Presenteeism among healthcare professionals in Mongolia: A mixed-method multicenter study

Presenteeism, defined as attending work while ill, is a growing concern among healthcare professionals due to its impact on well-being, work function, and the quality of care. Despite extensive global research, evidence from Mongolia remains limited, where workforce shortages and systemic constraints uniquely shape presenteeism. We examined factors associated with presenteeism among Mongolian healthcare professionals.

This study used an explanatory sequential mixed-method design. The quantitative phase consisted of a cross-sectional online survey of physicians and nurses at three referral-level state hospitals, who were selected by convenience sampling. The qualitative phase consisted of semi-structured interviews with clinician managers, selected through purposeful sampling until thematic saturation was reached. Data were thematically analyzed, and the findings were integrated through triangulation.

A total of 465 survey respondents (physicians and nurses) participated in the quantitative phase, of which 64.5% reported presenteeism. The factors significantly associated with presenteeism were psycho-physical health complaints (AOR = 4.51, p < 0.001), coworkers' support (AOR = 2.38, p < 0.001), and workload (AOR = 2.08, p < 0.001). Qualitative analysis of 14 interviews with clinician managers identified five interrelated themes: inadequate occupational health policy, shortcomings of occupational infrastructure, staff shortages and heavy workloads, informal workplace practices and professional norms, and unaddressed health burdens. Integration of quantitative and qualitative findings indicates that these associations are shaped by underlying organizational and structural conditions. Qualitative data explain how heavy workload, staff shortages, and informal workplace norms compel healthcare professionals to work despite illness, while strained coworker relationships reflect peer pressure and team-based expectations. Taken together, similar to the existing global literature, the results reveal that structural and organizational challenges, rather than individual health-related behaviors, are the primary drivers of presenteeism in this context.

The findings suggest that addressing presenteeism among healthcare professionals in Mongolia and similar low-resource settings requires coordinated national efforts targeting workplace conditions, organizational support, and occupational health policies to promote workforce well-being.