A cross-sectional study was conducted from June to July 2023 in five comprehensive specialized hospitals in Northwest Ethiopia: the University of Gondar Comprehensive Specialized Hospital (UoGCSH), Debre Markos Comprehensive Specialized Hospital (DMCSH), Debre Tabor Comprehensive Specialized Hospital (DTCSH), Tibebe-Ghion Comprehensive Specialized Hospital (TGCSH), and Felege-Hiwot Comprehensive Specialized Hospital (FHCSH).

All HCPsworking at comprehensive specialized hospitals in Northwest Ethiopia comprised the source population. The study population included HCPsat comprehensive specialized hospitals who met the inclusion criteria during the data collection period. Healthcare providersaged 18 years and above who provided informed consent were included in the study, while pregnant HCPsand those unwilling to participate were excluded from the study.

The single population proportion formula was utilized to determine the required number of participants for this study (17). Since this study was the first of its kind in Ethiopia, a proportion of 50% was used in the sample size calculation. The formula used is as follows n = Z α / 2 2 × p 1 − p d 2 where n is represents the desired sample size, Z is the typical normal distribution set at 1.96 (which corresponds to 95% CI), P represents the prevalence utilized in determining the optimal sample size and W is is the degree of accuracy required (with a marginal error of 0.05) Then computing for n = 1.96^2*0.5 (1–0.5)/0.05², n = 384. Considering a 10% non-response rate, the final calculated sample size was 422.

Participants from the hospitals were approached using a simple random sampling technique. To ensure representativeness among the hospitals, the sample size was proportionally allocated to each. The number of healthcare providers in the hospitals was 1,099, 381, 536, 453, and 435 from UOGCSH, DMCSH, TGCSH, FHCSH, and DTCSH, respectively. Consequently, we approached 160, 55, 79, 165, and 63 participants from UOGCSH, DMCSH, TGCSH, FHCSH, and DTCSH, respectively.

Health related quality of life was the main outcome variable. The predictor variables were the sociodemographic characteristics of the participants (sex, age, marital status, and educational status), work related variables (like working hours, experience and CPD) and clinical related variables (substance use and presence of chronic illness).

Health related quality of life: Quality of life was categorized as either good or poor using the Mean WHOQOL-BREF score. Accordingly, participants with a QOL that was lower than or equal to the mean score were classified as having a poor QOL, while those with a QOL that was higher than the mean were classified as having a good QOL (18).

Substance use: using at least one of a specific substance (alcohol, Khat or cigarettes) for nonmedical purposes within the last 3 months, according to the alcohol, smoking, and substance involvement screening tool (ASSIST) (19).

The structured questionnaire employed in this study was adapted from existing literature sources, with adjustments made to suit the context of the study area and the socio-demographic characteristics of the participants (15, 20). Subsequently, the questionnaire underwent translation into the local Amharic language and was then back-translated into English to ensure consistency. The data collection tool comprised four sections. The first part included socio-demographic characteristics of the study participants, such as age, sex, marital status, educational level, and monthly income. The second section covered job and clinical-related characteristics, including the type of profession, working hours, working experience, continuous professional training, and the presence of chronic illness. The third section involved the current substance use assessment tool. ASSIST was utilized to screen participantsbriefly for the use of psychoactive substances. This tool was developed and validated by the WHO (19).

The fourth section consisted of the HRQoL measuring tool. HRQoL was assessed by utilizing the World Health Organization Quality of Life Scale–Bref Version (WHOQoL-BREF), which is a 26-item self-administered generic questionnaire. The WHOQoL-BREF is a sound, cross-culturally valid assessment of HRQoL, as indicated by its four domains: physical health (7 items), psychological health (6 items), social relationships (3 items), and environmental domain (8 items) (21). In addition two individually scored items concerning the individuals’ impressions of their quality of life (QI) and health (Q2) Each of these items was scored from 1 to 5 on a response scale, which is agreed up on as five-point Likert scale (22). To compare domain scores, the mean score of all items in each domain was multiplied by 4, resulting in a “domain raw score” (which ranged from 4 to 20). This domain’s raw score was translated linearly into a domain score out of 100. The overall HRQOL was defined as the average of the four domain scores (23). WHOQoL–BREF has been used in Ethiopia (24–26).

To ensure data quality, the lead investigator organized a one-day training session at each study site for both data collectors and supervisors. A pretest involving 22 healthcare professionals (approximately 5% of the sample population) at Dessie Comprehensive Specialized Hospital was conducted. The pretest aimed to identify any potential issues with the data collection tool and evaluate the clarity, consistency, and ease of use of the questionnaire. Following the pretest, several adjustments were made, including rectifying typing errors and reorganizing the questionnaires. The internal consistency of ASSIST and WHOQoL–BREF was evaluated, yielding Cronbach’s alpha values of 0.78 and 0.85, respectively, indicating acceptable reliability.

The collected data underwent cleaning, coding, and entry into Epi Data 4.6.0, with analysis conducted using Statistical Package for Social Studies (SPSS) version 24. Descriptive analysis employed mean with standard deviation (SD), frequency, and percentages to explore data distribution. Bivariable and multivariable binary logistic regression analyses were utilized to identify factors associated with overall quality of life. For each variable, the odds ratio (OR) with a 95% confidence interval was computed, along with the corresponding p-value, to assess the strength of association. A significance level of <0.05 was used to determine the significance of the association between the outcome and the predictor variables. Model fitness was evaluated using the Hosmer and Lemeshow test, yielding a value of 0.802. Multicollinearity was assessed, with the maximum Variance Inflation Factor (VIF) found to be less than 5, indicating acceptable levels.

From 422 samples approached, 412 eligible healthcare providers participated, yielding a response rate of 97.6%. Most respondents (57.8%) were male, averaging 33.6 years of age (±6.4). The majority (58.7%) were single, and a significant portion (70.9%) held a bachelor’s degree. On average, participants earned 8,013 Birr per month (±2017.7) (Table 1).

Regarding employment-related attributes, around 25.5% were nurses, while over half, approximately 56.3%, underwent continuous professional training. The majority, approximately 78.6%, worked more than 8 h daily, and over a quarter, around 28.6%, possessed work experience exceeding 5 years. Chronic illnesses were noted in 17.5% of respondents. Substance usage was reported by over a quarter, about 28.2%, predominantly alcohol (73.3%) (Table 2).

Around 40.5% of participants indicated their perceived HRQoL as poor. In terms of perceived health satisfaction, over a quarter (26.7%) expressed dissatisfaction, while almost the same proportion (28.7%) reported satisfaction (Table 3).

In this study, over half (54.6%) of the participants scored lower than the average in their overall HRQoL. Across the four domains of quality of life, respondents recorded the lowest mean in the psychological domain (44.93 ± 19.38) and the highest mean in the social relationship domain (52.27 ± 25.84). The lowest and highest mean scores in overall HRQOL among the study participants were 22 and 83, respectively (Table 4).

Following the analysis using multiple logistic regression, several variables were identified as significantly correlated with HRQoL. Accordingly, healthcare providers (HCPs) who worked over 8 h per day were 1.85 times more prone to having poor HRQoL compared to those working fewer hours (AOR = 1.85, 95% CI: 1.12; 3.05). Similarly, HCPs with less than 2 years of work experience were 1.95 times more likely to report poor HRQoL than those with over 5 years of experience (AOR = 1.95, 95% CI: 1.04; 3.65). Additionally, healthcare providers with chronic illnesses were 2.11 times more likely to have poor HRQoL compared to those without such conditions (AOR = 2.11, 95% CI: 1.18; 3.75) (Table 5).

This study, the first of its kind in Ethiopia, aimed to assess the level of health-related quality of life and its predictors. However, the findings relied on self-reported data, potentially influenced by participants’ honesty and subject to recall bias. Additionally, assessing substance use may be affected by social desirability bias. The study only included healthcare professionals from governmental health institutions, potentially limiting the generalizability of the findings. Psychological variables were not evaluated in the study. The cross-sectional design precluded follow-up and hindered the establishment of causal relationships. Furthermore, while the WHO BREF assessment tool is cross-culturally valid, its validation in the Ethiopian context has not been established.