International Center for Research On Women, Washington, DC, USA.
WomenStrong International, Washington, DC, USA.
Hum Resour Health. 2024 Jul 8;22(1):50. doi: 10.1186/s12960-024-00934-9.
In the high disease burden and resource-constrained contexts of sub-Saharan Africa (SSA), health workers experience a range of psychosocial stressors that leave them vulnerable to developing burnout, which can reduce service quality and negatively impact their own health and wellbeing. As universal testing and treatment (UTT) for HIV scales up across SSA, we sought to understand the implications of this human resource-intensive approach to HIV prevention to inform decision-making about health workforce staffing and support needs.
Using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), we assessed the prevalence of three domains of burnout-emotional exhaustion, depersonalization, and personal accomplishment-among three cadres of health workers delivering health services in areas receiving a UTT intervention in Zambia and South Africa. These cadres included health facility workers (n = 478), community health workers (n = 159), and a study-specific cadre of community HIV care providers (n = 529). We used linear regression to assess risk factors associated with emotional exhaustion, the only domain with sufficient variation in our sample.
The MBI-HSS was completed by 1499/2153 eligible participants (69.6% response rate). Less than 1% of health workers met Maslach's definition for burnout. All groups of health workers reported lower levels of emotional exhaustion than found in previous studies of this type (mean score scores ranged from 10.7 to 15.4 out of 54 across health cadres). Higher emotional exhaustion was associated with higher educational attainment (βadj = 2.24, 95% CI 0.76 to 3.72), greater years providing HIV services (βadj = 0.20, 95% CI 0.03 to 0.36), and testing negative for HIV at last HIV test (βadj = - 3.88 - 95% CI 5.69 to - 2.07). Working as a CHW was significantly associated with lower emotional exhaustion (βadj = - 2.52, 95% CI - 4.69 to - 0.35). Among all health workers, irrespective of HIV status, witnessing stigmatizing behaviors towards people living with HIV among their co-workers was associated with significantly increased emotional exhaustion (βadj = 3.38, 95% CI 1.99 to 4.76).
The low level of burnout detected among health workers is reassuring. However, it remains important to assess how UTT may affect levels of emotional exhaustion among health workers over time, particularly in the context of emerging global pandemics, as burnout may impact the quality of HIV services they provide and their own mental health and wellbeing. Interventions to reduce HIV stigma in health facilities may protect against emotional exhaustion among health workers, as well as interventions to increase mindfulness and resilience among health workers at risk of burnout. Trial registration ClinicalTrials.gov number: NCT01900977.
在撒哈拉以南非洲（SSA）这个疾病负担重且资源有限的地区，卫生工作者面临着一系列的心理社会压力源，这使他们容易出现倦怠，从而降低服务质量，并对他们自己的健康和幸福感产生负面影响。随着在 SSA 范围内普遍开展艾滋病毒检测和治疗（UTT），我们试图了解这种人力资源密集型艾滋病毒预防方法的影响，为决策提供信息，包括卫生人力配置和支持需求。
我们使用马斯拉赫倦怠量表-人类服务调查（MBI-HSS）评估了在赞比亚和南非接受 UTT 干预的三个卫生工作者群体中，三个倦怠领域的流行情况-情感耗竭、去人性化和个人成就感。这些群体包括卫生机构工作人员（n=478）、社区卫生工作者（n=159）和一个专门的社区艾滋病毒护理提供者群体（n=529）。我们使用线性回归来评估与情感耗竭相关的风险因素，情感耗竭是我们样本中唯一变化足够大的领域。
有 1499/2153 名符合条件的参与者（69.6%的回复率）完成了 MBI-HSS。不到 1%的卫生工作者符合马斯拉赫倦怠的定义。所有卫生工作者群体报告的情感耗竭水平均低于之前对这种类型的研究（在卫生工作者群体中，平均得分为 10.7 至 15.4 分，满分为 54 分）。较高的情感耗竭与较高的教育程度（βadj=2.24，95%CI 0.76 至 3.72）、提供艾滋病毒服务的年限较长（βadj=0.20，95%CI 0.03 至 0.36）以及上次艾滋病毒检测呈阴性（βadj=-3.88，95%CI 5.69 至-2.07）有关。作为 CHW 工作与较低的情感耗竭显著相关（βadj=-2.52，95%CI-4.69 至-0.35）。在所有卫生工作者中，无论艾滋病毒状况如何，目睹同事对艾滋病毒感染者的污名化行为与情感耗竭显著增加有关（βadj=3.38，95%CI 1.99 至 4.76）。
在卫生工作者中检测到的倦怠水平较低令人欣慰。然而，评估 UTT 如何随时间影响卫生工作者的情感耗竭水平仍然很重要，特别是在出现新的全球大流行病的情况下，因为倦怠可能会影响他们提供的艾滋病毒服务质量以及他们自己的心理健康和幸福感。减少卫生机构中艾滋病毒污名的干预措施可能会保护卫生工作者免受情感耗竭的影响，而增加有倦怠风险的卫生工作者的正念和适应力的干预措施也可能会保护他们。试验注册临床试验.gov 编号：NCT01900977。
