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   Table of Contents      
ORIGINAL ARTICLE
Year : 2022  |  Volume : 8  |  Issue : 2  |  Page : 121-126

Quality of Life of Health Care Professionals During COVID-19 Pandemic in India


1 Medical Student, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
2 Medical Student, University College of Medical Sciences and Guru Tegh Bahadur Hospital, New Delhi, India
3 Associate Professor, Department of Community Medicine, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
4 Professor, Department of Medicine, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India

Date of Submission30-Dec-2021
Date of Decision20-Jan-2022
Date of Acceptance04-Apr-2022
Date of Web Publication23-Aug-2022

Correspondence Address:
Yash Aggarwal
31/D, K- Pocket, Sheikh Sarai Phase- II, New Delhi-110017
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mamcjms.mamcjms_134_21

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  Abstract 


Introduction: Nature of disease, poor working conditions, prolonged work duration, stigma, and discrimination in the community have worsened the well-being of health care professionals in COVID-19. This survey is conducted to understand the quality of life and its key determinants among health care workers (HCWs) during the COVID-19 pandemic in a low middle-income country like India. Methodology: A cross-sectional study using a Google form-based online questionnaire survey was planned at two COVID dedicated centers of New Delhi. A convenience sample of 300 HCWs involved in patient care at the study sites was studied using an SF-36 questionnaire for quality of life assessment and a self-made questionnaire (risk exposure assessment). Results: In the study, 61.0% were males and 40.72% were females across all specialties. The majority (77%) were single and 81.4% were from the age group of 20 to 30 years. 84% of the study subjects belonged to clinical specialties. Nearly 56% of study subjects reported being not satisfactory or uncomfortable in the personal protective equipment (PPE). Shortage of PPE was reported by 10% of study subjects. The majority (82.35%) of study subjects were satisfied with the quality of PPE. Satisfaction of the study subjects was less than satisfactory among food provided, accommodation, and transport facilities. Social isolation (70.5%) and lockdown restraints (57.6%) were reported by the majority of study subjects. The median score for the domain of general vitality was 55, for the emotional domain was 33, and for social was 62. The domains of quality of life were not significantly affected by place of work, discipline, age, sex, and type of work. Conclusion: The overall well-being of HCWs was affected during the pandemic mostly across mental, social, and general vitality domains. Social isolation was a key concern reported by the majority of HCWs.

Keywords: COVID-19, health care professional, mental health, quality of life


How to cite this article:
Kaur B, Aggarwal Y, Bhatnagar N, Singla S. Quality of Life of Health Care Professionals During COVID-19 Pandemic in India. MAMC J Med Sci 2022;8:121-6

How to cite this URL:
Kaur B, Aggarwal Y, Bhatnagar N, Singla S. Quality of Life of Health Care Professionals During COVID-19 Pandemic in India. MAMC J Med Sci [serial online] 2022 [cited 2022 Oct 6];8:121-6. Available from: https://www.mamcjms.in/text.asp?2022/8/2/121/354344




  Introduction Top


The COVID-19 pandemic has impacted lives across the globe. The pandemic did put health care professionals in an unprecedented situation, having to make impossible decisions and work under extreme pressures. These decisions included allocation of scant resources to equally needy patients, balancing their own physical and mental health care needs with those of patients, aligning their desire and duty to patients with those of family and friends, and providing care for all severely unwell patients with constrained or inadequate resources. The concerns for the poor quality of life of health care workers (HCWs) have existed across pandemics that have occurred in past. In the current COVID-19 pandemic also health systems have been exhausted and the concern for the quality of life of HCWs emerged as a priority area with the pandemic stretching from 2020 to 2021. Efficient utilization of resources is required at the time of pandemic and effective management of the health workforce is critical.[1]

COVID-19 disease is an infectious disease caused by the Severe Acute Respiratory Syndrome novel Coronavirus-2 (SARS nCoV-2) virus, which mainly spreads via aerosols of saliva/sputum while coughing or fluid discharged from the nose while sneezing.[2] Fomite-based or feco-oral mode of transmission of the virus is still debatable. The respiratory route of transmission with high communicability leads to the rapid spread of infection. Occupational health hazard, unsafe working environments, insufficient training in infection control, lack of sufficient protective equipment along with mistrust of the public together adversely impacts the quality of life of health workers in a major way.[3]. WHO defines quality of life as an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns. It is a broad-ranging concept affected in a complex way by the person’s physical health, psychological state, personal beliefs, social relationships, and relationship to salient features of their environment.[4]

This survey is conducted to understand the quality of life and its key determinants among HCWs during the COVID-19 pandemic in a low middle-income country like India. It will be essential to understand the overall well-being of health workers and suggest policy measures that can address the same.


  Objective Top


  1. To assess the quality of life of HCWs involved in COVID-19 prevention, control, and treatment in dedicated COVID-19 hospitals (Lok Nayak Hospital and GTB Hospital) in Delhi.
  2. To study the sociodemographic determinants affecting the quality of life of HCWs.



  Methodology Top


Study design

Google form-based online questionnaire survey – Cross-sectional study

Inclusion criteria

HCWs involved in patient care in COVID dedicated hospitals – Lok Nayak Hospital and GTB Hospital of Government of National Capital Territory of Delhi (GNCT Delhi).

Health Care workers (HCW) were categorised as per KUPPUSWAMY SCALE and must have undertaken.

Sampling

Convenience sampling was done in the study. All HCWs that fit the inclusion criteria were requested to participate in the study. Representativeness was ensured by having at least 10 HCWs from each department of Maulana Azad Medical College (MAMC) and Lok Nayak Hospital (LNH) and GTB Hospital involved in COVID care.

Data collection

The list of HCWs working at the study site was made by the investigators. The HCWs were contacted via phone and then an online Google form was sent via email. The period of the survey was June to July 2020. We assessed their quality of life while working with COVID-19 patients or suspects in the hospital. Repeat reminders were given after 7 days. A maximum of three reminders were given to every study participant who agreed to enroll in the study. Email reminders were followed up by telephonic reminders to ensure participation and reduce the dropout rate.

Study instruments

1. The Short Form Health Survey (SF-36) questionnaire measures health status, taking into account physical functioning, emotional and physical role functioning, mental health in general, social role functioning, body pain, and general health.[5],[6].

2. Self-designed questionnaire intended to measure demographics of HCWs, extent and type of involvement in COVID-19 pandemic control, and the level of exposure. Grading for the level of exposure was done as per Ministry of Health and Family Welfare guidelines that grades the HCWs in different criteria of risk for the level of PPE required.

The questionnaire was designed, pretested, and validated on five HCWs in the college before subjecting it to study subjects via online mode. Pretesting of the online version in five subjects was done and relevant changes were made to ensure that there was compliance in filling the online questionnaire and no dropouts in the middle of the study.

Data analysis

Data were entered in Statistical Package for the Social Sciences (SPSS) 24. Univariate analysis was done to check the data entry. The bivariate analysis included student's t-test for parametric data and chi-square test for categorical data. Data were summarized in appropriate tables and graphs along with appropriate measures of central tendency. Relevant subgroup analysis was done based on gender, age, profession, specialty, and type of care provided. Multivariate analysis was done to assess the key determinants impacting the Quality of Life (QOL) score among HCWs.

Statistical consideration

We considered P as 50% and prevalence as 40% and assumed 10% nonresponders.

We calculated sample size and statistical power using formula

n = (z)2 p ( 1 – p ) / d2, where P = 0.5

The sample size came out to be 110.

We assumed the response rate as 60 to 65%, so the form was sent to 170 candidates from each hospital - Lok Nayak Hospital and GTB Hospital.

Ethical Considerations; Objectives

Informed consent was taken from all the HCWs before beginning the study. All the data of the study were dealt with confidentially, and no data sharing was done without the permission of the study subjects. Participation was voluntary by HCW. Informed consent was taken before the study was conducted and protocol was approved by the Ethical Committee of both the Hospitals.


  Results Top


The study included 302 participants. The majority of the participants belonged to the age group of 21 to 30 years, which was 244 (80.8%) of the total population, followed by 46 (15.2%) of the study group of the age group 31 to 40 years. The study had 179 (59.3%) males and 123 (40.7%) females. Most of the study population was found to be unmarried counting to 235 (77.8%) participants. 254 (84.1%) participants were from the clinical departments. We found that many factors such as social isolation (211, 69.9%), lockdown restraints (175, 57.9%), financial (65, 21.5%), parental controls (37, 11.6%), and others (176, 55%) were key concerns impacting our study population.

The majority (89.1%) of the population used N95 masks, out of which, more than half of the participants {166 (54.9%)} found it uncomfortable, and nearly half (49.3%) reported the quality to be good. In total of 228 (75.49%) participants, suggested adequate availability of PPE for protection.

[Table 2] represents that 161(53.31%) out of 302 population showed satisfaction with working conditions, 188/257 (73.15%) were satisfied with meals provided to them, 244/268 (91.1%) were satisfied with accommodation given, but only 130/216 (60.1%) were satisfied with transportation facility. Good support from the colleagues and other HCWs was reported by more than half of the study subjects (57.3%). However few (30.8%) considered the administration as ‘very supportive’.
Table 1 Use of PPE among study subjects (N = 302)

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Table 2 Support structure available to study subjects

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[Table 3] shows various factors that assess the exposure to COVID-19 among study subjects. More than 30 patients affected by COVID-19 were seen by 130 (43%) of the study subjects per week. 288 (95.36%) of the HCWs worked in wards and ICU compared to 14 (4.63%) who worked in laboratories, isolation, and testing centers. The number of hours devoted to duty per week by HCWs was found to be 48 hours in a week for nearly half of the study population (159 (52.6%)). Around 89.4% (270) worked in red zone which is a high exposure zone involving direct physical contact, exposure from the clinically diagnosed case, and aerosol generating areas. Accidental exposure was reported by 103 study subjects (34.5%) and among them only 13 were tested positive. Nearly 91 out of 103 study subjects were not tested despite exposure.
Table 3 Assessment of COVID-19 exposure among study subjects

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Fear of getting infected was studied among HCWs. In [Figure 1], it was observed that HCWs from the preclinical department showed more fear (96.29%) of getting infected compared to those from clinical specialty (83.72%). Also, as per [Figure 2], those who were working in green zone (93.80%) showed more fear of getting infected than those working in red zone (6.20%). [Table 4] gave the scores obtained by SF-36 to measure quality of life among study subjects across all domains. Poorer scores were obtained for domains measuring mental health (median value – 64), vitality (median value – 55), social functioning (median value – 62.5), and emotional health (median value – 50). The scores of QOL did not vary significantly across gender and specialty/department after applying independent sample t test and Kruskel-Wallis test.
Figure 1 Fear of getting infected among study subjects across medical specialities

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Figure 2 Fear of getting infected as per the nature of job among study subjects

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Table 4 QOL measured by Short Form Health Survey Questionnaire-36 (SF-36) among study subjects

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  Discussion Top


Our study conducted in COVID dedicated hospitals of Delhi. We tried to assess the quality of life among treating HCWs, their satisfaction with the environment, and other extraneous factors that can potentially impact the quality of life and their fears to contract the disease.

Similar studies have been done for pandemics that came in past and for COVID-19 globally. The results have conclusively proven significantly poor quality of life and significant mental and physical health effects on HCWs in pandemics, outbreaks, and disaster-like situations. The determinants of poor QOL are near about the same across studies. Preti et al. found that there is empirical evidence across various pandemics that underlines the need to address the detrimental effects of epidemic/pandemic outbreaks on HCWs’ mental health.[7] Recommendations should include the assessment and promotion of coping strategies and resilience, special attention to frontline HCWs, provision of adequate protective supplies, and organization of online support services. In a study by Tran et al., physical activity and higher Health literacy (HL) were found to protect against anxiety and depression and were associated with higher Health-Related Quality of Life (HRQoL). Unexpectedly, smoking and drinking were also found to be coping behaviors. It is important to have strategic approaches that protect HCWs’ mental health and HRQoL.[8]

In a scoping review conducted by Shaukat et al., on mental and physical health impacts of COVID-19, working in a high-risk department, diagnosed family member, inadequate hand hygiene, suboptimal hand hygiene before and after contact with patients, improper PPE use, close contact with patients (≥12 times/day), long daily contact hours (≥15 hours), and unprotected exposure were found as significant concerns.[9] Another systematic review conducted for the literature among HCWs across pandemic found extensive strain was due to stress experiences as well as depression and anxiety symptoms. Severe degrees of those symptoms were found in 2.2% to 14.5% of study subjects. The severity of mental symptoms was influenced by age, gender, occupation, specialization, type of activities performed, and proximity to COVID-19 patients.[10] Satisfaction scores with a study done in Maharashtra during the pandemic demonstrated a high prevalence of symptoms of depression and anxiety and low QoL among Indian Healthcare professionals (HCPs) during the COVID‐19 pandemic.[11]

HCWs who treated COVID-19 patients in Serbia were more afraid of becoming infected or of transmitting the infection to a family member with a significantly low self-assessment of their mental status. Poor quality of sleep and health related quality of life correlated with high health anxiety and severe depressive symptoms and several demographic characteristics.[12] In our study, it was observed that HCWs from the preclinical department (96.29%) and working in the green zone (93.80%) showed more fear of getting infected compared to those from the clinical specialty (83.72%) and those working in the red zone (6.20%).

Of 1685 participants studied during mid-pandemic in the United States of America, 31% endorsed mild anxiety and 33% clinically meaningful anxiety; 29% reported mild depressive symptoms and 17% moderate to severe depressive symptoms; 5% endorsed suicidal ideation; and 14% screened positive for post-traumatic stress disorder.[13]

In a study conducted in Italy, a comparison between health care professionals working in COVID-19 wards and other units revealed that the former reported higher levels of both depressive symptoms and Posttraumatic Stress Syndrome (PTSS). Moreover, the results of regression analyses showed that in health care professionals working with COVID-19 patients, gender, marital status, and age significantly predicted depressive symptoms and PTSS.[14] However, the application of tests of significance in our study found no sociodemographic factor having a significant association with the quality of life of HCWs. However, satisfaction across various extraneous factors (food, administration, transport, accommodation) was reported suboptimal by HCWs influencing the poor quality of life scores reported by SF36 scale.

Significantly higher levels of stress, burnout, secondary trauma, anxiety, and depression were observed among professionals working with COVID-19 patients. Higher levels of stress and burnout and lower levels of compassion satisfaction were detected in professionals working in areas with higher rates of contagion. No interaction effects were found between working (or not) with patients affected by COVID-19 and working (or not) in areas with a more severe diffusion of this pandemic.[15],[16]

The overall findings indicate that the mental health of frontline HCWs requires further consideration and that targeted prevention and intervention programs are necessary. A strategic framework to support HCWs during the crisis period should exist in health care institutions and be enforced at the time of emergencies to ensure their care and well-being for ensuring ergonomics and optimum functional capacity.


  Implications Top


The quality of life of HCWs involved in care delivery during the COVID-19 pandemic is poor as was there in other pandemics in the past. The findings are in common with those globally. There is a need to design policy measures to effectively address anxiety and mental health issues emerging among HCWs at the time of pandemic. Considering the limited health manpower available, it is important that they are managed well and are in optimum health and well-being. The results of the study reiterate the emphasis on policies required to support HCW and manage them efficiently in pandemics, especially in low middle-income countries like India where scarce resources offer another challenge. The findings of the study are critical in framing the management protocol of HCWs during outbreaks and health emergencies.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
COVID-19: protecting health-care workers. The Lancet, Volume 395, Issue 10228, 922. DOI:https://doi.org/10.1016/S0140-6736(20)30644-9  Back to cited text no. 1
    
2.
Mohfw.gov.in. 2021. CLINICAL MANAGEMENT PROTOCOL FORCOVID-19 (In Adults). [online] Available at: <https://www.mohfw.gov.in/pdf/UpdatedDetailedClinicalManagementProtocolforCOVID19adultsdated24052021.pdf>.  Back to cited text no. 2
    
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Greenberg N, Docherty M, Gnanapragasam S, Wessely S. Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ 2020;368:1–4.  Back to cited text no. 3
    
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WHOQOL User Manual. PROGRAMME ON MENTAL HEALTH. 2014. P11 https://www.who.int/publications/i/item/WHO-HIS-HSI-Rev.2012.03  Back to cited text no. 4
    
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Ware JE, Snow K, Kosinski M, Gandek B. SF-36 health survey. Boston, Mass.: Health Institute, New England Medical Center.  Back to cited text no. 5
    
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Preti E, Di Mattei V, Perego G, Ferrari F, Mazzetti M, Taranto P et al. The Psychological Impact of Epidemic and Pandemic Outbreaks on Healthcare Workers: Rapid Review of the Evidence. Current Psychiatry Rep. 2020;43:1–22.  Back to cited text no. 7
    
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Tran T, Nguyen H, Pham L, Nguyen M, Nguyen H, Ha T et al. Impacts and interactions of COVID-19 response involvement, health-related behaviours, health literacy on anxiety, depression and health-related quality of life among healthcare workers: a cross-sectional study. BMJ Open 2020;10:11–13.  Back to cited text no. 8
    
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Shaukat N, Ali D, Razzak J. Physical and mental health impacts of COVID-19 on healthcare workers: a scoping review. Int J Emerg Med 2020;13:40.  Back to cited text no. 9
    
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Bohlken J, Schömig F, Lemke MR, Pumberger M, Riedel-Heller SG. COVID-19-Pandemie: Belastungen des medizinischen Personals [COVID-19 pandemic: stress experience of healthcare workers - a short current review]. Psychiatr Prax 2020;47:190–7.  Back to cited text no. 10
    
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Suryavanshi N, Kadam A, Dhumal G et al. Mental health and quality of life among healthcare professionals during the COVID–19 pandemic in India. Brain Behav. 2020;10:e01837  Back to cited text no. 11
    
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Stojanov J, Malobabic M, Stanojevic G, Stevic M, Milosevic V, Stojanov A. Quality of sleep and health-related quality of life among health care professionals treating patients with coronavirus disease-19 [published online ahead of print, 2020 Jul 16]. Int J Soc Psychiatry 2020;20764020942800.  Back to cited text no. 12
    
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Young PK, Kolcz DL, O'Sullivan DM, Ferrand J, Fried J, Robinson K. Health Care Workers' Mental Health and Quality of Life During COVID-19: Results From a Mid-Pandemic, National Survey. Psychiatr Serv. 2021;72:122–128.  Back to cited text no. 13
    
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Di Tella M, Romeo A, Benfante A, Castelli L. Mental health of healthcare workers during the COVID-19 pandemic in Italy. J Eval Clin Pract 2020;26:1583–7.  Back to cited text no. 14
    
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Trumello C, Bramanti S, Ballarotto G, Candelori C, Cerniglia L, Cimino S et al. Psychological Adjustment of Healthcare Workers in Italy during the COVID-19 Pandemic: Differences in Stress, Anxiety, Depression, Burnout, Secondary Trauma, and Compassion Satisfaction between Frontline and Non-Frontline Professionals. Int. J. Environ. Res. Public Health 2020;17:8358.  Back to cited text no. 15
    
16.
Buselli R, Corsi M, Baldanzi S, Chiumiento M, Del Lupo E, Dell’Oste V et al. Professional Quality of Life and Mental Health Outcomes among Health Care Workers Exposed to Sars-Cov-2 (Covid-19). Int. J. Environ. Res. Public Health 2020;17:6180.  Back to cited text no. 16
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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