Habtu Yitagesu, Kumie Abera, Selamu Medhine, Harada Hidenori, Kaneko Morie, Kaba Mirgissa, Girma Eshetu
Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
Department of Mental Health Epidemiology, School of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia.
PLoS One. 2025 Jan 10;20(1):e0314170. doi: 10.1371/journal.pone.0314170. eCollection 2025.
Despite the rising prevalence of common mental symptoms, information is scarce on how health workers make sense of symptoms of mental disorders and perceive a link with inadequate water, sanitation, and hygiene (WASH) as work stressors to understand causation and produce useful knowledge for policy and professionals. Therefore, this study aimed to explore how health workers perceive the link between inadequate WASH and common mental symptoms (CMSs) at hospitals in central and southern Ethiopian regions.
We used an interpretive and descriptive phenomenological design guided by theoretical frameworks. Three focus group discussions (FGDs) and 10 in-depth interviews with health workers were conducted. We explored the perceived link with inadequate WASH after assessing health workers' conceptualization of common mental health symptoms. The interviews and FGDs were audio recorded, transcribed, and translated into English. Coding and categorizing were supported by MaxQDA software 2020. Thematic analysis was performed and themes were supported by participants' quotes when necessary.
Four themes emerged from the data based on the guiding theoretical models relevant to the research questions. Most health workers believed and frequently suggested that inadequate water supply, functional hand hygiene, environmental cleaning, and waste management services at the points of care increased the risk of occupational stress, job anxiety, and occupational depression symptoms. Many participants believed that inadequate WASH would cause them to experience negative professional quality of life including burnout, compassion dissatisfaction, and compassion fatigue at work despite believing that WASH problems cannot be solved at the individual level. Participants recurrently listed many individual, organizational, and system-level barriers to reducing and coping with inadequate WASH as stressors.
Healthcare workers perceived inadequate WASH components as contributing to symptoms of common mental disorders and negatively impacting their professional quality of life. They faced multiple barriers at individual, organizational, and health system levels, which hindered their ability to manage work-related stress and seek mental health support. The findings suggest the implementation of integrated WASH and mental health services for healthcare workers, ranging from establishing individual-level interventions to increasing access to WASH around care areas through collaborative efforts with healthcare administration, broader health systems, water supplies, and sewerage services.
尽管常见精神症状的患病率不断上升，但关于卫生工作者如何理解精神障碍症状以及如何将与水、环境卫生和个人卫生（WASH）不足相关的工作压力视为导致精神障碍的原因，并为政策制定者和专业人员提供有用知识的信息却很少。因此，本研究旨在探讨埃塞俄比亚中南部地区医院的卫生工作者如何看待WASH不足与常见精神症状（CMSs）之间的联系。
我们采用了以理论框架为指导的解释性和描述性现象学设计。对卫生工作者进行了三次焦点小组讨论（FGD）和10次深入访谈。在评估了卫生工作者对常见心理健康症状的概念化之后，我们探讨了他们对WASH不足的认知联系。访谈和FGD均进行了录音、转录，并翻译成英文。编码和分类由MaxQDA 2020软件支持。进行了主题分析，并在必要时引用参与者的话语来支持主题。
根据与研究问题相关的指导理论模型，数据中出现了四个主题。大多数卫生工作者认为并经常表示，医疗机构的供水不足、手部卫生功能、环境清洁和废物管理服务增加了职业压力、工作焦虑和职业抑郁症状的风险。许多参与者认为，尽管他们认为WASH问题无法在个人层面得到解决，但WASH不足会导致他们在工作中经历负面的职业生活质量，包括职业倦怠、同情心不满和同情疲劳。参与者反复列出了许多个人、组织和系统层面的障碍，这些障碍阻碍了他们减少和应对WASH不足带来的压力。
医护人员认为WASH不足的因素会导致常见精神障碍症状，并对他们的职业生活质量产生负面影响。他们在个人、组织和卫生系统层面面临多重障碍，这阻碍了他们管理与工作相关压力并寻求心理健康支持的能力。研究结果表明，应为医护人员实施综合的WASH和心理健康服务，范围从建立个人层面的干预措施到通过与医疗管理部门、更广泛的卫生系统、供水和污水处理服务部门的合作努力，增加医疗机构周边的WASH设施。
