Burnout among primary healthcare workers during implementation of integrated mental healthcare in rural Ethiopia: a cohort study.
Burnout
Ethiopia
Healthcare workers
Job-related stress
Primary healthcare
Professional satisfaction
Wellbeing
Journal
Human resources for health
ISSN: 1478-4491
Titre abrégé: Hum Resour Health
Pays: England
ID NLM: 101170535
Informations de publication
Date de publication:
18 07 2019
18 07 2019
Historique:
received:
11
10
2018
accepted:
05
06
2019
entrez:
20
7
2019
pubmed:
20
7
2019
medline:
2
4
2020
Statut:
epublish
Résumé
The short-term course of burnout in healthcare workers in low- and middle-income countries has undergone limited evaluation. The aim of this study was to assess the short-term outcome of burnout symptoms in the context of implementation of a new mental health programme in a rural African district. We followed up 145 primary healthcare workers (HCWs) working in 66 rural primary healthcare (PHC) facilities in Southern Ethiopia, where a new integrated mental health service was being implemented. Burnout was assessed at baseline, i.e. when the new service was being introduced, and after 6 months. Data were collected through self-administered questionnaires, including the Maslach Burnout Inventory (MBI) and instruments measuring professional satisfaction and psychosocial factors. Generalised estimating equations (GEE) were used to assess the association between change in the core dimension of burnout (emotional exhaustion) and relevant work-related and psychosocial factors. A total of 136 (93.8%) of HCWs completed and returned their questionnaires at 6 months. There was a non-significant reduction in the burnout level between the two time points. In GEE regression models, high depression symptom scores (adjusted mean difference (aMD) 0.56, 95% CI 0.29, 0.83, p < 0.01), experiencing two or more stressful life events (aMD 1.37, 95% CI 0.06, 2.14, p < 0.01), being a community health extension worker vs. facility-based HCW (aMD 5.80, 95% CI 3.21, 8.38, p < 0.01), perceived job insecurity (aMD 0.73, 95% CI 0.08, 1.38, p = 0.03) and older age (aMD 0.36, 95% CI 0.09, 0.63, p = 0.01) were significantly associated with higher levels of emotional exhaustion longitudinally. In the short-term, there was no significant change in the level of burnout in the context of adding mental healthcare to the workload of HCWs. However, longer term and larger scale studies are required to substantiate this. This evidence can serve as baseline information for an intervention development to enhance wellbeing and reduce burnout.
Sections du résumé
BACKGROUND
The short-term course of burnout in healthcare workers in low- and middle-income countries has undergone limited evaluation. The aim of this study was to assess the short-term outcome of burnout symptoms in the context of implementation of a new mental health programme in a rural African district.
METHODS
We followed up 145 primary healthcare workers (HCWs) working in 66 rural primary healthcare (PHC) facilities in Southern Ethiopia, where a new integrated mental health service was being implemented. Burnout was assessed at baseline, i.e. when the new service was being introduced, and after 6 months. Data were collected through self-administered questionnaires, including the Maslach Burnout Inventory (MBI) and instruments measuring professional satisfaction and psychosocial factors. Generalised estimating equations (GEE) were used to assess the association between change in the core dimension of burnout (emotional exhaustion) and relevant work-related and psychosocial factors.
RESULTS
A total of 136 (93.8%) of HCWs completed and returned their questionnaires at 6 months. There was a non-significant reduction in the burnout level between the two time points. In GEE regression models, high depression symptom scores (adjusted mean difference (aMD) 0.56, 95% CI 0.29, 0.83, p < 0.01), experiencing two or more stressful life events (aMD 1.37, 95% CI 0.06, 2.14, p < 0.01), being a community health extension worker vs. facility-based HCW (aMD 5.80, 95% CI 3.21, 8.38, p < 0.01), perceived job insecurity (aMD 0.73, 95% CI 0.08, 1.38, p = 0.03) and older age (aMD 0.36, 95% CI 0.09, 0.63, p = 0.01) were significantly associated with higher levels of emotional exhaustion longitudinally.
CONCLUSION
In the short-term, there was no significant change in the level of burnout in the context of adding mental healthcare to the workload of HCWs. However, longer term and larger scale studies are required to substantiate this. This evidence can serve as baseline information for an intervention development to enhance wellbeing and reduce burnout.
Identifiants
pubmed: 31319872
doi: 10.1186/s12960-019-0383-3
pii: 10.1186/s12960-019-0383-3
pmc: PMC6639922
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
58Subventions
Organisme : Medical Research Council
ID : MR/M025470/1
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/S001255/1
Pays : United Kingdom
Références
Psychol Health. 2001 Sep;16(5):501-10
pubmed: 22804495
Afr J Psychiatry (Johannesbg). 2009 Feb;12(1):71-4
pubmed: 19526650
Milbank Q. 2005;83(3):457-502
pubmed: 16202000
J Adv Nurs. 2011 Feb;67(2):371-83
pubmed: 21044134
Soc Psychiatry Psychiatr Epidemiol. 2015 Jun;50(6):1005-11
pubmed: 25527209
BMC Health Serv Res. 2017 Jun 19;17(1):412
pubmed: 28629360
BMJ Open. 2015 Aug 23;5(9):e008331
pubmed: 26359284
J Affect Disord. 2015 Nov 1;186:32-9
pubmed: 26226431
BMC Psychiatry. 2017 May 5;17(1):167
pubmed: 28476149
J Affect Disord. 2013 Sep 25;150(3):931-40
pubmed: 23726778
Soc Sci Med. 2000 Aug;51(3):321-34
pubmed: 10855920
Nurs Ethics. 2017 May;24(3):337-348
pubmed: 26350707
N Engl J Med. 2014 Feb 6;370(6):552-7
pubmed: 24499213
Am J Respir Cell Mol Biol. 2016 Apr;54(4):524-31
pubmed: 26407210
J Nurs Manag. 2016 Mar;24(2):235-43
pubmed: 25900394
JAMA. 2004 Jun 2;291(21):2581-90
pubmed: 15173149
Annu Rev Psychol. 2001;52:397-422
pubmed: 11148311
BMC Med Educ. 2017 Nov 9;17(1):195
pubmed: 29121895
Dtsch Arztebl Int. 2011 Jan;108(4):47-52
pubmed: 21307991
Electron Physician. 2016 Sep 20;8(9):2924-2930
pubmed: 27790345
Psychiatry Res. 2013 Dec 15;210(2):653-61
pubmed: 23972787
J Ayub Med Coll Abbottabad. 2008 Jul-Sep;20(3):135-9
pubmed: 19610539
BMC Psychiatry. 2014 Jul 07;14:194
pubmed: 24999041
PLoS Med. 2012;9(12):e1001359
pubmed: 23300387
J Nurs Scholarsh. 2016 Jan;48(1):83-90
pubmed: 26650339
Glob Health Action. 2013 Jan 24;6:19287
pubmed: 23364090
Scand J Work Environ Health. 2015 Nov;41(6):565-8
pubmed: 26343843
PLoS One. 2014 Aug 14;9(8):e103754
pubmed: 25121789
Tunis Med. 2013 Jan;91(1):44-9
pubmed: 23404597
ISRN Nurs. 2012;2012:402157
pubmed: 22619733
Occup Med (Lond). 2012 Mar;62(2):145-7
pubmed: 22121245
Br J Psychiatry. 2016 Jan;208 Suppl 56:s4-12
pubmed: 26447174
Issues Ment Health Nurs. 2011;32(4):234-42
pubmed: 21355758
Behav Med. 1992 Summer;18(2):53-60
pubmed: 1392214
J Clin Nurs. 2012 Jun;21(11-12):1763-75
pubmed: 22458703
J Gen Intern Med. 2008 Oct;23(10):1581-8
pubmed: 18618195
Gen Hosp Psychiatry. 2010 Jul-Aug;32(4):345-59
pubmed: 20633738
Gates Open Res. 2018 Jun 11;2:4
pubmed: 29984356
Psychol Health Med. 2016 Jun;21(4):401-412
pubmed: 26325347
Evid Based Ment Health. 2018 Feb;21(1):30-34
pubmed: 28903977
Can J Psychiatr Nurs. 1979 Nov-Dec;20(6):5-9
pubmed: 260904
Hum Resour Health. 2017 Feb 3;15(1):10
pubmed: 28159007
Psychol Med. 1985 Feb;15(1):189-94
pubmed: 3991833
Jpn J Nurs Sci. 2016 Jan;13(1):156-65
pubmed: 26542752
Glob Health Action. 2014 Feb 13;7:23611
pubmed: 24560265
Hum Resour Health. 2017 Apr 24;15(1):31
pubmed: 28438214
Lancet. 2009 Jul 11;374(9684):170-3
pubmed: 19439350
Hum Resour Health. 2006 May 27;4:12
pubmed: 16729892
Acad Med. 2016 Sep;91(9):1251-6
pubmed: 26934693
PLoS One. 2012;7(9):e44948
pubmed: 22984592
Lancet. 2015 Apr 4;385(9975):1352-8
pubmed: 25458718