ORIGINAL ARTICLE
Y Usui, H Miura
Authors’ affiliations: Y Usui, H Miura, Department of International Health and Collaboration, National Institute of Public Health, Saitama, Japan Y Usui,, Department of Gerodontology, Tokyo Medical and Dental University, Tokyo, Japan Correspondence to: Y. Usui Department of International health and Collaboration National Institute of Public Health 2-3-6 Minami, Wako-shi 351-0197 Saitama Japan Tel.: +81-48-458-6111 Fax: +81-48-469-1573 E-mail: [email protected]
Workforce re-entry for Japanese unemployed dental hygienists Abstract: Objective: The aim of this study was to define the profile of unemployed dental hygienists who could be enticed to re-enter the workforce and the factors that could facilitate their re-entry into the dental field in Japan. Methods: The questionnaire was mailed with a postage-paid return envelope to a sample of 3095 licensed dental hygienists. A 50.4% response rate (S = 1477) was observed. Results: The rate of working dental hygienists was 60.3% (n = 891), and of unemployed dental hygienists was 39.7% (n = 586). Of the latter, 31.9% (n = 187) stated intentions of returning to the workplace. The unemployed dental hygienists seeking employment were more often married and had more children, compared with working dental hygienists currently. This group also had significantly fewer total service years. Moreover, only 11.96% of them belonged to the Japan Dental Hygienists’ Association, and 41.3% of those attended training workshops. According to their response, they perceived their top three major barriers to re-entry as ‘lack sufficient dental hygiene skill’, ‘child rearing’ and ‘poor working atmosphere’. ‘Flexibility in the work schedule’ and ‘location’ were the most important factors for re-entry from their perspective. Conclusion: There were not many dental hygienists hoping to return to the dental field. The findings suggested that strategies to encourage non-practicing dental hygienists to re-entry should be emphasized in the areas of a flexible working atmosphere, easy access to information on how to return to practice and guidance on how to maintain professionalism during inactivity. Key words: barriers; dental hygiene profession; re-entry; unemployed dental hygienists; work–life balance
Introduction
Dates: Accepted 21 July 2014 To cite this article: Int J Dent Hygiene 13, 2015; 74–78 DOI: 10.1111/idh.12101 Usui Y, Miura H. Workforce re-entry for Japanese unemployed dental hygienists © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
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| Int J Dent Hygiene 13, 2015; 74--78
Japan has entered a phase of an ageing society at a speed that any other countries in the world have not experienced. Concomitantly, the number of the dependent elderly has been increasing rapidly. The percentage of the total population over the age of 65 in 2011 was 23.3% (1). As a result of the emergence of such circumstances, the Long–Term Care Insurance Act passed in 1997. The aim of the Insurance Act was to create a social support system for long-term care of the bedridden elderly and persons suffering from dementia (2). The resulting Insurance System has been implemented from the year 2000. Focusing on the oral hygiene of the elderly, the condition of their oral health has deteriorated for the most part, although the proportion of elderly people over the age of 80 with more than 20 teeth has dramatically increased to 38.3% in 2011 (3). It is well known that oral health is related to overall health. Many studies indicate that an unclean oral
Usui and Miura. Re-entry for Japanese unemployed DH
cavity induces systemic disease, such as aspiration pneumonia and cardiovascular disease (4,5). In such a state, the demands of oral care and maintenance of oral function for the elderly, including performing oral function assessments (6), training for swallowing and stimulation of saliva secretion, have dramatically increased on dental hygienists (7–9). Although over 200 000 dental hygienists exist in Japan, only approximately 100 000 of them currently work (10). Thus, the employment rate of the Japanese dental hygienist is quite low in comparison with other countries (11–13). Because of concern about the shortage in dental hygiene manpower in Japan’s current population ratio, the need to investigate retention and re-entry points for dental hygienists increases (14). However, very little data on Japanese dental hygienists re-entry exist. Prefecture-level studies by Yoshida and Ueda have provided some important data (15,16). As response rate and sample size were quite low, they were not sufficient to represent an overview of Japanese dental hygienists, especially unemployed dental hygienists with the wish to re-entry. Therefore, the present study surveyed inactive Japanese dental hygienists to determine their reasons for inactivity and what barriers they perceived to re-entry into the workforce. The aim of this study was to determine the profile of unemployed dental hygienists who could be enticed to re-enter the workforce, and the factors that could facilitate their re-entry into the dental field in Japan.
Methods The study used cross-sectional data collected in 2011 in Japan. The sample of licensed dental hygienists was selected. A questionnaire was developed using an iterative process with 80 members of the dental hygienist school alumni association, especially with regard to simplifying answer options for several open-ended questions. The revised questionnaire contained ten open-ended and close-ended questions, demographic data (age, marital status, size of household and number of children), total service years as a dental hygienist, presence or absence of membership of Japanese Dental Hygienists’ Association, experience of workshop participants, desired job responsibilities and wages, personal barriers or anxieties about re-entry and important factors that would induce them to re-enter the workforce as a dental hygienist. The questionnaire was mailed with a postage-paid return envelope to a sample of 3095 licensed Japanese dental hygienists under the age of 60 years
through the four well-established alumni associations with a history of more than 40 years. From September to October 2011, a total of 1477 completed surveys was returned. Another 16 surveys were returned with faulty addresses. The adjusted response rate was 50.4% (n = 1477/3095). A chi-square test and t-test were used to test for the significance of the association between the working dental hygienists and unemployed dental hygienists seeking jobs. Data were analysed using SPSS version 19 (IBM, NY, USA). Research ethics
Ethical approval was obtained from the research ethics committee at the National Institute of Public Health Japan (Ethical Approval Number: NIPH-IBRA#11016). All participants involved in the study were informed about the nature of the study and what their participation would entail. The entire answered questionnaire was treated by ID number to preserve the anonymity of the respondents.
Results The rate of working dental hygienists was 60.3% (n = 891) and of unemployed dental hygienists 39.7% (n = 586). Of the unemployed dental hygienists, 31.9% (n = 187) stated intentions of returning to the workplace. The average age of the respondents overall (n = 14377) was 42.20 years10.48 years, and the average total service years as a dental hygienist was 12.17 8.26 years. Table 1 shows the demographic characteristics of two groups: currently working dental hygienists and unemployed dental hygienists seeking jobs. No significant difference in average age was observed between the working group and the unemployed job-seeking group: 40.32 10.39 years and 39.56 10.00 years, respectively. Significantly, more of the job-seeking unemployed group indicated that they were married (92.39%) and had more children (3.58 1.14) compared to the working group (67.58%, 3.49 1.36 and 1.30 1.11). The unemployed job-seeking group had significantly fewer total service years as a dental hygienist (9.33 5.96 years) compared to the current working group (14.37 8.59 years). Only 11.96% of them belonged to the Japan Dental Hygienists’ Association, and 41.3% of those had experiences attending training workshops compared with the working group (25.94 and 71.26%) (Table 2).
Table 1. Demographic data of current working and unemployed job-seeking dental hygienist groups
Demographic data
Working group (N = 891)
Unemployed job-seeking group (N = 187)
Statistical test
Age (years) (Ave. SD) Married (%) Size of household (Ave. SD) Number of children (Ave. SD)
40.32 10.39 67.58% 3.49 1.36 1.30 1.11
39.56 10.00 92.39% 3.58 1.14 1.58 0.99
t = 0.910 p = 0. 363 v2=46. 295 p = 0. 000 t = 0. 837 p = 0. 349 t = 3. 389 p = 0. 001
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Usui and Miura. Re-entry for Japanese unemployed DH
Table 2. Professional dimensions of current working and unemployed job-seeking dental hygienist groups
Professional dimension
Working group (N = 891)
Unemployed job-seeking group (N = 187)
Statistical test
Total service years as DH (years) Member of JDHA Experience of workshop participation
14.37 8.59 25.13% 71.26%
9.33 5.96 11.96% 41.30%
t = –9.588 p = 0. 000 v2=16.537 p = 0. 000 v2=11.209 p = 0. 001
Tables 3 and 4 present their desired job responsibilities and conditions, and wages. They desired the following job responsibilities: ‘oral disease prevention’, ‘assistance with the dentist’s work’ and ‘front-desk work and management of a dental clinic’. Of the unemployed job-seeking group, 45.1% expected to earn under ¥1200. Table 5 describes the barriers or anxieties about re-entry for the unemployed job-seeking group. The top three major barriers to re-entry cited were as follows: ‘lack sufficient dental
Table 3. Desired work responsibilities, if re-entering Work responsibilities
N (%)
Prevention of oral disease Assistant for dentist’s work Periodontal treatment Front-desk work & Management of a dental clinic Oral health care for medically dependent elderly and patients Risk assessment of dysphagia Others
150 116 110 83
(28.1) (21.8) (20.6) (15.6)
48 (9.0) 14 (2.6) 12 (2.3)
Table 4. Desired wages, if re-entering Wage (Hourly pay by yen)
N (%)
More than 2001 1801–2000 1601–1800 1401–1600 1201–1400 1001–1200 Less than 1000
2 3 6 32 58 70 13
(1.1) (1.6) (3.3) (17.4) (31.5) (38.0) (7.1)
Table 5. Personal Barriers or anxieties about re-entry for unemployed dental hygienist group Barriers
N (%)
Lack sufficient DH skill Child rearing & need to care for family members Poor working atmosphere Concern for building new relationships (Generation Gap) Personal health issues Household affairs None
71 (30.2) 68 (29.0)
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36 (15.3) 23 (9.8) 20 (8.5) 15 (6.4) 2 (0.9)
hygiene skill’, ‘child rearing’ and ‘poor working atmosphere’. ‘Flexibility in work schedule’ and ‘location’ were the most important factors regarding re-entry followed by ‘staff relationships including dentist-dental hygienist working relationship’ (Table 6).
Discussion This study attempted to depict the profile of Japanese unemployed dental hygienists as few surveys in the past had carried out. Overall, 1477 members of the licensed dental hygienists were surveyed with a 50.4% of response rate, qualifying as representative of the population of Japanese dental hygienists. By extracting unemployed dental hygienists with a desire to return to the dental field from the total collected data, this study successfully identified the target layer with the possibility of dental field returns. From this result of the survey, there were not many inactive dental hygienists who wish to re-enter the dental field, in spite of increasing in social demand and expectation on Japanese dental hygienists for providing oral health care to the elderly and the medically dependent persons. It was shown that unemployed dental hygienists who wish to return to dental work were more often marrieds and with a larger number of children in comparison with currently working dental hygienists. The unemployed dental hygienists with hope to re-enter had a significantly shorter duration of work experience compared to currently working dental hygienists. According to the Basic Survey on Wage Structure of the Ministry of Internal Affairs and Communications Statistics Bureau Japan, the average wage of currently working dental hygienists was ¥1150–¥1300 per hour (17). From our survey, approximately half of the unemployed dental hygienists
Table 6. Important factors for re-entry for unemployed dental hygienist group Factors
N (%)
Flexible working schedule Location of employment Relationships with co-workers Doctor’s personality Contents of duties Wage Training system for employees None
250 105 101 98 82 76 24 1
(33.9) (14.2) (13.7) (13.3) (11.1) (10.3) (3.3) (0.1)
Usui and Miura. Re-entry for Japanese unemployed DH
desired a relatively lower wage than the outcome of the National Survey. Their desired job responsibilities were ‘prevention of oral disease’ and ‘assistant work’. On the other hand, ‘oral health care for the elderly and medically dependent patients’ and ‘risk assessment of dysphagia’ that have been in high demand in Japan were chosen by few inactive dental hygienists. This suggests that the unemployed dental hygienists were prone to be chosen for lower job skills and responsibilities for which they did not expect a high income. The study also suggests that unemployed dental hygienists’ professional motivation as a whole was quite low. Saito et al. indicated that Japanese dental hygiene students’ motivation towards the profession was significantly lower than Canadian students. These authors concluded that most of the Japanese students enrolled in the dental hygiene programme immediately after high-school graduation without any work experiences (18,19). The length of education of the dental hygiene programme in Japan was once 1 or 2 years. As with the recent situation in European countries, dental hygiene education in Japan has been moving towards a bachelors degree and postgraduate education under the influence of the changing needs of the community (20–22). Since 2010, eight universities have bachelors degree programmes of oral health science, and all of the vocational dental hygienist schools (120) became a 3-year diploma programmes. Compared to the old dental hygiene curriculum, the new one has included more extended job descriptions, such as oral care and the evaluation of chewing and swallowing function for medically dependent patients, and pre- and post-operative oral care for patients who need medical operations. The other reason given for low motivation of unemployed dental hygienists was that most of them are female. It is considered that they may not continue their professional role, as the role of women in the home becomes more significant in Japan, such as a wife, a mother and a daughter-in-law. According to the White Paper on National Life, a turnover of Japanese women in the workforce is generally triggered by childbirth or marriage. This report reveals that Japanese women have worse work–life balance than women in Western countries. However, the number of Japanese women with children who wish to re-enter the workforce has been increasing, in spite of insufficient social support for parenting and family care (23). This reality supports the cited barriers for re-entry in the present study, such as ‘child rearing’, ‘household affairs’ and ‘family responsibilities’. To eliminate such concerns, it is important to develop a social environment such that those who wish to return to work are able to continue their profession while still performing housework and child care. In addition, important factors for re-entry that emerged in this study were ‘flexibility to work schedule’ and ‘location’. Previous studies had reported that factors related to the work environment were most important to turnover intentions (24). A controllable lifestyle, such as more flexible retraining, more part-time work, easier maternity leave provisions and a more flexible childcare
programme, has been an important factor in choice of employment field (25). Another significant barrier was ‘lack sufficient skill’. To overcome this, opportunities for retraining for the new techniques and procedures before re-entry might be necessary. In fact, professional organizations such as the Dental Hygienists Association and the Dental Association have held educational sessions and hands-on trainings on a regular basis. As revealed in this survey, however, most of the unemployed dental hygienists did not belong to these professional organizations. To promote their affiliation, it is necessary to demonstrate the significance of their subscription to professional associations through reunions and educational institutions. Easy access to information on how to return to practice as well as advice on how to maintain professional skills and knowledge during inactivity may help to dispel the misconceptions of inactive dental hygienists. Furthermore, in Japan, the possibility of legislative change surrounding hygienists’ practice has recently emerged; that is, dental hygienist’s practice will evolve from ‘under direct supervision by a dentist’ to ‘closely collaborates with a dentist’. The changes in legislation will have a positive effect on Japanese dental hygienists’ job responsibilities. The demands and expectations on dental hygienists who work as a member of multidisciplinary medical teams to maintain lifelong optimal oral health among medically dependent patients in their pursuit of a better quality of life will have thus been dramatically increased in Japan.
Conclusion This study identified the profile of unemployed dental hygienists who wished to re-enter the workforce in their field, but faced several barriers to doing so. The findings suggest that strategies to encourage inactive dental hygienists to re-enter their workforce should be emphasized, such as providing a flexible working atmosphere, easy access to adequate information on how to return to practice, and guidance on how to maintain professionalism during inactivity. As re-entry of inactive dental hygienists might be of great potential value to fill a workforce gap, these issues should be adequately explored in the future. Clinical relevance Scientific rationale for the study
As the employment rate of the Japanese dental hygienist is quite low, there is concern for the shortage in dental hygiene manpower. However, very little data exist in this area. Principal findings
The findings demonstrated the profile of unemployed dental hygienists who could be enticed to re-enter the workforce, and
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Usui and Miura. Re-entry for Japanese unemployed DH
the factors that could facilitate their re-entry into the dental field. Practical implications
The data are helpful in identifying the need of strategies to encourage inactive dental hygienists to re-enter their workforce.
Acknowledgements This study was funded by a part of the research project of the Ministry of Health, Labor and Welfare of Japan. A part of this study was presented at the 91st General Session and Exhibition of the International Association for Dental Research on March 22, 2013.
Conflict of interest The authors declare that they have no conflict of interest.
References 1 White Paper on Aging Society of the Cabinet Office. (in Japanese). Available at: http://www8.cao.go.jp/kourei/whitepaper/index-w.html (accessed 10 January 2014). 2 Long-term Care Insurance in Japan, General Affairs Division Health and Welfare Bureau for the Elderly Ministry of Health, Labor and Welfare. Available at: http://www.mhlw.go.jp/english/ topics/elderly/care/index.html (accessed 13 January 2014). 3 The 2010 Report of the Ministry of Health, Labor and Welfare, Japan. Available at: http://www.mhlw.go.jp/english/ (accessed 10 January 2014). 4 Tada A, Miura H. Prevention of aspiration pneumonia (AP) with oral care. Arch Gerontol Geriatr 2012; 55: 16–21. 5 Bansal M, Rastogi S, Vineeth NS. Influence of periodontal disease on systemic disease: inversion of a paradigm: a review. J Med Life 2013; 6: 126–130. 6 Horiguchi S, Suzuki Y. Screening test in evaluating swallowing function. Japan Med Assoc J 2011; 54: 31–34. 7 Yoneyama T, Hashimoto K, Fukuda H et al. Oral hygiene reduces respiratory infections in elderly bed-bound nursing home patients. Arch Gerontol Geriatr 1996; 22: 11–19. 8 Yoneyama T, Yoshida M, Ohrui T et al.; Oral Care Working Group. Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc 2002; 50: 430–433. 9 Forsell M, Sjogren P, Kullberg E et al. Attitudes and perceptions towards oral hygiene tasks among geriatric nursing home staff. Int J Dent Hyg 2011; 9: 199–203.
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10 The 2010 Report of the Ministry of Health, Labor and Welfare, Japan. Available at: http://www.mhlw.go.jp/toukei/saikin/hw/eisei/ 10/ (accessed 13 January 2014). 11 Widstrom E, Eaton KA, Luciak-Donsberger C. Changes in dentist and dental hygienist numbers in the European union and Economic area. Int Dent J 2010; 4: 312–316. 12 Johnson PM. International profiles of dental hygiene 1987 to 2006: a 21-nation comparative study. Int Dent J 2009; 9: 63–77. 13 Eaton KA, Newman HN, Widstrom E. A survey of dental hygienist numbers in Canada, the European Economic area, Japan and the United States of America in 1998. Br Dent J 2003; 195: 595–598. 14 OHara Y, Furukawa S, Ando Y et al. The shortage of dental hygienists at dental clinic in Japan-Report of a questionnaire survey of Japan Dental association’s members-(in Japanese). J Dent Health 2012;62:282–288. 15 Yoshida T, Eda S, Takaku S. Study on employee as dental hygienists in dental institutions: Saitama Pref. (in Japanese) Japanese J Dent Prac Adm 2010; 44: 216–226. 16 Ueda Y, Yagun A, Nagasaki Y, Kago M, Katayama S. Study on the reinstatement of unemployed dental hygienists: Kanagawa Pref. (in Japanese) Japanese J Dent Prac Adm 2011; 45: 286–293. 17 Basic Survey on Wage Structure of the Ministry of Internal Affairs and Communications Statistics Bureau Japan. Available at: http:// www.stat.go.jp/english/data/nenkan/1431-16e.htm (accessed 10 January 2014). 18 Saito A, Tomita C, Sato Y, Cathcart G. Perceptions of Japanese and Canadian dental hygiene students towards their profession. Int J Dent Hygiene 2009; 7: 188–195. 19 Saito A, Sunell S, Rucker L, Wilson M, Sato Y, Cathcart G. Learning climate in dental hygiene education: a longitudinal case study of a Japanese and Canadian programme. Int J Dent Hygiene 2010; 8: 134–142. 20 Kanji Z, Sunell S, Boschma G, Imai P, Craig BJ. A discourse on dental hygiene education in Canada. Int J Dent Hygiene 2011; 9: 242 –249. 21 Jongbloed-Zoet C, Bol-van den Hil EM, La Riviere-Ilsen J, van der Sanden-Stoelinga MSE. Dental Hygienists in the Netherlands: the past, present and future. Int J Dent Hygiene 2012; 10: 148–154. 22 Luciak-Donsberger C, Eaton KA. Dental hygienists in Europe: trends towards harmonization of education and practice since 2003. Int J Dent Hygiene 2005; 7: 273–284. 23 Walls that prevent women from continuing work and re-employment (in Japanese) pp. 61–99 White Paper on National Life 2006, Cabinet Office. Available at: http://www8.cao.go.jp/kourei/whitepaper/ (accessed 13 January 2014). 24 Coomber B, Barriball KL. Impact of job satisfaction components on intent to leave and turnover for hospital-bases nurses: a review of the research literature. Int Nurs Stud 2007; 44: 297–314. 25 Abbott A, Barrow S-Y, Lopresti F, Hittelman E. International employment in clinical practice: influencing factors for the dental hygienist. Int J Dent Hygiene 2005; 3: 37–44.
Y Usui, H Miura
Authors’ affiliations: Y Usui, H Miura, Department of International Health and Collaboration, National Institute of Public Health, Saitama, Japan Y Usui,, Department of Gerodontology, Tokyo Medical and Dental University, Tokyo, Japan Correspondence to: Y. Usui Department of International health and Collaboration National Institute of Public Health 2-3-6 Minami, Wako-shi 351-0197 Saitama Japan Tel.: +81-48-458-6111 Fax: +81-48-469-1573 E-mail: [email protected]
Workforce re-entry for Japanese unemployed dental hygienists Abstract: Objective: The aim of this study was to define the profile of unemployed dental hygienists who could be enticed to re-enter the workforce and the factors that could facilitate their re-entry into the dental field in Japan. Methods: The questionnaire was mailed with a postage-paid return envelope to a sample of 3095 licensed dental hygienists. A 50.4% response rate (S = 1477) was observed. Results: The rate of working dental hygienists was 60.3% (n = 891), and of unemployed dental hygienists was 39.7% (n = 586). Of the latter, 31.9% (n = 187) stated intentions of returning to the workplace. The unemployed dental hygienists seeking employment were more often married and had more children, compared with working dental hygienists currently. This group also had significantly fewer total service years. Moreover, only 11.96% of them belonged to the Japan Dental Hygienists’ Association, and 41.3% of those attended training workshops. According to their response, they perceived their top three major barriers to re-entry as ‘lack sufficient dental hygiene skill’, ‘child rearing’ and ‘poor working atmosphere’. ‘Flexibility in the work schedule’ and ‘location’ were the most important factors for re-entry from their perspective. Conclusion: There were not many dental hygienists hoping to return to the dental field. The findings suggested that strategies to encourage non-practicing dental hygienists to re-entry should be emphasized in the areas of a flexible working atmosphere, easy access to information on how to return to practice and guidance on how to maintain professionalism during inactivity. Key words: barriers; dental hygiene profession; re-entry; unemployed dental hygienists; work–life balance
Introduction
Dates: Accepted 21 July 2014 To cite this article: Int J Dent Hygiene 13, 2015; 74–78 DOI: 10.1111/idh.12101 Usui Y, Miura H. Workforce re-entry for Japanese unemployed dental hygienists © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
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| Int J Dent Hygiene 13, 2015; 74--78
Japan has entered a phase of an ageing society at a speed that any other countries in the world have not experienced. Concomitantly, the number of the dependent elderly has been increasing rapidly. The percentage of the total population over the age of 65 in 2011 was 23.3% (1). As a result of the emergence of such circumstances, the Long–Term Care Insurance Act passed in 1997. The aim of the Insurance Act was to create a social support system for long-term care of the bedridden elderly and persons suffering from dementia (2). The resulting Insurance System has been implemented from the year 2000. Focusing on the oral hygiene of the elderly, the condition of their oral health has deteriorated for the most part, although the proportion of elderly people over the age of 80 with more than 20 teeth has dramatically increased to 38.3% in 2011 (3). It is well known that oral health is related to overall health. Many studies indicate that an unclean oral
Usui and Miura. Re-entry for Japanese unemployed DH
cavity induces systemic disease, such as aspiration pneumonia and cardiovascular disease (4,5). In such a state, the demands of oral care and maintenance of oral function for the elderly, including performing oral function assessments (6), training for swallowing and stimulation of saliva secretion, have dramatically increased on dental hygienists (7–9). Although over 200 000 dental hygienists exist in Japan, only approximately 100 000 of them currently work (10). Thus, the employment rate of the Japanese dental hygienist is quite low in comparison with other countries (11–13). Because of concern about the shortage in dental hygiene manpower in Japan’s current population ratio, the need to investigate retention and re-entry points for dental hygienists increases (14). However, very little data on Japanese dental hygienists re-entry exist. Prefecture-level studies by Yoshida and Ueda have provided some important data (15,16). As response rate and sample size were quite low, they were not sufficient to represent an overview of Japanese dental hygienists, especially unemployed dental hygienists with the wish to re-entry. Therefore, the present study surveyed inactive Japanese dental hygienists to determine their reasons for inactivity and what barriers they perceived to re-entry into the workforce. The aim of this study was to determine the profile of unemployed dental hygienists who could be enticed to re-enter the workforce, and the factors that could facilitate their re-entry into the dental field in Japan.
Methods The study used cross-sectional data collected in 2011 in Japan. The sample of licensed dental hygienists was selected. A questionnaire was developed using an iterative process with 80 members of the dental hygienist school alumni association, especially with regard to simplifying answer options for several open-ended questions. The revised questionnaire contained ten open-ended and close-ended questions, demographic data (age, marital status, size of household and number of children), total service years as a dental hygienist, presence or absence of membership of Japanese Dental Hygienists’ Association, experience of workshop participants, desired job responsibilities and wages, personal barriers or anxieties about re-entry and important factors that would induce them to re-enter the workforce as a dental hygienist. The questionnaire was mailed with a postage-paid return envelope to a sample of 3095 licensed Japanese dental hygienists under the age of 60 years
through the four well-established alumni associations with a history of more than 40 years. From September to October 2011, a total of 1477 completed surveys was returned. Another 16 surveys were returned with faulty addresses. The adjusted response rate was 50.4% (n = 1477/3095). A chi-square test and t-test were used to test for the significance of the association between the working dental hygienists and unemployed dental hygienists seeking jobs. Data were analysed using SPSS version 19 (IBM, NY, USA). Research ethics
Ethical approval was obtained from the research ethics committee at the National Institute of Public Health Japan (Ethical Approval Number: NIPH-IBRA#11016). All participants involved in the study were informed about the nature of the study and what their participation would entail. The entire answered questionnaire was treated by ID number to preserve the anonymity of the respondents.
Results The rate of working dental hygienists was 60.3% (n = 891) and of unemployed dental hygienists 39.7% (n = 586). Of the unemployed dental hygienists, 31.9% (n = 187) stated intentions of returning to the workplace. The average age of the respondents overall (n = 14377) was 42.20 years10.48 years, and the average total service years as a dental hygienist was 12.17 8.26 years. Table 1 shows the demographic characteristics of two groups: currently working dental hygienists and unemployed dental hygienists seeking jobs. No significant difference in average age was observed between the working group and the unemployed job-seeking group: 40.32 10.39 years and 39.56 10.00 years, respectively. Significantly, more of the job-seeking unemployed group indicated that they were married (92.39%) and had more children (3.58 1.14) compared to the working group (67.58%, 3.49 1.36 and 1.30 1.11). The unemployed job-seeking group had significantly fewer total service years as a dental hygienist (9.33 5.96 years) compared to the current working group (14.37 8.59 years). Only 11.96% of them belonged to the Japan Dental Hygienists’ Association, and 41.3% of those had experiences attending training workshops compared with the working group (25.94 and 71.26%) (Table 2).
Table 1. Demographic data of current working and unemployed job-seeking dental hygienist groups
Demographic data
Working group (N = 891)
Unemployed job-seeking group (N = 187)
Statistical test
Age (years) (Ave. SD) Married (%) Size of household (Ave. SD) Number of children (Ave. SD)
40.32 10.39 67.58% 3.49 1.36 1.30 1.11
39.56 10.00 92.39% 3.58 1.14 1.58 0.99
t = 0.910 p = 0. 363 v2=46. 295 p = 0. 000 t = 0. 837 p = 0. 349 t = 3. 389 p = 0. 001
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Table 2. Professional dimensions of current working and unemployed job-seeking dental hygienist groups
Professional dimension
Working group (N = 891)
Unemployed job-seeking group (N = 187)
Statistical test
Total service years as DH (years) Member of JDHA Experience of workshop participation
14.37 8.59 25.13% 71.26%
9.33 5.96 11.96% 41.30%
t = –9.588 p = 0. 000 v2=16.537 p = 0. 000 v2=11.209 p = 0. 001
Tables 3 and 4 present their desired job responsibilities and conditions, and wages. They desired the following job responsibilities: ‘oral disease prevention’, ‘assistance with the dentist’s work’ and ‘front-desk work and management of a dental clinic’. Of the unemployed job-seeking group, 45.1% expected to earn under ¥1200. Table 5 describes the barriers or anxieties about re-entry for the unemployed job-seeking group. The top three major barriers to re-entry cited were as follows: ‘lack sufficient dental
Table 3. Desired work responsibilities, if re-entering Work responsibilities
N (%)
Prevention of oral disease Assistant for dentist’s work Periodontal treatment Front-desk work & Management of a dental clinic Oral health care for medically dependent elderly and patients Risk assessment of dysphagia Others
150 116 110 83
(28.1) (21.8) (20.6) (15.6)
48 (9.0) 14 (2.6) 12 (2.3)
Table 4. Desired wages, if re-entering Wage (Hourly pay by yen)
N (%)
More than 2001 1801–2000 1601–1800 1401–1600 1201–1400 1001–1200 Less than 1000
2 3 6 32 58 70 13
(1.1) (1.6) (3.3) (17.4) (31.5) (38.0) (7.1)
Table 5. Personal Barriers or anxieties about re-entry for unemployed dental hygienist group Barriers
N (%)
Lack sufficient DH skill Child rearing & need to care for family members Poor working atmosphere Concern for building new relationships (Generation Gap) Personal health issues Household affairs None
71 (30.2) 68 (29.0)
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36 (15.3) 23 (9.8) 20 (8.5) 15 (6.4) 2 (0.9)
hygiene skill’, ‘child rearing’ and ‘poor working atmosphere’. ‘Flexibility in work schedule’ and ‘location’ were the most important factors regarding re-entry followed by ‘staff relationships including dentist-dental hygienist working relationship’ (Table 6).
Discussion This study attempted to depict the profile of Japanese unemployed dental hygienists as few surveys in the past had carried out. Overall, 1477 members of the licensed dental hygienists were surveyed with a 50.4% of response rate, qualifying as representative of the population of Japanese dental hygienists. By extracting unemployed dental hygienists with a desire to return to the dental field from the total collected data, this study successfully identified the target layer with the possibility of dental field returns. From this result of the survey, there were not many inactive dental hygienists who wish to re-enter the dental field, in spite of increasing in social demand and expectation on Japanese dental hygienists for providing oral health care to the elderly and the medically dependent persons. It was shown that unemployed dental hygienists who wish to return to dental work were more often marrieds and with a larger number of children in comparison with currently working dental hygienists. The unemployed dental hygienists with hope to re-enter had a significantly shorter duration of work experience compared to currently working dental hygienists. According to the Basic Survey on Wage Structure of the Ministry of Internal Affairs and Communications Statistics Bureau Japan, the average wage of currently working dental hygienists was ¥1150–¥1300 per hour (17). From our survey, approximately half of the unemployed dental hygienists
Table 6. Important factors for re-entry for unemployed dental hygienist group Factors
N (%)
Flexible working schedule Location of employment Relationships with co-workers Doctor’s personality Contents of duties Wage Training system for employees None
250 105 101 98 82 76 24 1
(33.9) (14.2) (13.7) (13.3) (11.1) (10.3) (3.3) (0.1)
Usui and Miura. Re-entry for Japanese unemployed DH
desired a relatively lower wage than the outcome of the National Survey. Their desired job responsibilities were ‘prevention of oral disease’ and ‘assistant work’. On the other hand, ‘oral health care for the elderly and medically dependent patients’ and ‘risk assessment of dysphagia’ that have been in high demand in Japan were chosen by few inactive dental hygienists. This suggests that the unemployed dental hygienists were prone to be chosen for lower job skills and responsibilities for which they did not expect a high income. The study also suggests that unemployed dental hygienists’ professional motivation as a whole was quite low. Saito et al. indicated that Japanese dental hygiene students’ motivation towards the profession was significantly lower than Canadian students. These authors concluded that most of the Japanese students enrolled in the dental hygiene programme immediately after high-school graduation without any work experiences (18,19). The length of education of the dental hygiene programme in Japan was once 1 or 2 years. As with the recent situation in European countries, dental hygiene education in Japan has been moving towards a bachelors degree and postgraduate education under the influence of the changing needs of the community (20–22). Since 2010, eight universities have bachelors degree programmes of oral health science, and all of the vocational dental hygienist schools (120) became a 3-year diploma programmes. Compared to the old dental hygiene curriculum, the new one has included more extended job descriptions, such as oral care and the evaluation of chewing and swallowing function for medically dependent patients, and pre- and post-operative oral care for patients who need medical operations. The other reason given for low motivation of unemployed dental hygienists was that most of them are female. It is considered that they may not continue their professional role, as the role of women in the home becomes more significant in Japan, such as a wife, a mother and a daughter-in-law. According to the White Paper on National Life, a turnover of Japanese women in the workforce is generally triggered by childbirth or marriage. This report reveals that Japanese women have worse work–life balance than women in Western countries. However, the number of Japanese women with children who wish to re-enter the workforce has been increasing, in spite of insufficient social support for parenting and family care (23). This reality supports the cited barriers for re-entry in the present study, such as ‘child rearing’, ‘household affairs’ and ‘family responsibilities’. To eliminate such concerns, it is important to develop a social environment such that those who wish to return to work are able to continue their profession while still performing housework and child care. In addition, important factors for re-entry that emerged in this study were ‘flexibility to work schedule’ and ‘location’. Previous studies had reported that factors related to the work environment were most important to turnover intentions (24). A controllable lifestyle, such as more flexible retraining, more part-time work, easier maternity leave provisions and a more flexible childcare
programme, has been an important factor in choice of employment field (25). Another significant barrier was ‘lack sufficient skill’. To overcome this, opportunities for retraining for the new techniques and procedures before re-entry might be necessary. In fact, professional organizations such as the Dental Hygienists Association and the Dental Association have held educational sessions and hands-on trainings on a regular basis. As revealed in this survey, however, most of the unemployed dental hygienists did not belong to these professional organizations. To promote their affiliation, it is necessary to demonstrate the significance of their subscription to professional associations through reunions and educational institutions. Easy access to information on how to return to practice as well as advice on how to maintain professional skills and knowledge during inactivity may help to dispel the misconceptions of inactive dental hygienists. Furthermore, in Japan, the possibility of legislative change surrounding hygienists’ practice has recently emerged; that is, dental hygienist’s practice will evolve from ‘under direct supervision by a dentist’ to ‘closely collaborates with a dentist’. The changes in legislation will have a positive effect on Japanese dental hygienists’ job responsibilities. The demands and expectations on dental hygienists who work as a member of multidisciplinary medical teams to maintain lifelong optimal oral health among medically dependent patients in their pursuit of a better quality of life will have thus been dramatically increased in Japan.
Conclusion This study identified the profile of unemployed dental hygienists who wished to re-enter the workforce in their field, but faced several barriers to doing so. The findings suggest that strategies to encourage inactive dental hygienists to re-enter their workforce should be emphasized, such as providing a flexible working atmosphere, easy access to adequate information on how to return to practice, and guidance on how to maintain professionalism during inactivity. As re-entry of inactive dental hygienists might be of great potential value to fill a workforce gap, these issues should be adequately explored in the future. Clinical relevance Scientific rationale for the study
As the employment rate of the Japanese dental hygienist is quite low, there is concern for the shortage in dental hygiene manpower. However, very little data exist in this area. Principal findings
The findings demonstrated the profile of unemployed dental hygienists who could be enticed to re-enter the workforce, and
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the factors that could facilitate their re-entry into the dental field. Practical implications
The data are helpful in identifying the need of strategies to encourage inactive dental hygienists to re-enter their workforce.
Acknowledgements This study was funded by a part of the research project of the Ministry of Health, Labor and Welfare of Japan. A part of this study was presented at the 91st General Session and Exhibition of the International Association for Dental Research on March 22, 2013.
Conflict of interest The authors declare that they have no conflict of interest.
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