Table 1 Description of study design, interventions, and methods of outcome ascertainment for studies in the systematic literature review
Author | Country | Study design | Respondents | Intervention type | Description of intervention | Random allocation | Motivation definition provided | Instrument informed by motivation theory | Items/instrument used |
|---|---|---|---|---|---|---|---|---|---|
Alhassan et al. 2016 | Ghana | Randomized trial—group | Heterogeneous: clinical and non-clinical staff | Supervision | The Systematic Community Engagement (SCE) intervention included a structured step-by-step and cyclical process of facilitators engaging community groups/associations to assess health service quality at their nearest health facility. Facilitators provided feedback to facility heads, gaps in quality were identified, and action plans were developed to address gaps. Facilitators followed up with service providers to monitor progress on action plan.a Sixteen facilities were assigned to intervention, and sixteen served as controls. | Y | Y2 | Not described | Not described |
Aninanya et al. 2016 | Ghana | Non-randomized trial—group | Heterogeneous: community health nurses; midwives; other-medical assistants and public health nurses | Compensation; Supervision | Performance-based intervention (PBI) with financial and non-financial awards provided to the best-performing health workers at biannual ceremonies. Awards included monthly allowances (~ US$20), small appliances (e.g., refrigerators, televisions, microwaves) or certificates of recognition. Six facilities were allocated to the intervention group receiving PBI, and six facilities served as controls. | N | Y2 | Not described | Mutale et al. 2013 & Mbindyo et al. 2009 |
Carasso et al. 2012 | Zambia | Cross-sectional | Heterogeneous: nurses; doctors; midwives; pharmacy dispensers; classified daily employees | Compensation | Intervention facilities abolished a user fee, which authors theorize results in a loss of financial incentives to health worker and concurrent increase in utilization. The control group retained the user fee, theoretically improving financial incentives to health workers. The six facilities that continued to collect user fees were the intervention, and the fourteen facilities where user fees were abolished were the control. As the reverse policy would serve as an incentive to providers, we consider the retention of user fees to be the intervention. | N | N | Y—Hertzberg two-factor motivation theory | Not described |
Hosseinabadi et al. 2013 | Iran | Randomized trial—group | Heterogeneous: emergency medical service personnel (including emergency medical technicians, nurses, operating room attendants, and anesthetic technicians) | Supervision | Quality circles implemented as a participatory management technique to offer assistance to health workers dealing with work-related problems and led by a supervisor. The goal was to resolve work-related problems, improve performance and motivate employees. One facility served as the intervention facility and one facility served as the control. | Y | N | Y—Hertzberg two-factor motivation theory | Mohsenpour et al. 2002; Jafariayan, 2007 |
Liu et al. 2017 | China | Pretest–posttest | Homogenous: registered nurses; registered professional nurses; nurse practitioners; assistant head nurse | Supervision; Compensation; Lifelong learning | A web-based communication platform used to document comments from nurses and psychological forum held twice a year to discuss these; 2nd component to provide continuing education and certificates for nurses; 3rd component to offer spiritual rewards to encourage internal motivation of nurses. Salary and benefits were raised based on the performance appraisals. Study was conducted in one facility with historical control. | N | N | Not described | 38-item Chinese version of the Practice Environment Scale (CPPE-38) |
Shen et al. 2017 | Zambia | Randomized trial—group | Heterogeneous: district community medical officer; clinical officer; registered nurse; enrolled midwife; enrolled nurse; environmental health technician; classified daily employee, lab technician, other (administrators, human resource officers) | Compensation | Performance-based financing (PBF) was one intervention group, with financing linked to performance; Enhanced financing (EF) was the first control group, where the same amount of financing was given but not linked to performance; the pure control facilities were the third group where no financing was given Due to bottlenecks- the EF group only received about 56% of the financing amount as the PBF group- and therefore was dissimilar. Thirty districts were triplet-matched on key health systems and outcome indicators and randomly allocated to one of three arms, ten to PBF, ten to Control-Enhanced Financing, ten to a pure control. | Y | Y2 | Not described | Weiss et al. 1967: Minnesota Satisfaction Questionnaire Spector et al. 1985: Job Satisfaction Survey |
Vermandere et al. 2017 | Mozambique | Randomized trial—group | Heterogeneous: health care providers | Systems support | The intervention consisted of ten monthly audits in 15 facilities to examine stock cards and stock-counts of six contraceptives. The first intervention group received only a monthly evaluation report, reflecting the quality of their supply management. The second intervention group received the monthly evaluation report as well as material incentives conditional on facility performance (note: incentives at facility, not individual, level). The third group served as a control group. Fifteen health facilities in Maputo Province, Mozambique, were divided into 3 groups of five facilities: intervention group (monthly evaluation report), a second intervention group (monthly evaluation report and incentives), and finally a third group (control). | Y | N | Not described | Mutale et al. 2013 |