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Quality of life at work and Burnout in family health strategy workers

Calidad de vida em el trabajo y agotamiento em trabajadores de la estrategia de salud de la família

ABSTRACT

Objective:

To analyze the correlation between quality of life at work and Burnout in workers in the Family Health Strategy.

Methods:

Correlational, cross-sectional study carried out with 112 workers, in the pandemic period (October/2020 to June/2021), in Palmas/Tocantins. The Quality of Work Life Assessment Questionnaire (QWLQ-bref) and the Maslach Burnout Inventory - Human Services Survey (MBI-HSS) were used.

Results:

A strong negative correlation was identified between Emotional Exhaustion and the Physical/Health, Professional and Total Quality of Life Score at work; and moderate negative correlation between Depersonalization and all domains of Quality of Work Life. Professional Achievement showed a moderate positive correlation with the Psychological and Personal domains and with the Total Quality of Work Life Score.

Conclusion:

The best Quality of Work Life indices were correlated with lower Emotional Exhaustion and Depersonalization scores and higher scores of Professional Achievement.

Keywords:
Burnout; professional. Quality of life. Primary health care. National health strategies.

RESUMEN

Objetivo:

Analizar la correlación entre calidad de vida en el trabajo y Burnout en trabajadores de la Estrategia Salud de la Familia.

Métodos:

Estudio correlacional, transversal, realizado con 112 trabajadores, en el período de pandemia (octubre/2020 a junio/2021), en Palmas/Tocantins. Se utilizaron el Quality of Work Life Assessment Questionnaire (QWLQ-bref) y el Maslach Burnout Inventory - Human Services Survey (MBI-HSS).

Resultados:

Se identificó una fuerte correlación negativa entre el Agotamiento Emocional y el Score de Calidad de Vida Física/Salud, Profesional y Total en el trabajo; y correlación negativa moderada entre Despersonalización y todos los dominios de Calidad de Vida Laboral. El Logro Profesional mostró una correlación positiva moderada con los dominios Psicológico y Personal y con el Puntaje de Calidad de Vida Laboral Total.

Conclusión:

Los mejores índices de Calidad de Vida Laboral se correlacionaron con puntajes más bajos de Agotamiento Emocional y Despersonalización y puntajes más altos de Logro Profesional.

Palabras clave:
Agotamiento profesional; Calidad de vida; Atención primaria de salud; Estrategias de salud nacionales.

RESUMO

Objetivo:

Analisar a correlação entre qualidade de vida no trabalho e as dimensões do Burnout em trabalhadores da Estratégia Saúde da Família.

Métodos:

Estudo correlacional, transversal, executado com 112 trabalhadores, no período pandêmico (outubro/2020 a junho/2021), em Palmas/Tocantins. Utilizou-se o Questionário de avaliação da qualidade de vida no trabalho (QWLQ-bref) e o Maslach Burnout Inventory - Human Services Survey (MBI-HSS).

Resultados:

Identificou-se correlação negativa forte entre Exaustão Emocional e os domínios Físico/Saúde, Profissional e Escore Total da Qualidade de Vida no Trabalho; e correlação negativa moderada entre Despersonalização e todos os domínios da Qualidade de Vida no Trabalho. A Realização Profissional apresentou correlação positiva moderada com os domínios Psicológico, Pessoal e com o Escore Total da Qualidade de Vida no Trabalho.

Conclusão:

Os melhores índices de Qualidade de Vida no Trabalho estiveram correlacionados a menores escores de Exaustão Emocional e Despersonalização e a maiores escores de Realização Profissional.

Palavras-chave:
Esgotamento profissional; Qualidade de vida; Atenção primária à saúde; Estratégias de saúde nacionais.

INTRODUCTION

Workers of the Family Health Strategy (ESF) are key elements of Primary Health Care (PHC), as they provide care and assist the families in the assigned territory during and throughout the life cycle, contributing to the implementation of health policies11. Lima GKM, Gomes LMX, Barbosa TLA. Qualidade de vida no trabalho e nível de estresse dos profissionais da atenção primária. Saúde Debate. 2020;44(126):774-89. doi: https://doi.org/10.1590/0103-1104202012614
https://doi.org/10.1590/0103-11042020126...
. From this perspective, it is understood that working conditions are directly related to health conditions and quality of life, impacting the other people involved in this process and consequently the quality of the health services offered22. Mendes M, Trindade LL, Pires DEP, Martins MMFPS, Ribeiro OMPL, Forte ECN, et al. Nursing practices in the family health strategy in Brazil: interfaces with illness. Rev Gaúcha Enferm. 2021;42(spe):e20200117. doi: https://doi.org/10.1590/1983-1447.2021.20200117
https://doi.org/10.1590/1983-1447.2021.2...
.

Quality of Work Life(QWL) can be understood as a set of actions and organizational practices aimed to implement and develop improvements and innovations at the managerial, structural and technological levels33. Limongi França AC. Práticas de recursos humanos: conceitos, ferramentas e procedimentos. São Paulo: Atlas; 2007.. It can provide benefits both for workers by producing pleasure, achievement and well-being, and for the organization, for the results achieved, including increased quality of services provided and yield.

In this regard, national44. Lourenção LG. Qualidade de vida, engagement, ansiedade e depressão entre gestores de Unidades da Atenção Primária à Saúde. Rev Port Enferm Saúde Mental. 2018;(20):58-64. doi: https://doi.org/10.19131/rpesm.0227
https://doi.org/10.19131/rpesm.0227...
,55. Dias LOG, Carvalho VCS, Gomes MFP, Reticena KO, Santos MS, Fracolli LA. Investigação da Síndrome de Burnout em trabalhadores da Estratégia Saúde da Família de um município do interior do estado de São Paulo. Rev Atenção Saúde. 2020 [cited 2019 Jun 02];18(65):48-58. Available from: Available from: https://seer.uscs.edu.br/index.php/revista_ciencias_saude/article/view/6603
https://seer.uscs.edu.br/index.php/revis...
and international66. Orrù G, Marzetti F, Conversano C, Vagheggini G, Miccoli M, Ciaccini R, et al. Secondary traumatic stress and Burnout in healthcare workers during COVID-19 outbreak. Int J Environ Res Public Health. 2021;18(1):337. doi: https://doi.org/10.3390/ijerph18010337
https://doi.org/10.3390/ijerph18010337...
,77. Lasalvia A, Amaddeo F, Porru S, Carta A, Tardivo S, Bovo C, et al. Levels of burn-out among healthcare workers during the COVID-19 pandemic and their associated factors: a cross-sectional study in a tertiary hospital of a highly burdened area of north-east Italy. BMJ Open. 2021;11(1):e045127. doi: https://doi.org/10.1136/bmjopen-2020-045127
https://doi.org/10.1136/bmjopen-2020-045...
) researchers have investigated the presence of mental disorders, including Burnout in health workers, as it impacts not only the quality of life of workers, but also the quality of the work performed and hence patient safety.

The Burnout Syndrome, the result of prolonged exposure to chronic emotional and interpersonal stressors resulting from work, leads to the disruption of commitment to work, making it unsatisfactory and meaningless88. Maslach C, Leiter MP. The truth about burnout: how organization cause, personal stress and what to do about it. San Francisco: Jossey-Bass; 2000.. It triggers then negative emotional states that generate emotional exhaustion, depersonalization or cynicism (a negative interpersonal response that occurs when people are treated with cynicism or coldness, as if they were objects) and low professional achievement88. Maslach C, Leiter MP. The truth about burnout: how organization cause, personal stress and what to do about it. San Francisco: Jossey-Bass; 2000..

Thus, Burnout is characterized by the chronic stress present in the work environment99. Caixeta NC, Silva GN, Queiroz MSC, Nogueira MO, Lima RR, Queiroz VAM, et al. A Síndrome de Burnout entre as profissões e suas consequências. Braz J Hea Rev. 2021;4(1):593-610. doi: https://doi.org/10.34119/bjhrv4n1-051
https://doi.org/10.34119/bjhrv4n1-051...
added to intense functional and psychological exhaustion1010. Latorraca CAC, Pacheco RL, Martimbianco ALC, Riera R, et al. O que as revisões sistemáticas Cochrane dizem sobre prevenção e tratamento da síndrome de burnout e estresse no trabalho. Diagn Tratamento. 2019:24(3):119-25.) that reduces the quality of services provided by professionals, who in turn begin to perform their duties with decreased satisfaction, personal motivation and pleasure99. Caixeta NC, Silva GN, Queiroz MSC, Nogueira MO, Lima RR, Queiroz VAM, et al. A Síndrome de Burnout entre as profissões e suas consequências. Braz J Hea Rev. 2021;4(1):593-610. doi: https://doi.org/10.34119/bjhrv4n1-051
https://doi.org/10.34119/bjhrv4n1-051...
.

Furthermore, during the COVID-19 pandemic, ESF workers were exposed to a sudden change in the work process: in the first year of coping with the disease these workers mostly cared for patients who had symptoms suggestive of COVID-19 and received spontaneous demand assistance, and followed up mild and moderate cases. However, these health professionals were exposed to the risk of illness and death, in addition to the fear of contaminating friends and family, facing adverse working conditions, with lack of personal protective equipment, which led to psychological distress and a strong psychosocial impact1111. Oliveira GS, Monteiro LS, Carvalho MFAA, Freire AKS. Saúde mental em tempos da pandemia da COVID-19: concepções dos trabalhadores da atenção primaria a saúde. Res SocDev. 2020;9(10):e9449109339. doi: http://doi.org/10.33448/rsd-v9i10.9339
http://doi.org/10.33448/rsd-v9i10.9339...
.

A study carried out before the pandemic in a city in the northeast region of Brazil found a high level of Burnout in ESF, with 38.3% of professionals affected1313. Tomaz HC, Tajra FS, Lima ACG, Santos MM. Síndrome de Burnout e fatores associados em profissionais da Estratégia Saúde da Família. Interface. 2020;24(Supl 1):e190634. doi: https://doi.org/10.1590/Interface.190634
https://doi.org/10.1590/Interface.190634...
. As for quality of life, another study reported that about 22% of ESF nursing professionals were classified as having a quality of life ranging from regular to very poor, with better scores in the social relations and psychological domains1414. Silva KG, Parreira PMSD, Soares SSS, Coropes VBAS, Souza NVDO, Farias SNP. Quality of life of nursing professionals working in the family health strategy. Rev Enf Ref. 2020;V(4):e20028. doi: https://doi.org/10.12707/RV20028
https://doi.org/10.12707/RV20028...
.

In this context, it is essential that a situational diagnosis be made to support proactive organizational policies, with a view to preventing mental illnesses among workers and improving health outcomes in pandemic or non-pandemic periods.

Considering that QWL can be a protective factor against Burnout Syndrome, it is believed that investigating this construct is relevant to understanding this relationship. It could then be used as a tool by managers of health institutions to support the development and adoption of strategies for building a work environment that promotes the health of ESF workers, in addition to contributing to a better quality of care and greater yield.

In addition, there is still little research in the scientific literature on the health of ESF workers, more specifically in the pandemic period and in the northern region of Brazil. Deeper knowledge about QWL and Burnout Syndrome is necessary, so that strategies are sought to improve the health conditions of ESF workers, in order to ensure satisfactory performance of their functions and the effective use of PHC health policies1515. Maganhoto AMS. Qualidade de vida no/do trabalho dos profissionais da estratégia de saúde da família [dissertação].Uberlândia: Universidade Federal de Uberlândia; 2021. doi: http://doi.org/10.14393/ufu.di.2021.672
http://doi.org/10.14393/ufu.di.2021.672...
.

In view of the aforementioned, this study aimed to analyze the correlation between quality work life and the dimensions of Burnout in ESF workers.

METHODS

Correlational, cross-sectional study with a quantitative approach, carried out through non-probabilistic convenience sampling.

The study was carried out in the pandemic period (COVID-19) from October 2020 to June 2021. All ESF workers who performed their duties in the 34 Basic Health Units (UBS) in the city of Palmas (TO) distributed among eight territories of health were invited.

The UBS house the ESF teams, which provide assistance to the population in predetermined areas. Data from the Ministry of Health on Primary Health Care (ABS) coverage reveal that Palmas (TO) has 67 Family Health Strategy (ESF) teams, with 461 community health agents and endemic disease agents, 134 nursing assistants/technicians, 67 assistants/technicians in oral health, 67 dentists, 67 nurses and 67 doctors, totaling 863 workers. ABS coverage in the municipality is 100%1616. Ministério da Saúde (BR). Gabinete do Ministro. Portaria nº 2.436, de 21 de setembro de 2017. Aprova a Política Nacional de Atenção Básica, estabelecendo a revisão de diretrizes para a organização da Atenção Básica, no âmbito do Sistema Único de Saúde (SUS). Diário Oficial União. 2017 set 22 [cited 2019 Jun 02];154(183 Seção 1):68-76. Available from: Available from: https://pesquisa.in.gov.br/imprensa/jsp/visualiza/index.jsp?data=22/09/2017&jornal=1&pagina=68&totalArquivos=120
https://pesquisa.in.gov.br/imprensa/jsp/...
.

The workers who met the following inclusion criteria participated in the study: ESF professionals who were working in person during the data collection period. Three participants who failed to answer more than 20% of the questions on the data collection instruments were excluded, to avoid interference in data analysis.

After ESF workers were invited to participate in the study, data collection was performed, and all information relevant to the study was provided. The workers who verbally agreed to participate in the study received an envelope containing the data collection instrument along with two copies of the Free and Informed Consent Form (TCLE). Subsequently, the researchers returned to collect the completed questionnaires up to three times.

For data collection, the Participants' Profile Questionnaire, the Quality of Work Life Assessment Questionnaire - QWLQ-bref and the Maslach Burnout Inventory - Human Services Survey (MBI-HSS) were used.

The Quality of Work Life Questionnaire - QWLQ-bref, an abbreviated model of the QWLQ-78 questionnaire, was developed using the WHOQOL-100 parameters of the World Health Organization. It was designed by four researchers1717. Cheremeta M, Pedroso B, Pilatti LA, Kovaleski JL. Construção da versão abreviada do QWLQ-78: um instrumento de avaliação da qualidade de vida no trabalho. R Bras Qual Vida. 2011;03(1):01-15. doi: https://doi.org/10.3895/S2175-08582011000100001
https://doi.org/10.3895/S2175-0858201100...
,consisting of 20 questions subdivided into four domains: Physical/Health, Psychological, Personal and Professional, with answers based on the Likert scale (1-5 scores), and higher scores in these domains indicate a higher level of QWL.

The MBI-HSS developed by Maslach and Jackson1818. Maslach C, Jackson SE. The measurement of experienced burnout. J OccupBehav. 1981;2(2):99-113. doi: https://doi.org/10.1002/job.4030020205
https://doi.org/10.1002/job.4030020205...
and translated and validated into Portuguese by Lautert1919. Lautert L. O desgaste do profissional enfermeiro [tese]. Salamanca: Universid Pontificia Salamanca; 1995 [cited 2019 Jun 02]. Available from: Available from: https://summa.upsa.es/viewer.vm?id=14014⟨=es
https://summa.upsa.es/viewer.vm?id=14014...
was used for the assessment of the presence of Burnout Syndrome. It consists of 22 items distributed on a 5-point scale, ranging from “never” (0) to “daily” (4). The instrument assesses how the professionals experience their work in three dimensions: Emotional Exhaustion (EE), Depersonalization (DE) and Professional Achievement (PA). High scores in the Emotional Exhaustion and Depersonalization dimensions, associated with low scores in the Professional Achievement dimension indicate Burnout1919. Lautert L. O desgaste do profissional enfermeiro [tese]. Salamanca: Universid Pontificia Salamanca; 1995 [cited 2019 Jun 02]. Available from: Available from: https://summa.upsa.es/viewer.vm?id=14014⟨=es
https://summa.upsa.es/viewer.vm?id=14014...
.

Data were entered into the Software Statistical Package for the Social Sciences for Windows (SPSS®) version 22.0, with independent double entry. After correction of errors and inconsistencies, descriptive and inferential analyzes relevant to the study were carried out. In the analysis of associations between the dimensions of the QWL and Burnout Syndrome constructs, Pearson's correlation was used. Correlation values between 0.30 and 0.50 were considered moderate and values above 0.50 were considered strong2020. Ajzen I, Fishbein M. Understanding attitudes and predicting social behavior. Englewood Cliffs, New Jersey: Prentice Hall; 1980..

Data were collected after authorization by the Commission for the Evaluation of Research Projects of the Municipal Health Department of Palmas, Tocantins, and approval by the Research Ethics Committee of Universidade Federal do Tocantins (UFT), approved by Protocol No. 3,677,932 under CAAE No. 21331419.3.0000.5519.

After consent, participants received a copy of the TCLE, prepared according to the guidelines of Resolution 466/12.

RESULTS

Table 1 shows the categorization of the research participants' profile. The total number of participants was 112 health workers, with a mean age of 39.71 years (SD 9.34, ranging from 23 to 58 years). Most are female (82.10%), half are married or in a stable relationship (50.00%), 90.18% declared to be fully or partially responsible for supporting the family and more than half had completed higher education or graduate studies (56.25%).

Regarding the professional occupation, most participants were community health agents (CHA) (32.15%), followed by nursing assistants or technicians (25.89%). The largest proportion (46.40%) of workers have an employment contract. Of the total number of participants, 82.14% do not have another job. Regarding the frequency of practice of physical or leisure activities, a little more than half (53.57%) of the participants reported practicing physical or leisure activities.

As for monthly personal income, the mean was BRL 3,671.34 (equivalent to three minimum wages), with wages ranging from BRL 1,100.00 to BRL 10,000.00 (SD BRL 2,221.79).

Table 1 -
Categorization of the profile of ESF workers. Palmas, Tocantins, Brazil, 2020/2021

The mean working time in the ESF was nine years (SD 7.66 years; minimum 2 months; maximum 22 years), with a mean of hours worked per week of 44.48 hours (SD 9.9; minimum 24 hours; maximum 64 hours).

As shown in Table 2, the lowest mean in the assessment of QWL were assigned to the Physical/Health (3.73) and Professional (3.75) domains, considering scores from 1 to 5 on the Likert scale.

Table 2 -
Assessment of Quality of Work Life by workers in the Family Health Strategy. Palmas, Tocantins, Brazil, 2020/2021

In the assessment of Burnout dimensions, considering the 0-4 scale, Depersonalization had the lowest mean (0.80) and Professional Achievement the highest mean (2.91) (Table 3). Burnout is characterized by high scores in the Depersonalization and Emotional Exhaustion dimensions and low scores in the Professional Achievement dimension1919. Lautert L. O desgaste do profissional enfermeiro [tese]. Salamanca: Universid Pontificia Salamanca; 1995 [cited 2019 Jun 02]. Available from: Available from: https://summa.upsa.es/viewer.vm?id=14014⟨=es
https://summa.upsa.es/viewer.vm?id=14014...
.

Table 3 -
Assessment of Burnout dimensions by Family Health Strategy workers. Palmas, Tocantins, Brazil, 2020/2021

As seen in Table 4, in the correlation of the Burnout dimensions with QWL domains, there was a strong negative correlation between Emotional and Physical Exhaustion/Health, Professional and Total Score of QWL. All QWL domains had a strong positive correlation with the Total QWL Score.

Table 4 also shows a moderate negative correlation between Depersonalization and all QWL domains. Professional Achievement showed a moderate positive correlation with the Psychological and Personal domains and with Total Score of QWL.

Table 4 -
Correlation between Quality of Work Life domains and Burnout dimensions in ESF workers. Palmas, Tocantins, Brazil, 2020/2021

DISCUSSION

Regarding the demographic categorization of the population that participated in this study, most ESF workers are women and a considerable portion of them are married and responsible for supporting the family, a profile confirmed in other Brazilian surveys carried out in the states of Mato Grosso do Sul, Paraná, São Paulo2121. Sumiya A, Pavesi E, Macêdo JA, Farhat G, Trelha CS. Mudanças de hábitos de vida em trabalhadores da atenção primária durante a pandemia de COVID-19. J Manag Prim Health Care. 2020;12:1-13. doi: https://doi.org/10.14295/jmphc.v12.1106
https://doi.org/10.14295/jmphc.v12.1106...
and Minas Gerais2222. Azevedo ARI. Estresse ocupacional de trabalhadores da atenção primária à saúde no contexto da pandemia COVID-19 [dissertação]. Belo Horizonte: Universidade Federal de Minas Gerais; 2022 [cited 2019 Jun 02]. Available from: Available from: http://hdl.handle.net/1843/41548
http://hdl.handle.net/1843/41548...
. This factor can have a positive impact on QWL, since relatives can be a motivation for work. Moreover, a pleasant family environment can provide well-being and rest, improving performance at work2323. Rautenbach C, Rothmann S. Antecedents of flourishing at work in a fast-moving consumer goods company. J Psychol Afr. 2017;27(3):227-34. doi: https://doi.org/10.1080/14330237.2017.1321846
https://doi.org/10.1080/14330237.2017.13...
.

Another study2424. Pantoja FGB, Silva MVS, Andrade MA, Santos AAS. Avaliação do burnout em trabalhadores de um hospital universitário do município de Belém (PA). Saúde Debate. 2017;41(spe2):200-14. doi: https://doi.org/10.1590/0103-11042017S217
https://doi.org/10.1590/0103-11042017S21...
demonstrated that married workers had a lower prevalence of Burnout compared to single workers. On the other hand, the excess of tasks and the difficulty in reconciling professional and family demands can be a triggering factor of stress, physical and emotional exhaustion2525. Dalmolin GL, Possebon MR, Lanes TC, Shutz TC, Munhoz OL, Andolhe R. Estresse ocupacional e síndrome de burnout entre trabalhadores de saúde. Recien. 2022;12(37):67-77. doi: https://doi.org/10.24276/rrecien2022.12.37.67-77
https://doi.org/10.24276/rrecien2022.12....
. There is evidence that women who work excessive hours (in PHC and at home) are more subject to deterioration in mental and physical health2626. Lua I, Almeida MMG, Araújo TMD, Soares JFS, Santos KOB. Autoavaliação negativa da saúde em trabalhadoras de enfermagem da atenção básica. Trab Educ Saúde. 2018;16(3):1301-19. doi: https://doi.org/10.1590/1981-7746-sol00160
https://doi.org/10.1590/1981-7746-sol001...
.

More than 40% of the participants in the study have an effective employment contract, which gives them greater financial stability. Also, most participants do not have another employment contract, unlike findings in other settings2424. Pantoja FGB, Silva MVS, Andrade MA, Santos AAS. Avaliação do burnout em trabalhadores de um hospital universitário do município de Belém (PA). Saúde Debate. 2017;41(spe2):200-14. doi: https://doi.org/10.1590/0103-11042017S217
https://doi.org/10.1590/0103-11042017S21...
, which contributes to the reduction of physical and psychological exhaustion that lead to Burnout2525. Dalmolin GL, Possebon MR, Lanes TC, Shutz TC, Munhoz OL, Andolhe R. Estresse ocupacional e síndrome de burnout entre trabalhadores de saúde. Recien. 2022;12(37):67-77. doi: https://doi.org/10.24276/rrecien2022.12.37.67-77
https://doi.org/10.24276/rrecien2022.12....
.

The average workload was consistent with findings of another study. There is evidence that an excessive workload contributes to a higher level of stress, physical and psychological exhaustion, in addition to low professional achievement, contributing to the development of Burnout2727. Rocha RPS, Valim MD, Oliveira JLC, Ribeiro AC. Características do trabalho e estresse ocupacional entre enfermeiros hospitalares. Enferm Foco. 2019;10(5):51-7. doi: https://doi.org/10.21675/2357-707X.2019.v10.n5.2581
https://doi.org/10.21675/2357-707X.2019....
.

Although the average income of the participants was relatively low and varied significantly due to the discrepancy in the remuneration paid to the professional occupations in the ESF, a study showed that a high average income is associated with a higher prevalence of Burnout2424. Pantoja FGB, Silva MVS, Andrade MA, Santos AAS. Avaliação do burnout em trabalhadores de um hospital universitário do município de Belém (PA). Saúde Debate. 2017;41(spe2):200-14. doi: https://doi.org/10.1590/0103-11042017S217
https://doi.org/10.1590/0103-11042017S21...
, as many workers resort to other jobs to increase their earnings2828. Lopes CCP, Ribeiro TP, Martinho NJ. Síndrome de Burnout e sua relação com a ausência de qualidade de vida no trabalho do enfermeiro. Enferm Foco. 2012;3(2):97-101. doi: https://doi.org/10.21675/2357-707X.2012.v3.n2.264
https://doi.org/10.21675/2357-707X.2012....
, and consequently have to work excessive hours without enjoying the proper rest and leisure.

Most professionals said that they performed physical and leisure activities, which is a protective characteristic of Burnout, as there is evidence of a high prevalence of Burnout in sedentary workers2929. Diniz LS. Prevalência da Síndrome de Burnout em trabalhadores da atenção primária à saúde e fatores associados [dissertação]. Viçosa: Universidade Federal de Viçosa; 2018 [cited 2019 Jun 02]. Available from: Available from: https://locus.ufv.br//handle/123456789/20729
https://locus.ufv.br//handle/123456789/2...
.

The strong negative correlation between the Emotional Exhaustion dimension of Burnout and the Physical/Health, Professional domains and the total score of QWL indicate that the greater the emotional exhaustion, the lower the scores attributed to QWL.

In the QWL assessment, the lowest means were assigned to the same domains, that is, Physical/Health, Professional and total Score. In the pandemic period, ESF professionals had to face challenges inherent to the atypical scenario, both in the family and professional fields, which led to emotional and psychological problems1111. Oliveira GS, Monteiro LS, Carvalho MFAA, Freire AKS. Saúde mental em tempos da pandemia da COVID-19: concepções dos trabalhadores da atenção primaria a saúde. Res SocDev. 2020;9(10):e9449109339. doi: http://doi.org/10.33448/rsd-v9i10.9339
http://doi.org/10.33448/rsd-v9i10.9339...
, often caused by poor quality of sleep and rest, by physical and psychological overload during the referred period. They also did not feel comfortable in the work environment with the abrupt change in life habits, because they had to move away from their families due to the greater risk of infection, the lack of adequate and quick training to deal with this situation and also because they felt impotent facing an as yet unknown disease 2121. Sumiya A, Pavesi E, Macêdo JA, Farhat G, Trelha CS. Mudanças de hábitos de vida em trabalhadores da atenção primária durante a pandemia de COVID-19. J Manag Prim Health Care. 2020;12:1-13. doi: https://doi.org/10.14295/jmphc.v12.1106
https://doi.org/10.14295/jmphc.v12.1106...
. These factors contribute to greater emotional exhaustion in health professionals, as highlighted by other studies66. Orrù G, Marzetti F, Conversano C, Vagheggini G, Miccoli M, Ciaccini R, et al. Secondary traumatic stress and Burnout in healthcare workers during COVID-19 outbreak. Int J Environ Res Public Health. 2021;18(1):337. doi: https://doi.org/10.3390/ijerph18010337
https://doi.org/10.3390/ijerph18010337...
,77. Lasalvia A, Amaddeo F, Porru S, Carta A, Tardivo S, Bovo C, et al. Levels of burn-out among healthcare workers during the COVID-19 pandemic and their associated factors: a cross-sectional study in a tertiary hospital of a highly burdened area of north-east Italy. BMJ Open. 2021;11(1):e045127. doi: https://doi.org/10.1136/bmjopen-2020-045127
https://doi.org/10.1136/bmjopen-2020-045...
.

Regarding the moderate negative correlation between Depersonalization and all QWL domains, it was found that the higher the scores assigned to QWL, the lower the depersonalization. The literature shows that the more professionals remain dissatisfied with their work and do not feel well, the more indifference and distance from people in their work environment they may have to face, which even generates dehumanization of the care process and absenteeism1111. Oliveira GS, Monteiro LS, Carvalho MFAA, Freire AKS. Saúde mental em tempos da pandemia da COVID-19: concepções dos trabalhadores da atenção primaria a saúde. Res SocDev. 2020;9(10):e9449109339. doi: http://doi.org/10.33448/rsd-v9i10.9339
http://doi.org/10.33448/rsd-v9i10.9339...
,3030. Santos HEC, Garcia GPA, Fracarolli IFL, Marziale MHP. Burnout, instabilidade no trabalho, distúrbios osteomusculares e absenteísmo em profissionais de saúde: revisão de escopo. Cienc Enferm. 2021;27:37. doi: https://doi.org/10.29393/CE27-37BIHM40037
https://doi.org/10.29393/CE27-37BIHM4003...
.

Therefore, it is a disturbing condition, as ESF professionals provide direct care to patients. In order to ensure effective care, it is essential that health professionals establish bonds with the families assisted, so that they can properly welcome these people and establish a relationship of trust, tasks that require empathy and sensitivity from ESF professionals towards the others. The development of these characteristics is often more difficult in professionals who suffer from depersonalization3131. Celestino LC. O trabalho do enfermeiro da Estratégia Saúde da Família: condições de trabalho, riscos psicossociais e estratégias de gerenciamento [dissertação]. Ribeirão Preto: Universidade de São Paulo; 2018. doi: https://doi.org/10.11606/d.22.2019.tde-27032019-164349
https://doi.org/10.11606/d.22.2019.tde-2...
.

Furthermore, professionals affected by Burnout are more likely to have difficulties in their relationship with the work team, which negatively impacts their quality of life3232. Ramos CEB, Farias JA, Costa MBS, Fonseca LCT. Impactos da Síndrome de Burnout na qualidade de vida dos profissionais de enfermagem da atenção básica à saúde. R Bras Ci Saúde. 2019;23(3):285-96. doi: https://doi.org/10.22478/ufpb.2317-6032.2019v23n3.43595
https://doi.org/10.22478/ufpb.2317-6032....
.

Professional Achievement showed a moderate positive correlation with the Psychological, Personal domains and with the Total Score of QWL, indicating that the higher the score for these domains, the greater the professional achievement. Authors confirm that personal psychological well-being and happiness contribute to a better quality of life, greater engagement and self-motivation for work3333. Sgarbossa M, Mozzato AR. Motivos que levam os trabalhadores ao florescimento no ambiente de trabalho: uma revisão integrativa da literatura. Rev Gesto. 2020;8(1):30-43. doi: http://doi.org/10.31512/gesto.v8i1.3424
http://doi.org/10.31512/gesto.v8i1.3424...
.

It should be stressed that the Psychological domain showed a strong positive correlation with the personal, professional domain, in addition to QWL, and the Professional domain showed a strong positive correlation with Physical/Health, Psychological and Personal domain. By considering the difficulties faced by these professionals in the pandemic period, with the fears resulting from contamination by the virus and the large number of deaths, even of relatives and friends, these correlations demonstrate the relevance of psychological health to guarantee QWL. According to a study carried out in Indonesia3434. Sunjaya DK, Herawati DMD, Siregar AYM. Depressive, anxiety, and burnout symptoms on health care personnel at a month after COVID-19 outbreak in Indonesia. BMC Public Health. 2021;21(1):227. doi: https://doi.org/10.1186/s12889-021-10299-6
https://doi.org/10.1186/s12889-021-10299...
, the incidence of symptoms of depression, anxiety and stress among health professionals during the pandemic was also a factor that contributed to the incidence of Burnout signs.

Emotional Exhaustion showed a strong positive correlation with Depersonalization, collaborating with the strengthening of the assumption that Emotional Exhaustion leads to Depersonalization, as it is often a defense mechanism for professionals against emotional exhaustion and low personal achievement3535. Oliveira F, Feltrin SP, Nunes RZS, Vitali MM, Tuon L, Amboni G, et al. Qualidade de vida no trabalho e Burnout em equipes de Estratégia Saúde da Família. Mundo Saúde. 2020;44:475-85. doi: https://doi.org/10.15343/0104-7809.202044475485
https://doi.org/10.15343/0104-7809.20204...
. Thus, it is necessary to intervene in the aspects that lead to emotional exhaustion to prevent depersonalization and protect the health of workers and the quality of the care provided to the community.

Some limitations of this study include the difficulty of collecting data in person during the pandemic period, due to sanitary restrictions and the workload of health professionals, which resulted in a smaller number of participants. Another limitation is the research design that made it difficult to establish a causal relationship. A possible bias concerns the fact that only active workers participated in the study. Health professionals who were away for various reasons, including due to physical and mental health problems did not participate.

The findings of this study can contribute to professional practice by demonstrating the importance of carrying out a diagnosis on QWL and Burnout in ESF workers. This diagnosis seeks to identify critical nodes in an intervention aimed at preventing mental illness, supporting decisionmaking regarding working conditions both in the pandemic context and in everyday life.

CONCLUSION

Amidst the COVID-19 pandemic, the results of the present study point to a correlation between QWL and Burnout in ESF workers, where better QWL rates were related to lower scores in Emotional Exhaustion, Depersonalization and higher scores in Professional Achievement.

Moreover, the strong correlation between emotional exhaustion and depersonalization, both characteristics of Burnout, explain the importance of QWL for reducing the incidence of this syndrome. QWL is also important for the quality of care provided in the context of the ESF, with fewer professionals affected by emotional exhaustion and depersonalization.

Thus, based on the diagnosis identified, it has become evident that local managers must develop strategies and actions aimed to ensure better working conditions, in the search for a better quality of life at work for healthcare professionals, reducing therisk of Burnout.

Acknowledgments:

To the National Council for Scientific and Technological Development (CNPQ-Brasil) forscientific initiation scholarships for co-authorsViviane Reis Nunes and Bianca G. Lima.

To Universidade Federal do Tocantins (UFT) for the scholarship to co-author Mateus Portilho Pires through the Institutional Scholarship Program for Research Training (PIBIC-UFT).

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Edited by

Associate editor:

Rosana Maffacciolli
Editor-in-chief: João Lucas Campos de Oliveira

Publication Dates

  • Publication in this collection
    10 July 2023
  • Date of issue
    2023

History

  • Received
    10 Sept 2022
  • Accepted
    23 Dec 2022
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