The Impact of Affective Commitment and Leisure Satisfaction on Employees’ Quality of Life

Jongil Yuh1, *
1 Duksung Women’s University, Seoul, Republic of Korea

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© 2022 Jongil Yuh.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Human Development and Family Studies, Duksung Women’s University, Samyangro 144 Gil, Dobong-gu, Seoul 01369, Republic of Korea; Tel +82-2-901-8362; E-mail:



Employees’ quality of life is affected by both work and private life domains. As interest in a whole-life perspective has recently grown, how employees’ attitudes toward work and leisure experiences are associated with their quality of life has gained increasing international attention.


The purpose of this research was to examine the associations between affective commitment, leisure satisfaction, and employees’ quality of life and the moderating role of leisure satisfaction in the relationship between affective commitment and employees’ quality of life.


A sample of 154 female childcare teachers completed self-reported questionnaires measuring their affective organizational commitment, leisure satisfaction, and quality of life. Data were obtained from 17 childcare centers in Seoul, Korea, during the summer of 2021, using convenience sampling. Pearson correlation, hierarchical regression analyses, and bootstrapping methods were used to test the hypotheses.


The results revealed that affective commitment and leisure satisfaction were positively related to female childcare teachers’ quality of life. Moreover, after controlling for age and marital status, leisure satisfaction was shown to play a moderating role, indicating that affective commitment was more strongly associated with quality of life for individuals who had a high level of leisure satisfaction.


The findings underscore the significance of affective commitment and leisure satisfaction in enhancing female employees’ quality of life. The findings also highlight the consideration of leisure satisfaction as a target for intervention in enhancing female employees’ well-being.

Keywords: Experiences, Childcare centers, Controlling, Female employees, Affective commitment, Quality of life.


Quality of life is a key index of overall well-being worldwide. Since 2011, the Organization for Economic Co-operation and Development (OECD) has annually published the Better Life Index, which provides a comparison of the quality of life of individuals living in various nations. Quality of life has been understood as a multifaceted umbrella term that covers many different meanings [1, 2]. Felce and Perry [3] defined quality of life as a measure of overall general well-being that comprises objective descriptors and subjective evaluations within physical well-being, material well-being, social well-being, emotional well-being, and development and activity dimensions. According to Gasper [4], quality of life refers to the evaluation of major aspects of life or society. The World Health Organization’s (WHO) globally accepted definition of quality of life presents it as an individual’s perception of their position in life, within the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards, and concerns [5]. Despite its varied definitions, subjectivity has been recognized as a key aspect of defining quality of life [1].

Improving employees’ quality of life is of current interest for researchers and human resource professionals. The quality of work-life is a multidimensional dynamic construct that refers to the impact of the workplace on satisfaction in the work-life domain, nonwork life domain, and satisfaction with overall life [6]. Literature reviews stated that quality of work-life, which is crucial for an organization to attract and retain competent employees, is defined as a construct with various dimensions [7-9]. Empirical studies revealed that the quality of work-life is influenced by various factors, such as organizational climate, leadership style, emotional intelligence [6], organizational culture, work and personal goals [10], employees’ self-efficacy [11], and spiritual leadership [12]. Reviews and empirical findings show that employee’s quality of life comprises dimensions in various life domains.

A key to understanding the quality of life of employees is to understand their organizational commitment, which refers to their attitudes toward their organization. Meyer and Allen [13] categorized organizational commitment into affective commitment, normative commitment, and continuance commitment. A meta-analysis of Mayer and Allen’s three-component model of commitment revealed that affective commitment had the strongest and most favorable correlations with both organization- and employee-related outcomes [14]. Affective organizational commitment refers to “a psychological state that characterizes an employee’s relationship with their organization (p.395)” [15]. An affective commitment is the most important factor of loyalty and commitment among the three components [16, 17]. Moreover, it was more strongly related to work-life balance among women healthcare workers in India than were their normative and continuance commitments [18]. Individuals with substantial affective organizational commitments identify with, are involved in, and enjoy membership in the organization [19, 20]. They admire the atmosphere or culture of the company and experience a sense of enjoyment when completing job duties [19, 20]. Empirical research has demonstrated that affective commitment is positively related to work engagement and job satisfaction [21-24] while negatively related to turnover and intention to quit [25, 26]. The affective commitment is positively related to the meaningfulness of work and employee engagement and mediates the relationship between them [27]. Although affective commitment has been considered a crucial factor of work-related variables, research on the impact of employees’ affective commitment on their general quality of life from a whole-life perspective remains scant.

Leisure in nonwork areas is another essential variable in defining quality of life. Leisure can be defined as a “portion of an individual’s time that is not directly devoted to work or work-connected responsibilities or other obligated forms of maintenance or self-care (p.27),” embracing their freedom and choice [20]. McLean, Hurd, and Anderson suggested that leisure can be viewed in six diverse ways [28]. Whereas the classical view of leisure regards leisure as a state of being in which an activity is performed for its own sake, in contrast to purposeful action; it can be considered a symbol of social class, unobligated time, activity, a state marked by freedom, or spiritual expression [28]. These six views or definitions are used complementarily rather than exclusively. Despite the different approaches to leisure, there is a consensus that leisure makes people feel better about their lives. Newman, Tay, and Diener [29] proposed five core psychological mechanisms to explain why leisure promotes subjective well-being; these mechanisms included detachment recovery, autonomy, mastery, meaning, and affiliation (DRAMMA).

Leisure satisfaction has been recognized as a better predictor of quality of life than leisure per se. A meta-analysis revealed that leisure engagement and subjective well-being were moderately associated and were mediated by leisure satisfaction [30]. Leisure satisfaction refers to “the positive perceptions or feelings which an individual forms, elicits, or gains as a result of engaging in leisure activities and choices (p.22)” [31]. Previous empirical studies showed that leisure satisfaction predicted college students’ happiness and psychological well-being [32] and city residents’ quality of life and life satisfaction [33, 34]. Leisure satisfaction was found to impact Chinese college students’ overall well-being even after their personality traits were controlled [35]. Leisure satisfaction is positively associated with happiness from the Asia Barometer data [36] and happiness and quality of life domains from the telephone survey of Chinese Canadians and British Canadians [37]. Among the few studies examining employees’ leisure satisfaction and their quality of life, one conducted by Turkey indicated that increased leisure satisfaction among health professionals increased their quality of life [39]. While increasing attention has been drawn to leisure as a key element of general well-being, the understanding of leisure in non-Western countries is still limited [39, 40]. Asia-based research on the role of leisure satisfaction in the quality of life remains scarce [41].

Although employees’ quality of life encompasses both organization- and leisure-related domains, knowledge about the combined effects of both domains is limited. Previous studies have shown leisure-related variables as moderators [42, 43]. Frontline hospitality employees’ satisfaction with their leisure benefit system moderated the relationship between their work-to-leisure conflict and quality of life [42]. Exhausted employees failed to detach from work when they did not engage in pleasurable leisure experiences, whereas exhaustion did not predict psychological detachment from work when employees had pleasurable leisure experiences [43]. Although these findings imply that leisure satisfaction might intensify the relationship between affective commitment and quality of life, less attention has been paid to the delineation of the associations among affective commitment, leisure satisfaction, and quality of life. Moreover, knowledge regarding the integrated effects of affective commitment and leisure satisfaction on employees’ quality of life in a non-Western context remains limited. A recent study by Gui, Kono, and Walker showed that leisure and work domain satisfaction is positively related to subjective global life satisfaction among Hong Kong Chinese workers [44]. More research is needed to understand the intertwining effect of work and leisure in the Asian context to extend our knowledge of employees’ quality of life. In particular, according to a 2020 survey by the Better Life Index, Korea is one of the most overworked countries with a very poor work-life balance [45, 46]. The percentage of employees working prolonged hours was 25.2%, compared to the OECD average of 11% [45, 46]. Investigating the association between affective commitment and leisure satisfaction with the quality of life in Korea is of interest, given that the work-life balance, in particular among female employees, has recently become more pronounced in Korea [45, 47].

1.1. The Present Study

Based on all the above considerations, the general aim of the present study is to investigate the association between affective commitment, leisure satisfaction, and quality of life for female childcare teachers in Korea. Furthermore, the moderating effect of leisure satisfaction on the influence of affective commitment on the quality of life was examined. Early childhood work issues and teachers’ well-being have gained international attention and require further research [48-50]. Early childhood education has been known to have a high staff turnover [51] and challenges, such as workload, menial pay, and low social values [49]. The early childhood education and care workforce has received growing attention in many countries [52, 53]. Working in early childhood education and care is relatively challenging considering public perceptions, burnout, health risks, and turnover rates in the US [34], China [54], and Korea [55, 56]. In Korea, in the last two decades, governmental childcare support policy has been emphasized, operating an estimated 35,352 childcare centers as of December, 2020, compared to an estimated 20,097 childcare centers in 2001 [57, 58] despite decreasing fertility rate. However, the turnover rate is high, demonstrating that 12.2% of childcare teachers intended to quit their jobs, according to a childcare center survey conducted in 2018 [56]. Those who work in childcare in Korea are predominantly females. Although there is increasing attention on the importance of fostering employees’ well-being, a limited systematic investigation has been undertaken to assess variables in work and nonwork domains on their quality of life in early childhood education and care workforce comprised of predominantly females. In particular, early childhood educators’ well-being has been recognized to closely relate to high-quality education and care that facilitate development in young children [59]. Exploring whether affective commitment and leisure satisfaction influence quality of life would provide significant insights into the childcare field with the empirical evidence of the intertwining effect between work and nonwork domains on quality of life among employees.

Given that few studies have investigated the integrated effects of work-related and leisure-related variables among female employees in an Asian context, the current study fills the gap by providing insights into more detailed information concerning the enhancement of female employees’ well-being. Evidence of interaction can be confirmed if the effect of the focal predictor on the outcome variable differs in size, direction, or strength as a function of the moderating variable [60]. The interaction between affective commitment and leisure satisfaction and its influence on the quality of life can be depicted in the form of a conceptual diagram in Fig. (1). Therefore, the following hypotheses were formulated.

H1: Affective commitment is positively related to employees’ quality of life.

H2: Leisure satisfaction is positively related to employees’ quality of life.

H3: Leisure satisfaction moderates the relationship between affective commitment and quality of life. Specifically, the relationship between affective commitment and quality of life is stronger among employees who have high levels of leisure satisfaction than those who have low levels of leisure satisfaction.

Fig. (1). Conceptual model.


2.1. Participants

The participants of this study were 154 childcare teachers from 17 childcare centers in the Seoul metropolitan area of Korea. The average age of the sample was 39.92 years (SD=9.57). Regarding marital status, 92 (59.7%) women were married, and 62 (40.3%) were single. In terms of the highest level of education, 14 (9%) had graduated from high school, 73 (47.1%) had graduated from community colleges, 65 (42.2%) were university graduates, and 2 (1.3%) completed graduate school. The average work experience of the sample was 8.86 years (SD=5.60). All participants worked at childcare centers with full-day programs.

2.2. Procedures

A cross-sectional survey study was conducted. The study was reviewed and approved by the Human Ethics Committee of the university with the author’s affiliation. Ethical approval for the study was granted by the Human Ethics Committee of the university, and the study was conducted in accordance with the Declaration of Helsinki.

On receiving ethical approval, the research team contacted directors and teachers in childcare centers within the district where the university was located through phone or visitation during the summer of 2021. Directors and teachers were introduced to the purposes and procedures of the study. Teachers in seven childcare centers agreed to participate in the study. Childcare teachers were notified of the opportunity to participate in the study. The research team visited each childcare center with the survey package, which contained self-reported questionnaires and questions concerning demographic characteristics. Participants were informed that their participation in the study was voluntary. The research team assured the participants that their answers would be confidential and would be utilized solely for the purposes of the study. Signed informed consent forms were obtained from all participants. In total, 160 questionnaires were collected. Six invalid questionnaires were eliminated, and the remaining 154 valid questionnaires were included in the final analysis.

2.3. Measures

2.3.1. Affective Organizational Commitment

The affective commitment was assessed using a questionnaire that was modified by Jung [61] and adapted to childcare settings in Korea by Kang [62]. The questionnaire consisted of 7 items, and responses were provided using a five-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). This questionnaire is based on the organizational commitment questionnaire developed by Meyer and Allen [13]. With samples from the Koran population, affective commitment demonstrated satisfactory reliability, convergent validity, and construct validity [20]. The questionnaire included items, such as “I would be very happy to spend the rest of my career with this childcare center” and “I really feel as if this childcare center’s problems are my own.” Higher scores indicated greater levels of affective organizational commitment. The Cronbach’s alpha reliability of affective organizational commitment was .83 in the present study.

2.3.2. Leisure Satisfaction

Leisure satisfaction was assessed using a questionnaire developed by Ahn [63], in which overall leisure satisfaction was determined across five dimensions of perceived satisfaction. The questionnaire consisted of 17 items that measured health improvement (3 items), skill improvement (4 items), social relationship (3 items), self-development (3 items), and stress reduction (4 items), using a five-point Likert scale that ranged from 1 (strongly disagree) to 5 (strongly agree). Factor analysis using a sample of 1,079 adult Korean adults confirmed the five dimensions [63]. The questionnaire demonstrated satisfactory reliability [63] and was used in samples of the adult population in Korea [64, 65]. The questionnaire included items, such as “My leisure activity helps me have new experiences” and “My leisure activity gives me self-confidence.” Higher scores indicated greater levels of leisure satisfaction. In the present study, Cronbach’s alpha reliability for the total score was .93, and for health improvement, skill improvement, social relationship, self-development, and stress reduction dimensions, scores were .86, .78, .87, .90, and .92, respectively.

2.3.3. Quality of Life

The WHO Quality of Life BREF (WHOQOL-BREF) was used to measure the participants’ quality of life [66]. The WHOQOL-BREF has been validated cross-culturally, including the validation conducted in Korea [67]. The WHOQOL consisted of 26 items pertaining to four domains and one facet covering overall quality of life and general health. The responses to the items were provided using a five-point Likert scale that ranged from 1 to 5. The WHOQOL has been used in previous studies with samples of childcare teachers in Korea [68, 69]. The items covered four domains, which included physical health (e.g., “To what extent do you feel that physical pain prevents you from doing what you need to do?”), psychological health (e.g., “How often do you experience negative feelings, such as blue mood, despair, anxiety, depression?”), social relations (e.g., “How satisfied are you with your personal relationships?”), and environment (e.g., “How satisfied are you with the conditions of your living place?”). The Cronbach’s alpha reliability of the overall WHOQOL was .93 in the present study.

2.4. Statistical Analysis

Data analyses were performed using the statistical package SAS 9.4. and SAS PROCESS macro. Prior to the primary analyses, Cronbach’s alpha coefficients for internal consistency were calculated for each of the scales. The general tendency of the study variables (i.e., mean, standard deviation, range, and other characteristics) and the Pearson correlation coefficients between variables were employed. Hierarchical multiple regression analyses were used to examine the associations among the study variables. Moderation analyses were conducted by adopting Model 1 using the SAS PROCESS macro [60]. To test the moderating effects, a conditional process analysis was applied with a bootstrapped approach using 5,000 samples. Biases were corrected at 95% confidence intervals. The variables were centered, and products between the centered variables were included in the model as interaction terms.


Table 1 shows the Pearson product-moment correlations among affective organizational commitment, leisure satisfaction, and quality of life along with their respective means, standard deviations, ranges, and Cronbach’s alpha reliability. The reliability of the measures ranged from .83 to .93, which was considered acceptable. As shown in Table 1, quality of life was significantly correlated with affective commitment (r=.29, p<.001) and leisure satisfaction (r=.39, p<.001). Additionally, affective commitment was found to be significantly correlated with leisure satisfaction (r=.28, p<.001). Thus, Hypotheses 1 and 2 were supported.

Table 1. Confirmatory factor analysis results of measurement models.
Model Factors χ 2 df ∆χ 2 CFI TLI RMSEA
(90% CI)
Baseline model Three factors. 86.86 41 .95 .93 .08
.05 134.86
Model 1 Two factors: Affective commitment and leisure satisfaction were combined into one factor. 91.37 43 4.51 .94 .93 .09
.06 137.37
Model 2 Two factors: Quality of life and affective commitment were combined into one factor. 89.44 43 2.58 .95 .93 .08
.06 135.44
Model 3 Two factors: Quality of life and leisure satisfaction were combined into one factor. 353.08 43 266.22 .65 .55 .22
.16 399.08
Table 2. Descriptive statistics, zero-order correlations, and Cronbach’s α of the measures.
Variables Mean SD 1 2 3 4 5
1. Age (control) 39.43 9.57 -
2. Marital status (control) .40 .49 -.64** -
3. Affective commitment 3.52 .56 .25** -.11 (.83)
4. Leisure satisfaction 3.72 .54 .00 .09 .28** (.93)
5.Quality of life 3.46 .48 .16* .00 .29** .39** (.93)
Note. *p<0.05; **p<0.01.

Table 2 shows the hierarchical multiple regression analysis results. Participants’ age and marital status (dummy coded) were entered as covariates. As shown in Table 2, after controlling for the covariates, affective commitment (ß=.20, p<.05), leisure satisfaction (ß=.38, p<.001), and the interaction term (ß=.19, p<.05) displayed significantly positive effects on the quality of life. Affective commitment, leisure satisfaction, and the interaction term with the covariates of age and marital status explained 24% of the variance in the participants’ quality of life.

Moderation analyses were conducted by adopting Model 1 using SAS PROCESS macro. The bias-corrected 95% confidence interval for the interaction effect was bootstrapped 5,000 times (effect=191, SE=.078, lower limit=.037, upper limit=.344). Thus, Hypothesis 3 was supported. As shown in Table 3, affective commitment was related to their quality of life at one standard deviation above the mean of leisure satisfaction (ß=.279, SE=.082, 95% CI=.118-.440) and at average levels of leisure satisfaction (ß=.176, SE=.067, 95% CI=.043-.309). However, affective commitment was not significantly related to quality of life at lower levels of leisure satisfaction (ß=.072, SE=.077, 95% CI=-.081-.225).

Fig. (2) illustrates the plot of the interaction between affective commitment and leisure satisfaction on the quality of life. As shown in the plot, the association between affective commitment and quality of life was stronger in the group of teachers with high levels of leisure satisfaction (values greater than mean plus standard deviation) than those with low levels of leisure satisfaction (values less than mean minus standard deviation). Thus, it was observed that a higher affective commitment might lead to a higher quality of life among employees with high leisure satisfaction.

Table 3. Hierarchical regression on quality of life.
Predictors Model 1 (R2=.04) Model 2 (R2=.21) Model 3 (R2=.24)
Unstandardized coefficient SE Unstandardized coefficient SE Unstandardized coefficient SE
Age (control) .01 .01          .01 .00        .01 .00
Marital status (control) .14 .10          .08 .09        .08 .09
Affective commitment (A)          .17* .07        .17* .07
Leisure satisfaction (B)          .28** .07        .33** .07
A X B        .19* .08
F 3.08* 9.68** 9.22**
R 2 Change .17 .03
Note. *p<0.05; **p<0.01.
Fig. (2). Interaction effect between affective commitment and leisure satisfaction on quality of life.

Table 4. Bootstrapping results for moderating effect of leisure satisfaction.
Moderator Effect Bootstrapping SE p 95% CI
High level .28 .08 .00 [.12, .44]
Average .18 .07 .01 [.04, .31]
Low level .07 .08 .35 [-.08, .23]


This study examined the association of childcare teachers’ affective commitment and leisure satisfaction with their quality of life, as well as the moderating role of leisure satisfaction in the relationship between their affective commitment and quality of life. First, the finding that affective commitment related to the quality of life extended the results of previous studies, which reported a positive association between affective commitment and quality of work-life in an organization [25, 70]. The findings of this study imply that the positive attitude of employees, such as their affective commitment, is essential for individuals as well as organizations. Moreover, employees’ leisure satisfaction displayed a significant positive relationship with their quality of life in the present study. A previous study showed that leisure participation among high school teachers and college professors negatively predicted job stress, which negatively predicted their life satisfaction [71]. Given the observed positive relationship between leisure satisfaction and the quality of life of college students [35, 72, 73], the general public [74], and health professionals [38], the findings of this study also suggest that the leisure domain needs to be considered to improve the quality of life of female childcare teachers. Leisure experiences have the potential to enhance individuals’ general well-being and their ability to manage stress [72]. The findings show the importance of leisure-related variables in enhancing well-being among employees in non-Western cultural contexts.

Second, the moderation analyses demonstrated that leisure satisfaction moderated the strength of the relationship between affective commitment and quality of life. The interface between work and nonwork activities has gained increased interest among organizational psychologists [75]. The findings of this study that combine both domains suggest that leisure is not the opposite aspect of affective workplace commitment, thus emphasizing the importance of work-life balance. Work-life balance can be defined as “sufficient time to meet commitments at both home and work” (p.263) [76]. It can also be subjectively defined as “a perceived balance between work and the rest of life” (p.263) [76]. The present findings imply that active involvement in different domains of life reduces isolation and enhances one’s quality of life. A study that examined women in the US construction industry revealed that a balance between their work and personal time was one of the six most commonly reported factors that increased their desire to stay with their employer, whereas a poor balance between work and personal time was one of the six most commonly reported factors that increased their desire to leave [77]. Work-life imbalance could make it difficult for employees to preserve their well-being and could weaken their emotional bonds with the organization. Although work-life balance encompasses different formulations and theories, it has been recognized as the achievement of satisfying experiences in life domains and requires various resources, such as energy, time, and commitment, to be well distributed across domains [78]. Consistent with previous research, the present study, using a community sample in Korea, revealed that integrating affective commitment and leisure satisfaction enhances the quality of life. It showed that the work-life and personal life domains could interact to improve the quality of life for female childcare teachers in Korea. A previous study showed affective commitment associated with favorable work-related outcomes, including employee engagement [27]. The findings of the current study demonstrated that well-being, such as quality of life, is affected by affective commitment in work and leisure satisfaction in a personal context. Given that an imbalance in demands of varied roles rarely leads to long-term positive outcomes [78], an imbalance between work and personal leisure domains must be considered. The job design process can be enriched by considering these intertwining factors related to the quality of life from a whole-life perspective. The findings regarding the association between work and leisure domains would help better understand work-life balance beliefs. The intervention to foster well-being for female employees may ensure work-life balance, incorporating work-related and leisure roles in their daily lives.


There are several limitations to this study that should be carefully considered. First, the sample size of this cross-sectional study was small and was obtained using convenience sampling during the COVID-19 pandemic. Since a small sample size from convenience sampling reduces the representativeness of the sample, its findings should be generalized with caution. Future studies would benefit from larger samples with diverse workforces. Second, the participants in the present study were all female, but this was reflective of the extremely high proportion of female childcare teachers in Korea. Future studies that examine gender differences regarding quality of life across different workplaces could be insightful. For example, in a meta-analysis, leisure satisfaction was more strongly associated with subjective well-being for working men than for working women [30]. Third, the measures used in this study were derived exclusively from self-reported questionnaires. In addition, there might be a possible similar correlation between leisure satisfaction and quality of life. Future studies need to investigate other variables affecting the quality of life, including work-related and nonwork-related factors, using both quantitative and qualitative methods. In addition, future research needs t investigate mediation models using different factors and alternative conceptual models, such as affective commitment, as a moderator to better understand the mechanisms that influence the quality of life. With increased interest in quality of life among employees from a whole life perspective, more research needs to be designed to explore the role of affective commitment and leisure-related variables in various occupations in different cultural contexts.


This study demonstrated the interplay between affective commitment, leisure satisfaction, and quality of life. The findings of this study highlighted the significance of affective commitment and leisure satisfaction in enhancing employees’ quality of life. The association is more robust for employees who are satisfied with their leisure experiences. The balance between work and personal life domains has become increasingly essential, and work environments have changed dynamically during the COVID-19 pandemic. Employees need to allocate time specifically for leisure to prevent burnout. The findings of this study provide substantial support for the need to build a supportive environment in the workplace to ensure employees are provided sufficient leisure time. Ensuring the balance between employees’ attachment to the organization and their satisfaction with their personal leisure time would improve quality of life and prevent burnout, ultimately decreasing turnover.


This research was approved by the Research Ethics Committee of the Duksung Women’s University in Seoul, Korea (reference no. 2021-006-021-B).


No animals were used in this research. All human research procedures were followed in accordance with the ethical standards of the committee responsible for human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.


Informed consent was taken from all participants when they were enrolled.


STROBE guidelines and methodologies were followed in this study.


The data supporting the findings of this study are available from the corresponding author upon reasonable request.




The author declares no conflict of interest, financial or otherwise.


Declared none.


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