Work-related quality of life and associated factors among healthcare professionals in public hospitals of Bahir Dar City, Northwest Ethiopia

Abstract

Background

Work-Related Quality of Life (WRQoL) reflects healthcare professionals’ (HCPs) well-being and satisfaction in their work environment. It is a key determinant of retention, productivity, and organizational effectiveness. Despite its importance, evidence on WRQoL in Ethiopia remains limited.

Objective

To assess the level of WRQoL and its associated factors among HCPs in public hospitals of Northwest Ethiopia.

Methods

A facility‑based cross‑sectional study was conducted from May 15 to June 15, 2024, among 408 HCPs selected through simple random sampling. Of these, 385 participated, yielding a response rate of 94.4%. Data were collected using a self‑administered questionnaire, entered into EpiData version 4.7, and analyzed with SPSS version 27.0. WRQoL mean scores were calculated and treated as continuous variables in regression analyses, while descriptive presentation used standard cut‑off classifications. Linear regression analyses were performed. Simple linear regression was initially used to screen candidate variables, and those with p < .25 were entered into a multiple linear regression model. Final results are presented from the multiple regression analysis as coefficients (B, β) with 95% confidence intervals (CI). Statistical significance was set at p < .05.

Results

The overall WRQoL mean score was 2.45 ± 0.61 (95% CI: 2.39–2.51) on a five-point Likert scale. Domain analysis showed the highest score in control at work (2.84 ± 0.83), while working conditions (2.26 ± 0.82) and general well-being (2.34 ± 0.73) were lowest. Tertile classification revealed that 36.1% of participants had low WRQoL, 33.2% moderate and 30.6% high WRQoL. In multiple regression, monthly income (β = 0.193, p =.003) was positively associated with WRQoL, whereas psychological distress (β = −0.166, p =.003), longer work experience (β = −0.195, p =.016), and professional category (midwives: β = −0.215, p <.001; medical doctors: β = −0.137, p =.010) were negatively associated.

Conclusions

More than one third of HCPs experience low WRQoL, with deficits in working conditions and well-being. Addressing workload, inequities across professional categories, and psychosocial stressors, while strengthening resources such as fair income and supportive environments, is essential to improve WRQoL and ensure better patient care outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-026-14507-0.

Introduction

Work-related quality of life (WRQoL) is the extent to which employees are satisfied with personal and work-related needs through active participation in the workplace while achieving organizational goals [1, 2]. More specifically, WRQoL encompasses job security, performance, and employee happiness [3]. It is multidimensional, shaped by workload, autonomy, compensation, organizational support, interpersonal relationships, and the physical work environment, and is commonly assessed across domains such as control at work, stress at work, job and career satisfaction, working conditions, general well-being, and home–work interface [1]. Aligning organizational effectiveness with workforce well-being is essential to enhance satisfaction and performance [4].

For healthcare professionals (HCPs), WRQoL is especially critical due to demanding environments, high stress, and the responsibility of life-saving care, which necessitate supportive workplaces, fair remuneration, professional growth opportunities, and coping resources [5, 6]. High WRQoL enhances satisfaction, performance, and overall quality of life [7, 8]. In contrast, low WRQoL has been consistently linked to job dissatisfaction, workforce shortages, occupational stress, impaired treatment quality, increased attrition, and negative physical and mental health outcomes [6, 9]. These consequences reduce morale and impose recruitment, training, and turnover burdens on health systems [10], while also raising costs through absenteeism, reduced productivity, and staff turnover that undermine system sustainability [11].

Compared to other professions, HCPs experience lower WRQoL, particularly in low- and middle-income settings and during crises such as Coronavirus Disease 2019 (COVID-19) [9, 10, 12]. The physical work environment directly influences health, safety, and performance, and chronic strain contributes to burnout characterized by emotional exhaustion, depersonalisation, and reduced personal accomplishment [13–15]. Depersonalisation refers to emotional detachment and a cynical, impersonal attitude toward patients and colleagues, often adopted as a defense mechanism against chronic occupational stress and associated with diminished empathy and reduced quality of care [16]. Lower WRQoL is linked to poorer treatment quality, decreased patient satisfaction, and higher error rates, whereas higher WRQoL and well-being are associated with improved care outcomes [17, 18].

Globally, organizational pressures such as rising patient demands, technological change, and cost-efficiency imperatives intensify workloads and strain WRQoL [19–21]. Internationally, substantial proportions of HCPs report low WRQoL, including 45.7% of nurses in Iran [22] and 29.3% in India [23]. In Ethiopia, studies report WRQoL levels ranging from 32.2% to 50.9% among HCPs, highlighting gaps in workforce well-being [24–26]. Known predictors include income, professional category, and psychological distress, which influence WRQoL differently across contexts [8, 15].

Ethiopia’s health system faces resource limitations, a high disease burden, and a shortage of HCPs. These challenges result in demanding workloads, extended shifts, insufficient infrastructure, and limited medical supplies. Such conditions are particularly evident in public hospitals in Bahir Dar City, which function as referral centers with high patient volumes and diverse staffing patterns [26]. While prior Ethiopian studies have predominantly focused on nurses, evidence remains limited regarding broader groups of HCPs working in public hospitals. This narrow focus constrains the design of targeted interventions to improve workforce well-being across cadres [15]. Addressing this gap is crucial: identifying factors associated with WRQoL among HCPs can inform strategies to enhance job satisfaction, retention, and professional performance, while simultaneously reducing medical errors, improving coordination, and raising patient care quality and satisfaction [20, 21, 27, 28].

Therefore, this health facility-based cross-sectional study assesses the level of WRQoL and its associated factors among HCPs in public hospitals of Bahir Dar City, Northwest Ethiopia. By generating locally grounded evidence relevant to similar low- and middle-income contexts, the study contributes new insights into context-specific determinants of WRQoL. Integrating these determinants with established WRQoL domains [1], strengthens the case for organizational and policy interventions aimed at improving workforce well-being, which is essential for advancing maternal, neonatal, and general health outcomes.

Methods

Study design and participants

A health facility–based cross-sectional study was conducted from May 15 to June 15, 2024. The reporting of this study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, with the checklist provided in Appendix 1 [29]. The study was conducted in Bahir Dar City, the capital of the Amhara Region in Northwest Ethiopia, located approximately 578 km north-northwest of Addis Ababa. In 2024, the city’s population was estimated at about 640,000, with 49% male and 51% female residents [30].

Data were collected from the three public hospitals of Bahir Dar City, which together employ 2,273 healthcare professionals (HCPs): Felege Hiwot Comprehensive Specialized Hospital (FHCSH), Tibebe Ghion Specialized Teaching Hospital (TGSTH), and Addis Alem Primary Hospital (AAPH). Of these professionals, 1,301 were male and 972 were female (unpublished data, Bahir Dar City Health Bureau, 2024). The source population included all HCPs working in these hospitals, while the study population comprised randomly selected HCPs available during the data collection period. Healthcare providers with at least one year of work experience in Bahir Dar City public hospitals were eligible for inclusion. Those with less than one year of experience or providing voluntary/free services were excluded.

Sample size determination and sampling procedure

The sample size was determined using a single population proportion formula. Based on a previous study, 40.8% of HCPs were reported to have good WRQoL [26]. With a 95% confidence level, 5% margin of error, and 5% significance level, the required sample size was 371. After adding 10% for potential non-response, the final sample size became 408. The study was conducted in the three public hospitals of Bahir Dar City: AAPH, FHCSH, and TGSTH. A complete list of 2,273 healthcare professionals from the hospitals’ human resource units served as the sampling frame (883 from FHCSH, 1,214 from TGSTH, and 176 from AAPH). The total sample size of 408 was proportionally allocated to each hospital, resulting in 159 participants from FHCSH, 218 from TGSTH, and 31 from AAPH. Finally, participants were selected using computer-generated random numbers (SPSS version 27.0, random number generator function, accessed May 15, 2024), ensuring that every HCP had an equal chance of being included and minimizing selection bias.

Study variables

Dependent variable

Work-Related Quality of Work Life (WRQoL).

Independent variables

Socio‑demographic (age, sex, marital status, education, income, work experience), work‑related (burnout, workload, working conditions), individual (psychological distress, work–life balance, co‑worker relations), and organizational factors (work environment, promotion, pay, training).

Measurement and data collection

Data were collected using a validated, reliable, and self-administered questionnaire adapted from previous studies [1, 8, 15, 31, 32]. The tool was translated into Amharic and back-translated into English to ensure accuracy. It included items on socio-demographic and work-related characteristics, psychological distress, burnout, and WRQoL (Appendex 2). Psychological distress was measured using a validated 10-item instrument [32]. It was assessed as a general measure of mental health symptoms. Responses were rated on a five-point Likert scale ranging from 1 (“none of the time”) to 5 (“all of the time”). Mean scores were computed, with higher values indicating greater distress, and used as continuous variables in regression analyses. For descriptive purposes, distress was categorized as low (10–15), moderate (16–21), high (22–29), and very high (30–50). Burnout was assessed using items adapted from the Burnout Assessment Tool (BAT) [31]. Responses were rated on a five-point Likert scale ranging from 1 (“strongly disagree”) to 5 (“strongly agree”). Mean scores were computed, with higher values indicating greater burnout, and used as continuous variables in regression analyses. For descriptive prevalence, domain means greater than or equal to 2.5 were classified as presence of burnout, consistent with the midpoint threshold of the five-point Likert scale used in the BAT.

Work-Related Quality of Life (WRQoL) was measured using 23 Likert scale items adapted from the established WRQoL scale [1, 33]. Negatively worded items were rephrased positively so that higher scores consistently reflected better WRQoL. Across the six domains (control at work, stress at work, job and career satisfaction, working conditions, general well-being, and home–work interface), mean scores were calculated. A total WRQoL score was then computed as the sum of these domain means, with higher scores reflecting better perceived WRQoL. For regression analysis, WRQoL was treated as a continuous outcome, while for descriptive presentation it was categorized into tertiles (low, moderate, and high). Data collection was conducted in public hospitals of Bahir Dar City by three BSc nurses under the supervision of one MPH-trained professional. The questionnaire was self-administered and completed anonymously. To ensure confidentiality, questionnaires were distributed in paper form, filled individually by participants, and returned in sealed envelopes. Data collectors supervised the distribution and collection process but did not interfere while participants completed the forms. This procedure minimized risks of disclosure and assured participants that their responses, including negative experiences, would remain confidential.

Data quality control

Data were collected by trained data collectors following one day orientation. The questionnaire was pretested on 21 HCPs (5% of the sample) at the University of Gondar Comprehensive Specialized Hospital to assess clarity, consistency, and completion time. Necessary modifications were made to improve reliability and validity. The overall Cronbach’s alpha from the pretest was 0.87. During data collection, completeness was checked daily by data collectors and supervisors, with oversight from the principal investigator.

Reliability analysis confirmed excellent internal consistency for the WRQoL scale overall (Cronbach’s α = 0.880). Domain‑level reliability ranged from acceptable (General Well‑Being: α = 0.701; Job and Career Satisfaction: α = 0.744) to moderate (Home–Work Interface: α = 0.674; Working Conditions: α = 0.629). The control at work domain showed lower reliability (α = 0.533), but inter‑item correlations and Spearman’s rho supported partial consistency. Stress at work also showed minimal consistency between its two items. All domains were retained for analysis, with caution in interpreting control at work and stress at work. The psychological distress and burnout scales demonstrated excellent internal consistency (Cronbach’s α = 0.918 and 0.867, respectively).

Data processing and statistical analysis

Data were first checked for completeness and consistency, then coded and entered into EPI DATA version 4.7 and exported to SPSS version 27 for analysis. Descriptive statistics were computed and summarized using frequency tables and descriptive measures. For variables measured with Likert scale items, internal consistency was assessed using Cronbach’s α. Mean scores were calculated and treated as continuous variables in the regression analyses, while for descriptive presentation these scores were classified according to standard cut-off points.

For inferential analysis, simple linear regression was initially performed to screen candidate variables, with those showing p < .25 considered for inclusion. This relaxed threshold was used to avoid excluding potential predictors prematurely. In the final multiple linear regression model, statistical significance was set at p < .05, and results represent adjusted associations between explanatory variables and WRQoL. Crude associations are presented in Table S3. For categorical predictors, dummy variables were created to allow their inclusion in the regression models.

Prior to regression analysis, assumptions of linear regression were assessed. These included normality of residuals, linearity, homoscedasticity, and absence of multicollinearity. Collinearity diagnostics using Tolerance and Variance Inflation Factor (VIF) indicated no multicollinearity concerns among predictors. The multiple regression model was fitted using the Enter method, with WRQoL as the dependent variable and socio-demographic, work-related, burnout, and psychological distress variables as covariates. Model adequacy was evaluated using R squared, adjusted R squared, the overall F test, and residual diagnostics. Results are presented as regression coefficients (B and β) with 95% CI and p values. Five main tables are presented in the Results section. Supplementary Tables S1–S3 provides additional raw data and regression outputs, while Appendix 1 contains the STROBE checklist and Appendix 2 the questionnaire.

Ethical considerations

Ethical clearance was obtained from the Institutional Review Board (IRB) of Bahir Dar University, College of Medicine and Health Sciences (protocol number 966/2024, CMHS/IRB 01 008, approved May 24, 2024). Formal letters of support were secured from the Amhara Public Health Institute, and permission was granted by the medical directors of each participating hospital. The study was conducted in accordance with the principles of the Declaration of Helsinki. Confidentiality was maintained by using anonymous codes, and participants were assured that the data would not have any negative consequences on their personal or professional lives. Prior to data collection, the purpose of the study was explained, and verbal informed consent was obtained from all participants. The IRB confirmed that verbal consent was sufficient for ethics approval in this study context.

Results

Socio-demographic and work-related characteristics of HCPs

A total of 408 healthcare professionals were targeted, and 385 participated in the study, yielding a response rate of 94.4%. The majority of participants, 222 (57.7%), were aged 24–31 years, with a mean age of 31.9 years (SD ± 5). Just over half were male (51.7%) and most were followers of Orthodox Christianity (85.7%). More than half of the respondents were married (53.8%). In terms of profession, nurses represented the largest group (41.8%), followed by midwives (19.0%) and medical doctors/specialists (16.5%). Regarding educational attainment, most held a first degree (70.6%), while 16.7% had a master’s degree or above. Work-related characteristics showed that 39.5% of HCPs reported working ≤ 40 h per week, with a mean of 48.5 h (SD ± 13.2). Nearly half (45%) were working in inpatient departments (IPD). The most common range of work experience was 6–10 years (45.7%), with a mean of 10.2 years (SD ± 5.7). A large proportion, 301 (78.2%), earned a monthly salary between 5,001 and 9,999 Ethiopian birr (ETB), equivalent to ≈ 62–121 USD, with a mean salary of 7,882.8 ETB (SD 2,114.4). About one-third (32.2%) received a work risk allowance, and more than half (56.9%) reported having dependent family members (Table 1).

Table 1.

Socio-demographic and work-related characteristics of HCPs in public hospitals of Bahir Dar City, Northwest Ethiopia, 2024 (n = 385)

Variables	Category	Frequency	Percentage
Age of health care professionals	24–31 32–39 ≥ 40	222 115 48	57.7 29.8 12.5
Sex	Male Female	199 186	51.7 48.3
Religion	Orthodox Muslim Protestant	330 39 16	85.7 10.1 4.2
Marital Status	Single Married Divorced Widowed	159 207 14 5	41.3 53.8 3.6 1.3
Profession	Nurse Midwife GP and specialist Laboratory Pharmacist Others 1	161 73 64 35 31 21	41.8 19.0 16.5 9.1 8.1 5.5
Educational level	Diploma BSc Masters and above	49 272 64	12.7 70.6 16.7
Work hours	≤ 40 h 41–48 h ≥ 49	152 119 114	39.5 30.9 29.6
Work Experience	1–5 6–10 11–15 16–20 ≥ 21	60 176 78 39 32	15.6 45.7 20.3 10.1 8.3
Work unit	OPD IPD Emergency	170 173 42	44.2 44.9 10.9
Working hospital	Primary Specialized hospital	27 358	7.0 93.0
Work risk allowance payment	Yes No	124 261	32.2 67.8
Monthly Salary	≤ 5,000 ( ≈ < 61 USD) 2 5,001–9,999 (≈ 62–121 USD) 2 ≥ 10,000 ( ≈ > 122 USD) 2	28 301 56	7.3 78.2 14.5
Dependent Family	Yes No	219 166	56.9 43.1

¹ Others include Anesthetist, Physiotherapy, Psychiatry, Health Officer, and IESO

² USD equivalents were calculated using the average exchange rate during the data collection period (May 15–June 15, 2024), where 1 USD ≈ 82 ETB

Psychological distress and burnout

The mean psychological distress score among HCPs was 2.35 ± 0.97 (95% CI: 2.25–2.44). Based on categorical classification, 29.1% of participants reported low distress, 22.9% moderate distress, 23.1% high distress, and 24.9% very high distress. Item‑level responses indicated that nearly one‑third (28.1%) felt tired much of the time, 14.8% reported feeling nervous most of the time, 10.6% felt hopeless most of the time, and 9.4% felt depressed most of the time. In addition, 13.2% reported that nothing could cheer them up most of the time, while 15.6% felt worthless most of the time.

The mean burnout score was 2.48 ± 0.91 (95% CI: 2.38–2.57). Using a binary cut‑off, 44.9% of HCPs were classified as experiencing burnout, while 55.1% were classified as not experiencing burnout. Item‑level findings showed that 12.2% strongly agreed that their dedication to work exceeded what was healthy, 17.9% strongly agreed they would prefer a more challenging job, and 16.1% strongly agreed they neglected personal life in pursuit of work achievements. Conversely, nearly half (49.1%) strongly disagreed with statements about giving up in response to work difficulties, and 56.0% disagreed with risking their own health to achieve good results. About one‑third (34.5%) strongly agreed they would prefer another job to better develop talents, and 18.7% strongly agreed that their current work did not offer opportunities to develop abilities (Table 2; Table S1).

Table 2.

Mean score and standard deviation of psychological distress, and burnout among HCPs in Public Hospitals of Bahir Dar City, Northwest Ethiopia (n = 385)

Domain	Score Range (Min–Max)	Mean (± SD)	Classification Level	Frequency (%)	Mean (± SD) score
Psychological distress	1.00–5.00	2.35 (0.97)	Low distress	112 (29.1)	1.32 (0.19)
			Moderate distress	88 (22.9)	1.96 (0.15)
			High distress	89 (23.1)	2.54 (0.16)
			Very high distress	96 (24.9)	3.72 (0.62)
Burnout	1.00–5.00	2.48 (0.91)	No burnout	212 (55.1)	1.82 (0.39)
			Burnout present	173 (44.9)	3.29 (0.67)

Work-Related Quality of Life

Within the domain level, the general well-being domain showed mean scores ranging from 1.98 ± 1.08 for life satisfaction to 2.82 ± 1.30 for recent happiness. For the home–work interface domain, mean scores varied between 2.31 ± 1.15 and 2.49 ± 1.24. In the job and career satisfaction domain, item means ranged from 2.15 ± 1.10 for encouragement to develop new skills to 2.83 ± 1.27 for overall job satisfaction. For the control at work domain, mean scores ranged from 2.71 ± 1.19 to 3.07 ± 1.16. In the working conditions domain, item means ranged between 2.12 ± 1.03 and 2.43 ± 1.09. For the stress at work domain, mean scores were 2.65 ± 1.19 and 2.50 ± 1.22. The global WRQoL item, satisfaction with overall quality of working life, had a mean score of 2.49 ± 1.27 (Table S2).

The overall WRQoL mean score among health care professionals was 2.45 ± 0.61 (95% CI: 2.39–2.51), with observed scores ranging from 1.26 to 3.91 on a 1–5 Likert scale. Among the domains, control at work had the highest mean score (2.84 ± 0.83, 95% CI: 2.76–2.93). Stress at work (2.57 ± 0.86), home–work interface (2.42 ± 0.93), and job and career satisfaction (2.43 ± 0.77) showed moderate scores. Working conditions (2.26 ± 0.82) and general well-being (2.34 ± 0.73) had the lowest mean scores (Table 3).

Table 3.

Mean score and standard deviation of domains and overall WRQoL among HCPs in Public Hospitals of Bahir Dar City, Northwest Ethiopia (n = 385)

Domain	No. of Items	Mean score range (Min-Max)	Mean (± SD)	95% CI
General well-being	6	1.00–4.33	2.34 (0.73)	2.27–2.42
Home–work interface	3	1.00–4.67	2.42 (0.93)	2.32–2.51
Job and career satisfaction	6	1.00–4.17	2.43 (0.77)	2.36–2.50
Control at work	3	1.00–4.67	2.84 (0.83)	2.76–2.93
Working conditions	3	1.00–4.33	2.26 (0.82)	2.18–2.35
Stress at work	2	1.00–4.50	2.57 (0.86)	2.49–2.66
Overall WRQoL	23	1.26–3.91	2.45 (0.61)	2.39–2.51

The tertile classification of WRQoL indicated that more than one-third of participants (36.1%) were classified in the low WRQoL tertile, with a mean score of 1.83 ± 0.25 (95% CI: 1.78–1.87). Another 33.2% fell into the moderate tertile, with a mean score of 2.45 ± 0.17 (95% CI: 2.42–2.48). The remaining 30.6% were in the high WRQoL tertile, with a mean score of 3.18 ± 0.33 (95% CI: 3.12–3.24) (Table 4).

Table 4.

Tertile classification of WRQoL scores among HCPs in public hospitals of Bahir Dar City, Northwest Ethiopia (n = 385)

WRQoL tertile classifications	Frequency	Percent	Mean (± SD) score	95% CI
Low WRQoL	139	36.1	1.83 (0.25)	1.78–1.87
Moderate WRQoL	128	33.2	2.45 (0.17)	2.42–2.48
High WRQoL	118	30.6	3.18 (0.33)	3.12–3.24

Factors associated with work-related quality of life

In the simple regression analyses, several socio-demographic and work-related factors were significantly associated with WRQoL at a threshold of p < .25. These included sex, age, work experience, working hours per week, monthly income, psychological distress, burnout, professional category, educational qualification, dependent family, hospital type, and working unit (Table S3).

In the multiple regression model; monthly income, psychological distress, work experience, and professional category (midwives and medical doctors) remained statistically significant predictors of WRQoL. Specifically, for every one birr increase in monthly salary, WRQoL increased by 0.000055 units (B = 5.519E-5, β = 0.193, 95% CI [2.0E-5, 9.0E-5], p =.003). For each one-unit increase in psychological distress score, WRQoL decreased by 0.104 units (B = − 0.104, β = −0.166, 95% CI [− 0.172, − 0.037], p =.003). Each additional year of work experience was associated with a 0.021-unit decrease in WRQoL (B = − 0.021, β = −0.195, 95% CI [− 0.038, − 0.004], p =.016). Compared to nurses, midwives reported a 0.334-unit lower WRQoL score (B = − 0.334, β = −0.215, p <.001), and medical doctors reported a 0.223-unit lower WRQoL score (B = − 0.223, β = −0.137, p =.010). The final model explained 18.3% of the variance in WRQoL (R² = 0.183, Adjusted R² = 0.143), with a statistically significant overall fit (F(18, 366) = 4.568, p <.001) (Table 5).

Table 5.

Multiple linear regression predicting WRQoL among HCPs in public hospitals of Bahir Dar City, Northwest Ethiopia (n = 385)

Predictor variable	Unstandardized Coefficient (adjusted effect)			Standardized Coefficient (β)	95% CI for B	p-value
	B	SE
Age in years	−0.001	0.009		−0.010	−0.019, 0.017	0.908
Working hours per week	0.000	0.003		−0.011	−0.006, 0.005	0.851
Monthly salary in Ethiopian birr	5.519E-5	0.000		0.193	2.0E-5, 9.0E-5	0.003*
Work experience in years	−0.021	0.009		−0.195	−0.038, − 0.004	0.016*
Burnout	−0.012	0.036		−0.018	−0.083, 0.059	0.736
General psychological distress	−0.104	0.034		−0.166	−0.172, − 0.037	0.003*
Sex (Ref: Female)	0.083	0.061		0.069	−0.036, 0.203	0.171
Dependent family (Ref: yes)	0.104	0.061		0.085	−0.017, 0.224	0.091
Working hospital (Ref: primary hospital)	−0.113	0.137		−0.048	−0.382, 0.156	0.409
Profession (Ref: Nurse)
Midwife	−0.334	0.092		−0.215	−0.514, − 0.154	< 0.001*
Medical doctors / Specialist physicians	−0.223	0.086		−0.137	−0.392, − 0.053	0.010*
Laboratory professional / Technician	−0.084	0.116		−0.040	−0.312, 0.144	0.470
Pharmacist	−0.046	0.115		−0.021	−0.273, 0.180	0.687
Other HCPs1	−0.108	0.137		−0.041	−0.378, 0.161	0.431
Educational qualification (Ref: Diploma)
BSc degree	0.006	0.105		0.005	−0.200, 0.212	0.954
Masters and above	−0.121	0.124		−0.075	−0.366, 0.123	0.328
Working unit (Ref: OPD)
IPD	0.104	0.064		0.085	−0.022, 0.230	0.106
Emergency unit	0.135	0.102		0.070	−0.066, 0.336	0.187

¹ Others HCPs include Anesthetist, Physiotherapy, Psychiatry, Health Officer and IESO; SE= Standard Error; OPD =Outpatient Department, IPD = Inpatient Department, * significant at a p-value < 0.005

Discussion

This study assessed the WRQoL among HCPs and found an overall mean score of 2.45 (± 0.61), indicating a moderate level. Among the domains, control at work scored highest, while working conditions and general well-being scored lowest, with 36.1% of participants classified in the low WRQoL tertile. These findings align with other Ethiopian studies reporting moderate WRQoL, particularly in the working conditions and stress domains [8, 24–26, 34]. These consistent findings suggest systemic challenges such as resource shortages, high patient loads, and limited career progression opportunities across Ethiopian healthcare facilities [15].

Globally, WRQoL is strongly linked to patient care quality [17, 18], and crises such as the COVID-19 pandemic have further strained healthcare workers [14, 35, 36]. Studies from Nigeria and Uganda similarly reported moderate WRQoL, with organizational support and professional development opportunities emerging as key determinants [17, 33]. In Vietnam and Iran, stress and workplace violence were strongly associated with reduced WRQoL [18, 22]. These findings align with our study in Bahir Dar City, where WRQoL was constrained by inadequate infrastructure, high workloads, and limited organizational support. Together, this evidence highlights common barriers across low- and middle-income countries that undermine workforce well-being and patient care quality.

In contrast, studies from high-income countries generally report higher WRQoL scores, often due to stronger organizational structures, better compensation, and supportive work environments [1, 4, 37, 38]. This contrast underscores the influence of structural and resource factors on WRQoL [39].

Our analysis identified monthly income as a positive predictor of WRQoL, while psychological distress, longer work experience, and professional category (midwives and medical doctors) were negatively associated. The protective role of income reflects its buffering effect on stress and alignment with prior Ethiopian and international evidence [8, 17, 24, 37]. Conversely, the negative association between psychological distress and WRQoL aligns with findings from Ethiopia and international literature, where emotional exhaustion are consistently linked to lower WRQoL [13, 14, 18, 40, 41], confirming that mental health challenges are a universal determinant of diminished WRQoL.

Interestingly, longer work experience was negatively associated with WRQoL in our study. This contrasts with evidence from high-income countries, where experience often enhances coping and job satisfaction [6, 20, 38]. In Ethiopia and other resource-limited contexts, however, prolonged exposure to systemic challenges such as high patient loads, limited career progression, workplace violence, and shortages of supplies has been shown to erode WRQoL over time [15, 42]. This suggests that in resource-limited contexts, cumulative exposure to systemic stressors may outweigh the benefits of professional experience.

The lower WRQoL among midwives and medical doctors compared to nurses may be explained by the intensity and accountability embedded in their roles in maternal and newborn care [43–46]. Midwives, as primary caregivers in labor and delivery, are responsible for continuous monitoring, managing obstetric complications, and performing neonatal resuscitation, often within resource-constrained environments [47–49]. Similarly, medical doctors, particularly obstetricians, face complex clinical decision-making, emergency surgical responsibilities, extended working hours, and high cognitive demands, while maintaining accountability for maternal and neonatal outcomes. These life-saving responsibilities place them under sustained pressure, as delays or errors may directly lead to maternal or neonatal mortality [16, 42, 54]. Such demands are strongly associated with physician burnout and diminished well-being, ultimately lowering WRQoL [48, 50, 51].

In addition, these professions carry political and social accountability because maternal and newborn survival is a key public health priority, emphasized in global frameworks such as the Sustainable Development Goals (SDGs 3.1 and 3.2) [47, 49, 52]. This heightened responsibility intensifies stress and contributes to lower WRQoL. Evidence further shows that excessive workload in maternity care compromises both care quality and outcomes, and that high patient loads combined with insufficient staffing increase the risk of adverse maternal and neonatal outcomes, which in turn heightens stress among these professionals [44, 46, 53–55]. Together, these findings suggest that professional category is a significant determinant of WRQoL, as roles characterized by high clinical intensity, emotional demands, and societal expectations are more vulnerable to reduced WRQoL.

Limitations of the study

This study has several limitations that should be acknowledged. First, since the study population consisted of HCPs, there is a possibility of social desirability bias, as participants may have provided responses that reflect professional norms rather than their true perceptions. Second, the study excluded HCPs working in health centers and private clinics, which may limit the generalizability of the findings to all healthcare settings. Third, the study relied on a single-phase cross-sectional survey with a relatively high number of items, which may have introduced response fatigue and affected the accuracy of some responses. Fourth, although the questionnaire was self-administered and completed anonymously, data collectors who were HCPs distributed and supervised the process. While anonymity was assured, the presence of colleagues during distribution and collection may have created perceived pressure, potentially influencing participants’ willingness to disclose negative experiences. Finally, the study was not triangulated with qualitative methods, which could have provided richer insights into the contextual and experiential aspects of WRQoL.

Despite these limitations, the study has notable strengths. It is among the few studies in Ethiopia to comprehensively assess WRQoL among HCPs using a validated tool, thereby contributing valuable evidence to an under-researched area. The relatively large sample size enhances the reliability of the findings, and the inclusion of multiple professional categories allows for meaningful comparisons across groups. Moreover, the study highlights systemic challenges in healthcare delivery that are relevant for policy and workforce planning, offering practical implications for improving WRQoL and patient care quality.

Implications of the study

The findings of this study imply that improving the WRQoL of HCPs requires urgent attention from policymakers and health managers. Moderate WRQoL, particularly deficits in working conditions and general well-being, highlight systemic challenges such as resource shortages, high patient loads, and limited career progression opportunities. Addressing these issues through fair compensation, supportive leadership, recognition, and investment in infrastructure can enhance staff satisfaction, retention, and performance. Special focus should be given to midwives and medical doctors, whose critical responsibilities in maternal and newborn survival expose them to higher emotional strain and workload. Strengthening organizational support and promoting work-life balance will not only improve WRQoL but also contribute to better patient care outcomes and progress toward national and global health goals.

Conclusions

This study found that HCPs in Ethiopia experience a moderate level of WRQoL, with notable deficits in working conditions and general well-being. More than one third of participants were classified in the low WRQoL tertile, reflecting significant challenges in the work environment. Predictors such as income, psychological distress, longer work experience, and professional category (midwives and medical doctors compared to nurses) were significantly associated with WRQoL. These findings highlight systemic issues including resource shortages, high patient loads, and limited career progression opportunities, which collectively undermine HCPs’ well-being and the quality of patient care.

To address these challenges, hospital directors and health managers should prioritize investment in infrastructure, fair and competitive compensation, and supportive leadership practices. Special attention is needed for midwives and medical doctors, whose critical responsibilities in maternal and newborn survival expose them to higher emotional strain and workload. Hospitals should ensure adequate payment and benefits, expand staffing to reduce patient loads, and provide targeted psychosocial support for these groups. Institutions should strengthen recognition systems, offer continuous training and promotion opportunities, and adopt flexible scheduling to promote work–life balance. Introducing innovative hospital quality improvement strategies and monitoring essential support services for physical and mental well-being will further enhance WRQoL.

Although this study was conducted in three public health facilities over a one-month period, its findings are relevant beyond the study sites. Public healthcare institutions in Ethiopia operate under centralized governance structures led by the Ministry of Health and Regional Health Bureaus, with standardized salary scales, staffing structures, and administrative frameworks. As such, systemic challenges related to payment, staffing shortages, and workload pressures are likely similar across facilities. Nevertheless, given the cross-sectional design and limited number of facilities included, the findings should primarily inform institutional-level interventions while also serving as preliminary evidence for broader system-level discussions. Larger, multi-site and longitudinal studies are needed to generate nationally representative evidence to guide higher-level policy reforms.

Supplementary Information

Below is the link to the electronic supplementary material.

Author contributions

RMA were responsible for the conception of the research idea, study design, data collection, and performed the research. Dr. MH and YM provided help and supervised in the all process of the research work. RMA, LWT, and WFB entered and analyzed the data and interpreted the results. RMA, Dr, MH, YM and WFB participated in manuscript write-up and revision. All authors contributed to editorial changes in the manuscript, have read and approved the final manuscript. The authors have participated sufficiently in the work and agreed to be accountable for all aspects of the work.

Funding

This study was financially supported by Bahir Dar University. The funder has no role in study design, data collection, analysis, interpretation, the decision to publish, or the preparation of the manuscript.

Data availability

All related data has been presented within the manuscript. The data set supporting the conclusion of this article is available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

Ethical approval was obtained from the IRB of Bahir Dar University, College of Medicine and Health Sciences (protocol number 966/2024, approved May 24, 2024). Verbal informed consent was obtained from all participants, as approved by the IRB.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.