74 | Chapter 4 After every 50 completed questionnaires, a gift certificate (worth 50 euros) was awarded. Data collection closed at the end of April 2019. Figure 2. Flowchart study population Dutch midwives (N=896) Measures All measured variables are presented in figure 3. To measure burnout symptoms, we used the Dutch version of the Maslach Burnout Inventory.32 the UBOS-C (Utrecht Burnout Scale-clients) for professionals working with clients in social occupations or healthcare. Burnout is defined as a syndrome of exhaustion, cynicism and lack of professional efficacy.13 We used the UBOS-C subscales on exhaustion and cynicism. Both subscales are consistent and stable over time, and correlations with other burnout-scales are high, which confirms their content validity.32 The answers were given using a 7-point Likert scale (0=never; 6=always). The outcome was represented by mean scores that ranged from 0 to 6. The manual for the UBOS-C for healthcare professionals defines high exhaustion if scores are ≥ 2.5 and high cynicism if scores are ≥ 1.6.32 We considered burnout symptoms as high when both exhaustion and cynicism scored high.32 *NIVEL = Netherlands Institute for Health Services Research (n = 1301) Records removed: return to sender (n = 60) Records screened (n = 682) Records without informed consent (n = 6) Records assessed for eligibility (n =676 ) Records <100% completed (n = 152) Records included for analysis (n = 524 ) Identification Screening Included Sample midwives from NIVEL* register sample and from Social media recruitment (n=461) Records excluded, without informed consent (n = 0) Records screened (n=461) Records assessed for eligibility (n=372) Records <100% completed (n= 89) Records included for analysis (n=372) Total sample records included for analysis (n = 896) NIVEL register sample Social media recruitment
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