How to do (or not to do)… Measuring health worker motivation in surveys in low- and middle-income countries

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.

‘Know‐Can’ gap: gap between knowledge and skills related to childhood diarrhoea and pneumonia among frontline workers in rural Uttar Pradesh, India

“…As increasing attention has focused on strengthening the quality of frontline workers’ services, the concept of a ‘know‐do’ gap – a failure to provide adequate care despite having correct knowledge – has emerged. This concept has also been called knowledge translation failure and non‐adherence to clinical guidelines in the literature in various contexts . However, ‘ know‐do’ gap has been used by different authors to represent different parts of the pathway from the availability of evidence‐based guidelines to practice.…”

“…The gap between availability of clinical guidelines and provider practice is well documented and proposed reasons for this gap include provider negligence ; lack of motivation ; poor quality medical education and training ; insufficient time per patient from high caseloads ; lacking resources ; cultural barriers ; unclear clinical guidelines ; and other environmental factors . Provider‐level gaps (between knowledge & skills, skills & practice, and knowledge & practice) have also been studied .…”

Understanding the role of disease knowledge and risk perception in shaping preventive behavior for selected vector-borne diseases in Guyana

“…Lastly, a significant majority of the participants consisted of female for interviews conducted in private houses. SEM offers several advantages: it can (i) deal with omitted variable bias[48]; (ii) account for measurement error by using latent variables as indicators of observed variables[49]; (iii) solve for reverse relationship if the model is empirically identified; and (iv) compare models in terms of their best fit as well as perform multiple group analysis[50,51] (cf. S3 Text) Our SEM model is presented inFig 2 andis built assuming a linear structure of relationships using the maximum likelihood estimator (MLE) for participants interviewed in private houses.…”

Measuring the motivation of health workers: a reflection on the methodological issues and lessons learnt

“…An increasing body of research aims to understand health worker motivation LMICs (5)(6)(7)(8)(9)(10)(11)(12). A recent paper outlines the steps required in developing a high-quality motivation scale-which refers to a set of statements or questions in a survey intending to measure motivation (13). Nonetheless, few studies re ect on this methodology and challenges in its practical application (14).…”