Exploring the Psychological Impact on Contact Tracers
April 13th, 2021
Dr Aoife de Brún is Assistant Professor/Ad Astra Fellow at the UCD Centre for Research, Education and Innovation in Health Systems (UCD IRIS) at the School of Nursing, Midwifery and Health Systems in University College Dublin. She recently received €119,579 from the Health Research Board for a project entitled, ‘Contact tracing during the COVID-19 outbreak: Enabling rapid learning from experiences and exploring the psychological impact on tracers’.
When the first lockdown happened in March 2020, Dr Aoife de Brún became “one of those early volunteers” in UCD’s Covid-19 Contact Tracing Centre.
She and her fellow contact tracers were a crucial point of contact in the unfolding pandemic, breaking the bad news to those who tested positive, alerting close contacts and answering confused and frightened questions from members of the public.
The responsibility of the role was understandably daunting. Over socially distanced coffee breaks the volunteers - at that point mostly redeployed from the health and public sectors - would exchange notes.
“The research I’m doing now stemmed from those peer support conversations we were having and the ideas we were kicking around,” says Aoife. “People were talking about challenging calls and sharing advice about how they dealt with certain issues in the face of rapidly changing guidelines and evidence.”
She saw the potential value in using these experiences to promote rapid learning and to evaluate how processes and systems might be improved and deployed in future pandemic or disaster responses.
Aoife also became interested in exploring the psychological wellbeing over time of the contact tracers themselves.
When she started working as a contact tracer herself she was “a bit anxious in terms of wanting to do it right and sensitively and not being exactly sure what kind of response the call would get”.
The majority of people “were absolutely lovely; delighted to get the quick call and the information and wanted to be as helpful as possible”. But there were “other more challenging and upsetting calls to make”.
These included giving the dreaded news of a positive result to people with underlying conditions or whose close contacts were medically compromised.
In other difficult cases, people refused to share their close contacts “because they feel there's a stigma if other people know they tested positive”. Sometimes “there might be some anger”. Aoife will explore if the requisite supports are in place for contact tracers to shoulder the varied demands of the job.
HSE training is provided - including, as time has gone on, role play videos and regularly iterated FAQ scripts - but the early days were something of a new frontier.
“I think contact tracers were nervous about how best to manage the concerns of the public and deal with what is a very sensitive issue. As the pandemic went on we were dealing with more complex and challenging cases like breakouts in, for example, meat factories or nursing homes.”
Contact tracers verify clusters, escalating that information to public health experts. During infection surges, they are “dealing with a huge amount of calls and a burden of work which can be challenging… I think as the pandemic has gone on it may be taking a toll on contact tracing staff. Even if the bad calls don't happen often, are they having a lasting impact on people?”
Her first short quantitative surveys were completed last month and Aoife will collect data at two more points over the coming months.
“The anonymised surveys use psychometrically valid scales that have been used widely in published literature to measure emotional exhaustion, perceived stress, general health, anxiety, and post-traumatic stress reactions. Based on pre-existing benchmarks, as well as current benchmarks for during the COVID-19 pandemic, we will get a sense of whether the rates are worryingly high and how they vary over time.”
She wants to understand whether contact tracers feel better as they become more experienced, or whether there is, instead, a cumulative impact on their anxiety and stress levels. Aoife will arrange one-to-one qualitative interviews to “dive a bit deeper into the experiences” of contact tracers.
“We are looking at post-traumatic stress symptoms as well,” she confirms.
She will feed the results directly to the HSE, so recommendations can be actioned as quickly as possible.
Aoife is keen to see whether any psychological impact will be greater among more recent recruits, who unlike many earlier volunteers, are not necessarily from a healthcare background.
“It is understanding whether people who don't have that healthcare experience need additional support or training,” she explains. There are currently over 780 staff working across eight different contact tracing centres in Ireland. Until she was “pulled back into the day job” Aoife spent the first four months of the pandemic contact tracing.
“In the early stages I didn't feel confident. I didn’t feel I had the requisite experience yet. Over time I became more comfortable,” she says, conceding that it was “tiring” both to keep up with calls and the ever-changing advice, rules and recommendations.
“I think there are lots of positive experiences around contact tracing in terms of having a sense of purpose and a sense of helping out during a time of immense stress on the health system. A huge amount of motivation and gratification comes from that,” she says. “But there's also the potential for negative impacts in terms of anxiety and stress and potentially the cumulative effect of doing this for a while. So this is something we will document to understand if it is the case or not. Our findings will then inform the HSE’s best continuous improvement approach to the COVID-19 contact management programme.”
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