DISRUPTIONS IN PRIMARY HEALTH CARE DURING THE COVID-19 PANDEMIC IN SAUDI ARABIA
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Keywords
stress; role conflict; role ambiguity; social support; self-esteem; primary healthcare centers; COVID-19; Saudi Arabia
Abstract
In the midst of the COVID-19 pandemic, this study set out to determine what elements in the workplace would put healthcare workers (HCWs) at risk for experiencing stress. Thirteen hundred seventy-eight healthcare workers (HCWs) from primary health centres (including fever clinics, regular clinics, and clinics that specialise in treating COVID-19 symptoms) in Saudi Arabia were surveyed online using a multistage random sampling method to gather data on role conflict and ambiguity, self-esteem, and social support. Role conflict and ambiguity were significantly connected with stress, while social support was adversely correlated. Stress, role conflict, and ambiguity were far more prevalent among HCWs working in fever clinics compared to those in conventional primary care settings. Finally, HCWs, particularly those working in fever clinics, reported higher levels of stress due to job conflict and ambiguity as well as a lack of social support.
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1. Zhu, N.; Zhang, D.; Wang, W.; Li, X.; Yang, B.; Song, J.; Zhao, X.; Huang, B.; Shi, W.; Lu, R.; et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N. Engl. J. Med. 2020, 382, 727–733. [Google Scholar] [CrossRef] [PubMed] 2. Horesh, D.; Brown, A.D. Traumatic stress in the age of COVID-19: A call to close critical gaps and adapt to new realities. Psychol. Trauma 2020, 12, 331–335. [Google Scholar] [CrossRef] 3. World Health Organization. Coronavirus Disease 2019 (COVID-19) Situation Report–51. Available online: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200311-sitrep-51-covid-19.pdf?sfvrsn=1ba62e57_10 (accessed on 27 August 2020). 4. World Health Organization. Coronavirus Disease 2019 (COVID-19) Weekly Operational Update Situation Report. Available online: https://www.who.int/docs/default-source/coronaviruse/weekly-updates/wou-21082020.pdf?sfvrsn=e34ba8f3_2 (accessed on 27 November 2020). 5. Guanche, G.H. COVID-19. A challenge for healthcare professionals. Rev. Habanera Cienc. Med. 2020, 19, 1–4. [Google Scholar] 6. Talaee, N.; Varahram, M.; Jamaati, H.; Salimi, A.; Attarchi, M.; Dizaji, M.K.; Sadr, M.; Hassani, S.; Farzanegan, B.; Monjazebi, F.; et al. Stress and burnout in health care workers during COVID-19 pandemic: Validation of a questionnaire. J. Public Health 2020, 1–6. [Google Scholar] [CrossRef] 7. Yezli, S.; Khan, A. COVID-19 social distancing in the Kingdom of Saudi Arabia: Bold measures in the face of political, economic, social and religious challenges. Travel Med. Infect. Dis. 2020, 37, 101692. [Google Scholar] [CrossRef] [PubMed] 8. Johns Hopkins University and Medicine. Coronavirus Resource Center by Region (Saudi Arabia). Available online: https://coronavirus.jhu.edu/region/saudi-arabia (accessed on 8 November 2020). 9. Adly, H.M.; AlJahdali, I.A.; Garout, M.A.; Khafagy, A.A.; Saati, A.A.; Saleh, S.A. Correlation of COVID-19 Pandemic with Healthcare System Response and Prevention Measures in Saudi Arabia. Int. J. Environ. Res. Public Health 2020, 17, 6666. [Google Scholar] [CrossRef] 10. Ministry of Health. The Kingdom of Saudi Arabia’s: Experience in Health Preparedness and Response to COVID-19 Pandemic 2020. Available online: https://www.moh.gov.sa/en/Ministry/MediaCenter/Publications/Documents/COVID-19-NATIONAL.pdf (accessed on 3 December 2020). 11. Ortega-Galán, Á.M.; Ruiz-Fernández, M.D.; Lirola, M.-J.; Ramos-Pichardo, J.D.; Ibáñez-Masero, O.; Cabrera-Troya, J.; Salinas-Pérez, V.; Gómez-Beltrán, P.A.; Fernández-Martínez, E. Professional Quality of Life and Perceived Stress in Health Professionals before COVID-19 in Spain: Primary and Hospital Care. Healthcare 2020, 8, 484. [Google Scholar] [CrossRef] [PubMed] 12. Shechter, A.; Diaz, F.; Moise, N.; Anstey, D.E.; Ye, S.; Agarwal, S.; Birk, J.L.; Brodie, D.; Cannone, D.E.; Chang, B.; et al. Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic. Gen. Hosp. Psychiatry 2020, 66, 1–8. [Google Scholar] [CrossRef] 13. Cai, H.; Tu, B.; Ma, J.; Chen, L.; Fu, L.; Jiang, Y.; Zhuang, Q. Psychological Impact and Coping Strategies of Frontline Medical Staff in Hunan Between January and March 2020 During the Outbreak of Coronavirus Disease 2019 (COVID-19) in Hubei, China. Med. Sci. Monit. Int. Med. J. Exp. Clin. Res. 2020, 26, e924171. [Google Scholar] 14. Vizheh, M.; Qorbani, M.; Arzaghi, S.M.; Muhidin, S.; Javanmard, Z.; Esmaeili, M. The mental health of healthcare workers in the COVID-19 pandemic: A systematic review. J. Diabetes Metab. Disord. 2020, 19, 1967–1978. [Google Scholar] [CrossRef] 15. Ma, Y.; Rosenheck, R.; He, H. Psychological stress among health care professionals during the 2019 novel corona-virus disease Outbreak: Cases from online consulting customers. Intensive Crit. Care Nurs. 2020, 61, 102905. [Google Scholar] [CrossRef] 16. World Health Organization. MERS Situation Update January 2020. Available online: https://applications.emro.who.int/docs/EMCSR254E.pdf?ua=1 (accessed on 3 December 2020). 17. Alsubaie, S.; Temsah, M.H.; Al-Eyadhy, A.A.; Gossady, I.; Hasan, G.M.; Al-Rabiaah, A.; Jamal, A.A.; Alhaboob, A.A.; Alsohime, F.; Somily, A.M. Middle East Respiratory Syndrome Coronavirus epidemic impact on healthcare workers’ risk perceptions, work and personal lives. J. Infect. Dev. Ctries. 2019, 13, 920–926. [Google Scholar] [CrossRef] [PubMed] [Green Version] 18. Khalid, I.; Khalid, T.J.; Qabajah, M.R.; Barnard, A.G.; Qushmaq, I.A. Healthcare workers emotions, perceived stressors and coping strategies during a MERS-CoV outbreak. Clin. Med. Res. 2016, 14, 7–14. [Google Scholar] [CrossRef] [Green Version] 19. Park, J.S.; Lee, E.H.; Park, N.R.; Choi, Y.H. Mental health of nurses working at a government-designated hospital during a MERS-CoV outbreak: A cross-sectional study. Arch. Psychiatr. Nurs. 2018, 32, 2–6. [Google Scholar] [CrossRef] [Green Version] 20. Tunc, T.; Kutanis, R.O. Role conflict, role ambiguity, and burnout in nurses and physicians at a university hospital in Turkey. Nurs. Health Sci. 2009, 11, 410–416. [Google Scholar] [CrossRef] [PubMed] 21. Arafa, A.; Mohamed, A.; Saleh, L.; Senosy, S. Psychological Impacts of the COVID-19 Pandemic on the Public in Egypt. Community Ment. Heal. J. 2021, 57, 64–69. [Google Scholar] [CrossRef] [PubMed] 22. Johnson, A.R.; Jayappa, R.; James, M.; Kulnu, A.; Kovayil, R.; Joseph, B. Do Low Self-Esteem and High Stress Lead to Burnout Among Health-Care Workers? Evidence from a Tertiary Hospital in Bangalore, India. Saf. Health Work. 2020, 11, 347–352. [Google Scholar] [CrossRef] 23. Gray-Stanley, J.A.; Muramatsu, N.; Heller, T.; Hughes, S.; Johnson, T.P.; Ramirez-Valles, J. Work stress and depression among direct support professionals: The role of work support and locus of control. J. Intellect. Disabil. Res. 2010, 54, 749–761. [Google Scholar] [CrossRef] [Green Version] 24. Tae, Y.S.; Heitkemper, M.; Kim, M.Y. A path analysis: A model of depression in Korean women with breast cancer-mediating effects of self-esteem and hope. Oncol. Nurs. Forum 2012, 39–57. [Google Scholar] [CrossRef] [Green Version] 25. Pearce, J.L. Bringing Some Clarity to Role Ambiguity Research. Acad. Manag. Rev. 1981, 6, 665. [Google Scholar] [CrossRef] [Green Version] 26. Beard, F.K. Client role ambiguity and satisfaction in client-ad agency relationships. J. Advert. Res. 1999, 39, 69–78. [Google Scholar] 27. Thoits, P.A. Stress and Health: Major Findings and Policy Implications. J. Health Soc. Behav. 2010, 51, S41–S53. [Google Scholar] [CrossRef] [PubMed] [Green Version] 28. Adamczyk, K.; Segrin, C. Perceived Social Support and Mental Health among Single vs. Partnered Polish Young Adults. Curr. Psychol. 2015, 34, 82–96. [Google Scholar] [CrossRef] [Green Version] 29. Lee, J.-S.; Koeske, G.F.; Sales, E. Social support buffering of acculturative stress: A study of mental health symptoms among Korean international students. Int. J. Intercult. Relat. 2004, 28, 399–414. [Google Scholar] [CrossRef] 30. Alyahya, S.A. Psychological Stress among Informal Caregivers. Ph.D. Thesis, The Catholic University of America, Washington, DC, USA, 2020. [Google Scholar] 31. Lazarus, R.S.; Folkman, S. Cognitive Theories of Stress and the Issue of Circularity. In Dynamics of Stress; Springer International Publishing: Boston, MA, USA, 1986; pp. 63–80. [Google Scholar] 32. Lazarus, R.S. Theory-Based Stress Measurement. Psychol. Inq. 1990, 1, 3–13. [Google Scholar] [CrossRef] 33. Lambert, V.A.; Lambert, C.E. Literature review of role stress/strain on nurses: An international perspective. Nurs. Health Sci. 2001, 3, 161–172. [Google Scholar] [CrossRef] 34. Khamisa, N.; Peltzer, K.; Oldenburg, B. Burnout in Relation to Specific Contributing Factors and Health Outcomes among Nurses: A Systematic Review. Int. J. Environ. Res. Public Health 2013, 10, 2214–2240. [Google Scholar] [CrossRef] [Green Version] 35. Montgomery, A.; Spânu, F. Băban, A.; Panagopoulou, E. Job demands, burnout and engagement among nurses: A multi-level analysis of ORCAB data investigating the moderating effect of teamwork. Burn. Res. 2015, 2, 71–79. [Google Scholar] [CrossRef] [Green Version] 36. García-Herrero, S.; Lopez-Garcia, J.R.; Herrera, S.; Fontaneda, I.; Báscones, S.M.; Mariscal, M.A. The Influence of Recognition and Social Support on European Health Professionals’ Occupational Stress: A Demands-Control-Social Support-Recognition Bayesian Network Model. BioMed Res. Int. 2017, 2017, 1–14. [Google Scholar] [CrossRef] [PubMed] [Green Version] 37. Cohen, S. Perceived stress in a probability sample of the United States. The Claremont Symposium on Applied Social Psychology. In The Social Psychology of Health; Spacapan, S., Oskamp, S., Eds.; Sage Publications, Inc.: Newbury Park, CA, USA, 1988; pp. 31–67. [Google Scholar] 38. Cohen, S.; Kamarck, T.; Mermelstein, R. Perceived stress scale. Meas. Stress Guide Health Soc. Sci. 1994, 10, 1–2. [Google Scholar] 39. Almajwal, A.M. Stress, shift duty and eating behavior among nurses in Riyadh, Saudi Arabia. FASEB J. 2016, 30, lb324. [Google Scholar] 40. Alharbi, H.; Alshehry, A. Perceived stress and coping strategies among ICU nurses in government tertiary hospitals in Saudi Arabia: A cross-sectional study. Ann. Saudi Med. 2019, 39, 48–55. [Google Scholar] [CrossRef] [PubMed] [Green Version] 41. Siddiqui, A.F.; Al Zaalah, M.A.; Alqahtani, A.A.; Alqahtani, M.A.S. Perceived stress and its associated sociodemographic factors among physicians working in Aseer region of Saudi Arabia. J. Liaquat. Uni. Med. Health Sci. 2017, 16, 10–18. [Google Scholar] 42. Chaaya, M.; Osman, H.; Naassan, G.; Mahfoud, Z. Validation of the Arabic version of the Cohen perceived stress scale (PSS-10) among pregnant and postpartum women. BMC Psychiatry 2010, 10, 111. [Google Scholar] [CrossRef] [Green Version] 43. Rosenberg, M.; Schooler, C.; Schoenbach, C. Self-Esteem and Adolescent Problems: Modeling Reciprocal Effects. Am. Sociol. Rev. 1989, 54, 1004. [Google Scholar] [CrossRef] 44. Silber, E.; Tippett, J.S. Self-Esteem: Clinical Assessment and Measurement Validation. Psychol. Rep. 1965, 16, 1017–1071. [Google Scholar] [CrossRef] 45. Gray-Little, B.; Williams, V.S.L.; Hancock, T.D. An Item Response Theory Analysis of the Rosenberg Self-Esteem Scale. Pers. Soc. Psychol. Bull. 1997, 23, 443–451. [Google Scholar] [CrossRef] 46. Alsaqri, S.H.; Albagawi, B.S.; Aldalaykeh, M.K.; Alkuwaisi, M.J. Prediction of Depression among Undergraduate Nursing Students in North-Western Saudi Arabia: A Quantitative Cross-Sectional Study. Int. J. Adv. Appl. Sci. Taiwan 2019, 6, 72–78. [Google Scholar] 47. Lin, N. Conceptualizing Social Support. In Social Support, Life Events and Depression; Lin, N., Dean, A., Ensel, W., Eds.; Elsevier: New York, NY, USA, 1986; pp. 17–30. [Google Scholar] 48. Zalaquett, C.P.; Wood, R.J. Evaluating Stress: A Book of Resources; The Scarecrow Press: London, UK, 1998; pp. 185–197. [Google Scholar] 49. Zimet, G.D.; Dahlem, N.W.; Zimet, S.G.; Farley, G.K. The Multidimensional Scale of Perceived Social Support. J. Pers. Assess. 1988, 52, 30–41. [Google Scholar] [CrossRef] [Green Version] 50. Rizwan, M.; Aftab, S. Psychometric properties of the multidimensional scale of perceived social support in Pakistani young adults. Pak. J. Psychol. 2009, 40, 51–65. [Google Scholar] 51. Aroian, K.; Templin, T.N.; Ramaswamy, V. Adaptation and Psychometric Evaluation of the Multidimensional Scale of Perceived Social Support for Arab Immigrant Women. Health Care Women Int. 2010, 31, 153–169. [Google Scholar] [CrossRef] 52. Kahn, R.L.; Wolfe, D.M.; Quinn, R.P.; Snoek, J.D.; Rosenthal, R.A. Organizational Stress: Studies in Role Conflict and Ambiguity; Wiley: New York, NY, USA, 1964. [Google Scholar] 53. Bowling, N.A.; Khazon, S.; Alarcon, G.M.; Blackmore, C.E.; Bragg, C.B.; Hoepf, M.R.; Barelka, A.; Kennedy, K.; Wang, Q.; Li, H. Building better measures of role ambiguity and role conflict: The validation of new role stressor scales. Work. Stress 2017, 31, 1–23. [Google Scholar] [CrossRef] 54. Rizzo, J.R.; House, R.J.; Lirtzman, S.I. Role Conflict and Ambiguity in Complex Organizations. Adm. Sci. Q. 1970, 15, 150. [Google Scholar] [CrossRef] 55. Arafa, A.; Mohammed, Z.; Mahmoud, O.; Elshazley, M.; Ewis, A. Depressed, anxious, and stressed: What have healthcare workers on the frontlines in Egypt and Saudi Arabia experienced during the COVID-19 pandemic? J. Affect. Disord. 2021, 278, 365–371. [Google Scholar] [CrossRef] [PubMed] 56. Zhu, Z.; Xu, S.; Wang, H.; Liu, Z.; Wu, J.; Li, G.; Zhu, S. COVID-19 in Wuhan: Sociodemographic characteristics and hospital support measures associated with the immediate psychological impact on healthcare workers. EClinicalMedicine 2020, 24, 100443. [Google Scholar] [CrossRef] 57. Odriozola-González, P.; Planchuelo-Gómez, Á.; Irurtia, M.J.; de Luis-García, R. Psychological symptoms of the out-break of the COVID-19 confinement in Spain. J. Health Psychol. 2020. [Google Scholar] [CrossRef] 58. Lai, J.; Ma, S.; Wang, Y.; Cai, Z.; Hu, J.; Wei, N.; Wu, J.; Du, H.; Chen, T.; Li, R.; et al. Factors Associated with Mental Health Outcomes among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw. Open 2020, 3, e203976. [Google Scholar] [CrossRef] 59. Roy, D.; Tripathy, S.; Kar, S.K.; Sharma, N.; Verma, S.K.; Kaushal, V. Study of knowledge, attitude, anxiety & perceived mental healthcare need in Indian population during COVID-19 pandemic. Asian J. Psychiatry 2020, 51, 102083. [Google Scholar] 60. De Pablo, G.S.; Vaquerizo-Serrano, J.; Catalan, A.; Arango, C.; Moreno, C.; Ferre, F.; Shin, J.I.; Sullivan, S.; Brondino, N.; Solmi, M.; et al. Impact of coronavirus syndromes on physical and mental health of health care workers: Systematic review and meta-analysis. J. Affect. Disord. 2020, 275, 48–57. [Google Scholar] [CrossRef] [PubMed] 61. Joob, B.; Wiwanitkit, V. Traumatization in medical staff helping with COVID-19 control. Brain Behav. Immun. 2020, 87, 10. [Google Scholar] [CrossRef] [PubMed] 62. Chiara, P.; Luca, C.; Annalisa, P.; Chiara, R.; Panari, C.; Caricati, L.; Pelosi, A.; Rossi, C. Emotional exhaustion among healthcare professionals: The effects of role ambiguity, work engagement and professional commitment. Acta Bio Med. Atenei Parm. 2019, 90, 60–67. [Google Scholar] 63. Inoue, A.; Kawakami, N.; Eguchi, H.; Tsutsumi, A. Interaction effect of job insecurity and role ambiguity on psychological distress in Japanese employees: A cross-sectional study. Int. Arch. Occup. Environ. Health 2018, 91, 391–402. [Google Scholar] [CrossRef] [PubMed] [Green Version] 64. Leão, E.R.; Fabbro, D.R.D.; De Oliveira, R.B.; Dos Santos, I.R.; Victor, E.D.S.; Aquarone, R.L.; Andrade, C.B.; Ribeiro, V.F.; De Oliveira, R.C.; Friedlander, R.; et al. Stress, self-esteem and well-being among female health professionals: A randomized clinical trial on the impact of a self-care intervention mediated by the senses. PLoS ONE 2017, 12, e0172455. [Google Scholar] [CrossRef] [PubMed] 65. Molero Jurado, M.D.; Pérez-Fuentes, M.D.; Gázquez Linares, J.J.; Barragán Martín, A.B. Burnout in health professionals according to their self-esteem, social support and empathy profile. Front. Psychol. 2018, 9, 424. [Google Scholar] [CrossRef] [PubMed] 66. Arafa, A.E.; Anzengruber, F.; Mostafa, A.M.; Navarini, A.A. Perspectives of online surveys in dermatology. J. Eur. Acad. Dermatol. Venereol. 2018, 33, 511–520. [Google Scholar] [CrossRef] [PubMed]
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