Effort-reward imbalance and self-rated health with the mediating role of sleep quality and physical activity among healthcare workers.

Authors

Hassan Taherahmadi, Ali Motamedi Rad, Neda Mohammadi, Seyyed Mehdi Mirhashemi, Hussein Hawawu, Manoochehr Mahram, Seyyed Hamidreza Ghafelehbashi, Seyed Mahyar Mirhashemi, Zahra Hosseinkhani

Published in

Scientific reports. Jun 22, 2026. Epub Jun 22, 2026.

Abstract

Beyond its personal importance, the health of healthcare workers (HCWs) is a critical factor influencing healthcare system performance and patient care quality due to their direct involvement in patient outcomes and the operational efficiency of healthcare services. This study investigates the association between effort-reward imbalance (ERI) and self-rated health (SRH) among HCWs, exploring the potential mediating roles of sleep quality and physical activity. This cross-sectional study used baseline data from a convenience sample of the Qazvin Employee Health Cohort Study (2021-2022, northwestern, Iran). SRH was assessed using a single-item instrument. In the cohort study, trained interviewers administered the validated Persian versions of the 22-item ERI questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the International Physical Activity Questionnaire (IPAQ). We used structural equation modeling as our main analytical approach. Analysis of 1250 medical university employees revealed that 43.39% reported suboptimal SRH. Those with suboptimal SRH were older, more likely to be female, and had a significantly higher prevalence of ERI (66.5% vs. 56.1%), poor sleep quality (63.5% vs. 37.8%), and low physical activity (33.3% vs. 26.6%) compared to those with optimal SRH (all p < 0.01). In correlation analysis, SRH was negatively associated with effort, the effort-reward ratio, and poor sleep, and positively associated with reward, and physical activity. Structural equation modeling demonstrated that ERI had a significant direct negative association with SRH (β = -0.07, p = 0.017) and a significant indirect negative association via worsened sleep quality (β = -0.08, p < 0.001) and slightly better physical activity (β = 0.01, p = 0.015). Although more than half of the participants reported optimal SRH and physical activity levels, ERI and poor sleep quality were still prevalent among HCWs. Among HCWs, the SRH of those perceiving their work effort exceeded their rewards was affected by poor sleep quality. Policymakers and health system managers must account for the complex relationship between health and behavioral constructs in occupational settings.

PMID:
42332172
Bibliographic data and abstract were imported from PubMed on 23 Jun 2026.

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