Abstract:
Background: We wanted to try to account for worker motivation as a key factor that might affect
the success of an intervention to improve implementation of health worker practices in eight
district hospitals in Kenya. In the absence of available tools, we therefore aimed to develop a tool
that could enable a rapid measurement of motivation at baseline and at subsequent points during
the 18-month intervention study.
Methods: After a literature review, a self-administered questionnaire was developed to assess the
outcomes and determinants of motivation of Kenyan government hospital staff. The initial
questionnaire included 23 questions (from seven underlying constructs) related to motivational
outcomes that were then used to construct a simpler tool to measure motivation. Parallel
qualitative work was undertaken to assess the relevance of the questions chosen and the face
validity of the tool.
Results: Six hundred eighty-four health workers completed the questionnaires at baseline.
Reliability analysis and factor analysis were used to produce the simplified motivational index, which
consisted of 10 equally-weighted items from three underlying factors. Scores on the 10-item index
were closely correlated with scores for the 23-item index, indicating that in future rapid
assessments might be based on the 10 questions alone. The 10-item motivation index was also able
to identify statistically significant differences in mean health worker motivation scores between the
study hospitals (p < 0.001). The parallel qualitative work in general supported these conclusions
and contributed to our understanding of the three identified components of motivation.
Conclusion: The 10-item score developed may be useful to monitor changes in motivation over
time within our study or be used for more extensive rapid assessments of health worker
motivation in Kenya.
