Association between Japanese community health workers’ willingness to continue service and two categories of motives: Altruistic and self-oriented

Background As population aging progresses, volunteers in health field are expected to play a key role in health promotion and disease prevention, which may improve community residents’ health and well-being and at the same time help slow the growth of healthcare cost. The objective of this study is to examine the effects of self-oriented motives and altruistic motives as explanatory factors for Japanese Community Health Workers (CHWs)’ desire to continue their service. Unraveling the relative effects of these two types of motivation on CHW retention may lead to policy and practical implications for recruiting, training, and supporting CHWs in Japan. Haddad (2007) observed that citizens in Japan generally have a sense of governmental and individual responsibility for dealing with social problems. Applying these insights to CHWs, we hypothesize that altruistic motives have more potent influence on volunteers’ willingness to continue to serve than self-oriented motives. Methods Three cities in Shiga prefecture, Japan agreed to participate in the study. Anonymous, self-administered questionnaire was mailed to all CHWs who work in the three communities. The survey data were collected in March and April, 2013. A total of 417 questionnaires were mailed to CHWs, of which 346 were completed and returned (response rate 83.0%). Nine questionnaires missing response to the question concerning willingness to continue serving were removed from the analysis. The final analysis used 337 questionnaires (effective response rate 80.8%). Results One hundred ninety-nine (59.1%) of the respondents answered the question about willingness to continue CHW affirmatively, and 138 (40.9%) negatively. Controlling for other relevant factors, those with self-oriented motives in serving as CHWs were more likely to state they are willing to continue to serve (OR:1.54, confidence interval 1.00–2.37) than those without such motives. Those with altruistic motives were also more likely to say they want to continue their service (OR 1.56, confidence interval 1.08–2.27) than those without such motives. Contrary to our hypothesis, the two motives, altruistic and self-oriented, were shown to have nearly equal degree of influence on respondents’ willingness to continue serving as CHWs. Conclusion One practical implication of the research is that learning more about the twin motives, self-oriented and altruistic, of volunteers and tailoring the content of CHW training by municipal health professionals to address those motives may be beneficial.

oriented motives and altruistic motives as explanatory factors for Japanese Community Health Workers 23 (CHWs)' desire to continue their service. Unraveling the relative effects of these two types of motivation 24 on CHW retention may lead to policy and practical implications for recruiting, training, and supporting 25 CHWs in Japan. Haddad (2007) observed that citizens in Japan generally have a sense of governmental and 26 individual responsibility for dealing with social problems. Applying these insights to CHWs, we 27 hypothesize that altruistic motives have more potent influence on volunteers' willingness to continue to 28 serve than self-oriented motives.

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Methods 31 Three cities in Shiga prefecture, Japan agreed to participate in the study. Anonymous, self- 32 administered questionnaire was mailed to all CHWs who work in the three communities. The survey data 33 were collected in March and April, 2013. A total of 417 questionnaires were mailed to CHWs, of which Introduction 53 Though population aging can be observed in virtually all regions of the world today [1], its 54 advancement is most pronounced in the affluent nations. The rapidly aging population in such countries has 55 led to a number of policy challenges, one of the most important of which is an increase in healthcare costs 56 [2]. To help contain such cost increase, there has been a growing emphasis on health promotion and disease 57 prevention to fight chronic, lifestyle related diseases [3][4] and to help older adults maintain their 58 independence [5]. Health promotion and disease prevention measures targeting the elderly have been shown 59 to not only mitigate the risk of common health issues such as falls but also to improve socio-psychological 60 well-being of the recipients [6].

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It is increasingly difficult, however, for the government in industrialized nations to meet the needs of 63 all of its citizenry given the limited resources [7], and health promotion and prevention is no exception. In 64 response to such challenges, there is a growing interest in utilizing volunteers to provide health promotion 65 and education services as a way to help fill the gap between the population's needs and the resources

Household composition
Living alone Living together with family member(s) Years of service as CHW 1) 0.199

Experiences of CHW leadership role
No experiences Controlling for other relevant factors, those with self-oriented motives in serving as CHWs were 233 more likely to state they are willing to continue to serve (OR:1.54, confidence interval 1.00-2.37) than those 234 without such motives. Contrary to our hypothesis, the effect of altruistic motives on respondents' 235 willingness to continue serving as CHWs was slightly larger than that of self-oriented motives; the odds 236 ratio was 1.56(confidence interval 1.08-2.27) ( knowledge, but the emphasis has primarily been on the information needs of local residents, not the 290 volunteers. This research indicates that, in addition to altruistic motives, self-oriented motives play a 291 significant role in volunteer retention. One practical implication of the research is that learning more about 292 the twin motives, self-oriented and altruistic, of volunteers and tailoring the content of CHW training to 293 address those motives may be beneficial. For instance, many CHWs in Japan are older adults, which means 294 that they often have health issues and concern of their own; providing volunteers with training that addresses 295 volunteers' health needs and opportunities to attend health education classes may be successful in ensuring 296 continued service. Our research design is cross-sectional. To observe whether the volunteers actually continue their 300 health volunteer activities or not, one needs to employ a longitudinal research design. In the survey, because 301 of space limitation, a single question was used to assess the volunteers' self-oriented and altruistic motives.

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Further research is needed to evaluate and improve the reliability and validity of the question(s) and the 303 scale. One additional limitation of the present research is it involved a small number (n=3) of health 304 volunteer organizations located in the same region of a single prefecture in Japan.

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This study explored the effects of self-oriented and altruistic motives on community health volunteers' 308 willingness to continue serving in Japan. Controlling for other relevant factors, those with self-oriented 309 motives in serving as CHWs were more likely to state they are willing to continue to serve (OR:1.54, 310 confidence interval 1.00-2.37) than those without such motives. Contrary to our hypothesis, the effect of 311 altruistic motives on respondents' willingness to continue serving as CHWs was slightly larger than that of 312 self-oriented motives; the odds ratio was 1.56(confidence interval 1.08-2.27).

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One practical implication of the research is that learning more about the twin motives, self-oriented and 314 altruistic, of volunteers and tailoring the content of CHW training to address those motives may be 315 beneficial.