Abstract
Since the outbreak of the COVID-19 pandemic, healthcare workers have been at risk of poor mental health outcomes. Reasons cited relate to poor working conditions, shortages in staff and lack of psychological support that have significantly impacted stress levels within the working environment. Community healthcare workers (CHWs) have played a proactive role in the pandemic by disseminating information about the disease, conducting screening, contact tracing, and helping with the home delivery of chronic medication. Moreover, they are trained community members who help bridge the gap in healthcare service delivery between communities and healthcare facilities. They have been deployed in rural areas to address the inequity in service delivery. Despite their resilience, the psychological health and well-being of this cadre has been overlooked, resulting in high stress levels. The main aim of this study was to determine the prevalence of mental stress among the CHWs assigned to rural areas and identify factors associated with mental stress during the COVID-19 pandemic.
A cross-sectional survey was conducted on CHWs in the Capricorn District of Limpopo Province, from August 2022 until October 2022. The GHQ-12 screening tool was used to assess mental stress by online and print questions. Participants were conveniently sampled using a snowball methodology and 304 responses were received from the CHWs working in various community- based organisation (CBOs) in the district. The questionnaire included questions on socio-demographics, mental health risk assessment, challenges related to working conditions, and accessing mental health support. The data from completed surveys were analysed using the STATA version 17 statistical programme. A descriptive analysis was conducted to calculate the frequency of the socio-demographics and risk factors. Finally, the logistic regression (crude and adjusted) with odds ratios was used to identify the factors significantly associated with mental stress among CHWs in the Capricorn District.
The main results showed an increased prevalence of mental stress among CHWs in the Capricorn District (79.28%). Most respondents (n=280; 92.1%) were concerned about contracting COVID-19 infection at work or in the community. The mental stress was mainly related to the type of organisation the care worker was affiliated with and the type of work contract. Additionally, there was a statistically significant association between mental stress and occupational exposure to COVID-19, recurrent infection and lack of mental health support (AOR: 3.76, 95% CI: 1.26 - 11.21, p= 0.017; AOR: 7.34, 95% CI: 1.79 - 30.01, p= 0.005 & AOR: 0.24; 95% CI: 0.09 - 0.62; p= 0.003, respectively).
The findings of this study highlights the increased prevalence of mental stress among the CHWs in Capricorn District during the COVID-19 pandemic. The analysis showed that most participants were exposed to COVID-19 in the community and workplace. Repeated infections, and not having access to mental healthcare were significant risk factors. Both government agencies and non-profit organisations should benefit from the study's outcomes in dealing with future pandemics. Results from the study highlight the need for initiatives to reduce exposure to psychosocial risks and for policies that actively promote better mental health on the job. These results will also help decision-makers to understand the mental health needs of CHWs working in the healthcare system.