DEMOTIVATING FACTORS AMONG VIETNAMESE PUBLIC

HEALTHCARE WORKERS DURING THE CORONAVIRUS

PANDEMIC

By

Tran Ngoc Mai

21KN707H

A thesis submitted in partial fulfillment of

the requirements for the degree of

MASTER OF PUBLIC MANAGEMENT AND

ADMINISTRATION

at the

RIKKYO UNIVERSITY

2023
This thesis is approved by the Thesis Examination Committee.

Professor Mitsuhiko KATAOKA

Professor Koji KOTANI

Professor Makoto KAKINAKA

Professor Kyohei YAMADA

Professor Seunghoo LIM

ii
 ABSTRACT

Similar to healthcare professionals worldwide, Vietnamese healthcare workers

face many challenges during the coronavirus pandemic, especially those in the public

system. Many factors could negatively affect their motivation to work, such as the risk

of infection, income loss, longer working hours, etc. However, little research has been

conducted regarding Vietnamese healthcare workers. This study investigates how

public healthcare workers’ motivation has decreased during the pandemic and

evaluates the relationship between several factors and the motivation to work. An

online survey was conducted to collect necessary information, resulting in a sample

size of 426; approximately 90% of the respondents are from Hanoi, the capital city of

Vietnam. The data were analyzed using three regression models. The results indicate

that Vietnamese healthcare workers, particularly those in Hanoi, are less motivated to

work during the pandemic compared to the pre-COVID period, and the most

significant demotivator is fear of infection. Income loss and increased working hours

are not significantly related to motivation. Training does not affect working morale,

but the better healthcare workers are equipped with personal protection items, the more

willing they are to work. This implies that mental health support should be considered

to improve public healthcare workers’ working morale during a health crisis. However,

as most people in this sample are from Hanoi, and the sample size is small, a larger,

cross-sectional dataset including healthcare workers from all over the country is

preferable to examine the effects of possible demotivators on working motivation more

precisely.

Keywords: COVID-19, motivation, public healthcare system, Vietnam.

iii
 TABLE OF CONTENTS

Approval ii
Abstract iii
Table of Contents iv
List of Figures v
List of Tables vi
Acknowledgments vii

CHAPTER 1 1
INTRODUCTION 1

CHAPTER 2 5
VIETNAM AND ITS PUBLIC HEALTHCARE PERSONNEL
DURING THE PANDEMIC 5
2.1 COVID-19 pandemic in Vietnam 5
2.2 Vietnam’s healthcare personnel in the public system during the 6
COVID-19 Pandemic

CHAPTER 3 11
DATA AND METHODOLOGY 11
3.1 Study design 11
3.2. Hypotheses 16
3.3 Methodology 18
3.3.1 Variables 22
3.3.2 Regression model

CHAPTER 4 24
RESULTS 24
4.1 Summary statistics 24
4.2. Regression result 30
4.3 Discussion 35

CHAPTER 5 38
CONCLUSION 38

REFERENCES 40

iv
 LIST OF FIGURES

Figure 2.1: Public Healthcare workers who quit their jobs divided by 9
occupations.

Figure 2.2: Public Healthcare workers who quit their jobs divided by 10
cities/ provinces.

v
 LIST OF TABLES

Table 3.1: Question regarding sociodemographic factors in Section 1 12

Table 3.2: Question regarding motivation and demotivation factors in 13

Section 2

Table 3.3: Questions regarding the intention to leave in Section 3 15

Table 3.4: Variables 19

Table 4.1: Sociodemographic summary 24

Table 4.2: Summarization of the factors related to motivation evaluated 27

by five point-scale

Table 4.3: Summarization of questions regarding the intention to leave 28

Table 4.4: F-test results and R-squared 30

Table 4.5: Regression Results 30

vi
 ACKNOWLEDGMENTS

I want to express my gratitude to my instructor, Professor Koji Kotani, for the

attentive guidance and instructions throughout the process of writing this thesis.

I am grateful to the JDS program, JICA, and the Ministry of Health of Vietnam

for allowing me to pursue and complete my master's degree at Rikkyo University.

I want to thank all the lecturers at Rikkyo University for offering me valuable

academic knowledge. My sincere thanks go to all the staff members of Rikkyo

University for their support and assistance.

vii
 CHAPTER 1

INTRODUCTION

After the first known case was identified in Wuhan, China, in December 2019,

the Coronavirus disease (COVID-19) quickly spread worldwide, resulting in a global

pandemic. Until February 2023, approximately 6,8 million people have died from the

COVID-19 outbreak (Worldometers, 2023). The pandemic has profoundly affected

healthcare systems in many countries, and healthcare workforce shortages tied to

COVID-19 surges have repeatedly been happening. As the frontiers in the battle

against the pandemic, healthcare workers face multiple detrimental challenges, such

as a high infection rate, financial hardships due to general economic repercussions,

physical exhaustion, and psychological stress (Gupta et al., 2021), which could

negatively impact their working motivation. Motivation is essential to job satisfaction,

maintenance of professional competence, and turnover rate (Thi Hoai Thu et al., 2015;

Jafar, 2018). This study focuses on Vietnamese healthcare workers in the public

system, aims to evaluate their working motivation during the pandemic, and attempts

to identify the significant demotivators.

Many studies have been conducted on healthcare workers’ motivations to work

during the pandemic. According to Steers and Porter (1991), motivation is the desire

to act to achieve a goal; it energizes, directs, and sustains a person's behavior.

Motivation is currently considered an essential part of human resource management.

Many factors can influence motivation, such as salary, interpersonal relations,

organization policy, status, job security, rewards system, communication, and

leadership style (Saari & Judge, 2004; Zani et al., 2011; Bartels et al., 2010; Kark &

van Dijk, 2007). In the case of healthcare workers, motivation can be understood as

1
the willingness to perform their tasks, which directly affects the quality of services the

healthcare system provides (Temesgen et al., 2016). Daneshkohan’s (2015) study

suggests that healthcare workers can be motivated by good management, supervisors’

or managers' support, and good working relationships with colleagues, and they seem

to be demotivated by unfair treatment, poor management, and lack of appreciation.

During the COVID-19 pandemic, healthcare workers must deal with a health crisis

caused by a quickly spreading disease, which places a burden on the healthcare system

of many countries (Mogharab, 2022) and heightens the danger of occupational

exposure (Pokharel, 2021). Consequently, the risks of stress, demotivation, and

burnout are inevitable among healthcare workers. Topics related to demotivators and

motivators of healthcare workers have been drawing the attention of many researchers

worldwide.

Previous studies have suggested several factors that could cause demotivation

among healthcare professionals during the COVID-19 pandemic. In a cross-sectional

study targeting nurses working in public hospitals, with the data collected in late March

and early April 2020, which was the peak time of the pandemic in Spain, Soto-Rubio

et al. (2020) have found that psychological risks, such as interpersonal conflicts or a

lack of organizational justice could result in burnout and psychosomatic complaints.

Wu et al. (2020) surveyed 36 hospitals in 3 provinces of China. The results show that

most nurses (92.79%) are willing to participate in the care of patients with COVID-

19. Only a small portion (7.21%) of respondents are unwilling due to worry of

insufficient local protective measures and fear of infection, having a frail or weakened

immune system, one’s family being unsupportive, or lack of confidence in one’s work

skills. Apisarnthanarak et al. (2020)’s study in Thailand has a different result; among

2
160 healthcare professionals who participated in the study, which includes physicians,

nurses, assistant nurses, and other occupational staff, the majority are not willing to

take care of admitted patients; most of the respondents are fearful of COVID-19

despite reportedly having sufficient knowledge regarding disease transmission and

infection prevention.

Several methods have been proposed to motivate healthcare workers during the

pandemic, such as improving job satisfaction, training, and monetary rewards.

According to a study conducted in an Indonesian state hospital by Diana et al. (2021)

with a sample size of 62 nurses, job satisfaction significantly affects work motivation

and employee commitment. In turn, work motivation has a significant effect on

performance. Niskala et al. (2020) suggest that improvement in organizational stability

and employees’ well-being, development of professional identity, and employees’

emotional intelligence could help raise the job satisfaction level of healthcare workers.

Proper training is also considered a factor that helps improve motivation. According

to Alabri and Siron (2020)’s study in Oman, healthcare workers with better

professional skills and knowledge regarding COVID-19’s potential risks and

prevention methods have higher motivation. They show a more professional attitude

in dealing with patients infected by the virus and the patient’s attendants. Allam (2021)

has found that Egyptian nurses’ motivational knowledge and willingness to care for

COVID-19 patients are significantly improved after participating in a work motivation

training program. In the case of Qataris nurses, Nashwan’s (2020) study shows that

nurses in high-risk sections are more willing to work directly with COVID-19 patients.

Their reason might be the allowance given by their hospital, which is higher than that

3
of staff working in low-risk sections. Therefore, monetary benefits could also be an

effective motivation booster.

According to data from the Vietnamese Ministry of Health, until February

2023, Vietnam had more than 11 million infection cases and approximately 43

thousand deaths caused by the coronavirus. Vietnamese healthcare personnel faces

multiple challenges during the peaks of the pandemic, such as a high risk of infection,

longer working hours, a stressful working environment, and income loss. Many factors

could negatively affect the working motivation of healthcare workers. However, so

far, no research has focused on these potential demotivators. Since another wide

spreading epidemic is likely to happen in the future, it is necessary to understand the

main factors that cause demotivation in the specific conditions of Vietnam and propose

appropriate policies to improve working morale during an epidemic or a pandemic.

This research aims to fill that gap by answering the question: “What is the most

influential demotivator for Vietnamese healthcare workers working in the public

system during the COVID-19 pandemic?” Furthermore, two hypotheses are examined:

1) During COVID-19, the majority of Vietnamese healthcare workers have lower

working motivation compared to the pre-pandemic period, and 2) Decreased income

is the most significant factor that leads to demotivation among Vietnamese healthcare

workers during the pandemic. An online survey was designed using Qualtrics to collect

the necessary information. The survey was distributed by social media platforms. The

relationship between healthcare workers’ self-perceived motivation and several

potential demotivators is evaluated by three simple regression models. This study aims

to provide helpful information for policymakers to deal with future health crises.

4
 CHAPTER 2

VIETNAM AND ITS PUBLIC HEALTHCARE PERSONNEL

DURING THE PANDEMIC

2.1. COVID-19 pandemic in Vietnam

Vietnam shares a border with China; therefore, it was one of the first countries

affected by the coronavirus pandemic. According to information from the World

Health Organization, from January 2020, when Vietnam discovered its first confirmed

case, until February 2023, there have been approximately 11.5 million cases with more

than 40 thousand deaths, and more than 250 million vaccine doses have been

administered. According to the Ministry of Health, Vietnam has suffered four waves

of COVID-19. The first wave lasted from January to April 2020, when the number of

community cases was just 100 and no death. The second wave was from the end of

July to the beginning of December 2021, and the third wave was from January to

March 2021; the number of community cases increased during these two waves (554

and 910, respectively). However, the number of deaths was small (the sum of deaths

in the second and third waves is 35). The fourth wave started at the end of April 2021,

mainly related to the Delta variant, and is recognized as the most dangerous and

complicated, resulting in millions of confirmed cases.

Hoang (2022) divides the progress of the COVID-19 pandemic in Vietnam into

three stages. The first stage, where the country succeeded to some degree in preventing

the spreading of the pandemic; the second stage, where the pandemic became

uncontrollable; and the third stage, which is currently ongoing, where the pandemic

relatively gets under control again. The success in the first stage could be due to strict

public health and social measures and regulations applied by the government, notably,

5
adequate testing and contact tracing system; mandatory quarantine; targeted

lockdowns; mass gatherings, travel, and mobility restrictions; clear, consistent,

creative public health messaging and informing (Pollack et al., 2021). During this

stage, Vietnam gained recognition and praise worldwide for being one of the most

effective countries in dealing with the pandemic; the country became “overconfident,”

combined with other factors, such as the unexpectedly fast infecting speed of the new

Delta variant, which Vietnam did not have enough information about; the low of

vaccine supply and low vaccinate rate; lack of thorough preparation and shortage of

medical equipment; which ultimately led to the uncontrollable situation at the peak of

the pandemic during the second stage where the number of new cases was thousands

per day (Hoang, 2022). In the third stage, due to compulsory vaccination, until March

2023, approximately 85% of the population was vaccinated. It is evaluated that

Vietnam has achieved herd immunity, and the pandemic has become an endemic

(Ministry of Health, 2023).

2.2. Vietnam’s healthcare personnel in the public system during the COVID-19

pandemic

At the beginning of the pandemic, due to previous experiences from previous

health crises, such as the 2002 - 2024 SARS outbreak, the 2009 – 2010 swine flu

pandemic, and the government’s quick and strict regulations and measures to prevent

the coronavirus from spreading, the public healthcare system had sufficient capacity

to effectively manage the number of patients which was relatively small at that time.

The attitude towards COVID-19 of healthcare workers seemed to be generally

positive. Results from Huynh et al. (2020)’s research targeting healthcare

professionals working in Ho Chi Minh City suggest that Vietnamese healthcare

6
workers have sufficient knowledge regarding COVID-19. While they are worried

about the risks that they and their family might get an infection (82.3% and 79.8%

among all survey respondents, respectively), their overall attitude is positive. The

study also finds that the more knowledge healthcare workers have, the more likely they

will have a positive attitude. However, it is worth mentioning that the survey for this

study was conducted between January and February 2020, when the first wave of the

pandemic had just started; its effects were not significant compared to later waves, the

number of cases was low, and there was no death.

As the pandemic continues and its scale and severity become more prominent,

its weight on the healthcare system also increases. As the frontiers in the battle against

COVID-19, healthcare professionals cannot avoid facing high risks of infection due to

the nature of their work. They, therefore, must enhance strict infection prevention

measures, such as wearing entire body medical clothing throughout their whole shifts,

applying strict rules regarding patients’ treatments and patient samples’ handing

methods, which are subject to change when there is a new development in the situation,

being tested for COVID frequently inside the hospitals. Remarkably, many healthcare

professionals working in hospitals that directly treat COVID patients, especially

respiratory or infectious diseases specified hospitals, must work longer hours and

sometimes stay quarantined in their workplaces for weeks without being able to go

home to see their families. During the pandemic, it is compulsory for healthcare

workers, most notably doctors and nurses from areas with fewer patients, to go to the

most severely affected areas to aid the local healthcare facilities. The psychological

stress they endure during the peaks of the pandemic is expected to be more intense

than at the beginning.

7
 Healthcare workers do not only have to face health risks for themselves and

the people who are close to them, but as members of a society that is put under a lot of

pressure and changes during an unusual time, their lives are also negatively affected

in many aspects, notably decreased income, and stress due to abrupt changes in daily

lives. According to Joint Circular No. 10/2015/TTLT-BYT-BNV and No.

26/2015/TTLT-BYT-BNV published by the Ministry of Health in 2015, the basic

salary of a freshly graduated doctor is nearly 3.5 million VND, and a newly graduated

nurse is almost 2,8 million VND per month, both are not exceptionally high in

comparison to the average monthly salary of Vietnam which was approximately 6.7

million VND in 2022 (Trading Economic, 2023). In financially independent public

hospitals, which do not rely on state government funds, but on the revenue generated

from out-of-pocket patient payments and insurance, healthcare workers’ salaries are

typically higher than the basic level. However, this income is expected to be decreased

during the pandemic due to overall economic stagnation and the lack of patients during

lockdown periods. Moreover, their daily lives outside work are also affected; for

example, many people cannot see their family members, relatives, and friends for

weeks or months due to strict travel restrictions. In some previous cases, in areas that

had confirmed community cases, the whole neighborhoods could be put under

quarantine, and people were only permitted to go outside their houses a couple of times

per week to buy groceries and other necessities.

From January 1st, 2021, to June 30th, 2022, during eighteen months, 9680

public healthcare workers resigned from their jobs (Graph 1 and 2), which undoubtedly

caused the burden currently being put on the healthcare system to be heavier. The

Ministry of Health (2022) addressed four possible reasons for this situation, which are

8
(1) public healthcare personnel have to deal with a hefty workload and dangerous

working conditions during the pandemic, which leads to stress and burnout; (2) low

salary in comparison with jobs in the private sector; (3) lack of necessary facilities and

apparatus to work effectively; and (4) pressure being put on healthcare workers by

society and their families. This fact highlights the importance of finding out the main

demotivation factors to propose suitable and effective policies to improve the working

morale of healthcare workers and encourage them to stay in the public system during

a health crisis, as another epidemic or pandemic is bound to happen.

PUBLIC HEALTHCARE WORKERS WHO QUIT

THEIR JOBS DIVIDED BY OCCUPATIONS
Doctors Nurses Medical technicians Midwives Pharmacists Other

23%
32%

6%
3%
6%

30%

Figure 2.1.

9
 PUBLIC HEALTHCARE WORKERS WHO QUIT THEIR
JOBS DIVIDED BY CITIES/ PROVINCES
2500

2000

1500

1000

500

0
Ho Chi Hanoi Dong Nai Binh An Giang Long An Da Nang Can Tho Dong
Minh City Duong Thap

Figure 2.2

10
 CHAPTER 3

DATA AND METHODOLOGY

3.1. Study design

Vietnamese public healthcare system provides more accessible and affordable

healthcare services to the general population than private institutions; therefore, public

healthcare workers have an essential role in maintaining and improving public health.

During a crisis like the coronavirus pandemic, the public health system shoulder even

heavier responsibilities than usual. Public hospitals, especially those specializing in

contagious and respiratory diseases, are primarily tasked with hospitalizing and

treating COVID patients. Healthcare personnel must deal with changes in their

working environment and daily lives. Many factors can lead to stress and

demotivation, notably high risks of infection, decreased income, longer working hours,

and long periods of obligated quarantine during the peaks of the pandemic.

According to information from Vietnam’s Ministry of Health, in 2021 and

2022, thousands of healthcare workers, mostly doctors and nurses, resigned from

public hospitals or other public medical institutions to pursue higher-paying jobs in

the private sector. Moreover, a significant portion of them worked in big cities, such

as Ho Chi Minh City and Hanoi, where the demand for healthcare services is expected

to be significant. Motivating healthcare workers during a health crisis and encouraging

them to stay in the public system is undoubtedly essential for policymakers. The

factors that cause demotivation need to be addressed to provide the proper support.

This study aims to answer the research question: “During the COVID-19

pandemic, what is the biggest demotivator for Vietnamese healthcare workers in public

hospitals?” A survey was designed to collect the necessary data. The survey is divided

11
into three sections: Section 1 includes multiple-choice questions regarding the

respondents’ sociodemographic factors; Section 2 focuses on motivation during the

pandemic and factors that could affect it; Section 3 consists of three questions

regarding the respondents’ intention to leave their current positions. In particular,

section 2 has ten questions; question 1 asks about respondents’ self-perceived

motivation to work during the pandemic and uses a multiple-choice format, which

includes five choices with different severity levels, and is later conversed into a 5-point

scale during the data analysis process; questions from 2 to 8 are statements regarding

factors that could lead to demotivation, each is recorded on a 5 points scale: 1 =

strongly disagree, 2 = somewhat disagree, 3 = neutral, 4 = somewhat agree, 5 =

strongly agree; question 9 and 10 are both multiple-choices, in which respondents

choose the factors that they think are their most important motivator and demotivator.

Tables 3.1, 3.2, and 3.3 present detailed questions and statements.

Table 3.1.

Question regarding sociodemographic factors in Section 1

No Questions Answers

1 Do you work at a public Respondents choose “Yes” or “No.”

hospital? (Only respondents who choose “Yes” can proceed

with the next part of the survey.)

2 Which city or province is A list of all cities and provinces is provided for

your hospital in? respondents to choose from.

3 What is your gender? Respondents choose “Male,” “Female,” or

“Prefer not to reveal.”

12
4 What is your occupation? Respondents choose one option: “Doctor,”

“Nurse,” “Medical technician,” “Janitor,” “Office

staff,” “Security staff,” or “Other.”

5 How old are you Respondents write their ages.

6 What is your marital Respondents choose one option: “Single,”

status? “Married,” “Divorced,” or “Widowed.”

7 How long have you been Respondents choose one option: “Less than 1

working at your hospital? year,” “From 1 to 5 years,” “From 5 to 10 years,”

or “More than 10 years.”

8 What is the range of your Respondents choose one option: “Less than 5

monthly income before million VND/ month,” “From 5 million VND/

the pandemic? month to 10 million VND/ month,” “From 10

million VND/ month to 20 million VND/ month,”

“From 20 million VND/ month to 30 million

VND/ month,” or “More than 30 million VND/

month.”

Table 3.2.

Question regarding motivation and demotivation factors in Section 2

No Statement Note

1 Compared to before the Covid pandemic Respondents chose one from 5

started, how is your motivation to work choices: “Decreased a lot,”

during the pandemic? “Slightly decreased,” “Did not

change at all,” “Slightly

13
 increased,” or “Increased a

lot.”

2 I frequently have to work directly with 5 – point scale format (in

patients. which, 1 = Strongly disagree, 2

3 I frequently have to work directly with = Somewhat disagree, 3 =

patients’ samples. Neutral, 4 = Somewhat agree, 5

4 I am equipped enough by my hospital (with = Strongly agree)

protective clothing, equipment, etc.) to work

with patients who might be tested positive

for COVID during the pandemic.

5 I am well-trained and received enough

guidance from my hospital about working

with patients who might have tested positive

for COVID during the pandemic.

6 I am worried that I would be infected with

COVID due to my work.

7 My income from my job at the hospital

significantly decreased during the

pandemic.

8 I frequently have to work overtime during

the pandemic.

9 What factor makes you feel the most Respondents choose one from

stressed during the pandemic? the following choices: “Worry

about the risk of infection,”

14
 “Decreased income,” “Have to

work overtime a lot,” or

“Other” (respondents are asked

to write the factor.)

10 What is your biggest motivator during the Respondents choose one from

pandemic? the following choices: “Feeling

proud that I have accomplished

my duty,” “Salary,” “Special

allowance /Bonus money,”

“Proper training provided by

the hospital,” or “Other”

(respondents are asked to write

the factor.)

Table 3.3.

Questions regarding the intention to leave in Section 3

No Question Note

1 What is the reason(s) that make you Respondents can choose multiple

want to continue working in the options from the following choices:

hospital that you are currently in? “Job’s stability,” “Good salary,”

“Because I love my job,” “Because I

have a good relationship with my

coworkers,” “Because my current job

15
 is flexible with time,” “Because I think

my job is noble,” “Other.”

2 If you could find another job in the Respondents chose one from 3 choices:

medical field but not in the public “Yes,” “No,” or “I do not know.”

section but offering significantly

better wages, would you quit your

current job?

3 If you could find another job Respondents chose one from 3 choices:

unrelated to the medical field but “Yes,” “No,” or “I do not know.”

offering significantly better wages,

would you quit your current job?

The questionnaire was created using Qualtrics. The survey was conducted

online from August 19th to September 30th, 2022, and the questionnaire was distributed

by email, Facebook, and Zalo, two social media platforms used by many Vietnamese.

Most respondents are from two big hospitals in Hanoi, Viet-Duc University Hospital,

known as the largest surgical center in Vietnam, and Hanoi Central Odonto-

Stomatology Hospital, one of the top dental hospitals nationally. In total, 585 people

opened the survey link; 426 completed the questionnaire with a response rate of

72.82%.

3.2. Hypotheses

Healthcare workers, notably doctors and nurses working directly with patients,

have a high chance of coming in contact with virus carriers; therefore, not only them

but their families and loved ones also have to face more significant risks of infection.

16
They are required to work longer hours and follow stricter regulations and procedures

compared to the pre-pandemic period. Their income and lifestyles could also be

affected negatively. Healthcare workers must deal with many changes in the workplace

and their daily lives. In many cases, these changes might lead to stress and

demotivation. There is a trend of demotivation among healthcare workers worldwide.

Lavoie-Tremblay et al. (2022)’s study has found that during the pandemic in Canada,

nursing staff reports a high intention to leave their current setting and the profession,

and the intention is higher in nursing staff who directly care for COVID-19 patients

and for participants who report self-infection with COVID-19 and infection of a team

member at work. Said and El-Shafei’s (2021) study in Egypt also indicates that nurses

working on the front lines during COVID-19 have a high-stress level, and the majority

have low satisfaction with their jobs and the intention to leave. Malesza’s (2021) study

in Poland yields similar results; there seem to be more healthcare workers who hesitate

to work than motivated people during the pandemic. It is expected that the same trend

will be found in Vietnamese healthcare workers.

H1: During COVID-19, the majority of Vietnamese healthcare workers have

lower working motivation compared to the pre-pandemic period.

According to Huynh (2020), Vietnamese healthcare workers have sufficient

knowledge of the coronavirus. During the pandemic, the Vietnam Ministry of Health

has frequently been providing and updating instructions regarding methods to prevent

the spread of the infection, as well as continuously supplying healthcare workers with

sufficient equipment for COVID treatment and prevention, including respiratory

machines, protective clothes, masks, etc. (Ministry of Health, 2023). Healthcare

workers, especially those on the front lines, must receive training regarding infection

17
prevention methods. According to Decision No. 3355/QD-BYT published in July 2021

regarding COVID vaccination, healthcare workers are the most prioritized group to be

vaccinated first. It could be expected that despite facing a high risk of infection,

Vietnamese healthcare workers have enough knowledge and the necessary equipment

to protect their health during the pandemic. Therefore, fear of infection might be one

factor that leads to demotivation, but it is probably not the most important one.

On the other hand, the stagnant economy in general, lack of patients during the

lockdown periods, and travel restrictions severely affected the revenue of many

hospitals nationwide; the income of many healthcare workers might have significantly

decreased, which could cause difficulties in their lives. Moreover, the feeling of not

being compensated enough for the effort they put into their work could also lead to

dissatisfaction and stress. In addition, the basic wages of Vietnamese healthcare

personnel are low compared to the average income of the whole population. Therefore,

continuous pay cuts might negatively impact many healthcare workers. Income loss

might be Vietnamese healthcare workers' most significant demotivation factor. In that

case, as Gavric et al. (2023) suggest, financial incentives could be the most influential

factor in improving working motivation.

H2: Decreased income is the most significant factor that leads to demotivation

among Vietnamese healthcare workers during the pandemic.

3.3. Methodology

3.3.1. Variables

The dependent variable is the self-perceived motivation compared to the pre-

COVID period reported by healthcare workers in Question 1, Section 2 of the

questionnaire. The choices are converted into a 5-point scale according to their

18
severity: 1 = Decreased a lot, 2 = Slightly decreased, 3 = Did not change at all, 4 =

Slightly increased, 5 = Increased a lot.

Five factors that indicate possible demotivators are chosen for the regression

as independent variables, four related to external causes and one to internal causes.

The external causes are decreased_income, overtime, enough_gears, proper_training,

and the internal cause is worry_Covid. In addition, five sociodemographic factors are

added to one of the regression models, and they indicate respondents’ age, genders,

occupations, and the time they have been working at the current hospital. Detailed

information regarding the variables is presented in Table 3.4.

Table 3.4.

Variables

Variable Description Measurement

Dependent variable

Motivation_level Healthcare workers’ self-perceived working 5-point Likert

motivation during the pandemic scale

Independent variables

Decreased_income How much is healthcare workers’ income 5-point Likert

affected during the pandemic compared to scale

before the pandemic, according to their

perception?

Worry_covid How much do healthcare workers worry 5-point Likert

about the risk of getting infected with Covid scale

during the pandemic, according to their

perception?

19
Overtime How much do healthcare workers have to 5-point Likert

work overtime during the pandemic, scale

according to their perception?

Enough_gears How well do healthcare workers think they 5-point Likert

are equipped with protective apparatus by scale

their hospitals during the pandemic,

according to their perception?

Proper_training How well do healthcare workers think they 5-point Likert

are trained regarding methods to prevent scale

COVID-19 infection by their hospitals during

the pandemic, according to their perception?

Age Individuals’ ages

Nurse Dummy variable. Indicates whether an

individual is a nurse.

Doctor Dummy variable. Indicates whether an

individual is a doctor.

Working_time How many years has an individual been

working at their current hospital?

(Answers are converted to numbers: “Less

than 1 year” = 1, “From 1 to 5 years” = 2,

“From 5 to 10 years” = 3, “More than 10

years” = 4)

Male Dummy variable. Indicates whether an

individual is a man.

20
 These variables are chosen because, according to previous research, fear of

infection, decreased income, increased overtime, and whether an individual is trained

and appropriately equipped to deal with the infection risk could affect their stress level

and motivation to work. Xuan et al. conducted a study in 2020 regarding the economic

well-being and quality of life of the Vietnamese during the national distancing period.

Among 341 people who participated in their survey, nearly 67% suffered from

household income loss. World Bank’s report published in early 2022 also has a similar

result which shows that not only is there a trend in income reduction in the whole

country, nearly half of the households reported lower household incomes in December

2021 compared to the previous year. It is expected that healthcare workers’ pay is also

negatively impacted, and according to Nimrod et al. (2021), income loss and financial

restrain seemingly have an association with depressive symptoms during COVID-19.

Fear of infection is also possibly correlated with demotivation and hesitation

to work among healthcare workers, as shown in Malik’s (2022), Khanal’s (2021), and

Wang (2020)’s studies in Pakistan, Nepal, and China, respectively. According to Malik

(2022), there is a positive relationship between increased working hours and

demotivation, and the more healthcare workers feel protected by their hospitals, the

higher the working morale they seem to have. Moretti et al. (2022) have found that

healthcare workers negatively impacted by a shortage of personal protective

equipment and poor education on COVID-19 are more likely to feel reluctant to work.

In addition, sociodemographic factors, such as occupation, experience, age,

and gender, seem to have some impacts. From the result of Ilea et al. (2023)’s study,

from 2019 to 2022, Romanian physicians’ motivation seemed to increase while nurses’

motivation slightly decreased through the years. Ampil et al. (2022)’s cross-sectional

21
study in Indonesia, the Philippines, and Taiwan has found that healthcare workers in

their 30s and older are significantly less hesitant and more motivated to work than their

20s colleagues. Women working in the medical field seem to have higher anxiety

levels during the pandemic than men, according to Huang et al. (2021) and Moretti

(2022). However, it is worthy of note that in both samples, the number of females is

much bigger than that of males (the female proportion is approximately 62% and 75%,

respectively).

3.3.2. Regression model

This study utilizes the following three models to explore possible demotivators'

influence on the self-perceived motivation of Vietnamese healthcare workers in the

public system.

Model 1:

𝑀𝑜𝑡𝑖𝑣𝑎𝑡𝑖𝑜𝑛_𝑙𝑒𝑣𝑒𝑙 = 𝑏0 + 𝑏1 𝐷𝑒𝑐𝑟𝑒𝑎𝑠𝑒𝑑_𝐼𝑛𝑐𝑜𝑚𝑒 + 𝑏2 𝑊𝑜𝑟𝑟𝑦_𝐶𝑜𝑣𝑖𝑑 + 𝑢

Model 2:

𝑀𝑜𝑡𝑖𝑣𝑎𝑡𝑖𝑜𝑛_𝑙𝑒𝑣𝑒𝑙 = 𝑏0 + 𝑏1 𝐷𝑒𝑐𝑟𝑒𝑎𝑠𝑒𝑑_𝐼𝑛𝑐𝑜𝑚𝑒 + 𝑏2 𝑊𝑜𝑟𝑟𝑦_𝐶𝑜𝑣𝑖𝑑 +

𝑏3 𝑂𝑣𝑒𝑟𝑡𝑖𝑚𝑒 + 𝑏4 𝐸𝑛𝑜𝑢𝑔ℎ_𝑔𝑒𝑎𝑟𝑠 + 𝑏5 𝑃𝑟𝑜𝑝𝑒𝑟_𝑡𝑟𝑎𝑖𝑛𝑖𝑛𝑔 + 𝑢

Model 3:

𝑀𝑜𝑡𝑖𝑣𝑎𝑡𝑖𝑜𝑛_𝑙𝑒𝑣𝑒𝑙 = 𝑏0 + 𝑏1 𝐷𝑒𝑐𝑟𝑒𝑎𝑠𝑒𝑑_𝐼𝑛𝑐𝑜𝑚𝑒 + 𝑏2 𝑊𝑜𝑟𝑟𝑦_𝐶𝑜𝑣𝑖𝑑 +

𝑏3 𝑂𝑣𝑒𝑟𝑡𝑖𝑚𝑒 + 𝑏4 𝐸𝑛𝑜𝑢𝑔ℎ_𝑔𝑒𝑎𝑟𝑠 + 𝑏5 𝑃𝑟𝑜𝑝𝑒𝑟_𝑡𝑟𝑎𝑖𝑛𝑖𝑛𝑔 + 𝑏6 𝐴𝑔𝑒 + 𝑏7 𝑁𝑢𝑟𝑠𝑒 +

𝑏8 𝐷𝑜𝑐𝑡𝑜𝑟 + 𝑏9 𝑊𝑜𝑟𝑘𝑖𝑛𝑔_𝑡𝑖𝑚𝑒 + 𝑏10 𝑀𝑎𝑙𝑒 + 𝑢

where u = error terms that represent unobserved factors.

Stata is used for analyzing the correlations between the dependent and

independent variables. It is expected that the variance of the errors is not constant

across observations and may be a function of explanatory variables; therefore, the

22
Robust standard errors method is applied to obtain unbiased standard errors of OLS

coefficients under heteroscedasticity. F-test is used to check the coefficients between

independent variables (Wooldridge & Jeffrey, 2019).

Vietnamese healthcare workers who are or were working in the public system

are predicted to have a lower motivation to work during the peaks of the pandemic in

comparison to the pre-COVID period. Income loss and worry of infection are predicted

to be the most significant factors that lead to demotivation. Decreased income is

expected to have a more significant impact than fear of infection. The possible

associations between motivation, increased working hours, personal protection

equipment, and training are also examined. Sociodemographic factors, which are age,

occupation, gender, and how long have a person been working at their current hospital,

are added to Model 3 and have their effects evaluated.

23
 CHAPTER 4

RESULTS

4.1. Summary statistics

This research utilizes one dependent variable, which is healthcare workers’

self-perceived working motivation in comparison with the pre-COVID period, and

studies the possible relationship between this variable with several factors that could

lead to demotivation, such as decreased income and worry of infection, as well as the

effect of several socioeconomic factors, such as gender and occupation on motivation.

An online survey was conducted to collect data for the research, resulting in a sample

size of 426. The sociodemographic information of the sample is described in Table

4.1.

Table 4.1.

Sociodemographic summary

No Variable Description Min Max Mean Me Standard

dian deviation

1 Location Takes the value of 1 if 0 1 0.908 1 0.288

the individual lives in

Hanoi, 0 otherwise

2 Male Takes the value of 1 if 0 1 0.312 0 0.463

the individual

identifies as a male, 0

otherwise

24
3 Nurse Takes the value of 1 if 0 1 0.786 1 0.410

the individual is a

nurse, 0 otherwise

4 Doctor Takes the value of 1 if 0 1 0.091 0 0.289

the individual is a

doctor, 0 otherwise

5 Age An individual’s age 23 59 35.28 34 6.608

6 Single Takes the value of 1 if 0 1 0.150 0 0.358

the individual is

single, 0 otherwise

7 Married Takes the value of 1 if 0 1 0.812 1 0.391

the individual is

married, 0 otherwise

8 Working The individual chose 1 4 3.263 4 0.860

_time one from 4 options: 1 =

Less than one year, 2 =

1 to 5 years, 3 = 5 to 10

years, 4 = More than

10 years

9 Income The individual’s 1 5 2.671 3 0.897

monthly income

before the pandemic in

VND: 1 = Less than 5

million, 2 = 5 to 10

25
 million, 3 = 10 to 20

million, 4 = 20 to 30

million, 5 = More than

30 million

All respondents worked at public hospitals when the survey was conducted.

Approximately 90% of the respondents live in Hanoi, the capital city of Vietnam; the

rest are from other cities and provinces. Women comprise about 67% of the sample,

males 31%, while 2% chose not to reveal their genders. The majority (approximately

79%) are working as nurses, about 9% are doctors, and the rest have other occupations,

such as medical technicians (i.e., people who work with patients’ samples in hospitals’

laboratories), office workers (administration, human resources, accounting

department, etc.), engineers (i.e., people who set up and maintain hospitals’

equipment), janitors. Most of them are currently married. More than half of the

respondents are in their thirties, and more than half have worked at their current

hospital for over ten years. Approximately 57.5% had a monthly income of more than

10 million VND before the pandemic.

The respondents were asked about their motivation to work during the peaks

of the pandemic compared to pre COVID period, as well as their evaluation of several

factors that related to their working conditions and indicated changes that occurred

during the pandemic time. These factors are recorded using a 5-point Likert scale

format and summarized in Table 4.2.

26
 Table 4.2.

Summarization of the factors related to motivation evaluated by five point-scale

No Variable Min Max Mean Median Standard

deviation

1 Motivation_level 1 5 2.413 2 1.349

2 Direct_patient 1 5 3.812 4 0.660

3 Direct_sample 1 5 3.476 4 0.826

4 Decreased_income 1 5 4.117 4 0.758

5 Worry_covid 1 5 3.913 4 0.696

6 Overtime 1 5 3.404 3.5 0.852

7 Enough_gears 1 5 3.932 4 0.555

8 Proper_training 1 5 3.943 4 0.515

Out of 426 respondents, 238 people (approximately 56%) feel that their

motivation to work during the peaks of the pandemic is lower than the pre-COVID

period, 115 (27%) do not think their motivation changed at all, and 73 (17%) feel that

their motivation is higher than preceding “normal” times. This result is in accordance

with the initial prediction. It shows that it is necessary to apply suitable methods to

improve the working morale of healthcare workers in the public healthcare system

during a health crisis.

When asked whether they are working directly with patients and patients’

samples, approximately 75% (322 people) and 58% (246 people), respectively, chose

positive answers, which indicates that the majority of the respondents face higher risks

of infection during the pandemic in comparison to the general population due to the

27
nature of their jobs and workplaces. About 85% (363 people) think they have sufficient

personal protective equipment, and 87% (373 people) agree that their hospitals

adequately train them to work with patients who might test positive for COVID-19.

These numbers indicate that public hospitals make efforts to provide their employees

with the necessary equipment and knowledge to protect themselves.

However, in contradiction with the initial prediction, even though most people

think they have enough protective equipment and training, about 80% (344) are still

worried they might get infected with COVID-19 due to their work. Exactly 50% (213

people) of the sample are reportedly required to work overtime during the peaks of the

pandemic, which is understandable because public healthcare institutions bore the

primary responsibility of treating COVID patients. However, their income from their

job at the hospitals seems to decrease despite the increased duties, as about 88% (376

people) somewhat agree or strongly agree that their income is lower than in the pre-

COVID period.

Table 4.3 shows the results of questions in Section 3 of the survey regarding

healthcare workers’ intention to leave their current position in the public system.

Table 4.3

Summarization of questions regarding the intention to leave

No Questions Min Max Mean Median Standard

deviation

1 If you could find another job in 0 1 0.401 0 0.491

the medical field but not in the

public section but offering

significantly better wages,

28
 would you quit your current

job?

(= 1 if the respondent chooses

“Yes,” = 0 otherwise.)

2 If you could find another job 0 1 0.453 0 0.498

unrelated to the medical field

but offering significantly better

wages, would you quit your

current job?

(= 1 if the respondent chooses

“Yes,” = 0 otherwise)

According to the results, at the time of the survey, about 40% of the

respondents would quit their current jobs in the public healthcare system if they could

find a job that provides better financial benefits. In addition, when asked to choose the

reasons that make them want to stay with their current jobs (respondents could choose

multiple options), the majority picked stability (314 out of 426). Only 40 people chose

salary as one of the reasons for them to stay. This indicates that while healthcare

workers think that jobs in the public system are stable in the long term, their current

incomes are not competitive enough to keep them from going to the private sector if

offered higher salaries. This finding further indicates that motivating healthcare

workers is an essential task for public hospitals and the healthcare system, and

monetary incentives should be considered, among other methods, to improve working

morale.

29
4.2. Regression result

This study uses three different models to examine the influence of possible

demotivators on the self-perceived motivation of Vietnamese public healthcare

workers during the COVID-19 pandemic. Decreased income and fear of infection are

expected to be the main demotivators, and decreased income is predicted to have a

more significant effect on working morale. F-test results and regression results are

summarized in the following Table 4.4. and Table 4.5.

Table 4.4.

F-test results and R-squared

(95% confidence interval)

Model 1 Model 2 Model 3

F-statistic 4.54 5.27 3.50

Prob > F 0.0112 0.0001 0.0002

R-squared 0.0204 0.0561 0.0754

Table 4.4.

Regression results

Variable Model 1 Model 2 Model 3

Dependent variable

Motivation_level

Independent variable

Decreased_income 0.1345 0.099 0.104

(0.083) (0.082) (0.087)

Worry_covid -0.265*** -0.302*** -0.268***

30
 (0.097) (0.096) (0.101)

Overtime 0.088 0.090

(0.076) (0.077)

Enough_gears 0.396*** 0.389***

(0.119) (0.122)

Proper_training 0.069 0.033

(0.141) (0.146)

Age 0.030*

(0.015)

Nurse -0.362*

(0.199)

Doctor -0.312

(0.287)

Working_time -0.111

(0.112)

Male -0.093

(0.140)

_cons 2.896*** 1.054 0.703

Standard errors are in parentheses; significant level: * p<.1; ** p<.05; *** p<.01

In contradiction to the initial prediction, income loss does not significantly

affect Vietnamese healthcare workers’ motivation to work during the pandemic in all

three models. As reported in the previous section, most healthcare workers have lower

incomes from their jobs at public hospitals compared to the pre-COVID period, and

their motivation to work during the pandemic is generally lower than “normal” times.

31
However, pay cuts do not seem to impact motivation significantly. There might be two

reasons for this finding. One, public healthcare workers know they are safe from being

cut, and the income loss is only temporary; and two, the actual income of people in the

sample used for this research is high, and they can bear with temporary pay cuts during

the pandemic without significant difficulties. Like many other countries, Vietnam’s

public system jobs generally have high job security and stability, which means public

workers cannot be fired without a lengthy and complex process. Under normal

circumstances, public workers’ jobs are secured until retirement. Therefore, even

though their income from the hospitals decreases during the pandemic, it is likely that

most healthcare workers know that the pay cuts are only temporary.

Another factor worth mentioning is that about 90% of the people in the sample

used for this regression live and work in Hanoi, the capital city of Vietnam, where

many big hospitals are located. These hospitals do not only provide healthcare services

to citizens of Hanoi, but many other provinces as well because hospitals in big cities

are often better equipped than in small provinces, and due to a common belief among

many Vietnamese people that doctors and nurses in big cities hospitals are more

experienced and “better at their jobs.” Therefore, it would not be unexpected that the

actual incomes of healthcare workers, especially doctors and nurses in Hanoi, are

generally higher than those working in local healthcare facilities in many areas. Thus,

they might have more savings, so the temporary pay cut does not significantly impact

them.

In this model, fear of infection is the most significant demotivator. The more

healthcare workers worry that they might get infected with the coronavirus, the less

motivated they are. It is undeniable that coronavirus disease 2019 (COVID-19) is a

32
highly contagious infectious disease (Cascella et al., 2023). Even when provided with

sufficient protective equipment, such as masks and appropriate work clothing,

healthcare workers, especially those who work directly with patients, still face a high

risk of getting infected. Moreover, highly populated areas like Hanoi and Ho Chi Minh

City often suffered from aggressive outbreaks during pandemic peaks. In some cases,

there were several thousand new confirmed cases per day for several consecutive

weeks. Therefore, healthcare workers in big cities are expected to face an even greater

risk, which might be why the fear of infection is the most prominent demotivator. This

finding is in line with the common trend that has been happening in other countries:

During COVID-19, fear of infection has a negative effect on healthcare workers’

mental health, as found in multiple previous studies, such as Troisi et al. (2021),

Mohsin et al. (2021), Hamano et al. (2022), Kuhlmann et al. (2022)’s research in Italia,

Saudi Arabia, Japan, and German, respectively.

A portion of healthcare workers reportedly have to work longer hours during

the peaks of the pandemic. However, this factor does not significantly negatively

impact working morale. It is worth noting that most healthcare workers in the sample

are from a surgery specialty hospital and a dental specialty hospital which, unlike

respiratory or infectious diseases specialty hospitals, are not generally obligated to

treat COVID-19 patients continuously for an extended period. The stress level caused

by working overtime could differ between various groups of healthcare workers.

Therefore, for most people in this sample, it is understandable that working overtime

is not a significant demotivator. However, examining the relationship with a more

extensive and diverse sample is necessary to evaluate the population trend more

precisely.

33
 Regarding the factors that could motivate healthcare workers, having enough

protective equipment, such as masks, protective work clothes, etc., to work with

patients that might test positive for COVID significantly affect motivation. It could be

said that the more healthcare workers feel protected, the more motivated they are. Most

respondents (more than 80%) agree that their hospitals adequately train them to work

with patients that might test positive for COVID-19 and the patients’ samples.

However, training does not have a significantly positive effect on motivation. This

finding might be because current training content is not effective enough, as it mainly

focuses on providing healthcare workers with technical knowledge and skill but

neglects their emotional and mental state. Therefore, while healthcare workers can

protect themselves and care for patients using equipment and methods provided by the

hospitals, they are not taught how to cope with psychological risks, such as stress and

anxiety. Moreover, some healthcare workers might assume their hospital must be

responsible for training them so they can work safely and effectively. Thus, even

though training does not seem to motivate healthcare workers in this case, the lack of

it might lead to demotivation. Training has the potential to become one of the

motivation factors, as pointed out in Momanyi et al. (2016) and Tsiouris et al. (2022)’s

studies. In order to improve the effectiveness of training on work motivation for

healthcare workers, public hospitals could consider improving their training programs,

not only focusing on technical skills and knowledge but paying attention to the

psychological aspect as well, and not only for a specific period like the COVID-19

pandemic but also for the long term.

Regarding the socioeconomic factors, the older a healthcare worker is, the

more they seem to be motivated; however, not only is the number small (0.03), but it

34
is also only significant at a 10% percent level. If an individual is a nurse, they are more

likely to have lower motivation during the pandemic peaks compared to the pre-

COVID period. However, the effect is only significant at a 10% percent level, and the

effect of being a doctor on motivation is not significant at all. However, it is worth

noting that doctors only make up 9% of the sample, while the proportion of nurses is

more than 78%, plus the sample size is small (426). Therefore, a bigger sample with

more doctors would be necessary for examining the relationship between being a

doctor and motivation. The time the respondents have worked at current hospitals and

their genders also does not significantly affect working morale.

4.3. Discussion

As shown in previous research, healthcare workers worldwide have been

facing many challenges due to the COVID-19 pandemic, which could lead to stress,

burnout, and demotivation (Razu, 2021; Oțelea, 2022; Mohammadi, 2022; Paudel,

2023). Vietnamese healthcare workers are no exception. Healthcare workers,

especially those in the public healthcare system, are put on the front lines during the

coronavirus pandemic in Vietnam and are required to work directly with COVID

patients and patients who might test positive for the virus. As a result, they face a high

risk of infection, some must work longer hours, and many suffer from income loss.

Therefore, it is unsurprising for their working motivation to drop, especially during

the peaks of the pandemic.

The results of this study show that Vietnamese workers' motivation to work

during the pandemic is, in fact, lower in comparison to the pre-COVID period. While

most healthcare workers think they are provided with sufficient personal protective

equipment and are appropriately trained by their hospitals, they are still worried that

35
they might be infected with coronavirus while working. Fear of infection seems to be

the most significant demotivator. Even though most respondents reportedly have less

income from their current jobs at public hospitals compared to the pre-COVID period,

income loss does not seem to impact motivation significantly. In addition, having

enough personal protective equipment could significantly motivate healthcare

workers. Therefore, as suggested in Tomlin et al. (2020) and Appelbom et al. (2021)’s

studies, aside from protective equipment, training, monetary incentives, etc., it is

necessary to provide healthcare workers with proper psychological support.

Unfortunately, mental health is still not viewed as an important aspect of life

by many Vietnamese people; there is little recognition of prevalent common mental

illnesses, such as depression, anxiety, and substance abuse (Cohen, 2016). The number

of policies regarding mental health care, particularly in the government sector, is small

and incompatible with actual needs (Niemi et al., 2010). In order to motivate public

healthcare workers, especially during a healthcare crisis like the COVID-19 pandemic,

it might be necessary for the government and public hospitals to give mental health

care more attention and provide the healthcare workers with more appropriate,

adequate, and accessible psychological support. On the other hand, income loss does

not significantly impact motivation, according to the regression result. However, when

asked what the most significant factor that causes them to feel stressed during the peaks

of the pandemic is and presented with four options to choose from (“Worry about the

risk of infection,” “Decreased income,” “Had to work overtime a lot,” “Other”), out of

426 respondents, 200 chose fear of infection, and 195 chose decreased income.

Therefore, monetary incentives should still be considered when designing supportive

policies or programs for healthcare workers. Moreover, as suggested by Chu (2021)

36
and Nguyen et al. (2023), salary increases, improvement of the working environment

and working conditions, and improvement of managers’ management skills could help

improve healthcare workers' motivation and job satisfaction in the long run. Overall,

more research needs to be done to determine the effective and suitable methods to

improve the working motivation of Vietnamese healthcare workers.

37
 CHAPTER 5

CONCLUSION

The main goal of this study is to evaluate the impact of several possible factors

on the motivation to work during the COVID-19 pandemic of Vietnamese healthcare

workers in public healthcare facilities. The potential factors are fear of infection,

income loss, working overtime, whether the healthcare workers have been provided

with sufficient protective equipment, and whether they have been trained adequately

regarding infection prevention. In addition, sociodemographic factors, such as

occupation, age, the time an individual has been working at the current hospital, and

gender, are also evaluated. It is hypothesized that compared to the pre-COVID period,

Vietnamese public healthcare workers have lower motivation during the peaks of the

pandemic, and decreased income is expected to be the most influential factor that

caused motivation to drop. An online survey was conducted to collect the necessary

information for the study. Most respondents came from two public hospitals in Hanoi,

the capital city of Vietnam. In total, 426 people completed the survey; most of them

are nurses. Three simple regression models are used to analyze the collected data.

According to the results, Vietnamese healthcare workers’ self-perceived

motivation during the peaks of the pandemic is lower than in the previous “normal”

period. Contrary to the initial predictions, income loss does not significantly affect

motivation. Despite being provided with sufficient personal protective equipment and

training, most healthcare workers still worry that they might be infected with the

coronavirus due to their work. Fear of infection has a significant negative effect on

motivation. Moreover, the better-equipped healthcare workers are, the more motivated

they are to work, but training does not seem to impact working morale. This result

38
suggests that to improve the working morale of Vietnamese healthcare workers during

a health crisis, besides providing protective equipment, psychological and emotional

support, such as counseling services, encouragement, and validation, might be helpful.

In addition, aside from technical training, healthcare workers’ mental aspects should

be considered, and training content regarding stress management and motivation might

be beneficent.

This study has several limitations. First, the sample size is small. A much

larger sample should be used to evaluate the impacts of potential demotivators on the

working morale of Vietnamese healthcare workers more effectively and precisely.

Second, most people in the sample come from two hospitals in the same city. Building

a cross-sectional data set that includes healthcare workers from different hospitals in

multiple cities and provinces would be preferable. Third, there is an unbalance in the

portions of different groups in the sample; for example, the number of nurses is

overwhelmingly more than that of other professions, and the number of females is

much more than that of males. To examine the relationship between sociodemographic

factors, such as occupation and gender, with motivation more effectively, a better-

balanced sample is necessary. So far, little research has focused on the working

motivation of Vietnamese healthcare workers in the public healthcare system during

the COVID-19 pandemic. This study has contributed to this underexplored area and

provides evidence for the relationship between motivation and several possible

demotivators. The results of this study indicate that the mental health of healthcare

professionals should be paid more attention to, and it might be necessary to provide

them with a psychological support program or system, especially in challenging times,

for example, a widespread pandemic.

39
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