Correlation between Religious Orientation and Organizational Commitments among Midwives in Fatemiyeh Hospital , Hamedan in 2015-2016 ( Iran )

Shahin Tohidi, Arash Khalili, Safoora Jahan Ara, Shohreh Alimohamadi, Marziyeh Otogara, Arezoo Shayan 1 School of Nursing and Medical Emergencies Poldokhtar, Lorestan University of Medical Sciences, Lorestan, Iran. 2 School of Nursing and Midwifery, Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran. 3 Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran 4 Department of Health Promotion and Health Education, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran.

Please Cite This Article As: Tohidi Sh, Khalili A, Jahan ara S, Alimohamadi Sh, Otogara M, Shayan A. Correlation between Religious Orientation and Organizational Commitments among Midwives in Fatemiyeh Hospital, Hamedan in 2015-2016 (Iran).Health Spiritual Med Ethics.2018;5(1):8-14.Downloaded from jhsme.muq.ac.ir at 10:57 IRST on Wednesday December 5th 2018 perspective, religion refers to the influences of feelings and events that every human being experiences in his/her loneliness, in a way that he/she establishes a relationship between himself/herself and the divine affairs (9).The belief in a transcendent being that is associated with certain requirements in the person's behaviors and experiences is common to all definitions of religious orientation (10).Religious orientation means willingness to do religious practices and have religious thoughts (11).Duane, quoted by Mohammadi, states that individuals with intrinsic religious orientation show their religious practices in their behaviors while those with an extrinsic religious orientation, which has a more ungrown aspect compared to the inner orientation, pursue their own interests and seek to achieve their personal goals (12).Baker et al. reported that there was a direct and significant correlation between extrinsic religious orientation and anxiety, and an inverse significant correlation between intrinsic religious orientation and anxiety (13).Sidi et al. reported that the correlation between religious orientation and happiness was direct and even suggested religious orientation as a predictor of happiness and mental health (14).The study of Hadizadeh et al. showed that the organizational commitment of the midwives very low, and only a few number of midwives had high levels of organizational commitment (15).The study of Sadeghi et al. showed that with increasing religious orientation scores extrinsically, the scores of mental health and self-efficacy disorders increase, and as the scores tend to inner religious orientation, these scores decrease.Sadeghi et al. finally concluded that the extrinsic religious belief was associated with disorders of mental health and self-efficacy and intrinsic religious belief was associated with mental health (16).Abolghasemi et al. also reported that there was no significant association between religious orientation and job performance (17).Some studies have examined the relationship between religious orientation and certain variables such as job performance.In employees with high religious orientation, work activity and occupational attachment are higher, organizational commitment is higher, and thus they have better job performance (15).Midwifery is one of the professions that aim to provide maternal and neonatal health and to promote reproductive health and community health.Since the midwives' work-related stress is high, this high work-related stress can reduce the quality of their work, services they deliver, and their organizational commitment (18).Considering the importance of religious orientation and organizational commitment in the work environment, particularly midwifery, the present study was conducted to investigate the correlation between religious orientation and organizational commitment in midwives working in the hospital.

Methods
The study population of this descriptivecross-sectional study consisted of 100 midwives working in Fatemiyeh Hospital, affiliated to Hamedan University of Medical Sciences.Sampling was conducted by census method and midwives were enrolled in the study if they volunteered to participate in it.After explaining the objectives of the study, the questionnaires were given to the samples and arrangements were made with them to determine the time of returning the completed questionnaire.After the samples completed the questionnaires, the questionnaires were collected.The data collection instruments were the Religious Orientation Scale (ROS) and the Organizational Commitment Questionnaire (OCQ).
The ROS, developed by Allport, has 20 items, 11 of which address extrinsic religious orientation, and the remaining items address intrinsic religious orientation.In this scale, the items of the extrinsic religious orientation are scored as follows: I absolutely disagree: 5; I partly disagree: 4; I partly agree: 2; and I absolutely agree: 1, and for the items of the intrinsic religious orientation are scored as follows: I absolutely disagree: 1; I partly disagree: 2; I partly agree: 4; and I absolutely agree: 5 The lowest scores (9-45) are attained by individuals with intrinsic religious orientation Downloaded from jhsme.muq.ac.ir at 10:57 IRST on Wednesday December 5th 2018 and the highest scores  are attained by those who have extrinsic religious orientation.
The Cronbach's alpha coefficient of this instrument in the current study was estimated 0.75 and thus its reliability was confirmed.
The OCQ, developed by Allen and Meyer in 1990, has 24 items that are scored on a 7-point Likert scale.The OCQ addresses three components of organizational commitment: Affective commitment (the items 1-8), continuance commitment (the items 9-16), and normative commitment (the items .
The minimum and maximum total OCQ scores are 24 and 168, respectively.
The minimum and maximum affective commitment scores are 7 and 56, respectively, the minimum and maximum continuance scores are 8 and 56, respectively, and the minimum and maximum normative commitment scores are 8 and 56, respectively.The Cronbach's alpha coefficient of the OCQ in two studies was estimated 0.88 and 0.94 (21,22).The reliability of this instrument was confirmed by Cronbach's alpha coefficient of 0.78 for the present study.
Data were collected by the SPSS using descriptive statistics and Pearson correlation coefficient.

Result
Out of the 100 participants, 98 had bachelor's degree, one had associate's degree, and one had master's degree.The mean age of the participants was 38.41±2.4 years (range: .
The mean score of intrinsic religious orientation was 39.21±4.25  The highest commitment was the normative commitment.According to the scoring protocol of the OCQ, the participants had high organizational commitment.
According to Pearson correlation coefficient, there was a direct and significant correlation between internal religious orientation and total organizational commitment score (p=0.01,r=0.15).
There was a weak correlation between external religious orientation and organizational commitment (r=0.02), which was not statistically significant (p=0.78).

Discussion
The purpose of this study was to determine the relationship between religious orientation and organizational commitment of midwives working in Fatemiyeh Hospital, Hamadan.
Based on the findings of the study, our participants with a mean score of 136.3±8.07 years had a high organizational commitment, because according to the OCQ scoring protocol, the maximum total organizational commitment score is 168, which is close to the maximum total score attained in our study.
There was a direct and significant correlation between intrinsic religious orientation and total organizational commitment, but no significant correlation was observed between extrinsic religious orientation and total organizational commitment.A study in Malaysia showed that 50% of the nurses had high-level organizational commitment (23), and a study in Golestan, Iran showed that only 4% of the nurses had very high organizational commitment and 25.5% had high organizational commitment (24), which is consistent with the results of the present study, but Hadizadeh et al. reported that the organizational commitment of the midwives participating in their study was very Downloaded from jhsme.muq.ac.ir at 10:57 IRST on Wednesday December 5th 2018 low and low, and only a few midwives had high organizational commitment (15).A study in Golestan, Iran showed that the organizational commitment of the nurses working in the intensive care unit was lower than that of the nurses working in the general wards, but the difference was not statistically significant (24).
The reason for some inconsistencies in the results of the present study and other studies may be due to differences in the settings of the studies or the work environments, such as the maternity, specialized or general wards in hospitals or clinics.
In the study of Ghasemli et al., the correlation between extrinsic religious orientation and spiritual health was inverse and significant, while intrinsic religious orientation was directly correlated with spiritual health (25).
These results, in agreement with the results of our study, show the greater effect of intrinsic religious orientation on the studied variable.
Notably, studies have shown that organizational commitment is not associated with occupational burnout (26).This finding can be explained by the difference in religion and the level of religious teachings and the culture of societies.A study showed that there was a direct and significant correlation between extrinsic religious orientation and anxiety, and there was an inverse and significant correlation between intrinsic religious orientation and anxiety (12).
In line with the results of this study, the study of Abdollahi showed a relationship between intrinsic religious orientation and total organizational commitment.
That study showed that there was a relationship between the components of organizational commitment and spirituality in the work environment (27).
The studies of Ghanbari et al. ( 28) and Bahrami et al. (7) found a significant and direct correlation between religious orientation (intrinsic) and organizational commitment, which is consistent with the results of the current study.
Religious orientation is one of the predictors of general health and is considered to be in the same class as a component such as happiness (29).
Since medical professions such as midwifery are among the jobs that are affected by various stressors due to the responsibility to provide comfort, care and health to patients, it is important to maintain general health in stressful working conditions, and religious orientation can be helpful in this regard, and promoting mental health of individuals can have a positive impact on their organizational commitment.
Commitment is a multidimensional and subjective experience.Intrinsic motives are important to maintain commitment, so that the committed person can easily ignore his/her own personal issues and devote his/her power to the actions that are important to the stakeholders of his/her workplace (30).
The existence of a positive and significant correlation between organizational commitment and quality of work life (15) can be useful to assess the quality of life in health care workers such as midwives.
Therefore, the existence of a direct correlation between intrinsic religious orientation and organizational commitment can be considered a variable related to quality of life.
In general, people who find deep meaning and concept in their workplace have a sense of solidarity with others at work, see their values and goals in the values of the organization, believe that the organization values and considers the issues of its employees, and are adequately considerate, leading to their peace as they are fulfilling their duties in the organization (31).
Accordingly, due to the correlation between religious orientation and organizational commitment, religious orientation can ultimately contribute to organizational development by positively influencing personal performance.
If employees have a positive perception of religious orientation, they will feel highly committed to perform their duties (32).
Religious beliefs have a positive impact on meaning of life, and religious practices such as prayer, pilgrimage, etc. can lead to inner peace by creating hope and encouraging to adopt Downloaded from jhsme.muq.ac.ir at 10:57 IRST on Wednesday December 5th 2018 positive attitudes.The hope for God makes people less vulnerable to life problems (33,34).
Religious orientation has direct effect on mental, spiritual and physical health through the initial challenging assessment of situations (35).
Religious orientation also leads to happiness (36).It is clear that physical and mental health of staff in any organization, including health care organizations, is of great importance in the quality of services provided by them.
Continuous and vigilant presence at the bedside of patients and the people referring to health facilities requires healthy staff because such staff can constantly update their information with energy and commitment and to implement it in the arenas of health care provision for the community, and thus, in addition to achieving organizational goals optimally, they can lead the current community towards a more healthy one.
Koch and Steers studied the factors affecting organizational commitment.They identified personal factors such as the initial commitment and feeling belonging to the organization as an important factor, with the initial commitment referring to feeling committed in the early entrance to the organization because it can turn into a self-reinforcing cycle (37), so if religious values can be internalized in the staff by the mass media, education, universities, and other institutions, their organizational commitment will be enhanced.
The existence of an organizational commitment in the organization will help the managers of the organization to rely on the presence of individuals and be able to design long-term plans for the organization, since the organizational commitment of employees is one of the best predictive tools to ensure their continuous collaboration with the organization.
The main basis of the organization's plans for achieving the goals is human resources, and organizations, according to the existing human resources' capabilities, adjust their working procedures and, in the event of a low organizational commitment in the staff and their departure from the organization, the organizational plans will face challenges and even fail (38).

Conclusion
Clinical and midwifery care is confronted with many challenges, and midwives, with a regular presence at the bedside of client, have an important effect on satisfaction levels of the patients and other people referring to health facilities.Considering the results of this study and the positive correlation between the intrinsic religious orientation and organizational commitment.
it is suggested to take into account organizational commitment in the provision of health care services to develop the organization, create a work environment for the optimal delivery of services, and maintain satisfaction and health of midwives as well as with regards to the dominant religious context in Iran.