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ORIGINAL ARTICLE
Year : 2022  |  Volume : 20  |  Issue : 3  |  Page : 257-262

Awareness, anxiety, and stress among health-care workers deployed in swab collection during the COVID-19 pandemic in Andhra Pradesh, India: A cross-sectional study


1 Department of Public Health Dentistry, Narayana Dental College, Nellore, Andhra Pradesh, India
2 Department of Public Health Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
3 Narayana Dental College and Hospital, India

Date of Submission10-Feb-2021
Date of Decision27-Mar-2022
Date of Acceptance18-Apr-2022
Date of Web Publication17-Jun-2022

Correspondence Address:
Mounika Konduru
Department of Public Health Dentistry, Narayana Dental College, Chintareddypalem, Nellore - 524 003, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_18_21

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  Abstract 


Background: Swab collection is a challenging task, and the health-care workers (HCWs) have to face many difficulties while collecting swab samples of suspected patients. They often need to counsel the suspects as some think they do not have an infection but carry fear. Appropriate precautions should be taken in collecting specimens since this may expose HCWs to respiratory secretions from the suspects. Purpose: The purpose of the study was to assess awareness, anxiety, and stress among HCWs deployed in swab collection during the COVID-19 pandemic in Andhra Pradesh, India. Materials and Methods: A total of 102 HCWs filled out the questionnaire in this cross-sectional study. Google Forms were sent through WhatsApp and email. The participants were asked to forward the link to other known people who were also deployed in swab collection. The study took place in Nellore, Andhra Pradesh, for 1 month. Results: About 73.5% of HCWs underwent training in swab collection. 90% of the undergraduates and 89% of the postgraduates were unhappy while staying away from family. Most of the study participants continued to wear personal protective equipment until completion of the working period. 39 of 44 undergraduates felt that swab collection was a high-risk job, and 42 of 55 postgraduates felt the same. Conclusion: Most of the HCWs are unhappy staying away from their family while deployed in swab collection. Majority of them reported swab collection as a high-risk job. As they are frontline workers, an enhanced variety of support should be offered. Psychosocial support and effective measures should be made readily available to them.

Keywords: COVID-19, health-care workers, stress, swab collection


How to cite this article:
Konduru M, Kumar R V, Reddy V C, Gomasani S, Reddy VP, Prasanth P S. Awareness, anxiety, and stress among health-care workers deployed in swab collection during the COVID-19 pandemic in Andhra Pradesh, India: A cross-sectional study. J Indian Assoc Public Health Dent 2022;20:257-62

How to cite this URL:
Konduru M, Kumar R V, Reddy V C, Gomasani S, Reddy VP, Prasanth P S. Awareness, anxiety, and stress among health-care workers deployed in swab collection during the COVID-19 pandemic in Andhra Pradesh, India: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2022 [cited 2022 Sep 25];20:257-62. Available from: https://www.jiaphd.org/text.asp?2022/20/3/257/347728




  Introduction Top


In late December 2019, a previous unidentified coronavirus emerged from Wuhan, China, and resulted in a formidable outbreak in many cities in China and expanded globally. The disease is officially named COVID-19, by the WHO on February 11, 2020.[1]

The rapid global spread of the disease led to the declaration of COVID-19 as a pandemic on March 11, 2020.[2] The exact origin, location, and natural reservoir of the 2019-nCoV remain unclear.[1] A suggested route of human-to-human transmission is through airborne droplets, touching, or coming into contact with an infected person or a contaminated surface.

Infectious disease outbreaks are known to have a psychological impact on health-care workers (HCWs) as well as the general population. A notable example would be the psychological sequelae observed during the severe acute respiratory syndrome (SARS) outbreak in 2003.[3],[4] Studies on the SARS outbreak revealed that the HCWs experienced acute stress reactions.[5],[6],[7] Facing this large-scale infectious public health event, HCWs were under immense physical and psychological stress.[8] Such fear may have adverse effects.

HCWs being considered as the heroes of this pandemic situation are the main force on which the foundation of any health-care system rests; hence, it is of utmost importance that their mental and physical well-being must be taken care of so that they can perform their duties in the most efficient manner.[9] Swab collection is a challenging task, and the HCWs have to face many difficulties while collecting swab samples of suspected patients. They often need to counsel the suspects as some think they do not have an infection but carry fear. Appropriate precautions should be taken in collecting specimens since this may expose HCWs to respiratory secretions from the suspects. On top of that, the ever-increasing number of confirmed and suspected cases, overwhelming workload, depletion of personal protective equipment (PPE), and feelings of being inadequately supported may all contribute to the mental burden of these HCWs.[10] The published literature on the people posted to collect a swab from suspects during the COVID-19 pandemic in India is scanty, and no study was done to assess awareness, anxiety, and stress among HCWs posted during the COVID-19 pandemic in India. Hence, this study aimed to assess awareness, anxiety, and stress levels among HCWs deployed in swab collection during the COVID-19 pandemic in Andhra Pradesh, India. The objectives of the study were to assess awareness and anxiety regarding swab collection among HCWs and to assess stress among the same during the period of swab collection and during the quarantine period.


  Materials and Methods Top


Ethics

Ethical approval for the study was obtained from the institutional ethics board (Reference number IEC/NDCH/2020/P-08).

Study design

A cross-sectional study was designed to assess awareness, stress, and anxiety among HCWs deployed in swab collection in Nellore city, Andhra Pradesh. A list of professionals who were deployed in swab collection was obtained from Government Hospital, Nellore. A structured questionnaire was used to collect data from HCWs. The questionnaire consists of two sections. Section A comprises demographic details, while Sections B1, B2, B3, and B4 consist of questions regarding swab collection, family experiences, stress, and anxiety. The questionnaire was used to collect data on stress and anxiety. Before starting the study, the questionnaire was validated using a content validity index with Davis criteria 1992. It was given to two experts in the health-care field, and their response was recorded. Item and scale content validity was checked, and item content validity index score (Lynn 1986) was 1.0 and 0.9 for two experts, respectively, and the scale content validity index score (Waltz and Bausell 1981)[11] was 0.9 for both experts which were acceptable. The questionnaire was sent to 10 HCWs, on 1st and 3rd day to check the reliability; the results obtained by test–retest (Cronbach's alpha) was 0.90 which showed a high agreement.

The study was conducted for 1 month. The questionnaire was sent in the form of Google Forms through WhatsApp and email. The participants were asked to forward the link to other known people who were also deployed in the swab collection. The source of data is primary. A total of 102 of 150 HCWs participated in the study based on the inclusion and exclusion criteria and availability.

Informed consent

The consent was considered given by the participants once they have sent the filled Google Forms.

Inclusion criteria

HCWs (undergraduates and postgraduates of both medical and dental streams) who were deployed in the swab collection were included in the study.

Exclusion criteria

HCWs who were not willing to participate in the study were excluded.

Statistics

Statistical Package for the Social Sciences version 18 was used to determine the frequency distributions. Chi-square test was used to find the significant difference in knowledge on swab collection among undergraduates and postgraduates. “P” = 0.05 was considered statistically significant.


  Results Top


Of the total 102 participants, 63.7% were female and 36.3% were male. Among the study participants, 43.14% were undergraduates, 53.92% were postgraduates, and nearly 3% were working professionals. Of the total 102 study participants, 35.3% were married and 64.7% were unmarried [Table 1].
Table 1: Demographic details

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Comparison of knowledge scores in HCWs deployed in swab collection showed that among undergraduates, 77.3% of them underwent training and 22.7% of them were not trained. Among postgraduates, 74.6% of them underwent training and 25.4% were not trained.

Of 34 undergraduates who underwent training, 85.3% attended direct training and 14.7% attended indirect training. About 70.7% attended direct training, and 29.3% underwent indirect training among 55 postgraduates.

The majority of undergraduates (56.8%) and postgraduates (51%) continued to wear the PPE until the working period.

About 63.5% of the undergraduates and 83.6% of the postgraduates collected swab in <60 s. There was no statistically significant difference between undergraduates and postgraduates about knowledge on swab collection [Table 2].
Table 2: Comparison of knowledge scores in health-care workers on swab collection

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Regarding the perception of the quality of PPE among health care workers, it was found that 75% undergraduates and 73% postgraduates felt the quality was good, while the remaining 25% of the undergraduates and 27% of the postgraduates felt that PPE provided was of low quality [Figure 1].
Figure 1: Health-care workers' perception on quality of PPE. PPE: Personal protective equipment

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Among the 44 undergraduates, 43% of them said they were instructed to stay away from family after the swab collection; among 55 postgraduates, 52.7% of them said the same.

During their stay away from family, 70% of the undergraduates and 74% of the postgraduates stayed at home, while the remaining stayed at hotels.

The majority of participants (90% of the undergraduates and 89% of the postgraduates) were unhappy while staying away from family.

77.3% of the undergraduates and 54.5% of the postgraduates were quarantined for 7 days after collecting swabs, and there was a statistically significant difference between both the groups regarding the number of days quarantined [Table 3].
Table 3: Family experiences among health-care workers

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Among the health care workers deployed in swab collection in this study, it was found that 39 out of 44 undergraduates and 42 out of 55 postgraduates felt it was a high-risk job [Figure 2].
Figure 2: Health-care workers' perception about swab collection

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The majority of study participants (56.8% of the undergraduates and 60% of the postgraduates) who were deployed in swab collection said they had experienced stress during the swab collection. About 52.3% of the undergraduates said they had not faced any difficulties while collecting swabs, and among postgraduates, 50.9% said they had encountered difficulties while collecting swabs.

During the swab collection process, it was found that 47.8% of the undergraduates and 47.4% of the postgraduates collected swabs for 6 h. About 60% (approximately) of the undergraduates and postgraduates collected a limited number of samples per day. There was a statistically significant difference between the groups regarding the number of samples collected per day.

About 61.4% of the undergraduates and 74.6% of the postgraduates said that they underwent a COVID-19 test every 30 days [Table 4].
Table 4: Stress experiences among health-care workers deployed in COVID-19

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The majority of study participants (61.4% of the undergraduates and 56.4% of the postgraduates) said they had not experienced any anxiety or negative emotions during swab collection, and 75% of the undergraduates, 87.3% of the postgraduates, and said assistants accompanied them during swab collection.

Of the total study participants, 63.7% of the undergraduates and 61.8% of the postgraduates said they took consent from suspects before collecting swabs, and the majority of study participants (72.7% of the undergraduates and 78.2% of the postgraduates) said there was no trauma or bleeding that has occurred during swab collection procedures [Table 5].
Table 5: Fear and anxiety among health-care workers deployed in COVID-19

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  Discussion Top


This study explores the effect of COVID-19 pandemic on HCWs' mental health in Nellore city. Most of the study participants were females, and the response was the highest from areas with the highest number of reported COVID-19 cases in Nellore. This study found a 57% prevalence of stress and around 40% of anxiety among doctors. Amin et al. found a 43% prevalence of anxiety/depression among doctors within a month of detection of the first case of COVID-19,[9] Lai et al. in March 2020 reported a frequency of up to 40% of mild-to-moderate depressive symptoms among doctors of China during the outbreak,[10] while another survey on a small number of HCWss in China found that the workers showed signs of psychological distress during the pandemic.[12] However, a previous survey in 2016 among doctors working in a tertiary care hospital in Pakistan[13] reported an association of female gender and more service years with anxiety and depression.

Even among the general population, stress and anxiety-related disorders are found to be more common among females.[14] This is similar to the findings of our study. Moreover, doctors who were <35 years of age were more likely to be anxious and depressed than older doctors. Having children at home was another factor associated with anxiety and stress, and younger doctors were more likely to have children at home and hence more likely to be anxious about taking infection to their loved ones at home and hence distressed.

There was no significant difference in the knowledge scores among undergraduates and postgraduates on swab collection, yet a moderate-to-less knowledge score was more likely to be associated with anxiety/stress. Interestingly, the knowledge scores were not different among undergraduates and postgraduates because COVID-19 is a new disease, and the experiential knowledge about the pandemic is likely to be the same among both the groups.

Fear of being unprotected was another factor associated with anxiety/stress, which is plausible. Infection control practices and availability of PPE are also suboptimal in most of the hospitals. Due to a sudden and exponential rise of positive cases and patients needing medical care, even in developed countries such as the USA and UK, PPE is not readily available because of which a high number of the HCWs have already been infected.[15] Another study in China among health workers during this pandemic also reported fear among the staff for a shortage of PPE.[12]

In the present study, we found that doctors working in emergency and those directly in contact with COVID-19 suspects and positive cases were more likely to be depressed, as this group is most exposed and hence anxious. This is in line with a recent study conducted in China, where frontline health workers engaged in the direct diagnosis, treatment, and care of patients with COVID-19 were at a higher risk of anxiety/stress.[10]

To the best of our knowledge, this was the first study to determine the factors associated with stress and anxiety among a representative and diverse group of HCWs. Yet, stress and anxiety may have been underreported here as mental illness is a social stigma in our part of the world, not only among the general population but also among health-care providers.[9],[16],[17] Moreover, the possibility of participation bias in online surveys cannot be excluded, where the potential participants who are suffering from anxiety and stress do not choose to participate in the study. This would also result in an underreporting of the prevalence of anxiety/stress among HCWs.


  Conclusion Top


This study reports a 57% prevalence of stress among HCWs, and most of them are unhappy staying away from family while deployed in swab collection. Majority of them reported swab collection as a high-risk job. As they are frontline workers, an enhanced variety of support should be offered. Psychosocial support and effective measures should be made readily available to them.

Limitations

However, the major limitation of this study is the sample size (n = 102), which limits the generalizability of the findings. Since questionnaires were used, there may be bias associated with self-reporting.

Recommendations

HCWs are at the forefront of the fight against COVID-19. It is of utmost importance that adequate measures are to be taken to ensure their safety. Measures such as medical coverage for HCWs and their families can help to reduce their stress and insecurities. Adapted psychological interventions such as online counseling and cognitive behavioral therapy by trained psychologists to support physicians' mental health are recommended.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: Implications for virus origins and receptor binding. Lancet 2020;395:565-74.  Back to cited text no. 1
    
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McAlonan GM, Lee AM, Cheung V, Cheung C, Tsang KW, Sham PC, et al. Immediate and sustained psychological impact of an emerging infectious disease outbreak on health care workers. Can J Psychiatry 2007;52:241-7.  Back to cited text no. 3
    
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Ministry of Health Singapore. Communicable Diseases Surveillance in Singapore. Singapore: Ministry of Health, Singapore; 2004.  Back to cited text no. 4
    
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Grace SL, Hershenfield K, Robertson E, Stewart DE. The occupational and psychosocial impact of SARS on academic physicians in three affected hospitals. Psychosomatics 2005;46:385-91.  Back to cited text no. 7
    
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Temsah MH, Al-Sohime F, Alamro N, Al-Eyadhy A, Al-Hasan K, Jamal A, et al. The psychological impact of COVID-19 pandemic on health care workers in a MERS-CoV endemic country. J Infect Public Health 2020;13:877-82.  Back to cited text no. 8
    
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Amin F, Sharif S, Saeed R, Durrani N, Jilani D. COVID-19 pandemic- knowledge, perception, anxiety and depression among frontline doctors of Pakistan. BMC Psychiatry 2020;20:459.  Back to cited text no. 9
    
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Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open 2020;3:e203976.  Back to cited text no. 10
    
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Waltz CF, Bausell RB (1981). Nursing research: Design, statistics, and computer analysis. Philadelphia: F. A. Davis.  Back to cited text no. 11
    
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Chen Q, Liang M, Li Y, Guo J, Fei D, Wang L, et al. Mental health care for medical staff in China during the COVID-19 outbreak. Lancet Psychiatry 2020;7:e15-6.  Back to cited text no. 12
    
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Atif K, Khan HU, Ullah MZ, Shah FS, Latif A. Prevalence of anxiety and depression among doctors; the unscreened and undiagnosed clientele in Lahore, Pakistan. Pak J Med Sci 2016;32:294-8.  Back to cited text no. 13
    
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Kuehner C. Why is depression more common among women than among men? Lancet Psychiatry 2017;4:146-58.  Back to cited text no. 14
    
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Ranney ML, Griffeth V, Jha AK. Critical supply shortages – The need for ventilators and personal protective equipment during the COVID-19 pandemic. N Engl J Med 2020;382:e41.  Back to cited text no. 15
    
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Shah I, Khalily MT, Ahmad I, Hallahan B. Impact of conventional beliefs and social stigma on attitude towards access to mental health services in Pakistan. Community Ment Health J 2019;55:527-33.  Back to cited text no. 16
    
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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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