Factors shaping the mental health of healthcare workers during the COVID-19 pandemic: a qualitative study in Ghana.

Abstract

Introduction: The COVID-19 pandemic negatively impacted the working conditions and mental health of healthcare workers (HCWs) across the globe. Little is understood of the factors influencing the mental health of HCWs in low-and middle-income countries like Ghana, which faced significant challenges from the COVID-19 pandemic due to their overburdened healthcare systems. Our study qualitatively examined the multilevel factors influencing HCWs' mental health in response to the pandemic in Ghana, as well as coping strategies.

Methods: Utilizing an exploratory, descriptive qualitative research design, we purposively sampled and interviewed HCWs (n = 26) and administrators (n = 3) across 13 regions in Ghana from our parent study (N = 646) between November 2020 and February 2021. Semi-structured interviews explored pandemic preparedness, experiences responding to the pandemic, the impact of the pandemic on life, work, quality of care, and mental health; challenges and facilitators of the COVID-19 response; and coping strategies. Transcripts were coded through a group-based collaborative approach in the Dedoose software and analyzed thematically guided by the socio-ecological framework.

Results: HCWs reported experiencing fear, anxiety, stress, and depression due to the COVID-19 pandemic and cited several individual, interpersonal, institutional, and societal factors that adversely impacted their mental health. Individual-level factors included low knowledge of COVID-19 risk and sequelae and contraction of COVID-19. Interpersonal factors included being a parent/caregiver, risk posed to family/household as frontline workers, and social isolation. Institutional factors included inadequate health system capacity (i.e., low staffing capacity) and pandemic preparedness (i.e., inadequate COVID-19 training), and frontline working conditions (i.e., long work hours; higher COVID-19 infection risk). Societal factors were COVID-19-related stigma against HCWs, COVID-19 social conspiracies, and sociocultural beliefs about mental health in Ghana. Despite the negative impact of the pandemic on HCWs' lives, most reported not receiving adequate support from their workplace or the government to mitigate mental health distress. However, HCWs identified several protective factors and coping strategies, including prayer/spirituality, spiritual and emotional support from family and colleagues, and, although limited, work-based or government incentives and appreciation.

Conclusion: The COVID-19 pandemic has adversely impacted the mental health of HCWs in Ghana, who have inadequate resources to address these distresses. Investing in healthcare infrastructure, including expanding workforce and facility capacity and providing workplace mental health wellness services, can help mitigate the mental health impact of health crises like the COVID-19 pandemic on the healthcare workforce and subsequently maximize the capacity of the health system to respond to future pandemics.