1. Background
In today’s competitive world, work–life balance has garnered substantial attention from researchers and academics because of its effects on both professional and personal life (1). Work–life balance is defined as the ability to experience a sense of control, maintain productivity, and remain competitive in the workplace while simultaneously sustaining a happy and healthy home life with adequate leisure time (2). When relationships among work, life, and family are not effectively managed, work–family conflict may arise, causing harm to the individual, the organization, and, ultimately, society. In light of social changes in family and workforce structures over recent decades, women’s participation in the workforce has increased markedly (3, 4).
Although the challenges arising from increased employment among women in Iran are similar to those in other countries, perceptions and concepts related to the family among Iranian workers and employees appear to differ from those in developed countries. In Iran, women are considered the cornerstone of household affairs, and society places dual expectations on them. On the one hand, women are expected to participate in social activities and actively contribute to society. On the other hand, they are expected to fulfill their family roles effectively. Therefore, given the multitude of expected roles, understanding how working women in Iran manage to fulfill all these roles is of paramount importance (5-7).
Work–family conflict is particularly pronounced among women, who often face societal expectations to excel in both career and domestic spheres (8). A study by Hoseinzadeh et al. (9) revealed a significant relationship between work–family conflict, intention to leave the job, and job stress. Research has also demonstrated that employees with improved work–life balance achieve better performance outcomes while facing substantial work–family conflict and work-related stress (8). Therefore, addressing consequences such as depression, burnout, family stress, general psychological pressure, low productivity among employees with depression, absenteeism, and increased interpersonal crises, which can lead to substantial social harm, is essential (1, 10).
2. Objectives
In recent years, women’s participation in paid employment has expanded considerably because employment contributes to personal identity and promotes self-esteem, social status, and the fulfillment of economic needs and aspirations. In light of this trend, challenges such as work–family conflict among employed women warrant careful attention. Identifying modifiable factors and implementing appropriate educational interventions may help reduce work–family conflict (11). Although research on work–family conflict in Iran is limited, no study to date has examined this phenomenon in North Khorasan Province. Investigating the nature of work–family conflict and its contributing factors can improve understanding of the issue and inform the development of effective interventions to support employed women and their families. Accordingly, the present study aimed to assess the status of work–family conflict and identify its associated factors among women employed in the healthcare sector in Northeast Iran (Esfarayen County, North Khorasan Province). The study addressed the following questions:
1) What is the status of work–family conflict among women employed in the healthcare sector?
2) What factors predict work–family conflict among women employed in the healthcare sector?
3. Methods
3.1. Study Design and Participants
This descriptive-analytical, cross-sectional study was conducted among female healthcare workers in Northeast Iran (Esfarayen County) from 2024 - 2025. Based on the results reported by Malekiha et al. (12), the standard deviation was considered to be 39.41, and the estimation accuracy was set at 0.17 standard deviations. At a significance level of 5% and a test power of 80%, the sample size was calculated as follows:
In total, 272 female healthcare workers were invited to participate. After exclusions and nonresponse, 251 participants were included in the final analysis. The inclusion criteria were the provision of informed consent, residence in Esfarayen County, employment in the healthcare sector, and being married. The exclusion criteria were being single and incomplete questionnaire completion.
3.2. Sampling
Simple random sampling was used. After providing informed consent, participants received the questionnaire and were asked to complete it either immediately or at their earliest convenience.
3.3. Research Instruments and Measurement
1) Demographic information: This checklist included age, occupation, number of children, education level, work experience, employment type, income, spouse's education, spouse's occupation, history of illness, history of depression, job satisfaction, shift work status, and spouse's shift work status.
2) Netemeyer Work-Family Conflict Questionnaire (1996): This 10-item questionnaire assesses the degree of work–family conflict. It is scored on a 5-point Likert scale and includes 2 dimensions: work-to-family conflict (items 1 - 5) and family-to-work conflict (items 6 - 10). The reliability coefficient of the questionnaire has been reported as 0.88. Each item is scored from 1 (strongly disagree) to 5 (strongly agree). The total score ranges from 10 - 50, with higher scores indicating greater work–family conflict. The validity and reliability of this scale have been confirmed in research by Salahian et al. The Cronbach's alpha method was used to assess the scale's validity, and the coefficient was 0.86 (13).
3.4. Statistical Analysis
After questionnaire completion, the data were analyzed using SPSS version 24. Descriptive statistics, including frequency, mean, and standard deviation, were used to summarize the data. The normality of the data distribution was assessed using the Kolmogorov–Smirnov test. When the normality assumption was satisfied, independent-samples t tests, analysis of variance (ANOVA), and correlation coefficient analyses were applied as appropriate.
To identify factors associated with the outcome variable, univariate analyses were initially performed to evaluate the association between each independent variable and the outcome. Variables with P < 0.2 in the univariate analyses were entered into the multivariable model. Multivariable analysis was then conducted using the General Linear Model-Univariate procedure in SPSS with the enter method, in which all selected variables were entered simultaneously into the model. A P value < 0.05 was considered statistically significant.
4. Results
The study included 251 women working in the healthcare sector. The mean work–family conflict score was 25.17 ± 7.97, indicating a moderate level of work–family conflict. The normality of the work–family conflict score was assessed using the Kolmogorov–Smirnov test, and this assumption was met (P = 0.20). Therefore, independent-samples t tests, ANOVA, Pearson correlation analysis, and the generalized linear model were used. Multicollinearity was assessed using the variance inflation factor (VIF); because the VIF was < 2 for all variables, no multicollinearity was detected. The model R2 value was 0.45.
Work–family conflict was significantly associated with occupation, education level, history of depression, job satisfaction, and shift work (P < 0.05) (Table 1). Because the demographic variables included both quantitative and qualitative variables, Table 1 is divided into 2 parts. Independent-samples t tests and ANOVA were used to examine associations between work–family conflict and qualitative variables, whereas correlation coefficients were used for quantitative variables. For qualitative variables, the mean and standard deviation of work–family conflict are reported for each category.
Table 1.
Relationships Between Work–Family Conflict and Demographic Variables (N = 251)
| Variables | Count (%) | Mean ± SD | Test statistic | P value |
|---|---|---|---|---|
| Occupation | 8.18 | < 0.001 a | ||
| Deputy of Treatment | 88 (35.1) | 27.70 ± 8.30 | ||
| Deputy of Health | 76 (30.3) | 22.89 ± 7.81 | ||
| Deputy of Education | 87 (34.7) | 24.62 ± 7.10 | ||
| Education | -3.62 | < 0.001 b | ||
| Associate Diploma | 53 (21.1) | 21.73 ± 6.93 | ||
| Bachelor's Degree and above | 198 (78.9) | 26.10 ± 7.99 | ||
| Employment type | -1.25 | 0.21 b | ||
| Informal | 77 (30.7) | 24.23 ± 8.41 | ||
| Formal | 174 (69.3) | 25.59 ± 7.76 | ||
| Income | 0.08 | 0.93 b | ||
| Less than 15 | 207 (82.5) | 25.19 ± 8.08 | ||
| 15 and above | 44 (17.5) | 25.09 ± 7.51 | ||
| History of depression | 2.28 | 0.02 b | ||
| Have | 26 (10.4) | 28.53 ± 8.28 | ||
| Do not have | 225 (89.6) | 24.79 ± 7.86 | ||
| Job satisfaction | -4.31 | < 0.001 b | ||
| Have | 126 (50.2) | 23.08 ± 8.11 | ||
| Do not have | 125 (49.8) | 27.28 ± 7.27 | ||
| Shift work | 5.23 | < 0.001 b | ||
| Yes | 84 (33.5) | 28.71 ± 7.07 | ||
| No | 167 (66.5) | 23.40 ± 7.82 | ||
| Number of children | -1.20 | 0.23 b | ||
| Without children | 42 (16.7) | 23.83 ± 8.25 | ||
| With children | 209 (83.3) | 25.44 ± 7.91 | ||
| Quantitative demographic variables | ||||
| Age | 251 | -0.02 c | 0.74 | |
| Work history | 251 | 0.00 c | 0.93 | |
a One-way ANOVA.
b Independent samples test.
c Correlation coefficient.
According to the generalized linear model results, education, history of depression, shift work, and job satisfaction were significant (Table 2).
Table 2.
Results of Generalized Linear Model
| Variables | β | SE | 95% CI | t | P-Value |
|---|---|---|---|---|---|
| Occupation | |||||
| Deputy of Treatment | 1.09 | 1.17 | (-1.21, 3.41) | 0.93 | 0.35 |
| Deputy of Health | 0.35 | 1.22 | (-2.05, 2.75) | 0.29 | 0.77 |
| Deputy of Education | - | - | - | - | - |
| Education | |||||
| Associate Diploma | -3.01 | 1.27 | (-5.51, -0.50) | -2.37 | 0.01 |
| Bachelor's Degree and above | - | - | - | - | - |
| Employment type | |||||
| Informal | -0.76 | 1.04 | (-2.82, 1.28) | -0.73 | 0.46 |
| Formal | - | - | - | - | - |
| Depression history | |||||
| Have | 3.72 | 1.52 | (0.72, 6.73) | 2.44 | 0.01 |
| Do not have | - | - | - | - | - |
| Job satisfaction | |||||
| Have | -3.41 | 0.92 | (-5.23, -1.59) | -3.69 | < 0.001 |
| Do not have | - | - | - | - | - |
| Shift work | |||||
| Yes | 4.02 | 1.13 | (1.79, 6.25) | 3.55 | < 0.001 |
| No | - | - | - | - | - |
| Number of children | |||||
| Without children | -1.19 | 1.31 | (-3.78, 1.39) | -0.90 | 0.36 |
| With children | - | - | - | - | - |
5. Discussion
This study aimed to assess the prevalence and level of work–family conflict and to identify associated factors and predictors among women employed in the healthcare sector in Esfarayen, thereby providing potential policy implications. The results indicated a moderate level of work–family conflict among these women. Similarly, a study by Habibpour Gatabi (14) involving 1451 employed urban women across 9 provinces in Iran reported low levels of conflict on the overall role-conflict scale, with a high balance of roles. However, the work–family conflict score in the present study was lower than those reported in other studies, including Ebrahimi et al. (4) in western Iran and Zheng and Wu (15) in China. This difference could be attributed to factors such as differences in the target populations, cultural context, family structure, and the economic and social conditions in North Khorasan Province.
This study showed that a history of depression significantly affects work–family conflict, with women with a history of depression being more prone to this type of conflict. In contrast, Ragnarsdóttir et al. (16) reported statistically significant main effects of family-to-work conflict and work-to-family conflict on depression and anxiety. The more work–family conflict (work-to-family or family-to-work) women experienced, the more symptoms of depression and anxiety they reported. These findings suggest a bidirectional relationship between depression and work–family conflict.
A significant relationship was observed between work–family conflict and job satisfaction; specifically, work–family conflict was influenced by job satisfaction such that, as job satisfaction increased, work–family conflict decreased. Consistent with these results, Cha et al. (17) reported that as job satisfaction decreases, depression resulting from work–family conflict increases.
The results indicated that education may be an important factor in work–family conflict and that women with higher education levels experienced greater conflict. As individuals attain organizational positions with greater responsibility as a result of higher education, they may face greater work–family conflict because of increased work pressure. Consistent with this finding, Tunlid (18) reported that more highly educated mothers experienced greater work–family conflict than mothers with less education. In contrast, Fathipour et al. (19) reported that average work–family conflict was greater among individuals with education levels below a bachelor's degree than among other participants, which contradicts the results of the present study. These results suggest that higher education, in addition to its occupational benefits, may pose substantial challenges for women through work–family conflict.
This study found that the workplace setting was associated with work–family conflict. Women working in clinical and treatment-related positions experienced higher levels of conflict than those working in public health settings. This finding may be explained by longer working hours, heavier workloads, and a greater likelihood of shift work among clinical staff. Fathipour et al. (19) reported findings consistent with our results, concluding that people in jobs with longer working hours are exposed to greater work–family conflict. Recently, some organizations across the country have designated certain days of the week for remote work to reduce work–life conflict among working women. However, because the consequences of such decisions remain controversial, more detailed evaluation and research are needed. For example, some studies have shown that individuals who could work remotely from home experienced statistically higher levels of conflict; thus, home-based work was associated with higher levels of stress (11).
5.1. Study Limitations
As with similar studies, this research has several limitations. Its cross-sectional design precluded causal inference, and its focus on the eastern region of Iran limited the generalizability of the results to areas with different cultural and socioeconomic contexts. Moreover, reliance on self-report questionnaires may have introduced response bias, and the sample size may not have been sufficient for detailed subgroup analyses. Finally, not considering mediating factors such as organizational support and family-friendly policies limited the interpretation of the findings.
5.2. Conclusions
The results of this study indicate that female healthcare workers in Esfarayen experience moderate levels of work–family conflict. This moderate level of conflict may reflect the presence of social support and workplace flexibility. However, the findings suggest that higher levels of education, particularly among healthcare staff, may lead to increased conflict, which warrants attention. Organizations should provide educational and support programs to reduce the psychological pressure resulting from role conflicts, such as arranging flexible work shifts or working hours, increasing the number of days off for women, and increasing staffing levels to reduce workload and pressure. Additionally, future research should examine in greater detail the cultural and social factors influencing this phenomenon.
