An investigation into burnout in family physicians in low- and middle-income countries: a mixed methods study

Wright, Tanya Ruth

Abstract

Background
Burnout is a work-related stress phenomenon, characterised by exhaustion and disengagement from work, and with significant consequences. Highly prevalent among healthcare professionals, burnout is becoming an issue of global concern. Therefore, the aim of this study was to investigate the prevalence, associated factors, and experience of burnout in family physicians in low- and middle-income countries.

Method
This mixed-methods study collected data from family physicians in Pakistan, South Africa, Malaysia, Sri Lanka, and Zambia, using an online questionnaire containing the Oldenburg Burnout Inventory, followed by online semi-structured interviews with family physicians. Prevalence percentages were calculated, tests of association performed, and a hierarchical Poisson regression analysis conducted. Statistical significance was set at p ≤ .05. Interviews were analysed using a thematic approach.

Results
The overall sample size was 451. Burnout prevalence was 77.4% (95%CI 73.4-81.1). Significant risk factors for burnout were working over 50 hours per week (IRR, 1.06; 95%CI 1.01 – 1.11; p = .03) and conflict at work (IRR, 1.12; 95%CI 1.00 – 1.27; p = .05). Significant protective factors were manager support (IRR, 0.82; 95%CI 0.74 – 0.91; p = <.001), and a lack of conflict between work and home responsibilities (IRR, 0.82; 95%CI 0.74 – 0.92; p = .001). Interviews were conducted with 33 family physician participants. Thematic analysis identified four themes: demands; resources; living with work-related stress and burnout; and coping strategies and solutions.

Conclusions
Burnout is common among family physicians. Significant risk factors include working hours and work-related conflict while work-home balance and support act as protective factors. Burnout impacts on physician health, performance, and turnover intention.

Implications
This high prevalence of burnout has significant implications for physician health, performance, and staffing in these countries. Understanding the experience of physician burnout, together with risk and protective factors, is vital for developing interventions to prevent burnout or mitigate its impact.

Citation

Wright, T. R. (2025). An investigation into burnout in family physicians in low- and middle-income countries: a mixed methods study. (Thesis). Keele University. https://keele-repository.worktribe.com/output/1279898

• Thesis Type: Thesis
• Online Publication Date: Jun 26, 2025
• Deposit Date: Jun 17, 2025
• Publicly Available Date: Jun 27, 2025
• Public URL: https://keele-repository.worktribe.com/output/1279898
• Award Date: 2025-06