Safety attitudes, burnout and well-being among healthcare workers during the COVID-19 pandemic: an Indo-Pacific regional cross-sectional study

Introduction

The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact in Asia and has placed significant burden on already stretched healthcare systems. We examined the impact of COVID-19 on the safety attitudes among healthcare workers (HCWs), as well as their associated demographic and occupational factors, and measures of burnout, depression and anxiety.

Methods

A cross-sectional survey study utilising snowball sampling was performed involving doctors, nurses and allied health professions from 23 hospitals in Singapore, Malaysia, India and Indonesia between 29 May 2020 and 13 July 2020. This survey collated demographic data and workplace conditions and included three validated questionnaires: the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory and Hospital Anxiety and Depression Scale. We performed multivariate mixed-model regression to assess independent associations with the SAQ total percentage agree rate (PAR).

Results

We obtained 3,163 responses. The SAQ total PARs were found to be 35.7%, 15.0%, 51.0% and 3.3% among the respondents from Singapore, Malaysia, India and Indonesia, respectively. Burnout scores were highest among respondents from Indonesia and lowest among respondents from India (70.9%-85.4% vs. 56.3%-63.6%, respectively). Multivariate analyses revealed that meeting burnout and depression thresholds and shifts lasting ≥12 h were significantly associated with lower SAQ total PAR.

Conclusion

Addressing the factors contributing to high burnout and depression and placing strict limits on work hours per shift may contribute significantly towards improving safety culture among HCWs and should remain priorities during the pandemic.

PSYCHOMETRIC EVALUATION OF FLOOD DISASTER MANAGEMENT QUESTIONNAIRE: CONFIRMATORY FACTOR ANALYSIS AND ITEM RESPONSE THEORY ANALYSIS

Flood disaster is the commonest natural disaster with huge impact on healthcare services in Malaysia. The FloodDMQ-BM© questionnaire was developed as a tool to assess the knowledge, attitude, and practice of healthcare providers regarding patient management during a flood disaster. We aim to further validate the FloodDMQ-BM© questionnaire by using Confirmatory Factor Analysis (CFA) and Item Response Theory (IRT).This cross-sectional study involved doctors, nurses and paramedics working in the Emergency Department of Hospital Universiti Sains Malaysia, Hospital Raja Perempuan Zainab II and Hospital Kuala Krai. Respondents were required to complete the FloodDMQ-BM© questionnaire. The responses were analysed by using CFA and IRT to establish its validity and reliability. A total of 215 respondents participated in this study. CFA analysis with Maximum Likelihood Robust as the estimation method, on the attitude and practice components resulted in good factor loadings (>0.5) in nearly all items and excellent model fit indices values (CFI = 0.96-0.98, TLI = 0.95-0.96, SRMR = 0.04-0.05, RMSEA = 0.07). Meanwhile, IRT analysis on the knowledge section showed a good two-way marginal fit based on S-X2, and a good model fit with RMSEA of 0.08. Based on the 2PL model by using the IRT assessment of the knowledge section, one item in the knowledge section (K3) was removed (chi-squared residual >4) resulting in improved model fit. The included items had well-standardized loadings (>0.3) and marginal reliability of 0. 651.Our results confirmed that the FloodDMQ-BM© questionnaire displayed valid and reliable psychometric properties.