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Oct 04, 2021
The Podiatrists in Australia: Investigating Graduate
Employment (PAIGE) Study
Cylie Williams ,Anna Couch
[Monash University - School of Prima ry and Allied H ealth Care, Peninsula Health, Allied Health];
[Monash University - School of Prima ry and Allied H ealth Care, Peninsula Health, Podiatry]
dx.doi.org/10.17504/protocols.io.bwz2pf8e
Monash University
Cylie Williams
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ABSTRACT
The Podiatrists in Australia: Investigating Graduate Employment (PAIGE) study provides a systematic and
rigorous evidence-base for rural podiatric workforce policy development, by developing a database modelled on
the highly successful Medicine in Australia, Balancing Employment and Life (MABEL) longitudinal panel survey of
Australian doctors. Analysis of data from waves 1 and 2 of this database, and concurrently collected qualitative
data, address two key research questions about work location choice decisions and retention of podiatrists in
location and the profession.
DOI
dx.doi.org/10.17504/protocols.io.bwz2pf8e
DOCUMENT CITATION
Cylie Williams, Anna Couch 2021. The Podiatrists in Australia: Investigating Graduate Employment (PAIGE)
Study. pr otocols. i opr o t oco l s.i o
https://dx.doi.org/10.17504/protocols.io.bwz2pf8e
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This is an open access document distributed under the terms of the Creative Commons Attribution
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and source are credited
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Jul 30, 2021
LAST MODIFIED
Oct 04, 2021
DOCUMENT INTEGER ID
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ABSTRACT
The Podiatrists in Australia: Investigating Graduate Employment (PAIGE) study provides a systematic and rigorous evidence-base
for rural podiatric workforce policy development, by developing a database modelled on the highly successful Medicine in Australia,
Balancing Employment and Life (MABEL) longitudinal panel survey of Australian doctors. Analysis of data from waves 1 and 2 of
this database, and concurrently collected qualitative data, address two key research questions about work location choice decisions
and retention of podiatrists in location and the profession.
1 10/04/2021
Ci ta tion :Ci ta tion : Cylie Williams, Ann a Cou ch (10/04/2021). The Podiatrists in Australia: Investigating Graduate Em ployment (PAIGE) Study.
https://dx.doi.org/10.17504/protocols.io.bwz2pf8e
This is an open access protocol distributed under the terms of the Crea tiv e C om mo ns A ttri bu tio n Licen seCr eati ve Co mm on s Attri bu tio n Lice nse (https://creativecommons.org/licenses/by/4.0/),
which permits unrestricted use, distribution, an d reproduction in any m edium, provided the original author and source are credited
The "Podiatrists in Australia: Investigating Graduate Employment (PAIGE)" longitudinal survey - Protocol for a prospective cohort
study of Australian podiatrists' workforce participation
Au t h ors:Au t h ors:
Cylie M Williams1,2
Anna Couch1,2
Belinda O’Sullivan3
Hylton B Menz4
Terry Haines1,5
Ackn owl edgeme nt s:Ackn owl edgeme nt s:
Jennifer White 1
Matthew McGrail 6
Deborah Russell 7
Or g a ni s a ti o n s:Or g a ni s a ti o n s:
1. Monash University, School of Primary and Allied Health Care, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia
2. Peninsula Health, Allied Health, Hastings Rd, Frankston, VIC, 3199, Australia
3. Rural Clinical School, The University of Queensland, QLD, Australia
4. La Trobe University, School of Allied Health, Human Services and Sport, La Trobe University, Kingsbury Drive, Bundoora, VIC 3086,
Australia
5. National Centre for Healthy Ageing, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia
5. Monash Rural Health, Northways Road, Churchill VIC 3842, Australia
6. Monash Rural Health, PO Box 666, Bendigo VIC 3552, Australia
Fun ding:Fun ding:
Australian Podiatry Research and Education Foundation (APERF)
Australian Podiatry Association (APodA)
Au t h orsh i p cont ribution :Au t h orsh i p cont ribution :
CWM, HBM and TH conceived the original study. BS, JW, MM and DR supported refinement of survey design. AC, JW and CMW
collected data. AC, CMW and TH developed the analysis plan for quantitative data. AC, JW and CMW developed the analysis plan for
qualitative data. The funders had no role and will continue to have no role in methods, data analysis or reporting of results.
In t r oduct i onIn t r oduct i on
Australians have better health outcomes when they have timely access to health professionals and services. There has been a
strong focus on improving access to medical services in regional and rural areas [Wakerman 2016] and more recently, nursing and
allied health [Department of Health, 2019]. Allied health workers are increasingly needed to promote local chronic disease
management, including early intervention and follow-up, since the rates of chronic disease, especially Type 2 diabetes, are rapidly
escalating [Shaw, 2012].
The podiatry workforce has demonstrated skills in improving health outcomes and quality of life for people who have complications
of diabetes such as neuropathic foot disease, foot pain and vascular impairment. Appropriate management of these complications
can prevent lower limb amputations. Rates of amputation are higher for people living outside metropolitan settings, yet these are
precisely the areas where there are limited podiatry services [Bergin, 2011]. Podiatry is a small but growing workforce of
approximately 4,600 [Podiatry Board of Australia, 2018], yet only 7% of podiatrists work in outer regional or remote settings [Health
Workforce Australia, 2016]. In major cities there are 16 podiatrists per 100,000, however, in outer regional or remote settings these
numbers are 6.4-10.4 podiatrists per 100,000 [Health Workforce Australia, 2016]. It is critically important that policy makers better
understand how, why and when podiatrists make choices about their work location, so that current podiatry workforce
maldistribution can be improved.
Ai msAi ms
The Podiatrists in Australia: Investigating Graduate Employment (PAIGE) study provides a systematic and rigorous evidence-base
for rural podiatric workforce policy development, by developing a database modelled on the highly successful Medicine in Australia,
Balancing Employment and Life (MABEL) longitudinal panel survey of Australian doctors [Joyce, 2010]. Secondly, analysis of data
from waves 1 and 2 of this database, and concurrently collected qualitative data, address two key research questions about work
2 10/04/2021
Ci ta tion :Ci ta tion : Cylie Williams, Ann a Cou ch (10/04/2021). The Podiatrists in Australia: Investigating Graduate Em ployment (PAIGE) Study.
https://dx.doi.org/10.17504/protocols.io.bwz2pf8e
This is an open access protocol distributed under the terms of the Crea tiv e C om mo ns A ttri bu tio n Licen seCr eati ve Co mm on s Attri bu tio n Lice nse (https://creativecommons.org/licenses/by/4.0/),
which permits unrestricted use, distribution, an d reproduction in any m edium, provided the original author and source are credited
location choice decisions and retention of podiatrists in location and the profession.
Primary aim
- What financial, personal, professional, geographical, educational, and marketplace factors are associated with the decisions of
podiatrists about where they work?
Secondary aims
- What initiatives are undertaken by stakeholders to attract podiatrists to regional and rural settings, and how effective are they?
- What are the implications of mental health of podiatrists on podiatry practice in Australia?
- What are the key factors that impact on life long learning attributes of podiatrists in Australia? (Version 1.3)
- What are the implications of the coronavirus pandemic (COVID-19) on podiatry practice in Australia? (Version 1.4)
Me t h o dsMe t hods
Study design:
PAIGE was designed as a prospective cohort study of workforce participation and its determinants among Australian podiatrists
and podiatric surgeons.
The methods within this protocol are retrospectively described due to its publication date being after the data were collected, and
analysed within one publication. The protocol was only varied according to waves as outlined, otherwise no amendments were
made and the study protocol followed.
Participants and settings:
Podiatry participants were involved the collection of quantitative data via four waves of surveys. The first wave of data collection
was in 2017 to establish the baseline cohort for the study. The first and second wave were limited to Victoria in 2017 and 2018. In
Waves 1 and 2, all podiatrists registered to practice in Victoria were invited to participate (n=1,440) [5]. Additionally, survey
respondents who graduated within the past 5 years, currently employed within Victoria and who agreed to be contacted by
researchers, were recruited to participate in small focus groups. Waves 3 and 4 (2019 and 2020) targeted all podiatrists and
podiatric surgeons (Version 1.2). In Waves 3 and 4, the invitation to participate was extended to all podiatrists working in Australia
(n=5,429) [6].
Relevant stakeholder groups and agencies related to podiatry and podiatry employment in Victoria and interstate were invited to
participate in mapping available interventions regarding rural employment. These included Australian podiatry specific stakeholders
(e.g., Australian Podiatry Council, state based Australian Podiatry Associations, SARRAH, Department of Health and Human
Services), and other health profession stakeholders (e.g., Australian Physiotherapy Association, Occupational Therapy Association,
Speech Pathology Association, rural or regional employers).
Questionnaire and interview design
The survey design was based on the questions in MABEL [Joyce, 2010]. The research team mapped questions from MABEL survey
waves for relevance to the podiatry profession. Surveys were additionally be modified for practice relevant to the podiatry
profession. Wave 1 survey included seven sections: general demographics, job satisfaction, industry career progression intent, work
setting including staffing, family and social opportunities, finances and a discrete choice experiment (DCE) examining preferences
and trade-offs for different types of jobs; workload (10% increase, 10% decrease, hours remain the same); geographic location;
home visit load (0% home visits, 50% home visits, 100% home visits), finances (15% increase, remain the same, 15% decrease). The
job satisfaction domain was measured with the ten item version of the Warr-Cook-Wall Job Content Questionnaire [Warr, 1979].
Wave 2 and 3 surveys included seven sections: general demographics, job satisfaction, industry career progression intent, work
setting including staffing, family and social opportunities, mental health, personality, life experiences and risk taking behaviours.
Mental health measures included the Brief Resilience Scale [Smith. 2008], the abbreviated Maslach’s Burnout Inventory with an
additional three questions relating to job satisfaction domains [McManus. 2003], Kessler Psychological Distress Scale (K10)
[Kessler, 2003]. A personality measure collected with the Ten-Item Personality Inventory (TIPI) [Gossling, 2003], personal life events
were collected with the time frame of occurrence and risk taking behaviours, using questions refined through the MABEL survey
relating to financial, person and clinical risk taking.
The Wave 4 survey incorporated scales of lifelong learning and engagement in social media. Intent and attributes of learning were
collected through the Jefferson Scale of Lifelong Learning — Health Professions Students (JeffSLL-HPS) [Novak, 2014]. Social
media use and attitudes were collect with semantic scale [Survey] with purpose build questions on platform use and frequency.
3 10/04/2021
Ci ta tion :Ci ta tion : Cylie Williams, Ann a Cou ch (10/04/2021). The Podiatrists in Australia: Investigating Graduate Em ployment (PAIGE) Study.
https://dx.doi.org/10.17504/protocols.io.bwz2pf8e
This is an open access protocol distributed under the terms of the Crea tiv e C om mo ns A ttri bu tio n Licen seCr eati ve Co mm on s Attri bu tio n Lice nse (https://creativecommons.org/licenses/by/4.0/),
which permits unrestricted use, distribution, an d reproduction in any m edium, provided the original author and source are credited
COVID-19 questions were purpose built relating to accessibility of personal protection equipment availability, business contingency
plans and staffing plans.
Domains and waves are depicted in Figure 1.
Domai nDomai n
Wa veWa ve
11
Wa veWa ve
22
Wa veWa ve
33
Wa veWa ve
44
Demographics
✔
✔
✔
✔
Job satisfaction
✔
✔
✔
✔
Industry lead career education
and progression
✔
✔
✔
✔
Work setting
✔
✔
✔
✔
Family & Social
✔
✔
✔
✔
Finances
✔
Discrete choice experiment on
job choices
✔
Brief Resilience Scale
✔
✔
✔
Burnout
✔
✔
✔
Personality
✔
✔
✔
Personal life events
✔
✔
✔
Mental distress
✔
✔
✔
Risk taking behaviour
✔
✔
✔
Lifelong learning attributes
✔
Social media use
✔
Coronavirus pandemic impact on
practice
✔
Focus group questions for podiatrists were semistructured using a script and prompting. Questions prompted podiatrists to discuss
their decisions leading up to acceptance of current job role and what attracted them to the job. Additional questions focused on
locality, preconceptions of location, concerns of working environment, career aspirations and local and professional support.
Interview questions for stakeholders were undertaken individually via telephone and prompted discussion about recruitment
initiatives, perceived effectiveness of initiatives and and satisfaction with these initiatives.
Procedure
Waves data collection
We trialled the core data sets at each wave with four podiatrists who work in public and private sectors to determine any phrasing or
flow challenges. Minor amendments were made to how questions were worded, no content was changed. Potential podiatrist
participants were recruited through University graduates lists, Australian Podiatry Association email outs, social media and special
interest groups. Participants were invited to participate in survey Waves conducted approximately 1 year apart. Survey data were
collected online via Qualtrics® software (Qualtrics, Provo, UT, USA). Each participant self generated a unique participant number
based on their initials and date of birth and responses linked between survey waves and directed to data collected through Qualtrics
and privacy policies. Forced or requested responses were used to minimise missing data. Cookies are used by Qualtrics to allow
responses to be saved up to 4 hours within partial completion. Qualtrics® also routinely collects Internet Protocol (IP) addresses as
part of the de-identified metadata in the survey response. It was not pre-planned to routinely use or view IPs however if participant's
self generated code was in a form where data was unable to be linked from code alone, IPs were viewed and used as a last resort to
match data together with age, gender, postcode and training institution.
The survey tool was be adapted from questions asked in the MABEL longitudinal survey of Australian doctors [7]. The first wave
enabled collection of basic demographic data, current employment (hours of work, practice ownership), preferences for job types
(public/private or mixed), areas of interest of specialisation, practice ownership and location of work, personality, finances and
family circumstances and job satisfaction and work-life balance ratings. Participants were asked to identify past responses which
dictate question logic. The subsequent surveys, gathered information on variables that can change over time, for example work
location or mix of public and private work undertaken and enable analysis of factors predictive of change.
Figure 1. Key question doma ins and corresponding Wa ves.
4 10/04/2021
Ci ta tion :Ci ta tion : Cylie Williams, Ann a Cou ch (10/04/2021). The Podiatrists in Australia: Investigating Graduate Em ployment (PAIGE) Study.
https://dx.doi.org/10.17504/protocols.io.bwz2pf8e
This is an open access protocol distributed under the terms of the Crea tiv e C om mo ns A ttri bu tio n Licen seCr eati ve Co mm on s Attri bu tio n Lice nse (https://creativecommons.org/licenses/by/4.0/),
which permits unrestricted use, distribution, an d reproduction in any m edium, provided the original author and source are credited
Surveys used logic to minimise survey fatigue through two key questions relating to if the participant has changed their job or
changed where they lived. Where the participant responded those circumstances remained unchanged, they were not re-presented
with the survey items relating to job satisfaction, workplace environment or postcode of where they lived. Participants were
incentivised through a competition process at each wave, due to the length of the survey (approximately 45 min).
Podiatry focus group interviews. Participants (sample size determined as n=20) who met the focus group criteria from Wave 1 were
invited to participate in focus groups during the first year of the project. Participation was at a convenient time to both parties.
Recruitment to focus groups occurred via a workshop at the Australasian Podiatry conference, via special interest groups etc.), and
by participants stating agreement to be contacted on the survey. Focus groups explored factors affecting choice of work location.
Semi-structured questions explored: How they decided about their work location choices, what benefits and supports facilitated
their choice, what strategies should be included in regional promotion of workplaces as employers of choice and who should lead
this? All focus groups were recorded and responses transcribed for thematic data analysis
Stakeholder participant interviews
Relevant stakeholder groups and agencies related to podiatry and podiatry employment in Victoria and interstate were emailed
invitations to participate in a phone interview at a convenient time. During this recorded interview, questions enabled the participant
to explore recruitment and retention initiatives undertaken by the services during employment of podiatrists in regional setting in
Victoria.
Data analysis
We will report all survey data guided by the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) Checklist [Eysenbach,
2004].
Quantitative data will be analysed using a combination of single wave analysis methods (descriptive statistics, linear regression,
logistic regression) and multi-wave change analysis methods, such as repeated measures regression models and panel regression
models. We will use appropriate cohort data
Qualitative data will be thematically analysed using an inductive thematic approach incorporating constant comparison, and
concurrent data collection and analysis. We will use the Consolidated criteria for reporting qualitative research (COREQ) guidelines
to guide all reporting.
Et hi ca l a pprov a l s:Et hi ca l a pprov a l s:
Monash University Human Research Ethics Committee: 7871(Version 1.0)
Monash University Human Research Ethics Committee: 19959 (Version 1.1, Version 1.2, Version 1.3)
Protocol Version
Date
Action
Version 1.0 01/02/2017 Initial protocol development
Version 1.1 01/02/2019 Participant inclusion modification to whole of Australia
Version 1.2 01/02/2020 Addition of social media and life long learning questions for Wave 4
Version 1.3 01/03/2020 Addition of COVID impact question for Wave
5 10/04/2021
Ci ta tion :Ci ta tion : Cylie Williams, Ann a Cou ch (10/04/2021). The Podiatrists in Australia: Investigating Graduate Em ployment (PAIGE) Study.
https://dx.doi.org/10.17504/protocols.io.bwz2pf8e
This is an open access protocol distributed under the terms of the Crea tiv e C om mo ns A ttri bu tio n Licen seCr eati ve Co mm on s Attri bu tio n Lice nse (https://creativecommons.org/licenses/by/4.0/),
which permits unrestricted use, distribution, an d reproduction in any m edium, provided the original author and source are credited
