Patience A Afulani1,2, Linnet Ongeri3, Joyceline Kinyua3, Marleen Temmerman4, Wendy Berry Mendes5, Sandra J Weiss6. 1. Epidemiology and Biostatistics Department, University of California, San Francisco (UCSF), 550 16th St, 3rd Floor, San Francisco, CA, 94158, USA. Patience.Afulani@ucsf.edu. 2. UCSF Institute for Global Health Sciences, San Francisco, USA. Patience.Afulani@ucsf.edu. 3. Kenya Medical Research Institute, Nairobi, Kenya. 4. The Aga Khan University Medical College, Nairobi, Kenya. 5. UCSF Department of Psychiatry, San Francisco, USA. 6. UCSF Department of Community Health Systems, San Francisco, USA.
Abstract
BACKGROUND: Stress and burnout among healthcare workers has been recognized as a global crisis needing urgent attention. Yet few studies have examined stress and burnout among healthcare providers in sub-Saharan Africa, and even fewer among maternity providers who work under very stressful conditions. To address these gaps, we examined self-reported stress and burnout levels as well as stress-related physiologic measures of these providers, along with their potential predictors. METHODS: Participants included 101 maternity providers (62 nurses/midwives, 16 clinical officers/doctors, and 23 support staff) in western Kenya. Respondents completed Cohen's Perceived Stress Scale, the Shirom-Melamed Burnout scale, and other sociodemographic, health, and work-related items. We also collected data on heart rate variability (HRV) and hair cortisol levels to assess stress-related physiologic responses to acute and chronic stress respectively. Multilevel linear regression models were computed to examine individual and work-related factors associated with stress, burnout, HRV, and cortisol level. RESULTS: 85% of providers reported moderate stress and 11.5% high stress. 65% experienced low burnout and 19.6% high burnout. Average HRV (measured as the root mean square of differences in intervals between successive heart beats: RMSSD) was 60.5 (SD = 33.0) and mean cortisol was mean cortisol was 44.2 pg/mg (SD = 60.88). Greater satisfaction with life accomplishments was associated with reduced stress (β = - 2.83; CI = -5.47; - 0.18), while motivation to work excessively (over commitment) was associated with both increased stress (β = 0.61 CI: 0.19, 1.03) and burnout (β = 2.05, CI = 0.91, 3.19). Female providers had higher burnout scores compared to male providers. Support staff had higher HRV than other providers and providers under 30 years of age had higher HRV than those 30 and above. Although no association between cortisol and any predictor was statistically significant, the direction of associations was consistent with those found for stress and burnout. CONCLUSIONS: Most providers experienced moderate to high levels of stress and burnout. Individuals who were more driven to work excessively were particularly at risk for higher stress and burnout. Higher HRV of support staff and providers under age 30 suggest their more adaptive autonomic nervous system response to stress. Given its impact on provider wellbeing and quality of care, interventions to help providers manage stress are critical.
BACKGROUND:Stress and burnout among healthcare workers has been recognized as a global crisis needing urgent attention. Yet few studies have examined stress and burnout among healthcare providers in sub-Saharan Africa, and even fewer among maternity providers who work under very stressful conditions. To address these gaps, we examined self-reported stress and burnout levels as well as stress-related physiologic measures of these providers, along with their potential predictors. METHODS:Participants included 101 maternity providers (62 nurses/midwives, 16 clinical officers/doctors, and 23 support staff) in western Kenya. Respondents completed Cohen's Perceived Stress Scale, the Shirom-Melamed Burnout scale, and other sociodemographic, health, and work-related items. We also collected data on heart rate variability (HRV) and hair cortisol levels to assess stress-related physiologic responses to acute and chronic stress respectively. Multilevel linear regression models were computed to examine individual and work-related factors associated with stress, burnout, HRV, and cortisol level. RESULTS: 85% of providers reported moderate stress and 11.5% high stress. 65% experienced low burnout and 19.6% high burnout. Average HRV (measured as the root mean square of differences in intervals between successive heart beats: RMSSD) was 60.5 (SD = 33.0) and mean cortisol was mean cortisol was 44.2 pg/mg (SD = 60.88). Greater satisfaction with life accomplishments was associated with reduced stress (β = - 2.83; CI = -5.47; - 0.18), while motivation to work excessively (over commitment) was associated with both increased stress (β = 0.61 CI: 0.19, 1.03) and burnout (β = 2.05, CI = 0.91, 3.19). Female providers had higher burnout scores compared to male providers. Support staff had higher HRV than other providers and providers under 30 years of age had higher HRV than those 30 and above. Although no association between cortisol and any predictor was statistically significant, the direction of associations was consistent with those found for stress and burnout. CONCLUSIONS: Most providers experienced moderate to high levels of stress and burnout. Individuals who were more driven to work excessively were particularly at risk for higher stress and burnout. Higher HRV of support staff and providers under age 30 suggest their more adaptive autonomic nervous system response to stress. Given its impact on provider wellbeing and quality of care, interventions to help providers manage stress are critical.
Authors: Tait D Shanafelt; Michelle Mungo; Jaime Schmitgen; Kristin A Storz; David Reeves; Sharonne N Hayes; Jeff A Sloan; Stephen J Swensen; Steven J Buskirk Journal: Mayo Clin Proc Date: 2016-04 Impact factor: 7.616
Authors: Adaeze C Wosu; Unnur Valdimarsdóttir; Alexandra E Shields; David R Williams; Michelle A Williams Journal: Ann Epidemiol Date: 2013-10-05 Impact factor: 3.797
Authors: Jonathan Garcia; Amber Hromi-Fiedler; Robert E Mazur; Grace Marquis; Daniel Sellen; Anna Lartey; Rafael Pérez-Escamilla Journal: BMC Public Health Date: 2013-03-11 Impact factor: 3.295
Authors: Patience A Afulani; Raymond A Aborigo; Jerry John Nutor; Jaffer Okiring; Irene Kuwolamo; Beryl A Ogolla; Edwina N Oboke; John Baptist K Dorzie; Osamuedeme J Odiase; Jody Steinauer; Dilys Walker Journal: BMJ Glob Health Date: 2021-11