Abstract
Purpose There is limited research regarding how work-life balance (WLB) affects job satisfaction, and intention to leave among dental hygienists in clinical practice. The purpose of this study was to examine the relationships between WLB, job satisfaction, and turnover intention among dental hygienists.
Methods This study used a cross-sectional research design with a convenience sample of dental hygienists (n=274) recruited via social media. The web-based survey consisted of demographics and work characteristics, followed by three previously validated survey instruments: WLB Measure, Job Satisfaction Questionnaire (JSQ), and Turnover Intention Scale (TIS). Descriptive, correlational, and inferential analyses were used.
Results The survey completion rate was 76% (n = 209). Participants reported an average WLB of 3.20 (SD = 1.06) and an average JSQ of 3.54 (SD = 0.67) on a scale of 1 to 5. Additionally, participants reported an average TIS of 16.75 (SD = 6.22) on a scale of 6 to 30. A regression analysis with WLB, JSQ, and covariates was done to identify predictors of turnover intention. The model predicted 63% (adjusted R2 = 0.63, F (7, 200) = 47.33, p < .001) of the variance in turnover intention. Lower job satisfaction (JSQ; β = −0.65, t = −13.86, p < .001) and WLB (β = −0.21, t = −3.97, p < .001) predicted higher turnover intention.
Conclusion Findings suggested both job satisfaction and WLB were predictors of an employee’s turnover intention or intention to leave. These results suggest employers should consider their role in employees’ overall WLB, and job satisfaction, considering factors such as workload, communication, opportunities for advancement, and adequate recognition to retain dental hygienists.
INTRODUCTION
Currently, there is a high demand for dental hygienists in the United States (US).1 In addition, the US Bureau of Labor Statistics reports employment of dental hygienists is expected to grow 9% from 2023-2033, much faster than the average growth of dental hygienists in previous years, with about 16,400 openings for dental hygienists projected annually.1 It has also been reported that many of the positions needing to be filled are due to workers leaving the profession, leaving the workforce, or retiring.2 During the COVID-19 pandemic, dentists reported difficulties in hiring and retaining dental hygiene staff due to safety concerns and trouble finding childcare.2 However, these difficulties have persisted past the pandemic. Dental hygienists who have left their jobs or the dental field altogether report reasons including a negative workplace culture, insufficient pay, and feeling over-worked.3 Another factor in retention of health care providers is work-life balance.4 While there has been research into the effect of job satisfaction on burnout among dental hygienists,5–8 the effect of WLB on job satisfaction and intention to leave is unknown.6
The concept of WLB is when work and personal responsibilities complement each other and support well-being and personal growth.9 There has been difficulty in the past establishing a definition that can be agreed upon due to different conceptualizations of perceived WLB in employees.9 However the above definition has been endorsed by Khalil et al. after reviewing seven different conceptualizations of WLB found in literature (multiple roles, equity across multiple roles, satisfaction between multiple roles, fulfilment of roles, salience between multiple roles, relationship between conflict and facilitation, and perceived control between multiple roles).10 Research in the health care field, specifically among nurses, has shown that WLB is an important factor to consider when looking at burnout, job satisfaction, and intention to leave.11 A study with nurses demonstrated that a higher perceived workload contributed to an inability to maintain a healthy WLB, thus increasing the intent to leave the field.11
Similar to nursing, dental offices have been facing shortages of dental hygienists, potentially increasing workloads, causing concern about having enough providers to care for the number of patients seeking care.12 Dentists reported in January 2022 that staffing issues were their most significant concern.3 This has not improved significantly over time, as in 2025 across all practice types and dental service organizations (DSOs), 33-40% reported recruiting a dental hygienist in the past three months, and 75% of those practices indicated that it was very challenging to hire staff.13
Along with factors such as benefits, wages, and growth opportunities, retention strategies should include promoting a positive WLB.12 The purpose of this study was to examine the relationships among work-life balance, job satisfaction, and turnover intention among dental hygienists. The specific aims for the study included measuring the perception of work-life balance among dental hygienists; measuring job satisfaction among dental hygienists; determining turnover intention among dental hygienists; and modeling the relationship between work-life balance, demographics, and job satisfaction on turnover intention among dental hygienists.
METHODS
A cross-sectional survey research design was used with a convenience sample of dental hygienists in the US recruited via social media. The MCPHS University Institutional Review Board gave this study exempt status and assigned protocol number IRB-2024-2025-86. A CROSS checklist was used to guide reporting of methods and results to ensure reliability and transparency.8
Participants
The participants were recruited using social media sites such as Facebook, Instagram, and Reddit. Social media pages were found using the key terms dental hygiene, dental hygienists, RDH, and dental. Pages with over one thousand members were chosen for recruitment. The target population of this study was dental hygienists living in the US who were actively providing patient care at least 16 hours per week, and with a minimum of one-year of experience. Dental hygienists who had less than one-year of experience, did not live in the US, or worked less than 16 hours per week were excluded. An a priori power analysis was conducted using G*Power (Version 3.1.9.7) to determine the minimum sample size required for a multiple linear regression analysis. The results indicated that a minimum sample size of 118 participants would be sufficient to detect a medium effect size (f = 0.15) with a power of 0.80 and an alpha of 0.05 for significance.
Instrument
The final survey consisted of 55 items and used three validated instruments. The sections of the survey included: demographics and work characteristics (11 items), work-life balance (WLB) (4 items), job satisfaction (JS-Q) (34 items), and turnover intention (TIS-6) (6 items).
The WLB measure by Brough et al. measured perceptions of balance between a person’s work and other aspects of life.14 The instrument consists of four items using a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). The WLB measure was validated using psychometric testing in four samples of workers in Australia and New Zealand (n = 6983).14 A confirmatory factor analysis (CFA) was also completed to establish the results were an acceptable fit across the different samples, as well as testing against work demands and outcome variables such as job satisfaction, turnover intention etc. The Cronbach’s alpha for each sample was acceptable, ranging from 0.84 to 0.94.14 In this study sample, the Cronbach’s alpha was .93 showing high reliability and scores were calculated by averaging responses across the four items, higher values on this scale indicate increased work life balance.
The Job-Satisfaction Questionnaire (JS-Q) was created and validated by Ahmad et al. to measure job satisfaction among healthcare workers.15 This survey consists of 34 items divided into 8 domains: teamwork (5 items), leadership (5 items), reward and recognition (5 items), empowerment and participation (5 items), training and individual development (5 items), working hours (3 items), communication (4 items), and working conditions (3 items). A 5-point Likert scale was used for responses (1 = strongly disagree to 5 = strongly agree). The JS-Q was validated using both an exploratory factor analysis (EFA) and CFA, and showed an acceptable reliability with Cronbach’s alpha > 0.75 for all items and sub-scales.15 In this study, the JS-Q showed high overall reliability (α = .95) with higher values indicating more job satisfaction. However, two subscales showed poor reliability (reward and recognition, working conditions; α < .69) and so only the total JS-Q score was used, by averaging all items together. Additionally, one item was inadvertently omitted from the reward and recognition sub-scale in the survey. While a missing item can reduce Cronbach’s alpha and negatively impact reliability, for long measures (e.g., 20 or more items), dropping a single item does not impair overall scale measurement specificity or sensitivity. Given that this scale contains more than 30 items and still showed an excellent Cronbach’s alpha, it was decided to proceed with analyses using the JS-Q.
The Turnover Intention Scale (TIS-6) created by Bothma and Roodt is a shortened version of the original TIS, used to measure the likelihood of an employee leaving their current position.16 The TIS-6 contains 6 questions measuring turnover intention using a 5-point slider scale. The TIS-6 was validated by taking a consensus-based sample and conducting an EFA; the Cronbach alpha was 0.80.16 This scale was also tested across different timeframes (4-month and 4-year follow-up) to confirm validity. The scale showed good reliability in this study (α = .87). Scores were calculated by summing the responses; possible responses range from 6 to 30, with a score of 18 or higher indicating greater intention to leave.
Procedure
Participants were recruited from social media sites including Facebook, Instagram, and Reddit. Dental hygienist-based groups within these social media sites were identified, and group administrators granted permission to post the invitation. The invitation to participate included the purpose, inclusion/exclusion criteria, and contained the link to the survey hosted via an online platform (Qualtrics, Provo, UT, USA). After clicking on the link, participants had to consent before accessing survey questions. Anyone who did not consent was taken to the end of the survey. Qualtrics settings prevented participants from taking the survey more than once, prevented indexing search engines, and used the reCAPTCHA score to identify possible bots. To maintain confidentiality, IP addresses were not collected. Reminders were posted on social media sites a week after the initial post had been made (dates varied due to when permission was granted to post), and no incentives were offered for participation. The survey remained open from May 6 to 28, 2025 when an adequate sample was reached.
Statistical Analysis
The statistical analysis consisted of three steps. In the first step, descriptive statistics (i.e., frequency, mean, standard deviations, skewness, and kurtosis for demographics, WLB, JSQ, and the TIS) were calculated. Correlational analysis was conducted in the second step to test for multicollinearity between WLB, JSQ, and TIS, and to select covariates for the regression model. Covariates were selected from demographic variables if they correlated with any of the primary variables of interest. In the third step, regression analysis was conducted using WLB and JSQ to predict TIS while controlling for covariates. An alpha of .05 was used to determine statistical significance and assessed standardized βs to determine the strength of any statistically significant relationships. Following the analyses, linear assumptions were checked by assessing homoscedasticity, normality, and multicollinearity. These assumptions test whether a linear model is appropriate to use or if a non-linear or non-parametric model is necessary for reasons like skewed data or non-linear relationships (e.g., curvilinear or quadratic).17 Findings from these assessments showed a linear model was appropriate.
RESULTS
A total of 274 individuals accessed the survey link and of those 209 provided responses for at least 80% of the survey items, giving a completion rate of 76.3%. Most of the sample was White (82.3%), non-Hispanic (89%), female (98.6%), and married (65.1%) with a mean age of 42 (SD = 11.4) years. The sample was evenly distributed across the US and most (78%) worked in private practice settings, had provided dental hygiene care for a mean of 16 years (SD = 11.5), and worked an average of 31.7 hours (SD = 7.3) per week (Table I).
Demographics and Work Characteristics (N = 209)
Work-Life Balance, Job Satisfaction, and Turnover Intention
The mean score of the WLB measure was 3.20 (SD=1.06) with a median of 3.5 on a scale of 1 to 5. While the majority of participants were above the scale midpoint (2.5), 29.2% were below the midpoint suggesting lower levels of WLB. About half of participants (51.2%) agreed or strongly agreed with the statement I currently have a good balance between the time I spend at work and the time I have available for non-work activities and slightly fewer with the statement overall, I believe that my work and non-work life are balanced (Table II).
Work Life Balance Response Frequency (N = 209)
The mean for job satisfaction on the JS-Q was 3.54 (SD = .67) with a median of 3.6 on a scale of 1 to 5. Overall, the majority (93.8%) of the respondents reported job satisfaction above the scale midpoint (2.5) (Table III).
Job Satisfaction Questionnaire Response Frequency (N = 209)
The mean for turnover intention as measured by the TIS-6 was 16.75 (SD = 6.22) with a median of 17 on a scale of 6 to 30. About 40% of participants were above the midpoint of the scale, which was 18. Scores below 18 suggest intent to stay while scores above 18 suggest intent to leave. While about half of participants reported never or almost never considered leaving their job (47.9%), 42.6% reported dreaming about getting another job that better suited their personal needs to almost always or always (Table IV).
Turnover Intention Response Frequency (N = 209)
Work-Life Balance and Job Satisfaction Predicting Turnover Intention
A regression analysis was used to examine whether WLB and JSQ predict TIS (Table V). Covariates included relationship status, degree type, years providing care, and hours worked per week because they were significantly correlated with one or more of the variables of primary interest (i.e., WLB, JSQ, TIS). Consistent with the correlation analyses and appropriate scoring methods for each scale, the regression mean scores were used for WLB, JSQ, and summed totals were used for the TIS. The model was significant with a R2 of 0.63, meaning the predictors explained 63% of the variance in turnover intentions (F (7, 700) = 47.33, p<.001), suggesting that the model had high predictability. None of the covariates were significant predictors of turnover intentions (p > .05) meaning that when accounting for job satisfaction and work-life balance, the covariates did not predict turnover intention. Work life balance significantly negatively predicted turnover intention (β = −0.21, SE = 0.31, t = −3.97, p < .001). Participants with higher, compared to lower, work life balance reported less turnover intention. The model also revealed job satisfaction was a significant negative predictor of turnover intention (β = −0.67, SE = 0.31, t = −3.97, and p < .001). Participants with higher, compared to lower, job satisfaction reported less turnover intention. The results indicated that job satisfaction was a stronger predictor of turnover intention than WLB, as indicated by a larger β (beta).
Regression Model for Predictors of Turnover Intention (intention to leave)*
DISCUSSION
The purpose of this study was to examine the relationships between WLB, job satisfaction, and turnover intention among dental hygienists. Improving retention of employees has benefits including reduced financial loss from recruitment, higher quality of patient care provided, higher care continuity, and higher patient satisfaction.18 Results from this study found job satisfaction was a better predictor of turnover intention than WLB, although WLB was still a significant predictor. Because of this, employers should consider their role in job satisfaction for their employees.
Participants reported moderate levels of WLB. It was noteworthy that nearly one-third of the study sample was below the midpoint on the WLB scale, suggesting a lower level of WLB. The mean score on the WLB scale for the sample (3.20) was similar to research samples in the longitudinal study by Brough et al. (2.58 to 3.1).14 Although Sasaki et al. used a different measure of WLB, the results were similar.19 Their findings also found about one-third (36.6%) of their sample were satisfied or above the midpoint on WLB item.19
The second aim related to job satisfaction with findings showing it was moderate in this sample with a majority of participants scoring above the midpoint on the JSQ. This finding was consistent with previous research suggesting moderate job satisfaction.6,20 In contrast, Sasaki et al. found a majority of dental hygienists (80%) reported being satisfied with their job.19 This discrepancy may be due in part to use of an unvalidated survey by Sasaki et al. or the use of a different instrument to measure job satisfaction.
Although it is not possible to make definitive conclusions about the subscales in the JS-Q due to low subscale reliability, data from previous research suggest that lack of job satisfaction may originate from several specific areas including pay, benefits, and growth opportunities.19 In addition, research by Patel et al. with dental hygienists has suggested dissatisfaction with benefits and rewards.6 These findings point to the need for dental practice owners to explore ways to improve benefits, particularly retirement, and rewards to recognize excellence to improve job satisfaction. Communication to keep employees informed needs improvement, with less than half of participants having positive feelings about it in their practice setting. This finding was also noted in other job satisfaction research with dental hygienists.19
Conversely, the findings from this study suggest strengths in areas like teamwork, leadership, empowerment, and participation in the practice setting. In addition, about half of respondents reported a good balance between work and non-work activities which suggests some employers may be giving attention to WLB.
Overall, when considering job satisfaction items on multiple scales to identify the ones that fit best with a health care setting, it became apparent that development of a job satisfaction scale specific to dental hygienists is necessary. This would allow a more nuanced exploration of factors affecting job satisfaction given that the dental work environment is very different from other health care work settings. Most health care professionals work in large clinics or hospital settings versus the small dental practice settings where many dental hygienists are employed. These health care settings affect the organizational structure, reward and recognition (e.g., retirement and promotion), and aspects of patient care (e.g., time per patient, interprofessional collaboration).
Turnover intention in the sample suggested a trend towards intent to stay. However, 40% of the sample were above the midpoint, suggesting intent to leave which is of concern given the ongoing workforce shortage.3,13 A much larger percentage of participants reported considering another job (42.6%) as compared to the results of Patel et al. (29.6%).6 While the reason for this difference is unknown, it may be related to convenience sampling. However, this finding may suggest a change over time, with dental hygienists choosing to leave their job or the profession, which needs further investigation. Also, there is a systematic review and meta-analysis among Korean dental hygienists about factors impacting intention to leave. While the bulk of the literature is in Korean, using the tabular data, job satisfaction ranked number three and self-growth ranked number six in the statistically significant factors impacting turnover intention.21 Collaboration with those conducting research in the two countries is an opportunity that should be explored in the future.
The present study findings showed a strong correlation between job satisfaction and WLB. This is consistent with research conducted with dental hygienists in Korea.22 This finding suggests that identifying ways to improve WLB may improve job satisfaction. Possibilities for improving WLB include more autonomy with patient scheduling, opportunities for growth,19 enhanced staff support, dedicated breaks and lunch time, empathy and understanding when family needs to be prioritized over work, childcare support, parental leave,22 and more flexibility with paid time off.19,22
Findings from this study demonstrated that job satisfaction strongly predicts turnover intention among dental hygienists. These findings were similar to research among nurses showing job satisfaction as a predictor of turnover intention.23 Recent research has identified the top four factors associated with positive job satisfaction among dental hygienists were a positive workplace culture, practice philosophy, opportunities for growth, and fair pay.19 Other studies with dental hygienists have identified associations between job dissatisfaction, job stressors (e.g., job overload, poor physical environment, psychological distress), burnout, and intention to leave.6,20 Since findings from this study and similar research in the nursing field demonstrated a link between employee WLB, job satisfaction, and turnover intention,11 more research is needed to understand the specific factors impacting dental hygienists’ job satisfaction and WLB.
Limitations
Limitations to this study included the non-probability sample, which may introduce selection and non-response bias and limit generalizability of results. However, when considering the demographics of the study sample compared to that of dental hygienists working in the US the sample was comparable (1.4% men vs. 5.75%, 82.3 % White vs. 79.7%, 4.8% Black vs. 4.15%, and 0 Asian vs. 5.53 nationally).24 Use of social media for recruitment may also result in under-representation of some segments of the dental hygiene workforce such as those who do not use social media.25,26 However social media can also be effective for difficult to reach populations and specialized samples such as dental hygienists.25,26 Self-report in surveys is another limitation which is subject to socially desirable responses. There is, however, a strength in that this survey used previously validated instruments to measure WLB, job satisfaction, and turnover intention. While another limitation was low reliability for two JSQ sub-scales and a missing scale item, the overall JSQ scale reliability was excellent.
CONCLUSION
In this study, the influence of WLB and job satisfaction on turnover intention (intention to leave) among dental hygienists was examined. The results demonstrated that while WLB and job satisfaction were highly correlated, in the final analysis job satisfaction was a better predictor of intention to leave. Given the study findings and the ongoing workforce shortages in dental hygiene, it becomes increasingly important for employers to focus on strategies to improve job satisfaction and WLB to lower intent to leave and retain employees. Further research is needed to identify effective strategies to enhance job satisfaction and WLB among dental hygienists and reduce turnover intention.
IMPLICATIONS FOR DENTAL HYGIENE PRACTICE
Enhancing job satisfaction emerged as the strongest predictor of reduced turnover intention and should be considered as essential for retention of dental hygienists in the workforce.
Although a more moderate predictor than job satisfaction, work-life balance is associated with a lower turnover intention or intention to leave the workforce.
Dental practice settings need to identify and implement strategies to improve job satisfaction (e.g., positive workplace culture, benefits) and work-life balance (e.g., scheduling flexibility, manageable workloads, parental leave) in order to improve the retention of dental hygienists.
ACKNOWLEDGEMENTS
The authors wish to thank Dr. Paula Brough for granting permission to use the Work Life Balance instrument and Dr. Gert Roodt for permission to use the Turnover Intention Scale (TIS-6). The Job Satisfaction Questionnaire (JSQ) was in the public domain and permission was not required.
Footnotes
NDHRA priority area, Professional development: Occupational health (career satisfaction and longevity).
DISCLOSURES
The authors have no conflicts of interest to disclose.
- Received January 1, 2026.
- Accepted April 22, 2026.
- Copyright © 2026 The American Dental Hygienists’ Association
This article is open access and may not be copied, distributed or modified without written permission from the American Dental Hygienists’ Association.
