Abstract: Background　 The Job performance of community health service workers has an important impact on the high-quality development of the medical and health field. The Job performance of community health service workers is affected by the work motivation, but the discussion of the mechanism is not perfect. Objective　 This paper discusses how work motivation influences job performance through occupational stress and job satisfaction, and examines the moderating role of subjective well-being. Methods　A total of 3 925 questionnaires were collected from 4 000 health service workers, of which 3 854 were valid, with an effective recovery rate of 98.2%. Pearson correlation analysis was used to explore the relationship between variables, and Bootstrap was used to test the significance of the chain mediation effect and PROCESS was used to test the adjustment effect. Results　 The work motivation score of community health service workers was (125.960±16.528), and the Job performance score was (72.975±9.358). Work motivation, job satisfaction, social support and subjective well-being were positively correlated with job performance (P < 0.01), while occupational stress was negatively correlated with work motivation, job satisfaction, social support, subjective well-being and job performance (P < 0.01). Work motivation → occupational stress → job satisfaction → job performance path effect was significant (95%CI: 0.002,0.005), indicating that occupational stress and job satisfaction had a chain-mediated effect on job motivation and job performance of community health service workers. SWB had a significant moderating effect on the chain mediating effect of occupational stress and job satisfaction on the relationship between work motivation and job performance of community health service workers (95%CI: -0.003,-0.001). Conclusion　The work motivation of community health service workers not only has a positive impact on job performance, but also can influence job performance through the independent mediating effect of occupational stress and job satisfaction, and the chain mediating mode of occupational stress and job satisfaction. On the basis of negative mediating effect of occupational stress and positive mediating effect of job satisfaction, subjective well-being also negatively regulates the above chain mediating effect. It is suggested that the community health service center can improve the job performance by improving the work motivation of the community health service workers, helping the staff to better cope with occupational stress, and enhancing job satisfaction and subjective well-being.

Key words: Community health service workers, Motivation to work, Job performance, Chain mediation effect, Regulatory effect

摘要： 背景 社区卫生服务人员工作绩效对医疗卫生领域的高质量发展具有重要影响，社区卫生服务人员的工作绩效受到工作动机的影响，但对于其中的作用机制的探讨尚不完善。目的 探讨工作动机如何通过职业应激和工作满意度对工作绩效产生影响，以及考察主观幸福感在其中的调节作用。方法 本研究采用目的抽样的方法选取了4 000卫生服务人员进行调查，共回收问卷3 925份，其中有效问卷为3 854份，有效回收率98.2%。采用Pearson 相关分析探讨各变量之间的关系，并且通过Bootstrap对链式中介效应显著性进行检验以及PROCESS 运算检验调节效应。结果 社区卫生服务人员的工作动机得分为（125.960±16.528）分，工作绩效得分为（72.975±9.358）分。工作动机、工作满意度、社会支持、主观幸福感分别与工作绩效呈正相关（P＜0.01），职业应激分别与工作动机、工作满意度、社会支持、主观幸福感及工作绩效呈负相关（P＜0.01）。工作动机→职业应激→工作满意度→工作绩效路径效应显著（95%CI: 0.002,0.005），表明职业应激与工作满意度在社区卫生服务人员的工作动机与工作绩效的链式中介效应成立。主观幸福感对于职业应激和工作满意度在社区卫生服务人员工作动机和工作绩效关系中链式中介作用的调节效应显著（95%CI：-0.003,-0.001）。结论 社区卫生服务人员的工作动机不仅对工作绩效产生积极影响，而且可以通过职业应激和工作满意度的独立中介作用，以及职业应激-工作满意度的链式中介方式影响工作绩效。主观幸福感在负向调节职业应激的中介作用和正向调节工作满意度的中介作用的基础上，还负向调节了上述链式中介作用。建议社区卫生服务中心可以通过提高社区卫生服务人员的工作动机，帮助员工更好地应对职业应激，增强工作满意度和主观幸福感等方式去带动工作绩效的提升。

关键词: 社区卫生服务人员, 工作动机, 工作绩效, 链式中介效应, 调节效应