Workload moderates noise-to-health pathways via stress among healthcare workers: A multi-group SEM study

Hospital noise threatens healthcare workers’ (HCWs) well-being, yet the psychological mechanisms remain insufficiently understood. Drawing on the Noise-Stress Hypothesis and Job Demands-Resources (JD-R) model, this study tested whether noise stress (NStr) mediates the effects of noise annoyance (NA) and noise sensitivity (NSen) on non-auditory health effects (NaHEs) and occupational burnout (BO), and whether workload moderates these pathways. We conducted a cross-sectional survey (August 2024–August 2025) among 1182 HCWs from twelve hospitals in China. The questionnaire assessed NA for five sound-source categories and measured NStr, NSen, NaHEs, BO, and workload with validated instruments. Structural equation modelling with bootstrapping examined mediation, and multi-group analysis across NASA Task Load Index workload clusters—high (n = 351), medium (n = 596), and low (n = 235)—tested moderation. NStr significantly mediated the associations of NSen and NA with NaHEs and BO (β = 0.049–0.175, p < 0.001). NA also showed a residual direct effect on NaHEs (β = 0.262, p < 0.001), indicating partial mediation. Mediation pathways strengthened with increasing workload, and the indirect effect of NA on BO via NStr was significantly stronger in the high- than in the low-workload group, supporting moderated mediation. These findings identify NStr as a central mechanism linking environmental noise and individual susceptibility to HCWs’ health and burnout, amplified under high workload. They support dual-pathway interventions that combine hospital acoustic environment optimisation (e.g. sound source control, alarm management, spatial design) with stress- and resource-oriented programmes, prioritising high-workload units and noise-sensitive staff.