A STUDY OF EXTRINSIC AND INTRINSIC FACTORS INFLUENCING THE JOB MOTIVATION OF PUBLIC SECTOR HEALTH CARE WORKERS IN NAKURU COUNTY GRACE WATIRI GITHATU MBA-HCM 105281 r· ,- ····· . • -:1 t ; ~ .. . j · : . . . . . ,. ,. ' . · • I I A RESEARCH PROJECT SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE A WARD OF THE DEGREE OF MASTER OF BUSINESS ADMINISTRATION IN HEAL THCARE MANAGEMENT STRATHMORE BUSINESS SCHOOL STRATHMORE UNIVERSITY NAIROBI, KENYA MARCH,2021 Declaration I declare that this work has not been previously submitted and approved for the award of a degree by this or any other University. To the best of my knowledge and belief, the dissertation contains no material previously published or written by another person except where due reference is made in the dissertation itself. © No part of this dissertation may be reproduced without the permission of the author and Strathmore University Name of Candidate Grace Watiri Githatu Approval The dissertation of Grace Watiri Githatu was approved by the following: Name of Supervisor: Dr Ben Ngoye School/Institute/Faculty: Strathmore Business School Dr. George Njenga Executive Dean Strathmore University Business School. Dr. Bernard Shibwabo Director, Office of Graduate Studies Abstract Diverse factors provide indicators of job motivation challenges amongst the healthcare workers. These factors include the high level of employee tumover. For example, in 2017, an estimated 700 doctors quit employment from govemment run hospitals Graham, 2018). Additionally, the Kenya Medical Practitioners and Dentist Union (KMPDU) estimated that up to 2,300 doctors had left devolved sector employment between 2014 and 2016 for private sector engagement or further education abroad. Moreover, the various groups of the healthcare workers including doctors, nurses, and clinical officers have held numerous industiial strikes against their employer. Consequently, this study seeks to sh1dy the factors influencing the job motivation in the healthcare public sector. The study is based on Herzberg's 2-factor themy that splits factors affecting employee job motivation as extrinsic and motivating factors. The study used a descriptive research design and the target population was health workers in Nakuru County Public health facilities including doctors, clinical officers, laboratory technicians, phannacists and nmses. The study population was 1756 respondents. The sample size of this study, using Taro Yamane's (1967) formula, was 326 respondents. The correlation between diverse factors and job motivation were examined. The sh1dy fatmd a strong positive correlation between extrinsic factors and job motivation (r=0.633, p value =0.000). The study further fOlmd that there was a positive and statistically significant conelation between intrinsic factors and job motivation (r=0.795, p value =0.000) . The regression analysis results revealed that a unit increase in extrinsic factors is associated with 0.318 increases in the job motivation levels with intrinsic factors kept constant. On the other hand, a unit increase in the intrinsic factors is associated with 0.596 increases in the job motivation levels with exti·insic factors kept constant. The study thus recommends that the intrinsic factors such be considered and factored within the instih1tions in order to improve on the job motivation levels. The intrinsic factors that had the lowest scores were salary paid being commensmate with work done, dates of salary payments, salmy increments levels, salary being competitive for tasks undertaken, supportive work environment for work station, and supervisor fairness levels. Key Words: Career Advm1cement, Extrinsic Factons, Job Recognition, Job motivation Factors, Supervismy Relation 11! Table of Contents Declaration and Approval page .................................................................................. ii Abstract ....................................................................................................................... iii Table of Contents ........................................................................................................ iv List of Figures ........................................................................................................... viii List of Tables ................................................................................................................ ix List of Abbreviations ................................................................................................... x Chapter One ................................................................................................................. ! Introduction to the Study ............................................................................................ ! 1.1 Backgrotmd to the Study ......... ............ ... .... .... .. ..... ... ... ............... .......... ..... ..... .... .. 1 1.2 Problem statement ... ____ ...................................... _ ........ ... ....... _ .... __ .. ........ __ .......... .. _ 4 1.3 Research Objectives .... ....... ... .. ..... .... ............................... ..... ... .... .... ....... .. .. ... .... ... 6 1.3.1 Specific Objectives ....... ...... ....... ... ... .... ... .... ...... ... .... ...... ..... ... .. .... .... ..... ........ 6 1.4 Research Questions ... .............. .. ... ...... .. .... .. ......... .. ....... ......... ......... .................... .. 6 1.5 Significance of the Sh1dy ......... ... ....... .. ... .................... .......... ... .... ..... .... .. ......... .. .. 6 1. 6 Scope of the Study ............................................................ ......... ....... ............... __ .. 7 1. 7 Summary of the Chapter .............. .... ................. ..... .. ... ...... ... .. ..... ...................... ... 7 Chapter T'vo Literature Review ................................................................................ 8 2 .1 lntroducti on ............................ ..... ...... ... ..... ... .......... ......... .. ............ ....... ...... .......... 8 2.2 Theoretical Framework ......... .. .. .... ....... .... ...... .... ........... .. ...... ............... ................ 8 IV 2.3 Empirical Literatme ........................................ .............................................. ... .. 11 2.3.1 Influence ofExtiinsic Factors on Job motivation ........ .... ........................... 11 2.3 .2 Influence oflntrinsic factors on Job motivation ....... .................................. 15 2.4 Summary of Research Gaps ............... .... .............. .......... .... ....... ..... .... ....... .... .. ... 19 2.5 Conceptual Framework ... ....... ......... .................................................... ......... ...... 20 2.6 Summary of the Chapter ................... .. ..... ..... .... .............................................. ... 22 Chapter Three ............................................................................................................ 23 Research 1\'Iethodology .............................................................................................. 23 3 .1 Introduction ........................................................................................................ 23 3.2 The Research Design .... ........ ......................... .............................. .. .. ........ .. ........ 23 3.3 Population and Sarnpling ....................................................................... ............ 23 3.4 Research Instruments ... ..... ......................................................... ........ ................ 25 3.5 Data Collection Methods ............ ................................... .. ............ ........ ....... .... ... 26 3. 6 Data Analysis ........... .. ........................................................................................ 26 3. 7 Research Quality ................................................... ................. ...... .. .................... 2 7 3.7.1 Pilot Study ............................. .. .... ...... ...................... ................ ..... .. ...... ... .. .. 27 3.7.2 Validity of the Instruments .................................... ........ ............................. 28 3.7.3 Reliability of the Instruments ....................... ...... ......................................... 28 3.8 Ethical Issues in Research ................ ...... ................. ............ .............. .... ............. 29 3.9 Summary of the Chapter ................................. ... ...................... ........ .................. 29 Chapter Four .............................................................................................................. 30 v Data Analysis .............................................................................................................. 30 4.1 Introduction ..... .... .. .... ..... ....... ....... ... ... .............. .. ........ ...... .... ...... .. ... ............. .. ... . 3 0 4.2 ResponseRate ... .. ....... ... .. ..... .. .... .... ... ..... ...... .. .... ... .. .... .... ....... ..... ....... ...... .. ..... .. . 30 4.3 Demographic Characte1istics ... ........ .. .. .. ..... ... ... .... ... .. ........ ..... .............. ........ .. .. . 30 4.3.1 Gender Distribution ... .. .... ..... .... ........ .... .. ..... ...... .... ..... .. ........... .... .. .. ...... .... . 30 4.3 .2 Age Group Distiibution ... .... .... .... ... .... .. ... .. ... .... .... .... .. .... .. ...... ....... ... ... .. ..... 31 4.3.3 Job Cadre .... .. .......... ..... .. ....... .... ... .... .................... .. .... ......... .... ..... .... .... .. ..... 31 4.4 Reliability of the Instrument ....... ...... ....... ...... .. ...... ... ...... ... .. .... ......... ..... ....... ..... 32 4.5 Descriptive Statistics ... .... ... .. .. ....... ... ...... ......... ....... ..... ....... ... ...... .. ....... ............ .. 32 4.5.1 Extrinsic Factors and Job Motivation of the Healthcare Workers .......... .... 33 4.5.2 Intrinsic Factors and Job Motivation of the Healthcare Workers ... ... .. ... .... 36 4.5.3 Job Motivation of Health Workers ..... .. ..... .......... .. ................ ... .... .. .. .. .. .. .. .. 38 4.5.4 Correlational Analysis .. ... ..... ..... ...... ... ......... .. ..... ............ .... .... ....... .... ........... .. 39 Cl1aJ>te1· Five ................................................................................................................ 44 Summary of Findings, Discussions, Con clusion and Recommendations ............. .44 5.1 Introduction ..... ............ .. ..... .... ..................... .... ... .. ........... .. ........ .. .. .............. .. 44 5.2 Summary of Findings .. ... .. .......... ..... .... .... ....... .. ................... ..... .... .. ......... .... ..... .. 44 5.2.1 Extrinsic Factors and Job Motivation ofThe Healthcare Workers ... .... .. ... -44 5.2.2 Intrinsic Factors and Job Motivation of the Healthcare Workers ......... .. ... .45 5.3 Discussions of the Results .. ........ .. .. .... .... ... ................. .. ... .. .. ...... .. ......... .. .. ..... .. .. 46 5.3.1 Extrinsic Factors and Job Motivation of the Healthcare Workers .... .... .. .. .. 46 Vl 5.3.2 lntTinsic Factors and Job Motivation of the Healthcare Workers ........... : ... 50 5.3.3 Job Motivation of Health Workers ..... ...... .... ... ... .. .... .... ....... .. .... ... .. .. , ..... .... 53 5.4 Conclusions of the Study .. ... .... ... .. .. .. .... ..... .... .......... .. .. .. , ... .. ... .. ......... ..... .... .. ..... 53 5.5 Limitations of the Study ........ .. .. ..... .... .... ... ... .... ..... ..... .. .... .......... ... ... ... .. ..... ...... .. 54 5.6 Recomm endations of the Study ....... .... ....... ... .. ... ....... ....... .... ...... .. ........ ... , ...... ... 54 R eferences ................................................................................................................... 56 Appendices .................................................................................................................. 67 Appendix I: Letter oflntroduction ......... ........ .. .. ....... ...... .... .. ..... ... .... ........ .. ... ..... .... . 67 Appendix II: Research Instnnnent .. ........ .... ..... .. ... .. .. .......... ...... .. ... .. .... .... ..... .. ..... .. .. 68 Appen.dix III: Research Budget ....... .... .... ............... .. ............... .... ... ... ....... .. .. ..... ...... 70 Appendix IV: Work Plan .......... .. ..... .... ........ ..... ............ .. ... ..... ......... ...... ..... .. ..... .. .... 71 Vll List of Figures Figme 2. 1; Conceptual Framework ....... .. .. ..... .... ...... .. ...... ... ..... .. ... .......... ....... ... ... ...... 21 '\1111 List of Tables Table 3. 1; Target Population of the St11dy ....... ... .... .......... .... ........ .... .. ....... ..... .... ........ 24 Table 3. 2; Sample Size ......... .... ... .... .......... ......... .. .... ...... ........... .... ... ............ ... ........... 25 Table 4. 1; Response Rate ... ......................... .. ......... .. ............. ....... ............ ... ......... ... .... 30 Table 4. 2; Gender Distribution .. ... .................... ... ..... .. ..... .......... .... .. .. ........ ........ .. .. ..... 30 Table 4. 3; Age Group Distribution ........................................................ ... ......... " .. ..... 31 Table 4. 4; Job Cadre Distribution ............................... .... .. ....... .......... .. ....................... 31 Table 4. 5; Reliability of the Tnstrument.. .... .. .... ................................................. ...... .. . 32 Table 4. 6; Descriptive Statistics of Extrinsic Factors ............... ........... .. ..................... 33 Table 4. 7; Descriptive Statistics of the Intrinsic Factors ........................... .... ............ . 36 Table 4. 8; Job Motivation ofHealth Workers ..... ...... ........ .. ...... .. .. .... ........ ....... ... ....... 38 Table 4. 9; Correlational Analysis ........... ..................................... ............ ..... .............. 39 Table 4. 10; Model Smummy ... ............ .. ......... ... .................... .. ....... .. ..... ...... ..... .. ........ 40 Table4.11;ANOVA0 . •..•.•.•. ••........••.••.. • .. • .•• . . • . •...•. . . • . •... ••••• • .•. • ....• . ..• .. ...• • •• •• ••••.• .. •••• • .. •• 41 Table 4. 12; Coefficientsa ..... ....... .......................................................... ....... ............ .... 42 IX KMPDU List of Abbreviations Kenya Medical Practitioners and Dentist Union NACOSTI National Commission of Science, Technology and Innovation ORCID SPSS Open Researcher and Contributor Identifier Statistical Packages for Social Sciences X 1.1 Background to the Study Chapter One Introduction to the Study Better and quality healthcare services are an important detenninant of the social economic development of countries across the globe. According to World Health Organization (20 19), health care plays a critical role in the social economic development of countries. In this context, World Health Organization (2019) asserts that healthcare is important to human happiness, wellbeing and economic productivity. The health workers are the cogs that drive the achievement of healthcare systems. These healthcare workers include medical practitioners, nurses, midwives, allied healthcare professionals, health administrators, and public health personnel (Mete, 2017). The provision of quality and affordable healthcare is consequently dependent on the health workers' availability, accessibility, acceptability, and quality aspects (World Health Organization., 2014). In this context, the World Health Organization (20 14) indicates that availability of the health workers relates to the sufticiency of the healthcare workers with the requisite skills to serve the population under their jurisdiction. The accessibility characteristics of the health worker relates to the equitable access to health workers amongst the populace requiring their expertise (Nguyen & Giang, 2019). On the other hand, acceptability relates to the manner in which they treat their patients with dignity creating provision of development of trust aspects in healthcare provision (World Health Organization., 2014). Finally, the aspect of quality of healthcare relates to the competences, skill sets and behavioral aspects that compliant with professional standards expected of the healthcare workers (Lukwago, Basheka, & Odubuker, 2015). 1 Despite the importance of the healthcare workers to the functionality of the health care system across the world, there are diverse challenges prevalent with this workforce. These challenges impact negatively on the achievement of the four indicators characteristics of quality healthcare i.e., availability, accessibility, acceptability, and quality aspects. One of these challenges is job motivation among health care workers. According to Isse, Abdirahman, Najeemdeen, Abidemi, and Ahmad (20 18) job motivation relates to the full feeling ot: or enthusiastic response to the job. Similarly, Utomo, Poernomo, and Puspitaningtyas (20 18) noted that job motivation is a positive emotional feeling that is the result of the evaluation of person's work experience. There are diverse indicators of low job motivation including shortage of health workers in specific contexts such as rural areas, public health facilities and developing countries. The shortage of health workers in these contexts has been linked to lack of job motivation amongst the healthcare works leading to migration of doctors from developing to developed countries due to better income levels, working conditions, and facilities (World Health Organization., 2016). The job satisfaction level is int1uenced by intrinsic and extrinsic factors. The job motivational factors were deemed to be intrinsic/internal factors driving employee job motivation while the extrinsic factors are extrinsic/external factors preventing employee demotivation motivation levels. Thus Hui et al., (2012) assert that job motivation factors are sources of job motivation while factors contributing to demotivation motivation are known as extrinsic factors. According to Edoho, Bamidele, Neji, and Ekaette (2015) the extrinsic factors are related to the work environmental factors that would int1uence job motivation. These are factors that employers need to address as they lead to lack of job motivation. The extrinsic 2 factors include aspects such as salary, fringe benefits, vacations, and insurance amongst others (Hezekiah, Ayodotun, & Maxwell, 2014; Ukandu & Ukpere, 2014). According to Lukwago et a/., (2015) while the extrinsic factors aim to avoid demotivation motivation, the motivators have been noted as those factors whose presence would to lead to job motivation levels with the job functions . The motivators include aspects such as recognition, achievement, personal growth, and challenging work amongst others (Njenga, 20 17). The extrinsic factors influence job motivation m vanous ways. One of the key extrinsic factors is the monetary range of incentives as a factor leading to job motivation. The monetary job motivation relates to those aspects that have a direct monetary component including salaries, wages, allowances, perfonnance bonus and other monetary considerations (Saad, 2018). The monetary job motivation has been seen to be power motivators especially for the lower cadre of employees that need to satisfy their basic human needs such as food, shelter, and other social amenities (J ayewardenepura & Lanka, 20 17). Aguinis, J oo, and Gottfredson (20 13) further state that the monetary job motivation are high motivators because they help meet variety of basic needs (e.g. food), higher-level needs (e.g. belonging to a group), and purchase of status symbols such as big cars. The non-monetary motivators relate to aspects such as training and development, rewards and recognition, effective communication, and work environment (Plessis et al., 2016). Alnasrallah (2016) argues that social support from superiors is a key non­ monetary support for employees. This is attributed to the social support :from the employee's manager helping in relieving work-related stresses and ensuring that the 3 employees' efforts are recognized. Kassa (2015) further argue that job emichment is a key component of non-monetary job motivations for the employees. The job enrichment refers to the adding of tasks, responsibilities, and variety of tasks that help to make the employees feel empowered in their job environment (Novianty & Evita, 20 18). The training of the employees and the training opportunities help the employees feel empowered and thus motivated to work better (Ochola, 2018). The job motivation has been considered to control the etiorts of the employee to achieving specific goals and the resilience in the face of obstacles to the achievement of these goals (Khuong & Hoang, 2015). Job motivation is also associated with sustainable desired behaviors amongst the employees. Alnasrallah (2016) further notes that the job motivation regulates the attitude of the employee towards their fellow colleagues, work place, and diverse stakeholders within their work environment. Within the context of the healthcare, employee job motivation would thus regulate the attitude towards the healthcare setup and workers as well as patients within the given setup. This would be reflected in the quality of care given to the patients, productivity levels, turnovers and absenteeism levels (Saad, 20 18). 1.2 Problem statement In Kenya, there are diverse indicators of employee job satisfaction challenges in the health sector. One of the indicator of lack of employee job motivation in healthcare workers is the high level of employee turnover in the sector. In 2017, an estimated 700 doctors quit employment in public hospitals due to diverse employment satisfaction factors (Graham, 2018). On the other hand, the Kenya Medical Practitioners and Dentist Union (KMPDU) estimated that up to 2,300 doctors had left devolved sector employment between 2014 and 2016 for private sector or fwiher 4 education abroad (Graham, 2018). The various groups of the healthcare workers including doctors, nurses, and clinical officers have held numerous industrial strikes against their employer. These strikes have been undertaken to protest on the salary aspects, work conditions, career advancement and job recognition which informs their focus on this study. According to Kemri (2020), there has been a total of six national wide strikes and many more regional strikes between 2010 to 2016. Kemri (2020) further noted that in 2017 the doctors went on strike for a period of 100 days while the nurses were on strike for a period of 150 days marking one of the longest strikes in the healthcare sector. Nakum County has equally faced diverse industrial strikes on health-related challenges. According to County Government of Nakuru. (2021) amongst the challenges that has made the healthcare sector workers to a stalled 2017 Collective Bargaining Agreement which had not been implemented. As of 2021, the county government of Nakuru had only met 70% of the demands of the 2017 Collective Bargaining Agreement (CBA) (County Government ofNakuru., 2021)_ While the job motivation has been examined in Kenyan context, there are still prevalent gaps. The Kenyan studies examining aspects of job motivation include Njoroge and Yazdanifard (2014) who studied employee emotional intelligence on employee job motivation. While these studies have been useful in helping us understand employee job motivation, a number of gaps still persist. For example, the study by Hadjiphanis (2012) did not address employee job motivation among public healthcare workers, our demographic of interest that faces work dynamics that are different from many other sectors. Similarly, Nj oroge and Y azdanifard (20 14) study sought to link emotional intelligence to employee job motivation, excluding the broad array of factors that influence job motivation. Consequently, this study seeks to plug 5 these gaps by examining the extrinsic and job motivational factors influencing job motivation in the healthcare public sector. 1.3 Research Objectives The main objective of the study is to study the influence of various intrinsic and extrinsic factors on job motivation among health care workers in the public sector in Nakuru County. 1.3.1 Specific Objectives i) To examine the extent to which extrinsic factors (salary, work conditions and supervisory relations) influence the job motivation of the healthcare workers in the public sector. ii) To examine the extent to which intrinsic factors Uob recognition, career advancement and increased responsibility) influence the job motivation of the healthcare workers in the public sector. 1.4 Research Questions i) What is the influence of extrinsic factors on job motivation of the healthcare workers in the public sector health workers in Nakuru? ii) What is the influence of Intrinsic factors on the job motivation of healthcare workers in the public health sector in Nakuru? 1.5 Significance of the Study This study is of significance to a wide range of stakeholders in the health sector. These stakeholders include ministry of health officials in the national gove.rmnent, council of governors, developmental partners, and researchers within the area of human resources. The ministry of health and council of governors gains insights on the factors motivating the healthcare workers. This is critical in ensuring that they formulate adequate policies to address the issues that arise, be they relating to 6 reducing or mitigating the demotivating factors, or promoting the motivating factors. The developmental partners and researchers stand to gain insights into the phenomenon of the job satisfaction aspects amongst health workers which will further int1uence their knowledge development in their work. 1.6 Scope of the Study This study was geographically be based on Nakuru County. This is due to Nakuru being an exemplar ofthe diversity of the cotmtry, has a good mix or urban, peri-urban and rural settings within which public health facilities are located. The study was also be undertaken within 2019 to 2020. 1.7 Summary of the Chapter The health workers including medical practitioners, nurses, midwives, allied healthcare professionals, health administrators, and public health personnel are critical in ensuring that healthcare goals are achieved. The health care workers need to have adequate competences, skill sets and behavioral aspects that compliant with professional standards expected of the healthcare workers. The job motivation of the medical professional statT is impmiant to their service delivery. The job motivation challenges of the medical care professionals are indicated by industrial strikes of medical staff and job turnover. Various extrinsic or intrinsic factors influence the job motivation of medical staff across the globe including salary, work conditions, supervisory relations, job recognition, career advancement and increased responsibility. Nakuru county has faced diverse industrial strikes on health--related challenges such as a stalled 2017 Collective Bargaining Agreement which had not been implemented. This study sought to examine the influence of various intrinsic and extrinsic factors on job motivation among health care workers in the public sector in Nakuru County. 7 2.1 Introduction Chapter Two Literature Review This chapter documents the literature review of the work. The chapter is composed of the theoretical framework, empirical literature and the conceptual framework. The theoretical framework of the study discusses the themy to be used in the study and the manner in which it is relevant to the study. The empirical literature examines the studies that have been undertaken by other scholars in relation to the variables of the study, the findings of these studies and the research gaps. The conceptual framework examines the diagrammatic representation of the interrelationship between the independent variables and the dependent variable. 2.2 Them·etical Framew01·k The theoretical framework of this study was based on Herzberg's two factor theory, also called Herzberg's Job motivation and Extrinsic theory (Hui et al., 2012). According to Nanzushi (2015), the two-factor theory was advanced by Frederick Herzberg in 1959 after collection of data from 203 engineers and accountants within the Pittsburg area. The theory was concerned with the factors driving the employee perfonnance and working attitudes. These factors were divided into two factors that is job motivational and extrinsic factors . The job motivational factors were deemed to be intrinsic/internal factors driving employee job motivation while the extrinsic factors are extemal factors preventing employee demotivation motivation levels. The job motivation factors include achievement, recognition, work challenges, responsibility and development opportunity amongst others (Saqar & Al, 20 16). On 8 the other hand, the extrinsic factors include work policies, leadership quality, workplace relationships, working environment, compensation, security and status (Hee eta!., 2019). Other extrinsic factors include job security, salary, fringe benefits, work conditions, good pay, paid insurance, vacations, and promotion (Saqar & AI, 20 16). The extrinsic factors are also studied as maintenance factors in job motivation. The two-factor model produces four possible combinations that can be prevalent in work enviromnent; high extrinsic and high job motivation, high extrinsic and low job motivation, low extrinsic and high job motivation, and low extrinsic and low job motivation (Rasdi & Chen, 20 18)- The high extrinsic-high job motivation would be the ideal work enviromnent since the employees are highly motivated with low complaints. The high extrinsic-low job motivation leads to employees with low complaints but with equally low job motivation. The work is seen as a means of earning a living only (Ngaruiya & Oloko, 2015). The low extrinsic-low job motivation leads to the situations in which there is a high prevalence of complaints and employees are not motivated. This is the poorest of the working conditions that can be prevalent at work. This theory is applicable in this study because the study seeks to examine the factors intluencing the job motivation of public sector healthcare workers in Nakuru County. The studied factors would include extrinsic factors (salary, work conditions and supervisory relations) and job motivation factors (job recognition, career advancement and increased responsibility) on the job motivation aspects. These factors have been chosen since there has been various health care workers industrial strikes and some of the key aspects mentioned in those strikes are those factors. The theory has also been 9 used by other scholars examining diverse factors in±1uencing job motivation including Chatterjee (20 17), and Rastgoo (20 16) amongst others. The challenges of the job motivation within the health sector are a global phenomenon. In the United States of America, Collins, Collins, and Matthews (20 15) indicated that employee turnover rates were fairly high amongst some of the hospitals within the country. In this context, Collins et al., (2015) indicated that over 44% of the hospitals in the US indicated an employee turnover rate of over 10% in the year 2012. In India, Rajan (2017) documents challenges of employee turnover within the nursing fraternity in Tirunelveli city. Amongst the factors driving these aspects include excessive workload, demotivation motivation with the work, work related stress due to workload, and need to perform multiple tasks in the field (Raj an, 20 17). In Iraq, and in reference to the private hospitals in Erbil, Anwar and Shukur (2015) indicated the need for medical managers to motivate their employees as a strategy toward lower tun1over levels. In Nigeria, Ekere and Amah (20 14) noted job motivation challenges amongst the private sector hospitals in the country. Amongst the challenges noted included high employee turnover and low morale and productivity. This was due to lack of structures, and poor pay amongst other challenges. In South Africa, Sikwela (2016) in reference to the case ofPotchefstroom hospital noted that diverse job motivation strategies were adopted for both the doctors and nurses. These aspects included community service, rural and scarce skills allowances, continuing professional development, and commuted overtime for medical doctors (Sikwela, 2016). 10 In a study undertaken in Makassar, Saleh, Ramly and Gani (2015) noted diverse job motivation challenges amongst the nurses in the region. The challenge of poor working environment for the nurses was noted as a major challenge that impacted on the job motivation levels for the nurses. The challenge of working environment influence on the job motivation aspects amongst the nurses were further noted in Malaysia by Tahir and Hussein (20 18) in respect to public hospitals in the country. In Gaza strip hospitals in Palestine, Rn and Al-absi (20 19) raised the challenges of safety at workplace as a factor influencing job motivation amongst the nurses in the region. Al~absi and Tabee (2019) noted challenges v..rith motivational factors of payment, recognition, and work content aspects within the context of Palestine. In Malaysia, Hee and Kamaludin (2020) presence of challenging working environment that impacted negatively on the job motivation of the healthcare workers in the country. 2.3 Empirical Literature The empirical literature of the study examines the studies that have been undertaken touching on the influence of extrinsic factors and job motivational factors in a work environment. The study examined the context in which they were undertaken and the results of those studies. 2.3.1 Influence of Extrinsic Factors on Job motivation Diverse scholars across the globe have looked at the int1uence of extrinsic factors on job motivation across the world (e.g. Kumar, 2016; Smith, 2014; Gemeda & Tynjala, 20 15). Msengeti (20 15) notes that the extrinsic factors serve prevent demotivation motivation by their presence but not to satisfy or motivate the employees. However, Mete (2017) notes that the extrinsic factors may directly affect the individual job motivation, although they cannot enhance the degree of job motivation, but can 11 prevent demotivation levels. According to Alromaihi, Alshomaly, and George (2017) the extrinsic factors include aspects such as salary, work conditions, and supervisory relations amongst others. The following sub-sections look at these specific extrinsic factors. 2.3.1.1 Influence of Salary on Job Motivation The role of salary on job performance and job motivation was studied by Rismawati, Gani, Sukmawati, and Zakaria (2015) in a study based in Indonesia. The study was based on the quantitative methodology and used proportionate random sampling method to derive the target population of 250 respondents. Rismawati et al., (2015) study found that salary amounts and dates of payments influence the job motivation levels of the artisans. The study was not undertaken within the context of the health workers and thus presents a contextual gap to be filled by the current study. Focusing on the airline industry within Sri Lanka, Morais (2019) unde1iook a study that sought to examine the influence of extrinsic factors on the overall job motivation of the employees within the airline. Amongst the aspects that was studied is the role of salary as extrinsic factors influencing the overall job motivation. To achieve this objective, the study derived its sample membership from administration, aviation college, engineering, flight operations and in-flight, and ground handling of the airline. Morais (2019) study found that salary had a moderate positive correlation between salary and job motivation levels. The study being based on the airline industry provided a research gap that was explored in this study as it seeks to link salary aspects with job motivation aspects. 12 In Ethiopia, in a study focusing on the nurses working in emergency room of Aabet and Alert hospitals in the country, Merga (2017) studied the determinants of job motivation for these nurses. The study utilized a cross sectional descriptive study design and data was collected using structured questionnaire. The study found that competitive salary, salary increases, amount of monthly salary, and annual salary increment have a basis on the minimization of the job motivation levels (Merga, 20 17). In conclusion, the study noted the presence of a gap between the nurses' salary and current economic situation which led to the nurses' demotivation motivation in Ethiopia. 2.3.1.2 Influence of Work Conditions on Job Motivation In study based on the selected cow1ty refenal hospitals in Kenya, Tuwei (2019) undertook a study that sought to examine the mediating effect of job motivation on the relationship between quality of work life and service delivery. Amongst the aspects studied were the work conditions levels. The study was undertaken within Machakos, Nandi and Nyeri collilties using mixed methodology in which both the qualitative and quantitative data was collected. The safety and health of the working conditions were studied in the work environment within the referral hospitals in the selected counties. The study diverse work conditions that influenced job motivation within these counties including positive and supportive emotional climate in the hospitals; feeling of being in control of the work deliverables; encouragement to solve own work environment related challenges; presence of an open work environment; and encounters with other staff being work-centered as opposed to ego-centered. Tuwei (2019) further found that safe and healthy work environment was positively and statistically correlated with job motivation aspects. While this study has ex-plored the work conditions factors within a healthcare system, the study hasn't linked these 13 work conditions to job motivation of the health workers. The current study seeks to fill this gap. 2.3.1.3 Influence of Supervism·y Relations on Job Motivation In a study focusing on the millennia!' s job motivation, Campione (20 14) studied the role of supervisor's race, gender, age and cohort on the job motivation aspects. The study that was based in the United States used a sample size of 1,000 millennia! employees for the study. The quantitative data was sought for the study. Campione (2014) found that the millennia's relationship with their itmnediate supervisor has an int1uence on the intrinsic job motivation for the employee job motivation levels. The study further revealed that the presence of preference for older supervisors compared to the younger supervisors. This study specifically catered for the millennia's within the context of the United States of America, which is different from this study that focuses on the public sector healthcare workers in Kenyan context. In Ethiopia, Kibwana, Yigzaw, Molla, Roosmalen, and Stekelenburg (2018) undertook a study that sought to examine the job motivation between amongst anesthetists in Ethiopia. The study was based on cross sectional study in which 252 anesthetists were studied. The study studied the int1uence of supervision and management on the job motivation aspects. Amongst the supervisory aspects that the study found to influence the job motivation aspects included fairness of the supen,isor applying personnel policies and practices, annual performance appraisal being based on the work plan, and availability of the supervisor whenever the support is required (Kibwana eta!., 2018). The study was based on the anesthetists only while the current study was broad based focusing on all health worker cadres. 14 The role of the supervisory aspects on the nurses ' job motivation aspects were studied in a study by Daneshkohan eta!., (2015) focusing on the Iranian health workers. The study utilized a cross-sectional research design and a sample size of 250 health workers derived fifty-five health centers in Tehran. The study found that the supervisory skills of the health workers were insufficient leading to low job motivation levels for the healthcare workers. The supervisor's behaviors sometimes led to the increase of the cont1ict occurrence while change of supervisory style led to the job demotivation motivation aspects. The study further found that failure of the supenrisors to understand and support their staff led to the health workers demoralization (Daneshkohan et al. , 2015). The study was based on Iranian nurses and the manner in which the supervisory skills of the health workers influenced their job motivation. The study thus presents a contextual gap that this study addresses. Kemunto (20 18) undertook a study that examined the int1uence of work experience on the job motivation amongst the secondary school teachers in Kenya. The study utilized the theory of self-esteem, mixed method research approach, and structured questionnaire for the data collection processes. The study indicated that the work environment and ability to undertake the work functions in a. competent manner is key in ensuring job motivation levels of the teaching fraternity. Kemunto (2018) thus concluded that work environment is key in ensuring job motivation levels. The study focused on the job motivation amongst the teaching fratenuty while the current study is based on the healthcare workers hence creating a research gap to be pursued by the study. 15 2.3.2 Influence of Intrinsic factors on Job motivation 2.3.2.1 Influence of Job Recognition on Job Motivation The job motivation factors refers to those work related factors that improve on the job motivation aspects of the tasks undertaken. These tasks include job recognition, career advancement and increased job opportunities amongst other aspects. The job recognition is a critical aspect that has an influence on the job motivation of the healthcare workers. According to Mutuku (2014) recognition refers to the timely, informal or formal acknowledgement of a persons or teams behavior, efTort or business result that supports the organizations goals and values, and which have clearly been beyond normal expectations. In a study on the factors intluencing job motivation among health workers, Daneshkohan et a!. , (2015) studied the role of recognition on the job motivation of the health workers in Iran. The study noted that lack of recognition and appreciation was a factor intluencing the job motivation of the health workers in Iran. In Uganda, Shumba, Kielmann, and Witter (20 17) undertook a study that sought to examine the health workers' perception of the private-not-for- profit health facilities' organizational culture and its influence on retention in Uganda. The study noted the importance of the job recognition amongst peers. In this context, Shumba et a/., (20 17) indicated that the health workers in Uganda had low job motivation due to the lack of recognition amongst general cadres of health workers. The laboratory staff further indicated their job demotivation motivation due to lack of recognition in their job functions by the other health workers (Shumba et a!., 20 17). The study concluded that the recognition of the health workers is important in order to improve their job motivation levels. The study was based on the health workers in Uganda while the current study is based amongst the public sector health workers. It 16 also doesn't seek to linlc the role of the recognition of the health workers on the job motivation levels which is the focus of this study. In seeking to examine the intluence of recognition on the employee perfonnance in Vietnam, Nguyen and Giang (20 19) undertook a study that used structural equation modeling and confirmatory analysis for data analysis aspects. The study found that recognition played the most important role in the job motivation of the employees within the garment industty in Vietnam. This was attributed to the recognition mechanisms influences job motivation levels, productivity, and commitment aspects (Nguyen & Giang, 20 19). The role of the job recognition on the job motivation levels was studied by Mutuku (20 14) in a study that was based on the public universities in Kenya. The study was quantitative in nature and derived its target population from South Eastern Kenya University, Kenyatta and Machakos University College. The study found that acknowledging achievement encourages work commitment levels and hence job motivation levels. The study concluded that job recognition amongst the employees led to increased job motivation levels, improvement in employee productivity and enhancing employee retention levels (Mutuku, 2014). While the study links the job recognition to the job motivation levels within the university set up, this study sought to examine the role of job recognition on the job motivation levels of the public health workers. A research gap therefore exists to be filled by this study. 2.3.2.2 Influence of Career Advancement on Job Motivation In a study based on the Machakos, Nandi and Nyeri counties, Tuwei (20 19) in their study on the mediating effect of job motivation on the relationship between quality of 17 work life and service delivery also studied the career advancement aspects. Amongst the career advancement aspects that the study found to be critical in a healthcare system :included presence of a clear career advancement policy, fair and transparent way of filling open positions, promotion of the intemal staff before hiring from the outside, and well-structured induction process to new roles. Tuwei (2019) further found that career growth and development had weak positive relationship with job motivation that was statistically significant. The study details the career development aspects in a healthcare system didn't link the same to the job motivation of the healthcare workers which is the focus of the current study. 2.3.2.3 Influence of Increased Responsibility on Job Motivation The influence of the increased responsibilities on the job motivation aspects was studied. Aninkan (2014) undertook a study based in Nigeria that sought to examine the role of job enrichment on the job motivation levels. The study utilized the quantitative research design for the study which focused on the job motivation amongst the university employees. The study found that the increased responsibilities that required a variety of skills was positively and significantly associated with higher job motivation. Aninkan (2014) fmiher found that increased responsibilities vvith higher task significance had a positive and statistically significant relationship with job motivation amongst the universities . While this study examines the manner in which increased job responsibilities influences job motivation, the study was based in a university setup while the current study is based amongst the public sector. Similar to Aninkan (2014), Nanle (2015) also undertook a study in Nigeria that focused on the employee job motivation of selected public universities in South West 18 Nigeria. The study utilized the descriptive survey design and gathered data using the structured questionnaires for the study. The study revealed that by increasing the scope of one's job tasks then there was also increased job motivational levels. This was found to be especially true in contexts where the increased job responsibilities enhanced the skills of the employee as welJ as the importance of those increase job responsibilities in the wider job functions. Bunnad and Malik (2018) examined the factors influencing job motivation within call centers in Malaysia. The study found that diverse human resources factors influence the job motivation levels within the call centers in the country. Amongst the aspects that the study found to iniluence the job motivation levels included job characteristics, work environment, and job tasks supervisory aspects. The study while linking the aspects that influence job motivation aspects was undertaken in Malaysia while the current study is undertaken in Kenya. 2.4 Summary of Research Gaps The summary of the research gaps are presented below. Author Findings Research Gaps Rismawati et Rismawati et al., (2015) study The study was not undertaken a!., (2015) found that salary amounts and within the context of the dates of payments influence the health workers and thus job motivation levels of the presents a contextual gap to artisans. be filled by the current study Morais (20 19) study fOLmd that salary had a The study being based on the moderate positive correlation airline industry provided a between salary and job research gap that was 19 motivation levels. explored m this study as it seeks to link salary aspects with job motivation aspects Tuwei (2019) further found that safe and While this study has explored healthy work enviromnent was the work conditions factors positively and statistically within a healthcare system, correlated with job motivation the study hasn't linked these aspects. work conditions to job motivation of the health workers. The current study seeks to fill this gap. ~----------~----------------------~~---------------------- Daneshkohan The study found that the The study thus presents a et al., (2015) supervisory skills of the health contextual gap that this study workers were insufficient addressed. leading to low job motivation levels for the healthcare workers. The study was based on Iranian nurses and the manner in which the supervisory skills of the health workers influenced their job motivation. Shumba, . The study noted the importance The study was based on the Kielmann, and of the job recognition amongst health workers m Uganda Witter (20 17) peers. while the current study Is based amongst the public 20 sector health workers. It also doesn't seek to Jinlc the role of the recognition of the health workers on the job motivation levels which is the focus of this study. 2.5 Conceptual Framework The conceptual framework is a diagrammatic representation of the relationship between the variables. The study had two independent variables that is extrinsic factors examined in tenns of salary, work conditions, and supervisory relations. The other independent variable is the intrinsic factors that has job recognition, career advancement, and increased responsibilities. The job motivation was checked using the contentment at work, continuous skill improvement and long-tenn work commitment. These aspects have been derived from the empirical literature aspects. Extrinsic Factors Salary _ .. Work Conditions Supervisory Relations Job Motivation Contentment at Work ... Continuous Skill Improvement Intrinsic Factors Long Tenn Work Commitment Job Recognition Career Advancement ... Increased Responsibilities Figure 2.1; Conceptual Framework The extrinsic factors are those factors that are those factors that are external factors that are related to the job surrounding/context that prevents the employees' job dissatisfaction. The salary as an extrinsic factor enables the job motivation aspects 21 through the employee's capacity to meet their financial obligations (Morais, 2019). The work conditions influence on the job motivation aspects through ensuring that workers are able to improve their employee performance which then impacts on the job motivation aspects (Shwnba et al, 2017). The supervisory relations are further linked to job motivation aspects through its impact of such relations to the employee perfonnance which further impacts on their job motivation aspects (Gemeda & Tynjala, 2015). The influence of intrinsic factors on the job motivation aspects were examined using · job recognition, career advancement and increased responsibilities. The job recognition impacts on the job motivation through recognition of job achievement (Merga, 20 17). The career advancement and increased responsibilities impacts on the job motivation through addressing the appreciation of the capacity of the employee to take higher roles. 2.6 Summary of the Chapter The study was based on the Herzberg's two factor theory, also called Herzberg's Job motivation and Extrinsic theory. The theory was concerned with the factors driving the employee performance and working attitudes in which these two factors were divided into intrinsic and extrinsic factors. The job motivation factors include achievement, recognition, work challenges, responsibility and development opportunity amongst others. The extrinsic factors include work policies, leadership quality, workplace relationships, working environment, compensation, security and status. This theory is applicable in this study because the study seeks to examine the factors influencing the job motivation of public sector healthcare workers in Nakuru County. The study had two independent variables that is extrinsic factors examined in 22 tenns of salary, work conditions, and supervisory relations. The other independent variable is the intrinsic factors that has job recognition, career advancement, and increased responsibilities. The job motivation \Alas checked using the contentment at work, continuous skill improvement and long-tenn work commitment. Diverse reviewed studies documented various results in respect to the job motivation aspects. Rismawati et al., (2015) study found that salary amounts and dates of payments int1uence the job motivation levels of the a1iisans. Shumba, Kielmann, and Witter (20 17) noted the importance of the job recognition amongst peers. 3.1 Introduction Chapter Three Research Methodology This chapter of the study presents the research methodology of the work. The chapter focuses on research design, population and sampling, data collection methods, data analysis, research quality and ethical issues in research. 3.2 The Research Design According to Jenkins-smith, Copeland, Nowlin, Hughes, and Fister (2017) a research design refers to a plan for the information collection to address research question, and covers aspects on the procedures for data collection and analysis. This study utilizes the cross-sectional descriptive research design. According to Neuman (2014) a descriptive research design refers to a study whose purpose is to describe the research phenomenon using words or numbers with a view of presenting a profile, classification of types or an outline of steps to answer questions such as who, when, where, m1d how. In this context, the study describes the influence of extrinsic factors (salary, work conditions and supervisory relations) and motivating factors (job 23 recognition, career advancement and increased responsibility) on job motivation of the healthcare workers in the public sector health workers in Nakuru. 3.3 Population and Sampling This section describes the population and sampling of the study. According to Gathii, Wamukuru, Karanja, Muriithi, and Maina (20 19) the target population refers to the set of objects or people that have a distinguishing or common characteristic that is of interest to the researcher and to which the researcher would (nonnally) generalize the results to. The target population of this study was the health workers within Nakuru public health facilities that would include medical doctors, clinical officers, laboratory technicians, pharmaceutical technologists and nurses. The inclusion criteria included workers from public health institutions and have worked for more than six months in the sector. All the newly recruited staff that were less than six months were not included in the study as they had little experience in healthcare matters. The study population was 1756 respondents. Table 3.1; Target Population of the Study Personnel Medical Doctors Clinical Officers Laboratory Technicians Phannaceutical Technologists Nurses Total Source: County Government of Nakuru Frequency 106 172 116 132 1230 1756 The sampling process is the process of selecting a small sample size from the population for use in the study due to time and logistical challenges. The sample size of this study was undertaken using Taro Yamane's formula of 1967 (Yamane, 1967) as follows; 24 n = N( 2 ) where N is the target population (1756 respondents) and e is the margin of l+N e error (0.05). N 1756 1756 n = l+N(e2) = 1+1756(0.052) = 5.39 =326 respondents. The study uses the stratified random sampling as the sampling procedure for selecting the specific respondents to be used for the sample size aspects. According to Brase and Brase (2009) in stratified sampling, the population is divided into at least two groups (called strata) or more that share similar characteristics and then a simple random sampling is used to derive a proportionate sample size from each stratum. The proportionality of the sample size from each stratum is done based on their overall strength in the population (Brase & Brase, 2009). The stratified random sampling has a higher level of representativeness than the simple random sampling method. This informs its usage in this study. Table 3.2; Sample Size Personnel Medical Doctors Clinical Officers Laboratory Technicians Pharmaceutical Technologists Nurses Total 3.4 Research Instruments (10611756Y'326 (172/1756)*326 (116/1756)*326 (132/1756)*326 (1230/1756)*326 Frequen~y=~ 20 32 22 24 228 326 The research instrument details the item that was used for the purposes of collecting the data. This study used the structured questionnaire for data collection purposes. According to Gathii et a!., (2019) the structured questionnaire refers to a set of questions on research phenomenon to be addressed in writing and that have provided the respondents with a finite response options that they can choose from. The study 25 was developed from the empirical literature revlew through examination of the indicators utilized by diverse scholars in their respective studies. The study had two sets of questions that is categorical questions that focus on the demographic characteristics of the respondents and the likert-based questions that focus on the research variables. The categorical questions were used for the demographic characteristics of the respondents since they were collecting the factual information. The Iikert based questions was utilized for the research variables as they seek to collect opinion related aspects. The study used a five point Iikert based questionnaires with the following response options; l .No Extent, 2.Small Extent, 3.Moderate Extent, 4.Large Extent, and 5.Very Large Extent. 3.5 Data Collection Methods The data collection method details the manner in which the data was collected for the purposes of the study. The data collection method commenced from the procurement of the data collection authorization letter from Strathmore Business School. The researcher then applied for the Open Researcher and Contributor Identifier (ORCID) identification as a researcher which fonned a prerequisite for application of the National Commission of Science, Technology and Innovation (NACOSTI). The researcher using the university filed authorization letter and the NACOSTI permit then sought for data collection authority from the specific health institutions so as to collect data from their staff members. The researcher approached the medical superintendents of the hospitals \Vithin Nakuru region and sought authorization to collect data. The covid 19 health protocols that were put in place was that the physical questionnaires were to be distributed to the individual deparhnents in order to avoid congestion at a single collection point. The respondents were encouraged to fill in the questionnaire in a single sitting to avoid movement with the questionnaire in multiple 26 places given the sensitivity of a hospital environment. Gloves were used by both the researcher and the respondents in touching the questionnaires to prevent nosocomial infections. The questionnaires were distributed to the respective respondents who were provided with adequate time for them to have filled the questionnaires. The questionnaires were then collected after the agreed time interval elapsed. Which was ranging between 3-7 days? 3.6 Data Analysis The numerical data in this study had been collected using structured questionnaire and was analyzed using Statistical Packages for Social Sciences (SPSS). The S.PSS was utilized to derive various statistics to be used in this study both descriptive and inferential statistics. The descriptive statistics are used for the purposes of describing the data that has been collected. The descriptive statistics that was utilized in this study include the frequency distribution, mean and standard deviations. The multiple linear regression was used for regressing extrinsic factors and Intrinsic factors against Job motivation of the healthcare workers in the public sector health workers in Nakuru. This is with a view of examining inferential (conclusive) relationship between the independent variables and the dependent variable. The following linear regression model was utilized for the study; The regression model that was used is as follows; Y = fJo + fJ1X1 + fJzX2 + s ·where; Y= Job motivation of the healthcare workers in the public sector health workers in Nakuru fJo =constant; fJ1 and fJ2 =Coefficients of estimates,. 27 X1 =Extrinsic Factors X2 =Job motivational Factors c is the estimated error of the model The data analysis results presentation was undertaken using tabular form in which the data was presented in tables. 3. 7 Research Quality The research quality of the study was enhanced using the pilot study, validity of the instrwnents and reliability of the instnunents. 3. 7.1 Pilot Study The pilot study refers to a small-scale study that is undertaken for the purposes of eliminating any logistical and quality challenges that may hamper the achievement of the objectives of the study (Neergaard & Ulh0i, 2007). The pilot study is often undertaken in identical environmental conditions as possible to the final study. In this context, the pilot study for this study was undertaken amongst the healthcare workers in Nakuru. However, the respondents used in the pilot study were not utilized in the final study to avoid elements of contamination of the final study. According to Mugenda and Mugenda (2003 ), ten percent of the sample size should be used for the study. In this context, thirty three respondents were used for the pilot study. 3.7.2 Validity of the Instruments According to Osman (20 17) validity of the instmment refers to whether it measures what .it is designed to measure. Within the context of this study, the validity of the structmed questionnaire was the examination on whether it measures the research phenomenon at hand that is factors influencing the job motivation of public sector healthcare workers in Nakum County. According to Boslaugh and Watters (2008) the content validity refers to how well the process of measurement reflects the important 28 content of the domain of interest. The content validity of the research process was checked using subject matter experts with the area of job motivation of the healthcare workers. The face validity was ensured through putting subsections in the questionnaires catering for specific objectives, and as with content validity, through a review by subject matter experts. 3. 7.3 Reliability of the Instruments According to Neergaard and Ulh0i (2007), the reliability of the instrument refers to the replicability of the results in repeated instances. The reliability of the instrwnents used in this study was assessed using the Cronbach alpha coefficient which examines the internal reliability of latent variables. The Cronbach alpha coefficient of a threshold of0.7 was used in the study. 3.8 Ethical Issues in Research The ethical issues in research refers to the accepted behaviors when undertaking research. The ethical issues were catered for through seeking ethical approval :from the SUIERC and from NACOSTI, and administration of the consent statement to the respondents. The individual persons whom the data was collected from were presented with a consent statement. The consent statement advised the respondents on the purpose for data collection, requested their pmticipation, and assured them of the maintenance of anonymity as well as confidentiality aspects. 3.9 Summary of the Chapter This chapter has presented the methodological aspects of this research, and the exact manner in which the study was undertaken on the ground. The chapter will be followed by a chapter on the data analysis aspects. 29 Chapter Four Data Analysis 4.1 Introduction This chapter examined the results for the study and presented the same in tables. 4.2 Response Rate The study collected data through structured questionnaire from healthcare sector personnel comprising medical doctors, clinical officers, laboratory technicians, pharmaceutical technologists, and nurses. A total of 326 questionnaires were deployed and the response rate was as demonstrated in table 4.1 below. Table 4.1; Response Rate ,Job Cadres Distributed Returned Response Questionnaires Questionnaire Rate Doctor 20 12 60.0% Clinical Officers 32 25 78.1% Laboratory Technician 22 14 63 .6% Pharmacists 24 16 66.7% Nurses 228 205 62.9% Total 326 272 83.4% According to Boslaugh and Watters (2008), a response rate of 60% and above is considered adequate for studies with a huge number of respondents. A high response rate is desirable as it acts to reduce the non-response bias. 4.3 Demographic Characteristics The demographic characteristics of the respondents in the study are presented in tables below. 4.3 . .) Gender Distribution The gender distributions of the results were presented in table 4.2 below. Table 4.2; Gender Distribution Male Femaie Total Frequency 122 150 272 30 Percentage 44.9% 55.1% 100% The gender distribution results revealed that 44.9% of the respondents were male compared to 55.1% of the respondents who were female. The high number of the female members compared to the male members is in tandem with other studies on the healthcare sector. For example, (Nafei, 2015) in their study based on hospitals in Egypt achieved similar distributions. Other scholars observing similar trends include (Sumah & Baatiema, 2019), as well as (Muhindo, Joloba, & Nakanjako, 2016) amongst others. The high number of respondents that were female is attributable to the large number of female nurses which increases the overall number of female healthcare practitioners. 4.3.2 Age Group Distribution The age distributions of the results were presented in the table 4.3 below. Table 4.3; Age Group Distribution Age Group Below 30 Years 31-40 Years 41-50 Years Above 50 Years Total Frequency 46 117 69 40 272 Percentage 16.9% 43.0% 25.3% 14.8% 100.0% As shown in table 4.3 above, 16.9% of the respondents were below 30 years of age, 43.0% of the respondents fell in the 31-40 years of age, 25.3% of the respondents in the 41-50 years of age, and 14.8% of the respondents above 50 years of age. The age demographic information was useful in the study as members in different age groups have different motivational requirements. 4.3.3 Job Cadre The job cadre of the respondents were examined with the results presented in table 4.4 below. Table 4.4; Job Cadre Distdbution .Job Ca0.7 Extrinsic Factors 15 0.845 Yes Variable Reliable Intrinsic Factors 12 0.744 Yes Variable Reliable Job Motivation 4 0.752 Yes Variable Reliable The study results revealed that extrinsic factors, intrinsic factors, and job motivation had a Cronbach alpha coefficient of 0.845, 0.744, and 0.752 respectively. According to (Saunders, Lewis, & Thornhill, 2007) cronbach alpha coefficient of above 0. 7 is deemed sufficient as a measure of internal reliability. The Cronbach alpha coe111cient having exceeded the threshold of 0.7 Jed to the conclusion that the variables were reliable in nature and tit for use in the study. 4.5 Descriptive Statistics The descriptive statistics were utilized for the purposes of checking on the spread of the responses amongst the various indicators of the variables. 32 4.5.1 Extrinsic Factors and Job IVIotivation of the Health care W orkers The e'Airinsic factors influencing the job motivation levels of the healthcare workers we.re examined using a range fourteen indicators and the results presented in table 4.6 below. Table 4.6; Descriptive Statistics of Extrinsic Factors NE SE ME LE VLE Freq Freq Freq Freq Freq Mean Std.Dev % % % % % The salary that I am paid is 45 161 39 15 12 commensurate with the work I 16.5% 59.2% 14.3% 5.5% 4.4% 2.22 0.939 do I am satisfied with the dates 42 169 33 21 7 2.20 0.883 of the salary payments 15.4% 62.1% 12.1% 7.7% 2.6% I am happy with the sala1y 41 187 28 8 8 increments available in my 15.1% 68.8% 10.3% 2.9% 2.9% 2.10 0.793 role My salary is competitive for 39 174 37 11 11 2.19 0.878 the role I undertake 14.3% 64.0% 13.6% 4.0% 4.0% There is a supportive work 37 164 47 20 4 environment in my work 13.6% 60.3% 17.3% 7.4% 1.5% 2.23 0.828 station I feel that I am in control of 2 10 34 152 74 4.05 0.781 the work deli verables 0.7% 3.7% 12.5% 55.9% 27.2% I am always encouraged to 6 12 34 132 88 solve own work environment 2.2% 4.4% 12.5% 48.5% 32.4% 4.04 0.908 related challenges There is presence of an open 9 16 35 144 68 3.90 0.952 work environment 3.3% 5.9% 12.9% 52.9% 25.0% Encounters \V:ith other staff 13 5 30 150 74 being work -cantered as 3.98 0.943 4.8% 1.8% 11.0% 55.1% 27.2% opposed to ego-cantered. There is fairness ofthe 47 153 39 16 17 supervisor applying personnel 17.3% 56.2% 14.3% 5.9% 6.2% 2.28 1.021 policies There is fairness of the 57 162 37 7 9 supervisor applying personnel 21.0% 59.6% 13.6% 2.6% 3.3% 2.08 0.862 practices The annual perfonnance 60 155 42 14 1 appraisal being based on the 22.1% 57.0% 15.4% 5.1% 0.4% 2.05 0.784 work plan 33 There is availability of the supervisor whenever the support is required The supervisor's behaviors create a positive work environment The supervisors are consistent in their supervisory styles 6 2.2% 41 3.99 6.2% 12.1% 49.3% 30.1% 17 33 134 82 177 26 27 1 15.1% 65.1% 9.6% 9.9% 0.4% 2.15 46 160 44 17 5 2.17 16.9% 58.8% 16.2% 6.2% 1.8% 0.935 0.809 0.848 In respect to whether the salary paid was commensurate with the work done, mean of 2.22 and standard deviation of 0.939 were achieved. This indicated that the respondents on average felt the salary was commensurate with work done to a small extent. A moderate variation in the responses was observed. The satisfaction levels with the dates of salary payment were also examined in the study. On the levels of satisfaction with the dates of salary payments, the respondents were satisfied to a small extent as shown by the achieved mean of 2.20 and a standard deviation of 0.883. The respondents were also asked the extent to which they were happy with the salary increments available for their roles. This metric scored a mean of 2.10 and a standard deviation of 0. 793 indicating the level of satisfaction with salary increment to be to a small extent. On competitiveness of the salary relative to the role undertaken a mean of 2.19 was achieved indicating that on average the respondents felt the competitiveness was to a small extent. A standard deviation of 0.878 indicated that there was moderate spread of the respondents around the mean. The mean score of respondents feeling in control of the work deliverables was 4.05 (to a large extent) with a standard deviation of 0.781 (moderate spread). On encouragement to solve own work environment related challenges, a mean of 4.04 was achieved leading to the conclusion that on average the employees were 34 encouraged to do so. There was a moderate spread of the responses in respect to the item due to a standard deviation of0.908. The respondents were asked on whether there was presence of an open work enviromnent. This metric achieved a mean score of 3.90 (large extent) and a standard deviation of 0.952 (moderate spread of responses). The respondents were asked on whether the encounters with other staff were work entered as opposed to ego centered. The responses indicated a mean of 3.98 (large extent) and a standard deviation of 0.943 (moderate spread). In respect to the fairness of the supervisor in applying personnel policies, a mean of 2.28 and a standard deviation of 1.021 were achieved. The mean indicated that the respondents on average felt that there was fairness of the supervisor in applying personnel policies to a small extent The standard deviation of 1.021 led to the conclusion of a wide dispersion of responses around the mean. The respondents were also asked on whether there was fairness in the supervisor application of the personnel practices. The metric achieved a mean score of2.08 and a standard deviation of0.862 which implied that the respondents on average felt that there was fairness to a small extent The relationship between annual performance appraisal being based on the work plan achieved a mean score of 2.05 (small extent) and a standard deviation of 0.784 (moderate extent). The study further examined on whether there was availability of the supervisor whenever the support is required. The study achieved a mean score of 3.99 (large extent) and a standard deviation of 0.935(moderate spread of responses). 35 On the supervisor creation of a positive work enviromnent, a mean of 2.15 and standard deviation of 0.809 was achieved. This indicated that the respondents on average felt that supervisor's creation of positive work environment was undertaken to a small extent. Finally, the respondents were asked on the supervisors were consistent in their supervisor styles in which a mean of 2.17 (small extent) and 0. 848 (moderate spread) were achieved. 4.5.2 Intrinsic Factors and Job Motivation of the Healthcare Workers The role of the intrinsic factors on the job motivation of the healthcare workers was examined using twelve indicators. The results were presented in the table 4.7 below. Table 4. 7; Descri~tive Statistics of the Intrinsic Factors NE SE ME LE VLE Freq Freq Freq Freq Freq Mean Std.Dev % % % % % I am recognized in a timely 40 172 38 11 11 manner when I undertake, I 14.7% 63.2% 14.0% 4.0% 4.0% 2.19 0.882 excel in my work Infonnal acknowledgements are often utilized m 7 10 39 143 73 departments for excellent 2.6% 3.7% 14.3% 52.6% 26.8% 3.97 0.890 work Formal acknowledgements are often utilized m 29 177 26 13 27 departments for excellent 10.7% 65.1% 9.6% 4.8% 9.9% 2.38 1.070 work Peers recognize the work that 7 14 34 166 51 is well done by an individual 2.6% 5.1% 12.5% 61.0% 18.8% 3.88 0.860 I value the job recognition for 5 17 28 141 81 4.01 0.905 tasks that I undertake 1.8% 6.2% 10.3% 51.8% 29.8% Job recognition led to the 12 improvement of work 10 31 150 69 3.93 0.954 4.4% 3.7% 11.4% 55.1% 25.4% commitment levels Job recognition led to the 4 14 37 167 50 improvement of work 1.5% 5.1% 13.6% 61.4% 18.4% 3.90 0.807 productivity There is presence of a clear 33 172 27 13 27 2.37 career advancement policy 12.1% 63 .2% 9.9% 4.8% 9.9% 1.082 36 Open positiOns m my 40 179 26 25 2 department are filled in a fair 14.7% 65.8% 9.6% 9.2% 0.7% 2.15 0.809 manner Open positions m my 43 163 44 17 5 department are filled in a 15.8% 59.9% 16.2% 6.2% 1.8% 2.18 0.839 transparent manner Increased responsibilities led 15 19 34 128 76 to acquisition of variety of 5.5% 7.0% 12.5% 47.1% 27.9% 3.85 1.078 skills Increased responsibilities on 12 5 20 149 86 significant tasks led to 4.4% 1.8% 7.4% 54.8% 31.6% 4.07 0.926 satisfaction The respondents were asked on whether they were recognized in a timely maimer whenever they excelled in their work. The results of the study in respect to the metric was a mean of 2.19 and a standard deviation of 0.882. This indicated that the respondents on average felt that they were recognized in a timely manner to a small extent. The metric on the informal acknowledgements being utilized in departments for excellent work done achieved a mean of 3.97 (large extent) and standard deviation of 0.890 (moderate spread). The respondents on being asked on whether formal acknowledgement were often utilized in departments for excellent work scored a mean of2.38 and standard deviation of 1.070. This indicated that it was undertaken to a small extent. The peers' recognition ofthe work well done by an individual created a mean of3.88 (large extent) and a standard deviation of0.860 (moderate dispersion). The respondents were asked on whether they valued the job recognition for the tasks undertaken which achieved a mean of 4.01 (large extent) and standard deviation of 0.905 (moderate consensus). The job recognition leading to the improvement of the work commitment levels had a mean of 3.93 (large extent) and standard deviation of 0.954 (moderate spread). The respondents were further asked on whether job recognition led to the improvement of the work productivity levels. This metric had a mean of 3.90 (large extent) and a standard deviation of 0.807 (moderate spread). The 37 role of the various aspects of the job recognition on the job motivation factors has also gained coverage amongst diverse scholars. On there being a presence of a career advancement policy, a mean of 2.37 (small extent) and a standard deviation of 1. 082 (large dispersion) were achieved. The respondents were asked on whether increased responsibilities led to acquisition of variety of skills which led to the achievement of a mean of 3.85 (large extent) and standard deviation of 1.076 (large dispersion). The study results were similar to the other studies that have examined the research phenomenon. Finally, the respondents were asked on whether the increased responsibilities on significant tasks led to satisfaction with a mean of 4.07 (large extent) and a standard deviation of 0.926 (moderate spread). 4.5.3 .Job Motivation of Health Workers The job motivation of the health workers was examined using four components that is contentment in job undertaking, continuous increasing of skills in current job, looking forward to go to work, and commitment to the job in the long run. The results of the study were presented in table 4.8 below T able 4.8; Job Motivation of Health Worl{ers NE SE ME LE VLE Freq Freq Freq Freq Freq Mean Std.Dev % % % % % I feel contented undertaking 62 153 41 15 1 my job 22.8% 56.2% 15.1% 5.5% 0.4% 2.04 0.795 I continuously increasing my 7 21 27 158 59 skills in my current job 2.6% 7.7% 9.9% 58.1% 21.7% 3.89 0.920 I always look forward to 51 149 38 16 18 going to work 18.8% 54.8% 14.0% 5.9% 6.6% 2.27 1.044 I am willing to commit myself 58 161 38 7 8 into this job in the long run 21.3% 59.2% 14.0% 2.6% 2.9% 2.07 0 .848 38 The respondents were asked on whether they felt contented undertaking their job. The study found a mean of2.04 (small extent) and a standard deviation of0.795 (moderate spread). The study further asked the respondents on whether they were continuously increasing their skills on their current job in which a mean of3.89 (large extent) and a standard deviation of 0.920 (moderate spread) was achieved. The study further found that in respect to looking forward towards going to work a mean of2.27 (small extent) and a standard deviation of 1.044 (wide spread of responses from mean) was achieved. The study further asked the respondents on whether they were willing to commit themselves into the job in the long run. The study achieved a mean score of 2.07 (small extent) and standard deviation of0.848 (moderate spread). The long term job commitment is a key measure for the job motivation levels. 4.6 Correlational Analysis The study undertook the correlational analysis in order to examme the changes associated with the independent variables and the dependent variable. The results of the correlation analysis (extrinsic factors and intrinsic factors) and job motivation were presented in Table 4.9 below. Table 4.9; Correlational Analysis Extrinsic Factors Intrinsic Factors Pearson Correlation Sig_ (2-tailed) N Pearson Correlation Sig. (2-tailed) N **- Correlation is significant at the 0.01 level (2-tailed). Job Motivation .633'·'•' .000 272 .795''~ .000 272 The correlation between diverse factors and the job motivation were examined_ The study found a positive and strong positive correlation between extrinsic factors and job motivation (r=0.633, p value =0.000). According to (Fox, 2015) a correlation of 0.633 is considered to be positive and moderate in nature. The study noted that the 39 correlation between the extrinsic factors and job motivation was statistically significant due to a p value of less than 0.05. The study further found that there was a positive and statistically significant correlational relationship between intrinsic factors and job motivation (r-0.795, p value =0.000). The study noted that the Pearson correlation coefficient of 0.795 was moderately positive correlational relationship between intrinsic factors and job motivation levels. Regression Analysis The regression analysis was undertaken for the purposes of determining the influence of the extrinsic and intrinsic factors on the job motivation levels of the public healthcare workers in Nakuru. The results were presented in a series of three tables that is Model Summary (Table 4.10), ANOVA (Table 4.10), and Coetlicients (Table 4.10). Table 4.10; Model Summary Model R R Square Adjusted R Square 1 0.618 0.615 a. Predictors: (Constant), Intrinsic Factors, Extrinsic Factors Std. Error of the Estimate 0.14255 Wilson, Keating, and Beal-Hodges (2012) indicates that multiple linear correlation coefficient measures the correlation between the independent variables together on the dependent variable. The study found that the intrinsic and extrinsic factors cumulatively had 0. 786 conelational relationship with the job motivation levels of the healthcare personnel. The study further found that adjusted coefficient of determination score was 0.615. According to (Paulson, 2006) in a multiple linear regression, the adjusted coefficient of detennination presents the variation in the dependent variable that is attributable to the independent variable. The study noted that an adjusted coefficient of determination of 0.615 indicated that 61.5% of the variation in the job motivation is as result of the intrinsic and extrinsic factors. This 40 shows that the remainder of the variance that is 39.5% of the variance in the job motivation is as result of other factors not in the model. Table 4.11 ;ANOV An M odel Sum of Df Mean F Sig. Squares Square Regression 8.830 2 4.415 217.288 0.0005 1 Residual 5.466 269 0.020 Total 14.296 271 a. Dependent Variable: Job Motivation b. Predictors: (Constant), Intrinsic Factors, Extrinsic Factors The F test or the one way ANOV A is used for the purposes of testing the goodness of fit of the regression model that is the overall significance of the regression model. This is checked through testing the following hypotheses at 5% level of significance; Hr: Bi'f:O where i=l or 2 The study will test the overall significance of the regression model that its ability to predict the dependent variable. This was undertaken through testing the null hypothesis of none of the independent variables predicts the dependent variable against the alternative that at least a single independent variable predicts the dependent variable at 5% (0. 05) level of significance. The decision rule of the study is rejecting the null hypothesis if p value is less than the level of significance (0.05). The study results indicated that F (2,269) = 217.288 with a p value less than 0.05_ This led to the rejection of the null hypothesis and the acceptance of the alternative hypothesis. The results of the F test or one way ANOVA led to the conclusion that there is at least one independent variable that is a significant predictor of the job motivation. Having passed the F test, the two tailed t test were then undertaken in order to identify the specific independent variable (s) that were statistically significant predictors of the 41 job motivation in the health sector. The results of the t test are presented in the Table 4.12 below. Table 4.12;Coefficientsa Model Unstandardized Standardized t Sig. Coefficients Coefficients B Std. Error Beta (Constant) 0.176 0.130 1.354 0.177 Extrinsic Factors 0.318 0.027 0.436 11.564 0.000 Intrinsic Factors 0.596 0.035 0.636 16.862 0.000 a. Dependent Variable: Job Motivation In order to test on whether the extrinsic factors had a statistically significant influence on the job motivation, the following hypothesis was tested; where B 1 is the regression coefficient of extrinsic factors. The hypothesis testing was undertaken at 5% (0.05) level of significance with the decision rule being to reject the null hypothesis if p value is less than 0.05 . The study results revealed that t (271) = 11.564 with a p value less than 0.05. This led to the rejection of the null hypothesis and the acceptance of the alternative hypothesis. A conclusion was thus made that the extrinsic factor has a statistically signitl.cant ini1uence on the job motivation levels. The study further tested on whether the intrinsic factors had a statistically significant influence on the job motivation levels in which the following hypothesis was tested; where P2 is the regression coefficient of intrinsic factors. 42 The hypothesis testing was undertaken at 5% (0.05) level of significance with the decision rule being to reject the null hypothesis if p value is less than 0.05 . The study results revealed that t (271) = 16.862 with a p value less than 0.05. This led to the rejection of the null hypothesis and the acceptance of the alternative hypothesis. A conclusion was thus made that the intrinsic factors have a statistically significant influence on the job motivation levels. Having found that both the intrinsic and extrinsic factors are both statistically significant, the study further examined the regression analysis for the purposes of practical significance of these indicators. The study achieved the following linear regression model. Y=0.176 + 0.318X1 + 0.596X2 + 0.14255 where 0.176 is a regression constant, X1 is the extrinsic factors, X2 is the intrinsic factors, and 0.14255 is the standard error of the model. The regression models revealed that a unit increase in the extrinsic factor is associated with 0.318 increase in the job motivation levels with intrinsic factors kept constant. On the other hand, a unit increase in the intrinsic factors is associated with 0.596 increase in the job motivation levels with extrinsic factors kept constant. 43 Chapter Five Summary of Findings, Discussions, Conclusion and Recommendations 5.1 Introduction The study sought to examine the factors influencing job motivation of public sector healthcare workers in Nakum county. The study f1.uther examined the extrinsic and intrinsic factors influencing the job motivation of the public sector healthcare workers in Nakun.1 county. Data was collected from healthcare professionals using stmctured questionnaires in which a response rate of 83.4% was achieved for the study. The data was analyzed using the descriptive statistics in which the mean and standard deviation were provided and inferential statistics in which multiple linear regression analysis was undertaken. 5.2 Summary of Findings 5.2.1 Extrinsic Factors and Job Motivation of The Healthcare Workers The influence of the extrinsic factors on the job satisfaction were examined using a range of indicators. The study observed that a wide range of indicators of extrinsic factors had the respondents agreeing with those responses to a small extent. It was only five metrics of the extrinsic factors that had the respondents agreeing with those measures to a large extent. These measures include feeling being in control of work deliverables (mean 4.05), being always encouraged to solve own work environment related challenges (mean of 4.04), presence of open work environment (mean of 3.90), encounters with staff being work related (mean of 3.98), and supervisor availability whenever required (mean of 3.99). The results thus indicated that in a majority of the mctrics that the extrinsic factors were satisfacto1y to a small extent. The study found a positive and strong positive correlation between extrinsic factors and job motivation (1=0.633 , p value =0.000). In respect to vvhether the extrinsic 44 Chapter Five Summary of Findings, Discussions, Conclusion and Recommendat ions 5.1 Introduction The study sought to examine the factors in±1uencing job motivation of public sector healthcare workers in Nakuru county. The study further examined the extrinsic and intrinsic factors influencing the job motivation of the public sector healthcare workers in Nakuru county. Data was collected from healthcare professionals using structured questionnaires in which a response rate of 83.4% was achieved for the study. The data was analyzed using the descriptive statistics in which the mean and standard deviation were provided and inferential statistics in which multiple linear regression analysis was undertaken. 5.2 Summary of Findings 5.2.1 Extrinsic Factors and J ob Motivation of The Healthcare Workers The influence of the extrinsic factors on the job satisfaction were examined using a range of indicators. The study observed that a wide range of indicators of ex trinsic factors had the respondents agreeing with those responses to a small extent. It was only five metrics of the extrinsic factors that had the respondents agreeing with those measures to a large extent These measures include feeling being in control of work deliverables (mean 4.05), being always encouraged to solve own work environment related challenges (mean of 4.04), presence of open work environment (mean of 3.90), encounters with staff being work related (mean of 3.98), and supervisor availability whenever required (mean of 3.99). The results thus indicated that in a majority of the metrics that the extrinsic factors were satisfactory to a small extent. The study found a positive and strong positive correlation between extrinsic factors and job motivation (F0.633, p value =0.000). In respect to whether the extrinsic 45 factors had a statistically significant influence on the Job Motivation of the Healthcare Workers, the study found at test value of 11.564 with a p value less than 0.05. This led to the rejection of the null hypothesis and the acceptance of the alternative hypothesis. A conclusion was thus made that the extrinsic factors have a statistically significant influence on the job motivation levels. The regression models revealed that a unit increase in the extrinsic factor is associated with 0.318 increase in the job motivation levels with intrinsic factors kept constant. 5.2.2 Tnttinsic Factots and Job Motivation of the Healthcare Worl