An interview guide for clinicians to identify a young disabled person’s motivation to work

1 Introduction

There is an obvious link between motivation and work, derived from the belief and evidence that there are benefits to having a motivated workforce [1]. Although there is no clear consensus about a single definition, work motivation can generally defined as ‘a set of energetic forces that originate both within as well as beyond an individual’s being, to initiate work-related behaviors, and to determine its form, direction, intensity, and duration’ [2]. Motivation is thus identified as an energizing force, it is what induces action in employees. Also, this force has implications for the form, direction, intensity and duration of behaviour. That is, it explains what employees are motivated to accomplish, how they will attempt to accomplish it, how hard they will work to do so and when they will stop [1]. To achieve a highly effective organization, managers must ensure that their employees stay motivated. Moreover, motivation has often been shown to be a major criterion by which applicants are judged by employers [3]. Therefore work motivation is not only an important factor for people that are already engaged in work, but also for people that do not have work and are in search of employment.

Within this latter group, there is a group of young people with disabilities that have no employment experience. In European countries the percentage of young people with a disability or long-standing health problem is estimated to be 16% [4, 5]. The unemployment rate for young people with disabilities is growing. One group is leaving school and entering into disability registers without having worked, while a second group is entering these registers following a short period of work [4]. Although young people with disabilities often experience multiple forms of labour market disadvantage [6–8], with the right type and level of support they could be working and making a contribution to society. Employment is beneficial for people. Not only does it provide financial benefits but it also boosts self-esteem, the opportunity to develop, socialise and build social networks. Employment provides people with a sense of dignity, self-worth and purpose. Young people with disabilities who have little or no work related experience lack these benefits [9].

In spite of careful support and guidance by professionals, young people with disabilities still experience barriers when entering the labour market. There is widespread acknowledgement that considerably more disabled people could be helped to enter the labour market than is currently the case [9]. Therefore, knowledge of influencing factors is necessary to help them successfully participate in work. Previous research indicated that motivation can have a limiting or stimulating influence on participation [10–17]. In a recent study from Holwerda et al. [18] aimed at finding factors that predict work participation in young adults with autism spectrum disorder (ASD) and attention deficit disorder (ADD) those with ASD who were highly motivated were more likely to find work compared to their counterparts (Hazard Ratio(HR) = 2.18). Another study from Holwerda et al. [19] about predictors of work participation by young adults with mild intellectual disabilities showed that highly motivated individuals were three times more likely to find work than less motivated individuals (HR = 3.47) [19]. A possible explanation for this relationship is that motivation likely leads to greater initiative to search for employment. In general, if people are motivated to work, they show more initiative to search for employment or guidance, which can result in more opportunities to succeed [20]. In addition, motivated people are likely to receive more guidance or support to find a job and coaches and employers will tend to react more positively to motivated individuals [20–23].

A Delphi study of Achterberg et al. [24] revealed that professionals themselves consider motivation to be one of the most important factors for the work participation of young people with disabilities. Motivation should therefore be included in a participation plan during the disability assessment. This plan is made to guide and support participants in their search for work. Professionals who assess the work ability of the claimant and determine the kind and amount of support or guidance a claimant gets should be able to assess whether and in what way motivation is promoting or hindering their client’s entry into the labour market. The aim of the present study is to develop an interview guide that clinicians can use when conducting disability assessments. The list of topics should help professionals gain more insight in how their client’s motivation is potentially hindering or aiding their work participation. A first step in developing the interview guide was to prepare a list of topics based on the concept of work motivation and its underlying aspects within the literature. Existing instruments that measure work motivation or aspects thereof were reviewed. Based on this information open ended questions were formulated. The following research questions were developed:

What aspects of motivation for work can be determined from the literature?

2 Method

3 Results

Our search resulted in 845 publications: 621 from Pubmed, 224 from Psych Info and zero from Picarta (see Fig. 1). We first reviewed the title and abstracts based on our inclusion criteria. Motivation for work was not always clearly described in the abstract. A total of 795 articles were excluded because they did not describe motivation for work. Because the list of 50 articles contained 12 duplications, we reviewed 38 full articles. From the 38 articles, 28 were excluded because they did not describe any aspects of work motivation. This resulted in 10 articles that describe work motivation. Two articles [25, 26] were added following a review of the reference lists. These two additions described two aspects of work motivation. As a result a total of 12 articles were included (See Table 1). Moreover, from the 38 articles, 19 were excluded as they did not describe any instrument. Four articles were also excluded because the instruments that were described were no longer available. This resulted in 15 articles that described instruments that assess work motivation, plus the two additional articles [25, 26] for a total of 17 articles (See Table 2). A total of 12 articles that described aspects of work motivation and 17 articles that described instruments designed to assess work motivation remained.

What aspects of motivation for work can be determined from the literature?

Seven aspects of work motivation were identified in the 12 articles reviewed for this purpose: intrinsic motivation, extrinsic motivation, goal setting, self-efficacy, expectancy, values and work readiness.

Intrinsic motivation refers to engaging in an activity for its own sake and experiencing the pleasure and satisfaction that is derived from participation. Extrinsic motivation refers to doing an activity to attain an outcome, goal, or benefit (e.g., remuneration) [26–30]. Vansteenkiste et al. [28], Guay [30], and Ryan [30, 31] described different types of extrinsic motivation. This type of motivation operates from a continuum ranging from completely controlled behaviours (e.g. I do this because I will get a reward) to almost fully autonomous behaviours (e.g. I want to work because it’s a good way to meet people). The advantages of autonomous motivation (intrinsic motivation or well-internalized extrinsic motivation) relative to controlled motivation (poorly internalized extrinsic motivation) in terms of job search persistence among unemployed people have been reported in the literature [28].

Grahn & Gard [33], Haase & Heckhausen [34] and & Creed et al. [25], contend that goal setting seems to be at the heart of the work motivation process. Locke & Latham [35] suggested several reasons why goals are motivating: they direct attention, increase energy, lead to task persistence and the development of task strategies for accomplishing the goal. Goal formulation on a realistic level and commitment to one’s goals can promote a clearer focus in finding a job. Expressing one’s goals and defining them appropriately increases motivation [33]. Realistic goals stimulate action. Individuals will expend more effort to achieve the desired outcome if they believe the additional effort will lead to valued rewards [33]. This is called outcome-expectancy as described by Vansteenkiste et al. [28] and Grahn & Gard [33]. Moreover, self-efficacy (belief in one’s abilities to achieve a goal) must be present for goal setting to be effective [35]. This concept is also described by Vansteenkiste et al. [28] and Grahn & Gard [33]. An unemployed young disabled person with a high expectation of finding employment will search more intensively for a job compared to a person with lower expectations [28].

Vansteenkiste et al. [28] describe that together with (outcome and efficacy) expectancies, values (derived from society’s norms, individuals’ needs and sense of self) are considered to affect motivation through positive and negative valence. Values are assumed to affect a person’s definition of a situation, so that some objects, activities and potential outcomes are perceived as having positive valence (they become attractive), while others have a negative valence (they become aversive). The intensity of job search will be positively related to the extent to which finding a job is valued, or has positive valence.

Finally, Rose et al. [36], Li et al. [37], Cheng & Li-Tsang [38] and Lam et al. [26] considered work readiness as one aspect of motivation for work. Work readiness includes skills and behaviours that are necessary to successfully participate in (paid) work. Lam et al. [26] stated that there are different stages of readiness to change; some young people with disabilities are ready to take action in seeking a job and work, while others are not. It would be effective and efficient to match interventions with the person’s stage of readiness to change.

What instruments exist that measure the different aspects of motivation for work?

The 17 articles selected contained 15 different instruments. All instruments consisted of questionnaires that were either completed by the client [22, 35–42] or the interviewer [36, 47–49]. Most instruments were developed some time ago. The oldest was published in 1971 [40], the most recent in 2011 [31]. Eight of the 15 instruments were developed before 2000 [40–45, 48]. The authors of these instruments come from different parts of the world, e.g., Australia [25] and the Netherlands [49]. The instruments were used with a varied group of participants; some with a group of unemployed participants [26, 46], others with a group of employed participants [31, 49] or in both [33, 41].

Cassidy and Lynn’s Achievement Motivation Questionnaire and Vandewalle’s Work Domain Goal Orientation measure were the only instruments that particularly focused on young people. Their samples included healthy people from easily accesses groups such as university students [40, 41].

Most participants in the remaining articles were people with some kind of problem/disorder (physical as well as mental), for example patients with chronic musculoskeletal disorders [33] or patients with schizophrenia [29]. However, none of the instruments are specifically developed for the group of young people with disabilities that were of interest to us.

All of the instruments that were reviewed in the present study assessed motivation for work. However, as can be seen in Table 2, motivation has not been defined as a unitary construct. For example, achievement motivation [40], work readiness [26] and motivation to change [33] were all terms used to describe work motivation. Consequently, the underlying subscales of the instruments vary enormously and measure different aspects of the construct work motivation.

Vansteenkiste et al. [28], also used items that assessed the degree to which people valued having a job. We found three items in Feather [50], but the original instrument was not located. Moreover, these authors used items that assessed people’s expectations of finding a job.

How can the resulting information be used to guide clinicians’ assessment of work motivation in young people with disabilities?

From the information derived from the answers to the previous questions we formulated questions for each motivational aspect. If the client’s answer does not provide sufficient information, more specific questions can be asked using the additional information as a guide. The topics in the right column can be used as prompts. For intrinsic and extrinsic motivation, the following question was defined: ‘Why do you want to work?’. Some idea about the client’s motivation may be gauged by starting with a broad topic such as this. Topics that might be raised could include: enjoyment, money, status. For goal setting, the following question was defined: ‘What kind of goals do you set for yourself?’. Professionals should see whether their clients set goals for themselves and if so, whether these goals are SMART (specific, measurable, attainable, relevant, timely). A SMART goal clarifies exactly what is expected and the measures used to determine if the goal is achieved and successfully completed [56]. For the expectancy aspect, we formulated the following question: ‘What kind of expectations do you have with regard to finding and keeping a job?. Attention should be paid to how the young person feels about getting and keeping a job in the future. The question ‘How personally important do you find it to have a job?’ was been formulated to explore how a person values employment. How important is having a job, is this an attractive goal?

For self-efficacy, we formulated the question: ‘How confident do you feel about being able to find and keep a job successfully?’. This prompt may help explore whether clients have confidence in their abilities and belief in their job-seeking attempts. Finally, for work readiness, the following question was devised: To what extent are you ready to look for a job? Professionals should identify in which stage of desired change someone is [26].

Table 3 gives an overview of the questions and corresponding topics.

4 Discussion

We systematically searched the literature for underlying aspects of motivation to work. Seven aspects emerged from our literature survey: intrinsic motivation, extrinsic motivation, goal setting, expectancies, values, self-efficacy and work readiness. These aspects were derived from different theories, resulting in several perspectives on work motivation [57, 58].

Moreover, we found different instruments in the literature that were used to assess the level of work motivation with different populations. A topic list was generated and questions were formulated for each motivational aspect based on existing instruments. For example, the question ‘Why do you want to work?’ was included to explore the degree to which someone is intrinsically or extrinsically motivated. The question ‘How confident do you feel about being able to find and keep a job successfully?’ was included to explore whether someone has a high or low self-efficacy. The seven questions are intended to aid professionals in determining how each motivational aspect applies to the client being assessed. Moreover, possible relevant subtopics are mentioned per question. These subtopics can be used to ask supplementary questions, should the answer to the general question not provide sufficient information for the professional.

Work motivation is a complex and dynamic process. There are many different theories that have been set developed to explain work motivation [57–60]. We have succeeded in combining different theoretical orientations that each offer a unique perspective. Not only the extent to which someone is motivated, but also the reason behind the motivation is taken into account. The underlying aspects that we found are derived from well established theories of work motivation [1].

Since some theories overlap, it is not always possible to distinguish between different aspects. For example, work readiness, based on the transtheoretical model of change, shares similarities with some of the other constructs. The extent to which someone is ‘work ready’ depends on different personal attributes, such as self-efficacy [59]. However, because work readiness is a motivational aspect towards the work role in particular, we decided to include this aspect despite its similarities with others.

The aspects also seem to influence each other. For example, goal setting is influenced by perceived self-efficacy. People who perceive themselves to be more capable will set higher goals for themselves [50]. Despite this overlap and relation between these aspects, they were all taken into account in the topic list in order for professionals to obtain a comprehensive view of someone’s motivation to work.

The literature review described in this article led to the development of an interview guide with seven topics related to work motivation that appear to influence work participation among young people with disabilities. The existing instruments reviewed were not found to be adequate for this purpose.

Our target group differs from the general (working) population. Young people with disabilities experience physical, mental and/or developmental problems many of which limit their functioning and limit their participation in society [60]. They are especially vulnerable during the transition from school to work, which is an important milestone in their transition to adulthood [61]. Many of these young adults participate in special needs education and prepare for the labour market through vocational training and placements. However, only about 50% of them are competitively employed after leaving school [62, 63]. In general, young people with disabilities are much less likely to be employed than their non-disabled peers [64–66] and they experience considerably lower employment rates [4, 67]. When young people with disabilities begin their vocational careers, they often have no work experience. Most measures assume people have some level of work experience.

We did not want to develop an instrument that measures the level of motivation on a quantitative scale. The questions we developed are open-ended to encourage full, meaningful answers based on the client’s feelings and specific situation. These questions are intended to initiate the conversation without steering the client. Open-ended questions like ‘Why do you want to work?’ promote discussion that is essential to developing a picture of a person’s motivation to work. We did derive the corresponding topics that we formulated from existing instruments to make sure we covered all issues that were evidence-based.

The interview guide provides a clear framework of a variety of important motivation-related topics and provides clinicians with a way to begin such conversations with young people with disabilities. Such discussions may result in a more complete participation plan in which employment support and/or interventions are suggested. Due to the vulnerable labour market position that young disabled people have, adequate support from formal and informal sources is needed. The observation that an inhibiting motivational factor is present can be the starting point for specific advice aimed at its elimination or mitigation. Interventions can be developed to enhance the impact of facilitating motivational factors and reduce the effect of negative motivational factors on work participation. A potential intervention to modify the client’s motivation could be motivational conversation, helping to formulate realistic goals and empowering the disabled to be responsible for their participation despite their limitations [22].

Before actually using this interview guide clinicians need to consider the barriers and facilitators that could influence their client’s chances of success. It would be useful to involve clinicians who plan to use the interview guide in a discussion during the implementation process. Future research should include pilot testing the use of the interview guide and modifying the material as necessary.

Conflict of interest

This study was financially supported by a grant of the UWV Knowledge Centre of the Social Security Institute, Netherlands. The authors report no conflicts of interest that are directly relevant to the content of this article.