Stigma towards health care providers taking care of COVID-19 patients: A multi-country study

Exploring awareness of hearing loss and ear health in Jordanian adults

OBJECTIVE

To assess the awareness about hearing loss and ear health among adults in Jordan.

METHODS

A cross-sectional study was conducted where a questionnaire was filled from the month of November to the month of December of the year 2023, to assess the level of awareness about hearing loss and ear health. The participants included were Jordanian adults (age ≥ 18 years) residing in the North, Middle and South of Jordan.

RESULTS

Data from 333 participants (54.1% men) were analyzed. Participants between 18 and 28 years of age comprised 29.7% of the sample population. More than half of the participants (52.6%) held a university degree. Overall percentage of correct responses was 83%. Women, postgraduate degree holders, and participants diagnosed with hearing loss had an average of 11.96±1.47, 12.65±1.59 and 11.70±1.69 correct answers, respectively. The highest correct response received (97.6%) was for: hearing aids need to fit accurately to provide the maximum benefit. Furthermore, 97% of the sample correctly acknowledged that sudden hearing loss is an emergency and requires an immediate audiological assessment. The main misconception was that a deaf-mute cannot speak because of defects in the vocal tract, with only 39.3% of the sample providing a correct response. The other two misconceptions were: cotton buds are necessary for ear cleaning and are the safest means, and that ear drops are sufficient to treat earache, with 78.1% correct responses for each statement. Participants with higher level of education had higher odds of answering the questions correctly, with limited role observed for gender, prior diagnosis of hearing loss and a family history of hearing loss.

CONCLUSIONS AND RELEVANCE

Majority of the adults surveyed provided a correct answer to the hearing loss and ear health survey. While most of the sample population were aware that a sudden loss of hearing is considered an emergency, only one third knew that defects in vocal cords do not play a role in deafness/muteness. The study highlights the need of public education on causes of hearing loss and measures needed to prevent the onset of hearing loss, with emphasis on methods for caring of ear health.

From applause to disappointment - appreciation among healthcare providers that provided end-of-life care during the COVID-19 pandemic and its impact on well-being - a longitudinal mixed methods study (the CO-LIVE study)

BACKGROUND

The healthcare sector is facing increasing work pressure, making a healthy workforce essential. Appreciation is a factor influencing well-being, and the COVID-19 pandemic offers valuable insights into this. This study aims to: 1) describe to what extent end-of-life care providers felt appreciated and understood during the first 18 months of the pandemic, 2) examine the impact of appreciation on their well-being, and 3) explore their perceptions of what appreciation should look like.

METHODS

A longitudinal mixed methods study among healthcare providers in the Netherlands delivering end-of-life care during the COVID-19 pandemic. Surveys were conducted at four timepoints (n = 302), and interviews were conducted at three timepoints (n = 17) during the first 18 months of the pandemic. Generalized Estimating Equations analysis was performed on the quantitative data and thematic analysis was conducted on the interview data.

RESULTS

This study shows that feeling of appreciation among healthcare providers peaked in the first wave of the pandemic, but significantly dropped in the second wave, with only about half of the healthcare providers feeling appreciated. This slightly improved afterwards. Furthermore, nearly half of healthcare providers felt misunderstood during the first 18 months of the pandemic. Additionally, this study shows that between September 2020 and September 2021 about 1 in 3 healthcare providers had a score on the Well-Being Index indicating higher risk for burnout. Feeling appreciated and not feeling understood were both significantly associated with worse well-being. Interviews revealed that nurses did not always feel understood and appreciated by society, employers, patients and their families, as well as their own friends and family, leading to feelings of sadness, anger, and frustration. Three major themes emerged: 'recognizing real needs, 'we are not in this together' and 'short-lived appreciation that failed to lead to structural changes'.

CONCLUSIONS

This study shows that during the COVID-19 pandemic, healthcare providers often felt neither appreciated nor understood, which is associated with lower scores of well-being. The expressed appreciation often did meet their needs or expectations, from both employers and society. With healthcare provider well-being still under strain, sustained attention to appreciation and understanding is important for retaining the workforce.

Pandemic preparedness of Egyptian community pharmacists and potential facilitators to the successful implementation of a community pharmacy coronavirus disease 2019 referral service: a cross-sectional survey

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic resulted in an increased need for essential community services including new roles for pharmacists. Globally, community pharmacists are a highly accessible point of contact for referral.

OBJECTIVE

To assess the preparedness of and facilitators to community pharmacists referring patients with suspected COVID-19 symptoms for testing.

METHODS

A cross-sectional survey was administered using a structured questionnaire to 1023 pharmacists (one respondent in each pharmacy) in Egypt between 17 and 30 May 2020.

RESULTS

Pharmacists who had received pandemic referral training were significantly more familiar with the referral system in comparison to those who had not (n = 180; 17.6% vs. n = 841; 82.4%, P = .014). Case referral was significantly associated with the referrer (n = 161, 15.8%), demographics of region (P = .001), graduation year (P = .035), and gender (P = .015). The vast majority of respondents identified facilitators to referring, namely university-level teaching (n = 984, 96.7%), continuing professional development (n = 958, 94.3%), smartphone app (n = 809, 80.5%) or telephone hotline (n = 933, 91.5%), IT access (n = 861, 84.7%), and managing patients' attitudes through the media in terms of the importance of declaring symptoms to (n = 998, 97.7%) and cooperating with (n = 977, 96.2%) referrers.

CONCLUSIONS

Pharmacists' lack of preparedness to engage with the referral process and related roles contributing to tracking the national COVID-19 infection rate could be mitigated by the provision of facilitators suggested by respondents. These included improved cooperation from local healthcare authorities, educational interventions, technological solutions, and the use of the media. Demographics associated with pharmacists' attitudes to referral, and hence the reliability and validity of the national infection rate, demand further investigation.

Cautionary lessons from the COVID-19 pandemic: Healthcare systems grappled with the dual responsibility of delivering COVID-19 and non-COVID-19 care

During the COVID-19 pandemic, hospitals were challenged to provide both COVID-19 and non-COVID treatment. A survey questionnaire was designed and distributed via email to hospitals empanelled under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana(AB-PMJAY), the world's largest National Health Insurance Scheme. Telephonic follow-ups were used to ensure participation in places with inadequate internet. We applied support vector regression to quantify the hospital variables that affected the use vs. non-use of hospital services (Model-1), and factors impacting COVID-19 revenue and staffing levels (Model-2).We quantified the statistical significance of important input variables using Fisher's exact test. The survey, conducted early in the pandemic, included 461 hospitals across 20 states and union territories. Only 55.5% of hospitals were delivering emergency care, 26.7% were doing elective surgery and 36.7% providing obstetric services. Hospitals with adequate supplies of PPE, including N95 masks, and separate facilities designated for COVID-19 patients were more likely to continue providing emergency surgeries and services effectively. Data analysis revealed that large hospitals (> 250 beds) with adequate PPE and dedicated COVID-19 facilities continued both emergency and elective surgeries. Public hospitals were key in pandemic management, large private hospital systems were more likely to conduct non-COVID-19 surgeries, with not-for-profit hospitals performing slightly better. Public and large private not-for-profit hospitals faced fewer staff shortages and revenue declines. In contrast, smaller hospitals (< 50 beds) experienced significant staff attrition due to anxiety, stress and revenue losses. They requested government support for PPE supplies, staff training, testing kits, and special allowances for healthcare workers. The inclusion of COVID-19 coverage under AB-PMJAY improved access to healthcare for critical cases. Maintaining non-COVID-19 care during the pandemic indicates healthcare system resiliency. A state-wide data-driven system for ventilators, beds, and funding support for smaller hospitals, would improve patient care access and collaboration.

Stigmatization experiences of healthcare workers in the context of the COVID-19 pandemic: a scoping review

BACKGROUND

During the COVID-19 pandemic, healthcare workers face the stigmatization of those caring for COVID-19 patients, creating a significant social problem. Therefore, this study investigated the stigmatization of healthcare workers in the context of the COVID-19 pandemic.

METHODS

In this scoping review study, searches were conducted from December 2019 to August 2023 in Persian and English using various databases and search engines including PubMed (Medline), Embase, Scopus, ISI Web of Science, ProQuest, Science Direct, Springer, Cochrane Library, Google Scholar, and national databases. The study used English keywords such as Social Stigma, Health Personnel, Healthcare Worker, Medical Staff, Medical Personal, Physicians, doctors, Nurses, nursing staff, COVID-19, and coronavirus disease 2019, and their Persian equivalents, and their Persian equivalents to explore healthcare workers' experiences of COVID-19-related stigma.

RESULTS

From a total of 12,200 search results, 77 eligible studies were included in this study. stigmatization of healthcare workers caring for COVID-19 patients was evident from the literature because of fear, misinformation, and negative self-image. Manifestations were violence and deprivation of social rights, resulting in adverse biopsychosocial, occupational, and economic consequences. This condition can affect negatively health staff themselves, their families, and society as well. Anti-stigmatization measures include informing society about the realities faced by healthcare workers, presenting an accurate and empathetic image of health workers, providing psychosocial support to health workers, and encouraging them to turn to spirituality as a coping mechanism. There are notable research gaps in comprehending the phenomenon, exploring its variations across diverse healthcare roles and cultural contexts, examining its long-term effects, and monitoring shifts in stigma perceptions over time.

CONCLUSION

The COVID-19 pandemic has resulted in the stigmatization of healthcare workers, causing mistreatment and rights violations. This stigma persists even post-pandemic, posing a psychological dilemma for caregivers. Addressing this requires comprehensive strategies, including tailored stigma prevention programs and research to understand its psychological impact.

COVID-19 Linked Social Stigma Among Arab Survivors: A Cross-Sectional Experiences from the Active Phase of the Pandemic

Objective

This study aimed to explore the magnitude and variability of the disease-linked stigma among COVID-19 survivors and their experiences of social stigma, coping strategies, contextual challenges, and preferences for support.

Methods

An Arabic version of the social stigma survey questionnaire was designed and validated to obtain socio-demographic characteristics and quantitative measures of stigma encountered by the survivors. 482 COVID-19 survivors completed the survey, and the data were analyzed using descriptive statistics and thematic analysis.

Results

The results of this study revealed the prevalence of high levels of both perceived external stigma and enacted stigma among participants. Enacted and Internalized stigma were associated with survivors' educational background/ status. The participants suggested three levels of support: organizational, social, and personal. Establishing an online stigma reduction program and national psychological crisis interventions at the organizational level. It is crucial to assist coping mechanisms and societal reintegration techniques at the social level.

Conclusion

These results provide valuable insights for holistic health policy formation and preparedness strategies for future pandemics, helping survivors promote health and reintegrate into society, where stigma reduction and psychological crisis interventions are underdeveloped.

The COVID-19 pandemic's effects on mental and psychosocial health in the Philippines: A scoping review

Low- and middle-income countries (LMICs) remained at elevated risk for the effects of the COVID-19 pandemic because of persistent stressors to their health systems. Simultaneously facing high infection rates, strict containment measures and natural disasters, the Philippines provides important grounds for health research in LMICs. This review examined how the COVID-19 pandemic affected mental and psychosocial health in the Philippines. This scoping review included literature in English from 2020 to mid-2022 from PubMed, PsycInfo and SCOPUS, and used the PRISMA-ScR and PCC-question model. Two independent reviewers conducted blind article screening and data extraction using COVIDENCE software, followed by consensus building, data charting and analyses. This work identified 405 publications across PubMed (N = 56), PsycInfo (N = 106) and SCOPUS (N = 243), of which 76 articles addressed the Philippines. Article types included 54 research articles, 10 opinion pieces, 4 literature reviews, 6 letters to journals, 1 study protocol and 1 other report. These findings focused primarily on health professionals (N = 23) and educators/learners (N = 22) and reported mostly on moderate-to-severe clinical outcomes such as fear, depression, anxiety or stress. Coping behaviors, like resiliency and other ways of adapting to the pandemic, including religious, spiritual and community-oriented approaches highlighted experiences with stringent infection prevention and control measures to contain COVID-19 in the Philippines. The COVID-19 pandemic brought severe challenges to mental and psychosocial health in the Philippines. The literature focused mostly on healthcare workers and educators/learners, and moderate-to-severe mental health outcomes in these groups. There is a need to expand studies to other sociodemographic groups and communities across the Philippines. Future work stands to benefit from more in-depth qualitative, mixed methods, longitudinal and representative quantitative research in LMICs following this pandemic. Literature reviews remain important to synthesize post-pandemic experiences by providing context for future studies and health practice in the Philippines and other LMICs.

Ensuring Continuity of Tuberculosis Care during Social Distancing through Integrated Active Case Finding at COVID-19 Vaccination Events in Vietnam: A Cohort Study

COVID-19 significantly disrupted tuberculosis (TB) services in Vietnam. In response, the National TB Program (NTP) integrated TB screening using mobile chest X-rays into COVID-19 vaccination events. This prospective cohort study evaluated the integrated model's yield, treatment outcomes, and costs. We further fitted regressions to identify risk factors and conduct interrupted time-series analyses in the study area, Vietnam's eight economic regions, and at the national level. At 115 events, we conducted 48,758 X-ray screens and detected 174 individuals with TB. We linked 89.7% to care, while 92.9% successfully completed treatment. The mean costs per person diagnosed with TB was $547. TB risk factors included male sex (aOR = 6.44, p < 0.001), age of 45-59 years (aOR = 1.81, p = 0.006) and ≥60 years (aOR = 1.99, p = 0.002), a history of TB (aOR = 7.96, p < 0.001), prior exposure to TB (aOR = 3.90, p = 0.001), and symptomatic presentation (aOR = 2.75, p < 0.001). There was a significant decline in TB notifications during the Delta wave and significant increases immediately after lockdowns were lifted (IRR(γ1) = 5.00; 95%CI: (2.86, 8.73); p < 0.001) with a continuous upward trend thereafter (IRR(γ2) = 1.39; 95%CI: (1.22, 1.38); p < 0.001). Similar patterns were observed at the national level and in all regions but the northeast region. The NTP's swift actions and policy decisions ensured continuity of care and led to the rapid recovery of TB notifications, which may serve as blueprint for future pandemics.

Perceived risk of infection, ethical challenges and motivational factors among frontline nurses in Covid-19 pandemic: prerequisites and lessons for future pandemic

BACKGROUND

Infection risk was significant for front-line nurses during the Covid-19 outbreak. The pandemic presented several ethical difficulties and sapped nurses' drive to labor harder for longer periods. This study evaluates registered nurses' perceptions of Covid-19 infection risk, ethical dilemmas, and motivating factors.

MATERIALS AND METHODS

During March and April 2022, 400 registered nurses from a newly established tertiary care hospital participated in this cross-sectional exploratory survey. The risk assessment scale, motivation to work scale, and ethical dilemma scale were used to assess the perceived risk of infection, motivational factors and ethical challenges experienced by the nurses. Appropriate descriptive and inferential statistics were applied to compute the results.

RESULTS

76.4% of nurses feared working as a nurse put them at higher risk of infection. Besides the fear of contracting infection, nurses believed they were the source of infection to family members (70.8%) and people around (67.5%). 63.3% of nurses agree that they do not have the right to refuse treatment and every patient has the right to receive optimal care, regardless of age, gender, and medical conditions. Professional obligation to treat patients (72.3%) and sound professional knowledge and experience (83.5%) are important motivating factors to work during the pandemic. Multilinear regression analysis revealed that professional education (95% CI, 3.845 - 0.694, p = 0.005), Covid-19 positive status (95% CI,0.455-2.756, p = 0.006), and post-Covid-19 hospitalization (95% CI, 1.395-6.978, p = 0.003) and duration of hospitalization (95% CI, 0.754-0.058, p = 0.022) are independent predictors of higher perceived risk of infection among nurses.

CONCLUSIONS

During the pandemic, nurses were afraid to work and faced personal and family risks of contracting the virus. Despite these challenges, they still feel a strong sense of commitment and dedication to providing the best possible care. Nurse administrators need to create a supportive environment that follows ethical principles and meets the needs of nurses to boost their motivation and encourage them to continue working for longer periods.

Stigma and inequality in the management of coronavirus disease-2019 (COVID-19)- patients among healthcare providers in Saudi Arabia and associated beliefs: A cross sectional study

BACKGROUND

Stigma and discrimination (SAD) can greatly impact the management of Coronavirus Disease-19 (COVID-19) patients. Studies examining SAD in managing COVID-19 patients in Saudi Arabia (SA) are limited. This study examined the discrimination and inequality in treating COVID-19 patients and the associated beliefs among healthcare workers (HCWs) during the pandemic.

METHODS

This was a cross sectional study using an online self-administrated questionnaire by 414 HCWs from September 2022 to January 2023.

RESULTS

Of the 414 participants, 53.4% aged 18-30 years, were males (53.4%), mostly Saudi (82.1%), and residents of western SA (90.8%). Almost one-third of the participants (32.1%) were physicians, and 23.7% were pharmacists. 53.1% of the HCWs had work experience < 5 years, 49.3% either had a current/previous COVID-19 infection and 10.1% (n = 42) reported treating ≥ 2000 COVID-19 patients. Most of the participants had not received training on avoiding discrimination against COVID-19 patients (n = 246; 59.4%) and denied receiving any incentives from their institution (n = 294; 71%) or community (n = 248; 59.9%) during the pandemic. Less than 20% of the HCWs had observed some sort of discrimination in providing care for COVID-19 patients. The responses significantly differed by nationality, educational level, specialty, workplace and COVID-19 infection status (P < 0.05). Approximately, 20% of the participants held negative beliefs about COVID-19 patients and these responses varied significantly by nationality, work experience, workplace, gender, and age (p < 0.05). Cross-tabulation and regression analyses showed some differences by gender, workplace, specialty and COVID-19 infection status.

CONCLUSIONS

There was a low prevalence of negative beliefs about COVID-19 patients and a low prevalence of discriminatory behaviors in providing care for these patients in SA. Training and governmental regulations could further lower the prevalence of SAD against COVID-19 patients.

From pervasive chaos to evolutionary transition: The experience of healthcare providers during the COVID-19 pandemic

AIM

The outbreak of the COVID-19 pandemic confronted healthcare providers, especially physicians and nurses, with many unprecedented changes and physical and psychological pressures. This study aimed to explore the healthcare providers' experiences providing healthcare services for patients during the COVID-19 pandemic in "Golestan, Northeast Iran".

DESIGN

Qualitative, conventional content analysis.

METHODS

A total of 13 eligible participants were recruited through the purposeful sampling method. Data were gathered using semi-structured in-depth individual interviews. Transcripts were analysed using an inductive content analysis based on the Elo and Kyngas model. The COREQ checklist was used to prepare the manuscript.

RESULTS

The analysis of the data in this study led to the development of 16 subthemes and 5 themes emerged as follows pervasive chaos, imposed difficulties, paradoxical perceptions, committed efforts, and constructive transition.

CONCLUSION

The experience of HCPs during the COVID pandemic in "Iran" showed that despite the physical, mental, emotional, and social consequences, a kind of constructive evolution and transition has also taken place in personal, professional, and organizational dimensions. It is suggested that managers while strengthening and protecting the capabilities and skills that have emerged, to reduce the tensions of HCPs, have developed programs for comprehensive support from them in physical, psychological, social, and financial dimensions.

RELEVANCE TO CLINICAL PRACTICE

It is necessary to improve inter-professional cooperation, empathy, teamwork, professional commitment, and continuous learning in crises.

Compassion fatigue in healthcare providers: a scoping review

The detrimental impacts of COVID-19 on healthcare providers' psychological health and well-being continue to affect their professional roles and activities, leading to compassion fatigue. The purpose of this review was to identify and summarize published literature on compassion fatigue among healthcare providers and its impact on patient care. Six databases were searched: MEDLINE (Ovid), PsycINFO (Ovid), Embase (Ovid), CINAHL, Scopus, Web of Science, for studies on compassion fatigue in healthcare providers, published in English from the peak of the pandemic in 2020 to 2023. To expand the search, reference lists of included studies were hand searched to locate additional relevant studies. The studies primarily focused on nurses, physicians, and other allied health professionals. This scoping review was registered on Open Science Framework (OSF), using the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) extension to scoping review. From 11,715 search results, 24 met the inclusion criteria. Findings are presented using four themes: prevalence of compassion fatigue; antecedents of compassion fatigue; consequences of compassion fatigue; and interventions to address compassion fatigue. The potential antecedents of compassion fatigue are grouped under individual-, organization-, and systems-level factors. Our findings suggest that healthcare providers differ in risk for developing compassion fatigue in a country-dependent manner. Interventions such as increasing available personnel helped to minimize the occurrence of compassion fatigue. This scoping review offers important insight on the common causes and potential risks for compassion fatigue among healthcare providers and identifies potential strategies to support healthcare providers' psychological health and well-being.

Social stigma during COVID-19: A systematic review

Objectives

Stigmatization was reported throughout the COVID pandemic for COVID-19 patients and close contacts. The aim of this systematic review was to comprehensively examine the prevalence and impact of stigmatization during COVID-19 pandemic.

Methods

English articles were searched using online databases that included PubMed, Scopus, Embase, and Web of Science up to 24 August 2022. A two-step screening and selection process was followed utilizing an inclusion and exclusion criteria and then data was extracted from eligible articles. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was followed, and the risk of bias was assessed using the Newcastle-Ottawa Scale.

Results

Seventy-six studies were eligible for inclusion. Twenty-two studies reported the prevalence of social stigma due to COVID-19 infection with social isolation being the most commonly reported stigma. There were 20 studies that reported the majority of participants experienced stigma due to COVID-19 infection, which was as high as 100% of participants in two studies. Participants in 16 studies reported blaming from others as the second most common type of stigma, with various other types reported such as psychological pressure, verbal violence, avoidance, and labeling. The most common effect of the stigma was anxiety followed by depression, and then reduction of socialization.

Conclusion

Findings from the present review have identified that COVID-19-related stigma studies have generally focused on its prevalence, type, and outcome. Greater awareness of this topic may assist with improving public education during pandemics such as COVID-19 as well as access to support services for individuals impacted by stigmatization.

Assessing the Validity and Reliability of the Russian Version of the Leading a Culture of Quality in Infection Prevention Scale among Nurses in Kazakhstan

Background

Worldwide, hospitals are required to prioritize the culture of quality in infection prevention (CQIP) for patient safety. Assessing CQIP is crucial, but there is limited research, especially regarding nurses' perceptions. Insufficient information exists due to scarcity of validated instruments in local languages to measure CQIP internationally.

Purpose

This study assessed the "Leading a Culture of Quality in Infection Prevention Scale" Russian version's (LCQ-IPS-R) validity and reliability to assess the CQIP of hospitals in Kazakhstan based on nurses' perceptions.

Methods

This study utilized a methodological design and analyzed data from 204 nurses at the "National Research Center for Maternal and Child Health" in Astana City, Kazakhstan. The "cultural and linguistic adaptation" process involved a "forward-backward translation" technique. Content validity and construct validity were examined. Internal consistency reliability was explored for scale reliability.

Results

The scale's mean item range was from 3.56 (SD = 1.22) to 4.40 (SD = 0.85; SD = 0.92). The corrected item-total correlation ranged from 0.321 to 0.707. Six experts rated the I-CVI from 0.83 to 1.00, with an S-CVI/Ave of 0.90. The principal component analysis with Varimax rotation produced four distinct components of the LCQ-IPS-R, explaining 69.8% of the total variance. The tests of correlation between the LCQ-IPS-R's four components revealed medium to large positive associations among the components (r = 0.25-0.55, p < 0.001). The computed α for the LCQ-IPS-R was 0.909 while α values from four subscales ranged from 0.809 to 0.921. Conclusions/Implications for Practice. This study provides evidence of the LCQ-IP-R's reliability and validity in evaluating Russian-speaking nurses' perception of their hospital's CQIP. These findings open the door for further research on CQIP in healthcare settings in Kazakhstan, Central Asia, and other Russian-speaking countries. The scale provides essential baseline information to design effective interventions for achieving hospitals' infection prevention objectives.

The safety, health, and well-being of healthcare workers during COVID-19: A scoping review

The outbreak of the COVID-19 pandemic has affected the safety and well-being of healthcare workers. A scoping review was conducted to highlight the impact of COVID-19 on the safety, health, and well-being of healthcare workers and to shed light on the concerns about their perceived safety and support systems. A literature search was conducted in three different databases from December 1, 2019, through July 20, 2022, to find publications that meet the aim of this review. Using search engines, 3087 articles were identified, and after a rigorous assessment by two reviewers, 30 articles were chosen for further analysis. Two themes emerged during the analysis: safety and health and well-being. The primary safety concern of the staff was mostly about contracting COVID-19, infecting family members, and caring for patients with COVID-19. During the pandemic, the health care workers appeared to have anxiety, stress, uncertainty, burnout, and a lack of sleep. Additionally, the review focused on the suggestions of health care providers to improve the safety and well-being of workers through fair organizational policies and practices and timely, individualized mental health care.

A cross-sectional study factors associated with resilience among medical staff in radiology departments during COVID-19, Riyadh, Kingdom of Saudi Arabia

OBJECTIVES

This study aims to assess the level of resilience of medical workers in radiology departments in Riyadh, Kingdom of Saudi Arabia, during the COVID-19 outbreak and to explore associated factors.

SETTING

Medical staff, including nurses, technicians, radiology specialists and physicians, working in radiology departments at government hospitals in Riyadh, Saudi Arabia during the COVID-19 outbreak.

DESIGN

A cross-sectional study.

PARTICIPANTS

The study was conducted among 375 medical workers in radiology departments in Riyadh, Kingdom of Saudi Arabia. The data collection took place from 15 February 2022 to 31 March 2022.

RESULTS

The total resilience score was 29.37±6.760 and the scores of each dimension showed that the higher mean score was observed in the domain of 'flexibility', while the lowest was observed in 'maintaining attention under stress'. Pearson's correlation analysis showed that there was a significant negative correlation between resilience and perceived stress (r=-0.498, p<0.001). Finally, based on multiple linear regression analysis, factors affecting resilience among participants are the availability of psychological hotline (available, B=2.604, p<0.050), knowledge of COVID-19 protective measures (part of understanding, B=-5.283, p<0.001), availability of adequate protective materials (partial shortage, B=-2.237, p<0.050), stress (B=-0.837, p<0.001) and education (postgraduate, B=-1.812, p<0.050).

CONCLUSIONS

This study sheds light on the level of resilience and the factors that contribute to resilience in radiology medical staff. Moderate levels of resilience call for health administrators to focus on developing strategies that can effectively help cope with workplace adversities.

Stigma, Post-traumatic Stress, and COVID-19 Vaccination Intent in Mongolia, India, and the United States

Background: Stigma and discrimination during the coronavirus (COVID-19) pandemic have increased precipitously worldwide. This multinational study examines how stigma, blaming groups for virus spread, concern regarding contracting the virus, resource loss, life satisfaction, and protective behaviors that help control the spread of COVID-19 are associated with post-traumatic stress and vaccine intent in Mongolia, India, and the United States. Method: 1429 people in Mongolia, India, and the United States completed measures assessing stigma during the COVID-19 pandemic, post-traumatic stress, blame, protective behaviors, and vaccine intent. Results: Mean post-traumatic stress scores in all three countries exceeded the cut-off that is commonly used to determine probable post-traumatic stress. Post-traumatic stress was associated with COVID-19 stigma experience, personal behavior change due to COVID-19 stigma, blaming groups for the spread of COVID-19, fear of COVID-19, and resource loss. In India and the United States, personal behavior change due to COVID-19 stigma, anger at individuals spreading COVID-19, and perceived susceptibility to illness were positively associated with vaccine intent. Conclusions: Stigma is a collateral stressor during the pandemic. The findings underscore the importance of prompt action to address stigma as a deleterious consequence of the pandemic. The findings illuminate potential barriers to receiving the vaccine and provide direction for future research to address barriers.

The scar that takes time to heal: A systematic review of COVID-19-related stigma targets, antecedents, and outcomes

COVID-19, as a crucial public health crisis, has affected our lives in nearly every aspect. Besides its major health threats, COVID-19 brings severe secondary impacts, one of which is the rise of social stigma. Although numerous studies have examined the antecedents and outcomes of COVID-19-related stigma, we still lack a systematic understanding of who is being stigmatized during the COVID-19 pandemic, what exacerbates COVID-19-related stigma, and what impacts COVID-19-related stigma has on victims. Therefore, this review aims to provide a systematic overview of COVID-19-related stigma. With 93 papers conducted with 126,371 individuals in more than 150 countries and territories spanning five continents, we identify three targets that have received the most research: Chinese/Asian people, (suspected) patients and survivors, and healthcare workers. Furthermore, we find that for each stigma target, characteristics of the stigmatized, stigmatizer, and context contribute to COVID-19-related stigma and that this stigma negatively influences victims' health and non-health outcomes. We call for future research to provide a more integrative, balanced, and rigorous picture of COVID-19-related stigma via conducting research on neglected topics (e.g., contextual factors that contribute to stigma toward HCWs) and stigma interventions and using a longitudinal design. In practice, we urge governments and institutions (e.g., ministries of public health, hospitals) to pay close attention to stigma issues and to promote safe and inclusive societies.

The relationship between nurses' risk assessment and management, fear perception, and mental wellbeing during the COVID-19 pandemic in Saudi Arabia

During this pandemic, it is crucial to implement early interventions to help nurses manage their mental wellbeing by providing them with information regarding coping skills, preventive risk assessment approaches (such as hospital preparedness and rapid risk assessment), and the ability to respond. This study evaluated the effect of fear and risk assessment management on nurses' mental wellbeing during the COVID-19 pandemic in Saudi Arabia. A total of 507 nurses who worked in tertiary public hospitals were asked to take a descriptive design survey. Three survey scales were used to assess the survey: the Risk Assessment Scale, the Fear of COVID-19 Scale, and the Warwick-Edinburgh Mental Wellbeing Scale. Independent t-tests and a one-way ANOVA were used to examine the association between fear of COVID-19 and nurses' demographic characteristics on their mental wellbeing. A multiple regression analysis was performed to examine the predictors associated with mental wellbeing. Findings revealed that almost half of the participants showed moderate positive mental wellbeing, 49.7%, while only 14% had low levels of fear on the Warwick-Edinburgh Mental Well being Scale. Most of the respondents had low levels of fear on the Fear of COVID-19 Scale, 45%, while only 15% had high levels of fear on the scale. Then, some demographic variables, such as "age," "nationality," "total years of experience in the current hospital," and "region you work at" had statistically significant differences with p < 0.5. Meanwhile, risk assessment is also associated with mental wellbeing scores. All items on the Fear of COVID-19 Scale showed no significant difference with a P > 0.05. In conclusion, most nurses providing direct patient care to a patient with COVID-19 emphasized the importance of wearing PPE and performing hand hygiene before and after any clean or aseptic procedure. Meanwhile, although almost all nurses were vaccinated, they were still afraid of a COVID-19 infection. Additionally, the results reported that the older the nurses are, the better their mental wellbeing scores. Non-Saudi nurses had higher perceived mental wellbeing scores than Saudi nurses, and different working environments corresponded to different mental wellbeing scores. Finally, nurses' risk assessment was associated with mental wellbeing scores.

The direct and indirect effect of neuroticism on work engagement of nurses during COVID-19: A temporal analysis

Healthcare professionals such as nurses faced a tough time during the pandemic. Despite the personal and professional challenges, they contributed immensely during the pandemic. However, there were variations in nurses' work engagement during the pandemic. One reason could be their personality, especially neuroticism. Neuroticism represents individuals' proneness to distress in stressful situations, such as COVID-19. Hence, understanding how and in which conditions neuroticism influences work engagement is crucial. We used the Job Demand-Resource (JD-R) model to test the association between neuroticism and work engagement. As neuroticism represents the stress-proneness of an individual, we further investigated if stress mediates the neuroticism-work engagement link. For the nurses, patient interaction is an integral part of their job. Based on the data collected from the nurses, we tested if contact with patients (i.e., beneficiary contact) alleviates the adverse effect of neuroticism on work engagement. During COVID-19, there was an intense need for nursing support. Hence, avoiding duty when society is looking for support might induce a fear of stigmatization among the nurses. We examined if the perceived stigma of duty avoidance would affect the neuroticism-engagement relationship. Our results indicated that higher patient contact alleviated the adverse effect of neuroticism on work engagement. On the other hand, higher fear of stigma exacerbated the adverse effect of neuroticism on work engagement. We further checked the combined effect of beneficiary contact and fear of stigma on neuroticism-work engagement relationships. The findings highlighted the importance of societal factors and policymakers in enhancing nurses' work engagement.

Current Impact and Long-Term Influence of the COVID-19 Pandemic on Iraqi Healthcare Systems: A Case Study

Decades of wars, sanctions, and internal conflicts have compromised Iraq's health system, which once was the best system in the region. National and international efforts to revitalize the system have been successful to some extent; however, significant challenges still exist. The COVID-19 pandemic has exposed new vulnerabilities and exacerbated the existing ones, affecting the quality and the quantity of the health services delivered. This case study explored the baseline function of Iraq's health system within the context of the World Health Organization (WHO) health system framework. The paper also examined the country's response to the COVID-19 pandemic and some of its impacts. Results show that the system was not functioning optimally nor was it prepared to address the immediate impact of the current pandemic and other emerging public health issues. While mitigating the pandemic's short-term and long-term impacts are essential, it should not divert the focus from restructuring and strengthening the health system. Iraq may need to prioritize the health information system and leadership/governance as they provide the basis for health policies and regulations for all other health system building blocks.

COVID-19 related stigma, empathy and intention for testing in Jordan

Stigmatization of COVID-19 disease has been speculated due to misinformation about the disease, fearing of contracting the infection, absence of available cure, and holding responsibility for infecting others. We aimed to establish the prevalence of COVID-19 related stigma and its association with empathic responding, in addition to exploring predictors of stigma and testing intention among Jordanian people. A quantitative, descriptive and predictive design was used and data were collected using a web-based survey from 1074 adults. Findings showed that participants had high stigmatization against COVID-19 infection. Higher empathic responding (both cognitive and affective), being a female participant, and older age resulted in higher stigmatization. Only stigmatization of COVID-19 negatively predicted individuals' intention for testing. These findings warrant intensive efforts from the Jordanian government on a local and national level to provide ongoing public education related to several aspects of COVID-19 disease, in order to reduce or prevent the associated stigma and increase people's intention for testing.