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ORIGINAL ARTICLE
Year : 2022 | Volume
: 26
| Issue : 4 | Page : 245-250
Explaining the challenges of coping with coronavirus crisis in the workplaces: A qualitative study
Abdolhamid Tajvar1, Zahra Hosseini2, Mohammadreza Farahbakhsh3, Anahita Fakherpour4, Atefeh Homayuni5
1 Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
2 Associate Professor of Health Education and Promotion, Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
3 MSc in Occupational Health Engineering, School of Health, Kerman University of Medical Sciences, Kerman, Iran
4 MSc in Occupational Health Engineering, Department of Occupational Health and Safety Engineering, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
5 Student Research Committee, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
Correspondence Address:
Dr. Atefeh Homayuni
Student Research Committee, Hormozgan University of Medical Sciences, Bandar Abbas
Iran
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/ijoem.ijoem_26_22
Background: Workplaces play a highly important role in controlling or spreading the prevalence of coronavirus disease 2019 (COVID-19). Therefore, the lack of proper implementation of hygienic protocols in these environments might increase the risk of getting infected with the COVID-19 among the employees, following the increase of the COVID-19 at the family and community levels. This qualitative study aims to explain the challenges of coping with the coronavirus crisis in the workplaces. Methods: The present qualitative study was conducted with a conventional content analysis approach. We used purposeful sampling with maximum diversity in terms of working processes. Data were collected through semi-structured interviews. Interviews were performed to the point of information saturation. MAXQDA software version 10 was used for data management. Results: Through the content analysis of the interviews with the participants, we identified two main classes and nine sub-classes. The main classes included intra-organizational challenges (job nature, budget allocation problems, individual factors, disorganization, manpower and equipment, lack of commitment, and insufficient support of managers) and extra-organizational challenges (lack of accessibility to valid information, black market, and inter-sectorial coordination problems). Conclusion: The study findings indicated that organizations and industries face numerous internal and external challenges in coping with the COVID-19 pandemic. Paying attention to the mentioned limitations and attempting to eliminate them, especially by the governmental organizations, employers, and managers, could help in effectively confronting the COVID-19 pandemic.
Keywords: Challenge, coping, coronavirus, qualitative study, workplace
The first cases of respiratory syndrome with an unknown origin were identified in Wuhan city, Hubei province, China in early December 2019. A novel coronavirus was originally abbreviated as 2019-nCoV by the World Health Organization (WHO). This pathogen was later renamed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by the Coronavirus Study Group (CSG) and the disease was named coronavirus 2019 (COVID-19) by the WHO. Our knowledge about the transmission of the COVID-19 is day by day increasing. The clinical symptoms of this disease range from very mild non-respiratory cases to severe acute respiratory ones, sepsis, organ failure, and death. Also, in some cases, subjects have no clinical symptoms. Two main routes of transmission of the COVID-19 are classified into respiratory droplets and direct contact. The fine droplets are thrown out of the carrier's mouth or nose while sneezing, coughing, or even talking could spread the coronavirus (COVID-19) directly (infection of other subjects near/close to the carrier) or indirectly (contamination of the surrounding surfaces).[1],[2],[3],[4],[5] On February 7, 2020, the WHO introduced the outbreak of the COVID-19 as a global emergency and expressed concern about endangering worldwide public health.[6] The COVID-19 pandemic has so far infected 495,504,059 people and killed 6,192,346 worldwide. Based on the WHO report, up to now (April 7, 2022), 7,183,808 cases were confirmed and 140,492 deaths have been confirmed in Iran so far.[7]
The occurrence of global pandemics not only led to human mortalities and adverse physical and psychological consequences but also resulted in a major crisis in the global economy.[8],[9] The real costs and damages) financial and personal losses) caused by the global spread of the COVID-19 are still unknown precisely because the disease is poorly controlled and rapidly spreading until now. But it is enough to conceive the financial losses caused by the outbreak of the SARS in 2003, which affected only 8000 people, killed 800 people, and reported a financial loss of approximately 4 billion dollars.[8]
In the current critical situation, continual activities of several services and manufacturing companies would be inevitable. It is necessary that some of these companies increase their activities several times more than in normal situations. Therefore, the role of the workforce in effectively managing the present crisis is vital, so it is very important to maintain their health status.
In accordance with the orders of the Iranian headquarters confronting the COVID-19, the continuous activities of the occupations with low and medium risks became unimpeded, with the bet to complying with the hygienic protocols since April 20, 2020, and a large number of employers of companies and production units were required to attend in workplaces and conduct their duties.[10] Considerably, the instructions and guidelines regarding the prevention of the COVID-19 in companies and industries which were developed and released by the Environmental and Occupational Health Center, Ministry of Health and Medical Education have been generalized. Besides, because of various situations in different companies and industries (e.g., in terms of size, financial status, geographical location, type of work process, etc.), full implementation of hygienic protocols and instructions is not feasible. In doing so, this could increase the transmission risk of the COVID-19 virus among the employees in the workplaces, families, and societies.[11],[12]
According to the high transmission rate of the COVID-19, considering the possibility that the COVID-19 virus to remain with people for a long time due to genetic recombination[13] and since the activity of some service jobs and industries to provide essential services and meet the people's necessities are inevitable, therefore, identifying the existing problems about the implementation of hygienic protocols in the workplaces could be effective in providing practical solutions to reduce the barriers to management of the COVID-19 pandemic and increase the government's preparedness to deal with similar crises. According to the above-mentioned problems, the present study aimed to determine the challenges of coping with the COVID-19 in the workplaces in BandarAbbas city.
MethodsThe current study was conducted using the conventional content analysis approach. Content analysis is a qualitative research technique used to interpret the meaning of the content of the data text. The class coding in the conventional content analysis was adapted directly from the data text.[14] The study participants were selected among the occupational health and safety managers and officials of the service and manufacturing organizations and companies who were forced to provide services or production despite the outbreak of COVID-19. These organizations included power generation management companies, hospitals, steel factories, food industry, port service companies, shipbuilding, the gas refinery, and so on. The study purpose was first explained to the participants via phone call. If they tended to voluntarily take part in the interview and transfer their information and experiences on confronting the COVID-19 pandemic, then a consent form was sent to them. After signing the consent form, the interview process was carried out by making phone calls to those participants on a specific day and time. Thus, the participants in the study were selected by purposive sampling technique with the maximum diversity in terms of industry and service types and the sampling process continued until data saturation.
The data collection tools were mainly in-depth semi-structured interviews. The purpose of the semi-structured interviews with participants was to identify the problems facing organizations in the context of effective management of the COVID-19 crisis.
Due to the current conditions, to protect the interviewees' health, all interviews were conducted using phone calls by an appointment for a period of 6 months, from July to December 2020.
At the beginning of each session, the interviewer explained how to conduct the interview and what are the objectives of the study. After that, the interviews were recorded with the permission of the interviewees. The interviews began with the following questions: “How was your company managed the COVID-19 crisis?” and “What problems and obstacles have your company faced in the fight against COVID-19 which have been hindered your effective performance?” Furthermore, the “Follow-up questions” such as “Please explain more” and “Please give an example,” “If you have a memory, please tell us,” and “When you say... what do you mean?” were also used as needed.
A total of 12 participants consisting of eight males and four females were interviewed. The duration of each interview varied from 30 to 90 min. At the end of each interview, the recorded interviews were implemented and made ready for coding and analysis. The data analyses and data collection were performed simultaneously. The texts of the interviews were read several times and analyzed using the MAXQDA version 10 software. The data were converted into semantic units and repeatedly reviewed, and then coded to reveal the hidden thoughts, ideas, and meanings. After extraction of the initial codes, the codes with similar conceptions or relevant meanings were placed in one group within the same class; also, the researchers used the concepts which are representative of each class code with more abstraction to name each class. The analysis process continued until the emergence of the minor and major classes. Thus, the analysis process was continued by adding each interview and changing classes.
Considerably, to ensure the trustworthiness of our findings, the suggested method by Lincoln and Guba was applied.[15] Accordingly, four criteria including acceptance, validity, confirmability, and transferability were considered for evaluation.
ResultsAfter data analysis, two main classes and nine sub-classes were determined [Table 1].
Table 1: Main classes and sub-classes extracted from the conducted interviewsClass 1: Intra-organizational challenges
Class 1-1: Job nature
Project constraints, time constraints, manpower constraints such as the need for highly qualified specialists with specific skills to perform certain work processes, and the extent and dispersion of work areas including constraints due to work nature and conditions were considered by the most participants as the effective barriers to confronting the COVID-19 crisis in the workplaces. Because special expertise was required for some work processes, thus the organizations have to employ workforces outside the organization or even the forced use of sensitive and vulnerable workforces in these sectors despite the critical situation caused by the COVID-19 pandemic.
“Sometimes there are some special people who have to come and do a special job in the company. For example, if one of the machines breaks down, the company's mechanic is unable to solve it; therefore, we have to ask or take out the mechanic and take out the serviceman, etc.” (Participant No. 9).
Class 1-2: Budget allocation problems
Existing economical problems about taking the required measures such as the provision of sanitizers, disinfectants, and personal protective equipment (PPE) were major problems for most of the studied organizations and industries.
“Due to the coordination problems between the BandarAbbas branch and company's headquarter in Tehran regarding the provision of budget, only once 200 masks made from the common fabrics with no standard size were prepared and distributed among all personnel” (Participant No. 4).
Class 1-3: Individual factors
Most of the study participants expressed dissatisfaction with the lack of employees' cooperation within the organization in crisis management. Non-observance of quarantine regulations by personnel, unnecessary travels, non-usage of protective tools and equipment, or improper and inappropriate use of that equipment confirmed the lack of cooperation. Some factors such as low perception, restrictive behavioral beliefs, and low perception of the life-threatening COVID-19 were among all factors that contributed to the lack of cooperation.
“I do not believe neither masks/respirators nor gloves are useful. Masks are good, but if I didn't have clients, I wouldn't feel the need for a mask. I never believe in donning the gloves. I mean, one subject wears gloves not to touch his/her face by hand; however, I saw that he/she scratched his/her nose with the same gloves” (Participant No. 5).
Some participants declared that the opportunistic employees abused the existing conditions by pretending to lie about getting the COVID-19 and wanted to take advantage of a two-week vacation. In contrast, some employees concealed that they had the symptoms of the COVID-19 because of the fear of losing their jobs or job positions.
“Two of the personnel falsely pretended to get infected with the COVID-19 because they had a sport match and the third one, who had decisively pretended that he got sick and had false symptoms such as coughing” (Participant No. 1).
Also, some participants stated that the current situation had made some employees obsessed with disinfectants.
Class 1-4: Disorganization
Some study participants highlighted that their organizations in some dimensions, such as recognition of sensitive and vulnerable people, infected, or suspected people, and necessary predictions for employees' returning to the workplace after the Nowruz holiday, did not have any special planning and actions. Also, some of them did not have the necessary knowledge about the necessary measures to manage the crisis situations in some cases.
“We have two employees with diabetes. We didn't forbid them to come to workplace, because they are smart and cheerful.” In fact, neither they do not tend nor we do not force them not to come to the workplace (Participant No. 7).
Class 1-5: Manpower and equipment
Among all, lack of specialized health personnel, lack of welfare and dormitory facilities such as transportation services, and lack of facilities in personnel's camps and dormitories in some industries were obstacles that led to the problems in the effective management of the COVID-19 crisis based on the study participants' beliefs.
“A number of the workforces live in the Conex box (Container), their rooms are small, and they have the least facilities. They do not have specific equipment. They do not have an appropriate locker room” (Participant No. 3).
Class 1-6: Lack of commitment and insufficient support of managers
Most of the participants in the study pointed out that the insufficient support and inadequate cooperation of management and supervisors of different units were considered one of the major problems in the management of the COVID-19 crisis. Some factors included not paying attention to the predictions before the arrival of the disease in Iran, not providing sufficient PPE, not requiring the personnel to comply with the health and control principles, not forcing the contractor company by the management to prepare and distribute PPE, irresponsibility of the Health, Safety and Environment (HSE) unit, and so on.
“We held an emergency committee meeting during the COVID-19 outbreak. After the first session, several sessions were held in the HSE office without the presence of top management” (Participant No. 3).
“There was no obligation required by the supervisors of the units to comply with the controlling principles for the personnel” (Participant No. 4).
Class 2: Extra-organizational challenges
Class 2-1: Lack of accessibility to valid information
According to some participants' beliefs, other issues that organizations and industries make problems to deal effectively with the COVID-19 virus are the dissemination or distribution of contradictory information, sometimes false information, sporadic training on health tips against the COVID-19 virus, how is the COVID-19 virus spread, and how to be safe from the COVID-19 virus in the grouping media and cyberspace, which confuses many people.
“Many of the staff didn't wear masks at all, despite the given training provided for them. They said the MOHME or the WHO has declared that it was not required to wear a mask in the current situation and donning a mask would be increased the risk of the COVID-19” (Participant No. 15).
Class 2-2: Black market
According to most of the study participants, a considerable number of the organizations faced some problems during the outbreak of the COVID-19 virus in Iran, including the provision of hygienic items and PPE such as alcohol and masks. Some of the examples of the mentioned problems reported by the participants consisted of the lack of appropriate and standard PPE, low quality of the PPE, high cost of the health supplies and PPE at the beginning of the COVID-19 outbreak in Iran, lack of supervision of the Ministry of Industry, Mining, and Trade Institute regarding this issue, the existence of the black market, and cumbersome rules for the provision of the PPE.
“There is a black market in such a way that some people are selling the three-layer surgical masks. We aimed to prevent from the spread of the COVID-19 virus, we have to be content with some masks that are currently in the markets. Otherwise, these masks are not standard types of the three-layer masks” (Participant No. 5).
Class 2-3: Inter-sectorial coordination problems
Some participants expressed dissatisfaction with not addressing the shortcomings and deficiencies by the Deputy of Health and their pressures and forces on observing the hygienic principles at the same time. Some participants complained about the lack of proper supervision in the health centers on the COVID-19 prevention and control principles.
“The pressures that the health center put on us, bothered us a lot. We put under a lot of pressure in the February, during the outbreak of the COVID-19 virus in Iran. We were given a form in excel format, we had to record, document the performed actions, and then, monthly send to the health center. Due to high work load of the HSE personnel, they looked for a series of unexpected actions from the companies. Even though they knew what our shortcomings and needs were; however, the needs were not met and shortcomings were not taken into account” (Participant No. 4).
DiscussionThe study findings were determined in the form of two main classes (intra-organizational challenges and extra-organizational challenges) and nine sub-classes. Extra-organizational challenges refer to the problems and obstacles arising from outside of the organization. The poor performance of the governments and headquarters confronting the COVID-19 in planning and implementing the emergency response plan, and ultimately the poor management of the COVID-19 crisis was introduced as one of the important sub-classes. Amiri et al.[16] confirmed that the poor management of the COVID-19 crisis in Iran and also the lack of a comprehensive and integrated program for the COVID-19 prevention and control are considered the major shortcomings. In another study by Abdollahi et al.,[17] the manner and nature of the government decisions on managing the COVID-19 crisis were flawed.
Another weakness of the government was attributed to the poor management of the production and supply of standard health and safety equipment. This issue led to the employed subjects in the production and service companies of no access to the standard health and safety equipment or had to prepare them at multiple prices higher than the usual prices, which resulted in problems such as the provision of the budget. Nonetheless, the distribution process of masks and other hygienic products based on the proper and comprehensive planning in some countries such as some East Asian countries (e.g., Taiwan, etc.) has been under full control of the government. This might be one of the reasons for their relative success in fighting against COVID-19.[18] In the research performed by Wong et al.[11] (2020), about one-third of study participants concentrated on the importance of providing protective equipment including face masks and hand soaps when these protections were not available in the market places.
Many occupational health experts participating in the study stressed that the presentation of the contradictory information and lack of coordination in notifying the information regarding the COVID-19 by various government agencies and group media, such as radio and television, have contributed to the major problems in implementing the hygienic principles in the companies. For example, some of them stated that because it has been announced in the national official media that people in the communities and asymptomatic subjects do not need to use the masks, therefore many workers refused to wear the masks, while they were required to wear masks due to the working conditions. The study by Abdollahi et al. also criticized the manner of the government in notifying the information about the COVID-19.[17]
Restrictions regarding the nature and working conditions of various occupations have resulted in major difficulties to implement the hygienic protocols against the COVID-19 in some workplaces. Some study participants reported that most of the instructions and procedures developed by the MOHME are not appropriate to the type of work processes, job nature, and employees' working conditions in their companies, and many of them are not practically applicable. In the study conducted in Hong Kong (2020), one-third of the participants suggested that work instructions are required to be revised and updated.[11] Therefore, it is recommended that hygienic guidelines and protocols should be developed based on the risk assessment and all job characteristics.[12] In the review performed by Webester et al.,[19] paying attention to the subjects' jobs to prevent the spread of infectious diseases in the community is so crucial.
Most of the study participants were dissatisfied with the incorporation between the workers and organizations such as not doing self-quarantine at home, unnecessary vacations as much as possible, not usage or irrational and improper usage of the disinfectant products containing alcohol (of around 70 percent) or bleach. According to the study by Wong et al.[11] (2020), only two-thirds of the study respondents washed their hands with soap before eating foods or after bathroom use. Furthermore, the mentioned study findings showed that the respondents were worried about the “leave without pay” or “legal penalties for absenteeism or compulsory quarantine due to getting infected with the Influenza or COVID-19.”
One of the problems disrupting the fighting process against the COVID-19 was the concealment of illness and attendance at the workplace by some people who got infected with the COVID-19. The major causes of this issue are fear of losing their jobs or due to their employment contracts on a daily basis. Therefore, they had fear declaring their illnesses openly to the employer, consequently, causing them not to cooperate with the organizations. Baker et al.[12] pointed out the accessibility to paid leave varies greatly depending on the occupational position of the worker, type of industry, type of the duties, and financial situation of the company, and some workers due to the type of employment contract are useless from the benefits of leaving with salaries, and this issue leads to hide their illness and attend at the workplace to earn a living despite having symptoms, while attendance of the employees getting infected with the COVID-19 is a critical and concerning issue during the COVID-19 epidemic.
Some of the study participants also stated that some of the workforces took advantage of the current situation and pretended to be ill to take advantage of the two-week quarantine opportunity, and this led to the hard diagnosis of sick employees from non-patient ones; then both direct and indirect costs are imposed on the company.[20]
Another internal organizational problem was the lack of health professionals. Some of the participants highlighted that they are not able to alone implement hygienic protocols. Meanwhile, some participants complained about the authorities who did not have expertise in the field of health in the workplace. Therefore, led to the prolongation of the COVID-19 pandemic. It requires adherence to hygienic principles and protocols of the national headquarters confronting the COVID-19 in all workplaces to long-term success in confronting the COVID-19. On the other aspect, some suggestions include more serious investigation and supervision by the inspectors of the Iranian Universities of Medical Sciences. The Ministry of Cooperatives, Labor, and Social should employ occupational health and safety specialists in the companies and request the employers to support them by providing adequate protective equipment.
Most of the participants pointed out that the insufficient support and inappropriate cooperation of managers, employers, and supervisors are considered one of the major problems in managing the COVID-19 crisis. One study conducted in Japan (2020) showed that the most important factor influencing the motivation of the health care workers to work in the crisis situations, such as epidemics or pandemics, is ensuring the government support and hospital management and also trust between the employees and organization. Based on the mentioned study, the best ways to increase the trust between the organization and health service staff during the COVID-19 epidemic are the following: continuous provision of updated information to staff, continuous communication between the officials and staff and encouragement of the staff, compensation payment on getting infected with the COVID-19, and provision of appropriate protective equipment for the staff.[21] Another study concerning this issue, which was carried out in Thailand, found that it increases the feelings of confidence or trust, social interaction, and cooperation between the health professionals, as well as improves the motivation, performance, and quality of care services.[22]
ConclusionOverall, a total of two main classes and ten sub-classes were extracted from the qualitative content analysis. The study findings noted that the organizations and industries face several internal organizational challenges consisting of six sub-classes, such as job nature, budget allocation, individual factors, disorganization (e.g., lack of proper planning or unplanned), manpower and equipment, and top management support, and external organizational challenges consisting of four sub-classes (macro policies, accessibility to valid information, black market, and inter-sectorial coordination) in coping with the COVID-19 pandemic. Paying attention to the mentioned limitations and problems and attempting to rectify them, especially by the governmental organizations, employers, and managers, could help in effectively confronting the COVID-19 pandemic. Some of the best solutions are paying attention to all employees with different positions and their concerns, opinions, and experiences; continuous communication and cooperation; and trust between the employees and top management to efficiently and comprehensively solve the progressive problems in an organization.
Ethical considerations
The present study was approved by the Ethics Committee of the Hormozgan University of Medical Sciences (approval no. IR.HUMS.REC.1399.073). Before the interviews, a written consent form was obtained from all participants, and efforts were made to obtain the subjects' trust to participate in the study.
Abbreviations
COVID-19 = Coronavirus 2019; CSG = Coronavirus Study Group; DHS = District Health System; EOHC = Environmental and Occupational Health Center; HCWs = Health Care Workers; HSE = Health, Safety and Environment; MOHME = Ministry of Health and Medical Education; SARS-CoV-2 = Severe Acute Respiratory Syndrome Coronavirus 2; WHO = World Health Organization.
Declaration of patient consent
The authors clarify that they have obtained all appropriate participants consent forms. The participants understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Acknowledgments
The authors would like to acknowledge the financial support of the Hormozgan University of Medical Sciences. Also, they are grateful to all participants in this research.
Financial support and sponsorship
The authors are grateful to all participants in this research.
Conflicts of interest
There are no conflicts of interest.
References
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