新型冠状病毒肺炎疫情期间基层医疗卫生工作者职业紧张及其影响因素分析

Occupational stress and its influencing factors of primary health care workers during COVID-19

[背景]自新冠肺炎疫情暴发以来,基层医务人员面临着前所未有的工作压力,其职业紧张状况应引起重视。[目的]分析广东省基层医疗卫生工作者的职业紧张状况及其影响因素,提出针对性干预措施。[方法]采用多阶段分层随机抽样法,根据广东省统计局发布的各地级市2019年国内生产总值(GDP)将广东省各地级市分为“经济好”、“经济中等”和“经济差”三层,于2021年9月每层随机抽取4家基层医疗卫生机构,共1327名工作人员为研究对象。采用《职业紧张核心量表》(COSS)及课题组设计的基本情况问卷对其进行调查。两组组间得分比较采用Mann-Whitney U检验,多组组间得分比较采用Kruskal-Walis H检验。计数资料率的比较采用趋势性χ^(2)检验或Pearsonχ^(2)检验;职业紧张的影响因素分析采用二分类多因素logistic回归分析。[结果]本次调查中存在职业紧张的有365人,职业紧张发生率为27.5%。职业紧张总得分及其社会支持、组织与回报、要求与付出、自主性维度得分M(P25,P75)分别为45.0(40.0,50.0)、20.0(17.0,21.0)、14.0(12.0,17.0)、12.0(10.0,15.0)、5.0(4.0,6.0)分。二分类多因素logistic回归分析结果显示,高学历、低收入、医生岗位、长日工作时间、轮班作业与职业紧张的发生相关(P<0.05)。[结论]学历、月均收入、岗位、日工作时间、轮班是基层医务工作人员职业紧张发生状况的影响因素;应有针对性地开展干预,以降低其职业紧张水平。

[Background]Since the outbreak of COVID-19,primary health care workers have been facing unprecedented work pressure,and their occupational stress should be taken seriously.[Objective]To analyze the occupational stress situation and its influencing factors of primary health care workers in Guangdong Province,and to propose targeted interventions.[Methods]Using a multi-stage stratified random sampling method,each prefecture-level city in Guangdong Province was classified into"good","medium",or"poor"category based on its gross domestic product(GDP)in 2019 released by the Guangdong Provincial Bureau of Statistics.In September 2021,four primary health care institutions were randomly selected from each stratum,and a total of 1327 staff members were selected for the study.The Core Occupational Stress Scale(COSS)and a basic information questionnaire designed by the authors were used.Mann-Whitney U test was used to compare the means between two groups,and Kruskal-Walis H test was used to compare the means among multiple groups.The comparison of categorical data was performed by trendχ^(2)test or Pearsonχ^(2)test;the analysis of factors influencing occupational stress was performed by dichotomous multiple logistic regression analysis.[Results]There were 365 health care workers reporting occupational stress in this survey,and the positive rate of occupational stress was 27.5%.The total occupational stress score in M(P25,P75)and the scores of social support,organization and reward,demand and effort,and control were 45.0(40.0,50.0),20.0(17.0,21.0),14.0(12.0,17.0),12.0(10.0,15.0),and 5.0(4.0,6.0),respectively.The results of dichotomous multiple logistic regression analysis showed that high education,low income,doctor positions,long working hours in a day,and shift work were associated with the occurrence of reporting occupational stress(P<0.05).[Conclusion]Education,average monthly income,job category,daily working hours,and shifts are factors influencing the occurrence of reporting occupational stress in primary health care workers;targeted interventions should be implemented to reduce their occupational stress levels.