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Heidary Y, Alavi A. Relationship between Glass Ceiling and Job Promotion in Women Employees of Health Centers. JSBCH 2023; 7 (2) :1118-1125
URL: http://sbrh.ssu.ac.ir/article-1-217-en.html
1- Department of Health Services Management, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran , yh1357zahra@gmail.com
2- Department of Nursing, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
Keywords: Occupational, Health, Women
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Relationship between Glass Ceiling and Job Promotion in Women Employees of Health Centers
Yousef Heidary a , Azam Alavi b *

a Department of Health Services Management, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran.
b Department of Nursing, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran.
A R T I C L E I N F O A B S T R A C T
ORIGINAL ARTICLE
Background: Glass ceiling is introduced as an obstacle to the progress of competent individuals, especially women within organizations. The purpose of this study is to determine the relationship between the glass ceiling and job promotion of in Women Employees of Health Centers.
Methods: This was a correlation-descriptive study. 142 female employees working in the health centers of Shahrekord were studied through census. Data were collected using two Smith Glass Ceiling Questionnaires and a job promotion questionnaire in Chow organizations. Data analysis was performed with descriptive and inferential statistics tests (Pearson correlation) using SPSS software Ver.24.
Results: Pearson correlation test results showed that there was a negative and significant relationship between the mean score of the glass ceiling and the job promotion of women working in health centers (r = 0.73and p < 0.001).
Conclusion: According to the findings of the study, glass ceiling can prevent women's progress in health centers. Therefore, it is suggested that the Ministry of Health and health centers officials emphasize the meritocratic system and ask for support from the women who have shown the necessary capabilities in managerial positions.

Keywords: Occupational, Health, Women,Employment

Article History:
Received: 21 May 2023
Revised: 01 Aug 2023
Accepted: 07 Aug 2023
*Corresponding Author:
Azam Alavi
Email:
Azam_alavi92@yahoo.com
Tel: +98 38 33361003

Citation:
Alavi A, Heidary Y. Relationship between Glass Ceiling and Job Promotion in Women Employees of Health Centers. Journal of Social Behavior and Community Health (JSBCH). 2023; 7(2): 1118-1125.


Introduction
Women in every society play an important role in development if they are used with equilibrium and equality in different sectors to suit individual abilities and characteristics. women as a valuable asset in the path of development can increase the dynamics of organizational functions(Shafi et al., 2021; Shortland & Perkins, 2020). People are the most valuable resources of any organization and have the most important role in the development of the organization. According to the researchers, the organization's growth depends on the professional growth of employees. Women, as half of this valuable resource, face challenges in their professional development path (Khuong & Chi, 2017; Nazari, 2021; Taparia & Lenka, 2022). In the current society, though the claim of equality between sexes (men and women) regarding social and human right is being accepted; there is much distance between rational acceptance and its implementation. Still, attitudes and values of societies, especially developing societies, are in terms of power in the patriarchal structures (Jung & Cho, 2020). However, obstacles experienced by women are global phenomena in achieving high management positions. Compared to men, women are generally employed at a lower-level and lower-cadre positions (Mohammadkhani & Gholamzadeh, 2016; Sharma & Kaur, 2019a).These major and typically invisible obstacles in literature are known as "glass ceiling"
The glass ceiling is a metaphorical reference to the systemic and invisible barriers created in workplace which prevents minority groups from achieving high leadership and management, blocking their socio-economic progress (Gallardo-Pérez et al., 2021; Kulik & Rae, 2019; Lalisarabi, 2022; Mert, 2021). This phenomenon prevents many employees from progressing to high -level organizational and managerial positions (Cohen et al., 2020). This phenomenon, which is the result of many factors and elements, is a sign of cultural lag and is due to the inappropriate generalization of the biological differences between men and women in working areas with negative consequences- not making proper use of women's intellectual and specialized capabilities and managerial capabilities (Latifi & Karimi, 2019; Sharma & Kaur, 2019b). In fact, some women start growing up with others as they enter organizations, but as they reach higher levels, their growth rate decreases until they hit invisible agents (glass ceiling) (Chisholm-Burns et al., 2017).  The study by Rahim  et.al  suggested that women progressed marginally to a certain level in the organizational hierarchy before they faced glass ceiling that prevented their vision of achieving the top management levels (Rahim et al., 2018). Promotion of jobs is one of the most important concerns of all employees in today's organizations.
Occupational promotion refers to the stairs of progress in occupational and organizational positions. In other words, a job promotion contains the concept of progress in organizational situations in a workplace and how people can step in the path of promotion. Promotion is defined as a clear path to progress in organizational positions and the availability of organizational positions to all when competent (Lemons, 2003). According to the report released by The American Association of University Women (AAUW) (2016), women have recorded significant improvement in labor participation and executive positions, but there is stark disparity regarding women representation in corporate leadership position in many other institutions (Rahim et al., 2018).Governments are currently seeking NGOs as well as international organizations to promote women to an equal position with men in many areas, including medical health and education. In the field of health, despite the fact that women are involved in medical treatment, they are still under control of men and the patriarchal schemas (Mohajeran et al., 2017). Occupational progress is one of the most important factors in an organization. Organizations are a place where employees find ways to move up the job ladder. The purpose of job promotion in this study is for women to access more key posts. The culture of society plays an effective role in limiting women's job opportunities. In order to achieve balance, equality and elimination of discrimination and thus better development of society, it is necessary for women to be able to participate in the decision -making process at different levels of society. Over the last few decades, despite the significant increase in women's employment in the community, the development of women's job progress in management jobs has not yet increased, and their achievement to high levels of management is considered unusual. Given the important and prominent role of women in occupations such as health centers as well as the lack of research in this regard, this study aims to determine the relationship between glass ceiling and the job promotion in Women Employees of Health Centers of.

Methods
This study was a correlation-descriptive study. 142 female personnel working in the headquarters of the health network and health centers of Shahrekors city in Chaharmahal and Bakhtiari province (doctors, midwives, health caregivers, environmental health and occupational health experts) in the first half of 2020 entered the study by census method. The criteria for the entry of samples included having at least an associate degree, one year of work experience with contractual and formal recruitment, and the desire to participate in the study. After receiving a letter from the Islamic Azad University of Shahrekord Branch and referring to the Vice President of Research and Technology of Shahrekord University of Medical Sciences and the head of the Shahrekord Health Center, the questionnaires were distributed. Before starting work, the subject, the method of implementation and the purpose of the study were explained to the participants and informed consent was obtained. It was also assured that the private and personal information of the volunteers would be protected.
Data collection tool included two standard questionnaires, a glass ceiling questionnaire based on Smith model (2012) with a 38 score Likert scale questions (I fully agree (5), I agree (4), relatively agree (3), I disagree (2), and completely disagree (1), the minimum score in this tool is 38 and the maximum score is 190. the higher this score, the greater the glass ceiling in the organization would be(Bayati & Alavi, 2019). The formal and content validity of the questionnaire has been approved by Cronbach's alpha 0.82(Latifi & Karimi, 2019). The Chow Job Promotion Questionnaire has 8 questions and aims to examine the reasons for employees' job promotion in organizations. This questionnaire is based on the Likert scale including very important (1), important, (2), not somewhat important, 3; low important, 4; not important 5). In this questionnaire the minimum score is 8 and its maximum is 40 and the higher score indicates a better job promotion score. The reliability of the questionnaire regarding Cronbach's alpha method was 0.81(Chow & Luk, 1996). In the study byNekui Moghaddam et al., the reliability of this questionnaire was approved and Cronbach's alpha 0.78 was reported(Nekoei Moghadam et al., 2011). In the present study, the Cronbach's alpha was 0.86.
Data were analyzed by descriptive and inferential statistical tests (Pearson correlation, Mann-Whitney and Kruskal-Wallis) using SPSS software ver. 24.
This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Falavarjan Islamic
Azad University (
IR.IAU.FALA.REC.1397.01).

Results
Data analysis showed that majority of the samples 69 subjects (48.59%) were in the age range of over 40. The majority of the samples 59 (41.55) had undergraduate degrees and 59 subjects (41.55%) had a work experience between 11-20 years, Table 1.
 
Table1. Demographic characteristics of women employees in health centers
Frequency Percent
Age < 25 10 7.04
26-40 63 44.37
> 41 69 48.59
Years of work experience 1-10 42 29.58
11-20 59 41.55
> 20 35 24.64
Unanswered 6 4.22
Education Associate degree 24 16.90
BSN 59 41.55
MSc 53 37.32
MD 6 4.22
 
The Mean score of glass ceiling for female staff of the health network was 2.54 ± 0.82, and their mean score of job promotion was 3.75 ± 0.75. The results of Kolmogorov-Smirnov test showed that data had normal distribution. The results of Pearsons҆ correlation test demonstrated that there was a negative and significant relationship between the glass ceiling and job promotion (r = -0.732 and P < 0.001), Table 2.
 
Table 2. Correlation coefficient between glass ceiling and job promotion in women employees of health centers
Job promotion
142 N Glass ceiling
-0.732 Pearson correlation
0 < 001 P
 
Discussion
The results showed that there was a significant negative relationship between the glass ceiling and job promotion in Women Employees of Shahrekord Health Centers. In this context, Mohajeran et al.'s study (1396) showed that from the perspective of nurses, gender discrimination and gender stereotype and glass ceiling have been stated as the most important obstacles to promotion of nurses (Mohajeran et al., 2017). The findings of Nazarpour et al.'s research (1401) also showed that there was a significant and negative connection between glass ceiling and organizational development of female staff (physician, nurse and health workers) at Lorestan University of Medical Sciences (Nazarpouri & Sabzi, 2022). This confirmed the results of the present study. The results of this study are also in line with the findings by Glass and Cook (2016). The researchers reported that women perceived glass ceiling as one of their main obstacles, and that the leaders of organizations also play a role in this process; so, they lose their interest in their job and their performance is damaged (Glass & Cook, 2016). The glass ceiling creates barriers which make job conditions and progress for women less than than men. The study by Alwis et al. revealed that there was a negative relationship between glass ceiling and the development of women's career (De Alwis & Bombuwela, 2013). In fact, it can be acknowledged that the beliefs related to the barriers to job progress applied to women can increase or decrease their job level. Occupational beliefs make goals, which may lead to the choice of job path and behaviors in organizations.
 In line with the results of the present study, Titrak et al. (2014) also showed that women are keen on developing their personal skills to become leaders in the community, and they are increasingly believed to be decent leaders in society. However, women continue to believe that there are special obstacles in Turkey on the way of becoming a manager, which reduces their job performance (Titrek et al., 2014). In addition, Molaei et al. (1399) in a meta-analysis on the obstacles to women's promotion to the levels of governance in Iranian government showed that the glass ceiling is one of the most important obstacles to women's promotion. The increasing importance of human development paradigm has justified the pursuit of governments politically and culturally on the subject of women's partnerships. It is undeniable that in society, women suffer from inequality, and many women, and even men, are protesting. The difference between male and female employees and the clear restriction of women in managerial positions, and many other disadvantages indicate the existence of discrimination between men and women in organizations (Molaei et al., 2020).
 In addition, the results of YU's (2020) study indicated that glass ceiling is still one of the reasons for women's inaction in their federal elections and prevents them from their career (Yu, 2020). According to Sharma et al.'s research (2019), from the perspective of female managers working in India's service (hospital, banking, information), the concept of glass ceiling has been introduced in their career progress (Sharma & Kaur, 2019a). One of the factors in the absence of women in the organization is their low social capital and discrimination between men and women in accessing strategic resources and situations. This will give them less information, resources and support, and their chances of promotion are reduced (Rezapour et al., 2021). In this context, the results of Latifi et al. suggested that the glass ceiling of female staff in the academic organization is inversely related to feeling capable and its components (independence, effectiveness, trust) (Latifi & Karimi, 2019). According to the results of Samaei et al.'s  project (1401), the effect of glass ceiling on the empowerment of female staff of the Ministry of Sport and Youth of Iran was significant and negative (Samaei et al., 2022).  In this regard, Rahim et al.'s paper reviews the glass ceiling conundrum as a form of oppressive tendency which limits women’s career advancement in workplace.
 The most important obstacles to women's job development were cultural factors in society, especially the ceiling beliefs (Farah et al., 2020); these papers confirm the results of the present study. Today, women are more concerned about their progress than ever before, while the path of development and progress has been provided for them. The job pathway of female executives shows that most of them experience the outflow of growth path, especially those who want to upgrade to higher level jobs; in fact, they are faced with a glass ceiling that can only work in a limited number of management positions and requires huge responsibility (Lalisarabi, 2022). Despite the significant increase in women's employment in the community, the development of women's career progress in management jobs has not grown much and the achievement of women to management high levels has been considered unusual, and their career development has faced a major challenge. Glass ceiling implies an impenetrable obstacle in most organizations, without legal validity, and simply in accordance with implicit and unwritten agreements; it prevents the promotion of women in the organization, and unfortunately, women employees in health organizations are no exception.
There were limitations in conducting this research. This study was conducted only on women working in health network of Shahrekord. Necessary precautions must be made to generalize the results to other groups and cities. In addition, the present study also faced methodological restriction, as the correlation of the present study's method and the inference of the cause and effect was restricted.
Conclusion
Women, especially in healthcare professions, play a key role; therefore, the Ministry of Health and the officials of health centers should emphasize the meritocratic system, regardless of gender, and provide serious support for women who have shown the necessary capabilities in management positions and appoint them to key posts like men. Training courses in organizations are required to correct the attitudes of employees and managers towards women's abilities and highlight and promote their success in health organizations, especially for women managers. Managers can also provide strategies such as in-service training, involving employees in the organization's information, exercising emotional and social support, modeling, and creating more trust and attention to justice in the organization; therefore, women employees can solve problems with as much power and strength as possible, and promote their organization.

Acknowledgments
The authors would like to thank the Deputy Director of Research and Technology of Islamic Azad University of Shahrekord for cooperation. They would also appreciate all the female employees for their valuable participation.

Conflicts of interest
The authors declared no conflict of interest.

Funding
No funds, grants, or other support was received.

Ethical Considerations
This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Falavarjan Islamic
Azad University.

Code of Ethics
IR.IAU.FALA.REC.1397.01

Authors' Contribution
Y. H and A. A, conceptualized the study; A. A, conducted methodology; Y. H, made formal analysis; A. A, did the investigation; Y. H, did data curation; A. A, wrote the original draft; A. A, conducted review and editing; Y. H, found the resources and A. A, did the supervision. All the authors read and approved the final manuscript.

Open Access Policy
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Type of Study: Original Article | Subject: Social Behavior
Received: 2023/05/21 | Accepted: 2023/08/7 | Published: 2023/11/20

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