Measuring the reasons that discourage medical students from working in rural areas

Sonu Goel, Federica Angeli, Neetu Singla, Dirk Ruwaard*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


The sharply uneven distribution of human resources for health care across urban and rural areas has been a long-standing concern globally. The present study aims to develop and validate an instrument measuring the factors deterring final year students of Bachelor of Medicine and Bachelor of Surgery (MBBS) in 3 northern states of India, from working in rural areas. The medical student's de-motivation to work in rural India (MSDRI) scale was developed using extensive literature review followed by Delphi technique. The psychometric properties of the questionnaire were assessed in terms of content validity, construct validity, data quality and reliability. Exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA) was performed to identify the primary deterrents. Thirty-three items were generated from literature search followed by Delphi exercise. After assessing psychometric properties, the final instrument included 29 items whereas the EFA and CFA highlighted 5 main factors, namely lack of professional challenge, social segregation, socio-cultural gap, hostile professional environment, and lack of financial incentives as underpinning students' demotivation towards working in rural areas. The MSDRI instrument is the first valid and reliable measure for identifying deterring factors for MBBS students to work in rural areas of India. The use of it may be very helpful for policymakers as well as healthcare organizations in formulating effective measures to encourage medical students to work in rural areas, which suffer from a chronic shortage of medical personnel.

Original languageEnglish
Article number9448
Number of pages7
JournalMedicine (United States)
Issue number2
Publication statusPublished - 1 Jan 2018

Bibliographical note

© 2018 the Author(s)


  • barriers
  • career choice
  • discouraging factors
  • India
  • medical students

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