Introduction
Learning motivation: the core of self-directed learning
Self-directed learning (SDL) is considered as a promising methodology for lifelong learning, enabling individuals to self-assess their learning needs, frame their own learning objectives, locate resources, implement their learning strategy, and finally, evaluate their learning outcomes.1 The core driving force for SDL is learning motivation, identified as a critical determinant in the quality of SDL.2 It is crucial for motivating learners to improve academic achievement and influences learning outcomes.
Learning motivation can be classified into intrinsic motivation and extrinsic motivation according to Ryan and Deci.3 Intrinsic motivation is the motivation to engage in an activity for its own sake (achievement, interest, curiosity, etc) rather than for an external reward or trigger.3 Extrinsic motivation is the motivation to engage in an activity being a way to achieve some goal, such as money, social status improvement, friendship or avoidance of punishment.3
The assessment of learning motivation in SDL has been advanced through the development of various SDL Instrument Scales (SDLIs). Cheng et al developed the SDLI, one of the most widely accepted self-assessment SDL scales. In the scale, secondary indicators including identify a clear goal, keep learning regardless of success or failure, enjoying the process of finding solutions and never giving up learning when faced with difficulties, were used to describe learning motivation.4 Concomitantly, other researchers have developed several SDLIs,5–8 not only improving the research of self-regulated learning ability but also promoting the research of learning motivation. These studies highlight the importance of learning motivation9 and it is widely agreed that improving learning motivation can significantly improve SDL ability.2
Despite these advancements, a systematic framework for the motivation of SDL is still lacking. Current research recognises the connotation indicators of learning motivation generally include self-goal, learning interest, intrinsic value and learning needs, emphasising the role of personal interests and practical work needs, such as other people’s expectations, the impact of accidental events and external pressures, as well as career expectations, career crisis, career transformation and career planning.10 These influencing factors are complex and hierarchical, underscoring the need for further exploration to develop a more cohesive understanding of SDL motivation.
SDL in pharmacy education
Since Malcolm Knowles described the concept of SDL in 1975, its importance has been increasingly recognised within hospital education. Academic institutions such as the Liaison Committee on Medical Education, the Accreditation Council for Graduate Medical Education and the American Board of Internal Medicine have emphasised the necessity for medical personnel, including pharmacists, to cultivate SDL skills. Studies on medical student education and continuing professional education for medical personnel have also found that developing motivation is an efficient way to enhance SDL competence.11 The theory of adult education posits that hospital pharmacists and other medical staff exhibit characteristics such as maturity, independence, self-direction and individuality. Their motivations for learning are generally work needs, and they will formulate suitable study plans for the pace of learning and work. In the process of their continued learning, they should be motivated to stimulate their learning motivation to cultivate their SDL ability.12 From this perspective, an investigation of learning motivation may promote the improvement of SDL competence of hospital pharmacists.
SDL development in China
In China, the development of SDL can be traced back to the 1920s when the idea of SDL was initially put forward.13 Over the years, universities have increasingly focused on developing healthy learning motivation among students to improve the quality of both teaching and learning. It has been reported that most of the learners demonstrate a positive and healthy motivation to learn, while some learners showed insufficient motivation to pursue knowledge and progress due to the lack of interest in improving their quality, learning content,and motivation to pursue true knowledge, etc.14
In parallel with educational advancements, China’s medical sector has undergone significant reforms, which resulted in constantly updating and expansion of the roles of Chinese hospital pharmacists.15 Their focus has shifted from drug dispensing to providing direct pharmaceutical services for patients, a transformation more pronounced in large general hospitals.16 To align with international standards and meet the evolving demands of healthcare, Chinese scholars have proposed strategies for improving the core competencies such as SDL of the hospital pharmacists.17 The core competencies required for Chinese hospital pharmacists encompasses six dimensions including professional practical ability, coordination and communication capabilities, management capacity, critical thinking, continuous professional development and pharmacy service consulting ability. In this context, SDL stands out as a key mechanism to improve learning skill, a significant second-level indicator in the assessment of continuous professional development.18 In this way, SDL is not merely a learning approach but a vital tool for sustaining and advancing professional competence in the ever-changing landscape of healthcare.
Necessity of exploring learning motivation of SDL among Chinese hospital pharmacists
There is still a lack of research on the SDL of hospital pharmacists in China, especially in-depth studies on their motivation for learning. Therefore, exploring the motivation of SDL of hospital pharmacists would be able to improve the SDL training system for this profession in China.19
To vividly understand the motivation of SDL from their real experience, qualitative research with in-depth interviews was conducted.17 Therefore, the purpose of this study is to answer the following two questions: (1) As lifelong learners, where does the motivation of hospital pharmacists come from? (2) What learning motivations are influenced by the professional characteristics of hospital pharmacists.
Methods
Study design
Epistemologically, this study adheres to the framework of social constructionism, drawing inspiration from the seminal work of Cadoná and Scarparo.20 Methodologically, a multicentre qualitative research was employed. The semistructured interview has been proven to facilitate participants to share detailed accounts of experiences, interpretations and perspectives. Therefore, semistructured interviews were conducted on a participant-friendly basis. Throughout the data collection phase, our focus was on extracting genuine insights into participants’ motivation of SDL by tapping into the richness of their actual work experiences.
Setting and participants
Participants of this study were selected from the pharmacy departments of nine large tertiary hospitals in Henan Province, Central China.21 The sample hospitals were situated in cities across Henan Province, including Zhengzhou (n=3), Xuchang (n=1), Luoyang (n=1), Zhumadian (n=1), Kaifeng (n=1), Nanyang (n=1) and Pingdingshan (n=1). Among them, five hospitals were university-affiliated hospitals and four hospitals were city-level public hospitals. All of them were located in relatively developed urban areas.
Given that the main purpose of this study was to explore the motivation of hospital pharmacists to learn, pharmacists outside the hospital system were excluded. Purposive sampling was employed, guided by the principle of selecting respondents most likely to provide relevant and valuable information.22 To enhance sample diversity, various measures were taken: (1) participants represented different educational levels, including bachelor’s, master’s and doctoral degrees; (2) job titles encompassed junior, intermediate and senior levels; (3) participants had a broad distribution of working experience, ranging from 3 to 13 years; (4) various job positions, such as clinical pharmacist, dispensing pharmacist and department manager, were included; (5) both male and female participants were included in proportions consistent with the male-to-female ratio of hospital pharmacists in mainland China (Li et al,23). To ensure a clear understanding of SDL, participants had to meet specific inclusion criteria, including (1) a minimum of 3 years of experience as a hospital pharmacist; (2) possession of at least a bachelor’s degree (the minimum requirement for a pharmacist in large hospitals in China) and (3) and demonstrated communication and presentation skills.
Data collection
With the support of the Henan Provincial Pharmacy Services Special Committee, one investigator (ZY) initiated exploratory contact with the pharmacy department leaders of the sample hospital. The pharmacy department leaders compiled a list of potential participants based on inclusion criteria. Then, the investigator (ZY) made initial contact with eligible pharmacists in the sample hospitals by phone, WeChat or email to understand their willingness to participate in this study. For hospital pharmacists who were willing to participate in the interview, investigators further communicated with them to determine the time and place of the formal interview.
To ensure the reliability of the data collection process, all investigators had no direct colleague relationship with the participants, nor were the leaders of the participants. First, the researchers contacted the respondents by telephone, WeChat or face-to-face interviews and explained the purpose of the study. After the respondent signed a written informed consent form, the interview was conducted in a quiet and comfortable environment to achieve richer content.24 Most of the interviews were carried out in the office rooms of pharmacists from December 2020 to May 2021. Before the formal interview, the researchers explained the concepts of SDL and learning motivation for the participants. This process generally takes about 10 min and the duration of the formal interviews lasted from 30 to 60 min. The audiorecordings were transcribed verbatim by ZY and XW. The interviewers (ZY and LW) reviewed and checked the translation draft before data analysis. During the interviews, pharmacists from various cities communicated in Mandarin, and there were few dialect differences when the interviews were conducted. All the participants were offered the opportunity to review the transcripts to improve validity.
The process of formulating the interview guide for our study was initiated by defining the research goals and questions. A preliminary framework was then established through a review of existing literature. Open-ended questions were incorporated into the guide to facilitate the free expression of participants. To enhance the guide’s effectiveness, collaboration was undertaken with an industry expert from Zhengzhou University, who contributed to the refinement of questions for improved logic and coverage. Subsequently, a pilot interview was conducted at the First Affiliated Hospital of Zhengzhou University’s Pharmacy Department. Throughout the interview, continuous adjustments were made to the guide based on participant responses and emerging topics. This flexible approach ensured that the guide could effectively steer the interviews and meet the research goals. The interview guide is shown in box 1.
Questions used in the interview guide
Opening introduction: In our opinion, as a hospital pharmacist, you are a life-long learner and you have also used self-directed learning methods frequently throughout your career. We would like you to talk about your motivation for self-directed learning. Thank you for sharing your experience!
Q1: What motivates you to keep learning on your own?
Q2: What role do you think your characteristics play in your self-directed learning?
Q3: How will your colleagues or friends around you affect your SDL motivation?
Q4:Do you have any special motivation to get along with clinicians and nursing staff? What is it?
Q5: How has your environment affected your SDL motivation?
Q6: How does your career as a pharmacist affect your SDL motivation?
Q7: Some pharmacists feel obvious occupational pressure, do you feel the same? How does this affect your SDL motivation?
Q8: From a broader perspective, what other factors do you think to affect your SDL motivation?
Data analysis
NVivo V.12 software was applied to manage data and conduct data analysis. The data of this study were inductively analysed in accordance with thematic analysis.25 The steps of the thematic analysis are shown in figure 1. Data were reported under the guidance of the Consolidated Criteria for Reporting Qualitative Studies checklist (shown as online supplemental material).
Supplemental material
Steps of the thematic analysis.
Trustworthiness
Our group has adopted the following measures to ensure trustworthiness as our previous study17 has described: (a) all the research team members have extensive experience in conducting qualitative research; (b) the first author and the corresponding author kept close contact with education specialist and hospital pharmacy specialist to continuously resolve difficulties during the study (the primary challenges addressed included methodological guidance, such as constructing interview outlines, defining main and subtopics, establishing logical relationships between themes, and structuring the overall organisation of the articles); (c) after data analysis, the results of the study were confirmed by the participants to check consistency and (d) the study was conducted in strict compliance with the operational procedures and methods.
Patient and public involvement
Patients and the public were not involved in the production of the present research.
Results
We invited 50 pharmacists to participate, and 30 of them expressed willingness to join the study. Ultimately, 16 respondents were enrolled from the nine sampled hospitals until data saturation was achieved. Most of the participants (n=13) were female and the average age of the sample was 31.88 years old (from 24 to 40 years old). The baseline characteristics of the participants are shown in table 1.
Sociodemographic characteristics of participants
Through an examination of the interview data, we initially identified 122 codes, which were subsequently refined and condensed to 42 codes. On this basis, two categories of the motivation for SDL of hospital pharmacists were grouped: intrinsic and extrinsic motivation. Intrinsic motivations include curiosity, interest, achievement, self-efficacy and personal growth. Extrinsic motivation is more varied and richly layered. Specifically, extrinsic motivation includes interpersonal motivation, work-related motivation and career-related motivation. The themes and subthemes of the study findings are shown in figure 2.
The themes and subthemes of the study findings.
Intrinsic motivation
Intrinsic motivation for SDL refers to the internal factors and personal desires that drive individuals to engage in independent and self-driven learning activities. It is characterised by a genuine interest in the subject matter, a sense of curiosity and a sense of achievement, self-efficacy and personal growth.
Interest
As is well known, interest is the best teacher. Participants said that curiosity and interest are the primary drivers of self-learning for them.
I just feel myself slowly, err(modal particle）, will be more like my career. I think it is the power of interest and then I am more willing to carry out SDL. (P4)
Achievement
A sense of achievement pleasures success and is a positive energy that promotes SDL. Hospital pharmacists who are motivated to achieve specific learning outcomes are more likely to take the initiative in directing their learning process. Several participants mentioned:
The most important is a sense of recognition in clinical. The sense of value, will continue to promote my learning. (P8)
This time there will be (yes) that kind of harvest. Anyway, is the kind of joy which can promote learning. (P12)
Self-efficacy
Hospital pharmacists in the present study stated a strong desire to improve themselves due to the rapid development of pharmaceutical professional knowledge and medical practical skills. In addition, many pharmacists are eager to challenge themselves. That is, self-efficacy is an important intrinsic motivation in SDL. Participants mentioned this in their interviews:
I feel self-improvement or self-investment is very important, so I insist on buying (learning materials)”(P2)
I just wanted to challenge myself. (P4)
Personal growth
Individuals intrinsically motivated by SDL often view learning as a pathway to personal growth and development. They are motivated by the prospect of becoming a better version of themselves through continuous learning. Participants mentioned:
I just believe in myself and my ability to get better grades. Then, er…I’m quite conscious of my studies and I learn well (P1)
Extrinsic motivation
Extrinsic motivation for SDL refers to external factors or rewards that drive individuals to engage in independent learning activities. Unlike intrinsic motivation, which arises from internal desires and interests, extrinsic motivation involves external incentives or consequences.
Interpersonal motivation
Participants in our study stated that some interpersonal triggers motivated them to be self-directed learners. Interpersonal triggers typically emanate from individuals within their immediate social environment, with whom they engage on a day-to-day basis, for example, facilitators, colleagues, family members or patients. Those interpersonal motivations include peer influence, patient influence, social support and avoidance of negative consequences.
Peer influence
It was revealed that some senior clinicians or senior pharmacists continued to carry out SDL and became role models. These role models acted as facilitators to promote them as self-directed learners. These peer influences were mentioned several times by participants:
He has been a director, and there is no promotion pressure like our young people. He still maintains a high level of learning, and then I was touched about that. (P1)
Observing and learning from the achievements and successes of peers can motivate individuals to engage in SDL. Participants also mentioned a strong feeling of pressure from colleagues, which became a powerful motivation in SDL.
She has been learning, keep learning. She is now growing particularly fast. Now she is accepted by all as a model. You know, I got a strong feeling of challenge and pressure from her. And I began to ask myself: why couldn’t I become her? why couldn’t I exceed her? (P12)
Patients influence
In the past few decades, the core work of hospital pharmacists in China has shifted from drug dispensing to clinical pharmaceutical care. Therefore, some participants claimed that the demand for professional pharmaceutical services from patients motivated them to learn.
Even if when I work at the pharmacy dispenses place, I think patients will ask some questions about drugs. We have to be professional at least, so I often turn over some pharmacology books. (P9)
Patients keep asking you questions, and then you have to find out the answers. (P6)
Social support
Having encouragement and support from peers, mentors, colleagues or family members can motivate individuals to pursue SDL. Positive social interactions create an environment that fosters learning. Some hospital pharmacists from the present study stated that family members have expectations of their work, and they would work harder in the face of expectations from them.
My family, I care about them, and they have high expectations of me. I will work hard, keep learning and keep improving. (P16)
The child has a lot of homework every day, and it’s definitely not appropriate for you to sit there and play with your phone. Then I went to study with him. (P5)
Avoidance of negative consequence
The desire to avoid negative consequences, such as job loss or academic failure, can serve as a powerful extrinsic motivator. Participants stated that they usually engaged in SDL to mitigate potential negative outcomes.
Our teacher said that if you do not write you cannot graduate. Then, okay, I wrote it, and finished it within ten days. This was also a driving force. (P7)
Work-related motivations
From a broader perspective, participants mentioned the following four work-related motivations in SDL. (1) Task relevance. The job demand of hospital pharmacists is their main motivation for SDL. (2) Learning atmosphere. A working environment full of a learning atmosphere will prompt hospital pharmacists to develop the habit of SDL. (3) Adaptation to change. When they are rotated to new positions, The new position requires knowledge and skills that participants mention as motivation. (4) Occasional stimulus. Occasional stimulus during work would also trigger SDL.
Task relevance
The perceived relevance of learning to current job tasks and responsibilities is a significant motivator. Participants in this study said that when they see a direct connection between the acquired knowledge and their daily work, they are more likely to engage in SDL.
Let’s say there’s a new drug. I think this is helpful for patients, and it also makes a lot of improvement of myself. (P11)
A lot of clinical learning is problem-based and targeted. For example, if I read an article someday and coincidentally encountered similar questions from patients or doctors, then I will remember this very soon. (P5)
Learning atmosphere
Hospital pharmacists in the present study claimed that a good learning atmosphere will greatly promote their SDL motivations. A good learning atmosphere offers opportunities for collaborative learning, where pharmacists work together to achieve common goals. That is, interacting with others in the learning process can enhance motivation.
Everyone around you is constantly learning and improving. You can also facilitate learning by working in that environment. (P8)
Adaptation to change
Participants also mentioned job rotation. There will be a new urgent need in the new position, and the learning motivation will be greatly improved accordingly to adapt to change:
When I moved to a new department, which is a completely new area, then I was actually utterly confused, and began to learn. (P5)
For example, when I first came to the International Medical Department…… Then I thought I could find something to improve my work. (P4)
Occasional stimulus
There were also interviewees who mentioned the occasional stimulus, might make self-esteem frustrated, thereby strengthening the belief in SDL.
All of a sudden, there was something that hit me so hard, and I was impressed that I felt that it should be one of the beliefs I have learned so far. From that moment on, I told myself I can’t go on like this and start learning. (P2)
Career-related motivation
In this study, participants emphasised that under the current environment of hospital pharmacy transformation, the professional comprehensive quality requirements of pharmacists are getting higher and higher, and the career-related motivational forces will also turn into the impetus of SDL. Therefore, from the perspective of career-related motivation, professional development, promotion opportunities, industry trends and career pressure were emphasised by hospital pharmacists.
Professional development
Individuals engage in SDL to enhance their professional skills and knowledge, making them more competent and effective in their current roles.
I am also really not very clear about the future. However, I think our job has a bright future in foreign countries, or you have the chance to carry out work at least. So, just do it. (P11)
Promotion opportunities
Career advancement and the potential for promotions serve as strong motivators for SDL. Individuals may undertake SDL to position themselves for higher-level roles within their organisations.
I hope to be promoted to a higher position before 40, so I need to set a learning plan.(P9)
Industry trends
Participants from this study said that the government’s policy affected their motivation for self-learning. On the one hand, the government has issued a series of documents requiring pharmacists to provide high-quality pharmaceutical services; on the other hand, the policy has not given pharmacists enough support and guarantees, causing an obvious crisis for hospital pharmacists’ sense. Individuals engage in SDL to enhance their professional skills and knowledge, making them more competent and effective in their current roles.
The government has released a lot of documents and policies on providing professional pharmacy services to patients, which makes me feel that pharmacists are very important, so I’m going to study (P13)
They have a position, such as nurses or doctors. So, we are exploring and fighting for our positions. (P1)
Career pressure
Career pressure in the healthcare field, including pharmacy, often stems from the need for continuous learning to stay updated on new medications, treatment protocols and technologies. Hospital pharmacists may engage in SDL to proactively acquire the knowledge and skills needed for professional growth and advancement.
My job here is usually about checking prescriptions and dispensing medications. I realize that this job is very easy to alternative, so I have been in and constantly looking for different ways to improve myself. (P2)
Discussion
To our knowledge, this is one of the first qualitative studies to explore the motivation in SDL of hospital pharmacists in China. The study identified that motivation for SDL among hospital pharmacists encompasses both intrinsic motivations (curiosity, interest, achievement, self-efficacy, etc) and extrinsic motivations (interpersonal, work-related and career-related motivations). Previous research on learning motivation has primarily emphasised personal interests or job requirements.26 However, the results of our study contribute to a deeper understanding of other key determinants of motivation in SDL, such as curiosity, self-efficacy and external factors.
First, our research has revealed the intrinsic motivation of hospital pharmacists in SDL, including interest, achievement, self-efficacy and personal growth. This aligns with previous research findings. Cadorin et al determined the factor structure of the Self-Assessment Scale of SDL for Nursing Staff through a continuous survey of Italian nursing staff.27 Similarly, a US study constructed and validated the Self-Rating Scale of Self-Directed Learning for Pharmacy Education. Both studies came to similar conclusions, indicating that intrinsic motivation in SDL for medical workers, such as hospital pharmacists, primarily includes self-efficacy and personal interest.11 According to Swapna’s research, learners’learning motivation is manifested in interest orientation, self-encouragement and self-motivation.28 Similar to other medical professionals, many pharmacists have a strong desire to challenge themselves, exploring and innovating in their routine tasks, which serves as a motivation for SDL.29 Unlike studies in other regions, intrinsic motivation in SDL for Chinese hospital pharmacists is significantly influenced by the ongoing healthcare reforms in China. Against the backdrop of the deepening medical reforms, hospital pharmacists experience significant stimuli. With the continuous promotion of medical reform in China, the roles of hospital pharmacists are evolving, and traditional tasks such as drug dispensing are being replaced by skilled workers. In this new scenario, hospital pharmacists need to actively engage in front-line clinical practice. This overarching trend prompts them to acquire new knowledge and master new skills, influencing their intrinsic motivation. Second, as hospital pharmacists enter clinical departments and engage with patients, they face significant peer and patient influences. Specifically, clinicians, nurses and patients have not fully embraced the evolving professional role of pharmacists, and many of the pharmaceutical services provided by pharmacists have not been recognised.30 As a result, there is an urgent need for pharmacists to find fulfilment in their work to demonstrate their value. In their constant pursuit of recognition and acknowledgement, hospital pharmacists become more motivated to engage in SDL.
Previous studies have emphasised the importance of work-related motivations in SDL.31 Similarly, our study found that many of the external motivations of hospital pharmacists are work related, such as task relevance, collaborative learning, adaptation to change and occasional stimulus. As mentioned above, since 2005, clinical pharmacy began to develop comprehensively in mainland China, and the post requirements of hospital pharmacists have increased greatly.30 Their duties have shifted from drug dispensing to clinical pharmaceutical care, and their focus has shifted from ensuring drug supply to ensuring rational use of clinical drugs.32 Prompted by the changing macro working environment, hospital pharmacists need to use their time reasonably to carry out SDL to adapt to the new requirements of their jobs. Examining the aforementioned scenario from a macroscopic lens illuminates the adaptive challenges confronting hospital pharmacists within the dynamic healthcare landscape. Delving into a more nuanced perspective, pharmacists in hospital settings may contend with the prospect of occupational rotations. In these instances, the imperative demand surfaces for hospital pharmacists to wield robust SDL capabilities to acclimate to the nuanced requirements of novel professional roles. Moreover, underscored the paramount significance of cultivating a salutary learning milieu, serving as a linchpin in elevating the intrinsic motivation of hospital pharmacists towards a heightened engagement with SDL.33 Participants in this study indicated that creating a positive learning environment was crucial for enhancing the motivation of hospital pharmacists in SDL. Such a positive learning atmosphere not only helps hospital pharmacists stay abreast of the latest developments in medical and pharmaceutical fields but also stimulates their ongoing commitment to learning. This, in turn, improves their professional capabilities, enabling them to better serve patients with high-quality care.
Interpersonal motivations stand as a primary external motivator. The results of this study reveal that, for hospital pharmacists, the colleagues with whom they collaborate or compete, the patients they interact with in their professional capacity, and even their family members in their personal lives significantly influence their motivation for SDL. Specifically, hospital pharmacists often engage with clinicians or senior pharmacists in their daily work. Clinicians typically possess higher education levels and extensive knowledge.34 Similarly, senior pharmacists boast rich working experience and adept problem-solving skills.35 These professionals with commendable SDL habits become role models for aspiring pharmacists. It is noteworthy that clinicians, nurses and patients have not fully embraced the evolving professional role of pharmacists, and the recognition of many pharmaceutical services provided by pharmacists remains limited (Rao et al,30). Consequently, there arises an urgent need for pharmacists to find fulfilment in their work and showcase their value. In the relentless pursuit of recognition and acknowledgement, hospital pharmacists are further motivated to engage in SDL.36 Furthermore, as articulated by the participants in this study, social support emerges as a positive factor in promoting their SDL endeavours. Encouragement and support from peers, mentors, colleagues or family members serve as motivational forces propelling individuals toward SDL. Positive social interactions contribute to an environment conducive to learning. Some hospital pharmacists from the present study mentioned that family members, with certain expectations regarding their work, inspire them to exert greater effort.
The other theme we identified, career-related motivations, primarily includes professional development, promotion opportunities, industry trends and career pressures. On a positive note, hospital pharmacists’ career expectations or personal career planning will continue to motivate SDL.37 Although China’s clinical pharmaceutical healthcare system is in the process of development and transition, the professional and social status of pharmacists is increasing. From international experience, hospital pharmacists are a promising profession, which gives hospital pharmacists positive career expectations. On this basis, pharmacists will actively carry out personal career planning, thus becoming a source of motivation for SDLs.38 On the other hand, from a negative perspective, the pressure of career transition for hospital pharmacists is enormous. The development of clinical pharmacy in China is relatively late. In terms of the construction of policies and regulations and the development of pharmacy education, there is a big gap between China and developed countries.30 Interestingly, our survey found that many pharmacists are willing to be problem solvers. Based on this mentality, hospital pharmacists’ sense of occupational crisis and occupational pressure are often transformed into learning motivation. Through SDL, pharmacists continue to broaden their horizons, innovate themselves, reflect their professional values and gain a sense of professional accomplishment.
One of the highlights of the study is that the self-learning motivation of hospital pharmacists has been deeply explored for the first time. The impact of career development and job requirements on self-learning motivation has also been explored. Limitations of this study should be acknowledged: (1) The study was conducted in nine urban health facilities in a single province, excluding pharmacists in remote hospitals, limiting the generalisability of the findings. (2) The sample size, although typical for qualitative studies, is relatively small compared with quantitative studies, potentially affecting the representation of the entire population. (3) Gender imbalance was observed, with more female participants. Including a more balanced gender representation would have strengthened the study’s validity. Authors’ reflections on the current research: (1) Due to the small sample size, caution is needed when generalising the findings to larger populations. (2) The authors, having experienced the impact of the pandemic for about 3 years, acknowledge that their personal views and experiences may have influenced data interpretation, introducing subjective biases. (3) One of the primary researchers (ZY), being a hospital pharmacist, may introduce bias during result analysis. (4) In the context of ongoing comprehensive healthcare reform in China, participants may be influenced by social expectations, potentially aligning their responses with societal norms rather than expressing their true experiences. This response bias may distort research findings.
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