Barriers and coping mechanisms to accessing healthcare during the COVID-19 lockdown: a cross-sectional survey among patients with chronic diseases in rural Rwanda

Abstract Background Large scale physical distancing measures and movement restrictions imposed to contain COVID-19, often referred to as ‘lockdowns’, abruptly and ubiquitously restricted access to routine healthcare services. This study describes reported barriers and coping mechanisms to accessing healthcare among chronic care patients during the nationwide COVID-19 lockdown in Rwanda. Methods This cross-sectional study was conducted among chronic care patients enrolled in pediatric development, HIV/AIDS, non-communicable diseases, mental health, and oncology programs at 3 rural Rwandan districts. Active patients with an appointment scheduled between March–June 2020 and a phone number recorded in the electronic medical record system were eligible. Data were collected by telephone interviews between 23rd April and 11th May 2020, with proxy reporting by caregivers for children and critically ill-patients. Fisher’s exact tests were used to measure associations. Logistic regression analysis was also used to assess factors associated with reporting at least one barrier to accessing healthcare during the lockdown. Results Of 220 patient respondents, 44% reported at least one barrier to accessing healthcare. Barriers included lack of access to emergency care (n = 50; 22.7%), lack of access to medication (n = 44; 20.0%) and skipping clinical appointments (n = 37; 16.8%). Experiencing barriers was associated with the clinical program (p < 0.001), with oncology patients being highly affected (64.5%), and with increasing distance from home to the health facility (p = 0.031). In the adjusted logistic regression model, reporting at least one barrier to accessing healthcare was associated with the patient's clinical program and district of residence. Forty (18.2%) patients identified positive coping mechanisms to ensure continuation of care, such as walking long distances during suspension of public transport (n = 21; 9.6%), contacting clinicians via telephone for guidance or rescheduling appointments (n = 15; 6.8%), and delegating someone else for medication pick-up (n = 6; 2.7%). Of 124 patients who reported no barriers to accessing healthcare, 9% used positive coping mechanisms. Conclusion A large proportion of chronic care patients experienced barriers to accessing healthcare during the COVID-19 lockdown. However, many patients also independently identified positive coping mechanisms to ensure continuation of care - strategies that could be formally adopted by healthcare systems in Rwanda and similar settings to mitigate effects of future lockdowns on patients.

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Perceived Stress Level and Coping Mechanisms Among Health Allied Students

Global Journal of Health Science ◽

10.5539/gjhs.v12n9p50 ◽

2020 ◽

Vol 12 (9) ◽

pp. 50

Author(s):

Abd Alhadi Hasan ◽

Hussein Alqarni ◽

Nofaa Ali Alasmee

Keyword(s):

Nursing Students ◽

Nursing Student ◽

Academic Staff ◽

Coping Behaviors ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Convenience Sample ◽

Positive Coping ◽

Orientation Week ◽

And Coping

Purposes: This study identified and compared between the levels and types of stressors as well as coping behaviors. Design: Cross-Sectional Survey Methods: Data were collected using a convenience sample of 286 students Findings: The results showed that ‘‘teachers and nursing staff’ ’and ‘‘assignments and workload’’ were the highest sources of stress among nursing and MLS students. But this was much higher among nursing students. In addition, lack of professional knowledge and skills were cited the least stressors among both students’ groups. Practice Implications: The result can be used to support Nursing student to utilize positive coping mechanism to deal with stress successfully. Enhance academic staff awareness about re-allocation of the academic demands and the emphasis on the benefit of orientation week for the students.

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Effect of the Coronavirus Disease 2019 (COVID-19) Pandemic on Pediatric Resident Well-Being

Journal of Medical Education and Curricular Development ◽

10.1177/2382120520947062 ◽

2020 ◽

Vol 7 ◽

pp. 238212052094706 ◽

Cited By ~ 1

Author(s):

Pooja B Sanghavi ◽

Karla Au Yeung ◽

Carmela E Sosa ◽

Angela F Veesenmeyer ◽

Jolie A Limon ◽

...

Keyword(s):

Social Isolation ◽

Well Being ◽

Coping Mechanisms ◽

Lifestyle Changes ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Resident Perceptions ◽

Negative Effect ◽

The Mean ◽

And Coping

Objectives: This study aims to identify factors specific to the COVID-19 pandemic that affect resident physicians’ well-being, identify potential sources of anxiety, and assess for depression and stress among residents. Methods: A cross-sectional survey was performed in April 2020 that evaluated resident perceptions about COVID-19 pandemic, its impact on their personal lifestyle, and coping mechanisms adopted. The respondents also completed the Beck Depression Inventory-II (BDI-II) and Cohen Perceived Stress Scale (PSS-10). Results: Of 37 residents, 29 completed the survey for a response rate of 78%. We found that 50% of residents harbored increased anxiety due to the pandemic and reported fears of spreading disease. Factors that negatively impacted their well-being included social isolation from colleagues (78%), inability to engage in outdoor activities (82%), and social gatherings (86%). Residents expressed concern about the effect of the COVID-19 pandemic on their didactic education and clinical rotations. The mean PSS-10 total score was 17 (SD = 4.96, range = 0-33) and the mean BDI-II total score was 6.79 (SD = 6.00). Our residents adopted a number of coping mechanisms in response to COVID-19. Conclusions: We identified factors specific to the COVID-19 pandemic that adversely affected resident physician well-being. Trainees were concerned about the risk of developing COVID-19 and spreading this to their family. Residents also harbored anxiety regarding the effect of COVID-19 on their education. Lifestyle changes including social isolation also resulted in a negative effect on resident well-being. Developing strategies and resources directed to addressing these concerns may help support well-being and alleviate stress and anxiety.

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Prevalence of anxiety and depression in medical students of a public sector medical college in Islamabad and coping mechanisms adopted

Journal of the Pakistan Medical Association ◽

10.47391/jpma.2107 ◽

2021 ◽

Author(s):

Rizwan Zafar ◽

Muhammad Raheel ◽

Muhammad Ahmed Mujtaba ◽

Rabia Mahmood ◽

Muhammad Umair Nawaz ◽

...

Keyword(s):

Medical Students ◽

Sample Size ◽

Depression Scale ◽

Coping Mechanisms ◽

Anxiety And Depression ◽

Cross Sectional ◽

Medical College ◽

Positive Coping ◽

Brief Cope ◽

And Coping

The objectives of this study were to find out the frequency of anxiety and depression in medical students and various coping mechanisms adopted by them to identify the coping trends and to stress the need of equipping these students with positive coping tools to deal with anxiety and depression. A cross-sectional, questionnaire-based observational study was conducted on a population of 500 medical students of Federal Medical and Dental College, Islamabad. The duration of the study was three months. By using the WHO sample size calculator, taking the confidence level 95%, anticipated population proportion 70% and absolute precision required 7%, the sample size was calculated at 165. The samples were collected by non-probability consecutive sampling via a questionnaire. In the study, two instruments were used: 1) Aga Khan University Anxiety and Depression Scale (AKUADS), and 2) Brief Cope Inventory. ---Continue

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Knowledge and awareness about MERS-CoV among the dental students in Chennai

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl1.3091 ◽

2020 ◽

Vol 11 (SPL1) ◽

pp. 847-851

Author(s):

Nithyanandham Masilamani ◽

Dhanraj Ganapathy

Keyword(s):

College Students ◽

Large Scale ◽

Preventive Measures ◽

Positive Impact ◽

Educational Programs ◽

Dental Students ◽

Professional Organizations ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Mode Of Transmission

Middle East Respiratory Syndrome (MERS) induced by new ß coronavirus MERS-(CoV) had first been described in Saudi Arabia in September 2012. MERS-CoV communication inside the population is often identified with clustered households and cramped communal spaces. The purpose of the study is to assess the knowledge and awareness of MERS-CoV among dental students in India. This was a questionnaire-based cross-sectional survey of 100 dental college students in Chennai. The self-designed questionnaires contained ten questions focused on the knowledge and awareness of MERS-CoV amongst dental college students. Questionnaires were circulated through an online website survey planet. After the responses were received from 100 participants, data were collected and analyzed, .87% are aware of MERS-CoV through media 13% from professional channels. 84%are aware of the clinical manifestation of MERS-CoV. 81%Are aware of the mode of transmission of MERS-CoV. 76%are aware of the preventive measures against MERS -CoV.68%. Are aware of the incubation period of MERS-CoV. 74%aware of PCR as a diagnostic test for MERS-CoV. This study concluded that dental students had strong awareness and knowledge of MERS. Also, there are a few differences in information and behaviours that require change. Large-scale health educational programs on MERS also should be facilitated by professional organizations to expand their reach and to strengthen knowledge to have a positive impact on their behaviour.

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Public Health Workforce Burnout in the COVID-19 Response in the U.S.

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18084369 ◽

2021 ◽

Vol 18 (8) ◽

pp. 4369

Author(s):

Kahler W. Stone ◽

Kristina W. Kintziger ◽

Meredith A. Jagger ◽

Jennifer A. Horney

Keyword(s):

Public Health ◽

Health Workforce ◽

Work Experience ◽

Large Scale ◽

Health Workers ◽

Public Health Workforce ◽

Cross Sectional Survey ◽

Public Health Response ◽

Cross Sectional ◽

The U.S

While the health impacts of the COVID-19 pandemic on frontline health care workers have been well described, the effects of the COVID-19 response on the U.S. public health workforce, which has been impacted by the prolonged public health response to the pandemic, has not been adequately characterized. A cross-sectional survey of public health professionals was conducted to assess mental and physical health, risk and protective factors for burnout, and short- and long-term career decisions during the pandemic response. The survey was completed online using the Qualtrics survey platform. Descriptive statistics and prevalence ratios (95% confidence intervals) were calculated. Among responses received from 23 August and 11 September 2020, 66.2% of public health workers reported burnout. Those with more work experience (1–4 vs. <1 years: prevalence ratio (PR) = 1.90, 95% confidence interval (CI) = 1.08−3.36; 5–9 vs. <1 years: PR = 1.89, CI = 1.07−3.34) or working in academic settings (vs. practice: PR = 1.31, CI = 1.08–1.58) were most likely to report burnout. As of September 2020, 23.6% fewer respondents planned to remain in the U.S. public health workforce for three or more years compared to their retrospectively reported January 2020 plans. A large-scale public health emergency response places unsustainable burdens on an already underfunded and understaffed public health workforce. Pandemic-related burnout threatens the U.S. public health workforce’s future when many challenges related to the ongoing COVID-19 response remain unaddressed.

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Prepared and highly committed despite the risk of COVID-19 infection: a cross-sectional survey of primary care physicians’ concerns and coping strategies in Singapore

BMC Family Practice ◽

10.1186/s12875-021-01370-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jerrald Lau ◽

David Hsien-Yung Tan ◽

Gretel Jianlin Wong ◽

Yii-Jen Lew ◽

Ying-Xian Chua ◽

...

Keyword(s):

Primary Care ◽

Coping Strategies ◽

Stress Management ◽

Primary Care Physicians ◽

Well Being ◽

Pandemic Preparedness ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Accessible Information ◽

And Coping

Abstract Background Primary care physicians (PCPs) are first points-of-contact between suspected cases and the healthcare system in the current COVID-19 pandemic. This study examines PCPs’ concerns, impact on personal lives and work, and level of pandemic preparedness in the context of COVID-19 in Singapore. We also examine factors and coping strategies that PCPs have used to manage stress during the outbreak. Methods Two hundred and sixteen PCPs actively practicing in either a public or private clinic were cluster sampled via email invitation from three primary care organizations in Singapore from 6th to 29th March 2020. Participants completed a cross-sectional online questionnaire consisting of items on work- and non-work-related concerns, impact on personal and work life, perceived pandemic preparedness, stress-reduction factors, and personal coping strategies related to COVID-19. Results A total of 158 questionnaires were usable for analyses. PCPs perceived themselves to be at high risk of COVID-19 infection (89.9%), and a source of risk (74.7%) and concern (71.5%) to loved ones. PCPs reported acceptance of these risks (91.1%) and the need to care for COVID-19 patients (85.4%). Overall perceived pandemic preparedness was extremely high (75.9 to 89.9%). PCPs prioritized availability of personal protective equipment, strict infection prevention guidelines, accessible information about COVID-19, and well-being of their colleagues and family as the most effective stress management factors. Conclusions PCPs continue to serve willingly on the frontlines of this pandemic despite the high perception of risk to themselves and loved ones. Healthcare organizations should continue to support PCPs by managing both their psychosocial (e.g. stress management) and professional (e.g. pandemic preparedness) needs.

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Cross-Sectional Association between Hypercholesterolemia and Knee Pain in the Elderly with Radiographic Knee Osteoarthritis: Data from the Korean National Health and Nutritional Examination Survey

Journal of Clinical Medicine ◽

10.3390/jcm10050933 ◽

2021 ◽

Vol 10 (5) ◽

pp. 933

Author(s):

Byung Woo Cho ◽

Du Seong Kim ◽

Hyuck Min Kwon ◽

Ick Hwan Yang ◽

Woo-Suk Lee ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Knee Pain ◽

Logistic Regression Analysis ◽

National Health ◽

Large Scale ◽

Metabolic Diseases ◽

The Elderly ◽

Cross Sectional ◽

Ordinal Logistic Regression Analysis

Few studies have reported the relationship between knee pain and hypercholesterolemia in the elderly population with osteoarthritis (OA), independent of other variables. The aim of this study was to reveal the association between knee pain and metabolic diseases including hypercholesterolemia using a large-scale cohort. A cross-sectional study was conducted using data from the Korea National Health and the Nutrition Examination Survey (KNHANES-V, VI-1; 2010–2013). Among the subjects aged ≥60 years, 7438 subjects (weighted number estimate = 35,524,307) who replied knee pain item and performed the simple radiographs of knee were enrolled. Using multivariable ordinal logistic regression analysis, variables affecting knee pain were identified, and the odds ratio (OR) was calculated. Of the 35,524,307 subjects, 10,630,836 (29.9%) subjects experienced knee pain. Overall, 20,290,421 subjects (56.3%) had radiographic OA, and 8,119,372 (40.0%) of them complained of knee pain. Multivariable ordinal logistic regression analysis showed that among the metabolic diseases, only hypercholesterolemia was positively correlated with knee pain in the OA group (OR 1.24; 95% Confidence Interval 1.02–1.52, p = 0.033). There were no metabolic diseases correlated with knee pain in the non-OA group. This large-scale study revealed that in the elderly, hypercholesterolemia was positively associated with knee pain independent of body mass index and other metabolic diseases in the OA group, but not in the non-OA group. These results will help in understanding the nature of arthritic pain, and may support the need for exploring the longitudinal associations.

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Attitudes towards the New Zealand Government’s Smokefree 2025 goal associated with smoking and vaping in university students aged 18 to 24 years: results of a 2018 national cross-sectional survey

BMJ Open ◽

10.1136/bmjopen-2020-037362 ◽

2020 ◽

Vol 10 (11) ◽

pp. e037362

Author(s):

Ben Wamamili ◽

Mark Wallace-Bell ◽

Ann Richardson ◽

Randolph C Grace ◽

Pat Coope

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

New Zealand ◽

University Students ◽

Confidence Intervals ◽

Logistic Regression Analysis ◽

Smoking Prevalence ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Lower Odds

ObjectiveIn March 2011, New Zealand (NZ) launched an aspirational goal to reduce smoking prevalence to 5% or less by 2025 (Smokefree 2025 goal). Little is known about university students’ awareness of, support for and perceptions about this goal. We sought to narrow the knowledge gap.SettingUniversity students in NZ.MethodsWe analysed data from a 2018 cross-sectional survey of university students across NZ. Logistic regression analysis examined the associations between responses about the Smokefree goal with smoking and vaping, while controlling for age, sex and ethnicity. Confidence intervals (95% CI) were reported where appropriate.ParticipantsThe sample comprised 1476 students: 919 (62.3%) aged 18 to 20 and 557 (37.7%) aged 21 to 24 years; 569 (38.6%) male and 907 (61.4%) female; 117 (7.9%) Māori and 1359 (92.1%) non-Māori. Of these, 10.5% currently smoked (ie, smoked at least monthly) and 6.1% currently vaped (ie, used an e-cigarette or vaped at least once a month).ResultsOverall awareness of the Smokefree goal was 47.5% (95% CI: 44.9 to 50.1); support 96.9% (95% CI: 95.8 to 97.8); belief that it can be achieved 88.8% (95% CI: 86.8 to 90.7) and belief that e-cigarettes/vaping can help achieve it 88.1% (95% CI: 86.0 to 89.9).Dual users of tobacco cigarettes and e-cigarettes had greater odds of being aware of the Smokefree goal (OR=3.07, 95% CI: 1.19 to 7.92), current smokers had lower odds of supporting it (OR=0.13, 95% CI: 0.06 to 0.27) and of believing that it can be achieved (OR=0.15, 95% CI: 0.09 to 0.24) and current vapers had greater odds of believing that e-cigarettes/vaping can help to achieve it (OR=8.57, 95% CI: 1.18 to 62.52) compared with non-users.ConclusionsThe results suggest strong overall support for the Smokefree goal and belief that it can be achieved and that e-cigarettes/vaping can help achieve it. Smoking and vaping were associated with high awareness of the Smokefree goal, but lower support and optimism that it can be achieved.

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Maternal adherence to micronutrient supplementation before and during pregnancy in Northwest China: a large-scale population-based cross-sectional survey

BMJ Open ◽

10.1136/bmjopen-2018-028843 ◽

2019 ◽

Vol 9 (8) ◽

pp. e028843 ◽

Cited By ~ 6

Author(s):

Danmeng Liu ◽

Yue Cheng ◽

Shaonong Dang ◽

Duolao Wang ◽

Yaling Zhao ◽

...

Keyword(s):

Pregnant Women ◽

Large Scale ◽

Northwest China ◽

Population Based ◽

Shaanxi Province ◽

Micronutrient Supplementation ◽

Cross Sectional Survey ◽

Start Time ◽

Cross Sectional ◽

Scale Population

ObjectivesTo report the situation of maternal micronutrient supplementation before and during pregnancy in Northwest China and to examine the rates of and factors related to the adherence to micronutrient supplementation among pregnant women in this region, where dietary micronutrient intake is commonly insufficient.DesignA large-scale population-based cross-sectional survey.SettingTwenty counties and ten districts of Shaanxi Province.ParticipantsA sample of 30 027 women were selected using a stratified multistage random sampling method. A total of 28 678 women were chosen for the final analysis after excluding those who did not provide clear information about nutritional supplementation before and during pregnancy.Main outcome measuresMaternal adherence to micronutrient supplementation (high and low) were the outcomes. They were determined by the start time and duration of use according to Chinese guidelines (for folic acid (FA) supplements) and WHO recommendations (for iron, calcium and multiple-micronutrient (MMN) supplements).ResultsIn total, 83.9% of women took at least one kind of micronutrient supplement before or during pregnancy. FA (67.6%) and calcium (57.5%) were the primarily used micronutrient supplements; few participants used MMN (14.0%) or iron (5.4%). Adherence to supplementation of all micronutrients was low (7.4% for FA, 0.6% for iron, 11.7% for calcium and 2.7% for MMN). Higher educational levels, higher income levels, urban residence and better antenatal care (including pregnancy consultation and a higher frequency of antenatal visits) were associated with high adherence to micronutrient supplementation.ConclusionMaternal micronutrient supplementation before and during pregnancy in Northwest China was way below standards recommended by the Chinese guidelines or WHO. Targeted health education and future nutritional guidelines are suggested to improve this situation, especially in pregnant women with disadvantaged sociodemographic conditions.

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Patients’ attitudes toward conventional and herbal treatments for depression and anxiety: A cross-sectional Israeli survey

International Journal of Social Psychiatry ◽

10.1177/0020764021992385 ◽

2021 ◽

pp. 002076402199238

Author(s):

Or Burstein ◽

Alon Shamir ◽

Nurit Abramovitz ◽

Ravid Doron

Keyword(s):

Adverse Effects ◽

Large Scale ◽

Prescription Medications ◽

Depression And Anxiety ◽

Cultural Backgrounds ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Cultural Aspects ◽

Final Sample ◽

Choice Of Treatment

Background: As many patients view conventional antidepressants and anxiolytics negatively, it is not surprising that the willingness to apply these treatments is far from ideal, thus posing a critical barrier in promoting an effective and durable treatment. Aim: The present study aimed to explore patients’ attitudes toward conventional and herbal treatments for depression and anxiety, while considering cultural and demographic factors, to further elucidate the antecedes that putatively determine the treatment’s outcome. Methods: During June 2017, a cross-sectional survey was conducted using stratified sampling from a large-scale Israeli volunteer online panel. The final sample included 591 Jewish Israeli adults that reported they were suffering from depression or anxiety. Results: A heterogeneous range of attitudes toward treatment was found: for example, a large group of patients did not utilize prescription medications (39%), a professional consultation (12.9%), or any form of treatment (17.4%). Interestingly, these patients were significantly more likely to support naturally-derived treatments and were less concerned with scientific proof. Further, adverse effects were demonstrated as a prominent factor in the choice of treatment. A higher incidence of adverse effects was associated with an increased willingness to consider an alternative herbal treatment. Noteworthy attitudes were found in orthodox-Jewish individuals, who showed similar consultation rates, but utilized more psychological, rather than pharmacological treatments. Conclusions: It is proposed that patients’ perspectives and cultural backgrounds are needed to be taken into consideration during the clinical assessment and choice of treatment. The findings imply that a particular emphasis should be placed on patients that discard conventional pharmacological options and on distinct cultural aspects. Several recommendations for revising the current policy are advocated to promote more culturally-informed and patient-oriented care.

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