Social Stigma towards Health Care Workers during COVID ...

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OriginalArticle

SocialStigmatowardsHealthCareWorkersduringCOVIDPandemic:

AHospitalbasedCross-sectionalStudyinKolkata1 1 1 2 3 4RipanSaha ,VineetaShukla ,AnkitaMishra ,MeghnaMukherjee ,MausumiBasu ,RaghunathMisra

1 2 3 4PostgraduateStudent, StatisticiancumTutor, Professor&Head, Professor,DepartmentofCommunityMedicine,

IPGME&RandSSKMHospital,Kolkata,India

Correspondence:Dr.MausumiBasu,Email:[email protected]

Accessthisarticleonline

Website:

www.healthlinejournal.org

DOI:

10.51957/Healthline_196_2020

QuickResponseCode Howtocitethisarticle:

SahaR,ShuklaV,MishraA,MukherjeeM,BasuM,Misra

R.SocialStigmatowardsHealthCareWorkersduring

COVID-19pandemic:AHospitalbasedCross-sectional

StudyinKolkata.Healthline.2021;12(2):33-42.

Abstract:

Introduction:WiththeriseofCOVID-19pandemic,thehealthstaffshavefacedresistanceand

disrespectbythesociety.Theyhavebeenstigmatisedunnecessarilythathasbeenresultedfromfearand

poorknowledgeofgeneralpopulationregardingspreadofCOVID-19infection.Objective:Toestimatethe

proportion of health careworkerswho experienced social stigma during COVID-19 pandemic and to

determine the association of social stigma with their socio-demographic and other background

characteristics.Method:Adescriptivetypeofobservationalstudy,cross-sectionalindesignwascarried

outamonghealthcareworkers(HCWs)ofatertiarycarehospitalinKolkataduringtheCOVID-19lockdownth th

period(19 May2020–20 July2020)usingapre-designed,pre-tested,structuredschedule.Bysimple

randomsampling,422HCWswereselectedand410ofthemhadgivenconsenttoparticipateinthisstudy.

MSExcel2010andSPSSv20.0wereusedfordataentryandbinarylogisticregression.Results:About

52.68%hadexperienced'SignificantSocialStigma',32.92%experienced'InsignificantSocialStigma'and

only14.39%had'nostigma'.Agegroupsof25-40yearsandmodeoftransportbyhospitalvehiclehad

significantassociationwithsocialstigma.Conclusion:Morethanhalfofthestudypopulationexperienced

“SignificantSocialStigma”.TheHCWswhoweretravellingbyhospitalvehiclesfromhometoattendtheir

dutiesandHCWsofyoungeragegroupwerestigmatisedindifferentways.

Keywords:COVID-19,Pandemics,SARS-CoV-2,SocialStigma

Introduction:

Social stigma in the framework of health is the

negative associationbetween a personor groupof

persons who share a specific disease and certain[1]characteristics. In an epidemic/pandemic, this

mean people are labelled, discriminated against,

stereotyped, treated separately, and/or experience

lossofstatusbecauseofarecognizedconnectionwith

adisease.Suchbehaviourcanaffect thosewiththe

disease, caregivers, family, friends, doctors and[1]nursesandevencommunitiesatlarge. TheCOVID-

19 pandemic, being an unfamiliar communicable

disease, has provoked social st igma and

discriminationagainstpeopleperceivedtohavebeen

in contact with the virus, may be patients or[1]healthcareproviders. Eventhefamilymembersof

thehealthcareworkershavebeenstigmatized.

Among the 'Corona Warriors'; the healthcare

workers(HCWs)areconsideredthemostvulnerable

fortheirclosecontactwithpatients, theircontacts,

andasymptomaticcarriers.Asparticipationofhealth

care personnel in the treatment of COVID-19 are

HealthlineJournalVolume12Issue2(April-June2021)

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rising,theyareincreasinglyconsideredbythepublic

as petri dishes of the virus- a source of viral[2]dissemination.

Priortothis,therewerealreadyalarmingnumber

of incidences of physical and verbal assault on[3]healthcare provider. Now during COVID-19

pandemic,many incidents of stigmatization of[4]healthcareworkers,havecomeupacrosstheworld.

For instance, in Mexico, doctors and nurses used

bicycles during this pandemic, because they were

deniedaccesstopublictransportandfacedphysical

assaults; in Malawi, healthcare workers were

disallowed to use public transport, insulted in the[4]road,andevictedfromrentedapartments. Amobof

localsthrewstonesandspatuponateamofhealth

careworkersandcivicofficials inRanipura, Indore[5]who had gone to screen residents' there. An

Auxiliary Nurse Midwife was obstructed from[2]

enteringherhouseandmanhandledinBareilly. In

Moradabad'sNawabganjareaateamofdoctorsand[2]

medical staff were stoned. A group of ASHA

(Accredited Social Health Activist) workers were

assaulted in the Sadiq, area of Bangalore during[2]

conducting survey on symptomatic people. There

wasacomplainofobscenitylodgedbyChiefMedical

Superintendent (CMS)ofMMGDistricthospitalof

Ghaziabad against a group of five suspected[6]

coronavirus patients. A lady doctor in Surat was[7]verbally abused by her neighbour. Health Care

Workers raised their voices and showed their

concernovertheseincreasinginstancesofstigmaon

them.Funeral of a nurse who died of COVID-19 in

Sewakulvillage,WestUngaran,Semarangregencyin[8]

Central javawas rejected by several residents. In

Chennai, a neuro surgeon, who died of COVID-19[9]

infection,was denied decent burial. To tackle the

social stigma in COVID-19 pandemic,WHO tells to

createanenvironmentwhereopendiscussionamong[4]

healthcareworkersandpeopleispossible.

There are several studies worldwide which

speaks about psychological problems, depression,

stressandmentalhealthofHCWsduringCOVID-19

pandemic . However t he re i s dea r th o f

epidemiological research regarding social stigma

towardsthemduringthispandemicandwiththebest

ofourknowledge,probablythisisthefirststudyin

thispartofIndia.Withthisbackgroundthisstudywas

conductedonsocialstigmaperceivedbythehealth

careworkersworking ina tertiary carehospital in

Kolkata.

Method:

Adescriptivetypeofobservationalstudy,cross-

sectionalindesignwasconductedduringtheCOVID-th th

19lockdownperiod(19 May2020–20 July2020)

overaperiodof2monthsamonghealthcareworkers

ofatertiarycareteachinginstituteofKolkata,West

Bengal,India.

InclusionandExclusionCriteria:Allpersonswho

wereinvolvedinanytypeofhealthcareorhealthcare

relatedworkandweretravellingdailyfromoutside

thehospitalfortheirduty(eitherbytheirownvehicle

orvehicleprovidedbytheadministration)orthose

who had hostel accommodation but were availing

hospitaltransporttogohomeonholidays/off-days

wereincludedinthestudy.Healthcareworkerswho

didnotgiveinformedwrittenconsentwereexcluded.

SampleSizeandSamplingTechnique:Assuming

proportion (p) of social stigma as 50%, standard

normaldeviateZ=1.96(for95%confidenceinterval)

and 5% absolute precision (d),sample size was2

calculated using Cochran's formula as (Z x p x 2

(1-p)/(d) )= 384. After adding 10% non-response

rate, final sample sizewas calculated to be 422.By

simplerandomsamplingmethod,422peoplewere

chosen froman available list of the staffs from the

travel register for data collection. However, 12 of

themdidnotgavetheirconsenttoparticipateinthe

study.Thusatotalof410peoplewereincluded.

Studytool:Apre-designed,pre-testedstructured

schedule was used for data collection which was

prepared in consultation with 3 experts; 1 public

health specialist , 1 social scientist and 1

psychologists.Aftertheschedulewasdesigneditwas

pretested among 20 HCWs of the same institution

who were not included in final study. Minor

correctionsweremade in the schedule.From their

responses Cronbach's Alpha (α)was calculated for

Sahaetal StigmatowardsFrontlineCoronaWarriors...

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frequencyandpercentage;binarylogisticregression

wasdone;Pearson's Chi Square Test and odds

ratiowith95%ConfidenceIntervalswerecalculated.

A p value of <0.05 was considered statistically

significant.

Ethics Committee Approval: Approval from

InstitutionalEthicsCommittee(IEC)wastakenvide

memo no . IPGMER/IEC/2020/391 dated

18/05/2020.

OperationalDefinitions:

Health Care Workers: Health care worker or

“HCW”meansanypaid(bythegovernmentorbythe

contractors)orunpaidperson(includinghealthcare

students/ volunteers) working in a health care

facilityorhospitalonpermanentorcontractualbasis,

and involved directly or indirectly in patient care/

academics/ hospital administration/ hospital

upkeep and security on a consistent and regularly

scheduledbasisforfiveormorehoursperweek.In

Indiancontext,theyincludedoctors,nurses,support

staffs, technicians, para medical staffs, medical

students,interns,externs,house-staffsetc.

Residence(hostel):HealthCareWorkerswhohad

hostel accommodation but used to go their home

duringholidays/off-days.

Socio Economic Classification: Revision of the[11]Prasad'ssocialclassificationfortheyear2020

Otherbackgroundcharacteristics:Itincludestype

oftransportusedbytheHCWs,contactwithCOVID-

19positivepatient,postinginfeverclinic.

Table 1 shows distribution of the study

population as per their Socio-demographic

profile.Out of 410 HCWs, 54.6%were females and

45.4%weremales. About 39.3%were in the age

groupof25-40yearswithmeanageof36.53±12.3

years,medianageof34yearsandarangeof18to62

years. Most (80.2%)of the participants followed

Hinduism;59.8%weremarried;28.8%belonged to

ScheduledCaste,3.2%toScheduledTribe,15.1%to

Other Backward Classes and 52.9% to General

category. Regarding education, majority (54.1%)

were Graduate &above. About 87.3% lived with

each question. The question with α>0.7 were

includedinfinalschedule.Thescheduleconsistedof

twoparts:

First part included Socio-demographic

characteristics (age, gender, religion, caste,marital

status, type of family, education, socioeconomic

status, current residence, department of work,

addictionsetc.).

Second part included 17 Components to assess

socialstigma.Responsesofsocialstigmacomponents

werenotedin5pointLikertScalescoring'0'(zero)to

4fortheirresponsesof'Never','Rarely','Sometimes',

'Often' and 'Very often' respectively.Median of the

social stigma response score (aggregated) was

calculatedanditwasfoundtobe7.Scoresbelow7

wereconsideredtobe'No-significantSocialStigma'

(NSS) and scores >=7 were taken as having

'Significant Social Stigma'. Among the NSS, those

having'0'scoreweremarkedas'Nosocialstigma',

scores1to6as'InsignificantSocialStigma'.

Studyvariables:Thestudyvariableswerebroadly

Dependent variables (Social Stigma to HCWs) and

Independent variables (age in completed years,

gender, religion, caste, marital status, residence,[10]

currently living with, type of family, level of[11]education, occupation, socio-economic status,

transport,addiction).

Data collection technique: After obtaining

approvalfromInstitutionalEthicsCommittee(IEC),

datacollectionwasdonebyface-to-faceinterviewby

the investigator and co-investigators, maintaining

physical distance andwearingmask, face shield &

cap.Informedwrittenconsentwastakenfromallthe

participantsafterexplainingthepurpose&natureof

the study and ensuring their anonymity &

confidentiality.

Data analysis: Data were entered in Microsoft

Office Excel 2010(Microsoft Corp, Redmond, WA,

USA) and analysis were done using Statistical

PackagefortheSocialSciences(SPSSforWindows,

version 20.0, SPSS Inc., Chicago, USA). Descriptive

and Inferential Statistics for study variables were

performed. Descriptive results were expressed by


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Table1:Socio-demographicprofileofstudypopulation(N=410)

<25

25-40

41-55

>55

Female

Male

Hindu

Muslim

Christian

Other(Buddhist,Jain,Secular)

Others(general)

SC

OBC

ST

Married

Unmarried

Others(Separated,divorced,Widow)

Hostel

Quarter

Rentedhouse

Ownhouse

Alone

Family

Joint

Nuclear

Non-formaleducation

Primary

Middleschool

Secondary

Highersecondary

Graduatesandabove

101(24.6)

161(39.3)

97(23.7)

51(12.4)

224(54.6)

186(45.4)

329(80.2)

76(18.7)

3(0.7)

2(0.5)

217(52.9)

118(28.8)

62(15.1)

13(3.2)

245(59.8)

161(39.2)

4(1.0)

10(2.4)

13(3.2)

174(42.4)

213(52.0)

52(12.7)

358(87.3)

149(36.3)

261(63.7)

14(3.4)

6(1.5)

26(6.4)

57(13.9)

85(20.7)

222(54.1)

n(%)Socio-demographiccharacteristics

Agegroup(in

completedyears)

Gender

Religion

Caste

Maritalstatus

CurrentResidence

Livingwith

Typeoffamily

Levelof

education

Doctor

Nurse

Paramedicalstaff(LabTechnician,

Physiotherapyinterns)

Others(House-keeping,

clericalstaffs,admini-

strativestaffs,Security,

Labtechnician,GDA*etc.)

ClassI(Upper)

ClassII(UpperMiddle)

ClassIII(Middle)

ClassIV(LowerMiddle)

ClassV(Lower)

Yes

No

48(11.7)

176(42.9)

25(6.1)

161(39.3)

216(52.7)

164(40.0)

16(3.9)

11(2.7)

3(0.7)

89(21.7)

321(78.3)

Occupation

Socio-economic

class(ModifiedBGPrasadScale

[11]2020)

Addictions(ifany)

family members whereas rest 12.7% lived alone.

Amongtherespondents,42.9%wereNurses,11.7%

wereDoctorsand6.1%wereParamedicalstaffs.As[11]

per Modified BG Prasad Scale, January 2020,

majority(52.7%)belongedtoClassIwhileonly0.7%

wereinClassV.Mostofthem(87.3%)weretravelling

by hospital vehicles and 12.7% by own vehicles.

Addiction was found among 21.7% of the study

population.

Distributionofthestudypopulationaccordingto

response to different components of social stigma

wasdemonstrated inTable2AandTable2Bwhich

revealedthatpeopledidnotavoidtalkingto46.1%of

the HCWs; only 38.0% of the HCWs were not

consideredassourceofinfection;9.5%wereordered

tovacatethehousebytheirlandlord.Only52%ofthe

respondentshadnofeartostepoutoftheirresidence.

Whenenquiredaboutpsychologicalstatus,13.9%of

theHCWsreportedtobedepressedsometimesand

13.0%were depressedmore often. Though 13.9%

faced verbal abuse sometimes or more by the

patient's relatives and 6.4% faced verbal abuse by

their neighbours sometimes or moreduring last 1

month, there was no incidence of physical abuse.

Socialmediaharassmentwasfacedby7.7%ofHCWs.


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Outofthe410participants,16.1%haddifficultiesin

carparking/watersupply/supplyofessentialitems

totheirhome.Duringthispandemic,only61%ofthe

studypopulationneverregrettedtobeinthisnoble.

Table3depictedpredictorsofsocialstigmausing

binary logistic regression. In simple binary logistic

regression analysis, age of the participant, female

gender, general caste,currently residing in rented

house,nuclear family , education up tomid school,

livingalone,PerCapitaMonthlyIncome,occupation

(doctors), mode of transport by hospital vehicle,

addiction and contactwith COVID-19 patientwere

foundtobestatisticallysignificant.

These were considered for final binary logistic

regression analysis and age group, female gender,

generalcaste,midschooleducation,livinginrented

house, mode of transportby hospital vehicle, and

contact with COVID-19 patient were proved to be

Table2A:Distributionofthestudypopulationaccordingtoresponsetodifferentcomponentsofsocialstigma(N=410)

InformationsoughtNevern(%)

Rarelyn(%)

Sometimesn(%)

Oftenn(%)

Veryoftenn(%)

1.Peopleavoidtalkingtomewhentheyseeme.

2.Peoplebehavestrangelyandshowunusualexpressionwhentheyseemeleavingfordutyorreturning.

3.Myfamilymembers,relativesandfriendsareavoidingmeandnotspendingtimewithmeliketheyusedto.

5.Mylandlordhasaskedmetovacatehouse.

6.Myfamilyhasaskedmetostayinhospitalpremisesandnottoreturnhome.

7.Myneighboursareavoidingmeetingandtalkingtomyfamilymembers.

8.Ifeelscaredtostepoutofmyhouseforduty.

4.PeoplethinkImightbeinfectedwithCovid-19andtransmitinfectiontothem.

9.Mycolleagueshavechangedtheirbehaviourtowardsmeandstartedbehavingstrangely.

189(46.1)

203(49.5)

288(70.2)

156(38.0)

371(90.5)

361(88.0)

244(59.5)

213(52.0)

377(92.0)

102(24.9)

94(22.9)

82(20.0)

69(16.8)

12(2.9)

25(6.1)

34(8.3)

105(25.6)

15(3.7)

94(22.9)

90(22.0)

25(6.1)

111(27.1)

16(3.9)

13(3.2)

76(18.5)

68(16.6)

15(3.7)

22(5.4)

19(4.6)

15(3.7)

67(16.3)

11(2.7)

4(1.0)

35(8.5)

21(5.1)

3(0.7)

3(0.7)

4(1.0)

0(0)

7(1.7)

0(0)

7(1.7)

21(5.1)

3(0.7)

0(0)

statisticallysignificantwithstigmascore.

Figure 1 showed that about 53% of the study

population faced 'Significant Social Stigma'; 33%

had'Insignificant Social Stigma' and only 14% had

faced'NoSocialStigma'.

Discussion:

Engagement ofHCWs in hospitals& clinic sputs

them at high risk of contracting the severe acute

respiratory syndrome coronavirus-2 (SARS-CoV-[12]

2). The accelerating spread of COVID-19 and its

outcomes has led people to fear, panic, concern,[13]anxietyandthusconstitutesstigma.

In thepresentstudy52.34%of theHCWsfaced[14]

significantsocialstigma.AstudybyUvaisetal at

Calicut , Kerala among healthcare workers

(haemodialysisstaff-nursesandtechnicians)during

COVID-19 showed that 54.6%of the dialysis staff


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Table2B:Distributionofthestudypopulationaccordingtoabusefacedbythem(N=410)

InformationsoughtNevern(%)

Rarelyn(%)

Sometimesn(%)

Oftenn(%)

Veryoftenn(%)

1.Ihavebeenfeelingdepressedandinlowmoodsincelast1month.

2.Ihavefacedverbalabusebyneighboursinlast1month.

3.Ihavefacedverbalabusebypatients’relatives/otherpeopleinlast1month.

4.Ihavefacedphysicalabusebyneighboursinlast1month.

5.Ihavefacedphysicalabusebypatients’relatives/otherpeopleinlast1month.

6.Ihavefacedproblemregardingcarparking/watersupply/homedeliveryofitemsatmyresidence.

7.Ihavebeenharassedonsocialmedia.

8.IfeelIwouldhavepreferredtobeinsomeotherjobratherthanbeingahealthcareworker.

227(55.4)

317(77.3)

297(72.4)

410(100)

402(98.0)

322(78.5)

358(85.6)

250(61.0)

73(17.8)

36(8.8)

87(21.2)

0(0)

4(1.0)

22(5.4)

28(6.8)

59(14.4)

57(13.9)

48(11.7)

13(3.2)

0(0)

4(1.0)

51(12.4)

22(5.4)

46(11.2)

47(11.5)

9(2.2)

13(3.2)

0(0)

0(0)

15(3.7)

6(1.6)

28(6.8)

6(1.5)

0(0)

0(0)

0(0)

0(0)

0(0)

3(0.7)

27(6.6)

perceived significant stigma during COVID-[15]19.Another study by Uvais et al among doctors

working inCOVID-19–designatedhospitals in India

revealed that62.1%hadhigher levelsofperceived[16]stigma.Ramaci et al at Italy has suggested that

stigmahasahighimpactonworkers'outcomesand

compliance.PerceivedstigmaamongtheHCWsisa

major mediator for psychiatric problems during

COVID-19 pandemic. The WHO issued specific

psychosocial considerations to reduce the growing[17]stigmaofCOVID-19.

Duetothelackofstudiesontheperceivedstigma

byHCWsduringCOVID-19,studiesweredrawnfrom

other sources- SevereAcuteRespiratory Syndrome

(SARS) and Middle East Respiratory Syndrome[18]

coronavirus(MERS-CoV).A studybyVermaetal

amongGeneral Practitioners (GPs) and Traditional

ChineseMedicinePractitionersaftertheoutbreakof

SARS pandemic in Singapore revealed that stigma

towards GPs who were involved in SARS-affected

patient care was significantly higher than that of

Traditional Chinese Medicine (TCM) practitioners.[19]Study by Koh et al in Singapore among HCWs

during SARS pandemic demonstrated that 49%

HCWs experienced social stigmatization. In Taiwan

20%ofHCWsengagedwiththeSARSoutbreak felt

s t igmat iza t ion and re jec t ion f rom the ir [20]neighbourhoodrevealedfromastudybyBaietal.

Stigma had both direct and indirect influence on

mental health among nurses working at a

government-designated hospital in Gyeonggi-do,

SouthKorea duringMERS-CoV epidemic described[21]

byParketal.[22] AstudybyTayloretal fromtheUnitedStates

and Canada showed that avoidance of HCWs is a

widespreadproblemduringtheCOVID-19pandemic.

Over a quarter of Non-HCW adults believed that

HCWsshouldbeisolatedfromcommunitiesandtheir

familiestoobecauseoffearthatHCWisasourceof[23]

infection. Netherland study by Kluytmans et al

foundthatHCWsaremorelikelytoacquireCOVID-19

inthecommunity,ratherthaninhospitalsettingslike

non-HCWs.


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Table3:Predictorsofsocialstigma:Binarylogisticregression(N=410)

ParamedicalStaff

Others

Independentvariables

SignificantSocialStigmapresent(n=216)

AOR(95%CI) pvalueOR(95%CI)

Female

Male

SC

ST

OBC

Others(General)

Hostel

Quarter

Rentedhouse

Ownhouse

Alone

Family

Joint

Nuclear

Doctor

Nurse

Gender

Caste

Nonformaleducation

MiddleSchool

Secondary

HigherSecondary

Graduateandabove

Levelof

Education

Residence

Livingwith

Typeoffamily

Occupation

142

74

58

10

31

117

4

20

26

41

125

6

10

109

91

35

181

65

151

19

118

10

69

2.62(1.76-3.91)

1

0.82(0.53-1.29)

2.85(0.76-10.64)

0.85(0.49-1.50)

1

0.31(0.09-1.02)

2.59(1.00-6.69)

0.65(0.36-1.17)

0.72(0.44-1.19)

1

2.01(0.55-7.33)

4.47(1.19-16.70)

2.25(1.49-3.39)

1

2.01(1.09-3.72)

1

0.56(0.37-0.85)

1

2.90(1.31-6.40)

2.71(1.74-4.22)

0.88(0.38-2.09)

1

5.93(2.09-16.82)

1

0.38(0.19-0.77)

1.58(0.31-8.19)

0.14(0.05-0.34)

1

0.81(0.126-5.49)

38.02(7.99-180.91)

1.69(0.51-5.57)

0.26(0.12-0.57)

1

5.74(0.47-70.19)

12.69(1.66-97.23)

3.29(1.62-6.72)

1

0.97(0.32-2.97)

1

0.60(0.34-1.07)

1

1.75(0.45-6.79)

1.67(0.49-5.79)

0.48(0.11-1.99)

1

<25

25-40

41-55

>55

Agegroup(incompleted

years)

61

92

50

13

4.45(2.11-9.39)

3.89(1.93-7.87)

3.11(1.48-6.55)

1

34.89(9.29-131.01)

14.89(4.92-45.14)

11.38(3.87-33.49)

1

p<0.001

p<0.001

p<0.001

-

0.001

-

0.007

0.580

p<0.001

-

0.833

<0.001

0.389

0.001

-

0.171

0.014

0.001

-

0.962

-

0.085

-

0.419

0.413

0.310

-

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ContactwithCOVID19Positive

patient

Addictions(ifany)

Hospitalvehicle

Ownvehicle

Yes

No

Yes

No

Transport205

11

38

178

40

176

4.99(2.49-10.03)

1

1.76(0.99-3.11)

1

1.49(0.93-2.38)

1

39.94(7.59—210.26)

1

2.41(1.05-5.54)

1

1.33(0.59-2.95)

1

p<0.001

-

0.038

-

0.49

-

ModelFit:CoxandSnellR-Square=0.365,NagelkerkeR-Square=0.487,OmnibusTestp<0.001,Hosmer-LemeshowTestp=0.074

American data collected from February-April,

2020revealedthatthemajorityofreportedCOVID-[24]

19 cases (89%) were non HCWs. Similarly

Canadian research demonstrated that HCWs had a

risk of only 0.14 % of developing COVID-19, [25]

comparedto0.10%inthegeneralpopulation. Ina[26]studybyJhaetal inMaxSuperspecialityHospitalin

India,14.7%ofHCWswhoparticipatedhadflu-like

symptoms, and only 1.8% of them had COVID-19

infection.Thusthereisnobasisfortheattitudesthat

HCWsshouldbeseparatedfromtheircommunities

and/orfamilies.

Strengths&Limitations:

Strengthsofthepresentstudyare:

• There is a dearth of epidemiological research

study about healthcare worker's stigmatization

duringCOVID-19pandemicandtothebestofour

knowledgethisisprobablythefirststudycarried

outinthispartofIndia.

• Largesamplesize.

• Highresponserate(97.15%).

• Our findings provide valuable information that

HCWs are associated with the “COVID Stress

Syndrome”andinterventionsthatreduce“COVID

Stress Syndrome” may also reduce stigma

towardsHCWs.

Limitations:

• Firstly, there was lack of a validated scale that

specifically assesses the stigma associatedwith

COVID-19.

• Secondly,thecross-sectionaldesigndidnotallow

exploringthechangesinstigmapatternovertime.

• The third limitation was possibility of social

desirability bias, that is, responses to some

questionsbeingsociallyfavourable.Moreoverthe

study population were recruited from a single

institute for this studywhich limit the external

validity.Lastbutnottheleastqualitativemethod

was not used which would have added more

insightstotheproblem.

ConclusionandRecommendations:

TheCOVID-19hasemotionallyaffectedthelives

ofHCWs-bothforthephysicalthreatofthedisease,

and fear of stigmatisation. This study has revealed

that more than half of the study population

experienced “Significant Social Stigma”.The HCWs

whoweretravellingfromhometoattendtheirduties

were stigmatised in different ways. Many of them

wereconsideredassourceofinfectionbythesociety.

People avoided them and reacted strangely when

Figure1:Piediagramshowingdistributionofstudypopulationaccordingtopresenceofsocialstigma(N=410)


::41::


theyhadseenthemgoingtodutyorcominghome.

FewRentedhouseresidentswereorderedtovacate

the house by their landlords. They had difficulties

regardingwatersupply,carparkinganddeliveryof

essentialitemstotheirhome.

It is not known at this point whether this

pandemicwillhaveacontinuingeffect,oritwillend

after an extended time-hence it is important that

stigmatowardstheseHCWsbeexploredandtreated.

Community awareness generation through mass

mediawillplayanimportantrole.Accommodationof

the HCWs in hospital facility may be considered,

especially during the pandemic. Co-operation,

assistanceandstrictmeasuresfrom administration

forthesafetyofHCWsandtheirfamilymemberscan

reducethestigma.Developmentofanenvironment/

forum, where open discussion among health care

workers and people is possible, will educate the

generalpopulationandcleartheredoubtanditwill

reducethestigma.

Declaration:

Funding:Nil

ConflictofInterest:Nil

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