By Jo Borghi (London School of Hygiene & Tropical Medicine)
This published paper on ‘How to do (or not to do)… Measuring health worker motivation in surveys in low- and middle-income countries’ aims to provide a practical overview of the steps involved in designing and implementing surveys measuring health worker motivation in LMICs and analysing and interpreting the findings obtained- with the purpose to increase and improve performance in the long run.
Step 1: Conceptualising motivation
Motivation is a complex construct as indicated in this definition: “Work motivation is a set of energetic forces that originate both within as well as beyond an individual’s being, to initiate workrelated behaviour, and to determine its form, direction, intensity, and duration.” (Pinder 2008)
Step 2: Developing and pre-testing a tool
Having selected a conceptualisation of motivation, the first step in developing a survey tool is to identify a set of questions to measure motivation, referred to as a measurement scale
Step 3: Sample size considerations and sampling
Sample size is a further consideration prior to survey administration. The techniques used to assess the validity of the motivation measure (step 5) require certain minimum sample sizes, dependent on the number of dimensions, items and other factors
Step 4: Exploratory data analysis
Once the data have been collected, it is important to start with an exploration of the data, estimating mean and median scores and frequencies for each item, and checking for missing data.
Step 5: Assessing validity of motivation measures
Before using motivation measurements in core analyses, researchers should ensure the measures are valid or that they measured what was intended using exploratory of confirmatory factor analysis.
Step 6: Measurement Reliability
Reliability refers to the extent to which the measurement scale produces similar results under similar conditions
Step 7: Core Analysis
Once validity and reliability are established, the motivation measure can be used within analysis depending on the objective of the study. If the objective is to describe motivation levels, item responses can be combined into a composite score typically calculated as the arithmetic mean of a health worker responses. This step also explains how to examine determinants of motivation and changes in motivation over time.
Step 8: Presenting findings
When reporting findings, it is important to be transparent as to the steps taken to generate results and decisions made during this process.
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