Caspian Journal of

Introduction
Job satisfaction is used to measure how content an employee is with the job [1]. High job satisfaction can improve the enthusiasm of the staff and is beneficial to the success and progress of the organization. It can lead to lower turnover [2] and high-quality services [3]. Healthcare staff with low job satisfaction may suffer from medical problems themselves [4] and health of individual employees may influence the overall stability of the healthcare staff [5]. Dissatisfied employees are more likely to leave the organization, and as a result, the remaining employees may engage in counterproductive activities such as low-quality service and cause damage to equipment [6].
Job satisfaction is defined as harmonizing the people’s understanding of needs and what they receive from their jobs and is recognized as one of the most important research variables belonging to organizational behaviors and also as a crucial variable in the organization’s researches and theories [7]. Improving the quality of health services is a continuing challenge to managers in the health system [8]. As a matter of fact, the job satisfaction of health care employees is a very important factor that has a profound impact on productivity as well as on the quality of patient care [9]. Job satisfaction has a direct link with absenteeism and turnover of the staff in organizations [10]. The issue of job satisfaction has always been considered as a problem in organizations. In a way that up to the year 1980, more than 4000 articles have been published concerning this issue [11].
There are several factors associated with job satisfaction. A survey conducted by Maissiat et al. [12] indicated that job satisfaction was associated with professional accomplishment, freedom of expression and appreciation. An investigation undertaken by Atif et al. [13] revealed that age, educational background, years of service, and income were significantly associated with job satisfaction among physicians.
The factors that impact job satisfaction are often categorized into extrinsic and intrinsic ones [14]. Intrinsic factors are related to the work itself (such as the ability to develop one’s skills, sense of autonomy, success, achievement and control); whereas extrinsic factors are not directly related to the work itself (such as, salary and relationships with colleagues) [14, 15]. 
A systematic review in Saudi Arabia showed a very low job satisfaction among healthcare workers that highlighted the need to adopt intervention strategies to improve job conditions in the health settings [16]. 
Since there was no comprehensive study to aggregate the study findings on job satisfaction among healthcare workers in Iran, this systematic review was aimed to synthetize the findings of relevant studies with the two following main research objectives; 1) Assessing the status of job satisfaction in different groups of health professions and 2) Determining the factors related to job satisfaction Among health care workers.

Materials and Methods
In this systematic review, Embase, Magiran, Web of Science, Scopus, PubMed, PsycINFO and Google Scholar databases were searched during the years 2000-2022 with the keywords in 4 main categories that are presented in Table 1.



Exclusion and inclusion criteria of the studies
Population: Only studies which conducted on personnel working at healthcare sectors were included. Personnel working in nontherapeutic and administrative departments were excluded from the study. Intervention: All included studies were observational and no intervention was performed. Outcome: Studies that do not have the outcomes of the study (job satisfaction) or have examined unrelated outcomes were excluded. Study design: Observational studies either as cross-sectional or correlational design that was published in Persian and English during the years 2000 to the end of 2022 were included. Commentary, letter, and editorials studies were excluded. 

Study selection and data extraction
The title and abstract of all studies searched by key words were screened according to the inclusion and exclusion criteria. The reason for exclusion is presented in the PRISMA flowchart (Figure 1). After final identification, the required data including citation, place of study in Iran. population, study desing, and main finding related to job satisfaction and related factors.

Quality assessment
The modified Newcastle–Ottawa scale based was used to determine the quality of studies according to selection, comparability, and outcome. The maximum overall score was 10 including a maximum score of 5 for selection, 2 for comparability, and 3 for outcome.

Results
Based on the inclusion criteria, 125 articles were identified, of which 8 articles were evaluated and analyzed. All studies were conducted between 2000 and 2022 and were related to the job satisfaction of Iranian health care workers. The characteristics of included studies are presented in Table 2.



Status of job satisfaction
The findings by Mosadegh Rad showed that hospital employees were moderately satisfied with their jobs [17] In the study by Asghari et al. the mean score was 54.43±10.54 out of 75 and 63% of nurses had moderate job satisfaction. Most of the participants with high job satisfaction were in supervising positions (75%) [18]. The average job satisfaction score among the health care staff in Khomeinishahr health network (centers, building, and network home) in the study by Daniali et al. was 43.49±13.1 out of 100 [19]. Among midwiferies, the mean score of job satisfaction was 44.75±16.43 (out of 100), job satisfaction was classified as 23.8% low, 69.5%moderate and 6.7% high. The utmost satisfaction was among supervisor (61.9%) and the most reason of grievances were both salary (83.8%) and job promotion (57.1%) [20].

Factors related to job satisfaction
The findings indicated that; salaries, benefits, promotion, contingent rewards, interpersonal relationships and working conditions were the best predictors of job satisfaction among hospitals’ employees. Specific job satisfaction dimensions indicated that highest dissatisfaction levels occur in the area of benefits, contingent rewards, communication, salaries, work conditions and promotion. Areas of dissatisfaction were signals for change [17].
The findings indicated that; the prevailing place was for Job security with an average 4.39 and then followed by a suitable salary with an average 4.38 of 5 scores. Among multinational’s factors, job responsibility with an average of 4.38 and job interest with an average of 4.38 were placed as the most important factors in employees’ performance. Seventy one percent of employees mentioned that two factors of suitable salary and job security are the most important obstacle for improvement of employee’s performance [21].
Among midwiferies, there was a significant relationship between total job satisfactions with all that aspects. In this study, there was no significant relationship between total job satisfactions with factors including age, job experience, education and marital status. Although; there was a statistically significant relationship between total job satisfaction with salary and employment status (P<0.05) [22].
The findings indicate that; the highest average of the satisfaction was related to satisfaction of coworker’s dimension 4.05±­0.87, and the least average belonged to satisfaction of salary 1.54±0.74. Furthermore, there was positive and statisticant relation between the whole satisfaction and all other five dimensions of the Smith-Kendall-Hullin model. Finally the analysis among two variables (sex and age) and whole job satisfaction had significant relationship [23].
Among personnel of health care centers, the most satisfaction was related to relationship with colleague and the least satisfaction was related to salary and benefits. The mean stress score was 29.21±18.12. Pearson correlation test showed a significant negative correlation between job stress and job satisfaction (r=-0.50, P<0.001). In this study, a significant relationship was found between sex and stress (P=0.01) [19].
The study by Rezaei et al. on 205 nurses from Poursina Medical and Educational Center of Rasht showed significant direct effect of mentoring on job satisfaction; Also, the organizational justice and commitment significantly mediated the relationship between mentoring and job satisfaction [20].
The findings by Salimi et al. indicated significant relationship between organizational trust and job satisfaction. Also, the means of organizational trust and job satisfaction were found to be significantly different among participants in terms of gender, position, affiliation, work experience and qualifications. No difference was found between married and single participants [24].

Discussion
Considering the importance of job satisfaction in the health system and the need to increase job satisfaction among employees, most countries are looking for ways to increase the job satisfaction of employees in these sectors. In Iran, to achieve this goal, some studies have investigated the factors related to job satisfaction. Therefore, the purpose of this study was to investigate job satisfaction and its related factors among Iranian healthcare personnel based on existing studies and literature. In general, there are limited studies evaluating job satisfaction with a few studies focusing on healthcare personnel. In this review, only one out of 8 studies were conducted among personnel of healthcare centers. Given the importance of primary prevention services provided by healthcare personal it is a necessity to conduct more studies on these personnels. Furthermore, most of the studies did not perform multivariate regression model to adjust for confounders [25]. The study findings revealed heterogenous result in the status of job satisfaction according to the study population and place of the study. For example, Mosadegh Rad et al. found moderate job satisfaction among hospital employees [17], while Daniali [19] and Sabooteh [22] using quantitative reports found similar mean score among midwifes and personnel of health care centers. Measurement of Job satisfaction as a subjective concept is greatly influenced by the questionnaire and method of data collection. There was heterogeneity in measurement tools among studies. Mosadegh Rad [17] used jab satisfaction survey, while Daniali [19] and Sabooteh [22] use Job description Index for job satisfaction measurement. Another source of heterogeneity is the place of work in terms of public or private. The inconsistency about job satisfaction among different health and medical care personnel also found in other countries of our region. In a systematic review in Saudi Arabia, job satisfaction was ranged from 92% among nurses to 7.3% among physicians [26]. 
This study revealed different contributing factors for job satisfaction among studies. Mosadegh Rad et al. indicated that Salaries, benefits, promotion, contingent rewards, interpersonal relationships and working conditions are the best predictors of job satisfaction among hospitals employees [17].
Factors affecting job satisfaction included loyalty to employees, job security, good pay, good working conditions, smart discipline, participation, recognition and promotion [17]. About seventy one percent of the employees named the two factors of adequate salary and job security as the most important obstacles for improving the performance of employees [21]. the organizational justice and commitment significantly mediated the relationship between mentoring and job satisfaction. Regarding the findings, it can be expected that nurses’ job satisfaction will increase with improving mentorship in health care organizations. In addition, the supervisors of nursing sections can strengthen their role as an organizational mentor by improving fair and committed job behaviors to enhance the job satisfaction of nurses under their supervision. The implications of these results are discussed with the focus on improving job satisfaction [20]. Another source of heterogeneity is the place of work in terms of public or private. The inconsistency about job satisfaction among different health and medical care personnel also found in other countries of our region. In a systematic review in Saudi Arabia, job satisfaction was ranged from 92% among nurses to 7.3% among physicians [16].

Conclusion
The finding of this systematic review revealed that the mean score of job satisfaction among different types of health-care personnel were similar and had a moderate job satisfaction. Salaries, benefits, promotion, contingent rewards, interpersonal relationships and working conditions were the best predictors of job satisfaction among hospitals’ employees. Specific job satisfaction dimensions indicated that highest dissatisfaction levels occur in the area of benefits, contingent rewards, communication, salaries, work conditions and promotion.

Ethical Considerations
Compliance with ethical guidelines
This article is review with no human or animal sample. There were no ethical considerations to be considered in this work.

Funding
This research did not receive any specific funding from granting agencies nor commercial or not-for-profit sectors.

Authors' contributions
Conceptualization and study design: Amin Amiri, Mahsa Amiri and Mohammad Naderi; Writing and supervision: Amin Amiri and Mohsen Amiri Nia.

Conflict of interest
The authors declared no conflict of interest.

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