge and skills?	0.463
	10	How much can you upgrade your professional knowledge and skills in terms of available resources?	0.417
Responsibility dimension	1	How are you responsible in the midwifery profession?	0.646	0.96
	2	How much do you have responsibility for your career after the end of your shift?	0.566
Physical-Mental dimensions	1	How much do you want to stay in the midwifery profession in the future?	0.554	0.98
	2	How much the midwifery profession affect midwife’s mental health?	0.550
	3	How much is leisure time in the midwifery profession?	0.464
	4	How much the midwifery profession affect midwife’s physical health?	0.419
Social dimension	1	How do you evaluate the social status of the midwifery profession in the community?	-0.651	0.88
	2	How do you evaluate the social acceptance of the midwifery profession in the community?	0.546

Discussion

The purpose of this study was to design and evaluate the validation indexes of a questionnaire for measuring job satisfaction in midwives. The initial questionnaire was designed based on data extracted from qualitative study of midwives, using expert opinions and reviewing existing studies in job satisfaction. After completing the validity and reliability stages, job satisfaction in midwives questionnaire was developed with 25 questions in four dimensions, which was completed by the participants. Considering that the majority of participants completed the questionnaire in 10 minutes, this tool could be easily used in screening. The findings of this study showed that, the job satisfaction in midwives questionnaire had accepted validity and reliability.

Iranian midwives job satisfaction instrument (MJSI) was finalized with five factors, including: 1) communication features, 2) professional features, 3) responsibility aspects, 4) physical-mental aspects and 5) social aspects, respectively. It is well known that, factor affecting job satisfactions varies among health professionalism, depending on the time and place [1]. In our extensive search through literature, we found no special tool to assess job satisfaction of Iranian and European midwives and studies that have examined job satisfaction in midwives have used researcher-made tools, Mueller and McCloskey Satisfaction Scale (MMSS), Minnesota questionnaire (MSQ) and the job satisfaction inventory (JDI) [18-24].

The closest study of instrument design to our study method was the Faye et al. study. Their study, aimed to develop an instrument to measure job satisfaction of medical staff including physicians, midwives, and technicians in sub-Saharan Africa with content validity, construct validity (confirmatory factor analysis) and reliability. Based on this study’s result, eight dimensions, with 25 item, were identified as the main dimension of job satisfaction scale, which included continuous education, salary and benefits, management style, tasks, work environment, workload, moral satisfaction and job stability [4]. Reliability was assessed based on internal consistency, which was good for all dimensions but moral satisfaction was lower than 0.70. Test-retest showed intra class coefficient range: 0.60 to 0.91. It was pointed out that in terms of population studied and methodology, this study is the most similar to our study. Consistent with the present study, there were similarities in the field of subscales such as professional and physical-mental aspects with the subscales of salary and benefits, workload, job stability in the mentioned tools, but in the field of subscales such as tasks, work environment, continuous education and especially Moral satisfaction and management style were not so similar. Also in the field of reliability scores, the present instrument received higher scores (0.73 to 0.98 Cronbach’s alpha and ICC equal to 0.898). These differences can be due to the heterogeneity of the study population (doctors, midwives and technicians) and non-specificity for the midwifery group and the lack of item extraction in a qualitative study, different geographical location of the two studies and perhaps due to different types of structural validity in Two studies.

One of the most common tools for measuring job satisfaction is the Mueller and McCloskey Satisfaction Scale, which has been used in a variety of geographic and clinical settings such as midwives[19, 20]. The tool consists of 31 items with 5-point Likert, which are grouped into eight subscales: job satisfaction (3 items), planning (6 items), family and work balance (3 items), communication with colleagues (2 items), interaction (4 items), professional opportunities (4 items), praise and appreciation (4 items) and a sense of independence and responsibility (5 items).

The reliability of this tool has been confirmed with a Cronbach’s alpha score of 0.89. In our tool, one of the extracted dimensions was the communication dimension, which is specific to the midwifery group, including items such as the individual’s relationship with midwives in their main work environment and other public and private organizations, gynecologists, neonatologists, general practitioners and inspectors. Our tools also had almost identical items to the Mueller and McCloskey Satisfaction Scale in terms such as the professional dimension and the responsibility dimension. In the professional dimension of the present tool, there are questions about the use of professional skills, the possibility of upgrading practical skills, the use of skills and knowledge in providing services, workload, the opportunity to upgrade knowledge and skills, the amount of leisure, flexibility to working hours and economic security. The present tool has specific features that are not found in the Mueller and McCloskey Satisfaction Scale, such as the availability of resources and the development of professional skills and the application of the midwifery profession in life, responsibility during and after work. It is noteworthy that despite the similarities between the subscales of the present tool and the Mueller and McCloskey Satisfaction Scale, the nature of the questions in each subscale and the application of the information obtained are different from the classic Mueller and McCloskey Satisfaction Scale because the tool items were extracted from the midwife sample.

Other common tools used to measure job satisfaction are the Minnesota tool and job satisfaction inventory (JDI) which have been used to measure the job satisfaction of midwives[21, 22]. The Minnesota Job Satisfaction Questionnaire (MSQ) consists of 19 items with 5-point Likert and 6 subscales, including payment system (3 questions), type of job (4 questions), opportunities for advancement (3 questions), organizational climate (2 questions), leadership style (4 questions) and physical condition (3 questions). The reliability of the Minnesota Job Satisfaction Questionnaire using Cronbach’s alpha test was .086. The job satisfaction inventory (JDI) consists of 54 items with 5-point Likert and similar subscales to the Minnesota Questionnaire that its reliability of the using Cronbach’s alpha test was .094.

In our tools, there are items in the field of Physical-Mental dimensions such as job security, job stress and the desire to stay in the profession, in the social dimension such as assessing social status and acceptance in society, as well as items in the field of professional dimension. It is emphasized again that the relative similarity of the subscales in the existing tools and the present tools, the nature of the questions that are placed in each subscale is different depending on the population that is examined especially that occupations such as medical sciences and especially midwifery have very sensitive conditions that are not comparable to other occupations. Therefore, this issue shows the value of the designed tool more than before.

Our instrument is a comprehensive and multidimensional scale with specific subscales for measuring the job satisfaction of the midwifery group. Our study includes dimensions that, due to the nature of job satisfaction, overlap with some items of available tools. But since the present study was conducted qualitatively in the first stage, which is a strength over all studies, the items of the tool are extracted from the opinions of midwives who are the main target group of this tool. Therefore, it has more credibility for measuring job satisfaction than general tools for this population group.

Of the weaknesses of the current study, only midwives employed in urban areas were studied, therefore, this is a limitation of present study. The small number of samples studied can also be considered as another limitation of this study. So, further study with larger sample size is suggested using confirmatory analysis factor. The strength of this study is that, the tool developed is the first tool that has been designed and validated exclusively with the participation of midwives only. Another strength of this study is that all steps of instrument psychometrics have been performed to confirm this instrument.

The role of midwives in the health of mother and child, that is one of the main components of primary health care, is undeniable. On the other hand, failure to pay attention to the issue of job satisfaction disrupts the organization system and causes rebellion and reduced sense of responsibility, employees’ morale, and proper service delivery. Therefore, it is important to study the job satisfaction of midwives and obtain accurate information about the components of midwives’ job satisfaction in order to design effective interventions with verified tool. We recommend the use of present questioner, for evaluating the job satisfaction of midwives, and also for management and research purposes.

Conclusion

Our study showed that, Iranian midwives’ job satisfaction consists of five main factors, including communications, professional features, responsibility, and physical, mental and social aspects. We recommend the use of present questioner as a valid tool for evaluating the job satisfaction of Iranian midwives.

Questions guide in qualitative phase.

(DOCX)

Click here for additional data file.

A minimal set of data for the study.

(SAV)

Click here for additional data file.

Consent to participate in the project.

(DOCX)

Click here for additional data file.

Iranian midwives job satisfaction instrument (MJSI)-English version.

(DOCX)

Click here for additional data file.

Iranian midwives job satisfaction instrument(MJSI)-Persian version.

(DOC)

Click here for additional data file.

Manual for scoring the MJSI.

(DOC)

Click here for additional data file.

12 May 2021

PONE-D-21-09782

Development and psychometric properties of midwives job satisfaction instrument : A sequential exploratory study

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Reviewer #2: Yes

Reviewer #3: No

**********

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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Reviewer #1: Yes

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Reviewer #3: Yes

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Please see my attached review

Reviewer #2: in the abstract saying four facters while at discussion , said 5 factors... and not clear with their respective

rationale for inclusion criteria and experience at least 5 year, but at the result session you included participants who have <5 year experience.

Grammatic and spelling error were there.

Reviewer #3: Development and psychometric properties of midwives job satisfaction instrument : A sequential exploratory study

Thank you for inviting me to review this manuscript. Please see my comments as follows:

This study has some grammatical and typo errors and should be revised by an expert person in the field of English literature.

Abstract

1.Is this a study to evaluating job satisfaction of Iranian midwives? If so, please mention in the title.

2.Results: authors stated that derived four factors, but they mentioned six factors.

3.While authors designed a 58-item questionnaire, how they stated that used a 25-item questionnaire for psychometric evaluation?

Methods

1.As this study was development and psychometric evaluation of questionnaire, I am concerning about the name of “mix method study”.

2.What was the first question to start interview?

3.Who conducted the interviews? How long was the length of each interview?

4.Who were the 10 experts that evaluated the tool?

5.Who were 10 midwives that completed the questionnaire for test-re-test study?

Results

1.In the results section of abstract, authors stated that they developed four items for the questionnaire and in the main text they mentioned five factors.

2.Please report the characteristics of participants in both qualitative and quantitative parts of the study.

Discussion

1.The first and second paragraph of discussion are repetition of what authors wrote in background. Please revise them.

2.Why authors compared their designed questionnaire with those designed in African countries, and why not with European or other developed countries?

Conclusion

1.In the discussion section authors claimed that they found five factors, and here they report four factors.

References

Please use the abbreviation form of journals in all references.

**********

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Reviewer #3: Yes: Prof Parvin Abedi

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Submitted filename: commented.docx

Click here for additional data file.

16 Jul 2021

HI,

Thank you for your valuable suggestions.

Major revision comments

1. Abstract

In the methodology part there are two types of study (design qualitative and crass sectional study design). What type’s method used to select the participants during crass -sectional study design?

Applied to the manuscript. Line 30-32. In order to investigate the construct validity, a cross-sectional study was conducted with the participation of 121 midwives with Census sampling.

Result: there is no any indication whether those four factors (communication, professional features, responsibility, and physical, mental, and social aspects) are they significantly affect the job satisfaction or variables used to assess the job satisfaction?

Applied to the manuscript. Line 37-43. In the qualitative phase and after reviewing the existing texts and tools by the research team, a 58-item questionnaire was developed and then entered into the psychometric phase. Then, the tool was finalized with five factors, including :1) communication features, 2) professional features, 3) responsibility aspects, 4) physical-mental aspects and 5) social aspects, respectively. After the psychometric process, a specific questionnaire was developed to measure the midwives’ job satisfaction with 25 items which explained a total of 49.95% of the total variance.

Please rephrase the sentence Validity and reliability no need of used in the result part

It was deleted.

2. Methodology: developments of job satisfaction, the word educayion is incorrect, like this there are a lot of words which are incorrect so need of deep correction.

All corrections were made.

3. Phase 2: Psychometric evaluation:

You have been used to both qualitative and quantitative methods were used to determine the face validity. There different types of qualitative and quantitative methods, what types of study method did you apply for this study? No clear method:

Applied to the manuscript. Line 143-151. Face validity conducted with qualitative and quantitative methods. In the quantitative face validity, the level of difficulty, relevance and ambiguity of the items were investigated by face to face interview with 10 midwives (faculty member and midwife working in health centers, hospitals, and counseling centers). Then, to determine the quantitative face validity, the impact score method was used. An item with a score equal to or greater than 1.5 was retained and other items were deleted. A 5-point Likert scale was used for determining the importance of items. The classification of very important (5), important (4), relatively important (3), slightly important (2), and unimportant was considered (67). reference: 18. Creswell Jw, Plano Clark VL. Designing and Conducting, Mixed Method Research: Thousand Oaks Ca: Sage. 2011(

4. The calcification of very important (5), important (4), relatively important (3), slightly important (2), and unimportant was considered. The word calcification or classification I think you used for classification please correct it.where did you get such classification .are they prepared by yourself? If you have any source, please put the reference

Applied to the manuscript. Line 143-151.Face validity conducted with qualitative and quantitative methods. In the quantitative face validity, the level of difficulty, relevance and ambiguity of the items were investigated by face to face interview with 10 midwives (faculty member and midwife working in health centers, hospitals, and counseling centers). Then, to determine the quantitative face validity, the impact score method was used. An item with a score equal to or greater than 1.5 was retained and other items were deleted. A 5-point Likert scale was used for determining the importance of items. The classification of very important (5), important (4), relatively important (3), slightly important (2), and unimportant was considered (67).). reference: 18. Creswell Jw, Plano Clark VL. Designing and Conducting, Mixed Method Research: Thousand Oaks Ca: Sage. 2011(

5. There is no any operational definition why didn’t you put?

In the qualitative phase and after reviewing the existing texts and tools by the research team, a 58-item questionnaire was developed and then entered into the psychometric phase. Applied to the manuscript. Line 135-138.The midwives’ job satisfaction questionnaire consisting of five sections: 1) communication features, 2) professional features, 3) responsibility aspects, 4) physical -mental aspects and 5) social aspects.

6. Discussion

Line 17 and 22 the reference style not correct just you are used the Vancouver reference style, please check the style. Applied to the manuscript. Line 254 and 259.they were corrected.

In a study, Faye et al. aimed to develop an instrument to measure job satisfaction of medical staff including physicians, midwives, and technicians in sub-Saharan Africa.

In another study, Bekro et al. examined 221 midwives in Addis Ababa in Ethiopia.

7 All tables are illegible. Use line to discriminate each variable. Applied to the manuscript. Line 387-433. they were corrected.

Tab 1 Demographic characteristics and other factors related to job satisfaction in midwives

Variable Category N(%)

Age (years) Less than 25 29(23)

25-30 19(15)

31-35 9(7)

36-40 17(14)

More than 40 47(38)

Marital status Single 35(30)

Married 85(70)

Work experience (years) Less than 5 47(39)

6-10 8(6)

11-15 21(17)

More than 16 44(36)

Current task Supervisor 3(2)

Staff 10(8)

Therapist 56(46)

Training 8(6)

Health service provider 25(20)

Clinic staff 5(4)

Gynecologist assistant 4(3)

Administrative department 10(8)

Tab 2: Kaiser-Meyer-Olkin Measure and Bartlett's Sphericity test of Sampling Adequacy of the questioner of the job satisfaction among Iranian midwives

KMO and Bartlett's Test

Kaiser-Meyer-Olkin Measure of Sampling Adequacy. 0.640

Bartlett's Test of Sphericity Approx. Chi-Square 845.696

df 300

Sig. .000

Table 3: The total variance explained by factors of the job satisfaction tool among Iranian midwives

Component Initial Eigen values Extraction Sums of Squared Loadings Rotation Sums of Squared Loadings

Total % of Variance Cumulative % Total % of Variance Cumulative % Total % of Variance Cumulative %

1 3.934 15.738 15.738 3.934 15.738 15.738 2.280 9.122 9.122

2 3.128 12.512 28.250 3.128 12.512 28.250 2.178 8.714 17.836

3 1.823 7.292 35.542 1.823 7.292 35.542 2.143 8.573 26.408

4 1.671 6.684 42.226 1.671 6.684 42.226 2.061 8.243 34.652

5 1.581 6.326 48.552 1.581 6.326 48.552 2.000 8.000 42.651

6 1.438 5.751 54.303 1.438 5.751 54.303 1.825 7.300 49.951

7 1.219 4.877 59.180 1.219 4.877 59.180 1.677 6.708 56.659

8 1.171 4.683 63.863 1.171 4.683 63.863 1.525 6.101 62.760

9 1.029 4.116 67.979 1.029 4.116 67.979 1.305 5.219 67.979

10 .895 3.580 71.559

11 .850 3.399 74.958

12 .779 3.115 78.073

13 .706 2.825 80.899

14 .642 2.570 83.469

15 .588 2.351 85.819

16 .515 2.062 87.881

17 .496 1.983 89.864

18 .454 1.814 91.678

19 .413 1.651 93.329

20 .365 1.458 94.787

21 .330 1.318 96.106

22 .280 1.120 97.226

23 .240 .961 98.187

24 .232 .930 99.116

25 .221 .884 100.000

Extraction Method: Principal Component Analysis.

Table 4: The 5-factor construct , factor load of each item and the scores of Cronbach's alpha coefficient

Factors name Items Factor Loadings α

Communications dimension 1 How is your relationship with the midwifery team (faculty, trainers, and faculty members)? 0.734 0.73

2 How is your relationship with midwife colleagues at other health care centers, organizations, etc.? 0.667

3 How is your relationship with midwives working in the NGO sector? 0.661

4 How is your relationship with GPs? 0.591

5 How is your relationship with gynecologists? 0.587

6 How is your relationship with pediatricians? 0.551

7 How do you relate to those around you and ordinary people? 0.476

Professional dimension 1 Does midwifery meet the economic needs of a middle-aged person? 0.597 0.85

2 How is job security in the midwifery profession in terms of the labor market? 0.597

3 What is midwifery occupational safety? (Protecting employees from wage and salary fluctuations and eventually losing their jobs) 0.552

4 What is the flexibility of a midwife's work hours? 0.537

5 Do you think it is possible to improve practical skills in the midwifery profession? 0.536

6 How much can you use your knowledge and skills in service delivery? 0.522

7 In your opinion, how much is your workload compared to the working time during each shift? 0.510

8 How useful is the midwifery profession's usefulness in a midwife's life? 0.481

9 How much time can you upgrade your professional knowledge and skills? 0.463

10 How much can you upgrade your professional knowledge and skills in terms of available resources? 0.417

Responsibility dimension 1 How are you responsible in the midwifery profession? 0.646 0.96

2 How much do you have responsibility for your career after the end of your shift? 0.566

Physical-Mental dimensions 1 How much do you want to stay in the midwifery profession in the future? 0.554 0.98

2 How much the midwifery profession affect midwife's mental health? 0.550

3 How much is leisure time in the midwifery profession? 0.464

4 How much the midwifery profession affect midwife's physical health? 0.419

Social dimension 1 How do you evaluate the social status of the midwifery profession in the community? -0.651 0.88

2 How do you evaluate the social acceptance of the midwifery profession in the community? 0.546

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Applied to the manuscript. Line 308-310.This study was confirmed by the Ethics Committee of Ilam University of Medical Sciences. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories.

We will update your Data Availability statement on your behalf to reflect the information you provide.

Applied to the manuscript. Line 298-300.There are no ethical or legal restrictions on sharing a de-identified data set. The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request

4) We noticed you have some minor occurrence of overlapping text with the following previous publication(s), which needs to be addressed:

https://www.jcdr.net/ReadXMLFile.aspx?id=7981

In your revision ensure you cite all your sources (including your own works), and quote or rephrase any duplicated text outside the methods section. Further consideration is dependent on these concerns being addressed.

Applied to the manuscript. Line 97-98. It should be noted that the main researchers in this study have experience in instrument design and psychometrics [14,15].

Reference

14. Taheri S, Tavousi M, Momenimovahed Z, Direkvand-Moghadam A, Tiznobaik A, Suhrabi Z, Taghizadeh Z. Development and psychometric properties of maternal health literacy inventory in pregnancy. PLoS One. 2020 Jun 11;15(6):e0234305.

15. Direkvand-Moghadam A, Delpisheh A, Montazeri A, Sayehmiri K. Quality of life in infertile menopausal women; Development and psychometric of an instrument. J. clin. diagn.2016;10(6): Ic01-Ic05.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

________________________________________

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

________________________________________

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

________________________________________

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

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________________________________________

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Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) (Limit 200 to 20000 Characters)

Please see my attached review

Reviewer #2: in the abstract saying four facters while at discussion , said 5 factors... and not clear with their respective

Applied to the manuscript. Line 37-43.Then, the tool was finalized with five factors, including :1) communication features, 2) professional features, 3) responsibility aspects, 4) physical-mental aspects and 5) social aspects, respectively. After the psychometric process, a specific questionnaire was developed to measure the midwives’ job satisfaction with 25 items which explained a total of 49.95% of the total variance.

rationale for inclusion criteria and experience at least 5 year, but at the result session you included participants who have <5 year experience.

Applied to the manuscript. Line 120-122 and 171-173.In this study, in qualitative phase, the inclusion criteria were; being a faculty member or a midwife with at least 5 years of experience in health centers, hospitals, and counseling centers who were key informants. But in quantitative phase, in order to investigate the construct validity, a cross-sectional study was conducted with the participation of 121 midwives with census sampling. therefore, the inclusion criteria were; all faculty member and all midwife working in health centers, hospitals, and counseling centers that would like to participate in the study, with any level of work experience.

Grammatic and spelling error were there.

It is correct.

Reviewer #3: Development and psychometric properties of midwives job satisfaction instrument : A sequential exploratory study

Thank you for inviting me to review this manuscript. Please see my comments as follows:

This study has some grammatical and typo errors and should be revised by an expert person in the field of English literature.

Abstract

1.Is this a study to evaluating job satisfaction of Iranian midwives? If so, please mention in the title.

Applied to the manuscript. Line 1-2.Development and psychometric properties of Iranian midwives job satisfaction instrument : A sequential exploratory study

2.Results: authors stated that derived four factors, but they mentioned six factors.

Applied to the manuscript. Line 38-43.Then, the tool was finalized with five factors, including :1) communication features, 2) professional features, 3) responsibility aspects, 4) physical-mental aspects and 5) social aspects, respectively.

3.While authors designed a 58-item questionnaire, how they stated that used a 25-item questionnaire for psychometric evaluation?

Applied to the manuscript. Line 37-43.The initial questionnaire was 58 items, which reached 25 items in the validity and reliability stages by removing the items in different stages.

Methods

1.As this study was development and psychometric evaluation of questionnaire, I am concerning about the name of “mix method study”.

Applied to the manuscript. Line 103-110.This research started with a qualitative study and continued with a quantitative study. This method was introduced by Creswell and Plano Clark as one of the five main types of mix method studies (16). The sequential exploratory study is divided into two types of theory design and instrument design. The present study is a tool design study (17). To build a tool, we need to understand the concept of job satisfaction by using the experience of participants. Having a conceptual framework is the first step in designing a tool. Therefore, the qualitative part of the study was designed and implemented to design the tool, and then its psychometric property was confirmed in a quantitative study.

16. Creswell JW, Plano Clark VL. Designing and Conducting Mixed Methods Research. 2007.

17. Creswell J W, Clark V L. P. Designing and Conducting Mixed Methods Research, SAGE.2014.

2.What was the first question to start interview?

Applied to the manuscript. Line 124-128.The first question to start interview was: “What comes to mind when you hear the word job satisfaction? As the study progressed, additional questions or new questions were asked from the interviewees. Exploratory questions such as: "What do you mean?" or "If you can please explain more" or Please explain to me? or Please tell me about your experience were also used in the interviews as needed

3.Who conducted the interviews? How long was the length of each interview?

Applied to the manuscript. Line 129-131.The interview was conducted by the researcher. The duration of each interview was between 45 to110 minutes, depending on the amount of information, participation, and cooperation of the participants.

4.Who were the 10 experts that evaluated the tool?

Applied to the manuscript. Line 158-159.In order to evaluate the qualitative content validity, 10 experts in gynecology, midwifery, reproductive health, maternal and child health, health education participated.

5.Who were 10 midwives that completed the questionnaire for test-re-test study?

Applied to the manuscript. Line 181.To determine the stability of the questionnaire, 10 midwives (faculty member and midwife working in health centers, hospitals, and counseling centers) participated. They were asked to complete the final questionnaire twice, at an interval of 2 weeks.

Results

1.In the results section of abstract, authors stated that they developed four items for the questionnaire and in the main text they mentioned five factors.

Applied to the manuscript. Line 37-43. Then, the tool was finalized with five factors, including :1) communication features, 2) professional features, 3) responsibility aspects, 4) physical-mental aspects and 5) social aspects, respectively. After the psychometric process, a specific questionnaire was developed to measure the midwives’ job satisfaction with 25 items which explained a total of 49.95% of the total variance.

2.Please report the characteristics of participants in both qualitative and quantitative parts of the study.

Applied to the manuscript. Line 18-191.In qualitative phase, in total, 10 expert person aged 27- 45 years participated in this study. The lowest work experience was 5 years and the highest work experience was 26 years. The participants’ current tasks of the participants were included two supervisors, two staff, two Training, two health service provider, one gynecologist assistant and one clinic staff.

Applied to the manuscript. Line 202.In quantitative phase, in construct validity, Demographic data for the sample are presented in table 1.

Tab 1 Demographic characteristics and other factors related to job satisfaction in midwives

Variable N(%)

Age (years) Less than 25 29(23)

25-30 19(15)

31-35 9(7)

36-40 17(14)

More than 40 47(38)

Marital status Single 35(30)

Married 85(70)

Work experience (years) Less than 5 47(39)

6-10 8(6)

11-15 21(17)

More than 16 44(36)

Current task Supervisor 3(2)

Staff 10(8)

Therapist 56(46)

Training 8(6)

Health service provider 25(20)

Clinic staff 5(4)

Gynecologist assistant 4(3)

Administrative department 10(8)

Discussion

1.The first and second paragraph of discussion are repetition of what authors wrote in background. Please revise them.

It was correct.

Applied to the manuscript. Line 225-233.The purpose of this study was to design and evaluate the validation indexes of a questionnaire for measuring job satisfaction in midwives. The initial questionnaire was designed based on data extracted from qualitative study of midwives, using expert opinions and reviewing existing studies in job satisfaction. After completing the validity and reliability stages, job satisfaction in midwives questionnaire was developed with 25 questions in four dimensions, which was completed by the participants. Considering that the majority of participants completed the questionnaire in 10 minutes, this tool could be easily used in screening. The findings of this study showed that, the job satisfaction in midwife’s questionnaire had accepted validity and reliability.

2.Why authors compared their designed questionnaire with those designed in African countries, and why not with European or other developed countries?

Applied to the manuscript. Line 247-250.In our extensive search through literature, we only found two studies that have been done to design and psychometric job satisfaction tools in Iranian physicians and nurses [14,15], and no tool was found to assess job satisfaction of Iranian and European midwives.

Conclusion

1.In the discussion section authors claimed that they found five factors, and here they report four factors.

Applied to the manuscript. Line 282-285.Our study showed that, Iranian midwives’ job satisfaction consists of five main factors, including communications, professional features, responsibility, and physical, mental and social aspects. We recommend the use of present questioner as a valid tool for evaluating the job satisfaction of Iranian midwives.

References

Please use the abbreviation form of journals in all references. Applied to the manuscript. Line 327-384.

References

1. Khavayet F, Tahery N, Alizadeh Ahvazi M, Tabnak A. A Survey of Job Satisfaction among Midwives Working in Hospitals. JMRH. 2018;6(1):1186-92.

2. Lu AC, Gursoy D. Impact of job burnout on satisfaction and turnover intention: do generational differences matter?. JHTR. 2016 Feb;40(2):210-35.

3. Liu D, Mitchell TR, Lee TW, Holtom BC, Hinkin TR. When employees are out of step with coworkers: How job satisfaction trajectory and dispersion influence individual-and unit-level voluntary turnover. Acad. Manag. Ann.. 2012 Dec;55(6):1360-80.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes: Prof Parvin Abedi

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Submitted filename: Response to Reviewers.docx

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24 Sep 2021

2 Dec 2021

_HI,

Thank you for your valuable suggestions.

_______________________________________

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: Thanks for invitation and giving extra time.

in th e Abstract some spelling error...like Crass sectional to be cross sectional. It was corrected. Abstract section. Line 31 and 32.

Reviewer #4: I want to thanks for getting this chance to review your document. I have got it well written and interesting topic. However, it is better to consider the following issues.

• It is better to take the last sentence of the first paragraph to the end of background section. It was corrected. background section. Line 56.

• In phase I: why being a faculty member or a midwife with at least 5 years of experience included? Why 5 year is selected? Why not more or less? In the explanation it should be said that According to the work experience of researchers and also consulting with experts in this field and according to the specific issue of job satisfaction in order to obtain the best results from the qualitative section of key informants, the inclusion criterion of at least 5 years of work experience was considered.

• Ethical statement is described in two place, in method section and in declaration section. Please avoid one of it based on journal format. It was corrected. Acknowledgments section. line 349.

• The discussion section is not in line with objective and findings. The second paragraph of discussion is typically background. The study used in the fourth paragraph of the discussion has no the same objective with your study. Therefore, it is impossible comparing these two study. the discussion have no justification for the similarity and difference occurred with other studies.

�  Overall, the discussion is somewhat seems poor, try two modify it.

Dear Reviewer

Hi, we tried very hard to write a worthy discussion, even though there was no tool for job satisfaction in the midwifery group and only one manuscript in the medical sciences in the field of tools. We hope it is satisfactory. It was corrected. Discussion section. Line 231-319.

• The sum of participants in table 1is not 121. Some are 120 some are 121. Why this difference occurred? . It was corrected. Table 1. line 405.

Reviewer #5: Thank you so much o give me an opprtunity ti re-review the study. the authors have perfomed the corrections carefully.

thre are only two comments: 1) I think it is better to report alpha cronbach for each domain not total. It was corrected. result section. line 214-216.

2) it ould be good if the authors put the persian of questionre as supplemntry file. Applied to the manuscript. It was placed in the supplementary part.

Good luck

________________________________________

Submitted filename: Response to Reviewers.docx

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4 Jan 2022

Development and psychometric properties of Iranian midwives job satisfaction instrument ( MJSI) : A sequential exploratory study

PONE-D-21-09782R2

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14 Jan 2022

PONE-D-21-09782R2

Development and psychometric properties of Iranian midwives job satisfaction instrument( MJSI) : A sequential exploratory study

Dear Dr. Taheri:

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