# Burnout and Its Associated Factors Among Long-Term Care Workers: A Mixed-Methods Study Based on the Social–Ecological Framework

## TL;DR

This study explores burnout among long-term care workers in China, finding that burnout is influenced by personal, organizational, and policy-level factors, and suggests ways to reduce it.

## Contribution

The study introduces a mixed-methods approach using the Social–Ecological Framework to identify multilevel correlates of burnout in Chinese long-term care workers.

## Key findings

- Burnout was common, with 30.77% mild, 33.00% moderate, and 17.00% severe cases.
- Burnout dimensions were associated with factors like gender, age, employment arrangement, and policy recognition.
- Qualitative insights emphasized training, emotional reciprocity, and policy support as potential buffers against burnout.

## Abstract

Burnout among long-term care workers is a public health concern, yet mixed-methods evidence from China is scarce. To examine multilevel correlates of burnout, a convergent mixed-methods study using a Social–Ecological Framework was conducted. In the quantitative strand, 494 workers were surveyed using two-stage cluster sampling, and probability-weighted multivariable linear regression examined factors associated with emotional exhaustion, depersonalization, and reduced personal accomplishment. In the qualitative strand, 15 participants completed semi-structured interviews; transcripts were managed in MAXQDA 2025 and analyzed thematically. Burnout was common (30.77% mild, 33.00% moderate, 17.00% severe). Quantitative findings showed that burnout dimensions were associated with gender, age, marital status, employment arrangement, institution type, training intensity, caregiver burden, and recognition of the long-term care insurance policy (p < 0.05). Qualitative findings highlighted cognitive adaptation, emotional reciprocity with older adults, organizational training and support, and policy recognition as potential buffering resources. These findings suggest that burnout is shaped by influences across multiple levels. Coordinated efforts may help alleviate burnout by strengthening training systems, reducing caregiving burden, enhancing recognition of long-term care policies, and elevating the societal value of care work. Future research should validate these potential courses of action through longitudinal or intervention studies.