Fostering student motivation towards community healthcare: a qualitative study

OBJECTIVES: This study investigated what kinds of experiences influence regional quota (chiikiwaku) medical students’ motivation to practice community healthcare (CH), and the mechanism of this influence, by focusing on their experiences in a community-based medical education (CBME) programme. DESIGN: A qualitative thematic analysis based on interviews. SETTING: Participants were recruited from the chiikiwaku students of Kobe University, Japan, using purposive sampling. PARTICIPANTS: Fourteen students participated. The median (IQR) age of participants was 23 (23–24); half were sixth-year and half fifth-year students. ANALYSIS: From September to December 2018, the interviews were audiorecorded and transcribed verbatim. Data were analysed according to the ‘Steps for Coding and Theorisation’ method. Our theoretical framework comprised three internal motives (ie, needs, cognitions and emotions) and their subordinate motivation theories self-determination theory, expectancy-value theories, and positive and negative emotions, respectively. RESULTS: Three mechanisms and corresponding experiences emerged. The first mechanism, envisioning and preparing for practising CH, included corresponding experiences—empathy for the community, grasping the demands for CH, understanding the practices of CH, finding a role model and diminishing the conflicts between personal life and career. The second mechanism, belonging to a supportive community, included the robust construction of students’ CH community and harmonisation with community residents. The third mechanism, psychological effects included the affect heuristic and framing effect. Student experiences brought about the changes and influences described in the presented mechanisms, and had both positive and negative impacts on their motivation towards CH. These results can be interpreted through the multifaceted lenses of motivation theories. CONCLUSIONS: The authors revealed that motivation mechanisms of medical students towards CH derived from positive interaction with community residents, healthcare professionals and other students, and from exposure to attractive community environments and cultures. These experiences should be incorporated into CBME programmes to further encourage positive attitudes towards CH.