Framework of Motivations
for Community Health Workers

JOHN LEE, ARIJIT SARKAR

Motivational Theory (Page 1 of 2)

Hierarchy of needs

Motivation is a need or desire that an individual experiences which drives him to fulfil a goal (Stuart-Kotze). Behavior serves as the mechanism in which a goal becomes achieved. Therefore, needs drive behaviors which fulfil goals to reduce the tension caused by unsatisfied needs (Kelly). The literature describes motivation as an unsatisfied need; satisfying the need results in the attainment of a goal. The following diagram was proposed by Joe Kelly in How Managers Manage (Stuart-Kotze).

unsatisfied needs (motivations) –> drives –> behavior –> goals –> relaxation

While the goals may be more easily identifiable as the end result, the unsatisfied needs may be more difficult to recognize (Stuart-Kotze). For example, when an employee takes a coffee break, he has one goal, to get coffee, but this may reflect many different needs. The employee may be fulfilling a need to socialize with coworkers; to satiate a craving; to simply take a break. From the goal, the needs are indistinguishable. Similarly, the goals of CHWs are often to help their communities, but their unsatisfied needs, their motivations, are not always clear. While many theories have proposed frameworks in which to identify and categorize these needs, one of the most comprehensive theories is Abraham Maslow’s Theory of Human Motivation. The theory attempts to divide human motivation into five unsatisfied needs. Maslow posits that his theory is a ‘general-dynamic’ theory for motivation; it does not necessarily represent behavior theory. While behavior is almost always driven by motivation, it is also affected by socio-cultural, biological, and circumstantial factors (Maslow). Therefore, motivation only partly describes the behavior in which a goal is fulfilled.

Maslow proposes a pyramid model of motivation called the “Hierarchy of Needs”. He identifies an order of five human needs: physiological, safety, love, esteem, and self-actualization (Maslow). Each of these levels is pre-potent to one another, in that the lower level must be satisfied before the next level can be focused on. Once one need has been satisfied and the individual has moved up to the next level, the needs in the lower level are no longer of priority to the individual. Maslow suggests, using the argument of prepotency, that needs have an urgency of satisfaction which must be addressed before other needs can be focused on (Stuart-Kotze). Therefore, if there are multiple unsatisfied needs and a particular need is the lowest unsatisfied need, the satisfaction of this need must occur before any other unsatisfied need can receive focus. Only when a deprived need has been gratified, could it release an individual to pursue other, possibly more, social goals (Maslow).

Figure 1: Maslow’s pyramid of needs and human motivation

Physiological

The most prepotent of all stages, physiological needs are those necessary of keep homeostasis (Maslow). This can include food, shelter, water, clothing, money, etc.

Safety

This need often refers to physical safety or psychological security, but in respect of incentive structure, it can be related to job security, tenure, protection, insurance, or savings accounts (Maslow).

Love

Maslow described a need for affiliation, acceptance, and belongingness (Stuart-Kotze). Maslow states, “He will hunger for affectionate relations with people in general, namely, for a place in his group, and he will strive with great intensity to achieve this goal.”

Esteem

The need to be recognized by others, achievement, and self-esteem. According to Maslow, neglecting these needs will lead to feelings of inferiority and weakness.

Self-actualization

Maslow’s final and highest level of need, this refers to be completely intrinsically driven to recognize one’s identity and thoroughly achieve that identity at all efforts. For example, a man realizing his ability to paint, and becoming a painter.

The pyramid that Maslow suggests defines a rigid structured hierarchy of needs, but in reality the levels are much more fluid. Needs may be met partially when they involve high ideals and values (Maslow). For example, martyrs give up physiological needs due to their ideals. Most people may not function to this extreme, but some leniency between the levels exists in which a person relinquishes some partial needs for the fulfilment of higher ideals. This could describe why CHWs may engage in often costly volunteer health work.

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