1. Introduction

As work environments continue to evolve, job satisfaction remains an important cornerstone of human resource management in any organization, particularly within the healthcare sector [1]. Along with workload perception, it plays a crucial role in influencing the staff turnover, the quality of care delivered [2], and the overall patient satisfaction [3].

The foundational definition of job satisfaction is often credited to Hoppock [4], who described it as a result of various psychological, physiological and environmental factors that lead an individual to genuinely feel satisfied with their job. This underscores the complex and multidimensional nature of job satisfaction, shaped by both personal experiences and external influences [5].

Workload denotes the “amount of performance required to carry out work activities in a specified time” [6], while workload perception refers to how each working individual experiences and evaluates their workload, regardless of the actual workload level; it depends on the balance between job demands and available resources [7].

Job satisfaction is influenced by two main categories of factors including work-related and personal/behavioral factors. Work-related factors include the salary system, career expectations, job security, work environment and company culture, occupational health, working hours and flexibility, and the content and type of the job, while personal and behavioral factors encompass mainly socio-demographic attributes (such as gender, education, work experience, age, health, and marital status) and psychosocial traits (including personal characteristics) among others [8].

Several studies have been conducted to assess the level of job satisfaction among dietitians worldwide. In Jordan, Pakistan, and South Africa, dissatisfaction was primarily linked to low income, limited promotion opportunities, and lack of respect for the dietetic profession [9–11]. In Germany, 16% of dietitians felt unappreciated, while 9% perceived no future career growth [12]. In the U.S., 40% of dietitians working in metabolic nutrition were dissatisfied with income [13], with some considering career changes [14]. By contrast, those with managerial roles or with strong work-life balance reported greater satisfaction [15,16]. Supportive environments, flexible schedules, and professional recognition were also associated with greater satisfaction [17,18]. Besides, employment setting further influenced satisfaction levels. Dietitians working in the public sector and rural areas often faced more challenges due to limited resources and higher physical demands [11,19]. Older and more experienced dietitians also reported higher satisfaction [11], as did those with traits like agreeableness and strong teamwork skills [20–22]. In general, higher levels of perceived workload have been associated with lower job satisfaction [23], and dietitians generally reported low job satisfaction and high workload, influenced by factors such as salary, work setting, recognition, and support [9,11].

Employment location may also shape professional experiences and satisfaction, particularly for healthcare professionals who practice both locally and abroad, due to differences in working conditions, income, organizational support, and career development opportunities across settings. Understanding whether Lebanese dietitians practicing in Lebanon only differ from those practicing in Lebanon and abroad may provide important insights into context-specific determinants of job satisfaction and perceived workload.

Given the persistent challenge of malnutrition in Lebanon [24] where 31.2% of hospitalized patients were identified as at risk of malnutrition according to the Nutrition Risk Screening (NRS-2002), and 35.6% met the Global Leadership Initiative on Malnutrition (GLIM) criteria for malnutrition, alongside increased economic pressures on the healthcare system [24], studying job satisfaction and workload among Lebanese dietitians becomes particularly essential. Prior to the establishment of the Lebanese Order of Dietitians (LOD) in 2022, dietitians in Lebanon faced several professional challenges, and progress in strengthening the profession remains limited. The country’s socio-political instability, economic crisis, and strained healthcare system significantly affect the working conditions of healthcare professionals, including dietitians. In addition, the profession is largely female-dominated, with women estimated to represent the majority of practicing dietitians, while men constitute a small minority of the workforce [25].

To the best of our knowledge, no previous studies have specifically investigated perception of workloads and career satisfaction among this population. Within the healthcare sector, research focused on nurses [26–29], pharmacists [30–32], physiotherapists [33], and other healthcare providers [34–36].

The present cross-sectional study aims (1) to assess the perceived workload and job satisfaction levels among Lebanese practicing dietitians and (2) to explore its association with sociodemographic characteristics and employment location (Lebanon only vs Lebanon and abroad).

2. Materials and methods

3. Results

3.2 Sociodemographic data

A total number of 138 Lebanese dietitians participated in this study, with 50.7% aged 20–30 years. The socio‐demographic characteristics of the participants are shown in Table 1. All of them were females, with an equal proportion of 49.3% being married and single. Most respondents (65.2%) did not have any children, and the greatest number of respondents were living in Mount-Lebanon area (42%). Around half of them had a full-time job (50.5%). When it comes to the income status, 42% reported making between 100–1000$, while 12 dietitians (8.7%) reported earning <100$ per month. As for the education level, more than half of the respondents held a Master degree (56.5%), and 88.4% got their highest degree from a private university, with the majority having graduated since 6–12 years (42%). Most respondents were employed in the medical fields (69.6%), and in a private workplace (91.3%). From the eight workplace sectors included, clinics were the most prevalent (19.6%), followed by specialized centers (16.7%), and polyclinics (13%).

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Table 1. Sociodemographic characteristics of the study population.

https://doi.org/10.1371/journal.pone.0346681.t001

3.3. Job satisfaction scores

The median for the total JSS was 60.4%, indicating a slight job satisfaction among dietitians (Table 2). Respondents were the most satisfied with the nature of work (79%), co-workers (71.1%), communication (70.7%), supervision (70.1%), and fringe benefits (67.1%), with a median score belonging to the ‘moderately satisfied’ category. They were slightly satisfied with contingent rewards (65.5%), and operating conditions (53.9%), while the lowest median scores were reported for payment (42.2%), and promotion (41.6%), indicating slight dissatisfaction.

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Table 2. Job satisfaction scores per theme and total scores for dietitians.

https://doi.org/10.1371/journal.pone.0346681.t002

3.5. JSS stratified according to employment location

When the sample was stratified according to employment locations (dietitians practicing in Lebanon and abroad vs. dietitians practicing in Lebanon only), job satisfaction scores among dietitians practicing in Lebanon and abroad were significantly higher in several facets (p < 0.05), namely payment (49.9 vs 37.1%), promotion (57.1 vs 32.2%), supervision (71.1 vs 63.3%), operating conditions (61.0 vs 44.3%), co-workers (78.0 vs 66.1%), and nature of work (85.1 vs 75.5%), as shown in Table 3. The only two exceptions were communication (76.0% for dietitians working in Lebanon and abroad and 78.1% for dietitians working in Lebanon only; p = 0.002) and fringe benefits in which the median score was identical for both sectors at 62.1%, showing a non-statistically significant difference (p = 0.118).

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Table 3. Job satisfaction stratified according to employment location: (A) Lebanon and Abroad (n = 30) and (B) Lebanon Only (n = 108).

https://doi.org/10.1371/journal.pone.0346681.t003

Beyond these numerical comparisons, the scores were interpreted qualitatively to provide a clearer understanding of participants’ satisfaction levels. Dietitians practicing in Lebanon only were slightly unsatisfied with payment; slightly satisfied with promotion, fringe benefits, and operating conditions; moderately satisfied with supervision, contingent rewards, co-workers, and communication; and very satisfied with the nature of their work. Dietitians practicing in Lebanon and abroad were slightly satisfied with payment, promotion, supervision, fringe benefits, contingent rewards, and operating conditions, and moderately satisfied with co-workers, nature of work, and communication.

3.6. Workload scores

The total median workload score of our population was 62.8%, indicating a slightly high workload (Table 4). The subscales indicate that dietitians perceived their daily work-related tasks as more mentally (70%, moderately high) than physically (60%, slightly high) demanding. They reported successfully accomplishing their task to a moderately high level (80%), with moderately high effort (70%) and a slightly low rush to perform it (40%). They also reported slightly high levels of frustration (60%) reflecting insecurity, discouragement, irritation, stress or annoyance while performing their tasks.

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Table 4. Workload scores for dietitians.

https://doi.org/10.1371/journal.pone.0346681.t004

3.7. Workload scores stratified according to employment location

When workload scores were stratified by employment location (dietitians practicing in Lebanon and abroad versus Lebanon only), no statistically significant difference was observed in total workload perception between the two groups (p = 0.532), with both scores falling within the “slightly high” workload range (Table 5).

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Table 5. Workload stratified according to employment location: (A) Lebanon and Abroad (n = 30) and (B) Lebanon Only (n = 108).

https://doi.org/10.1371/journal.pone.0346681.t005

Analysis of workload subscales revealed statistically significant differences in three components. Dietitians practicing in Lebanon only reported higher mental demand compared to those practicing in Lebanon and abroad (median: 70% vs 60%; p = 0.0001). Temporal demand also differed significantly between groups (p = 0.0001), despite identical median scores, reflecting differences in score distributions. In contrast, frustration was significantly higher among dietitians practicing in Lebanon and abroad (median: 70%, moderately high) compared to those practicing in Lebanon only (median: 60%, slightly high; p = 0.001).

These findings suggest that while overall workload perception is comparable between employment locations, specific workload dimensions differ according to practice context.

3.8. Multivariate analysis of job satisfaction and workload

Multivariable linear regression analyses were conducted to examine factors independently associated with total job satisfaction score (JSS%) and total workload perception (NASA-TLX%), adjusting for age group, duration of practice, education level, income category, employment sector, and practice location (Table 6).

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Table 6. Multivariate linear regression models for (A) Total job satisfaction score (JSS%) and (B) Total workload score (NASA-TLX%).

https://doi.org/10.1371/journal.pone.0346681.t006

In the adjusted model for job satisfaction, age remained a significant predictor, with dietitians aged 31–40 years and 41–50 years reporting higher JSS compared to those aged 20–30 years. Duration of practice was also independently associated with job satisfaction, particularly among dietitians with 11–15 years and 16–20 years of experience, who demonstrated significantly higher JSS than those with less than 5 years of practice. Higher education level was positively associated with job satisfaction, with both Master’s and PhD holders reporting higher JSS compared to those holding a Bachelor’s degree.

Income category showed a strong positive association with job satisfaction, with progressively higher JSS observed across increasing income levels. Employment sector was also independently associated with job satisfaction, with dietitians working in the public sector reporting higher JSS compared to those in the private sector.

Practice location was initially associated with higher job satisfaction among dietitians practicing in Lebanon and abroad. However, inclusion of an interaction term between practice location and income category revealed a statistically significant interaction (p < 0.001), indicating that the association between practice location and job satisfaction varied by income level. After accounting for this interaction, income remained a key predictor of job satisfaction, while the independent effect of practice location was attenuated.

In the adjusted model for workload perception, age and duration of practice were not significantly associated with total NASA-TLX scores. Higher education level and income category were associated with higher reported workload, while employment sector and practice location were also independently associated with workload perception. Dietitians practicing in Lebanon and abroad reported higher workload scores compared to those practicing in Lebanon only, after adjustment for covariates.

• β = unstandardized regression coefficient; SE = standard error.
• Practice location × income interaction included only in Panel A (JSS model).
• Model type: multiple linear regression.

4. Discussion

Although a recent cross-sectional study has assessed job satisfaction among Lebanese female dietitians working across various professional contexts within the private and public sectors [39], to the best of our knowledge, no previous research has examined workload perception among Lebanese dietitians in these sectors.

In our study, the median for total JSS was 60.4%, indicating that, overall, Lebanese dietitians were slightly satisfied with their jobs. This aligns with the average JSS of professionals working in the healthcare domain in the United States [6] and with previous studies in South Africa [11] and Iran [40], where dietitians in Iran had a mean JSS of 57% and those in Africa 61% falling within the slightly satisfied range.

When the total satisfaction score was dissected into facet scores, a moderate satisfaction was reported with the nature of work, co-workers, communication, supervision, and fringe benefits among our population. This was consistent with Chen et al. [41] who compared job satisfaction of eight healthcare professions, including dietitians, in private settings, and with Van den Berg et al. [11] in South Africa where dietitians were the most satisfied with the nature of their work. Slight dissatisfaction was reported with payment and promotion, which recorded the lowest satisfaction scores. Payment is typically seen as the primary factor influencing job satisfaction, as it serves as a key incentive for employees. Reduced job satisfaction among dietitians has been attributed to several factors, including low or nonexistent salary increases, inadequate compensation in comparison to other sectors, and earnings that undervalue their training and experience. In addition to working long hours, most salaries fall short of the educational requirements necessary to become a dietitian [42]. The United Nations Development Program (UNDP) also reported that women receive 29% less income and less professional value than men, which is particularly concerning given that dietetics is regarded as a female-dominated field [43].

In the Lebanese context, the ongoing economic crisis, characterized by currency devaluation, inflation, and banking restrictions, may represent an important contextual factor influencing perceptions of compensation adequacy, as real income value has declined across multiple professions, including nutrition and dietetics.

Multiple studies across different countries have reported dissatisfaction with promotion opportunities among dietitians, reflecting a consistent global concern in the profession. In our study, dietitians expressed slight dissatisfaction with promotion, mirroring trends observed elsewhere. Studies from South Africa, the United States, Australia and Canada all reported that promotion opportunities were among lowest-rated facets of job satisfaction, often linked to the limited senior roles in the profession, lack of leadership pathways and restricted upward mobility [11,44–46]. These findings collectively indicated that limited promotion prospects are a persistent issue in dietetics, regardless of region, and may be associated with overall job dissatisfaction and turnover rate [47].

When examining socio-demographic variables, job satisfaction in our sample was significantly associated with middle-aged groups (31–40 years), longer duration of practice (16–20 years), higher education levels, and higher income. These findings are consistent with studies conducted in South Africa [11], the United States [42,48], Brazil [49], and Germany [12].

Lower job satisfaction among younger dietitians may reflect early-career challenges documented in Lebanon and the region, including job insecurity, limited employment opportunities, low wages, and constrained career advancement pathways [50,51]. Evidence from international literature also suggests that newly graduated dietitians often experience difficulties transitioning into stable employment, underemployment, or roles that do not fully utilize their qualifications, which may negatively influence early-career job satisfaction [52–53].

Herzberg's Two-Factor Theory provides a useful framework for interpreting these patterns, suggesting that job satisfaction and dissatisfaction arise from two important factors; motivators that lead to satisfaction and hygiene factors that, if inadequate, contribute to dissatisfaction. Older and more experienced dietitians, who are more likely to hold higher positions and have greater motivators such as professional recognition, reported higher job satisfaction. Similarly, better paid and more highly educated dietitians may benefit from stronger hygiene factors such as job security and adequate compensation, thereby reducing dissatisfaction [54]. In this study, middle age was significantly linked to satisfaction with payment and nature of work. These associations may reflect developmental changes across the life course, as the relationships between income and life satisfaction tend to be stronger in midlife and weaker in younger and older ager, potentially moderating the influence of age on job satisfaction [55]. This is the result of the positive “spillover effect” whereby greater overall life satisfaction during midlife enhances job satisfaction [56]. No other significant associations were found between sociodemographic data and job satisfaction.

When job satisfaction was stratified according to employment location, dietitians practicing in Lebanon and abroad reported higher job satisfaction scores across most facets compared to those practicing in Lebanon only. Significant differences were observed particularly for payment, promotion opportunities, supervision, operating conditions, contingent rewards, co-workers, and nature of work, while no significant differences were found for fringe benefits, and communication scores were slightly higher among dietitians practicing in Lebanon only.

These findings are consistent with previous international literature suggesting that exposure to work environments outside the local context may be associated with higher satisfaction, potentially due to improved working conditions, clearer career pathways, and enhanced professional recognition [57]. In the Lebanese context, dietitians practicing abroad are more likely to benefit from higher income levels and stronger organizational support, which may collectively contribute to higher satisfaction across several job-related domains [58]. Interestingly, satisfaction with co-workers was also higher among dietitians practicing in Lebanon and abroad, possibly reflecting differences in workplace culture and team dynamics. Conversely, communication scores were marginally higher among dietitians practicing in Lebanon only, potentially reflecting closer interpersonal interactions within smaller or more familiar work environments [59]. Fringe benefits did not differ significantly, suggesting they may not be the primary drivers of satisfaction differences.

Regarding workload perception, no previous study has examined this aspect among Lebanese dietitians, and research on this topic remains limited globally. To the best of our knowledge, the only identified study assessing workload perception among dietitians was conducted in South Africa [11]. Other studies have addressed related topics such as burnout, which has been found to be high among dietitians and nutritionists, with heavy workloads making them more vulnerable to it [60]. In our study, the median workload score was 62.8%, indicating a slightly high perceived workload. Respondents reported their work as more mentally than physically demanding, consistently with the findings of van den Berg et al. [11], likely reflecting the predominance of clinical practice roles.

For work-related frustration, as conceptually defined by the NASA-TLX frustration subscale, refers to negative emotional states such as discouragement, irritation, stress and annoyance rather than qualitative participant feedback. Both studies reported slightly high frustration levels, with higher scores in Lebanon (60% vs 50%).

This discrepancy does not contradict prior literature suggesting associations between temporal demand and negative work-related emotions [61]; however, frustration appears to be influenced by multiple interacting factors, including resource availability, organizational support and broader socioeconomic conditions. In Lebanon, the economic context may represent an additional stressor, even when reported temporal demands were lower. Accordingly, frustration should be viewed as a multifactorial construct rather than the result of a single workload component, as supported by Sanclemente et al. [62].

When workload perception was stratified according to employment location, dietitians practicing in Lebanon only and those practicing in Lebanon and abroad reported comparable overall workload levels, with no statistically significant difference in total workload scores and both groups falling within the “slightly high” workload range. However, differences emerged at the level of specific workload components.

Dietitians practicing in Lebanon only reported significantly higher mental demand compared to those practicing in Lebanon and abroad, which may reflect greater cognitive strain associated with limited resources, staff shortages, and increased role burden within the local healthcare context. In contrast, frustration levels were significantly higher among dietitians practicing in Lebanon and abroad, suggesting that despite potentially better working conditions or compensation, challenges related to adaptation, dual practice responsibilities, or cross-cultural work environments may contribute to emotional strain. Temporal demand also differed significantly between the two groups, despite similar median scores, indicating distributional differences in perceived time pressure.

These findings are consistent with previous literature (e.g., Van den Berg et al. (11)) showing that workload perception is multidimensional and influenced not only by task volume but also by organizational context, resource availability, and psychosocial factors. Higher perceived workload, particularly in specific components such as mental demand and frustration, has been associated with lower job satisfaction, which aligns with the patterns observed in the present study [63]. Furthermore, according to Karasek’s Job Demand–Control model, differences in perceived workload across employment locations may reflect variations in autonomy, control, and support within different practice environments [64].

Despite being the first study addressing job satisfaction and workload perception among practicing dietitians in Lebanon, and one of the few to explore workload in this profession globally, this study had its limitations. The relatively small sample size (n = 138), the unequal distribution across some subgroups, particularly the public sector (8.7%), and dietitians with more than 20 years of experience, in addition to the Nabatieh area (1.4%) with no respondents from the southern district due to conflicts in the country during data collection, may have limited the statistical power of subgroup analyses and the precision of regression estimates. Consequently, findings related to these small groups should be interpreted cautiously. In addition, the use of convenience sampling instead of random sampling due to the lack of access to the national registry of dietitians constitutes another bias. The cross-sectional design of the study limits the ability to establish causal relationships between workload perception and job satisfaction. The observed associations should therefore be interpreted with caution, as the temporal direction between predictors and outcomes cannot be determined. Longitudinal studies would be required to better understand causal pathways. In addition, recruitment through social media platforms such as LinkedIn and Instagram may have introduced selection bias. Dietitians who are more active on professional or social media networks may have been more likely to encounter and respond to the survey. Dietitians who are less active online or who have limited access to these platforms may have been underrepresented. Consequently, the study sample may not fully reflect the characteristics of the entire population of practicing dietitians in Lebanon. Moreover, because the survey was distributed through social media platforms, the total number of dietitians who viewed the survey invitation was unknown; therefore, the response rate could not be calculated.

Finally, reliance on self-reported data which may be subject to bias due to dishonesty, misunderstanding, or external influences such as the prevailing conditions in Lebanon at the time of data collection might have temporarily affected dietitians’ responses.

Despite the above-mentioned limitations, the present study provides a valuable foundation for actions and future research. Policymakers, and healthcare administrators in collaboration with the Lebanese Order of Dietitians are encouraged to design strategies aimed at improving the dietitians’ workplace environment and overall career satisfaction. Addressing workload management in both sectors, offering competitive compensation, ensuring professional development opportunities, supporting career development and mentorship targeting young dietitians and incorporating stress management programs into the workplace can strengthen the profession and enhance the quality of care provided for patients. Furthermore, larger, and stratified random samples with broader geographic coverage could yield more representative results across both employment sectors and different Lebanese regions. Comparative studies with other countries in the region can shed the light on cultural factors influencing the job satisfaction and workload perception among dietitians, and qualitative research can provide richer insights into the lived experiences of dietitians.

The multivariable analyses further strengthen the results of the descriptive and stratified analyses by demonstrating that several sociodemographic and professional factors are independently associated with job satisfaction and workload perception among dietitians. In particular, income emerged as a key determinant of job satisfaction, and the significant interaction between income and practice location suggests that the higher satisfaction observed among dietitians practicing in Lebanon and abroad is largely driven by economic factors rather than practice location alone. In contrast, workload perception appeared to be influenced by a different set of factors, highlighting the multidimensional nature of workload and its partial independence from job satisfaction. These results underscore the importance of addressing both economic and organizational determinants when designing interventions to improve dietitians’ professional well-being.

Supporting information

Acknowledgments

The authors would like to acknowledge the Lebanese Order of Dietitians (LOD) for their continuous support through promoting the survey, and all practicing dietitians who agreed to participate in this study.