PDF(Pubmed)
Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
摘要：
背景：在撒哈拉以南非洲（SSA）的高疾病负担和资源受限的背景下，卫生工作者经历了一系列的社会心理压力，使他们容易发展倦怠，这可能会降低服务质量，并对他们自己的健康和福祉产生负面影响。随着艾滋病毒的通用检测和治疗(UTT)在SSA范围内扩大，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,以便为卫生人力人员配备和支持需求决策提供信息.
方法：使用Maslach倦怠量表-人类服务调查(MBI-HSS)，我们评估了三个领域的倦怠情绪衰竭的患病率，去个性化,和个人成就-在赞比亚和南非接受UTT干预的地区提供卫生服务的三名卫生工作者干部中。这些干部包括医疗机构工作人员(n=478)，社区卫生工作者（n=159），以及专门研究的社区HIV护理提供者干部（n=529）。我们使用线性回归来评估与情绪衰竭相关的危险因素，我们样本中唯一具有足够变化的域。
结果：MBI-HSS由1499/2153名符合条件的参与者完成（69.6%的应答率）。不到1%的卫生工作者符合Maslach对职业倦怠的定义。与以前的此类研究相比，所有卫生工作者组的情绪疲惫程度均较低（在54名卫生干部中，平均得分为10.7至15.4）。较高的情绪衰竭与较高的教育程度相关（βadj=2.24，95％CI0.76至3.72），提供艾滋病毒服务的年限更长(βadj=0.20，95%CI0.03至0.36)，并且在最后一次HIV检测中HIV检测呈阴性（βadj=-3.88-95％CI5.69至-2.07）。作为CHW工作与较低的情绪衰竭显着相关（βadj=-2.52，95％CI-4.69至-0.35）。在所有卫生工作者中，无论艾滋病毒感染状况如何，在同事中目睹对HIV感染者的污名化行为与情绪衰竭显著增加相关(βadj=3.38,95%CI1.99~4.76).
结论：卫生工作者中检测到的低水平倦怠令人放心。然而,随着时间的推移，评估UTT如何影响卫生工作者的情绪疲惫水平仍然很重要，特别是在新兴的全球流行病的背景下，因为倦怠可能会影响他们提供的艾滋病毒服务的质量以及他们自己的心理健康和福祉。减少卫生机构中艾滋病毒污名的干预措施可以防止卫生工作者情绪疲惫，以及干预措施，以提高有职业倦怠风险的卫生工作者的正念和韧性。试验注册ClinicalTrials.gov编号：NCT01900977。
方法：使用Maslach倦怠量表-人类服务调查(MBI-HSS)，我们评估了三个领域的倦怠情绪衰竭的患病率，去个性化,和个人成就-在赞比亚和南非接受UTT干预的地区提供卫生服务的三名卫生工作者干部中。这些干部包括医疗机构工作人员(n=478)，社区卫生工作者（n=159），以及专门研究的社区HIV护理提供者干部（n=529）。我们使用线性回归来评估与情绪衰竭相关的危险因素，我们样本中唯一具有足够变化的域。
结果：MBI-HSS由1499/2153名符合条件的参与者完成（69.6%的应答率）。不到1%的卫生工作者符合Maslach对职业倦怠的定义。与以前的此类研究相比，所有卫生工作者组的情绪疲惫程度均较低（在54名卫生干部中，平均得分为10.7至15.4）。较高的情绪衰竭与较高的教育程度相关（βadj=2.24，95％CI0.76至3.72），提供艾滋病毒服务的年限更长(βadj=0.20，95%CI0.03至0.36)，并且在最后一次HIV检测中HIV检测呈阴性（βadj=-3.88-95％CI5.69至-2.07）。作为CHW工作与较低的情绪衰竭显着相关（βadj=-2.52，95％CI-4.69至-0.35）。在所有卫生工作者中，无论艾滋病毒感染状况如何，在同事中目睹对HIV感染者的污名化行为与情绪衰竭显著增加相关(βadj=3.38,95%CI1.99~4.76).
结论：卫生工作者中检测到的低水平倦怠令人放心。然而,随着时间的推移，评估UTT如何影响卫生工作者的情绪疲惫水平仍然很重要，特别是在新兴的全球流行病的背景下，因为倦怠可能会影响他们提供的艾滋病毒服务的质量以及他们自己的心理健康和福祉。减少卫生机构中艾滋病毒污名的干预措施可以防止卫生工作者情绪疲惫，以及干预措施，以提高有职业倦怠风险的卫生工作者的正念和韧性。试验注册ClinicalTrials.gov编号：NCT01900977。
