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Vallières F, Kok M, Mahmud I, Sarker M, Jeacocke P, Karuga R, Limato L, Kea AZ, Chikaphupha K, Sidat M, Gilmore B, Taegtmeyer M. Measuring motivation among close-to-community health workers: developing the CTC Provider Motivational Indicator Scale across six countries. HUMAN RESOURCES FOR HEALTH 2020; 18:54. [PMID: 32738907 PMCID: PMC7395979 DOI: 10.1186/s12960-020-00495-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 07/18/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Close-to-community (CTC) health service providers are a cost-effective and important resource in the promotion of and increasing access to health services. However, many CTC provider programmes suffer from high rates of de-motivation and attrition due to inadequate support systems. Recent literature has identified the lack of rigorous approaches towards measuring and monitoring motivation among CTC providers as an important gap. Building on scales used in previous studies, we set out to develop a short, simple-to-administer scale to monitor and measure indicators of CTC provider motivation across CTC programmes implemented in six countries: Ethiopia, Kenya, Malawi, Mozambique, Indonesia, and Bangladesh. METHODS We used focus group discussions (n = 18) and interviews (n = 106) conducted with CTC providers across all six countries, applying thematic analysis techniques to identify key determinants of motivation across these contexts. These themes were then used to carry out a systematic search of the literature, to identify existing scales or questionnaires developed for the measurement of these themes. A composite 24-item scale was then administered to CTC providers (n = 695) across the six countries. Survey responses were subsequently randomly assigned to one of two datasets: the first for scale refinement, using exploratory techniques, and the second for factorial validation. Confirmatory factor analysis was applied to both datasets. RESULTS Results suggest a 12-item, four-factor structure, measuring community commitment, organisational commitment, job satisfaction, and work conscientiousness as common indicators of motivation among CTC providers across the six countries. CONCLUSIONS Consistent with previous studies, findings support the inclusion of job satisfaction, organisational commitment, and work conscientiousness within the CTC Provider Motivation Indicator Scale. In addition, findings further supported the addition of a fourth, community commitment, sub-scale. Practical applications of the revised scale, including how it can be applied to monitor motivation levels within CTC provider programming, are discussed.
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Affiliation(s)
- Frédérique Vallières
- Trinity Centre for Global Health, School of Psychology, Trinity College Dublin, 7-9 Leinster Street South, Dublin 2, Ireland
| | - Maryse Kok
- KIT Royal Tropical Institute, Mauritskade 64, 1092 AD Amsterdam, The Netherlands
| | - Ilias Mahmud
- James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Malabika Sarker
- James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Philippa Jeacocke
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA UK
| | | | - Licia Limato
- Eijkman Institute for Molecular Biology, Jl. Diponegoro No.69, Jakarta, Indonesia
| | | | | | - Mohsin Sidat
- Department of Community Health, University Eduardo Mondlane, Maputo, Mozambique
| | - Brynne Gilmore
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Miriam Taegtmeyer
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA UK
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Rajbhandari R, Rai S, Hathi S, Thapa R, Rai I, Shrestha A. The quality of skilled birth attendants in Nepal: High aspirations and ground realities. PLoS One 2019; 14:e0214577. [PMID: 30947314 PMCID: PMC6448824 DOI: 10.1371/journal.pone.0214577] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 03/17/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND While Nepal's maternal mortality ratio (MMR) has improved overall, the proportion of maternal deaths occurring in health facilities and attended to by skilled birth attendants (SBAs), has nearly doubled over 12 years. Although there are numerous socioeconomic, environmental and other factors at play, one possible explanation for this discrepancy between utilization of skilled maternal care services and birth outcomes lies in the quality of care being provided by SBAs. The objective of this study is to determine how competent SBAs are after training, across multiple settings and facility types in Nepal. METHODS We used a quantitative cross-sectional analysis to evaluate a sample of 511 SBAs, all female, from 276 sub-health posts (SHP), health posts (HP), primary healthcare centers (PHC), and district and regional hospitals in the mountain, hill, and terai districts of Nepal. Any SBA actively employed by one of these health facilities was included. SBAs who had received less than three months of training were excluded. Outcomes were measured using SBAs' scores on a standardized knowledge assessment, clinical skills assessment, and monthly delivery volume, particularly as it compared with the WHO's recommendation for minimum monthly volume to maintain competence. RESULTS SBAs on average exhibit a deficiency of both knowledge and clinical skills, failing to meet even the 80-percent standard that is required to pass training (knowledge: 75%, standard deviation 12%; clinical skills: 48%, standard deviation 15%). Moreover, SBAs are conducting very few deliveries, with only 7 percent (38/511) meeting the minimal volume recommended to maintain competence by the WHO, and a substantial fraction (70/511, 14%) performing an average of no monthly deliveries at all. CONCLUSIONS Taken together, our findings suggest that while countries like Nepal have made important investments in SBA programs, these healthcare workers are failing to receive either effective training or sufficient practice to stay clinically competent and knowledgeable in the field. This could in part explain why institutional deliveries have generally failed to deliver better outcomes for pregnant women and their babies.
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Affiliation(s)
- Ruma Rajbhandari
- Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.,Nick Simons Institute, Kathmandu, Nepal
| | | | - Sejal Hathi
- Stanford Medical School, Palo Alto, California, United States of America
| | | | - Indra Rai
- Nick Simons Institute, Kathmandu, Nepal
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Borghi J, Lohmann J, Dale E, Meheus F, Goudge J, Oboirien K, Kuwawenaruwa A. How to do (or not to do)… Measuring health worker motivation in surveys in low- and middle-income countries. Health Policy Plan 2018; 33:192-203. [PMID: 29165641 PMCID: PMC5886192 DOI: 10.1093/heapol/czx153] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2017] [Indexed: 11/13/2022] Open
Abstract
A health system's ability to deliver quality health care depends on the availability of motivated health workers, which are insufficient in many low income settings. Increasing policy and researcher attention is directed towards understanding what drives health worker motivation and how different policy interventions affect motivation, as motivation is key to performance and quality of care outcomes. As a result, there is growing interest among researchers in measuring motivation within health worker surveys. However, there is currently limited guidance on how to conceptualize and approach measurement and how to validate or analyse motivation data collected from health worker surveys, resulting in inconsistent and sometimes poor quality measures. This paper begins by discussing how motivation can be conceptualized, then sets out the steps in developing questions to measure motivation within health worker surveys and in ensuring data quality through validity and reliability tests. The paper also discusses analysis of the resulting motivation measure/s. This paper aims to promote high quality research that will generate policy relevant and useful evidence.
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Affiliation(s)
- J Borghi
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, UK
| | - J Lohmann
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
| | - E Dale
- Department of Health Systems Financing, World Health Organization, Geneva, Switzerland
| | - F Meheus
- International Agency for Research on Cancer, World Health Organization, Lyon, France
- Centre for Health Policy, Wits University, Johannesburg, South Africa
| | - J Goudge
- Centre for Health Policy, Wits University, Johannesburg, South Africa
| | - K Oboirien
- Centre for Health Policy, Wits University, Johannesburg, South Africa
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Lohmann J, Souares A, Tiendrebéogo J, Houlfort N, Robyn PJ, Somda SMA, De Allegri M. Measuring health workers' motivation composition: validation of a scale based on Self-Determination Theory in Burkina Faso. HUMAN RESOURCES FOR HEALTH 2017; 15:33. [PMID: 28532426 PMCID: PMC5441099 DOI: 10.1186/s12960-017-0208-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 05/11/2017] [Indexed: 05/28/2023]
Abstract
BACKGROUND Although motivation of health workers in low- and middle-income countries (LMICs) has become a topic of increasing interest by policy makers and researchers in recent years, many aspects are not well understood to date. This is partly due to a lack of appropriate measurement instruments. This article presents evidence on the construct validity of a psychometric scale developed to measure motivation composition, i.e., the extent to which motivation of different origin within and outside of a person contributes to their overall work motivation. It is theoretically grounded in Self-Determination Theory (SDT). METHODS We conducted a cross-sectional survey of 1142 nurses in 522 government health facilities in 24 districts of Burkina Faso. We assessed the scale's validity in a confirmatory factor analysis framework, investigating whether the scale measures what it was intended to measure (content, structural, and convergent/discriminant validity) and whether it does so equally well across health worker subgroups (measurement invariance). RESULTS Our results show that the scale measures a slightly modified version of the SDT continuum of motivation well. Measurements were overall comparable between subgroups, but results indicate that caution is warranted if a comparison of motivation scores between groups is the focus of analysis. CONCLUSIONS The scale is a valuable addition to the repository of measurement tools for health worker motivation in LMICs. We expect it to prove useful in the quest for a more comprehensive understanding of motivation as well as of the effects and potential side effects of interventions intended to enhance motivation.
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Affiliation(s)
- Julia Lohmann
- Institute of Public Health, Faculty of Medicine, Heidelberg University, Im Neuenheimer Feld 324, Heidelberg, Germany
| | - Aurélia Souares
- Institute of Public Health, Faculty of Medicine, Heidelberg University, Im Neuenheimer Feld 324, Heidelberg, Germany
| | | | - Nathalie Houlfort
- Département de Psychologie, Université du Québec à Montréal, C.P. 8888 succursale Centre-ville, Montréal, Québec H3C 3P8 Canada
| | - Paul Jacob Robyn
- World Bank, Health, Nutrition, Population Global Practice, 1818H Street, NW Washington, DC 20433 United States of America
| | - Serge M. A. Somda
- Département de Recherche Clinique, Centre MURAZ, 2054 Avenue Mamadou Konaté, 01 BP 390, Bobo-Dioulasso, Burkina Faso
| | - Manuela De Allegri
- Institute of Public Health, Faculty of Medicine, Heidelberg University, Im Neuenheimer Feld 324, Heidelberg, Germany
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Batura N, Skordis-Worrall J, Thapa R, Basnyat R, Morrison J. Is the Job Satisfaction Survey a good tool to measure job satisfaction amongst health workers in Nepal? Results of a validation analysis. BMC Health Serv Res 2016; 16:308. [PMID: 27461030 PMCID: PMC4962514 DOI: 10.1186/s12913-016-1558-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 07/15/2016] [Indexed: 11/10/2022] Open
Abstract
Background Job satisfaction is an important predictor of an individual’s intention to leave the workplace. It is increasingly being used to consider the retention of health workers in low-income countries. However, the determinants of job satisfaction vary in different contexts, and it is important to use measurement methods that are contextually appropriate. We identified a measurement tool developed by Paul Spector, and used mixed methods to assess its validity and reliability in measuring job satisfaction among maternal and newborn health workers (MNHWs) in government facilities in rural Nepal. Methods We administered the tool to 137 MNHWs and collected qualitative data from 78 MNHWs, and district and central level stakeholders to explore definitions of job satisfaction and factors that affected it. We calculated a job satisfaction index for all MNHWs using quantitative data and tested for validity, reliability and sensitivity. We conducted qualitative content analysis and compared the job satisfaction indices with qualitative data. Results Results from the internal consistency tests offer encouraging evidence of the validity, reliability and sensitivity of the tool. Overall, the job satisfaction indices reflected the qualitative data. The tool was able to distinguish levels of job satisfaction among MNHWs. However, the work environment and promotion dimensions of the tool did not adequately reflect local conditions. Further, community fit was found to impact job satisfaction but was not captured by the tool. The relatively high incidence of missing responses may suggest that responding to some statements was perceived as risky. Conclusion Our findings indicate that the adapted job satisfaction survey was able to measure job satisfaction in Nepal. However, it did not include key contextual factors affecting job satisfaction of MNHWs, and as such may have been less sensitive than a more inclusive measure. The findings suggest that this tool can be used in similar settings and populations, with the addition of statements reflecting the nature of the work environment and structure of the local health system. Qualitative data on job satisfaction should be collected before using the tool in a new context, to highlight any locally relevant dimensions of job satisfaction not already captured in the standard survey.
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Purohit B, Maneskar A, Saxena D. Developing a tool to assess motivation among health service providers working with public health system in India. HUMAN RESOURCES FOR HEALTH 2016; 14:15. [PMID: 27080388 PMCID: PMC4832524 DOI: 10.1186/s12960-016-0111-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 04/06/2016] [Indexed: 05/16/2023]
Abstract
BACKGROUND Addressing the shortage of health service providers (doctors and nurses) in rural health centres remains a huge challenge. The lack of motivation of health service providers to serve in rural areas is one of the major reasons for such shortage. While many studies have aimed at analysing the reasons for low motivation, hardly any studies in India have focused on developing valid and reliable tools to measure motivation among health service providers. Hence, the objective of the study was to test and develop a valid and reliable instrument to assess the motivation of health service providers working with the public health system in India and the extent to which the motivation factors included in the study motivate health service providers to perform better at work. METHODS The present study adapted an already developed tool on motivation. The reliability and validity of the tool were established using different methods. The first stage of the tool development involved content development and assessment where, after a detailed literature review, a predeveloped tool with 19 items was adapted. However, in light of the literature review and pilot test, the same tool was modified to suit the local context by adding 7 additional items so that the final modified tool comprised of 26 items. A correlation matrix was applied to check the pattern of relationships among the items. The total sample size for the study was 154 health service providers from one Western state in India. To understand the sampling adequacy, the Kaiser-Meyer-Olkin measure of sampling adequacy and Bartlett's test of sphericity were applied and finally factor analysis was carried out to calculate the eigenvalues and to understand the relative impact of factors affecting motivation. RESULTS A correlation matrix value of 0.017 was obtained narrating multi-co-linearity among the observations. Based on initial factor analysis, 8 out of 26 study factors were excluded from the study components with a cutoff range of less than 0.6. Running the factor analysis again suggested the inclusion of 18 items which were subsequently labelled under the following heads: transparency, goals, security, convenience, benefits, encouragement, adequacy of earnings and further growth and power. CONCLUSIONS There is a great need to develop instruments aimed at assessing the motivation of health service providers. The instrument used in the study has good psychometric properties and may serve as a useful tool to assess motivation among healthcare providers.
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Affiliation(s)
- Bhaskar Purohit
- />Indian Institute of Public Health Gandhinagar (PHFI), Drive in Road, Ahmedabad, 380054 India
| | | | - Deepak Saxena
- />Indian Institute of Public Health Gandhinagar (PHFI), Drive in Road, Ahmedabad, 380054 India
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