IFGH 2012: The Challenges of Developing a Tool to Monitor Changes in Health Worker Motivation at Primary Care Level in Ghana

Authors:Prytherch H.¹, Aninanya G.A.², Williams J.² Wiskow C.^3, Leshabari M.T.⁴,Burghardt J.⁵, Marx M. 1, Sauerborn R¹.

Author Affiliations:1 Institute of Public Health, University of Heidelberg, Germany, 2 Navrongo Health Research Centre, Ghana, 3 Independent Public Health Consultant, Switzerland, 4 School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Tanzania, 5 Institute of Psychology, University of Heidelberg, Germany

Option 1– Scientific / Empirical Research Findings Presented as – Poster

Aims:

The QUALMAT project seeks to improve the quality of maternal and neonatal health (MNH) care in rural sub- Saharan Africa. Provider skills and motivation levels are considered to hold the key to their performance. An incentive scheme and a Clinical Decision Support System will be piloted at selected primary level facilities. Here the development of an instrument to monitor the effects of these interventions on MNH provider motivation in Ghana is described.

Methods:

The process was informed by a literature review, the QUALMAT conceptual framework and qualitative research conducted in Ghana. A panel approach was used to identify constructs where changes were expected. These pertained to the working context (performance and management aspects), as well as to the providers attitudes and behaviour (individual aspects). Items were elaborated for each construct, referring, wherever possible, to tools that had already been used in the context of developing countries. The items pertaining to provider behaviour (timeliness, attendance etc) were also included in a further, short instrument for completion by a peer. For both instruments a 4-point likert scale was used.

Results:

The self-administered and peer administered instruments were pre-tested with 75 health workers in Ghana in July 2011. Subsequently, 23 items with poor psychometric performance were eliminated. Factor analysis of the remaining 42 items confirmed the use of the three aspects which accounted for 56% of the variance. Cronbach’s alpha was 0.871.

Discussion/conclusions/ implications:

The items that performed poorly came from the constructs ‘self-efficacy’, ‘work meaningfulness’ and ‘motivation’ itself, indicating the need for further research into these concepts in the context of Ghana. This is partly endorsed by findings from the qualitative research. Negatively phrased questions worked less well, indicating that they were not so readily understood. The responses made by peers were overwhelmingly positive, implying possible cultural limitations to this approach.