A qualitative study on nutrition and well-being of healthcare shift workers

Abstract

Shift work presents a variety of health challenges. Despite the acknowledged significance of nutrition in supporting health, there is limited qualitative research on the specific dietary habits and nutritional challenges by healthcare shift workers. The present study aimed to explore challenges in maintaining optimum lifestyle behaviours among healthcare shift workers. Forty healthcare shift workers were interviewed in depth individually. The session was audio recorded and transcribed verbatim, and the interviews were conducted either face-to-face or via video call, depending on the participants’ preferences. Three key themes emerged: food intake, sleep quality, and physical activity. The participants expressed concerns about meal skipping, irregular meal schedules, food accessibility, lack of sleep, and barriers to physical activity. This study highlighted significant challenges faced by healthcare shift workers in maintaining optimal dietary and other lifestyle behaviours, emphasising the interconnectedness of food intake, sleep quality, and physical activity. Addressing such issues is crucial for improving the overall health and well-being of this workforce.

Introduction

Shift work, typically characterised by irregular and non-traditional working hours, is prevalent in the healthcare industry and affects millions of workers globally. This includes various shift types such as rotating shifts, fixed night shifts, and extended hours, all of which present unique physiological and social challenges to workers. The unique demands of shift work are associated with various health challenges, particularly circadian rhythm misalignment¹. The circadian rhythm controls the initiation of wakefulness and sleep at appropriate biological times and signals when to eat and fast. When activities of eating and sleeping do not align with these circadian cues, misalignment occurs, disrupting the body’s natural rhythms^2,3. This is specifically evident in shift workers, who often experience chronic circadian misalignment due to the reversal of their fast-feeding and sleep-wake cycles⁴. Continuous circadian disruption may increase the risk of chronic diseases such as cardiovascular disorders, diabetes, and obesity^5,6.

Shift work can lead to both physiological and psychological consequences. Physiologically, it can result in biochemical changes and lifestyle alterations, whereas psychologically, it may cause anxiety, stress, and depression. The combination of rotating shift work, circadian misalignment and stress may contribute to weight gain due to the consumption of unhealthy foods, along with possible reductions in physical activity caused by increased fatigue and disturbances in social activities⁷. Additionally, poor dietary habits can exacerbate the adverse health effects of shift work, contributing to fatigue, decreased cognitive function and poorer health outcomes⁸. The demanding nature of their jobs can negatively affect their well-being, leading to increased stress, burnout and diminished quality of life⁹. A well-organised shift rotation can minimise the negative impacts on workers’ health and well-being.

Studies have reported that shift workers often experience irregular eating patterns, inadequate nutrient intake and a reliance on convenient foods^10–12. For example, shift workers are more likely to skip meals, especially breakfast, and engage in nocturnal eating¹³. Shift work may influence the type and content of food consumed, the timing of eating, and the eating habits of shift workers. High consumption of unhealthy foods, such as saturated fats, snacks, and soft drinks, along with low intake of fruits and vegetables, is commonly observed among shift workers^14,15. This is related to a growing field of nutrition, known as chrononutrition, which focuses on how eating habits in relation to the circadian rhythm affect health. Chrononutrition may be a valuable tool for improving the health of shift workers by enhancing metabolic health and overall health¹³.

The relationship between nutrition and health is well-established, emphasising the vital role of proper dietary habits in maintaining physical and mental well-being. Optimal nutrition refers to the adequate intake of essential nutrients such as carbohydrates, proteins, fats, vitamins, and minerals that are needed to support bodily functions, maintain energy levels, and reduce the risk of chronic diseases¹⁶. Systematic reviews and meta-analyses indicate that balanced and nutritious diets stabilise energy levels, improve cognitive function, and enhance overall mood and well-being^17,18. This diet should involve a variety of food groups in appropriate proportions. These benefits are particularly essential for healthcare professionals, who often operate under high-stress conditions¹⁹. These findings underscore the importance of understanding and addressing the specific needs of shift workers, particularly in the context of nutrition and well-being.

Despite the recognised importance of nutrition in maintaining health, qualitative research exploring the specific dietary habits and nutritional challenges faced by healthcare shift workers is limited. Most existing studies focus on quantitative assessments, which often overlook the nuanced experiences and perspectives of workers that influence their dietary choices, including their personal health beliefs and work environment constraints. Additionally, a targeted qualitative study among shift workers on how meal timing, dietary choices and nutritional knowledge impact their psychosocial wellbeing is still lacking. While some international qualitative studies exist^20–22, few have explored these challenges through the lens of Malaysia’s unique healthcare system, cultural food environment, and work culture. To address this gap, we aim to conduct an in-depth exploration of the nutritional well-being of healthcare shift workers in Malaysia. By understanding their experiences, we seek to identify key factors related to dietary intake and overall well-being. This study contributes new insights into a culturally and contextually specific population, enhancing the global understanding of shift work’s impact on nutrition and health.

Methods

Study participants

This study was conducted from February to March 2024 and included healthcare workers aged between 18 and 40 years who were required to work at least two types of shifts and have been in their current setting for at least one year. Shift work was categorised as follows: three shifts – workers rotate through morning shifts, afternoon shifts, and night shifts, each lasting 8 h; and two shifts – workers rotate through two shifts per day, with each shift lasting 12 h. The participants were literate in either English or Malay, and those with a diagnosis of sleeping disorders or mental illness were excluded. Recruitment was conducted purposively across various medical departments in hospitals located in Klang Valley to represent a diverse range of roles and ensure a comprehensive understanding of the issue. The recruitment focused on nurses, medical assistants, and health attendants who were working in shifts. Medical doctors were not included because of a lack of available participants. Ethical approval was granted from the Medical Research and Ethics Committee and the National Medical Research Registry (REC/01/2023 (ST/MR/17)).

Interview procedures

All participants received a participant information sheet and provided written or digital informed consent. The interviews were in Malay or English, depending on the participants’ preferences. However, most interviews were conducted using a mix of Malay and English, reflecting the common code-switching communication style among Malaysian healthcare workers. Background information was collected, and interviews were audio-recorded.

The interview guide was designed based on existing literature and was refined with input from the experts. A pilot interview was conducted with one participant to ensure the clarity and relevance of the questions, and minor adjustments were made accordingly. The final guide focused on dietary habits, perceived barriers to healthy eating, and the impact of nutrition on well-being (Table 1).

Table 1.

Examples of questions in the topic guide.

Key interview	Probing/guidelines
Building rapport	Introduction about the interview, asking participants’ background
Dietary practices, aimed to understand overall dietary practices during shift work	- How do you feel about your diet? - How would you describe your attitude to healthy eating? - How do you manage your diet while working shift work?/What is your typical dietary intake in different shifts
Diet and well-being	- Describe your feeling about working on different shifts - Do you have time to do any exercise? - Do you sleep well? - How often have you felt stressed or anxious due to not having enough time to eat? How do you cope with this feeling?
Healthy lifestyle	Is there any other concern on nutrition that you would like to talk about?
Close for discussion

The interviews were conducted in a quiet setting or via an online platform and lasted between 30 and 60 min. The interviewer, who had a background in nutrition, was trained in qualitative interviewing and was familiar with the clinical and cultural context of healthcare shift workers. To enhance data authenticity and minimise bias, rapport was built using active listening, clarification, and unconditional acceptance techniques.

Reflexivity was maintained throughout the process by acknowledging how the researchers’ professional experiences might influence data interpretation. The interviews concluded once data saturation was achieved, with no new emerging themes identified. The principal investigator kept the data strictly private and confidential.

Data analysis

All interviews were transcribed verbatim and analysed in their original language or bilingual form to preserve meaning and contextual accuracy. Quotes used for reporting were translated into English for reporting consistency.

The data were analysed thematically, which involved several key steps: familiarisation with the data, generation and definition of codes, theme selection, and final report²³. The dataset was coded via computer-assisted qualitative data analysis software (Atlas.Ti^® version 23). The software was primarily utilised to tag and name the codes extracted from the transcription and to generate links or networks between the codes. The initial codes that emerged were discussed among three researchers to ensure consistency and accuracy. The researchers came from different but relevant backgrounds: a dietitian, a physiologist with expertise in circadian rhythms, and a statistician experienced in qualitative research. These relevant backgrounds facilitated rigorous thematic interpretation through reflexive discussion. The emerging subthemes were then coded into each theme and thoroughly discussed and agreed upon by all research members. Every step of the analysis was cross-checked to ensure credibility and promote data trustworthiness²⁴.

The reporting of this study adhered to the Standards for Reporting Qualitative Research (SRQR) checklist.

Results

Demographic data

A total of 40 respondents participated in this in-depth interview session. The gender distribution was 20% male and 80% female. Most participants (95%) followed a 3-shift work structure, with the remaining 5% following a 2-shift structure. Participants’ BMI status, as classified by the World Health Organization (WHO), ranged from normal weight to morbid obesity. Over 60% were categorised as either overweight or obese, indicating a high prevalence of excess body weight among the study population. The detailed participant backgrounds are outlined in Table 2.

Table 2.

Background of the participants (n = 40).

Variable	Category	n (%)
Age	19–29	9 (23)
	30–39	31 (77)
Gender	Male	8 (20)
	Female	32 (80)
Race	Malay	38 (95)
	Others	2 (5)
Marital Status	Single	9 (22)
	Married	28 (70)
	Widowed/Divorced	3 (8)
Occupation	Medical Assistant	2 (5)
	Nurse	29 (72)
	Health Attendant	9 (23)
Years Working in Shift	1–5 years	19 (48)
	6–10 years	11 (27)
	> 10 years	10 (25)
Shift Structure	2 shifts	2 (5)
	3 shifts	38 (95)
Household Income	< RM 5,250	28 (70)
	RM 5,250 – RM 11,820	9 (22)
	> RM 11,820	3 (8)
Academic Qualification	Primary	1 (2.5)
	Secondary	6 (15)
	Tertiary	33 (82.5)
BMI Category (kg/m²)	Normal (18.5–24.9)	14 (35)
	Overweight (25–29.9)	12 (30)
	Obese Class I (30–34.9)	8 (20)
	Obese Class II (35–39.9)	4 (10)
	Morbid Obese (> 40)	2 (5)

The results indicate three key themes concerning the nutritional issues and well-being of healthcare shift workers: food intake, sleep quality, and physical activity (Table 3).

Table 3.

Nutritional issues and well-being of healthcare shift workers.

Themes	Subthemes
Food intake	Skipping meals Irregular meal schedules Difficulties accessing nutritious food during night shifts Recommendations for employer to provide food to staff
Sleep quality	Lack of sleep Poor sleep quality Good sleep quality
Physical activity	Not exercising Barriers to exercise Exercise to improve mood

Theme 1: Food intake

Healthcare shift workers reported significant disruptions in eating patterns. Four subthemes emerged: skipping meals, irregular meal schedules, difficulties accessing nutritious food during night shifts, and suggestions for institutional food support.

• Skipping meals.

When questioned about their dietary habits during working shifts, meal skipping was commonly attributed to time constraints and work demands. Most participants expressed that they often deprioritised eating due to urgent patient care responsibilities. These responses highlight how occupational demands often take precedence over self-care behaviours such as regular eating, particularly during high-intensity shifts.

“Always skip meals because there is no time, busy with work. I have been skipping meals because work is just so demanding, and I feel like there are not enough hours in the day to get everything done.” (P1).

“I always have something urgent to deal with during working hours, and it’s like I can’t afford to take a break. I care too much about work to the point of often skipping meals.” (P9).

A common challenge is eating breakfast, especially during the morning shift, when they only consume their meal after completing their shift.

“If morning shift, usually skip breakfast and only start taking food during lunch, for evening shift usually will try to eat around 7.00–7.30 pm and for night shift will eat late dinner after midnight when finishing with work.” (P20).

“Yes, I don’t have time to eat, especially during the morning shift. I need to follow doctor rounds and only can eat after that if free time. If busy, continue working till the end of the shift.” (P12).

• Irregular meal schedules.

The participants also experienced irregular meal timings, primarily because their work involved shift schedules. Participants described eating based on opportunity, rather than routine.

“Most of the time, I’m so busy on the ward that I can’t stick to a regular eating schedule. Instead of skipping meals altogether, I will grab a quick snack whenever I can to make sure my stomach is not empty.” (P4).

“I find it really hard to stick to a regular meal schedule while working shifts, especially during night shifts. Sometimes, I’m hungry at odd hours, and other times, I’m not hungry at all. I only eat whenever I feel hungry.” (P39).

• Challenges related to accessing nutritious food during night shifts.

A majority reported poor access to healthy foods during night shifts. Snacking and unhealthy options were claimed to be more easily accessible than healthy foods.

“It is mainly about the food options available to me during those late hours. The only things I can easily get are instant noodles, sausages, and a bunch of snacks. I would love to have something more nutritious; there are just not any other options around.” (P8).

“No café open at my hospital, but have the option to buy from Grab or Food Panda apps. Most of the shops sell limited food, and many of them are unhealthy choices such as fried food or fast foods.” (P22).

• Recommendations for providing food to staff.

The participants suggested that their employer provide food, especially during night shifts. This is to ensure that workers are able to eat properly despite their busy schedules and limitations in food availability.

“It is about the lack of food options during our shifts. Most places are closed, and we are left with vending machine snacks or whatever we can bring from home. It is not always the healthiest or most convenient. I was thinking hospitals should consider providing food for the night shift staff. It would make a huge difference for us.” (P7).

“Mealtime should be included in the working time and provide meals to the staff, especially during the night shift”. (P39)

Theme 2: Effects on sleep quality

The analysis revealed a prevalent theme of sleep-related issues regarding sleep experiences. Participants expressed concerns about both the quantity and quality of sleep. Three subthemes emerged: lack of sleep, poor sleep quality, and cases of good sleep due to adaptation or routine.

• Lack of sleep.

The participants reported not having enough sleep, mostly because of evening or night shift schedules and other commitments at home, such as house chores and taking care of children.

“I’m not getting enough sleep, especially with these night shifts. I don’t get enough sleep one night, and then I’m even more tired the next day, which makes it even harder to sleep the following night.” (P2).

“Not enough sleep. Usually, I managed to sleep around 3–5 hours only daily depending on my shift schedule.” (P22).

• Poor sleep quality.

The participants also reported poor sleep quality, attributing it to factors such as disruption of their natural circadian rhythms and the inability to achieve restful, uninterrupted sleep during the day. These sleep disturbances are frequently linked to increased fatigue and reduced overall well-being.

“I find myself sleeping less than 4 hours most nights, and I wake up feeling even more tired than when I went to bed. It’s like my mind is so wound up during the week with work and other responsibilities that I can’t seem to unwind enough to get a decent night’s sleep. But the weird thing is, on my days off, I can sleep for a solid 6 to 8 hours without any trouble.” (P4).

“It’s been tough to maintain a consistent sleep schedule with my job. Some days, I have to work late into the night, and other days, I have to wake up early in the morning. It’s like my body never knows when it’s supposed to sleep, and as a result, I feel tired all the time.” (P27).

• Good sleep quality.

Interestingly, few participants reported having good-quality sleep despite working a shift. This is mainly because their bodies gradually adapt to irregular sleeping patterns, allowing them to achieve restful sleep consistently.

“I have been getting enough sleep almost every day. I have been making it a priority to stick to a consistent sleep schedule, even on my days off. I have noticed that I wake up feeling more refreshed and energized, and I have more focus and productivity throughout the day.” (P8).

“I have realized that over time, my body seems to adapt to my sleeping patterns, and I have been getting really good sleep quality as a result. I used to struggle with feeling unrested, even after a full night’s sleep. But lately, I have been waking up feeling refreshed and energized, and I think it’s because my body has adapted to my sleep schedule.” (P20).

Theme 3: Effects on physical activity

Subthemes emerged, including not exercising at all, limited opportunities to exercise, and happiness in exercise.

• Not exercise.

Some participants reported not exercising, often because of time constraints and fatigue from their demanding shift schedules.

“No time to exercise due to shift working schedule. It’s hard to find the motivation when I’m feeling overwhelmed with my work commitments.” (P1).

“Well, with my shift work being so uncertain, it’s been really challenging to find the time and energy to fit in regular exercise. Some days, I’m working long hours, and other days, I’m just too tired to even think about exercise.” (P2).

Some participants mentioned that they did not engage in structured exercise routines because their jobs involve a lot of walking, and they have household chores to attend after work hours.

“Not exercise, a lot of walking during working time and doing house chores. With my job, I’m constantly on my feet, walking around, and lifting things. Plus, when I get home, there is always a ton of house chores to tackle. So, while I may not be doing traditional workouts, I think I am definitely getting my fair share of physical activity.” (P34).

A few participants did not exercise due to time constraints and did not see the need to exercise.

“Not exercise due to time constraints and also a habit. I find myself strapped for time most days. Between my job, household responsibilities, and other commitments, it’s hard to find out time for exercise. It has become a habit of not exercising.” (P32).

• Limited opportunities for exercise.

There were also participants who claimed limited time to exercise but were still able to exercise during their rest day. They indicated that while they were interested in being physically active, their irregular work hours and lack of accessible facilities made it difficult to maintain a regular exercise routine.

“Limited time to exercise, only able to brisk walk or jogging during the rest day.” (P5).

“Less time to exercise. I can only exercise on weekends. Usually walk in the park.” (P37).

• Finding happiness in exercise.

Some participants perceived exercise as personal time for stress relief, so they prioritise making time for activities they enjoy, such as playing badminton, going to the gym, or using exercise equipment at home. They described exercise as a crucial part of their routine that helped them manage stress and improve their overall well-being.

“Will always find time to exercise. Usually will go to the gym for 1 hour after work.” (P26).

“Exercise every day at home because I have the exercise tools.” (P33).

Discussion

Shift work is known as a work schedule that consists of irregular hours that deviate from the typical schedule of daytime work and involves rotations or fluctuations between early morning, evening, and nighttime schedules²⁵. The phenomenon of circadian rhythm misalignment that arises from working in shifts leads to disruptions in dietary intake and lifestyle among shift workers¹⁶. Three key themes concerning nutritional issues and the well-being of healthcare shift workers emerged in this study: food intake, sleep quality, and physical activity. In order to explore the nutritional well-being of healthcare shift workers, a qualitative method was selected for this study, as quantitative studies are not equipped to offer comprehensive and adaptable data on cultural-contextual phenomena²⁶. Qualitative investigations allow researchers to examine and explain a wide range of questions pertaining to life experiences, knowledge, attitudes, feelings, perceptions, and opinions²⁷. This qualitative approach facilitated a rich, contextual understanding of the interplay between nutrition, timing of intake, and well-being in the context of shift work. In the Malaysian setting, local cultural norms such as communal eating practices, fasting during Ramadan, and rice-based or high-carbohydrate meals may also influence food choices, meal timing, and eating behaviours among shift workers, which adds another layer of complexity to the findings.

Meal skipping, irregular meal schedules, and limited access to nutritious food, especially during night shifts, were prevalent issues among the participants. The majority of healthcare shift workers revealed that the timing of shift schedules and excessive workload demands were the main reasons for skipping meals. Some workers practised irregular eating patterns, delaying meals until the end of their shifts. These findings are consistent with other studies that also reported irregular eating patterns and inadequate nutrient intake among shift workers^28,29. Both meal skipping and irregular dietary timings can lead to insufficient energy intake, prompting workers to resort to quick, convenient foods that are often less nutritious, such as snacks, instant noodles, sausages, and fast foods²⁹. This behaviour is particularly common among those who do not have time to prepare home-cooked meals, especially night shift workers, who faced difficulties accessing healthy food choices in this study. The timing and composition of meals are crucial for addressing the circadian rhythm of metabolic and digestive processes, as well as for managing the direct physiological consequences in the nutritional management of shift workers on night rotations³⁰.

Increased snacking behaviours indicate that shift workers are prone to increased cravings for foods, high caffeine consumption, energy drinks, and sweet beverages to stay awake and prevent fatigue^29,31. Chrononutrition, or the circadian timing of food intake, is often associated with metabolic outcomes. Disruptions in dietary choices and eating patterns are usually linked to various negative health implications due to circadian dysregulation, such as cardiovascular disease, diabetes, hypertension, and obesity, which can also lead to fatigue and reduced cognitive function^32–34. This finding is further supported by a study by Oike and colleagues³⁵, which reported that individuals with irregular feeding times and sleep deprivation have the highest prevalence of developing metabolic disorders. Additionally, late-night consumption of energy-dense food and breakfast skipping are associated with an increased risk of obesity and metabolic syndrome due to prolonged periods of lipogenesis and fat accumulation^29,36. An extended eating window, or the duration between the first and last caloric intake of the day, is considered a chronodisruptor that can eventually lead to metabolic syndrome³⁷.

Disruption of sleep cycles was identified as a major theme, with most participants reporting both reduced sleep duration and poor sleep quality. This phenomenon is well-documented in the literature, with many studies consistently suggesting that shift work is strongly associated with impaired alertness and daily performance due to circadian dysregulation and the disruption of normal sleep-wake cycles, leading to sleep disorders and poor sleep quality³⁸. The combination of abnormal working hours and increased demands of shift work inhibits healthcare workers from obtaining sufficient sleep, resulting in chronic fatigue and reduced overall well-being³⁹. This situation is further exacerbated for those who juggle work with home responsibilities, such as childcare. Transitioning between different shifts also contributes to difficulties in falling and staying asleep. Studies have shown that consistently poor sleep quality can lead to psychological issues, including depression, chronic fatigue, stress, and increased job dissatisfaction^16,39. Moreover, night shift fatigue may lead to incidents of human error and injury, which could be detrimental to patient care⁴⁰.

Additionally, poor sleep quality has been linked to significant changes in eating behaviour, especially among shift workers, where it can increase late-night appetite, leading to the consumption of readily available foods, which in turn can lead to obesity^16,41,42. Altered sleep-wake cycles, together with unhealthy dietary habits, may contribute to a potential mediating role between shift work and chronic diseases¹⁴. Adequate rest and sleep after work are essential for recovery, efficient functioning, and managing fatigue levels, especially in shift workers. According to the recommendations of the National Sleep Foundation, the average duration of sleep for adults is 7 to 9 h per day to achieve good rest for the mind and body⁴³. Interestingly, some participants reported managing to maintain consistent sleep cycles and experiencing good sleep quality despite their hectic work schedules. This suggests that different individuals may have different coping strategies and adaptations to abnormal working hours, enabling them to achieve better sleep quality. In addition, this might be due to different shift structures that accommodate personal sleep preferences and patterns. Another factor affecting this adaptation could be that the participants had been working in shifts for years and had learned to cope well. However, age-related differences in coping strategies were not captured in this study as all participants were aged between 19 and 39 years. This may limit the generalisability of the findings to older shift workers, who may have different health risks or more established adaptation mechanisms due to longer shift work exposure.

Time constraints, work fatigue, and a lack of accessible facilities were cited by the majority of participants as barriers to regular physical activity. These findings align with other research indicating that shift workers often struggle to maintain regular physical activity due to hectic work schedules and continuous fatigue compared with non-shift workers⁴⁴. Variations in the physical workload resulting from distinct work duties, patients, and resources available throughout different types of shifts could also be contributing factors⁴⁵. While some participants did not engage in any exercise, others managed to incorporate physical activity during rest days or through daily activities such as walking during shifts and doing household chores. Several participants highlighted that physical activity, despite their tight work schedules, served as a coping mechanism for relieving work stress and improving mood. Research supports the notion that regular physical activity can mitigate some of the negative impacts of shift work, particularly in reducing the risk of chronic diseases and psychological issues⁴⁶.

Physical activity is associated with numerous health benefits, including improved cardiovascular fitness, musculoskeletal functioning, and body composition. According to the World Health Organisation (2010), 150 min of moderate-intensity physical activity per week are needed to achieve health benefits, which have protective effects against the development of cardiovascular diseases, diabetes, and cancers, while also reducing all-cause mortality. Providing opportunities and support systems for healthcare workers, such as onsite exercise facilities or regular wellness programs involving physical trainers or dietitians, could encourage increased physical activity and promote better health outcomes^47,48. In addition, workplace health promotion interventions, particularly those focused on recommendations for healthy lifestyle education programs, dietary habits, and physical activity, should be implemented to improve the health and well-being of healthcare shift workers³⁰.

This study offers a novel contribution by deepening our understanding of the key factors pertaining to the dietary intake and overall well-being of shift workers, with significant implications for policymakers and stakeholders. Addressing the highlighted domains of challenges identified in the study is crucial for the shift workforce. Effective intervention strategies may include implementing structured meal plans that accommodate to shift workers’ timetables, providing education on the importance of sleep hygiene, and promoting workplace wellness initiatives to encourage physical activity. These efforts aim to adopt a holistic approach that integrates nutrition, physical activity and sleep management for shift workers. One of the study’s limitations was the predominant proportion of Malay participants, which may limit the generalisability of the findings in the context of Malaysia’s multi-ethnic populations. In addition, the gender distribution of participants was skewed toward females. In Malaysian norms, where women often shoulder more domestic duties may influence the coping strategies, time availability for sleep and exercise, and dietary behaviours, which could have affected the study themes. Furthermore, the lack of available medical doctors recruited could restrict insights into the diverse roles of healthcare shift workers. Future studies should further investigate the nutritional well-being of medical doctors in different regions. Additional research should focus on developing targeted interventions to optimise the well-being of shift workers.

Conclusion

In conclusion, this study emphasised the significant challenges of nutritional and well-being, particularly concerning food intake, sleep quality, and physical activity, faced by healthcare shift workers. Importantly, this study offers specific insights into how cultural norms, gender roles, and work-life demands shape their coping strategies. These important issues need to be addressed in order to maintain the overall health and well-being of workers.

By adopting a qualitative approach, this study offers an in-depth understanding of the lived experiences, the insights that are often overlooked in quantitative studies. It makes a valuable contribution to both Malaysian and global literature on shift work, especially by representing perspectives from Southeast Asia, which are underrepresented in current research. The findings of this study may provide beneficial data for stakeholders to understand the struggles faced by shift workers. Future studies must focus on the highlighted challenges and implement intervention strategies to improve the health outcomes of shift workers.

Author contributions

Conceptualisation: NIMFT; Methodology: NMS; Formal analysis and investigation: NMS; Writing-original draft preparation: EN, NMS; Writing-review and editing: NIMFT, NASMA, NJ, LWC, SLL; Funding acquisition: NIMFT, NJ; Supervision: NIMFT, NJ; Project administration: NIMFT, NJ. All authors read and approved the final manuscript. These authors jointly supervised this work.

Funding

This study was supported by Ministry of Higher Education via the Fundamental Research Grant Scheme, Universiti Teknologi MARA (UiTM), FRGS/1/2023/SS10/UITM/02/16.

Data availability

The datasets generated and analysed during the current study are available from the corresponding author, Nur Islami Mohd Fahmi Teng, upon reasonable request.

Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted from the Medical Research and Ethics Committee and the National Medical Research Registry (REC/01/2023 (ST/MR/17)). Informed consent was obtained from all participants involved in the study.