Healthcare Workers' Knowledge and Attitude Towards
COVID-19 and Its Effect on Their Mental Health in England
Ifedayo Eunice Ayeni, John Kainesie, Madhini
Sivasubramanian
Faculty of health science and wellbeing, University of
Sunderland in London, England.
*Corresponding
author:ayeni.ifedayo@yahoo.com
Submitted: 18.03.2024 Accepted: 17.04.2024 Published: 27.04.2024
Keywords: COVID-19, Mental Health,
Health Personnel, Attitude of Health Personnel
Introduction
COVID-19
is a virus triggered by the “SARS-CoV-2” virus that affects most of the country
around the world by inhaling and touching the infected ones (Huynh et al.,
2020). It had a far-reaching, negative impact on healthcare systems worldwide
and healthcare workers play a critical role in the country’s healthcare
delivery system, as they facilitate a continuum of care and containment of
diseases such as the COVID-19 pandemic. Healthcare workers have been playing a
huge frontline role globally in treating infected people, according to Patwary
et al., (2022) and they are at risk of covid 19 infection due to their direct
exposure to suspected and confirmed cases of patient in healthcare facilities.
Alwani et al., (2020) stated that there are high chances of development of
mental health issues among healthcare workers because of constantly working
under pressure and risking their lives. It was documented that most of the
healthcare workers are encountering signs of depression, distress,
sleeplessness, and anxiety. This is because, they are very closely working and
dealing with ill patients and are at the highest danger of contracting the
virus (Bhagavathula et al., 2020).
A
study by Cortez et al., (2020) reported that in Italy almost 45% of healthcare
workers have some sort of mental disorder that was majorly due to the
overburden of responsibilities and tasks to be accomplished along with getting
infected and carrying the infection to their home. Similarly, research by
Baloran, (2020) stated that in China almost 25% of healthcare workers have
developed some sort of mental disorder because of working in stressful
situations and seeing people losing their lives due to this virus. Another
study by Xu et al., (2020) reported that 23% of the healthcare staff had
anxiety issues in UK. Ahmed et al., (2021) observed that most of the healthcare
staff is depressed because of the huge number of individuals dying daily and
not being able to save them because of critical situations. Moreover, Xu et
al., (2020) reported that because of insufficient spaces for infected people,
the staff members were depressed as they couldn’t accommodate all the patients
and couldn’t provide them treatment. Alwani et al., (2020) declared the mental
reaction of healthcare workers to an outbreak could be subject to many elements
which might cause uneasiness and stress, for example, feeling helpless against
deterioration caused by the virus, absence of authority over the circumstance,
the rapid spread of the infection, wellbeing of their family, and being
quarantined. Alrubaiee et al., (2020) discussed that
having the necessary knowledge related to the ongoing crisis and knowing
approaches to handle the situation is necessary to shape the attitude of the
individuals towards it.
De
Vroege & van den Broek, (2021) revealed that
talking with family and friends is an effective coping strategy as they could
share their experience with them and provide them relevant knowledge about the
virus. Sorokin et al., (2020) indicated that to reduce the stress of the
healthcare workers the hospital authorities need to implement safety protocols
in the hospital by providing them with proper protective kits to cover
themselves up so that no physical contact is made with the patients. Maharlouei et al., (2020) added that staying connected with
their religious beliefs is another coping strategy used by most healthcare
workers. This study specifically addresses the knowledge and attitude of
healthcare workers and aims to investigate whether the appropriate knowledge
and attitude help in reducing mental health issues in healthcare workers.
Method
We
used quantitative study with closed ended structured anonymous questionnaire as
a tool to collected data. Purposive sampling technique was used to recruit
health workers at the study site including nurses, physician, pharmacy,
occupational therapist, administration working in the selected hospital. Total
of 100 respondents were employed purposively to get appropriate meaningful
results for the study. An ethical approval form and consent form was sent to
get informed consent and approval. The result was analysed using SPSS and
inferential statistics including frequency, tables, percentages, and
hypotheses. The 100 questionnaires administered were returned and completed
appropriately; these were used for analysis with a response rate of 100%. The
first section reports the demographic characteristics of the respondents
including their age, qualification, sex, occupation, religion, marital status,
experience, financial condition, house members, their department, and sources
of information related to COVID-19. The second part examines the knowledge of
respondents related to the covid-19 and the third part examines their attitude
towards it. The fourth part examines the mental health issues faced by the
respondents and the fifth part highlights the coping strategies implemented by
respondents to reduce the impact of the COVID-19 crisis on the mental health of
healthcare workers. The dependent variable (knowledge, attitude and mental
health) and independent variables (demographic characteristics of the participants)
was investigated using the T-test and ANOV. The results were analysed using
SPSS and are presented in table form and graphs along with the interpretations.
Analysis was considered statistically significant when p value <0.05.
Inferential
statistical methods that are used to draw inferences about the relationships
between variables are referred to as inferential statistics. They vary from
descriptive statistics in that they are specifically designed to test
hypotheses rather than to provide descriptive information. Inferential
statistics use the characteristics of your sample to make educated estimates
about the broader population as a whole and make use of hypothesis testing. the
aim is to compare populations or analyse connections between variables by
examining samples of data. Statistical tests are used to determine whether
hypotheses or forecasts are correct. Statistical tests are classified into
three types: comparison tests, correlation tests, and regression tests. Participants
were given one point for a correct answer (strongly agree and agree) in the
knowledge of COVID-19 section while zero points were given for wrong answers
(strongly disagree and disagree). They were also given one point for correct
answers (yes) in the attitude section and zero points for wrong answers (no)
(Parajuli et al., 2020).
Results
Socio-demographic
Analysis of respondents
Table
1 summarise the sociodemographic characteristics of the respondent. 32% of the
healthcare workers who participated in the survey are between the age group of
20 to 29 years. Almost 31% of the healthcare workers were between the age group
of 30 to 39 years, 24% were between the age group of 40-49 years and 13% were
above 50 years. about half of the healthcare workers who participated in the
survey were male whereas; 40% of them were female. Whereas 5% refrain from
mentioning their gender and 2% selected nonbinary/third gender. 39% of the
healthcare workers who participated in the survey were single, 42% of them were
married. 15% of them were divorced and only 5% of them were widowers. Most of
the respondents were nurses (39%), the rest were physicians (34%), pharmacists
(13%), occupational therapist (9%) and physical therapist (5%).
Table
1 Socio-demographic Analysis of respondents
|
Variable |
Response |
Frequency |
Percent |
|
Age |
20 to 29 years |
32 |
32.0 |
|
30 to 39 years |
31 |
31.0 |
|
|
40 to 49 years |
24 |
24.0 |
|
|
Above 50 years |
13 |
13.0 |
|
|
Total |
100 |
100.0 |
|
|
Sex |
Male |
53 |
53.0 |
|
Female |
40 |
40.0 |
|
|
Prefer not to say |
5 |
5.0 |
|
|
Non-binary/third gender |
2 |
2.0 |
|
|
Total |
100 |
100.0 |
|
|
Marital Status |
Single |
39 |
39.0 |
|
Married |
46 |
46.0 |
|
|
Divorced |
10 |
10.0 |
|
|
Widower |
5 |
5.0 |
|
|
Total |
100 |
100.0 |
|
|
Occupation |
Physician |
34 |
34.0 |
|
Nurse |
39 |
39.0 |
|
|
Pharmacy |
13 |
13.0 |
|
|
Occupational Therapist |
9 |
9.0 |
|
|
Physical Therapist |
5 |
5.0 |
|
|
Total |
100 |
100.0 |
|
|
Religion |
Christian |
66 |
66.0 |
|
Muslim |
10 |
10.0 |
|
|
Judaism |
8 |
8.0 |
|
|
Hinduism |
5 |
5.0 |
|
|
Buddhism |
11 |
11.0 |
|
|
Total |
100 |
100.0 |
|
|
House Members |
1 |
32 |
32.0 |
|
2 |
19 |
19.0 |
|
|
3 |
24 |
24.0 |
|
|
<3 |
25 |
25.0 |
|
|
Total |
100 |
100.0 |
|
|
Financial Situation |
No change |
33 |
33.0 |
|
Better than usual |
24 |
24.0 |
|
|
Worse than usual |
43 |
43.0 |
|
|
Total |
100 |
100.0 |
|
|
Experience |
>5 years |
19 |
19.0 |
|
5-10 years |
42 |
42.0 |
|
|
10-20 years |
26 |
26.0 |
|
|
<20 years |
13 |
13.0 |
|
|
Total |
100 |
100.0 |
|
|
Health Sector |
Acute care |
33 |
33.0 |
|
Intensive unit |
24 |
24.0 |
|
|
Home care |
16 |
16.0 |
|
|
Outpatient clinic |
15 |
15.0 |
|
|
Emergency |
8 |
8.0 |
|
|
Others |
4 |
4.0 |
|
|
Total |
100 |
100.0 |
|
|
Level of Education |
Primary |
7 |
7.0 |
|
High school/ diploma |
27 |
27.0 |
|
|
College level |
46 |
46.0 |
|
|
Postgraduate |
20 |
20.0 |
|
|
Total |
100 |
100.0 |
|
|
COVID-19 Sources |
Television |
18 |
18.0 |
|
Social media |
51 |
51.0 |
|
|
Website of hospital/
health ministry |
4 |
4.0 |
|
|
Friends |
10 |
10.0 |
|
|
Relative |
17 |
17.0 |
|
|
Total |
100 |
100.0 |
Knowledge
of healthcare workers about COVID-19
Table
2 summarise knowledge of healthcare workers about COVID-19. The pie chart below
depicts respondents’ knowledge about COVID-19. It indicates that 89.125% of the
healthcare workers possess good knowledge related to COVID-19, its symptoms,
treatment, and prevention, whereas; 10.875% of the healthcare workers possess
poor knowledge.
Table
2 Knowledge of healthcare workers about COVID-19
|
|
Questions |
Response |
Frequency |
Percent |
|
KNW1 |
Fever, dry cough,
difficulty in breathing are the common clinical symptoms of COVID 19 |
Strongly Agree |
66 |
66.0 |
|
Agree |
30 |
30.0 |
||
|
Disagree |
4 |
4.0 |
||
|
Strongly Disagree |
0 |
0.0 |
||
|
Total |
100 |
100.0 |
||
|
KNW2 |
Sneezing runny nose,
stuffy nose, and headache are less common in persons affected with COVID 19 |
Strongly Agree |
30 |
30.0 |
|
Agree |
49 |
49.0 |
||
|
Disagree |
17 |
17.0 |
||
|
Strongly Disagree |
4 |
4.0 |
||
|
Total |
100 |
100.0 |
||
|
KNW3 |
Loss of taste and smell
are also common features of COVID-19 infection |
Strongly Agree |
54 |
54.0 |
|
Agree |
44 |
44.0 |
||
|
Disagree |
2 |
2.0 |
||
|
Strongly Disagree |
0 |
0.0 |
||
|
Total |
100 |
100.0 |
||
|
KNW4 |
Currently, there is no
treatment for COVID-19 infection, but early symptoms and supportive treatment
can help most patients recover from infection |
Strongly Agree |
42 |
42.0 |
|
Agree |
32 |
32.0 |
||
|
Disagree |
18 |
18.0 |
||
|
Strongly Disagree |
8 |
8.0 |
||
|
Total |
100 |
100.0 |
||
|
KNW5 |
Most COVID-19 infective
patients will not develop severe illness but elderly patients having chronic
illness DM, and COPD are likely to develop severe illness |
Strongly Agree |
47 |
47.0 |
|
Agree |
35 |
35.0 |
||
|
Disagree |
18 |
18.0 |
||
|
Strongly Disagree |
0 |
0.0 |
||
|
Total |
100 |
100.0 |
||
|
KNW6 |
COVID-19 does not affect
children |
Strongly Agree |
42 |
42.0 |
|
Agree |
39 |
39.0 |
||
|
Disagree |
15 |
15.0 |
||
|
Strongly Disagree |
4 |
4.0 |
||
|
Total |
100 |
100.0 |
||
|
KNW7 |
A COVID-19-infected
person with fever can infect other people |
Strongly Agree |
57 |
57.0 |
|
Agree |
33 |
33.0 |
||
|
Disagree |
8 |
8.0 |
||
|
Strongly Disagree |
2 |
2.0 |
||
|
Total |
100 |
100.0 |
||
|
KNW8 |
COVID-19 virus spread via
respiratory droplets |
Strongly Agree |
44 |
44.0 |
|
Agree |
39 |
39.0 |
||
|
Disagree |
11 |
11.0 |
||
|
Strongly Disagree |
6 |
6.0 |
||
|
Total |
100 |
100.0 |
||
|
KNW9 |
Ordinary people should
wear a general mask |
Strongly Agree |
50 |
50.0 |
|
Agree |
42 |
42.0 |
||
|
Disagree |
8 |
8.0 |
||
|
Strongly Disagree |
0 |
0.0 |
||
|
Total |
100 |
100.0 |
||
|
KNW10 |
Lockdown is an effective
measure to slow down the spread of infection. |
Strongly Agree |
84 |
84.0 |
|
Agree |
16 |
16.0 |
||
|
Disagree |
0 |
0 |
||
|
Strongly Disagree |
0 |
0 |
||
|
Total |
100 |
100.0 |
||
|
KNW11 |
People infected with
COVID-19 should immediately be placed in proper isolation |
Strongly Agree |
96 |
96 |
|
Agree |
4 |
4 |
||
|
Disagree |
0.0 |
0.0 |
||
|
Strongly Disagree |
0.0 |
0.0 |
||
|
Total |
100 |
100.0 |
||
|
KNW12 |
Health care professionals
with direct contact should take tablet hydroxychloroquine is a prophylaxis |
Strongly Agree |
32 |
32.0 |
|
Agree |
51 |
51.0 |
||
|
Disagree |
13 |
13.0 |
||
|
Strongly Disagree |
4 |
4.0 |
||
|
Total |
100 |
100.0 |
||
|
KNW13 |
COVID-19 is resistant to
sanitizers with at least 70% alcohol |
Strongly Agree |
38 |
38.0 |
|
Agree |
38 |
38.0 |
||
|
Disagree |
14 |
14.0 |
||
|
Strongly Disagree |
10 |
10.0 |
||
|
Total |
100 |
100.0 |
||
|
KNW14 |
A COVID-19 vaccine has
started to be administered |
Strongly Agree |
74 |
74.0 |
|
Agree |
26 |
26.0 |
||
|
Disagree |
0 |
0.0 |
||
|
Strongly Disagree |
0 |
0.0 |
||
|
Total |
100 |
100.0 |
||
|
KNW15 |
A patient infected with
COVID-19 should wear a surgical mask |
Strongly Agree |
46 |
46.0 |
|
Agree |
46 |
46.0 |
||
|
Disagree |
8 |
8.0 |
||
|
Strongly Disagree |
0 |
0.0 |
||
|
Total |
100 |
100.0 |
||
|
KNW16 |
The estimated incubation
period is 2-14 days. |
Strongly Agree |
64 |
64.0 |
|
Agree |
36 |
36.0 |
||
|
Disagree |
0 |
0.0 |
||
|
Strongly Disagree |
0 |
0.0 |
||
|
Total |
100 |
100.0 |
Overall
Attitude of Healthcare Workers on COVID-19
Table
3 summarise respondents Overall Attitude of Healthcare Workers on COVID-19 The
pie chart below depicts healthcare workers’ attitudes towards COVID-19 in
healthcare facilities in England. It indicates that 73.167% of the healthcare
workers have a positive attitude towards COVID-19, whereas; 26.833% of the
healthcare workers have a negative attitude towards COVID-19.
Table 3 Overall Attitude of Healthcare
Workers on COVID-19
|
|
Question |
Response |
Frequency |
Percent |
|
ATT1 |
Can England win the
battle against Covid-19 |
Yes |
78 |
78.0 |
|
No |
22 |
22.0 |
||
|
Total |
100 |
100.0 |
||
|
ATT2 |
Are you confident about
working in a hospital during the COVID-19 pandemic? |
Yes |
92 |
92.0 |
|
No |
8 |
8.0 |
||
|
Total |
100 |
100.0 |
||
|
ATT3 |
Does your family support
you to work in the hospital during the pandemic? |
Yes |
89 |
89.0 |
|
No |
11 |
11.0 |
||
|
Total |
100 |
100.0 |
||
|
ATT4 |
Do you experience anxiety
and fear while working during the pandemic? |
Yes |
83 |
83.0 |
|
No |
17 |
17.0 |
||
|
Total |
100 |
100.0 |
||
|
ATT5 |
Are you being trained to
work for COVID-19 patients? |
Yes |
87 |
87.0 |
|
No |
13 |
13.0 |
||
|
Total |
100 |
100.0 |
||
|
ATT6 |
Do you regularly follow
infection prevention measures? |
Yes |
100 |
100.0 |
|
No |
0 |
0 |
||
|
Total |
100 |
100.0 |
||
|
ATT7 |
Have you been wearing
face mask and gloves during hospital practice? |
Yes |
96 |
96.0 |
|
No |
4 |
4.0 |
||
|
Total |
100 |
100.0 |
||
|
ATT8 |
Do you feel under
pressure as you could carry COVID 19 to your family? |
Yes |
86 |
86.0 |
|
No |
14 |
14.0 |
||
|
Total |
100 |
100.0 |
||
|
ATT9 |
Do you have sufficient
knowledge about protective measures against COVID-19? |
Yes |
89 |
89.0 |
|
No |
11 |
11.0 |
||
|
Total |
100 |
100.0 |
||
|
ATT10 |
All patients with a
confirmed diagnosis of COVID-19 should be admitted to the intensive care unit |
Yes |
51 |
51.0 |
|
No |
49 |
49.0 |
||
|
Total |
100 |
100.0 |
||
|
ATT11 |
Are you worried about
being infected with COVID-19? |
Yes |
76 |
76.0 |
|
No |
24 |
24.0 |
||
|
Total |
100 |
100.0 |
||
|
ATT12 |
If getting COVID-19, will
you accept isolation in health facilities? |
Yes |
89 |
89.0 |
|
No |
11 |
11.0 |
||
|
Total |
100 |
100.0 |
Mental
Health Issues among Healthcare Workers on COVID-19
Table
4 summarises Mental Health Issues among Healthcare Workers on covid 19. The
above graph results show that out of 100, 83 respondents have developed mental
health problems due to the increasing death count in the country and working in
close contact with the infected patients. 81 healthcare workers feel stressed
as they feel they will get infected and will transmit the virus to their
families.
Table
4 Mental Health Issues among Healthcare Workers
Respondents
Coping Strategies during COVID-19
Table
5 summaries coping strategies implemented by healthcare workers during covid
19. The resulting graph below indicates that out of 100 respondents, 78
respondents declared that accepting responsibility is the best coping strategy
for them. 75 respondents revealed that escaping evidence is one of the coping
strategies they adopt to relieve their stress, 74 declared planned problem
solving and 73 declared calling friends as their coping strategies to relieve
mental stress. Out of 100, 63 respondents responded that not watching
statistics as the appropriate coping strategy to stay away from mental stress.
60 respondents find mental relief in religiousness and praying. Other coping
strategies highlighted during the analysis were positive appraisal (59 respondents),
spending time with family members and kids (56 respondents), confrontational
coping (54 respondents), seeking social support (51 respondents), daily
exercise (49 respondents), social distancing (42 respondents) and only 25
respondents have reported to drink and smoke to relieve stress caused by
COVID-19.
Table
5. Respondents Coping Strategies,
HCWs
within the age group 30-39 had a slightly positive mean score than other age
groups (p<0.001). HCWs in the age group 30-39 also had better mental health
mean scores than those in other age groups (p= 0.022). HCWs with more than 20
years of experience had slightly more significant knowledge mean score than the
others (p=0.006). Those with less than 5 years of experience had higher mental
health mean scores than the rest (p=0.032).
Occupational
and Physical therapists had slightly higher knowledge mean score than nurses,
physicians, and pharmacists (p=0.016). Physicians had a higher attitude mean
score than the other HCWs (p=0.001). COVID-19 sources from relatives had
slightly more significant knowledge mean scores than the other sources
(p<0.001). HCWs whose financial situations are better than usual had a
higher mental health mean score than those with no change or worse than usual
financial situations (p=0.015).
Knowledge and Attitude of Healthcare Workers towards
COVID-19
The result revealed that healthcare workers possess a
good amount of knowledge related to the origin, symptoms, treatment, and
precautions related to covid-19 outbreak. Similar results were reported
Yıldırım & Güler, (2020) as they also observed that as the situation is new
in the healthcare system therefore, they have properly educated their
healthcare workers by providing them with proper training to handle the
situation. Social media plays a major role in enhancing the knowledge of
healthcare workers. Muruganandam et al., (2020) also
reported that social media has now become an important source of information as
due to this people stay updated with everything going around and keep track of
the news. However, Tadesse et al., (2020) argued that social media also spreads
negativity because many fake news and statistics that are circulated increase
the mental pressure on individuals. The results of the study specified that the
majority of the respondents were completely aware of the indications of
COVID-19 patients like fever, runny nose, loss of taste and smell, and
headache. Also, all the respondents knew that loss of taste and smell are
common symptoms of COVID-19 in most of the patients. However, most of the
respondents believed that there is no definitive treatment for COVID-19 but
identifying symptoms at the initial stage and providing supportive treatments
can help most patients recover from the infection.
It was also indicated through the result that those
patients who are already suffering from major health problems such as
respiratory or cardiac issues are less likely to recover from the virus. Alrubaiee et al., (2020) also corroborate that patients
with low immunity due to other diseases are more prone to coronavirus because
of weak health conditions. The results however indicate that most of the
healthcare workers agreed that COVID-19 does not affect children.
Mental Health Issues in Healthcare Workers
The result of the study carried out by conducting
quantitative analysis revealed that the majority of the healthcare workers
reported having some sort of mental health issues because of the ongoing
coronavirus outbreak. Answering the second research question it was concluded
that the consequences of COVID-19 on the psychological state of healthcare
workers are deteriorating as most of them reported developing anxiety, acute
stress, depression, and insomnia. Most of the respondents reveal that they get
tensed and depressed when they hear about death in the ward, someone in the
hospital staff contracting the virus, and an increase in several cases. Other
than that, the fear of losing someone dear and working in close contact with
the patients increases anxiety levels in most healthcare workers. Similar
outcomes were reported by Bakshi et al., (2020) as they found that healthcare
workers fear contracting the virus as they are more exposed to the patients,
and for that, they wear PPE kits during their duty hours to stay protected.
They also reported that when anyone from the hospital gets a virus it increases
their stress level, and they take extra measures to protect themselves.
Coping Strategies of Healthcare Workers
It was identified that accepting their current duty in
the COVID-19 ward as their responsibility is one of the best coping strategies
because when they keep reminding themselves that they are playing the most
critical role in fighting against the virus they feel motivated and confident.
It was indicated in the literature and analysis that implementing strategies to
protect themselves helps healthcare workers more confident because when they
are protected and tension-free about their health only then they will be able
to provide care to others. The results also indicated that staying away from
the current statistics is another way to keep the negativity away because
sometimes the statistics are not real and do not depict the actual situation
thus misguiding the people. Also taking protective measures, connecting with
friends and family, escaping the evidence by not looking at the statistics, and
planned problem-solving were also identified as viable coping strategies. Other
than that, a few of the respondents also reported that exercising to relax
their body and spiritual connection were also effective coping strategies for
them to relax their minds.
There are certain limitations of this study that need
to be addressed by future researchers to make their study more beneficial and
significant. Thus, it is recommended that future researchers conduct
qualitative analysis to gain better insights into the responses of the
respondents. The reasoning can enhance the significance of the study by
increasing its applicability. Secondly, it is recommended that a larger sample
size in quantitative analysis can reveal more generalisable results thus future
researchers need to survey with a larger sample size. Lastly, involving
healthcare workers from more hospitals can increase the generalisability of the
results and can provide more extensive findings.
Acknowledgments
I would like to acknowledge Dr Russell Kabir who took
the time to read through and implement edits in this manuscript.
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