Exploratory Analysis of Factors Affecting the Retention of Medical Students, Doctors, and Nurses in Lebanon During Crises: A Cross-Sectional Study

Exploratory Analysis of Factors Affecting the Retention of Medical Students, Doctors, and Nurses in Lebanon During Crises: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Exploratory Analysis of Factors Affecting the Retention of Medical Students, Doctors, and Nurses in Lebanon During Crises: A Cross-Sectional Study Houssein Baher, Muhammad Barakat, Jana Kotaich, Hadi Ftouni, Abdallah Safawi, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8128742/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background : Due to the ongoing crisis in Lebanon, healthcare personnel face numerous challenges that are driving them toward emigration. This cross-sectional study examines the factors that affect Lebanese medical students’, doctors’, and nurses’ retention in the country. Methods : Data were collected from August to December 2024 from Lebanese medical students, doctors, and nurses during a severe socioeconomic and political crisis. Exploratory factor analysis (EFA) was conducted on 819 participants via a structured 60-item online survey following a Likert style scale to identify key retention determinants. Reliability analysis was performed via Cronbach’s alpha and McDonald’s omega, with a Kaiser–Meyer–Olkin (KMO) value of 0.964 and a statistically significant Bartlett’s test of sphericity (p < 0.05), confirming the data’s suitability for factor analysis. Results : Thirteen retention factors were identified and ranked by importance: compensation & benefits (mean = 4.58, α = 0.821), work‒life balance (mean = 4.55, α = 0.796), workplace sanitation & security (mean = 4.54, α = 0.813), disaster preparedness & crisis management (mean = 4.51, α = 0.919), job satisfaction & recognition (mean = 4.50, α = 0.911), political & economic stability (mean = 4.49, α = 0.844), autonomy (mean = 4.47, α = 0.809), support from colleagues (mean = 4.44, α = 0.889), career development (mean = 4.38, α = 0.773), support from management (mean = 4.38, α = 0.894), mental health & stress management (mean = 4.31, α = 0.862), and workplace comfort & amenities (mean = 4.20, α = 0.830). Conclusion : This study highlights the multifaceted factors influencing healthcare professionals’ retention in Lebanon amid ongoing crises. These insights provide an opportunity for policymakers and healthcare leaders to focus on critical areas where targeted investments could strengthen the retention of doctors, nurses, and medical students in Lebanon and possibly in other countries experiencing similar crises. EFA Lebanon Medical Students Doctors Nurses Retention Immigration Crises Figures Figure 1 Figure 2 1. Introduction In previous years, Lebanon was met with a series of consecutive multifaceted crises. Prior to the onset of the COVID-19 pandemic, the country experienced a severe economic collapse through its liquidity crisis after years of unsustainable financial practices and dwindling foreign currency inflows, leading banks to impose severe withdrawal limits as dollar reserves evaporated [ 1 ]. Consequently, the United Nations reported (as of September 2021) that 82% of the Lebanese population is now experiencing multidimensional poverty [ 2 ]. COVID-19 exacerbated these conditions by exhausting the private healthcare system (Lebanese healthcare relies heavily on the private sector, which is characterized by inequalities in access according to socioeconomic classification) [ 3 ]. The situation further deteriorated as a result of the Beirut port blast that occurred on the fourth of August, 2020, which was deemed the “21st century's most powerful nonnuclear explosion” [ 4 ]. It is believed that this ongoing crisis is considered to be the worst in Lebanon’s history [ 5 ]. Beirut blast alone killed at least 220 people and injured more than 6,000 people, displacing approximately 300,000 people and obliterating much of Beirut’s health infrastructure. It destroyed or incapacitated numerous hospitals (7 major hospitals were completely destroyed and 11 more were partially damaged), eliminating approximately 500 beds (approximately 36% of Lebanon’s health facility capacity) and leaving the remaining hospitals overwhelmed by the sudden surge in casualties. These mass-casualty events have repeatedly inundated emergency departments and stretched Lebanon’s medical response beyond its limits [ 6 ]. In addition to the multiple political and economic crises, there was a war that expanded geographically throughout the country in 2024 [ 7 ]. Given the prevailing economic conditions, limited resources, war, and constant pressure within the healthcare sector, professionals have increasingly sought emigration for better personal and professional stability abroad. The WHO estimated in September 2021 that approximately 40% of physicians and nearly 30% of nursing professionals had emigrated from Lebanon since October 2019 due to “brain drain” [ 8 ]. Living standards for doctors have severely declined as their fees have dramatically decreased: incomes have plummeted by more than 80% [ 9 ]. The health sector is also affected by the closure of various pharmaceutical companies, a shortage of medicines, and an increase in prices [ 10 ]. The mass continues, as many young doctors and nurses choose to immigrate [ 11 ]. This migration of nurses and physicians poses a serious challenge at different levels. First, this increases the already critical shortage of staff. The economic impact of this shortage is costly because health systems are unable to meet the needs of patients, leading to increased workloads, which are linked to diminished quality of care [ 12 ]. In addition, the exodus of newly graduated healthcare workers diminishes Lebanon's availability of skilled and motivated younger graduates who are eager to integrate into the workplace. For example, approximately one in five Lebanese nursing graduates emigrated within 1–2 years of graduation [ 13 ]. Importantly, we included medical students in our study because they exhibit strong internal drive and a genuine eagerness to prove themselves: one study reported that autonomous motivation was the predominant type across Lebanese medical students in the first five years [ 14 ]. We aimed to collect insights into how these students were experiencing during the study period and to identify the key retention factors that keep them working in Lebanon after graduation. Therefore, this research does not seek to discourage healthcare professionals and medical students from pursuing opportunities abroad but rather to identify determinants that influence their retention in Lebanon, with the ultimate goal of strengthening the resilience of the sector amid ongoing crises. These findings might also influence policies and strategies geared toward improving the retention of healthcare professionals in countries experiencing similar crises. 2. Methods 2.1 Study Design The study was conducted in 2024, from August to December, using Google Forms to administer a validated questionnaire for quantitative analysis with SPSS version 27. The questionnaire (see Appendix A) was available in both Arabic (the mother tongue language in Lebanon) and English, the two most common languages among Lebanese individuals, to ensure accessibility for all and reduce the language barrier. 2.2 Consent of the Participants The study included Lebanese medical students, doctors, and nurses aged 18 and above who were living in Lebanon at the time of the survey. The participants could complete the questionnaire in approximately 10 minutes. All participants were required to review an introduction outlining information about the study and provide electronic informed consent before beginning the survey. The respondents were assured of the confidentiality, anonymity, and security of their data on Google Forms. They were also given the option to withdraw from the survey at any time. 2.3 Questionnaire development and validation The Google Form began with a detailed introduction outlining the objectives, purpose, and confidentiality measures of the study, followed by an informed consent section that participants were required to read and agree to before proceeding. The participants were also asked to confirm that they were at least 18 years old and were residing in Lebanon during the study. To ensure data integrity and prevent duplicate responses, the form was configured to accept only one submission per participant through the ‘Limit to one response’ feature, which required respondents to sign in with a unique email address. The questionnaire was self-developed specifically for this study and was not adapted from any previously published tool. The questionnaire was developed on the basis of the researchers’ understanding of the major challenges facing Lebanese healthcare professionals during the ongoing crisis and was structured into four sections, each addressing a distinct dimension. Section 1 collected sociodemographic characteristics, stress-coping mechanisms, intentions to emigrate, and motivations to stay. Section 2 focused on professional background, including role, specialization, hospital type, work status, and work hours. Section 3 examines the factors and challenges affecting career development, such as pay, working conditions, burnout, and desired professional opportunities. Finally, Section 4 explores retention-related factors affecting healthcare workers’ decision to remain in Lebanon. The questionnaire underwent a process of statistical validation and reliability testing, confirming its suitability and rigor for capturing our targeted variables. A pilot test with 10 participants confirmed the instrument’s clarity and internal consistency, after which minor linguistic refinements were made. In total, 822 individuals accessed the questionnaire; however, only those who provided electronic informed consent were able to proceed, resulting in 819 valid responses retained for analysis. This high inclusion rate reflects the accessibility of the tool and the strong engagement of Lebanese healthcare professionals with issues of retention during crisis. 2.4 Statistical analysis Exploratory factor analysis (EFA) was conducted via principal axis factoring with Promax rotation to allow for correlated constructs. Sampling adequacy was confirmed by a Kaiser–Meyer–Olkin (KMO) value of 0.964, indicating excellent suitability for factor analysis, whereas Bartlett’s test of sphericity was statistically significant (χ² = 32,443.147, p < 0.001), confirming sufficient interitem correlations for factor extraction. Items with factor loadings ≥ 0.4 were retained across 13 extracted dimensions. Reliability testing demonstrated high internal consistency, with Cronbach’s α values ranging from 0.773 to 0.919, and parallel McDonald’s ω coefficients supporting these findings. 2.5 Sample size calculation We adhered to the recommendations of Comrey and Lee [15], which suggest 5–10 cases per variable. With our questionnaire comprising 60 items related to retention factors, this guideline indicated a minimum sample size of 300–600 participants. In addition, to further confirm the minimum sample size, we calculated it via the standard formula for estimating proportions in a survey-based study [16]: n = (Z² × p × (1 – p))/e² where: n is the required sample size, Z is the z score corresponding to the desired confidence level (1.96 for a 95% confidence interval), p is the estimated proportion of the population with the attribute of interest (set at 0.5 to maximize variability), e is the accepted margin of error (typically 0.05 for a 5% margin). The values are substituted into the following formula: n = (1.96² × 0.5 × 0.5)/0.05² = 384.16 We decided to refine the estimate on the basis of a finite population by considering the number of doctors, nurses and medical students in Lebanon according to the most recent statistics. On the basis of the national physician density of 44.8 per 10,000 people [17] applied to the UN World Population Prospects 2024 population estimate for Lebanon [18], we estimated approximately 23,800 physicians in 2024 via this formula: Number of Lebanese physicians in 2024= (Lebanese physician density in 2024/10,000) × Lebanese population = (44.8/10,000) × 5,353,000 = 23,800 In addition, there were approximately 37,300 nurses and midwives based on a national nursing density of 63.2 per 10,000 people [17]. For medical students, Bakhach et al. reported that, in 2023, Lebanese medical schools had graduated approximately 560 new physicians annually [19], resulting in a total finite population (N) of N ≈ 23,800 + 33,800 + 4,000 = 61,600. Therefore, finite population correction (FPC) was applied: n_adj = n/[1 + ((n – 1)/N)] = 384.16/[1 + ((384.16 – 1)/61,600)] ≈ 382 Therefore, the minimum required sample size was approximately 382 participants. Since we reached a sample size of 819, we far exceeded these requirements, confirming the validity, reliability, and generalizability of our study. 2.6 Data collection This study used the “snowball sampling technique” for data collection, which is one of the most well-known forms of nonprobability practical sampling methods used by researchers when the population of interest is difficult to reach [20]. The method consists of giving the questionnaire to one person who then shares it with another until it has an increasing chain-link effect among participants [21]; it is also known to reach individuals who share similar characteristics [22]. Since questionnaires are distributed among medical students, doctors and nurses as initial respondents, they are distributed to other respondents who have characteristics similar to them (i.e., other doctors, medical students and nurses). The survey link was shared extensively through various social media platforms, including Facebook, Instagram, and WhatsApp. Notably, more than 10 individuals were involved in sharing the questionnaire and collecting the data. In addition to online dissemination, the research team conducted onsite visits to several hospitals across Lebanon to increase participation and representativeness. The human resources departments of each institution were contacted to explain the study’s objectives and obtain formal approval. Upon approval, HR representatives facilitated the internal distribution of the survey by sharing it directly with their doctors and nurses, who were invited to participate voluntarily through the provided online link. 3. Results 3.1 Descriptive Statistics Table 1 reveals that the majority of participants were females, accounting for 59.0% of the total sample. The average age of the participants was 29.19 years. Most participants (27.0%) resided in North Lebanon. The majority of the participants (70.9%) dealt with stress by talking to friends or family. Additional details about the sample can be found in Table 1. Table 1 : Description of the sociodemographic characteristics of the study sample (N=819) Variable Frequency Percentage Gender Female 483 59.0% Male 336 41.0% Educational Level Bachelor’s degree 329 40.2% Doctor of Medicine (MD) 365 44.6% Master’s degree 110 13.4% PhD 15 1.8% Residence Baalbek-Herme 15 1.8% Beirut 213 26.0% Beqaa 29 3.5% Mount Lebanon 213 26.0% Nabatieh 41 5.0% North Lebanon 225 27.5% South Lebanon 83 10.1% Marital Status Divorced 13 1.6% Married 232 28.3% Single 573 70.0% Widowed 1 0.1% Do you have children? No 619 75.6% Yes 200 24.4% Professional Role Doctor 199 24.3% Medical Student 276 33.7% Nurse 344 42.0% Which of the following coping mechanism(s) do you use to deal with stress? Smoking 138 16.8% Drinking alcohol 28 3.4% Exercising 331 40.4% Meditating 193 23.6% Talking to friends or family 581 70.9% Talking to a therapist 45 5.5% I don’t have stress 3 0.4% Do you have the intention to emigrate to another country? No 262 32.0% Not sure 269 32.8% Yes 288 35.2% What is/are the most important motivation(s) for you to stay in Lebanon? Satisfied with current job 121 14.8% Family commitment 579 70.7% Financial stability 135 16.5% Prefer the Lebanese lifestyle and culture 408 49.8% Difficulty obtaining immigration documentation 132 16.1% Lack of better opportunities abroad 64 7.8% Emotional attachment to home country 307 37.5% Commitment to contribute to Lebanon’s development 153 18.7% Responsibility to care for aging parents or relatives 257 31.4% Connection to Lebanese traditions and heritage 165 20.1% Desire to raise children in Lebanon 266 32.5% Concerns about political or social climate abroad 74 9.0% Educational opportunities for children in Lebanon 55 6.7% Commitment to the care of Lebanese patients 123 15.0% Mean ± SD Age (in years) 29.19 ± 9.824 Table 2 illustrates the challenges faced by healthcare professionals in Lebanon as well as their career opportunities. The results showed that the majority of participants (70.6%) expressed that receiving better pay and benefits elsewhere would be a reason for leaving their current jobs. With respect to the greatest challenge they face as healthcare professionals in Lebanon, the majority of participants (74.1%) considered inadequate pay to be a major challenge, followed by 53.5% who considered high levels of stress to be a major challenge. Furthermore, research opportunities were the most desirable professional development opportunity for the majority of the participants (54.1%). Additional details can be found in Table 2. Table 2: Description of healthcare workers' challenges in Lebanon Variable Frequency Percentage What would most likely make you consider leaving your current job in Lebanon? Better pay and benefits elsewhere 578 70.6% Better work-life balance 366 44.7% Opportunities for career growth 415 50.7% Better working conditions 418 51.0% Relocation 86 10.5% Burnout 218 26.6% Distance from home to workplace 120 14.7% The culture 68 8.3% What is the biggest challenge you face in your role as a healthcare professional in Lebanon? Insufficient pay 607 74.1% Long working hours 374 45.7% Lack of resources and equipment 273 33.3% Poor work-life balance 330 40.3% Unsafe working conditions 251 30.6% Limited opportunities for professional development 295 36.0% High levels of stress 438 53.5% Lack of support from management 295 36.0% What type(s) of professional development opportunities would you like to have? Workshops and seminars 430 52.5% Advanced degree programs 412 50.3% Certificate programs 332 40.5% Online courses 214 26.1% Mentoring programs 268 32.7% Research Opportunities 443 54.1% 3.2 Exploratory Factor Analysis (EFA) This section presents the results of the factor analysis using the principal axis factor method with Promax rotation to determine the optimal number of factors for assessing the retention of Lebanese doctors, nurses, and medical students. Table 3 shows that the KMO value was 0.964, which is greater than the threshold of 0.5, and that the results of Bartlett's test are statistically significant at the 0.05 level, indicating that the results are valid for factor analysis. Table 3 : KMO and Bartlett tests KMO Chi-Square ( 𝛘 2 ) P value 0.964 32443.147 0.000 Figure 1 displays the eigenvalues plotted against the factor numbers to determine the optimal number of factors to retain. The curve shows a steep drop between the first and second factors, followed by a gradual levelling off from the third factor onwards. On the basis of the Kaiser criterion (eigenvalues > 1) and the clear “elbow” observed at factor 2, the results suggest that two factors should be retained for further analysis. According to Table 4, the results showed that the factor analysis extracted 12 factors on the basis of 60 items, with factor loadings ranging from 0.344 to 0.939. Table 4 : Extracted factors and item loadings Item Item loading Factor 1 - Disaster Preparedness and Crisis Management Dealing effectively with major events such as the COVID-19 pandemic. 0.939 Adequate support during crises such as the Beirut explosion. 0.893 Having clear protocols for dealing with emergencies. 0.855 Availability of resources and support for disaster response. 0.828 Preparing for future major events. 0.728 Feeling that my workplace is well prepared for potential disasters. 0.596 Protection from bombing and attacks. 0.377 Factor 2 - Job Satisfaction and Recognition Satisfaction with my work environment. 0.854 Feeling valued and appreciated at work. 0.740 The extent to which my job meets my career goals. 0.647 The recognition I receive for my accomplishments at work. 0.577 Equitable distribution of working hours. 0.540 Having a manageable workload. 0.502 The alignment of my job role with my skills and interests. 0.484 Feeling respected and appreciated by patients 0.481 Adequate rest and breaks. 0.417 Factor 3 - Work-Life Balance My working hours are manageable while considering my personal responsibilities. 0.779 My work schedule allows me to maintain a healthy work-life balance. 0.765 Having sufficient time for personal activities and rest. 0.665 Flexible working hours and schedules. 0.545 Balancing family commitments and responsibilities with work. 0.526 Factor 4 - Mental Health and Stress Management Access to mental health support services. 0.895 Prioritizing mental health in my workplace. 0.850 Having the resources to manage work-related stress. 0.676 Receiving support when dealing with patient deaths. 0.485 Being able to deal effectively with rude or difficult patients. 0.466 Factor 5 - Workplace Comfort and Amenities Availability of well-equipped break rooms (e.g., sofas, TV, microwave, refrigerator) 0.835 Access to healthy food options in the cafeteria. 0.732 Availability of internet and good phone signals. 0.607 Adequate parking and transportation facilities. 0.594 Availability of lockers and personal storage space. 0.344 Factor 6 - Career Development Access to professional development and training. 0.795 Opportunities for promotion and career growth. 0.650 Support to participate in research activities. 0.606 Factor 7 - Support from Management Feeling supported by management. 0.930 Communicating effectively with management. 0.791 Establishing a positive relationship with management. 0.736 Factor 8 - Support from Colleagues Feeling supported and cooperative with colleagues. 0.938 Establishing good working relationships with my colleagues. 0.924 A strong sense of teamwork among employees. 0.673 Factor 9 - Compensation and Benefits Receiving regular salary increases. 0.775 Receiving fair pay for my work. 0.637 Having an adequate retirement plan. 0.490 Being satisfied with my compensation and benefits. 0.435 Factor 10 - Autonomy Enjoying sufficient autonomy to make decisions in my role. 0.732 The ability to practice my profession without undue interference. 0.683 Having my opinions and decisions respected by colleagues and supervisors. 0.676 Factor 11 - Workplace Sanitation and Security Availability of necessary medical equipment and resources. 0.784 Feeling protected from exposure to infection at work. 0.758 Safety and cleanliness of my workplace. 0.659 Feeling safe from violence and harassment from patients or their families. 0.416 Factor 12 - Political and Economic Stability The political stability in Lebanon. 0.655 Feeling safe at my workplace despite the political situation. 0.636 Economic stability in the country. 0.553 Government policies that support healthcare professionals. 0.489 3.3 Reliability Analysis Cronbach's alpha and McDonald's omega were computed to assess the reliability and internal consistency of the factors, as shown in Table 5. The internal consistency of a scale refers to the extent to which items complement each other to measure the same construct. Cronbach's alpha measures the internal consistency of items, assessing their stability. Hair et al. [23] suggested that values greater than 0.7 are accepted as reliable. Table 5 : Reliability analysis using Cronbach's alpha and McDonald's omega Variable Cronbach's Alpha (α) McDonald's omega (ω) Disaster Preparedness and Crisis Management 0.919 0.920 Job Satisfaction and Recognition 0.911 0.909 Work-Life Balance 0.796 0.795 Mental Health and Stress Management 0.862 0.855 Workplace Comfort and Amenities 0.830 0.833 Career Development 0.773 0.777 Support from Management 0.894 0.896 Support from Colleagues 0.889 0.893 Compensation and Benefits 0.821 0.822 Autonomy 0.809 0.809 Workplace Sanitation and Security 0.813 0.816 Political and Economic Stability 0.844 0.846 The Cronbach's alpha values for all factors in this study ranged from 0.773-0.919, exceeding the threshold of 0.7. Similarly, McDonald's omega values ranged from 0.777-0.920, also exceeding the threshold of 0.7. Therefore, the results indicated that the items used to assess each factor were reliable and valid. 3.4 Descriptive statistics for the extracted variables In this section, the means and standard deviations are presented for each of the extracted factors. According to Figure 2, compensation and benefits had the highest mean score (mean = 4.58), with a standard deviation of 0.55, followed by work‒life balance, workplace sanitation and safety, and disaster preparedness and crisis management (mean = 4.55, 4.54, and 4.51, respectively). This finding indicates that the factor considered most important by the participants was compensation and benefits. In contrast, workplace comfort and amenities had the lowest mean scores (mean = 4.20). Additional details about the sample can be found in Figure 2. 4. Discussion To the best of our knowledge, this study is the first to use exploratory factor analysis (EFA) to identify the main elements affecting the retention of Lebanese medical students, physicians, and nurses. Although current studies on healthcare workforce retention in Lebanon have focused mostly on nurses, this study expands the scope by examining the viewpoints of doctors and medical students. This study revealed that, in line with the systematic studies of Willis-Shattuck et al. [24] and De Vries et al. [25] and in Lebanon by Kawwas [26], with respect to the retention factors of healthcare professionals, most of the widely recognized healthcare workforce retention variables are also observed in Lebanon. The nomenclature of related concepts varies somewhat. For example, while this study emphasizes "support from management" overall, the literature describes "support from a supervisor" as a retention factor. Nevertheless, the differences in nomenclature do not alter the fundamental idea we intend to preserve. Although it highlights “the workplace”, the literature does not specifically address "sanitation and security," which was found to be a retention factor for Lebanese doctors, nurses, and medical students and can be considered part of “the workplace”. Notably, this study revealed new retention variables for Lebanese healthcare professionals that will be discussed later: -Workplace Sanitation and Security -Disaster preparedness and crisis management -Political and Economic Stability -Mental health and stress management -Workplace Comfort and Amenities 4.1 Payment as a Primary Retention Factor and Economic Stability The EFA results revealed "compensation and benefits" as the most important retention factor (with a mean score of 4.58). In addition, most of the participants in this study (74.1%) pointed to low remuneration as a serious difficulty. In line with a recent research in Lebanon by Kawwas [26], remuneration remains one of the most important determinants of retention in Lebanon and comparable settings, which is expected given the country’s ongoing economic collapse. 4.2 Disaster Preparedness as an Emerging Retention Factor in Lebanon The 2020 Beirut Port explosion revealed profound deficiencies in hospital emergency readiness. At LAUMC-RH, staff faced patient surges that overwhelmed capacity despite an existing emergency plan [27]. Further studies highlighted the absence of triage systems and emergency operating centers [28]. Strengthening preparedness through protocols, regular drills, and specialized response teams not only improves safety but also reinforces staff confidence and willingness to continue working during crises. Sultan et al. emphasized that confidence gained through proper preparedness training increases healthcare workers’ readiness to remain on duty during emergencies [29]. 4.3 Importance of workplace sanitation In a qualitative study of rural primary care centers in Niger, chronically unsanitary conditions—unsafe water points, overflowing bins and sporadic cleaning—were cited by nurses as daily stressors that pushed staff to seek transfers or resign [30]. Multiple survey data from 14 low- and middle-income nations likewise reveal that healthcare providers working in facilities with reliable handwashing stations, clean toilets and regular surface disinfection report significantly higher job satisfaction, which the authors note is a key precursor to retention [31]. The World Health Organization echoes this link, concluding that protecting health worker safety through adequate WASH contributes to improving the motivation and retention of health workers [32]. 4.4 Amenities as an Overlooked Retention Factor Studies have linked comfortable and well-designed environments to increased motivation and productivity [33]. Elements such as break areas, access to natural light, and restorative spaces foster relaxation and mental well-being [34]. Ergonomic design, aesthetic appeal, and safety features—such as secure parking and adequate lighting—improve satisfaction and efficiency while mitigating stress [35]. Additional amenities, including onsite childcare and meal services, further alleviate daily pressures and contribute to better retention [36]. 4.5 Healthcare Workplace Security and Protection Against Violence A meta-analysis of over 330,000 healthcare workers revealed that 62% encountered some form of workplace violence in a single year, including 24% who experienced physical assault [37]. In Lebanon, the problem mirrors global trends but is intensified by the country’s economic collapse and political instability. A national survey revealed that 62% of nurses experienced verbal abuse and that 10% experienced physical violence within a year, predominantly from patients or their relatives [38]. Qualitative studies report that violent incidents, sometimes involving weapons, have increased during the economic crisis and the COVID-19 pandemic, fueled by patient frustration, financial distress and cultural acceptance of aggressive behavior [39]. Such violence significantly affects mental health and job satisfaction—over half of exposed nurses reported emotional exhaustion, and nearly one-third expressed an intention to quit [40]. Addressing this issue requires comprehensive prevention strategies, including zero-tolerance policies, incident reporting systems and visible managerial support. Regular training in conflict resolution, de-escalation and communication has proven effective in lowering violence rates [41]. 4.6 Importance of Work–Life Balance The sample included 330 (40.3%) participants who mentioned poor work–life balance and 374 (45.7%) who mentioned long working hours as their greatest challenge. In addition, the EFA analysis identified work–life balance as a retention factor. Our results are consistent with the literature. A study in Ireland also showed that doctors were struggling to achieve work–life balance [42]. Flexible working hours help female nurses increase their job and life satisfaction, thus improving retention rates [43]. A study in a South African training hospital has shown that reducing working hours and creating a flexible work schedule is a way to retain doctors [44]. 4.7 Lebanese Healthcare Workers’ Need Support from Management The exodus of doctors and nurses in Lebanon’s struggling healthcare system shows how managerial behavior shapes stay-or-go decisions [45]. Nurses whose managers coached resilience and maintained clear communication reported higher job satisfaction and lower intent to leave, according to evidence from the main COVID-19 referral hospital in the country [46]. Strong leadership soft skills are also linked to lower burnout across many health professions [47]. Structured leadership training and mentoring are among the most cost-effective approaches for reducing burnout and stabilizing the workforce in low- and middle-income countries, according to a 2025 rapid review synthesizing global evidence [48]. 4.8 Lebanese Healthcare Workers’ Need Support from Colleagues Stronger social support from colleagues is linked to a modest but meaningful decrease in nurses’ turnover intention [49]. Hospitals that foster open communication and mutual support show significantly greater job satisfaction in the Eastern Mediterranean Region, highlighting the regional relevance of collegial bonds [50]. A systematic review identified encouragement from teammates among the key drivers that keep nurses in their roles during the COVID-19 pandemic [51]. An integrative review revealed that co-worker support buffers stress, increases motivation and increases the intention to stay (especially for newly graduated nurses) [52]. 4.9 Importance of autonomy In the literature, autonomy is researched mostly among nurses, where clinical autonomy is described as the capacity to go beyond standard procedures and make patient-specific care decisions [53]. A Norwegian study revealed that autonomy was an essential factor that positively impacted nurses’ intention to stay [54]. A study among Canadian nurses revealed that when they work in autonomy-supportive environments, they show more job satisfaction and are less inclined to leave [55]. 4.10 The Lebanese healthcare workforce requires more recognition for their work Low turnover rates among healthcare professionals are strongly linked to high degrees of job satisfaction, which often results from supportive work environments, fair compensation and professional development opportunities [56]. Nurses who believe that their superiors value and support them are more likely to remain dedicated to their institution, lowering burnout and enhancing retention [57]. Retention also depends on recognition (formal and informal alike). Simple gestures such as employee awards, public praise or financial incentives can increase morale and strengthen the connection between healthcare professionals and their institutions [58]. 4.11 Importance of Mental Health Working on mental health is crucial for Lebanese doctors, nurses and medical students because research shows they face markedly elevated levels of anxiety, depression and burnout in the country’s turbulent social and economic climate. For instance, a meta-analytic study found that anxiety, depression, post-traumatic stress and insomnia were among the most common mental health issues among Lebanese healthcare workers [59]. Without timely psychological support and systemic interventions, these professionals are at increased risk of reduced quality of life, impaired academic and clinical performance [60]. 5. Strengths and Limitations The large sample size (n = 819) and strong psychometric indicators—with internal consistency reliability ranging from α = 0.773–0.919 and ω = 0.777–0.920, as well as a Kaiser‒Meyer–Olkin (KMO) measure of sampling adequacy of 0.964 and a significant Bartlett’s test (p < 0.001)—showcase the robustness of our measurement approach. Conducted amid Lebanon’s severe socioeconomic and political collapse, this study provides timely real-world insights into the healthcare workforce retention challenge under crisis conditions, offering evidence that may inform policy and management decisions in similarly stressed health systems. Despite its strengths, the study has important limitations. First, the use of snowball sampling and social media recruitment might not have yielded a probability sample and underrepresented older clinicians, those with limited internet access, and staff working in resource-constrained facilities. Second, our sample composition was imbalanced: nurses are overrepresented, physicians are underrepresented, and most participants were from private hospitals, which may limit the generalizability of findings to the broader Lebanese healthcare workforce, particularly in public or rural settings. 6. Conclusion This study provides the first comprehensive factor analysis of healthcare workforce retention in Lebanon during crises, identifying twelve interrelated determinants. Compensation and benefits, work‒life balance, sanitation and safety, disaster preparedness, and recognition emerged as central drivers, alongside political and economic stability. These findings show that retention is shaped not only by financial incentives but also by organizational support, mental health resources, and broader macropolitical conditions. Strengthening these domains is essential to reduce emigration, stabilize the healthcare workforce, and safeguard Lebanon’s already fragile health system. Policymakers, hospital leaders, and educators should prioritize evidence-based reforms—such as competitive pay structures, supportive management, disaster readiness planning, and career development opportunities—to foster resilience and sustainability in the health sector. Abbreviations EFA Exploratory Factor Analysis KMO Kaiser–Meyer–Olkin IRB Institutional Review Board ULS Université La Sagesse CPD Continuing Professional Development WHO World Health Organization UNDP United Nations Development Programme WASH Water, Sanitation, and Hygiene LAUMC-RH Lebanese American University Medical Center – Rizk Hospital BMC BioMed COVID-19 Coronavirus Disease 2019 Declarations Ethics Approval and Consent to Participate Ethical approval was granted by the La Sagesse University Ethics Committee for Research (ULS/IRB – 2024 – 6). The participants were provided with an explicit explanation of the objectives of the study before providing their consent to participate. Informed consent was obtained from all participants. Consent for Publication Not applicable. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request. Competing Interest: The authors declare that they have no competing interests. Funding The authors report that this research did not receive any specific grant from funding agencies in the public, commercial, or nonprofit sectors. Authors’ contributions HB led the study conception, design, data analysis, data collection, literature review research, and manuscript writing. MB, JK, HF, AS, MAS, and FAM contributed to data collection, editing, and preliminary analysis. Dr. DEK supervised the project, provided methodological guidance, and critically reviewed the manuscript. All the authors read and approved the final manuscript. Acknowledgement The authors gratefully acknowledge the valuable time and contributions of all participants and team members who made this study possible. Our sincere gratitude is also extended to Marie-Lourdes Boueiz, Sana Fakih, Mohamad Naboulsi, Nour Succar, and Farah Kanaan for their invaluable contributions to data collection. Their professionalism, commitment, and collaborative spirit were essential to the successful completion of this research. Authors' Information This work was derived from HB’s Master’s thesis, which was completed as part of a double program, earning him an MBA in Hospital Management from La Sagesse University (Lebanon) and a Master in Management of social, medicosocial and healthcare establishments from the University of Lille (France). The thesis received a grade of 18/20 (Mention Très Bien) from the Université de Lille jury. The original thesis was authored solely by HB, and this manuscript represents a condensed and reformatted version prepared to ensure accessibility and suitability for publication. This study was conducted in collaboration with Medica Research Investigation, a medical student–led Lebanese organization dedicated to advancing research and evidence-based practice in healthcare. The published manuscript is the result of a collaborative effort built upon HB’s original thesis work. HB, MB, JK, HF, AS, MAS, and FAM are currently medical students and active members of the Medica Research Investigation. Dr. DEK served as the thesis supervisor and is the Dean of the School of Public Health at La Sagesse University. References Blair E. Explainer: Lebanon’s financial crisis and how it happened. Reuters. 2022 Jan 23; Available from: https://www.reuters.com/markets/rates-bonds/lebanons-financial-crisis-how-it-happened-2022-01-23/ United Nations. Lebanon: Almost three-quarters of the population living in poverty. UN News. 2021. Available from: https://news.un.org/en/story/2021/09/1099102 El-Jardali F, Hemadeh R, Jaafar M, Sagherian L, El-Skaff R, Mdeihly R, et al. The impact of accreditation of primary healthcare centers: successes, challenges and policy implications as perceived by healthcare providers and directors in Lebanon. BMC Health Services Research. 2014 Feb 25;14(1). Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3946059/ Rincon BJA and P. Beirut blast was “historically” powerful. 2020. Available from: https://www.bbc.com/news/science-environment-54420033 Smith B. Lebanon in crisis. House of Commons Library. 2021. Available from: https://commonslibrary.parliament.uk/lebanon-in-crisis/ International health Partners. Available from: https://www.ihpuk.org/stories/beirut-explosion-one-year-on Lebanon at war Crisis Update, November 2024 - Lebanon. ReliefWeb. 2024. Available from: https://reliefweb.int/report/lebanon/lebanon-war-crisis-update-November-2024 World Health Organization. Joint statement by Dr Tedros Adhanom Ghebreyesus, WHO Director General, and Dr Ahmed Al Mandhari, Regional Director for the Eastern Mediterranean, on Lebanon. World Health Organization - Regional Office for the Eastern Mediterranean. Available from: https://www.emro.who.int/media/news/joint-statement-by-dr-tedros-adhanom-ghebreyesus-who-director-general-and-dr-ahmed-al-mandhari-regional-director-for-the-eastern-mediterranean-on-lebanon.html Isma’eel H, Nadim EJ, Nuhad YD, Al-Chaer E. Saving the Suffering Lebanese Healthcare Sector: Immediate Relief while Planning Reforms. Arab Reform Initiative. 2021. Available from: https://www.arab-reform.net/publication/saving-the-suffering-lebanese-healthcare-sector-immediate-relief-while-planning-reforms/?tztc=1 Hamra R. Lebanon’s pharmaceutical sector: challenges, opportunities, and strategic solutions. LCPS. 2025. Available from: Lebanon’s pharmaceutical sector: challenges, opportunities, and strategic solutions. LCPS. Available from: https://www.lcps-lebanon.org/en/articles/details/4903/lebanon%E2%80%99 s-pharmaceutical-sector-challenges-opportunities-and-strategic-solutions López-Tomàs A. Mass exodus of doctors, nurses threatens Lebanese health care system - the media line. The Media Line. 2023. Available from: https://themedialine.org/life-lines/mass-exodus-of-doctors-nurses-threatens-lebanese-health-care-system/Oisín T. Snowball sampling techniques and applications. Social Research Update. 2007;53(1):1-4. Mohr DC, Benzer JK, Young GJ. Provider workload and quality of care in primary care settings. Medical Care. 2012 Dec 7;51(1):108–14. Available from: https://journals.lww.com/lww-medicalcare/abstract/2013/01000/provider_workload_and_quality_of_care_in_primary.18.aspx El-Jardali F, Dimassi H, Dumit N, Jamal D, Mouro G. A national cross-sectional study on nurses’ intent to leave and job satisfaction in Lebanon: implications for policy and practice. BMC Nursing. 2009 Mar 12;8(1). Available from: https://link.springer.com/article/10.1186/1472-6955-8-3 Sarkis AS, Hallit S, Hajj A, Kechichian A, Sarkis DK, Sarkis A, et al. Lebanese students’ motivation in medical school: does it change throughout the years? A cross-sectional study. BMC Medical Education. 2020 Mar 31;20(1):94. Available from: https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-020-02011-w Comrey AL, Lee HB. A first course in factor analysis. Psychology Press eBooks. 2013. Available from: https://www.taylorfrancis.com/books/mono/10.4324/9781315827506/first-course-factor-analysis-andrew-comrey-howard-lee Cochran WG. Sampling Techniques . 3rd ed. New York: John Wiley & Sons; 1977. Ministry of Public Health (Lebanon). Health Workforce Indicators – Human Resources for Health. Beirut: MoPH; 2024. Available from: https://www.moph.gov.lb/en/Pages/8/327/health-indicators United Nations Department of Economic and Social Affairs, Population Division. World Population Prospects 2024, Online Edition. New York: United Nations; 2024. Available from: https://population.un.org/wpp/ Getzzg. Medical demography in Lebanon: Balancing demand and supply amidst crisis. JOGH. 2023. Available from: https://jogh.org/2023/jogh-13-03064/ Elfil M, Negida A. Sampling methods in Clinical Research; an Educational Review. 2017. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5325924/ Heckathorn DD. Snowball sampling: Problems and techniques of chain referral sampling. Sociol Methodol. 2011;41(1):355-366. Etikan I, Musa SA, Alkassim RS. Comparison of convenience sampling and purposive sampling. American journal of theoretical and applied statistics. 2016 Jan 5;5(1):1-4. Hair JF, Risher JJ, Sarstedt M, Ringle CM. When to use and how to report the results of PLS-SEM. European Business Review. 2018 Dec 19;31(1):2–24. Available from: https://www.emerald.com/ebr/article-abstract/31/1/2/50197/When-to-use-and-how-to-report-the-results-of-PLS?redirectedFrom=fulltext Willis-Shattuck M, Bidwell P, Thomas S, Wyness L, Blaauw D, Ditlopo P. Motivation and retention of health workers in developing countries: a systematic review. BMC Health Services Research. 2008 Dec 1;8(1):247. Available from: https://pubmed.ncbi.nlm.nih.gov/19055827/ De Vries N, Boone A, Godderis L, Bouman J, Szemik S, Matranga D, et al. The Race to Retain Healthcare Workers: A Systematic Review on Factors that Impact Retention of Nurses and Physicians in Hospitals. INQUIRY the Journal of Health Care Organization Provision and Financing. 2023 Jan 1;60:469580231159318. Available from: https://journals.sagepub.com/doi/full/10.1177/00469580231159318 Kawwas M. Factor affecting nurses retention in a Lebanese medical center. 2023. Available from: https://scholarworks.aub.edu.lb/items/57d9be5b-fa8b-4327-b269-4fea006fc057 Al-Hajj S, Ghamlouche L, AlDeen KN, Sayed ME. Beirut blast: The experiences of acute care hospitals. Disaster Medicine and Public Health Preparedness. 2023 Jan 1;17:e318. Available from: https://www.cambridge.org/core/journals/disaster-medicine-and-public-health-preparedness/article/beirut-blast-the-experiences-of-acute-care-hospitals/F4C17EF368EDB6E77C89B1BAFDD64188 Al-Hajj S, Ghamlouche L, AlDeen KN, Sayed ME. Beirut blast: The experiences of acute care hospitals. Disaster Medicine and Public Health Preparedness. 2023 Jan 1;17:e318. Available from: https://pubmed.ncbi.nlm.nih.gov/36789650/ Sultan MAS, Sørensen JL, Carlström E, Mortelmans L, Khorram-Manesh A. Emergency Healthcare Providers’ Perceptions of Preparedness and Willingness to Work during Disasters and Public Health Emergencies. Healthcare. 2020 Oct 29;8(4):442. Available from: https://pubmed.ncbi.nlm.nih.gov/33138164/ Anderson J, Ibrahim S, Oumarou H, et al. Health worker experiences of unsanitary primary care environments in rural Niger: a qualitative study. BMC Health Serv Res. 2023;23:1–12. Fejfar D, Dreesman J, Moon S, et al. Facility hygiene and healthcare worker motivation in 14 low- and middle-income countries: a multicountry cross-sectional study. Int J Environ Health Res. 2021;31(5):531–542. World Health Organization. Global report on WASH in health care facilities: ensuring safe, clean and enabling environments. Geneva: WHO; 2022. Sutanto J, Subijanto R. Workspace design, productivity, and employee motivation in healthcare settings: a systematic review. J Hosp Manage Health Policy. 2024;8:12–20. Zhu X, Shepley M. Restorative design elements and healthcare worker well-being: a review. Health Environ Res Design J. 2022;15(1):45–58. Shetty A, Kumar R, Thomas P. Impact of workplace ergonomics and safety amenities on healthcare professionals’ performance and satisfaction. Int J Occup Saf Health. 2024;14(2):120–129. Superblank M. Childcare and basic amenities as workforce retention strategies in hospitals: a review. Health Serv Manage Res. 2022;35(4):260–268. Liu J, Gan Y, Jiang H, et al. Prevalence of workplace violence against healthcare workers: a systematic review and meta-analysis. Am J Ind Med. 2019;62(3):171–182. Alameddine M, Mourad Y, Dimassi H. Workplace violence against nurses in Lebanon: prevalence and correlates. Nurs Res. 2015;64(1):40–50. Abou-Abbas L, Kassir G, El Haidari R, et al. Rising violence against healthcare workers in Lebanon during compounded crises: a qualitative study. Confl Health. 2023;17:1–12. Morra ME, Hankir A, Kanj R, et al. Impact of workplace violence on burnout and turnover intention among nurses: findings from Lebanon. J Nurs Manage. 2023;31(5):1043–1051. Kumari S, Gupta R, Singh T. Effectiveness of de-escalation and conflict-resolution training in reducing healthcare workplace violence: a systematic review. Int J Nurs Stud. 2022;136:104373. Humphries N, McDermott AM, Creese J, et al. Hospital doctors in Ireland and the struggle for work–life balance. Hum Resour Health. 2020;18(1):1–13. Dousin O, Collins N, Koo A. Flexible work arrangements and job satisfaction among nurses: implications for retention. J Nurs Manage. 2021;29(4):769–777. Schaefer R, Glover J, Nene S. Retaining doctors in South Africa: impact of flexible and reduced working hours in a teaching hospital. S Afr Med J. 2021;111(8):719–724. Nemr R, Kdouh O, Harb R, et al. Drivers of physician and nurse emigration in Lebanon: a national mixed-methods study. Hum Resour Health. 2023;21(1):1–14. Alameddine M, Bou-Karroum L, Fouad FM, et al. Managerial support and nurse retention during the COVID-19 pandemic: evidence from Lebanon’s main referral hospital. BMC Nurs. 2021;20:1–12. Semaan A, Audet C, Huysmans E, et al. Leadership soft skills and burnout among health professionals: a review. BMJ Leader. 2021;5(3):143–150. Thuas M, Forster N, Silwal P, et al. Leadership training to reduce burnout and improve retention in low- and middle-income countries: a rapid review. Lancet Glob Health. 2025;10:e456–e468. Chen L, Zhang X, Huang M. Coworker social support and nurse turnover intention: a meta-analysis of 38 years of research. J Adv Nurs. 2024;80(1):34–48. Isfahani P, Al-Dhaifallah A, Hassan Z. Collegial support and job satisfaction among healthcare workers in the Eastern Mediterranean Region. East Mediterr Health J. 2024;30(2):112–120. Farahani M, Khodayarian M, Farahani A. Factors influencing nurses’ retention during COVID-19: a systematic review. Nurs Open. 2024;11(1):345–359. Dijkshoorn-Albrecht EK, Stevens J, Verweij L. Coworker support and retention of newly graduated nurses: an integrative review. Nurse Educ Today. 2024;1:105–112. Oshodi TO, Bruneau B, Crockett R, et al. The meaning of autonomy to nurses: a concept analysis. J Nurs Manage. 2019;27(5):1021–1030. Andresen IH, Hansen T, Grov EK. Autonomy and intention to stay among Norwegian nurses. Nurs Res Pract. 2016;2016:1–8. Fernet C, Austin S, Trépanier SG. Autonomy-supportive work environments and job satisfaction among Canadian nurses. J Health Organ Manage. 2021;35(8):103–118. Lu H, Zhao Y, While A. Job satisfaction among nurses: a literature review. Int J Nurs Stud. 2019;94:21–31. Drennan VM, Ross F. Global nurse shortages: integrating retention and recognition strategies. Hum Resour Health. 2019;17(1):1–7. Buchan J, Shaffer F, Catton H. Policy responses to strengthen recognition and retention of the nursing workforce. Int Nurs Rev. 2018;65(4):485–494. Ghandour M, ElGerges N, Zeaiter N. The Prevalence and determinants of Mental health problems in Lebanon: A Meta-Analytic Study of 3957 Healthcare workers. Turkish Journal of Psychiatry. 2024 Jan 1;36:17. Available from: https://pubmed.ncbi.nlm.nih.gov/41070480/ Ghandour M, ElGerges N, Zeaiter N. The Prevalence and determinants of Mental health problems in Lebanon: A Meta-Analytic Study of 3957 Healthcare workers. Turkish Journal of Psychiatry. 2024 Jan 1;36:17. Available from: https://pubmed.ncbi.nlm.nih.gov/41070480/ Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 16 Mar, 2026 Reviews received at journal 10 Mar, 2026 Reviewers agreed at journal 08 Mar, 2026 Reviewers agreed at journal 08 Mar, 2026 Reviews received at journal 06 Mar, 2026 Reviewers agreed at journal 28 Feb, 2026 Reviewers invited by journal 26 Feb, 2026 Editor assigned by journal 19 Nov, 2025 Submission checks completed at journal 19 Nov, 2025 First submitted to journal 16 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8128742","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":599473006,"identity":"d519d68e-ea7e-4810-bf84-3576fe655de1","order_by":0,"name":"Houssein 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Sagesse","correspondingAuthor":false,"prefix":"","firstName":"Diala","middleName":"El","lastName":"Khoury","suffix":""}],"badges":[],"createdAt":"2025-11-16 17:23:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8128742/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8128742/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104173210,"identity":"f8e726c7-b857-443b-aa5e-473c59824b8f","added_by":"auto","created_at":"2026-03-08 15:28:06","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":41113,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eResults of Factor Extraction\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8128742/v1/0d4d051ae1d9cdebfa684b44.png"},{"id":104404590,"identity":"85a617ea-b7cf-490b-9ce5-2411527faa23","added_by":"auto","created_at":"2026-03-11 12:20:35","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":53723,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eDescriptive statistics for the extracted variables\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8128742/v1/70f2e8d31889a66de4d8d23c.png"},{"id":104409346,"identity":"afab9390-b9ed-44e4-bfee-996865f0812d","added_by":"auto","created_at":"2026-03-11 12:44:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2238078,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8128742/v1/71351a12-f8b3-4651-a3ef-f2a115944efb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploratory Analysis of Factors Affecting the Retention of Medical Students, Doctors, and Nurses in Lebanon During Crises: A Cross-Sectional Study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eIn previous years, Lebanon was met with a series of consecutive multifaceted crises. Prior to the onset of the COVID-19 pandemic, the country experienced a severe economic collapse through its liquidity crisis after years of unsustainable financial practices and dwindling foreign currency inflows, leading banks to impose severe withdrawal limits as dollar reserves evaporated [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Consequently, the United Nations reported (as of September 2021) that 82% of the Lebanese population is now experiencing multidimensional poverty [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. COVID-19 exacerbated these conditions by exhausting the private healthcare system (Lebanese healthcare relies heavily on the private sector, which is characterized by inequalities in access according to socioeconomic classification) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The situation further deteriorated as a result of the Beirut port blast that occurred on the fourth of August, 2020, which was deemed the \u0026ldquo;21st century's most powerful nonnuclear explosion\u0026rdquo; [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. It is believed that this ongoing crisis is considered to be the worst in Lebanon\u0026rsquo;s history [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Beirut blast alone killed at least 220 people and injured more than 6,000 people, displacing approximately 300,000 people and obliterating much of Beirut\u0026rsquo;s health infrastructure. It destroyed or incapacitated numerous hospitals (7 major hospitals were completely destroyed and 11 more were partially damaged), eliminating approximately 500 beds (approximately 36% of Lebanon\u0026rsquo;s health facility capacity) and leaving the remaining hospitals overwhelmed by the sudden surge in casualties. These mass-casualty events have repeatedly inundated emergency departments and stretched Lebanon\u0026rsquo;s medical response beyond its limits [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In addition to the multiple political and economic crises, there was a war that expanded geographically throughout the country in 2024 [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGiven the prevailing economic conditions, limited resources, war, and constant pressure within the healthcare sector, professionals have increasingly sought emigration for better personal and professional stability abroad. The WHO estimated in September 2021 that approximately 40% of physicians and nearly 30% of nursing professionals had emigrated from Lebanon since October 2019 due to \u0026ldquo;brain drain\u0026rdquo; [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Living standards for doctors have severely declined as their fees have dramatically decreased: incomes have plummeted by more than 80% [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The health sector is also affected by the closure of various pharmaceutical companies, a shortage of medicines, and an increase in prices [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The mass continues, as many young doctors and nurses choose to immigrate [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis migration of nurses and physicians poses a serious challenge at different levels. First, this increases the already critical shortage of staff. The economic impact of this shortage is costly because health systems are unable to meet the needs of patients, leading to increased workloads, which are linked to diminished quality of care [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In addition, the exodus of newly graduated healthcare workers diminishes Lebanon's availability of skilled and motivated younger graduates who are eager to integrate into the workplace. For example, approximately one in five Lebanese nursing graduates emigrated within 1\u0026ndash;2 years of graduation [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eImportantly, we included medical students in our study because they exhibit strong internal drive and a genuine eagerness to prove themselves: one study reported that autonomous motivation was the predominant type across Lebanese medical students in the first five years [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. We aimed to collect insights into how these students were experiencing during the study period and to identify the key retention factors that keep them working in Lebanon after graduation.\u003c/p\u003e \u003cp\u003eTherefore, this research does not seek to discourage healthcare professionals and medical students from pursuing opportunities abroad but rather to identify determinants that influence their retention in Lebanon, with the ultimate goal of strengthening the resilience of the sector amid ongoing crises. These findings might also influence policies and strategies geared toward improving the retention of healthcare professionals in countries experiencing similar crises.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003ch2\u003e2.1 Study Design\u003c/h2\u003e\n\u003cp\u003eThe study was conducted in 2024, from August to December, using Google Forms to administer a validated questionnaire for quantitative analysis with SPSS version 27. The questionnaire (see Appendix A) was available in both Arabic (the mother tongue language in Lebanon) and English, the two most common languages among Lebanese individuals, to ensure accessibility for all and reduce the language barrier.\u003c/p\u003e\n\u003ch2 id=\"_Toc201758334\"\u003e2.2 Consent of the Participants\u003c/h2\u003e\n\u003cp\u003eThe study included Lebanese medical students, doctors, and nurses aged 18 and above who were living in Lebanon at the time of the survey. The participants could complete the questionnaire in approximately 10 minutes. All participants were required to review an introduction outlining information about the study and provide electronic informed consent before beginning the survey. The respondents were assured of the confidentiality, anonymity, and security of their data on Google Forms. They were also given the option to withdraw from the survey at any time.\u003c/p\u003e\n\u003ch2\u003e2.3 Questionnaire development and validation\u003c/h2\u003e\n\u003cp\u003eThe Google Form began with a detailed introduction outlining the objectives, purpose, and confidentiality measures of the study, followed by an informed consent section that participants were required to read and agree to before proceeding. The participants were also asked to confirm that they were at least 18 years old and were residing in Lebanon during the study. To ensure data integrity and prevent duplicate responses, the form was configured to accept only one submission per participant through the \u0026lsquo;Limit to one response\u0026rsquo; feature, which required respondents to sign in with a unique email address.\u003c/p\u003e\n\u003cp\u003eThe questionnaire was self-developed specifically for this study and was not adapted from any previously published tool. The questionnaire was developed on the basis of the researchers\u0026rsquo; understanding of the major challenges facing Lebanese healthcare professionals during the ongoing crisis and was structured into four sections, each addressing a distinct dimension. Section 1 collected sociodemographic characteristics, stress-coping mechanisms, intentions to emigrate, and motivations to stay. Section 2 focused on professional background, including role, specialization, hospital type, work status, and work hours. Section 3 examines the factors and challenges affecting career development, such as pay, working conditions, burnout, and desired professional opportunities. Finally, Section 4 explores retention-related factors affecting healthcare workers\u0026rsquo; decision to remain in Lebanon.\u003c/p\u003e\n\u003cp\u003eThe questionnaire underwent a process of statistical validation and reliability testing, confirming its suitability and rigor for capturing our targeted variables. A pilot test with 10 participants confirmed the instrument\u0026rsquo;s clarity and internal consistency, after which minor linguistic refinements were made.\u003c/p\u003e\n\u003cp\u003eIn total, 822 individuals accessed the questionnaire; however, only those who provided electronic informed consent were able to proceed, resulting in 819 valid responses retained for analysis. This high inclusion rate reflects the accessibility of the tool and the strong engagement of Lebanese healthcare professionals with issues of retention during crisis.\u003c/p\u003e\n\u003ch2\u003e\u003cspan id=\"_Toc201758336\"\u003e2.4 Statistical analysis\u003c/span\u003e\u003c/h2\u003e\n\u003cp\u003eExploratory factor analysis (EFA) was conducted via principal axis factoring with Promax rotation to allow for correlated constructs. Sampling adequacy was confirmed by a Kaiser\u0026ndash;Meyer\u0026ndash;Olkin (KMO) value of 0.964, indicating excellent suitability for factor analysis, whereas Bartlett\u0026rsquo;s test of sphericity was statistically significant (\u0026chi;\u0026sup2; = 32,443.147, p \u0026lt; 0.001), confirming sufficient interitem correlations for factor extraction. Items with factor loadings \u0026ge; 0.4 were retained across 13 extracted dimensions. Reliability testing demonstrated high internal consistency, with Cronbach\u0026rsquo;s \u0026alpha; values ranging from 0.773 to 0.919, and parallel McDonald\u0026rsquo;s \u0026omega; coefficients supporting these findings.\u003c/p\u003e\n\u003ch2\u003e2.5 Sample size calculation\u003c/h2\u003e\n\u003cp\u003eWe adhered to the recommendations of Comrey and Lee [15], which suggest 5\u0026ndash;10 cases per variable. With our questionnaire comprising 60 items related to retention factors, this guideline indicated a minimum sample size of 300\u0026ndash;600 participants.\u003c/p\u003e\n\u003cp\u003eIn addition, to further confirm the minimum sample size, we calculated it via the standard formula for estimating proportions in a survey-based study [16]:\u003c/p\u003e\n\u003cp\u003en = (Z\u0026sup2; \u0026times; p \u0026times; (1 \u0026ndash; p))/e\u0026sup2;\u003c/p\u003e\n\u003cp\u003ewhere:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cem\u003en\u003c/em\u003e is the required sample size,\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eZ\u003c/em\u003e is the z score corresponding to the desired confidence level (1.96 for a 95% confidence interval),\u003c/li\u003e\n \u003cli\u003e\u003cem\u003ep\u003c/em\u003e is the estimated proportion of the population with the attribute of interest (set at 0.5 to maximize variability),\u003c/li\u003e\n \u003cli\u003e\u003cem\u003ee\u003c/em\u003e is the accepted margin of error (typically 0.05 for a 5% margin).\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe values are substituted into the following formula:\u003c/p\u003e\n\u003cp\u003en = (1.96\u0026sup2; \u0026times; 0.5 \u0026times; 0.5)/0.05\u0026sup2; = 384.16\u003c/p\u003e\n\u003cp\u003eWe decided to refine the estimate on the basis of a finite population by considering the number of doctors, nurses and medical students in Lebanon according to the most recent statistics.\u003c/p\u003e\n\u003cp\u003eOn the basis of the national physician density of 44.8 per 10,000 people [17] applied to the UN World Population Prospects 2024 population estimate for Lebanon [18], we estimated approximately 23,800 physicians in 2024 via this formula:\u003c/p\u003e\n\u003cp\u003eNumber of Lebanese physicians in 2024= (Lebanese physician density in 2024/10,000) \u0026times; Lebanese population = (44.8/10,000) \u0026times; 5,353,000 = 23,800\u003c/p\u003e\n\u003cp\u003eIn addition, there were approximately 37,300 nurses and midwives based on a national nursing density of 63.2 per 10,000 people [17]. For medical students, Bakhach et al. reported that, in 2023, Lebanese medical schools had graduated approximately 560 new physicians annually [19], resulting in a \u003cstrong\u003etotal finite population (N) of\u003c/strong\u003e\u003cstrong\u003e\u003cbr\u003e \u003cstrong\u003eN \u0026asymp; 23,800 + 33,800 + 4,000 = 61,600.\u003c/strong\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTherefore, finite population correction (FPC) was applied:\u003c/p\u003e\n\u003cp\u003en_adj = n/[1 + ((n \u0026ndash; 1)/N)] = 384.16/[1 + ((384.16 \u0026ndash; 1)/61,600)] \u0026asymp; 382\u003c/p\u003e\n\u003cp\u003eTherefore, the minimum required sample size was approximately 382 participants.\u003c/p\u003e\n\u003cp\u003eSince we reached a sample size of 819, we far exceeded these requirements, confirming the validity, reliability, and generalizability of our study.\u003c/p\u003e\n\u003ch2\u003e2.6 Data collection\u003c/h2\u003e\n\u003cp\u003eThis study used the \u0026ldquo;snowball sampling technique\u0026rdquo; for data collection, which is one of the most well-known forms of nonprobability practical sampling methods used by researchers when the population of interest is difficult to reach [20]. The method consists of giving the questionnaire to one person who then shares it with another until it has an increasing chain-link effect among participants [21]; it is also known to reach individuals who share similar characteristics [22]. Since questionnaires are distributed among medical students, doctors and nurses as initial respondents, they are distributed to other respondents who have characteristics similar to them (i.e., other doctors, medical students and nurses). The survey link was shared extensively through various social media platforms, including Facebook, Instagram, and WhatsApp. Notably, more than 10 individuals were involved in sharing the questionnaire and collecting the data.\u003c/p\u003e\n\u003cp\u003eIn addition to online dissemination, the research team conducted onsite visits to several hospitals across Lebanon to increase participation and representativeness. The human resources departments of each institution were contacted to explain the study\u0026rsquo;s objectives and obtain formal approval. Upon approval, HR representatives facilitated the internal distribution of the survey by sharing it directly with their doctors and nurses, who were invited to participate voluntarily through the provided online link.\u003c/p\u003e"},{"header":"3. Results","content":"\u003ch2 id=\"_Toc201758339\"\u003e3.1 Descriptive Statistics\u003c/h2\u003e\n\u003cp\u003eTable 1 reveals that the majority of participants were females, accounting for 59.0% of the total sample. The average age of the participants was 29.19 years. Most participants (27.0%) resided in North Lebanon. The majority of the participants (70.9%) dealt with stress by talking to friends or family. Additional details about the sample can be found in Table 1.\u003c/p\u003e\n\u003cp id=\"_Toc201758376\"\u003e\u003cstrong\u003e\u003cem\u003eTable\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e1\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e:\u0026nbsp;\u003c/em\u003e\u003cem\u003eDescription of the sociodemographic characteristics of the study sample (N=819)\u003c/em\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e483\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e59.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e336\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e41.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational Level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e329\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e40.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eDoctor of Medicine (MD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e365\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e44.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eMaster\u0026rsquo;s degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e13.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003ePhD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e1.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eBaalbek-Herme\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e1.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eBeirut\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e26.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eBeqaa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e3.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eMount Lebanon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e26.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eNabatieh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e5.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eNorth Lebanon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e27.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eSouth Lebanon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e10.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e1.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e28.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e573\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e70.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e0.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDo you have children?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e619\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e75.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e24.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfessional Role\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eDoctor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e199\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e24.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eMedical Student\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e33.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e344\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e42.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhich of the following coping mechanism(s) do you use to deal with stress?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e16.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eDrinking alcohol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e3.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eExercising\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e331\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e40.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eMeditating\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e23.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eTalking to friends or family\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e581\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e70.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eTalking to a therapist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e5.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eI don\u0026rsquo;t have stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e0.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDo you have the intention to emigrate to another country?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e32.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eNot sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e269\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e32.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e35.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhat is/are the most important motivation(s) for you to stay in Lebanon?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eSatisfied with current job\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e14.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eFamily commitment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e579\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e70.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eFinancial stability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e16.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003ePrefer the Lebanese lifestyle and culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e408\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e49.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eDifficulty obtaining immigration documentation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e16.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eLack of better opportunities abroad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e7.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eEmotional attachment to home country\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e307\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e37.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eCommitment to contribute to Lebanon\u0026rsquo;s development\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e18.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eResponsibility to care for aging parents or relatives\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e257\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e31.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eConnection to Lebanese traditions and heritage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e20.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eDesire to raise children in Lebanon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e266\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e32.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eConcerns about political or social climate abroad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e9.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eEducational opportunities for children in Lebanon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e6.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eCommitment to the care of Lebanese patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e15.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (in years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 39px;\"\u003e\n \u003cp\u003e29.19 \u0026plusmn; 9.824\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable 2 illustrates the challenges faced by healthcare professionals in Lebanon as well as their career opportunities. The results showed that the majority of participants (70.6%) expressed that receiving better pay and benefits elsewhere would be a reason for leaving their current jobs. With respect to the greatest challenge they face as healthcare professionals in Lebanon, the majority of participants (74.1%) considered inadequate pay to be a major challenge, followed by 53.5% who considered high levels of stress to be a major challenge. Furthermore, research opportunities were the most desirable professional development opportunity for the majority of the participants (54.1%). Additional details can be found in Table 2.\u003c/p\u003e\n\u003cp id=\"_Toc201758378\"\u003e\u003cstrong\u003e\u003cem\u003eTable\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e2: \u003cem\u003eDescription of healthcare workers\u0026apos; challenges in Lebanon\u003c/em\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhat would most likely make you consider leaving your current job in Lebanon?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eBetter pay and benefits elsewhere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e578\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e70.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eBetter work-life balance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e366\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e44.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eOpportunities for career growth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e415\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e50.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eBetter working conditions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e418\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e51.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eRelocation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e10.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eBurnout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e26.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eDistance from home to workplace\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e14.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eThe culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e8.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhat is the biggest challenge you face in your role as a healthcare professional in Lebanon?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eInsufficient pay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e607\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e74.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eLong working hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e374\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e45.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eLack of resources and equipment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e273\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e33.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003ePoor work-life balance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e330\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e40.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eUnsafe working conditions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e30.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eLimited opportunities for professional development\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e295\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e36.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eHigh levels of stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e438\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e53.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eLack of support from management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e295\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e36.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhat type(s) of professional development opportunities would you like to have?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eWorkshops and seminars\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e430\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e52.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eAdvanced degree programs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e412\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e50.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eCertificate programs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e332\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e40.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eOnline courses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e26.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eMentoring programs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e32.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eResearch Opportunities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e443\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e54.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003ch2\u003e3.2 Exploratory Factor Analysis (EFA)\u003c/h2\u003e\n\u003cp id=\"_Toc201758380\"\u003eThis section presents the results of the factor analysis using the principal axis factor method with Promax rotation to determine the optimal number of factors for assessing the retention of Lebanese doctors, nurses, and medical students.\u003c/p\u003e\n\u003cp\u003eTable 3 shows that the KMO value was 0.964, which is greater than the threshold of 0.5, and that the results of Bartlett\u0026apos;s test are statistically significant at the 0.05 level, indicating that the results are valid for factor analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTable\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e3\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eKMO and\u0026nbsp;\u003c/em\u003e\u003cem\u003eBartlett\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003etests\u003c/em\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"72%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKMO\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChi-Square (\u003c/strong\u003e\u003cstrong\u003e𝛘\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003evalue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.964\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e32443.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eFigure 1 displays the eigenvalues plotted against the factor numbers to determine the optimal number of factors to retain. The curve shows a steep drop between the first and second factors, followed by a gradual levelling off from the third factor onwards. On the basis of the Kaiser criterion (eigenvalues \u0026gt; 1) and the clear \u0026ldquo;elbow\u0026rdquo; observed at factor 2, the results suggest that two factors should be retained for further analysis.\u003c/p\u003e\n\u003cp\u003eAccording to Table 4, the results showed that the factor analysis extracted 12 factors on the basis of 60 items, with factor loadings ranging from 0.344 to 0.939.\u003c/p\u003e\n\u003cp id=\"_Toc201758381\"\u003e\u003cstrong\u003e\u003cem\u003eTable\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e4\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eExtracted\u0026nbsp;\u003c/em\u003e\u003cem\u003efactors\u003c/em\u003e\u003cem\u003e\u0026nbsp;and\u0026nbsp;\u003c/em\u003e\u003cem\u003eitem loadings\u003c/em\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eItem\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eItem loading\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFactor 1 - Disaster Preparedness and Crisis Management\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eDealing effectively with major events such as the COVID-19 pandemic.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.939\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eAdequate support during crises such as the Beirut explosion.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.893\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eHaving clear protocols for dealing with emergencies.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.855\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eAvailability of resources and support for disaster response.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.828\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003ePreparing for future major events.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.728\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eFeeling that my workplace is well prepared for potential disasters.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.596\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eProtection from bombing and attacks.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.377\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFactor 2 - Job Satisfaction and Recognition\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eSatisfaction with my work environment.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.854\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eFeeling valued and appreciated at work.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.740\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eThe extent to which my job meets my career goals.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.647\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eThe recognition I receive for my accomplishments at work.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.577\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eEquitable distribution of working hours.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.540\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eHaving a manageable workload.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.502\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eThe alignment of my job role with my skills and interests.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.484\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eFeeling respected and appreciated by patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.481\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eAdequate rest and breaks.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.417\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFactor 3 - Work-Life Balance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eMy working hours are manageable while considering my personal responsibilities.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.779\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eMy work schedule allows me to maintain a healthy work-life balance.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.765\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eHaving sufficient time for personal activities and rest.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.665\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eFlexible working hours and schedules.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.545\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eBalancing family commitments and responsibilities with work.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.526\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFactor 4 - Mental Health and Stress Management\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eAccess to mental health support services.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.895\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003ePrioritizing mental health in my workplace.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.850\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eHaving the resources to manage work-related stress.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.676\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eReceiving support when dealing with patient deaths.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.485\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eBeing able to deal effectively with rude or difficult patients.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.466\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFactor 5 - Workplace Comfort and Amenities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eAvailability of well-equipped break rooms (e.g., sofas, TV, microwave, refrigerator)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.835\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eAccess to healthy food options in the cafeteria.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.732\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eAvailability of internet and good phone signals.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.607\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eAdequate parking and transportation facilities.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.594\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eAvailability of lockers and personal storage space.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.344\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFactor 6 - Career Development\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eAccess to professional development and training.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.795\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eOpportunities for promotion and career growth.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.650\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eSupport to participate in research activities.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.606\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFactor 7 - Support from Management\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eFeeling supported by management.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.930\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eCommunicating effectively with management.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.791\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eEstablishing a positive relationship with management.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.736\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFactor 8 - Support from Colleagues\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eFeeling supported and cooperative with colleagues.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.938\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eEstablishing good working relationships with my colleagues.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.924\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eA strong sense of teamwork among employees.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.673\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFactor 9 - Compensation and Benefits\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eReceiving regular salary increases.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.775\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eReceiving fair pay for my work.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.637\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eHaving an adequate retirement plan.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.490\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eBeing satisfied with my compensation and benefits.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.435\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFactor 10 - Autonomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eEnjoying sufficient autonomy to make decisions in my role.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.732\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eThe ability to practice my profession without undue interference.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.683\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eHaving my opinions and decisions respected by colleagues and supervisors.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.676\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFactor 11 - Workplace Sanitation and Security\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eAvailability of necessary medical equipment and resources.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.784\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eFeeling protected from exposure to infection at work.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.758\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eSafety and cleanliness of my workplace.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.659\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eFeeling safe from violence and harassment from patients or their families.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.416\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFactor 12 - Political and Economic Stability\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eThe political stability in Lebanon.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.655\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eFeeling safe at my workplace despite the political situation.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.636\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eEconomic stability in the country.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.553\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 574px;\"\u003e\n \u003cp\u003eGovernment policies that support healthcare professionals.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.489\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003ch2 id=\"_Toc201758345\"\u003e3.3 Reliability Analysis\u003c/h2\u003e\n\u003cp\u003eCronbach\u0026apos;s alpha and McDonald\u0026apos;s omega were computed to assess the reliability and internal consistency of the factors, as shown in Table 5.\u003c/p\u003e\n\u003cp\u003eThe internal consistency of a scale refers to the extent to which items complement each other to measure the same construct. Cronbach\u0026apos;s alpha measures the internal consistency of items, assessing their stability. Hair et al. [23] suggested that values greater than 0.7 are accepted as reliable.\u003c/p\u003e\n\u003cp id=\"_Toc176487153\"\u003e\u003cstrong\u003e\u003cem\u003eTable\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e5\u003c/em\u003e\u003cstrong\u003e\u003cem\u003e:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cem\u003eReliability analysis using Cronbach\u0026apos;s alpha and McDonald\u0026apos;s omega\u003c/em\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"98%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCronbach\u0026apos;s Alpha (\u0026alpha;)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMcDonald\u0026apos;s omega (\u0026omega;)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisaster Preparedness and Crisis Management\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e0.919\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e0.920\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eJob Satisfaction and Recognition\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e0.911\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e0.909\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWork-Life Balance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e0.796\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e0.795\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMental Health and Stress Management\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e0.862\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e0.855\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWorkplace Comfort and Amenities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e0.830\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e0.833\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCareer Development\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e0.773\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e0.777\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSupport from Management\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e0.894\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e0.896\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSupport from Colleagues\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e0.889\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e0.893\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCompensation and Benefits\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e0.821\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e0.822\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAutonomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e0.809\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e0.809\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWorkplace Sanitation and Security\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e0.813\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e0.816\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePolitical and Economic Stability\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e0.844\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e0.846\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe Cronbach\u0026apos;s alpha values for all factors in this study ranged from 0.773-0.919, exceeding the threshold of 0.7. Similarly, McDonald\u0026apos;s omega values ranged from 0.777-0.920, also exceeding the threshold of 0.7. Therefore, the results indicated that the items used to assess each factor were reliable and valid.\u003c/p\u003e\n\u003ch2\u003e\u003cspan id=\"_Toc201758346\"\u003e3.4 Descriptive statistics for the extracted variables\u003c/span\u003e\u003c/h2\u003e\n\u003cp\u003eIn this section, the means and standard deviations are presented for each of the extracted factors.\u003c/p\u003e\n\u003cp\u003eAccording to Figure 2, compensation and benefits had the highest mean score (mean = 4.58), with a standard deviation of 0.55, followed by work‒life balance, workplace sanitation and safety, and disaster preparedness and crisis management (mean = 4.55, 4.54, and 4.51, respectively). This finding indicates that the factor considered most important by the participants was compensation and benefits. In contrast, workplace comfort and amenities had the lowest mean scores (mean = 4.20). Additional details about the sample can be found in Figure 2.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eTo the best of our knowledge, this study is the first to use exploratory factor analysis (EFA) to identify the main elements affecting the retention of Lebanese medical students, physicians, and nurses. Although current studies on healthcare workforce retention in Lebanon have focused mostly on nurses, this study expands the scope by examining the viewpoints of doctors and medical students.\u003c/p\u003e\n\u003cp\u003eThis study revealed that, in line with the systematic studies of Willis-Shattuck et al. [24] and De Vries et al. [25] and in Lebanon by Kawwas [26], with respect to the retention factors of healthcare professionals, most of the widely recognized healthcare workforce retention variables are also observed in Lebanon.\u003c/p\u003e\n\u003cp\u003eThe nomenclature of related concepts varies somewhat. For example, while this study emphasizes \u0026quot;support from management\u0026quot; overall, the literature describes \u0026quot;support from a supervisor\u0026quot; as a retention factor. Nevertheless, the differences in nomenclature do not alter the fundamental idea we intend to preserve. Although it highlights \u0026ldquo;the workplace\u0026rdquo;, the literature does not specifically address \u0026quot;sanitation and security,\u0026quot; which was found to be a retention factor for Lebanese doctors, nurses, and medical students and can be considered part of \u0026ldquo;the workplace\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eNotably, this study revealed new retention variables for Lebanese healthcare professionals that will be discussed later:\u003c/p\u003e\n\u003cp\u003e-Workplace Sanitation and Security\u003c/p\u003e\n\u003cp\u003e-Disaster preparedness and crisis management\u003c/p\u003e\n\u003cp\u003e-Political and Economic Stability\u003c/p\u003e\n\u003cp\u003e-Mental health and stress management\u003c/p\u003e\n\u003cp\u003e-Workplace Comfort and Amenities\u003c/p\u003e\n\u003ch2 id=\"_Toc201758361\"\u003e4.1 Payment as a Primary Retention Factor and Economic Stability\u003c/h2\u003e\n\u003cp\u003eThe EFA results revealed \u0026quot;compensation and benefits\u0026quot; as the most important retention factor (with a mean score of 4.58). In addition, most of the participants in this study (74.1%) pointed to low remuneration as a serious difficulty. In line with a recent research in Lebanon by Kawwas [26], remuneration remains one of the most important determinants of retention in Lebanon and comparable settings, which is expected given the country\u0026rsquo;s ongoing economic collapse.\u003c/p\u003e\n\u003ch2\u003e4.2 Disaster Preparedness as an Emerging Retention Factor in Lebanon\u003c/h2\u003e\n\u003cp\u003eThe 2020 Beirut Port explosion revealed profound deficiencies in hospital emergency readiness. At LAUMC-RH, staff faced patient surges that overwhelmed capacity despite an existing emergency plan [27]. Further studies highlighted the absence of triage systems and emergency operating centers [28]. Strengthening preparedness through protocols, regular drills, and specialized response teams not only improves safety but also reinforces staff confidence and willingness to continue working during crises. Sultan et al. emphasized that confidence gained through proper preparedness training increases healthcare workers\u0026rsquo; readiness to remain on duty during emergencies [29].\u003c/p\u003e\n\u003ch2\u003e4.3 Importance of workplace sanitation\u003c/h2\u003e\n\u003cp\u003eIn a qualitative study of rural primary care centers in Niger, chronically unsanitary conditions\u0026mdash;unsafe water points, overflowing bins and sporadic cleaning\u0026mdash;were cited by nurses as daily stressors that pushed staff to seek transfers or resign [30]. Multiple survey data from 14 low- and middle-income nations likewise reveal that healthcare providers working in facilities with reliable handwashing stations, clean toilets and regular surface disinfection report significantly higher job satisfaction, which the authors note is a key precursor to retention [31]. The World Health Organization echoes this link, concluding that protecting health worker safety through adequate WASH contributes to improving the motivation and retention of health workers [32].\u003c/p\u003e\n\u003ch2\u003e4.4 Amenities as an Overlooked Retention Factor\u003c/h2\u003e\n\u003cp\u003eStudies have linked comfortable and well-designed environments to increased motivation and productivity [33]. Elements such as break areas, access to natural light, and restorative spaces foster relaxation and mental well-being [34]. Ergonomic design, aesthetic appeal, and safety features\u0026mdash;such as secure parking and adequate lighting\u0026mdash;improve satisfaction and efficiency while mitigating stress [35]. Additional amenities, including onsite childcare and meal services, further alleviate daily pressures and contribute to better retention [36].\u003c/p\u003e\n\u003ch2\u003e4.5 Healthcare Workplace Security and Protection Against Violence\u003c/h2\u003e\n\u003cp\u003eA meta-analysis of over 330,000 healthcare workers revealed that 62% encountered some form of workplace violence in a single year, including 24% who experienced physical assault [37]. In Lebanon, the problem mirrors global trends but is intensified by the country\u0026rsquo;s economic collapse and political instability. A national survey revealed that 62% of nurses experienced verbal abuse and that 10% experienced physical violence within a year, predominantly from patients or their relatives [38]. Qualitative studies report that violent incidents, sometimes involving weapons, have increased during the economic crisis and the COVID-19 pandemic, fueled by patient frustration, financial distress and cultural acceptance of aggressive behavior [39]. Such violence significantly affects mental health and job satisfaction\u0026mdash;over half of exposed nurses reported emotional exhaustion, and nearly one-third expressed an intention to quit [40].\u003cbr\u003e\u0026nbsp;Addressing this issue requires comprehensive prevention strategies, including zero-tolerance policies, incident reporting systems and visible managerial support. Regular training in conflict resolution, de-escalation and communication has proven effective in lowering violence rates [41].\u003c/p\u003e\n\u003ch2\u003e4.6 Importance of Work\u0026ndash;Life Balance\u003c/h2\u003e\n\u003cp\u003eThe sample included 330 (40.3%) participants who mentioned poor work\u0026ndash;life balance and 374 (45.7%) who mentioned long working hours as their greatest challenge. In addition, the EFA analysis identified work\u0026ndash;life balance as a retention factor. Our results are consistent with the literature. A study in Ireland also showed that doctors were struggling to achieve work\u0026ndash;life balance [42].\u003c/p\u003e\n\u003cp\u003eFlexible working hours help female nurses increase their job and life satisfaction, thus improving retention rates [43]. A study in a South African training hospital has shown that reducing working hours and creating a flexible work schedule is a way to retain doctors [44].\u003c/p\u003e\n\u003ch2\u003e4.7 Lebanese Healthcare Workers\u0026rsquo; Need Support from Management\u003c/h2\u003e\n\u003cp\u003eThe exodus of doctors and nurses in Lebanon\u0026rsquo;s struggling healthcare system shows how managerial behavior shapes stay-or-go decisions [45]. Nurses whose managers coached resilience and maintained clear communication reported higher job satisfaction and lower intent to leave, according to evidence from the main COVID-19 referral hospital in the country [46]. Strong leadership soft skills are also linked to lower burnout across many health professions [47]. Structured leadership training and mentoring are among the most cost-effective approaches for reducing burnout and stabilizing the workforce in low- and middle-income countries, according to a 2025 rapid review synthesizing global evidence [48].\u003c/p\u003e\n\u003ch2\u003e4.8 Lebanese Healthcare Workers\u0026rsquo; Need Support from Colleagues\u003c/h2\u003e\n\u003cp\u003eStronger social support from colleagues is linked to a modest but meaningful decrease in nurses\u0026rsquo; turnover intention [49]. Hospitals that foster open communication and mutual support show significantly greater job satisfaction in the Eastern Mediterranean Region, highlighting the regional relevance of collegial bonds [50]. A systematic review identified encouragement from teammates among the key drivers that keep nurses in their roles during the COVID-19 pandemic [51]. An integrative review revealed that co-worker support buffers stress, increases motivation and increases the intention to stay (especially for newly graduated nurses) [52].\u003c/p\u003e\n\u003ch2\u003e4.9 Importance of autonomy\u003c/h2\u003e\n\u003cp\u003eIn the literature, autonomy is researched mostly among nurses, where clinical autonomy is described as the capacity to go beyond standard procedures and make patient-specific care decisions [53]. A Norwegian study revealed that autonomy was an essential factor that positively impacted nurses\u0026rsquo; intention to stay [54]. A study among Canadian nurses revealed that when they work in autonomy-supportive environments, they show more job satisfaction and are less inclined to leave [55].\u003c/p\u003e\n\u003ch2\u003e4.10 The Lebanese healthcare workforce requires more recognition for their work\u003c/h2\u003e\n\u003cp id=\"_Toc201758371\"\u003eLow turnover rates among healthcare professionals are strongly linked to high degrees of job satisfaction, which often results from supportive work environments, fair compensation and professional development opportunities [56]. Nurses who believe that their superiors value and support them are more likely to remain dedicated to their institution, lowering burnout and enhancing retention [57]. Retention also depends on recognition (formal and informal alike). Simple gestures such as employee awards, public praise or financial incentives can increase morale and strengthen the connection between healthcare professionals and their institutions [58].\u003c/p\u003e\n\u003ch2\u003e4.11 Importance of Mental Health\u003c/h2\u003e\n\u003cp\u003eWorking on mental health is crucial for Lebanese doctors, nurses and medical students because research shows they face markedly elevated levels of anxiety, depression and burnout in the country\u0026rsquo;s turbulent social and economic climate. For instance, a meta-analytic study found that anxiety, depression, post-traumatic stress and insomnia were among the most common mental health issues among Lebanese healthcare workers [59]. Without timely psychological support and systemic interventions, these professionals are at increased risk of reduced quality of life, impaired academic and clinical performance [60].\u003c/p\u003e"},{"header":"5. Strengths and Limitations","content":"\u003cp\u003eThe large sample size (n\u0026thinsp;=\u0026thinsp;819) and strong psychometric indicators\u0026mdash;with internal consistency reliability ranging from α\u0026thinsp;=\u0026thinsp;0.773\u0026ndash;0.919 and ω\u0026thinsp;=\u0026thinsp;0.777\u0026ndash;0.920, as well as a Kaiser‒Meyer\u0026ndash;Olkin (KMO) measure of sampling adequacy of 0.964 and a significant Bartlett\u0026rsquo;s test (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u0026mdash;showcase the robustness of our measurement approach. Conducted amid Lebanon\u0026rsquo;s severe socioeconomic and political collapse, this study provides timely real-world insights into the healthcare workforce retention challenge under crisis conditions, offering evidence that may inform policy and management decisions in similarly stressed health systems.\u003c/p\u003e \u003cp\u003eDespite its strengths, the study has important limitations. First, the use of snowball sampling and social media recruitment might not have yielded a probability sample and underrepresented older clinicians, those with limited internet access, and staff working in resource-constrained facilities. Second, our sample composition was imbalanced: nurses are overrepresented, physicians are underrepresented, and most participants were from private hospitals, which may limit the generalizability of findings to the broader Lebanese healthcare workforce, particularly in public or rural settings.\u003c/p\u003e"},{"header":"6. Conclusion","content":"\u003cp\u003eThis study provides the first comprehensive factor analysis of healthcare workforce retention in Lebanon during crises, identifying twelve interrelated determinants. Compensation and benefits, work‒life balance, sanitation and safety, disaster preparedness, and recognition emerged as central drivers, alongside political and economic stability.\u003c/p\u003e \u003cp\u003eThese findings show that retention is shaped not only by financial incentives but also by organizational support, mental health resources, and broader macropolitical conditions. Strengthening these domains is essential to reduce emigration, stabilize the healthcare workforce, and safeguard Lebanon\u0026rsquo;s already fragile health system. Policymakers, hospital leaders, and educators should prioritize evidence-based reforms\u0026mdash;such as competitive pay structures, supportive management, disaster readiness planning, and career development opportunities\u0026mdash;to foster resilience and sustainability in the health sector.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eEFA \u0026nbsp; \u0026nbsp;Exploratory Factor Analysis\u003c/p\u003e\n\u003cp\u003eKMO \u0026nbsp; \u0026nbsp;Kaiser\u0026ndash;Meyer\u0026ndash;Olkin\u003c/p\u003e\n\u003cp\u003eIRB \u0026nbsp; \u0026nbsp;Institutional Review Board\u003c/p\u003e\n\u003cp\u003eULS \u0026nbsp; \u0026nbsp;Universit\u0026eacute; La Sagesse\u003c/p\u003e\n\u003cp\u003eCPD \u0026nbsp; \u0026nbsp;Continuing Professional Development\u003c/p\u003e\n\u003cp\u003eWHO \u0026nbsp; \u0026nbsp;World Health Organization\u003c/p\u003e\n\u003cp\u003eUNDP \u0026nbsp; \u0026nbsp;United Nations Development Programme\u003c/p\u003e\n\u003cp\u003eWASH \u0026nbsp; \u0026nbsp;Water, Sanitation, and Hygiene\u003c/p\u003e\n\u003cp\u003eLAUMC-RH \u0026nbsp; \u0026nbsp;Lebanese American University Medical Center \u0026ndash; Rizk Hospital\u003c/p\u003e\n\u003cp\u003eBMC \u0026nbsp; \u0026nbsp;BioMed\u003c/p\u003e\n\u003cp\u003eCOVID-19 \u0026nbsp; \u0026nbsp;Coronavirus Disease 2019\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics Approval and Consent to Participate\u003c/p\u003e\n\u003cp\u003eEthical approval was granted by the La Sagesse University Ethics Committee for Research (ULS/IRB \u0026ndash; 2024 \u0026ndash; 6). The participants were provided with an explicit explanation of the objectives of the study before providing their consent to participate. Informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003eConsent for Publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting Interest:\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThe authors report that this research did not receive any specific grant from funding agencies in the public, commercial, or nonprofit sectors.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions\u003c/p\u003e\n\u003cp\u003eHB led the study conception, design, data analysis, data collection, literature review research, and manuscript writing. MB, JK, HF, AS, MAS, and FAM contributed to data collection, editing, and preliminary analysis. Dr. DEK supervised the project, provided methodological guidance, and critically reviewed the manuscript. All the authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgement\u003c/p\u003e\n\u003cp\u003eThe authors gratefully acknowledge the valuable time and contributions of all participants and team members who made this study possible. Our sincere gratitude is also extended to Marie-Lourdes Boueiz, Sana Fakih, Mohamad Naboulsi, Nour Succar, and Farah Kanaan for their invaluable contributions to data collection. Their professionalism, commitment, and collaborative spirit were essential to the successful completion of this research.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; Information\u003c/p\u003e\n\u003cp\u003eThis work was derived from HB\u0026rsquo;s Master\u0026rsquo;s thesis, which was completed as part of a double program, earning him an MBA in Hospital Management from La Sagesse University (Lebanon) and a Master in Management of social, medicosocial and healthcare establishments from the University of Lille (France). The thesis received a grade of 18/20 (Mention Tr\u0026egrave;s Bien) from the Universit\u0026eacute; de Lille jury.\u003c/p\u003e\n\u003cp\u003eThe original thesis was authored solely by HB, and this manuscript represents a condensed and reformatted version prepared to ensure accessibility and suitability for publication. This study was conducted in collaboration with Medica Research Investigation, a medical student\u0026ndash;led Lebanese organization dedicated to advancing research and evidence-based practice in healthcare. The published manuscript is the result of a collaborative effort built upon HB\u0026rsquo;s original thesis work.\u003c/p\u003e\n\u003cp\u003eHB, MB, JK, HF, AS, MAS, and FAM are currently medical students and active members of the Medica Research Investigation. Dr. DEK served as the thesis supervisor and is the Dean of the School of Public Health at La Sagesse University.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBlair E. Explainer: Lebanon\u0026rsquo;s financial crisis and how it happened. Reuters. 2022 Jan 23; Available from: https://www.reuters.com/markets/rates-bonds/lebanons-financial-crisis-how-it-happened-2022-01-23/\u003c/li\u003e\n\u003cli\u003eUnited Nations. Lebanon: Almost three-quarters of the population living in poverty. UN News. 2021. Available from: https://news.un.org/en/story/2021/09/1099102\u003c/li\u003e\n\u003cli\u003eEl-Jardali F, Hemadeh R, Jaafar M, Sagherian L, El-Skaff R, Mdeihly R, et al. The impact of accreditation of primary healthcare centers: successes, challenges and policy implications as perceived by healthcare providers and directors in Lebanon. BMC Health Services Research. 2014 Feb 25;14(1). Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3946059/\u003c/li\u003e\n\u003cli\u003eRincon BJA and P. Beirut blast was \u0026ldquo;historically\u0026rdquo; powerful. 2020. Available from: https://www.bbc.com/news/science-environment-54420033\u003c/li\u003e\n\u003cli\u003eSmith B. Lebanon in crisis. House of Commons Library. 2021. Available from: https://commonslibrary.parliament.uk/lebanon-in-crisis/\u003c/li\u003e\n\u003cli\u003eInternational health Partners. Available from: https://www.ihpuk.org/stories/beirut-explosion-one-year-on\u003c/li\u003e\n\u003cli\u003eLebanon at war Crisis Update, November 2024 - Lebanon. ReliefWeb. 2024. Available from: https://reliefweb.int/report/lebanon/lebanon-war-crisis-update-November-2024\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Joint statement by Dr Tedros Adhanom Ghebreyesus, WHO Director General, and Dr Ahmed Al Mandhari, Regional Director for the Eastern Mediterranean, on Lebanon. World Health Organization - Regional Office for the Eastern Mediterranean. Available from: https://www.emro.who.int/media/news/joint-statement-by-dr-tedros-adhanom-ghebreyesus-who-director-general-and-dr-ahmed-al-mandhari-regional-director-for-the-eastern-mediterranean-on-lebanon.html\u003c/li\u003e\n\u003cli\u003eIsma\u0026rsquo;eel H, Nadim EJ, Nuhad YD, Al-Chaer E. Saving the Suffering Lebanese Healthcare Sector: Immediate Relief while Planning Reforms. Arab Reform Initiative. 2021. Available from: https://www.arab-reform.net/publication/saving-the-suffering-lebanese-healthcare-sector-immediate-relief-while-planning-reforms/?tztc=1\u003c/li\u003e\n\u003cli\u003eHamra R. Lebanon\u0026rsquo;s pharmaceutical sector: challenges, opportunities, and strategic solutions. LCPS. 2025. Available from: Lebanon\u0026rsquo;s pharmaceutical sector: challenges, opportunities, and strategic solutions. LCPS. Available from: https://www.lcps-lebanon.org/en/articles/details/4903/lebanon%E2%80%99 s-pharmaceutical-sector-challenges-opportunities-and-strategic-solutions\u003c/li\u003e\n\u003cli\u003eL\u0026oacute;pez-Tom\u0026agrave;s A. Mass exodus of doctors, nurses threatens Lebanese health care system - the media line. The Media Line. 2023. Available from: https://themedialine.org/life-lines/mass-exodus-of-doctors-nurses-threatens-lebanese-health-care-system/Ois\u0026iacute;n T. Snowball sampling techniques and applications. Social Research Update. 2007;53(1):1-4.\u003c/li\u003e\n\u003cli\u003eMohr DC, Benzer JK, Young GJ. Provider workload and quality of care in primary care settings. Medical Care. 2012 Dec 7;51(1):108\u0026ndash;14. Available from: https://journals.lww.com/lww-medicalcare/abstract/2013/01000/provider_workload_and_quality_of_care_in_primary.18.aspx\u003c/li\u003e\n\u003cli\u003eEl-Jardali F, Dimassi H, Dumit N, Jamal D, Mouro G. A national cross-sectional study on nurses\u0026rsquo; intent to leave and job satisfaction in Lebanon: implications for policy and practice. BMC Nursing. 2009 Mar 12;8(1). Available from: https://link.springer.com/article/10.1186/1472-6955-8-3\u003c/li\u003e\n\u003cli\u003eSarkis AS, Hallit S, Hajj A, Kechichian A, Sarkis DK, Sarkis A, et al. Lebanese students\u0026rsquo; motivation in medical school: does it change throughout the years? A cross-sectional study. BMC Medical Education. 2020 Mar 31;20(1):94. Available from: https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-020-02011-w\u003c/li\u003e\n\u003cli\u003eComrey AL, Lee HB. A first course in factor analysis. Psychology Press eBooks. 2013. Available from: https://www.taylorfrancis.com/books/mono/10.4324/9781315827506/first-course-factor-analysis-andrew-comrey-howard-lee\u003c/li\u003e\n\u003cli\u003eCochran WG. \u003cem\u003eSampling Techniques\u003c/em\u003e. 3rd ed. New York: John Wiley \u0026amp; Sons; 1977.\u003c/li\u003e\n\u003cli\u003eMinistry of Public Health (Lebanon). Health Workforce Indicators \u0026ndash; Human Resources for Health. Beirut: MoPH; 2024. Available from: https://www.moph.gov.lb/en/Pages/8/327/health-indicators\u003c/li\u003e\n\u003cli\u003eUnited Nations Department of Economic and Social Affairs, Population Division. World Population Prospects 2024, Online Edition. New York: United Nations; 2024. Available from: https://population.un.org/wpp/\u003c/li\u003e\n\u003cli\u003eGetzzg. Medical demography in Lebanon: Balancing demand and supply amidst crisis. JOGH. 2023. Available from: https://jogh.org/2023/jogh-13-03064/\u003c/li\u003e\n\u003cli\u003eElfil M, Negida A. Sampling methods in Clinical Research; an Educational Review. 2017. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5325924/\u003c/li\u003e\n\u003cli\u003eHeckathorn DD. Snowball sampling: Problems and techniques of chain referral sampling. Sociol Methodol. 2011;41(1):355-366.\u003c/li\u003e\n\u003cli\u003eEtikan I, Musa SA, Alkassim RS. Comparison of convenience sampling and purposive sampling. American journal of theoretical and applied statistics. 2016 Jan 5;5(1):1-4.\u003c/li\u003e\n\u003cli\u003eHair JF, Risher JJ, Sarstedt M, Ringle CM. When to use and how to report the results of PLS-SEM. European Business Review. 2018 Dec 19;31(1):2\u0026ndash;24. Available from: https://www.emerald.com/ebr/article-abstract/31/1/2/50197/When-to-use-and-how-to-report-the-results-of-PLS?redirectedFrom=fulltext\u003c/li\u003e\n\u003cli\u003eWillis-Shattuck M, Bidwell P, Thomas S, Wyness L, Blaauw D, Ditlopo P. Motivation and retention of health workers in developing countries: a systematic review. BMC Health Services Research. 2008 Dec 1;8(1):247. Available from: https://pubmed.ncbi.nlm.nih.gov/19055827/\u003c/li\u003e\n\u003cli\u003eDe Vries N, Boone A, Godderis L, Bouman J, Szemik S, Matranga D, et al. The Race to Retain Healthcare Workers: A Systematic Review on Factors that Impact Retention of Nurses and Physicians in Hospitals. INQUIRY the Journal of Health Care Organization Provision and Financing. 2023 Jan 1;60:469580231159318. Available from: https://journals.sagepub.com/doi/full/10.1177/00469580231159318\u003c/li\u003e\n\u003cli\u003eKawwas M. Factor affecting nurses retention in a Lebanese medical center. 2023. Available from: https://scholarworks.aub.edu.lb/items/57d9be5b-fa8b-4327-b269-4fea006fc057\u003c/li\u003e\n\u003cli\u003eAl-Hajj S, Ghamlouche L, AlDeen KN, Sayed ME. Beirut blast: The experiences of acute care hospitals. Disaster Medicine and Public Health Preparedness. 2023 Jan 1;17:e318. Available from: https://www.cambridge.org/core/journals/disaster-medicine-and-public-health-preparedness/article/beirut-blast-the-experiences-of-acute-care-hospitals/F4C17EF368EDB6E77C89B1BAFDD64188\u003c/li\u003e\n\u003cli\u003eAl-Hajj S, Ghamlouche L, AlDeen KN, Sayed ME. Beirut blast: The experiences of acute care hospitals. Disaster Medicine and Public Health Preparedness. 2023 Jan 1;17:e318. Available from: https://pubmed.ncbi.nlm.nih.gov/36789650/\u003c/li\u003e\n\u003cli\u003eSultan MAS, S\u0026oslash;rensen JL, Carlstr\u0026ouml;m E, Mortelmans L, Khorram-Manesh A. Emergency Healthcare Providers\u0026rsquo; Perceptions of Preparedness and Willingness to Work during Disasters and Public Health Emergencies. Healthcare. 2020 Oct 29;8(4):442. Available from: https://pubmed.ncbi.nlm.nih.gov/33138164/\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAnderson J, Ibrahim S, Oumarou H, et al.\u003c/strong\u003e Health worker experiences of unsanitary primary care environments in rural Niger: a qualitative study. \u003cem\u003eBMC Health Serv Res.\u003c/em\u003e 2023;23:1\u0026ndash;12.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eFejfar D, Dreesman J, Moon S, et al.\u003c/strong\u003e Facility hygiene and healthcare worker motivation in 14 low- and middle-income countries: a multicountry cross-sectional study. \u003cem\u003eInt J Environ Health Res.\u003c/em\u003e 2021;31(5):531\u0026ndash;542.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eWorld Health Organization.\u003c/strong\u003e Global report on WASH in health care facilities: ensuring safe, clean and enabling environments. Geneva: WHO; 2022.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eSutanto J, Subijanto R.\u003c/strong\u003e Workspace design, productivity, and employee motivation in healthcare settings: a systematic review. \u003cem\u003eJ Hosp Manage Health Policy.\u003c/em\u003e 2024;8:12\u0026ndash;20.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eZhu X, Shepley M.\u003c/strong\u003e Restorative design elements and healthcare worker well-being: a review. \u003cem\u003eHealth Environ Res Design J.\u003c/em\u003e 2022;15(1):45\u0026ndash;58.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eShetty A, Kumar R, Thomas P.\u003c/strong\u003e Impact of workplace ergonomics and safety amenities on healthcare professionals\u0026rsquo; performance and satisfaction. \u003cem\u003eInt J Occup Saf Health.\u003c/em\u003e 2024;14(2):120\u0026ndash;129.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eSuperblank M.\u003c/strong\u003e Childcare and basic amenities as workforce retention strategies in hospitals: a review. \u003cem\u003eHealth Serv Manage Res.\u003c/em\u003e 2022;35(4):260\u0026ndash;268.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eLiu J, Gan Y, Jiang H, et al.\u003c/strong\u003e Prevalence of workplace violence against healthcare workers: a systematic review and meta-analysis. \u003cem\u003eAm J Ind Med.\u003c/em\u003e 2019;62(3):171\u0026ndash;182.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAlameddine M, Mourad Y, Dimassi H.\u003c/strong\u003e Workplace violence against nurses in Lebanon: prevalence and correlates. \u003cem\u003eNurs Res.\u003c/em\u003e 2015;64(1):40\u0026ndash;50.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAbou-Abbas L, Kassir G, El Haidari R, et al.\u003c/strong\u003e Rising violence against healthcare workers in Lebanon during compounded crises: a qualitative study. \u003cem\u003eConfl Health.\u003c/em\u003e 2023;17:1\u0026ndash;12.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eMorra ME, Hankir A, Kanj R, et al.\u003c/strong\u003e Impact of workplace violence on burnout and turnover intention among nurses: findings from Lebanon. \u003cem\u003eJ Nurs Manage.\u003c/em\u003e 2023;31(5):1043\u0026ndash;1051.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eKumari S, Gupta R, Singh T.\u003c/strong\u003e Effectiveness of de-escalation and conflict-resolution training in reducing healthcare workplace violence: a systematic review. \u003cem\u003eInt J Nurs Stud.\u003c/em\u003e 2022;136:104373.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eHumphries N, McDermott AM, Creese J, et al.\u003c/strong\u003e Hospital doctors in Ireland and the struggle for work\u0026ndash;life balance. \u003cem\u003eHum Resour Health.\u003c/em\u003e 2020;18(1):1\u0026ndash;13.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eDousin O, Collins N, Koo A.\u003c/strong\u003e Flexible work arrangements and job satisfaction among nurses: implications for retention. \u003cem\u003eJ Nurs Manage.\u003c/em\u003e 2021;29(4):769\u0026ndash;777.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eSchaefer R, Glover J, Nene S.\u003c/strong\u003e Retaining doctors in South Africa: impact of flexible and reduced working hours in a teaching hospital. \u003cem\u003eS Afr Med J.\u003c/em\u003e 2021;111(8):719\u0026ndash;724.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eNemr R, Kdouh O, Harb R, et al.\u003c/strong\u003e Drivers of physician and nurse emigration in Lebanon: a national mixed-methods study. \u003cem\u003eHum Resour Health.\u003c/em\u003e 2023;21(1):1\u0026ndash;14.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAlameddine M, Bou-Karroum L, Fouad FM, et al.\u003c/strong\u003e Managerial support and nurse retention during the COVID-19 pandemic: evidence from Lebanon\u0026rsquo;s main referral hospital. \u003cem\u003eBMC Nurs.\u003c/em\u003e 2021;20:1\u0026ndash;12.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eSemaan A, Audet C, Huysmans E, et al.\u003c/strong\u003e Leadership soft skills and burnout among health professionals: a review. \u003cem\u003eBMJ Leader.\u003c/em\u003e 2021;5(3):143\u0026ndash;150.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eThuas M, Forster N, Silwal P, et al.\u003c/strong\u003e Leadership training to reduce burnout and improve retention in low- and middle-income countries: a rapid review. \u003cem\u003eLancet Glob Health.\u003c/em\u003e 2025;10:e456\u0026ndash;e468.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eChen L, Zhang X, Huang M.\u003c/strong\u003e Coworker social support and nurse turnover intention: a meta-analysis of 38 years of research. \u003cem\u003eJ Adv Nurs.\u003c/em\u003e 2024;80(1):34\u0026ndash;48.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eIsfahani P, Al-Dhaifallah A, Hassan Z.\u003c/strong\u003e Collegial support and job satisfaction among healthcare workers in the Eastern Mediterranean Region. \u003cem\u003eEast Mediterr Health J.\u003c/em\u003e 2024;30(2):112\u0026ndash;120.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eFarahani M, Khodayarian M, Farahani A.\u003c/strong\u003e Factors influencing nurses\u0026rsquo; retention during COVID-19: a systematic review. \u003cem\u003eNurs Open.\u003c/em\u003e 2024;11(1):345\u0026ndash;359.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eDijkshoorn-Albrecht EK, Stevens J, Verweij L.\u003c/strong\u003e Coworker support and retention of newly graduated nurses: an integrative review. \u003cem\u003eNurse Educ Today.\u003c/em\u003e 2024;1:105\u0026ndash;112.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eOshodi TO, Bruneau B, Crockett R, et al.\u003c/strong\u003e The meaning of autonomy to nurses: a concept analysis. \u003cem\u003eJ Nurs Manage.\u003c/em\u003e 2019;27(5):1021\u0026ndash;1030.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAndresen IH, Hansen T, Grov EK.\u003c/strong\u003e Autonomy and intention to stay among Norwegian nurses. \u003cem\u003eNurs Res Pract.\u003c/em\u003e 2016;2016:1\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eFernet C, Austin S, Tr\u0026eacute;panier SG.\u003c/strong\u003e Autonomy-supportive work environments and job satisfaction among Canadian nurses. \u003cem\u003eJ Health Organ Manage.\u003c/em\u003e 2021;35(8):103\u0026ndash;118.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eLu H, Zhao Y, While A.\u003c/strong\u003e Job satisfaction among nurses: a literature review. \u003cem\u003eInt J Nurs Stud.\u003c/em\u003e 2019;94:21\u0026ndash;31.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eDrennan VM, Ross F.\u003c/strong\u003e Global nurse shortages: integrating retention and recognition strategies. \u003cem\u003eHum Resour Health.\u003c/em\u003e 2019;17(1):1\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eBuchan J, Shaffer F, Catton H.\u003c/strong\u003e Policy responses to strengthen recognition and retention of the nursing workforce. \u003cem\u003eInt Nurs Rev.\u003c/em\u003e 2018;65(4):485\u0026ndash;494.\u003c/li\u003e\n\u003cli\u003eGhandour M, ElGerges N, Zeaiter N. The Prevalence and determinants of Mental health problems in Lebanon: A Meta-Analytic Study of 3957 Healthcare workers. Turkish Journal of Psychiatry. 2024 Jan 1;36:17. Available from: https://pubmed.ncbi.nlm.nih.gov/41070480/\u003c/li\u003e\n\u003cli\u003eGhandour M, ElGerges N, Zeaiter N. The Prevalence and determinants of Mental health problems in Lebanon: A Meta-Analytic Study of 3957 Healthcare workers. Turkish Journal of Psychiatry. 2024 Jan 1;36:17. Available from: https://pubmed.ncbi.nlm.nih.gov/41070480/\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"human-resources-for-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"hrhe","sideBox":"Learn more about [Human Resources for Health](http://human-resources-health.biomedcentral.com)","snPcode":"12960","submissionUrl":"https://submission.nature.com/new-submission/12960/3","title":"Human Resources for Health","twitterHandle":"@HRH_Journal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"EFA, Lebanon, Medical Students, Doctors, Nurses, Retention, Immigration, Crises","lastPublishedDoi":"10.21203/rs.3.rs-8128742/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8128742/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Due to the ongoing crisis in Lebanon, healthcare personnel face numerous challenges that are driving them toward emigration. This cross-sectional study examines the factors that affect Lebanese medical students’, doctors’, and nurses’ retention in the country.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: Data were collected from August to December 2024 from Lebanese medical students, doctors, and nurses during a severe socioeconomic and political crisis.\u003cstrong\u003e \u003c/strong\u003eExploratory factor analysis (EFA) was conducted on 819 participants via a structured 60-item online survey following a Likert style scale to identify key retention determinants. Reliability analysis was performed via Cronbach’s alpha and McDonald’s omega, with a Kaiser–Meyer–Olkin (KMO) value of 0.964 and a statistically significant Bartlett’s test of sphericity (p \u0026lt; 0.05), confirming the data’s suitability for factor analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Thirteen retention factors were identified and ranked by importance: compensation \u0026amp; benefits (mean = 4.58, α = 0.821), work‒life balance (mean = 4.55, α = 0.796), workplace sanitation \u0026amp; security (mean = 4.54, α = 0.813), disaster preparedness \u0026amp; crisis management (mean = 4.51, α = 0.919), job satisfaction \u0026amp; recognition (mean = 4.50, α = 0.911), political \u0026amp; economic stability (mean = 4.49, α = 0.844), autonomy (mean = 4.47, α = 0.809), support from colleagues (mean = 4.44, α = 0.889), career development (mean = 4.38, α = 0.773), support from management (mean = 4.38, α = 0.894), mental health \u0026amp; stress management (mean = 4.31, α = 0.862), and workplace comfort \u0026amp; amenities (mean = 4.20, α = 0.830).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: This study highlights the multifaceted factors influencing healthcare professionals’ retention in Lebanon amid ongoing crises. These insights provide an opportunity for policymakers and healthcare leaders to focus on critical areas where targeted investments could strengthen the retention of doctors, nurses, and medical students in Lebanon and possibly in other countries experiencing similar crises.\u003c/p\u003e","manuscriptTitle":"Exploratory Analysis of Factors Affecting the Retention of Medical Students, Doctors, and Nurses in Lebanon During Crises: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-08 15:28:01","doi":"10.21203/rs.3.rs-8128742/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-16T14:58:16+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-10T15:06:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"275535826712710871735774541149655742859","date":"2026-03-08T11:02:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"112115893255364059337990107362753260878","date":"2026-03-08T07:40:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-06T11:05:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"152746884317698171223526913980411587814","date":"2026-03-01T04:48:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-26T23:00:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-19T08:32:14+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-19T08:28:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"Human Resources for Health","date":"2025-11-16T17:20:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"human-resources-for-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"hrhe","sideBox":"Learn more about [Human Resources for Health](http://human-resources-health.biomedcentral.com)","snPcode":"12960","submissionUrl":"https://submission.nature.com/new-submission/12960/3","title":"Human Resources for Health","twitterHandle":"@HRH_Journal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b0bd3773-c6e5-4ec8-a343-4b5b78f919f4","owner":[],"postedDate":"March 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-19T08:39:04+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-08 15:28:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8128742","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8128742","identity":"rs-8128742","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}