Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Medicine, 615 N. Wolfe Street, Room E8646, Baltimore, MD, 21205, USA.
Hum Resour Health. 2021 Jan 6;19(1):4. doi: 10.1186/s12960-020-00522-7.
Poor health worker motivation, and the resultant shortages and geographic imbalances of providers, impedes the provision of quality care in low- and middle-income countries (LMICs). This systematic review summarizes the evidence on interventions used to motivate health workers in LMICs. A standardized keyword search strategy was employed across five databases from September 2007 -September 2017. Studies had to meet the following criteria: original study; doctors and/or nurses as target population for intervention(s); work motivation as study outcome; study design with clearly defined comparison group; categorized as either a supervision, compensation, systems support, or lifelong learning intervention; and conducted in a LMIC setting. Two independent reviewers screened 3845 titles and abstracts and, subsequently, reviewed 269 full articles. Seven studies were retained from China (n = 1), Ghana (n = 2), Iran (n = 1), Mozambique (n = 1), and Zambia (n = 2). Study data and risk of bias were extracted using a standardized form. Though work motivation was the primary study outcome, four studies did not provide an outcome definition and five studies did not describe use of a theoretical framework in the ascertainment. Four studies used a randomized trial-group design, one used a non-randomized trial-group design, one used a cross-sectional design, and one used a pretest-posttest design. All three studies that found a significant positive effect on motivational outcomes had a supervision component. Of the three studies that found no effects on motivation, two were primarily compensation interventions and the third was a systems support intervention. One study found a significant negative effect of a compensation intervention on health worker motivation. In conducting this systematic review, we found there is limited evidence on successful interventions to motivate health workers in LMICs. True effects on select categories of health workers may have been obscured given that studies included health workers with a wide range of social and professional characteristics. Robust studies that use validated and culturally appropriate tools to assess worker motivation are greatly needed in the Sustainable Development Goals era.
医疗工作者的工作积极性不高，导致医护人员短缺且分布不均，这阻碍了中低收入国家（LMICs）提供高质量医疗服务。本系统综述总结了激励 LMIC 医疗工作者的干预措施的证据。从 2007 年 9 月至 2017 年 9 月，我们使用标准化的关键词搜索策略在五个数据库中进行检索。研究必须符合以下标准：原始研究；目标人群为医生和/或护士；工作积极性是研究结果；研究设计有明确界定的对照组；分为监督、补偿、系统支持或终身学习干预；在中低收入国家进行。两名独立评审员筛选了 3845 篇标题和摘要，随后对 269 篇全文进行了审查。从中国（n=1）、加纳（n=2）、伊朗（n=1）、莫桑比克（n=1）和赞比亚（n=2）保留了 7 项研究。使用标准化表格提取研究数据和偏倚风险。尽管工作积极性是主要的研究结果，但有 4 项研究没有提供结果定义，5 项研究没有描述在确定过程中是否使用了理论框架。有 4 项研究使用了随机试验组设计，1 项使用了非随机试验组设计，1 项使用了横断面设计，1 项使用了预测试后设计。有 3 项研究发现对激励结果有显著积极影响的研究都有监督部分。有 3 项研究发现对激励没有影响，其中 2 项主要是补偿干预，第 3 项是系统支持干预。有 1 项研究发现补偿干预对卫生工作者激励有显著负面影响。在进行这项系统综述时，我们发现激励中低收入国家医疗工作者的有效干预措施的证据有限。鉴于纳入的研究涵盖了具有广泛社会和职业特征的医疗工作者，因此，某些类别的医疗工作者可能存在真实效果，但这些效果可能被掩盖了。在可持续发展目标时代，迫切需要使用经过验证和具有文化适应性的工具来评估工人激励的强有力研究。
