Healthcare workers and the COVID-19 pandemic : A mixed methods study

The COVID-19 pandemic placed unprecedented pressure on healthcare systems and healthcare workers (HCWs). Frontline HCWs faced both an increased infection risk and psychological distress. By combining a register-based study (Study I) and a questionnaire based study (Studies II and III), as well as quantitative and qualitative methods, this mixed methods thesis aims to improve our understanding of work-related health risks and stressors among HCWs during the first 15 months of the COVID-19 pandemic in Finland’s capital region (until April 2021), across primary and tertiary care. Methods: Study I combined national and local registry data from public and private healthcare to assess the difference in COVID-19 outcomes between HCWs and non HCWs. The outcomes considered were infections, hospitalizations, ICU admissions, and mortality among working-age individuals. The dataset included 26,271 COVID-19 infections, of whom 2,201 (8.4%) were HCWs. Logistic regression models were employed to analyze hospitalization, ICU admission, and mortality odds. Studies II and III were based on an online survey assessing HCWs’ COVID-19-related working conditions and work-related well-being. The questionnaire was conducted from June 2020 to April 2021 with 1,580 volunteering HCWs (895 in tertiary, 685 in primary care). Additionally, 579 respondents submitted 1,666 prompted free-text responses. The responses were analyzed using quantitative and qualitative methods. Results: The HCWs were overrepresented in SARS-CoV-2 infection statistics. While their risks of ICU admission and mortality did not differ from the general population, they had a higher likelihood of hospitalization (OR 1.25, 95% CI 1.02–1.53, p = 0.031). Unlike in the general population, higher income did not appear protective among HCWs; rather, it was associated with an increased hospitalization risk (OR 2.00, 95% CI 1.16–3.45, p =0.013), likely due to job-related exposure and the inability to work remotely. Primary care HCWs reported more challenges in their work-related well-being than those in tertiary care, despite the similar self-reported infection rates and less frequent care of COVID-19 patients. Personal protective equipment (PPE) shortages and changing infection prevention and control (IPC) guidelines were identified as major stressors. Clear IPC guidance correlated with better recovery from work (OR 1.51, 95% CI: 1.06–2.14, p <0.05), while inadequate PPE availability was linked to greater work-related stress (OR 1.49, CI: 1.18–1.88, 0.001) and an excessive workload (OR 1.51, CI: 1.01–2.25, p <0.05). Conclusion: The pandemic exposed HCWs to significant occupational risks, with heightened infection and hospitalization rates and key stressors tied to PPE availability and unclear IPC guidance. The association between the income level and the risk of hospitalization differed markedly between HCWs and the general population, as the hospitalization risk among HCWs with COVID-19 did not follow the typical socioeconomic gradient in health, in which individuals with a lower socioeconomic status experience a higher disease burden. In this study, higher income among HCWs was associated with an increased risk of hospitalization, which likely reflects the frontline working conditions, including those in higher-income healthcare roles as well. In addition, challenges in their work-related well-being were more pronounced in primary care. Future preparedness efforts should address HCW risks more promptly. The reasons behind increased hospitalization among HCWs warrant further study.

Grantor dc:publisher

Helsingin yliopisto

Year dc:date.issued

2026

Author dc:creator

• Aulanko, Ida

• lääketiede

Statement dc:rights

• Julkaisu on tekijänoikeussäännösten alainen. Teosta voi lukea ja tulostaa henkilökohtaista käyttöä varten. Käyttö kaupallisiin tarkoituksiin on kielletty.
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• Publikationen är skyddad av upphovsrätten. Den får läsas och skrivas ut för personligt bruk. Användning i kommersiellt syfte är förbjuden.

Language dc:language.iso

eng

Handle dc:identifier.uri

http://hdl.handle.net/10138/625621

OAI record oai:identifier

https://helda.helsinki.fi/server/oai/request?verb=GetRecord&metadataPrefix=dim&identifier=oai%3Ahelda.helsinki.fi%3A10138%2F625621