Health professionals are constantly in the position to motivate clients to improve their health. There are full workshops on how to help people live healthier and happier lives. Frederick Herzberg developed one of the popular theories of needs-based motivation that managers in the business community use quite often.



In this article, I will explain how Herzberg came to develop his theory, explain how it is different from the other popular theories, and give practical examples of how the theory is put into play.

There are many parallels between Herzberg's theory and the better-known Maslow's Hierarchy of Needs theory of motivation. Both promote that a person's basic needs must be met before the higher, more enriching needs can be addressed. Herzberg just uses different phraseology, really. The big difference between the two theories is Herzberg believes that you can have dissatisfaction and satisfaction at the same time. Motivation is a very challenging issue. I work to motivate clients on a daily basis, so this theory, in addressing the separation between the two, helps me to consider what may be missing in the basic needs of a client, which may be holding them back from accomplishing a goal they have set.

Frederick Herzberg developed his theory as a result of investigating 200 accountants and engineers in Pittsburgh, PA, and published his findings in the book, Motivation to Work, in 1959. The results of this study proved surprising to Herzberg and his colleagues, but led to what was originally known as the Two Factor Theory, which has been a major influence in how managers think about motivation. Herzberg found that there were entirely two different sets of factors associated with the feelings people had about work. Although the current theory is that there was just a one-dimensional line of satisfaction - a person was either satisfied or dissatisfied in their job- Herzberg felt there were actually two dimensions at play. There were factors that truly motivated people, but then there were other factors that led to dissatisfaction and did not influence motivation. Motivation factors addressed the amount of satisfaction and psychological growth a person experienced, and dissatisfaction was based on hygiene factors. Until the hygiene factors were satisfied, a person would continue to experience some aspect of dissatisfaction. On the other hand, once there was no more dissatisfaction, there was no more point in focusing on improving the hygiene factors, but it was then time to focus on the motivating factors.

Although hygiene factors are not the source of satisfaction, these issues must be dealt with first to create an environment in which personal satisfaction and motivation can even be possible. Examples of hygiene factors include the actual living conditions of the person, the quality of their personal relationships, their income and how they like their job, the status they hold in the community or their job, job security. The absence of these factors leads to dissatisfaction.

How many times have you worked with a client who wishes to lose weight, only to hear about the personal problems they are having at home? These personal problems represent a ‘hygiene' factor that must be dealt with before they will ever accomplish more, such as remain motivated to focus on healthy eating and exercise.

Another example of a hygiene factor is their financial position. If they worry about paying the bills, their attention will be distracted from the health suggestions you provide. They may wonder how they can afford to buy more fruit, or, how they can really justify your services right now.

A person's social situation is another area to investigate. Social relationships in both their personal life and their work environment can be a source of support while they work on improving health habits. Many people like to share their goals and challenges with others and some will use that time to use their friends and colleagues as a source of motivation and encouragement. If they lack that support system, it's important to consider how they will stay on track.

Finally, if your client is unhappy with their job or work environment, again, they are dealing with hygiene factors and may appear to be less motivated to work on their health issues.

The above examples are just a few to consider before moving onto the motivating factors. Ignoring these issues could mean failure for your client, which will then ultimately reflect on your practice. Although many of these issues appear to be outside the scope of many health professionals' practice, this emphasizes a need for a wide range of resources you can refer your clients to for further help in various areas. It also points out the importance of really getting to know the needs and concerns of your clients. If you don't understand what else is going on in their lives, you will continue to push them for health changes they just are not prepared to make at this time!

Examples of motivation factors include things that enrich our lives. For clients, this may include such examples as achievement in a personal goal they have set up with you, recognition for that achievement, the amount of responsibility the person has for not only achieving that goal but in coming up with it, themselves. Also included are the interest they have in the task they have chosen, the likelihood of success, and the chance for growth in other areas of their lives as a result, such as increased self-esteem, better relationships with others, etc. The absence of these factors leads to no satisfaction and lack of motivation.

Perhaps most important to client motivation is in helping individuals believe that the work they are doing is important and that their tasks are meaningful. Share stories of success of other clients to show them that their efforts can be successful. Make a big deal out of meaningful tasks that may have become ordinary along the way. Continually encourage and congratulate them for their progress and their efforts.

To help clients feel like they are doing a good job, they should be placed in positions where they are not being set up for failure. Help them set clear, achievable goals and make sure they know what those goals are at each visit. Adjust the goals as needed along the way. Individuals need regular, timely feedback on how they are doing.

Clients will also be more motivated if they have ownership of their work. This means providing enough freedom and power to carry out their tasks so they feel they ‘own' the result. They are the ones who should create their goals and strategies for how they will achieve them. Your role is one of motivation, education, and unconditional support. Others in their lives may show frustration at their occasional set-backs and expect more progress, so they need someone ‘in their corner', so to speak.

I have taken the Herzberg Theory of Dual-Structure of motivation and applied it to motivating clients in the healthcare setting. In the business community, this theory is applied to employees, but there are many who disagree with this theory, because Herzberg does not include pay in the motivator category. However, just as we could say that if people would improve their health, they would feel better and their relationships, and such, would improve, reality is that until a person has these other ‘hygiene' factors under control, they will not be motivated to actually take steps to improve their health.