Predictors of social response to COVID-19 among health care workers caring for individuals with confirmed COVID-19 in Jordan

Introduction

Over the past two years, the COVID-19 pandemic has been threatening human lives around the world, and health-care professionals are among those who are at higher risk due to immediate exposure to infection and infected people (Gan et al., 2020). Waves of COVID-19 outbreak are continuingly taking different forms and series adding further long-term burden on healthcare professionals. A recent study showed that the general population, due to COVID-19, were suffering stress, anxiety, depression, and psychological disturbances (Hamaideh et al., 2021). Nevertheless, health-care workers (HCWs) have demonstrated exceptional courage and commitment despite their fears of being at higher risk of infection and assumed to infect others (Liu et al., 2020). Approximately 14% of WHO-reported COVID-19 cases are HCWs (Organization, 2020a). In addition, HCWs are also considered a source of virus transmission according to public perception (Dalky et al., 2020).

The increasing reports of spread of COVID-19 has provoked fear and concern among people globally (Tang et al., 2020). Important concerns include a stigma associated with COVID-19 and the issues related to unknown pathophysiology, treatment, and effectiveness of vaccination (Dalky et al., 2020; Organization, 2020b). This situation has created a new form of stigma and discrimination against individuals with COVID-19 (Tang et al., 2020). There has been a harsh attitude toward those who have been infected and HCWs caring for individuals confirmed with COVID-19 (Bhanot et al., 2020). The stigmatizing behaviors demonstrated the dread of the unknown and the unexplained negative attitudes toward infected people or suspected of being infected, as well as, those suspected of spreading the virus such as HCWs (Bhanot et al., 2020). Societies have blamed people infected with COVID-19 for being ignorant and indifferent (Morin, 2021). This had indicated the need for more emphasis on research to understand the public responses and forms of understanding such dilemmas.

The pandemic has put an extraordinary psychological burden on HCWs due to work in high-demanding environments forcing them to isolate themselves for fear of transmitting the infection and further accusations of spreading the infection (Rodríguez and Sánchez, 2020). In addition, it has been noticed that the use of social media to negatively reporting and addressing the COVID-19 pandemic has led to social discrimination against those confirmed with COVID-19 and HCWs, as well (Singh and Subedi, 2020). Regrettably, HCWs are labeled, faced loss of status and discrimination due to the stigma associated with COVID-19 (Singh and Subedi, 2020). Public responses in the form of social discrimination and stigmatizing behaviors are increasingly being observed against individuals with confirmed COVID-19 and HCWs caring for individuals with COVID-19 (Abuhammad et al., 2021; Bhanot et al., 2020). Discriminatory behaviors are observed in the form of denial of infection, concealment of being infected, or refusal of the COVID-19 test. Thus, the need to emphasize such an issue would enable understanding reasons and contributing factors related to burnout and psychological distress among HCWs.

The ongoing transmission, the increasing number of COVID-19 cases, and the growing need to study the effects of community response, discrimination, and stigmatization against HCWs and individuals with confirmed COVID-19 infections are important areas that needs further exploration (Dalky et al., 2020). This makes addressing social discrimination practiced against individuals with COVID-19 and HCWs a significant issue (Dalky et al., 2020). Because of their long and intense exposure to various stressors, it is important to address and understand coping strategies used by HCWs and individuals with COVID-19 to manage stigma practiced against them. This will provide information guidance on what interventions could be implemented to maintain the best care for individuals infected with COVID-19 and maintaining the mental wellness of HCWs, as well. Although studies are increasingly published in the context of psychological consequences of COVID-19 worldwide, there is still a need to address public responses and how it is affecting HCWs’ coping abilities; in particular, in the Arab culture. This study investigated the perception of social discrimination and coping strategies, and predictors of social discrimination and coping toward COVID-19 among HCWs and individuals with COVID-19.

The aims of this study were:

Research Questions:

Methods

Results

Discussion

Responses to COVID-19 might influence the process of treatment and willingness to collaborate. Therefore, differences in perception of social responses in the form of social discrimination between HCWs and individuals with confirmed COVID-19 is a core component in coping with the disease. The results of this study showed that individuals with confirmed COVID-19 had a higher perception of social discrimination and a lower level of coping with COVID-19 compared to HCWs. The results indicate that the general and ordinary individuals are more likely to be exposed to discrimination and possess a lower level of ability to cope with the disease and related factors than the HCWs. Moreover, it is possible that HCWs might have a higher level of knowledge and competency to manage discrimination phrases or cues or have lower sensitivity for such expressions that contributed to their feelings of being discriminated against. It is expected due to their education and training that HCWs are more capable of coping with the disease and manage discrimination than the general population (Chew et al., 2020). Such major differences in perception of being discriminated against may cause conflicts in understanding, communicating, or commitment to a treatment plan that interferes with the achievement of health-care outcomes. The results do support previous reports in which social discrimination and fear of communicable diseases hampered the response of the public (Brooks et al., 2020; Liebrenz et al., 2020). It has also been noted that social discrimination has forced people to negate their positive results of infection to avoid discrimination leading them to avoid seeking healthcare services and lacking protective health measures that endangered others' health conditions and lives (Brooks et al., 2020; Liebrenz et al., 2020).

While COVID-19, due to its pandemic nature and global influence pattern, is considered a stress-inducing illness, coping strategies are still required to manage the disease and its consequences (Hamaideh et al., 2021). In this study, HCWs used coping strategies more effectively than individuals with COVID-19. In previous reports, HCWs were challenged in managing their responsibilities due to stigma and discrimination (Dalky et al., 2020). Nevertheless, they were able to better use the coping strategies than ordinary people. It is worth saying that social isolation and job burden are factors that have contributed to increased job stress among HCWs (Bani-Hani and Hamdan-Mansour, 2021; Singh and Subedi, 2020). Thus, HCWs might have depended largely on their learned adaptation skills to manage job stress to be able to handle discrimination and cope better COVID-19. On the other hand, ordinary people probably lack the skills and knowledge to manage discrimination due to fear of losing their social and occupational privileges (Chew et al., 2020). There were differences in using coping strategies between HCWs and individuals with confirmed COVID-19. Such difference might negatively affect HCWs, due to the fact that they are more vulnerable to COVID-19 infection compared to the general population. It has been confirmed that such differences might influence and explain the level of care provided by the HCWs and the low level of compliance and collaboration of individuals with confirmed COVID-19 (Kar et al., 2021). The degree to which a person fears COVID-19 is an element that could be important in understanding the coping process. Fear is an emotional state that stimulates self-defense behaviors; thus, fear of infection would influence coping strategies leading to poor prognosis (Kim et al., 2020).

Besides, many factors could be related to social discrimination against individuals with confirmed COVID-19 or HCWs caring for those people. Such factors might be related to the collectivist culture that puts high social pressure on people and affects their decisions to seek healthcare services (Al Ali et al., 2017; Aldalaykeh et al., 2019). For instance, fear and anxiety from the spread of COVID-19 may lead to social discrimination in people having disease, places that are considered sources of the infection such as hospitals, and even people who were in quarantine (CDC, 2020). Furthermore, social discrimination and stigmatized behaviors are extensively noted in mental health research; however, these variables in the context of COVID-19 seem to lead to the same negative effect on health-care outcomes (Brooks et al., 2020). The notion that social discrimination is a multifaceted factor infers that a reciprocal relationship exists between the bio-psycho-social and cultural components of human wellbeing (Dalky et al., 2020). In other words, the social discrimination might take various forms depending on the cultural definition of discrimination. People with COVID-19 who complied with the quarantine have reported higher levels of psychological disturbances such as stress and anger (Brooks et al., 2020). Such a critical health situation in addition to poor coping and discrimination, might be a threat to successful endorsement and implementation of public healthcare plans against COVID-19 leading to poor healthcare outcomes (Fu et al., 2021).

Furthermore, the study found that HCWs and individuals with confirmed COVID-19 who have a high level of education and use over-the-counter medication showed greater coping with COVID-19. The results support previous equivalent studies that indicated using emotional-based coping among low educated people compared to using problem-based coping among those with a high level of education (Mohammadzadeh et al., 2020; Shamsi et al., 2021). This reflects the differences in the behavioral responses related to individual knowledge and experience. In addition, the results showed that HCWs who earned a high income showed greater coping with COVID-19. These findings are in line with previous studies that found financial constraints were linked to and predicted higher levels of stress and lower levels of effective coping (Atchison et al., 2020; Barbara et al., 2020; Cluver et al., 2020). Similarly, age and literacy play a positive role in predicting effective coping and positive responses (Darraj et al., 2016; Magsamen-Conrad et al., 2019; Moukaddam and Shah, 2020; Volk et al., 2021), older people and more literate ones were found to use more effective coping strategies with COVID-19 than younger and illiterate people. Such findings were consistent with previous studies that reported a higher level of coping connected to higher levels of resiliency (Pearman et al., 2020).

Conclusions

This study focused on exploring predictors of coping and responses to social discrimination in the form of stigma among HCWs and individuals with confirmed COVID-19. The findings showed that individuals with COVID-19 were more likely to face social discrimination than HCWs. Yet, in dealing with COVID-19, HCWs used more effective coping strategies with COVID-19 than non-medical infected individuals. The main conclusion of this study is that predictors of social discrimination and coping were educational level, age, monthly income, and taking over-the-counter medication. Although both social discrimination and coping are complicated and may be influenced by a variety of factors, we must reconsider and find ways to reinforce them in light of the probable recurrence of COVID-19 and other future global pandemic risks. Innovative strategies are to be granted to clinical practice and the public sectors to best tackle the challenges associated with the COVID-19 pandemic. In addition, public media also has to be targeted to combat discrimination and support individuals confirmed with COVID-19 and HCWs caring for them.

Data availability