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Publication, Part of

Dentists’ Working Patterns, Motivation and Morale - 2018/19 and 2019/20 Methodology

Annex D – Motivation Questions and Analytical Assumptions

The Dental Working Patterns (DWP) Survey is short, straightforward, and relatively easy to answer, which is important when trying to engage dentists. As well as providing data for the Dentists’ Working Patterns, Motivation and Morale series of reports, the survey is also linked to data for the Dental Earnings and Expenses Estimates reports, meaning there is an ongoing requirement to maintain the response rate. Therefore, when the decision was taken to monitor the motivation and morale levels of primary care dentists by the addition of new questions to the 2012 DWP Survey, an important requirement was to keep them as concise and clear as possible, so that they would not add an excessive burden to respondents and adversely affect participation rates.

Initial steps for designing the motivation questions included a review of those found in the 2012 Business Trends Survey of the British Dental Association (BDA) as well as the National NHS Staff Survey[1] and GP Worklife Survey[2]. Consideration was also given to the Armed Forces Continuous Attitude Survey (AFCAS)[3] that includes similar questions on morale and motivation as well as the ONS Question Bank of survey questions.

A broad overview of the motivation questions contained in these surveys highlighted five general categories of:

  • Self
  • Others
  • Pay
  • Equipment
  • Progression

Taking these five categories as a starting point, motivation questions from the BDA Business Trends Survey were chosen that elicited the broadest range of responses from recipients meaning that differences in motivation between groups of survey respondents should be readily identifiable. For example, of two questions on feelings (placed in the ‘self’ category):

I feel good about my job as a dentist

I feel good about working at this practice

The first question received a broader range of answers (from ‘strongly agree’ to ‘strongly disagree’) than the second, meaning there would be a greater chance of variation measured against the explanatory variables (such as dental type, gender or age) under investigation.

Based on this approach six motivation questions, one on leaving general dental practice and one on morale were selected for the DWP Survey. Table D1 shows the questions used for analysis in the report and how they cover the five categories as discussed in paragraph D3. Responses to the leaving question were considered a result of motivation, rather than a driver, and are analysed separately in the main report. The question on morale is assigned to the category of ‘environment’, which represents a combination of all five categories listed.

Table D1: Motivation and Morale Questions in the Dental Working Patterns Survey, 2018/19 and 2019/20

Motivation Questions








I feel good about my job as a dentist

I receive recognition for the work I do1

I feel my pay is fair2

I have all the equipment and resources I need to do my job properly

My job gives me the chance to do challenging and interesting work

There are opportunities for me to progress in my career







Leaving Question



I often think about leaving general dentistry


Morale Question



How would you rate your morale as a dentist?


1. Spoken recognition or acknowledgement (i.e. not financial) from colleagues

2. Pre-tax income (after all expenses removed) for primary care dentistry

Regarding questions A-G, dentists were asked to indicate how strongly they agreed or disagreed with the statements using a five-point Likert[4] scale:

  • Strongly agree
  • Agree
  • Neutral
  • Disagree
  • Strongly disagree

Likert scales are often used in psychology to measure people’s attitudes to a particular topic. They are described by some statisticians as ordinal scales where no assumptions can be made about the size of the differences between each category (i.e. between ‘strongly agree’ or ‘agree’ and ‘neutral’ etc.) just that one category is ranked higher or lower than other (e.g. ‘strongly agree’ is higher than ‘agree’ etc). Others, however, treat well-constructed Likert scales[5] as an interval scale and assume that the distances between each item are equal and indicative of the degree of difference between responses; this allows answers to be scored sequentially and then summed or averaged for each respondent.

Because of these differing views on the interpretation of Likert scales the results in this report are presented in two ways. The first approach uses more traditional analytical methods for ordinal scales by analysing questions individually. In the second, the Likert scale is scored sequentially and the answers to questions (A-F) for each dentist are combined to produce an average ‘motivation index’, which is discussed in the next section.

For question (H) on morale the answers were described on a similar five-point scale from ‘very high’ to ‘very low’.


Analytical Assumptions for the Average ‘Motivation Index’

For the purposes of calculating the ‘motivation index’, the Likert scale is treated sequentially and the distances between each response are assumed to be equal and they are scored as shown below:

  • ‘Strongly agree’                    100%
  • ‘Agree’                                      75%
  • ‘Neutral’                                   50%
  • ‘Disagree’                                25%
  • ‘Strongly disagree’                   0%

Each dentist’s responses to the six motivation statements are then combined into a single average figure termed their ‘motivation index’ (i.e. [% for A + % for B + % for C + % for D + % for E + % for F]/6), which forms the basis of the analysis in the relevant sections. Such a methodology makes several assumptions:

  • The perception of the terms ‘strongly agree’ or ‘agree’ etc. are the same for each dentist who answers the survey.
  • The perception of the terms ‘strongly agree’ or ‘agree’ etc. are the same for all the motivation questions in the survey.
  • By covering the five categories of self, others, equipment, progression and pay, combining the responses into a single ‘motivation index’ provides a useful measure of motivation that can supplement the single question analysis.
  • An average ‘motivation index’ of 100% would indicate a dentist was more motivated than a colleague who scored 0%. However, whilst an average score of 50% might indicate neutrality, no attempt has been made to give the scores an inherent meaning. The ‘motivation index’ is solely a means to measure differences in motivation between the groups under investigation.

The average ‘motivation index’ of dentists is considered using univariate and multivariate analysis. The multivariate analysis also makes several assumptions that are explained in more detail in Annex E.

Please note that these assumptions are made to allow a measure of motivation to be presented in as clear, concise, and accessible way as possible. However, to test these assumptions and give them further validity, more traditional analytical methods using ordinal scales are also presented in other sections of the report and both sets of results should be taken into consideration when interpreting the results.


[4] A Likert scale is a psychometric scale commonly used in research that employs questionnaires. It is the most widely used approach to scaling responses in survey research.

[5] A well-constructed Likert scale offers symmetry of clearly defined categories about a midpoint. In such symmetric scaling, equidistant attributes will typically be more clearly observed or, at least, inferred. It is when a Likert scale is symmetric and equidistant that it will behave more like an interval-level measurement.

Potential Causes of Low Morale

Time series analysis of the first four years’ motivation and morale results showed that both were decreasing. As a result, a new section was added to the survey in 2018 to attempt to identify some possible causes of this falling motivation and morale. These potential causes were identified working in collaboration with the DWG, followed examination of the most recent BDA Business Trends reports, and resulted from extensive research. The new question is shown in a copy of the DWP Survey in Annex A of the main report, with the seven potential causes offered shown below in table D2 (as well as one free text ‘Other’ category).

Table D2: Potential Causes of Low Morale Question in the Dental Working Patterns Survey, 2016/17 to 2019/20



Administration and paperwork


Disparity between treatment complexity and financial return1


Inadequate levels of remuneration for preventative care


Increasing expenses and/or declining income2


Risk of litigation and cost of indemnity fees




Recruitment and retention issues4


Other (Please state)5

1. Treatment complexity based on technical (and not patient) factors

2. Pre-tax income (after all expenses removed) for primary care dentistry

3. External regulations (including NHS/Health Service, GDC, practice inspection and decontamination)

4. Dental workforce staff (including other dentists, dental nurses, hygienists, technicians)

5. Please state any other issue(s) that have a detrimental effect on your morale in primary care dentistry

The new question was asked once at the end of the survey and asked dentists to rate on a five-point Likert scale the extent to which the seven suggested issues had a detrimental effect upon their morale:

  • Major Effect
  • Moderate Effect
  • Minor Effect
  • No Effect
  • Not Applicable

A final free text option was also provided as an eighth category. Responses to this new question are presented in Chapter 8 of the main report.

Last edited: 27 August 2020 10:35 am