Motivation and Factors Affecting It among Health Professionals in the Public Hospitals, Central Ethiopia

Motivation and associated factors of health development army in the implementation of health extension packages in Northwest Ethiopia: a cross-sectional study

INTRODUCTION

Health development army is a network of women volunteers organised to promote health and prevent disease through community empowerment and participation.

OBJECTIVE

To assess the level of motivation and associated factors of the health development army in the implementation of health extension packages in Northwest Ethiopia.

DESIGN

Data were from a community-based cross-sectional study.

SETTING

This study was conducted in Mecha district, Northwest Ethiopia. The district is located around 30 km from Bahir Dar, the capital city of Amhara National Regional State, Ethiopia.

PARTICIPANTS

A total of 624 health development army members were interviewed using a structured questionnaire from 20 April 2020 to 20 May 2020.

OUTCOME MEASURES

Motivation was assessed using a five-item Likert scale statement ranging from 1 to 5. Data were collected using a structured questionnaire and analysed using a binary logistic regression model.

RESULTS

The proportion of health development army members, who had motivation in the implementation of the health extension package, was 47.8% (95% CI (43.90 to 51.80)). The odds of having motivation were higher among health development army members who lived in urban areas ((adjusted OR, AOR 2.47; 95% CI (1.21 to 5.03)), were less than 30 years ((AOR 2.42; 95% CI (1.22 to 4.78)), had more than 4 years work experience ((AOR 4.72; 95% CI (2.54 to 8.76)), had high intrinsic job satisfaction ((AOR 2.31; 95% CI (1.51 to 3.55)), had good community support ((AOR 2.46; 95% CI (1.34 to 4.51)), received supportive supervision ((AOR 1.85; 95% CI (1.24 to 2.77)) and were recognised for their efforts ((AOR 1.52; 95% CI (1.01 to 2.30)).

CONCLUSION

The proportion of motivation among health development army members was low. To increase the motivation of health development army members in the implementation of the health extension package, measures or strategies may consider targeting members who live in rural areas, are older than 30 years, have less than 4 years of work experience, report low job satisfaction, have low community support, do not have supportive supervision and are not recognised.

Work motivation and factors associated with it among health professionals in Debre Markos Comprehensive Specialized Hospital

Motivation is the level of a person's willingness to put forth and maintain an effort in support of organizational goals. However, motivation towards task execution is affected by the organization and individual goals. For instance, low morale among the staff can damage the quality of service delivery. Hence, this study was intended to assess the working motivation status and factors associated with it among health professionals at Debre Markos Comprehensive Specialized Hospital. A hospital-based cross-sectional study was employed. Stratified sampling techniques were used to extract sample from each job category proportionally. To make the distribution fair, all health workers were grouped according to their job title and selected by using the lottery method from each group. A standardized, self-administered questionnaire was used to collect data. Data was checked, coded, and entered into EpiData 3.1 and exported for analysis into SPSS 25. Variable in the multivariable logistic regression model with a p value of < 0.05 at 95% CI were taken as significantly associated to motivation status. A total of 319 people were involved, with a 100% response rate. 20.4% of health professionals were motivated at Debre Markos Comprehensive Specialized Hospital. Job satisfaction (AOR 6.46, 95% CI 1.72, 24.35), the presence of adequate medical supplies (AOR 5.01, 95% CI 1.23, 25.37), work place security (AOR 6.78, 95% CI 1.498, 30.72), and the presence of training opportunities in health facilities (AOR 2.23, 95% CI 1.01, 4.96) were significant factors associated with motivation status. The proportion of motivated health professionals was very low compared to previous studies in Ethiopia. The presence of security at work, adequate medical equipment, drugs, and supplies, job satisfaction, and the presence of training opportunities were predominant motivational factors. The hospital administration needs to give priority and work to safeguard security, ensure adequate medical supplies, and offer training to improve their satisfaction and motivation.

Factors related to intensive care unit Nurses' work engagement: A web-based survey

A questionnaire survey on the personal and work factors related to work engagement among intensive care unit nurses concerning their recovery experiences and the nursing practice environment was conducted using a web-based tool. Two individual factors (demographics and experience on recovery from job stress) and four work factors (work employment type, nursing method, COVID-19 nursing experience, and nursing practice environment) were surveyed. Data from 244 participants were obtained, and survey items were analyzed using a multiple regression analysis with work engagement as the dependent variable. The results show that 3-5 years of nursing experience is significantly associated with lower work engagement. Conversely, certifications for higher-level and specialized nursing, mastery experience such as learning new things, 1-9 days/month of COVID-19 nursing experience, and suitable nursing practice environment were significantly associated with higher work engagement. These factors are considered important for improving the work engagement of intensive care unit nurses.

Health professionals' routine practice documentation and its associated factors in a resource-limited setting: a cross-sectional study

OBJECTIVES

Documenting routine practice is significant for better diagnosis, treatment, continuity of care and medicolegal issues. However, health professionals' routine practice documentation is poorly practised. Therefore, this study aimed to assess health professionals' routine practice documentation and associated factors in a resource-limited setting.

METHODS

An institution-based cross-sectional study design was used from 24 March up to 19 April 2022. Stratified random sampling and a pretested self-administered questionnaire were used among 423 samples. Epi Info V.7.1 and STATA V.15 software were used for data entry and analysis, respectively. Descriptive statistics and a logistic regression model were employed to describe the study subjects and to measure the strength of association between dependent and independent variables, respectively. A variable with a p value of <0.2 in bivariate logistic regression was considered for multivariable logistic regression. In multivariable logistic regression, ORs with 95% CIs and a p value of <0.05 were considered to determine the strength of association between dependent and independent variables.

RESULTS

Health professionals' documentation practice was 51.1% (95% CI: 48.64 to 53.1). Lack of motivation (adjusted OR (AOR): 0.41, 95% CI: 0.22 to 0.76), good knowledge (AOR: 1.35, 95% CI: 0.72 to 2.97), taking training (AOR: 4.18, 95% CI: 2.99 to 8.28), using electronic systems (AOR: 2.19, 95% CI: 1.36 to 3.28), availability of standard documentation tools (AOR: 2.45, 95% CI: 1.35 to 4.43) were statistically associated factors.

CONCLUSIONS

Health professionals' documentation practice is good. Lack of motivation, good knowledge, taking training, using electronic systems and the availability of documentation tools were significant factors. Stakeholders should provide additional training, and encourage professionals to use an electronic system for documentation practices.

Factors influencing the motivation of maternal health workers in conflict setting of Mogadishu, Somalia

Motivated health workers play an important role in delivering high-quality maternal health services, especially in low-income countries where maternal mortality rates are high, and shortages of human resource for health is prevalent. The aim of this study is to investigate maternal health workers' motivation in three tertiary hospitals in Mogadishu Somalia. We used a semi-structured questionnaire that was validated and widely used in Sub-Saharan Africa to collect data from 220 health workers across three tertiary hospitals in Mogadishu between February and April 2020. Health worker motivation was measured using seven constructs: general motivation, burnout, job satisfaction, intrinsic job satisfaction, organizational commitment, conscientiousness, timeliness and attendance. A multiple linear regression analysis was performed to determine the predictors of health worker motivation. The results show that male health workers have a higher work motivation, with a mean score of 92.75 (SD 21.31) versus 90.43 (SD 21.61) in women. As regards to profession, significant correlation was found between health workers' motivation and being an assistant (coeff, 6.873, p = 0.001), nurse (coeff, 5.111, p = 0.000), physicians (coeff, 2.898 p = 0.042), pediatric assistants (coeff, 2.878, p = 0.048), midwife (coeff, 3.822, P = 0.01), and others (supervisor and pharmacist) (coeff, 5.623, P = 0.001). Unexpectedly, the gynecologists and midwives were the least motivated groups among the different professions, with mean scores of 83.63, (SD: 27.41) and 86.95 (SD: 21.08), respectively. Of the aforementioned seven motivation constructs, the highest mean motivation scores (from 1-5) were observed in conscientiousness and intrinsic job satisfaction. These results highlight the importance of targeted interventions that increase female health workers' motivation, particularly gynecologists and midwives. This can be done by providing non-financial incentives, in addition to encouraging their participation in the decision-making process. Further research is needed to investigate the effect of a lack of motivation among gynecologists and midwives on maternal health in Somalia.

Descriptive phenomenology study of the reasons for the low uptake of free health service package among type II diabetic patients

BACKGROUND

Although several diabetes management and control programs are introduced in Iran, rate of using such cares in patients with Type II Diabetic in Ahvaz is low and they show no tendency for receiving free diabetes service package. The aim of this study was to identify reasons behind low uptake of free health service package among T2DM patients in Ahvaz, Iran.

METHODS

This descriptive phenomenology study based on semi-structured guided interviews of patients with Type II Diabetic in Ahvaz, was carried out in the year 2021. Through purposeful sampling, 495 patients with diabetics who not received health services package more than 6 months were interviewed until the data saturation. The gathered data were analyzed through conventional content analysis.

RESULTS

Reasons were categorized into three themes which include 13 subthemes and 57 codes. Themes included individual, accessibility, and structural factors. Besides, subthemes were lack of awareness, poor health literacy, adverse patients experience, difficulties to use services, verbal miscommunication cultural barriers, low trust, geographic barriers, time barriers, financial difficulties, lack of human resources, poor service delivery, and organizational factors were as barriers to participation.

CONCLUSION

Regarding individual level, there is a need for further training of diabetic patients. Besides, for accessibility and structural factors Iranian healthcare system needs a comprehensive integrated care for the management of diabetes, this underlines the collaboration for improving patients' uptake of free health service package.

Key factors influencing motivation among health extension workers and health care professionals in four regions of Ethiopia: A cross-sectional study

Background

Although Ethiopia has improved access to health care in recent years, quality of care remains low. Health worker motivation is an important determinant of performance and affects quality of care. Low health care workers motivation can be associated with poor health care quality and client experience, non-attendance, and poor clinical outcome. Objective this study sought to determine the extent and variation of health professionals’ motivation alongside factors associated with motivation.

Methods

We conducted a facility based cross-sectional study among health extension workers (HEWs) and health care professionals in four regions: Amhara, Oromia, South nations, and nationalities people’s region (SNNPR) and Tigray from April 15 to May 10, 2018. We sampled 401 health system workers: skilled providers including nurses and midwives (n = 110), HEWs (n = 210); and non-patient facing health system staff representing case team leaders, facility and district heads, directors, and officers (n = 81). Participants completed a 30-item Likert scale ranking tool which asked questions across 17 domains. We used exploratory factor analysis to explore latent motivation constructs.

Results

Of the 397 responses with complete data, 61% (95% CI 56%-66%) self-reported motivation as “very good” or “excellent”. Significant variation in motivation was seen across regions with SNNPR scoring significantly lower on a five-point Likert scale by 0.35 points (P = 0.003). The exploratory factor analysis identified a three-factors: personal and altruistic goals; pride and personal satisfaction; and recognition and support. The personal and altruistic goals factor varied across regions with Oromia and SNNPR being significantly lower by 0.13 (P = 0.018) and 0.12 (P = 0.039) Likert points respectively. The pride and personal satisfaction factor were higher among those aged > = 30 years by 0.14 Likert scale points (P = 0.045) relative to those aged between 19-24years.

Conclusions

Overall, motivation was high among participants but varied across region, cadre, and age. Workload, leave, and job satisfaction were associated with motivation.

Changes in health worker knowledge and motivation in the context of a quality improvement programme in Ethiopia

A knowledgeable and motivated workforce is critical for health systems to provide high-quality services. Many low- and middle-income countries face shortages in human resources and low health worker motivation but are also home to a burgeoning number of quality improvement (QI) programmes. This study evaluates whether and how motivation and clinical knowledge in three cadres of health workers changed in the context of a QI programme for maternal and newborn health in Ethiopia. This mixed-methods study used a pre–post comparison group design with matched comparison areas. We interviewed 395 health workers at baseline in April 2018 and 404 at endline in June 2019 from seven districts (woredas) with QI and seven comparison woredas. Three cadres were interviewed: health extension workers, facility-based skilled midlevel maternal and newborn care providers, and non-patient-facing staff. A qualitative component sought to triangulate and further elucidate quantitative findings using in-depth interviews with 22 health workers. Motivation was assessed quantitatively, exploratory factor analysis was used to categorize motivation dimensions, and regression-based difference-in-difference analyses were conducted. Knowledge was assessed through a clinical vignette. Qualitative data were analysed in a deductive process based on a framework derived from quantitative results. Although knowledge of the QI programme was high (79%) among participants from QI woreda at endline, participation in QI teams was lower (56%). There was strong evidence that health worker knowledge increased more in areas with QI than comparison areas. Three motivation dimensions emerged from the data: (1) ‘helping others’, (2) ‘pride and satisfaction’ and (3) ‘external recognition and support’. We found strong evidence that motivation across these factors improved in both QI and comparison areas, with weak evidence of greater increases in comparison areas. Qualitative data suggested the QI programme may have improved motivation by allowing staff to provide better care. This study suggests that although QI programmes can increase health worker knowledge, there may be little effect on motivation. Programme evaluations should measure a wide range of outcomes to fully understand their impact.

Job satisfaction behind motivation: An empirical study in public health workers

The health sector is characterized as labor-intensive, which means that the effectiveness of an organization that operates within its context is inextricably linked to the level of employee performance. Therefore, an essential condition, in order to achieve higher standards, in terms of the effectiveness of the health units, as well as set the foundations of a solid health system, is to take maximum advantage of the full potential of human resources. This goal can only be accomplished by providing the appropriate incentives, which will naturally cause the adoption of the desired attitude and behavior. In the case of Greece, there is not enough research relative to the needs of health workers and, consequently, the incentives that can motivate them. This article aims to investigate the dynamics that may be behind health workers at a public hospital in Northern Greece. Data were collected from 74 employees in the hospital and were analyzed using ANOVA analysis. The results show that key motivators for the employees can be considered the relationships with their colleagues and the level of achievement, while the level of rewards and job characteristics play a secondary role. These results make it clear that, in order for the hospital's management to be able to improve the level of employee performance, it should ensure the establishment of a strong climate among employees, and also acknowledge the efforts made by them.

Assessment of Job Satisfaction Level and Its Associated Factors among Health Workers in Addis Ababa Health Centers: A Cross-Sectional Study

Health workers account for the largest share of public expenditures on health and play an important role in improving the quality of health services. There is concern that poor health worker performance limits the effectiveness of health systems strengthening efforts. A cross-sectional study was conducted from September to October 2016 in Addis Ababa health centers. Data were collected from 420 healthcare workers using a pretested and structured questionnaire by trained data collectors. EPI Info 7 was used for data entry, and analysis was done by SPSS version 20. Bivariate and multivariate logistic analyses were used to identify factors associated with the outcome variable and to control confounders. $P$ values less than 0.05 were considered statistically significant. The overall job satisfaction level accounts for 53.8% with 95% CI of (48.9%, 59.0%). Marital status and professional qualification were the potent predictors of job satisfaction. Respondents who never married were 1.65 times more likely to be satisfied in their job than those married or divorced (AOR: 1.65 (95% CI: 1.02, 2.66)). Laboratory professionals and nursing professionals were 2.74 and 1.97 times more likely to be satisfied in their job compared to health officers (AOR: 2.47 (95% CI: 1.14, 6.59) and AOR: 1.97 (95% CI: 1.12, 3.48), respectively). More than half of the healthcare workers in the study area were satisfied in their job. Marital status and healthcare workers’ profession type were predictors of job satisfaction. Research studies indicate that there is a positive relationship between performance and job satisfaction. Accordingly, the present study aimed at determining the level of job satisfaction of health workers and its associated factors in the health centers of Addis Ababa, Ethiopia.

Understanding job satisfaction and motivation among nurses in public health facilities of Ethiopia: a cross-sectional study

Background

Poor job conditions and limited resources are reducing job satisfaction and motivation among nurses in low-income countries, which may affect the quality of services and attrition rates. The objective of this study was to examine job satisfaction, motivation and associated factors among nurses working in the public health facilities of Ethiopia, with the aim of improving performance and productivity in the health care system.

Methods

The study employed a cross-sectional two-stage cluster sampling design. From a random sample of 125 health facilities, 424 nurses were randomly selected for face-to-face interviews in all regions of Ethiopia. Nurses responded to questions about their overall job satisfaction and job conditions, including items related to intrinsic and extrinsic motivation, using a 5-point Likert scale. Multilevel analysis was performed to adjust for different clustering effects. Satisfaction levels (percent of respondents who were satisfied) were calculated for individual items, and composite mean scores (range: 1–5) were calculated for motivational factors. Adjusted odds ratios were computed to examine the association of these factors with overall job satisfaction.

Results

Overall, 60.8% of nurses expressed satisfaction with their job. Composite mean scores for intrinsic and extrinsic motivational factors were 3.5 and 3.0, respectively. Job satisfaction levels were significantly higher for female nurses (65.6%, p = 0.04), those older than 29 years (67.8%, p = 0.048) and had over 10 years work experiences (68.8%, p = 0.007). Satisfaction with remuneration (AOR = 2.04, 95% CI = 1.36, 3.06), recognition (AOR = 2.21; 95% CI = 1.38, 3.53), professional advancement (AOR = 1.54; 95% CI = 1.06, 2.29), features of the work itself (AOR = 1.65; 95% CI = 1.20, 2.91) and nurses’ work experiences from 5 to 10 years (AOR = 0.37, 95% CI = 0.17, 0.79) were significantly associated with overall job satisfaction after controlling for other predictors.

Conclusions

The study findings are signals for the Ministry of Health to strengthen the human resource management system and practices to improve nurses’ overall job satisfaction and motivation, especially among nurses with 5 to 10 years of experience on the job. Expanded recognition systems and opportunities for advancement are required to increase nurses’ job satisfaction and motivation. Equitable salary and fringe benefits are also needed to reduce their dissatisfaction with the job.

The effect of human resource management on performance in hospitals in Sub-Saharan Africa: a systematic literature review

Hospitals in Sub-Saharan Africa (SSA) face major workforce challenges while having to deal with extraordinary high burdens of disease. The effectiveness of human resource management (HRM) is therefore of particular interest for these SSA hospitals. While, in general, the relationship between HRM and hospital performance is extensively investigated, most of the underlying empirical evidence is from western countries and may have limited validity in SSA. Evidence on this relationship for SSA hospitals is scarce and scattered. We present a systematic review of empirical studies investigating the relationship between HRM and performance in SSA hospitals.Following the PRISMA protocol, searching in seven databases (i.e., Embase, MEDLINE, Web of Science, Cochrane, PubMed, CINAHL, Google Scholar) yielded 2252 hits and a total of 111 included studies that represent 19 out of 48 SSA countries.From a HRM perspective, most studies researched HRM bundles that combined practices from motivation-enhancing, skills-enhancing, and empowerment-enhancing domains. Motivation-enhancing practices were most frequently researched, followed by skills-enhancing practices and empowerment-enhancing practices. Few studies focused on single HRM practices (instead of bundles). Training and education were the most researched single practices, followed by task shifting.From a performance perspective, our review reveals that employee outcomes and organizational outcomes are frequently researched, whereas team outcomes and patient outcomes are significantly less researched. Most studies report HRM interventions to have positively impacted performance in one way or another. As researchers have studied a wide variety of (bundled) interventions and outcomes, our analysis does not allow to present a structured set of effective one-to-one relationships between specific HRM interventions and performance measures. Instead, we find that specific outcome improvements can be accomplished by different HRM interventions and conversely that similar HRM interventions are reported to affect different outcome measures.In view of the high burden of disease, our review identified remarkable little evidence on the relationship between HRM and patient outcomes. Moreover, the presented evidence often fails to provide contextual characteristics which are likely to induce variety in the performance effects of HRM interventions. Coordinated research efforts to advance the evidence base are called for.