Turnover Intention among Staff Who Support Older Adults Living Alone in Japan: A Cross-Sectional Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Authors have conducted a study of turnover intention among staff at community general support centers in Japan. CGSCs have the potential to be an important component of the social safety net to support older adults in Japan, but effective staffing is required. Investigations of staff turnover are important; however, the current manuscript has some important flaws.

 

CONCERNS

1. The authors do not specify how the primary variable (turnover intention) was assessed.

 

2. The first two rows of Table 1 are unclear: The authors should report the actual mean (SD) of age and years of work experience in each turnover intention group, not the N. It is unclear what the p-values for the first two rows are testing.

 

3. Although it is never stated explicitly in the article, the method suggests that the survey contained 15 items (although it is unclear), but only 8 items are reported in Table 2. Importantly, although the text indicates that “difficulty coping with older adults’ declining cognitive function” is reported in Table 2, it is not.

 

4. It is unclear how the nominal variable of “healthcare of social care qualifications” was included in the regression – more explanation of the dichotomization of this variable is necessary.

 

5. Authors could suggest adjustments to training for staff at CGSCs that would prepare staff work with single-dwelling older adults.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The study is very interesting and useful but: 

1) the abstract mentions 183 participants while the text mentions 283 people: what is the correct number?

2) 2.1. data collection: The study participants were 1,002 social workers; care manager supervisors; nurses; public health nurses; and other healthcare, welfare, and long-term care staff working at CGSCs across Japan.
is a misleading figure according to the abstract and the numbers of respondents (283 or 183 yet to be clarified). Clarify.

3) 2.2. write: To ensure its validity, we used a multistage process to develop the questionnaire. What process are we talking about? what did it consist of? explain in detail

4) The discussions are poor. A description of the results found, a correlation with the current literature, etc. is expected. Absolutely expand.

5) The respondents are either 283 or 183. in both cases, the sample is small and should definitely be enlarged but this can also be worked on: the limitation is partly included but I would also go into more detail with statistical analysis because it can be done. That would be good.

6) how was the risk of bias handled by the researchers?

7) Expand the literature and thus the references.

 

Author Response

Please see the attachment.

 

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The study tackles an omnipresent phenomenon of the retention of care staff in formal care provision to older people ageing in place. The literature review is moderate, focusing mostly on Japan. Please expand the review, focusing also on home-care and day centres and studies conducted in other parts of the world. There are studies out there exploring how the care is provided, by whom and what kind of work-loads, payment and cultural issues are related to care provision.  You may want to expand the search to other types of care workers, not only health workers.

 

The abstract could be significantly improved by removing duplicate information and providing specific, more detailed information. Maybe explaining what the prevailing culture of care is in Japan in the first few sentences to make readers aware in what context the study was conducted in.

Abstract:

Rather than repeat in R(rows)11,12» turnover intention, perceived difficulty of supporting older adults living alone, and other variables« X times in the abstract, spell out what other variables were as readers have already familiarized themselves with the purpose of the study.

R12: spell out which multivariate analysis was used

R17 18: we already know that perceived … is significantly linked to turnover intentions (leave the sentence out or rephrase)

Could the staff be supported and not only observed in terms of education and enforcing cultural value of supporting older people to live alone?

 

R 47, 48: this information is now conveyed to readers for the third time – please reduce the repetition throughout the manuscript. “The number of single-dwelling older 47 adults in Japan has increased, highlighting the importance of decision-making support for  those receiving end of life home care.”

 

R97: Spell out what was the procedure of questionnaire development or rephrase “ .. and is described in the following paragraphs..

I think that so many subchapters are too much for short information that is conveyed in 2.2 – 2.3

 

R110 : how many testers is “small number of testers” – spell out the number!

 

2.3. Informed Consent and Data Collection – was there an ethics application? If yes, say it now or explain why this is not custom in Japan.

 

2.4 the survey contents have again too many subchapters. This information belongs to item development subsection (2.2.1)

 

R 134: “adults they were responsible for were capable of living independently” this is very difficult to understand – can you rephrase?

 

It is my personal opinion that the response categories are wrong and there are too little of them. This may be due to translation to English, so please consider:

 

“no,” “a little,” “often,” and “yes”, .. “a little” conveys info about amount, but “often” conveys information about frequency. So this is amiss in terms of what is actually measured –a frequency, an amount or agreement of sort?

 

Chapter 2.6. there is a repetition of informed consent info here, so I would either merge the two subchapters (the informed consent and ethics) together or eliminate info about informed consent from here.

 

Chapter 3.1. Could you explain a bit how the survey respondents are similar or are different from population parameters? Is survey actually representative of population or not?

 

Chapter 4. When you expand the literature review in the introduction, you will be able to have a better and more elaborate discussion. This section is quite short and unimaginative, which is a pity as you bring forward innovative findings and you need to place them better in the literature about ageing, care needs, care provision, and issues related to all of these issues.

 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Authors have responded to concerns and the current manuscript is a significant improvement.

Author Response

We appreciate the reviewer's positive assessment of the revised manuscript.

Reviewer 3 Report

Comments and Suggestions for Authors

The authors have made necessary improvements to the manuscript. Well done!

There is still a minor issue: 

A panel of experts, comprising researchers in public health nursing, home health L 177 - Wow many experts? Give number!

 

Author Response

There is still a minor issue:
A panel of experts, comprising researchers in public health nursing, home health L 177 - Wow many experts? Give number!

We have revised the manuscript based on your comments.

Line 177
A panel of 5 experts,