Barriers and enablers in delivering healthcare during the second wave of COVID-19 in 2021: A Qualitative Study from two tertiary-care hospitals of India

Clinical Research Results Abstract Background/Objectives: The high incidence of COVID-19 in India has put an undue pressure on the health-care providers (HCPs) posted in COVID-19 wards. The primary aim of this study was to explore the barriers and enablers of delivering health-care in specialized COVID-19 wards during the second COVID-19 wave in India.Methods: The qualitative study was conducted in two tertiary-care hospitals of Lucknow and Pune cities in India. HCPs (physicians and nurses) posted in hospitals were approached for data collection. Data was collected using `diaries` followed by `in-depth interviews (IDIs)`. HCPs were requested to document day-to-day barriers and/or enablers of delivering healthcare in COVID-19 wards for seven-days in diaries. After this, IDIs were conducted to co-create meaning with interviewees by reconstructing perceptions of events/experiences related to health-care delivery. Selection of respondents was purposive with maximum variation. Selected were (a) Physicians: work-experience (senior faculty/resident/postgraduate-medical student), gender (b) Nurses: work-experience (< 5 or >5 years), work shift (night/day duty). IDIs were conducted till saturation. Thematic analysis was used to interpret data. Key themes were established based on emerging concepts.Results: Between March-June 2021, qualitative data was collected from 32 HCPs posted in COVID-19 wards (Table 1). Three distinct themes (Table 2) emerged: (a) `Occupational barriers`: lack of training &/or refresher-training before posting; moral/ethical dilemmas (self-care versus care of patients, caring for all severely unwell patients within constrained resources) ; quality and completeness of PPE; misfitting PPEs and/or gloves; excessive work-load/reporting formalities (b) `Phycological barriers`: feeling of burnt out` because of prolonged working-hours; unfeeling/impersonal response toward patients; feeling dissatisfied because of COVID-19 duty; impaired patient-provider communication (c) `Social Barriers` : Social stigma and high expectations from society. Availability of PPE, support of family/friends, solidarity and cooperation of colleagues and availability of seniors were perceived as enablers.Discussion: The study provides critical contextual data on the occupational, psychological and social barriers that negatively impact the job productivity of HCPs. Along with psycho-social stress, the HCPs face systemic and logistical barriers that may adversely affect service-delivery and result in negative health outcomes for COVID-19 patients.These need to be addressed urgently. Research Idea Abstract Service Development & Evaluation Abstract Declaration of Interest Trial Registration: NAFunding: This research was commissioned by NIHR Global Health Research Unit on Respiratory Health (RESPIRE) as part of RESPIRE/IPCRG qualitative research school 2020, using UK aid from the UK Government. It also received funding from Global Health strand of Elizabeth Blackwell Institute of Health Research, University of Bristol QR GCRF strategy Reference: 2021-344. References and Clinical Trial Registry Information