Perceived preparedness to respond to the COVID-19 pandemic: A study with healthcare workers in Ghana

  1. Patience A. Afulani
  2. Akua O. Gyamerah
  3. Raymond Aborigo
  4. Jerry John Nutor
  5. Hawa Malechi
  6. Amos Laar
  7. Mona Sterling
  8. John Koku Awoonor-Williams

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Abstract

Introduction

Healthcare workers’ (HCWs) preparedness to respond to pandemics is critical to containing disease spread. Low-resource countries, however, experience barriers to preparedness due to limited resources. In Ghana, a country with a constrained healthcare system and high COVID-19 cases, we examined HCWs’ perceived preparedness to respond to COVID-19 and associated factors.

Methods

472 HCWs completed questions in a cross-sectional self-administered online survey. Perceived preparedness was assessed using a 15-question scale (Cronbach alpha=0.91) and summative scores were created (range=0-45). Higher scores meant greater perceived preparedness. We used linear regression with robust standard errors to examine associations between perceived preparedness and potential predictors.

Results

The average preparedness score was 24 (SD=8.9); 27.8% of HCWs felt prepared. In multivariate analysis, factors associated with higher perceived preparedness were: training (β=3.35, 95%CI: to 4.69); having adequate PPE (β=2.27, 95%CI: 0.26 to 4.29), an isolation ward (β=2.74, 95%CI: 1.15 to 4.33), and protocols for screening (β=2.76, 95%CI: 0.95 to 4.58); and good perceived communication from management (β=5.37, 95%CI: 4.03 to 7.90). When added to the model, perceived knowledge decreased the effect of training by 28.0%, although training remained significant, suggesting a partial mediating role. Perceived knowledge was associated with a 6-point increase in perceived preparedness score (β=6.04, 95%CI: 4.19 to 7.90).

Conclusion

HCWs reported low perceived preparedness to respond to COVID-19. Training, clear protocols, PPE availability, isolation wards, and communication play an important role in increasing preparedness. Government stakeholders must institute necessary interventions to increase HCWs’ preparedness to respond to the ongoing pandemic and prepare for future pandemics.

Strengths and limitations of this study

  • This is one of the few studies globally to empirically examine Healthcare workers’ (HCWs) perceived preparedness to respond to COVID-19, and the first study to do so among HCWs in Ghana and in Africa.

  • We developed a perceived preparedness for COVID-19 scale and conducted psychometric analysis to confirm its validity and reliability; this scale can facilitate similar research in other settings.

  • We show that providers have low perceived preparedness to respond to the COVID-19 pandemic, and that this is associated with a lack of training on COVID-19, PPE, clear protocols, and isolation wards, as well as poor communication from management.

  • The use of an online survey with recruitment via social media may have accounted for a relatively young sample.

  • Findings are based on self-reported data from a cross-sectional survey, thus, there may be social desirability bias and associations described are not causal.

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  1. ScreenIT

    SciScore for 10.1101/2020.07.10.20151142: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Context: Healthcare delivery in Ghana is based on a 3-tier system: 1) the primary level, which is delivered by community-based health planning and services compounds, maternity homes, health centers, and district hospitals; 2) the secondary level, implemented by regional hospitals; and 3) the tertiary level, which is run by specialists at the teaching hospitals.
    Context: Healthcare
    suggested: None

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations and Strengths: A key limitation of this study is the sampling approach. Specifically, the use of an online survey with recruitment via social media may have accounted for the relatively young sample. Thus, this sampling limitation and volunteer bias will affect the generalizability of the findings to all HCWs in Ghana. Nonetheless, this is the first study to our knowledge assessing HCWs preparedness for COVID-19 in Ghana and in Africa, thus, study findings are instructive to the current pandemic response. In addition, given that the country was on partial lock-down during the study period, an online survey was the best option available. A second limitation is social desirability bias from the self-reported data—providers may want to project a greater sense of preparedness than they actually have. The use of composite scores from several questions helps address this limitation. Finally, because this was a cross-sectional study, associations described are not causal.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2020.07.10.20151142 on medRxiv
  3. Version published to 10.35500/jghs.2020.2.e24