Inadequate preparedness for response to COVID-19 is associated with stress and burnout among healthcare workers in Ghana

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

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Abstract

The COVID-19 pandemic has compounded the global crisis of stress and burnout among healthcare workers. But few studies have empirically examined the factors driving these outcomes in Africa. Our study examined associations between perceived preparedness to respond to the COVID-19 pandemic and healthcare worker stress and burnout and identified potential mediating factors among healthcare workers in Ghana.

Methods

Healthcare workers in Ghana completed a cross-sectional self-administered online survey from April to May 2020; 414 and 409 completed stress and burnout questions, respectively. Perceived preparedness, stress, and burnout were measured using validated psychosocial scales. We assessed associations using linear regressions with robust standard errors.

Results

The average score for preparedness was 24 (SD = 8.8), 16.3 (SD = 5.9) for stress, and 37.4 (SD = 15.5) for burnout. In multivariate analysis, healthcare workers who felt somewhat prepared and prepared had lower stress (β = -1.89, 95% CI: -3.49 to -0.30 and β = -2.66, 95% CI: -4.48 to -0.84) and burnout (β = -7.74, 95% CI: -11.8 to -3.64 and β = -9.25, 95% CI: -14.1 to –4.41) scores than those who did not feel prepared. Appreciation from management and family support were associated with lower stress and burnout, while fear of infection was associated with higher stress and burnout. Fear of infection partially mediated the relationship between perceived preparedness and stress/burnout, accounting for about 16 to 17% of the effect.

Conclusions

Low perceived preparedness to respond to COVID-19 increases stress and burnout, and this is partly through fear of infection. Interventions, incentives, and health systemic changes to increase healthcare workers’ morale and capacity to respond to the pandemic are needed.

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  1. Version published to 10.1371/journal.pone.0250294
  2. ScreenIT

    SciScore for 10.1101/2020.08.18.20177410: (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

    No key resources detected.

    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: There are some limitations to the study. First, the use of an online survey with a volunteer sample limits the generalizability of findings to all HCWs in Ghana. This was, however, the best option available for rapid data collection as the country was in partial lock-down due to the COVID-19 pandemic. To address this limitation, we recruited from diverse platforms such as Facebook and WhatsApp pages of different professional groups, graduation year groups, and regional groups of HCWs. Survey links were also emailed to leaders of professional organizations and Ghana Health Service directors to share with members of their groups. Thus, our sample is diverse in terms of gender, age, years of experience, region, and facility type as shown in the sample distribution—which increases the representativeness of the findings. Moreover, our study sets the stage for future research to examine these issues in a more representative sample under circumstances that allow for probability sampling. Additionally, as with all self-reported data, social desirability and recall bias are potential limitations. The use of composite scores from validated psychosocial measures, however, helps to address this limitation. Finally, this was a cross-sectional study, thus, associations described are not causal. Despite these limitations, this is the first study to our knowledge assessing perceived preparedness for COVID-19 and psychological well-being among HCWs in Africa and con...

    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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  3. Version published to 10.1101/2020.08.18.20177410 on medRxiv