key: cord-1023558-v5tyhn2u authors: Abuhammad, Sawsan; Alzoubi, Karem H.; Al‐Azzam, Sayer; Alshogran, Osama Y.; Ikhrewish, Rawan E.; Amer, Zahra'a W. Bany; Suliman, Maram M. title: Stigma toward healthcare providers from patients during COVID‐19 era in Jordan date: 2022-03-25 journal: Public Health Nurs DOI: 10.1111/phn.13071 sha: f77457fd04f009ae49f7a6a78a615cc364745be2 doc_id: 1023558 cord_uid: v5tyhn2u AIM: This study aimed to explore healthcare providers' (HCP) stigmatization from patients during the COVID‐19 outbreak in Jordan. METHOD: A cross‐sectional design was used. Data collection was conducted between May and July 2021. The research questionnaire included demographic information about participants and multiple statements that reflect stigma of participants toward HCPs. Regression analysis was conducted to assess the association between stigma and explanatory variables. RESULTS: A total of 777 surveys were included in the study. Many people show high stigma toward HCPs during COVID‐19 pandemic. Various factors including hearing news all time (p<.001), having children (p<.024), and smoking (p<.001) were significant in prediction stigma toward HCPs. CONCLUSION: This one of few studies conducted in Jordan regarding the stigma toward HCP from other people with chronic diseases. Our study found that many people showed some stigma toward HCP during COVID‐19. Stigmatization of HCP related to a pandemic is a lesson most people have not learned. It is not enough to cheer HCPs. A clear, sensible public education campaign about the public's risks by interacting with HCP is necessary. does not automatically do away with people's discriminatory attitudes towards HCPs due to the widespread fear that they are SARSCoV2 carriers. This issue has not been studied systematically. Therefore, this study aimed to examine the prevalence and factors that influence the stigmatization toward HCPs during the Covid-19 pandemic. One focus of the current study was to determine the prevalence of the stigmarelated belief that HCPs are sources of infection and to determine the correlates of such attitudes. The fear of COVID-19 and its associated outcomes resulted in the development of COVID Stress Syndrome . This syndrome comprises three fundamental aspects. First, people fear that Covid-19 is life-threatening alongside the fear of meeting potentially contaminated surfaces. Second is the fear about the impact of COVID-19 on the socio-economic status of individuals . Lastly, people have xenophobic fears that people who get into the country from foreign countries are sources of infection (Taylor, Landry, Paluszek et al., 2020a; Taylor, Landry, Rachor et al., 2020b) . These fears are related and are associated with seeking reassurance and thoughts and nightmares related to the virus (Taylor, Landry, Paluszek et al., 2020a; Taylor, Landry, Rachor et al., 2020b) . As a result, it is expected that stigmatizing attitudes related to HCP, such as beliefs that healthcare providers are sources of covid-19, would have a positive relationship with the COVID Stress Syndrome. In the case that the assumption is true, then it can also be predicted that HCP-related stigmatizing attitudes caused by fear and the avoidance of HCPs are associated with other forms of avoidance during the pandemic, such as not leaving home, avoiding other people, and avoiding essential store like drug stores and supermarkets due to the fear of interacting with possibly infected people in these places. The researcher was also fascinated by the question of whether the daily applauding of the HCPs has any significant relationship with the stigmatization of HCP. The question of interest was: Do encouraging people to applaud HCPs reduce stigmatization? If the answer to the question is yes, then the two should have a negative correlation. However, there might be a negative correlation between the two as people might applaud HCPs from the safety of their homes while at the same time viewing HCP as sources of infection. This would show that people have a negative attitude toward HCPs. Clearly, HCPs are primarily at the frontline among people and groups that are susceptible to infection. As a result, reports on fears from communicating with HCPs have been made in Egypt and around the world (Abdelhafiz & Alorabi, 2020). For example, reports have been made concerning taxi drivers refusing to drive medical doctors, residents refused to have healthcare providers as their neighbors, and restaurants have shunned away from delivering food to hospitals (Abdelhafiz & Alorabi, 2020; Abuhammad et al., 2020) . Over 75% of Egyptian physicians who participated in the Covid-19 related burnout study revealed that healthcare professionals are experiencing stigmatization linked to harassment by families of patients resulting in different burnout dimensions (Abdelhafiz & Alorabi, 2020) . WHO released a document about mental health and psychosocial consideration during the pandemic, which identified this type of stigma and reported strategies on methods that would help healthcare providers to handle this form of stigma (WHO, 2020). The incidents of stigma among HCPs collectively point to a potentially concealed threat which can result in underreporting of cases, fear to seek medical care and assistance, and the negative impact it has on the emotional and mental health of groups experiencing stigmatization. Up to our knowledge, limited information exists about stigma associated with COVID-19 among HCPs. Thus, the primary objective of this study was to assess HCPs stigmatization during the COVID-19 outbreak in Jordan. This study is a cross-sectional and survey-based study carried out in Therefore, 777 surveys were included in the final analysis. After agreeing to participate in the study, the participants were requested to provide their demographic information, after which questions that were to be answered sequentially appeared. The demographic factors included in the survey were religion, career, domicile, education, gender, and residential area. This study was approved by the institutional ethics committee of Jordan University of Science and Technology. The researchers were assured the participants that participation is voluntary, and no risks will be from participating in the study. To protect the anonymity of the participants, no information regarding ID of the participants were included. The degree of devaluation and discrimination that affected individuals infected with COVID-19 infection was measured using the COVID-19 stigma measures. The self-administered questionnaire used was developed by See et al (2009) . and aims to gather data on discrimination attitudes and fear towards people who have been infected or exposed to the virus. The questionnaire had three aspects; acceptance of COVID-19 previous infected and individuals exposed to the virus, discrimination, and fear. The coefficient alpha for fear was 0.72, for discrimination was 0.83 and for acceptance was 0.56. The questionnaire allowed the respondents to choose between yes (2 points) and no (1 point) answers. The author adapted and translated the questionnaire. The translated instrument was distributed and checked by five experts from pharmacy and nursing faculties. All items were clear and without errors. Then, the study instrument was tested among 20 patients and these patients were excluded from the main sample. The authors asked the patients for the clarity of the instrument. The instrument was found valid and measure what it supposed to measure. The Cronbach alpha of the scale was 0.87. Descriptive data are primarily presented as counts and percentages. The results concerning stigma toward HCPs were expressed as percentages of responders who agreed/disagreed with each statement. Multiple regressions test was used to determine predictors of stigma toward healthcare workers. Analysis was conducted using SPSS version 25. The response rate was 78%. More than half of participants were females (58.5%) and married (61%) ( Table 1 ). The age mean was 34.5 and SD = 8.8 Many people show high stigma toward HCPs. The following statements about HCPs stigmatization showed about 50% agreement by participants. These items are healthcare workers who work in hospitals are more likely to have COVID-19 (53%); for the safety of the community, health care workers should not go out in public (57.2%); and healthcare workers who treat people with COVID-19 should be isolated (48%) ( The were not significant in predicting the stigma toward HCPs (Table 3) . attitudes (Lynch et al., 2020) . Several people witnessed deaths within their communities during the 1918 influenza pandemic. The sight of hearses, funerals, and coffins became a common occurrence within the community (Crosby, 2003) . However, this is not the case during the COVID-19 pandemic, as exposure to death and sickness has only been experienced, for several people, through media than personal experience Abuhammad, Alzoubi, Khabour, 2021 those who stigmatize HCP also stigmatize foreigners and avoid drug stores and retail staff working in these stores. However, the breadth and boundary of fear and avoidance need further investigation. People who have higher levels of HCP fear and avoidance also avoid other groups of people as they fear these groups of people, such as children and people who look sick, because they believe they are carriers of the virus . Previous studies on perceived vulnerability to disease have revealed that individuals with high levels of fear of infection even stigmatize those who remotely possess features that suggest ill health, such as disabled, obese, and older people (Schaller & Park, 2011) . Also, a recent investigation among health-care workers in Indonesia documented that a 21.9 of the providers experienced stigmatization because of COVID-19 (PMID: 33762053). Our study found that hearing news all time, having children, and smoking were significant predictors of stigma toward HCPs. Similarly, a study found that factors that predict the stigmatization of people infected with COVID-19 include residential area, income, and downloaded an app that traces COVID-19 cases . Although this is the first known study that examines stigma during a pandemic, Kelly et al., 2019 investigated the predictors among pandemic survivors. The study revealed that people between the age of 20 and 49 and those with higher education were at a higher risk of experiencing stigma regardless of their culture and country of origin. A reasonable explanation for this is the lack of information about new infectious diseases and how to control the situation. It has been uncommon for most countries to experience large-scale disease outbreaks that are severe. The dissemination of health information in the most accurate way through new media can effectively solve the problem. The implication of this study is that most HCPs has experienced stigmatization at the workplace from their colleagues and peers. In specific, the number of individuals who felt appreciated was lower than the number in the community. Therefore, organizations should use more anti-stigma measures, promote positive role models, reduce uncertainties and perceived discrimination, and actively implement programs that reduce opportunities for organizational and interpersonal stress (Abuhammad et al., 2019) . It is also recommended that changes in procedures or routines are explicitly explained before implementation and that organizational departments work as a team. Besides, healthcare organizations such as hospitals should focus on upholding standards of care for all patients and ensure routine patients received equally quality care (Abuhammad et al., 2022) . All these should be a component of organizational planning during a pandemic. Taylor (2019) noted that ostracism, avoidance, and shunning have been common during past outbreaks and pandemics such as the SARS outbreak. Pandemic historians have identified that political leaders, survivors, and public health officials often forget lessons derived from past pandemics (Crosby, 2003 Although the current study is one first systematic investigation to examine the stigmatization of HCPs during the COVID-10 pandemic, it has various strengths and limitations. One of the strengths of this study is the large sample size and the researcher's knowledge. The study limitation is that the study was cross-sectional research. The study was carried out several months into the pandemic. As a result, there is a possibility that the attitude and behaviors of the study participants may change. Besides, the assessment was limited to self-reported attitudes and behavior provided by the study participants instead of observational evaluations of individual behaviors. However, the findings of this study are consistent with other studies conducted before COVID-19 pandemic (Bai et al., 2004; Koh et al., 2005) . More research is needed to investigate the largely unrecognized and under-valued problem of HCP stigmatization. There are various areas that future research may consider. One of these areas is the evaluation of the generalizability of this study's findings. Also, further research may be needed to ascertain if the findings can be replicated using different methods that measure stigmatization. While considering alternative methods, the methods can be used to evaluate the estimations of the odds presented by the respondents indicating that HCP is highly likely to be infected with COVID-19. In summary, this one of few studies conducted in Jordan regarding the stigma toward HCP from other people with chronic diseases. Our study found that many patients showed some stigma toward HCP during COVID-19. There are many factors may predict this type of stigma such as being smoker and hearing news all the time. Stigmatization of HCP related to a pandemic is a lesson most people have not learned. 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How to cite this article Stigma toward healthcare providers from patients during COVID-19 era in Jordan No conflict of interest. Data will be available upon request for reasonable reason.