Extrinsic or intrinsic motivation? The incentive mechanism to target rural outreach services into remote locations within the county medical community: a mixed-methods study.

Abstract

The effectiveness of rural outreach remains limited due to the lack of suitable incentives within the county medical community. Based on the Existence, Relatedness and Growth (ERG) theory and work motivation theory, our study explored the incentive mechanisms of rural outreach through a new framework that incorporates external incentives, work-related personality traits and job performance. An explanatory sequential mixed-methods study comprises a cross-sectional quantitative study (Study 1) and a qualitative study (Study 2). County hospitals within the county medical community in Hubei province, China. 511 and 20 specialists who participated in rural outreach at county hospitals were recruited for the quantitative study and qualitative study, respectively. Hierarchical regression analysis was used to explore the relationship among external incentives (suggested by the ERG theory), work-related personality traits and job performance. In-depth interviews were used to explain why the existence factors had no effect on job performance of rural outreach. In Study 1, our findings showed that relatedness and growth factors significantly improved job performance, with work-related personality traits acting as a mediating factor (p<0.001). Existence factors had no significant effect on job performance (p>0.05). In Study 2, our findings revealed that existence factors may weaken specialists' altruism. Most specialists viewed rural outreach as a chance to enhance their clinical skills and advance their career development rather than as an opportunity for financial compensation. We recommend that policymakers should foster a supportive and growth-oriented environment for rural outreach programmes. Enhancing work-related personality traits may strengthen specialists' intrinsic motivation and promote sustained engagement in rural service.