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Randell M, Wahyono TYM, Dynes M, Tinessia A, Li M, Danchin M, Oktarinda, Fitriyani F, Saraswati LD, Jenkins K, Aung KD, Noorzad AK, Shetye M, Dewi L, Yosephine P, Leask J, Sheel M. Service disruptions, trauma and burnout during the COVID-19 pandemic among healthcare providers delivering immunisation and maternal and child health services in Indonesia. BMJ Glob Health 2024; 9:e014318. [PMID: 38950913 PMCID: PMC11216070 DOI: 10.1136/bmjgh-2023-014318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 06/07/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic resulted in extreme strain on health systems including the health workforce, essential health services and vaccination coverage. We examined disruptions to immunisation and maternal and child health (MCH) services, concerns of personal well-being and delivery of healthcare during the pandemic as well as factors associated with self-reported trauma or burnout among healthcare providers (HCPs). METHODS In March-April 2022, we conducted a cross-sectional survey among HCPs in two provinces of Indonesia. HCPs involved in COVID-19 or routine immunisation and MCH services were randomly selected from district/city health office registration lists. We descriptively analysed service disruptions experienced by HCPs as well as trauma, burnout and concerns of personal well-being and delivery of healthcare during the pandemic. Multivariate logistic regression analyses were undertaken to identify factors associated with trauma or burnout. RESULTS We recruited 604 HCPs. Mobilisation of staff from routine health services to COVID-19 response duties was a key reason for service disruptions (87.9%). Strategies such as community outreach and task shifting were implemented to overcome disruptions. Trauma or burnout during the pandemic was reported by 64.1% HCPs, with 23.5% reporting worse mental or emotional health.Factors associated with trauma or burnout included delivery of COVID-19 immunisation (adjusted OR (aOR) 2.54, 95% CI 1.08 to 5.94); and delivery of both COVID-19 immunisation and routine immunisation compared with no involvement in vaccination programmes (aOR 2.42, 95% CI 1.06 to 5.52); poor treatment in the workplace (aOR 2.26, 95% CI 1.51 to 3.38) and lower confidence to respond to patient queries on COVID-19 immunisation (aOR 1.51, 95% CI 1.03 to 2.22). CONCLUSION HCPs experienced service disruptions, trauma and burnout and implemented strategies to minimise disruptions to service delivery and improve patient experiences. Our study highlights the need to ensure that workforce resilience and strategies to protect and support HCPs are considered for pandemic planning, preparedness and management.
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Affiliation(s)
- Madeleine Randell
- The University of Sydney, School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Tri Yunis Miko Wahyono
- Universitas Indonesia, Department of Epidemiology, Faculty of Public Health, Jakarta, Indonesia
| | - Michelle Dynes
- UNICEF East Asia and Pacific Regional Office, Bangkok, Thailand
| | - Adeline Tinessia
- The University of Sydney, School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Mu Li
- The University of Sydney, School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Margie Danchin
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- The University of Melbourne, Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Oktarinda
- Universitas Indonesia, Department of Epidemiology, Faculty of Public Health, Jakarta, Indonesia
| | - Fitriyani Fitriyani
- Universitas Indonesia, Department of Epidemiology, Faculty of Public Health, Jakarta, Indonesia
| | - Lintang Dian Saraswati
- Universitas Diponegoro, Department of Epidemiology, Faculty of Public Health, Semarang, Indonesia
| | - Kylie Jenkins
- The University of Sydney, School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | | | | | | | - Lulu Dewi
- Ministry of Health of the Republic of Indonesia, Jakarta, Indonesia
| | - Prima Yosephine
- Ministry of Health of the Republic of Indonesia, Jakarta, Indonesia
| | - Julie Leask
- The University of Sydney, School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Meru Sheel
- The University of Sydney, School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia
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Chaudhry B, Islam A, Matthieu M. Towards Designs of Workplace Stress Management Mobile Apps for Frontline Health Workers during COVID-19 and Beyond: A Qualitative Study. JMIR Form Res 2021; 6:e30640. [PMID: 34806985 PMCID: PMC8789255 DOI: 10.2196/30640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 09/15/2021] [Accepted: 09/27/2021] [Indexed: 01/30/2023] Open
Abstract
Background In recent years, mobile apps have been developed to prevent burnout, promote anxiety management, and provide health education to workers in various workplace settings. However, there remains a paucity of such apps for frontline health workers (FHWs), even though FHWs are the most susceptible to stress due to the nature of their jobs. Objective The goal of this study was to provide suggestions for designing stress management apps to address workplace stressors of FHWs based on the understanding of their needs from FHWs’ own perspectives and theories of stress. Methods A mixed methods qualitative study was conducted. Using a variety of search strings, we first collected 41 relevant web-based news articles published between December 2019 and May 2020 through the Google search engine. We then conducted a cross-sectional survey with 20 FHWs. Two researchers independently conducted qualitative analysis of all the collected data using a deductive followed by an inductive approach. Results Prevailing uncertainty and fear of contracting the infection was causing stress among FHWs. Moral injury associated with seeing patients die from lack of care and lack of experience in handling various circumstances were other sources of stress. FHWs mentioned 4 coping strategies. Quick coping strategies such as walking away from stressful situations, entertainment, and exercise were the most common ways to mitigate the impact of stress at work. Peer support and counseling services were other popular methods. Building resilience and driving oneself forward using internal motivation were also meaningful ways of overcoming stressful situations. Time constraints and limited management support prevented FHWs from engaging in stress management activities. Conclusions Our study identified stressors, coping strategies, and challenges with applying coping strategies that can guide the design of stress management apps for FHWs. Given that the pandemic is ongoing and health care crises continue, FHWs remain a vulnerable population in need of attention.
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Affiliation(s)
- Beenish Chaudhry
- University of Louisiana at Lafayette, 104 E. University Circle, Lafayette, US
| | - Ashraful Islam
- University of Louisiana at Lafayette, 104 E. University Circle, Lafayette, US
| | - Monica Matthieu
- Saint Louis University, 3500 Lindell Blvd., Tegeler Hall, 3rd floor, Saint Louis, US
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Zucchelli F, Donnelly O, Rush E, Smith H, Williamson H. Designing an mHealth Intervention for People With Visible Differences Based on Acceptance and Commitment Therapy: Participatory Study Gaining Stakeholders' Input. JMIR Form Res 2021; 5:e26355. [PMID: 33759791 PMCID: PMC8075076 DOI: 10.2196/26355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 01/22/2023] Open
Abstract
Background Given their growing popularity, mobile health (mHealth) apps may offer a viable method of delivering psychological interventions for people with an atypical appearance (ie, visible difference) who struggle with appearance-related distress. Acceptance and Commitment Therapy (ACT), a third-wave cognitive behavioral approach, has been used effectively in mHealth and is being increasingly applied clinically to common psychosocial difficulties associated with visible differences. We planned to design an ACT-based mHealth intervention (ACT It Out) for this population. Objective The aim of this study is to gain key stakeholder input from user representatives and psychological clinicians to optimize the intervention’s design for future development and uptake. To do so, we explored considerations relating to mHealth as a delivery platform for adults with visible differences and elicited stakeholders’ design preferences and ideas based on initial author-created content. Methods Within a participatory design framework, we used a mix of qualitative methods, including usability sessions and a focus group in a face-to-face workshop, and interviews and textual feedback collected remotely, all analyzed using template analysis. A total of 6 user representatives and 8 clinicians were recruited for this study. Results Our findings suggest that there are likely to be strengths and challenges of mHealth as an intervention platform for the study population, with key concerns being user safeguarding and program adherence. Participants expressed design preferences toward relatable human content, interactive and actionable features, flexibility of use, accessibility, and engaging content. Conclusions The findings offer valuable design directions for ACT It Out and related interventions, emphasizing the need to carefully guide users through the intervention while acknowledging the limited time and space that mHealth affords.
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Affiliation(s)
- Fabio Zucchelli
- The Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Olivia Donnelly
- The Outlook Service, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Emma Rush
- Vitiligo Support UK, London, United Kingdom
| | - Harriet Smith
- The Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Heidi Williamson
- The Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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