Burnout Among LTC Workers in China: A Convergent Mixed-Methods Study

Abstract Objectives Framed within the Social Ecological Framework (SEF), this mixed-methods study investigates the layered drivers of burnout among long-term care (LTC) workers in urban China, aiming to inform strategies for workforce sustainability amid rapid population aging. Methods A convergent mixed-methods design was implemented from October to December 2023. The quantitative phase surveyed LTC workers across six Nanjing districts, while the qualitative phase involved semi-structured interviews to capture subjective insights. Data integration provided a multidimensional understanding of burnout. Results A total of 494 care workers completed the survey, and 15 joined interviews. Emotional exhaustion (EE) was elevated in women, married individuals, and those with permanent positions. Depersonalization (DP) was lower among those with higher education and those working in home-based settings. Reduced personal accomplishment (PA) was more prevalent among older and married workers and those with extended working hours. Training intensity emerged as a protective factor for EE and DP, whereas care burden increased both. All three burnout components were positively associated with professional titles. Interestingly, policy recognition was linked to lower PA. Qualitative data revealed additional mitigating factors, including psychological adjustment, training access, emotional reciprocity, and policy recognition. Conclusions Burnout among LTC workers is shaped by a convergence of individual traits, organizational dynamics, and policy perceptions. Enhancing training, organizational support, and societal appreciation of care roles, alongside efforts to attract younger workers, may help address structural vulnerabilities in the LTC workforce. Key messages • Using a convergent mixed-methods design and the Social Ecological Framework, this study explores multilevel factors potentially contributing to burnout among LTC workers in urban China. • Multilevel factors within the Social Ecological Framework influence burnout differently. Access to training, organizational support, and care recognition may help sustain the LTC workforce.