Factors Influencing the Choice of a Healthcare Career in Medicine and Nursing among Emiratis

Abstract
The United Arab Emirates (UAE) has been experiencing a rampant shortage of nurses and other medical practitioners, particularly those of UAE origin for the past few decades. This is attributed to the fact that most of the UAE nationals are not willing to pursue careers in the healthcare sector due to numerous factors, an aspect that has forced the country to rely on expatriate medical practitioners. The purpose of this dissertation is to establish the factors that influence the choice of a healthcare career in medicine and nursing among Emiratis, as well as propose possible initiatives that can be implemented to encourage UAE nationals pursue careers in the healthcare sector. The study is conducted using a qualitative research approach whereby the primary data collection instrument used is phenomenological interviewing, and supplemented by collection of data from secondary sources. Findings made in this study reveal that low remunerations, inadequate training facilities, and poor public perception about the nursing profession among others are the leading preventative factors. As a result, the study has proposed a review of the medical practitioners’ salaries, establishment of more training medical centres, and launching a national wide campaign to sensitize the public about the important roles played by nurses in the economic development of UAE among other initiatives, as a way of encouraging more Emiratis pursue careers in the healthcare sector.

Table of Contents

Abstract 2

CHAPTER I: BACKGROUND INFORMATION.. 6

1.1 Introduction. 6

1.2 Aim and Objectives. 8

1.3 Structure of the dissertation. 8

CHAPTER II: LITERATURE REVIEW… 10

2.0 Introduction. 10

2.1 Overview of the Literature. 10

2.1.1 An overview of healthcare sector in the UAE.. 10

2.1.2 Imbalanced governmental spending in comparison to other sectors. 11

2.1.3 Expatriates’ Overload. 12

2.1.4 UAE Medical Education versus Global Trends. 13

2.1.5 Electronic Dimension of Healthcare in the UAE.. 14

2.2 Factors influencing People’s Career Choices. 15

2.2.1 Theoretical Framework (Career Choice Theory) 15

2.2.2 Developmental Career Choice Perspective. 16

2.2.3 Person-Environment Fit Perspective. 16

2.2.4 Social Cognitive Career Theory (SCCT) 17

2.2.5 Generational Theory: Career Choice in the New Millennium.. 18

2.2.6 Parsons Theory. 18

2.3 People’s Career Aspirations. 19

2.4 Factors influencing Emiratis’ choice of healthcare careers. 19

2.4.1 Economic factors. 20

2.4.2 Psychological determinants with regard to healthcare professional 22

2.4.3 Cultural and Religious Restraints. 23

2.4.4 Educational constraints: Westernisation. 24

2.4.5 Lack of Enough Training Facilities. 25

2.4.6 Advanced technologies as one more preventive factor 25

2.4.7 Mandatory doctor’s supervision. 26

2.5 Literature on the initiatives that can promote Emiratis choice of healthcare careers 27

2.5.1 Theoretical Background. 27

2.5.1.1 The Objective Factor Theory. 27

2.5.1.2 The Subjective Factor Theory. 28

2.6 Initiatives to encourage Emiratis choose careers in the healthcare sector 31

2.6.1 Establishing early and middle college medical schools a. 31

2.6.2 Launching mentorship programmes and a national campaign. 33

2.6.3 Salary as a motivating factor 35

2.7 Summary. 37

CHAPTER III.THE METHODOLOGY.. 39

3.1 Introduction. 39

3.2 Research Design. 39

3.2.1 Theoretical background. 40

3.3 Research Methods and Approach. 42

3.3.1 Research Strategy. 43

3.4 Research Population and the Sampling Technique. 44

3.4.1 The Sampling process, Sample size and Characteristics. 44

3.4.2 Eligibility Criteria. 45

3.5 Research Instrumentation. 46

3.5.1 Data Collection. 46

3.6 Data Analysis. 49

3.6.1 Data analysis process. 50

3.7 Promoting validity and trustworthiness of the data collected. 51

3.7.1 Bracketing strategies to promote validity and trustworthiness of the findings. 51

3.7.2 Data Triangulation. 53

3.8 Ethical Considerations. 53

3.9 Piloting. 54

Bibliography. 56

CHAPTER I: BACKGROUND INFORMATION
1.1 Introduction
One of the current characteristics of the UAE healthcare sector is the low number of healthcare professionals as compared to the large population in the area. Foremost, a chronic shortage of qualified medical staff members is observed in all areas of healthcare provision in contrast to an increasing demand for the services due to population growth (Delloitte 2011; Loney et al. 2013; Alrawi and Hussain 2011). The shortage of healthcare workers seems paradoxical because the UAE government has heavily invested in the health sector (Delloitte 2011; Loney et al. 2013). Moreover, the country’s health sector is ranked 27th internationally, in comparison to systems of other giant economies such as Canada (ranked number 30), Australia (number 32), Qatar (number 44), and Kuwait (number 45) (Amalki, Fitzgerald and Clark 2011, p.785).

The UAE government has tried to solve the problem through a number of approaches among them being the use of expatriates’ assistance (Barlem et al. 2011). Nevertheless, residents’ engagement in healthcare delivery is a huge concern for the authorities and quick solutions are needed, especially based on the trajectory that the local population is expected to reach 15.5 million by 2050 (Bell 2014; The UAE Media Council 2014).

The status quo can be attributed to a number of reasons. First, overreliance on expatriates in different sectors of the UAE economy resulted into a challenging demographic situation in the country. Specifically, in 2010, the percentage of the local population was only 950,000 people (11%), while the rest of the inhabitants (8.3 million) were foreign employees of different origins (Loney et al. 2013, p.2).

Second, the current statistics showed that only 20% of the medical practitioners are of Emirati origin (Todorova 2014; Loney et al. 2013). The greater part of positions is distributed between expatriates from Philippines, India, and neighbouring Arab countries, as well as senior management and consultants from Europe, North America, and Australia (Loney et al. 2013, p.2). In contrast, Saudi Arabia, which is also expatriate-dependent, has 54% of residential medical practitioners (Almalki, Fitzgerald and Clark 2011).

Third, the government attempted to engage the locals in nationwide workforce by means of Emiratisation policies. The procedure involves increasing the number of residential workforce throughout the private sectors in accordance with governmental regulations in order to balance the labour market in the country (The UAE Media Council 2014; Delloitte 2011). Indeed, the UAE public sector employs 52% of the country’s nationals, while the private sector has employed only 4% of the country’s nationals (The UAE Media Council 2014).

Moreover, official reports from the government estimated that even this little percentage of locals in workforce will decrease because of the low wages in the private sector and lack of continuing training and professional development opportunities (The UAE Media Council 2014; Delloitte 2011; Amalki, Fitzgerald & Clark 2011).

Fourth, expatriate workforce in the healthcare has led to local professionals developing poor attitude towards the healthcare field. Along with 53% employment rates among Emiratis in the public sector, 19.9% of the residents, mostly fresh graduates, do not wish to work at all (Amalki, Fitzgerald & Clark 2011; The UAE Media Council 2014; Delloitte 2011). In this regard, it can be assumed that to a certain degree, foreign practitioners deny the local people both job and professional growth opportunities, thereby resulting in social inequity between these two groups of population.

Fifth, educational background of the local and foreign healthcare practitioners is distinct. It can involve either local qualification throughout UAE medical institutions or originate from Western states where the standards of care delivery are different. This process is a direct driving force for the clash of cultures, contradiction and inconsistency between Eastern and Western traditions, as well as language barriers between the Emirati population and foreign practitioners. Consequently, due to the nature of healthcare provision in terms of cultural sensitivity and the need of standardised techniques among healthcare professionals, there is a need for addressing this problem as well (Alrawi & Hussain 2011).

It follows that outsourcing is no longer applicable in this case, especially because of the multicultural differences between foreign healthcare providers and residential patients as well as increasing costs of expatriates’ recruitment (Kvedaraviciene & Boguslauskas 2010). By the same token, medical practitioners from overseas today constitute approximately 93% of the entire staff of medical facilities in Abu Dhabi alone (Abdel-Razig & Alameri 2013). Therefore, the government’s efforts in Emiratisation of the sector do not seem successful, and officials must develop local talents in order to fill in the staffing gap, cater for the projected demand, and address social inequity problem.

1.2 Aim and Objectives
In order to address this issue, this research study aims at determining the factors that influence the choice of a healthcare career in medicine and nursing among Emiratis. In the context of this enquiry, healthcare practitioners are defined as nurses and doctors. The topic for discussion is broad and it requires thorough studying. Nevertheless, in the scope of this exploration, the research questions are narrowed down into two:

What factors influence Emiratis’ choice of healthcare careers in medicine and nursing?
What initiatives can promote Emiratis to choose careers in medicine and nursing in higher numbers?
These questions most explicitly highlight the chosen research topic. No academic research is available that would thoroughly consider factors preventing individuals from pursuing careers as doctors and nurses in the UAE context. Therefore, their opinions on the problem are crucial evidence to be studied.

1.3 Structure of the dissertation
This dissertation comprises of five chapters. Chapter one introduces the topic under research, states the research problem, as well as highlights the aim and objectives of the present day study. Chapter two presents a review of the literature relating to the shortage of nurses and other medical practitioners in the UAE, with much emphasize being laid on the factors hindering Emiratis from pursuing careers in the healthcare sector. Other aspects such as a general overview of the UAE’s health sector have briefly been analysed. Chapter two has also discussed a number of theories relating to the topic under research such as career choice theories and the general employment theories.

Chapter three presents the methodology that was used in carrying out this study. Qualitative research methodology is discussed in details with a justification for using this research technique being highlighted. Other elements such as research instrumentation and the ethical considerations involved in this study have been highlighted.

Chapter four summarizes the findings made in this study as well as the discussion that can be raised from the findings made. Finally, chapter five presents a general conclusion derived from chapter four with some other issues noted while conducting the study being highlighted. The chapter ends by proposing feasible recommendations.

CHAPTER II: LITERATURE REVIEW
2.0 Introduction
The purpose of chapter two is to review the currently existing literature based on the set research questions in order to present an explicit justification of the study, clarify the existing literature gap, and identify possible opportunities for the researcher to contribute to better understanding of the roots of the research problem. In this chapter, the researcher explores what other researchers and scholars have written about the same or related issue.

The researcher discusses the status of healthcare in the United Arab Emirates in relation to the increased demand for quality clinical care following a rise in the country’s population (Abdel-Razig & Alameri 2013, 197). Furthermore, an in-depth analysis of some of the factors that influence the choice of a healthcare career in medicine and nursing among Emiratis, shortage of medical professionals, as well as why students choose other careers over medicine is carried out.

2.1 Overview of the Literature
2.1.1 An overview of healthcare sector in the UAE
A general overview of the UAE’s data in relation to healthcare provision shows that the country’s population has been rising and is expected to grow even more intensively in the near future (Salem 2004; Delloitte 2011).The available estimates demonstrate that there were 8.4 million inhabitants in 2010, showing the highest growth indices, and 14.21% in 2005-2010, the number of residents is expected to double by 2029 (Fares et al. 2014). The high pace of population increase is attributed to the high annual growth rate, which is currently at 1.4% (Salem 2004; Delloitte 2011; Bazoobandi 2013), as well as intensive trade immigration into the country (Amalki, Fitzgerald & Clark 2011; The UAE Media Council 2014).

Other than the rising general population of the country, the demand for healthcare services is also triggered by other factors such as the change in lifestyle, particularly among the young population. U.S.-U.A.E. Business Council (2014), report that conditions resulting from the consumption of fast foods and sedentary lifestyles such as diabetes, Alzheimer’s disease, asthma, atherosclerosis, chronic liver, metabolic syndrome, and obesity among other lifestyle disease are on the rise. Heart diseases and cancer, particularly among the aging population has been reported to have dramatically risen for the past one decade.

Despite the high demand for healthcare services in the country, U.S.-U.A.E. Business Council (2014) highlights that UAE’s healthcare system has been struggling with the high immigrant driven population growth, as well as striving to regulate the sharply rises in per-capita healthcare spending resulting from chronic diseases and high levels of affluence. This is due to the fact that the number of healthcare facilities and that of medical practitioners is considerably low. Shocking statistics reported by the U.S.-U.A.E. Business Council (2014) show that UAE had a total population of 9.2 million people in 2010 with only 104 hospitals across the seven Emirates of which about 36.4% of the hospitals are owned by the government.

The report also shows that by 2014, there were 19.3 physicians per 10,000 persons, as well as 40.9 Nurses and Midwives per 10,000 persons in the country. Related findings have been reported by other sources such as Hannawi and Salmi (2014, pp.339), which reports that UAE currently has one of the lowest ratios for nurses (at 2.7), and that of physicians (at 1.5) across the Gulf Cooperation Council (GCC). These healthcare indicators confirm that there is a critical shortage of medical practitioners in the UAE and that the country’s healthcare market is lagging behind both in developed across the GCC and in the world at large. With this brief overview of the current status of the health sector in the UAE, it is essential to explore the main factors contributing to the shortage of local healthcare workers of UAE origin.

2.1.2 Imbalanced governmental spending in comparison to other sectors
On economic matters, Salem (2004); Amalki, Fitzgerald and Clark (2011); The UAE Media Council (2014); and Delloitte (2011) reported a lower government spending on the healthcare sector compared to other industries in historical perspective, such as expenditures on defence and security as summarised in Table 1 below while Table 2 shows the Health Expenditure indicators 2010. According to the World Health Organization (WHO) (2013), the health sector in the UAE is given less priority. For example, in 2010 the sector was allocated with only 4.0% of the total budget (WHO, 2013).

Table 1: UAE vs. Other Countries’ Expenditures on Healthcare and Military (H/M) % of GDP

Source: (The UAE Media Council 2014)

Table 2: Health Expenditure indicators 2010

Source: (WHO 2012)

Similar tendencies were observed in Saudi Arabia, while well-developed western economies, such as Canada and Australia, decreased their funding on defence needs. Consequently, the UAE healthcare receives lower funding compared to its defence industry.

2.1.3 Expatriates’ Overload
The United Arab Emirates is one of the countries with many private healthcare facilities compared to public health institutions (Almazroui, A. 2014, n. p).While there were seven hospitals and 12 healthcare centres in the UAE in 1971, their number grew to 92 hospitals in 2011 (only 15 government-owned) and 246 primary care centres respectively (Amalki, Fitzgerald & Clark 2011; The UAE Media Council 2014; Delloitte 2011). However, the private sector is foreign-professional-sourced to a great extent. Surprisingly, 80% of the healthcare staff in the UAE are foreigners (Delloitte 2011).

One of the major reasons for such statistics is the inadequacy of local healthcare professionals, which forces the government to seek specialists from other regions of the world. Although foreign medical practitioners are preferred for their high educational level and advanced professional skills, constant frictions and misunderstanding occurs between them and the nationals concerning language, religion and cultural barriers to list a few (Vainman & Halsberger 2013). Moreover, surveys have revealed that expatriates do not feel the need to study any traditions, local language or maintain multicultural care (Cleary et al. 2014).

Apart from that, recruitment of foreign practitioners requires excess costs to be invested by the healthcare providers. Specifically, licensing, travel expenditures, and high turnover rates due to the lack of professional growth nationwide can be listed in this case (Cleary et al. 2014). Besides, the governmental policies of Emiratisation allow two-year employment for expatriates and demand 4-per-cent increase in nationals among employees in private sector (The UAE Media Council 2014). Therefore, the Emiratis have to be encouraged into the healthcare sector in order to solve this problem (Vainman & Halsberger 2013).

Expatriates find a booming healthcare business as the country is devoid of enough home-grown doctors, medical training institutions, and pharmaceutical industries (Sahoo, S. 2013, n. p). Notably, the environment for private healthcare facilities was welcoming as the United Arab Emirates’ population had nowhere to seek these services. Additionally, the country has a strong economy and only a negligible percentage of the population cannot afford private healthcare (Kloep 2011, p.151).

As a result, investment in the private healthcare made the government quite reluctant in investing in public healthcare administration in the Emirates (Nematollahi & Isaac 2011, p.4). Noteworthy is the fact that some Emirates such as Dubai have a state of the art private healthcare and a private health insurance is mandatory (Alkraiji, El-Hassan & Amin 2014, p.38). Individuals who do not have an international health insurance cover may have to incur exceptionally high costs of treatment in private health clinics (Sahoo 2013).

2.1.4 UAE Medical Education versus Global Trends
McKimm and McLean (2011, p. 626) analysed how to develop a global health practitioner and whether it is necessary at all to “think globally and act locally”. The researchers briefly introduced the issue of globalisation in medicine and acknowledged that the current world cannot avoid this phenomenon. Despite the fact that their work was generalized, the UAE widely implements popular worldwide healthcare initiatives as evidenced from a range of studies (Chen 2011; AbuAlRub et al. 2013; Toledo 2013).

Moreover, referring to the topic of over-reliance on expatriates (Sahoo 2013; Toledo 2013; Vainman & Halsberger 2013), the global healthcare professional approach would be a win-win solution. Specifically, these specialists are proved to be “tomorrow’s leaders, change agents and members of effective multi-personal teams” (McKimm & McLean 2011, p.626). In other words, besides in-depth knowledge in medicine, they all have to be aware of cultural, political, environmental and social factors of the locality they are going to devote their career to.

Certainly, this concept appears like an idealistic paradigm of healthcare training, but the authors have introduced several points to organise a balanced international curriculum in this regard. Nevertheless, the scholars have omitted one extremely important detail with respect to the issue namely, opposition between the West and East cultures whereas Westerners frequently show their supremacy and dominance in this case. The occident influence on Emirati healthcare development is related to this field in retrospect.

Basically, the local officials have heavily relied on either “funding graduates to complete residency and fellowship training in the Western educational systems” or just recruited expatriates to make them drivers of quality care in the country (Abdel-Razig & Alameri 2013, p.196). In this way, national stakeholders of the medical educational process in particular, as well as healthcare career in general, have been initially discouraged by Westernisation, to some extent, in their accessibility to the sector.

2.1.5 Electronic Dimension of Healthcare in the UAE
Another educational implication that is both globalisation-driven and challenging for Emiratis is the electronic dimension of healthcare. Alkraiji, El-Hassan and Amin (2014) studied health informatics (HI) implementation in the Arab states, specifically countries in the Gulf region, including the UAE and they reported a deficiency of appropriate skills of dealing with advanced technologies among the local practitioners.

Moreover, “interoperability, the lack of coordination and cooperation and authority of regulation, and ethical issues linked to confidentiality of medical data” have also been identified just to list a few (Alkraiji, El-Hassan & Amin 2014, p.36). The above-indicated issues evidence about one more gap in holistic education of medical practitioners in the UAE, which is connected with inadequate HI teaching. In line with the aforementioned research, Chen (2011) also underlined the current inefficient use of available technological opportunities by nationals in the region.

Apart from that, the scholar confirmed the findings of the precursor. Specifically, the author has advocated to not taking into account of uniqueness of culture where these technologies are implemented and improper training for practitioners as primary reasons of failure of these ventures (Chen 2011, p.234).

2.2 Factors influencing People’s Career Choices
2.2.1 Theoretical Framework (Career Choice Theory)
Career choice has extensively been studied in a number of disciplines such as vocational and organizational psychology. According to Swanson and Fouad (2014, pp.112), the study of career choices is dated back to the early 20th century, even though most of the often cited theories on career choice were developed in the mid-20th century. Scholars and theorists have sought to comprehend the nature of career choices, as well as identify the primary factors influencing career decision-making. It has emerged clearly that career choice is a dynamic process that develops over time, through numerous experiences and evaluative processes (Brown & Al 2002, p.510).

A number of theories are used in explaining people’s career choices and how they are influenced by various factors such as developmental, individual, environmental and social variables. This section explores the core theories that are often used in explaining people’s career choices namely Developmental Career Choice Perspective Theory; Person-Environment Fit Perspective Theory; Social Cognitive Career Theory (SCCT); Generational Theory; and Parson’s theory (Swanson & Fouad 2014, pp.114).

2.2.2 Top of Form
Bottom of Form
Developmental Career Choice Perspective
Developmental career choice theories claim that career choice is highly determined by factors such as family interactions, early childhood experiences, and life-long socializations. Some of the early influences acknowledged within developmental career choice theories include education, individual needs, family values, gender, class, as well as parent-child relations. The main developmental theories are Roe’s “Personality Development and Career Choice Theory”; Ginzberg et al.’s “Career Development Theory”; as well as Gottfredson’s “Developmental Theory of Occupational Aspirations: Circumscription and Compromise” (Roe 1956, p.25; Gottfredson & Johnston 2009; p.35; Ginzberg et al. 1951, p.48).

Though the three theories have some slight differences in terms of stages, concepts, and processes, they all emphasize on determinants across one’s life span claiming that career choice is influenced by life-long socialization, early childhood experiences, as well as family interactions. However, the theories have some weaknesses such as failing to account for individual variance in stage process and progression, as well as contextual issues and variables such as race, gender, social class, and the process of occupational choice.

According to Swanson and Fouad (2014, pp.116), there is a need for carrying out further research to explore contextual variables determining career choice since developmental theories have received only mixed empirical support. The theories also ignore crucial contextual variables such as parenting style (Zbilgin & Malakh-Pines 2007, pp.68).

2.2.3 Person-Environment Fit Perspective
A number of person-environment theories have also been developed in attempt to explain career choice with relation to connection between the environment and individual’s personality. According to Zbilgin and Malakh-Pines (2007, pp.72), the theories presume that people choose careers depending on the environmental factors whereby career chosen are as a result of environmental factors matching individuals’ personalities, attitudes, abilities, and values.

The most widely used person-environment theory is Holland’s “Career Typology” which was built from Strong’s theory developed in the 1950s (Brown & Al 2002, p.510). Career Typology Theory proposes that career choice behavior if influenced by the interplay between the environment and one’s personality and it further presumes that people choose career environments that best fit with their skills, attitude, abilities, and values. However, recent studies have criticized Holland’s “Career Typology” claiming that it lacks validity on aspects such as of vocational outcomes (Swanson & Fouad 2010, p.110).

2.2.4 Social Cognitive Career Theory (SCCT)
According to Lee et al. (2015, pp.98), social cognitive career theory identifies self-efficacy as the primary predictor of career choice. SCCT was developed in 1994 by Lent et al and it had been derived from Bandura’s (1977; 1986) social cognitive theory (Lent et al. 2014, pp.269). The theory provides a framework for understanding the relationship between individuals’ social and environmental determinants. Patton and McMahon (2014, p.80) further suggest that the theory focuses on the relationship between self-efficacy, goals, as well as outcome expectations with regard to career choice.

According to the theory, career choice is determined by social learning and personal achievements whereby one chooses careers that fit their past successes and expertise in attempts to maintain self-efficacy and increase probability of future success (Brown & Al 2002, p.515; Patton & McMahon 2014, p.82).

The SCCT theory has garnered much support from studies carried out most recently, particularly in relation to career choice in academic and science arenas (Swanson & Fouad 2014, p.117). Swanson and Fouad (2010, pp.118) provided a meta-analysis of studies carried out to ascertain the relationship between career choice and self-efficacy and a statistically significant interplay was found between the two. It was found that people select careers which they are likely to be most successful in.

The SCCT theory and the Holland’s theory have also been jointly applied in attempts to predict career choice , though combining the two theories has been encountered by numerous limitations such as the inability to explain barriers to career choice, particularly with regard to gender differences. The main criticism of SCCT is that most of the research has emphasized on hypothetical choices in academic and science arenas. In addition, most of the research has not explored the construct among many populations in various real life situations and settings (Swanson & Fouad 2010, pp.120).

2.2.5 Generational Theory: Career Choice in the New Millennium
Other than the above explained three theories, there exist a number of other theories that are used in explaining career choice particularly with the dawn of the 21st century which was marked by remarkable technological advancements. Generational theory is among such theories though it has not gained much popularity Lyons, and Schweitzer (2012, pp.67). The theory is based on demographic data that plays an instrumental role in predicting, relating, as well as explaining the economic and social-political life. According to Lyons, and Schweitzer (2012, pp.68), generational arenas are featured by social, political and economic events that in turn impact the attitudes, fundamental values, work ethics as well as professional aspirations of the cohort members.

Generational theories group people into various cohorts on grounds of their date of birth and most of the popular generational typologies are based Howe and Strauss’ work, which acknowledged four generational cohorts namely Veterans (1925-1945); Baby Boomers (1946-1964); Generation X (1965-1979) and Generation Y or Millennials (1980-present) (Parry & Urwin 2011, pp.83). Nevertheless, the theory is criticized because of grouping individuals into cohorts based on their ages though some people may not identify with the features of their generational era (Parry & Urwin 2011, pp.83).

2.2.6 Parsons Theory
Parsons Theory was developed by the father of Parsons Theory, Frank, who emphasized on the fact that people tend to choose careers that match their talents, especially if they are rewarding. The approach involves matching one’s talents to some target occupations (Burns 2015, p.12). According to the theory, one ought to relate their judgment to their traits in relation to the targeted labour market (Taylor 1994, pp.323).

Parson’s theory dictates that an individual carries out an in-depth analysis of their interests, professional skills, personality and social values and evaluates them using the occupations that demand such traits (Herr 2013, pp.279). The theory suggests that people can only make a decision regarding their future career once they understand their abilities and interests. Moreover, they should have enough understanding of the availability of job posts in the existing labour market.

2.3 People’s Career Aspirations
People’s career aspirations, which relates to individuals’ career objectives, as well as short-term and long-term career goals depending on one’s career path planning, can be categorized into five main groups namely job security, expertise, freedom, balance, as well as the conventional career success (Wicht & Ludwig-Mayerhofer 2014, pp.301) suggest. According to White and Green (2015, pp.312); and Kharkongor, and Albert (2014, pp.548), some people tend to seek solid jobs that they perceive to be stable and offer them predictable and reliable income. Such individuals prefer working in organizations that provide them secured positions over advancement.

Career success entails people being inspired to improve their professional skills so as to accomplish advancement in organizations’ hierarchy levels. Such people seek positions that establish them certain status, responsibilities, authority or/and higher salaries Kharkongor, and Albert (2014, pp.548). Expertise encompasses people seeking positions that offer them professional and technical enhancement.

Freedom as a career inspiration tool is common among persons who seek individualism; want to gain autonomy for their activities and thoughts (Archer, DeWitt, and Wong, 2014, pp.68). Finally, balance as category of career inspiration is common among persons who prefer jobs that value their personal interests and such individuals perceive their career to be equal to non-work values as well as interests such as religion, family and personal issues (Bednarz 2014, pp.89).

2.4 Factors influencing Emiratis’ choice of healthcare careers in medicine and nursing
Hannawi and Salmi (2014, pp.333) describe health workers as the ultimate resource for any strong health system since even with the availability of funds and medical supplies, efficient workforce is mandatory for them to be distributed. Countries in the Middle East and North Africa (MENA) have been experiencing numerous health workers challenges which are associated with their societal, cultural, political and economic contexts of individual country (Hannawi & Salmi 2014, pp.335).

Beladi, Chao, Ee, and Hollas (2015, pp.392) suggest that in general, countries in this region have been experiencing shortage of health workforce for many decades which is attributed to moral problems, geographical maldistribution, as well as skill imbalances. United Arab Emirates (UAE) among other Middle East countries has been wrestling with the demand of good health systems since they lack adequately trained local health workers, thereby considerably relying on foreign healthcare professionals (Alameddine et al. 2015, pp.314.

In attempt to investigate the factors influencing people’s choice for nursing and medical related careers in UAE, the researcher based the study on the dictates of the Parson’s theory. According to the theory, one ought to relate their judgment to their traits in relation to the targeted labour market (Taylor 1994, pp.323). The Parson’s theory dictates that an individual carries out an in-depth analysis of their interests, professional skills, personality and social values and evaluates them using the occupations that demand such traits (Herr 2013, pp.279). Through the theory, the researcher sought to find out the major reasons why Emiratis especially youths joining higher educational institutions are quite reluctant in taking up medical careers.

2.4.1 Economic factors
While explaining the imbalanced correlation between local and foreign specialists in the UAE healthcare sector, a number of researchers have come up with different conclusions. To illustrate, Jasim (2008) highlighted that lower salaries in the industry as compared to other fields is the major demotivating factor. Shibani, Saidani and Alhajeri (2013) attributed the issue to the government’s overreliance on traditional performance appraisal methods, such as rating scales, essay appraisal, and ranking. These means are dated and inadequate in current market conditions.

At the same time, more up-to-date techniques are overlooked, involving assistance of assessment centres, behaviourally anchored rating scales, human resource accounting method, and management by objectives among other aspects (Shibani, Saidani and Alhajeri 2013). Consequently, human resource managements in the healthcare facilities overlook employees’ concerns or possible dissatisfaction because of improper assessment tools which leads to their needs remaining unmet.

This circumstance results into high turnover among expatriates and unwillingness to be employed at all among Emiratis (Fares et al. 2014; Jasim 2008; Alrawi & Hussain 2011). Apart from that, when looking at the issue in terms of the social context, Shallal (2011) explains that factors such as age, income, education, and workplace stress need to be considered in order to raise job satisfaction levels, especially among the Emirati females. These problems can be addressed by means of previously indicated up-to-date needs’ assessment and performance appraisal methods.

Working as a healthcare practitioner in the United Arab Emirates’ healthcare sector is one of the most unfavourable jobs in terms of its financial rewards (Almazroui 2014). Many healthcare providers have to cope with low wages and lack of promotion despite many years of service delivery (Francis, Rao, & Sridahar 2013, p.134). The meagre pay does not allow medical staff to have decent lives compared to other professionals; thus, discouraging students interested in the medical profession from pursuing it. Those living and working in the urban centres of Dubai and Abu Dhabi were particularly disadvantaged in the recent decades. The United Arab Emirates’ real estate industry is very expensive. Hence, doctors may not afford decent housing courtesy of their low wages compared to administrators in the oil and gas industry (Sahoo 2013).

The United Arab Emirates is a country with a strong economy courtesy of its huge energy supplies. Arguably, energy such as oil and gas are some of the highly priced natural resources in the twenty first century. The fact that many oil and natural gas deposits in other regions are being exhausted at an alarming speed makes the United Arab Emirates one of the major economic players in the industry (Bell 2014). Hence, the oil and gas industry has attracted the interests of many elites as it has smart financial packages. Arguably, persons working in the oil and gas industry receive a good pay for their services (Ghazal, Vidican & Samulewicz 2011, pp.462).

According to a report prepared by Neuhof (2013, p.1), salaries offered to persons working in the oil sector in GCC grew two times the global average in the year 2013. This circumstance was as a result of the increase in salaries offered to workers in the national oil companies. It was the same in the UAE where the wage of the oil corporations’ employees increased by 100 percent, while their benefits were also extended (Allen, Hyder & Robinson 2015, pp.36). In comparison, salaries of nurses and doctors have been risen from 3 to 5 percent and from 5 to 10 percent respectively, as reported by Sahoo (2013).

These statistical data does not fit the overall increases in investment and funding of the field, which is evidenced by other comprehensive finance-based investigations of the field such as those by OBG (2011; 2013), Amaize, Mady and Benson (2011), and IBP (2009; 2014) to name a few. To be more precise, the well-being of employees in the sector is overlooked by policy-makers, which can be another discouraging factor to be engaged in work in healthcare. This has made a lot of youths flock in the oil and gas related disciplines to make them relevant in the field.

Many of them admit that they would not want to study Medicine as the financial rewards for such a profession in the United Arab Emirates is not significant when compared to the rewards generated in the oil and natural gas industry (Ausman et al. 2013, pp.17). Students who do not qualify to pursue such careers still draw back from medicine in favour of finance and business administration (Alkraiji, El-Hassan & Amin 2014, p.41).

2.4.2 Psychological determinants with regard to healthcare professional field
Psychological aspect is also relevant in the context of the given research. In particular, Ahmed et al. (2009, p.e1) underlined substantial depression and anxiety rates among medical staff and students, where “the second-year medical students exhibited the highest percentage level of these states.” On the contrary, the findings by Ahmadi et al. (2008) evidenced low depression rates among Emirati medical students. Nevertheless, this aspect is a notable one to be regarded. To be more precise, this factor can be detected as one of the barriers among the nationals in terms of emotional stability during studying and transfer to working conditions in the sector.

Accurate identification of the problems in this regard is likely to result in an opportunity to take specific preventive measures to mitigate stresses for locals and facilitate their smooth transition from graduates to practitioners. This factor is also justified by the inquiry by Smith (2011) who has detected a 51% level of mental illness prevalence among the UAE female healthcare students by means of General Health Questionnaire (GHQ-28). In addition, the studied sample has not sought counselling services due to differences that exist between American/European and Eastern worldviews.

Specifically, the nationals are not habituated to this psychological service as an option, but prefer religious beliefs as a solution. In this regard, Amiri et al. (2013) have explored suicidal behaviour and attitudes among UAE medical students through the lens of religiosity and socio-demographic characteristics, such as communication with peers and family members. The researcher has clarified lower rates of suicidal attempts and beliefs in Emiratis in comparison to the international indices in these respects. Again, the scholar has asserted religiosity and spirituality as the factors preventing Emiratis from this type of behaviour. Despite that the results of the previous studies are controversial; they should be taken into account in the scope of this exploration.

2.4.3 Cultural and Religious Restraints
The UAE is a multinational country; the issue of mixed cultural environment within healthcare field can be considered as a potential preventive factor for Emirati students to choose a career in medicine. This aspect is especially acute in relation to the role of females determined by the Islamic social and religious norms. In particular, Chu and Abdulla (2014, p.449) explore the issue from police officers’ standpoint and come to the conclusion that “women can be as good as male officers in doing police work,” as evidenced by the female sample studied in the scope of their research. At the same time, Walton, Akram and Hossain (2014) investigated healthcare perceptions of Dubai women and found out controversial results: namely, traditional beliefs of Emirati females forbid treating the opposite gender, especially for women. Moreover, female patients are unlikely to accept the treatment administered by male healthcare practitioners (Walton, Akram & Hossain 2014).

The number of female healthcare workers is less when compared to that of men (Bell 2014). Noteworthy is the fact that women may not practice medicine throughout their lives. Some of them may drop their jobs once they get spouses and children. The case is attributed to the social and cultural connotations that discourage them from pursuing further studies or practising demanding careers such as medicine at the expense of their families (El Amouri & O’Neill 2014, p.135).The medical profession is particularly unfavourable to the Emirati women as they are supposed to work for long hours and probably at night. Therefore, some of them give up on the profession to attend to their families while others shift to other less demanding but well-paying professions (Bell 2014).

Though health is considered as a paramount aspect in the Islamic religion and the religion requires Muslims to try remaining as healthy as possible, religious and cultural restraints significantly hinder embracement of heath care related careers, especially among women. Cultural customs and Islamic laws impact women’s life in various stages such as their education and employment opportunities (Voas & Fleischmann 2012). According to Moghadam (2003), Islamic countries record the highest gender gap in education and female enrollment in institutions of learning has been reported to be substantially low. Though presently this may not be the case in UAE, the older female generation was denied an opportunity to work in the healthcare among other professions that require formal education (Voas & Fleischmann 2012).

Contemporary medicine in the UAE is still heavily cultural- driven as revealed by McLeen et al. (2010). For instance, female patients prefer female doctors in the gynaecological clinical encounter (McLeen et al. 2010). These findings are in line with Scott (2003); and Vainman and Haslberger (2013) who called engagement of female representatives in the area as the most salient solution to workforce shortage in healthcare. Conversely, McLean et al. (2010), Nelson (2004), King (2008), and Garner and Christiansen (2008), emphasised on residential perceptions of an occupation of a doctor as solely male, while that of a nurse as a female one.

2.4.4 Educational constraints: Westernisation
UAE medical education has been analysed by researchers as well as a discouraging factor for Emiratis in terms of pursuing career in the field. Foremost, reshaping of the overseas educational strategies is a challenge for the locals since it is performed as simple coping of international teaching frameworks, whereas the procedure of reformation in the area should be nation-specific (Roff 2005). While educational innovations in the sphere are welcomed by residential healthcare professionals, the quality of training provided nationwide is yet to be achieved (Khosravi, Rezaee & Sabetian 2014).

It is necessary to note that the countries in the Gulf region, inclusive of the UAE, are updating their medical education strategies, but Emiratisation of education; creation of the nation-specific educational system rather than copying the western approaches, is unfortunately a too rarely phenomenon (Hamdy et al. 2010). Apart from that, educational process is too time-consuming as it takes one from five to eight years to graduate and get a high qualification in the field.

On the other hand, studying abroad for Emirati students is not less challenging. To illustrate, Ghadah (2014, p.33) concluded that Emirati and Saudi students pursuing their healthcare degrees in US universities encounter difficulties in “speaking, presentation, participation and socialisation.” Simultaneously, UAE implements such a novel approach from the Western culture as multiple mini-interviewing for selecting medical residents, and it has proved to be effective in the region (Ahmed et al. 2014). However, this tool also revealed higher chances of the applicants from overseas to be employed as compared to the local ones.

2.4.5 Lack of Enough Facilities for Training Healthcare Professionals in the United Arab Emirates
The training facilities for healthcare providers in the United Arab Emirates are not enough. Similarly, they are not well equipped to train special healthcare providers who specialize in fields such as Gynaecology, Surgery, Obstetrics, and Paediatrics among others (Sahoo 2013). Many healthcare instructors in the United Arab Emirates’ medical schools admit that the post graduate study programmes for healthcare providers in the United Arab Emirates are wanting when compared to other academic fields (Blair, I, Grivna, M and Sharif, A.A. 2014, p.3). Hence, some of the Emirati healthcare professionals such as doctors go for training in other countries (Alkraiji, El-Hassan & Amin 2014, p.41).

Research indicates that some of the institutions of higher education in the United Arab Emirates offering medical related courses do not allow for specialization as they are devoid of resources (Wollin & Fair-weather 2012, p.24). Those who wish to further their studies in a particular medical branch may either have to do it abroad as there are no facilities to allow them specialize in the country (El-Salibi 2012).

It is also believed that the Emirati trained healthcare providers are not as competitive as the foreign expatriates. The claims may be roughly correct as few medical institutions in the United Arab Emirates reach the global training standards and specialization is quite rare for home grown Emirati doctors (Bell 2014). Similarly, the Emirate trained healthcare providers do not mainly specialize; thus, making them half-baked graduates when compared to foreign expatriates running private health institutions (Bell 2014).

2.4.6 Advanced technologies as one more preventive factor
Alrawi and Hussain (2011) suggest that e-health is a developing option of healthcare delivery in the national level and a challenge for the area simultaneously. Specifically, the scholars put an accent on a range of barriers medical practitioners and other actors involved are forced to face due to this innovation. To be more precise, the researchers listed such challenges as additional educational training for current and future employees, healthcare access, quality and cost (Alrawi & Hussain 2011, p.118).

Similar conclusions were made by Delloitte (2011, p.10) who described the UAE healthcare system as a “late adopter of the global medical technology and equipment”. Berwick (2003) expanded the exploring of this concern and highlighted costliness of the failing incorporation of advanced technologies into enhancement of healthcare. Additionally, the author proposed a range of steps to be undertaken in order to pose innovation as an incentive for existing personnel and upcoming professional, rather than make it a challenge.

Despite that, stages such as “find and support innovators, invest in early adopters, make early adopter activity observable” among others seem salient since they have been formulated on the basis of developed countries (Delloitte 2011). Thus, these points have to be either specified in accordance with the country’s conditions in the sector or researched in-depth to provide more justification to be used within the UAE context.

2.4.7 Mandatory doctor’s supervision
In addition, certain inadequacies exist in doctor-to-graduate relationship that can be defined as preventable. For example, van den Eiden et al. (2014) detected the tension in transition to working practice in baccalaureate graduates because of not allowing them to perform gynaecological examinations on their own. This circumstance disqualifies them in patients’ eyes, which leads to distrust of the latter and non-confidence and even anxiety in the graduates.

Similar consequences of inappropriate supervision have been identified in the nursing field (Nelson 2004; Garner & Christiansen 2008; Wollin & Fairweather 2012). In particular, nurses gain high-level education in the field and feel capable to perform their duties as doctor’s assistants rather than being supervised by the physicians as watchdogs all the time. This issue is especially relevant for primary care provision since nurses are well-trained in this regard. It follows that this factor is also to be considered in the context of this research since it significantly impacts Emiratis’ choice of healthcare careers in medicine and nursing.

2.5 Literature on the initiatives that may promote Emiratis to choose careers in medicine and nursing in higher numbers
The current acute shortage of nurses and other health professionals in the UAE, particularly those of UAE origin can be addressed through implementation of a hybrid of strategies among them being adoption of initiatives that can encourage Emiratis to choose careers in the health sector in higher numbers. The approaches adopted should focus on changing the perception of the general society about nursing and other medical related professions, improving the education system in the country, as well as the economic wellbeing of medical practitioners just to mention a few. This section explores the Emiratis culture influences UAE’s nationals career choices based on objective and subjective theories. The section also evaluates the main strategies through which Emiratis can be encouraged to choose careers in medicine and nursing in higher numbers.

2.5.1 Theoretical Background

For the policy makers to implement the most appropriate initiatives aimed at improving the number of Emiratis pursuing careers in the healthcare sector, it would be a prudent idea to first identify the main factors influencing Emiratis career decision based on the cultural context. This can be achieved by evaluating findings made in studies that have previously investigated the cultural effect on career choice among the UAE residents, as well as theories that might be related to cultural effects on career choices. A number of theories can be used in explaining the cultural effect on career choices such as the general employment theories; Subjective factor theory and Objective factor theory.

2.5.1.1 The Objective Factor Theory
The objective factor theory suggests that people choose career in different fields based on a number of objectives and measurable characteristics such as salary and remunerations, benefits, career development prospects, location, educational opportunities, as well as the nature of the work to be performed among other factors (Schreuder and Coetzee 2006, p.187). The theory assumes that graduates and persons looking for employment are rational and therefore make career choices after an objective evaluation the profession.

2.5.1.2 The Subjective Factor Theory
Subjective factor theory on the other hand suggests that there exists a similarity between personality patterns and the nature of profession one chooses. The theory assumes that people have a tendency of pursuing careers in fields and organizations that they perceive to have the ability of providing satisfaction for their recognized and unrecognized needs such as their emotional needs. According to Schreuder and Coetzee (2006, p.187), career decision choice is mainly dominated by psychological and social factors such as the status of the career, reputation of the field or organization, as well as other related factors.

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The two theories developed by Behling, Labovitz, and Gainer in 1968 can help readers understand the type of factors Emirates use when deciding which careers to pursue, in which sectors, and in which organizations. In addition, Yu and Cable (2014, p.49) found out that culture plays an instrumental role in influencing individuals’ career choices. The figure below shows a summary of the factors influencing career and organizational choice based on Behling, Labovitz, and Gainer’ objective and subjective theories.

Figure 1: Factors influencing career and organizational choice based on Behling, Labovitz, and Gainer’ objective and subjective theories.

Source: (Yu and Cable 2014, p.49)

Based on these two theories, a number of studies have been conducted in various parts of the world inclusive of UAE in attempt to find out the factors influencing graduates career choice. A study conducted by Judith Baines in 2009 in the London School of Economics (LSE) using a sample size of 1,300 students representing all the six continents reported findings that are closely related to the two theories. Baines’ study was seeking to find out the effects of culture on career decision among students of various origins studying in the LSE. According to this study, financial security and parents were found to be the leading factors that influence students’ career decision making. Out of the 1,300 students sampled, 80% of them selected financial security as the factor they would consider first before choosing a career with 46% of the students choosing it as their first choice.

With respect to what students considered as “good careers”, Baines reported that most students considered good careers as professions that would earn them status or prestige as well as financial security. Though students from different continents differed on what they considered as “good” careers, students of Asian origin (inclusive of Emirates) were reported to find financial reward being more vital compared to other students involved in the study (Baines 2009, pp.49). As a result, most Asian students’ career choice was reported to be in the high paying sectors such as the banking and finance industry, as well as the oil and gas sector among other industries.

Salaries were found to be among the factors that majority of the sampled Asians perceived to be important while choosing a career field. Baines (2009, pp.50) also reported that most students particularly those of Asian origin considered job security as a priority when choosing the career sector. With respect to career prestige or status in sector choice, no major differences were noted among the sampled students. Moreover, students from the Asian continent were found to place less importance on public service in determining their career sector choice (Baines 2009, pp.50). These findings can be used in explaining why most UAE nationals are not willing to pursue careers in the healthcare sector, a field that is low paying and looked down by most of the society members.

With respect to element of personal interests as highlighted in the Subjective Factor Theory, Baines (2009, pp.50) found out that this element was among the main influences for career sector choice for all the cultures. However, contrarily to findings made by other studies, Baines’s study reported insignificant effect of culture on career choice since students have common influences.

In a study carried out by El-Salibi (2012) seeking to find out job satisfaction among registered nurses working in UAE Ministry of Health Hospitals (MOH), crucial findings were made that relate to the objective and subjective theories discussed above. The findings made can also be used in explaining why most graduates are not willing to pursue a career in the health sector. According to El-Salibi (2012, pp.73), low remunerations was among the principal reasons behind nurses’ dissatisfaction

As a result, the researcher recommended that healthcare leaders should revisit the scale of nurses working under MOH so as to promote their retention and satisfaction. El-Salibi (2012, pp.74) noted that the cost of living in UAE was considerably escalating, hence additional benefits and payments for registered nurses are a priority. The author pinpointed that the salary scale for nurses had not been reviewed by the ministry of health since 2007 despite the fact that the country has been hit by economic crisis that have escalated the cost of living. The salaries and benefits that nurses are currently receiving are inadequate to enable them live a decent life by paying for housing, taxes, schooling, continuing education, transportation and medical treatment among other inevitable living costs.

Payment disparity was also noted since nurses in the health authority of Abu Dhabi (HAAD) were found to earn twice the amount nurses working under MOH were receiving. This dwindled MOH nurses’ motivation to work, reduced their commitment, and overall satisfaction. The researcher noted that such nurses were willing to seek alternative jobs in the private sector, an aspect that would automatically exacerbate the existing shortage of nurses, particularly those of UAE origin (El-Salibi 2012, pp.67).

Rewards inform of decent salaries and benefits have also been reported in other studies conducted in the UAE setting such as Buerhaus 2008; Gieter et al. 2006; Eastaugh 2002; Bratton & Gold 2007. Buerhaus (2008) noted that Emiratis consider rewards as essential elements in attracting and retaining nurses and there was no exception to this rule. Another motivational factor or element that Emiratis consider when choosing a career field as noted by Buerhaus (2008) include professionals needs which is in line with the self-actualization need as depicted in Maslow’s theory. This confirmed that appropriate measures were lacking that would have enabled nurses to expand their potentials.

As the objective theory suggests about the factors influencing people’s career choices, Bratton and Gold (2007) reported that Emirati nurses and even expat nurses of Asian origin, specifically the Arabic nurses prefer a field where they can use continuous professional development to foster their job to progress and succeed in the developed countries. Currently, most of the Emiratis nurses are diploma holders and advancing their education is hindered by a wide range of factors such as low pay, organizational barriers, and inadequate time (El-Salibi 2012, pp.67).

Overall, based on the objective and subjective theory that highlight issues that reflect how Emiratis culture shapes UAE’s nationals decision towards career choice, it is evident that Emiratis prefer career fields that are intellectually driven to promote their education and professional growth, provide decent remunerations, as well as jobs that attain them professional recognition. This is not the case for the healthcare careers, an aspect that makes nursing a less desirable career choice for Emiratis compared to other professions. Therefore, appropriate initiatives should be implemented focusing on the cultural and other issues highlighted in the subjective and objective theories.

2.6 Initiatives to encourage Emiratis choose careers in the healthcare sector in higher numbers
2.6.1 Establishing early and middle college medical schools and other training facilities
With the current rampant increase in the demand for nurses and other medical professionals in the UAE, there is a need for the federal government to devise effective strategies of enticing more people into health professions. This can be achieved through formation of early and middle college schools emphasising on the healthcare careers (San Pedro et al. 2013, pp.179-182). Lack of adequate training facilities and centres has previously been cited in this study as a leading preventative factor for UAE nationals to pursue medical related careers. Consequently, establishing more training centres cross the seven cities is likely to be an effective counter-measure to the current problem of low enrolment for nursing courses.

Early and middle colleges are jointly formed between the institutions of higher learning and high schools, whereby students simultaneously pursue both high school and college-level courses in a campus. According to San Pedro et al. (2013, pp.179-182), students in 10th and 11th grade are the most targeted by middle colleges whereby they are provided with rigorous course work and high level of individualized support. Depending on the stipulated policy, students usually do not earn college credit for the courses they pursue in college campuses.

Early colleges on the other hand integrate all high school years with college years to form a single program that takes less time to complete than when the two programs are pursued separately. Students graduate from early colleges with either two years of transferable university/college credit or an associate’s degree. The main advantage of early colleges is that students can start earning while still pursuing their studies, an aspect that is likely to significantly entice more school aged youths to pursue a career in healthcare (Edmunds et al. 2013, pp.22).

Establishment of early and middle colleges as a way of encouraging more people to pursue healthcare related careers has been tested and proven to be an effective approach in other countries such as USA and Australia. In the USA for example, a country that is also experiencing a severe shortage of nurses, the Early College High School Initiative that is sponsored by Bill & Melinda Gates Foundation has played an instrumental role increasing the number of youths, particularly those from disadvantaged families pursuing health professions (San Pedro et al. 2013, pp.183). The initiative was designed specifically to target Afro-American and Hispanic students whose graduation rate is substantially low compared to that of white students. According to Edmunds et al. (2013, pp.23), early and middle colleges have been successful in bringing more students into healthcareers, and more such institutions are under developments in various states across USA with Michigan having the highest number of such institutions.

Nevertheless, such initiatives are likely to face numerous challenges particularly policy related barriers. Some of the challenges may encompass issues to do with dual registration and credit, credit transferability, eligibility of students enrolled in such institutions for college courses, certification of teachers, as well as funding and autonomy among others (Silvestri et al. 2014, pp.753).

For example, in the USA, the main challenge that this initiative faces include the issue of some states limiting the number of courses high school students can take (Villarruel et al. 2015, pp.59). Similar issues are likely to occur in the UAE but the challenges can be solved in an amicable way considering that success of such an initiative is likely to solve a problem that has jeopardized provision of quality health services in the country and it is likely to become bigger if effective measures are not swiftly adopted.

Though establishing middle and early colleges may be a long term goal, the country may also emphasize on building more nursing and medical training schools in attempt to make the profession more attractive. This measure has of late been adopted by some of the emirates with Dubai being at the top of the list. Building at least five nursing schools is stipulated as one of the main objectives of the Dubai 10 Year Healthcare Plan launched in 2015 (The National UAE 2015; Ansamed.info 2015). According to The National UAE (2015), Dubai will need more than 7,323 doctors and 8,510 nurses in the next one decade and this can only be achieved by training more UAE nationals to become proficient health professionals.

Already, one institution, the University of Sheikh Mohammed bin Rashid for Medicine and Health Sciences, has already been completed and it will produce its first graduates in September 2015. If similar healthcare plans are adopted by the other emirates, the number of UAE students taking nursing courses can increase considerably (The National UAE 2015; Ansamed.info 2015).

2.6.2 Launching mentorship programmes and a national campaign

Other than establishment of middle and early colleges, the UAE government, society, well-wishers, and other stakeholders can embark on a national wide campaign to sensitize the public about the significant roles nurses and other medical professionals play. According to Ryan (2015), the UAE society looks down on the nursing profession because of lack of awareness about the indispensable roles played by nurses. As a result, engaging in a national wide campaign focusing on changing the general population’s perception towards the nursing career is likely to be an effective approach of encouraging more students to take health professions (Alselaimi 2014; Ryan 2015).

Similar campaign has been launched in other countries in the Middle East such as Saudi Arabia and Qatar where the number of nurses particularly that of the states’ nationals is at disquieting levels. A study conducted by Alselaimi (2014) about the status of the health sector in Saudi Arabia and Qatar revealed that the number of youths joining nursing schools has declined at an unprecedented pace, resulting to acute shortage of Qatari nurses who account for less than 6% of the total healthcare workforce. In the UAE, if swift measures are not adopted to change the society’s poor perception towards the nursing profession, the problem of nurse shortage will continue escalating and the country will continue depending on expatriates.

In addition, the campaign should also focus on encouraging women to join the nursing profession. Perlstein et al. (2014) and Kagan et al. (2015) highlight that though Emirati women have in the recent past been empowered to join the national workforce, only a negligible percentage of them have joined the nursing profession.

Recently, a number of mentorship programs such as the Rashid Hospital Emirati Nurse Mentorship Program (RHENMP) have been launched though they have been reported to be less effective. RHENMP among other programs focus on highlighting the significance of nurses in most of the departments in the healthcare facilities. As a result, slogans such as the “Value the Role of the Nurse in the UAE” among others have become common. According to Kagan et al. (2015), comprehensive mentorship programs are essential for improving the retention of Emirati nurses, as well as maintaining their job satisfaction. The programs support nurses’ professional progress and facilitate Emirati nurses’ adaptation, retention, and fulfillment of clinical practice and carrier development.

All the seven cities of the UAE should embark on campaigns such as the one currently run by the Dubai Department of Health and Medical Services (DOHMS) aimed at addressing the current acute shortage of UAE national nurses. Sharif et al. (2013, pp.276) state that DOHMS has adopted effective strategies of enticing young high school graduates to the nursing profession. The department has of late provided UAE nationals pursuing nursing with numerous privileges and facilities such as supporting the nursing programme at the University of Sharjah (UoS) (Sharif et al. 2013, pp.276).

The department has also been providing students signing up for the nursing programme with stipend of Dh2, 500 which is increased yearly by Dh500 for all the four years of study. In addition, the University of Sharjah in collaboration with DOHMS has been covering the cost of study for all the national nursing students on top of DOHMS offering national nursing graduates incentives such as Dh24, 000 after successful completion of the studies. As a result, Fares et al. (2014, pp.7) suggest that nursing schools in the state, particularly UoS, have started recording a gradual increase in the number of students enrolling for nursing courses, though a lot need to be done to entice more youths to pursue a career in nursing and healthcare.

Other than providing numerous privileges to the UAE nationals taking nursing courses, the department has also implemented other strategies such as regularly visiting schools around the country to sensitize students about the indispensable role played by nurses in the growth of any nation (Fares et al. 2014, pp.8). The campaign has also been directed to citizens at sport clubs, shopping malls, and other social places through distribution of brochures and posters. Overall, application of such measures by the federal and state governments, institutions of higher learning, society and other stake holders can significantly make youths re-consider pursing a healthcare career.

2.6.3 Salary as a motivating factor
In the previous section, low salaries and remunerations were cited as a leading demotivating factor for students and professionals in the healthcare sector. The issue of income disparity has deeply been explored and it emerged that low salaries offered to health professionals compared to salaries offered to employees working in other sectors such as the oil and gas industry, the government’s overreliance on traditional performance appraisal methods, such as rating scales, essay appraisal, and ranking, are core factors discouraging UAE nationals from pursuing a career in this line.

Therefore, reviewing salaries and other benefits currently offered to medics should be reviewed and a policy put in place so that they will regularly be reviewed probably after three or five years. In line with this, a study carried out by Herzberg, Mausner, and Snyderman (2011) whose findings have been supported by other recent studies such as Gaki, Kontodimopoulos, and Niakas (2013); Toode, Routasalo, and Suominen (2011); and Ojakaa, Olango, and Jarvis (2014) revealed that increases in salaries is among the main elements that many workers consider as motivating factors. This is not an exemption in the UAE health sector.

Currently, a number of emirates have realized the role decent pay plays in retaining and attracting a pool of talented health professionals, specifically from the youth segment. An example of such a state is Dubai, which in 2015 declared that wages and benefits provided to nurses and medics at large will be increased to make them competitive with that of professionals working in other sectors, as well as that of other GCC and western countries. In addition, Dubai’s authority pledged to introduce more flexible shifts, as well as partner with the private sector to train more nursing students and nursing assistants in the state with a two-year diploma (The National UAE 2015). If such measures are effectively implemented, they are likely to attract more students or youths in the nursing career and help in boosting the current severely low number of nurses in country, specifically those of UAE origin.

The National UAE (2015) reports that the authority is also planning to retain and attract a pool of high caliber medics and healthcare staff to fill gaps existing in numerous specialties such as anaesthesia. This will be achieved by improving the residency programme, as well as by sponsoring Emirati physicians for postgraduate degrees abroad.

A report presented by Dywili, Bonner, and O’BRIEN (2013) revealed that most of the nurses in the UAE were resigning since a pay of less than Dh3,000 could not support them and their family in a country that has a high cost of living. The report also stated that some nurses who possessed proficient qualifications, skills, and experience were resigning because they were ranked in different salary categories based on their education. This subjected them to low pay that could not decently sustain them and their families (Dywili, Bonner & O’BRIEN, 2013, pp.518). For example, towards the end of year 2014, a couple of Asian nurses resigned from various hospitals such as Al Qasimi Hospital after receiving decent offers in the USA and Europe (Villarruel et al. 2015).

Other approaches may include encouraging the UAE community to discard cultural and religious practices or beliefs such as limiting the roles of women; and collaborating with various organizations such as the World Health Organization Regional Office for the Eastern Mediterranean (WHO-EMRO) and the International Council of Nurses (ICN) in organizing for education events and workshops so as to enhance nurses skills and knowledge. Rreligious and cultural norms have been cited in this study as key preventative factors that hinder women from pursuing healthcare careers since they are not required to treat males who are not closely related to them. Such norms also discourage Muslim women from being treated by men (Dywili, Bonner & O’BRIEN, 2013, pp.520). Overall, implementation of a hybrid of all these proposed approaches is likely to significantly promote Emiratis to choose careers in medicine and nursing in higher numbers.

2.7 Summary
Chapter two presents an in-depth exploration of the status of healthcare in the United Arab, theories used in explaining people career choice, factors that influence the choice of a healthcare career in medicine and nursing among Emiratis, as well as strategies that can be adopted so as to encourage Emiratis choose careers in medicine and nursing in higher numbers. Based on the systematic analysis of literature carried out in this chapter, the demand for healthcare services has been on the rise in UAE as the population increase at a rampant pace and people adopt Western lifestyles.

The change in lifestyle which is characterized by consumption of fast foods among the features among the UAE residents has resulted to emergence of lifestyle diseases such as obesity and heart diseases among other health challenges. Despite the consistent increase in the demand for healthcare services, the number of medical practitioners, particularly those of UAE origin is extremely low. The healthcare system in the country is also characterized by low funding from the federal government, extremely high percentage of foreign medical practitioners, as well as low nurse and physicians ratios.

Numerous theories are used to explain people’s career choice among them being the Developmental Career Choice Perspective Theory; Person-Environment Fit Perspective Theory; Social Cognitive Career Theory (SCCT); Generational Theory; and Parson’s theory. However, factors influencing people’s career choice for medical practitioners in UAE has been based on Parson’s theory which dictates that individuals relate their judgment to their traits in relation to the targeted labour market and that they carry out an in-depth analysis of their interests, professional skills, personality and social values, thereby choosing careers that demand such traits.

The main factors influencing people’s career choice among the Emiratis include economic related factors, psychological factors, cultural and religious aspects, educational constraints, as well as lack of adequate facilities for Training Healthcare Professionals in the United Arab Emirates. Based on the analysis carried out in this section, it is clear that low salaries in the healthcare sector compared to other fields are a major demotivating factor. Psychological factors such as high depression and anxiety rates among medical staff and students has also been reported to be among the main factors that greatly hinder many students from pursuing medical related courses.

In addition, cultural, religious and educational restraints are also leading factors that make many students in the country avoid pursuing careers in medicine. This aspect is especially acute in relation to the role of females determined by the Islamic social and religious norms. With respect to education constraints, it has been found that reshaping of the overseas educational strategies is a challenge for the locals since it is performed as simple coping of international teaching frameworks, whereas the procedure of reformation in the area should be nation-specific. The quality of healthcare training provided nationwide is also yet to be achieved. Furthermore, lack of adequate training facilities in the UAE has also been found to be a leading factor that hinders locals from choosing careers in the medical field.

The current situation of critical shortage of nurses of UAE origin can be corrected by implementing initiatives aimed at encouraging Emiratis choose careers in the healthcare sector. This can be achieved by employing counter-measures approaches to the preventative factors discouraging Emiratis from pursuing medical related careers. Some of these approaches include increasing pay and benefits of the medical workers so as to attract more graduates, and launching mentorship programmes and a national campaign aimed at sensitizing the public about the importance of nurses for any country’s economic growth. Other measures include establishing early and middle college medical schools and other training facilities that would emphasis on the healthcare careers.

CHAPTER III.THE METHODOLOGY
3.1 Introduction
Chapter 3 presents the methodological framework applied in this research whose purpose is to determine the factors influencing the choice of a healthcare career in medicine and nursing among Emiratis, as well as proposing feasible initiatives through which the number of Emiratis pursuing careers in the health sector can be improved. The chapter discusses the methods and the procedures used in conducting this study. This chapter comprises of nine sections; the research design, the sampling method and process, selection of the participants and sample population, as well as data instrumentation. Other aspects such as data analysis tools employed, data triangulation, ethical considerations and limitations of the methodology employed in this study are also discussed.

3.2 Research Design
Research design is described as the systematic plan outlining the methods and procedures applied while carrying out a given research study (Litosseliti 2010, pp.34). It entails data collection instruments, aligning or arranging the collected data, and analysing the data collected which are guided by the aim of a given research study. According to Litosseliti (2010, pp.34), the most widely used research designs include quantitative research design, qualitative research design, a hybrid or a mixture of quantitative and qualitative research designs, as well as the systematic literature review. The latter relies on secondary sources of data while the former are used for conducting primary studies.

Litosseliti (2010, pp.35) describes quantitative research approach as a research design that involves approximating phenomena from a large number of participants using surveys which aid in summarizing features across groups. The approach usually encompasses collection and analysis of numerical data. Qualitative research methodology on the other hand focuses on describing phenomena in an in-depth and comprehensive way, and it involves a small number of participants.

The required data is collected using data collection instruments such as in-depth interviews which are classified into three; phenomenological interviewing, interviewing of elites and interviewing children. Other data collection tools commonly used include observation; focus groups; as well as collecting data from secondary sources which many experts term as a supplement to the primary data collected. Systematic literature review methodology relies on data collected and findings made in primary studies. The approach entails searching for, assessing, as well as synthesizing and integrating findings made in past primary studies thereby making a general conclusion.

Based on the nature and purpose of this study whose objectives are to (1) determine the factors influencing healthcare career choices among Emiratis; and (b) use these findings to develop appropriate policies and address workforce shortage by means of residential professionals, the researcher had to use qualitative research approach. The main advantages for using this research approach include the fact that phenomenological interviewing creates a room for identifying new phenomena and providing a deeper understanding about the topic under research.

The qualitative research design is best suited to achieve the posed research goals to clarify “the meaning individuals or groups ascribe to a social problem” (Cresswel 2013, p.4). A qualitative approach assists researchers in “understanding the context, the consequences or outcomes, and the significance of what is being investigated in the larger world” (Charmaz 2014, p.2). Indeed, this technique enabled the researcher to not only identify the factors preventing the Emirati from pursuing healthcare careers, but also the connection between these factors and the potential consequences of further ignorance of these issues in a broader context, in relation to operations of the sector as a whole.

The researcher targeted a diversified sample, involving several respondents per specified focus groups, such as students, doctors, nurses, healthcare administrators, and officials in the intended field. This approach to the research procedure allowed making more valid, unbiased and credible conclusions from the research results, with higher possibility to generalisation of the findings.

3.2.1 Theoretical background
The present day study was conducted using both phenomenology and grounded theory qualitative approaches. To study the positions of the targeted groups of healthcare professionals, including nurses and medics, a phenomenological approach was identified as the most appropriate framework for the chosen research direction. Grounded theory on the other hand, which is arguably the most successful qualitative research strategy in the modern psychology and social science, was used to develop a new theory about the Emiratis’ choice of careers as per the trend presented in the data collected. The theory developed is based or is “grounded” on the analysis of the qualitative empirical evidence obtained in in this study.

3.2.1.1 Grounded theory

According to ,,, grounded theory is a qualitative methodological approach used by researchers with the primary aim being to develop a “grounded theory” that can be used in explaining and describing the phenomena or experience under study which in this case is the factors influencing Emiratis’ choice of healthcare careers in medicine and nursing. For an accurate theory to be generated, Wertz et al (2011) suggest that data from all available sources, be it primary or/and secondary data, is considered, as long as it can contribute to the development of the theory. The most commonly used data collection instruments and sources are in-depth interviews, though images, observations, past literature and studies, as well as diaries can be used.

Data from the various sources is compared using a technique known as “constant comparison” where data relating to contradictory cases that may challenge the emerging theory are noted. The data helps in highlighting the weaknesses of the developed theory. Though this methodological framework is associated with a number of benefits for social and philosophical studies, an aspect that makes it the most popular qualitative research approach, it involves a complex process of sampling, collection of data, as well as analysis.

According to Charmaz (2012) and Charmaz (2014), grounded theory is concerned with the clarification of individual opinions with respect to the problem under discussion. However, the data collected in the process of researching the phenomenon is to become a theory that would offer an explanation of the subject of the research. A grounded theory approach is to be based on such sub-processes as suggested by Charmaz (2012) and Charmaz (2014).

identification of substantive research area, which is social structure of nationwide healthcare practice in the UAE;
data collection with regard to the substantive area detected;
open coding stage of the data obtained;
data collection and processing requires writing chronicle memos;
selective coding and theoretical sampling are other phases: i.e. identification of the main categories and secondary ones, clearly distinguishing core codes and related ones;
literature review and formulating a theory in line with the findings from the sources is the final stage.
3.2.1.1 Phenomenology

The phenomenological research approach was also used in this research as it presents an opportunity to describe a lived experience of a phenomenon or event within the chosen context (Heidegger 2005). Heidegger (2005), as a conceptualist of this framework, noted that its implications for research in the social sciences are strong. The student or professional under analysis is the entity and he or she cannot be perceived as an isolated thing. The only real phenomenological sound approach would be to perceive the entity in the context of an encounter or relationship as constructed between the researcher/analyst and the participant (Gillham 2005; Palmer et al. 2010). The manner, in which the encounter is built, therefore, has tremendous implications for the results of the study and must be carefully observed.

Phenomenological approach is used for describing and exploring experiences based on the data collected from the individuals who have lived through those experiences. This approach helps in discovering phenomena and unearthing previously overlooked or unnoticed issues. According to Wertz et al (2011), the approach explores the meaning of a phenomenon, thereby revealing meanings that are overlooked or hidden as well as identify the impact of the respective experience, rather than simply making suggestions.

This technique enabled a researcher to detect characteristics of the shared experience of the sample in relation to the questions considered (Creswell 2013; Beavan 2011). The main objectives of the exploration cannot be achieved via a survey-oriented or questionnaire methodology, for instance, primarily because personalised visions of the issue – a shared perception of the research question – were clarified in pursuit of the research objectives. Selecting the participants in the scope of diversified health-care-related respondents enabled an understanding of perspectives of various stakeholders. All these aspects should be analysed in a holistic manner to provide a thorough picture of what hinders Emiratis from becoming healthcare professionals.

For instance, healthcare officials may find educational opportunities well-developed in the UAE, while current medics as well as nurses would detect them as elements that require substantial reform and as needing to be brought up to date with the state of the art. In this regard, it was possible to provide a summarised perception of this factor or another as a sort of public opinion on the issue. The decision to follow a particular career is an intensely subjective one with various personal motivations and narratives underpinning it. Thus, it was submitted that a phenomenological approach was suitable due to the development of an interactive relationship of the researcher with the object under study.

It must be noted, as an important retort to a common misconception, that the phenomenological approach is not merely descriptive. A good example is the interpretative phenomenological approach (IPA) whereby the researcher takes the descriptions of the participant and seeks to understand the context of theoretical explanations in the discipline what meaning is constructed within the mind of the participant in a given context (Bryman 2012; Bound 2011). Therefore, phenomenology perfectly fit the chosen research direction of data collection, while IPA was found appropriate for the data analysis.

3.3 Research Methods and Approach
The qualitative approach adopted in this study bears remarkable resemblances in many ways to IPA. The main components of this phenomenological approach have been set out in summary below (Larkin 2006): First, IPA’s phenomenological component maps out the participants’ concerns and their orientation toward the world in the form of the experiences that they claim for themselves (e.g., ‘how has this phenomenon been understood by this person?’).

Secondly, IPA’s interpretative component contextualises these claims within their cultural and physical environments, and then attempts to make sense of the mutually constitutive relationship between ‘person’ and ‘world’ from within a psychological framework (e.g., ‘what does this mean for this person, in this context?’). Finally, the overall outcome for the researcher should be a renewed insight into the ‘phenomenon at hand’ informed by the participant’s own relatedness to, and engagement with, that phenomenon.

3.3.1 Research Strategy
The outlined research questions required in-depth understanding of the healthcare sector in the UAE context in relation to its perception by professionals in the area. Therefore, the qualitative technique as a means of clarification of the governing forces of human behaviour determining career choices was applied as a centrepiece of the research strategy (Cresswell 2013). In this way, it was possible to thoroughly clarify all related subtopics for a broad coverage of the issue in question sequentially, including:

a situational analysis of the UAE healthcare sector and its current characteristics;
providing a justification of the necessity for this enquiry (Lester 1999);
a holistic and critical analysis of the findings of precursors in the area, underlying the valuable contributions and shortcomings of the studies reviewed in the scope of the research;
the nationwide economic, social, educational and other constraints, as well as expatriate-to-resident inequities in the intended sphere;
presentation of the factors derived from the sub-topic analyses to appropriately detect and interpret the answers to the research questions (Merriam 2009), to list a few.
Based on the rationale provided, it is clear that a multilevel analysis of the problem under consideration is needed in order to explain the phenomenon gradually, through a different-level paradigm. For this reason, a qualitative research model was followed to focus on a range of crucial contexts of the issue investigated.

3.4 Research Population and the Sampling Technique

3.4.1 The Sampling process, Sample size and Characteristics
The first step of conducting the interview involved the identification of the appropriate respondents. Purposive sampling technique was used on the grounds of targeting a specific category of individuals within the UAE healthcare industry so as to save time and reach the targeted number of respondents as quickly as possible (Polit and Beck 2008; Bryman 2012). Afterward, snowballing was used.

Using these two methods, four medical students and four nursing students from the two universities located in Alain and in Sharjah were selected. The sample size selected for this study is within the range recommended for studies conducted using phenomenological and grounded theory approaches. Wertz et al (2011) suggest that the two approaches require a small number of participants; between 15 and 20.

These establishments were targeted for the enquiry as the governmental university that offers a medicine major and the other one provides students with an opportunity to acquire a bachelor’s degree in nursing. The management of these student-diverse institutions, involving both nationals and foreigners, were contacted in order to obtain their consent for conducting a research within their facilities. As soon as the approval was obtained, the researcher applied purposive sampling for recruiting the participants.

Additionally, four doctors and four nurses; one from each category and hospital were recruited from two governmental and two private hospitals in Dubai and Alain. These institutions were targeted since their operations are based on diverse medical staff. This group of the sample could define the factors that influenced them towards choosing their current occupation, the challenges they faced in the field, and give suggestions on what needs to be improved. When the management of healthcare facilities approved the participation of the targeted respondents and the recruited participants provided their formal consent, the interview stage was planned with these groups of the sample as well.

Apart from that, four healthcare managers working in the above-mentioned public and private hospitals were involved in conducting the current research as respondents. These medical practitioners helped in understanding the challenges that the intended professionals face in the care provision environment and how these obstacles can be overcome. One more group of respondents was government officials: two from the Ministry of Health and two from the Ministry of Education, presented their views on the policies implemented in the field and possible recommendations from their perspective. The researcher found the officials on the Healthcare Ministry’s website and sent them an invitation with a succinct explanation of the research aim and objectives.

3.4.2 Eligibility Criteria
The targeted groups for the study were identified on the basis of the findings made in the literature review. In order to select the participants, a set of important criteria was developed. Drawing upon Velasso (2010) eligibility criteria allows for the optimisation of “the external and internal validity of the study,” “improve its feasibility,” “minimise ethical concerns,” “ensure the homogeneity of the sample population,” “reduce confounding,” and “increase the likelihood of finding a true association between exposure/ intervention and outcomes.”

Initially, purposive sampling was used to recruit and select the participants on the basis of their “special experience and competence” (Merriam 2009, p.77; Yin 2011; Bryman 2012). On further stages of the research, snowballing was used: “selecting new data collection units as an offshoot of existing ones” (Yin 2011, p.89). After the list of “attributes essential” was developed, the researcher proceeded “to find or locate the unit matching the list” (Merriam 2009, p.77). Hence, the following criteria were applied to include participants in the study:

First, being at least a second-year student of Emirati origin studying medicine or nursing in one of the chosen universities was one of the factors to consider for student respondents. In this way, the researcher had an opportunity to obtain information concerning the research questions from a “closely defined group for whom the research question” were “significant” (Smith 2011, p.56). Undoubtedly, the participants within this group had a possibility to evaluate the pros and cons of the degree pursued and career field one has chosen, share own lived experience in this respect, as appropriate for phenomenology (Heidegger 2005; Greefield and Jensen 2010).

Secondly, with respect to professionals in the field, an Emirati origin and two-year (and more) experience is a major requirement. From this perspective, the researcher was guided by the rule that “those sampled are relevant to the research questions that are being posed” (Bryman 2012, p.418). Indeed, working in the area of interest for this period of time allowed the participants to cognise this professional sphere in different aspects. Therefore, the recruited respondents were able to identify the factors that can be discouraging for choosing a career in the healthcare sector, in line with phenomenological postulates (Heidegger 2005; Greefield and Jensen 2010; Wertz et al. 2011). Lastly, consent of the respondent was also a crucial criterion that the respondents had to meet since it acted as an indication of voluntary “ethics of collaboration” (Wertz et al. 2011, p.354).

3.5 Research Instrumentation
Research instrumentation refers to the process and the data collection tools used for gathering data from the respondents. According to Taylor, Stephen, and Kathryn (2006, pp.233), questionnaires, interviews, observations, focus group discussions, as well as experiments are the primary data collection tools, though the choice for a given data collection instrument is influenced by the aim and objectives of a study. For qualitative research studies, interviews and focus group discussion are the main data collection instruments, though they are supplemented by collecting data from secondary sources.

Though using focus group discussion as the data collection instrument would have provided detailed information and more insights about the topic under research, it was not possible for the researcher to employ this instrument since it was practically impossible to assemble all the participants involved in this study to one venue at the same time because of conflicting working schedules. As a result, the researcher opted to employ in-depth interviewing as the main primary data collection tool, whose findings were supplemented by data collected from secondary sources. The interview questions attached in the appendix were guided by the research objectives highlighted in chapter one as well as the review of the literature performed in chapter two.

3.5.1 Data Collection
3.5.1.1 In-depth Interview

Once the participants of this study were selected as explained in the above section, the next step was gathering data from them. They were contacted through various means such as through emails whereby participants were sent emails detailing the aims and objectives of the study, the importance of participating in the study, and the time the interview was scheduled for. Participants were required to confirm their participation, the time they would be available for the interview, and the method of interview they found most convenient (ie through Skype, face-to-face, or interview over the phone).

Interviewees in favor of phone call interview gave out their phone numbers; those willing to be interviewed through Skype stated their Skype addresses; while participants willing to be interviewed through face-to-face interview stated their locations and the time they were available. This enabled the researcher to prepare the interviewing schedule. The interviewing process started by the researcher making a formal introduction and informing participants about the ethical considerations involved in this study such as protecting participants’ privacy by coding data or assigning them number among other issues discussed in section 3.8 below.

Primary data was obtained from medical and nursing students, healthcare professionals, such as doctors, nurses, managers, and government officials to understand the problem from a broader context. To achieve this goal, a set of questions were developed and organised into semi-structured interviews. This type of interviewing was reasonable as it enabled the researcher to have “an interview guide” (i.e. a questionnaire with a range of topics to be covered) and allow the interviewee to guide the conversation simultaneously (Creswell 2013; Smith, Flowers and Larkin 2009).

Moreover, this approach is consistent with a core of phenomenology, which is clarification of the sense of sociologic phenomenon in light of a lived experience of this phenomenon within the specified context (Heidegger 2005). Apart from that, the outlined interview procedure allowed the planned data collection as required by one of the bracketing methods to ensure unbiased and valid study results (Chan, Fung and Chien 2013). In this way, the researcher obtained data that allows in-depth understanding of the research questions from the perspectives of the stakeholders whose opinions were explored.

Prior to conducting an interview, ethics approval was sought from the organisations invited to take part in the research procedure. Letter of invitation which contained a well-reasoned explanation about the study was sent to them to provide a clarification on the given research from different perspectives. A signed consent from each of the respondents was obtained. Whereas the researcher speaks Arabic proficiently, there was no need for the interpreter’s service during interviewing. This suggestion was tested during the piloting of the study.

Interview Technique

Furthermore, the research procedure itself involved gradual implementing the phenomenological part of the enquiry in order to clarify the lived experiences of the sample interviewed. A questionnaire based on a set of open-ended questions was developed to obtain information required for the achievement of the research goals (see Appendix A). The approach suggested by Smith and Osborn (2008, p.61) was used to construct questions in anticipation of semi-structured interviews, including:

determination of the overall area to be tackled in the interview;
putting the topics in the most appropriate sequence;
thinking of appropriate questions related to each area; and
consider going about possible probes and prompts which could follow from answers that might be given to some of the questions.
In this way, it was possible to evidence the researcher’s awareness in the topic while simultaneously allowing the interviewee to provide ample responses regarding their experiences in the field thereby expanding the existing knowledge on understanding the phenomenon (Yin 2011; Axinn and Pearce 2006). In-depth interviews were conducted on a one-to-one basis, making it easy for the recruited respondents to expand on the topic in question in accordance with the level of their expertise and experience (Heidegger 2005; Lester 1999; Biggerstaff and Thompson 2008).

Moreover, a semi-structured interview ensured high validity of the research results, evidencing their unbiased, accurate and credible nature (Cresswell 2013; Polit and Beck 2008; Yin 2011). Following the results of piloting, duration of the interviewing process was projected to take not less than 60 minutes per participant. Due to the fact that this technique is time-consuming (Gillham 2005) and at least 44 respondents were to be interviewed, more time was allocated for the interviewing phase as compared to other stages of the enquiry process.

3.5.1.2 Collecting data from secondary sources

The researcher highly depended on data from secondary sources such as text-books, previously conducted studies, peer-reviewed journals, as well as reports prepared by the government and other organizations among other sources. Data from these sources was used for providing the background and historical context for the present day study. This is in line with Taylor, Stephen, and Kathryn (2006, pp.239) suggestion that collecting data from secondary sources for qualitative studies is paramount since it provides the background information about the study and helps in setting research objectives based on the identified research gap.

Taylor and colleagues also suggest that secondary data helps in supplementing findings made using the primary data collection tools (interviews, observation, and group discussion) based on the brief coverage of the topic under research that may have previously been published. Nevertheless, this data collection tool is not considered as a fundamental data collection tool for qualitative studies.

Using this data collection instrument, a detailed review of the literature for the purpose of obtaining secondary data in relation to the research topic was conducted. In this way, it was possible to provide a holistic picture of the current situation within the UAE healthcare sector and justify the research aims, objectives and questions, in order to gain an approval from DMU Research Ethics Committee on the basis of a justified necessity for this exploration (see Appendix B). Also, the secondary data was used as a background for developing a questionnaire per specified focus groups of the sample invited for participation in the enquiry.

The data collection tools used are in line with Wertz et al (2011) suggestion that data for grounded theory and phenomenological qualitative research approaches is collected using instruments such as in-depth interviews and observations that promote a high degree of interaction between the participants and the researcher. However, Wertz et al (2011) suggest that documents are also valid. The in-depth interviews used are unstructured and contain open-ended questions that help in the collection of rich and meaningful data.

3.6 Data Analysis

Just like most other qualitative studies, data analysis was performed by summarizing the data gathered, and then presenting findings derived from the raw data in a more organized manner so as to communicate the most crucial observations made. The researcher employed thematic analysis approach which entails describing, summarizing, categorizing the mass of words made by the participants, identifying relationships and patterns, as well as developing minor and major themes (Jonker 2010, pp.155; Creswell 2013). The analysis process was conducted while considering specific themes. Tables were used to present the research findings, whereby graphs, charts and tables aided in tabular data presentations (Yin 2011).

Through thematic analysis of the data where all common and uncommon themes were identified and compared, it was possible to detect themes of the interviews, outline frequency of the themes identified, and conduct further textual analysis of these data in accordance with IPA. The above steps comprised the constituents of the general picture of the issue in question in relation to the positions of healthcare professionals and formulate the generalised shared/ common lived experience (Smith, Flowers and Larkin 2009). Further, the findings from all interviews will be compared with the previous researches in area and a list of justified factors that potentially may prevent the Emirati from choosing nursing and medical careers will be composed.

3.6.1 Data analysis process
In the data analysis procedure, the researcher followed the four-stage guidance appropriate for IPA method, as it was explained previously (see Figure 1 below).

Figure 1: IPA data analysis

Source: (Creswell 2013)

First, the recorded interviews were accurately transcribed and re-read by the researcher. Secondly, the theme identification phase was performed. At the current stage of the enquiry, the researcher worked with the verbatim text obtained from semi-structured interviews containing rich narratives on the set questions presented by the participants such as cutting and sorting world lists and key word in context (KWIC) techniques (‘Finding themes’ n.d.). In this way, both a priori and novel themes were identified in the research. Finally, while initial clustering of the themes was performed, the summary table containing a variety of themes derived from the interview context will be created on the next stages of the research procedure with regard to a greater number of interviews conducted and materials obtained for analysis accordingly.

3.7 Promoting validity and trustworthiness of the data collected

3.7.1 Bracketing strategies to promote validity and trustworthiness of the findings
Whereas the researcher was well aware on the topic under consideration, there was a need to ensure that one “does not influence the participant’s understanding of the phenomenon” (Chan, Fung and Chien 2013, p.1). A means that was used to establish the above principle in a research procedure is bracketing, i.e. putting aside one’s own knowledge on subject, beliefs, experience or any attitudes concerning the data to be collected while conducting the study.

Chan, Fung and Chien (2013), Charmaz (2014), and Charmaz (2012) underlined that in hermeneutic phenomenology, there is certain knowledge on the issue in question, but specified gaps are to be clarified in this case. Therefore, the investigator ensured that appropriate measures were taken to minimise own impact on the findings interpreted. In order to achieve this goal, the researcher followed the strategies proposed by Chan, Fung and Chien (2013) to minimise personal bias as potential influencers on the research outcomes in conducting the study:

Reflexivity based on self-reflection: The researcher honestly and precisely detected own interests and values with respect to the study objectives and attempted to mitigate their potential influences by bracketing them. This was done via writing a reflexive diary, with indication of personal feelings, interests and perceptions during the enquiry process (Chan, Fung and Chien 2013).

Deciding the scope of the literature review

Findings made in the previous studies relating to the present day research problem were analysed and incorporated as a basis for the framework of the research procedure. For instance, the findings of precursors were useful in terms of justification of the topic under discussion, methodology to be used, and development of questionnaires per targeted groups of respondents. Hence, one paid attention to that the task of the literature review in this case was to “justify the research proposal while maintaining own curiosity in this area” (Chan, Fung and Chien 2013, p.4).

Planning data collection: This phase referred to interviewing the respondents in accordance to the developed semi–structured questionnaires. In this regard, the questionnaire was perceived as a schedule guide in the process to allow the interviewees expand and elaborate on the points, but not provide the directives for a response.

Planning data analysis: Overall, one-on-one interviews, in line with interpretive phenomenology, enabled participants to develop “rich descriptions of human experiences” (Chan, Fung and Chien 2013, p.5). Nevertheless, the researcher had to be sure that the answers provided by the respondents were valid and correctly interpreted by the investigator. In this case, the Colaizzi’s data analysis method was applied to maintain trustworthiness of the research outcomes (Chan, Fung and Chien 2013). It allowed detecting meaningful information from responses, organising it into themes as well as categorising them, while minimising misinterpretation of the data analysed (Charmaz 2014; Charmaz et al. 2014).

Following the above steps, the researcher aimed to ensure the integrity of the data collected and minimise occurrence of any potential bias in the process of data interpretation.

Translation issues

Due to the fact that all respondents were of Emirati origin and interviews were conducted in Arabic, the issue of translation had to be taken into account in the research strategy. The English versus Arabic language was not set as an eligibility criterion and choosing either Arabic or English language for answering the questions was dependent on the choice of the respondent. At the same time, it is necessary to pay attention to that the “participants and the main researcher had the same non-English native language and the non-English data lead to an English publication” (van Ness et al., 2010, p.314).

Therefore, there was a need to “minimise potential threats to validity” by the investigator (Esposito 2001, p.568) in order to ensure that the results obtained were of high quality and credibility. First, both the researcher and participants were of the same language origin. Thus, the data collection process, transcription, as well as initial interpretation of the primary findings obtained, should not have had any translation difficulties, in line with the rationale provided by van Ness et al. (2010) and Larkin and de Casterlé (2007), who emphasised on the consistency of these processes if the researcher and the sample involved speak the same language. Simultaneously, interpretation challenges linked to a proper translation of the meaning conveyed may appear even when the assistance of a translator is applied (van Ness et al. 2010) thereby making impacts on the study findings (Larkin and de Casterlé 2007).

Secondly, the researcher proficiently speaks the two languages, though using the recommendation by van Ness et al. (2010, p.315) is advisable, when “a researcher” should operate “as a moderator in cooperation with a professional translator.” Nonetheless, the researcher had little funds available to hire a specialist for assistance with translation during all interviews. Therefore, the investigator will use the professional’s assistance at least in the final findings interpretation part dealing with highlighting the quotations from the participants “to contribute to trustworthiness of the qualitative research” (van Ness et al., 2010, p.316). Also, piloting of the questionnaire showed that translation concerns were not a high-degree threat to the data integrity and validity.

3.7.2 Data Triangulation
A number of strategies were implemented in attempt to ensure that the data collected was valid, trustworthy and authentic. One of such strategies employed included data triangulation, which is described as the cross verification of the data and findings made in a study. For the present day study, the researcher relied on inter-rater reliability triangulation which encompasses independent evaluation of the collected data, with the aim of finding out whether the respondents made consistent or closely related reports. Data triangulation played an instrumental role in ensuring that the collected data was accurate and reliable.

3.8 Ethical Considerations
Various ethical issues were considered before conducting the interviews. To start with, participants were informed about the purpose and objectives of the research, as well as the sequence of the introduced procedures. Furthermore, the researcher received the informed consent from the participants. The research was organised in line with the ethical guidelines provided by the British Psychological Society (2009). In addition, guaranteeing the participants’ confidentiality of their personal information was one of the central ethical principles. Guaranteeing confidentiality was ensured by giving one’s commitment to the provisions of the data protection legislation concerning the storage, processing, and access to information (Cresswell 2013; Wertz et al. 2011).

Moreover, the participants’ anonymity was protected by assuring the participants that their identities will be anonymised. All information for the research was obtained from individual consent of every participant by explicitly explaining all relevant aspects of the enquiry, the participant’s role in the process, and answering all questions regarding the research procedure that appeared in the process.

3.9 Piloting
Following the reasoning provided in the ‘Research Methodology’ section, pre-testing of the research procedure by means of piloting was conducted. This mini-research phase allowed the researcher to detect certain flaws and clarify the research potential of the questionnaire developed, in accordance with the rationale presented by van Teijingen and Hudley (2002), Seidman (2013), Sampson (2004), and Chenail (2011). In particular, one participant from each respondent group was interviewed.

The interviews were conducted in the Arabic language in order to make sure that they could expand on the topic freely without any cultural barriers or other obstacles, as well as understand if the issue of translation may be a sufficient barrier in the data interpretation. Regardless of that, the questionnaire was initially developed in English, the investigator took into account translation issues and all formulations of the questions were interpreted by the researcher accurately.

The findings of the piloting were of great importance for the implementation of the main research. First and foremost, the researcher had to cut some questions planned for the interview guide initially. During pre-testing, some of the questions resulted into repeatable answers or the interviewed participants of a particular group could not find appropriate answer to the question as it was articulated (Cresswell 2013; Yin 2011; Chenail 2011). Similar suggestions were made by Seidman (2013) and Sampson (2004).

Consequently, the interview protocol was adjusted on the basis of piloting results. In this way, the researcher was able to understand the importance of creating “study-specific questions for the interviews” in order to conduct “naturalistic and discovery-orientated inquiries” should be undoubted as compared to “utilising of pre-established questionnaires or survey instruments” (Chenail 2011, p.255).

The piloting procedure enabled the investigator to realise that the above approach is a knowledge-transition manner in which “investigators become instruments through which data for their studies are collected or generated” (Chenail 2011, p.255). Moreover, it was a good experience to test some ethical considerations, such as researcher-to-respondent collaboration. Although initially the researcher was not sure whether or not the respondents will be likely to allow using technology in recording of the interviewing, all participants piloted did not forbid applying a Dictaphone in the process.

Besides, the researcher had an opportunity to clarify the approximate interview duration, which was one hour, plus-minus ten minutes on average, or practically the same as planned initially. Finally, the results of the performed piloting allowed clarifying common, a priori, themes, i.e. the ones identified during the literature review (e.g. education as a preventive factor for Emirati in pursuing a career in healthcare), and uncommon themes (e.g. strong feminist worldviews in some female respondents).

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Appendix A

Questionnaire Guide (Semi-Structured Interview)

Your willingness and availability to participate in this study is highly appreciated. The central aim of your kind assistance is to identify and clarify the factors preventing Emiratis from choosing a healthcare profession in medicine and nursing amongst other career opportunities. This objective will be achieved by means of phenomenological approach. This technique refers to researching of your attitudes, beliefs, and perceptions concerning the topic and understanding this phenomenon from your standpoint, as a first-hand participant of this process. As a result, the researcher has developed a set of questions with respect to the phenomenological method. In this way, it is possible to cover a range of care delivery issues and create a shared perception of stereotypes preventing the Emirati from pursuing healthcare careers in medicine and nursing. What is more, the questionnaire is formulated as a semi-structured interview in order to allow you (an interviewee) lead the conversation and reflect on the topic. Undoubtedly, confidentiality of the information you give during this study is guaranteed since all the data obtained will strictly be used for the purpose of the study. The researcher also acknowledges that you may not be in a position to answer all the questions. Please feel free to answer as many questions as you can.

Group A : Medicine and nursing students
Group B : Experienced/Graduated medical staff
Group C : Healthcare managers
Group D : Government officials
Note: Under each question, I have noted the group that was capable to provide the most informative and explicit answers for the posed question.

Questionnaire for Medical and nursing Students

Objective 1

What factors did influence your choice of a specialisation in medicine?
(Group A/B)

How did your parents/friends or relatives influence your choice?
(Group A/B)

Does the information from the media affect your choice? If yes, How?
(Group A/B)

In your opinion, what benefits (if any) does medicine/nursing career offer?
(Group A/B)

What can you tell about the government policies in this regard? Did they influence your choice?
(Group A, B)

Do you think that a medical occupation is popular in UAE? How?
(Group A, B, C, D)

In your opinion, what challenges healthcare practitioners may face in pursuing their degree/ career?
(Group A, B, C, D)

How developed the level of education in the field is?
(Group D)

What about IT in medicine? Is it an encouraging/ discouraging factor for being a medical or nursing student/ for being a doctor or nurse?
(Group A, B)

From your point of view, is gender important in terms of choosing a major in healthcare?
(Group A, B, C, D)

What do you think of expatriates in the role of medics in UAE?

(Group B, C, D)

Objective 2

What do you think can improve the current healthcare in UAE?
(Group B, C, D)

Which governmental incentives can be used as assistance?
(Group A, B, C, D)

How can educational infrastructure help?
(Group D)

How healthcare career popularity as a career can be increased among the Emiratis?
(Group B, C, D)

Thank you so much for your kind assistance!


 

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