The wellbeing triad: modelling the interdependent pathways of healthcare workers’ happiness, motivation, and health in a rural setting in Kenya

Early Abstract:

Aim: This study evaluated the relationships and recursive pathways among healthcare workers linking happiness, work motivation, and health-related quality of life (HRQoL) in a rural setting in Kenya.
Methods: Using a cross-sectional dataset collected across all hospitals (n=24) at the secondary and tertiary healthcare levels in a rural county called Meru. Using STATA 15.1®, a Three-Stage Least Squares (3SLS) regression model was applied to assess the bidirectionality of the topic under study. Utilising the 3SLS method addressed the simultaneity bias while controlling for demographic, occupational, and socioeconomic confounders, including professional cadre, work hours, marital status, income, etc.
Results: The structural model confirmed a highly significant, positive bidirectional feedback loop forming a virtuous cycle with happiness catalysing work motivation (B=0.290,p<0.001), which, in turn, recursively fuelled baseline happiness (B=0.345,p<0.001). Importantly, happiness functioned as a powerful protective shield for health status (B=0.468,p<0.001), whereas overall motivation exerted no direct statistical effect on HRQoL (B=-0.136,p<0.001). However, excessive weekly hours imposed immense and direct physical strain on healthcare workers (B=-0.410), while baseline happiness deficits were mainly among lower- and mid-level professional cadres.
Conclusion: To enhance the well-being of rural healthcare workers, it is essential to shift from reactive management to a proactive, human-centered design approach. High motivation alone does not shield healthcare workers in rural areas from experiencing low HRQoL due to burnout. Therefore, based on the findings, health policymakers should enforce strict limits on working hours and enhance management strategies through competitive, consistent remuneration and adequate staffing to alleviate heavy workloads. These strategies could promote health, happiness, motivation, and overall well-being, unlocking the self-reinforcing aspect of workforce motivation.
Keywords: happiness, healthcare workers, health-related quality of life, Kenya, motivation, wellbeing.