The work motivations of the health practitioner who stays for a substantial time in the very remote Indigenous community workplace

Figures & data

Table 1. Examples of HPMS final items and their IPIP derivatives

HPMS item	IPIP derivative
40. Usually I prefer routine to variety	Prefer variety to routine
44. Usually I love having to adapt to new situations at work	Am open to change
42. Usually I choose work that also involves adventure	Seek adventure
41. Usually I will take risks to gain new experience	Take risks
67. I am more inclined to stay in a job if I am central to the service to keep it running	Want to be in charge Take control of things
71. I am more inclined to stay in a job if it does not present me with complex clinical challenges often (reverse)	Like to solve complex problems Accept challenging tasks
99. I am committed to putting duty above my own needs in health practice	Sacrifice myself for others

Table 2. HPMS respondent distribution by remoteness of workplace

Remoteness classification	N	%
Major cities	67	11.7
Regional (inner and outer)	151	26.4
Remote	161	28.1
Very remote	193	33.7

Table 3. HPMS frequencies of variables of interest

HPMS variable	N	Response	N	%
Gender	547	Female	424	77.5
		Male	123	22.5
Race	547	Indigenous	17	3.1
		Non‐Indigenous	530	96.9
Country of birth	538	Australia	409	76.0
		Other (English first Language)	98	18.2
		Other	31	5.8
Age	547	20–30-years	83	15.2
		31–40-years	94	17.2
		41–50-years	133	24.3
		51–60-years	173	31.6
		>60-years	64	11.7
Single/Couple	547	Partnered	393	71.9
		Single	154	28.1
Children	542	No children	216	39.9
		Children	326	60.1
Family stage	324	Pre‐school age	42	13.0
		Primary school	56	17.3
		High school	57	17.6
		Boarding high school university	47	14.5
		Left school, at home	42	13.0
		Left school, left home	189	58.3

Table 4. The 17‐health practitioner work motivation subscales: Their constituent items and component loadings

New Motivation Subscale	Constituent items	PCA item loading
1. Avoidance Needs	1. In choosing any job, my big priorities include avoiding the people hassles I faced in past workplaces (R);	.82
	2. I am committed to avoiding conflicts I've met in previous workplaces (R);	.82
	3. Wherever I work, I feel the need to feel anonymous in community after hours (R);	.59
	4. I believe that re‐locating to a new job is a good way for me to find emotional healing (R).	.44
2. Belonging Needs	1. Given the choice, I will choose a job that helps me feel a good sense of place and belonging, both in and out of work;	.76
	2. Wherever I work, I feel the need to feel that both I and those close to me are well respected by the community we live in;	.73
	3. I will choose a job that helps me feel part of committed team;	.66
	4. In choosing any job, my big priorities will include feeling familiar and comfortable in the community I live in;	.57
	5. I believe that getting involved in community activities is essential for my effective primary health‐care practice.	.54
3. Challenge Seeker	1. Usually I choose work that involves adventure;	.84
	2. Usually I will take risks to gain new experience;	.82
	3. Usually I am considered by some as too high a risk taker;	.70
	4. Usually I love having to adapt to new situations at work.	.66
4. Variety Seeker	1. Usually I prefer routine to variety (R);	.73
	2. Usually I work best where certainty prevails (R);	.72
	3. I would quit a job where I sometimes have to deal with threatening and aggressive behaviour (R);	.70
	4. Usually I would refuse to drive through the bush on dirt roads at night (R).	.51
5. Clinical Competence	1. I am more inclined to stay in a job if I am not presented with complex clinical challenges often (R);	.75
	2.Given the choice, I will choose a job that helps me build my skills to deal with complex presentations in my patients/clients;	.74
	3. Usually I enjoy taking on a large clinical workload.	.72
6. Career Management	1. In choosing any job, my big priorities include the career opportunities the job offers;	.81
	2. In choosing any job, my big priorities include developing my private practice;	.58
	3. Wherever I work, I feel the need to gain on‐the‐job experience to significantly advance my clinical skills;	.56
	4. Given the choice, I will choose a job that helps me be recognised in my community as an expert in my field.	.56
7. Clinical Self‐Containment	1. Wherever I work, I feel the need to have frequent and easy access to good clinical supervision (R);	.74
	2. Wherever I work, I feel the need to be able to regularly access a mentor (R);	.73
	3. I would quit a job where I feel professionally isolated a lot of the time (R);	.65
	4. I would quit a job where I get very little positive feedback from management and patients/clients (R);	.62
	5. I am more inclined to stay in a job if I have ready access to expert clinical support (R);	.58
	6. I would quit a job where my employer does not show strong leadership in what is expected (R).	.55
8. Managerial Self‐confidence	1. I am more inclined to stay in a job if I am free to do my job with very little managerial oversight;	.69
	2. I am more inclined to stay in a job if I am central to keeping the service running;	.67
	3. I am more inclined to stay in a job if I have a significant management role;	.60
	4. I am more inclined to stay in a job if I have management at a good distance from my workplace.	.57
9. Compassion	1. I am committed to having work which gives me a strong sense of meaning in life;	.82
	2. I am committed to providing care for those who are underserved;	.80
	3. I am committed to delivering care to those who are unable to maintain good health without help;	.78
	4. In considering a new job, I prefer one that offers me a strong sense of purpose;	.74
	5. I am committed to making a substantial difference in this world via my work;	.73
	6. In considering a new job, I prefer one that enables me to serve my mission to help people in real need;	.68
	7. I am committed to standing up for the rights of those with less say, even when it costs me in some way;	.59
	8. Given the choice, I will choose a job that helps me achieve goals inspired in me by a strong role model.	.55
10. Financial Incentives	In choosing any job, my big priorities include:
	1. …to receive allowances, tax breaks, and/or HECS pay outs;	.84
	2. …to significantly increase my retirement funding;	.76
	3. …negotiating a contract with cash bonus for staying the full term;	.76
	4. …continuing professional development costs being met by the employer;	.75
	5. …negotiating a generous pay and annual leave package;	.69
	6. …very good pay for any after‐hours on‐call and call‐outs;	.68
	7. …being able to obtain a scholarship to help me further my post graduate studies;	.68
	8. …being provided with well subsidised accommodation	.62
11. Intercultural Interests	1. In considering a new job, I prefer one that introduces me to the stories and views of Aboriginal and Torres Strait Island people;	.91
	2. In considering a new job, I prefer one that teaches me to communicate well with people from another culture;	.89
	3. In considering a new job, I prefer one that raises my confidence in working with people of other cultures;	.89
	4. In considering a new job, I prefer one that helps me to learn to speak an Aboriginal or Torres Strait Islands language;	.75
	5. In considering a new job, I prefer one that involves me helping to close the gap between Indigenous and non‐Indigenous health status.	.74
12. Lifestyle Preferences	1. Wherever I work, I feel the need to establish a very comfortable work/leisure balance;	.80
	2. Wherever I work, I feel the need to be inspired by the surrounding environment I live in;	.79
	3. I am committed to choosing a work situation that allows me an optimally healthy lifestyle. (R);	.70
13. Living Location Preferences	1. Usually I prefer rural community living to city living;	.78
	2. Usually I am excited by the idea of living in wilderness country;	.78
	3. Wherever I work, I feel the need to be within easy driving distance of major capital cities (R);	.73
	4. I would quit a job where the local climate makes life uncomfortable sometimes (R).	.55
14. Personal Demand Preferences	1. I would quit a job where clients/patients regularly approach me out‐of‐hours about their needs (R);	.81
	2. I would quit a job where I quite often get called out by the job after hours (R);	.79
	3. I would quit a job where there is no backfill of my job when I take leave (R);	.63
	4. I would quit a job where most of my patients /clients have limited English (R);	.59
	5. I believe that mixing social and clinical relationships should be avoided (R).	.52
15. PHC Orientation	1. Wherever I work, I feel the need to be the leader of the health/medical team I work in;	.79
	2. Wherever I work, I feel the need to feel welcomed to teach my area of expertise to staff, students and/or community residents;	.71
	3. Wherever I work, I feel the need to feel free to use my professional relationship networks to get things done for my clients /patients;	.63
	4. Wherever I work, I feel the need to feel free to deliver local community health education programs;	.60
	5. I am committed to developing evidence‐based knowledge about those with very substantial health/medical needs;	.56
	6. Given the choice, I will choose a job that helps me carry out research in areas of special clinical interest to me;	.55
	7. Wherever I work, I feel the need to feel a real passion for doing my job;	.53
	8. In considering a new job, I prefer one that requires me to both manage staff and provide clinical services.	.43
16. Relationship Imperatives	1. In choosing any job, my big priorities include the needs and wants of those special to me;	.86
	2. I am committed to making joint decisions with those important to me about any career move;	.82
	3. I am committed to having a job within no more than a few hours' drive of my family networks.	.63
17. Spiritual Beliefs	1. Wherever I work, I feel the need to feel I am carrying out God's will in helping people less well off than me;	.87
	2. I am committed to work that is consistent with my spiritual belief system;	.71
	3. Wherever I work, I feel the need to express my gift for helping those who are suffering.	.56

Note. PHC = primary health care.

Table 5. The 17‐new health practitioner work motivation subscales: Internal reliabilities

New Subscale	N (% of total)	Total score range: Actual/Possible	Mean scale score	Mean inter‐item correlations	Cronbach's α
Intercultural Interests (five items)	454 (83.0)	5.0–30.0/5.0–30.0	22.79	.68	.91
Compassion (eight items)	437 (79.9)	8.0–48.0/8.0–48.0	38.99	.46	.87
Financial Interests (eight items)	408 (74.6)	8.0–48.0/8.0–48.0	28.58	.46	.87
Primary Health Care Orientation Preferences (eight items)	417 (76.2)	8.0–40.0/8.0–48.0	34.89	.30	.77
Challenge Seeker (four items)	455 (83.2)	4.0–24.0/4.0–24.0	16.16	.44	.75
Clinical Self Containment (six items)	442 (80.8)	6.0–34.0/6.0–36.0	17.54	.31	.73
Personal Demand Preferences (five items)	433 (79.2)	6.0–30.0/5.0–30.0	20.09	.34	.71
Living location (four items)	453	6.0–24.0/4.0–24.0	18.38	.35	.69
Lifestyle (three items)	447	5.0–18.0/3.0–18.0	11.96	.41	.68
Avoidance Needs (four items)	431	4.0–24.0/4.0–24.0	15.01	.31	.65
Belonging Needs (five items)	444	9.0–30.0/5.0–30.0	24.00	.29	.65
Relationship Imperatives (three items)	448	3.0–18.0/3.0–18.0	11.72	.40	.64
Spiritual Beliefs (three items)	429	3.0–18.0/3.0–18.0	9.70	.37	.64
Clinical Competence (three items)	452	3.0–18.0/3.0–18.0	13.45	.35	.61
Variety Seeker (four items)	458	4.0–24.0/4.0–24.0	15.22	.27	.59
Career Building (four items)	430	6.0–24.0/4.0–24.0	15.96	.24	.55
Managerial Self‐confidence (four items)	450	7.0–24.0/4.0–24.0	16.29	.23	.54

Table 6. The 14‐health practitioner work motivation subscales: Likely high and low score meanings

New Motivation Subscale	High score: Likely meanings	Low score: Likely meanings
1. Avoidance Needs (four items)	Low avoidance needs; positive attraction to job; not deterred by after‐hours contact with community.	High avoidance needs, e.g., seeking very remote job to escape discomforts and to heal from previous setbacks; avoidant of exposure outside work hours.
2. Belonging Needs (five items)	Seeks team membership and wants sense of acceptance, familiarity, participation, belonging, and respect.	Little felt need for feeling accepted or belonging; low attraction to team work.
3. Challenge Seeker (four items)	Seeks work that offers adventure and risk; relishes change; bored by routine.	De‐motivated by risk, uncertainty and novel and challenging work environments.
4. Clinical Competence (three items)	Relishes high clinical demand and opportunity to develop advanced skills.	De‐motivated by complex and high clinical demands; not driven to develop advanced skills.
5. Clinical Self‐Containment (eight items)	Low felt need for oversight, clinical support; motivated by high professional autonomy.	Motivated by prospect of strong clinical and other support; will leave a job where these are lacking.
6. Compassion (eight items)	Feels a strong pull to serve the underserved; seeks meaning, purpose from “making a difference.”	Low sense of altruism concerning those with special needs; pragmatic reasons to seek a job.
7. Financial Incentives (eight items)	Job decisions very monetary driven, in both cash and kind.	Monetary incentives relatively weak motivators in seeking a new job.
8. Intercultural Interests (five items)	Seeking to develop intercultural skills and to help “close the (Indigenous/non indigenous health status) gap.”	Low interest in working in the intercultural arena.
9. Lifestyle (three items)	Very motivated towards work, which enables balanced lifestyle, in an appealing environment.	Not very motivated by lifestyle‐balance issues.
10. Living Location Preferences (four items)	Motivated towards work in remote and very remote locations and to experience their associated living and geographic extremes.	Prefers to live urban and/or be able to easily access city life, while avoiding work in immoderate environment.
11. Personal Demand Preferences (five items)	Motivated towards a job with unclear social/clinical/time boundaries, possibly low back‐up, with clientele with limited English.	Very probably de‐motivated by out‐of‐hours work, weak social/clinical boundaries, low back‐fill and limited English speaking service recipients.
12. PHC Orientation (eight items)	Motivated by a socially assertive PHC preventative and positive role involving community engagement.	Avoidant of community health engagement and out of hours of work; wants clear work/non work boundaries.
13. Relationship Imperatives (three items)	Motivation towards job very influenced by practitioner's perceptions of his/her significant others' needs.	Motivation towards a job uncomplicated by the perceived needs of significant others.
14. Spiritual Beliefs (three items)	Strong spiritual beliefs around God's will; sense of gift to help the less fortunate.	Pragmatic beliefs around what needs to be done and why.

Note. PHC = primary health care.

Table 7. Logistic regression summary: Each of 14 subscales with the dependent variable VRI 3-years+/no VRI community work experience

Subscale	Wald	OR	95% confidence interval	p
Living location preferences	21.06	1.20	[1.11, 1.30]	.001
Clinical self‐containment	19.69	1.12	[1.07, 1.18]	.001
Challenge seeker	8.23	1.12	[1.04, 1.20]	.004
Intercultural interests	11.65	1.11	[1.04, 1.17]	.001
Personal demand preferences	6.70	1.08	[1.02, 1.14]	.010
Relationship imperatives	41.43	0.75	[0.69, 0.82]	.001
Lifestyle	8.49	0.80	[0.69, 0.93]	.004
Compassion	4.19	0.96	[0.92, 1.00]	.041
Belonging needs	3.43	0.93	[0.87, 1.00]	.064
Spiritual Beliefs	.93	0.94	[0.87, 1.01]	.087
Financial interests	1.60	0.98	[0.95, 1.01]	.205
PHC orientation	0.00	1.00	[0.96, 1.04]	.987
Avoidance needs	0.72	1.03	[0.96, 1.10]	.397
Clinical competence	2.37	1.08	[0.98, 1.18]	.124

Note. OR = odds ratio; PHC = primary health care.

Table 8. Logistic regression summary: Subscales and practitioners' personal variables

Variable	Wald	OR	95% CI for OR	p
Relationship Imperatives	18.46	0.80	[0.72, 0.88]	.001
Lifestyle	5.06	0.80	[0.66, 0.97]	.024
Intercultural interests	16.87	1.17	[1.09, 1.27]	.001
Clinical self‐containment	5.50	1.09	[1.01, 1.16]	.019
Gender	9.71	3.26	[1.55, 6.84]	.002
Profession	17.14	4.13	[2.11, 8.09]	.001
Constant	1.69	0.10		.193

Note. OR = odds ratio.

short-legendFigure 1.