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Stigma Associated with COVID-19 Among Health Care Workers in Indonesia

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Stigma Associated with COVID-19 Among Health Care Workers in Indonesia Disaster Medicine and Public Health Preparedness Stigma Associated with COVID-19 Among Health Care Workers in Indonesia www.cambridge.org/dmp Amanda Yufika MD1,2, Rovy Pratama MD2, Samsul Anwar MSc3, Wira Winardi MD4, Nurfanida Librianty MD5, Nyoman Ananda Putri Prashanti MD6, Tri Novita Wulan Sari MD7, Prattama Santoso Utomo MD8, Theresia Dwiamelia MD9, Original Research Putu Pangestu Cendra Natha MD10,11, Salwiyadi Salwiyadi MD12,13, Cite this article: Yufika A, Pratama R, Anwar S, 14 15 16 et al. Stigma associated with COVID-19 among Febrivan Wahyu Asrizal MD , Ikram Ikram MD , Irma Wulandari MD , Disaster Med health care workers in Indonesia. 17,18 19 Public Health Prep. doi: https://doi.org/10.1017/ Sotianingsih Haryanto MD, PhD , Nice Fenobilire MD , Abram L Wagner PhD, dmp.2021.93. MPH20, Kurnia Fitri Jamil MD, PhD12,13,21, Mudatsir Mudatsir PhD2,21,22 and Keywords: Harapan Harapan MD, DTM&H, PhD2,21,22 stigma; COVID-19; health care workers; indonesia 1Department of Family Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia; 2 3 Corresponding author: Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia; Department Amanda Yufika, of Statistics, Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala, Banda Aceh, Aceh, Email: [email protected] Indonesia; 4Department of Pulmonology and Respiratory Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia; 5Department of Environmental Health, Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia; 6Bangli Hospital, Bangli, Bali, Indonesia; 7Sungai Dareh Hospital, Dharmasraya, West Sumatra, Indonesia; 8Department of Medical Education and Bioethics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; 9Panti Rahayu Hospital, Karangmojo, Yogyakarta, Indonesia; 10Department of Internal Medicine, Faculty of Medicine, Universitas Udayana, Denpasar, Bali, Indonesia; 11Department of Internal Medicine, Sanglah Hospital, Denpasar, Bali, Indonesia; 12Department of Internal Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia; 13Department of Internal Medicine, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, Indonesia; 14M Natsir Hospital, Solok, West Sumatra, Indonesia; 15Dr H Yuliddin Away Hospital, Tapaktuan, Aceh, Indonesia; 16M. Hatta Brain Hospital, Bukittinggi, West Sumatra, Indonesia; 17Raden Mattaher Hospital, Jambi, Jambi, Indonesia; 18Faculty of Medicine and Medical Sciences, Jambi University, Jambi, Jambi, Indonesia; 19Pariaman Hostiptal, Pariaman, West Sumatra, Indonesia; 20Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA; 21Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia and 22Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia Abstract Objective: The aim of this study was to assess the stigma associated with coronavirus disease - 2019 (COVID-19) among health care workers (HCWs) in Indonesia during the early phase of the pandemic. Methods: A cross-sectional study was conducted in 12 hospitals across the country in March, 2020. A logistic regression was employed to assess the association between stigma and explana- tory variables. Results: In total, 288 HCWs were surveyed, of which 93.4% had never experienced any out- breaks. Approximately 21.9% of the respondents had stigma associated with COVID-19. HCWs who were doctors, had not participated in trainings related to COVID-19, worked in the capital of the province, worked at private hospitals, or worked at a hospital with COVID-19 triage protocols were likely to have no stigma associated with COVID-19. Conclusions: The stigma associated with COVID-19 is relatively high among HCWs in the early phase of the COVID-19 pandemic in Indonesia. Adequate dissemination of knowledge and adequate protection are necessary to reduce stigma among HCWs. © Society for Disaster Medicine and Public Health, Inc. 2021. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:// creativecommons.org/licenses/by/4.0/), which Introduction permits unrestricted re-use, distribution, and reproduction in any medium, provided the Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome corona- original work is properly cited. virus 2 (SARS-CoV-2),1 was declared as a pandemic by the World Health Organization (WHO) on 11 March 2020 due to its alarming level of spread and severity.2 The emergence and spread of COVID-19 has caused confusion, anxiety and fear, and led to stigma on certain populations for being the reason for this outbreak.3,4 In the era of social media as it is today, myths and fake news around COVID-19 also spread rapidly, creating fear and stigma among the society.5 There was frequent use of terms like “Chinese virus” or “China virus” instead of COVID-19 on Twitter, indicating that stigma may be perpetuated on social media.6 A rise of stigma against people from Downloaded from https://www.cambridge.org/core. IP address: 170.106.35.76, on 25 Sep 2021 at 21:25:36, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/dmp.2021.93 2 A Yufika et al. China was also observed in Indonesia at the early phase of the pan- Indonesia’s COVID-19 Project. Some results of this project have demic, where the disease was referred to as “Chinese virus,” or as a been published previously.24–26 The location of the hospitals was punishment for Chinese suppression of Uighur Muslims.7 also taken into account, so that the 12 hospitals consisted of those Stigma against particular ethnic groups was also reported in located in urban and sub-urban areas. previous outbreaks.8–11 Fear, stigmatization, and discrimination towards Russian Jewish immigrants was reported in New York Study instrument City during the typhoid and cholera outbreak in 1892.10 The Chinese-American community in San Francisco faced extreme dis- A questionnaire was developed to assess stigma associated with crimination during an outbreak of bubonic plaque in 1900, attrib- COVID-19 among HCWs. Information related to socio- uted to rats transported from Hong Kong.8 An outbreak of demographic and workplace characteristics, HCW professional hantavirus in the United States in 1993 led to fear, stigmatization, details, knowledge of COVID-19, exposure to COVID-19 informa- and discrimination towards native Americans due to reports that tion, and experience of outbreak-related trainings, was also col- referred the infection as a Navajo disease.9 During the severe acute lected. The questionnaire was tested among HCWs and was respiratory syndrome (SARS) outbreak, stigma towards people evaluated by 2 microbiologists before being used in the study. who look Asian in the United States was reported, although the country was not severely affected.8 Stigma against health care Data collection workers (HCWs) also often occurs during outbreaks, due to their close contact with patients.8,11 HCWs in the 12 hospitals were approached and asked to partici- Studies suggest that stigma is associated with negative health pate in the study face-to-face. A brief overview of the study’s aims, outcomes.12–14 Stigma and discrimination negatively affect public risks, and benefits was provided by the research staff to the poten- health efforts in diseases such as mental illness, epilepsy, tubercu- tial participants. HCWs who agreed to participate were asked to losis, leprosy, and HIV/AIDS.8,12,13 Stigma caused people with HIV sign a written informed consent prior to the interview. to hide their disease, avoid voluntary testing and counseling, and not seek for treatment, which pushed the epidemic underground. Study variables Fear of being stigmatized during an outbreak may cause people to deny clinical symptoms and not seek medical care.5,8 Furthermore, Stigma associated with COVID-19 among HCWs was assessed stigma may lead people to distrust the government, health using a 6-item questionnaire. The questions used in the question- professionals, and the health care system.6,12,13 In the context of naire were: (1) Chinese people are more prone to getting infected the COVID-19 pandemic, public health measurements taken to with SARS-CoV-2; (2) it is easier for SARS-CoV-2 to infect contain the outbreak such as mask use, quarantine, and isolation Chinese people compared to other ethnicities; (3) anyone who fueled stigma towards the disease.15 It is therefore imperative that returned from China more than 14 days ago has to be avoided, people trust their government and health care systems, so that they although they show no symptoms of COVID-19; (4) it is fair for will be cooperative.6 Europeans and Americans to suspect all Asian people visiting their Stigma associated with a particular disease is very dangerous, in countries are infected with COVID-19; (5) in my opinion, it is particular if it comes from HCWs, as it may lead to poor health care natural for a new disease to emerge in China due to their unusual service provision, and even denial of treatment to patients.16 eating habits; and (6) in my opinion, the COVID-19 outbreak is a According to previous studies, factors associated with stigma curse towards Chinese people. Items were measured on a 5-point among HCWs include inadequate knowledge of the disease, irra- Likert type scale indicating respondents’
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