Background <p>Retaining home care workers who are experiencing increasing job demands alongside deteriorating occupational health has become a growing concern. Previous research has found occupational self-efficacy, that is belief in one’s own capabilities to successfully fulfil work-related responsibilities, associated with work wellbeing and meaningfulness. The aim of this study was to explore how home care workers who experience threatened occupational health perceive the importance of occupational self-efficacy for their occupational health and their sense of meaningfulness at work.</p> Methods <p>Eight home care workers with threatened work ability, defined as having accumulated 30 days or more of sick leave in the past year, were interviewed. The semi-structured interviews were analysed using Braun and Clarke’s reflexive thematic analysis.</p> Results <p>Based on the analysis, an overarching theme—“Occupational self-efficacy, health and meaningfulness at work walking hand in hand”—was generated, together with two main themes. The main themes were “Holding on to myself through the balancing act of health, worth and work”, and “Protecting the value of meaningfulness in the face of organisational challenges”. The findings highlight a reciprocal relationship between occupational self-efficacy, health and meaningfulness at work, however, influenced by work environment.</p> Conclusions <p>Supporting the inner health and sense of worth of home care workers experiencing ill health enhances sustainable occupational self-efficacy. A balanced sense of meaningfulness at work further contributes to this process. Although occupational self-efficacy is a personal resource, it is strongly influenced by the psychosocial and organisational work environment, underscoring the importance of developing a healthy work environment.</p>