Incentives on the motivation and job performance; insights from community health workers in Iran

Enhancing workforce motivation in primary health care systems is crucial to improving both program sustainability and service quality. Given this necessity, this study investigated how stakeholders perceive and prioritize financial and non-financial incentives, based on fundamental principles of motivation theory.

This study utilized a directed qualitative content analysis approach to rigorously examine data within the framework of Herzberg's Two-Factor Theory. The participants purposefully involved a sample of 25 individuals from the primary health care workforce in the Tehran province. To gather data, semi-structured interviews were carried out. The analysis began with an initial familiarization phase. Interview transcripts were read multiple times to enable a holistic understanding of content and context. Meaning units were identified and labeled based on the conceptual categories derived from the framework. The analysis was performed manually and with the assistance of ATLAS.ti software (version 8).

An analysis of the perspectives, 64% of participants reported a very high level of importance for financial incentives vs. non-financial. The majority agreed with the payment of a fixed salary in addition to performance-based incentives, considering both quantitative and qualitative criteria. Most important subthemes, including level of importance of incentives, mechanisms of incentives, interval of incentives, methods of incentives, administer of incentives, criteria of incentives, and adherence to fairness. Some participants perceived financial and non-financial factors as complementary elements in fostering motivation and enhancing performance. One key finding indicates that emphasizing non-financial incentives (respect, and prompt appreciation, outstanding employees), while also considering each individual's unique needs and circumstances, is crucial.

This study suggests a degree of flexibility in the boundaries between the two categories of Herzberg's theory, particularly in specific cultural and economic settings. Taken together, these results highlight the critical importance of designing integrated strategies that simultaneously address extrinsic and intrinsic incentives to enhance the performance of the health care workforce.