Workload-moderated pathways from hospital acoustic environment to healthcare workers' health and burnout via noise stress

The hospital acoustic environment significantly affects staff wellbeing, yet the mechanisms linking indoor sound sources to health outcomes, and how work context moderates these pathways, remain insufficiently understood for evidence-based building design. 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. A cross-sectional survey was conducted among 1,182 healthcare workers (HCWs) from twelve hospitals in China. NA was assessed for five main sound-source categories in hospitals: medical equipment, human speech, human activities, surrounding environment, and non-medical equipment. Structural equation modelling with multi-group analysis across workload clusters (high, medium, low) tested mediation and 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 direct effect on NaHEs (β = 0.262, p < 0.001), indicating partial mediation. Mediation pathways strengthened with increasing workload, supporting moderated mediation. These findings inform healthcare building design by supporting dual-pathway interventions that integrate acoustic treatment (sound source control, alarm management, sound-absorbing materials, spatial zoning) with operational provisions for high-workload units, and that prioritise noise-sensitive staff in environmental planning.