Autonomous motivation and its change among primary healthcare workers in shandong province: A survey based on self-determination theory

To compare primary healthcare workers’ (PHCWs) initial motivation of choosing medicine and current work motivation based on Self-Determination Theory (SDT), reveal changes in autonomous motivation—defined as engaging in an activity out of full volition and personal choice—and analyze the causes and consequences of these changes on work outcomes. The participants were PHCWs of Shandong Province of China. A mixed-methods design was adopted. The cluster, multi-stage sampling method was applied for questionnaire survey, and 1200 PHCWs were selected in 36 primary care facilities. The purposive sampling method was used for in-depth interviews and 107 PHCWs among survey participants were selected. The questionnaire was developed by the authors for exploring PHCWs’ initial motivation of choosing medicine and current work motivation. The motivations were categorized into autonomous motivation and controlled motivation based on the SDT. The “motivation change” variable was constructed by comparing the dominant types of initial motivation and current motivation. Descriptive statistics, ANOVA, and multiple linear regression were used to analyze survey data, thematic framework method was used to analyze interview data. The largest proportion of participants maintained their autonomous motivation (36.2 %), followed by those who became more autonomous (27.8 %), those who maintained controlled motivation (23.2 %), and those whose motivation became less autonomous (12.8 %). PHCWs who maintained autonomous motivation showed the most favorable outcomes, including lower turnover intention and job burnout, and higher job satisfaction and work performance, followed by those who became more autonomous. In contrast, PHCWs who maintained non-autonomous motivation and less autonomous motivation demonstrated the poorest outcomes. Interview data indicated that motivation changes were mainly influenced by the fulfillment of three psychological needs: meaning, competence, and relatedness. Autonomous motivation is associated with better work outcomes among PHCWs. Enhancing autonomous motivation requires a more supportive organizational environment based on enhanced informatics infrastructure, improved training systems, and innovative patient communication mechanisms.