Prevalence and determinants of effort-reward imbalance, job strain, and co-exposure among Ethiopian healthcare workers

• This study presents the prevalence of effort-reward imbalance (ERI), job strain (JS), and the co-occurrence of both ERI and JS among central and southern Ethiopian healthcare workers. • Psychosocial work-related factors of effort-reward imbalance (ERI), job strain (JS), and the co-occurrence of both ERI and JS among central and southern Ethiopian healthcare workers. • The measurement tools, along with the strong theoretical models used for this study to assess ERI and JS could be scaled up to investigate other occupational contexts. Evidence on psychosocial stressors, such as effort-reward imbalance (ERI) and job strain (JS), among healthcare workers (HCWs) in Ethiopia is limited, despite their high exposure to demanding working conditions. This study aimed to estimate the prevalence of ERI, JS, and their co-occurrence, and to identify associated factors among Ethiopian HCWs. A cross-sectional study was conducted in nine Ethiopian public hospitals between January and February 2023. Stratified cluster random sampling was applied, with hospitals serving as strata and hospital units as clusters. Data were collected using the Job Content Questionnaire (JCQ-17) and ERI-10. Analyses included confirmatory factor analyses, descriptive statistics, and robust Poisson regression models. Of 1,426 participants, 65% reported ERI, 65% reported JS, and 47% experienced both. The strongest predictors were work-family conflict, sleep problems, organisational injustice, and low social support increased the prevalence ratio of effort-reward imbalance, job strain, and their co-occurrence. Additionally, higher scores of list of threatening events (LTEs), longer working hours, and high job demands were associated with higher prevalence of ERI, and higher decision latitude was associated with lower prevalence of ERI. The high prevalence of ERI, JS and both highlights a considerable psychosocial strain among healthcare workers. Work–family conflict, organisational injustice, limited social support, sleep problems, list of threatening events, longer working hours, and high job demands contributed to these outcomes, while greater decision latitude was protective. These findings highlight the need for targeted interventions that strengthen organisational justice, enhance support systems, establish work-family wellness schemes, and promote healthier work schedules.