Researchers of positive psychology have progressively increased the awareness of individual happiness studies and their benefits to society (Flynn & MacLeod 2015). Although researchers and lay people often define happiness as life satisfaction or a sense of well-being, studies also define happiness as positive subjective experiences (Delle Fave et al. 2016; Joshanloo & Weijers 2014; Scorsolini-Comin & Dos Santos 2010; Wren-Lewis 2014). However, despite the variance in happiness definitions, research confirms that an increase in individual happiness is advantageous to the individual and also enables societies to function better, thereby supporting the notion of incorporating aspects of happiness when formulating economic policy (Flynn & MacLeod 2015; Guzi & De Pedraza García 2015; Powdthavee 2007).

The multiple dimensions of happiness mentioned above and their cross-country differences or similarities may arguably be because of the variance in cultural dimensions and their collective influence on the happiness of individuals and societies, such as the Hofstede’s dimensions (Delle Fave et al. 2016; Ye, Ng & Lian 2015). Hofstede’s dimensions are measurements of a country’s ‘cultural style’ that were constructed based on the basic problems that all societies could be faced with (Harvey 2011; Minkov & Hofstede 2011).

Theories such as the comparison theory and Maslow’s needs theory support the fact that culture is linked to happiness or subjective well-being (Diener & Lucas 2000; Schyns 1998; Ye et al. 2015). The comparison theory relates to the degree to which happiness is dependent on the comparisons between the standards of quality of life and the perceived life circumstances, whereas Maslow’s needs theory states that as more needs of an individual are met, the happier the individual will be (Aydin 2012; Diener & Lucas 2000; Schyns 1998; Ye et al. 2015).

A study undertaken to explain the impact of cultural variables on happiness across different countries confirms that Hofstede’s power distance dimension correlates negatively with happiness and that raising gender equality may also improve a country’s happiness measurement (Ye et al. 2015). Furthermore, Ye et al. (2015) state that individualist cultured countries such as European countries and the USA countries are happier or have higher levels of subjective well-being than people in a collectivist culture such as East Asian countries. This is confirmed by studies such as that conducted by Stearns (2012) who states that East Asian cultures have lower happiness expectations than what European and American cultures are accustomed to (Chiu et al. 2011; Stearns 2012; Ye et al. 2015). Culture is therefore an important factor to consider when measuring happiness across countries, and the measurement of happiness across countries is in itself very important (Diener 2000; Diener, Diener & Diener 1995; Heukamp & Ariño 2011; Inglehart & Klingemann 2000; Kenny 1999; Ye et al. 2015).

Although happiness predominantly features in the research disciplines of philosophy, religion and psychology, it has subsequently become a focus in the fields of sociology, economics and neurology. As a result, it has been rather influential in the formulation and publication of public policy (Aydin 2012; Frey et al. 2008; Okulicz-Kozaryn 2016). Economists have focused on happiness studies because of their relevance and the effects of institutional conditions such as quality of governance and the size of social capital on individual well-being (Frey & Stutzer 2002). Frey and Stutzer (2002) further mention that such studies assist economists to understand the formation of well-being and the prediction of societies and individuals’ future utilities. The concept of utility refers to the choices people make in relation to tangible goods, which influence the supply and demand theory of economics and as a result measures of happiness serve as proxies for utility (Frey & Stutzer 2002).

The literature confirms that although, in previous decades, wealthier people were generally happier than poorer people in the same country, developed countries are not necessarily happier than developing countries and in addition concluded that the increase in income over time failed to increase happiness levels of people (Easterlin 2003; Fox 2003; Robinson, Kennedy & Harmon 2012).

Happiness studies have thus been of great importance in the business sector. Pryce-Jones and Lindsay (2014:51) define happiness at work as the ‘mind-set which enables action to maximise performance and achieve potential’. Happiness at work may also be described as ‘the worker’s experience of safety and healthiness of work, good leadership, competence, change management, support at work and how meaningful the employee finds the work’ (Anttonen & Vainio 2010:1246; Utriainen et al. 2011).

This is particularly relevant in the service sector industry, where it has been established that a causal link exists between happy customers and greater profits (Chun & Davies 2009). However, Chun and Davies (2009) state in an article in the Harvard Business Review that the same factors that increase customer satisfaction and in turn generate higher profits, actually have a negative correlation on the happiness of employees.

Hence, because increasing both the customer satisfaction levels and employee happiness is crucial and beneficial to business, it is suggested to link the two by engaging employees with reasons and ways to please customers and thereafter acknowledge and reward appropriate staff behaviour. This in turn assists employees to have a sense of achieving their full potential (Chun & Davies 2009; Pryce-Jones & Lindsay 2014).

The business model of many private sector physiotherapy practices is under pressure because of changes in the health care market forces, causing the costs of running private physiotherapy practices to escalate, whilst the remuneration for such physiotherapy services is diminishing (Ijntema, Mollema & Duits 2016; Neidhardt 2009). The need to modify the business models of physiotherapy practices is essential for practice owners to ensure that they maintain and improve their market share in this particular service industry (Neidhardt 2009). However, a general problem is that physiotherapy practice owners are not equipped to understand where and how these changes should be made, and in addition, information to support such decisions is not readily available (Ijntema et al. 2016; Neidhardt 2009).

In addition to the business model, many private sector physiotherapy practices have started up without the consideration of a business plan, which indicates that factors such as staff recruitment and retention strategies, competition and market segments and business strategies have been either neglected or poorly planned prior to start up because of the lack of business acumen gained from their tertiary education (Desveaux et al. 2012; Wassinger & Baxter 2011). This could therefore lead to mismanagement of business processes and poor leadership attributes that may negatively influence the happiness levels of private sector physiotherapy staff.

A pioneering Canadian study established that the physiotherapy workforce identified a critical need for business acumen (Desveaux et al. 2012). Thirty-eight per cent of the physiotherapists surveyed worked in the private sector and exceeded the expected perceived importance of business acumen in their workplace setting, whereas the remaining 62% of public employed physiotherapists demonstrated a decline in the expected perceived importance of acquiring and implementation of business acumen (Desveaux et al. 2012). The contrast highlighted by Desveaux et al. (2012) relates to the general problem that physiotherapists are not equipped with sufficient business acumen to understand the business aspects of their practice environment and the important relation of business acumen to their practice and management of their staff.

It is therefore evident that physiotherapy practice owners need to identify and analyse aspects of their practices that require attention, improvement and managerial execution of solutions for the problems identified (Neidhardt 2009). This article identifies that happiness levels of private sector physiotherapists in South Africa have not been analysed and that physiotherapy practice owners have limited business knowledge to improve the happiness levels of their staff and thereby improve the success of their practices. This relates to the notable problems in the health care industry across professions, such as staff retention, where physiotherapy practice owners fail to recognise their employees as internal customers and strategic key partners (Ijntema et al. 2016).

There is insufficient information available to know whether private sector physiotherapists in South Africa are happy. This investigation may enable physiotherapy practice owners to implement evidence-based retention and recruitment strategies for high performing physiotherapy staff and in turn generate a workforce that is more productive, demonstrates greater collaboration with staff and patients, produces happier patients, is more positively energised, is less absent and is more loyal to the practice (Kjerulf 2013; Job Satisfaction Index 2015; Pryce-Jones & Lindsay 2014).

Thus far, few studies have been conducted to assess the quality of life, life satisfaction or subjective well-being of physiotherapists in the global health care sector, and to the authors’ knowledge, there has been no attempt to measure these variables in the South African private physiotherapy sector. However, studies of happiness have been progressively conducted internationally and among the local nursing sector of southern Africa. Studies relating to happiness levels of public sector nursing staff in southern Africa indicated that nursing staff are unhappy with their working environment and dissatisfied with the management skills of their supervisors and that the organisational cultures are not conducive to generate high levels of job satisfaction or happiness at work (Pietersen 2005). Therefore, further studies of happiness in the international and national health care sector are necessary across the medical professionals such as nurses, physiotherapists and medical officers, to determine their levels of satisfaction and happiness at work. It is noted that happiness would benefit from multifaceted methodological and theoretical perspectives, such as ethnographic approaches, to understand how health care professionals still experience happiness despite difficult and stressful conditions at work (Einarsdóttir 2012).

The private physiotherapy sector is representative of a business operating within the service industry, as the product consumed is the service rendered by the physiotherapist. Furthermore, these private sector physiotherapists in South Africa form a diverse cultured workforce such as in Australia (Adams et al. 2014) and require studies to support the management of practice owners to thereby ensure that their staff maintain favourable happiness levels at work and in turn generate happy staff and patients.

The literature on happiness uses various measurement instruments in their quest to determine the level of happiness of a specific population and thereby contribute to happiness research, which is gradually becoming a field of primary importance (Dambrun et al. 2012). Dambrun et al. (2012) present the development of two measurement scales of happiness, which intimately link to a preceding theoretical model named the self-centeredness or selfless happiness model presented by Dambrun and Ricard (2011). The two scales of measurement by Dambrun et al. (2012) are the Subjective Fluctuating Happiness Scale (SFHS) and the Subjective Authentic-Durable Happiness Scale (SA-DHS), which are characterised by high internal consistency, a logical factorial structure and stability over time.

A more widely used measuring instrument of happiness is the Oxford Happiness Inventory (OHI), which is a broad measure of personal happiness developed in the late 1980s (Bekhet et al. 2008). This measurement instrument has been used cross-culturally on a worldwide platform and forms the foundation of the Chinese Happiness Inventory (Bekhet et al. 2008). The OHI has been improved to the Oxford Happiness Questionnaire (OHQ) containing similar items to the OHI and is presented on a uniform Likert scale, which is less susceptible to questionnaire and respondent bias (Hills & Argyle 2002). Moreover, a short-form version of the OHQ was devised for use when space and time are limited (Hills & Argyle 2002). The correlation between the results of the full scale and short-form scale is greater than 0.90 and deemed highly significant, p < 0.001 (Hills & Argyle 2002).

A recent study conducted among the undergraduate students at the Nipissing University in Canada used the OHQ as a measuring instrument to explore the relationship between happiness and six domains, namely academic success, financial security, familial support, living environment, self-image and social relations (Flynn & MacLeod 2015). However, to date, no studies have used the OHQ or any other valid measure of happiness to determine the level of happiness of physiotherapists in the private sector of South Africa.

Previous studies relating to happiness were used to identify the independent variables for this study in combination with OHQ, which is a proven reliable research instrument. The following independent variables were selected and investigated in this study: influence, social relations, purpose, life balance, optimism, work and leisure. The dependent variable was happiness. The conceptual model created for this study and related survey items are presented in Figure 1.

At present, there is no literature addressing the happiness levels of private sector physiotherapists in South Africa. Therefore, this study may establish a foundation for future research to further investigate and contribute to the body of knowledge with regard to happiness in the health care sector and in addition empower physiotherapy practice owners to increase the happiness levels of their staff, thereby gaining the confirmed benefits that increased employee happiness produces. In addition, this study may provide insight as to what the private sector physiotherapy workforce of South Africa perceive as important in terms of happiness in the workplace.

The descriptive statistics in Table 2 indicate that the majority of the respondents (n = 168, 42.5%) reside in the Gauteng Province of South Africa. The majority fall into the age groups 20–30 and 31–40 years of age (n = 249, 63%) and are female (n = 347, 88%). Two hundred and seventy-two respondents (69%) were married, 63% (n = 249) obtained a 4-year degree, 44% have up to 10 years working experience and two-thirds of the respondents are owners of private physiotherapy practices (66%, n = 262). The analysis of variance results is presented in Table 3. The five-point Likert scale values were in the range of 1 (Strongly Disagree) to 5 (Strongly Agree). All variables have mean scores between agree and strongly agree for the 395 respondents.

Table 4, the Pearson’s correlation coefficients, indicates that happiness has a high positive correlation with life balance (0.74) and a moderate positive correlation with work (0.52), social relations (0.42), optimism (0.40) and influence (0.49). However, the dependent variable illustrates a poor positive correlation with leisure (0.30).

The p-value for all the independent and dependent variables is below 0.05 and thus illustrates significant relationships (Collis & Hussey 2013; Wegner 2013).

Furthermore, the results concluded that the independent variables are able to cause positive effects on the dependent variable, happiness. Happiness is thus moderately correlated with influence, social relations, life balance, optimism and work and poorly correlated with leisure. The hypotheses were evaluated using a multiple regression analysis (Table 3). The following findings were derived from this study:

This study is the first attempt to determine the happiness levels of physiotherapists in South Africa and thus provides deeper insight into what the private sector physiotherapy workforce of South Africa perceives as important in terms of happiness at the workplace. The empirical evidence above and the integrated proposed model may enable physiotherapy practice owners to focus on their workforce and their well-being. They are more likely to generate and share new ideas and create greater cooperation between colleagues and with patients. They could become more energised, more loyal to their practices and possibly more productive in accordance with the established benefits of increased happiness, highlighted in the literature review (Job Satisfaction Index 2015; Kjerulf 2013; Pryce-Jones & Lindsay 2014).

This study has pioneered a way forward for physiotherapy practice owners to adapt their practice model by aligning their intrinsic operations towards enhanced staff happiness and thus more favourable financial bottom lines via the proposed statistical model. Factors of staff retention and recruitment of high performing staff remain a concern for developing countries, such as South Africa, with regard to the increasing shortage of health care staff, often lost because of immigration factors to more developed countries. Hence, this study contributes to enable physiotherapy practice owners to adapt their business model to counter the changes in the health care market forces. They can thus understand the driving forces behind their organisational culture and thereby develop appropriate retention and attraction strategies and consequently foster happier workforces that generate positive effects on their practice bottom line.