Evaluation of Psychological Impact of COVID-19 on Health-Care Workers

Extending Kingdon's Multiple Streams Policy Framework Through an Analysis of How Community Health Workers in India Are Driving Policy Changes

In this paper we develop and provide a novel account of the process through which the Accredited Social Health Activists (ASHAs), a cadre of seemingly powerless community health workers in India, are navigating a complex policy process to incrementally achieve their goals. ASHAs have been demanding better working conditions, better compensation, and regularisation as public service employees through protests and strikes and have managed to gain concessions from both the Central and various State governments. We observed two important aspects that emerged: (a) ASHAs achieved incremental increases in their wages despite being the lowest in the health system hierarchy, and, (b) major gains were made during the 2 years of the pandemic. We examine and analyse ASHAs' engagement and strategies used, both overt and covert, sometimes with the government, and the role of other actors in determining these policy outcomes. We do so by drawing on academic literature and news media reports; we trace the changes in ASHAs' wages by tying together key events, 'windows of opportunity', and actions of 'policy entrepreneurs' involved in the process.In doing so, we further develop and propose an extension to Kingdon's multiple streams policy framework through the addition of a 'narrative stream'.

Lessons learned from the COVID-19 response in Sri Lankan hospitals: an interview of frontline healthcare professionals

Introduction

The COVID-19 pandemic revealed the lack of preparedness in health systems, even in developed countries. Studies published on COVID-19 management experiences in developing countries, including Sri Lanka, are significantly low. Therefore, lessons learned from pandemic management would be immensely helpful in improving health systems for future disaster situations. This study aimed to identify enablers and barriers to COVID-19 management in Sri Lankan hospitals through healthcare workers' perceptions.

Methods

Frontline doctors and nurses from different levels of public hospitals were interviewed online. Both inductive and deductive coding and thematic analysis were performed on the transcribed data.

Result and discussion

This study identified four themes under enablers: preparing for surge, teamwork, helping hands and less hospital-acquired infections. Seven themes were identified as barriers: lack of information sharing, lack of testing facilities, issues with emergency equipment, substandard donations, overwhelmed morgues, funding issues and psychological impact. These preparedness gaps were more prominent in smaller hospitals compared with larger hospitals. Recommendations were provided based on the identified gaps.

Conclusion

The insights from this study will allow health administrators and policymakers to build upon their hospital's resources and capabilities. These findings may be used to provide sustainable solutions, strengthening the resilience of the local Sri Lankan health system as well as the health systems of other countries.

The Psychological Morbidity among Health Care Workers During the Early Phase of Covid-19 Pandemic in India: A Systematic Review and Meta-Analysis

Across India, there have been multiple studies conducted to address the issues of the mental health of healthcare workers during the COVID-19 pandemic. The present study estimated the pooled prevalence of psychological morbidity among healthcare workers during the early phase of the COVID 19 pandemic in India. We searched the following electronic bibliographic databases: PubMed, ScienceDirect, Wiley online library, and Google scholar for studies conducted from the onset of the COVID 19 pandemic until 25 September 2021. The methodological quality of each study was scored and outcome measures with uniform cut off scores as per various screening measurements were evaluated. According to the current meta analysis, the pooled estimates of depression, anxiety, stress, and insomnia among Indian healthcare workers during the COVID 19 pandemic are 20.1% (95% CI: 15.6 to 24.6%; n = 21 studies), 25.0% (95% CI: 18.4 to 31.6%; n = 20 studies), 36% (95% CI: 23.7 to 48.2%; n = 22 studies) and 18.9% (95% CI: 9.9 to 28.0%; n = 6 studies) respectively. In subgroup analyses, low quality studies based on the JBI checklist (Score < 3/9) and studies using DASS 21 showed a higher pooled prevalence of depression and anxiety. About 20-36% of the healthcare workers in India reported having depression, anxiety, and stress during the early phase of the COVID 19 pandemic. The present study provides a comprehensive review of the overall burden of mental health problems among healthcare workers during the COVID 19 pandemic in India necessitating appropriate intervention strategies to protect these frontline groups before the memory of the pandemic crisis starts to fade.

Acute stress, worry, and impairment in health care and non-health care essential workers during the COVID-19 pandemic

OBJECTIVE

Health care and non-health care essential workers working in face-to-face interactions during the coronavirus disease 2019 (COVID-19) pandemic may be vulnerable to psychosocial distress. Limited empirical research on COVID-19-related psychosocial outcomes has utilized probability-based samples including both health care and non-health care essential workers.

METHOD

We surveyed a sample of 1,821 United States self-identified essential workers, collected using probability-based methods, working in face-to-face interactions during the early phase of the COVID-19 outbreak (March 18, 2020 through April 18, 2020), in three consecutive 10-day cohorts. We assessed acute stress, health-related worries, and functional impairment. Demographics, secondary stressors (lack of childcare or health care, lost wages), and pre-COVID-19 mental and physical health were examined as predictors of psychological outcomes.

RESULTS

Acute stress (β = .08, p = .001), health-related worries (β = .09, p = .001), and functional impairment (β = .05, p = .034) increased over time in the early weeks of the outbreak. Health care essential workers reported lower functional impairment (β = -.06, p = .009) and acute stress (β = -.06, p = .015) compared with non-health care essential workers. Across the sample, prior mental and physical health ailments, inability to obtain health care, lost wages, younger age, female gender, and Hispanic ethnicity were associated with acute stress (βs = -.14 to .15, ps ≤ .001), health-related worries (βs = -.09 to .14, ps ≤ .001), and functional impairment (βs = -.08 to .16, ps ≤ .006). Lack of childcare (β = .09, p < .001) was positively associated with acute stress.

CONCLUSION

Non-health care essential workers may be vulnerable to negative psychosocial outcomes. Targeted training and support may help facilitate coping with the effects of working in-person during the ongoing COVID-19 pandemic. Findings may help inform intervention efforts, critical as COVID-19 becomes endemic and society must learn to live with its evolving variants. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Practical resiliency training for healthcare workers during COVID-19: results from a randomised controlled trial testing the Community Resiliency Model for well-being support

Objective

To introduce the Community Resiliency Model (CRM) as mental well-being support for healthcare workers working through the height of the COVID-19 pandemic.

Design

Randomised controlled trial with a no treatment control group.

Setting

Two large urban health systems in the Southern United States between October 2020 and June 2021.

Participants

Eligible participants were currently employed as healthcare workers within the participating healthcare systems. 275 employees registered and consented electronically in response to email invitations. 253 participants completed the baseline survey necessary to be randomised and included in analyses.

Intervention

Participants were assigned 1:1 to the control or intervention group at the time of registration. Intervention participants were then invited to 1-hour virtual CRM class teaching skills to increase somatic awareness in the context of self and other care.

Main outcome measures

Self-reported data were collected rating somatic awareness, well-being, symptoms of stress, work engagement and interprofessional teamwork.

Results

Baseline data on the total sample of 275 (53% nurses) revealed higher symptoms of stress and lower well-being than the general population. The intervention participants who attended a CRM class (56) provided follow-up survey data at 1 week (44) and 3 months (36). Significant improvement for the intervention group at 3 months was reported for the well-being measures (WHO-5, p<0.0087, d=0.66; Warwick-Edinburgh Mental Well-Being Scale, p<0.0004, d=0.66), teamwork measure (p≤0.0002, d=0.41) and stress (Secondary Traumatic Stress Scale, p=0.0058, d=46).

Conclusion

Baseline results indicate mental health is a concern for healthcare workers. Post intervention findings suggest that CRM is a practical approach to support well-being for healthcare workers during a crisis such as this pandemic. The simple tools that comprise the model can serve as a starting point for or complement self-care strategies to enhance individual resilience and buffer the effects of working in an increasingly stressful work environment.

Psychosocial impact of COVID-19 pandemic on healthcare workers in India & their perceptions on the way forward - A qualitative study

Background & objectives:

The healthcare system across the world has been overburdened due to the COVID-19 pandemic impacting healthcare workers (HCWs) in different ways. The present study provides an insight into the psychosocial challenges faced by the HCWs related to their work, family and personal well-being and the associated stigmas. Additionally, the coping mechanisms adopted by them and their perceptions on the interventions to address these challenges were also explored.

Methods:

A qualitative study was conducted between September and December 2020 through in-depth telephonic interviews using an interview guide among 111 HCWs who were involved in COVID-19 management across 10 States in India.

Results:

HCWs report major changes in work-life environment that included excessive workload with erratic timings accentuated with the extended duration of inconvenient personal protection equipment usage, periods of quarantine and long durations of separation from family. Family-related issues were manifold; the main challenge being separated from family, the challenge of caregiving, especially for females with infants and children, and fears around infecting family. Stigma from the community and peers fuelled by the fear of infection was manifested through avoidance and rejection. Coping strategies included peer, family support and the positive experiences manifested as appreciation and recognition for their contribution during the pandemic.

Interpretation & conclusions:

The study demonstrates the psychological burden of HCWs engaged with COVID-19 care services. The study findings point to need-based psychosocial interventions at the organizational, societal and individual levels. This includes a conducive working environment involving periodic evaluation of the HCW problems, rotation of workforce by engaging more staff, debunking of false information, community and HCW involvement in COVID sensitization to allay fears and prevent stigma associated with COVID-19 infection/transmission and finally need-based psychological support for them and their families.

The Impact of Community Generated PPE During the SARS-COV-2 Pandemic in Southeast Alabama and Gulfport Mississippi

Background: The early stages of the SARS-COV-2 pandemic left many hospital systems devoid of personal protective equipment. Community-driven groups manufactured Personal Protective Equipment (PPE) as a form of temporary replacement until supply could increase to frontline healthcare workers. The purpose of this study was to survey hospital systems in Alabama and Mississippi who requested and received PPE to determine recipient opinions concerning community involvement. Methods: A 15-question Qualtrics survey was distributed to hospital systems who requested and received community-generated PPE (CGPPE) from the group known as Alabama Fighting COVID. 275 responses were gathered over a period of 6 months. Results: Survey data showed that most respondents from healthcare and healthcare-associated professions responded that wearing community generated personal protective equipment provided them with the perception of added protection (55.31% of participants selected either "Agree" or "Strongly Agree"), and that it improved their outlook and desire to work during the pandemic (51.77% of participants selected either "Agree" or "Strongly Agree"). Conclusions: Most respondents reported that wearing community generated personal protective equipment not only provided them with the perception of added protection, but that it improved their outlook and desire to work during the pandemic. With these responses in mind, our study raises questions concerning whether local CGPPE distribution could improve well-ness outcomes of healthcare workers (HCWs) not only in relation to decreased viral transmission, but also in favorable psychosocial health assessments. Further implications for research concerning community involvement during future medical crises are indicated, especially with the current rise of the delta variant strain.