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

IntroductionThe COVID-19 pandemic has compounded the global crisis of stress and burnout among healthcare workers (HCWs). But few studies have empirically examined the factors driving these outcomes. We examined the association between perceived preparedness to respond to the pandemic and HCW stress and burnout and identified potential mediating factors among HCWs in Ghana. MethodsData are from HCWs in Ghana who completed a cross-sectional self-administered online survey; 414 and 409 HCWs completed stress and burnout questions, respectively. Perceived preparedness, stress, and burnout were measured using validated psychosocial measures. We assessed associations using linear regressions with robust standard errors. ResultsThe 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, HCWs who felt somewhat prepared and prepared had lower stress ({beta} = -1.89, 95%CI:-3.49 to -0.30 and {beta} = -2.66, 95%CI:-4.48 to -0.84) and burnout ({beta} = -7.74, 95%CI:-11.8 to -3.64 and {beta} = -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 burnout. Fear of infection partially mediated the relationship between perceived preparedness and stress/burnout, accounting for about 16 to17% of the effect. ConclusionLow perceived preparedness to respond to COVID-19 increases stress and burnout, and this is partly through fear of infection. Interventions to increase HCWs morale and capacity to respond to the pandemic are needed. Strengths and limitations of this studyO_LIOur study is among the first to report data on COVID-19 related stress and burnout among HCWs in Africa and to identify contributing factors, including HCWs perceived preparedness to respond to the pandemic. C_LIO_LIWe used validated psychosocial measures of stress and burnout, as well as a perceived preparedness for COVID-19 scale developed by our team, which has high validity and reliability; this scale can facilitate similar research in other settings. C_LIO_LIOur study shows that among healthcare workers in Ghana, low perceived preparedness to respond to the COVID-19 pandemic is associated with higher levels of stress and burnout and this association is partially mediated by fear of infection. C_LIO_LIPerceived appreciation from management and family support on the other hand are associated with lower stress and burnout. C_LIO_LIFindings are based on self-reported data from a cross-sectional online survey, thus, there may be social desirability bias; associations described are not causal; and the online survey may limit generalizability. C_LI

Perceived preparedness to respond to the COVID-19 pandemic: A study with healthcare workers in Ghana

IntroductionHealthcare workers (HCWs) preparedness to respond to pandemics is critical to containing disease spread. Low-resource countries, however, experience barriers to preparedness due to limited resources. In Ghana, a country with a constrained healthcare system and high COVID-19 cases, we examined HCWs perceived preparedness to respond to COVID-19 and associated factors. Methods472 HCWs completed questions in a cross-sectional self-administered online survey. Perceived preparedness was assessed using a 15-question scale (Cronbach alpha=0.91) and summative scores were created (range=0-45). Higher scores meant greater perceived preparedness. We used linear regression with robust standard errors to examine associations between perceived preparedness and potential predictors. ResultsThe average preparedness score was 24 (SD=8.9); 27.8% of HCWs felt prepared. In multivariate analysis, factors associated with higher perceived preparedness were: training ({beta}=3.35, 95%CI: to 4.69); having adequate PPE ({beta}=2.27, 95%CI: 0.26 to 4.29), an isolation ward ({beta}=2.74, 95%CI: 1.15 to 4.33), and protocols for screening ({beta}=2.76, 95%CI: 0.95 to 4.58); and good perceived communication from management ({beta}=5.37, 95%CI: 4.03 to 7.90). When added to the model, perceived knowledge decreased the effect of training by 28.0%, although training remained significant, suggesting a partial mediating role. Perceived knowledge was associated with a 6-point increase in perceived preparedness score ({beta}=6.04, 95%CI: 4.19 to 7.90). ConclusionHCWs reported low perceived preparedness to respond to COVID-19. Training, clear protocols, PPE availability, isolation wards, and communication play an important role in increasing preparedness. Government stakeholders must institute necessary interventions to increase HCWs preparedness to respond to the ongoing pandemic and prepare for future pandemics. Strengths and limitations of this studyO_LIThis is one of the few studies globally to empirically examine Healthcare workers (HCWs) perceived preparedness to respond to COVID-19, and the first study to do so among HCWs in Ghana and in Africa. C_LIO_LIWe developed a perceived preparedness for COVID-19 scale and conducted psychometric analysis to confirm its validity and reliability; this scale can facilitate similar research in other settings. C_LIO_LIWe show that providers have low perceived preparedness to respond to the COVID-19 pandemic, and that this is associated with a lack of training on COVID-19, PPE, clear protocols, and isolation wards, as well as poor communication from management. C_LIO_LIThe use of an online survey with recruitment via social media may have accounted for a relatively young sample. C_LIO_LIFindings are based on self-reported data from a cross-sectional survey, thus, there may be social desirability bias and associations described are not causal. C_LI