Risk perception and psychological state of healthcare workers in referral hospitals during the early phase of the COVID-19 pandemic, Uganda

Abstract

Background Safeguarding the psychological well-being of healthcare workers (HCWs) is crucial to ensuring sustainability and quality of healthcare services. During the COVID-19 pandemic, HCWs may be subject to excessive mental stress. We assessed the risk perception and immediate psychological state of HCWs early in the pandemic in referral hospitals involved in the management of COVID-19 patients in Uganda. Methods We conducted a cross-sectional survey in five referral hospitals from April 20–May 22, 2020. During this time, we distributed paper-based, self-administered questionnaires to all consenting HCWs on day shifts. The questionnaire included questions on socio-demographics, occupational behaviors, potential perceived risks, and psychological distress. We assessed risk perception towards COVID-19 using 27 concern statements with a four-point Likert scale. We defined psychological distress as a total score > 12 from the 12-item Goldberg’s General Health Questionnaire (GHQ-12). We used modified Poisson regression to identify factors associated with psychological distress. Results Among 335 HCWs who received questionnaires, 328 (98%) responded. Respondents’ mean age was 36 (range 18–59) years; 172 (52%) were male. The median duration of professional experience was eight (range 1–35) years; 208 (63%) worked more than 40 h per week; 116 (35%) were nurses, 52 (14%) doctors, 30 (9%) clinical officers, and 86 (26%) support staff. One hundred and forty-four (44%) had a GHQ-12 score > 12. The most common concerns reported included fear of infection at the workplace (81%), stigma from colleagues (79%), lack of workplace support (63%), and inadequate availability of personal protective equipment (PPE) (56%). In multivariable analysis, moderate (adjusted prevalence ratio, [aPR] = 2.2, 95% confidence interval [CI] 1.2–4.0) and high (aPR = 3.8, 95% CI 2.0–7.0) risk perception towards COVID-19 (compared with low-risk perception) were associated with psychological distress. Conclusions Forty-four percent of HCWs surveyed in hospitals treating COVID-19 patients during the early COVID-19 epidemic in Uganda reported psychological distress related to fear of infection, stigma, and inadequate PPE. Higher perceived personal risk towards COVID-19 was associated with increased psychological distress. To optimize patient care during the pandemic and future outbreaks, workplace management may consider identifying and addressing HCW concerns, ensuring sufficient PPE and training, and reducing infection-associated stigma.

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“…Moreover, staff were overwhelmed with coping with the pandemic personally and professionally. Past studies conducted in Africa of a similar nature and topic were also conducted via quantitative methods [ 27 , 39 ]. The sample obtained was recruited with difficulty despite the multiple formal and informal platforms used to advertise it and encourage participation.…”

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“…Participants perceived PLW as well as healthcare workers to be highly susceptible to SARS-CoV-2 infection. Similarly, studies across the Sub-Saharan Africa region have shown high risk perception of COVID-19 among healthcare workers [ 46 , 47 , 48 ]. In one study, Girma et al found that health professionals working in public university hospitals in Ethiopia reported greater perceived vulnerability to COVID-19 than other prevalent infectious diseases in the region, including HIV, malaria, and tuberculosis, underscoring these findings [ 47 ].…”

“…This stigma has the potential to discourage preventive behaviors critical for controlling the spread of the pandemic, such as screening, social distancing, using proper hygiene, and seeking treatment for positive cases [ 59 , 60 ]. Moreover, recent studies point to stigma as a barrier to disclosing one’s COVID-19 status to those around them, putting others at risk of contracting the disease [ 48 , 61 , 62 , 63 ]. Several recommendations have been posited to address the stigma related to COVID-19.…”

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