Self-actualization and its psychosocial determinants among community health workers in rural Taiwan: a...

Community health workers (CHWs) frequently operate in resource-limited rural environments where high work demands and persistent psychosocial stressors may challenge psychological functioning. Guided by the Biopsychosocial Model, this study examined how individual health, social support, life stress, and burnout are associated with self-actualization-conceptualized here as a growth-oriented dimension of positive psychological functioning, which may overlap with broader eudaimonic well-being constructs, rather than as a fully distinct or independent domain.

A cross-sectional survey was conducted among 328 CHWs employed in Hualien County, Taiwan. Validated instruments were adapted to assess self-rated health, perceived social support, life stress, and burnout components. To avoid construct redundancy with the growth-oriented outcome, the reduced personal accomplishment dimension of burnout was excluded from the primary analysis. Hierarchical multiple regression analyses were performed to examine the incremental associations of biopsychosocial factors with self-actualization while controlling for demographic variables. Given that all variables were collected using self-report measures at a single time point, potential common method variance cannot be ruled out. The 2014 dataset provides a theoretically informative pre-pandemic baseline for understanding relatively stable patterns of psychological functioning in a rural health workforce.

Self-actualization was positively associated with better self-rated health (β = 0.22, p < .01) and higher perceived social support (β = 0.28, p < .001). Emotional exhaustion (β = -0.15, p < .05) and depersonalization (β = -0.20, p < .01) were significantly and negatively associated with self-actualization. Life stress also showed a modest but significant negative association (β = -0.15, p < .05). The final model explained 39% of the variance in self-actualization, indicating a meaningful level of explained variance, with health and social resources contributing the largest proportion of incremental explanatory power.

The findings indicate that health resources and supportive social environments are closely associated with higher levels of growth-oriented psychological functioning among rural CHWs, whereas psychological strain-particularly emotional and relational depletion-is concurrently associated with lower self-actualization. These findings should be interpreted within a broader eudaimonic well-being framework rather than as evidence of a fully distinct construct. By providing a pre-pandemic reference point, the study offers insight into relatively stable psychosocial mechanisms that may inform future research and intervention design, underscoring the importance of organizational contexts that enhance support and reduce strain to support sustained positive psychological growth in rural community health settings.