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Table 2 Description of study characteristics, reported outcomes, and narrative results for all seven studies retained from the systematic review

From: Approaches to motivate physicians and nurses in low- and middle-income countries: a systematic literature review

Author Intervention group Instrument details Sampling Groups Reported outcome Results Significant findings Narrative description of results
Alhassan et al. (2016) Supervision 19 items
4-point Likert scale ranging from (1) "Very Disappointing" to (4) "Very Satisfactory"
Reliability: Cronbach's alpha: >0.7
234 participants at endline (Intervention = 103, Control = 131) Group 1 (intervention): 32 facilities received SCE intervention
Group 2 (control): 32 control facilities
Motivation Factor 1: Physical work environment and resource availability Difference between Intervention and Control at Baseline: mean= −0.01 (SE= 0.01)
Difference between Intervention and Control at Follow-up (2 years later): mean= 0.10 (SE=0.08)
Difference in Difference: mean= 0.11 (SE=0.12)
NS Difference-in-difference analyses of the levels of staff motivation from 2012 to 2014 found that SCE-receiving facilities rated motivation proxies (career prospects, perceived workload, and overall motivation) higher than non-SCE facilities. (p<0.0001) The association between SCE and financial incentives and physical work environment was low or negative.
  Motivation Factor 2: Financial and extrinsic incentives1 Difference between Intervention and Control at Baseline: mean= −0.19 (SE= 0.01)
Difference between Intervention and Control at Follow-up (2 years later): mean= −0.09 (SE=0.08)
Difference in Difference: mean = −0.28 (SE = 0.12)
NS
  Motivation Factor 3: Intrinsic incentivesb Difference between Intervention and Control at Baseline: mean= 0.22 (SE= 0.04)
Difference between Intervention and Control at Follow-up (2 years later): mean= 0.44 (SE=0.07)
Difference in Difference: mean = 0.22 (SE = 0.08)
NS
  Motivation Factor 4: Career prospects and opportunities for further education Difference between Intervention and Control at Baseline: mean= 0.68 (SE= 0.11)
Difference between Intervention and Control at Follow-up (2 years later): mean= 0.79 (SE=0.10)
Difference in Difference: mean=0.11 (SE=0.17)
+
  Motivation Factor 5: Perceived workload and staff availability Difference between Intervention and Control at Baseline: mean= 0.51 (SE= 0.11)
Difference between Intervention and Control at Follow-up (2 years later): mean= 0.51 (SE=0.08)
Difference in Difference: mean=0.00 (SE=0.14)
+
  Overall motivatione Difference between Intervention and Control at Baseline: mean= 0.24 (SE= 0.04)
Difference between Intervention and Control at Follow-up (2 years later):mean= 0.32 (SE=0.06)
Difference in Difference: mean=0.08 (SE=0.07)
+
Aninanya et al. 2016 Compensation; Supervision 14 items4-point Likert scale ranging from (1) "Strongly agree" to (4) "Strongly disagree"
Reliability: Cronbach's Alpha: 0.7041
50 participants at endline (Intervention = 25; Control = 25) Group 1 (intervention): 6 facilities allocated as intervention-receiving PBI
Group 2 (control): 6 facilities allocated as comparison – did not receive PBI
Motivational construct: Intrinsic Motivation Difference between Intervention and Control at Baseline: Score= -0.25
Difference between Intervention and Control at Endline (3 years later):Score= 0.20
Difference-in-Difference:Score= 0.00
NS Overall motivation was slightly higher in comparison compared to intervention group. Overall motivation increased in intervention group, but remained constant in comparison group over time. Difference-in-difference was small. All changes in motivation were not statistically significant.
      Overall motivation5 Difference between Intervention and Control at Baseline: Score= -0.11
Difference between Intervention and Control at Endline (3 years later): Score= 0.08
Difference-in-Difference:Score= 0.01
NS  
Carasso et al. 2012 Compensation 3 items
5-point Likert scale ranging from (1) "Very satisfied" to (5) "Very dissatisfied"
Reliability:
Cronbach's
Alpha: 0.67
90 participants at endline (Intervention = 33; Control = 57) Group 1 (intervention): 14 facilities where user fees were removed- resulting in lower worker financing
Group 2 (control): 6 facilities where user fees were still charged-resulting in higher worker financing
Extrinsic motivation Mean motivation at endline for Intervention group: Mean= -0.55
Mean motivation at endline for Control group: Mean= 0.33
- Staff in intervention group (with poorer health financing) reported higher extrinsic motivation than those in the control group. This finding was statistically significant (p<0.05).
Hosseinabadi et al. 2013 Supervision 17 items
5-point Likert scale
Range not described
Reliability:
Stated as reliable; not described in paper
40 participants at endline (Intervention = 24; Control = 16) Group 1 (intervention): 1 facility received quality circles
Group 2 (control): 1 facility did not receive quality circles
Motivational Factors Mean motivation at baseline for Intervention Group: mean= 35.25 (SD= 8.38)
Mean motivation at endline (3 months) for Intervention Group: mean=43.50 (SD=7.63)
Mean motivation at baseline for Control Group: mean=36.68 (SD= 8.51)
Mean motivation at endline (3 months) for Control Group: mean= 34.25 (SD= 7.93)
+ There were no statistically significant differences in mean motivational scores between groups at baseline. At endline, motivation was significantly higher in intervention compared to control group.
Liu et al. 2017 Supervision; Compensation; Lifelong learning 10 items
4-point Likert scale ranging from (1)"Strongly agree" to (4) "Strongly disagree"
Reliability: not described
1050 participants at baseline
920 participants at endline
Group 1 (baseline): 1 facility receiving life-long learning and compensation intervention
Group 1 (endline): historical control – same facility did not receive life-long learning and compensation intervention
Internal work Motivation Score at baseline:Mean= 3.15 (SD= 0.40)
Score at endline: mean= 3.22 (SD= 0.64)
Difference in score from baseline to follow-up (2-years later) not reported. Calculated by authors to be: mean= 0.07
+ Post intervention, there was a statistically significant positive change in internal work motivation over time (p<0.05).
Internal motivation differed by the assigned work unit- with those from the operating room and post-anesthesia care unit demonstrating the lowest scores of internal work motivation.
Shen et al. 2017 Compensation 39-items
5-point Likert scale ranging from (1) "Very dissatisfied" to (5) "Very satisfied"
Reliability: not described
326 participants at baseline (Intervention = 147, Control 1 = 87, Control 2 = 92)
357 participants at endline (Intervention: 166, Control 1 = 92, Control 2 = 99)
Group 1 (intervention): 10 districts received PBF
Group 2 (control 1): 10 districts received EF
Group 3: (control 2): 10 districts received no PBF and no EF
Motivational Construct 1: Teamwork Pairwise regression results:
PBF v. EF: β=0.39 SE=3.13
PBF v. Control: β=0.93 SE=1.43
EF v. Control: β=1.62 SE=3.51
NS There was no statistically significant difference in any of the motivational outcomes between groups.
      Motivational Construct 2: Autonomy Pairwise regression results: 
PBF v. EF: β=0.82 SE=4.31
PBF v. Control: β=1.31 SE=1.77
EF v. Control: β=1.30 SE=4.49
NS  
      Motivational Construct 3: Recognition Pairwise regression results:
PBF v. EF: β=0.38 SE=3.28
PBF v. Control: β=-0.84 SE=1.33
EF v. Control: β=-0.89 SE=2.85
NS  
      Motivational Construct 4: Change Pairwise regression results:
PBF v. EF: β=-2.10 SE=2.66
PBF v. Control: β=1.03 SE=1.24
EF v. Control: β=3.83 SE=2.64
NS  
      Motivational Construct 5: Self-concept Pairwise regression results: PBF v. EF: β=-0.73 SE=1.87
PBF v. Control: β=0.77 SE=1.08
EF v. Control: β=2.21 SE=2.36
NS  
      Motivational Construct 6: Work environment Pairwise regression results:
PBF v. EF: β=-1.79 SE=2.60
PBF v. Control: β=1.26 SE=1.26
EF v. Control: β=4.31 SE=3.03
NS  
      Motivational Construct 7: Leadership Pairwise regression results:
PBF v. EF: β=-3.08 SE=4.89
PBF v. Control: 
β=1.21 SE=2.61
EF v. Control: β=5.55 SE=5.15
NS  
      Motivational Construct 8: Well-being Pairwise regression results:
PBF v. EF: β=1.10 SE=2.98 PBF v. Control: β=2.42a SE=1.24
EF v. Control: β=3.93 SE=2.50
NS  
Vermandere et al. 2017 Systems support 23 items
5-point Likert scale ranging from (1) "Strongly agree" to (5) "Strongly disagree"
Reliability: not described
55 participants at baseline (Group 1 = 17, Group 2 = 16, Group 3 = 22)
40 participants at 1st follow-up (Group 1 = 12, Group 2 = 12, Group 3 = 16)
39 participants at 2nd follow-up (Group 1 = 10, Group 2 = 12, Group 3 = 17)
Group 1 (intervention 1): 5 facilities receiving monthly evaluation
Group 2 (intervention 2): 5 facilities receiving monthly evaluation + financial incentives
Group 3 (control): 5 facilities receiving not receiving facility audits
Overall motivatione Motivation at Baseline (Group 1): median=88.5 IQR=87–92
Motivation at Follow-up 2 (1 year later) (Group 1): median=90 IQR=88–90
Motivation at Baseline (Group 2): median=93 IQR=86.5–95
Motivation at Follow-up 2 (1 year later) (Group 2): median=87 IQR=83–90
Motivation at Baseline (Group 3): median=84.5 IQR=79–93
Motivation at Follow-up 2 (1 year later) (Group 3): median=87 IQR=83–90
None of the differences between 2nd follow-up and baseline were reported but p values presented were all non-significant
NS There was no statistically significant difference in motivation between intervention group and comparison group at baseline, endline, or over time
  1. Significant findings: + is positive,—is negative, NS non-significant findings at 95%
  2. aFinancial and material work conditions of a job (e.g., salary increment, promotion, accommodation, etc.)
  3. bInner joy and satisfaction derived from a job (e.g., societal recognition and respect; appreciation shown by clients, etc.)
  4. cAs authors only provided a pooled sample size from baseline and follow-up surveys, reported sample size is the same at baseline and follow-up
  5. dBaseline or control performance is the pre-intervention performance in the intervention arm, or if not measured, the end performance in the control arm
  6. eComposite score of multiple constructs
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