Psychosocial Framework of Resilience: Navigating Needs and Adversities During the Pandemic, A Qualitative Exploration in the Indian Frontline Physicians

Abstract

IntroductionFrontline healthcare workers (HCW) have faced significant plight during the ongoing Coronavirus disease 2019 (COVID-19) pandemic. Studies have shown their vulnerabilities to depression, anxiety disorders, post-traumatic stress, and insomnia. In a developing country like India, with a rising caseload, resource limitations, and stigma, the adversities faced by the physicians are more significant. We attempted to hear their “voices” to understand their adversities and conceptualize their resilience framework.MethodsA qualitative approach was used with a constructivist paradigm. After an initial pilot, a socio-demographically heterogeneous population of 172 physicians working in COVID-designated centers were purposively sampled from all over India. Following in-depth virtual interviews using a pre-formed semi-structured guide, the data was transcribed and translated verbatim. The interview was focused on their challenges, needs, and processes of coping and support. Charmaz’s grounded theory was used for analysis supplemented by NVivo 10 software.ResultsFear of infection, uncertainty, stigma, guilt, and social isolation emerged as the main challenges. Simultaneously, their “unmet needs” were flexible work policies, administrative measures for better medical protection, the sensitivity of media toward the image of HCW, effective risk communication for their health, and finally, social inclusion. Their resilience “framework” emerged as a process while navigating these adversities and consisted of three facets: forming a “resilient identity,” managing the resilience, and working through the socio-occupational distress. The role of mental well-being, social network, peer support, problem negotiation, and self-care emerged as the key coping strategies.ConclusionThe study findings support the global call for better psychosocial health and quality of life of the frontline HCWs. Their “unheard voices” explored in the study can anchor subsequent resilience-enhancing interventions and policies. Guidelines focusing on the psychological wellbeing of frontline HCWs need to be grounded in their unmet needs and lived experiences.

Prioritizing the Mental Health and Well-Being of Healthcare Workers: An Urgent Global Public Health Priority

“…A qualitative study based on semi-structured interviews with 172 physicians working in COVID-designated centers across India, found support for resilience as a learned and evolving process: Most of the participants mentioned resilience as a continuum developed through experiencing and facing an unprecedented crisis, aided by social support and past encounters with stress. The results suggested that the consistent living through hardships and adversities of the COVID-19 crisis with responsible risk-taking, helped pave the way for problem-solving, personal efficiency and coping in the physicians (77). Empathy, optimism, and self-efficacy can also improve personal healthrisk perception, which is vital for psychological resilience during pandemics (77,78).…”

“…The results suggested that the consistent living through hardships and adversities of the COVID-19 crisis with responsible risk-taking, helped pave the way for problem-solving, personal efficiency and coping in the physicians (77). Empathy, optimism, and self-efficacy can also improve personal healthrisk perception, which is vital for psychological resilience during pandemics (77,78).…”

“…Focused social and organizational support and understanding of the distress faced by healthcare workers during times of crisis and in general, can help reduce the stigma and improve social connections while reducing barriers to utilization of mental health interventions aimed at supporting healthcare workers. This has been termed an "epidemic of empathy" and has the potential of bringing together science and humanism in a way that might be beneficial even after cessation of the pandemic (77,101).…”

Uncertainty, Sex and Sexuality during the Pandemic: Impact on Psychosocial Resilience

“…[62] Certain individual traits like hope, motivation, humour, personal skills are shown to improve resilience [63]. A recent qualitative study on the frontline healthcare workers during Covid-19 found out that "resilience framework" comprised of "resilient identity" formation by social network, sense of purpose, gratitude, hope, "resilience management" by professional collectivism, problem negotiation, assumption of vulnerable role, and "working through distress" via self-care, risk minimization, peer and social support, lifestyle changes and relationships [64]. Across literature, the role of social and interpersonal relationships has been emphasized in strengthening resilience.…”

Culturally-tailored Peer Support for Doctors and Nurses of Indian Origin

“…Mental health well-being of HCWs in India is compounded with lack of poor infrastructure and huge shortage of trained professionals leading to large treatment gap [6]. The pandemic has worsened the health and well-being status and various psychological resilience framework are proposed [7,8]. As we prepare to tackle the aftermath of the pandemic, addressing staff fatigue and wellbeing should be a key priority for all organisations.…”