The effect of positive psychology interventions on job satisfaction work engagement and withdrawal intentions among remote working cancer survivors

Abstract

Advances in cancer treatment have significantly increased the survival rate of cancer patients, but these survivors often face challenges in the workplace. Existing literature highlights the significant influence of cancer on job performance, job satisfaction, and the increased risk of withdrawal intention. However, the effects of positive psychology interventions on cancer survivors, particularly in less urbanized settings and remote worker communities, remain underexplored. This study investigates the effects of positive psychology interventions on job satisfaction, work engagement, and withdrawal intentions among cancer survivors in rural and remote workforce communities. A Randomized Control Trial (RCT) was employed, involving 68 cancer survivors. The study used the Minnesota Job Satisfaction Questionnaire, the Utrecht Work Engagement Scale, and the Withdrawal Intention Scale to measure outcomes following a 14-session positive psychology intervention. The results revealed statistically significant improvements in the experimental group compared to the control group. Job satisfaction mean scores increased from 50.23 to 58.94, work engagement mean scores rose from 26.79 to 31.05, and withdrawal intentions mean scores decreased from 48.35 to 39.05. These findings highlight the potential of positive psychology interventions to address the unique challenges faced by cancer survivors in remote workforce communities, particularly in less urbanized areas. By enhancing job satisfaction and work engagement while reducing withdrawal intentions, these interventions can significantly contribute to the occupational well-being of cancer survivors, advocating for their integration into cancer care and organizational practices.

Supplementary Information

The online version contains supplementary material available at 10.1038/s41598-025-19250-w.

Introduction

Job satisfaction is an employee’s positive and pleasant feeling about their job, stemming from various factors such as working conditions, organizational rules, employee relations, social status, income, and cultural factors¹. Satisfied employees tend to perform their duties more effectively and efficiently². Work engagement is a rewarding and positive psychological condition related to work, arising from vigor, dedication, and absorption³. Research indicates a positive correlation between job satisfaction and work engagement, with satisfied employees more likely to be engaged in their tasks^4,5. Conversely, a lack of job satisfaction can lead to increased withdrawal intentions, absenteeism, and decreased performance^6,7. Withdrawal intentions refer to an employee’s conscious and deliberate thoughts about leaving their job, which may precede actual turnover behavior. They are typically driven by dissatisfaction, emotional exhaustion, or a perceived mismatch between the individual and the organizational environment.

Among the myriad factors influencing employee performance in organizations, illness stands out as a particularly significant and impactful element⁸. Cancer, a significant factor affecting employee performance and job satisfaction, imposes substantial emotional and physical challenges, leading to long-term occupational disruptions and decreased job performance and satisfaction⁹. According to global epidemiological estimates, approximately 40–50% of cancer diagnoses occur during individuals’ prime working years (ages 20–64), particularly in high-income and middle-income countries¹⁰. A cancer diagnosis often causes emotional distress, leading to lasting occupational disruptions, interpersonal crises, and lower job satisfaction. Stage II marks a key phase where patients typically receive treatments like chemotherapy but often retain the ability to maintain functional capacity¹¹.

Cancer survivors, often diagnosed during working years, experience long-term occupational disruptions and decreased job performance and satisfaction^12,13. Treatments often cause side effects, leading to interpersonal crises and increased workplace tension^14,15. Dionisi-Vici et al. examined the employment status of 240 cancer survivors in various cities in Italy and found that the late effects of cancer have a negative impact on their job satisfaction¹⁶. Moreover, Mousa et al. examined cancer survivors in urban areas of Kuala Lumpur, Malaysia, and found that cancer significantly reduces their work engagement¹⁷. While these international studies provide valuable insights, it is important to acknowledge that differences in healthcare infrastructure, cultural perceptions of illness, and access to workplace accommodations may influence cancer survivors’ occupational outcomes across countries.

Beyond the psychological and physical challenges of cancer survivorship, financial toxicity, defined as the economic burden arising from reduced income and elevated medical expenses, adds another critical layer of stress¹⁸. Such financial strain not only impacts survivors’ quality of life and emotional well-being but may also intensify their intention to withdraw from work due to perceived unsustainability of employment during treatment.

Research suggests that advanced financial toxicity, including bankruptcy, is linked to a nearly twofold increase in mortality risk among cancer survivors¹⁹. These economic stressors further underscore the importance of psychosocial interventions aimed at improving both emotional resilience and occupational continuity.

Psycho-oncologic interventions, aimed at improving mental health, can reduce disease-related symptoms, enhance mental health, and potentially extend life expectancy^20,21. Positive psychology, rooted in Seligman’s work, promotes happiness through a joyful, committed, and meaningful life²². Beyond Seligman’s model, Fredrickson’s Broaden-and-Build Theory suggests that positive emotions expand thought-action repertoires, helping individuals build lasting psychological, social, and physical resources²³. This is especially relevant for cancer survivors, as such emotions buffer psychological harm and boost work engagement. Similarly, Keyes’ Complete Mental Health Model defines flourishing as high emotional, psychological, and social well-being, beyond just the absence of illness²⁴, suggesting that fostering positive emotions and meaning can enhance job satisfaction and reduce withdrawal among survivors. Positive psychology interventions, such as gratitude exercises, strengths-based development, and mindfulness practices, have shown a statistically significant impact on job satisfaction and work engagement in various occupational settings^25,26. For instance, a study by Cortini et al.²⁵ showed that the implementation of positive psychology interventions resulted in an 8% increase in employee job satisfaction. These approaches not only promote individual well-being but also create a positive organizational culture, leading to increased productivity, improved teamwork, and overall job satisfaction among employees²⁷. Additionally, Musa et al. examined the impact of spirituality on 126 cancer survivors in urban areas of Kuala Lumpur and demonstrated that spirituality can lead to enhanced work engagement¹⁷. Moreover, Positive psychology can mitigate withdrawal behaviors by promoting positive emotions, strengths, and meaningful experiences²⁸.

Despite the documented benefits of positive psychology interventions in enhancing job satisfaction and work engagement, their effects among cancer survivors remain largely unexplored. Existing research has primarily focused on urban environments, leaving a gap in understanding the potential of positive psychology interventions for cancer survivors in rural communities and remote working conditions^16,17. Additionally, the role of positive psychology interventions in mitigating withdrawal intentions among cancer survivors has not been adequately investigated²⁹. Therefore, the study aims to investigate the impact of a 14-session positive psychology intervention on job satisfaction and work engagement, and its role in shaping withdrawal intentions. Rural, remote-working cancer survivors face distinct challenges. Geographic isolation limits access to specialized care and support, while poor infrastructure and digital barriers increase work-related stress. Weaker social and professional networks add to emotional isolation and reduce workplace accommodations. These factors raise the risk of dissatisfaction, disengagement, and early job exit. Addressing these issues is vital for equitable survivorship care and job retention.

Materials and methods

Research design

This study employed a randomized controlled trial (RCT) design with pre-test and post-test measures and a control group to investigate the effects of positive psychology interventions on job satisfaction, work engagement, and withdrawal intentions among cancer survivors in rural and remote communities. In this study, ‘remote workers’ refers to participants whose jobs are performed from geographically distant settings. A randomized controlled trial (RCT) design was adopted for this study, as it allows for robust evaluation of the causal effects of the positive psychology intervention while minimizing selection bias³⁰. The use of random assignment enhances internal validity and enables clearer interpretation of intervention outcomes in a real-world setting³¹. The philosophical foundation of this research is rooted in positivism, which emphasizes observable and measurable evidence to develop knowledge³². Positivist epistemology supports the use of quantitative methods to examine cause-and-effect relationships through rigorous statistical testing³³.

Conceptual model of the study

This model explores the impact of positive psychology interventions on job satisfaction, work engagement, and withdrawal intentions among cancer survivors who work remotely in rural areas. The model begins with the selection of a sample of cancer survivors at stage two who are undergoing chemotherapy and are employed remotely in rural communities. The positive psychology interventions, which include mindfulness practices and gratitude exercises, are key concepts in this framework. These interventions are designed to influence three main variables: job satisfaction, work engagement, and withdrawal intentions, which are measured using tools like the Minnesota Job Satisfaction Questionnaire (MJSP), the Utrecht Work Engagement Scale - Student Version (UWES-S), and the Withdrawal Intention Scale (WIS). The data collected is analyzed using statistical methods such as Multivariate Analysis of Variance (MANOVA) and Analysis of Variance (ANOVA). The expected outcomes include an increase in job satisfaction and work engagement scores, along with a decrease in withdrawal intention scores, indicating the effectiveness of these interventions in improving the work-related outcomes of cancer survivors in remote work settings.

Procedure

After random assignment, participants in the intervention group attended 14 weekly, 45-minute group sessions (6–8 members each), conducted in-person by therapists licensed by the Iranian Psychological Association. All therapists had formal training in positive psychology and at least two years of experience with cancer patients. The program was grounded in Seligman’s PERMA model, Fredrickson’s broaden-and-build theory, and Keyes’ flourishing model. Sessions focused on gratitude, personal strengths, optimism, mindfulness, resilience, goal setting, and meaning-making, delivered through lectures, discussions, and practical exercises. Content was culturally adapted for rural Iranian cancer survivors by incorporating locally relevant examples, family-centered values, and rural work dynamics. Fidelity was ensured via a standardized manual and therapist checklists. Attendance and engagement were monitored throughout. The control group received standard oncological care and general psychosocial support but no structured intervention; they were offered the program free of charge after the study. To minimize contamination, sessions were held on separate days, and participants were asked not to share session content across groups.

Sampling method and participants

Sampling method

This study, after registration and obtaining ethical approval employed a convenience sampling method to recruit research participants from the visitors to Razi Hospital in Tabriz. Data collection was conducted from October 2023 to January 2024. Participants were recruited from individuals diagnosed with stage II cancer who sought treatment at Razi Hospital in Tabriz, Iran, and who were living in rural areas. Rural residency was defined according to the classification provided by the Iranian Statistical Center, referring to communities with fewer than 6,000 inhabitants and without formal municipal government. All participants were from such areas within East Azerbaijan Province. The sample included individuals diagnosed with breast cancer (38%), colorectal cancer (12%), gastric cancer (28%), hematologic cancers (12%), and other types (10%). A convenience sampling strategy was employed, whereby patients meeting the inclusion criteria were identified during routine visits and referred by clinical staff. A brief screening interview conducted by a clinical psychologist assessed eligibility, particularly regarding participants’ employment status (i.e., actively working remotely during the 3–6 months following cancer diagnosis). While this method allowed for efficient recruitment, it may have introduced self-selection bias, as participants who agreed to participate might have had more interest in psychological support or higher motivation to engage with workplace challenges.

Participants

A power analysis was conducted using G*Power 3.1 software to determine the appropriate sample size. Assuming a medium effect size (f = 0.25), a power of 0.80, and α = 0.05, the minimum required sample size for a between-group comparison using ANCOVA with one covariate was 68 participants (34 per group). A total of 89 participants were initially recruited to assess their eligibility, allowing for potential dropout. Ultimately, 68 participants completed the study and were included in the final analysis.

Inclusion Criteria:

• Diagnosed with stage II cancer.

• Receiving chemotherapy treatment.

• Diagnosed within the past three to six months.

• Employed remotely in an organization or company from the time of cancer diagnosis to the intervention.

• Residing in rural communities.

• No history of substance abuse.

• No history of serious chronic diseases, such as severe diabetes, heart disease, or kidney failure.

Exclusion Criteria:

• Incomplete responses to the study questionnaires.

• Concurrent participation in conflicting or experimental treatments.

• Inability to regularly follow up on sessions and complete assessments.

Informed consentand right to withdraw

All methods were performed in accordance with the relevant guidelines and regulations as outlined by the Declaration of Helsinki. Ethical approval for this study was obtained from the Secretariat of the Biomedical Ethics Committee of Tabriz University (Approval No. 51666 − 16476). Informed consent was obtained from all participants prior to participation, and their rights, including the right to withdraw at any time, were fully respected.

Randomization, blinding, confidentiality, and anonymity

Participants were randomly assigned to either the experimental or control group using a computer-generated randomization sequence. To ensure balanced group allocation, randomization was stratified by baseline job satisfaction scores and gender. The allocation process was managed by an independent researcher who was not involved in recruitment or intervention delivery, ensuring strict allocation concealment. Due to the nature of the intervention, blinding participants and therapists was not feasible. However, outcome assessments were conducted by independent evaluators blinded to group assignments, and participants were instructed not to disclose their group allocation to the assessors. Assessors underwent training to minimize potential biases and uphold the integrity of the blinding process.

To protect participants’ privacy, all data were anonymized by assigning unique codes to each participant instead of using personal identifiers. Responses were treated confidentially and used solely for research purposes. The securely stored data were accessible only to authorized members of the research team, further ensuring the confidentiality and anonymity of all participants.

Instruments

Job satisfaction

Job satisfaction was measured using the Minnesota Job Satisfaction Questionnaire (MJSQ). This 20-item instrument evaluates various dimensions of job satisfaction, including supervision, compensation, advancement, recognition, and general working conditions. Responses are recorded on a 5-point Likert scale, ranging from 1 (very dissatisfied) to 5 (very satisfied). The Persian version of the MJSQ, previously validated in Iranian studies, was used in this research. In the present study, the scale demonstrated excellent internal consistency (Cronbach’s alpha = 0.89).

Work engagement

Work engagement was assessed using the Utrecht Work Engagement Scale – 9 item version (UWES-9), which measures three dimensions: vigor, dedication, and absorption. Items are rated on a 7-point Likert scale from 0 (never) to 6 (always/every day)³⁴. The UWES-9 was chosen for its strong psychometric properties in working populations. The validated Persian version was administered, and internal consistency in the current sample was high (Cronbach’s alpha = 0.91).

Withdrawal intention

The Withdrawal Intention Scale (WIS) was used to evaluate participants’ inclination to leave their current job. It includes items measuring intent and tendency toward withdrawal behavior, rated on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree). The Persian translation used in this study has demonstrated reliability and construct validity in Iranian contexts. The internal consistency in the current sample was satisfactory (Cronbach’s alpha = 0.86).

All instruments were administered in validated Persian versions, and the intervention sessions were also conducted entirely in Persian by licensed therapists fluent in the language and familiar with the cultural context. To ensure intervention fidelity, therapists followed a standardized manual and received weekly supervision by a senior clinical psychologist. To reduce response bias, especially social desirability, participants were assured of anonymity and confidentiality and were informed that their participation would not affect their medical care or employment status.

Ethical conduct during data collection

The research team upheld ethical principles throughout the data collection process, including respecting participants, maximizing benefits while minimizing harm (beneficence), and ensuring fair treatment for all participants (justice). Participants were handled with care and sensitivity, particularly considering the potentially sensitive questions regarding mental health and job satisfaction. By integrating rigorous data collection methods with strict ethical guidelines, this study ensured the acquisition of high-quality and reliable data while safeguarding participants’ rights and well-being. This approach not only strengthens the credibility of the research findings but also aligns with the ethical standards expected in scientific research involving human subjects.

Results

As shown in (Fig. 1), in this study, 89 individuals were initially selected to assess their eligibility. After the screening process, 9 participants were excluded, with 8 not meeting the inclusion criteria and 1 declining to participate. Consequently, 80 participants were randomly assigned to either the experimental group or the control group, each comprising 40 participants. Both groups completed pre-test questionnaires. The experimental group received a Positive Psychology Intervention, while the control group did not receive any intervention. Following the intervention period, both groups completed post-test questionnaires. In the experimental group, 6 participants were excluded from the post-test analysis, with 2 withdrawing consent and 4 failing to complete the intervention. Similarly, 6 participants from the control group were excluded from the post-test analysis, all due to withdrawing consent. Ultimately, 34 participants from each group were included in the final analysis, ensuring a balanced and unbiased sample to evaluate the effects of the Positive Psychology Intervention.

Fig. 1.

Consort Flow Diagram.

(Table 1 ) presents the demographic findings for both the experimental and control groups, providing a comprehensive view of the participant characteristics. In terms of gender distribution, the experimental group consisted of 67.65% males (23 participants) and 32.35% females (11 participants), while the control group comprised 61.76% males (21 participants) and 38.24% females (13 participants). Regarding marital status, 41.18% of the experimental group (14 participants) were single, and 58.82% (20 participants) were married. In contrast, the control group had 38.24% single participants (13 participants) and 61.76% married participants (21 participants). The age distribution for the experimental group showed that 23.53% were aged 20–29 years (8 participants), 35.29% were aged 30–39 years (12 participants), and 41.18% were aged 40–49 years (14 participants). Similarly, the control group included 29.41% of participants aged 20–29 years (10 participants), 32.35% aged 30–39 years (11 participants), and 38.24% aged 40–49 years (13 participants). This demographic data highlights the balanced distribution of participants across gender, marital status, and age categories, ensuring the representativeness and reliability of the study outcomes.

Table 1.

Demographic findings according to the two experimental and control groups.

Variables		The frequency of the experimental group	Percent	The frequency of the control group	Percent
Gender	Male	23	67.65	21	61.76
	Female	11	32.35	13	38.24
Marital status	Single	14	41.18	13	38.24
	married	20	58.82	21	61.76
Age	20–29 years	8	23.53	10	29.41
	30–39 years	12	35.29	11	32.35
	40–49 years	14	41.18	13	38.24

In (Table 2), the descriptive statistics of the experimental and control group participants’ scores in the variables of job satisfaction, work engagement, and withdrawal intentions are presented separately in the pre-test and post-test stages.

Table 2.

Descriptive statistics for job satisfaction, work engagement, and withdrawal intentions of the two experimental and control groups in the pre-test and post-test.

Experimental group		Control group
Variables	Pre-test	Post-test	Pre-test	Post-test
	M ± SD	M ± SD	M ± SD	M ± SD
Job satisfaction	50.23 ± 11.26	58.94 ± 11.35	50.58 ± 13.06	48.94 ± 13.46
Work engagement	26.79 ± 4.82	31.05 ± 4.57	26.91 ± 5.07	28.00 ± 4.06
Withdrawal intentions	48.35 ± 10.98	39.05 ± 13.43	48.82 ± 9.44	47.52 ± 11.25

According to (Table 2). In all variables, the mean of the experimental group improved from the pre-test to the post-test. This improvement in the variable of job satisfaction and work engagement included an increase in the mean, and for the variable of withdrawal intentions, it included a decrease in the mean. In contrast, few changes were observed in the control group. Therefore, the difference between the two groups in the post-test phase favors the experimental group.

Assumption checks were conducted prior to the ANCOVA analyses. The Shapiro–Wilk test confirmed the normality of distribution for all outcome variables. The test yielded non-significant results for job satisfaction (W = 0.973, p = 0.351), work engagement (W = 0.981, p = 0.529), and withdrawal intentions (W = 0.968, p = 0.274), indicating that the assumption of normality was met. Levene’s test also showed homogeneity of variances for job satisfaction (F = 1.02, p = 0.317), work engagement (F = 0.78, p = 0.462), and withdrawal intentions (F = 0.91, p = 0.344), satisfying the equality of variances assumption. Additionally, the assumption of homogeneity of regression slopes was verified, with non-significant group × pre-test interactions for job satisfaction (F = 0.308, p = 0.613), work engagement (F = 0.527, p = 0.419), and withdrawal intentions (F = 0.443, p = 0.529). These results confirmed that the assumptions for conducting ANCOVA were met.

The results of univariate covariance analysis were used to determine the effectiveness of positive psychology on job satisfaction, work engagement, and withdrawal intentions. The results of univariate covariance analysis are reported in (Table 3).

Table 3.

The results of univariate covariance analysis of the difference between the experimental and control groups in job satisfaction, work engagement, and withdrawal intentions.

Variables	Source	Sum of Squares	df	Mean Square	F	p	Partial Eta Squared
Job satisfaction	Pre-test	5006.05	1.00	5006.05	62.13	0.001	0.49
	group	1786.35	1.00	1786.35	22.17	0.001	0.25
	Error	5237.71	65.00	80.58
Work engagement	Pre-test	744.62	1.00	744.62	98.93	0.001	0.60
	group	167.44	1.00	167.44	22.25	0.001	0.26
	Error	489.26	65.00	7.53
Withdrawal intentions	Pre-test	1933.37	1.00	1933.37	20.20	0.001	0.24
	group	1142.85	1.00	1142.85	11.94	0.001	0.16
	Error	6220.98	65.00	95.71	62.13

According to the results of the univariate covariance analysis presented in Table 3, after controlling for pre-test effects, significant differences were observed between the mean post-test scores of the experimental and control groups across the variables of job satisfaction (Partial Eta Squared η² = 0.25, p < 0.01, F = 22.17), work engagement (η² = 0.26, p < 0.01, F = 22.25), and withdrawal intentions (η² = 0.16, p < 0.01, F = 11.94). This indicated that the intervention, presumably based on positive psychology principles, significantly improved job satisfaction and work engagement among cancer survivors. Moreover, it effectively reduced their withdrawal intentions, as indicated by the decrease in mean scores for this variable in the experimental group compared to the control group. The effect sizes of 0.25 for job satisfaction, 0.26 for work engagement, and 0.16 for withdrawal intentions confirm that these differences are statistically significant within the population. According to Cohen’s (1988) guidelines, partial eta-squared values of 0.01, 0.06, and 0.14 represent small, medium, and large effects, respectively. The observed effect sizes in this study, η² = 0.25 for job satisfaction, η² = 0.26 for work engagement, and η² = 0.16 for withdrawal intentions—thus indicate large effects across all three variables. These large effect sizes suggest that the intervention had not only statistically significant but also practically meaningful impacts.

Discussion

The primary aim of this study was to investigate the effect of positive psychology intervention on job satisfaction, work engagement, and withdrawal intention among remote-working cancer survivors in rural areas. The study’s results revealed a statistically significant positive impact of positive psychology interventions on job satisfaction, work engagement, and withdrawal intentions among cancer survivors in remote workforce and rural communities. The current investigation observed a significant enhancement in job satisfaction, as evidenced by the increase in mean scores from 50.23 to 58.94 in the experimental group following the intervention. The study also noted a statistically significant increase in work engagement mean scores, escalating from 26.79 to 31.05. This suggests the interventions probably enhanced the participants’ vigor, dedication, and absorption in their work roles. This change suggested that the cancer survivors became more psychologically resilient and motivated, demonstrating a stronger connection and commitment to their job tasks. On the other hand, withdrawal intentions’ mean scores decreased from 48.35 to 39.05, signifying a reduced desire to leave their jobs among the participants. This reduction was particularly important, as it suggested that the positive psychology interventions helped mitigate some of the emotional and psychological challenges that cancer survivors face, which might otherwise lead to job withdrawal. This observation supports the main hypothesis that applying positive psychology interventions positively affects job satisfaction and work engagement and reduces withdrawal intentions among cancer survivors in remote workforce and rural communities. Beyond statistical significance, the improvements observed in the experimental group likely hold clinical and practical significance.

Positive psychology techniques such as gratitude, strength-based reflection, and meaning-making may support cancer survivors in the workplace by enhancing resilience, positive affect, and self-efficacy. Gratitude interventions have been shown to boost job satisfaction and psychological resources through improved coping and workplace interactions. Meaning-making helps survivors reconnect with purpose and rebuild motivation³⁷, while strength-based reflection fosters self-confidence and persistence in work roles³⁸. These mechanisms may explain the observed improvements in work engagement and job satisfaction.

Participants may have experienced noticeable enhancements in their work satisfaction, engagement, and desire to remain employed despite the ongoing challenges of cancer survivorship and remote work. These positive shifts could translate into better occupational functioning, emotional well-being, and reduced risk of job withdrawal. Although our conclusions are based on quantitative outcomes, they align with the broader goals of psycho-oncological interventions aimed at promoting resilience and workplace reintegration.

Comparison with previous studies

The findings of this study provide significant insights into the effects of positive psychology interventions on cancer survivors who work remotely and live in rural areas, offering unique comparative perspectives. This section compares the findings with previous research to emphasize the strengths and innovative aspects of the current study while addressing the limitations of earlier works.

Initially, the increase in job satisfaction in our study aligned with the findings of Cortini et al.²⁵, who observed an 8% rise in job satisfaction following positive psychology interventions. Our research expanded upon this by specifically highlighting the impact on cancer survivors and pinpointing the targeted benefits for this group. Furthermore, Donaldson et al.²⁶, demonstrated the effectiveness of positive psychology in boosting work engagement. Our findings corroborated this but also emphasized the significant effect within a specialized cohort of cancer survivors, thereby providing detailed insights into context-specific impacts.

The enhancements in job satisfaction and work engagement observed in this study echoed the positive outcomes noted in previous research, like that of Cortini et al.²⁵. Yet, our research distinguished itself by delving into both work engagement and withdrawal intentions, thus offering a more comprehensive view of the effects of positive psychology in the workplace for cancer survivors.

In reference to the foundational theories of Seligman²², our study emphasized the importance of nurturing strengths, enhancing positive emotions, and cultivating a sense of meaning. These elements, which are pivotal in Seligman’s positive psychology framework, theoretically underpinned the psychological mechanisms through which our interventions yielded their beneficial outcomes, marrying theoretical concepts with our empirical findings in improving job satisfaction, work engagement, and reducing withdrawal intentions among cancer survivors.

Kaplan et al.²⁹ explored the connection between positive affectivity and reduced withdrawal intentions, finding a correlation between a positive work environment and lower withdrawal tendencies. Our study extended these findings by demonstrating how positive psychology interventions specifically reduced withdrawal behaviors in remote-working cancer survivors. We further elaborated on this by highlighting the mechanisms through which positive psychology fostered a supportive environment that not only enhanced positive affectivity but also directly contributed to diminishing the propensity for withdrawal among cancer survivors. This alignment with Kaplan’s research underscored the broader applicability and efficacy of positive psychology principles in mitigating withdrawal intentions, particularly in the context of chronic illness and workplace integration.

Previous studies, such as those by Degi²⁰ and Faller et al.²¹, had shown improvements in mental health, quality of life, and job performance due to psycho-oncologic interventions in cancer patients. Our study built on this by zeroing in on the specific effects of positive psychology interventions on job satisfaction, work engagement, and withdrawal intentions among cancer survivors in less accessible areas.

Recent studies by Dionisi-Vici et al.¹⁶ examined the employment status of 240 cancer survivors in various cities in Italy and found that the late effects of cancer have a negative impact on their job satisfaction. Moreover, Mousa et al.¹⁷ examined cancer survivors in urban areas of Kuala Lumpur, Malaysia, and found that cancer significantly reduces their work engagement. These studies demonstrate the negative effects of cancer on job satisfaction and work engagement, with their samples all being in urban communities and employed on-site.

While Parent-Lamarche³⁹ showed that teleworking can lead to reduced work engagement and increased intention to quit, the present study, by examining the effects of positive psychology interventions on these aspects among cancer survivors working remotely in rural areas, demonstrated that positive psychology interventions can lead to increased work engagement and reduced intention to quit in individuals who telework.

The novelty of our research lies in examining these variables in rural communities and among individuals who work remotely. Our study showed that positive psychology interventions can effectively improve job satisfaction, and work engagement, and reduce withdrawal intentions in this population, thus addressing the limitations of previous studies and filling existing research gaps. This comparison not only enhances the existing academic discourse but also provides actionable insights for customizing workplace support to meet the distinctive needs of cancer survivors in rural and remote communities.

Policy implication

These findings are significant not only in their statistical validity but also in their real-world applicability. They show that targeted psychological support can probably have a profound and positive effect on the work-related attitudes and behaviors of cancer survivors, particularly those with remote occupations who are living in areas with fewer resources and support systems.

The findings from this study suggest several implications for policy and practice. First, healthcare and organizational policies should recognize and integrate positive psychology interventions as a standard component of cancer care, especially for those in the workforce. Implementing these interventions can improve job satisfaction and engagement and reduce the likelihood of job withdrawal among cancer survivors.

Second, policies should be developed to support the training of psychologists and counselors in positive psychology, ensuring that these interventions are delivered effectively and are accessible to cancer survivors, particularly in remote worker communities who are in rural areas. Furthermore, workplaces can be encouraged to create environments that foster positive psychological experiences, which in turn could enhance employee engagement and satisfaction.

Third, the research underscores the importance of considering the unique challenges faced by cancer survivors in rural and remote workforce communities. While the intervention demonstrated promising effects in this study, its broader implementation in real-world rural contexts may face substantial barriers. In rural areas, shortages of licensed therapists and structural limitations (e.g., transportation, scheduling constraints) can further reduce uptake. To address these challenges, alternative models of delivery may be necessary. For instance, telepsychology services using mobile platforms could extend access to remote areas. Additionally, training community health workers or oncology nurses to deliver adapted versions of the intervention through brief, structured modules could enhance scalability. Embedding such interventions within routine oncology follow-up or survivorship care plans could also improve accessibility.

Lastly, positive psychology can significantly contribute to enhancing organizational productivity by improving job satisfaction. Organizational productivity refers to the effective use of resources to produce goods or services that meet target customers’ needs, influenced by management practices and organizational culture⁴⁰. Job satisfaction plays a vital role in boosting productivity as it motivates employees to work more efficiently, aiding in achieving the broader objectives of the organization⁴¹. Satisfied employees tend to be more engaged, perform better, and are more likely to contribute positively towards organizational goals. High productivity, driven by employee satisfaction, can lead to increased profitability and enhanced customer service, thus improving the organization’s reputation and stability⁴².

Therefore, it is evident that positive psychology, by elevating job satisfaction, can play a significant role in increasing organizational productivity. This boost in productivity not only aids in enhancing the profitability of the organization but also contributes to its sustained stability and reputation. Hence, investing in positive psychology interventions is crucial not just for the mental well-being of the employees but also for the profitability and long-term success of the organization.

Limitations

The use of self-report questionnaires for measuring job satisfaction, work engagement, and withdrawal intentions may also introduce response biases such as social desirability, which could skew the results. Furthermore, the use of convenience sampling, while practical for this study’s context, may have introduced selection bias. Participants who volunteered to take part in a psychological intervention may differ systematically from the broader cancer survivor population—particularly in terms of motivation, readiness to change, and receptivity to psychosocial support. This could limit the generalizability of the findings.

Moreover, A key limitation of this study is the absence of follow-up assessments, which prevents conclusions about the sustainability of intervention effects. It remains unclear whether improvements in job satisfaction, engagement, and withdrawal intentions are maintained over time. Future research should include follow-up evaluations to assess the long-term impact and durability of such interventions. Cultural factors, given the study’s location in Iran, might influence the outcomes and their applicability in different contexts, suggesting the need for cross-cultural research to validate the findings universally. Moreover, the study did not thoroughly examine the participants’ psychological health status before the intervention, which could affect their response to the positive psychology treatments. Although this decision was made to minimize participant burden during active cancer treatment, it limits our ability to control for baseline mental health conditions such as depression, anxiety, or emotional exhaustion. These psychological factors are known to significantly influence work-related outcomes, including job satisfaction and withdrawal intentions. As such, we cannot rule out the possibility that variation in participants’ mental health may have contributed to some of the observed differences, independent of the intervention. In addition, due to the modest sample size (N = 68) and uneven subgroup distributions, we couldn’t conduct interaction or subgroup analyses by cancer type, diagnosis timing, or demographics. Larger, more diverse samples are needed to examine potential moderators. Minor demographic imbalances, particularly in gender, also emerged between experimental and control groups. Although randomization aimed to reduce such differences, the small sample size limited group equivalence. Gender disparities may have influenced intervention responsiveness, as prior research links gender to job satisfaction and engagement. Additionally, the rural Iranian context of our sample may limit generalizability. Cultural norms around mental health, support, and work, such as reliance on religious or community coping, could have shaped engagement. These patterns likely differ from urban or Western settings, warranting replication in diverse populations to assess generalizability and cultural adaptation needs. Finally, we didn’t assess pre-intervention psychological health in depth, which may have influenced treatment response. The lack of sensitivity analyses also limits our ability to rule out unmeasured confounding. Future research should include larger samples and richer covariate data.

Conclusion

The primary objective of this research was to examine the impact of positive psychology interventions on job satisfaction, work engagement, and withdrawal intentions among cancer survivors who are working remotely in communities. The innovative aspect of this study lies in its focus on applying positive psychology interventions to support this unique demographic, providing a deeper understanding of how these interventions can be tailored to enhance occupational well-being and retention among cancer survivors.

• The research investigated key parameters such as job satisfaction, work engagement, and withdrawal intentions among cancer survivors.

• Quantitative findings include a significant increase in job satisfaction (from 50.23 to 58.94) and work engagement (from 26.79 to 31.05), and a decrease in withdrawal intentions (from 48.35 to 39.05) post-intervention in the experimental group.

In summary, the study illustrates the potent role of positive psychology in improving job satisfaction and work engagement while reducing withdrawal intentions among cancer survivors working remotely and living in less urbanized areas. Future research should explore the long-term effects of these interventions and examine cultural and regional differences in the effectiveness of positive psychology interventions. Additionally, it would be beneficial to investigate the specific components of positive psychology interventions that are most effective and to explore their applicability in different work environments and among diverse populations of cancer survivors.

Supplementary Information

Below is the link to the electronic supplementary material.

Author contributions

1-Hamid Yari Renani: Conceptualization, Methodology, Supervision.2-Alireza Rahmanian: Investigation, Writing – Original Draft.3-Zahra Saeidi: Investigation, Visualization.4-Behrooz Birashk: Methodology, Writing – Review & Editing.5-Iman Saraei: Investigation, Writing – Original Draft.6-Shirin Ghodusi: Writing – Review & Editing.

Data availability

The data used in this study are available from the corresponding author upon reasonable request.

Declarations

Competing interests

The authors declare no competing interests.