Abstract
BackgroundAlthough 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).MethodsWe 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).ResultsOur 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.ConclusionsThe 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.
Highlights
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
Research on health worker motivation in LMICs has mostly focused on the overall amount or on determinants and outcomes of motivation, leaving other relevant dimensions discussed in the psychological literature such as motivation composition relatively unexplored [4, 9]
Corresponding quantitative measurement tools (e.g., [10,11,12,13]), while without doubt useful to answer many research questions, are not suited to others, including that around the crowding out effect which deals with a shift in motivation composition from intrinsic to extrinsic forms
Summary
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. Interventions targeting health worker motivation such as performance-based financing (PBF) have become extremely popular among policy makers in low- and middleincome countries (LMICs) [2, 3] Despite the attention such interventions are receiving, gaps in understanding remain. Corresponding quantitative measurement tools (e.g., [10,11,12,13]), while without doubt useful to answer many research questions, are not suited to others, including that around the crowding out effect which deals with a shift in motivation composition from intrinsic to extrinsic forms
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