title: Motivation or demotivation of health workers providing maternal health services in rural areas in Vietnam: findings from a mixed-methods study.
abstract: BACKGROUND
  Motivation is an important driver for health professionals to maintain their professional competencies, continue in the workforce and make a positive contribution to their workplace. While there is some research about the motivation of health workers in low- to middle-income countries, maternal morbidity and mortality remains high and this can be lowered by improving the quality of maternal health services and the training and maintenance of the skills of maternal health workers. This study examines the impact of motivation on maintenance of professional competence among maternal health workers in Vietnam using mixed methods.
  
  
  METHODS
  The study consisted of a survey using a self-administered questionnaire of 240 health workers in five districts across two Vietnamese provinces and in-depth interviews with 43 health workers and health managers at the commune, district and provincial level to explore external factors that influenced motivation. The questionnaire includes a 23-item motivation instrument based on the Kenyan health context, modified for Vietnamese language and culture.
  
  
  RESULTS
  The 240 responses represented an estimated 95% of the target sample. Multivariate analysis showed that three factors contributed to the motivation of health workers: access to training (β = -0.14, P = 0.03), ability to perform key tasks (β = 0.22, P = 0.001) and shift schedule (β = -0.13, P = 0.05). Motivation was higher in health workers self-identifying as competent or who were enabled to provide more maternal care services. Motivation was lower in those who worked more frequent night shifts and those who had received training in the last 12 months. The interviews identified that the latter was because they felt the training was irrelevant to them, and in some cases, they do not have the opportunity to practice their learnt skills. The qualitative data also showed other factors relating to service context and organisational management practices contributed to motivation.
  
  
  CONCLUSIONS
  The study demonstrates the importance of understanding the motivations of health workers and the factors that contribute to this and may contribute to more effective management of the health workforce in low- and middle-income countries.
authors.affiliation: Health Management Training Institute, Hanoi School of Public Health, Hanoi, Vietnam. thunguyenhoai75@yahoo.com.
authors.forename: Nguyen Thi Hoai
authors.initials: NT
authors.lastname: Thu
authors.affiliation: Menzies Centre for Health Policy, University of Sydney, Sydney, Australia. a.wilson@sydney.edu.au.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wilson
authors.affiliation: Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Australia. fiona.mcdonald@qut.edu.au.
authors.forename: Fiona
authors.initials: F
authors.lastname: McDonald
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003906:Developing Countries; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D000068097:Maternal Health; D008427:Maternal Health Services; D009042:Motivation; D009721:Nurse Midwives; D010820:Physicians; D011247:Pregnancy; D019035:Rural Health Services; D012424:Rural Population; D011795:Surveys and Questionnaires; D014744:Vietnam; D000078329:Workforce