Adv in Health Sci Educ DOI 10.1007/s10459-014-9505-9
Demographic characteristics of Ghanaian optometry students and factors influencing their career choice and institution of learning Samuel Bert Boadi-Kusi • Samuel Kyei • Khathutshelo Percy Mashige • Emmanuel Kwasi Abu • Daniel Antwi-Boasiako • Abraham Carl Halladay
Received: 16 September 2013 / Accepted: 25 March 2014 Ó Springer Science+Business Media Dordrecht 2014
Abstract Optometry is only provided at tertiary level in two institutions in Ghana, with an average of 50 students graduating each year for a population of approximately 24.6 million. No information on the demography of optometry students and factors that influence their choice of optometry as a career and institution of learning is available. This information is important as it will assist optometry institutions to formulate effective student recruitment strategies. To assess the demographic characteristics of Ghanaian optometry students, the factors that influence their selection of optometry as a career and institution of learning. We conducted a cross sectional study among Ghanaian optometry students using a structured questionnaire to collect data on the demographic characteristics and factors that might influence their choice of optometry as a career as well as choice of institution of learning. Two hundred and eighty students from the two optometry training institutions in Ghana; University of Cape Coast (48.2 %) and Kwame Nkrumah University of Science and Technology (51.8 %) responded to the questionnaire. Their ages ranged from 17 to 28 years with most being males (72.5 %), and the majority (79 %) being from urban areas. The main factors that influenced their career choice were job availability after graduation (90 %) and desire to help other people (89.2 %). Factors that influenced their institution choice were preference for an institution (36.8 %) and proximity to home (24.4 %). In the absence of adequate optometry jobs in the public health sector, women will remain marginalised specifically those in rural areas. This marginalisation is however, a reflection of a broader societal disadvantage for women. Greater effort needs to be made to recruit high school students from rural areas to study optometry and more institutions need to provide optometry instruction throughout the country.
S. B. Boadi-Kusi (&) S. Kyei E. K. Abu D. Antwi-Boasiako A. Carl Halladay Department of Optometry, School of Physical Sciences, University of Cape Coast, Cape Coast, Ghana e-mail: [email protected] S. B. Boadi-Kusi K. P. Mashige Discipline of Optometry, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Keywords
Optometry education Career choice Counselling University Ghana
Introduction Career choices are required by all individuals, often forming in childhood, requiring more thought in adolescence and continuing throughout adulthood (Bandura et al. 2001). With the development of competitive job systems following advances in information technology, deciding on a career has become a complex science, leading to a shift towards individuals pursuing the careers they want, sometimes changing direction. Decisions on career choices are often influenced by multiple factors such as job availability, competition, economic conditions, social issues, family background, academic opportunities, life events and individual motivation (such as personal interest, prospects of good financial remuneration and family influence) (McCord et al. 2008; Pinchot et al. 2008; Mkondo et al. 2007; Bryant et al. 2006; Ohman et al. 2002; Bandura et al. 2001; Ohman et al. 2001). Others factors include enthusiasm, challenges, motivation to help others, the ability to define one’s own personal goals, influence from the media, prestige and status (Bryant et al. 2006). Once a career choice has been made, a number of factors can affect the students’ choice of institution (Ming 2010), including the location of the institution or its proximity to home (Astin 1984; Terenzini et al. 1994). Many students are influenced by parents or relatives, with most parents preferring their children to attend the university they attended, for a number of reasons (Arredondo 1999). The reputation of the institution or academic strength in a certain field may motivate them to influence their wards in choosing it (Servier 1986; Kohn et al. 1976). Higher education in Ghana is mainly provided by the government (public) and private sector. There is a great demand for public higher education institutions due to the relatively low cost (Manuh et al. 2007). Approximately 34.3 % of students in higher education are women (NCTE 2007). With a Gross Enrolment Ratio for men being double that for women, the Gender Parity Index for Gross Enrolment in higher education is 0.48, falling far short of the required equity targets (UNESCO 2006: 126). However, the enrolment of women in higher education institutions has improved over the past 17 years; in 1991 only 21 % of students in Ghanaian universities were women (Effah 2003) compared to the recent enrolment figure of 34.4 % (NCTE 2007). Women participation in higher private education institutions is higher than in public sector institutions, with women making up 41 % of students in private universities (NCTE 2006), compared to 35 % in the public sector (Lugg et al. 2007). Less than 35 % of the students who apply to tertiary institutions are admitted due to growing numbers of qualified secondary school leavers, inadequate university infrastructure and staffing limitations (Manuh et al. 2007). The majority of these students are men from wealthy backgrounds and top second cycle schools (Lugg et al. 2007; Addae-Mensah 2000) in the more privileged cities of the various regions of Ghana. Students who qualify to attend tertiary institutions have the option of pursuing programs of interest based on the courses they studied at the senior high school level. For students who enjoy working with and helping people, they may explore several career options in the health professions, such as medicine, dentistry, pharmacy, nursing and optometry among others. Optometry is considered as having a ‘glamour factor’ and a potentially good income which makes it a more desirable career option as a profession (Farkas 2006). The Doctor of Optometry (OD) degree is a 6 year professional program that is offered by two government institutions in Ghana: Kwame Nkrumah University of Science and Technology (KNUST) located in
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Demographic characteristics
Kumasi and the University of Cape Coast (UCC) in Cape Coast (Randall and Kumah 2004; Ovenseri-Ogbomo et al. 2011). The Doctor of Optometry program trains students to perform comprehensive eye examinations which include the correction of refractive errors, orthoptic assessment, low vision and visual rehabilitation, diagnosis and management of ocular diseases through the use of diagnostic and pharmaceutical agents. There are currently about 300 practising ODs that have been produced by the two optometry training institutions in Ghana for a population of 24.6 million. This means that the average optometrist to population ratio is 1:82,000, which is much higher than the recommended ratio of 1:10,000 (Oduntan et al. 2014). While there are a number of private universities in Ghana, none provides instruction in optometry. These suggest the need for more institutions to provide optometry instruction in Ghana. The government of Ghana subscribes to the primary health care philosophy, a core concept of the World Health Organisation that focuses on health equity-producing policies and includes all areas that play a role in health such as access to health services, environment and lifestyle (Starfield 2011). However, there is limited access to optometric services in rural areas in Ghana. The government needs to provide these services, which will generate a demand as jobs will become available, in rural areas. Also, admission policies at institutions offering the optometry program should give preference to students from rural areas as several studies (Anzenberger et al. 2011; McAuliffe and Barnett 2009; Rabinowitz et al. 2008) have shown that students from rural backgrounds are more likely to engage in rural practice compared to those from urban backgrounds. This has been attributed to the familiarity of rural students with rural values and systems (Anzenberger et al. 2011; McAuliffe and Barnett 2009; Rabinowitz et al. 2008). Therefore, admission of students from rural and remote areas would facilitate attraction and retention of optometrists in those areas. Making a career decision and choosing an institution involves exhaustive career and institutional research (Wattles 2009; Trevor et al. 2008). However, information on factors that influence students’ choice of optometry as a career and institution of learning is lacking in Ghana. This information is important as it will assist in marketing the program and recruitment of prospective students. The aim of this study was to assess the demographic characteristics and establish the factors that influenced the choice of optometry as a career and institution of learning among optometry students in Ghana.
Methods Study design We carried out a descriptive cross-sectional survey using a self-administered questionnaire. The design of the questionnaire was based on a review of relevant literature on MEDLINE from 2002 to 2012 using search words ‘‘career’’ ‘‘choice’’ ‘‘health profession’’ and ‘‘optometry education’’. We collected quantitative data, enabling the students to select responses from a number of options. The questionnaire had 35 questions and obtained data on demographic characteristics and factors that influenced their career choice and institution of learning. Participants The study population included all registered optometry students in the two training optometry institutions in Ghana. There were 310 registered optometry students in the two
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institutions at the time of this study and all were included in the study. Two hundred and eighty students gave consent to partake in the study. Data collection Once permission had been obtained from the heads of the two departments of optometry, we conducted a pilot study among fifteen students (who did not form part of the final study) in order to critically evaluate and finalize the questionnaire. All queries concerning the questionnaire during the pilot study were addressed accordingly before we conducted the final study. The questionnaires were then distributed in both institutions to the optometry students who agreed to participate in the study, and once completed, were collected by staff members. Data analysis Data was captured and analyzed with the Statistical Programme for Service Solutions (SPSS), version 21.0 (Chicago, IL, USA). We used descriptive statistics such as frequencies and percentages, and cross tabulations to analyze the data as well as Chi square to test for association between variables. Ethical consideration Approval to conduct this study was obtained from the Ethical Review Board of the University of Cape Coast. All participants signed informed consent documents to participate in this study prior to the commencement of the research. Participants were ensured of confidentiality as responses were anonymous and participation was voluntary.
Results Demographic characteristics We distributed 295 questionnaires to the optometry students and 280 students returned them, giving a response rate of 95 %. The analysis was therefore carried out on a sample of 280 (N = 280, 95 %) completed questionnaires, which was considered adequate for tolerable confidence intervals around the desired parameters. The participants’ ages ranged from 17 to 28 years, with a mean and standard deviation of 21.6 ± 2.16 years, and included 203 (72.5 %) males and 77 (27.5 %) females (Table 1). The distribution of responses was very similar, with 135 (48.2 %) from UCC and 145 (51.8 %) from KNUST. The majority of students (90.7 %) were Ghanaians from the Ashanti region (28.9 %), Greater Accra (12.5 %), Central region (11.4 %), Northern region (3.3 %), Upper East region (2.1 %) and Upper West region (.4 %). Others (9.3 %) were students from countries outside Ghana (international students) (Table 1). The majority of participants were from urban areas (79 %) with only 14.6 % coming from rural areas. Others (6.4 %) could not be categorized due to uncertainty regarding their responses (Table 1).
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Factors influencing their choice of career Optometry was the first career choice for 61.4 % of the participants. Of these, 136 (48.6 %) were males and 36 (12.8 %) were females. Of the one-third (38.6 %), who indicated that optometry was not their first choice of study, 66 (23.6 %) were males and 42 (15 %) were females (Table 1). Of these students, the first choice of study was medicine (29.3 %), Table 1 Age distribution by nationality, region, home area, choice of career and institution 16–20 years
21–25 years
26–30 years
Total
Male (%)
Female (%)
Male (%)
Female (%)
Male (%)
Female (%)
Male (%)
59 (21.1)
21 (7.5)
3 (1.1)
10 (3.6)
127 (45.4)
34 (12.1)
11 (3.9)
2 (.7)
197 (70.0)
57 (20.4)
1 (.4)
10 (3.6)
2 (.7)
0 (.0)
6 (2.1)
20 (7.1)
62 (22.1)
31 (11.1)
128 (45.7)
44 (15.7)
13 (4.6)
2 (.7)
203 (72.0)
77 (27.5) 11 (4.2)
Female (%)
Nationality Ghanaian International Total
Ghanaian region GA
8 (3.1)
4 (1.5)
15 (5.8)
7 (2.7)
1 (.4)
0 (.0)
24 (9.2)
ER
5 (1.9)
2 (.8)
17 (6.5)
1 (.4)
2 (.8)
0 (.0)
24 (9.2)
3 (1.2)
WR
5 (1.9)
1 (.4)
9 (3.5)
2 (.8)
1 (.4)
1 (.4)
15 (5.8)
4 (1.5)
VR
5 (1.9)
2 (.8)
11 (4.2)
6 (2.3)
1 (.4)
0 (.0)
17 (6.5)
8 (3.1)
CR
6 (2.3)
1 (.4)
17 (6.5)
7 (2.7)
1 (.4)
0 (.0)
24 (9.2)
8 (3.1)
AR
20 (7.7)
10 (3.8)
41 (15.8)
13 (5.0)
2 (.8)
1 (.4)
63 (24.2)
24 (9.2)
NR
2 (.8)
0 (.0)
5 (1.9)
1 (.4)
1 (.4)
0 (.0)
8 (3.1)
1 (.4)
BAR
4 (1.5)
1 (.4)
11 (4.2)
2 (.8)
1 (.4)
0 (.0)
16 (6.2)
3 (1.2)
UER
2 (.8)
1 (.4)
2 (.8)
0 (.0)
1 (.4)
0 (.0)
5 (1.9)
1 (.4)
UWR
1 (.4)
0 (.0)
0 (.0)
0 (.0)
0 (.0)
0 (.0)
1 (.4)
0 (.0)
Total
58 (22.3)
22 (8.5)
128 (49.2)
39 (15.0)
11 (4.2)
2 (.8)
197 (75.0)
63 (24.2)
Rural
8 (2.9)
3 (1.1)
28 (10.1)
1 (.4)
0 (.0)
0 (.0)
36 (13.0)
4 (1.4)
Urban
16 (5.8)
9 (3.2)
49 (17.7)
18 (6.5)
6 (2.2)
0 (.0)
71 (25.6)
27 (9.7)
City
43 (15.5)
Home area
33 (11.9)
17 (6.1)
40 (14.4)
24 (8.7)
6 (2.2)
2 (.7)
79 (28.5)
Others
3 (1.1)
2 (.7)
10 (3.6)
1 (.4)
1 (.4)
0 (.0)
14 (5.1)
3 (1.1)
Total
60 (21.7)
31 (11.2)
127 (45.8)
44 (15.9)
13 (4.7)
2 (.7)
200 (72.0)
77 (27.8)
Current institution UCC
16 (5.7)
14 (5.0)
75 (26.9)
21 (7.5)
6 (2.2)
2 (.7)
97 (34.8)
37 (13.3)
KNUST
45 (16.1)
17 (6.1)
53 (19.0)
23 (8.2)
7 (2.5)
0 (.0)
105 (37.0)
40 (14.3)
Total
61 (21.9)
31 (11.1)
128 (45.9)
44 (15.8)
13 (4.7)
2 (.7)
202 (72.0)
77 (27.6)
Institutional choice Yes
49 (17.6)
22 (7.9)
84 (30.1)
30 (10.8)
9 (3.2)
2 (.7)
142 (50.0)
54 (19.4)
No
12 (4.3)
9 (3.2)
44 (15.8)
14 (5.0)
4 (1.4)
0 (.0)
60 (21.5)
23 (8.2)
Total
61 (21.9)
31 (11.1)
128 (45.9)
44 (15.8)
13 (4.7)
2 (.7)
202 (72.0)
77 (27.6)
Choice of optometry Yes
39 (14.0)
16 (5.8)
91 (32.7)
18 (6.5)
6 (2.2)
2 (.7)
136 (48.0)
36 (12.9)
No
22 (7.9)
14 (5.0)
37 (13.3)
26 (9.4)
7 (2.5)
0 (.0)
66 (23.7)
40 (14.4)
Total
61 (21.9)
30 (10.8)
128 (46.0)
44 (15.8)
13 (4.7)
2 (.7)
202 (72.0)
76 (27.3)
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S. B. Boadi-Kusi et al.
Fig. 1 Factors considered as important in choice of career
dentistry (3.5 %), pharmacy (2.8 %) and others science-related programs such as actuary, biology, electrical engineering, petroleum engineering and nursing. For most of the students, the factors rated as the most influential in career choice of optometry was ‘‘job availability’’ (90 %) and ‘‘desire to help others’’ (89.2 %). Others are shown in Figs. 1 and 2. Factors influencing their choice of institution of learning One hundred and ninety-seven (70 %) of participants indicated that their current institutions were their institutions of first choice (Table 1). Personal preference for the institution was rated as the most important (35.8 %) factors that influenced their choice of institution of learning, followed by influence from parents (25.1 %) and proximity to home (24.4 %). Scholarship grant (77.3 %) and influence from the media (75.6 %) were rated as unimportant (Fig. 3) in terms of institution choice.
Discussion The gender distribution of the respondents in this study indicated that more males than females were pursuing optometry (p = 0.002). This could be due to the general low ratio of female to male enrolment in tertiary education in Ghana (Lugg et al. 2007) and the fact that few females take science, a prerequisite for optometry, in the West African Senior School Examination Certificate (Eguridu 2013). Johnson et al. (1991) suggested that women are less likely to attend higher educational institutions regardless of their academic ability and achievements. Furthermore, males could possibly have more interest in studying optometry compared to their female counterparts (Lugg et al. 2007). Male students prefer investigative and enterprising careers (Yuh 1995). The results of this study are
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Demographic characteristics
Fig. 2 Factors rated as not important
Fig. 3 Factors influencing choice of institution
however, different from those of Mashige and Oduntan (2011), who reported more female (69.5 %) than male (30.5 %) students studying Optometry in South African institutions. This could be due to differences in educational policy, cultural setting and the emphasis placed on female education between Ghana and South Africa.
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S. B. Boadi-Kusi et al.
The majority (79 %) of the students (Table 1) being from urban areas is of concern as approximately 49.1 % of Ghanaians live in rural areas (GSS 2011). Optometric services are scarce in the rural areas of Ghana, one reason being that many people may not be able to afford the cost of eye care services, as they are provided on a consumer pays basis by private practitioners. The lack of paying clients may be a major factor contributing to the scarcity of optometric services in rural areas. This suggests the need for admission policies of training institutions to be re-evaluated, and for there to be greater representation of rural students. As graduates from rural areas are more likely to return to their home areas to practice (Anzenberger et al. 2011; McAuliffe and Barnett 2009; Rabinowitz et al. 2008), admission process should give them preference to ensure that all areas of Ghana are adequately served by optometrists (Lugg et al. 2007). However, in the absence of paying clients in these areas, optometric services need to be provided as part of public health care. Many of the respondents (61.4 %) indicated that optometry was their first choice of study. A significant number (38.6 %) indicated that optometry was not their first choice, and as their courses of first choice were in a health science-related field, this is aligned with many (89.2 %) rating the desire to help others as one of the most important factors influencing their career choice. This is similar to a South African study in which majority of optometry students cited the desire to help others as a very important factor in choosing their career (Mashige and Oduntan 2011). In addition, job availability after graduating was rated by 90 % of the students as an important choice factor. This is similar to the findings of Mkondo et al. (2007) in Zimbabwe and Baboolal and Hutchinson’s (2007) finding in the West Indies conducted among physiotherapy and medical students respectively. Prestige of the profession (83.2 %), potential to earn a good salary (80.3 %), flexible working hours (69.2 %) and good grade point (80.3 %) were factors considered important by respondents in choosing optometry as a career. These were consistent with reports by Mustafa et al. (2008) and Takeda et al. (2013) who reported that prestige, money and personal development were important factors which influenced medical students in their career decision making in Turkey and Japan respectively. Lambert et al. (2008) also found that majority of newly qualified doctors who chose ophthalmology as a career cited the prospect of good working hours and conditions as important factors in the United Kingdom. The influence of good grade points also affirms the reports by Munyingi (2012) that academic factors influences career choices among students in Kenya. Although Taylor et al. (2004) reported a high parental influence on career choices in the USA, this factor was not rated as important in this study. Similarly, the influence of friends did not play an important role in the decision of the students in choosing optometry as a career. These findings are similar to those of Mashige and Oduntan (2011), who found that neither parents nor relatives had a significant influence on a career choice of optometry among South African optometry students. However, these results of the current study differ with those of earlier reports by Ferry et al. (2000) and Singaravelu et al. (2005) who found that family and community were instrumental and influential in career choices among high school students in Pennsylvania, USA. The results of the Ghanaian and South African studies suggest that the respondents were independent and chose their own careers with little or no influence from their parents and friends. Contrary to reports that experience working with professionals in the fields of agriculture (Jones and Larke 2005) and medicine (Ramsey et al. 2004; Soethout et al. 2004) seemed to increase students’ interest in those careers, most of the respondents in this study rated experience working with optometrists and treatment from an optometrist as not being an important factor in their career choice. This could be due to the low encounter of respondents with optometrists owing to the small numbers of practitioners in Ghana. In
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Demographic characteristics Table 2 Logistic regression between choice of institution and factors that influences choice of institution Factors
Exp (B)
Wald
Sig.
Lower bound
Upper bound
Institution
.193
41.518
.000
.072
.265
Proximity
.529
5.507
.019
.492
1.417
Relatives/parents
1.315
.933
.334
.521
1.730
Friends
1.220
.367
.544
.607
2.222 1.486
Media
.715
.622
430
.344
Secure
2.236
6.096
.014
.259
.877
.302
9.287
.002
.399
1.769
2.120
3.177
.075
1.268
6.222
Cost Scholarship 2
p = 12.28, v = .092, df = 7
addition, this result could have been influenced by the fact that few optometrists are in the public sector, which is where the majority of Ghanaians seek eye and health care services (Gobah and Liang 2011). Many (75.6 %) respondents indicated that personal preference (always wanting this institution) was not important in selecting the institution of study. This may have been as a result of there being few institutions offering optometry in Ghana, hence, limited the options for prospective students wanting to study the profession. The media was not indicated as having a significant influence in the respondents’ choice of institution (Table 2) (OR .715, 95 % CI .344–1.468). This is despite the fact that media ranking from the 4 International College and Universities (4ICU) places UCC and KNUST among the top 100 universities in Africa (Saky 2013), suggesting that media rankings might not have a significant impact on the general college-bound student population (Bradshaw et al. 2001; Lillard and Gerner 1999). Cost of university fees was not considered important in the choice of institution of learning. This is contrary to reports that indicate that cost-related issues are important (Manski and Wise 1983) as the financial realities of a college education are likely to influence a student’s choice of where to attend college (Kim 2004). This finding could be due to the fact that both the two optometry training institutions in Ghana are government subsidised resulting in fees being relatively low compared to private academic institutions. Of note was the finding that neither parents (62.4 %) nor friends (71 %) had an influence in students’ choice of institution. This result contradicts the findings by Cabrera and LaNasa (2000) in the USA, that parental influence had a direct and positive relationship with the decision regarding college choices. A 2007 report by the National Postsecondary Education Cooperative also reported that, regardless of socioeconomic status (SES) or ethnic and racial category, parents play the strongest role in the college choice and decision-making processes for students (Cabrera and LaNasa 2000; Ming 2010). The variation in this study could be due to the fact that students in Ghana struggle to obtain admission to public universities that receive government subsidy irrespective of location, due to the limited number of places. This is particularly so for those programs which are only provided in a few universities, such as optometry. As a result, parental guidance may not necessarily be influential, as choice of institution is not based on the individual’s preference but on the availability of opportunities. For those who can afford the more expensive private universities, applications and admissions is based mainly on the ability to pay, hence parental influence could be higher.
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Conclusion and recommendations The results of this study show that there is gender, regional and urban–rural disparities in students studying optometry in Ghana. It is recommended that students in rural areas in particular be exposed to optometry as a profession as part of a comprehensive recruitment strategy, and that, special effort be made to attract females who have good grade points. Universities offering optometry program should increase their awareness campaigns in high schools located in rural areas, especially in the northern sector of Ghana. Given the scarcity of eye care services in the rural areas and the strong link between funding and services, it is recommended that the government provides the necessary funds for supporting rural optometry services. The results of this study indicate that where there is a job issue economic, social and personal factors were significant influences in the students’ choice of optometry as a career. With only two institutions in the country that provide optometry instruction students don’t really have much of a choice, suggesting that more institutions need to offer the program throughout the country. The public health sector needs to expand optometry services, be it through private/public partnerships, mobile services or referral through to district level hospitals. There is therefore a need for the profession to re-evaluate its profile as a career choice, and to have awareness campaigns, specifically in rural areas, on what optometry entails, its training and practice, as well as the job opportunities for optometrists in both the private and public sectors. Acknowledgments The authors wish to express their gratitude to the heads of the two optometry training institutions in Ghana for providing valuable research assistance. Conflict of interest The authors declare no conflict of interest.
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S. B. Boadi-Kusi et al. Rabinowitz, H. K., Diamond, J. J., Markham, F. W., & Wortman, J. R. (2008). Medical school programs to increase the rural physician supply: A systematic review and projected impact of widespread replication. Journal of Academic Medicine, 83, 235–243. Ramsey, A. H., Haq, C., Gjerde, C. L., & Rothenberg, D. (2004). Career influence of an international health experience during medical school. Journal of Family Medicine, 36, 412–416. Randall, J. W., & Kumah, D. B. (2004). The emergence of university optometric education in Ghana. Optometry Education, 29, 80–84. Saky, R. (2013). Choicism news. Retrieved May 20, 2013 from www.choicism.com. Servier, R. A. (1986). Freshmen at competitive liberal arts college: A survey of factors influencing institutional choice. Unpublished dissertation, Ohio State University, Columbus, OH. Singaravelu, H. D., White, L. J., & Bringaze, T. B. (2005). Factors influencing international students career choice. Journal of Career Development, 32, 45–49. Soethout, M. B. M., ten Cate, T. J., & van der Wal, G. (2004). Factors associated with the nature and timing and stability of the specialty career choices of recently graduated doctors in European countries. Medical Education, 9, 7–16. Starfield, B. (2011). Politics, primary healthcare and health. Journal of Community Health, 65, 653–655. Takeda, Y., Morio, K., Snell, L., Otaki, J., Takahashi, M., & Kai, I. (2013). Characteristic profiles among students and junior doctors with specific career preferences. BMC Medical Education, 13(125), 1–11. Taylor, J., Harris, M., & Taylor, S. (2004). Parents have their say about their college aged children’s career decisions: National Association of Colleges and Employers. Employer Journal, 64(3), 1–5. Terenzini, P. T., Rendon, L. I., Upcraft, M. L., Millar, S. B., Allison, K. W., Gregg, P. L., et al. (1994). The transition to college: Diverse students, diverse stories. Research in Higher Education, 35, 57–73. Trevor, W. L., Michael, J. G., & Anthony, J. B. (2008). Career choices for ophthalmology made by newly qualified doctors in the United Kingdom, 1974–2005. Ophthalmology, 8, 3. doi:10.1186/1471-2415-8-3. UNESCO. (2006). Global education digest 2006: Comparing education statistics across the world. Montreal: UNESCO Institute of Statistics. Wattles, D. W. (2009). The science of getting rich. Retrieved 20 May, 3013, from www.thescienceofgettingrich. net. Yuh, E. N. (1995). Some correlates of vocational orientations of some selected secondary school students. M.Ed. project, University of Ibadan.
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Demographic characteristics of Ghanaian optometry students and factors influencing their career choice and institution of learning Samuel Bert Boadi-Kusi • Samuel Kyei • Khathutshelo Percy Mashige • Emmanuel Kwasi Abu • Daniel Antwi-Boasiako • Abraham Carl Halladay
Received: 16 September 2013 / Accepted: 25 March 2014 Ó Springer Science+Business Media Dordrecht 2014
Abstract Optometry is only provided at tertiary level in two institutions in Ghana, with an average of 50 students graduating each year for a population of approximately 24.6 million. No information on the demography of optometry students and factors that influence their choice of optometry as a career and institution of learning is available. This information is important as it will assist optometry institutions to formulate effective student recruitment strategies. To assess the demographic characteristics of Ghanaian optometry students, the factors that influence their selection of optometry as a career and institution of learning. We conducted a cross sectional study among Ghanaian optometry students using a structured questionnaire to collect data on the demographic characteristics and factors that might influence their choice of optometry as a career as well as choice of institution of learning. Two hundred and eighty students from the two optometry training institutions in Ghana; University of Cape Coast (48.2 %) and Kwame Nkrumah University of Science and Technology (51.8 %) responded to the questionnaire. Their ages ranged from 17 to 28 years with most being males (72.5 %), and the majority (79 %) being from urban areas. The main factors that influenced their career choice were job availability after graduation (90 %) and desire to help other people (89.2 %). Factors that influenced their institution choice were preference for an institution (36.8 %) and proximity to home (24.4 %). In the absence of adequate optometry jobs in the public health sector, women will remain marginalised specifically those in rural areas. This marginalisation is however, a reflection of a broader societal disadvantage for women. Greater effort needs to be made to recruit high school students from rural areas to study optometry and more institutions need to provide optometry instruction throughout the country.
S. B. Boadi-Kusi (&) S. Kyei E. K. Abu D. Antwi-Boasiako A. Carl Halladay Department of Optometry, School of Physical Sciences, University of Cape Coast, Cape Coast, Ghana e-mail: [email protected] S. B. Boadi-Kusi K. P. Mashige Discipline of Optometry, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Keywords
Optometry education Career choice Counselling University Ghana
Introduction Career choices are required by all individuals, often forming in childhood, requiring more thought in adolescence and continuing throughout adulthood (Bandura et al. 2001). With the development of competitive job systems following advances in information technology, deciding on a career has become a complex science, leading to a shift towards individuals pursuing the careers they want, sometimes changing direction. Decisions on career choices are often influenced by multiple factors such as job availability, competition, economic conditions, social issues, family background, academic opportunities, life events and individual motivation (such as personal interest, prospects of good financial remuneration and family influence) (McCord et al. 2008; Pinchot et al. 2008; Mkondo et al. 2007; Bryant et al. 2006; Ohman et al. 2002; Bandura et al. 2001; Ohman et al. 2001). Others factors include enthusiasm, challenges, motivation to help others, the ability to define one’s own personal goals, influence from the media, prestige and status (Bryant et al. 2006). Once a career choice has been made, a number of factors can affect the students’ choice of institution (Ming 2010), including the location of the institution or its proximity to home (Astin 1984; Terenzini et al. 1994). Many students are influenced by parents or relatives, with most parents preferring their children to attend the university they attended, for a number of reasons (Arredondo 1999). The reputation of the institution or academic strength in a certain field may motivate them to influence their wards in choosing it (Servier 1986; Kohn et al. 1976). Higher education in Ghana is mainly provided by the government (public) and private sector. There is a great demand for public higher education institutions due to the relatively low cost (Manuh et al. 2007). Approximately 34.3 % of students in higher education are women (NCTE 2007). With a Gross Enrolment Ratio for men being double that for women, the Gender Parity Index for Gross Enrolment in higher education is 0.48, falling far short of the required equity targets (UNESCO 2006: 126). However, the enrolment of women in higher education institutions has improved over the past 17 years; in 1991 only 21 % of students in Ghanaian universities were women (Effah 2003) compared to the recent enrolment figure of 34.4 % (NCTE 2007). Women participation in higher private education institutions is higher than in public sector institutions, with women making up 41 % of students in private universities (NCTE 2006), compared to 35 % in the public sector (Lugg et al. 2007). Less than 35 % of the students who apply to tertiary institutions are admitted due to growing numbers of qualified secondary school leavers, inadequate university infrastructure and staffing limitations (Manuh et al. 2007). The majority of these students are men from wealthy backgrounds and top second cycle schools (Lugg et al. 2007; Addae-Mensah 2000) in the more privileged cities of the various regions of Ghana. Students who qualify to attend tertiary institutions have the option of pursuing programs of interest based on the courses they studied at the senior high school level. For students who enjoy working with and helping people, they may explore several career options in the health professions, such as medicine, dentistry, pharmacy, nursing and optometry among others. Optometry is considered as having a ‘glamour factor’ and a potentially good income which makes it a more desirable career option as a profession (Farkas 2006). The Doctor of Optometry (OD) degree is a 6 year professional program that is offered by two government institutions in Ghana: Kwame Nkrumah University of Science and Technology (KNUST) located in
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Kumasi and the University of Cape Coast (UCC) in Cape Coast (Randall and Kumah 2004; Ovenseri-Ogbomo et al. 2011). The Doctor of Optometry program trains students to perform comprehensive eye examinations which include the correction of refractive errors, orthoptic assessment, low vision and visual rehabilitation, diagnosis and management of ocular diseases through the use of diagnostic and pharmaceutical agents. There are currently about 300 practising ODs that have been produced by the two optometry training institutions in Ghana for a population of 24.6 million. This means that the average optometrist to population ratio is 1:82,000, which is much higher than the recommended ratio of 1:10,000 (Oduntan et al. 2014). While there are a number of private universities in Ghana, none provides instruction in optometry. These suggest the need for more institutions to provide optometry instruction in Ghana. The government of Ghana subscribes to the primary health care philosophy, a core concept of the World Health Organisation that focuses on health equity-producing policies and includes all areas that play a role in health such as access to health services, environment and lifestyle (Starfield 2011). However, there is limited access to optometric services in rural areas in Ghana. The government needs to provide these services, which will generate a demand as jobs will become available, in rural areas. Also, admission policies at institutions offering the optometry program should give preference to students from rural areas as several studies (Anzenberger et al. 2011; McAuliffe and Barnett 2009; Rabinowitz et al. 2008) have shown that students from rural backgrounds are more likely to engage in rural practice compared to those from urban backgrounds. This has been attributed to the familiarity of rural students with rural values and systems (Anzenberger et al. 2011; McAuliffe and Barnett 2009; Rabinowitz et al. 2008). Therefore, admission of students from rural and remote areas would facilitate attraction and retention of optometrists in those areas. Making a career decision and choosing an institution involves exhaustive career and institutional research (Wattles 2009; Trevor et al. 2008). However, information on factors that influence students’ choice of optometry as a career and institution of learning is lacking in Ghana. This information is important as it will assist in marketing the program and recruitment of prospective students. The aim of this study was to assess the demographic characteristics and establish the factors that influenced the choice of optometry as a career and institution of learning among optometry students in Ghana.
Methods Study design We carried out a descriptive cross-sectional survey using a self-administered questionnaire. The design of the questionnaire was based on a review of relevant literature on MEDLINE from 2002 to 2012 using search words ‘‘career’’ ‘‘choice’’ ‘‘health profession’’ and ‘‘optometry education’’. We collected quantitative data, enabling the students to select responses from a number of options. The questionnaire had 35 questions and obtained data on demographic characteristics and factors that influenced their career choice and institution of learning. Participants The study population included all registered optometry students in the two training optometry institutions in Ghana. There were 310 registered optometry students in the two
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institutions at the time of this study and all were included in the study. Two hundred and eighty students gave consent to partake in the study. Data collection Once permission had been obtained from the heads of the two departments of optometry, we conducted a pilot study among fifteen students (who did not form part of the final study) in order to critically evaluate and finalize the questionnaire. All queries concerning the questionnaire during the pilot study were addressed accordingly before we conducted the final study. The questionnaires were then distributed in both institutions to the optometry students who agreed to participate in the study, and once completed, were collected by staff members. Data analysis Data was captured and analyzed with the Statistical Programme for Service Solutions (SPSS), version 21.0 (Chicago, IL, USA). We used descriptive statistics such as frequencies and percentages, and cross tabulations to analyze the data as well as Chi square to test for association between variables. Ethical consideration Approval to conduct this study was obtained from the Ethical Review Board of the University of Cape Coast. All participants signed informed consent documents to participate in this study prior to the commencement of the research. Participants were ensured of confidentiality as responses were anonymous and participation was voluntary.
Results Demographic characteristics We distributed 295 questionnaires to the optometry students and 280 students returned them, giving a response rate of 95 %. The analysis was therefore carried out on a sample of 280 (N = 280, 95 %) completed questionnaires, which was considered adequate for tolerable confidence intervals around the desired parameters. The participants’ ages ranged from 17 to 28 years, with a mean and standard deviation of 21.6 ± 2.16 years, and included 203 (72.5 %) males and 77 (27.5 %) females (Table 1). The distribution of responses was very similar, with 135 (48.2 %) from UCC and 145 (51.8 %) from KNUST. The majority of students (90.7 %) were Ghanaians from the Ashanti region (28.9 %), Greater Accra (12.5 %), Central region (11.4 %), Northern region (3.3 %), Upper East region (2.1 %) and Upper West region (.4 %). Others (9.3 %) were students from countries outside Ghana (international students) (Table 1). The majority of participants were from urban areas (79 %) with only 14.6 % coming from rural areas. Others (6.4 %) could not be categorized due to uncertainty regarding their responses (Table 1).
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Factors influencing their choice of career Optometry was the first career choice for 61.4 % of the participants. Of these, 136 (48.6 %) were males and 36 (12.8 %) were females. Of the one-third (38.6 %), who indicated that optometry was not their first choice of study, 66 (23.6 %) were males and 42 (15 %) were females (Table 1). Of these students, the first choice of study was medicine (29.3 %), Table 1 Age distribution by nationality, region, home area, choice of career and institution 16–20 years
21–25 years
26–30 years
Total
Male (%)
Female (%)
Male (%)
Female (%)
Male (%)
Female (%)
Male (%)
59 (21.1)
21 (7.5)
3 (1.1)
10 (3.6)
127 (45.4)
34 (12.1)
11 (3.9)
2 (.7)
197 (70.0)
57 (20.4)
1 (.4)
10 (3.6)
2 (.7)
0 (.0)
6 (2.1)
20 (7.1)
62 (22.1)
31 (11.1)
128 (45.7)
44 (15.7)
13 (4.6)
2 (.7)
203 (72.0)
77 (27.5) 11 (4.2)
Female (%)
Nationality Ghanaian International Total
Ghanaian region GA
8 (3.1)
4 (1.5)
15 (5.8)
7 (2.7)
1 (.4)
0 (.0)
24 (9.2)
ER
5 (1.9)
2 (.8)
17 (6.5)
1 (.4)
2 (.8)
0 (.0)
24 (9.2)
3 (1.2)
WR
5 (1.9)
1 (.4)
9 (3.5)
2 (.8)
1 (.4)
1 (.4)
15 (5.8)
4 (1.5)
VR
5 (1.9)
2 (.8)
11 (4.2)
6 (2.3)
1 (.4)
0 (.0)
17 (6.5)
8 (3.1)
CR
6 (2.3)
1 (.4)
17 (6.5)
7 (2.7)
1 (.4)
0 (.0)
24 (9.2)
8 (3.1)
AR
20 (7.7)
10 (3.8)
41 (15.8)
13 (5.0)
2 (.8)
1 (.4)
63 (24.2)
24 (9.2)
NR
2 (.8)
0 (.0)
5 (1.9)
1 (.4)
1 (.4)
0 (.0)
8 (3.1)
1 (.4)
BAR
4 (1.5)
1 (.4)
11 (4.2)
2 (.8)
1 (.4)
0 (.0)
16 (6.2)
3 (1.2)
UER
2 (.8)
1 (.4)
2 (.8)
0 (.0)
1 (.4)
0 (.0)
5 (1.9)
1 (.4)
UWR
1 (.4)
0 (.0)
0 (.0)
0 (.0)
0 (.0)
0 (.0)
1 (.4)
0 (.0)
Total
58 (22.3)
22 (8.5)
128 (49.2)
39 (15.0)
11 (4.2)
2 (.8)
197 (75.0)
63 (24.2)
Rural
8 (2.9)
3 (1.1)
28 (10.1)
1 (.4)
0 (.0)
0 (.0)
36 (13.0)
4 (1.4)
Urban
16 (5.8)
9 (3.2)
49 (17.7)
18 (6.5)
6 (2.2)
0 (.0)
71 (25.6)
27 (9.7)
City
43 (15.5)
Home area
33 (11.9)
17 (6.1)
40 (14.4)
24 (8.7)
6 (2.2)
2 (.7)
79 (28.5)
Others
3 (1.1)
2 (.7)
10 (3.6)
1 (.4)
1 (.4)
0 (.0)
14 (5.1)
3 (1.1)
Total
60 (21.7)
31 (11.2)
127 (45.8)
44 (15.9)
13 (4.7)
2 (.7)
200 (72.0)
77 (27.8)
Current institution UCC
16 (5.7)
14 (5.0)
75 (26.9)
21 (7.5)
6 (2.2)
2 (.7)
97 (34.8)
37 (13.3)
KNUST
45 (16.1)
17 (6.1)
53 (19.0)
23 (8.2)
7 (2.5)
0 (.0)
105 (37.0)
40 (14.3)
Total
61 (21.9)
31 (11.1)
128 (45.9)
44 (15.8)
13 (4.7)
2 (.7)
202 (72.0)
77 (27.6)
Institutional choice Yes
49 (17.6)
22 (7.9)
84 (30.1)
30 (10.8)
9 (3.2)
2 (.7)
142 (50.0)
54 (19.4)
No
12 (4.3)
9 (3.2)
44 (15.8)
14 (5.0)
4 (1.4)
0 (.0)
60 (21.5)
23 (8.2)
Total
61 (21.9)
31 (11.1)
128 (45.9)
44 (15.8)
13 (4.7)
2 (.7)
202 (72.0)
77 (27.6)
Choice of optometry Yes
39 (14.0)
16 (5.8)
91 (32.7)
18 (6.5)
6 (2.2)
2 (.7)
136 (48.0)
36 (12.9)
No
22 (7.9)
14 (5.0)
37 (13.3)
26 (9.4)
7 (2.5)
0 (.0)
66 (23.7)
40 (14.4)
Total
61 (21.9)
30 (10.8)
128 (46.0)
44 (15.8)
13 (4.7)
2 (.7)
202 (72.0)
76 (27.3)
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S. B. Boadi-Kusi et al.
Fig. 1 Factors considered as important in choice of career
dentistry (3.5 %), pharmacy (2.8 %) and others science-related programs such as actuary, biology, electrical engineering, petroleum engineering and nursing. For most of the students, the factors rated as the most influential in career choice of optometry was ‘‘job availability’’ (90 %) and ‘‘desire to help others’’ (89.2 %). Others are shown in Figs. 1 and 2. Factors influencing their choice of institution of learning One hundred and ninety-seven (70 %) of participants indicated that their current institutions were their institutions of first choice (Table 1). Personal preference for the institution was rated as the most important (35.8 %) factors that influenced their choice of institution of learning, followed by influence from parents (25.1 %) and proximity to home (24.4 %). Scholarship grant (77.3 %) and influence from the media (75.6 %) were rated as unimportant (Fig. 3) in terms of institution choice.
Discussion The gender distribution of the respondents in this study indicated that more males than females were pursuing optometry (p = 0.002). This could be due to the general low ratio of female to male enrolment in tertiary education in Ghana (Lugg et al. 2007) and the fact that few females take science, a prerequisite for optometry, in the West African Senior School Examination Certificate (Eguridu 2013). Johnson et al. (1991) suggested that women are less likely to attend higher educational institutions regardless of their academic ability and achievements. Furthermore, males could possibly have more interest in studying optometry compared to their female counterparts (Lugg et al. 2007). Male students prefer investigative and enterprising careers (Yuh 1995). The results of this study are
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Fig. 2 Factors rated as not important
Fig. 3 Factors influencing choice of institution
however, different from those of Mashige and Oduntan (2011), who reported more female (69.5 %) than male (30.5 %) students studying Optometry in South African institutions. This could be due to differences in educational policy, cultural setting and the emphasis placed on female education between Ghana and South Africa.
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The majority (79 %) of the students (Table 1) being from urban areas is of concern as approximately 49.1 % of Ghanaians live in rural areas (GSS 2011). Optometric services are scarce in the rural areas of Ghana, one reason being that many people may not be able to afford the cost of eye care services, as they are provided on a consumer pays basis by private practitioners. The lack of paying clients may be a major factor contributing to the scarcity of optometric services in rural areas. This suggests the need for admission policies of training institutions to be re-evaluated, and for there to be greater representation of rural students. As graduates from rural areas are more likely to return to their home areas to practice (Anzenberger et al. 2011; McAuliffe and Barnett 2009; Rabinowitz et al. 2008), admission process should give them preference to ensure that all areas of Ghana are adequately served by optometrists (Lugg et al. 2007). However, in the absence of paying clients in these areas, optometric services need to be provided as part of public health care. Many of the respondents (61.4 %) indicated that optometry was their first choice of study. A significant number (38.6 %) indicated that optometry was not their first choice, and as their courses of first choice were in a health science-related field, this is aligned with many (89.2 %) rating the desire to help others as one of the most important factors influencing their career choice. This is similar to a South African study in which majority of optometry students cited the desire to help others as a very important factor in choosing their career (Mashige and Oduntan 2011). In addition, job availability after graduating was rated by 90 % of the students as an important choice factor. This is similar to the findings of Mkondo et al. (2007) in Zimbabwe and Baboolal and Hutchinson’s (2007) finding in the West Indies conducted among physiotherapy and medical students respectively. Prestige of the profession (83.2 %), potential to earn a good salary (80.3 %), flexible working hours (69.2 %) and good grade point (80.3 %) were factors considered important by respondents in choosing optometry as a career. These were consistent with reports by Mustafa et al. (2008) and Takeda et al. (2013) who reported that prestige, money and personal development were important factors which influenced medical students in their career decision making in Turkey and Japan respectively. Lambert et al. (2008) also found that majority of newly qualified doctors who chose ophthalmology as a career cited the prospect of good working hours and conditions as important factors in the United Kingdom. The influence of good grade points also affirms the reports by Munyingi (2012) that academic factors influences career choices among students in Kenya. Although Taylor et al. (2004) reported a high parental influence on career choices in the USA, this factor was not rated as important in this study. Similarly, the influence of friends did not play an important role in the decision of the students in choosing optometry as a career. These findings are similar to those of Mashige and Oduntan (2011), who found that neither parents nor relatives had a significant influence on a career choice of optometry among South African optometry students. However, these results of the current study differ with those of earlier reports by Ferry et al. (2000) and Singaravelu et al. (2005) who found that family and community were instrumental and influential in career choices among high school students in Pennsylvania, USA. The results of the Ghanaian and South African studies suggest that the respondents were independent and chose their own careers with little or no influence from their parents and friends. Contrary to reports that experience working with professionals in the fields of agriculture (Jones and Larke 2005) and medicine (Ramsey et al. 2004; Soethout et al. 2004) seemed to increase students’ interest in those careers, most of the respondents in this study rated experience working with optometrists and treatment from an optometrist as not being an important factor in their career choice. This could be due to the low encounter of respondents with optometrists owing to the small numbers of practitioners in Ghana. In
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Demographic characteristics Table 2 Logistic regression between choice of institution and factors that influences choice of institution Factors
Exp (B)
Wald
Sig.
Lower bound
Upper bound
Institution
.193
41.518
.000
.072
.265
Proximity
.529
5.507
.019
.492
1.417
Relatives/parents
1.315
.933
.334
.521
1.730
Friends
1.220
.367
.544
.607
2.222 1.486
Media
.715
.622
430
.344
Secure
2.236
6.096
.014
.259
.877
.302
9.287
.002
.399
1.769
2.120
3.177
.075
1.268
6.222
Cost Scholarship 2
p = 12.28, v = .092, df = 7
addition, this result could have been influenced by the fact that few optometrists are in the public sector, which is where the majority of Ghanaians seek eye and health care services (Gobah and Liang 2011). Many (75.6 %) respondents indicated that personal preference (always wanting this institution) was not important in selecting the institution of study. This may have been as a result of there being few institutions offering optometry in Ghana, hence, limited the options for prospective students wanting to study the profession. The media was not indicated as having a significant influence in the respondents’ choice of institution (Table 2) (OR .715, 95 % CI .344–1.468). This is despite the fact that media ranking from the 4 International College and Universities (4ICU) places UCC and KNUST among the top 100 universities in Africa (Saky 2013), suggesting that media rankings might not have a significant impact on the general college-bound student population (Bradshaw et al. 2001; Lillard and Gerner 1999). Cost of university fees was not considered important in the choice of institution of learning. This is contrary to reports that indicate that cost-related issues are important (Manski and Wise 1983) as the financial realities of a college education are likely to influence a student’s choice of where to attend college (Kim 2004). This finding could be due to the fact that both the two optometry training institutions in Ghana are government subsidised resulting in fees being relatively low compared to private academic institutions. Of note was the finding that neither parents (62.4 %) nor friends (71 %) had an influence in students’ choice of institution. This result contradicts the findings by Cabrera and LaNasa (2000) in the USA, that parental influence had a direct and positive relationship with the decision regarding college choices. A 2007 report by the National Postsecondary Education Cooperative also reported that, regardless of socioeconomic status (SES) or ethnic and racial category, parents play the strongest role in the college choice and decision-making processes for students (Cabrera and LaNasa 2000; Ming 2010). The variation in this study could be due to the fact that students in Ghana struggle to obtain admission to public universities that receive government subsidy irrespective of location, due to the limited number of places. This is particularly so for those programs which are only provided in a few universities, such as optometry. As a result, parental guidance may not necessarily be influential, as choice of institution is not based on the individual’s preference but on the availability of opportunities. For those who can afford the more expensive private universities, applications and admissions is based mainly on the ability to pay, hence parental influence could be higher.
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Conclusion and recommendations The results of this study show that there is gender, regional and urban–rural disparities in students studying optometry in Ghana. It is recommended that students in rural areas in particular be exposed to optometry as a profession as part of a comprehensive recruitment strategy, and that, special effort be made to attract females who have good grade points. Universities offering optometry program should increase their awareness campaigns in high schools located in rural areas, especially in the northern sector of Ghana. Given the scarcity of eye care services in the rural areas and the strong link between funding and services, it is recommended that the government provides the necessary funds for supporting rural optometry services. The results of this study indicate that where there is a job issue economic, social and personal factors were significant influences in the students’ choice of optometry as a career. With only two institutions in the country that provide optometry instruction students don’t really have much of a choice, suggesting that more institutions need to offer the program throughout the country. The public health sector needs to expand optometry services, be it through private/public partnerships, mobile services or referral through to district level hospitals. There is therefore a need for the profession to re-evaluate its profile as a career choice, and to have awareness campaigns, specifically in rural areas, on what optometry entails, its training and practice, as well as the job opportunities for optometrists in both the private and public sectors. Acknowledgments The authors wish to express their gratitude to the heads of the two optometry training institutions in Ghana for providing valuable research assistance. Conflict of interest The authors declare no conflict of interest.
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