Hannah Gallivan
School of Psychology
University College Dublin

Joan Tiernan
School of Psychology,
Newman Building,
Belfield,
Dublin 4

T: 01-716 8587
E: joan.tiernan@ucd.ie

Précis
Differences in perceptions of the IDA are evident due to gender, practice type, loyalty and satisfaction. Members identified factors inhibiting and facilitating engagement in the Association.

Abstract
Statement of the problem
Many members in the IDA are not actively involved in the Association. Therefore, despite representation being a key function of the IDA, members are not equally represented in the Association.

Purpose of the study
This study aimed to examine IDA members’ views, with a view to identifying changes that might enhance the members’ active engagement.

Materials and methods
A self-report questionnaire was developed following an analysis of interviews and a focus group with IDA members. The IDA distributed the questionnaire to its members by email.

Results
Survey participants (N=240) consisted of 128 male IDA members, 79 female IDA members, and 33 participants who did not report their gender. Analysis yielded differences in terms of perceptions of the IDA due to gender, practice type, loyalty and satisfaction. Key inhibitors of engagement identified include: communication barriers; family commitments; feeling as though time spent involved is unproductive; and, the perception of an old boys’ club. Key facilitators of engagement identified include: representation; continuing professional development (CPD); social interaction; and, support.

Conclusions
While differences in terms of perceptions of the IDA were observed in the analysis of gender and practice type, the most profound differences were observed between loyal and less loyal participants, and between satisfied and dissatisfied participants.Loyal and satisfied participants were generally more positive about all aspects of the IDA than less loyal and dissatisfied participants.The IDA should target inhibitors of engagement as identified by less loyal and dissatisfied members.It may be useful to firstly address communication barriers in the IDA in an attempt to increase membership engagement.

Introduction
Levels of employee/membership engagement have been found to have significant consequences for both individuals and organisations; job satisfaction, autonomy and organisational success have all been linked to this construct.1,2 The Irish Dental Association (IDA) seems to be witnessing a lack of engagement among many of its members; only 42% of current/lapsed members reported active involvement in the IDA, with only 19% of members reporting an interest in future involvement.3 In addition, current engagement patterns are not indicative of membership; members are not equally represented at committee and group level in terms of gender, geographical location, professional status or age.3 Given that the number one reason for the belief that the IDA could meet future challenges was reported by members as being proactive and progressive members, and that members have identified representation as a key reason for joining the Association,3 there is a need to identify the roots of this problem and to change the current engagement pattern.

In order to create change in an organisation, an understanding of the collective thought processes informing behaviour needs to be achieved;4 this suggests that bi-directional communication is required for organisational change. Bi-directional communication is often complicated by the existence of subcultures in organisations.5 Various subcultures exist in the IDA in terms of geographical location, gender and practice type.3 Furthermore, the dental profession is rapidly becoming more feminised; in 2008, 33% of registered dentists were female, versus 60% of those who graduated from dentistry in Ireland in the same year.6 As profiles within an organisation change, so might collective thought processes. For instance, different gender norms have been documented in dentistry – women tend to work fewer hours than men and are more likely to work in public practice than private practice.3 In addition, research suggests that male dental students are more motivated by self-employment and business-related factors, while female dental students are more motivated by people-oriented motives.7 Female dentists are also more likely to take career breaks and plan to retire earlier than their male counterparts.8 However, one cannot generalise across organisational cultures.

If cultural transformation is to improve the efficacy of a service (or, in the present study, to increase engagement in an organisation), then participants must be asked what such terms mean to them;4 it cannot be assumed that such definitions are known or that each participant would define such terms in the same way. Literature suggests that change is not easily brought about by top-down demands9 – the motivations, needs and fears of members at all levels must be considered.

Thus, the present study aims to investigate the views of both male and female dentists in terms of engagement in the IDA, with a view to understanding what needs to change in order to enhance the active involvement of members. This study will be carried out using a mixed methods approach. Differences in perceptions of the IDA will be examined in terms of gender, practice type, loyalty and satisfaction.

Method
Interviews and a focus group were carried out with nine IDA members and one member of the management team at IDA House. The purpose of this was to get a general overview of the issues surrounding engagement in the IDA, from as representative a sample as possible. From the analysis of the interviews and focus group, a self-report questionnaire was developed, which incorporated the central themes that had arisen in order to see whether or not these themes would be confirmed by the majority of IDA members, and to assess whether or not there were any key issues surrounding engagement that had not been previously mentioned by participants.

The survey included a section on demographic information (16 items), in addition to the following 13 scales:

• information flow (four items, e.g., “I get enough information I need from the IDA to be a good practitioner”);
• teamwork (six items, e.g., “the people on Board/Council are concerned about each other”);
• meetings (five items, e.g., “decisions made at meetings [branch, subcommittee or others] get put into action”);
• morale (eight items, e.g., “the IDA respects its members”);
• organisational culture (25 items – the total score for information flow, teamwork, meetings and morale);
• involvement (two items: “I have been asked to be involved in IDA committees or groups”);
• identification with the IDA (eight items, e.g., “I am proud to be a member of the IDA” – all items on the above-mentioned scales were answered on a five-point scale from “strongly agree” to “strongly disagree”);
• work–life balance (five items, e.g., “the demands of work interfere with my home, family or social life” – all items answered on a four-point scale from “never” to “almost always”);
• perceptions of the IDA – barriers (15 items: “hierarchy is very important in the IDA” – all items answered on a five-point scale from “strongly agree” to “strongly disagree”);
• perceptions of change (15 items, e.g., “involve more women in the running of the IDA” – all items answered on a three-point scale from “definite need to change” to “no need to change”);
• perceptions of meetings in the IDA (six items, e.g., “most meetings are a waste of time” – four items answered on a five-point scale from “strongly agree” to “strongly disagree” and two-items answered on a five-point scale from “very effective” to “very ineffective”);
• overall satisfaction with the IDA (30 items, e.g., “support for new graduates” – all items answered on a five-point scale from “very satisfied” to “very dissatisfied”); and,
• training (eight items, e.g., “business training for dentists” – all items answered on a four-point scale from “yes definitely” to “don’t know”).

In total, there were 128 items in the survey.

Having obtained consent from the appropriate ethics board (TMREC-SPsy, Ethics Reference number: 20117), a pilot study was carried out for the quantitative questionnaire using four participants who were not used in the actual study. The pilot study confirmed that participants understood the questions that they were being asked and identified necessary changes to the survey. Additionally, the pilot provided an estimation of the time required to complete the questionnaire.

Researchers created a web link to the survey using the ‘Survey Monkey’ online software tool. The IDA emailed the survey link to 1,237 of its members on April 17, 2012. Two reminder emails were sent out by the IDA (one approximately two weeks later, and the other approximately four weeks later) to encourage members to complete the survey if they had not already done so. After six weeks the survey was closed. At this point, 240 participants had responded out of the 1,237 members that had been emailed – a 19.4% response rate. One hundred and twenty eight participants were male and 79 participants were female; 33 did not report their gender.

Survey data was analysed using SPSS software. Having assessed the demographic information of participants and the reliabilities of each of the survey scales (which all had a Cronbach’s alpha coefficient above 0.7 and therefore were deemed reliable), principal component analysis (PCA), Pearson’s r correlations, a one-way non-repeated ANOVA, and a series of one-way independent t-tests were carried out to address the research aims.

Results

JIDA_Dec2012-Jan2013_JIDAComparison of qualitative and quantitative themes
All items in the IDA survey (apart from demographic items) were subjected to PCA. The purpose of this analysis was to assess whether or not the themes that arose in the qualitative data (the interviews and focus group) would also be identified in the quantitative data (the survey). PCA revealed seven components/themes that corresponded with the themes that had emerged from the qualitative data. Thus, using two different methods, similar results were observed. (Table 1)

Examination of differences between participants with regard to gender, practice type, satisfaction and loyalty
A series of analyses (a two-way ANOVA and independent t-tests) were carried out to examine differences between groups.Only significant results will be presented in this paper.

Gender differences

Perceptions of the IDA – barriers
T-test analyses observed gender differences with respect to perceptions of barriers in the IDA (Table 2). Many of the differences observed between males and females lay in the extent of agreement/disagreement, i.e., both males and females responded to items in the same direction but one group agreed/disagreed significantly more so than the other group.

Practice type differences
There were three groups of participants with regards to type of practice – public practice (HSE: 11.7%), private practice (71.3%) and other public service (2.5%). The study aimed to assess these groups, as far as possible, in equal measure, so that they could be compared. Thus, due to the small proportion of participants reporting to be in other public service, this group was removed from the analysis so as not to skew results. Private practice participants (109 males and 55 females) and public practice participants (eight males and 20 females) remained.

 Training
A two-way non-repeated ANOVA revealed a significant interaction between practice type and gender on need for training in the IDA (F(1, 188)=9.991; p<0.05). In order to locate the source of this disordinal interaction, tests of simple effects (TOSE) were conducted.

Analysis revealed that female participants in private practice reported the greatest need for training, followed by male participants in public practice, then followed by male participants in private practice and finally by female participants in public practice. On the whole, those in private practice reported a greater need for training than did those in public practice, and male participants reported a greater need for training than did female participants. This appears to be in line with themes that arose in the qualitative analysis – that males need the IDA to counteract isolation in their work. Training may be viewed as both informative and social by this group (Table 3).

Work–life balance
In terms of work–life balance, t-tests revealed that although both public practice and private practice participants reported having “more to do than they can handle comfortably” and that they “always seem to be serving someone else’s agenda”, those in public practice did so more often than did private practice participants (Table 4).

Perceptions of the IDA – barriers
T-test analyses found significant differences between public practice participants and private practice participants with respect to the five barriers. With the exception of the item “the IDA is biased towards private practice”, differences here lay in the extent of agreement/disagreement (i.e., both public practice and private practice participants responded in the same direction). 

Differences with regard to satisfaction and loyalty
Frequency analysis
The majority of participants reported being loyal to the IDA (67.1%, n=161) as opposed to being less loyal to the IDA (28.3%, n=68).

Similarly, the majority of participants reported being satisfied with the IDA (56.7%, n=136), as opposed to being dissatisfied with the IDA (29.2%, n=70).

JIDA_Dec2012-Jan2013_JIDA

Totalled scales
T-tests revealed significant differences between satisfied and dissatisfied participants for each of the totalled scales apart from training. Examination of the means shows that, apart from the perceptions of change scale, satisfied participants scored higher than did dissatisfied participants on all of these scales. Higher scores are indicative of more positive perceptions of the given scale.

Work–life balance
Significant differences were observed between groups with respect to “the demands of work interfere with my home, family or social life”, “my work life has a negative impact on my family or social life”, “I have a good balance between my job and my family life” and “I always seem to be serving someone else’s agenda”. Examination of the mean scores indicates that both groups responded in a similar range – between two (“some of the time”) and three (“a lot of the time”).

Involvement
T-test analyses reveal significant differences between groups with respect to both “I have been asked to be involved in IDA committees or groups”, and “I have a say in the decision making in the IDA”, as illustrated in Table 5. Looking to the means, satisfied participants had higher scores than dissatisfied participants on both of these items.

JIDA_Dec2012-Jan2013_JIDA

Perceptions of the IDA – barriers

T-test analyses found significant differences between satisfied and dissatisfied participants with respect to nine barrier items (Table 6). Examination of the means show that on some of these items the differences observed lay in the extent of agreement/disagreement – both satisfied and dissatisfied participants responded in the same direction.

JIDA_Dec2012-Jan2013_JIDA

Perceptions of meetings
Significant differences between groups were observed with respect to all items on the perceptions of meetings scale. Examination of the mean scores indicates that both satisfied and dissatisfied participants responded to each of these items in the same direction; differences observed lie in the extent of agreement/disagreement.

Differences with regard to loyalty
Analyses revealed very similar differences between loyal and less loyal participants as those observed between satisfied and dissatisfied participants, with loyal participants generally reporting more positive perceptions on each of the scales than less loyal participants. Thus, these results will not be presented here.

Discussion

Research aims and results
This study aimed to identify the factors facilitating and inhibiting engagement in the IDA. In order to achieve this, researchers examined differences between IDA members in terms of gender, practice type, satisfaction and loyalty with regard to various aspects of the Association. The ultimate objective of the current study was to identify possible changes the IDA could make in order to enhance membership engagement.

Factors identified as inhibitors of engagement in the qualitative analyses include: poor communication between the IDA and its members; perceptions of an old boys’ club; members feeling too intimidated to become involved; gender differences; time commitment; family commitments; and, feeling that time spent involved is wasted and that meetings are badly run. Factors identified as facilitators of engagement in the qualitative analyses were: the role of the IDA in representation; social events in the IDA; support from the IDA; provision of information about dentistry; educational opportunities and, CPD.

Analysis found that loyal and satisfied participants reported more positively in terms of information flow, meetings, teamwork, morale and satisfaction, some of the work–life balance items, and the involvement items, than did less loyal and dissatisfied participants. Both less loyal and dissatisfied participants reported that they had not been asked to be involved in the IDA. Few differences were observed in terms of gender and practice type. However, males and private practice participants wanted training more so than females and public practice participants. Female participants reported that the IDA is biased towards private practice, whereas male participants did not agree. Similarly, public practice participants reported that the IDA is biased towards private practice while private practice participants disagreed. Public practice participants also reported more negatively in terms of work–life balance than private practice participants. Perceptions of barriers observed confirmed qualitative data observations – key barriers identified include communication issues, hierarchy, having too few women in the IDA, family commitments and perceptions of biases in the IDA.

Results in light of previous literature
Both less loyal and dissatisfied participants indicated that they had not been asked to be involved in the IDA. Much of the previous research on engagement identifies factors such as being involved in decision making, having a sense of significance, having one’s opinion heard and being attended to as a unique individual as key antecedents to engagement.2,10 If members of the IDA are not being asked to get involved, additional opportunities for these antecedents to occur are very limited and thus, this is a barrier that needs to be addressed.

Although few gender differences were identified in the current study, the differences that were observed are consistent with previous literature. For instance, the current study found that female participants disagreed significantly less than males with the item “the IDA is really just a boys’ club”. Given that more males are currently involved in the IDA than females,3 a perception of an old boys’ club may be attributed to ‘cross-cultural’ communication differences between men and women.11

As women are more likely to work in public practice while men are more likely to work in private practice,3 findings that female participants and public practice participants agreed that the IDA is biased towards private practice, while male participants and private practice participants disagreed, that females and public practice participants agreed more than males and private practice participants with the item “the AGM caters more for the interests of private practice dentists”, and that private practice participants but not public practice participants felt that general practice is not represented in the IDA, are indicative of potential biases in the data. Thus, these results must be interpreted cautiously.

Research that has highlighted representation as a key driver for IDA recruitment3 is supported by findings that both male and female participants (females more so) want more women involved in the running of the IDA, and that both public practice and private practice participants (public practice more so) want the IDA to be more involved in advocacy. Furthermore, previous research identified the improvement of public relations as one of the top two most wanted improvements in the IDA3 – the current study found that both male and female participants (females more so) thought the IDA should use its budget for media campaigns on the importance of dentistry for overall health.

In terms of work–life balance, it may be the case that gender differences are less pronounced than the literature suggests.12 Although females agreed more than males that having a family makes it harder to attend meetings and CPD events, male participants also agreed with this item, regardless of practice type (although public practice participants agreed more than private practice participants). Thus it would seem that family commitments pose a barrier to involvement for IDA membership in general, rather than for a particular group (namely females).

Findings from qualitative analysis are supported by the finding that male participants reported to want training more so than did females. Interview data suggested that male members value and need the social aspects of the IDA more than females do. Thus, the fact that training is also an opportunity to meet and socialise with colleagues may explain this gender difference. It is interesting that within public practice (which is dominated by females), males reported a greater need for training, while in private practice (which is dominated by males), females reported a greater need for training. Perhaps communication differences between men and women11 render the ‘minority’ gender in a given practice type feeling somewhat inferior and thus, wanting more training. Of course, it could also be argued that once again training is viewed as a means of social interaction and that the ‘minority’ gender in a given practice type sees it as an opportunity to meet more same sex colleagues.

Communication as a barrier is another finding from the survey, which supported the data from the interviews and focus group. Neither loyal nor less loyal participants agreed that there is bottom-up communication in the IDA; less loyal and dissatisfied participants agreed that communication is all top-down and disagreed that the IDA is good at listening to the needs of its members. In addition, dissatisfied and less loyal participants agreed that the IDA is just a boys’ club and that decisions are made by the ‘Dublin brigade’ – it may be that these participants do not feel as though they are making a contribution to the IDA, which analysis of the qualitative data found to be of importance for engagement. Finally, it should be noted that both satisfied and dissatisfied participants agreed that there are too few women involved in the running of the IDA. This reflects themes from the qualitative analysis, which highlighted the need for the IDA to cater to its membership profile; participants emphasised the need to better facilitate women and young graduates in the Association.

With regard to meetings, results from the survey are not in line with the interview and focus group data. Survey participants agreed that meeting preparation and the chairing of meetings is effective, that work gets done at meetings and that work is the priority at meetings, and disagreed that most meetings are a waste of time and that meetings tend to be more about socialising than about getting the work done. Although there were differences observed between loyal and less loyal participants, as well as between satisfied and dissatisfied participants, these differences lay in the extent of the agreement – all groups agreed on the direction of the item (whether in agreement or disagreement). Qualitative analysis, on the other hand, observed that meetings are unproductive, are poorly run and take up too much time. Thus negative perceptions of meeting in the qualitative data cannot be generalised across IDA members.

 

Methodological strengths and weaknesses
A key strength of this study is the mixed methods approach used. A mixed methods approach combines the strengths of both qualitative and quantitative analyses.13 Another strength of the current study lies in the strong reliabilities observed on each of the survey scales. This allows researchers to be confident that scales measured what they were intended to measure. In addition, a cultural, bottom-up approach was used. Literature suggests that organisational culture allows for the engagement of an organisation on a level of meaning4 – it was the members of the Association themselves who determined the results of the study.

However, the unequal sizes of groups being compared (e.g., there were many more male participants than female participants) may limit just how far results can be generalised. In addition, all data collected in the current study was based on self-report, thus both intentional and unintentional distortions are possible. Likert type measures (as used in the survey) may lead to inaccurate spontaneous answers, if the participant is not sure of their response and feels under pressure to come up with an answer.14

Suggestions for change
Themes identified in this study suggest that interaction between members greatly influences culture in the IDA. Communication was identified as a barrier to engagement throughout this study (in interviews, the focus group and the survey). It has been suggested that bi-directional communication is necessary for organisational change.4

Thus, in an effort to increase membership engagement, communication could be the most important issue to address in the IDA. A number of small changes could be made to enhance communication, for example, emphasising the services available to IDA members, asking members directly to get involved in the Association, actively trying to recruit female members and young graduates, acknowledging the contribution of engaged members, offering communication training for members, increasing public relations, and putting formal and structural mechanisms in place for two-way communication.

Conclusions
Key factors identified as influencing engagement in the IDA include hierarchy, time constraints, work–life balance, perceptions of an old boys’ club, communication and training. In addition, a number of differences were found between loyal and less loyal members and between satisfied and dissatisfied members. Few differences were observed between male members and female members or between public practice members and private practice members. Nevertheless, all significant differences provide useful information about the culture of the IDA and how to enhance engagement, as conceived by members themselves. Communication was identified as the area to focus on, firstly with regard to adjusting the culture in the IDA so that engagement can be better facilitated.

Future research should address the methodological weaknesses described above and examine engagement in other dental associations or in similar associations so that more comparative analyses in this area of research could be made.

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