114 | Chapter 5 community and hospital-based care to bundled payments for maternity care collaborations. For some participants, this was one of the reasons for leaving the job. Furthermore, we found that a lack of social resources contributed to the decision to leave the job. A lack of commitment within the team of colleagues contributed to frustrations and conflicts, which also led to increased job demands. Previous research shows that social support from colleagues is a primary contributing factor for wellbeing at work. 28,37 The lack of social resources is associated with a higher risk of experiencing a burnout, an indicator for leaving a job. 38 Not feeling supported by their colleagues, who at the same time are equal business partners, led to increased job demands, i.e., being dependent on the goodwill of business partners for adjustments in work. Previous research confirms that there is a knowledge gap regarding the role of midwives as entrepreneurs, together with being a business partner as an important social resource. 35 Strength and limitations One strength of this study is its mixed methods design. The findings are based on both quantitative and qualitative data among the target population of midwives in the Netherlands. By means of this design, we could study the process of the intention to leave to actual turnover from different perspectives. Moreover, respondents were able to express themselves freely in the survey because of the anonymity of this type of research technique. Within the in-depth interview, we were able to explore and deepen our data. Nevertheless, there is a possibility that participants may have given more socially desirable answers during the interview. The interviewer who carried out most of the interviews is a midwife, which could be a limitation. This may have influenced the participants, either helping or hindering them from telling their own story. However, we do not think that this led to bias because all participants completed a member check and we did not need to make any adjustments. Furthermore, the samples comprised both a representative sample of the population for the quantitative study together with a good variability in participant characteristics for the qualitative study. 1 Another strength of this study is the use of the JD-R model for the methods and analysis of this study. The JD-R model is a heuristic model that demonstrates the possibilities of identifying the demands and resources for a specific occupational group. 14 One weakness of this study is the generalisation to midwives in other countries. In comparison to other countries, midwifery care in the Netherlands is organised differently and the population consists of a large number of community midwives. However, we believe that our results can be used internationally to refine and reorganise maternity care so that midwives can practise in a sustainable way.
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