Table 2.

Mixed Methods Studies.

Author(s), Year of Publication	Country	Main Objective	Sample Size	Main Research Findings
Brunie et al., (2014) [34]	Republic of Uganda	To examine factors related to CHW motivation and level of activity in 3 family planning programs in Uganda.	n = 226	Facilitating determinants of the CHWs motivation included acquiring new skills, social responsibility, enhanced status, helping the community, supportive supervision with helpful feedback, clients’ interest in family planning (programme) and hope for other opportunities such as future employment and advancements.
				Barriers to the CHWs motivation were lack of transport, stockouts of drugs and essential supplies, inability to support their own family from their job and complains from clients on family planning.
Chandler et al., (2009) [35]	United Republic of Tanzania	To evaluate factors affecting motivation, including reasons for varying levels of motivation, amongst clinicians in Tanzania.	n = 211	Quantitatively, among 177 clinicians’ higher salary was associated with intrinsic motivation and, was a prerequisite determinant for any other intervention to change motivation using non-financial ways.
				Qualitatively, among 34 clinicians, predominantly monetary-based determinants, the prestigious perception of status of being a healthcare professional and organizational social and physical environment were determinants of motivation.
Chin-Quee et al., (2016) [36]	Republic of Rwanda	To compare intervention and control districts and vis-à-vis CHWs’ work-related activities, their perceptions of workload manageability and reports of job satisfaction, motivation and service quality, as well as their clients’ reports of satisfaction and quality of care.	n = 400	The top three determinants of motivation among the CHWs’ in Rwanda were altruism, characterised by their desire to help their community; acquiring novel knowledge and skill; and getting and maintaining admirable professional status in the community. Receiving monetary and material goods was ranked low in the list of determinants of motivation among the community health workers. However, no statistically significant differences in determinants of the CHWs’ motivation were reported between the intervention and control groups.
Kok et al., (2018) [37]	Republic of Kenya	To assess whether this intervention influenced CHWs’ perceptions of supervision and CHW motivation over the period of 1 year after the implementation.	n = 74	Differences in the quantitative and qualitative results were evident regarding the effect of the supervision intervention on CHWs’ motivation. Qualitatively, CHWs reported the intervention enhancing their motivation due to its enhanced recognition, more support, increased knowledge, sharing the burden/workload and feeling of belongingness and team spirit. However, qualitatively, no statistically significant determinants were identified, but work conscientiousness significantly decreased from the baseline to midline $p=000,r=0.29$.
Ojakaa et al., (2014) [38]	Republic of Kenya	To investigate factors influencing motivation and retention of HCWs at primary health care facilities in three different settings in Kenya: the remote area of Turkana, the relatively accessible region of Machakos, and the disadvantaged informal urban settlement of Kibera in Nairobi.	n = 404	Among 404 healthcare workers, two statistically significant determinants of motivation were reported: manageability of workload had an odds ratio of $5.1(\mathit{CI}=2.1\mathit{to}12.0)$ and salary had an odds ratio of $13.5(\mathit{CI}=4.315\mathit{to}42.185)$
				Qualitatively, facilitators of motivation included satisfaction with salary, job security, positive response from patients and good relations in the community. Demotivators were discrimination in training, poor housing quality, language barrier for non-locals, transport problems, lack of electricity, limited education choices, career stagnation, no allowances and no mentoring support from supervisors.
Sanou et al., (2016) [39]	Republic of Uganda	To investigate the factors influencing community health workers (CHWs) motivation and retention in health service delivery.	n = 134	Qualitatively identified determinants of motivation among CHWs comprised community recognition, status, regular training and provision of supplies.
				Quantitatively determinants of motivation included training opportunities (82.8%), opportunity to serve the community (79.9%), social knowledge or understanding (64.2%), supervision (41.0%), status in the community (53.0%), good working conditions (41.0%), supplementary income (24.6%), community support (farm work) (9.7%) and national benefits (0.7%).
Zinnen et al., (2012) [17]	United Republic of Tanzania	To contribute to empirical evidence on human resources for health motivation factors to assist policymakers in promoting effective and realistic interventions.	n = 285	Powerful motivators of the 285 human resources for health were primarily monetary, including salary and allowances.
				Non-monetary motivators varied, including the working equipment and conditions (environment), training and supervision, increased staff, better work environment, transport, good housing, enough drugs and supplies and better management.