Psychological and physiological stress and burnout among maternity providers in a rural county in Kenya: individual and situational predictors

Abstract

Background Stress and burnout among healthcare workers has been recognized as a global crisis needing urgent attention. Yet few studies have examined stress and burnout among healthcare providers in sub-Saharan Africa, and even fewer among maternity providers who work under very stressful conditions. To address these gaps, we examined self-reported stress and burnout levels as well as stress-related physiologic measures of these providers, along with their potential predictors. Methods Participants included 101 maternity providers (62 nurses/midwives, 16 clinical officers/doctors, and 23 support staff) in western Kenya. Respondents completed Cohen’s Perceived Stress Scale, the Shirom-Melamed Burnout scale, and other sociodemographic, health, and work-related items. We also collected data on heart rate variability (HRV) and hair cortisol levels to assess stress-related physiologic responses to acute and chronic stress respectively. Multilevel linear regression models were computed to examine individual and work-related factors associated with stress, burnout, HRV, and cortisol level. Results 85% of providers reported moderate stress and 11.5% high stress. 65% experienced low burnout and 19.6% high burnout. Average HRV (measured as the root mean square of differences in intervals between successive heart beats: RMSSD) was 60.5 (SD = 33.0) and mean cortisol was mean cortisol was 44.2 pg/mg (SD = 60.88). Greater satisfaction with life accomplishments was associated with reduced stress (β = − 2.83; CI = -5.47; − 0.18), while motivation to work excessively (over commitment) was associated with both increased stress (β = 0.61 CI: 0.19, 1.03) and burnout (β = 2.05, CI = 0.91, 3.19). Female providers had higher burnout scores compared to male providers. Support staff had higher HRV than other providers and providers under 30 years of age had higher HRV than those 30 and above. Although no association between cortisol and any predictor was statistically significant, the direction of associations was consistent with those found for stress and burnout. Conclusions Most providers experienced moderate to high levels of stress and burnout. Individuals who were more driven to work excessively were particularly at risk for higher stress and burnout. Higher HRV of support staff and providers under age 30 suggest their more adaptive autonomic nervous system response to stress. Given its impact on provider wellbeing and quality of care, interventions to help providers manage stress are critical.

Prevalence of Burnout among Catholic Religious Men and Women Working In Rural Areas: A Case of Lodwar Diocese in Turkana County, Kenya

“…The findings are in line with findings of Francis, Robbins, and Wulff (2013) that conducted a study with Presbyterian Church (USA) pastors using Emotional Exhaustion in Ministry Scale and found that female pastors had significantly higher levels of emotional exhaustion and depersonalization than male pastors. Furthermore, the findings resonate with findings of Afulani et al (2021) who found that Female providers' scored high scores of emotion exhaustion compared to male providers. Catholic religious women experiencing more emotional exhaustion than religious men could be attributed to the nature of their ministry.…”

Exploring the Association between Sleep Quality and Heart Rate Variability among Female Nurses

“…Several researchers have reported that female nurses generally have worse sleep problems than do male nurses [ 9 , 10 ]. Additionally, compared to male healthcare providers, female healthcare providers had higher burnout scores and a greater workload when they attempted to seek a work-life balance [ 11 ].…”

“…In addition, the influence of shift work and sleep disturbances on HRV and autonomic function has been an active area of investigation [ 27 ]. Afulani et al [ 11 ] investigated the relationship between HRV and sociodemographic factors among healthcare workers. Afulani’s study found single health providers and those with higher income had higher HRV than did clinical providers who were married and those with lower income, respectively.…”

A cross-sectional study on the pursuit of happiness among healthcare workers in the context of health systems strengthening: The case of Meru County, Kenya.

“…Research on the growing epidemic of mental health-related issues among healthcare workers, such as anxiety, burnout, depression, and substance abuse, confirm the challenges they are experiencing [1][2][3][4][5] . In comparison, there is a dearth of research on healthcare workers' positive mental health aspects such as happiness, especially in low-and middle-income countries 1,2 .…”