Selamu Medhin, Thornicroft Graham, Fekadu Abebaw, Hanlon Charlotte
Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, PO Box 9086, Addis Ababa, Ethiopia.
Centre for Global Mental Health and Centre for Implementation Science Health Services and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
BMC Health Serv Res. 2017 Jun 19;17(1):412. doi: 10.1186/s12913-017-2370-5.
Wellbeing of healthcare workers is important for the effective functioning of health systems. The aim of this study was to explore the conceptualisations of wellbeing, stress and burnout among healthcare workers in primary healthcare settings in rural Ethiopia in order to inform the development of contextually appropriate interventions.
A qualitative study was conducted in a rural zone of southern Ethiopia. A total of 52 frontline primary healthcare workers participated in in-depth interviews (n = 18) or Focus Group Discussions (FGDs) (4 groups, total n = 34). There were 35 facility based healthcare professionals and 17 community-based health workers. Data were analysed using thematic analysis.
Most participants conceptualised wellbeing as absence of stress rather than as a positive state. Many threats to wellbeing were identified. For facility-based workers, the main stressors were inadequate supplies leading to fears of acquiring infection and concerns about performance evaluation. For community health workers, the main stressor was role ambiguity. Workload and economic self-sufficiency were a concern for both groups. Burnout and its symptoms were recognised and reported by most as a problem of other healthcare workers. Derogatory and stigmatising terms, such as "chronics", were used to refer to those who had served for many years and who appeared to have become drained of all compassion. Most participants viewed burnout as inevitable if they continued to work in their current workplace without career progression. Structural and environmental aspects of work emerged as potential targets to improve wellbeing, combined with tackling stigmatising attitudes towards mental health problems. An unmet need for intervention for healthcare workers who develop burnout or emotional difficulties was identified.
Ethiopian primary healthcare workers commonly face job-related stress and experience features of burnout, which may contribute to the high turnover of staff and dissatisfaction of both patients and providers. Recent initiatives to integrate mental healthcare into primary care provide an opportunity to promote the wellbeing of healthcare workers and intervene to address burnout and emotional problems by creating a better understanding of mental health.
医护人员的福祉对于卫生系统的有效运作至关重要。本研究的目的是探讨埃塞俄比亚农村基层医疗环境中医护人员对福祉、压力和职业倦怠的概念理解，以便为制定因地制宜的干预措施提供依据。
在埃塞俄比亚南部的一个农村地区开展了一项定性研究。共有52名一线基层医护人员参与了深度访谈（n = 18）或焦点小组讨论（4组，共n = 34）。其中有35名医疗机构的医护专业人员和17名社区卫生工作者。采用主题分析法对数据进行分析。
大多数参与者将福祉概念化为没有压力，而非一种积极的状态。确定了许多对福祉的威胁。对于医疗机构的工作人员来说，主要压力源是物资供应不足导致对感染的恐惧以及对绩效评估的担忧。对于社区卫生工作者来说，主要压力源是角色模糊。工作量和经济自给自足是两组人员都关心的问题。大多数人认识到职业倦怠及其症状是其他医护人员的问题并进行了报告。诸如“慢性病患者”等贬损性和污名化的词汇被用来指代那些服务多年且似乎已耗尽所有同情心的人。大多数参与者认为，如果他们继续在当前工作场所工作而没有职业发展，职业倦怠是不可避免的。工作的结构和环境方面成为改善福祉的潜在目标，同时要解决对心理健康问题的污名化态度。确定了对出现职业倦怠或情绪问题的医护人员进行干预的未满足需求。
埃塞俄比亚基层医护人员普遍面临与工作相关的压力，并经历职业倦怠的特征，这可能导致员工高流动率以及患者和医护人员的不满。最近将精神卫生保健纳入初级保健的举措提供了一个机会，通过更好地理解心理健康来促进医护人员的福祉，并干预解决职业倦怠和情绪问题。
