Work Motivation among Occupational Therapy Graduates in Malaysia.

OBJECTIVE/
BACKGROUND: Occupational therapy that focuses on servicing clients demands motivated workers for quality service delivery. The objectives of this study were: (a) to determine the level of work motivation among occupational therapy graduates in Malaysia and (b) to determine if there is a difference in work motivation among these graduates based on work sector, job position, length of work experience, and gender.
METHODS: This cross-sectional study recruited occupational therapy bachelor's degree graduates using an online survey. The Work Extrinsic and Intrinsic Motivation Scale (WEIMS) was used to measure level of work motivation.
RESULTS: Responses from 82 (60.3%) graduates (male: 26.8%; female: 73.2%) were analysed. Sixty-two (75.6%) graduates worked locally and 20 (24.4%) worked in foreign countries. The average Work Self-Determination Index (W-SDI) score for WEIMS is +11.38 with 78 (95.1%) of graduates demonstrated a self-determined motivational profile and 4 (4.9%) demonstrated a nonself-determined profile. Graduates in the private sector (13.10 ± 6.47) show significantly higher W-SDI score compared to those in the public sector (9.40 ± 6.06), p = 0.01. W-SDI scores appeared higher among clinician (11.67 ± 6.40), case manager (13.33), and others (14.90 ± 8.23); and those with work experience of 5-6 years (13.11 ± 6.90) and less than one year (12.65 ± 7.12). Male (10.29 ± 6.86) and female (11.79 ± 6.39) graduates shared equally high score. There is no significant difference in W-SDI score based on job position, length of work experience, and gender.
CONCLUSION: Occupational therapy graduates have high work motivation as evident by their self-determined profile. Only work sector imposes difference in work motivation among these graduates.

Introduction

Work motivation is said to be linked to the delivery of quality of service by enhancing workers' performance as well as directing them towards personal and cooperation goals (Alhassan et al., 2013; Elmadag, 2006; Peters, Chakraborty, Mahapatra, & Steinhardt, 2010). Highly motivated workers is the key component of successful health system performance (Peters et al., 2010). Occupational therapy, a profession that focuses on servicing clients with different needs demands motivated workers for quality service delivery. Although there are many studies on work motivation among health care workers (Alhassan et al., 2013; Bemhard, 1984; Bennett & Franco, 1999, pp. 1–45; Hoonakker et al., 2013; Peters et al., 2010; Raming, 2009), similar study relevance to occupational therapy is hardly available.

There are two major types of motivation, i.e., intrinsic motivation (IM) and extrinsic motivation (EM) (Gray & Starke, 1988; Irum, Sultana, Ahmed, & Mehmood, 2012; Nawab, Bhatti, & Shafi, 2011; Raming, 2009; Ryan & Deci, 2000). IM refers to doing something because it is interesting or enjoyable; EM refers to doing something because it leads to a separable outcome (Ryan & Deci, 2000). IM although is considered as the best motivator as it has a significant effect on performance, persistence, and well-being that satisfies innate psychological needs (Ryan & Deci, 2000), both types of motivation have the potential to enhance performance of a person (Gray & Starke, 1988; Nawab, Bhatti, et al., 2011).

Investigating work motivation specific to occupational therapy is important because it links closely to the effort that they put to improve the quality of care and client's safety (Alhassan et al., 2013). To do this, understanding of the elements that inform motivation is important. According to Self-Determination Theory (SDT), there are three psychological needs: (a) need for autonomy; (b) need for competence; and (c) need for relatedness (Gagné & Deci, 2005; Ryan & Deci, 2000). Conditions that support these three needs are the basis to maintain a person's IM and promote internalization of EM. Achieving maintenance of IM and internalization of EM allows a person to become more self-determined (Gagné & Deci, 2005; Ryan & Deci, 2000). SDT maintains that motivation can be distinguished based on the degree of autonomy (Gagné & Deci, 2005; Ryan & Deci, 2000; Tremblay, Blanchard, Taylor, Pelletier, & Villeneuve, 2009). IM has the highest autonomy and can lead to the most positive outcomes. Depending on the respective levels of autonomy, EM is further divided into four types: (a) integrated regulation (INTEG) – where a person identifies the value of an activity to the extent that it becomes part of his/her sense of self; (b) identified regulation (IDEN) – where a person has greater freedom and volition in an activity because the behaviour matches his/her personal goal and identities; (c) introjected regulation (INTRO) – where behaviour or activity is taken in by a person but has not been accepted as a part of him/her; and (d) external regulation (EXT) – where the certain activity is done to obtain a reward. Both IM and EM are intentional and stand in contrast to amotivation (AMO) which means lacks of intention and motivation (Gagné & Deci, 2005; Ryan & Deci, 2000; Tremblay et al., 2009).

Malaysia has enjoyed rapid expansion in both public and private healthcare sectors since the past decade. For instance, in 2012, there were 225 private hospitals in Malaysia and by 2018, the number is projected to increase to 239 (Teo, 2013). The healthcare expansion has created many job opportunities for the field of occupational therapy especially among graduates with a bachelor's degree. Many graduates with various lengths of work experience have been recruited for different job positions in public or private sectors. Work motivation among these graduates may be different if they value the characteristics of each sector differently. Private sector is known to attract workers in terms of: (a) trust gaining from clients; (b) good working conditions; and (c) having own autonomy in certain aspects of their management (Peters et al., 2010). Public sector offers better values from the aspects of employment benefits and superior's recognition (Peters et al., 2010). Both sectors offer equally attractive values, but, workers in public sector enjoy lesser autonomy and show lower motivation compared to their counterparts as reported in Pakistan (Irum et al., 2012) and Australia (Keane, Lincoln, Rolfe, & Smith, 2013). Work motivation is speculated to be influenced by job position as different job positions have different characteristics of work. Peters et al. (2010) identifies seven major characteristics of work that can influence work motivation: (a) work itself; (b) relationship at work; (c) workplace condition; (d) personal development opportunities; (e) pay/rewards; (f) management; and (g) organisational policies (Peters et al., 2010). Work environment that provides feedback, learning opportunity, reward, and recognition tends to increase workers' motivation and satisfaction (Guzman, 2007; Hoonakker et al., 2013). Work experience is an important element for workers' performance as it consists of both quantitative and qualitative components that can be translated into related skills, motivations, and knowledge. Although length of work experience may affect work motivation in many aspects (Tesluk & Jacobs, 1998), some studies show that length of work experience does not impose any difference in motivation (Urošević & Milijić, 2012; Whitehouse, Hird, & Cocks, 2007).

Work motivation may be related to demographic variables such as gender (Buelens & Van den Broeck, 2007; Kanfer & Ackerman, 2000). Men and women have different motivation against salary and work–family relationship (Buelens & Van den Broeck, 2007). Study shows women although tend to be more motivated in terms of intrinsic work motivation, difference in work motivation between genders remains insignificant (Eskildsen, Kristensen, & Westlund, 2004).

Given work motivation is very important and yet there is no solid information relevance to the field of occupational therapy, the objectives of our study were: (a) to determine the level of work motivation among occupational therapy graduates in Malaysia, and (b) to determine if there is a difference in work motivation among occupational therapy graduates in Malaysia based on work sector, job position, length of work experience, and gender.

Methods

Design and participants

This cross-sectional study was conducted through an online “Survey Monkey”. The study surveyed occupational therapy bachelor's degree graduates of one of the higher learning institutions in Malaysia. This institution was selected because: (a) it offered the first occupational therapy bachelor's degree in Malaysia in 2004, and (b) it accepts students from different racial and religious backgrounds, reflecting the actual social characteristics of Malaysian society. The list obtained from this institution showed at the time of the study, a total of 136 students had been successfully graduated. Krejcie and Morgan (1970) formula was used for the sample size calculation. The calculation showed that the study needs at least 101 graduates (Krejcie & Morgan, 1970). We invited graduates to participate in the study via a social media alumni group, created by the staff in this institution. We included a brief introduction about the study, an information sheet, and a link to the survey in our invitation. Consent to participate was done by clicking the survey link. We also sent out emails to all graduates immediately after the invitation to ensure that everyone was informed regarding this study. Three weeks later, another email reminder was sent. The initial deadline of completing the survey was one month after the invitation. We later extended the deadline to two months for collection of more responses.

Instrumentation

We used Work Extrinsic and Intrinsic Motivation Scale (WEIMS) (see Appendix I), available in Tremblay et al. (2009) to measure the level of work motivation. WEIMS had been used in many published studies (Bolltoft, 2015; Jayaweera, 2015; Kim, 2013; Proenca & Cristina, 2013; Serrata, 2015; Shu, 2015). WEIMS is constructed based on SDT and consists of 18 items that can be divided into six subscales, corresponding to the six types of motivations postulated by SDT namely IM, INTEG, IDEN, INTRO, EXT, and AMO. Item in each subscale is scored on a Likert-type scale, from “1” (does not correspond at all) to “7” (corresponds exactly). The score of each subscale can be generated using the mean score of the 3 items within the subscale. The Work Self-Determination Index (W-SDI) is used to express the attainment of either self-determined or nonself-determined motivational profiles. W-SDI is generated using the score of each subscale through the following formula:

The possible W-SDI score of this WEIMS ranges in between ±36. The total score reflects individuals' relative level of self-determination. A positive score indicates a self-determined profile and a negative score suggests a nonself-determined profile. In terms of construct validity, WEIMS has an item-to-total correlation above 0.50 for all the subscales and for internal consistency of its six subscales, it has Cronbach's alpha coefficients ranging from 0.64 (AMO) to 0.83 (INTEG) (Tremblay et al., 2009).

No translation was performed to the WEIMS in the study because: (a) all graduates have good English proficiency –scoring at least Band 2 in the Malaysian University English Test (MUET) is the graduation requirement of this institution, and (b) throughout the entire curriculum, most of the courses were conducted and examined in English. No adaptation was performed to WEIMS because: (a) this was the first study that attempted to explore the work motivation among occupational therapy graduates in Malaysia, and (b) the need of adaptation to suit Malaysian cultural context is not substantiated. We believe maintaining the WEIMS in its original version was a more realistic option. Demographic data collected include graduate's work sector, job position, and length of work experience.

Data Analyses

Statistical analyses were done using IBM SPSS software (version 21.0) with level of significance set to .05. We used descriptive statistics to analyse demographics of graduates as well as distributions of WEIMS subscales and W-SDI. For differences in work motivation based on work sector and gender, we used independent samples t-test. For differences in work motivation based on job position and length of work experience, we used One-Way Analysis of Variance (ANOVA).

Results

We received responses from 92 (67.6%) graduates out of the 136 graduates (or 91.1% of needed response of 101). Only responses from 82 (60.3%) graduates were included in the final analyses because eight graduates had incomplete responses and two were unemployed at the time of study. shows the demographics of the 82 graduates that had completed the study. Graduates were predominantly female (n = 60, 73.2%) and worked in a private sector (n = 44, 53.7%). Majority of them worked locally (n = 62, 75.6%) especially in the rapidly developed and highly populous Central Region of Malaysia (n = 36, 43.9%). There were 15 (18.3%) graduates working in Singapore and other countries (n = 5, 6.1%). Clinician (n = 59, 72%) was the biggest group, followed by educator (n = 11, 13.4%). There were five graduates who hold other job positions such as operation officer, auditor, and contractor etc. The five of them were included in all analyses because we believe that they do require application of occupational therapy knowledge and skill for work performance.

Table 1

Demographics of the responded graduates.

	Frequency
	n	%
Gender
Male	22	26.8
Female	60	73.2
Work sector
Public	38	46.3
Private	44	53.7
Job position
Clinician	59	72.0
Case manager	1	1.2
Educator	11	13.4
Self-employed	3	3.7
Postgraduate student	3	3.7
Other[*]	5	6.1
Region
West Malaysia: Northern Region	9	10.9
West Malaysia: East Coast	4	4.9
West Malaysia: Central Region	36	43.9
West Malaysia: Southern Region	10	12.2
East Malaysia: Sabah & Sarawak	3	3.7
Singapore	15	18.3
Other countries[**]	5	6.1

Other professions include operation officer, auditor, and contractor.

Other countries include Japan, United Kingdom, and Brunei.

shows the distributions of all the six subscales of WEIMS and the W-SDI. All subscales of WEIMS have high mean scores except for the subscale of AMO. Graduates have good work motivation with +11.39 W-SDI average score. Among them, 78 (95.1%) demonstrated self-determined profile and only 4 (4.9%) demonstrated nonself-determined profile.

Table 2

WEIMS and W-SDI.

	Min	Max	Mean	Std. Dev	95% CI
					Lower bound	Upper bound
Motivation subscale
Intrinsic motivation	2.67	7.00	5.81	0.90	5.61	6.01
Integrated regulation	3.33	7.00	5.44	1.04	5.21	5.66
Identified regulation	3.33	7.00	5.57	0.93	5.37	5.77
Introjected regulation	1.33	7.00	4.61	1.37	4.31	4.91
External regulation	3.00	7.00	5.16	1.09	4.92	5.40
Amotivation	1.33	5.67	2.52	1.18	2.26	2.78
W-SDI	-3.67	23.00	+11.39	6.51	9.96	12.82
W-SDI, Work Self-Determination Index.

shows that on average, graduates from a private sector have higher W-SDI score (13.10 ± 6.47), signifying higher self-determined profile compared to those in the public sector (9.40 ± 6.06), t(80) = 2.66, p = 0.01. Clinician (11.67 ± 6.40), case manager (13.33), and others (14.90 ± 8.23) have relatively higher W-SDI scores, but difference between them is not significant, F(5, 76) = 0.60, p = 0.70. Graduates with 5–6 years of work experience displayed the highest W-SDI score (n = 12, score = 13.11 ± 6.90), followed by those with less than one year of work experience (n = 22, score = 12.65 ± 7.12). No significant difference is noted based on length of work experience F(6,75) = 0.66, p = 0.68. Similarly, there is no significant difference in W-SDI score based on gender (male: 10.29 ± 6.86; female: 11.79 ± 6.39), t (80) = −0.92, p = 0.36. Both genders show self-determined profile.

Table 3

W-SDI based on job position and length of work experience.

	Frequency (n)	Mean	Std. Dev	95% CI		p
				Lower bound	Upper bound
Gender
Male	22	10.29	6.86	-4.73	1.73	0.36[a]
Female	60	11.79	6.39	—	—
Work sector
Public	38	9.40	6.06	-6.46	-0.93	0.01[a]
Private	44	13.10	6.47	—	—
Job position
Clinician	59	11.67	6.40	1.00	13.33	0.70[b]
Case Manager	1	13.33	—	—	—
Educator	11	9.49	7.22	4.63	14.34
Self-employed	3	9.33	6.43	-6.64	25.30
Postgraduate Student	3	8.89	5.17	3.95	21.73
Others[*]	5	14.60	8.23	4.38	24.82
Work experience (Years)
<1	22	12.65	7.12	9.49	15.81	0.68[b]
1–2	14	11.93	7.24	7.75	16.11
2–3	11	10.00	5.75	6.14	13.86
3–4	10	9.27	4.62	5.96	12.57
4–5	7	9.52	6.75	3.28	15.77
5–6	12	13.11	6.90	8.73	17.50
>6	6	10.28	6.23	3.74	16.82

Other professions include operation officer, auditor, and contractor.

independent samples t-test.

one-way analysis of variance.

Discussion

We obtained considerably high response rate in our study (67.6%). This rate is higher than the 33.0% obtained by most online survey (Nulty, 2008). Graduates in our study have high work motivation as evident by their self-determined profile. By referring to responses in motivation subscales, we believe it is potentially due to their engagement in work that is interesting and/or work that has potential of directing them towards personal goals (IM, INTEG, & IDEN) (Gagné & Deci, 2005). There is a close linkage between such reasoning and the philosophy of occupational therapy. This meaningful, interesting, and yet challenging profession aids graduates in gaining high work motivation through various aspects. For instance, by helping and caring for others (Hoonakker et al., 2013; Nain, 2013) and/or at a more complicated level, by overcoming continuous challenge when working with individuals with a widely diverse background (Chan, 2007). Drawing from the understanding that self-determination of workers is important in supporting an organisation (Gagné & Deci, 2005), we are confident that the continuous involvement of these highly motivated graduates can advance the profession of occupational therapy towards a more positive and productive direction. Precisely, we can expect better patient outcomes and therapeutic impacts from the clinical perspective. In academic field, our expectation is focused on better curriculum enhancement, effective student supervision, and active research involvement.

Because the sources of motivation differ among people and may affect people differently (Pardee, 1990), we also investigated whether there is a difference in work motivation based on work sector, job position, length of work experience, and gender. The finding that graduates in a private sector displayed higher work motivation than those in the public sector is consistent with previous studies (Irum et al., 2012; Keaneetal., 2013; Zeffane, 1994). As discussed earlier, there are many differences between public and private sectors, especially on issues related to practice system (Nawab, Ahmad, & Shafi, 2011). In public sector, workers often experience difficulty in maintaining effective communication because of the implementation of bureaucracy system that focuses on complicated procedures (Nawab, Ahmad, et al., 2011). This system may affect the positive relationship between workers and superior, making alteration of workers' motivation becomes unavoidable (Hoonakker et al., 2013; Nawab, Ahmad, et al., 2011). Workers in a private sector may enjoy better working environment with less bureaucracy and this supportive and harmony working environment can contribute to the difference in work motivation (Irum et al., 2012). We speculate that graduates in our study may have been experiencing similar challenges.

Our study encores report by Urošević & Milijić (2012) that workers with the same qualification have similar motivation regardless of their duration of experience. With all graduates holding a bachelor's degree except a few with postgraduate qualifications, there is no difference in work motivation based on length of work experience. Graduates with 5–6 years of work experience as well as those with less than one year of experience shared similar high motivation. This is potentially because healthcare workers often gain motivation through providing help and delivering service (Nain, 2013), rather than accumulating it through time. The nature of occupational therapy profession that encourages continuous professional development and independent learning could have further enhanced their motivation (Hoonakker et al., 2013).

Our study found no difference in motivation among graduates holding different job positions. We speculate that graduates actually have chosen the type of job that well suits their personality, interest, and goal as reflected through their high scores in subscales of IM, INTEG, and IDEN. A collision between personality and work can lead to certain behaviours that promote work motivation (Naquin & Holton, 2002). Consistent with the report by Eskilden, Kristensen and Westlund (2004), our study found no gender difference in work motivation, signifying both genders may have similar perception regarding the health care system (Hojat et al., 2000). Specifically, they exert similar effort towards serving their clients.

Results of our study are potentially generalisable to graduates holding equivalent degree from other countries in the Southeast Asia and East Asia regions. Our results were mainly contributed by graduates working in the Central Region of Malaysia (including Kuala Lumpur) and Singapore. These places share many similarities with other larger cities or urban areas in these regions in terms of having rapid infrastructural development, robust economic support, and strong population growth. Graduates in these places or cities may demonstrate similar level of work motivation due to urbanisation. Generalisability of our results is further enhanced by recruiting graduates from different racial and religious backgrounds. This is in line with the fact that Southeast Asia and East Asia regions have unique and rich racial and religious compositions.

Limitations and Recommendations

There were three limitations in our study: (a) a minimum responses of 101 was not achieved despite allocation of extra time by extending the deadline. This may subject our results of no difference in work motivation based on job position, length of work experience, and gender to Type II errors; (b) our results may only be generalised to occupational therapy graduates holding at least a bachelor's degree. Work motivation of diploma graduates needs to be investigated separately as they are likely to experience and to react on issues related to various characteristics of work differently; and (c) there may be other important factors that affect work motivation and this demands a more specific investigation. Interviewing graduates using semi-structured or in-depth formats may provide us with greater insight on issues related work motivation.

Conclusion

In general, Occupational therapy graduates have high work motivation with self-determined motivational profile. Graduates that work in the private sector have higher work motivation than those in the public sector. Work motivation does not vary among graduates based on job position, length of work experience, and gender.

Does not correspond at all		Corresponds moderately			Corresponds exactly
1	2	3	4	5	6				7
1. Because this is the type of work I chose to do to attain a certain lifestyle.						2	3	4	5	6	7
2. For the income it provides.						2	3	4	5	6	7
3. I ask myself this question, I don't seem to be able to manage the important tasks related to this work.						2	3	4	5	6	7
4. Because I derive much pleasure form learning new things.						2	3	4	5	6	7
5. Because it has become a fundamental part of who I am.						2	3	4	5	6	7
6. Because I want to succeed at this job, if not I would be very ashamed of myself.						2	3	4	5	6	7
7. Because I chose this type of work to attain my career goals.						2	3	4	5	6	7
8. For the satisfaction I experience form taking on interesting challenges.						2	3	4	5	6	7
9. Because it allows me to earn money.						2	3	4	5	6	7
10. Because it is part of the way which I have chosen to live my life.						2	3	4	5	6	7
11. Because I want to be very good at this work, otherwise I would be very disappointed.						2	3	4	5	6	7
12. I don't know why, we are provided with unrealistic working condition.						2	3	4	5	6	7
13. Because I want to be a “winner” in life.						2	3	4	5	6	7
14. Because it is the type of work I have chosen to attain certain important objectives.						2	3	4	5	6	7
15. For the satisfaction I experience when I am successful at doing difficult tasks.						2	3	4	5	6	7
16. Because this type of work provides me with security.						2	3	4	5	6	7
17. I don't know, too much is expected of us.						2	3	4	5	6	7
18. Because this job is part of my life.						2	3	4	5	6	7

Reprinted with permission from Tremblay, M. A., Blanchard, C. M., Taylor, S., Pelletier, L. G., & Villeneuve, M. (2009). Work Extrinsic and Intrinsic Motivation Scale: Its value for organizational psychology research. Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement, 41(4), 213–226.