Intentions to leave and actual turnover of community midwives in the Netherlands. A mixed method study exploring the reasons why | 97 We used the results of part 1 to provide input for part 2. Theoretical framework We used the adjusted Job Demands and Resources model created by Hoonakker et al..13 (Figure 1) as theoretical framework. The decision to use the JD-R model as a theoretical framework is mainly related to its heuristic nature, as it has the potential to identify the demands and resources for a specific professional group, in this case midwives.14 Within this model, the wellbeing of a professional is dependent on two concepts: job demands and job resources. Job demands are the physical, psychological, social, and organisational characteristics of a job. Job resources are the resources that help to achieve work goals or reduce the demands of the job, including receiving feedback, having task control, or having social support. Wellbeing itself is a combination of work engagement and exhaustion/burnout.13-15 Exhaustion/burnout can ultimately lead to withdrawal behaviour, intending to leave and, ultimately, to actual turnover, which is the focus of this study.13 Figure 1. The adjusted Job Demands and Resources model, including the possible outcomes of stress/burnout and job satisfaction/commitment13 PART 1 Survey study In part 1, we conducted a cross-sectional study. We used three questions that were part of the ‘Dutch national wellbeing of midwives study’,16 measuring the wellbeing of midwives in the Netherlands. The ‘Dutch national wellbeing of midwives study’ was conducted in 2019. This cross-sectional study was carried out among practising midwives in the Netherlands using a questionnaire that was constructed using validated scales.16 The validated scales used were the Dutch versions of: (1) the Maslach Burnout Inventory, the UBOS-C (Utrecht Burnout Scale-clients) for professionals working with clients in social professions or health care,17 the UWES (Utrecht Work Engagement Scale),18 the
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