Table 2.
Constructs and items that did not perform well psychometrically
| Construct | Item | Source | How they did not perform |
|---|---|---|---|
| Self-efficacy (locus of control) |
I do not always feel in control of things that affect my work at this workplace | Adapted from (31) | Did not load to any factor to the minimum of 0.3 (some negative factor loadings) |
| I am confident about my ability to take a normal delivery. | Adapted from (30) | Did not load to any factor. The item also caused discussion during pre-test as not all staff were formally mandated to take deliveries and were therefore uncertain about whether they could respond. | |
| Work meaningfulness | I chose my profession to serve our people | Developed with reference to the qualitative research, which showed social values to be a source of motivation in all three countries. | The majority of respondents (strongly) agreed with this statement at pretest. |
| I am happy to contribute to providing these important MNH services to the community | Developed with reference to the qualitative research, which showed that being able to help the community was a source of job satisfaction in all three countries | Most respondents (strongly) agreed with this statement at pretest | |
| Provider feels valued/exploited |
With this job I have to worry about how to support myself and my family financially | Adapted from (30, 31) | Most respondents (strongly) agreed with this statement at pretest |
| My job offers adequate pay compared with similar jobs (e.g. teachers) | (30, 31) | Most respondents (strongly) disagreed with this statement at pretest | |
| Attitudes to patients | I feel like I don't care for patients like I used to | (31) | Did not load to any factor to the minimum of 0.3 (Cronbach's α of this construct was only 0.176) |
| Generally I feel great sympathy for the patients | Developed with reference to the qualitative research, which provided examples of MNH providers limited sympathy with patients in all three countries | Did not load to any factor to the minimum of 0.3 (Cronbach's α of this construct was only 0.176) | |
| It makes me feel appreciated when patients are grateful | Developed with reference to the qualitative research, which show that being able to help patients was a source of job satisfaction in all three countries | Cronbach's α of this construct was only 0.176, however this items loaded to the individual aspects at 0.432 so it was retained. | |
| Pride/shame | There are times when I feel ashamed of how we take deliveries here | Developed by authors, drawing upon the proposal of pride/shame as a construct (30) | Most respondents (strongly) disagreed with this statement at pre-test |
| Motivation | I only do this job so that I get paid at the end of the month | (19, 31) | Most respondents (strongly) disagreed with this statement at pre-test |
| Burnout | The work related to MNH care is the most stressful part of my job | Adapted from (31) | Most respondents (strongly) agreed with this statement at pretest |
| I feel totally drained at the end of every day | Adapted from (19, 31) | Did not load to any factor to the minimum of 0.3 | |
| After a day off I have new energy to work hard again. | Developed by authors with reference to qualitative findings that indicated that health workers at some facilities do not have sufficient rest and recovery time. | Did not load to any factor to the minimum of 0.3 | |
| Satisfaction | My expectations of this job have largely not been met | Developed with reference to qualitative findings, which indicated that when providers described their expectations of their work as having been clear at the outset, their described levels of motivation were higher. | Did not load to any factor to the minimum of 0.3 |
| Timeliness | I am often absent from work | Adapted from (30) as used by (19) | Most respondents (strongly) disagreed with this statement at pretest. |
| Even if I am called to take a delivery at night, I go to work the next day | Developed with reference to qualitative research that absenteeism is a problem at facilities in all three countries, and that being disturbed for a delivery a night was cited as a reason for needing time off. | Most respondents (strongly) agreed with this statement at pretest | |
| Behavior to patients | I always welcome and praise women who come to deliver at the facility | Developed with reference to qualitative research that indicated that not all staff appreciated the difficulties women faced to come and deliver at a health | Most respondents (strongly) agreed with this statement at pretest |
| I may be rude to the patients if they don't do what I ask | Developed with reference to qualitative research that gave examples that ‘not all staff’ are polite to the patients, particularly if they consider they do not accept what a provider suggests. | Most respondents (strongly) disagreed with this statement at pretest | |
| I usually allow companions to stay with women in labor. | Developed with reference to WHO MNH recommendations. | Most respondents (strongly) disagreed with this statement at pretest | |
| Conscientiousness | I am reliable and dependable at work | (30) | Most respondents (strongly) agreed with this statement |
| At work I do things that need doing without being told | (19, 30) | Most respondents (strongly) agreed with this statement | |
| Cooperativeness | I sometimes find it hard to get on with the staff that have a different training to me | Developed based on qualitative research that indicated divisions existed between more highly and lesser trained staff. | Did not load to any factor to the minimum of 0.3 |