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Anger WK, Dimoff JK, Alley L. Addressing Health Care Workers' Mental Health: A Systematic Review of Evidence-Based Interventions and Current Resources. Am J Public Health 2024; 114:213-226. [PMID: 38354343 PMCID: PMC10916736 DOI: 10.2105/ajph.2023.307556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2023] [Indexed: 02/16/2024]
Abstract
Background. Mental health is declining in health care workers. Objectives. To provide a comprehensive assessment of intervention literature focused on the support and treatment of mental health within the health care workforce. Search Methods. We searched online databases (e.g., Medline, PsycINFO). Selection Criteria. We selected manuscripts published before March 2022 that evaluated the target population (e.g., nurses), mental health outcomes (e.g., burnout, depression), and intervention category (e.g., mindfulness). Data Collection and Analysis. Of 5158 publications screened, 118 interventions were included. We extracted relevant statistics and information. Main Results. Twenty (17%) earned study quality ratings indicating design, analysis, and implementation strengths. Randomized controlled trials were used by 52 studies (44%). Thirty-eight percent were conducted in the United States (n = 45). Ninety (76%) reported significant changes, and 46 (39%) reported measurable effect sizes. Multiple interventions significantly reduced stress (n = 29; 24%), anxiety (n = 20; 17%), emotional exhaustion or compassion fatigue (n = 16; 14%), burnout (n = 15; 13%), and depression (n = 15; 13%). Authors' Conclusions. Targeted, well-designed mental health interventions can improve outcomes among health care workers. Public Health Implications. Targeted health care‒focused interventions to address workers' mental health could improve outcomes within this important and vulnerable workforce. (Am J Public Health. 2024;114(S2):S213-S226. https://doi.org/10.2105/AJPH.2023.307556).
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Affiliation(s)
- W Kent Anger
- W. Kent Anger and Lindsey Alley are with Oregon Health & Science University (OHSU), Oregon Institute of Occupational Health Sciences, Portland, OR 97233. Jennifer Dimoff is with University of Ottawa, Telfer School of Management, Ottawa, Ontario, Canada
| | - Jennifer K Dimoff
- W. Kent Anger and Lindsey Alley are with Oregon Health & Science University (OHSU), Oregon Institute of Occupational Health Sciences, Portland, OR 97233. Jennifer Dimoff is with University of Ottawa, Telfer School of Management, Ottawa, Ontario, Canada
| | - Lindsey Alley
- W. Kent Anger and Lindsey Alley are with Oregon Health & Science University (OHSU), Oregon Institute of Occupational Health Sciences, Portland, OR 97233. Jennifer Dimoff is with University of Ottawa, Telfer School of Management, Ottawa, Ontario, Canada
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Shrivastava R, Singh A, Khan A, Choubey S, Haney JR, Karyotaki E, Tugnawat D, Bhan A, Naslund JA. Stress Alleviation Methods for community-Based Health ActiVists (SAMBHAV): Development of a digital program for stress reduction for community health workers in rural India. SSM - MENTAL HEALTH 2023; 4:100230. [PMID: 38188869 PMCID: PMC10769151 DOI: 10.1016/j.ssmmh.2023.100230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Background Community health workers (CHWs) face high levels of stress (both professional and personal) and risk of burnout, highlighting the need for efforts to promote their mental health and well-being. This study seeks to develop a digital stress reduction program for CHWs in rural India. Methods A stepwise design process was employed to adapt and digitize the evidence-based World Health Organization's Self-Help Plus (SH+) intervention for addressing psychological distress among CHWs in Madhya Pradesh, India. This involved participatory design workshops with CHWs to ensure that the digital stress reduction intervention would be relevant for their needs and the local culture and context. Small groups of CHWs reviewed the adapted program content, allowing the research team to make refinements such as simplifying language, tailoring content to the local setting, and ensuring that program materials are both interesting and relevant. Simultaneously, the research team digitized the content, leveraging a combination of video and graphical content, and uploaded it to the Sangath Learning Management System, a digital platform accessible on a smartphone app. Results In total, 18 CHWs contributed to the adaptation of the SH+ content and digital intervention development. Participants commented on finding some terms difficult to follow and recommended simplifying the language and providing detailed explanations. Participants offered positive feedback on the adapted content, expressing that they found the examples covered in the material both relatable and relevant to their own personal experiences at home and in the workplace. By combining participants' insights and comments with feedback from content experts, it was possible to finalize a digital Hindi version of the SH+ intervention for CHWs in rural India. Conclusions This study is timely given the continued detrimental impacts of the COVID-19 pandemic, and offers a promising and potentially scalable digital program to alleviate psychological distress among frontline health workers.
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Affiliation(s)
| | | | | | | | | | - Eirini Karyotaki
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | | | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Shrivastava R, Sharma L, Jolly M, Ahuja R, Sharma R, Naslund JA, Agrawal J, Shidhaye R, Mehrotra S, Hollon SD, Patel V, Tugnawat D, Kumar A, Bhan A, Bondre AP. "We are everyone's ASHAs but who's there for us?" a qualitative exploration of perceptions of work stress and coping among rural frontline workers in Madhya Pradesh, India. Soc Sci Med 2023; 336:116234. [PMID: 37778144 DOI: 10.1016/j.socscimed.2023.116234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 08/23/2023] [Accepted: 09/09/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE More than a million female village-level lay providers called 'Accredited Social Health Activists (ASHAs)', who deliver primary care, face high levels of stress due to work demands and low compensation, within the context of poverty and gender inequality. Evidence on ASHAs has focused on workplace challenges from a system perspective, without sufficient probing into individual-level stress. This study aims to gain perspectives into the experiences of work stress, the related health symptoms, and the responses to stress among ASHAs in India. METHODS Focus group discussions (FGDs) conducted with ASHAs in Sehore district, Madhya Pradesh, were audio-recorded and transcribed. Grounded theory was used to generate themes under the various domains of ASHAs' work and domestic life. We identified pathways between the conditions that trigger stressful events, experiences of these events, resulting perceptions, effects on health and wellbeing, and approaches used by ASHAs to respond to stress. RESULTS Six FGDs with 59 ASHAs generated the following themes: (a) Facility: Workload, undue pressures, unstructured work; ASHAs' relationships with seniors (e.g., feelings of being disrespected, blamed, or targeted), and low access to physical and administrative resources; (b) Home: Feelings of guilt for putting less time for family/child care; disrespect by the elderly for a poorly incentivised job; (c) Community: Low acceptance by the villagers; caste- and gender-bias; difficult community-level relationships (emotional labour, fear/stigma towards her services); (d) Somatic and psychological symptoms: headache, exhaustion, depressive symptoms (to cite a few); and (e) Responses to stress: Motivation (support from peers, family, a sense of identity/pride, incentives), Individual strengths (e.g., social responsibility), and spiritual recourse mechanisms. CONCLUSIONS This study will inform the development of a strengths-based coaching intervention to address work stress among ASHAs. The findings are relevant to building the evidence on alleviation of work stress among female frontline cadres in low-resource settings globally.
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Affiliation(s)
- Ritu Shrivastava
- Sangath, 106, Good Shepherd Colony, Kolar Road, Bhopal, Madhya Pradesh, 462042, India.
| | - Lochan Sharma
- Sangath, 106, Good Shepherd Colony, Kolar Road, Bhopal, Madhya Pradesh, 462042, India
| | - Mehak Jolly
- Sangath, 106, Good Shepherd Colony, Kolar Road, Bhopal, Madhya Pradesh, 462042, India
| | - Romi Ahuja
- Sangath, 106, Good Shepherd Colony, Kolar Road, Bhopal, Madhya Pradesh, 462042, India
| | - Radhika Sharma
- Sangath, 106, Good Shepherd Colony, Kolar Road, Bhopal, Madhya Pradesh, 462042, India
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, United States
| | - Jyotsna Agrawal
- National Institute of Mental Health and Neurosciences, Hosur Road, Lakkasandra, Wilson Garden, Bengaluru, Karnataka, 560029, India
| | - Rahul Shidhaye
- Pravara Institute of Medical Sciences, Tal: Rahata, Dist: Ahmednagar, Maharashtra, 413736, India
| | - Seema Mehrotra
- National Institute of Mental Health and Neurosciences, Hosur Road, Lakkasandra, Wilson Garden, Bengaluru, Karnataka, 560029, India
| | - Steve D Hollon
- Vanderbilt University, Brentwood, TN, 37027, United States
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, United States
| | - Deepak Tugnawat
- Sangath, 106, Good Shepherd Colony, Kolar Road, Bhopal, Madhya Pradesh, 462042, India
| | - Ananth Kumar
- National Health Systems Resource Centre, National Institute of Health & Family Welfare Campus, Baba Gang Nath Marg, Block F, Munirka, New Delhi, Delhi, 110067, India
| | - Anant Bhan
- Sangath, 106, Good Shepherd Colony, Kolar Road, Bhopal, Madhya Pradesh, 462042, India
| | - Ameya P Bondre
- Sangath, 106, Good Shepherd Colony, Kolar Road, Bhopal, Madhya Pradesh, 462042, India
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Liu M, Wang J, Lou J, Zhao R, Deng J, Liu Z. What is the impact of integrated care on the job satisfaction of primary healthcare providers: a systematic review. HUMAN RESOURCES FOR HEALTH 2023; 21:86. [PMID: 37915032 PMCID: PMC10619237 DOI: 10.1186/s12960-023-00874-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/27/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND AND OBJECTIVES The integration of care influenced the job satisfaction of healthcare professionals, especially affecting primary healthcare providers (PCPs). This study aimed to perform a systematic review to explore the impact of integrated care on the job satisfaction of PCPs on the basis of Herzberg's two-factor theory. METHODS This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched 6 electronic databases, including CNKI, WANFANG, PubMed, Web of Science, Cochrane Library, and Embase. Data were retrieved from inception to 19 March 2023. The Mixed Methods Appraisal Tool (MMAT) version 2018 was used to assess the methodological quality of studies for inclusion in the review. RESULTS A total of 805 articles were retrieved from databases, of which 29 were included in this review. 2 categories, 9 themes, and 14 sub-themes were derived from the data. 2 categories were identified as intrinsic and extrinsic factors. Intrinsic factors included 4 themes: responsibilities, promotion opportunities, recognition, and a sense of personal achievements and growth. Extrinsic factors included 5 themes: salaries and benefits, organizational policy and administration, interpersonal relationships, working conditions, and work status. To specify some key information under certain themes, we also identify sub-themes, such as the sub-theme "workload", "work stress", and "burnout" under the theme "work status". CONCLUSIONS Findings suggested that the integration of care had both negative and positive effects on the job satisfaction of PCPs and the effects were different depending on the types of integration. Since PCPs played a vital role in the successful integration of care, their job satisfaction was an important issue that should be carefully considered when implementing the integration of care.
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Affiliation(s)
- Mei Liu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
| | - Jian Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China.
| | - Jiaxu Lou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
| | - Ruonan Zhao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
| | - Jiahui Deng
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
| | - Ziyu Liu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China.
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Makina-Zimalirana N, Bisnauth M, Shangase N, Davies N, Jiyane A, Buthelezi F, Rees K. Workplace wellbeing among health care workers providing HIV services in primary care in Johannesburg: a mixed methods study. Front Public Health 2023; 11:1220301. [PMID: 38026318 PMCID: PMC10643173 DOI: 10.3389/fpubh.2023.1220301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background Burnout among Health Care workers (HCWs) impacts on provider-patient relations and quality of care. Anova Health Institute (Anova) is a large South African non-profit organization and PEPFAR/USAID implementing partner. We conducted a study among HCWs providing HIV-related services in primary care settings in Johannesburg, South Africa, to examine levels of burnout, understand factors affecting workplace wellbeing, and explore strategies to prevent burnout. Methods We used a sequential mixed-method approach. Data were collected between February and April 2022. The first phase consisted of a survey using the Maslach Burnout Inventory Human Services Survey (MBI-HSS) to measure levels of burnout. We then interviewed a subset of survey participants to understand the experiences that may affect wellbeing. We used descriptive statistics to quantify burnout rates for each MBI dimension (emotional exhaustion, personal accomplishment, and depersonalization). Qualitative data analysis was guided by the Job Demands-Resources Framework that explores the interactions between demands and resources in the workplace. Results Survey findings (n = 194) revealed that although depersonalization rates were low at 6%, 21% of participants had high emotional exhaustion and 24% reported low professional accomplishment. Less than half (41%, n = 80) had scores in the high category for any one of the three MBI-HSS dimensions. The MBI-HSS dimensions differed significantly by type of work and job title. Roving positions (HCW working in more than one health facility) were more likely to experience higher emotional exhaustion and lower professional accomplishment. Qualitative findings (n = 25) indicate that a number of job demands, including high workload, inadequate mental health support, and challenging relationships with stakeholders, had a negative effect on HCWs' wellbeing. However, finding meaningfulness in their work, working as a team, and practicing autonomy were experienced as resources that reduced the negative effect of these demands. Conclusion While measured burnout syndrome rates were low, various experiences negatively impacted at least one in five HCW. We identified key resources that provided buffering against workplace stressors. We recommend that as well as addressing key drivers of burnout, access to these resources should be fostered, for example by strengthening interventions that offer recognition, and promoting team interactions through social activities and support groups.
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Affiliation(s)
| | | | | | | | - Anele Jiyane
- Anova Health Institute, Johannesburg, South Africa
| | | | - Kate Rees
- Anova Health Institute, Johannesburg, South Africa
- Department of Community Health, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Menguer LDS, Pereira EV, da Silva ACR, de Farias JM. Burnout syndrome and job satisfaction in community health workers. Rev Bras Med Trab 2023; 21:e2021903. [PMID: 39132269 PMCID: PMC11316535 DOI: 10.47626/1679-4435-2021-903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/15/2021] [Indexed: 08/13/2024] Open
Abstract
Introduction Community health workers play a prominent role in the primary care context in Brazil. Burnout syndrome is an important work-related condition whose consequences affect job satisfaction. Objectives To evaluate the extent of burnout syndrome and job satisfaction among community health workers in a city in southern Santa Catarina. Methods This analytical, individual, cross-sectional study was conducted in Family Health Units. The participants were selected through random probability sampling, with a sampling error of 10%. After sociodemographic data collection, the Maslach Burnout Inventory and a job satisfaction scale were applied. Results All 66 included workers were women. According to the analyses, there was a moderate positive correlation between satisfaction with colleagues and satisfaction with supervisors. There were weak positive correlations between emotional exhaustion and depersonalization and between professional fulfillment and satisfaction with promotions. However, there was a weak negative correlation between emotional exhaustion and both professional fulfillment and satisfaction with salary. Conclusions The results indicate that the conditions of these workers are sufficiently satisfactory to deal with the demands of the job. Nevertheless, there was substantial dissatisfaction with salary, which can be a demotivator and trigger work-related depression.
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Affiliation(s)
- Lorhan da Silva Menguer
- Educação Física, Universidade do Extremo Sul
Catarinense (UNESC), Criciúma, SC, Brazil
- Grupo de Estudo e Pesquisa em Promoção da Saúde
(GEPPS), UNESC, Criciúma, SC, Brazil
| | - Eduarda Valim Pereira
- Educação Física, Universidade do Extremo Sul
Catarinense (UNESC), Criciúma, SC, Brazil
- Grupo de Estudo e Pesquisa em Promoção da Saúde
(GEPPS), UNESC, Criciúma, SC, Brazil
- Programa de Pós-Graduação em Saúde Coletiva,
UNESC, Criciúma, SC, Brazil
| | - Antonio Carlos Rosa da Silva
- Grupo de Estudo e Pesquisa em Promoção da Saúde
(GEPPS), UNESC, Criciúma, SC, Brazil
- Programa de Pós-Graduação em Saúde Coletiva,
UNESC, Criciúma, SC, Brazil
| | - Joni Marcio de Farias
- Educação Física, Universidade do Extremo Sul
Catarinense (UNESC), Criciúma, SC, Brazil
- Grupo de Estudo e Pesquisa em Promoção da Saúde
(GEPPS), UNESC, Criciúma, SC, Brazil
- Programa de Pós-Graduação em Saúde Coletiva,
UNESC, Criciúma, SC, Brazil
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Gelaw YM, Hanoch K, Adini B. Burnout and resilience at work among health professionals serving in tertiary hospitals, in Ethiopia. Front Public Health 2023; 11:1118450. [PMID: 37346106 PMCID: PMC10279861 DOI: 10.3389/fpubh.2023.1118450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/16/2023] [Indexed: 06/23/2023] Open
Abstract
Background The quality of healthcare service is strongly affected by the health professionals' levels of burnout and resilience at work (RaW). Developing resilience is a key component of medical professionalism. Although burnout and resilience are indicators used to assess the level of workplace hardship, there is a dearth of information in most developing countries, including Ethiopia. Objective To assess the levels of burnout and 'resilience at work' among health professionals who work in the surgical care departments in teaching Ethiopian hospitals. Methods A cross-sectional study design was applied among health professionals employed in surgical, gynecologic, and obstetric (Gyn/Obs) departments of two acute-care hospitals (n = 388). A structured self-administered English version questionnaire, consisting of validated scales to measure RaW and burnout, was used to collect the data;22 items of Maslach's burnout inventory human service survey tool and 20 items of Win wood's resilience at work' measuring tool" was employed to assess the health professionals' burnout level and Resilience at work, respectively. Linear logistics regression was employed for inferential statistical analysis to identify factors that predict RaW and burnout. Results Burnout syndrome was shown among 101 (26.0%) study participants. Furthermore, 205 (52.8%), 150 (38.7%), and 125 (32.2%) participants presented high emotional exhaustion, high depersonalization, and low personal accomplishment, respectively. Emotional exhaustion was predicted by the participants' profession, the hope of promotion, professional recognition, and workload. Depersonalization was predicted by age, profession, and perceived workload of the participants. The predictors for personal accomplishment were profession, relationship at work, professional recognition, and having a managerial position in addition to clinical duty. The participants' mean RaW score was 78.36 (Standard deviation ±17.78). A negative association was found between RaW and emotional exhaustion and depersonalization. In contrast, a positive association was identified between RaW and personal accomplishment. The type of profession and marital status were positive predictors of RaW. Conclusion A substantial amount of health professionals experience high burnout in one or more burnout dimensions. Level of RaW is more affected by burnout syndrome. Therefore, promoting activities that increase the level of professional RaW and recognition in their professional practice is needed to reduce job burnout. These findings are especially important concerning low socio-economic countries, as resilience is a vital component of the development of healthcare systems.
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Affiliation(s)
- Yared Mulu Gelaw
- Department of Emergency and Disaster Management, Sackler Faculty of Medicine, School of Public Health, Tel-Aviv University, Tel Aviv, Israel
- Department of Health Service Management, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Kashtan Hanoch
- Department of Health Service Management, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Bruria Adini
- Department of Surgery, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Birhane R, Medhin G, Demissie M, Tassew B, Gebru T, Tadesse B, Jebena MG, Teklu AM, Deyessa N. Depression and Burnout among Health Extension Workers in Ethiopia: A Cross-Sectional Study. Ethiop J Health Sci 2023; 33:63-74. [PMID: 38362477 PMCID: PMC10866296 DOI: 10.4314/ejhs.v33i1.7s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 01/24/2023] [Indexed: 02/17/2024] Open
Abstract
Background Depression and burnout are common among healthcare workers (HCWs) and negatively affect their well-being and the quality of the service they provide. However, the burden of depression and burnout among health extension workers (HEWs) in Ethiopia and their relationship has not been documented well.The objective of this study was to estimate the prevalence of depression and burnout among HEWs in Ethiopia and to investigate the relationship between these conditions. Materials and Methods We used a cross-sectional study design and collected data from 584 rural and 581 urban HEWs in Ethiopia, as part of the 2019 national health extension program assessment. The Patient Health Questionnaire (PHQ-9) and Burnout Self-Test were used to screen HEWs for depression and burnout, respectively. We used descriptive statistics to estimate the magnitude of depression and burnout, and logistic regression to examine their relationship. Result Based on PHQ-9 cutoff scores of 10, the prevalence of major depression was 16.5% among rural and 8.9% among urban HEWs, whereas burnout risk was 39.8% among rural and 12.6% among urban HEWs. The odds of having depression among HEWs with burnout risk was relatively higher compared to those without burnout risk [For rural HEWs, the adjusted odds ratio (AOR) is 11.88 at a 95% confidence interval (CI; 5.27, 26.80), and for urban HEWs, the AOR is 11.49 at a 95% CI (5.35, 24.63)]. Conclusion The prevalence of depression and burnout is high among HEWs in Ethiopia, with a significant rural-urban difference, and burnout is a significant predictor of depression. Mental health interventions that enable prevention, early detection, and management are needed especially for rural HEWs who are in charge of preventive health service delivery for the disadvantaged rural communities.
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Affiliation(s)
- Rahel Birhane
- CDT-Africa, College of Health Sciences, Addis Ababa University
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
- MERQ Consultancy PLC, Addis Ababa
| | - Mekdes Demissie
- CDT-Africa, College of Health Sciences, Addis Ababa University
- Centre for Innovative Drug Development and Therapeutic Studies for Africa (CDT-Africa), College of Health Science, Addis Ababa University
| | - Berhan Tassew
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Teklemichael Gebru
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Biniyam Tadesse
- MERQ Consultancy PLC, Addis Ababa
- Department of Health Economics, Management and Policy, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Mulusew G Jebena
- Department of Epidemiology, Institute of Health, Jimma University
| | | | - Negussie Deyessa
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Bafei SEC, Chen J, Qian Y, Yuan L, Zhou Y, Sambou ML, Walker AN, Li W, Liu S. The Association between Burnout, Social Support, and Psychological Capital among Primary Care Providers in Togo: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59010175. [PMID: 36676799 PMCID: PMC9864046 DOI: 10.3390/medicina59010175] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/28/2022] [Accepted: 01/10/2023] [Indexed: 01/18/2023]
Abstract
Background and Objectives: Job burnout is prevalent among primary care providers (PCPs) in different countries, and the factors that can alleviate burnout in these countries have been explored. However, no study has addressed the prevalence and the correlates of job burnout among Togolese PCPs. Therefore, we aimed to examine the prevalence of burnout and its association with social support and psychological capital among PCPs in Togo. Material and Methods: We conducted a cross-sectional study in Togo from 5 to 17 November 2020 among 279 PCPs of 28 peripheral care units (PCUs). Participants completed the Maslach Burnout Inventory, Job Content Questionnaire, and Psychological Capital Questionnaire. Data were analyzed using the Mann-Whitney U test, Kruskal-Wallis H test, Pearson correlation analysis, and multiple linear regression. Results: We received 279 responses, out of which 37.28% experienced a high level of emotional exhaustion (EE), 13.62% had a high level of depersonalization (DP), and 19.71% experienced low levels of personal accomplishment (PA). EE had a significant negative correlation with the supervisor's support. In contrast, self-efficacy, hope, optimism, and resilience had a significant negative correlation with DP and a significant positive correlation with PA. Furthermore, supervisors' support significantly predicted lower levels of EE. Optimism significantly predicted lower levels of DP and higher levels of PA. Conclusions: Burnout is common among Togolese PCPs, and self-efficacy, optimism, and supervisors' support significantly contribute to low levels of job burnout among Togolese PCPs. This study provided insight into intervention programs to prevent burnout among PCPs in Togo.
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Affiliation(s)
- Solim Essomandan Clémence Bafei
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Jiaping Chen
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Yinan Qian
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Lei Yuan
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Yimin Zhou
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Muhammed Lamin Sambou
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Anita Nyarkoa Walker
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Wei Li
- Department of Anesthesiology, Children’s Hospital of Nanjing Medical University, Nanjing 210008, China
- Correspondence: (W.L.); (S.L.)
| | - Sijun Liu
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
- Correspondence: (W.L.); (S.L.)
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Rose AL, Jack HE, Wan C, Toloza E, Bhattiprolu K, Ragunathan M, Schwartz KT, Magidson JF. Implementing Task-Shared Child and Adolescent Psychological Interventions in Low- and Middle-Income Countries: A Scoping Review. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022:1-16. [PMID: 36507739 PMCID: PMC10258230 DOI: 10.1080/15374416.2022.2151450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Effective "task shared," or nonspecialist delivered, psychological interventions for children and adolescents have been developed or adapted in low- and middle-income countries with the aim of closing the global treatment gap for youth mental health care. Yet, delivery remains limited, in part due to the lack of knowledge of associated implementation, or process, outcomes. This scoping review aims to describe, examine the quality of, and synthesize findings on implementation outcomes of child and adolescent psychological interventions in low-and middle-income countries. METHODS PubMed, Web of Science, and PsycInfo were searched for studies on child and adolescent psychological interventions in low- and middle-income countries reporting on implementation outcomes. After abstract and full-text review, data were extracted and summarized on implementation outcomes and quality of implementation outcomes reporting. Implementation barriers and recommendations for addressing barriers were also charted and narratively synthesized. RESULTS Out of 5,207 manuscripts, 86 met inclusion criteria. Younger children were underrepresented. Studies largely reported feasibility and acceptability and did not state hypotheses or use conceptual models. Barriers primarily related to interventions being too complex, not an acceptable fit with participant cultures, and facilitators lacking time for or experiencing distress delivering interventions. Recommendations focused on increasing intervention fit and flexibility, training and support for facilitators, and linkages with existing systems. CONCLUSIONS Rigorous, broader implementation outcomes research is needed within child and adolescent psychological intervention research in low-and middle-income countries. Current evidence suggests the importance of the further developing strategies to increase acceptability to participants and better support facilitators.
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Affiliation(s)
- Alexandra L. Rose
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Helen E. Jack
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Christine Wan
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Emilia Toloza
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Kavya Bhattiprolu
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Meera Ragunathan
- Department of Psychology, University of Maryland, College Park, MD, USA
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Ahmed F, Hawulte B, Yuya M, Birhanu S, Oljira L. Prevalence of burnout and associated factors among health professionals working in public health facilities of Dire Dawa city administration, Eastern Ethiopia. Front Public Health 2022; 10:836654. [PMID: 36033755 PMCID: PMC9403244 DOI: 10.3389/fpubh.2022.836654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 07/05/2022] [Indexed: 01/21/2023] Open
Abstract
Background Burnout is a common condition among health workers, characterized by emotional tiredness, depersonalization, and a sense of low personal accomplishment. Ethiopia has major health workforce management challenges, including shortages, poor motivation, retention, and performance, and research evidence is limited for health professionals' burnout status, particularly in Eastern Ethiopia. Therefore, this study is aimed at determining the prevalence of burnout and associated factors among health professionals working at governmental health facilities in Eastern Ethiopia. Method An institutional-based cross-sectional study was conducted among health professionals using structured self-administered validated questionnaires using the Maslach Burnout Inventory scale. Data were entered into Epi-Data version 3.1 and exported to SPSS version 22 for analysis. Multivariable logistic regression was used to determine the association between burnout and its predictors. Results A total of 508 health professionals were approached, out of which 501 participated (a response rate of 98.4%). The magnitude of burnout was 54.1 with a 95% confidence interval of 49.9-58.0%. Working in a hospital (AOR = 3.55, 95%CI: 2.00, 6.33), age >/= 40 (AOR = 3.98, 95%CI:1.60, 9.89) and 30-39 years (AOR = 1.90, 95%CI:1.08, 3.34), being female(AOR = 2.41, 95%CI: 1.37, 4.25), being widowed (AOR = 3.39, 95%CI: 1.13, 10.18), having intention of leaving work (AOR = 2.28, 95%CI: 1.35, 3.87), using at least one substance (AOR = 2.24, 95%CI: 1.36, 3.69), having a 6-11 years of experience (AOR = 2.17, 95%CI: 1.15, 4.06), having no job supervision (AOR = 4.65, 95%CI: 2.07, 10.43), monthly payment <10,000 Ethiopian Birr (AOR = 5.69, 95%CI: 2.30, 14.07) and between 10,000 to 15,000 Ethiopian Birr (AOR = 2.74, 95%CI: 1.22, 6.15), working in Pediatric Unit (AOR = 3.28, 95%CI: 1.24, 8.70), and profession type (Midwifery, Public health officer, Medical Laboratory professionals) were factors significantly associated with burnout. Conclusion Burnout affected more than half of the health professionals working in governmental health facilities in Dire Dawa. Health facility type, age, sex, marital status, intention to leave work, substance use, work experience, job supervision, monthly payment, profession type, and working unit were significantly associated predictors of burnout.
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Affiliation(s)
- Fila Ahmed
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Behailu Hawulte
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mohammed Yuya
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Simon Birhanu
- School of Nursing and Midwifery, Haramaya University, Harar, Ethiopia,*Correspondence: Simon Birhanu
| | - Lemessa Oljira
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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12
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Alqassim AY, Shami MO, Ageeli AA, Ageeli MH, Doweri AA, Melaisi ZI, Wafi AM, Muaddi MA, El-Setouhy M. Burnout Among School Teachers During the COVID-19 Pandemic in Jazan Region, Saudi Arabia. Front Psychol 2022; 13:849328. [PMID: 35719515 PMCID: PMC9205293 DOI: 10.3389/fpsyg.2022.849328] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Burnout is a syndrome that results from stressors in the work environment that have not been successfully managed. The prevalence of burnout among schoolteachers was always controversial. COVID-19 pandemic added more stressors to teachers since they had to change their working styles in response to the pandemic lockdowns or curfews. In Saudi Arabia, the prevalence and determinants of burnout among school teachers were not measured by any other group during the COVID-19 pandemic stressors. Methods A cross-sectional survey was conducted among 879 teachers in the Jazan region, Saudi Arabia, using the Maslach Burnout Inventory (MBI), during April 2021. Multistage cluster random sampling was used. Results The mean age of the participants was 41.4 (±6.9) years. Male teachers represented 52.6% of the participants while females represented 47.4%. Most teachers showed burnout symptoms (69.6%). Consequences of burnout were observed, such as using psychotropic medications (4.6%), absenteeism (45.6%), lack of job satisfaction (7.7%), and changing schools (15.8%). Using the MBI scale, most teachers showed medium or high emotional exhaustion (57.6%), low depersonalization (62.2%), and low personal accomplishment (51.4%). Conclusion Most teachers showed symptoms of burnout during the COVID-19 pandemic. Being an expert and ability to adapt to technology during the COVID-19 pandemic proved to effectively reduce burnout symptoms. Increasing incentives, early detection, and improving the work environment is recommended to diminish burnout consequences.
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Affiliation(s)
- Ahmad Y Alqassim
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | | | - Ahmed A Ageeli
- Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | | | - Abrar A Doweri
- Jazan Health Affairs, Ministry of Health, Jazan, Saudi Arabia
| | | | - Ahmed M Wafi
- Department of Physiology, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Mohammed A Muaddi
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Maged El-Setouhy
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia.,Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Rose AL, Fenelon DL, Fils-Aimé JR, Dubuisson W, Singer SFC, Smith SL, Jerome G, Eustache E, Raviola G. Development of an Innovative Digital Data Collection System for Routine Mental Health Care Delivery in Rural Haiti. GLOBAL HEALTH: SCIENCE AND PRACTICE 2021; 9:990-999. [PMID: 34933992 PMCID: PMC8691881 DOI: 10.9745/ghsp-d-20-00486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/22/2021] [Indexed: 11/17/2022]
Abstract
Mental health information systems in low-resource settings are scarce worldwide. Data collection was accurate, yet sustainable staffing was a challenge when using task-shared clinical providers for data collection in health centers in rural Haiti. Integrating mental health data collection within existing data collection systems would help close this key gap. Introduction: Effective digital health management information systems (HMIS) support health data validity, which enables health care teams to make programmatic decisions and country-level decision making in support of international development targets. In 2015, mental health was included within the Sustainable Development Goals, yet there are few applications of HMIS of any type in the practice of mental health care in resource-limited settings. Zanmi Lasante (ZL), one of the largest providers of mental health care in Haiti, developed a digital data collection system for mental health across 11 public rural health facilities. Program Intervention: We describe the development, implementation, and evaluation of the digital system for mental health data collection at ZL. To evaluate system reliability, we assessed the number of missing monthly reports. To evaluate data validity, we calculated concordance between the digital system and paper charts at 2 facilities. To evaluate the system's ability to inform decision making, we specified and then calculated 4 priority indicators. Results: The digital system was missing 5 of 143 monthly reports across all facilities and had 74.3% (55/74) and 98% (49/50) concordance with paper charts. It was possible to calculate all 4 indicators, which led to programmatic changes in 2 cases. In response to implementation challenges, it was necessary to use strategies to increase provider buy-in and ultimately to introduce dedicated data clerks to keep pace with data collection and protect time for clinical work. Lessons Learned: While demonstrating the potential of collecting mental health data digitally in a low-resource rural setting, we found that it was necessary to consider the ongoing roles of paper records alongside digital data collection. We also identified the challenge of balancing clinical and data collection responsibilities among a limited staff. Ongoing work is needed to develop truly sustainable and scalable models for mental health data collection in resource-limited settings.
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Affiliation(s)
- Alexandra L Rose
- Department of Psychology, University of Maryland, College Park, MD, USA.
- Partners In Health, Boston, MA, USA
| | | | | | | | | | - Stephanie L Smith
- Partners In Health, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Giuseppe Raviola
- Partners In Health, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Aranda-Reneo I, Pedraz-Marcos A, Pulido-Fuentes M. Management of burnout among the staff of primary care centres in Spain during the pandemic caused by the SARS-CoV-2. HUMAN RESOURCES FOR HEALTH 2021; 19:133. [PMID: 34724937 PMCID: PMC8558543 DOI: 10.1186/s12960-021-00679-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/20/2021] [Indexed: 05/07/2023]
Abstract
BACKGROUND The provision of healthcare during the pandemic caused by the SARS-CoV-2 virus represented a challenge for the management of the resources in the primary care centres. We proposed assessing burnout among the staff of those centres and identifying factors that contributed to its appearance and those that limited it. METHODS An observational study which, by means of anonymous questionnaires, collected information about: (i) demographic variables; (ii) the characteristics of each position; (iii) the measures implemented by the medical decision-makers in order to provide care during the pandemic; and (iv) the Burnout Clinical Subtype Questionnaire (BCSQ-36). We performed a descriptive analysis of the burnout mentioned by the staff, and, by means of a multivariate analysis, we identified the factors which influenced it. Using logit models, we analysed whether receiving specific training in COVID-19, feeling involved in decision-making processes, and/or working within different healthcare systems had effects on the development of burnout. RESULTS We analysed the replies of 252 employees of primary care centres in Spain with an average age of 45 (SD = 15.7) and 22 (SD = 11.4) years of experience. 68% of the participants (n = 173) indicated burnout of the frenetic subtype. 79% (n = 200) of the employees had high scores in at least one burnout subtype, and 62% (n = 156) in at least two. Women older than 45 had a lower probability of suffering burnout. Receiving specific training (OR = 0.28; CI95%: 0.11-0.73) and feeling involved in decision-making (OR = 0.32; CI95%:0.15-0.70) each reduced the probability of developing burnout. Working in a different department increased the likelihood of developing burnout of at least one clinical subtype (OR = 2.85; CI95%: 1.38-5.86). CONCLUSIONS The staff in primary care centres have developed high levels of burnout. Participation in decision-making and receiving specific training are revealed as factors that protect against the development of burnout. The measures taken to contain the adverse effects of a heavy workload appear to be insufficient. Certain factors that were not observed, but which are related to decisions taken by the healthcare management, appear to have had an effect on the development of some burnout subtypes.
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Affiliation(s)
- Isaac Aranda-Reneo
- Department of Economic Analysis and Finances, Faculty of Social Sciences, Avda. Real Fábrica de Seda S/N, University of Castilla-La Mancha, 45600, Talavera de la Reina, Spain.
| | - Azucena Pedraz-Marcos
- Nursing Department, Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Montserrat Pulido-Fuentes
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
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Dalmasso G, Di Prinzio RR, Gilardi F, De Falco F, Vinci MR, Camisa V, Santoro A, Casasanta D, Raponi M, Giorgi G, Magnavita N, Zaffina S. Effectiveness of Psychological Support to Healthcare Workers by the Occupational Health Service: A Pilot Experience. Healthcare (Basel) 2021; 9:732. [PMID: 34198556 PMCID: PMC8231947 DOI: 10.3390/healthcare9060732] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/06/2021] [Accepted: 06/10/2021] [Indexed: 12/03/2022] Open
Abstract
Work-related stress is a significant risk for healthcare workers (HCWs). This study aims at evaluating the effectiveness of an individual psychological support programme for hospital workers. In all, 35 workers participated (n). A control group of 245 workers (7n) was set. Occupational distress was measured by the General Health Questionnaire, (GHQ-12), the quality of life by the Short Form-36 health survey, (SF-36), and sickness absence was recorded. Costs and benefits of the service were evaluated and the return on investment (ROI) was calculated. The level of distress was significantly reduced in the treated group at the end of the follow-up (p < 0.001). Quality of life had significantly improved (p < 0.003). A 60% reduction of sickness absence days (SADs) following the intervention was recorded. After the treatment, absenteeism in cases was significantly lower than in controls (p < 0.02). The individual improvement of mental health and quality of life was significantly correlated with the number of meetings with the psychologist (p < 0.01 and p < 0.03, respectively). The recovery of direct costs due to reduced sick leave absence was significantly higher than the costs of the programme; ROI was 2.73. The results must be examined with caution, given the very limited number of workers treated; this first study, however, encouraged us to continue the experience.
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Affiliation(s)
- Guendalina Dalmasso
- Health Directorate, Bambino Gesù Children’s Hospital IRCCS, 00146 Roma, Italy; (G.D.); (M.R.)
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (R.R.D.P.); (N.M.)
| | - Reparata Rosa Di Prinzio
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (R.R.D.P.); (N.M.)
- Department of Woman, Child & Public Health, A. Gemelli Policlinic Foundation IRCCS, 00168 Roma, Italy
| | | | - Federica De Falco
- Health Directorate, Occupational Medicine Unit, Bambino Gesù Children’s Hospital IRCCS, 00146 Roma, Italy; (F.D.F.); (M.R.V.); (V.C.); (A.S.); (D.C.)
| | - Maria Rosaria Vinci
- Health Directorate, Occupational Medicine Unit, Bambino Gesù Children’s Hospital IRCCS, 00146 Roma, Italy; (F.D.F.); (M.R.V.); (V.C.); (A.S.); (D.C.)
| | - Vincenzo Camisa
- Health Directorate, Occupational Medicine Unit, Bambino Gesù Children’s Hospital IRCCS, 00146 Roma, Italy; (F.D.F.); (M.R.V.); (V.C.); (A.S.); (D.C.)
| | - Annapaola Santoro
- Health Directorate, Occupational Medicine Unit, Bambino Gesù Children’s Hospital IRCCS, 00146 Roma, Italy; (F.D.F.); (M.R.V.); (V.C.); (A.S.); (D.C.)
| | - Daniela Casasanta
- Health Directorate, Occupational Medicine Unit, Bambino Gesù Children’s Hospital IRCCS, 00146 Roma, Italy; (F.D.F.); (M.R.V.); (V.C.); (A.S.); (D.C.)
| | - Massimiliano Raponi
- Health Directorate, Bambino Gesù Children’s Hospital IRCCS, 00146 Roma, Italy; (G.D.); (M.R.)
| | - Gabriele Giorgi
- Department of Psychology, European University of Rome, 00163 Roma, Italy;
| | - Nicola Magnavita
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (R.R.D.P.); (N.M.)
- Department of Woman, Child & Public Health, A. Gemelli Policlinic Foundation IRCCS, 00168 Roma, Italy
| | - Salvatore Zaffina
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (R.R.D.P.); (N.M.)
- Health Directorate, Occupational Medicine Unit, Bambino Gesù Children’s Hospital IRCCS, 00146 Roma, Italy; (F.D.F.); (M.R.V.); (V.C.); (A.S.); (D.C.)
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Mengist B, Amha H, Ayenew T, Gedfew M, Akalu TY, Assemie MA, Alene M, Desta M. Occupational Stress and Burnout Among Health Care Workers in Ethiopia: A Systematic Review and Meta-analysis. Arch Rehabil Res Clin Transl 2021; 3:100125. [PMID: 34179761 PMCID: PMC8212011 DOI: 10.1016/j.arrct.2021.100125] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To estimate the pooled national burden of occupational stress, burnout, and contributing factors among health care workers in Ethiopia. DATA SOURCES Both published and unpublished observational studies conducted on the burden of occupational stress and burnout among health workers in Ethiopia were included. STUDY SELECTION This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered on PROSPERO (CRD42020166585). The eligibility of the studies was evaluated based on predetermined inclusion and exclusion criteria. DATA EXTRACTION Data extraction was conducted using major databases; PubMed, Google Scholar, Cumulative Index to Nursing and Allied Health, Scopes, Cochrane Library, the Web of Science, and African Journals Online were involved in the review. Two reviewers extracted data independently using a standardized data extraction checklist on Microsoft Excel. Any discrepancy was resolved by including the third reviewer for a possible consensus. DATA SYNTHESIS Fourteen studies, with a total of 4066 health care workers, were included in the meta-analysis. The pooled burdens of occupational stress and burnout were 52.9% (95% confidence interval [CI], 46.2-59.7) and 39.1% (95% CI, 23.9-52.3), respectively. Major determinants of occupational stress were being female (odds ratio [OR], 1.9; 95% CI, 1.1-3.3), being younger (OR, 1.4; 95% CI, 1.03-1.9), having a lower educational level (OR, 2.7; 95% CI, 1.05-7.2), and being satisfied with a job (OR, 0.3; 95% CI, 0.2-0.5). Being married (OR, 0.7; 95% CI, 0.5-0.9), having a lower educational level (OR, 0.5; 95% CI, 0.4-0.8), and working in shifts (OR, 0.7; 95% CI, 0.5-0.9) were significant predictors of burnout. CONCLUSIONS More than half and more than one-third of health care workers were affected by occupational stress and burnout, respectively, in Ethiopia, and sociodemographic and occupation-related factors were significant factors. Measures that improve job satisfaction, career development, and educational opportunities should be strengthened.
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Affiliation(s)
- Belayneh Mengist
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos
| | - Haile Amha
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos
| | - Temesgen Ayenew
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos
| | - Mihretie Gedfew
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos
| | - Tadesse Yirga Akalu
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos
| | - Moges Agazhe Assemie
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos
| | - Muluneh Alene
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos
| | - Melaku Desta
- Department of Midwifery, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Naslund JA, Karyotaki E. Reducing psychological distress and depression in humanitarian emergencies: An essential role for nonspecialists. PLoS Med 2021; 18:e1003625. [PMID: 34138878 PMCID: PMC8211261 DOI: 10.1371/journal.pmed.1003625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
John Naslund and Eirini Karyotaki discuss Mark Jordans and colleagues' accompanying research study on therapy for people with psychological distress in Nepal.
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Affiliation(s)
- John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Eirini Karyotaki
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Clinical, Neuro- and Development Psychology, Section Clinical Psychology, Vrije Universiteit, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands
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18
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Yitbarek K, Abraham G, Berhane M, Hurlburt S, Mann C, Adamu A, Tsega G, Woldie M. Significant inefficiency in running community health systems: The case of health posts in Southwest Ethiopia. PLoS One 2021; 16:e0246559. [PMID: 33606733 PMCID: PMC7895414 DOI: 10.1371/journal.pone.0246559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/22/2021] [Indexed: 11/30/2022] Open
Abstract
Background Although much has been documented about the performance of the health extension program, there is a lack of information on how efficiently the program is running. Furthermore, the rising cost of health services and the absence of competition among publicly owned health facilities demands strong follow up of efficiency. Therefore, this study aimed to assess the technical efficiency of the health posts and determinants in Southwestern Ethiopia. Methods and materials We used data for one Ethiopian fiscal year (from July 2016 to June 2017) to estimate the technical efficiency of health posts. A total of 66 health posts were included in the analysis. We employed a two-stage data envelopment analysis to estimate technical efficiency. At the first stage, technical efficiency scores were calculated using data envelopment analysis program version 2.1. Predictors of technical efficiency were then identified at the second stage using Tobit regression, with STATA version 14. Results The findings revealed that 21.2% were technically efficient with a mean technical efficiency score of 0.6 (± 0.3), indicating that health posts could increase their service volume by 36% with no change made to the inputs they received. On the other hand, health posts had an average scale efficiency score of 0.8 (± 0.2) implying that the facilities have the potential to increase service volume by 16% with the existing resources. The regression model has indicated average waiting time for service has negatively affected technical efficiency. Conclusion More than three-quarters of health posts were found inefficient. The technical efficiency score of more than one-third of the health posts is even less than 50%. Community mobilization to enhance the uptake of health services at the health posts coupled with a possible reallocation of resources in less efficient health posts is a possible approach to improve the efficiency of the program.
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Affiliation(s)
- Kiddus Yitbarek
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia
- * E-mail:
| | - Gelila Abraham
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Melkamu Berhane
- Department of Pediatrics and Child Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Sarah Hurlburt
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Carlyn Mann
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Ayinengida Adamu
- Department of Public Health, Bahirdar University, Bahirdar, Ethiopia
| | - Gebeyehu Tsega
- Department of Public Health, Bahirdar University, Bahirdar, Ethiopia
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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Rispel LC, Ditlopo P, White J, Blaauw D. Methodological considerations in establishing and maintaining longitudinal health workforce studies: Lessons learned from the WiSDOM cohort in South Africa. Glob Health Action 2021; 14:1996688. [PMID: 34927577 PMCID: PMC8725765 DOI: 10.1080/16549716.2021.1996688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health workforce cohort studies are uncommon in low-and middle-income countries (LMICs), especially those in sub-Saharan Africa. OBJECTIVE Describe the methodology and lessons learned from establishing and maintaining the WiSDOM (Wits longitudinal Study to Determine the Operation of the labour Market among its health professional graduates) health professional cohort study in South Africa. METHODS WiSDOM is a prospective longitudinal cohort study that commenced in 2017. The cohort focuses on the eight professional groups of clinical associates, dentists, doctors, nurses, occupational therapists, oral hygienists, pharmacists and physiotherapists. Annual, electronic follow-up surveys have been conducted in 2018, 2019 and 2020 with informed consent. Key steps in establishing the WiSDOM cohort include consultation, communication and marketing, stakeholder feedback, resources and infrastructure. Retention strategies consist of an electronic database, detailed cohort contact information, cohort engagement, communication and feedback, short survey tools, and appropriate incentives. RESULTS We obtained an overall response rate of 89.5% at baseline in 2017, 79.6% in 2018, 68.3% in 2019 and 72.8% in 2020. The largest decline in response rates is for medical doctors: 66.0% response rate in 2018, 53.2% in 2019 and 58.2% in 2020. However, for each of the three follow-up surveys, we have obtained response rates in excess of 80% for clinical associates, dentists, nurses, oral hygienists, pharmacists and physiotherapists. Since baseline, the outright refusals have remained very low at 4.7%. The multiple logistic regression analysis showed that self-identified race was the only significant socio-demographic difference between medical doctor respondents and non-respondents. Black African doctors and Indian doctors were 2.0 and 2.6 times more likely respectively to respond than White doctors (p < 0.05). CONCLUSION Other LMICs can learn from WiSDOM's lessons of establishing and maintaining a health professional cohort that aims to generate new knowledge for health system transformation.
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Affiliation(s)
- Laetitia C. Rispel
- Centre for Health Policy & South African Research Chairs Initiative (SARChI), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Prudence Ditlopo
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Janine White
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Duane Blaauw
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Jones S, White S, Ormrod J, Sam B, Bull F, Pieh S, Gopalakrishnan S, van den Broek N. Work-based risk factors and quality of life in health care workers providing maternal and newborn care during the Sierra Leone Ebola epidemic: findings using the WHOQOL-BREF and HSE Management Standards Tool. BMJ Open 2020; 10:e032929. [PMID: 33191248 PMCID: PMC7668354 DOI: 10.1136/bmjopen-2019-032929] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Before the 2014, Ebola epidemic in Sierra Leone, healthcare workers (HCWs) faced many challenges. Workload and personal risk of HCWs increased but their experiences of these have not been well explored. HCWs evaluation of their quality of life (QoL) and risk factors for developing work-based stress is important in helping to develop a strong and committed workforce in a resilient health system. METHODS Cross-sectional study using World Health Organisation Quality of Life (WHOQOL)-BREF and Health and Safety Executive (HSE) Standards Tools in 13 Emergency Obstetric Care facilities to (1) understand the perceptions of HCWs regarding workplace risk factors for developing stress, (2) evaluate HCWs perceptions of QoL and links to risk factors for workplace stress and (3) assess changes in QoL and risk factors for stress after a stress management programme. RESULTS 222 completed the survey at baseline and 156 at follow-up. At baseline, QoL of HCWs was below international standards in all domains. There was a significant decrease in score for physical health and psychological well-being (mean decrease (95% CI); 2.3 (0.5-4.1) and 2.3 (0.4-4.1)). Lower cadres had significant decreases in scores for physical health and social relationships (13.0 (3.6-22.4) and 14.4 (2.6-26.2)). On HSE peer-support and role understanding scored highly (mean scores 4.0 and 3.7 on HSE), workplace demands were average or high-risk factors (mean score 3.0). There was a significant score reduction in the domains relationships and understanding of role (mean score reduction (95% CI) 0.16 (0.01-0.31) and 0.11 (0.01-0.21)), particularly among lower cadres (0.83 (0.3-1.4). CONCLUSION HCWs in low-resourced settings may have increased risk factors for developing workplace stress with low QoL indicators; further exploration of this is needed to support staff and develop their contribution to the development of resilient health systems.
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Affiliation(s)
- Susan Jones
- School of Nursing and Midwifery, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Sarah White
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Judith Ormrod
- School of Nursing and Midwifery, University of Manchester, Manchester, UK
| | - Betty Sam
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Florence Bull
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Steven Pieh
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Belus JM, Rose AL, Andersen LS, Ciya N, Joska JA, Myers B, Safren SA, Magidson JF. Adapting a Behavioral Intervention for Alcohol Use and HIV Medication Adherence for Lay Counselor Delivery in Cape Town, South Africa: A Case Series. COGNITIVE AND BEHAVIORAL PRACTICE 2020; 29:454-467. [PMID: 36171964 PMCID: PMC9512118 DOI: 10.1016/j.cbpra.2020.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Human immunodeficiency virus (HIV) and problematic alcohol use are two ongoing and interconnected epidemics in South Africa, with untreated problematic alcohol use associated with poorer HIV treatment outcomes and disease progression. A lack of trained mental health providers is a primary barrier to increasing access to evidence-based treatment in this setting. To address this gap, we integrated evidence-based intervention components for problematic alcohol use and antiretroviral therapy (ART) adherence, adapted for lay provider delivery in an HIV primary care setting in Cape Town, South Africa. The intervention, locally termed "Khanya" in isiXhosa, which means glow, direction, or light, comprises Life Steps adherence counseling, motivational interviewing, behavioral activation, and relapse prevention, including mindfulness-based relapse prevention components. In this case series, we present a detailed description of the intervention and provide three clinical cases of individuals who received the Khanya intervention to showcase necessary clinical adaptations and the supervision needed for optimal treatment delivery, flexibility in intervention delivery, and overall successes and challenges. We present descriptive data on alcohol use and ART adherence outcomes for the cases to supplement the narrative discussion. Successes of intervention delivery included participant uptake of mindfulness skills, reductions in alcohol use despite varying levels of motivation, and interventionist mastery over various clinical skills. Challenges included delivering the intervention within the allotted time and the strong influence of substance-using social networks. Overall, a pragmatic approach to intervention delivery was necessary, as was ongoing support for the interventionist to promote fidelity to both treatment components and therapeutic skills. Trial registration ClinicalTrials.gov identifier: NCT03529409. Trial registered on May 18, 2018.
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Burnout among Nurses Working in Ethiopia. Behav Neurol 2020; 2020:8814557. [PMID: 33123299 PMCID: PMC7586184 DOI: 10.1155/2020/8814557] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/07/2020] [Accepted: 10/11/2020] [Indexed: 11/18/2022] Open
Abstract
Background Burnout is a condition of emotional exhaustion, depersonalization, and low personal accomplishment that can occur among individuals who work with people in some capacity. Nursing is a stressful profession that deals with human aspects of health and illness and can ultimately lead to job dissatisfaction and burnout. Although burnout among nurses has been addressed in previous research, the heterogeneous nature of the result findings highlights the need for a detailed meta-analysis in Ethiopia. Thus, this review is aimed at identifying the prevalence of burnout among nurses in Ethiopia. Methods A search strategy was implemented using electronic databases (PubMed/MEDLINE, Google Scholar, Web of Science, Cochrane Library, Africa-Wide Information, and African Index Medicus) which were systematically searched online to retrieve related articles using keywords. Studies which were included in this review were written in the English language because writing articles in other languages in Ethiopia is uncommon. The combination of key terms including "burnout", "nurse" and "Ethiopia", "systematic review" and protocols was used. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist guideline was followed stepwise. All published articles starting from inception to February 2020 were included, and we did not find unpublished studies. Heterogeneity across the included studies was evaluated by the inconsistency index. All statistical analysis was done using R and RStudio software for Windows, and a random-effects model was applied to estimate the overall prevalence of burnout among nurses in Ethiopia. It is registered in PROSPERO (CRD42020188092). Results The database searched produced 1060 papers. After adjustment for duplicates and inclusion and exclusion criteria, seven articles with 1654 total nurses were found suitable for the review. Except for one cohort study, all studies were cross-sectional. The overall pooled prevalence of burnout among Ethiopian nurses was estimated to be 39% (95% CI: 27%-50%). Conclusions Burnout affects two out of five nurses in Ethiopia. Therefore, effective interventions and strategies are required to reduce burnout among nurses.
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The Effectiveness of Ego State Therapy in the Reduction of Athletes’ Stress Levels. ADDICTIVE DISORDERS & THEIR TREATMENT 2020. [DOI: 10.1097/adt.0000000000000211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Deng D, Naslund JA. Psychological Impact of COVID-19 Pandemic on Frontline Health Workers in Low- and Middle-Income Countries. HARVARD PUBLIC HEALTH REVIEW (CAMBRIDGE, MASS.) 2020; 28:http://harvardpublichealthreview.org/wp-content/uploads/2020/10/Deng-and-Naslund-2020-28.pdf. [PMID: 33409499 PMCID: PMC7785092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Healthcare systems in many countries have been overwhelmed by the coronavirus disease (COVID-19) pandemic, with increasing demands to contain and respond to the virus. The result has been increased pressure on frontline health workers. As the pandemic unfolds, the impact on health systems in low-income and middle-income countries (LMICs) is becoming apparent. In lower resource settings, the detrimental effects on frontline health workers will likely be significant due to fragmented infrastructure, low compensation, and significant shortages of necessary resources such as personal protective equipment. These high stress conditions, coupled with risk of infection and fears and anxieties among patients, can result in grave psychosocial consequences for frontline health workers, who play a vital role in delivering the bulk of primary care services in LMICs. In this narrative review, we consider the psychological impact of the COVID-19 pandemic on frontline health workers in LMICs. We describe the important role of frontline health workers, summarize existing literature on burnout and risks to mental health in this essential workforce, and consider how public health emergencies exacerbate these concerns to showcase their vulnerability to mental health impacts of COVID-19. We explore emerging research on the detrimental effects of the COVID-19 pandemic on health workers and consider possible approaches to mitigate these consequences. This review draws from existing studies and emerging evidence to highlight the critical need to consider the wellbeing of frontline health workers, and to address these challenges as health systems respond to the pandemic.
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Affiliation(s)
- Davy Deng
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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