title: An international comparison of stakeholder motivation to implement liver cancer control.
abstract: BACKGROUND
  The World Health Organization offers clear guidance on the development of national cancer control programmes based on a country's level of resources, yet the motivation to implement such programmes may be driven by factors other than resources.
  
  
  OBJECTIVE
  To compare stakeholder motivation to implement a national liver cancer control programme and assess if variation in motivation was associated with stakeholder characteristics or with national indicators of need and resources.
  
  
  METHODS
  Relevant stakeholders were purposively selected from 13 countries (Australia, China, France, Germany, Italy, Japan, Nigeria, South Korea, Spain, Taiwan, Thailand, Turkey and USA) to participate in a structured survey on liver cancer control. Respondents included 12 individuals working in clinical, 5 in policy and 3 in advocacy roles from each country. Stakeholders' motivation was measured using a scale grounded in expectancy theory and knowledge gained during previous qualitative interviews. Comparisons across countries and respondent characteristics were conducted using hierarchical regression. Country level motivation scores, holding constant individual level covariates, were correlated with indicators of need and resources and tested using Pearson's correlation coefficients.
  
  
  RESULTS
  In total, 260 stakeholders, equally drawn from the study countries, completed the survey (45% response rate). At the national level, motivation was highest in Nigeria, Thailand and China (P < 0.001), and lowest in Italy (P < 0.001) and Germany (P = 0.003). Higher motivation was observed among stakeholders working at the international level relative to the local level (P = 0.017). Motivation was positively associated with a country's relative burden of liver cancer (P = 0.015) and negatively associated with their level of resources (P = 0.018).
  
  
  CONCLUSIONS
  This study provides the first empirical evidence on the motivation of stakeholders to implement national cancer control programmes. Furthermore, we demonstrate that motivation is more clearly associated with a country's cancer control needs rather than resources.
authors: Department of Health Policy and Management and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA, Institute for Global Health, University of Massachusetts, Amhurst, MA 01003, USA and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA and Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, MD 21202, USA jbridge7@jhu.edu.
authors: John F P
authors: JF
authors: Bridges
authors: Department of Health Policy and Management and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA, Institute for Global Health, University of Massachusetts, Amhurst, MA 01003, USA and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA and Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, MD 21202, USA.
authors: Susan M
authors: SM
authors: Joy
authors: Department of Health Policy and Management and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA, Institute for Global Health, University of Massachusetts, Amhurst, MA 01003, USA and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA and Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, MD 21202, USA.
authors: Barri M
authors: BM
authors: Blauvelt
authors: Department of Health Policy and Management and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA, Institute for Global Health, University of Massachusetts, Amhurst, MA 01003, USA and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA and Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, MD 21202, USA.
authors: Weili
authors: W
authors: Yan
authors: Department of Health Policy and Management and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA, Institute for Global Health, University of Massachusetts, Amhurst, MA 01003, USA and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA and Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, MD 21202, USA.
authors: Jill A
authors: JA
authors: Marsteller
mesh_terms: D055088:Early Detection of Cancer; D014943:Global Health; D006284:Health Plan Implementation / Q000458:organization & administration*; D006291:Health Policy; D006801:Humans; D008113:Liver Neoplasms / Q000517:prevention & control*; D008960:Models, Psychological; D009042:Motivation; D036301:Qualitative Research; D011795:Surveys and Questionnaires
keywords: Motivation; cancer control; health policy; implementation; liver neoplasms