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Journal of Social Service Research
ISSN: 0148-8376 (Print) 1540-7314 (Online) Journal homepage: https://www.tandfonline.com/loi/wssr20
Attitudes Toward Women in Health Care
Organizations: A Turkish Case Study
Sukru Anıl Toygar, Derya Kara & Mehmet Kırlıoğlu
To cite this article: Sukru Anıl Toygar, Derya Kara & Mehmet Kırlıoğlu (2020) Attitudes Toward Women in Health Care Organizations: A Turkish Case Study, Journal of Social Service Research, 46:2, 264-272, DOI: 10.1080/01488376.2018.1555109
To link to this article: https://doi.org/10.1080/01488376.2018.1555109
Published online: 26 Feb 2019.
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Attitudes Toward Women in Health Care Organizations: A Turkish
Case Study
Sukru Anıl Toygara, Derya Karaband Mehmet Kırlıogluc
a
Faculty of Health Sciences, Selcuk University, Konya, Turkey;bFaculty of Economics and Administrative Sciences, Health Care Management Department, Ankara Haci Bayram Veli University, Ankara, Turkey;cFaculty of Health Sciences, Social Work Department, Necmettin Erbakan University, Konya, Turkey
ABSTRACT
The aim of this article is to examine the health care employees’ attitudes toward women in health care organizations in Turkey. It was measured using a 25-item scale by Spence, Helmreich, and Stapp (1973). The study was conducted on 541 employees: 279 males and 262 females. Structural equation model (SEM) was applied to analyze the relationship between gender, marital status, and income and attitudes toward woman. The result of this analysis showed that the relations between gender, marital status, and income and attitudes toward woman were statistically significant. All three hypotheses were statistically sup-ported. This result indicated that employees’ marital status and (monthly) income signifi-cantly predicted their scores of attitudes toward woman in a positive direction. Besides, employees’ gender significantly predicted their scores of attitudes toward woman in an inverse direction. Future research can focus on investigating the effects of the attitudes toward women on other elements (e.g., performance, motivation, job satisfaction) or a wider sample to reach more generalized results.
KEYWORDS
Attitudes toward women; health care organizations; health care employees; Turkey
Introduction
In organizations, women’s participation in the workforce has been an important concern recently. Today, nearly 50% of women around the world are officially in the labor force and women constitute approximately one-third of all workers (Tzannatos, 1999). According to the OECD countries, in 2011, the employment rate of women was the highest in Iceland (77.3%) and was the lowest in Turkey (27.8%). According to the Global Gender Gap Index (2015), Turkey is the 130th most unequal country among 134 countries. Moreover, it is the lowest-performing country from the region on the Economic Participation and Opportunity subindex. The feminization of the workers, which is often a phenomenon identified with the half of the work-force, or even more than half of the workwork-force, is also true for the health sector. As a matter of fact, according to TUIK (2009) data, 28% of those employed in all sectors are female while
this rate is 55% for health care (Urhan & Etiler, 2011). Employers have denied women training for positions of higher skill and responsibility using (a) the femininity argument, (b) the short work–life argument, and (c) the argument that men resent working for a woman. As a result, women are relatively less skilled, especially for positions of responsibility in technical and execu-tive occupations, and in the professions (Agassi, 1975).
Changing gender roles in the last 20 – 25 years have allowed more women to combine domestic responsibilities with paid work outside the home. Gender employment gap in Turkey has been no exception despite Turkey’s long-standing leading position in the region in terms of industrializa-tion, economic growth, democratizaindustrializa-tion, and women’s rights (_Ilkkaracan, 2012). Women’s traditional caring responsibilities as well as their primary responsibility for housework remain a significant barrier to employment opportunities (Lane, 2008). Aycan (2004) studied key success
CONTACTSukru Anıl Toygar sanil.toygar@selcuk.edu.tr Faculty of Health Sciences, Selcuk University, Konya 42250, Turkey. Color versions of one or more of the figures in the article can be found online atwww.tandfonline.com/wssr.
ß 2019 Taylor & Francis Group, LLC
factors for women in management in Turkey. Findings of this study suggest that the socio-cul-tural context impacts women’s career advance-ment in two ways. First, gender-role stereotypes may constitute a barrier in cultures where wom-en’s family-related responsibilities cannot be negotiated. Second, attitudes toward women’s career advancement create barriers for women. Gender-role stereotypes and attitudes toward women’s career advancement, in turn, influence women’s own self-perceptions and ideals as well as the support they receive from their organiza-tion and families. The high participaorganiza-tion rate on the labor force is desirable for the economy. Although this is the desired situation, it is known that this ratio is constantly decreasing over the years as far as our country is concerned. One of the most basic reasons for this is the fact that women cannot take the place that they need to take in employment, that is, the labor-force par-ticipation rate of women is low. For this reason, policies have been developed in recent years to ensure the employment of women (Korkmaz & Korkut,2012).
Literature
Attitudes Toward Women in Societies
The issue of attitudes toward women in different cultures has been an important concern in the world. Mostafa (2005) reported that attitudes toward women involve expectations directed at women and these ideas are often based on nega-tive stereotypes and broad assumptions about women’s characteristics. Work and family activ-ities frequently occur at different times and pla-ces, and because men were assumed to have primary responsibility at work and women were assumed to have primary responsibility at home (Clark, 2001). Traditionally, modern society has differentially allocated men and women to differ-ent social roles in the division of labor. Although such a gender-based allocation of jobs is not necessarily inevitable because of differences in reproductive and lactation functions, women are much more likely to be engaged in the care and nurture of children (Alwin, Braun, & Scott, 1992). Mostafa (2005) reported that
modernization theory argues that increases in urbanization, education, and women’s involve-ment in the workforce lead to increasingly similar roles for men and women and, hence, a favorable attitude toward women. As an individual woman makes decisions about education, family forma-tion, fertility, and labor market participation over her life cycle, one can see these choices as influ-enced by her personal perception of the trad-itional family model where the man is the breadwinner and the woman is the homemaker (Fortin, 2005).
There are large amount of research in attitudes toward woman in other countries in the world. Abdalla (1996) investigated attitudes toward women in the Arabian Gulf region and findings revealed a cultural effect on professional employ-ees’ attitudes toward the rights and roles of women in the society. These results suggest that while Arab women are willing to accept more responsibilities in the political, occupational, edu-cational, and social spheres, Arab men are not willing to share these responsibilities with them. The men’s traditional stance and a number of rules and regulations are surrounding women, particularly. Although there exists some evidence that attitudes in these societies are, in general, changing toward a less traditional stance, these societies are reluctant to abandon their traditional viewpoint of women primarily committed to the house and children. In the majority of Indian families, girls grow up in a culture that presumes that their duties and capabilities are different from those of the boys. Girls are socialized to be submissive. Women’s education and employment continue to be low although women outnumber men in employment in the primary (agriculture) sector. Thus, traditional patriarchal attitudes toward women still prevail and are strengthened and perpetuated in the home (Budhwar, Saini & Bhatnagar, 2005). Alwin et al. (1992) compared with respect to attitudes toward female labor-force participation in Germany, Great Britain, and the United States. Results indicate that men and women reflect substantial preference for a primary familial role for women, especially when children are present. Intra-country patterns of predictable variation in attitudes are quite coun-tries considered: attitudes favoring the labor-force
involvement of women are associated labor-force experience, schooling, and birth cohort. Loo and Thorpe (1998) investigated attitudes toward wom-en’s roles in society and found that attitudes toward women’s roles in society have become more liberal since the mid-1970s for both men and women.
Country cultures vary around the globe with regard to their levels of masculinity/femininity. According to Hofstede, Turkey is in the middle range in terms of the masculinity/femininity (the accepted gender roles in society) (Kara, Uysal & Magnini, 2012). Society’s perspective on women affects women’s participation in the workforce. Women cannot join the workforce due to some attitudes of the society such as “The woman should be staying at home, looking after her child, dealing with domestic affairs” (Korkmaz & Korkut, 2012). In addition, proverbs and idioms, which are commonly used in Turkish culture, such as “female bird makes the nest” and “men make houses, women make homes” can be shown as examples of the preparation of cognitive pro-cess behind women’s stay away from working life (Kalaycı Kırlıoglu, Akarc¸ay & Kırlıoglu, 2016). In Turkey, women play an increasingly active role in the economy. It is found that there is generally a positive attitude toward women’s participation in the labor force (Aycan, 2001). When the par-ticipation of women in the labor force is exam-ined according to the regions in the world, Turkey (27.6%) was very low in women’s employment in 2010, which was approximately half of the Developed Economies and European Union (53.0%), Central and South-Eastern Europe (non-EU) and CIS (49.9%), East Asia (66.7%), South-East Asia and the Pacific (58.7%), Latin America and the Caribbean (53.5%), and Sub-Saharan Africa (64.5%). However, compared to the countries of the Middle East (18.4%) and North Africa (24.2%), there is a parallel trend in terms of women’s participation in the workforce (Karabıyık, 2012). While there have been large amounts of research in this area around the world, little research has been conducted on the attitudes toward women in Turkey. Therefore, the main objective of this study is to examine the attitudes toward women with respect to demo-graphic variables such as gender, marital status, age, and education level in health care
organizations in Turkey. From this evaluation, we can reach some conclusions about attitudes toward women in health sector in Turkey. Also, such rich information will contribute to the the-oretical and practical underpinnings to attitudes toward woman for literature.
Gender, Marital Status, and Income Effect on Attitudes Toward Women
Despite the increasing participation of women in the workforce and positive attitudes toward it, societal values and expectations may create a bar-rier for career development. In Turkish culture, maintaining family integrity and harmony and taking care of children are the primary responsi-bilities of women (Aycan,2001).
In a society, attitudes toward women are influ-enced by many factors such as gender (Askar & Ahmad, 2003; Bankart, 1985; Diwan & Menezes, 1992; Haworth, Povey, & Clift, 1986; McKinney, 1987; Mostafa, 2003, 2005). In the past two deca-des, researchers have devoted increased attention to the role of gender in the determination of work attitudes. Gender is a social and contextual key variable which may condition individual needs, values and constraints, organizational and social context, job characteristics, and even access to justice (Hatipoglu Aydin & Aydin, 2016; Loscocco & Roschelle, 1991). Vella (1994) exam-ined the link between the gender-role perceptions of females and the impact of these perceptions on labor market behavior. In the light of this information, the study concludes that a trad-itional attitude of gender roles affects labor mar-ket behavior. Askar and Ahmad (2003) studied factors determining attitudes toward women occupying supervisory positions at various organ-izations in Kuwait with a sample of 278 partici-pants. The results of the study indicated a relatively positive attitude toward women manag-ers. Sex of the participant was found to be statis-tically significant in determining attitudes toward female managers with women more supportive to women in supervisory positions. Mar’i (1983) examined the sex-role perceptions of Palestinian man and women in Israel. According to the study findings, 2.2% of the women indicated that they are traditional (i.e., the major role of a woman is
in the home and for the family); 12.5% are bal-anced in their perceptions (i.e., a woman should be both self-and family-oriented); and 85.3% of the female subjects indicated that they are liberal (i.e., a woman’s ambitions come before her family obligations). On the average, men expressed bal-anced perceptions, and woman expressed liberal ones. Mostafa (2003) studied attitudes toward women who work in Egypt and found that there are significant differences between men’s and women’s perceptions toward women’s roles and participation in society. Mostafa (2005) investi-gated attitudes toward female managers in the United Arab Emirates and found that UAE stu-dents have significantly different attitudes toward female managers from those of the older genera-tions. There are significant differences between males’ and females’ perceptions of women’s roles and participation in society. The study predicts that modernity may diminish patriarchal attitudes toward women managers in the Arab World. Bankart (1985) studied Japanese attitude toward women using Spence et al.’s (1973) Attitudes Toward Women Scale (AWS). A comparison of mean scores on the AWS and the percentage of agreement on individual scale items indicated that men were more conservative than women, generally endorsing the traditional view of wom-en’s place in the home and a separation of mwom-en’s and women’s activities. Although mothers were more liberal than men, unmarried college women held the most liberal views of the sample. Rowland (1977) found that attitudes were found to be more liberal in 1976 than in 1975 for both males and females. Moreover, Haworth et al. (1986) found that men were significantly more traditional in their attitudes toward women com-pared with the women. Elamin and Omair (2010) examined the males’ attitudes toward working females in Saudi Arabia and the paper reveals that Saudi males report very traditional attitudes toward working women. Thus, we propose to test the following hypotheses:
H1: Gender of the employees determines the
atti-tude toward women
In a society, attitudes toward women are also influenced by marital status (Abdalla, 1996; Baker
& Terpstra, 1986). The participation of the mar-ried woman in the labor force is more compli-cated than the single woman in Turkey. There are some reasons that prevent married women from working and these are the role that society has placed upon itself such as the number of children, especially children’s ages, and whether there is an elderly care or not. Especially if a woman has children aged 0–5 years, they do not prefer to join the labor force and take care of this age group in Turkey (Korkmaz & Korkut, 2012). Recent findings of the Household Labor Force Survey showed that the labor-force participation rates of women (aged 29–45 years) with children (29.9%) are significantly lower than for those without children (45.5%) (Erarslan & Aycan, 2017). Elamin and Omair (2010) investigated males’ attitudes toward working females in Saudi Arabia and their findings showed that single par-ticipants were reported having less traditional attitudes than married participants. Thus, we pro-pose to test the following hypotheses:
H2: Marital status of employees determines the
atti-tude toward woman.
Attitudes toward women were influenced by also income levels of employees. Wages have been shown to influence an employee’s decision to leave the organization (Kline & Hsieh, 2007). Educational and experiential differences, the pro-pensity of women to work in part-time jobs and occupational segregation may explain gender wage differences (Kara & Murrmann, 2011). More families are comprised of dual earners where both partners participate in the labor mar-ket and are expected to participate in work in the household. However, there continue to be a per-sistent gender gap in pay with women’s hourly pay averaging 86% of men’s although women are generally more educated and are spending more time in the labor market (Lane, 2008). Bartol (1980) reported that an average working woman would need a 71% raise to bring her income to the equivalent of males’ at the same level of achievement. Harris and Firestone (1998) studied changes in predictors of gender-role ideologies among women and found that overall family income is significantly and positively associated
with more egalitarian gender-role views. Thus, we propose to test the following hypothesis:
H3: Income level of employees determines the
atti-tude toward women.
Methods
Sample
This sampling scheme also met the acceptable level of sample size that was suggested for the study. The study used a proportional stratified random sampling based on the number of health care organizations and their total number of employees. Based on this information, the total survey population is estimated as 871.334 (according to the Tuik Data, 2016). This figure was treated as the limit of the universe and fol-lowing the sample size calculation as suggested by Yamane (2001), the appropriate sample size turned out to be 383.
Instruments
The first part of the survey comprises characteris-tics of employees (gender, marital status, monthly income level). In second part, the short version of Attitudes Toward Women is measured using a 25-item scale developed by Spence et al. (1973). The scale was scored on a four-point Likert-type response ranging from 0 “strongly disagree” to 3 “strongly agree”. It indicated good reliability with a Cronbach alpha of 0.85. To prevent potential language problems, the questionnaire was trans-lated into Turkish using back translation method by the research team.
Procedure
Data collection took place during the months of October 2017 through January 2018 in health care organizations in Ankara, the capital city of Turkey. Initially, based on the size of the health
care organization, an appropriate number of questionnaires was sent to each organization managers. The managers of these organizations distributed questionnaires to employees and col-lected them. In total, 967 questionnaires were dis-tributed. The questionnaire was completed by employees who work in health care organizations. After a waiting period of 6 months, 571 usable questionnaires were generated and they provided a response rate of almost 59%.
Results
The first part of the data analysis procedure includes descriptive analysis. The characteristics of respondents revealed male and female partici-pants accounted for 51.6% and 48.4% of the sam-ple, respectively. The marital status distribution of respondents showed that married employees accounted for 73.49% and single employees 26.6% of the sample. In terms of monthly income status, 13.5% is earning a monthly income of 1500 TL (Turkish Lira) and less, 21.6% is earning a monthly income of 1501–2500 TL, 43.1% is earning a monthly income of 2501–3000 TL and 21.8% is earning a monthly income of 3500 TL and over. The distribution of employees’ ages were as follows: 18–30 years old (24.6%), 31–40 years old (33.3), 41–50 years old (27.5%), and 50 þ (14.6%). Additionally, when the educa-tional level of the employees was examined, it was seen that 10% was primary school graduate, 21.1% was high school graduate, 11.3% had asso-ciate degree, 44.7% had bachelor’s degree, and 12.9% had postgraduate degree.
Moreover, the relations between gender, mari-tal status, and income and attitudes toward woman were examined using structural equation modeling (SEM) with the maximum likelihood method of estimation. As it is shown in Table 1, in the structural model including marital status, gender, income, and attitudes toward woman, the relations between marital status and attitudes toward woman (t=–2.799, p<.05); gender and attitudes toward woman (t=–11.119, p<.001); income (monthly) and attitudes toward woman (t¼ 12.9977, p=.000) were statistically significant. The gender of health care employees affects their attitudes toward women. In other words, male Table 1. Structural model including gender, marital status,
income, and attitudes toward woman.
Hypothesized path Estimate S.E. C.R. p Attitudes toward women Gender –7.778 0.700 –11,119 .000 Attitudes toward women Marital status 2.217 0.792 2.799 .005 Attitudes toward women Income (monthly) 4.786 0.368 12.997 .000
employees’ attitudes toward women are negative than women employees. The attitudes of the employees to women differ according to their marital status; for example, the average score of attitudes toward single women is higher than that of married women. Finally, according to their monthly income level, their attitudes toward women change. As monthly income level increases, their average of attitudes toward women also increases. All three hypotheses were statistically supported. In other words, it was found that being single caused a 2.2-point increase in attitude scores against women; being a man leads to a 7.8 unit decrease in attitude scores against women. Moreover, when the income increases by one unit, the attitude toward the woman increases by 4.8 units.
v2/SD, CFI, GFI, RMSEA, and SRMR were
accepted as criteria for this study, and these goodness-of-fit indices are widely used in the lit-erature (Boomsma, 2000; Hayduk, Cummings, Boadu, Pazderka-Robinson, & Boulianne, 2007; Hooper, Coughlan, & Mullen, 2008; Hu & Bentler, 1999; McDonald & Ho, 2002). Acceptable values and goodness-of-fit indices are shown in Table 2 (Ayyıldız & Cengiz, 2006; C¸okluk, S¸ekercioglu, & B€uy€uk€ozt€urk, 2012; Hoe, 2008; Hooper et al., 2008; Crewley & Fan, 1997; _Ilhan & C¸etin, 2014; Munro, 2005; Schreiber, Nora, Stage, Barlow, & King, 2006; S¸ims¸ek, 2007; Yılmaz, 2009). Findings regarding the research hypotheses are presented at Figure 1.
Furthermore, model fit indices were in acceptable levels (v2/SD = 0.74; RMSEA=.000; SRMR=.02;
GFI=.99; CFI = .99). This result indicated that employees’ gender significantly predicted their scores of attitudes toward women (bGender! Attitudestowardwoman=–0.38) in an inverse direction.
Besides, employees’ marital status significantly pre-dicted their scores of attitudes toward women (bMaritalStatus!Attitudestowardwoman=0.10) in a positive
direction. Moreover, employees’ income (monthly) significantly predicted their scores of attitudes toward women (bIncomeMonthly!Attitudestowardwoman=0.45) in a
positive direction.
Conclusion
This study was performed at health care organi-zations in Ankara, which is the capital city of Turkey and it investigated the attitudes toward women. The attitudes toward woman were meas-ured using a 25-item scale by Spence et al. (1973). SEM was applied to analyze the relation-ship between gender, marital status, and income and attitudes toward women.
The findings of previous studies showed that sex (Askar & Ahmad, 2003; Mostafa, 2003) of the participant was found to be statistically signifi-cant in determining attitudes toward female. A study done by Harris and Firestone (1998) found that overall family income is significantly and positively associated with more egalitarian gen-der-role views. Moreover, Elamin and Omair (2010) found that the difference between the two marital status was significant. This study found that the relations between gender, marital status, and income and attitudes toward woman were statistically significant. All three hypotheses were statistically supported. This result indicated that employees’ gender significantly predicted their scores of attitudes toward woman (bGender!Attitudestowardwoman=–0.38) in an inverse
direction. Besides, employees’ marital status sig-nificantly predicted their scores of attitudes toward woman (bMaritalStatus!Attitudestowardwoman=0.10) in a
positive direction. Moreover, employees’ income (monthly) significantly predicted their scores of attitudes toward woman (bIncomeMonthly! Attitudestowardwoman=0.45) in a positive direction.
Elamin and Omair (2010) investigated males’ attitudes toward working females in Saudi Arabia and their findings showed that single participants were reported having less traditional attitudes than married participants. Thus, we propose to test the following hypotheses:
Attitude toward women and their participation of labor force is different in many countries. It should be taken into account that woman may play an important role in creating economic Table 2. The result of goodness-of-fit of the model.
Criteria Value
Reference values
Acceptable values Goodness-of-fit indices v2 /SD 0.74 <5 <2 CFI 0.99 >0.90 >0.95 GFI 0.99 >0.90 >0.95 RMSEA 0.00 <0.10 <0.08 SRMR 0.02 <0.08 <0.05
growth, increasing employment, and creating world-scale businesses in Turkey (Soysal, 2010). Women need to go into their jobs knowing that there will be some barriers; however, they also need to know some women have broken the bar-riers and that they have the capability to do so, as well (Crampton & Mishra, 1999).
Although progress has been made in terms of women obtaining managerial positions in health care organizations, Odewahn and Ezell (1992) suggest that several gender differences persist. To overcome these barriers, they suggest that effort must be directed to altering perceptions of organ-izational power and equal access to promotion (in cited Loo & Thorpe, 1998). Organizations must implement training programs that alter the attitudes toward women in management (Crampton & Mishra, 1999).
The fact that this study was conducted in a hos-pital in Ankara constitutes the limitation of the study. Therefore, as the results of the research rep-resent the period in which it was made and the province of Ankara, it cannot be generalized. This study provides contributions to growing literature by examining the attitudes toward women in health care organizations. Moreover, research find-ings should be utilized by employees who work at health care organizations to improve their view of attitudes toward woman. Future research can focus on investigating the effects of the attitudes toward women on other elements (e.g., performance, motivation, job satisfaction) or a wider sample to reach more generalized results.
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