Factors associated with occupational fatigue among healthcare workers in Malaysia: a systematic review

Clinical Snapshot

Key Findings

• P Value: Not reported at the review level; individual study statistics not synthesised

• Effect Size: No pooled effect size calculable; thematic frequency analysis: high job demands identified in 66.67% of studies (6/9), high effort in 11.11% (1/9), sustained strain in 11.11% (1/9), COVID-19 pandemic context in 11.11% (1/9)

• Primary Outcome: Thematic synthesis of factors associated with occupational fatigue among Malaysian HCWs across nine included studies (n=4,662 participants)

• Nnt Or Sensitivity: Not applicable for this systematic review design; no diagnostic accuracy, therapeutic, or prognostic effect measures were synthesised

• Confidence Interval: Not applicable — narrative synthesis only; no confidence intervals reported

Clinical Application

The review does not evaluate specific interventions; therefore, direct feasibility assessment is not applicable. The proposed conceptual framework and call for standardised fatigue surveillance are feasible policy directions. Implementation of validated, standardised fatigue monitoring tools within Malaysian healthcare institutions would require organisational commitment, staff training, and integration with existing occupational health infrastructure. The heterogeneity of instruments currently in use (five different scales identified) suggests that consensus on a standard tool is a necessary precondition for meaningful surveillance. While this review is specific to Malaysia, the findings carry indirect relevance to Australian healthcare practice. Both countries operate mixed public-private healthcare systems with comparable HCW workforce pressures, particularly in the post-COVID-19 context. The RACGP and Safe Work Australia have identified healthcare worker fatigue as a priority occupational health issue, and Australian jurisdictions have implemented fatigue risk management frameworks (e.g., under the Work Health and Safety Act 2011). The TGA does not regulate fatigue assessment instruments, but AHPRA and state health departments have issued guidance on safe working hours. The finding that high job demands are the predominant fatigue driver aligns with Australian evidence and supports existing RACGP recommendations for workload management in general practice and hospital settings. The PBS does not directly apply to fatigue management interventions identified in this review. Australian clinicians and health administrators may use this review to contextualise the need for similar systematic evidence synthesis within the Australian healthcare workforce, particularly for under-researched HCW subgroups. Healthcare workers employed in Malaysian public and private healthcare settings, including doctors, nurses, and allied health professionals. Findings are most directly applicable to hospital-based HCWs in urban and peri-urban Malaysian settings given the geographic distribution of included studies (Selangor, Kuala Lumpur, Melaka, Sarawak, Peninsular zones). Applicability to rural, primary care, and East Malaysian (Sabah) HCWs is uncertain.

Abstract

BACKGROUND: Due to the nature of their work, occupational fatigue is an important issue among healthcare workers (HCWs), with implications for workers' health, patient safety and healthcare organisation performance. However, the evidence on factors of work fatigue among HCWs in Malaysia remains fragmented. OBJECTIVE: To synthesise the existing evidence on work fatigue among HCWs in Malaysia, with a focus on its associated factors across HCW populations and to examine the types of fatigue instruments used. DESIGN: Systematic literature review. SETTING: Literature on fatigue among HCWs in Malaysia. PARTICIPANT: Studies on occupational fatigue involving HCWs conducted within the Malaysian context. METHOD: A systematic literature search was conducted using electronic databases of PubMed, Scopus, Web of Science and Science Direct. Studies must involve HCWs. Studies not in English, focusing on burn-out and different fatigue constructs, such as compassion fatigue, were excluded. Data extracted included study characteristics, setting, fatigue instruments, HCW groups and key findings. Factors associated with fatigue were synthesised thematically. This review followed Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, and the quality of the study was assessed using the Newcastle-Ottawa Scale. MAIN OUTCOME MEASURE: Factors associated with work fatigue among HCWs in Malaysia. RESULTS: Out of 1699 articles screened, 138 studies were within the Malaysian setting. Nine (n=9) articles were finally included. One study, each was conducted nationwide, in Peninsular zones, in Melaka and Kuala Lumpur, also, three studies in Selangor and two in Sarawak. A total of 4662 HCWs participated, of which 1419 were doctors (30.4%), 1014 nurses (21.8%) and 2229 HCWs of various positions (47.8%). Fatigue instruments used were the Occupational Fatigue/Exhaustion Recovery Scale, the Chalder Fatigue Scale, the Fatigue Assessment Scale, the Zoom Exhaustion and Fatigue Scale, and the postacute COVID syndrome checklist. Two studies used electroencephalogram. Thematic synthesis identified factors such as high job demands (66.67%), high effort (11.11%), sustained strain (11.11%), and an environmental/contextual factor related to the COVID-19 pandemic (11.11%). An integrated conceptual framework is proposed. CONCLUSION: Occupational fatigue among HCWs in Malaysia is multifactorial. Limitations include heterogeneity in study design and fatigue assessment tools. Despite the limited number of included studies, the findings provide theory-informed insights into understanding occupational fatigue; however, they should be interpreted cautiously, despite the need for standardised work fatigue surveillance as part of an efficient fatigue management system. REGISTRATION: This review was registered under PROSPERO with the ID of CRD420251001576.