Razavi Journal of Medicine

Razavi Journal of Medicine

Factors Associated with Retention Intention of Physicians in Rural Areas of Afghanistan: A Cross-Sectional Study Using Ordinal Logistic Regression

Articles in Press

Document Type : Original Article

Authors
Ahmad Nawid Sadid 1, 2
Vahid Ghavami 3
Fatemeh Kokabi Saghi 4, 5
Rasoul Raesi 6
Alireza Darroudi 4, 4
Javad Moghri 4, 5
Seyed Saeed Tabatabaee 4, 5
1 Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.
2 Instructor at Herat Medical Faculty, Atefi Health Institute, Herat, Afghanistan
3 Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
4 Social Determinants of Health Research Center, Basic Sciences Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
5 Department of Management Sciences and Health Economics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
6 Department of Public Health, School of Health, Torbat Jam Faculty of Medical Sciences, Torbat Jam, Iran.
10.30483/rjm.2026.254725.1510
Abstract
Background: A major challenge in healthcare systems is the limited retention of physicians in underserved areas.

Objectives: This study aimed to identify the factors related to the retention of physicians in rural areas of Afghanistan.

Methods: This analytical cross-sectional study was conducted among physicians working in rural areas across 34 provinces of Afghanistan. A sample of 352 physicians was selected using a multistage sampling method. Data were collected using a standardized questionnaire designed to assess physicians' desire for retention in underserved areas. Retention intention was measured using a single question with a five-point Likert scale ranging from "very low" to "very high," and this ordinal variable served as the dependent variable in the analysis. Mean (standard deviation) and frequency (percentage) were used for data description, and an ordinal logistic regression model was employed for analysis. All statistical analyses were performed using SPSS version 26, with the significance level set at 5%.

Results: Of the total participants, 82.10% (n=289) were male, 84.94% (n=299) were married, and 77.84% (n=274) were native to rural areas. The study found that 46% of physicians had a moderate desire for retention, and 28% had a high to very high desire. Financial incentives received the highest importance scores, followed by regulatory interventions and personal/professional support. Employment status was the strongest negative predictor, with long-term contract physicians having 54% lower odds of retention than permanent employees (OR=0.46, p=0.009). Each unit increase in personal/professional support compliance raised retention odds by 8% (OR=1.08, p<0.001). Native physicians showed significantly higher retention desire than non-natives (p<0.001), particularly at moderate levels. Age and work experience had weak inverse correlations with retention. Non-financial organizational support factors emerged as more critical determinants than financial incentives or educational interventions.

Conclusion: Physician retention is associated with educational interventions, regulatory interventions, financial incentives, and personal and professional support. Policymakers may consider prioritizing and improving these factors when formulating retention strategies.
Keywords
Retention of Physicians
Rural Areas
Afghanistan
Human Resources Planning

Acknowledgements: The authors of this article express their gratitude to the Vice Chancellor for Research of MUMS as well as all the Physicians of the rural areas Afghanistan who participated in this study.


Ethical considerations: This study was conducted based on the declaration of ethical principles of Helsinki and the good clinical practices at the site were approved by the Mashhad University of Medical Sciences with the code of ethics (IR.MUMS.FHMPM.REC.1401.047) and after receiving a written introduction letter, the studied hospitals were referred to. After explaining the purpose and method of the research, informed consent was obtained from the participants. Confidentiality and privacy were assured for all study participants. All methods were carried out in accordance with relevant guidelines and regulations under ethics approval and consent to participants.


Availability of data and materials: The datasets generated and/or analyzed during this study are not publicly available confidentiality of information but are available from the corresponding author on reasonable request basis.


Competing interests: The authors declare that they have no competing interests.


Funding: The authors have not received any funding 


Consent for publication: Not applicable.


Authors Contributions: SST was involved in conceived of the presented idea, the conceptualization of the study. JM involved in data collection, and drafting of the manuscript. VGH, RR, and AD involved in data analysis and drafting of the manuscript. FK was involved in conceived of the presented idea and the conceptualization of the study, and drafting of the manuscript. ANS was involved in the literature search, the conceptualization of the study, data collection, contributed to statistical analysis and wrote the main manuscript text.  All authors read, revised and approved the final manuscript.

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

 
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Razavi Journal of Medicine

Articles in Press, Accepted Manuscript
Available Online from 10 September 2026