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Evaluating barriers and potential solutions to speaking up about coronavirus disease 2019 (COVID-19) symptoms: A survey among nursing home workers
Published online by Cambridge University Press: 04 April 2023
Abstract
Objective:
Quantify the frequency and drivers of unreported coronavirus disease 2019 (COVID-19) symptoms among nursing home (NH) staff.
Design:
Confidential telephone survey.
Setting:
The study was conducted in 70 NHs in Orange County, California, December 2020–February 2022.
Participants:
The study included 120 NH staff with COVID-19.
Methods:
We designed a 40-item telephone survey of NH staff to assess COVID-19 symptom reporting behavior and types of barriers [monetary, logistic, and emotional (fear or stigma)] and facilitators of symptom reporting using 5-point Likert scales. Summary statistics, reliability of survey constructs, and construct and discriminant validity were assessed.
Results:
Overall, 49% of surveys were completed during the 2020–2021 COVID-19 winter wave and 51% were completed during severe acute respiratory coronavirus virus 2 (SARS-CoV-2) δ (delta)/ (omicron) waves, with a relatively even distribution of certified nursing assistants, licensed vocational or registered nurses, and nonfrontline staff. Most COVID-19 cases (71%) were detected during mandated weekly NH surveillance testing and most staff (67%) had ≥1 symptom prior to their test. Only 34% of those with symptoms disclosed their symptom to a supervisor. Responses were consistent across 8 discrete survey constructs with Cronbach α > 0.70. In the first wave of the pandemic, fear and lack of knowledge were drivers of symptom reporting. In later waves, adequate staffing and sick days were drivers of symptom reporting. COVID-19 help lines and encouragement from supervisors facilitated symptom reporting and testing.
Conclusions:
Mandatory COVID-19 testing for NH staff is key to identifying staff COVID-19 cases due to reluctance to speak up about existing symptoms. Active encouragement from supervisors to report symptoms and stay home when ill was a major driver of symptom reporting and resultant infection prevention and worker safety measures.
- Type
- Original Article
- Information
- Copyright
- © The Author(s), 2023. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America
Footnotes
a
Authors of equal contribution.
b
Authors of equal contribution.
PREVIOUS PRESENTATION. These data were presented as a poster abstract at IDWeek 2022 on October 21, 2022, in Washington, DC.
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Gussin et al. supplementary material
Gussin et al. supplementary material
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