Between duty and family: exploring predictors of work-interfering family guilt and work–family conflict among healthcare workers in Pakistan

Abstract

Introduction

Healthcare professionals in Pakistan, particularly parents of young children, face significant challenges balancing work and caregiving, contributing to high turnover, especially among women. No studies have examined work-interfering family guilt (WIFG) and work–family conflict (WFC) in this context, nor explored these dynamics among both mothers and fathers. Thus, this study investigates predictors of WIFG and WFC among healthcare professionals with children under 12 years in Pakistan.

Methods

A cross-sectional study surveyed 188 healthcare professionals (physicians, nurses and allied health workers) across Pakistani hospitals using purposive and snowball sampling. Data were collected online via Google Forms with a validated questionnaire (Content Validity Index=0.9, Cronbach’s alpha=0.9) assessing WIFG, WFC and predictors (eg, workload, childcare access). Multiple linear regression analyses were conducted in STATA V.15.

Results

Mothers reported higher WIFG than fathers (β=6.8; 95% CI 4.9 to 8.5), with lack of childcare access (β=2.5; 95% CI 0.2 to 4.6) increasing WIFG and higher parenting self-efficacy reducing it (β=−2.8; 95% CI −0.5 to –0.03). WFC was elevated with longer work hours (β=1.0; 95% CI 0.3 to 1.6) and when both parents worked, while younger professionals (β=−0.15; 95% CI −0.2 to –0.01) and fathers (β=−2.3; 95% CI −4.1 to –0.5) reported lower WFC.

Conclusions

Findings underscore the urgency of institution-led initiatives, such as on-site childcare and flexible scheduling, to mitigate WIFG and WFC among Pakistani healthcare professionals. Including fathers offers novel, gender-inclusive insights, informing policies to enhance well-being and reduce turnover.

WHAT IS ALREADY KNOWN ON THIS TOPIC

• Work–family conflict (WFC) and work-interfering family guilt (WIFG) are common among healthcare professionals globally, especially mothers. In Pakistan, these dynamics are intensified by gender norms, extended family structures and limited childcare access, yet have not been locally studied.

WHAT THIS STUDY ADDS

• This is the first study in Pakistan to examine predictors of WIFG and WFC among healthcare professionals, including both mothers and fathers. It shows that mothers report significantly higher guilt, while lack of childcare and longer work hours exacerbate both outcomes. Parenting self-efficacy emerged as a protective factor.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

• Findings support the need for institutional reforms such as on-site childcare and flexible scheduling. Including fathers offers gender-inclusive insights that can inform more equitable workforce policies and improve retention and well-being in Pakistan’s healthcare sector.

Background

In the past two decades, healthcare facilities worldwide have faced escalating demands driven by ageing populations. Low-income and middle-income countries (LMICs), including Pakistan, have been particularly affected by a significant shortage of healthcare workers. This scarcity is exacerbated by a notable trend of skilled professionals leaving the country in pursuit of better career prospects abroad. According to the Bureau of Emigration and Overseas Employment, in 2022 alone, approximately 765 000 Pakistanis, including 2500 physicians, emigrated, underscoring the magnitude of this challenge.¹

During crises and emergencies, the situation could have been further aggravated, as seen during the COVID-19 crisis, particularly among professionals working in specialised units such as intensive care units and dialysis units.2,4 Working in medical units with complex and high physical, cognitive and emotional demands exposes healthcare workers to various psychosocial risks, including job stress, burnout, emotional labour, workplace aggression, guilt and work–family conflict (WFC).⁵ These risks have been linked to poorer physical and mental health, reduced psychological well-being and lower quality of care. They also interfere with workers’ private lives and family environment, making it challenging to balance both areas effectively. Ultimately, these psychosocial risks can increase healthcare workers’ intentions to leave, either by seeking a different medical unit or permanently leaving the profession.²

Guilt, particularly work-interfering family guilt (WIFG), is a significant psychological phenomenon among healthcare workers, especially those who are also parents. WIFG occurs when work responsibilities encroach on family time or obligations, leading to feelings of guilt and conflict.⁶ This can be particularly pronounced in healthcare settings, where irregular hours, high job demands and emotional labour are common.⁷ Healthcare parents may experience heightened levels of WIFG due to the nature of their work, which often requires them to balance demanding patient care responsibilities with their role as parents.⁸ This conflict can lead to increased stress, burnout and negative effects on both their work and family life. Studies have shown that healthcare parents experiencing high levels of WIFG may be more likely to report lower job satisfaction, higher levels of emotional exhaustion and difficulties in maintaining a healthy work–life balance.9,11

WFC describes the challenge of balancing work and family responsibilities, where the demands of each role conflict with each other.12,14 WFC can occur in two ways: family-to-work conflict, when family obligations interfere with work responsibilities, and WFC, when work demands encroach on family time.12,14 In healthcare settings, nurses commonly experience WFC, which can negatively impact their retention, job satisfaction, psychological well-being, work stress and commitment to their organisation.15,17 The effect of WFC on healthcare parents can be especially significant. A study conducted in Pakistan showed that WFC is negatively associated with the mental well-being of healthcare workers.¹⁸ Juggling patient care and family duties can result in heightened stress and burnout,^{19 20} impacting their job satisfaction and psychological health.¹⁸ Furthermore, WFC can strain family relationships and impede their ability to fulfil caregiving roles beyond their professional responsibilities, intensifying the conflict.¹⁷

Healthcare professionals often face intense work demands that interfere with family responsibilities, leading to emotional distress known as WIFG and role strain described as WFC. These challenges are linked to burnout, reduced job satisfaction and workforce attrition. In Pakistan, high turnover—especially among women—is exacerbated by caregiving pressures, limited workplace flexibility and entrenched gender norms. While international literature has explored WIFG and WFC, most studies focus exclusively on mothers, neglecting fathers who also navigate work–family tensions. Moreover, no prior research has examined these phenomena in Pakistan’s unique sociocultural context, particularly among healthcare professionals raising young children under 12 years of age—a developmental stage that typically requires high parental involvement, logistical support and emotional availability. This study addresses that gap by investigating predictors of WIFG and WFC among both mothers and fathers. Findings aim to inform gender-inclusive, context-sensitive policies that support healthcare worker well-being and retention.

Methods

Study design and setting

A cross-sectional analytical study was conducted between November 2024 and March 2025, targeting healthcare professionals across Pakistan. Data were collected using an online questionnaire developed on Google Forms, which was distributed via email and popular social media platforms such as WhatsApp, Facebook, Instagram and LinkedIn.

Study population

The study population consisted of healthcare professionals across Pakistan who were currently employed in clinical, allied health or administrative roles within the healthcare sector. The participants were required to have at least one child aged 12 years or younger and be proficient in reading and understanding English. In addition, those who provided informed consent were included. Eligibility was limited to individuals aged 18 years or older. Those who were retired, unemployed or non-healthcare professionals, as well as individuals who did not meet the parental criteria or had incomplete survey responses, were excluded from the study. Additionally, participants without internet access or those facing language barriers were not included.

Sampling technique and sample size

Participants were recruited using a non-probability purposive sampling technique. An online questionnaire was developed on Google Forms and disseminated via multiple channels, including professional healthcare networks, email invitations to healthcare institutions and social media platforms frequented by healthcare professionals. The snowball sampling method was also employed, encouraging initial respondents to share the survey link with their colleagues and peers. This strategy ensured the recruitment of a diverse sample and maximised participation.

The sample size was calculated using Stata statistical software V.17.0. The calculation was based on an anticipated R-squared value ranging from 0.06 to 0.24, considering five covariates, with a power of 80% and an alpha of 0.05. The initial estimate suggested a minimum sample size of 177 participants. To account for potential non-responses or incomplete data, a 10% inflation rate was applied, resulting in a final sample size of approximately 195 participants, which was rounded up to 200 for this study.21,23

Study questionnaire

The study used a questionnaire to assess work–family guilt, ideal self-discrepancy, parenting self-efficacy and related constructs, using validated tools untested in Pakistan, thus requiring content validation and pilot testing for appropriateness. It began with screening questions to exclude ineligible participants, followed by sections on sociodemographic, family and work variables. Work-Interfering-with-Family Guilt (WIFG) was measured with Borelli et al’s²⁴ WIFGS, ideal self-discrepancy via Liss et al’s²⁵ protocol (rating 15 adjectives like ‘loving’ for ideal and self as a mother), parenting self-efficacy with Dumka et al’s²⁶ measure, employment peer norms with one item (‘In my social circle, it’s normal for women to work while raising children’), motivation to work with two researcher-developed items (eg, ‘I work to support my family’) and WFC with Netemeyer et al⁶ subscale—all scored on a 5-point Likert scale (1=strongly disagree, 5=strongly agree). The tool was administered in English language. Since the tool was neither validated nor piloted on the Pakistani population, the content validity was assessed from six psychology experts (overall I-CVI 0.96; S-CVS 0.95), and pilot testing was done on 10 participants (Cronbach’s alpha: 0.9).

Definitions

The variable definitions are mentioned in table 1.

Table 1. Variable definitions.

Variable	Definitions
Parenting self-efficacy	Parenting self-efficacy is defined as the degree to which individuals believe they are able to perform the tasks of parenting, such as managing children’s behaviour.26
Ideal self-discrepancy	The degree to which an individual perceives she deviates from an “ideal” mother influences her vulnerability to WIF guilt.25
Childcare facility used	The utilisation of organised, professional services or centres where caregivers provide supervision, education and support to children, typically while parents are at work or managing other responsibilities.
Both parents work.	Both partners are professionally employed or running their business outside their homes.
WIFG	Work-interfering family guilt (WIFG) is the emotional distress or guilt individuals feel when they perceive that their work responsibilities are negatively impacting their ability to fulfil family obligations.21
WFC	Work-family conflict (WFC) or work interfering with family conflict refers to a form of inter-role conflict where the demands of work and family are incompatible in some respect. It occurs when responsibilities in one domain (work or family) interfere with obligations in the other, leading to strain and difficulty in effectively managing both roles.6

WIF, work-interfering family.

Participant recruitment

Data collection for this study was conducted through a structured questionnaire developed on Google Forms, accessible exclusively to healthcare professionals working in Pakistan. The questionnaire link, along with a brief introduction to the study and an informed consent form, was shared through professional healthcare networks, social media platforms such as Facebook, WhatsApp, Twitter and LinkedIn, and email invitations to healthcare institutions. The study materials, including the consent form and the questionnaire, were provided in English to suit the language proficiency of the participants. To proceed with the questionnaire, participants were required to provide voluntary consent by clicking on the designated link included in the study materials. Only those who consented were able to access the questionnaire.

Patient and public involvement

Data were collected using an online questionnaire and no direct involvement with participants was involved.

Statistical analysis

Statistical analysis was conducted using Stata V.17.0. Descriptive statistics included means and SDs for normally distributed continuous variables, medians and IQRs for skewed data, and frequencies and percentages for categorical variables, supplemented by histograms and bar charts. Mean Work-Interfering-with-Family Guilt (WIFG) and WFC scores were reported by covariates (eg, age, sex, employment type). Separate multiple linear regression models examined factors associated with WIFG and WFC as distinct outcomes, with sociodemographic factors (age, sex, marital status, education), work-related variables (type of employment, healthcare role), family-related factors, parental self-agency (PSA) and ideal self-discrepancy as covariates to control for confounding. Multicollinearity was checked using correlation coefficients (corr) for continuous variables and eta tests for categorical variables. Model diagnostics included outlier detection via Cook’s distance, residual plots and normality of residuals assessed using the Kolmogorov-Smirnov test and normal probability plots. Post hoc tests (variance inflation factors) further evaluated model adequacy. R-squared values quantified explained variance in WIFG and WFC, with significance set at p<0.05. Interaction was also checked at a significance level of <0.1. This manuscript adheres to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for cross-sectional studies. A completed STROBE checklist is submitted as online supplemental file 3.

Results

A total of 210 participants completed the questionnaire, of which 188 met the eligibility criteria and were included in the study. The average age of participants was 34 years (SD=5.6), with 55.9% male and 44.1% female. Most participants were Sindhi (35.1%), followed by Urdu-speaking (21.8%) and Punjabi (17.0%), and the majority resided in Sindh (96.3%). On average, participants had been married for 8.2 years (SD=5.4) and had 1.7 children (SD=0.8), with the eldest child averaging 6.5 years (SD=5.1). Physicians constituted the largest professional group (39.4%), followed by nurses (30.3%) and dentists (8.5%). Most held undergraduate degrees (70.2%), and 40.5% reported a monthly household income between PKR100 000 and PKR149 999. The majority were employed full time (96.3%) in government or semigovernment organisations (69.7%), primarily in inpatient settings (72.8%). Participants worked an average of 42 hours per week (SD=3.4) across 5.8 workdays (SD=0.5). Table 2 provides an overall sociodemographic characteristics of study participants.

Table 2. Participants’ characteristics (N=188).

Covariates	Mean (SD)/n (%)
Age (years)	34 (5.6)
Gender
Female (mother)	83 (44.1)
Male (father)	105 (55.9)
Ethnicity
Baloch	5 (2.6)
Bihari	1 (0.5)
Chitrali/Balti	2 (1.06)
Gujrati	7 (3.7)
Hazari	1 (0.5)
Kashmiri	1 (0.5)
Pashtoon	21 (11.2)
Punjabi	32 (17.0)
Sindhi	66 (35.1)
Urdu speaking	41 (21.8)
Memon	11 (5.9)
State/province
Sindh	181 (96.3)
Punjab	4 (2.1)
Balochistan	1 (0.5)
KPK	2 (1.06)
Years of marriage	8.2 (5.4)
Total number of children	1.7 (0.8)
Age of eldest child (years)	6.5 (5.1)
Age of youngest children	4.1 (3.2)
Children under 12 years	1.5 (0.6)
Profession
Clinical researcher	4 (2.1%)
Dentist/dental hygienist	16 (8.5%)
Dietitian/nutritionist	2 (1.06%)
Healthcare administrator/manager	11 (5.85%)
Mental health counsellor	1 (0.5%)
Nurse (RN/LPN)/nurse practitioner	57 (30.3%)
Orthodontist	1 (0.5%)
Pharmacist	7 (3.7%)
Physical therapist (PT)	2 (1.06%)
Physician (MD/DO)	74 (39.4%)
Radiologic technologist	4 (2.1%)
Respiratory therapist	4 (2.1%)
healthcare analyst	1 (0.5%)
Education level
Primary or less	2 (1.06)
High school	7 (3.7)
Graduate	132 (70.2)
Masters/postgraduate	39 (20.7)
Doctoral/PhD	8 (4.2)
Monthly household income (PKR)
<50 000	1 (0.5)
50 000–99 999	32 (17.0)
100 000–149 999	77 (40.5)
150 000–199 999	31 (16.5)
>200 000	47 (25%)
Employment type
Full time	181 (96.3)
Part time	4 (2.1)
Self-employed/other	3 (1.6)
Organisation type
Government/semigovernment	131 (69.7)
Private	57 (30.3)
Department
Inpatient	137 (72.8)
Outpatient/office-based	51 (57.2)
Average work hours/week	42 (3.4)
Average workdays/week	5.8 (0.5)

Prevalence of WIFG and WFC among study participants

The prevalence of WIFG and WFC was examined by categorising scores into low, moderate and high levels based on their SD from the mean. As illustrated in the graph, 23% of individuals reported low guilt, while a majority (65%) fell into the moderate range, and 12% experienced high guilt. On the other hand, WFC showed a distinct pattern, with low conflict observed in 20% of individuals, moderate levels in 16% and a significantly high prevalence of conflict at 64%. This comparison highlights the differing distributions and prevalence of these constructs (online supplemental figure 1).

WIFG and WFC scores across different covariates

According to table 3, participants aged ≤30 years demonstrated notably higher scores for both WIFG (30.84±8.74) and WFC (37.64±7.91) compared with those aged >30 years (WIFG: 25.77±7.94; WFC: 33.53±7.95). Similarly, females consistently reported elevated scores (WIFG: 31.46±8.54; WFC: 36.42±8.20) compared with males (WIFG: 23.92±6.83; WFC: 33.40±7.87). Among ethnic groups, Punjabis emerged with the highest WFC scores (38.26±6.72), while Sindhis exhibited comparatively lower scores (WFC: 34.94±6.92).

Table 3. Mean WIFG and WFC scores across different covariates.

Group	WIFG score (mean±SD)	WFC (mean±SD)
Age category
≤30	30.8±8.7	37.6±7.9
>30	25.7±7.9	33.5±7.9
Gender
Female (mother)	31.4±8.5	36.4±8.2
Male (father)	23.9±6.8	33.4±7.8
Ethnicity
Sindhi	25.8±7.4	34.9±6.9
Punjabi	28.4±7.6	38.2±6.7
Pashtoon	26.4±8.2	32.0±9.2
Other	28.2±9.9	33.2±9.1
Monthly income
≤150 000	28.9±8.2	36.8±7.2
>150 000	24.8±8.3	31.7±8.4
Profession category
Physicians and dentists	26.9±8.4	34.3±7.9
Nurses and allied clinicians	28.3±8.0	36.7±7.0
Pharmacists and non-clinical	25.4±9.7	30.8±10.1
Department
Inpatient	28.4±8.1	36.6±6.9
Outpatient/office-based	23.9±8.6	29.7±9.0
Working hours per week
≤40 hours	23.2±8.7	29.1±9.5
>40 hours	28.0±8.2	35.8±7.3
Years married
≤7	28.9±8.4	36.2±7.5
>7	25.0±8.1	32.6±8.4
Organisation type
Govt/semi govt	27.5±8.5	35.8±7.5
Private	26.5±8.3	32.2±8.8
Career level group
Early career	29±9.10	36.0±8.4
Experienced	26.5±8.1	34.2±7.9
Spouse employment status
Employed	29.2±8.8	35.3±8.1
Unemployed	24.6±7.2	33.9±8.1
Is your spouse a health professional
Yes	28.6±9.4	35.9±6.1
No	26.8±8.1	34.3±8.5
Type of family
Joint family	28.8±8.9	36.3±7.7
Nuclear family	25.2±7.4	32.6±8.1
Child care facility used
Yes	27.2±8.3	34.8±7.9
No	27.3±9.1	34.1±9.3
Both parents work
Yes	27.2±8.5	34.6±7.9
No	27.5±8.7	34.9±8.9

WFC, work–family conflict; WIFG, work-interfering family guilt.

Furthermore, participants earning ≤PKR150 000 per month recorded higher scores for WIFG (28.95±8.23) and WFC (36.85±7.23) relative to those earning >PKR150 000 (WIFG: 24.85±8.30; WFC: 31.76±8.46). Nurses and allied clinicians also stood out with elevated scores (WIFG: 28.34±8.01; WFC: 36.76±7.00), followed by physicians and dentists (WIFG: 26.95±8.41; WFC: 34.33±7.90). Moreover, inpatient healthcare workers exhibited higher WIFG (28.49±8.10) and WFC (36.60±6.95) scores in comparison to outpatient or office-based workers (WIFG: 23.92±8.68; WFC: 29.73±9.01) (table 3).

Shifting the focus to working hours, participants working >40 hours weekly reported increased scores for WIFG (28.03±8.25) and WFC (35.83±7.38) compared with those working ≤40 hours (WIFG: 23.25±8.73; WFC: 29.16±9.53). Interestingly, marital duration also influenced scores, with those married ≤7 years showing higher WIFG (28.89±8.41) and WFC (36.28±7.56) scores than those married >7 years (WIFG: 25.04±8.13; WFC: 32.65±8.46) (table 3).

In addition, early career professionals (WIFG: 29.00±9.10; WFC: 36.03±8.41) exhibited higher scores compared with experienced professionals (WIFG: 26.54±8.14; WFC: 34.20±7.99). Joint family participants reported elevated WIFG (28.83±8.90) and WFC (36.39±7.75) scores compared with nuclear family participants (WIFG: 25.24±7.45; WFC: 32.64±8.18). Finally, healthcare professionals with employed spouses (WIFG: 29.21±8.82; WFC: 35.31±8.15) and those whose spouses were also healthcare professionals (WIFG: 28.60±9.49; WFC: 35.97±6.16) recorded higher scores (table 3).

Factors correlated with WIFG and WFC

The correlation matrix in online supplemental table 1 reveals strong negative correlations of WIFG and WFC with PSA (r=−0.52 and r=−0.57, respectively), and a moderate positive correlation between WIFG and WFC (r=0.70). Weak positive correlations are observed for both WIFG (r=0.17) and WFC (r=0.25) with work hours per week, as well as with night shifts per week (WIFG: r=0.18; WFC: r=0.43). Negligible correlations are seen for ideal self-discrepancy with WIFG (r=0.003) and WFC (r=−0.01).

The graph in figure 1 illustrates the mean WIFG scores across age groups, separated by gender. Females, represented by the red dashed line, consistently show higher WIFG scores compared with males, represented by the blue solid line, throughout the age range. Both genders exhibit fluctuations in WIFG scores with age, but the trend indicates a general decrease in scores as individuals grow older. This comparison highlights age-related patterns and gender differences in WIFG across the sample population.

Figure 1. Comparison of work-interfering family guilt (WIFG) scores between females (mothers) and males (fathers) across age groups.

To assess whether WFC and WIFG represent overlapping or distinct constructs, we conducted a correlation analysis between their respective scores. A strong positive association was observed (r=0.70, p<0.001), indicating that while the two constructs were measured using distinct tools and captured different psychological dimensions—role interference versus emotional distress—they tended to co-occur in practice among healthcare professionals.

In the multivariable linear regression analysis for WIFG, mothers notably showed higher WIFG scores compared with fathers (β 6.8; 95% CI 4.9 to 8.5). Interestingly, the lack of access to childcare facilities was also associated with increased WIFG scores (β 2.5; 95% CI 0.2 to 4.6). Parenting self-efficacy, on the other hand, demonstrated an inverse association, with higher self-efficacy linked to lower WIFG scores (β −2.8; 95% CI −0.5 to –0.03). Furthermore, elevated levels of WFC were notably associated with higher WIFG scores (β 0.5; 95% CI 0.4 to 0.6).

For WFC, younger participants and fathers notably demonstrated lower conflict scores (β −0.15; 95% CI −0.2 to –0.01; B=−2.3; 95% CI –4.1 to –0.5, respectively). Notably, higher parenting self-efficacy was linked to reduced WFC scores (β −0.6; 95% CI −0.8 to –0.4). Among professions, physicians and dentists (β 6.0; 95% CI 3.4 to 8.5) as well as nurses and allied health workers (β=5.3; 95% CI 2.6 to 8.0) showed strikingly higher WFC scores compared with pharmacists. Moreover, participants without both parents working revealed elevated WFC scores (β 5.4; 95% CI 1.4 to 9.4), while those employed full-time reported increased scores compared with part-time/self-employed individuals (β 3.7; 95% CI −0.2 to 7.7). Unsurprisingly, longer work hours (β 1.0; 95% CI 0.3 to 1.6) and higher WIFG scores (β 0.5; 95% CI 0.4 to 0.6) were strongly associated with elevated WFC levels. Finally, the interaction effects revealed that physicians and dentists, as well as nurses and allied health workers, displayed notably higher WFC scores (β 5.8; 95% CI 0.5 to 9.0 and β 4.4; 95% CI 1.2 to 7.5, respectively) when only one parent was a working professional, as compared with pharmacists and non-clinicians where both parents were working. This highlights the interplay between professional roles and parental employment arrangements in shaping conflict outcomes (table 4).

Table 4. Multivariable analysis for factors associated with WIFG and WFC.

Variable	WIFG			WFC
	β	SE	95% CI	β	SE	95% CI
Age	–	–	–	−0.15	0.06	−0.2 to 0.01
Gender
Male	Ref			Ref
Female	6.8	0.9	4.9 to 8.5	−2.3	0.9	−4.1 to 0.5
Availability of childcare facility
Yes	Ref			–	–	–
No	2.5	1.1	0.2,4.6	–	–	–
Parenting self-efficacy	−2.8	0.1	−0.5 to 0.03	−0.6	0.1	−0.8 to 0.4
WFC	0.5	0.05	0.4 to 0.6	–	–	–
Profession
Physician and dentists	–	–	–	6.0	1.3	3.4 to 8.5
Nurses and allied health workers	–	–	–	5.3	1.3	2.6 to 8.0
Pharmacists and non-clinicians	–	–	–	Ref
Both parents work
No	–	–	–	5.4	2.0	1.4 to 9.4
Yes	–	–	–	Ref
Employment status	–	–	–
Part time/self employed				Ref
Full time				3.7	2.0	−0.2 to 7.7
Work hours per day				1.0	0.3	0.3 to 1.6
WIFG score				0.5	0.05	0.4 to 0.6

WFC, work–family conflict; WIFG, work-interfering family guilt.

Discussion

This study offers valuable insights into the factors associated with WIFG and WFC among healthcare professionals in Pakistan, a topic that has seen limited exploration in the local context. The analysis reveals that both WIFG and WFC are linked to several contributing factors, with younger professionals, women and those in demanding clinical roles with extended work hours being most affected. While these observations align with international research, they also shed light on unique local factors, such as family structures, limited availability of childcare facilities and the employment status of spouses. These cultural and social dynamics emphasise the need for context-specific interventions to better address work-family challenges faced by healthcare professionals in Pakistan.

The multivariable analysis revealed significant gender differences in WIFG, with mothers reporting higher levels of guilt compared with fathers. This finding is consistent with prior studies, including those conducted in the USA, where mothers exhibited stronger associations between caregiving and guilt when work interfered with family responsibilities.^{24 27} Research by Borelli et al and others supports this observation, highlighting how societal expectations disproportionately place caregiving demands on women.²⁴ In South Asian societies, these expectations may be even more pronounced due to deeply ingrained cultural norms, potentially exacerbating WIFG among mothers in comparison to fathers.²⁸

Similarly, gender differences in WFC were noted, with fathers reporting relatively lower family-to-work conflict compared with mothers.²⁹ While global research has shown that fathers often experience less interference from family obligations affecting their professional roles, both parents tend to report comparable levels of WFC.³⁰ This disparity likely reflects persistent societal views that frame parenting primarily as a maternal responsibility, thereby reducing perceived conflict for fathers when family demands arise.

Our analysis also showed that limited access to childcare facilities was significantly associated with higher WIFG scores. This aligns with existing literature suggesting that the absence of reliable childcare options forces parents—particularly mothers—to make difficult choices between work and family responsibilities.^{31 32} These choices may amplify feelings of guilt, as parents perceive themselves as neglecting either their professional duties or their children. In LMICs such as Pakistan, such challenges are intensified by cultural norms and underdeveloped infrastructure, where formal childcare centres are less common.³³ Instead, families often rely on relatives for childcare, which may not always align with professional schedules or standards of care.

Parenting self-efficacy demonstrated an inverse relationship with both WIFG and WFC in our study, suggesting a potentially protective effect. Participants with higher self-efficacy reported lower scores in both domains, reflecting greater confidence in managing parenting responsibilities and balancing competing demands. These findings are consistent with Bandura’s Social Cognitive Theory, which posits that self-efficacy influences how individuals navigate stress and role conflict.³⁴ Parents with higher self-efficacy may be better equipped to manage time, reduce emotional strain and maintain a healthier work–family balance, thereby mitigating the intensity of WIFG and WFC.

Globally, several healthcare institutions and corporations have successfully implemented on-site childcare and flexible scheduling to support working parents. For instance, Mindtree in India offers on-site daycare through its Little Critters centre, which has been highlighted by the International Finance Corporation (IFC) as part of its Tackling Childcare initiative. This initiative demonstrates that employer-supported childcare can improve retention, productivity and gender equity in the workforce (IFC, 2017). ³⁵ In the UK, the National Health Service provides family-friendly policies including job sharing and part-time roles to accommodate parental responsibilities.³⁶ A scoping review by McArthur et al further emphasises that access to childcare is a critical social determinant of health, influencing healthcare access and workforce stability.³⁷ These models offer valuable insights for Pakistani healthcare institutions, which could adapt similar strategies to address WFC and guilt among professionals. Incorporating flexible shifts, staggered work hours and subsidised childcare could be feasible steps toward creating a more inclusive and supportive work environment.

The observed association between WIFG and WFC also highlights their interconnection. Higher levels of guilt were significantly linked to increased conflict, suggesting an emotional spillover effect—where guilt about neglecting family due to work obligations contributes to perceived strain between professional and personal roles. Previous studies by Wang et al, Judge et al and Gerçek support this idea, emphasising how social norms around ideal parenting intensify guilt and conflict when work disrupts family life.38,40 In Pakistan’s cultural context, these expectations may intensify such experiences, especially for mothers. In addition, the strong correlation observed between WFC and WIFG (r=0.70) suggests that while these constructs are conceptually distinct, they frequently co-occur in practice. This reinforces the idea that role-based conflict and emotional distress are interlinked experiences for healthcare professionals and may require integrated interventions that address both structural and psychological dimensions of work–family strain.

Our findings further reveal profession-specific variations in WFC, with physicians, dentists and nurses reporting significantly higher conflict than pharmacists and non-clinicians.^{41 42} The demanding and unpredictable nature of clinical roles likely contributes to this discrepancy, as these professionals often endure long hours, emotional labour and patient-care responsibilities that interfere with family obligations. Full-time employment compounds this challenge, as rigid schedules and limited flexibility may restrict the ability to balance work and home roles.

This study is pioneering in its exploration of WIFG and WFC among healthcare professionals in Pakistan, particularly parents of young children. Unlike most studies that focus solely on healthcare professional mothers, this research also includes fathers, highlighting that both parents face significant challenges. While its cross-sectional design limits causality and online surveys introduce potential biases, these are outweighed by the study’s unique contribution to understanding WIFG and WFC in a high-stress occupational group. The findings offer practical implications for designing workplace policies that support healthcare workers in managing work–family responsibilities. Nonetheless, this study has several limitations. First, the use of purposive and snowball sampling may limit generalisability, as participants were recruited through professional networks and social media platforms, introducing potential selection bias. Second, data were collected via self-administered online questionnaires using Google Forms, which may be subject to reporting bias and social desirability effects. Third, while the inclusion of a wide range of healthcare professionals enhances the breadth of findings, subgroup sizes were not powered for role-specific analysis, limiting nuanced comparisons across professions. Lastly, the cross-sectional design restricts causal inference between predictors and outcomes.

Future research should explore longitudinal studies to better understand causal relationships between predictors and WFC among healthcare professionals, with a focus on parents. Institutions should prioritise implementing family-friendly workplace policies, including providing on-site child care assistance to reduce parenting stress, particularly for mothers. Additionally, targeted interventions, such as mental health support and flexible work schedules, can help mitigate WFC. Expanding studies to include diverse healthcare settings globally would further enhance the generalisability and applicability of these findings.

Conclusions

This study aimed to investigate the predictors of WIFG and WFC among healthcare professionals in Pakistan raising children under 12 years of age. By including both mothers and fathers, it offers a gender-inclusive perspective on how clinical demands, limited childcare access and societal expectations contribute to work–family strain. The strong correlation between WFC and WIFG highlights the emotional toll of role conflict and underscores the need for integrated institutional support. As the first study of its kind in Pakistan, these findings provide a foundation for future research and policy development. Longitudinal studies and workplace reforms—such as on-site childcare and flexible scheduling—are essential to reduce WFC and promote healthcare workforce retention and well-being.

Data availability statement

Data are available on reasonable request.