{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T13:23:52Z","timestamp":1783085032242,"version":"3.54.6"},"reference-count":59,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"unspecified","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,6,4]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"\n Background<\/jats:title>\n Due to the nature of their work, occupational fatigue is an important issue among healthcare workers (HCWs), with implications for workers\u2019 health, patient safety and healthcare organisation performance. However, the evidence on factors of work fatigue among HCWs in Malaysia remains fragmented.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To synthesise the existing evidence on work fatigue among HCWs in Malaysia, with a focus on its associated factors across HCW populations and to examine the types of fatigue instruments used.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Systematic literature review.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Literature on fatigue among HCWs in Malaysia.<\/jats:p>\n <\/jats:sec>\n \n Participant<\/jats:title>\n Studies on occupational fatigue involving HCWs conducted within the Malaysian context.<\/jats:p>\n <\/jats:sec>\n \n Method<\/jats:title>\n A systematic literature search was conducted using electronic databases of PubMed, Scopus, Web of Science and Science Direct. Studies must involve HCWs. Studies not in English, focusing on burn-out and different fatigue constructs, such as compassion fatigue, were excluded. Data extracted included study characteristics, setting, fatigue instruments, HCW groups and key findings. Factors associated with fatigue were synthesised thematically. This review followed Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, and the quality of the study was assessed using the Newcastle-Ottawa Scale.<\/jats:p>\n <\/jats:sec>\n \n Main outcome measure<\/jats:title>\n Factors associated with work fatigue among HCWs in Malaysia.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Out of 1699 articles screened, 138 studies were within the Malaysian setting. Nine (n=9) articles were finally included. One study, each was conducted nationwide, in Peninsular zones, in Melaka and Kuala Lumpur, also, three studies in Selangor and two in Sarawak. A total of 4662 HCWs participated, of which 1419 were doctors (30.4%), 1014 nurses (21.8%) and 2229 HCWs of various positions (47.8%). Fatigue instruments used were the Occupational Fatigue\/Exhaustion Recovery Scale, the Chalder Fatigue Scale, the Fatigue Assessment Scale, the Zoom Exhaustion and Fatigue Scale, and the postacute COVID syndrome checklist. Two studies used electroencephalogram. Thematic synthesis identified factors such as high job demands (66.67%), high effort (11.11%), sustained strain (11.11%), and an environmental\/contextual factor related to the COVID-19 pandemic (11.11%). An integrated conceptual framework is proposed.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Occupational fatigue among HCWs in Malaysia is multifactorial. Limitations include heterogeneity in study design and fatigue assessment tools. Despite the limited number of included studies, the findings provide theory-informed insights into understanding occupational fatigue; however, they should be interpreted cautiously, despite the need for standardised work fatigue surveillance as part of an efficient fatigue management system.<\/jats:p>\n <\/jats:sec>\n \n Registration<\/jats:title>\n This review was registered under PROSPERO with the ID of CRD420251001576.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-118439","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T13:07:00Z","timestamp":1783084020000},"page":"e118439","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Factors associated with occupational fatigue among healthcare workers in Malaysia: a systematic review"],"prefix":"10.1136","volume":"16","author":[{"given":"Mohamad Asraf","family":"Ahmad Nazari","sequence":"first","affiliation":[{"name":"Public Health Medicine Department, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor Darul Ehsan, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1058-8763","authenticated-orcid":false,"given":"Siti Sara","family":"Yaacob","sequence":"additional","affiliation":[{"name":"Public Health Medicine Department, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor Darul Ehsan, Malaysia"},{"name":"Public Health Department, Hospital Al-Sultan Abdullah, UiTM Puncak Alam, Puncak Alam, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamarulzaman","family":"Muzaini","sequence":"additional","affiliation":[{"name":"Public Health Medicine Department, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor Darul Ehsan, Malaysia"},{"name":"Public Health Department, Hospital Al-Sultan Abdullah, UiTM Puncak Alam, Puncak Alam, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohd Fikri","family":"Rosely","sequence":"additional","affiliation":[{"name":"Occupational Safety and Health Unit, Medical Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nik Khairol Reza","family":"Md Yazin","sequence":"additional","affiliation":[{"name":"Occupational Safety and Health Sector, Disease Control Division, Ministry of Health Malaysia, Putrajaya, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2580-6153","authenticated-orcid":false,"given":"Mariam","family":"Mohamad","sequence":"additional","affiliation":[{"name":"Public Health Medicine Department, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor Darul Ehsan, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"2026070306001872000_16.7.e118439.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0169-8141(96)00044-3"},{"key":"2026070306001872000_16.7.e118439.2","doi-asserted-by":"publisher","DOI":"10.1097\/01.jom.0000161740.71049.c4"},{"key":"2026070306001872000_16.7.e118439.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.trf.2015.01.003"},{"key":"2026070306001872000_16.7.e118439.4","unstructured":"World Health Organization . 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