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

Authors

Rose Nabi D K Muthuri

Published in

Rural and remote health. Volume 26. Issue 4. Pages 11012. Epub Oct 21, 2026.

Abstract

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.
The author used a cross-sectional dataset collected across all hospitals (n=24) at the secondary and tertiary healthcare levels in the rural county of Meru. Using STATA v15.1, 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 such as professional cadre, work hours, marital status, and income.
The 3SLS simultaneous equation structural model confirmed a highly significant, positive bidirectional feedback loop between overall happiness and overall motivation (β=0.290, p<0.001), and (β=0.329, p<0.001), respectively), establishing a mutually reinforcing virtuous cycle. Overall motivation presented a strong, positive direct effect on overall health status (β=0.299, p<0.001), which in turn recursively fuelled overall motivation (β=0.184, p<0.001). In contrast, direct structural paths from overall health status to happiness (β=0.054, p<0.05), and overall happiness to health status (β=0.083, p<0.05), were statistically non-significant, as was the effect of weekly work hours on health status (β=0.024, p<0.05). Across cadres, nursing professionals reported significantly higher baseline happiness relative to physicians/doctors (β=4.225, p<0.05). Additionally, being married was significantly associated with higher overall motivation (β=6.881, p<0.05). Finally, higher income tiers consistently demonstrated significant positive direct effects on overall health status relative to the lowest earning tier.
To enhance the wellbeing 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 wellbeing, unlocking the self-reinforcing aspect of workforce motivation.

PMID:
42902553
Bibliographic data and abstract were imported from PubMed on 21 Oct 2026.

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