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      ‘Stressed, uncomfortable, vulnerable, neglected’: a qualitative study of the psychological and social impact of the COVID-19 pandemic on UK frontline keyworkers

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          Abstract

          Objectives

          Non-healthcare keyworkers face distinct occupational vulnerabilities that have received little consideration within broader debates about ‘essential’ work and psychological distress during the COVID-19 pandemic. The aim of this study was therefore to explore the impact of the pandemic on the working lives and mental health and well-being of non-healthcare keyworkers in the UK.

          Design

          In-depth, qualitative interviews, analysed using a reflexive thematic analysis.

          Setting

          Telephone or video call interviews, conducted in the UK between September 2020 and January 2021.

          Participants

          23 participants aged 26–61 (mean age=47.2) years employed in a range of non-healthcare keyworker occupations, including transport, retail, education, postal services, the police and fire services, waste collection, finance and religious services.

          Results

          Keyworkers experienced adverse psychological effects during the COVID-19 pandemic, including fears of COVID-19 exposure, contagion and subsequent transmission to others, especially their families. These concerns were often experienced in the context of multiple exposure risks, including insufficient personal protective equipment and a lack of workplace mitigation practices. Keyworkers also described multiple work-related challenges, including increased workload, a lack of public and organisational recognition and feelings of disempowerment.

          Conclusions

          In efforts to reduce psychosocial concerns among non-healthcare keyworkers, there is a need for appropriate support during the COVID-19 pandemic and in preparation for other infections (eg, seasonal influenza) in the future. This includes the provision of psychological and workplace measures attending to the intersections of personal vulnerability and work conditions that cause unique risks and challenges among those in frontline keyworker occupations.

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          Most cited references49

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          Using thematic analysis in psychology

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            Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019

            Key Points Question What factors are associated with mental health outcomes among health care workers in China who are treating patients with coronavirus disease 2019 (COVID-19)? Findings In this cross-sectional study of 1257 health care workers in 34 hospitals equipped with fever clinics or wards for patients with COVID-19 in multiple regions of China, a considerable proportion of health care workers reported experiencing symptoms of depression, anxiety, insomnia, and distress, especially women, nurses, those in Wuhan, and front-line health care workers directly engaged in diagnosing, treating, or providing nursing care to patients with suspected or confirmed COVID-19. Meaning These findings suggest that, among Chinese health care workers exposed to COVID-19, women, nurses, those in Wuhan, and front-line health care workers have a high risk of developing unfavorable mental health outcomes and may need psychological support or interventions.
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              The behaviour change wheel: A new method for characterising and designing behaviour change interventions

              Background Improving the design and implementation of evidence-based practice depends on successful behaviour change interventions. This requires an appropriate method for characterising interventions and linking them to an analysis of the targeted behaviour. There exists a plethora of frameworks of behaviour change interventions, but it is not clear how well they serve this purpose. This paper evaluates these frameworks, and develops and evaluates a new framework aimed at overcoming their limitations. Methods A systematic search of electronic databases and consultation with behaviour change experts were used to identify frameworks of behaviour change interventions. These were evaluated according to three criteria: comprehensiveness, coherence, and a clear link to an overarching model of behaviour. A new framework was developed to meet these criteria. The reliability with which it could be applied was examined in two domains of behaviour change: tobacco control and obesity. Results Nineteen frameworks were identified covering nine intervention functions and seven policy categories that could enable those interventions. None of the frameworks reviewed covered the full range of intervention functions or policies, and only a minority met the criteria of coherence or linkage to a model of behaviour. At the centre of a proposed new framework is a 'behaviour system' involving three essential conditions: capability, opportunity, and motivation (what we term the 'COM-B system'). This forms the hub of a 'behaviour change wheel' (BCW) around which are positioned the nine intervention functions aimed at addressing deficits in one or more of these conditions; around this are placed seven categories of policy that could enable those interventions to occur. The BCW was used reliably to characterise interventions within the English Department of Health's 2010 tobacco control strategy and the National Institute of Health and Clinical Excellence's guidance on reducing obesity. Conclusions Interventions and policies to change behaviour can be usefully characterised by means of a BCW comprising: a 'behaviour system' at the hub, encircled by intervention functions and then by policy categories. Research is needed to establish how far the BCW can lead to more efficient design of effective interventions.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2021
                12 November 2021
                12 November 2021
                : 11
                : 11
                : e050945
                Affiliations
                [1]departmentResearch Department of Behavioural Science and Health, Institute of Epidemiology and Health Care , University College London , London, UK
                Author notes
                [Correspondence to ] Dr Tom May; t.may@ 123456ucl.ac.uk
                Author information
                http://orcid.org/0000-0003-3077-523X
                http://orcid.org/0000-0001-5568-6474
                http://orcid.org/0000-0002-6952-334X
                Article
                bmjopen-2021-050945
                10.1136/bmjopen-2021-050945
                8593269
                34772752
                f8969f2e-b2cf-40b0-91b8-61c8aa4bcdcd
                © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:  https://creativecommons.org/licenses/by/4.0/.

                History
                : 04 March 2021
                : 01 November 2021
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000279, Nuffield Foundation;
                Award ID: WEL/FR-000022583
                Funded by: FundRef http://dx.doi.org/10.13039/100014013, UK Research and Innovation;
                Award ID: ES/S002588/1
                Funded by: FundRef http://dx.doi.org/10.13039/100004440, Wellcome Trust;
                Award ID: 205407/Z/16/Z
                Award ID: 221400/Z/20/Z
                Categories
                Qualitative Research
                1506
                2474
                1725
                Original research
                Custom metadata
                unlocked

                Medicine
                covid-19,mental health,occupational & industrial medicine,qualitative research
                Medicine
                covid-19, mental health, occupational & industrial medicine, qualitative research

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