As a part of the ViSHWaS study, we surveyed HCWs in Kenya. The study involved a comprehensive survey of healthcare professionals, including physicians, nurses, administrative workers, and other allied health professionals. The demographic profile of the participants revealed that the majority were in the young adult age group. In terms of experience, more than half of the participants had over 11 years of experience in the healthcare field. Registered nurses were the most common cadre, and emergency medicine was the most common primary area of work. Regarding violence characteristics, nearly half of the participants reported experiencing violence themselves at their workplaces, while a significant percentage reported violence against their colleagues. Verbal violence and emotional abuse were the most common forms of violence. Interestingly, a small percentage reported online, virtual, or cyber harassment, with Facebook being the most common platform. The most common type of aggressor was the patient or a relative or family member. Verbal violence was most common, followed by emotional violence. More than half of the HCWs who encountered violence reported feeling less motivated or dissatisfied with their job as a result of these incidents.
Our studies revealed a high incidence of workplace violence among young adults (80%) in the healthcare field, with females experiencing a greater frequency of such incidents compared to their male counterparts. This finding aligns with the results of Alshahrani et al., cross-sectional study conducted in multiple emergency departments in Saudi Arabia [16], where over 90% of their study participants fell within the 20–39 age group. They also noted that 80% of the respondents acknowledged the existence of violence reporting procedures within their institutions, with only one-third of the respondents indicating that they had not utilized any of these measures. In contrast, our study revealed that nearly two-thirds of the respondents affirmed the existence of violence reporting procedures within their institutions, while fewer than 50% mentioned reporting workplace-related violence to either the police or their institution's administration. Numerous studies have examined the connection between HCW gender and the likelihood of encountering violence. While some studies have discovered no disparity in the occurrence of violence based on gender, others have suggested that male HCWs might have a heightened risk of experiencing violence. On the contrary, certain studies have indicated that female HCWs are more prone to encountering various forms of violence. Gender has emerged as a noteworthy predictor of violence, even after accounting for potential confounding factors such as age. A similar trend of females experiencing a greater frequency of workplace violence than their male counterparts was observed in a large public Italian hospital [17], where female HCWs encountered a higher incidence of verbal violence in the form of insults compared to their male counterparts, while male HCWs experienced more physical violence (bodily contact) than female HCWs did [13] A meta-analysis conducted by Byon et al., aimed to determine the prevalence of workplace violence (WPV) against HCWs, revealing a rate of 22%. Among these cases, 36% comprised non-physical acts of violence, while 10% resulted in physical harm to the HCW [14]. Similar findings have been documented in prior studies, where non-physical violence, particularly in the form of verbal abuse, was consistently identified as the most common type of violence directed towards HCWs [16–20]. Our results indicate that almost 50% of the participants identified patients or their relative's caretakers as the individuals responsible for acts of aggression. Conversely, approximately 12.5% of the respondents experienced aggression from their supervisors, while about 7% reported mistreatment from their colleagues. Interestingly, other research studies have similarly identified patients and their family members as the primary sources of aggression, reinforcing our own findings [21–23].
According to data from the International Committee of the Red Cross, during the initial six months of the COVID-19 pandemic, there were over 600 recorded incidents of violence directed towards HCWs [24]. In a comprehensive review of research concerning violence against HCWs, Chirico et al., identified a significant prevalence of such incidents amid the COVID-19 pandemic. They concluded that HCWs faced an exceptionally elevated risk of experiencing such episodes during this unprecedented health crisis [25]. The pandemic-induced overcrowding and less hospitable hospital setting can lead to heightened stress levels for HCWs, patients, and their families. This, in turn, escalates the potential for increased incidents of violence against HCWs [24, 25]. In our study, nearly 80.2% of the participants noted a rise in violence-related events during the pandemic, whereas 17.6% of HCWs reported a decline in the frequency of violence.
Most respondents in our study expressed reduced motivation and increased job dissatisfaction after encountering violence. Some even contemplated changing their current department or workplace, while some HCWs contemplated leaving the profession altogether. In alignment with our results, a study conducted by Rafeea et al., indicated that 26% of HCWs contemplated resigning due to their experiences with workplace violence [26]. All this can be attributed to the consequences of violence, which manifest as reduced productivity and focus, compromised work quality, increased reliance on defensive medical practices, and psychological effects such as excessive stress, depression, or Post-Traumatic Stress Disorder. These factors collectively impact the quality of patient care [27].
The connection between age and the risk of WPV against HCWs has shown varying results in different studies. Our study identified a trend where an increase in age (26–45) is linked to a heightened likelihood of experiencing physical and psychological violence among HCWs, after which the trend seemed to decline. A US-based study found that increased age is associated with higher odds of violence against HCWs [28]. On the contrary, the European Nurses' Early Exit (NEXT) study has reported that as age increases, the odds of encountering workplace attacks decrease [29]. In a separate study by Wu et al., they found no significant association between age and the risk of WPV among physicians [30].
In our research, we identified a notably heightened risk of violence among HCWs with more extensive work experience. This contradicts the findings of some other studies that suggest the opposite trend. [31]. After assessing the association between healthcare facility type and workplace violence, our studies concluded that workplace violence related to healthcare was more common in government academic and non-academic institutions compared to private academic and non-academic institutions; this is similar to a study done by Shaikh et al., from Pakistan that reported a reduced likelihood of WPV in private healthcare settings [32]
The data also revealed that a significant proportion (93.6%) of participants were familiar with occupational safety and health (OSH) guidelines, and most reported the availability of violence reporting procedures. However, a considerable number (58.8) of violent incidents were not reported to the administration, hospital, or police, even though nonreporting has been seen in other studies (citations. This may be due to several reasons, including negative repercussions such as retaliation from violence perpetrators or reporting incidents that would be of no use, as noted by Al Anazi et al. [33], where 92% expressed this. Al-Turki et al., in their investigation conducted in family medicine centers within Riyadh city, identified that HCWs tended to underreport instances of violence due to their perception that reporting would yield no meaningful outcomes, and some were apprehensive about jeopardizing their employment [34]. Similarly, in two Saudi studies, participants regarded reporting as ineffectual or of little significance [35, 36]. In an Iranian study, HCWs who had experienced victimization believed that reporting held limited value, as they perceived no meaningful action would be taken [37]. Therefore, even though HCWs possess a good understanding of OSH guidelines and the necessary procedures, it is recommended that efforts be made to streamline and simplify these processes while ensuring that reporting does not expose HCWs to harm or adverse consequences.
STRENGTHS AND LIMITATIONS
The present study encompasses 1,402 healthcare participants from 40 counties in Kenya, contributing valuable insights to the existing body of evidence regarding the violence encountered by HCWs, especially in Kenya. To our knowledge, this will be the first and most in-depth cross-sectional analysis. The substantial participant count of around 1,500 participants enhances the robustness and reliability of our research outcomes.
However, it is crucial to recognize specific limitations. Firstly, there is a notable risk of recall bias since we asked participants to recollect incidents from the past year. Furthermore, potential response bias may have been introduced in ranking questions, where respondents might have favoured the top-listed options, potentially biased the results and the interpretation of the data. As our study follows a cross-sectional design, it offers a snapshot of data at a specific point in time without delving into temporal relationships or changes over time.
Top of Form