The concept of patient motivation: a qualitative analysis of stroke professionals' attitudes.

BACKGROUND AND PURPOSE The purpose of this work was to investigate how stroke rehabilitation professionals understand the concept of motivation and the ways that they use this concept in their clinical practice. METHODS This qualitative study used semistructured, in-depth interviews with the professionals working in the stroke unit of an inner-city teaching hospital in the UK. RESULTS Motivation was a frequently used concept and was described as an important determinant of rehabilitation outcome. Motivation was attributed to patients on the basis of their demeanor (proactivity was equated with motivation, passivity with lack of motivation) and their compliance with rehabilitation (compliance was seen as indicative of motivation, noncompliance as a lack of motivation). These criteria were found to have blurred boundaries. The determinants of motivation were located partly in personality factors but also in social factors. Central among the social factors were aspects of the professionals' own behavior taken to positively and negatively affect motivation. Some professionals reported treating unmotivated patients differently from motivated ones, especially if these unmotivated patients were elderly. Motivation was described as a potentially dangerous label. CONCLUSIONS Professionals are wary of the concept of motivation yet commonly use it in their clinical practice. The blurred boundaries of the criteria used to identify motivation mean that patients must strike a delicate balance between proactivity and compliance to avoid being categorized as unmotivated. The way the concept of motivation is used in clinical practice might have negative implications for patient care, eg, when reticent yet motivated patients are labeled unmotivated.