literature review of motivation

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On what motivates us: a detailed review of intrinsic v. extrinsic motivation

Laurel s. morris.

1 Department of Psychiatry, Depression and Anxiety Center for Discovery and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA

Mora M. Grehl

2 Department of Psychology, Temple University, Philadelphia, PA 19122 USA

Sarah B. Rutter

Marishka mehta, margaret l. westwater.

3 Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06510 USA

Motivational processes underlie behaviors that enrich the human experience, and impairments in motivation are commonly observed in psychiatric illness. While motivated behavior is often examined with respect to extrinsic reinforcers, not all actions are driven by reactions to external stimuli; some are driven by ‘intrinsic’ motivation. Intrinsically motivated behaviors are computationally similar to extrinsically motivated behaviors, in that they strive to maximize reward value and minimize punishment. However, our understanding of the neurocognitive mechanisms that underlie intrinsically motivated behavior remains limited. Dysfunction in intrinsic motivation represents an important trans-diagnostic facet of psychiatric symptomology, but due to a lack of clear consensus, the contribution of intrinsic motivation to psychopathology remains poorly understood. This review aims to provide an overview of the conceptualization, measurement, and neurobiology of intrinsic motivation, providing a framework for understanding its potential contributions to psychopathology and its treatment. Distinctions between intrinsic and extrinsic motivation are discussed, including divergence in the types of associated rewards or outcomes that drive behavioral action and choice. A useful framework for understanding intrinsic motivation, and thus separating it from extrinsic motivation, is developed and suggestions for optimization of paradigms to measure intrinsic motivation are proposed.

Introduction

Motivation is an integral component of human experience. Children spontaneously explore novel items, and adults autonomously engage in new hobbies, even in the absence of clear extrinsic reinforcers. Thus, not all actions are driven by tangible external stimuli or outcomes, known as ‘extrinsic’ motivation, but are driven by more internal drivers, known as ‘intrinsic’ motivation, where the activity is perceived as its own outcome.

Intrinsically motivated behaviors are computationally similar to extrinsically motivated behaviors, in that they strive to maximize goal attainment and minimize punishment, represented mathematically as value and effort cost functions, respectively (Gottlieb, Lopes, & Oudeyer, 2016 ). However, subjective internal value functions are difficult to characterize, and our understanding of how they are computed and integrated is limited (Gottlieb et al., 2016 ).

Dysfunction in intrinsic motivation represents an important transdiagnostic facet of psychiatric symptomology, which is often classified as distinct psychological constructs, such as apathy in neurological disorders, anhedonia in depression, and negative symptoms in schizophrenia. Each of these symptom domains may be underpinned by a shared dysfunction of intrinsic motivation, and interventions targeting intrinsic motivation have the potential to improve treatment outcomes for affected individuals.

However, due to a lack of clear consensus, the contribution of intrinsic motivation to psychiatric disorders remains poorly understood. This review aims to provide an overview of the conceptualization, measurement, and neurobiology of intrinsic motivation, providing a framework for understanding the potential contributions to psychopathology and its treatment.

Historical conceptualizations of intrinsic motivation

During the early 20th century, prominent descriptions of motivation were at odds with each other. Woodworth ( 1918 ) suggested that intrinsic motivation governed activities perpetuated by their own ‘native drive’, whereas Thorndike ( 1911 ) and Watson ( 1913 ) argued that external stimuli governed behavior. Also centered on internal drives, Hull's ( 1943 ) ‘drive theory’ posited that all behaviors were performed to seek or avoid primary biological states, including hunger or pain. However, the drive theory could not explain many behavioral anomalies, such as hungry rats withstanding painful electric shocks to explore a novel environment (Nissen, 1930 ), or rhesus monkeys performing a puzzle task for no biological reason or external reinforcer (Harlow, 1950 ). By narrowly presuming that biological states drive all behavior, drive theory failed to account for instances in which an organism prioritizes higher-order cognitive drives over physiological ones.

The shortcomings of drive theory led to the emergence of alternate theories of intrinsic motivation. Some argued that homeostatic maintenance of optimal biological or cognitive states (Hebb, 1955 ; McClelland & Clark, 1953 ; McClelland, Atkinson, Clark, & Lowell, 1967 ), or mitigation of incongruency or uncertainty (Festinger, 1957 ; Kagan, 1972 ), drove behavior. However, these theories emphasized external stimuli or cognitive representations of external goal states as key drivers of behavior. In the mid-to-late 20th century, several models underscored the importance of novelty-seeking, interest, and autonomy in driving intrinsic motivation. Novelty-seeking was suggested to energize approach behavior via curiosity and exploration that leads to skill mastery, information attainment, or learning (Kaplan & Oudeyer, 2007 ). Interest and enjoyment in an activity might boost intrinsic motivation by engendering ‘flow’, a prolonged state of focus and enjoyment during task engagement that stretches one's skillset (Csikszentmihalyi, 1975 ; Nakamura & Csikszentmihalyi, 2009 ). Finally, self-determination theory (Deci & Ryan, 1980 ) proposed that human needs for competence, achievement, and autonomy drive intrinsic motivation, aligning with observations that intrinsic motivation stems from an internal perceived autonomy during task engagement (DeCharms, 1968 ; Lamal, 2003 ). These models highlight the role of achievement and perceived autonomy (DeCharms, 1968 ) in driving intrinsic motivation, coinciding with current computational frameworks of intrinsic reward (Chew, Blain, Dolan, & Rutledge, 2021 ; Murayama, Matsumoto, Izuma, & Matsumoto, 2010 ).

The introduction of external goals: a shift to extrinsic motivation

While intrinsic motivation has been proposed to be divorced from external reinforcers, our understanding of motivation has been led largely by using external reinforcers as conceptual and experimental tools. Here, we briefly review historical perspectives on external drivers of motivated behavior, outlining prominent goal- and action-focused models of extrinsic motivation.

Early psychological models of extrinsic motivation suggested that ‘will’ and ‘intention’ fostered goal achievement, emphasizing the influence of goal expectation on action and control (Lewin, 1951 ; Tolman, 1932 ). Within this framework, environmental features, as well as an individual's internal state or memory, determine their actions when pursuing a goal, or, more specifically, the cognitive representation of a goal (Kagan, 1972 ). This requires multiple cognitive representations to be developed, maintained, and updated, with a particular reliance on external stimuli and learning (Deci, Koestner, & Ryan, 1999 ; Kagan, 1972 ; Kagan & Moss, 1983 ).

Alongside psychological model development, economic models of motivation emerged. These models propose that extrinsic goals, or incentives, elicit motivated behavior via a cost-benefit analysis, where motivated choice occurs when benefits outweigh costs. More recently, behavioral economics has considered how individual personality traits, biases, and irrationalities influence motivated behavior (Strombach, Strang, Park, & Kenning, 2016 ). A recent model (Strombach et al., 2016 ) incorporates various factors into the classical cost-benefit analysis, including traditional intrinsic (e.g. satisfaction) and extrinsic drivers (e.g. money), with negative influences from costs (e.g. effort, pain), which are merged into a single dynamic, subjective and state-dependent factor that drives motivated behavior. Though this approach is powerful, the explicit focus on incentives provides limited explanatory power for various paradoxical behaviors, including rodents overcoming the high cost to self-stimulate certain brain regions (e.g. nucleus accumbens; Nac) or extrinsic reinforcers' dampening effect on intrinsic motivation.

In reinforcement learning models of decision-making, an organism, or agent, learns which actions maximize total reward. This process has been formalized within computational sciences and modern artificial intelligence systems (Sutton & Barto, 1981 ; Witten, 1977 ), where learning and decision-making depend on an extrinsic outcome. One theory suggests that motivated action is driven solely by a need to reduce reward prediction errors (RPEs; Kaplan and Oudeyer, 2007 ), or the mismatch between expectation and outcome (Montague, Dayan, & Sejnowski, 1996 ; Schultz et al., 1997 ). RPEs can also be conceptualized as valuation signals for novel outcomes or unexpected stimuli. RPE-based learning then drives motivated behavior, or action choice, but even if the agent displays intact encoding of action or outcome value, motivated behavior can be dampened by reduced novelty. This highlights the role of novelty, expectation and prediction in learning per se , rather than choice valuation.

In action-focused models of motivation, incentives can trigger approach or avoidance behavior by signaling a potential goal state (Berridge, Robinson, & Aldridge, 2009 ). Incentive motivation thus relies on expectancy, probability, and value of outcomes, which are thought to dictate behavioral choice and decision-making. While greater reliance on stimulus-outcome rather than stimulus-response contingencies has led some to describe incentive motivation as proactive (Beckmann & Heckhausen, 2018 ), others have characterized it as reactive due to the central role of learning from past experience (Bolles, 1972 ). Reliance on an expected outcome was central to behaviorism (Watson, 1913 , 1930 ) and operant conditioning (Skinner, 1938 ), which assume that actions are driven by a reinforcer, and instrumental value is assigned to the behavior itself. Stimulus-response pairs dominate behaviorism and modern theories of habitual behavior (Gläscher, Daw, Dayan, & O'Doherty, 2010 ), where the dependency on previously reinforced actions ultimately governs motivated choice (de Wit et al., 2011 ; Gillan, Robbins, Sahakian, van den Heuvel, & van Wingen, 2016 ; Voon et al., 2014 ). However, this renders behaviors as repetitive, insensitive to punishment and divorced from goals (Robbins, Gillan, Smith, de Wit, & Ersche, 2012 ). Therefore, these action-focused models of motivated behavior almost entirely discount intrinsic motivation since extrinsic motivators usurp control of behavior.

Several limitations of extrinsic motivation models must be considered when attempting to characterize intrinsic motivation. First, for cost-benefit analysis and reinforcement learning, an internal representation of the outcome must first be learned, which requires previous experience of the goal. However, intrinsic motivation can occur for novel outcomes, or behaviors that are uncertain or ambiguous. Second, motivation can occur for activities that may already be fully predictable, marking a significant limitation for reinforcement-learning models of motivation, which assume that reward prediction errors drive learning for motivated action. Third, these frameworks cannot fully explain spontaneous novelty seeking or exploratory behavior, in which no external reward is expected and no cost is overcome (Deci et al., 1999 ; Marsden, Ma, Deci, Ryan, & Chiu, 2014 ).

Separating and integrating intrinsic and extrinsic motivation

A key question is whether intrinsic and extrinsic motivation can, or should, be experimentally or theoretically separated. There is some evidence that they are dissociable constructs at the neural level. The most compelling support comes from case reports of patients with basal ganglia lesions who developed ‘psychic akinesia’, a syndrome characterized by difficulty with self-generated action initiation but no difficulty in performing complex cognitive or motor tasks when prompted (Laplane, Baulac, Widlocher, & Dubois, 1984 ; Lugaresi, Montagna, Morreale, & Gallassi, 1990 ). In patients with alien hand syndrome, medial prefrontal and anterior cingulate cortex (ACC) lesions lead to a loss of intentional motor control, whereas (pre)-supplementary motor area lesions lead to impairments in implementing motor intentions (Brugger, Galovic, Weder, & Kägi, 2015 ; Nachev, Kennard, & Husain, 2008 ). Preclinical findings further show that photostimulation of GABAergic amygdala projections modulates extrinsic motivation without affecting intrinsically motivated behavior (Seo et al., 2016 ). Together, these findings suggest that intrinsic and extrinsic motivation reflect different cortico-striatal-limbic circuits.

Behavioral research primarily supports the view that intrinsic and extrinsic motivation are partially distinct, interacting processes. For example, if the motivation for intrinsic and extrinsic goals were independent constructs, they might demonstrate an additive or subtractive effect on each other (Woodworth, 1921 ). Indeed, the expectation (Liu & Hou, 2017 ) and experience (Badami, VaezMousavi, Wulf, & Namazizadeh, 2011 ) of an extrinsic reinforcer can increase intrinsic motivation. However, reports of the ‘undermining effect’, in which an external reinforcer reduces intrinsic motivation (Cerasoli, Nicklin, & Ford, 2014 ; Deci, 1971 ; Deci, Benware, & Landy, 1974 ; Lepper & Greene, 1978 ; Lepper, Greene, & Nisbett, 1973 ) have sparked debate over how extrinsic reinforcers affect internally-motived behaviors (Cameron & Pierce, 2002 ; Lamal, 2003 ; Lepper, Keavney, & Drake, 1996 ). One explanation for the undermining effect suggests that the presence of an external reinforcer shifts one's perception of the locus of control over the behavior from internal to external (Deci & Ryan, 1980 ). This implicates a key role of agency, or the belief of action ownership, in intrinsic motivation. While controversial, mounting evidence supports this account of the undermining effect, where various extrinsic motivators (e.g. food, social observation; Ryan, 1982 ) decrease intrinsic motivation when their delivery is contingent on task-performance.

A useful framework for parsing motivated action into intrinsic and extrinsic is the Rubicon model of action phases (Heckhausen & Heckhausen, 2018 ; Heckhausen, 1989 ). Within this framework, pre-decisional option deliberation occurs, which is followed by choice intention formation and planning, volitional action, outcome achievement, and evaluation ( Fig. 1 ). Husain and Roiser ( 2018 ) recently proposed a complementary model to deconstruct apathy and anhedonia into underlying cognitive processes, including option generation, anticipation, action initiation, prediction, consumption and learning. This parcellation broadly reflects the five main stages of the Rubicon model: (1) pre-decisional deliberation ( option generation ); (2) intention formation, planning, initiation ( anticipation ); (3) volitional action ( action initiation, prediction ), (4) outcome achievement ( consumption ); and (5) evaluation ( learning ; Figure 1 ). Within these overlapping frameworks, the initial pre-decisional deliberation/option generation phase represents the point at which intrinsic and extrinsic facets of motivation diverge, as early drivers of behavior can be intrinsic (e.g. enjoyment, interest, exploration) or extrinsic (e.g. social reward). The differences between these early drivers highlight a key distinction between intrinsic and extrinsic motivation, in which the former is a fundamentally proactive process and the latter reactive.

Schematic framework for parsing motivated action. Motivated decision-making and action is parsed into separate phases of choice, action and outcome valuation, combining and building upon separate frameworks including the Rubicon model of action phases, well-established computational mechanisms and a recent cognitive framework describing anhedonia and apathy. During choice valuation, pre-decisional deliberation includes option generation, a cost-benefit analysis and option selection. Intrinsic and extrinsic motivation diverges during this early choice valuation phase. Once choice valuation has been computed and an option selected, planning and anticipation occurs. During action valuation, volitional action is initiated and action sustainment or acceleration is maintained. During outcome valuation, outcome achievement and consumption ensue, followed by evaluation based on learning via prediction error (PE) updating. Created with BioRender.com .

If a behavior were intrinsically motivated, the pre-decisional deliberation phase might be determined by biological drives, the need to restore homeostasis (Hebb, 1949 ; Hull, 1943 ), or a state of incongruency resolution (Festinger, 1957 ; Kagan, 1972 ) as described by early theories of intrinsic motivation. In contemporary frameworks, novelty-seeking, exploration, or interest in learning or achievement would render subsequent actions as intrinsically motivated. If a behavior were extrinsically motivated, this pre-decisional deliberation phase would represent the cost-benefit analysis in economic models, prediction-error minimization in reinforcement learning, or effort-reward trade-off computation. Under incentive motivation and behaviorist theories, the pre-decisional deliberation phase would be triggered by conditioned stimuli making conscious deliberation unnecessary and inefficient.

A combination of intrinsic and extrinsic factors likely enters into the pre-decisional deliberation phase to guide motivated behavior ( Fig. 1 ). Although intrinsic and extrinsic motivation are conceptually distinct processes, attempts to formally define them have identified several mechanisms by which they interact, leading to questions about their dissociability. Since they can interact in an additive or subtractive fashion, they may indeed be separate, independent drivers of behavior that are amalgamated during a pre-decisional deliberation phase of behavioral choice.

Measuring intrinsic motivation

Human behavior.

Early attempts to quantify intrinsic motivation were largely based on behavioral observation, wherein intrinsic motivation was measured as free choice of an activity in the absence of an external stimulus or performance rating (Butler & Nisan, 1986 ; Daniel & Esser, 1980 ; Liu & Hou, 2017 ). These studies also implemented self-report measures of participants' interest or enjoyment in an activity. While such measures do capture intrinsic motivation as inherent task enjoyment, they are limited by their qualitative and indirect nature, as well as by variability in participant insight. However, more objective measures are difficult to develop due to the inherently unobservable nature of intrinsic motivation.

Since spontaneous novelty-seeking and exploratory behavior reflect intrinsic motivation, one candidate objective measure may be the explore-exploit paradigm (Gittins & Jones, 1979 ; Robbins, 1952 ). In explore-exploit foraging tasks, participants must choose among various options and either exploit a previously reinforced choice or explore a novel alternative option. An individual's tendency to either explore an environment or exploit their pre-existing knowledge is influenced by perseverance (Von Culin et al., 2014 ), which acts as an indicator of confidence in the absence of immediate reward. Healthy adults flexibly employ a mix of exploitative and exploratory choices, where striatal and prefrontal dopamine signaling is proposed to drive exploration and exploitation, respectively (Badre, Doll, Long,, & Frank,, 2012 ; Daw, O'Doherty, Dayan, Seymour, & Dolan, 2006 ; Mansouri, Koechlin, Rosa, & Buckley, 2017 ). While these tasks capture one's willingness to trade-off exploratory v. exploitative behaviors, they do not measure free-choice exploratory behavior in the absence of explicit reinforcers, which would be most consistent with intrinsic motivation.

Paradigms that allow an individual to choose to explore an environment without extrinsic reinforcers, or to engage in a previously enjoyable or interesting activity, would more closely index intrinsic motivation. Additionally, outcomes that relate to achievement or autonomy, without socially rewarding feedback or monetary outcomes, would also putatively engage intrinsic motivation. Task parameters related to exploration, enjoyment, achievement, and autonomy can each be modulated and computationally modeled to determine their effects on free choice or behavioral activation vigor.

Current computational approaches depend on modeling decision-making, outcome learning, or action-outcome associations to drive our understanding of motivation. Traditional decision-making models often rely on softmax functions to compute values of available actions (Wilson & Collins, 2019 ), where action selection is based on the ‘policy’ of the best outcome. Computationally, an action selection process computes the probability of an action occurring in any state and the expected reward. A policy is developed based on the assumption that motivated actions are performed to increase the probability of rewards and decrease the probability of punishment. Yet, in everyday life, our actions can be motivated by an arbitrary cue that may signal an internal rewarding state. For example, a standard algorithm solving for motivated action assumes that all actions have equal probability, yet this discounts the unknown drivers and evaluators of internal rewards. Hence, they act as limiting factors to the applicability of decision-making models in studies of intrinsic motivation.

Neuroimaging

Functional neuroimaging [e.g., functional magnetic resonance imaging (fMRI), electroencephalography (EEG)] offers a measurement modality that may be particularly apt for the study of internally driven processes like intrinsic motivation. Research using fMRI has characterized the neural correlates of various internal processes that lack clear behavioral indicators (e.g. rumination, emotion regulation, pain perception; Zhou et al., 2020 ; Wagner, N'Diaye, Ethofer, and Vuilleumier, 2011 ), yet few studies have assessed the neural correlates of intrinsic motivation in humans, which likely reflects the limitations in its behavioral measurement. Studies have largely assessed intrinsic motivation via comparisons with neural responses to extrinsic reinforcers during fMRI, which can be correlated with self-reported intrinsic motivation (Bengtsson, Lau, & Passingham, 2009 ; Chew et al., 2021 ; Linke et al., 2010 ). Despite the relative paucity of neuroimaging studies that clearly separate intrinsic v. extrinsic motivation, existing work provides preliminary insight into the neural circuitry of intrinsic motivation.

First, extrinsic reinforcers have elicited amygdala, ACC, ventromedial prefrontal cortex (vmPFC), orbitofrontal cortex (OFC), and ventral striatal (VS) or Nac activity in healthy subjects that was associated with higher self-reported extrinsic motivation but lower self-reported intrinsic motivation (Linke et al., 2010 ). This could suggest that intrinsic motivation relates to a lower sensitivity of these regions to extrinsic reinforcers, general deactivation of these regions, or that the dampening impact of extrinsic reinforcers on intrinsic motivation is subserved by these regions. Others report that intrinsic motivation (operationalized as the amount of free-time spent on a puzzle-task, which did not relate to task enjoyment, interest, or accuracy), was associated with deactivation in the amygdala, dorsal ACC, dorsomedial striatum, and insula during puzzle-task onset (Marsden et al., 2014 ). This is another piece of evidence linking neural deactivation to intrinsic motivation; however, since these tasks were not related to traditional ‘intrinsic motivators’ like task enjoyment, findings may relate to boredom-reduction behavior that might be more related to punishment avoidance rather than intrinsic motivation per se .

Bengtsson et al. ( 2009 ) operationalized intrinsic motivation as task-performance with and without explicit experimental observation during fMRI scanning, which boosted self-reported intrinsic motivation. The authors found greater neural activation of ACC, OFC, and lateral prefrontal cortex during task-performance errors when participants were observed (Bengtsson et al., 2009 ). While implicating a similar network of brain regions as prior studies, these findings cannot be divorced from error-related neural activation modulated by task salience (e.g. observed v. not).

In contrast, Murayama et al . ( 2010 ) provide a more optimal operationalization of intrinsic motivation, in which participants performed a task that was previously rated as inherently interesting, and successful task performance served as the intrinsic reward. During fMRI scanning, feedback for both extrinsic (monetary feedback) and intrinsic (accuracy feedback) rewards elicited VS activation. Participants then had the option to perform the same task without feedback, and intrinsic motivation was operationalized as time spent on the second version of the task. During the second session, VS activation was only diminished for extrinsic rewards, which could reflect reduced VS habituation to intrinsic rewards (Murayama et al., 2010 , 2015 ). Additionally, greater reductions in neural responses to extrinsic reinforcers were related to lower intrinsic motivation (i.e. task engagement time outside of the scanner), suggesting that neural habituation to extrinsic reinforcers may relate to lower intrinsic motivation. A recent computational neuroimaging study modeled intrinsic rewards as successful spatial-motor task performance without experienced errors, which was divorced from learning (Chew et al., 2021 ). This modeling of intrinsic rewards was akin to the accuracy feedback operationalization of Murayama et al . ( 2010 ). Both extrinsic (monetary) reward and intrinsic performance-based rewards (successful task completion) recruited vmPFC activation, which related to subjective happiness (Chew et al., 2021 ). Although limited in their ability to dissociate activation from task performance per se and explicit feedback related to achievement, these studies are the closest examples of objective measures of intrinsic motivation, and they suggest that putative reward-processing regions (VS, vmPFC) encode intrinsic rewards.

Complementary studies have examined how curiosity, or the intrinsic motivation to learn, modulates neural responses and influences memory recall (Gruber, Gelman, & Ranganath, 2014 ; Kang et al., 2009 ). High-curiosity states augment midbrain and v. activity (Gruber et al., 2014 ), as well as bilateral caudate (Kang et al., 2009 ) and anterior insula (Lee & Reeve, 2017 ) responses, which may improve learning and memory. As these paradigms index intrinsic motivation independently from a rewarding outcome, they perhaps provide the strongest support for partially overlapping circuits of extrinsic and intrinsic motivation.

The brain's dopamine system supports a range of appetitive and aversive motivational processes, including behavioral activation, exertion of effort, and sustained task engagement (Diederen & Fletcher, 2020 ; Salamone, Yohn, López-Cruz, San Miguel, & Correa, 2016 ). The mesolimbic pathway, projecting from the ventral tegmental area (VTA) to limbic regions, including the Nac, amygdala, and hippocampus, facilitates reinforcement and associative learning by acting as a ‘Go’ signal for foraging or exploration (Huang, Lv, & Wu, 2016 ). Although it has long been known that dopamine transmission subserves motivational processes, some evidence suggests that it is particularly important for intrinsic motivation. For example, mesolimbic dopamine contributes to exploration for the sake of interest (DeYoung, 2013 ; Panksepp & Moskal, 2008 ), and novel and unexpected stimuli elicit phasic dopamine spikes in rodents (Fiorillo, 2003 ; Hooks & Kalivas, 1994 ; Schultz, 1998 ). In patients with depression, deep-brain stimulation of dopaminergic brain regions including the Nac (Schlaepfer et al., 2007 ) and the mesolimbic dopamine projections from the VTA (Fenoy et al., 2018 ) increased subjective interest in, and motivational energy for, previously enjoyable activities (Schlaepfer et al., 2007 ). Dopamine has also been associated with intrinsically motivated flow states (de Manzano et al., 2013 ; Gyurkovics et al., 2016 ).

However, since VTA dopamine spiking is reduced for expected events (Schultz, 1998 ), it may not be a strong candidate neural mechanism for intrinsic motivation, which can occur for predictable activities. Efforts to reconcile the role of dopamine in learning and motivation suggest that while phasic cell firing signals RPEs (Kim et al., 2020 ), phasic dopamine release and local modulation in key regions, such as the VS/NAc, relates to approach motivation (Berke, 2018 ; Mohebi et al., 2019 ). Indeed, while VTA dopamine cell firing occurs during reward prediction, only NAc dopamine release covaries with reward availability and ramps up during approach and consumption of reward (Mohebi et al., 2019 ). Moreover, increasing dopamine in rodents increases their willingness to exert effort, and this has since been replicated across species, including via pharmacological manipulation in humans (Salamone, Correa, Farrar, & Mingote, 2007 ; Treadway & Zald, 2011 ). This suggests that, while VTA dopamine spiking underpins reward prediction and learning, it is local NAc dopamine release that encodes motivational drive.

Opioids, norepinephrine, and related neurotransmitter systems

Though a comprehensive account of the neurotransmitter systems subserving motivated behavior is beyond the scope of this review, we note that endogenous opioid and cannabinoid systems may uniquely modulate intrinsically motivated behavior. For example, mu- and delta-opioid receptor activation underlies the pleasurable effects of opioid and non-opioid drugs of abuse (Berrendero, Robledo, Trigo, Martín-García, & Maldonado, 2010 ; Trigo, Martin-García, Berrendero, Robledo, & Maldonado, 2010 ), as well as primary reinforcers (Hsu et al., 2013 ; Kelley & Berridge, 2002 ). Activation of mu-opioid receptors has also been shown to mediate motivational states following delta-9-tetrahydrocannabinol (THC) administration in rodents (Ghozland et al., 2002 ), likely via interactions with the mesolimbic dopamine system. Further evidence implicates antidepressant effects of endogenous opioids in both animals and humans (Peciña et al., 2018 ), which many partly reflect improved intrinsic motivation (e.g. time mice spent swimming during the forced swim test; Kastin, Scollan, Ehrensing, Schally, and Coy, 1978 ). Additionally, the endocannabinoid system interacts with both endogenous opioid and dopaminergic systems to influence intrinsic motivation, such as social play (Trezza et al., 2012 ; Trezza & Vanderschuren, 2008 ), and voluntary exercise, in rodents (Dubreucq, Koehl, Abrous, Marsicano, & Chaouloff, 2010 ). Since these systems have been primarily examined in animal models, pharmacological manipulation in humans would be an important next step in delineating the contribution of opioid and endocannabinoid systems to intrinsic v. extrinsic motivation.

Intrinsic motivation and psychiatry: focus on anhedonia

Problems with motivation are observed across many neuropsychiatric disorders, and these often correspond to distinct symptoms ( Table 1 ). This section focuses on anhedonia, a reduced ability to experience pleasure (Ribot, 1986 ), as a prevalent clinical manifestation of deficient intrinsic and extrinsic motivation.

Explicit studies of ‘intrinsic motivation’ in neuropsychiatric disorders

Note: Cohort abbreviations: AUD, alcohol use disorder; FEP, first-episode psychosis; MDD, major depressive disorder; PD, Parkinson's disease; SCZ, schizophrenia; SUDs, substance use disorders; SZA, schizoaffective disorder. Evidence abbreviations: EM, extrinsic motivation; IM, intrinsic motivation.

In the Diagnostic and Statistical Model of Mental Disorders, 5th edition (DSM- 5 ), anhedonia serves as one of two cardinal symptoms of depressive disorders, where it is defined as the ‘loss of interest or pleasure in all, or almost all, activities’, (American Psychiatric Association, 2013 ). The second cardinal symptom relates to persistent depressed mood. Approximately one-third of individuals with depression report clinically significant anhedonia (Pelizza & Ferrari, 2009 ), and these individuals are at-risk for poorer treatment outcomes, including nonresponse, relapse, and increased suicidality, relative to their non-anhedonic peers (Morris, Bylsma, & Rottenberg, 2009 ; Nierenberg et al., 1999 ).

Anhedonia remains an important clinical target that, by definition, implicates perturbations in intrinsically-motivated behavior, yet most empirical studies of anhedonia and motivation have investigated their relationship using extrinsic reinforcers. Findings broadly support theories of reward dysfunction in depression (reviewed by Sescousse, Caldú, Segura, and Dreher, 2013 ; Roiser & Husain, 2018; Borsini, Wallis, Zunszain, Pariante, and Kempton, 2020 ), where anhedonia has been associated with a reduced bias toward a monetary reward in individuals with depression (Liu et al., 2011 ) and their first-degree relatives (Liu et al., 2016 ). Children who are at-risk for depression show reduced VS and anterior insula responses to monetary gains, implicating blunted reward sensitivity as an antecedent to anhedonia (Luking, Pagliaccio, Luby, & Barch, 2016 ). Moreover, vmPFC responses during unexpected reward receipt may indirectly relate to anhedonia in depressed patients by modulating task motivation (Segarra et al., 2016 ). Interestingly, reward sensitivity disturbances in depression might not extend to aberrant reward learning (Huys, Pizzagalli, Bogdan, & Dayan, 2013 ) where adults with moderate depression show intact VS RPE-signaling during probabilistic learning (Rutledge et al., 2017 ). Nevertheless, there have been suggestions that perturbations in domains more related to intrinsic motivation, such as model-based future planning or effort initiation and invigoration, may be key in underlying anhedonia (Berwian et al., 2020 ; Cooper, Arulpragasam, & Treadway, 2018 ; Rutledge et al., 2017 ). Finally, affect can also alter both the valence and evaluation of an activity, which can, in turn, modulate the likelihood of selecting a more inherently interesting task (Isen & Reeve, 2006 ). Anhedonic individuals have more pessimistic likelihood estimates and reduced positive affective forecasts relative to controls while also demonstrating greater reliance on negative emotion during future-oriented cognition (Marroquín & Nolen-Hoeksema, 2015 ).

While few studies have implemented objective measures of intrinsic motivation in studying anhedonia, recent work links this symptom with difficulties with representations of future states during early stages of motivated behavior (Moutoussis et al., 2018 ). Since intrinsic motivation is driven more by proactive factors as opposed to the more reactive domain of extrinsic motivation, parsing future-oriented decision-making might provide novel insights not only into mechanisms of intrinsic motivation but also anhedonia. When considering the pre-decisional deliberation phase of motivated action ( Fig. 1 ), the representation of a future state may be critical for distinguishing intrinsic v. extrinsic motivation. For example, disrupted representations of intrinsic reinforcers (e.g. autonomy, achievement, task enjoyment, novelty seeking), energy expenditure (Treadway, Cooper, & Miller, 2019 ; Winch, Moberly, & Dickson, 2014 ), or fatigue (Müller, Klein-Flügge, Manohar, Husain, & Apps, 2021 ) might disrupt choice deliberation and interrupt ensuing stages of motivation. This could critically determine the capacity for self-generated, intrinsically-motivated actions (Husain & Roiser, 2018 ). However, relatively few studies have examined this distinction. One study developed a cognitive task that aimed to capture separate measures of self-generated ( intrinsic ) v. externally generated ( extrinsic ) motivation during the option-generation phase (Morris et al., 2020 ). This distinction linked self-generated option generation (intrinsic motivation) to anhedonia symptoms in healthy adults (Morris et al., 2020 ). However, this task still relies on extrinsic rewards, and there is a need for improved tasks that index both behavioral and neural correlates of intrinsic drivers of motivated behavior.

Summary and future directions

In this review, we summarize how intrinsic motivation has been conceptualized, measured, and related to neural function to elucidate its role in psychopathology. In contrast to extrinsic motivation, which has been rapidly incorporated into prominent cognitive, computational, and neurobiological models of human behavior, knowledge of intrinsic motivation remains limited due to evolving conceptualizations, imprecise measurement, and incomplete characterization of its biological correlates. We identify three potential areas of interest for future research.

First, additional objective measures of intrinsically motivation should be developed. This remains challenging experimentally since even the closest approximations of intrinsic motivation (Murayama et al., 2010 ; Rutledge et al., 2017 ) define the construct relative to extrinsic motivation, and other paradigms (e.g. exploration/exploitation tasks) rely on the presence of extrinsic reinforcers. Rather than defining motivated behavior as intrinsic or extrinsic, a more tractable approach might be to consider separate drivers of behavior that can be intrinsic or extrinsic. Future paradigms could index intrinsic motivation by characterizing the effects of intrinsic v. extrinsic reinforcers on motivation for an activity that is enjoyable. Such a design would enable more complex modeling of the effects of distinct reinforcers, and interactions between them, on motivated behavior, which would resolve inconsistencies surrounding the impact of extrinsic reinforcers on intrinsic motivation. For example, monetary incentives might reduce motivation only when a perceived agency is low, or when task enjoyment is high. These interactions might explain paradoxical observations like the undermining effect.

Second, computational models are needed to characterize intrinsic motivation. Computational models of motivation have been successfully implemented in studies of extrinsic motivation, yet few are appropriate for intrinsic motivation due to a focus on action-outcome associations. However, if the intrinsic reward were operationalized as a measurable outcome (e.g. completion of an enjoyable task), reinforcement-learning models could estimate how intrinsic reward value is represented. Advancements in the computational area could significantly improve understanding of the latent processes underlying (ab)normal decision-making, thereby identifying novel therapeutic targets.

Third, although evidence supports the bifurcation of intrinsic and extrinsic motivation at the psychological level, findings at the neural level are more equivocal. Given the overarching role of the mesolimbic dopamine system in learning, reward value estimation, and exploratory behavior, it is perhaps unsurprising that current evidence supports largely overlapping neural circuits for intrinsically and extrinsically motivated behavior. One potential avenue involves targeted pharmacological manipulations or neuromodulation of cortico-limbic circuits to determine if intrinsically and extrinsically motivated behaviors can be systematically modulated in humans. By elucidating the neural circuits of distinct motivational processes and their associations with specific symptom profiles, this approach would improve targeted interventions for highly heterogenous and debilitating disorders like depression.

Financial support

All authors report no financial disclosures. This work was supported by the National Institute of Mental Health (LSM, grant number K01MH120433) and the National Institute on Drug Abuse (MLW, T32DA022975).

• DOI: 10.31838/jcr.07.06.100
• Corpus ID: 219060263

A REVIEW OF MOTIVATION THEORIES, MODELS AND INSTRUMENTS IN LEARNING ENVIRONMENT

• Valarmathie Gopalan , J. A. Bakar , A. Zulkifli
• Published in Journal of Critical Reviews 1 April 2020
• Education, Computer Science, Psychology

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LITERATURE REVIEW ON THEORIES MOTIVATION

People possess something that machines don’t-human spirit and inspiration. It is the spirit and inspiration that leads associates to apply their human capital to meet the goals of the organization, the human spirit is highly inspired through motivation. Motivation is essential to almost any aspect of life. Understanding job satisfaction and work motivation can be key elements to improving productivity. This paper seeks to introduce the four major need theories areas: Maslow’s Hierarchy of Needs, Herzberg’s Motivation Theory, Alderfer’s ERG Theory, and McClelland’s Need for Achievement Theory. It also goes further to analyze these theories bringing to the fore various similarities and differences that exist amongst them.

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This study aims to describe the relevance of Abraham Maslow's hierarchy of needs theory with the work motivation fellow of Islamic counseling organizations. The research used is; library research that using content analysis as a technique in analyzing related data. The results of this study, namely; Fulfilling the needs of each fellow Islamic counseling organization are one of the causes that can describe the ups and downs of work motivation fellow. The fulfillment needs to be referred to here, namely; needs formulated by Abraham Maslow, the physiological needs, the safety needs, the belongingness and love needs, the esteem needs, and the need for self-actualization.

An Occupational Study of Job and Need Satisfaction

Ratings from Ss in various occupations of important needs satisfied by jobs were consistent with Maslow's hierarchy of needs. A questionnaire having construct validity was developed to estimate job satisfaction from measures of need satisfaction.

Pragmatic Identity in China and the US Real Estate Advertising: Critical Pragmatic Analysis

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Job Satisfaction of Information Technology Artisans in Nigeria

The support for information technology (IT) artisanship is growing in Lagos and other parts of Nigeria despite evidence that the income and the achievement opportunities are very low. The objective of this study was to examine the job satisfaction among IT artisans in Lagos, Nigeria. Data were collected from 300 respondents using a researcher-administered questionnaire. Maslow’s hierarchy of needs theory was deployed. However, the hierarchies were considered independent variable groups and not a linear fashion as suggested by Maslow. The respondents reported that they are not satisfied with their jobs. They, however, reported the trendiness of IT and the expectation of a breakthrough in their jobs as the basis for choosing to remain in their jobs.

Investing in human capital: exploring causes, consequences and solutions to nurses’ dissatisfaction

Background Human capital (employees) is the most important asset for healthcare. However, nurses experience some of the highest rates of burnout and dissatisfaction. In 2017, the Nursing and Midwifery Council reported that, for the first time since 2008, more nurses and midwives are leaving the profession in the UK than joining it. Aims The aim of this paper is to explore the literature regarding the importance of human capital within healthcare sectors in the UK, with a particular focus on nurses and job satisfaction. Methods A literature review was conducted with the focus on the aim, as stated above. Findings and conclusions have been summarised. Potential causes, consequences and solutions to job dissatisfaction are explored. Results Factors related to job satisfaction include pay, respect, security, workload, recognition, responsibility, environment, autonomy, personal growth, administrative bureaucracy and caseload. Investing and promoting ‘organisational compassion’ could be a key part of the solution. Conclusions More research using the same validated tools for measuring job satisfaction will help with consistency and comparability across hospitals. It is hoped this could provide information aiding recruitment and retention, which is a problem within both the NHS and independent sectors.

Motivasi dan kepuasan kerja pegawai puskesmas BLUD dan non-BLUD Kabupaten Semarang

The public demand for health service professionalism and transparent financial management made some Puskesmas in Semarang regency changed the status of public health center to BLUD. The implementation of Puskesmas BLUD and non-BLUD requires resources that it can work well in order to meet the expectations of the community. The aim of this study is to know the difference of work motivation and job satisfaction of employees in Puskesmas BLUD and non-BLUD. Method of this research is a comparative descriptive with a quantitative approach. The object of this research are work motivation and job satisfaction of employees in Puskesmas BLUD and non-BLUD Semarang regency. This Research showed that Sig value. (P-value) work motivation variable was 0.019 smaller than α value (0.05). It showed that there was a difference of work motivation of employees in Puskemas BLUD and non-BLUD. Sig value (P-value) variable of job satisfaction was 0.020 smaller than α value (0.05). It showed that there was a difference of job satisfaction of BLUD and non-BLUD. The average of non-BLUD employees motivation were 76.59 smaller than the average of BLUD employees were 78.25. The average of job satisfaction of BLUD employees were 129.20 bigger than the average of non-BLUD employee were 124.26. Job satisfaction of employees in Puskesmas BLUD was higher than non-BLUD employees.

The Relation between the Work Motivation and Job Satisfaction of Secondary School Teachers

Faktor-faktor yang berhubungan dengan kinerja penyuluh pertanian di kabupaten ciamis jawa barat.

Agricultural extension agent was the main spearhead in carrying out counseling. A good agricultural extension agent can be reflected in their performance. The purpose of this study were: (1) describe the characteristics of agricultural extension agent, (2) describe the level of competence, level of work motivation, and describe level of performance of agricultural extension agent, (3) analyze the relationship between characteristics of agricultural extention agent and the level of performance of agricultural extension agent, (4) analyze the relationship between the level of competency of agricultural extension agent and the level of performance of agricultural extension agent, (5) analyze the relationship between the level of motivation of agricultural extension agent and the level of performance of agricultural extension agent. Responden in this study were 48 field extension agent who are civil servant in Ciamis Regency West Java and selected by census. Data were analyzed using Rank Spearman correlation test. The results showed that agricultural extension agent in Ciamis Regency were dominated by extension agent who were old, undergraduate educated, had little training, and had a long working period. Agricultural extension agent in Ciamis Regency generally have sufficient competency which tends to be high and generally dominated by the need for achievement motivation. The results also show that there is a relationship between managerial competence and performance, social competence with performance, technical competence with performance, level of competency with performance, and the need for achievement with performance.Keywords: Agricultural Extension Agent,Competence, Motivation, Performance.

Are Spanish public employees happier in their job performance in the era of Industry 4.0?

Since the end of the 20th century, economists have been attracted to the study of the economics of happiness (e.g., Singh, & Alexandrova, 2020; Crespo & Mesurado, 2015; Ferrer-i-Carbonell,2013). The use of the term happiness characterizes an essential volume of this bibliographical production as a synonym for the words satisfaction, well-being, or quality of life (Teixeira&Vasque, 2020; Carlquist et al., 2017). Under this umbrella, the culture of happiness management teaches us that a management model or direction oriented to the holistic search for happiness or job satisfaction of its employees is one of the essential axial pieces that organizations have to increase the commitment of their human capital, and therefore, their productivity and business performance (Ravina et al., 2019). Public administration employees are not exempt from this reality, a group that is characterized by job stability compared to private company employees. This article is dedicated to them. The era of Industry 4.0 is a period that is characterized, among other things, by the high precariousness of labor that is originated by the implementation of management models in advanced economies. This phenomenon is derived from the technological point of view by the automation and massive robotization of production processes and the supply chain. Together with the digitalization of companies, both factors are very present in the ecosystems of the Covid-19, and have come, perhaps, to stay in the future (Bragazzi, 2020; Ghadge et al., 2020). In line with the above, a more holistic examination of this issue seems likely to show that there is a keen interest among people to enter into Work mostly in public administrations, in search of a permanent contract for their entire working life. As is known, this is especially true in countries with high unemployment levels, such as Spain. Its unemployment rate is 20.1% in mid-2020. In the collective imagination of these individuals, there is the conviction that this type of Work constitutes ambrosia of eudaimonic happiness, job security, and quality of life, especially at present, in times of the Covid-19 pandemic (Fernández-Urbano, & Kulic, 2020). In this sense, it should be noted that in the last decades of the 21st century, there has been a growing interest in researching public employees' job satisfaction (e.g., Ryu&Bae, 2020; Steijn &Van der Voet, 2019; Luechinge et al., 2010). Most of the studies carried out on this scientific topic to date show empirically that public sector workers are happier than individuals in the private sphere. It's basically due to the intrinsic benefits (flexibility, vacation, or family reconciliation, among others) that this type of government entity offers concerning for-profit organizations (e.g., Lahat&Ofek, 2020; Sánchez-Sánchez, & Puente, 2020; Danzer,2019). In this context, this article aims to examine, as a priority in the era of Industry 4.0, whether there are observed differences in the levels of congratulations between human capital working in the private sector and that working in the public sector in Spain, by analyzing a set of variables that define positions: hours, salary, stability, promotion, and stress. Finally, we must indicate, on the one hand, that the choice of this spatial framework is motivated by the scarce literature investigating the happiness of Spanish public employees in an economy with high levels of youth unemployment (Núñez-Barriopedro et al., 2020). On the other hand, the results achieved in this study may be useful in the future for the implementation of public policies aimed at significantly promoting the welfare of working citizens through the happiness management approach (Ravina-Ripoll et al., 2019), or for taking this management concept to private companies to increase the motivation of their employees (Foncubierta-Rodríguez & Sánchez-Montero, 2019). Keywords: Happiness, human resources, Industry 4.0, public sector.

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Exploring healthcare workers’ perceptions of child health research at Kamuzu Central Hospital, Malawi: an interpretative phenomenological analysis

• Myness Kasanda Ndambo 1 , 2 ,
• Tuntufye Brighton Ndambo 3 &
• Lucinda Manda-Taylor 1 , 2  

Human Resources for Health volume  22 , Article number:  57 ( 2024 ) Cite this article

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Children’s health is a global public health priority and a determinant of development and sustainability. Its effective delivery and further improvements require constant and dedicated research on children, especially by child healthcare workers (HCWs). Studies have shown a high involvement of child HCWs from developed countries in child health research, with an under-representation from the global south in authorship and leadership in international collaborations. To our knowledge, there is very little literature on challenges faced by child HCWs in Malawi in conducting child health research. We sought to explore the lived experiences of child HCWs at Kamuzu Central Hospital (KCH) in Malawi by examining their perceptions of child health research and assessing the availability of child health research opportunities.

From July 2023 to August 2023, we conducted five key informant interviews with purposively sampled policymakers and 20 in-depth interviews with child HCWs at KCH. The interviews were conducted in English, audio-recorded, and transcribed verbatim. We utilised interpretative phenomenological analysis by reviewing initial transcripts for familiarity, generating codes manually, and refining them into broader themes through comparisons and iterative processes.

The analysis revealed three main themes on perceptions of child HCWs at KCH in child health research. These are (i) perceived motivation and challenges for engaging in child health research, (ii) perceptions of resource availability and research opportunities at KCH, and (iii) perceptions of gaps in research training and participation among child HCWs.

Conclusions

Our study has uncovered critical factors influencing the low participation of child HCWs in child health research at KCH. Lack of collaboration, limited financial opportunities, and non-research-based training were the key barriers to participation in child health research among child HCWs at KCH. We advocate for the inclusion of child HCWs at all stages of collaborative health research, transparency on funding opportunities for child health research, and inclusion of research in the training of HCWs. These initiatives can strengthen the participation of child HCWs in child health research and ultimately enhance child health outcomes in Malawi.

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Children’s health is a global public health priority and a determinant of development and sustainability [ 1 , 2 , 3 ]. Studies show a significant improvement in children’s health as evidenced by a sustained reduction in global child mortality from 12.7 to 5.7 million between 1990 and 2015. Child health research has significantly reduced mortality and morbidity [ 1 , 4 , 5 , 6 , 7 ]. Despite the reduction, estimated 16,000 children worldwide continue to die daily due to preventable causes [ 8 ]. Most of these deaths are clustered in developing countries [ 9 , 10 , 11 ] and comprise preventable infectious diseases [ 12 , 13 ]. Despite the higher burden of child mortality in developing countries, research in child health is dominated by researchers from developed countries [ 2 , 12 , 14 , 15 , 16 ].

Participation in child health research is one of the glaring inequalities between the developed and the developing world [ 17 , 18 ]. Previous studies have reported an under-representation in research by health professionals from the developing world in authorship and leadership in international collaborative research [ 18 ]. For instance, a global literature search on HIV/AIDs reported high dominance by North America and Western and Central Europe in scientific productions [ 18 ]. The study also showed low levels of leadership by Africans in international collaborative HIV/AIDS research [ 18 ]. It is argued that the absence of infrastructure and inadequate funding exacerbates the low participation in research leadership and authorship in the global south [ 19 , 20 , 21 ].

Africans do not take the leading roles in studies and authorship because of inadequate methodological skills in research design, analytical skills, and language problems (English), which hinder them in writing publications [ 18 ]. A study in Malawi on research experience among health professionals reported that all participants (100%) indicated a willingness to be trained in research, 3 (5.3%) had ever written a journal article, 23 (40.4%) had ever participated in research projects, and 18 (31.6%) had been trained in research methods [ 22 ].

Research has further shown that limitations of child health research in different areas result in gaps that cause physicians to extrapolate from adult studies, implement interventions that may not have been adequately evaluated, and even give out medications that may be potentially harmful to children or culturally and socially unacceptable [ 12 ].

Like other developing countries, Malawi needs medical treatments that reflect biological and non-biological variations [ 12 , 23 ] to make evidence-based decisions on the most efficient and cost-effective interventions [ 24 ]. In support, the Government of Malawi emphasises the need to conduct health research on child health [ 25 ]. The Malawi National Health Policy II points to insufficient capacity in research, among others, as a serious challenge that affects service delivery [ 26 , 27 ]. However, to our knowledge, there needs to be more literature on the perspectives of child healthcare workers (HCWs) at Kamuzu Central Hospital (KCH) in Malawi in conducting child health research. Therefore, this study sought to explore child HCWs’ experiences conducting child health research at KCH, assessing their perspectives and the availability of research opportunities at both delivery and policy levels.

Study design and setting

We applied interpretative phenomenological analysis (IPA), a qualitative research approach that investigates how individuals make sense of their lived experiences [ 28 , 29 , 30 , 31 , 32 , 33 ], to examine how child HCWs perceive their research experiences. IPA is suitable when more knowledge of the explored phenomenon is needed.

Key Informant Interviews (KIIs) and Individual In-Depth Interviews (IDIs) generated detailed descriptions of child HCWs' experiences in conducting child health research at KCH, a tertiary hospital with a well-established paediatric section in Lilongwe, Malawi (Fig.  1 ). KCH is a primary site for child health studies, making it suitable for exploring child HCWs' research experiences. Policymakers are also at Lilongwe's Ministry of Health (MoH) Headquarters.

Map showing the study area

Recruitment

We purposively [ 34 ] sampled 20 HCWs involved in child healthcare delivery and five policymakers responsible for the paediatric section at KCH. Previous research has shown that at least six IDIs are enough to reach saturation [ 35 ]. Being an IPA approach, 25 participants were more than enough to get detailed research perceptions without targeting saturation [ 29 ]. Policymakers included health directors, managers, and a coordinator in the child health space. HCWs included doctors, clinicians, nurses, pharmacists, lab technicians, and biomedical engineers. The principal investigator (MKN) and the unit leader at the KCH paediatric unit compiled a list of prospective participants. MKN contacted them to explain the study before sending consent forms and planning for interviews. All contacted participants agreed to participate.

Data collection

MKN collected data using the same interview guide for both categories from July 2023 to August 2023. The interview guide was developed in English (Supplementary Information 1) and pre-tested by MKN at Area 25 Health Centre in Lilongwe to five purposively sampled HCWs involved in child healthcare delivery. The pre-test results assisted in refining the questions for clarity. The interview guide included questions on perceptions of child health research in Malawi, the importance of child health research, child HCWs’ current capacity in research, and the availability of research opportunities among child HCWs.

The IDIs provided a detailed exploration of everyone’s perspective [ 36 ], and KIIs created room for triangulation of results. Participants were explained the study, and MKN obtained signed informed consent. All participants were identified using numbers. MKN conducted interviews in English and audio-taped to make sure that everything was captured. All participants were professional HCWs who had gone up to tertiary education level and were conversant with English. Participants were interviewed in their offices for confidentiality and to create a safe environment to explain their perceptions freely. The interviews lasted 30–45 min, and we provided lunch allowances to all the participants. MKN took notes and summarised key points after every interview for validation [ 30 ].

Data analysis

The recordings were transcribed verbatim in English by MKN. TBN listened to all recordings and cross-checked the verbatim transcription. Using IPA, we analysed data flexibly in five steps described by Smith et al. [ 29 ]. Firstly, MKN was immersed in the data set by repeatedly reading the transcripts while stepping into the participants’ shoes as deeply as possible to note the initial thoughts, observations, and responses concerning the research objectives [ 37 ]. Secondly, MKN developed a codebook examining codes related to general perceptions of child health research.

Thirdly, LMT and TBN checked the codebook for validation by independently reading the first two transcripts line by line and identifying emerging codes to ensure coding reliability and consistency. The researchers regrouped for a final codebook through a consensus process by looking at commonalities and differences [ 38 ]. The final codebook was agreed upon by the joint consensus of all authors [ 38 , 39 ]. Fourthly, MKN coded all transcripts manually using the validated codebook by grouping similar excerpts in a Word document for easy immersion/familiarisation with the data through repeatedly and active reading [ 40 ]. Fifthly, all authors regrouped again and identified relationships between codes. The frequently identified codes were merged, and themes were generated from these codes. Throughout these steps, we focused on participants’ interpretations of their experiences in research. This manuscript comprises summaries, interpretations, and quotes from participants’ excerpts.

Ethical considerations

The College of Medicine Research Ethics Committee (COMREC) [P.06/23-0089] approved this study. Before data collection, we obtained written informed consent from all participants. We maintained confidentiality and anonymity by allocating numbers and transcripts to the participants. Each participant was informed about voluntary participation and the option to withdraw at any stage without repercussions. This study was conducted per the Declaration of Helsinki guidelines and regulations [ 41 ].

Reflexivity

We were mindful of our prior experiences and preconceptions shaped by our backgrounds in health research [ 31 , 32 , 33 , 37 , 42 ]. As researchers immersed in data collection, transcription, and analysis, we acknowledged that our understanding could influence interpretations. Through ongoing reflexive practices, such as team discussions and journaling, we recognised the subjectivity of our perspectives [ 31 , 32 , 33 , 37 , 42 ].

MKN played a pivotal role throughout the study, engaging in data collection, transcription, and leading the analysis, which enabled nuanced interpretations of HCWs' participation in child health research [ 43 ]. Our collective experience in qualitative research shaped our analytical stance and guided the emphasis on certain themes. By acknowledging our positionality and the iterative nature of our interpretations, we aimed to enhance the transparency and rigour of our study [ 43 ]. Reflexivity enriched our understanding and guided the interpretation and presentation of findings.

There were more female participants in the HCW category (60%) but one female participant in the policymaker category (20%) (Table  1 ). Most participants in the HCW category were aged between 25 and 34 years (65%), with most policymakers being above 45 years old (60%). All the nurses were females. Two doctors in the HCW group have a publication each, a pharmacist has two publications, and the publications for all the policymakers who participated in the KIIs add up to 104.

Participants in this study reported low involvement in research. Three key themes emerged from the transcripts. These are (i) perceived motivation and challenges for engaging in child health research, (ii) perceptions of resource availability and research opportunities at KCH, and (iii) perceptions of gaps in research training and participation among child HCWs. The themes are discussed below.

Perceived motivation and challenges for engaging in child health research

Participants reported some intrinsic professional motivation and multifaceted challenges for engaging in child health research. A willingness to better understand child health issues was reported as a strong motivator among child HCWs at KCH to engage in child health research.

“We know that part of our job is to look at the progress of the diseases and how the evolution has been for many years… looking at the fact that medicine is dynamic…all the changes that are happening in terms of vaccines, medicines, and all the changes, make everybody who works in the pediatric department to have that feeling and need to do more research. So yes, the willingness is there.” ID1 18, Doctor “Research that can tell us about the changing epidemiology of the disease would be paramount, and that should be very well documented and disseminated through the layers for implementation purposes to influence decision making that is still not happening... emerging conditions like Non Communcable Dseases (NCDs) in children...” KII 04, Policymaker

Child HCWs and policymakers expressed that financial incentives influence their motivation for engaging in research. Participants associate research with significant economic gains despite the struggles researchers have to go through to secure grants.

“…research comes with a lot of resources, so some can be used to improve the lives of the people conducting research.” IDI 10, Clinical Administrator “There is freedom of money in research if you find a grant. I know you have to struggle to find a grant, but after the struggle, there’s something you can benefit from. Healthcare workers do not know that research has some monetary benefits.” KII 04, Policymaker

However, other participants showed reluctance to engage in research due to various barriers within their environment, as explained below.

“…People are not oriented on how they can conduct research in children… in our lab, we generate data, so we expect that people will come to ask what they have noted, but only a few have come to ask us for data... So, it just shows that people are not interested in the data.” IDI 05, Lab Technician “Most of us get discouraged because we do not see the results of most studies happening here.” 1D1 19, Pediatric nurse

Policymakers emphasised the need for increased research initiatives to empower child HCWs to research in their respective hospital settings.

“The effort of research itself is low… We need to move in a direction where you can wake up and start writing a research question independently. It is something that needs to be pushed.” KII 04, Policymaker

Participants highlighted the limited involvement of nursing professionals in research, attributing it to insufficient capacity. Nurses reported that, unlike medical professionals, they are mostly overlooked in child health research.

“Most of us, especially nurses, are quiet. We are not active, unwilling, and do not participate more compared to the other side of medical, like the clinicians and the other team. Most of us are not experienced in research. So, with a lack of knowledge and expertise in research, we are not active compared to the other team.” IDI 01, Palliative nurse “No, in nursing, no. In pediatric? I have never heard of it, but the medical ones, like the doctors, are the ones who do that. For us, it is just continued professional development (CPD). Maybe because I am a junior, I don’t know much, but I have worked here for four years.” 1DI 20, Pediatric nurse

Some participants attributed their limited involvement in research to their busy clinical schedules, as outlined below.

“We don’t have time... doing normal clinical work is a lot of burden, and then there is the administration, clinical work, and teaching. … You need to formulate a time frame for research. People are torn between sitting behind their laptops and working on research or seeing patients. So the patient always takes precedence.” IDI 10, Clinical Administrator ” Research needs time, and for health professionals in Government hospitals, there is so much pressure for work, so we prioritise seeing clients over doing research. … We are so much interested in doing research, especially in medical equipment for neonates, children, and all that, but what limits us is the time factor.” IDI 16, Biomedical Engineer

In addition to time constraints, female nurses link their limited participation in research to gender roles, which hinder their ability to pursue research opportunities outside of their working hours.

“Women are too busy than men in our culture. Males find a lot of information on the Internet on how to conduct research. For females, we come to work and are busy with our daily routine; we go back home, are tired with the kids, and go to bed ...” IDI 19, Pediatric nurse.

These findings underscore the importance of addressing these barriers and enhancing support for child HCWs and policymakers to foster a conducive environment for research in child health.

Perceptions of resource availability and research opportunities at KCH

In this study, we were keen to understand the available research opportunities for child HCWs at KCH. Participants reported that research is not a priority in the annual budget at KCH, with only a small portion allocated for research activities. Child HCWs indicated that these funds often get diverted into clinical expenditures, leaving little-to-no resources available for research endeavours.

“Government policy demands every institution to allocate 1-2% of the annual funding to research, but in most cases, this money is not available for research …maybe the priority is on the clinical part of treating the patients. So, if I am interested in doing a study, I have to find funding to conduct it even though it will benefit the hospital.” IDI 05, Pharmacist.

Participants, therefore, emphasised the need for institutional support, including allocating a budget line specifically for research to minimise the diversion of funds from research to service delivery and encourage child HCWs to engage in research activities.

“They should allocate a certain amount for research because if they can, it will have its budget line within the hospital that the hospital cannot tap from for other expenses... That would make people interested in research because they would know there are already some funds I can utilise elsewhere.” IDI 05, Pharmacist

Child HCWs expressed concerns about limited funding opportunities for research, advocating for funders to be more open to supporting new researchers. They suggested that funders should allow new researchers to participate in grant writing competitions and allocate grants to encourage early career researchers.

“Funders should be more open to new people writing grants. The case of looking for proven records and experience. Where do you get the experience if you are starting? Give new people some small grants and see how they handle that...” IDI 10, Clinical Administrator

These sentiments were echoed by policymakers who admitted that, as a country, very little money is allocated for research.

“As a country, we are not investing in research in terms of money. People can have ideas, but we do not expect them to take the little money from their pockets. ” KII 04, Policymaker

Child HCWs highlighted the challenge of securing external funding for research projects due to the need for more institutional support and resources. The theme exposes the systemic challenges child HCWs face at KCH in pursuing research opportunities, including inadequate funding and competing priorities within the healthcare system.

Perceptions of gaps in research training and participation among child HCWs

Participants expressed a clear need for more emphasis on research training to address capability gaps among HCWs.

“…if we were exposed to training … I think I can be confident enough to research on my own and develop some manuscripts for publication.” 1D1 19, Pediatric Nurse “When someone is doing a study, we ask for our involvement to get mentored. But how involved are we? They have already developed a concept, done everything, and now they are on data collection; that is when we are involved. So, I would say our involvement should start from conceptualisation.” IDI 03, Nurse Administrator

Participants expressed inadequate training and capacity-building opportunities among HCWs, hindering their ability to engage in research activities effectively.

“I would say the opportunities are limited; if we had such opportunities, we have the team of people that are always willing to work in research, to do more research, but such opportunities are minimal…we need some sort of training here and there...” IDI 05, Pharmacist “I wouldn’t say there is any training in the department or at a hospital level to enhance someone’s progress with research. We get interested in doing research, but at the hospital level, there are no training and capacity-building activities.” 1DI 18, Doctor

Participants highlighted the need for more exposure to research training due to the absence of research concepts in clinical, medical, and nursing education curricula. They suggested incorporating research concepts into CPD programs as a potential solution to bridge this gap.

We underwent medical training and internship and were introduced to research concepts when we started working. It is a new concept to us, so it becomes a challenge... Again, it should be part of CPD. We do CPD as professionals, but mostly, it’s the same things that we do in the hospitals. I have never seen research being part of it.” ID1 18, Doctor

Policymakers acknowledged the importance of incorporating child HCWs into technical working group meetings to expose them to research gaps in the health system.

“I think it is about including them in our technical working groups; that is when they will be open and be exposed to implementation arrangements. They will also be motivated to say this is the area we can do something on.” KII 01, Policymaker

There was a perceived need to strengthen collaborations with stakeholders in various areas of healthcare to improve child HCWs' participation in research.

“…People should know that who is there in this area. We have people specialising in child health, but where are they? Do we know them? Why? They are somewhere in an organisation where we can’t even access them. But why do we have people specialising in child health? They are the ones who are supposed to be in the forefront...” IDI 03, Nurse Administrator

The results under this theme describe the multifaceted gaps that hinder child HCWs’ engagement in research activities and the importance of addressing these gaps through enhanced researcher involvement, training and capacity-building opportunities, policy support on health education curriculum, and improved collaboration with stakeholders.

This study offers valuable insights into the perceptions of child HCWs at KCH regarding child health research. Despite a general willingness among child HCWs to engage in research, participation still needs to improve due to various challenges.

A significant challenge identified was the need for more research capacity among child HCWs at KCH. Our study identified that child HCWs at KCH have a low drive to engage in child health research due to a lack of research training during their studies. This is in contrast to Tanzania, where a similar study found that over half of the participants had received research training at a university or medical college [ 44 ], which may result in regional differences in research capacity among child HCWs in sub-Saharan Africa. These disparities could impact research outcomes and the effectiveness of child health interventions in different countries. We recommend urgent reforms in the clinical education curriculum in Malawi to incorporate research training and bridge this gap.

Our findings highlight a significant involvement gap in research collaboration practices at KCH, where child HCWs are mainly involved in data collection rather than other processes, such as developing protocols, data analysis, and manuscript writing. The challenge is further exacerbated by the absence of a dedicated child health department within the Ministry of Health to foster collaboration and ownership of child health initiatives. In addition to advocating for establishing a standalone child health department to improve stakeholder collaboration and child health outcomes [ 45 , 46 ], we also advocate for a comprehensive engagement approach for child HCWs in research from conceptualisation to report writing. Collaboration between academic and research institutions can provide cost-effective training and expertise sharing, as recommended by the previous studies [ 44 , 47 , 48 , 49 ].

Gender constraints were also identified as a significant challenge for participation in research among female child HCWs at KCH. While male child HCWs have taken the initiative to self-train in research during their spare time using the internet, female child HCWs lack such opportunities due to household gender roles which fill their non-professional work time. Similar findings from other African countries have been reported [ 44 , 50 ]. Policymakers are urged to implement strategies to empower female child HCWs, including early involvement in research processes and creating supportive environments conducive to research engagement. Additionally, KCH child HCWs face significant time constraints due to heavy workloads, similar to findings from both African and developed countries [ 50 , 51 , 52 , 53 , 54 , 55 ]. To address this, we recommend allocating protected research time within the hospital, supported by increased human resources and integration of research into duty rosters.

Financial constraints were another significant challenge to research participation at KCH as the annual budget needs to prioritise research. This highlights the need for a dedicated budget line for research to ensure adequate funding. Lack of financial resources limits the ability to conduct research and affects the quality and scope of studies. With sufficient funding, procuring materials, compensating participants, and covering other essential expenses is easier. Prior research has also identified insufficient finances as a barrier to African research [ 44 , 47 ], indicating a broader systemic issue. Addressing this financial gap is crucial to fostering a research culture, building capacity among child HCWs, and improving healthcare outcomes through evidence-based practices. Enhanced funding mechanisms from governmental and non-governmental sources are needed to overcome these obstacles and promote a research-oriented healthcare environment.

Limitations

This is the first study to explore HCW experiences in child health research at KCH in Malawi. Our child HCW sample had more females, while the Policymaker sample included only one female, potentially introducing gender bias. Interpretative Phenomenological Analysis (IPA) allowed for detailed and nuanced perceptions of child health research at KCH. However, a qualitative study cannot establish causality, and the sample from a single hospital in central Malawi may limit generalizability. Despite this, the identified barriers and recommendations likely apply to all government hospitals in Malawi, as they share common health education institutions and policies. Further research involving multiple sites and more balanced gender representation is needed to validate and extend these findings.

Our study has identified crucial factors contributing to the low participation of child HCWs in child health research at KCH. We found notable gaps in research participation among child HCWs at KCH, including a lack of collaboration, limited financial opportunities, and non-research-based training. Some child HCWs expressed a strong research interest, but challenges at both individual and institutional levels hinder engagement. We advocate for targeted capacity-building interventions to address these challenges and promote a culture of research excellence. Prioritising these initiatives can foster a conducive environment for child health research and enhance outcomes in Malawi.

Availability of data and materials

The dataset generated and analysed during the current study is not publicly available. Even without identifiers such as names, the dataset could hold identifiable participant information in aggregate form due to some narratives in the transcripts with participants sampled in a single district. The pediatric department at KCH is a small section. With potential identifiers in the transcript narratives, we believe it would be ethically inappropriate to publicly share the data that could reveal our participants’ identities if read by someone within the district or KCH. The dataset or part of it could be available from the corresponding author at a reasonable request with permission from KCH. No datasets were generated or analysed during the current study.

Abbreviations

Healthcare Workers

Ministry of Health

• Kamuzu Central Hospital

Human Immunodeficiency Virus

Acquired Immunodeficiency Syndrome

College of Medicine Research Ethics Committee

Key Informant Interview

Individual In-depth Interviews

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Acknowledgements

The authors are grateful to the Management and Staff at Kamuzu Central Hospital (KCH), the Management and Staff of the KCH pediatric section, and all HCWs who participated in the study. The authors acknowledge the International Child Health Group for the financial support. The authors recognise the Ministry of Health and all Policymakers who participated in the study. Last but not least, the authors appreciate the staff members at the Training and Research Unit of Excellence for their administrative support throughout the study.

This study was supported by the International Child Health Group (ICHG), UK (ICHG Project No. ICHG835/537044). The funding body had no role in the study’s design, data collection, analysis, interpretation of data, or manuscript write-up.

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MKN, TBN, and LMT conceptualised and designed the study. MKN collected and analysed data with TBN. MKN drafted the manuscript. TBN and LMT reviewed the manuscript, provided input, and suggested additions and changes. All authors read and approved the final manuscript.

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The College of Medicine Research Ethics Committee (COMREC) approved the study [Protocol No. P.06/23-0089]. Before data collection, we obtained written informed consent from all participants. We maintained confidentiality and anonymity by allocating numbers to the participant transcripts. The information letter informed participants of their choice to participate and the option to withdraw at any stage of the research process. This study was conducted per the Declaration of Helsinki guidelines and regulations.

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Ndambo, M.K., Ndambo, T.B. & Manda-Taylor, L. Exploring healthcare workers’ perceptions of child health research at Kamuzu Central Hospital, Malawi: an interpretative phenomenological analysis. Hum Resour Health 22 , 57 (2024). https://doi.org/10.1186/s12960-024-00938-5

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In 2023 the Chief Evaluation Office partnered with the Employment and Training Administration (ETA) to fund a study focused on exploring approaches to measure and increase equity in ETA’s discretionary grant-making programs. This study sought to explore how grant-makers – such as Federal agencies, State and local government agencies, and philanthropic organizations – define, assess, and increase equity in their grant-making process.

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Motivation and Engagement in Language Learning

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This chapter focuses on motivation and engagement, the two constructs that are the main drivers of language learning. Research in language learning motivation has been flourishing in recent years due to the change of focus from cognitive to affective variables and the new motivational theory proposed by Zoltan Dörnyei (2005), namely the second language (L2) motivational self-system. The theory proposes that having a vision is a key factor motivating language learners, with a pivotal role played by the language learning experience. However, recent empirical findings show that motivation does not necessarily lead to higher proficiency (Dunn & Iwaniec, 2021). Hence, in this chapter, we also consider engagement, a construct related to motivation, which is deemed to be the behavioural manifestation of the motivational drive. This chapter introduces the concepts of motivation and engagement and discusses how they are related. Key research findings and their implications for teaching professionals are presented. There is also a thorough discussion of how motivation and engagement can be augmented to spur students’ learning. To this end, the chapter focuses on the heavily under-theorized concept of the language learning experience as an antecedent to engagement and how it can be optimized by tending to learners’ needs in terms of autonomy, competence, and relatedness. A careful examination of how students’ visions of themselves can be made more robust follows. Finally, guidance on how practising teachers can research different aspects of their own learners’ motivation is provided.

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Iwaniec, J., Khaled, H.Y. (2024). Motivation and Engagement in Language Learning. In: Cirocki, A., Indrarathne, B., McCulloch, S. (eds) Cognitive and Educational Psychology for TESOL. Springer Texts in Education. Springer, Cham. https://doi.org/10.1007/978-3-031-66532-5_7

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