prevalence-of-bullying-among-employed-bahraini-women-working-in-the-primary-health-care-in-the-kingdom-of-bahrain-603618e84dee2

ISSN: 13412051 Volume 28, Issue 02, February, 2021 4121 Prevalence of Bullying among Employed Bahraini Women Working in the Primary Health Care in the Kingdom of Bahrain Basem Al Ubaidi1 , Hala Al Farra1 , Wafa Alfara1 , Shooq Alsooreti1 , Reham Al-Garf1 , Haifa Al Jasim1 , Raja Al Noaimi1 Ministry of Health, Manama, Bahrain, P.O. Box 12 Manama, Bahrain1 ABSTRACT— Workplace bullying has increased lately. Interests to study the prevalence of workplace bullying and its associated factors have been steadily growing recently. 437 Bahraini female workers, aged 18 years or more responded. Our sample was collected through a convenient sample of HCWs working in 15 randomly chosen health centres. A NAQ-R questionnaire was sent to them. In this study, 76.2% of the participating Bahraini female HCW’s subjectively reported that they had not been bullied in the past six months. The mean score on the NAQ-R was M31.59+-SD10.90 with a range from 22 to 108.There was a significant relationship between the type of work and the work system. The number of sick leaves increased by those who experience bullying. Half of the HCWs respondents didn’t know about the presence of any support system. Violence against female HCWs in Bahrain is a prevalent problem. Enforcing the rules and regulations is a great way to avoid conflict and therefore bullying. Educating the female workers about the available support system is highly recommended. KEYWORDS: work, women, bullying, Bahrain. 1. INTRODUCTION Bullying is a part of the human experience and can be encountered by different genders, ages and ethnicities at any time. It can occur in various places, such as homes, workplaces, or care institutions. Gerberich defined physical bullying as all assaults with physical contacts leading to an injury such as pushing, kicking, or slapping [2]. On the other hand, Uzun defined verbal bullying as any words emotionally used to harm a person, such as name calling, swearing, or assaults [3]. Workplace bullying is a prevalent problem in many countries. The phenomenon was first described by the Swedish researcher Heinz Leymann in 1984 when he defined workplace bullying as hostile and unethical communication that occurs at least once weekly over a period of at least 6 months [4]. Many factors could be related to bullying towards women in their workplace. These could be environmental- related factors, such as workplace layout, employer practices, the timing and\or length of working hours, and the clarity of employee’s job description. For example, the lack of comfortable waiting areas for patients in any healthcare facility could increase the risk of bullying amongst female employees. Additionally, females working early morning or late-night shifts, and during holidays are more vulnerable to bullying [1]. Furthermore, female employees who suffer from poverty, received a poor education, were exposed to bullying from parents, were victims of sexual abuse during their childhood, and those who had accepted bullying are also at increased risk [5]. Other risk factors such as young adults with learning disabilities and employees with a family history of psychiatric disorders are also at increased risk of bullying in there. Moreover, employed adults who belong to some minor ethnic groups are more vulnerable to bullying in the workplace. Workplaces with a transparent bullying reporting system and a well-trained security system are found to have lower incidences of bullying amongst working women [6]. Bullying could result in a variety of serious outcomes, such as illness, disability, and death.

Ubaidi, et.al, 2021 International Medical Journal 4122 Bullying victims could suffer from depression, anxiety, sleep disorders, eating disorders, and even suicidal ideation and attempts.6 Bullying can have a tremendously negative impact on women's health since it is related to high smoking rates, alcohol consumption, and substance abuse. Workplace productivity may be reduced as a result, due to lack of job satisfaction and high staff turnover. There may be high absenteeism rates, or high presenteeism rates where the employee is present but with minimum or no productivity. Victims may lose their job as a result of their poor employability and/or lack of career development [6]. As a result, organisations may not function properly, thus affecting the country's financial stability [5]. According to the 2017 US Workplace Bullying Survey, approximately 60% of US workers were victims of bullying, 30% of whom are female. YouGov's 2015 poll for the Trade Union Congress (TUC) showed that 29% of employees were bullied at work with women likely to be victims (34%) [7]. Four in ten women in the USA showed that gender discrimination comes in many forms for working women [8]. One of the most widely used questionnaires in research to assess the presence of workplace bullying is the Negative Act Questionnaire revised (NAQ-R). The NAQ-R was developed and subsequently revised with the aim of becoming a standardised research tool for measuring exposure to workplace bullying. A set of 22 questions was used. A twenty third question was added to the NAQ-R to assess self-labelled bullying and that’s through asking the individuals directly if they had been bullied at work in the past six months [4]. A cross-sectional study was conducted amongst dental interns in Karachi, Pakistan in 2017 using the NAQ-R, showing bullying prevalence (objective bullying) at 36.8%, whilst the self-labeled bullying (subjective bullying) was 55%. Reporting bullying by the bullied participants was only 14.5%, the main reason being that there was a belief that reporting was not useful (28.8%) and that employees were frightened of the repercussions of reporting bullying (22%) [9]. A sampling study done in Beirut, Lebanon in 2018 involved 447 participants from shops, banks, travel agencies and restaurants. The study showed that 69% of participants reported that they have never been bullied, based on the NAQ-R score. When asked about the perpetrators, 15.7% of the bullied participants reported it was their manager / supervisor while 13.7% reported co-workers as the bully. However, only 4.2% and 3.2% reported being bullied by clients and subordinates, respectively. Moreover, 2.3% of the participants reported that the bullying was directed only at them and 2.8% of the participants declared that they had witnessed bullying in the workplace. The study also revealed that those who had not taken any sick leave scored lower NAQ-R scores than those who had [4]. A cross-sectional study was done between Health Care Workers (HCWs) in the Ministry of Health (MOH) facilities in Arar city, KSA [10]. in 2018 which reported that 48.6% of participants reported exposure to violence at work in the past year. Physicians were the main exposed group (59%). Furthermore, the relationship between violence towards HCWs and the working shift type was statistically significant with more exposure to violence experienced amongst those working evening or night shifts. Despite suffering, only 16.4% of the bullied HCWs reported the issue to a higher authority, the most common reason cited was that it was useless and they feared negative consequences. A descriptive survey-based study conducted in the Kingdom of Bahrain in 2005-06 showed that (88.4%) of the sample confirmed the presence of bullying against females in the workplace and public places. The study concluded that bullies targeting women fell between three categories: work colleagues, managers, and customers (52% and 42.8% and 27.8%), respectively [11]. Another study conducted in 2018 in the Kingdom of Bahrain showed that 87% of physicians were exposed to at least one episode of bullying from patients at a particular time during their practice. The majority of the respondents were females aged between 35-44 years. Verbal abuse reported the most (95%). In relation to bullying of physicians, 75% of physicians reported negative feelings such as anger, irritability, and low concentration after the abuse occurred [6]. However, bullying at work is under-reported and under-investigated. Many barriers could result in female employees not reporting bullying, such as acceptance of bullying, lack of knowledge of any abuse reporting

ISSN: 13412051 Volume 28, Issue 02, February, 2021 4123 policy, unawareness of workers about the escalating trends of bullying at their workplace, fears of expulsion from work, and a sense of the futility of reporting [11]. The Bahraini Woman Supreme Council supports the needs of women in the workplace and their well-being. The Council has introduced an anti-bullying against women strategy within in the Kingdom of Bahrain, including consequences against the abuser [12]. Regarding females’ employment, Bahrain Labour Law (Title V), states that responsibilities should be equally assigned to female and male workers, without discrimination based on gender. Additionally, circumstances in which women are prohibited from working night shifts and in particular workplaces are clearly defined. It also states that employers must provide clear documentation about women's employment labour law in the workplace. However, specific actions toward the abuse of women in the workplace are not mentioned [12]. Nationally, a well-developed strategic plan was published in 2019 by the Ministry of Health in Bahrain, with guidelines for the protection of women from bullying in primary health care settings [13]. The guidelines discuss domestic bullying including bullying from the female’s intimate partner. Specifically, bullying against women in the workplace was not mentioned. Despite that fact, the authors of the guidelines have agreed that the same protocols should be followed towards any incidence of female bullying, either by an intimate partner or in the workplace [13]. Many previous studies have highlighted that women are highly vulnerable to bullying in the workplace and that it is a problem which continues to escalate. Therefore, the authors of this paper decided to conduct this study to gather comprehensive, local statistics about the situation in Bahrain and as a result, to consider the significant consequences bullying has on women’s physical and mental health and their well-being. 2. Aim ● To measure the prevalence rate of bullying amongst Bahraini women working in Primary Health Care in the Kingdom of Bahrain and its associated factors. 3. Methodology Subjects Our study targeted all working Bahraini females in primary health care who are ≥18 years in good physical condition (self-reported) and can read Arabic. Bahraini female workers covering three small governmental clinics that have a smaller setup, catchment area and staff number were excluded from the study. 4. Sampling Fifteen health centres were randomly selected from a total of twenty-five health centres distributed across five health regions within Bahrain. Three centres from each region were selected, totalling fifteen health centres. A soft copy of the questionnaire was distributed as a google form to the in-charges of the selected health centre to be distributed amongst female Bahraini’s working in the health centre. A convenience sample was selected from each health centre. The study was an analytical, cross-sectional survey which was conducted between November to December 2020. According to the total population of the Bahraini working females in local health centres in the Kingdom of Bahrain, the target sample size was 460 with 95% CI. A total of 437 participants (95%) responded to the questionnaire. 5. Sample size calculation Sample size has been determined according to the following formula: =1+×2 Where =1400 the population of Bahraini females working in health centers, and denotes the allowed probability of committing an error in selecting a sample from the population. Therefore, the sample size is =14001 1+1400×0.052=312

Ubaidi, et.al, 2021 International Medical Journal 4124 6. The study instruments The researchers adopted the NAQ-R which is a standardised research tool for measuring exposure to workplace bullying [4]. The questionnaire consisted of three parts: demographic data, the modern standard Arabic-version of the Negative Acts Questionnaire-Revised (NAQ-R) and an assessment of risk factors in the workplace (Appendix 1). NAQ-R is a twenty-two-item questionnaire with a Likert scale of 1-5 (never, occasionally, once in a month, once in a week, and daily). [4] Respondents are prompted to state how often they have been subjected to the questionnaire's 22 negative acts based on their workplace experience over the last six months. Reliability coefficients for total and subscale scores of the NAQ-R ranged from 0.63 to 0.90. The Arabic NAQ-R had a good concurrent validity [4]. According to, a mean score scale between 0 and 32 indicates no experience of bullying victimization; 33-44 indicates medium bullying victimization, and 45 or more indicates experience of severe bullying victimization [14], [15]. NAQ-R can serve as a general mobbing/workplace bullying indicator. NAQ-R is a measure of perceived victimization with workplace bullying. It includes questions regarding the experience of bullying, such as frequency of encounter, duration and who the main preparatory (s) were. 7. Ethical consideration Ethical approval for the study was granted on 20/01/2020 by the Primary Care Ethical Research Committee within the Bahrain’s Ministry of Health. (Participant consent was granted by each participant who opted to respond to the survey. Data collected for the study was confidential and entered anonymously into the system for analysis purposes. 8. Statistical Analysis SPSS 23 was used for data entry and analysis. Frequencies and percentages were computed for the categorical variables. Mean, median, and standard deviation were computed for the quantitative variables. Kolmogorov- Smirnov was used to investigate normality of a quantitative variable within sociodemographic groups. Mann- Whitney test was used to determine whether there was a significant difference in mean scores between two groups. Kruskal-Wallis test was used to determine whether there is a significant difference in mean scores between more than two groups. In all statistical tests, p-value of less than 0.05 was statistically considered significant. 9. Results The distribution of the 437 respondents amongst the health centres and their socio-demographic data is shown in Table 1. Females aged between 30-39 years represented 50% of all respondents with around 85% of respondents being married and the vast majority working on the shift scale (62%). Table 1: Socio-demographic Characteristics (n = 437) Characteristics n (%) Health Region Health Region 1 77 (17.6) Health Region 2 38 (8.7) Health Region 3 108 (24.7) Health Region 4 113 (25.9)

ISSN: 13412051 Volume 28, Issue 02, February, 2021 4125 Health Region 5 101 (23.1) Age in years <30 109 (24.9) 30 - 39 219 (50.1) ≥40 109 (24.9) Educational Level High School or below 30 (6.9) Diploma 104 (23.8) Bachelor 233 (53.3) Higher studies 70 (16) Marital status Single 47 (10.8) Married 371 (84.9) Divorced 16 (3.7) Widow 3 (0.7) Department Doctors 91 (20.8) Nursing 148 (33.9) Pharmacy 28 (6.4) Laboratory 30 (6.9) Dental Services 49 (11.2) Medical Records 37 (8.5) Cleanings 1 (0.2) Others 53 (12.1) Years of experience <5 113 (25.9) 5 - 10 164 (37.5) 11 - 15 89 (20.4) >15 71 (16.2) The current system of work Regular 164 (37.5) Shift 271 (62) Part-time 2 (0.5) The number of sick leave during the past year 0 - 3 221 (50.6) 4 - 6 125 (28.6) >6 91 (20.8) Physical disabilities Yes 7 (1.6) No 430 (98.4) Mental illnesses Yes 9 (2.1) No 428 (97.9) Table 2 illustrates the characteristics associated with bullying, showing that 76% of participants had not experienced bullying at work during the past 6 months. However, 37% of participants reported experiencing bullying during the past 1-2 years. Amongst those who reported experiencing bullying, 68.9% of the bullies were both males and females, however, customers attending the health care facility represented the majority of most perpetrators, (61.5%) whilst supervisors counted for about 34%. The victims of bullying who did not report the incidence to their supervisors over the past five years were higher than those who did (73% and 26% respectively).

Ubaidi, et.al, 2021 International Medical Journal 4126 Table 2: Characteristics associated with bullying n (%) Bullied at work in the past six months (n = 437) Yes, rarely 53 (12.1) Yes, sometimes 39 (8.9) Yes, several times a week 9 (2.1) Yes, almost daily 3 (0.7) No 333 (76.2) Start of bullying (n = 100) During the last six months 20 (20) Between the last 6 and 12 months 15 (15) Between the last year and two years 37 (37) More than two years ago 28 (28) Sex of bullies (n = 103) Men 4 (3.9) Women 28 (27.2) Men and women 71 (68.9) The number of men who bullied you (n = 74) <3 43 (58.1) 3 - 4 15 (20.3) >4 16 (21.6) The number of women who bullied you (n = 84) <3 46 (54.8) 3 - 4 13 (15.5) >4 25 (29.8) Persons bullying you (n = 104) Supervisor 35 (33.7) Colleagues 45 (43.3) Your employees 11 (10.6) Customers 64 (61.5) Number of people bullied (n = 101) Only you 7 (6.9) You and several others 69 (68.3) Everyone at work 25 (24.8) Witness bullying at work over the past 6 months (n = 437) Never 201 (46) Yes, rarely 129 (29.5) Yes, sometimes 84 (19.2) Yes, often 23 (5.3) bullied at work over the past five years (n = 437) Yes 149 (34.1) No 288 (65.9) Witness bullying at work over the past five years (n = 437) Yes 201 (46) No 236 (54) Report bullying to supervisor over the past five years (n = 437) Yes 117 (26.8) No 320 (73.2) Time of bullying (n = 437) Official working 233 (53.3) Vacation days 38 (8.7) Studying the work environment factors related to bullying, as shown in Table 3, 52% of participants had no

ISSN: 13412051 Volume 28, Issue 02, February, 2021 4127 knowledge of the existence of support systems for females exposed to bullying. In addition, the majority of respondents (49%) did not know about the presence of a bullying reporting system within their institution. Moreover, 48% of participants did not know about any existing guidelines, policies and/or preventive measures against bullying in their health care facility. Table 3: Work Environment Yes No Don't know n (%) n (%) n (%) There are comfortable places to wait for the customers at your workplace 338 (77.3) 70 (16) 29 (6.6) The existence of a support system for female employees exposed to bullying 66 (15.1) 145 (33.2) 226 (51.7) The existence of a reporting system for bullying, discrimination, abuse and misconduct 105 (24) 117 (26.8) 215 (49.2) Clarity of work responsibilities and job description of female employees 344 (78.7) 51 (11.7) 42 (9.6) A flexible management approach with participation in decisionmaking 273 (62.5) 95 (21.7) 69 (15.8) Having a flexible management style with the required guidance and support 267 (61.1) 96 (22) 74 (16.9) Availability of human resources and a sufficient number of female staff 152 (34.8) 216 (49.4) 69 (15.8) Having an appropriate daily work rate in terms of available time and reality of work 242 (55.4) 160 (36.6) 35 (8) The existence of a clear mechanism to measure the performance of the work of female employees 213 (48.7) 154 (35.2) 70 (16) The existence of guidelines, policies and preventive measures against bullying in the health institution 86 (19.7) 143 (32.7) 208 (47.6) The direct supervisor has the ability to resolve disputes between female employees 274 (62.7) 83 (19) 80 (18.3) The direct supervisor has the ability to resolve disputes between female employees and customers 303 (69.3) 62 (14.2) 72 (16.5) A healthy competitive work environment 259 (59.3) 100 (22.9) 78 (17.8) Table 4 shows that there is no significant relationship between age, educational level, marital status, and years of experience of participants and the NAQ-R score. However, there was a significant relationship between the NAQ-R score and participants’ working departments since it was the highest among nurses and medical record staff (34.17 +/- 12.82 and 34 +/- 12.58 respectively). Physicians and laboratory staff also got the lowest NAQ-R score (28.21 +/- 7.78 and 28.53 +/- 6.13 respectively). Moreover, the NAQ-R score was significantly related to the current work system, which was higher among females working on the shift scale than those working on the regular scale (33.32 +/- 11.83 and 28.82 +/- 8.53 respectively). There was a significant relationship between the number of sick leaves taken by working females during the past year and their experience of bullying. Those who took more than six days of sick leaves had the highest NAQ-R score (33.15 +/- 10.67). The mean score on the NAQ-R was M31.59+- SD10.90 with a range from 22 to 108. According to the NAQ-R score, the frequency of the respondents who scored 32 or less (no bullying) was (67.7%), medium bullying was 23.7%, and severe bullying was 9.6%.

Ubaidi, et.al, 2021 International Medical Journal 4128 Table 4: Relationship between Socio-demographic Characteristics and NAQ-R Score Characteristics NAQ-R Score P-value Mean ± SD Median Health Region Health Region 1 32.78 ± 12.61 28.00 Health Region 2 27.79 ± 5.64 26.00 Health Region 3 32.16 ± 9.49 29.00 0.099 Health Region 4 30.40 ± 9.30 28.00 Health Region 5 32.85 ± 13.50 28.00 Age in years <30 32.07 ± 11.59 29.00 30 - 39 31.84 ± 10.68 29.00 0.069 ≥40 30.61 ± 10.68 26.00 Educational Level High School or below 29 ± 9.31 26.00 Diploma 33 ± 11.12 31.00 0.159 Bachelor 31.55 ± 11.48 28.00 Higher studies 30.77 ± 8.96 27.00 Marital status Single 31.36 ± 10.39 29.00 Married 31.7 ± 11.15 28.00 0.991 Divorced / Widow 30.05 ± 6.83 27.00 Department Doctors 28.21 ± 7.78 26.00 <0.001 Nursing 34.17 ± 12.82 30.00 Pharmacy 30.64 ± 7.15 29.50 Laboratory 28.53 ± 6.13 28.00 Dental Services 31.02 ± 11.07 27.00 Medical Records 34 ± 12.58 31.00 Others 31.3 ± 10.3 29.50 Years of experience <5 31.26 ± 11.66 28.00 5 - 10 31.66 ± 10.85 28.00 0.196 11 - 15 32.28 ± 9.63 31.00 >15 31.11 ± 11.45 26.00 The current system of work Regular 28.82 ± 8.53 26.00 <0.001 Shift 33.32 ± 11.83 30.00 The number of sick leave during the past year 0 - 3 30.11 ± 10.28 27.00 4 - 6 33.07 ± 11.83 28.00 0.002 >6 33.15 ± 10.67 32.00 Cronbach’s Alpha for NAQ-R is 22 and for Work Environment items is 13. 10. Discussion Violence against health care workers is a well-recognised occupational hazard. This study aimed to assess the prevalence of bullying among Bahraini female health care workers (HCW’s) in primary health care centres located across five health regions in the Kingdom of Bahrain. In this study, 76.2% of the participating Bahraini female HCW’s subjectively reported that they had not been bullied in the past six

ISSN: 13412051 Volume 28, Issue 02, February, 2021 4129 months, in comparison to 69% reported in Lebanon. In Pakistan, more than 55% of respondents experienced bullying based on the self- labelling method, compared to 23.8% in Bahrain. In Saudi Arabia, 48.6% of the health care workers from both genders reported exposure to workplace bullying in the past year. In this study, the mean score of the NAQ-R was M31.59+-SD10.90, with a range from 22 to 108, those figures being lower when compared to the Swedish study in which their NAQ-R mean score was M 37+- SD 8.1 with a range from 23 to 68. In Pakistan, the presence of workplace bullying over the previous 6-month period, based on the NAQ-R score, was 36.8% and did not differ by gender, site, age, place of schooling and whether respondents lived with their family or not. According to the NAQ-R score, bullying measured highest amongst the medical records department (M34+- SD12.58) and the nursing department (M34.17+-SD12.82). This can be explained by the fact that medical records and nursing departments work as front-liners in primary care health centres and manage the issues such as the lack of regular appointments and patient triaging. In Saudi Arabia, the nursing department scored the lowest in reporting bullying compared to physicians and others. Prevalence of bullying according to the NAQ-R score between those who are working shift patterns and those who are working on the regular pattern was statistically significant, bullying being higher in the former group. This can be explained by the fact that shift HCW’s are under more pressure because they work during late night hours and public holidays. However, the relationship between bullying and the current system of work needs to be targeted with more caution and focus on factors that might be corresponding to such differences. This study found that those exposed to workplace bullying reported a higher number of sick leaves, similar to the result of the Lebanese study. This relationship may be explained by the fact that bullied individuals feel excluded from work life. Employees who are bullied tend to experience deterioration and impairment of health affecting their psychological status leading to psychosomatization and an increased number of sick leaves. Of those who endorsed the self-labeling item as seeing themselves as being bullied, 33.7% identified a supervisor as the perpetrator of the bullying compared to 15.7% in Lebanon. 43.3% identified colleagues as the bullies compared to 13.7 % in Lebanon, while the majority (61.5%) reported being bullied by customers compared to only 4.2% in Lebanon. This study found only 26.8% of participants have ever reported bullying to their supervisor in the past five years. Similar results were shown in the Pakistani study where only 14.5% of respondents who were bullied had ever reported the bullying acts with the majority choosing to remain silent. The authors of this study consider that bullying is under reported because of lack of awareness of reporting guidelines and policies, lack of trust in the reporting system and concerns about the repercussions of reporting bullying. 11. Conclusion Bullying among employed females is underestimated and poorly investigated in the Kingdom of Bahrain, hence the authors decided to conduct this study. The researchers found that HCWs’ bullying is significantly related to the type of work based on the department they work at and the work system. It was also found that more bullying resulted in more sick leaves. This study showed that around half of the respondents didn’t have any idea about the existence of a support system for employed females exposed to bullying. Furthermore, the majority of the participants did not have any idea about the availability of a clear bullying reporting system in their institution. Therefore, the authors recommend conducting focused educational workshops addressing bullying among working females in order to raise the awareness of this huge problem and to encourage the victims to utilise the available support systems. It is also significant to point out that the reaction to workplace bullying may vary from one person to another and that not everyone exposed to workplace bullying will experience its negative consequences. It might be worthwhile to direct future efforts to study the correlation between workplace bullying and each of depression, life satisfaction and to assess the need for workshops that enhance the resilience of our employees accordingly. To add, efforts

Ubaidi, et.al, 2021 International Medical Journal 4130 should be targeted towards improving clients’ education on the dynamics of the health centre system to help minimise the exposure of the staff working at the front desk; such as the receptionists and nurses to bullying. 12. References [1] Al Ubaidi B. (2018) Workplace Bullying in Healthcare: An Emerging Occupational Hazard. Bahrain Medical Bulletin. 40(1), pp. 43-45. [2] Gerberich S. (2004) An epidemiological study of the magnitude and consequences of work-related bullying: The Minnesota Nurses' Study. Occupational and Environmental Medicine.61(6), pp. 495-503. [3] Uzun Ö. (2003) Profession and society. Journal of Nursing Scholarship. 35(1), pp. 81-5. [4] Makarem, N.N., Tavitian-Elmadjian, L, R., Brome, D., Hamadeh, G.N. & Einarsen S. (2018) Assessment of workplace bullying: reliability and validity of an Arabic version of the Negative Acts Questionnaire-Revised (NAQ- R). BMJ Open. 8(12). Pp1-9. [5] Winstanley, S. & Whittington, R. (2004) Aggression towards health care staff in a UK general hospital: variation among professions and departments. Journal of clinical nursing. 13(1), pp. 3-10. [6] Abusharqrah, A., Alherz, F., Alshaikh, F, Bahzad, N. & Al-Saffar, B. (2018) Exposure to bullying among Physicians working at the Primary Care in the Kingdom of Bahrain. Int J Med Res Prof. 4(4), pp. 102-06. [7] Rai, A. & Agarwal, U.A. (2018) Workplace bullying and employee silence. Personnel Review. 2, pp. 5. [8] Parker, K. & Funk, C. (2017) Gender discrimination comes in many forms for today’s working women. Pew Research Center. 14, pp. 14. [9] Ullah R, Siddiqui F, Zafar M, Iqbal K. Bullying experiences of dental interns working at four dental institutions of a developing country: A cross-sectional study. Work. 2018;61(1):91-100. [10] Al Anazi, R, B., Alqahtani S, M., Mohamed A, E., Hammad S, M. & Khleif H. (2020) Violence Against Health – Care Workers in Governmental Health Facilities in Arar City, Saudi Arabia. Hindawi, The Scientific World Journal 2020 (Article Id 6380281). Pp 6. [11] Al Gharaibeh, F. (2011) Women’s empowerment in Bahrain. Journal of International Women's Studies. 12(3), pp. 96- 113. [12] Alexandre, L. & Kharabsheh, R. (2019) The evolution of female entrepreneurship in the Gulf Cooperation Council, the case of Bahrain. International Journal of Gender and Entrepreneurship. 11, pp. 7. [13] MOH Bahrain (2019) Guidelines for women protection against bullying in a primary health care setting. [Online. Retrieved from http://intranet.health.gov.bh/Departments/ HCMS/DocsCenter/Guidelines%20and%20Procedures/MCH%20Guidelines/woman%20protection%20gui deline20 19.pdf.

ISSN: 13412051 Volume 28, Issue 02, February, 2021 4131 [14] Dåderman A, Ragnestål-Impola C. Workplace bullies, not their victims, score high on the Dark Triad and Extraversion, and low on Agreeableness and Honesty-Humility. Heliyon. 2019;5(10): e02609. [15] Notelaers, G. & Einarsen S. (2013) The world turns at 33 and 45: Defining simple cutoff scores for the Negative Acts Questionnaire–Revised in a representative sample. European Journal of Work and Organizational Psychology. 22(6), pp. 670-82. This work is licensed under a Creative Commons Attribution Non-Commercial 4.0 International License.