Motivation

Motivation refers to desires and visions that drive and direct people and organisations to engage with a practice. We hypothesise that co-creation as well as the participatory format of the training seminars will lead to increased intrinsic ownership and motivation to practice childbirth care in a different way [34]. Further, we hope that participants will invest themselves in the process and thereby take ownership. The participatory processes and the intervention itself may facilitate ‘bottom-up’ insights and formulations of positive social actions to improve childbirth care, and foster solidarity and the motivation needed to act, care and support shifts in the practice of childbirth care. In Tanzania, birth attendants’ motivation to engage in performance enhancing activities has been linked to financial gains [35]. A remarkable finding from the PartoMa pilot study in Zanzibar, however, was that ‘low-dose, high-frequency training’ which took place outside working hours, without per diems or allowances, still had a consistently high attendance rate (an average of 60–70% of staff) [14]. It thus appeared that birth attendants chose to participate in seminars not because it provided them with extrinsic material rewards, but because it created immaterial intrinsic rewards. Active participation of birth attendants in the training seminars is further expected to have a positive influence on their commitment and job-satisfaction [36]. Related to adult learning theory, it may even be argued that attending during their free time without allowances, amplified the birth attendants’ experience of self-directed learning, meaning that their gain in knowledge and skills was largely within their control and a free choice, thereby enhancing their striving and acceptance of a personal responsibility for own learning [37]. We hypothesise that this ‘new’ enabling environment with increased intrinsic motivation will also affect birth attendants who do not participate in the co-creation process as well as non-users of the intervention.