簡介: COVID-19疫情凸顯了醫護人員在抗擊感染中的重要角色。由於直接和間接接觸COVID-19患者，他們面臨著感染的高風險。高風險的環境和困難的情況對醫護人員產生了前所未有的心理影響，影響了他們提供護理的意願。此外，照顧COVID-19患者的醫護人員也面臨著恐懼、污名和心理壓力。因此，本研究旨在了解和評估COVID-19疫情期間醫護人員提供護理的意願，影響意願的因素以及心理健康狀況。本研究分為兩部分：1）通過系統性回顧和荟萃分析估計醫護人員提供護理COVID-19患者的意願比例，並確定影響意願率的因素；2）使用縱向研究設計，調查COVID-19恐懼與提供護理意願之間的關係，以心理壓力為中介，並考慮污名的調節作用。
方法：第一部分進行了文獻回顧，利用Cochrane Library、Medline、Embase和Registers收集相關研究。共識別出符合納入標準的15個不同國家的19個研究。我們使用STATA 17.1軟件進行荟萃分析和荟萃回歸分析來分析數據。使用I2統計量評估異質性水平，使用漏斗圖和Egger's檢驗評估發表偏倚的存在。第二部分在台灣國立成功大學醫院的醫護人員中進行了一項縱向研究。我們使用三個追蹤測量波次，即社區爆發前的基線（波次1），社區爆發期間（波次2）和首次社區爆發後一個月（波次3）。使用Hayes提出的PROCESS Model 8（即調節中介模型。
結果：第一部分結果顯示，醫護人員提供護理COVID-19患者的意願綜合比例為65.9%。荟萃分析顯示，在COVID-19病例和死亡率較高的研究中，醫護人員的意願較高。醫護人員的意願在醫院床位數量較多且人均收入屬於中等偏高收入國家的國家中較高。荟萃回歸分析顯示，COVID-19病例數、死亡率和人均床位數量與意願率顯著相關。第二部分結果顯示，COVID-19恐懼對提供護理意願的影響通過心理壓力的間接效應是顯著的。條件直接效應的結果表明，感知和自我污名調節了COVID-19恐懼與提供護理意願之間的正向關聯（感知污名：係數=-1.11，SE=0.40，p<0.01；自我污名：係數=-0.44，SE=0.08，p<0.01），而任何污名對COVID-19恐懼到心理壓力的條件間接效應是不顯著的。
結論：醫護人員提供護理COVID-19患者的意願綜合比例較高。恐懼、污名和心理壓力是影響醫護人員提供護理意願的主要因素。研究還發現COVID-19病例數、死亡率和人均床位數量與意願率顯著相關。因此，通過了解疫情的嚴重情況和影響醫護人員福祉的因素，政策制定者和醫療機構可以制定適當的干預措施和資源規劃，以更好地支持他們。

Introduction: The COVID-19 pandemic has highlighted the essential role that healthcare workers (HCWs) play in combating the infection. Due to the direct and indirect contact with COVID-19 patients, they are at high risk of getting the infection. The high-risk environment and challenging situation have an unprecedented psychological impact on HCWs’, impacting their willingness to provide care. Further, the HCWs’ taking care of COVID-19 patients are experiencing fear, stigma, and psychological distress; therefore, this study aims to understand and assess the willingness to provide care, factor influencing willingness and psychological wellbeing of healthcare workers during the COVID-19 pandemic. This research consists of two parts, 1) to estimate the proportion of HCWs willingness to provide care to COVID-19 patients and to identify factors contributing to the willingness rate through a systematic review and meta-analysis; and 2) to investigate the relationship between fear of COVID-19 and willingness to care for patients mediated by psychological distress and the moderating role of stigma among healthcare workers using a longitudinal study design.
Methods: For part I a literature review was conducted utilizing Cochrane Library, Medline, Embase, and Registers to collect relevant studies. A total of nineteen studies from fifteen different countries, which met the inclusion criteria, were identified. To analyze the data, we conducted meta-analysis and meta-regression analysis utilizing STATA 17.1 software. The level of heterogeneity was assessed using the I2 statistic, and the presence of publication bias was evaluated using funnel plots and Egger's test. For part II a longitudinal study was conducted among National Cheng Kung University Hospital, Taiwan HCWs. We use three waves of tracking measurements, i.e., baseline before the community outbreak period (wave1), during community outbreak (wave 2), and a month after the first community outbreak (wave 3). PROCESS Model 8 (i.e., moderated mediation model) suggested by Hayes was used.
Results: the first part, the combined rate of healthcare workers' willingness to provide care to COVID-19 patients was determined to be 65.9%. Meta-analyses showed high willingness in studies with high COVID-19 cases and deaths. Willingness among HCWs was higher in countries with high numbers of hospital beds per capita and with upper middle-income to high income. The meta-regression analysis showed that COVID-19 cases, death rates, and the number of beds per capita were significantly associated with the willingness rate. For part II the indirect effect of fear of COVID-19 on willingness to provide care to COVID-19 patients via psychological distress was significant. The results of conditional direct effect indicated that both perceived and self-stigma moderated the positive association between fear of COVID-19 and willingness to provide care to patients (perceived stigma: coefficient = -1.11, SE = 0.40; p<0.01; self-stigma: coefficient = -0.44, SE = 0.08; p<0.01) whereas the conditional indirect effect of any stigma on fear of COVID-19 to psychological distress is non-significant.
Conclusion: The pooled rate of willingness to provide care to COVID-19 patients among the HCWs was high. Fear, stigma, and psychological distress are the primary factors influencing healthcare workers' willingness to provide care to patients. The study also identified that COVID-19 cases, death rates, and the number of beds per capita were significantly associated with the willingness rate. Therefore, by understanding the pandemic critical situation and factors affecting HCWs wellbeing, the policymakers and healthcare organizations can design appropriate interventions and resource planning to support them better.

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