USING MIXED METHODS APPROACH TO EXPLAIN COVID-19 PANDEMIC RELATED STRESS AND THE ASSOCIATED FACTORS AMONG THE HEALTHCARE WORKERS IN KOTA SETAR DISTRICT HEALTH OFFICE
DOI:
https://doi.org/10.37268/mjphm/vol.24/no.3/art.2658Keywords:
stress, COVID-19 pandemic, healthcare workersAbstract
The COVID-19 pandemic had resulted a surge in the prevalence of a wide range of psychological problems, which include stress particularly among the frontliners. This mixed methods study aimed to determine the risk factors of stress among the targeted HCWs, and the explanation based on the individual experiences. An explanatory sequential mixed methods study was conducted among the HCWs at Kota Setar Health District Office, Kedah during the third wave of the COVID-19 pandemic. Social Cognitive Theory (SCT) was used as a framework to facilitate and guide the exploration, as well as explaining the factors predicting stress among the HCWs. The study was started with a retrospective cross-sectional study in the quantitative approach to determine the predicting factors of stress, followed by a qualitative exploration to explain the development of stress among the conveniently sampled informants. Stress was measured using the DASS-21, with those scored moderate [19–25], severe [26–33], and very severe [34+]) stress were selected conveniently for in-depth interviews. The predicting factors were identified using the multivariate logistic regression in the quantitative study, and inductive and deductive thematic analysis were conducted to identify the related coding and themes for the qualitative study. A total of 533 data of HCWs were analysed in the 1st phase of the study and 20 informants were interviewed in the 2nd phase. HCWs who worked at the district health office (AOR= 2.310, 95% CI: 1.177-4.535) and those with higher education (AOR= 2.899, 95% CI: 1.613-5.211) predicted higher odds of developing stress. Qualitatively, HCWs who worked at the health district office experienced work and task increment during pandemic, poor organizational support, poor support from superior and absent of related policy that led to higher stress among them. Meanwhile, the higher stress experienced by those of higher education level was explained by the inconsistencies of instruction received from superior, as well as the policy at national level, posing a challenge to manage the pandemic as well as dealing with the anxious community. Stress among the HCWs who participated in this study was predicted by place of work and education level, due to increase in workload, lack of support system and inconsistencies in management policy.
References
Hebles M, Trincado-Munoz F, Ortega K. Stress and Turnover Intentions Within Healthcare Teams: The Mediating Role of Psychological Safety, and the Moderating Effect of COVID-19 Worry and Supervisor Support. Front Psychol. 2022 Jan 31;12:758438. doi: 10.3389/fpsyg.2021.758438. PMID: 35173646; PMCID: PMC8841584.
World Health Organization (WHO). (2023, February 21). Stress. https://www.who.int/news-room/questions-and-answers/item/stress#:~:text=What is stress%3F,experiences stress to some degree
Spoorthy MS, Pratapa SK, Mahant S. Mental health problems faced by healthcare workers due to the COVID-19 pandemic–A review. Asian journal of psychiatry. 2020 Jun 1;51:102119.
Lua PL, Imilia I. Work-related stress among healthcare providers of various sectors in peninsular Malaysia. Malaysian Journal of Psychiatry. 2011 Dec 1;20(2):30-44.Lkyhug
Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, Wu J, Du H, Chen T, Li R, Tan H. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA network open. 2020 Mar 2;3(3):e203976-.Uy
Fauzi MF, Yusoff HM, Robat RM, Saruan NA, Ismail KI, Haris AF. Doctors’ mental health in the midst of COVID-19 pandemic: The roles of work demands and recovery experiences. International journal of environmental research and public health. 2020 Oct;17(19).Shanafelt T, Ripp J, Trockel M. Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic. Jama. 2020 Jun 2;323(21):2133-4.
Kiat SS, Liang L, Ramli SR, Matrikulasi S, Abdul Muti NH, Unimas SA, Abdul Rahman NM, Balachandran JP, Hamzah AS. Psychological symptoms among healthcare workers handling COVID-19 patients. Med. J. Malays. 2021 Mar;76:138-44.
Ishak, A. R., Nazli, S. N., Aziz, M. Y., Shahid, N. S. M., & Wan Shafai, W. N. L. S. (2022). Quality of Life and its Association with Depression, Anxiety and Stress among Environmental Health Officer (EHO) and Assistant Environmental Health Officer (AEHO) in Selangor During 2019 Coronavirus Pandemic (COVID-19). Malaysian Journal of Medicine and Health Sciences, 168-175.
Shanafelt T, Ripp J, Trockel M. Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic. Jama. 2020 Jun 2;323(21):2133-4.
Kakunje A. Stress among health care professionals: The need for resiliency. Online Journal of Health and Allied Sciences. 2011;10(1):1-2.
Piko BF. Burnout, role conflict, job satisfaction and psychosocial health among Hungarian health care staff: A questionnaire survey. International journal of nursing studies. 2006 Mar 1;43(3):311-8.
Sasidharan S, Dhillon HS. Stress and burnout among health-care workers in the coronavirus disease 2019 intensive care unit. International Journal of Critical Illness and Injury Science. 2021 Oct;11(4):257.
Forghanisardaghi, M., & Arakelyan, H. Aging and stress. 2019 https://www.researchgate.net/publication/332696704_Aging_and_Stress
Institute for Public Health. National Health and Morbidity Survey (NHMS) 2019:Non-communicable diseases, healthcare demand, and health literacy – Key findings. In Ministry of Health Malaysia (Vol. 20). Institute for Public Health, National Institutes of Health (NIH). 2020.
National Research Council. Understanding racial and ethnic differences in health in late life: A research agenda. 2004 Jun 18.
Kaur J, Cheong SM, Mahadir Naidu B, Kaur G, Manickam MA, Mat Noor M, Ibrahim N, Rosman A. Prevalence and correlates of depression among adolescents in Malaysia. Asia Pacific Journal of Public Health. 2014 Sep;26(5_suppl):53S-62S.
Williams DR, Hogue C, Hargraves MA, Collins KS. Race, stress, and mental health: Findings from the Commonwealth Minority Health Survey. Minority health in America: Findings and policy implication from the commonwealth fund minority health survey. 2000.
Yeoh SH, Tam CL, Wong CP, Bonn G. Examining depressive symptoms and their predictors in Malaysia: Stress, locus of control, and occupation. Frontiers in psychology. 2017 Aug 22;8:1411.
Yusoff F, Saari R, Naidu BM, Ahmad NA, Omar A, Aris T. Methodology of the national school-based health survey in Malaysia, 2012. Asia Pacific Journal of Public Health. 2014 Sep;26(5_suppl):9S-17S.
Packer S. Religion, Stress, and Superheroes. InStress: Concepts, Cognition, Emotion, and Behavior 2016 Jan 1 (pp. 465-471). Academic Press.
De Mei, B., Lega, I., Sampaolo, L., & Valli, M. COVID-19: Stress management among healthcare workers. 2020 March 28.
Brown SL, Bulanda JR, Lee GR. The significance of nonmarital cohabitation: Marital status and mental health benefits among middle-aged and older adults. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences. 2005 Jan 1;60(1):S21-9.
Cortès-Franch I, Escribà-Agüir V, Benach J, Artazcoz L. Employment stability and mental health in Spain: towards understanding the influence of gender and partner/marital status. BMC public health. 2018 Dec;18(1):1-1.
Simon RW. Revisiting the relationships among gender, marital status, and mental health. American journal of sociology. 2002 Jan;107(4):1065-96.
Lecic-Tosevski D, Vukovic O, Stepanovic J. Stress and personality. Psychiatriki. 2011 Oct 1;22(4):290-7.
Winkler JG, Jalilzadeh Masah D, Moran JK, Bretz J, Tsagkas I, Goldschmidt T, Schouler-Ocak M. Psychological stress during the COVID-19 pandemic: consequences for psychiatric patients and therapeutic implications. Der Nervenarzt. 2021 Mar;92:243-51.
Hämmig O, Gutzwiller F, Bauer G. Work-life conflict and associations with work-and nonwork-related factors and with physical and mental health outcomes: a nationally representative cross-sectional study in Switzerland. BMC Public Health. 2009 Dec;9(1):1-5.
Kim SC, Quiban C, Sloan C, Montejano A. Predictors of poor mental health among nurses during COVID?19 pandemic. Nursing Open. 2021 Mar;8(2):900-7.
Panatik SA, Badri SK, Rajab A, Rahman HA, Shah IM. The impact of work family conflict on psychological well-being among school teachers in Malaysia. Procedia-social and behavioral sciences. 2011 Jan 1;29:1500-7.
Fuad MD, Al-Zurfi BM, AbdulQader MA, Bakar MF, Elnajeh M, Abdullah MR. Prevalence and risk factors of stress, anxiety and depression among medical students of a private medical University in Malaysia in 2015. Educ Med J. 2015;7.
Hamzah NA, Adznam SN, Taib MN, Mun CY, Ibrahim Z, Azam S. Contributions of socio-demographic and psychosocial characteristics, functional status and physical activity level on prevalence of depressive symptoms among rural elderly in Johor state. Malaysian Journal of Nutrition. 2018 Jun 1;24(2).
McCarthy B, Carter A, Jansson M, Benoit C, Finnigan R. Poverty, material hardship, and mental health among workers in three front-line service occupations. Journal of Poverty. 2018 Jul 4;22(4):334-54.
Sidik SM, Arroll B, Goodyear-Smith F, Ahmad R. Prevalence of depression among women attending a primary urban care clinic in Malaysia. Singapore Med J. 2012 Jul 1;53(7):468-73.
Akhtar-Danesh N, Landeen J. Relation between depression and sociodemographic factors. International journal of mental health systems. 2007 Dec;1:1-9.
Dalgard OS, S? rensen T, Sandanger I, Nygård JF, Svensson E, Reas DL. Job demands, job control, and mental health in an 11-year follow-up study: Normal and reversed relationships. Work & stress. 2009 Jul 1;23(3):284-96.
Seger S, Tee CG, Uddin S, Sia WH, Lwin MA. Factors associated with depression among adults in Mantin, Malaysia. International E-Journal of Science, Medicine & Education. 2019 Jan 1;13(1).
Yee WS, Lin LP. Anxiety and depressive symptoms among communities in the east coast of Peninsular Malaysia: A rural exploration. Malaysian Journal of Psychiatry. 2011 Jun 1;20(1):59-71.
Walton M, Murray E, Christian MD. Mental health care for medical staff and affiliated healthcare workers during the COVID-19 pandemic. European Heart Journal: Acute Cardiovascular Care. 2020 Apr;9(3):241-7.
Kushal A, Gupta S, Mehta M, Singh MM. Study of stress among health care professionals: A systemic review. Int J Res Foundation Hosp Healthcare Adm. 2018 Jan;6(1):6-11.
Tselebis A, Moulou A, Ilias I. Burnout versus depression and sense of coherence: Study of Greek nursing staff. Nursing & Health Sciences. 2001 Jun;3(2):69-71.
TENG CI, HSIAO FJ, CHOU TA. Nurse?perceived time pressure and patient?perceived care quality. Journal of nursing management. 2010 Apr;18(3):275-84.
Bubonya M, Cobb-Clark DA, Wooden M. Mental health and productivity at work: Does what you do matter?. Labour economics. 2017 Jun 1;46:150-65.
Chua SN. The economic cost of mental disorders in Malaysia. The Lancet Psychiatry. 2020 Apr 1;7(4):e23.
Czaba?a C, Charzy?ska K. A systematic review of mental health promotion in the workplace. Wellbeing: A complete reference guide. 2014 Feb 3:1-56.
Fiabane E, Giorgi I, Sguazzin C, Argentero P. Work engagement and occupational stress in nurses and other healthcare workers: the role of organisational and personal factors. Journal of clinical nursing. 2013 Sep;22(17-18):2614-24.
Harnois G, Gabriel P. Mental health and work: Impact, issues and good practices.
Khan A, Ullah S, Azam K, Khan S. Individual differences and mental health disorders among industrial workers A cross sectional survey of Hayatabad Industrial Estate Peshawar, Pakistan. International Review of Business Research Papers. 2010 Feb;6(1):30-9.
LaMontagne AD, Martin A, Page KM, Reavley NJ, Noblet AJ, Milner AJ, Keegel T, Smith PM. Workplace mental health: developing an integrated intervention approach. BMC psychiatry. 2014 Dec;14(1):1-1.
Rampal L, Liew BS. Malaysia's third COVID-19 wave-a paradigm shift required. The Medical Journal of Malaysia. 2021 Jan 1;76(1):1-4.
Bandura A. The evolution of social cognitive theory. Great minds in management. 2005;2005:9-35.
Merriam SB, Tisdell EJ. Qualitative research: A guide to design and implementation. John Wiley & Sons; 2015 Aug 24.
Doleman G, De Leo A, Bloxsome D. The impact of pandemics on healthcare providers' workloads: A scoping review. J Adv Nurs. 2023 Dec;79(12):4434-4454. doi: 10.1111/jan.15690.
Fulham-McQuillan, H., O’Donovan, R., Buckley, C.M. et al. Exploring the psychological impact of contact tracing work on staff during the COVID-19 pandemic. BMC Health Serv Res 23, 602 (2023). https://doi.org/10.1186/s12913-023-09566-6
Tomlin J, Dalgleish-Warburton B, Lamph G. Psychosocial Support for Healthcare Workers During the COVID-19 Pandemic. Front Psychol. 2020 Aug 11;11:1960. doi: 10.3389/fpsyg.2020.01960. PMID: 32849149; PMCID: PMC7431467.
Giorgi, G.; Lecca, L.I.; Leon-Perez, J.M.; Pignata, S.; Topa, G.; Mucci, N. Emerging Issues in Occupational Disease: Mental Health in the Aging Working Population and Cognitive Impairment—A Narrative Review. BioMed Res. Int. 2020, 2020, 1742123.
Zhou, T.; Xu, C.; Wang, C.; Sha, S.; Wang, Z.; Zhou, Y.; Zhang, X.; Hu, D.; Liu, Y.; Tengfei, T.; et al. Burnout and well-being of healthcare workers in the post-pandemic period of COVID-19: A perspective from the job de-mands-resources model. BMC Health Serv. Res. 2022, 22, 284.
Santana-López, B.N.; Santana-Padilla, Y.G.; Bernat-Adell, M.D.; González-Martín, J.M.; Santana-Cabrera, L. The Need for Psychological Support of Health Workers during the COVID-19 Pandemic and the Influence on Their Work. Int. J. Environ. Res. Public Health 2022, 19, 8970. https://doi.org/10.3390/ijerph19158970
Kowal M, Coll-Martín T, Ikizer G, Rasmussen J, Eichel K, Studzi?ska A, Kosza?kowska K, Karwowski M, Najmussaqib A, Pankowski D, Lieberoth A, Ahmed O. Who is the Most Stressed During the COVID-19 Pandemic? Data From 26 Countries and Areas. Appl Psychol Health Well Being. 2020 Dec;12(4):946-966. doi: 10.1111/aphw.12234. Epub 2020 Sep 29. PMID: 32996217; PMCID: PMC7537225.
American Psychological Association. Stress and decision-making during the pandemic.
Lennon, Annie. “What to Know about Decision Fatigue during the Pandemic.” Medical News Today, MediLexicon International, 24 Jan. 2022, www.medicalnewstoday.com/articles/covid-19-decision-fatigue-expert-tips-on-how-to-cope
