{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T13:42:09Z","timestamp":1767966129512,"version":"3.49.0"},"reference-count":105,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T00:00:00Z","timestamp":1710892800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Sefako Makgatho Health Sciences University (SMU)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>As the world grappled with the COVID-19 pandemic, healthcare workers (HCWs) continued to provide uninterrupted health care service delivery; therefore, this disproportionately affected their wellbeing. Our study explored the wellbeing of HCWs during the COVID-19 era in public health facilities in the City of Johannesburg, Gauteng province, South Africa. A qualitative study was conducted among twenty (20) HCWs through face-to-face in-depth interviews (IDIs) in the form of semi-structured interviews, audiotapes, and transcribed verbatim, and thematically analyzed with NVivo version 10. The findings showed that over half of HCWs (aged between 27 and 60 years) tested positive for COVID-19. Also, one third of HCWs\u2019 family members tested positive while some died due to COVID-19 infection. Informed by the workers\u2019 wellbeing framework, four themes emerged with fourteen sub-themes. Firstly, unsafe work environment was characterized by human resource related challenges such as increased workload; staff shortage; insufficient resources, e.g., personal protective equipment (PPE); poor policies in terms of compensation\/allowance for being infected with COVID-19; poor health services; and death of colleagues. Secondly, poor health outcomes were described as strained emotional (psychosocial distress) and physical (respiratory related conditions) wellbeing. Thirdly, home and community environments were negatively impacted by interrupted relationships with family and friends, and experiences of deaths of loved ones. Finally, HCWs engaged personal wellbeing strategies through self-motivation; staying positive; family support; and participating in resilience-promoting extra mural activities to cope during the pandemic. In conclusion, the wellbeing of HCWs was aggravated during the COVID-19 era and led to low morale and compromised healthcare quality. This study advocates for promotion of greater resilience, and psychological and physical safety of HCWs through evidence-based, multilevel-multicomponent interventions at the workplace, home, and community environments in addition to strengthening public health policies and response to future pandemics.<\/jats:p>","DOI":"10.3390\/ijerph21030372","type":"journal-article","created":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T09:14:33Z","timestamp":1710926073000},"page":"372","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The Wellbeing of Healthcare Workers during COVID-19 Era in Public Primary Health Facilities in Johannesburg, South Africa"],"prefix":"10.3390","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-5077-0267","authenticated-orcid":false,"given":"Glory","family":"Makhado","sequence":"first","affiliation":[{"name":"Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6304-2345","authenticated-orcid":false,"given":"Busisiwe","family":"Ntuli","sequence":"additional","affiliation":[{"name":"Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5820-0281","authenticated-orcid":false,"given":"Lindiwe","family":"Zungu","sequence":"additional","affiliation":[{"name":"College of Graduate Studies, University of South Africa, Pretoria 0003, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6036-201X","authenticated-orcid":false,"given":"Ntevhe","family":"Thovhogi","sequence":"additional","affiliation":[{"name":"Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3068-9406","authenticated-orcid":false,"given":"Peter Modupi","family":"Mphekgwana","sequence":"additional","affiliation":[{"name":"Research Administration and Development, University of Limpopo, Polokwane 0727, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9047-9136","authenticated-orcid":false,"given":"Sogolo Lucky","family":"Lebelo","sequence":"additional","affiliation":[{"name":"Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Johannesburg 1709, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3735-1248","authenticated-orcid":false,"given":"Sphiwe","family":"Madiba","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, University of Limpopo, Polokwane 0700, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8339-9875","authenticated-orcid":false,"given":"Perpetua","family":"Modjadji","sequence":"additional","affiliation":[{"name":"Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa"},{"name":"Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa"},{"name":"Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Johannesburg 1709, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,20]]},"reference":[{"key":"ref_1","unstructured":"(2021, August 17). CDC: Engaging Employees in Their Health and Wellness. Centers for Diseases Control and Prevention, Available online: https:\/\/www.cdc.gov\/workplacehealthpromotion\/initiatives\/resource-center\/case-studies\/engage-employees-health-wellness.html."},{"key":"ref_2","unstructured":"(2021, July 28). CDC: Mission Possible: Measuring Worker Well-Being. Centers for Diseases Control and Prevention, Available online: https:\/\/blogs.cdc.gov\/niosh-science-blog\/2021\/06\/25\/wellbq\/."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/j.outlook.2022.03.014","article-title":"Nurse well-being: A concept analysis","volume":"70","author":"Patrician","year":"2022","journal-title":"Nurs. Outlook"},{"key":"ref_4","unstructured":"Harvard Business Review Analytic Services (2013). The Impact of Employee Engagement on Performance, Harvard Business Review Analytic Services. Available online: https:\/\/hbr.org\/resources\/pdfs\/comm\/achievers\/hbr_achievers_report_sep13.pdf."},{"key":"ref_5","unstructured":"Institute for Health and Productivity Studies (2015). From Evidence to Practice: Workplace Wellness That Works, Johns Hopkins Bloomberg School of Public Health. Available online: https:\/\/www.transamericainstitute.org\/docs\/default-source\/jhu\/from-evidence-to-practice---workplace-wellness-that-works.pdf?sfvrsn=dcbd5e9b_32."},{"key":"ref_6","unstructured":"WHO (2016). Working for Health and Growth: Investing in the Health Workforce\u2014Report of the High-Level Commission on Health Employment and Economic Growth, The World Health Organization. Available online: http:\/\/apps.who.int\/iris\/bitstream\/10665\/250047\/1\/9789241511308-eng."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/j.colegn.2021.06.002","article-title":"Nurse wellbeing during the coronavirus (2019) pandemic: A qualitative descriptive study","volume":"28","author":"Jarden","year":"2021","journal-title":"Collegian"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Hayashino, Y., Utsugi-Ozaki, M., Feldman, M.D., and Fukuhara, S. (2012). Hope modified the association between distress and incidence of self-perceived medical errors among practicing physicians: Prospective cohort study. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0035585"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s12992-020-00621-z","article-title":"Mental health impacts among health workers during COVID-19 in a low resource setting: A cross-sectional survey from Nepal","volume":"16","author":"Khanal","year":"2020","journal-title":"Glob. Health"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"113441","DOI":"10.1016\/j.psychres.2020.113441","article-title":"The mental health impact of the covid-19 pandemic on healthcare workers, and interventions to help them: A rapid systematic review","volume":"293","author":"Muller","year":"2020","journal-title":"Psychiatry Res."},{"key":"ref_11","unstructured":"ILO, FAO, IFAD, and WHO (2020). Impact of COVID-19 on People\u2019s Livelihoods, Their Health and Our Food Systems, World Health Organization. Available online: https:\/\/www.who.int\/news\/item\/13-10-2020-impact-of-covid-19-on-people\u2019s-livelihoods-their-health-and-our-food-systems."},{"key":"ref_12","unstructured":"WHO (2023, September 12). Coronavirus (COVID-19) Dashboard. Available online: https:\/\/covid19.who.int\/."},{"key":"ref_13","unstructured":"WHO (2023, September 22). Pneumonia of Unknown Cause\u2014China. Available online: https:\/\/www.who.int\/csr\/don\/05-january-2020-pneumonia-of-unkown-cause-china\/en\/."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Moodley, S.V., Zungu, M., Malotle, M., Voyi, K., Claassen, N., Ramodike, J., Thunzi, N., and Mlangeni, N. (2021). A health worker knowledge, attitudes and practices survey of SARS-CoV-2 infection prevention and control in South Africa. BMC Infect. Dis., 21.","DOI":"10.1186\/s12879-021-05812-6"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Arnetz, J.E., Goetz, C.M., Arnetz, B.B., and Arble, E. (2020). Nurse Reports of Stressful Situations during the COVID-19 Pandemic: Qualitative Analysis of Survey Responses. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17218126"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1017\/ice.2020.58","article-title":"Escalating infection control response to the rapidly evolving epidemiology of the coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 in Hong Kong","volume":"41","author":"Cheng","year":"2020","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2218","DOI":"10.1093\/cid\/ciaa287","article-title":"Risk Factors of Healthcare Workers With Coronavirus Disease 2019: A Retrospective Cohort Study in a Designated Hospital of Wuhan in China","volume":"71","author":"Ran","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_18","first-page":"E001","article-title":"Mental health survey of 230 medical staff in a tertiary infectious disease hospital for COVID-19","volume":"38","author":"Huang","year":"2020","journal-title":"Chin. J. Ind. Hyg. Occup. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e203976","DOI":"10.1001\/jamanetworkopen.2020.3976","article-title":"Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019","volume":"3","author":"Lai","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Lee, N., and Lee, H.-J. (2020). South Korean Nurses\u2019 Experiences with Patient Care at a COVID-19-Designated Hospital: Growth after the Frontline Battle against an Infectious Disease Pandemic. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17239015"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1177\/0269216320947966","article-title":"Prioritising workforce wellbeing and resilience: What COVID-19 is reminding us about self-care and staff support","volume":"34","author":"Mills","year":"2020","journal-title":"Palliat. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"100424","DOI":"10.1016\/j.eclinm.2020.100424","article-title":"Frontline nurses\u2019 burnout, anxiety, depression, and fear statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: A large-scale cross-sectional study","volume":"24","author":"Hu","year":"2020","journal-title":"eClinicalMedicine"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Hall, L.H., Johnson, J., Watt, I., Tsipa, A., and O\u2019Connor, D.B. (2016). Healthcare Staff Wellbeing, Burnout, and Patient Safety: A Systematic Review. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0159015"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1111\/inm.12416","article-title":"Mental healthcare staff well-being and burnout: A narrative review of trends, causes, implications, and recommendations for future interventions","volume":"27","author":"Johnson","year":"2018","journal-title":"Int. J. Ment. Health Nurs."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s12245-020-00299-5","article-title":"Physical and mental health impacts of COVID-19 on healthcare workers: A scoping review","volume":"13","author":"Shaukat","year":"2020","journal-title":"Int. J. Emerg. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e042945","DOI":"10.1136\/bmjopen-2020-042945","article-title":"Hospital bed capacity and usage across secondary healthcare providers in England during the first wave of the COVID-19 pandemic: A descriptive analysis","volume":"11","author":"Mateen","year":"2021","journal-title":"BMJ Open"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e60","DOI":"10.7861\/fhj.2020-0176","article-title":"The value of healthcare worker support strategies to enhance wellbeing and optimise patient care","volume":"8","author":"Diver","year":"2021","journal-title":"Future Healthc. J."},{"key":"ref_28","unstructured":"ACCCOS Investigators (2021). Patient care and clinical outcomes for patients with COVID-19 infection admitted to African high-care or intensive care units (ACCCOS): A multicentre, prospective, observational cohort study. Lancet, 397, 1885\u20131894."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Garba, S.M., Lubuma, J.M.-S., and Tsanou, B. (2020). Modeling the transmission dynamics of the COVID-19 Pandemic in South Africa. Math. Biosci., 328.","DOI":"10.1016\/j.mbs.2020.108441"},{"key":"ref_30","unstructured":"Worldmeter (2023, September 22). World\/Countries\/South Africa. Available online: https:\/\/www.worldometers.info\/coronavirus\/country\/south-africa\/."},{"key":"ref_31","unstructured":"(2022, June 30). SouthAfricaRo. COVID-19 Alert System, Available online: https:\/\/www.gov.za\/covid-19\/about\/about-alert-system."},{"key":"ref_32","unstructured":"(2022, June 23). Staff Writer. South Africa Ends Covid Curbs Including Mask Wearing. Business Tech. Available online: https:\/\/businesstech.co.za\/news\/trending\/599478\/south-africa-ends-covid-curbs-including-mask-wearing\/."},{"key":"ref_33","unstructured":"Statista (2023, September 12). Total Number of Coronavirus (COVID-19) Vaccination Doses Administered in South Africa as of 6 March 2022, by Province. Statista. Available online: https:\/\/www.statista.com\/statistics\/1245767\/total-number-of-covid-19-vaccination-doses-in-south-africa-by-province\/."},{"key":"ref_34","unstructured":"Abdool Karim, S. (2021). COVID Vaccine Mandates Don\u2019t Have to Undermine Your Rights\u2013Here\u2019s Why, Bhekisisa Centre for Health Journalism."},{"key":"ref_35","unstructured":"Republic of South Africa (2004). National Health Act No. 61 of 2003, Government Gazette, No. 26595."},{"key":"ref_36","unstructured":"(2024, January 04). ConstitutionofSouthAfrica. Bill of Rights, Available online: https:\/\/www.justice.gov.za\/legislation\/constitution\/SAConstitution-web-eng-02.pdf."},{"key":"ref_37","unstructured":"South African Government (2021, August 28). Occupational Health and Safety Act 85 of 1993, Available online: https:\/\/www.gov.za\/documents\/occupational-health-and-safety-act."},{"key":"ref_38","unstructured":"Dhai, A. (2021). To Vaccinate or Not to Vaccinate: Mandatory COVID-19 Vaccination in the Workplace, Health and Medical Publishing Group (HMPG)."},{"key":"ref_39","unstructured":"WHO (2023, December 12). Tracking SARS-CoV-2 Variants. Available online: https:\/\/www.who.int\/en\/activities\/tracking-SARS-CoV-2-variants\/."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e889","DOI":"10.1016\/S2214-109X(21)00271-0","article-title":"Communicable and non-communicable diseases coexisting in South Africa","volume":"9","author":"Modjadji","year":"2021","journal-title":"Lancet Glob. Health"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Mkhwanazi, T.W., Modjadji, P., Mokgalaboni, K., Madiba, S., and Roomaney, R.A. (2023). Multimorbidity, Treatment, and Determinants among Chronic Patients Attending Primary Health Facilities in Tshwane, South Africa. Diseases, 11.","DOI":"10.3390\/diseases11040129"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"992481","DOI":"10.3389\/fpubh.2022.992481","article-title":"Essential health services delivery in South Africa during COVID-19: Community and healthcare worker perspectives","volume":"10","author":"Mosam","year":"2022","journal-title":"Front. Public Health"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2159","DOI":"10.4102\/hsag.v28i0.2159","article-title":"The mental health and wellbeing of healthcare workers during COVID-19 in South Africa","volume":"28","author":"Watermeyer","year":"2023","journal-title":"Health SA Gesondheid"},{"key":"ref_44","first-page":"e923549","article-title":"The Effects of Social Support on Sleep Quality of Medical Staff Treating Patients with Coronavirus Disease 2019 (COVID-19) in January and February 2020 in China","volume":"26","author":"Xiao","year":"2020","journal-title":"Med. Sci. Monit."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Zhu, Z., Xu, S., Wang, H., Liu, Z., Wu, J., Li, G., Miao, J., Zhang, C.-Y., Yang, Y., and Sun, W. (2020). COVID-19 in Wuhan: Immediate Psychological Impact on 5062 Health Workers. medRxiv.","DOI":"10.1101\/2020.02.20.20025338"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e67","DOI":"10.1017\/S1463423622000536","article-title":"Exploring primary healthcare practitioners\u2019 experiences regarding the coronavirus disease 2019 (COVID-19) pandemic in KwaZulu-Natal, South Africa","volume":"23","author":"McHunu","year":"2022","journal-title":"Prim. Health Care Res. Dev."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.4102\/phcfm.v13i1.3084","article-title":"A qualitative study to explore primary health care practitioners\u2019 perceptions and understanding regarding the COVID-19 pandemic in KwaZulu-Natal, South Africa","volume":"13","author":"Nxumalo","year":"2021","journal-title":"Afr. J. Prim. Health Care Fam. Med."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Scheunemann, A., Kim, A.W., Moolla, A., and Subramaney, U. (2023). Coping strategies employed by public psychiatric healthcare workers during the COVID-19 pandemic in southern Gauteng, South Africa. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0277392"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Rwafa-Ponela, T., Price, J., Nyatela, A., Nqakala, S., Mosam, A., Erzse, A., Lalla-Edward, S.T., Hove, J., Kahn, K., and Tollman, S.M. (2022). \u201cWe Were Afraid\u201d: Mental Health Effects of the COVID-19 Pandemic in Two South African Districts. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19159217"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1038\/s41586-022-04411-y","article-title":"Rapid epidemic expansion of the SARS-CoV-2 Omicron variant in southern Africa","volume":"603","author":"Viana","year":"2022","journal-title":"Nature"},{"key":"ref_51","unstructured":"Britannica (2022, September 12). Gauteng Province, South Africa. Available online: https:\/\/www.britannica.com\/place\/Gauteng."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups","volume":"19","author":"Tong","year":"2007","journal-title":"Int. J. Qual. Health Care"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Havaei, F., Ma, A., Staempfli, S., and MacPhee, M. (2021). Nurses\u2019 Workplace Conditions Impacting Their Mental Health during COVID-19: A Cross-Sectional Survey Study. Healthcare, 9.","DOI":"10.3390\/healthcare9010084"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1097\/MLR.0000000000001109","article-title":"A Meta-Analysis of the Associations Between the Nurse Work Environment in Hospitals and 4 Sets of Outcomes","volume":"57","author":"Lake","year":"2019","journal-title":"Med. Care"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1097\/JOM.0000000000001330","article-title":"Expanding the Paradigm of Occupational Safety and Health: A New Framework for Worker Well-Being","volume":"60","author":"Chari","year":"2018","journal-title":"J. Occup. Environ. Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"2001217","DOI":"10.1183\/13993003.01217-2020","article-title":"Abnormal pulmonary function in COVID-19 patients at time of hospital discharge","volume":"55","author":"Mo","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1652","DOI":"10.4102\/hsag.v26i0.1652","article-title":"Coping strategies used by nurses during the COVID-19 pandemic: A narrative literature review","volume":"26","author":"Sehularo","year":"2021","journal-title":"Health SA Gesondheid"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1016\/j.brat.2003.08.008","article-title":"Social cognitive theory of posttraumatic recovery: The role of perceived self-efficacy","volume":"42","author":"Benight","year":"2004","journal-title":"Behav. Res. Ther."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Lathabhavan, R., Bharti, T., and Marznaki, Z.H. (2023). Role of resilience and self-coping strategy in determining positive emotions during pandemic among healthcare professionals in Iran. BMC Psychol., 11.","DOI":"10.1186\/s40359-023-01323-y"},{"key":"ref_60","unstructured":"Statistics South Africa (2023, April 27). Mid-Year Population Estimates, Available online: http:\/\/www.statssa.gov.za\/publications\/P0302\/P03022019.pdf."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e053680","DOI":"10.1136\/bmjopen-2021-053680","article-title":"Lived experiences of healthcare workers on the front line during the COVID-19 pandemic: A qualitative interview study","volume":"11","author":"Grailey","year":"2021","journal-title":"BMJ Open"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"e95","DOI":"10.1056\/NEJMc2014960","article-title":"The South African Response to the Pandemic","volume":"382","year":"2020","journal-title":"New Engl. J. Med."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"115","DOI":"10.2174\/1381612826666200707121636","article-title":"Repurposing Drugs for the Management of Patients with Confirmed Coronavirus Disease 2019 (COVID-19)","volume":"27","author":"Lovato","year":"2021","journal-title":"Curr. Pharm. Des."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1896","DOI":"10.1093\/cid\/ciab398","article-title":"Severe Acute Respiratory Syndrome Coronavirus 2 Infection Among Healthcare Workers in South Africa: A Longitudinal Cohort Study","volume":"73","author":"Nunes","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"309","DOI":"10.7196\/SAMJ.2021.v111i4.15434","article-title":"Primary healthcare workers at risk during COVID-19: An analysis of infections in HIV service providers in five districts of South Africa","volume":"111","author":"Rees","year":"2021","journal-title":"South Afr. Med. J."},{"key":"ref_66","unstructured":"TheCitizen (2023, October 27). 36% of Gauteng Healthcare Workers Are Not Vaccinated. Available online: https:\/\/www.citizen.co.za\/krugersdorp-news\/own-your-life\/36-of-gauteng-healthcare-workers-are-not-vaccinated\/."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1007\/s10389-020-01313-z","article-title":"Stress and burnout in health care workers during COVID-19 pandemic: Validation of a questionnaire","volume":"30","author":"Talaee","year":"2022","journal-title":"J. Public Health"},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Khubchandani, J., Bustos, E., Chowdhury, S., Biswas, N., and Keller, T. (2022). COVID-19 Vaccine Refusal among Nurses Worldwide: Review of Trends and Predictors. Vaccines, 10.","DOI":"10.3390\/vaccines10020230"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"m3582","DOI":"10.1136\/bmj.m3582","article-title":"Risk of hospital admission with coronavirus disease 2019 in healthcare workers and their households: Nationwide linkage cohort study","volume":"371","author":"Shah","year":"2020","journal-title":"BMJ"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.7196\/SAMJ.2020.v110i10.15022","article-title":"Mental health of healthcare workers during the COVID-19 outbreak: A rapid scoping review to inform provincial guidelines in South Africa","volume":"110","author":"Robertson","year":"2020","journal-title":"South Afr. Med. J."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"3015","DOI":"10.2147\/JMDH.S330041","article-title":"Healthcare Workers\u2019 Burdens During the COVID-19 Pandemic: A Qualitative Systematic Review","volume":"14","author":"Koontalay","year":"2021","journal-title":"J. Multidiscip. Healthc."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1809","DOI":"10.1016\/j.dsx.2020.09.016","article-title":"Effects of COVID-19 in South African health system and society: An explanatory study","volume":"14","author":"Mbunge","year":"2020","journal-title":"Diabetes Metab. Syndr. Clin. Res. Rev."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1097\/NCQ.0000000000000596","article-title":"Nursing Moral Distress and Intent to Leave Employment During the COVID-19 Pandemic","volume":"37","author":"Sheppard","year":"2022","journal-title":"J. Nurs. Care Qual."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.4102\/curationis.v42i1.1901","article-title":"Challenges of quality improvement in the healthcare of South Africa post-apartheid: A critical review","volume":"42","author":"Maphumulo","year":"2019","journal-title":"Curationis"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s13033-015-0004-z","article-title":"Health system governance to support integrated mental health care in South Africa: Challenges and opportunities","volume":"9","author":"Marais","year":"2015","journal-title":"Int. J. Ment. Health Syst."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.4102\/phcfm.v9i1.1252","article-title":"Which primary care model? A qualitative analysis of ward-based outreach teams in South Africa","volume":"9","author":"Marcus","year":"2017","journal-title":"Afr. J. Prim. Health Care Fam. Med."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"566212","DOI":"10.3389\/fpsyg.2020.566212","article-title":"Emotional, Behavioral, and Psychological Impact of the COVID-19 Pandemic","volume":"11","author":"Pedrosa","year":"2020","journal-title":"Front. Psychol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"113145","DOI":"10.1016\/j.psychres.2020.113145","article-title":"Aggregated COVID-19 suicide incidences in India: Fear of COVID-19 infection is the prominent causative factor","volume":"290","author":"Dsouza","year":"2020","journal-title":"Psychiatry Res."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"102073","DOI":"10.1016\/j.ajp.2020.102073","article-title":"First COVID-19 suicide case in Bangladesh due to fear of COVID-19 and xenophobia: Possible suicide prevention strategies","volume":"51","author":"Mamun","year":"2020","journal-title":"Asian J. Psychiatry"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1046\/j.1365-2648.2003.02938.x","article-title":"Psychological distress: Concept analysis","volume":"45","author":"Ridner","year":"2004","journal-title":"J. Adv. Nurs."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.jiph.2017.06.011","article-title":"\u201cIt feels like I\u2019m the dirtiest person in the world.\u201d: Exploring the experiences of healthcare providers who survived MERS-CoV in Saudi Arabia","volume":"11","author":"Almutairi","year":"2018","journal-title":"J. Infect. Public Health"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1089\/hs.2016.0068","article-title":"The psychosocial challenges of caring for patients with Ebola virus disease","volume":"15","author":"Smith","year":"2017","journal-title":"Health Secur."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1016\/j.bbi.2020.04.049","article-title":"A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak","volume":"88","author":"Chew","year":"2020","journal-title":"Brain Behav. Immun."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1016\/S0140-6736(20)30460-8","article-title":"The psychological impact of quarantine and how to reduce it: Rapid review of the evidence","volume":"395","author":"Brooks","year":"2020","journal-title":"Lancet"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1159\/000507639","article-title":"Mental Health and Psychosocial Problems of Medical Health Workers during the COVID-19 Epidemic in China","volume":"89","author":"Zhang","year":"2020","journal-title":"Psychother. Psychosom."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"103809","DOI":"10.1016\/j.ijnurstu.2020.103809","article-title":"Prevalence and associated factors of depression and anxiety among nurses during the outbreak of COVID-19 in China: A cross-sectional study","volume":"114","author":"Zheng","year":"2021","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"2169","DOI":"10.2147\/JMDH.S317884","article-title":"Comorbidities and Risk Factors for Severe Outcomes in COVID-19 Patients in Saudi Arabia: A Retrospective Cohort Study","volume":"14","author":"Shaikh","year":"2021","journal-title":"J. Multidiscip. Healthc."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"8562","DOI":"10.1038\/s41598-021-88130-w","article-title":"A systematic review and meta-analysis of geographic differences in comorbidities and associated severity and mortality among individuals with COVID-19","volume":"11","author":"Thakur","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_89","doi-asserted-by":"crossref","unstructured":"Mphekgwana, P.M., Sono-Setati, M.E., Mokgophi, T.V., Kifle, Y.G., Madiba, S., and Modjadji, P. (2023). Retrospective Analysis of the Outcome of Hospitalized COVID-19 Patients with Coexisting Metabolic Syndrome and HIV Using Multinomial Logistic Regression. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20105799"},{"key":"ref_90","doi-asserted-by":"crossref","unstructured":"Ratshikhopha, E., Muvhali, M., Naicker, N., Tlotleng, N., Jassat, W., and Singh, T. (2022). Disease Severity and Comorbidities among Healthcare Worker COVID-19 Admissions in South Africa: A Retrospective Analysis. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19095519"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1080\/21635781.2020.1765911","article-title":"Going to \u201cWar\u201d: Military Approach as the Antidote to Defeating COVID-19","volume":"8","author":"Jetly","year":"2020","journal-title":"Mil. Behav. Health"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1002\/jts.22405","article-title":"Introduction to the Special Issue on Moral Injury: Conceptual Challenges, Methodological Issues, and Clinical Applications","volume":"32","author":"Litz","year":"2019","journal-title":"J. Trauma. Stress"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1192\/bjp.2018.55","article-title":"Occupational moral injury and mental health: Systematic review and meta-analysis","volume":"212","author":"Williamson","year":"2018","journal-title":"Br. J. Psychiatry J. Ment. Sci."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.bbi.2020.04.028","article-title":"A longitudinal study on the mental health of general population during the COVID-19 epidemic in China","volume":"87","author":"Wang","year":"2020","journal-title":"Brain Behav. Immun."},{"key":"ref_95","doi-asserted-by":"crossref","unstructured":"Luce\u00f1o-Moreno, L., Talavera-Velasco, B., Garc\u00eda-Albuerne, Y., and Mart\u00edn-Garc\u00eda, J. (2020). Symptoms of Posttraumatic Stress, Anxiety, Depression, Levels of Resilience and Burnout in Spanish Health Personnel during the COVID-19 Pandemic. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17155514"},{"key":"ref_96","doi-asserted-by":"crossref","unstructured":"Engelbrecht, M.C., Heunis, J.C., and Kigozi, N.G. (2021). Post-Traumatic Stress and Coping Strategies of South African Nurses during the Second Wave of the COVID-19 Pandemic. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18157919"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"100373","DOI":"10.1016\/j.eclinm.2020.100373","article-title":"COVID-19 and Healthcare worker\u2019s families: Behind the scenes of frontline response","volume":"23","author":"Souadka","year":"2020","journal-title":"eClinicalMedicine"},{"key":"ref_98","doi-asserted-by":"crossref","unstructured":"Sheen, J., Clancy, E.M., Considine, J., Dwyer, A., Tchernegovski, P., Aridas, A., Lee, B.E.C., Reupert, A., and Boyd, L. (2022). \u201cDid You Bring It Home with You?\u201d A Qualitative Investigation of the Impacts of the COVID-19 Pandemic on Victorian Frontline Healthcare Workers and Their Families. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19084897"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1017\/S0033291705004411","article-title":"Origins of depression in later life","volume":"35","author":"Blazer","year":"2005","journal-title":"Psychol. Med."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1080\/07317115.2021.1928355","article-title":"Emotional Resilience of Older Adults during COVID-19: A Systematic Review of Studies of Stress and Well-Being","volume":"45","author":"Sterina","year":"2022","journal-title":"Clin. Gerontol."},{"key":"ref_101","doi-asserted-by":"crossref","unstructured":"Nkyi, A.K., and Baaba, B. (2024). Coping, health anxiety, and stress among health professionals during COVID-19, Cape Coast, Ghana. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0296720"},{"key":"ref_102","doi-asserted-by":"crossref","unstructured":"Taylor, S., and Asmundson, G.J. (2004). Treating Health Anxiety: A Cognitive-Behavioral Approach, Guilford Press.","DOI":"10.1016\/S1077-7229(04)80015-4"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"100759","DOI":"10.1016\/j.cegh.2021.100759","article-title":"How are healthcare workers coping with mental health challenges during COVID-19 pandemic? \u2014A cross-sectional multi-countries study","volume":"11","author":"Htay","year":"2021","journal-title":"Clin. Epidemiol. Glob. Health"},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1016\/j.ajic.2020.06.214","article-title":"Exploring stress coping strategies of frontline emergency health workers dealing Covid-19 in Pakistan: A qualitative inquiry","volume":"49","author":"Munawar","year":"2021","journal-title":"Am. J. Infect. Control"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.1111\/jonm.13336","article-title":"Psychological resilience, coping behaviours and social support among health care workers during the COVID-19 pandemic: A systematic review of quantitative studies","volume":"29","author":"Labrague","year":"2021","journal-title":"J. Nurs. Manag."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/21\/3\/372\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:16:36Z","timestamp":1760105796000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/21\/3\/372"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,20]]},"references-count":105,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,3]]}},"alternative-id":["ijerph21030372"],"URL":"https:\/\/doi.org\/10.3390\/ijerph21030372","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,20]]}}}