Transcampus.com

advert
Home Instructors Journals ContactUs
Home

 

Instructors

 

Journals

 

Contact Us

 

JOURNAL OF RESEARCH IN NATIONAL DEVELOPMENT VOLUME 5 NO 2, DECEMBER, 2007

DEMOGRAPHIC PREDICTORS OF BURNOUT AMONG HIV/AIDS COUNSELLORS

James A. Adekoya and Gboyega E. Abikoye
Department of Psychology, Olabisi Onabanjo University, Ago-Iwoye

Abstract
Counsellors have been identified as an at-risk group for burnout, especially when the setting is HIV/AIDS counselling center. Considering the nature of the illness, the multifaceted needs of the client, the relative paucity of available counsellors/counselling centers and various psychosocial issues connected with HIV/AIDS, the potential for burnout is particularly high among HIV/AIDS counsellors. Despite these problems, little or nothing is being done by way of rigorous research and ameliorative activities on this important issue. This study represented an attempt at empirically investigating the experience of emotional exhaustion among HIV/AIDS counsellors in Lagos State, Nigeria. Two hundred conveniently selected counsellors participated in this cross-sectional survey. Participants were 170 females and 70 males with an average age of 34.19 years and a standard deviation of 6.82. Results indicated that respondents were very high on emotional exhaustion and depersonalisation but very low on personal accomplishment. Additionally, age, education and work experience significantly predicted emotional exhaustion{R=.50; F=26.01; P<.01}, depersonalisation{R=.50; F=20.48; P<.01} and personal accomplishment {R=.50; F=20.64; P<.01}. Furthermore, results indicated that there was a significant influence of marital status on emotional exhaustion, {F(4,235)=7.83; P<.01 }, depersonalization{F(4,235)=4.85 P<.05} and personal accomplishment {F(4,235)=5.88; P <.05}, with single (yet to marry) counsellors scoring significantly higher (mean=35.23) than married (mean=27.92) respondents on the three dimensions of burnout. These findings were exhaustively discussed and recommendations were made, especially on the need for psychologists, researchers, practitioners,  and other stakeholders to all begin to take burnout seriously, addressing it actively rather than just accepting it as ubiquitous but impervious to intervention. This could improve both the lives of the concerned professionals and the quality of the services they provide.  
Key words: Demographic factors, Burnout Syndrome, Counselling, HIV/AIDS


Introduction
        Counselling in Voluntary Counselling and Testing (VCT) settings is a confidential dialogue between a person and a care provider aimed at enabling the person cope with stress and make personal decisions related to HIV/AIDS, including evaluation of personal risks of HIV transmission, making an informed choice about being tested for HIV and facilitation of preventive behaviour (UNAIDS 2002). Voluntary Counselling and Testing has been shown to be a cost-effective HIV/AIDS intervention strategy (UNAIDS, 2002) as it plays vital roles within a comprehensive range of measures for HIV/AIDS prevention and support.  The potential benefits of VCT include improved health status through good nutritional advice and early access to care and treatment/prevention for HIV/related illness; emotional support; better ability to cope with HIV-related anxiety; awareness of safer options for reproduction and infant feeding; motivation to initiate or (and) maintain safer sexual and drug-related behaviours; and several other benefits.  Indeed, VCT is generally acknowledged to be an important entry point to prevention and care and has become the standard procedure in HIV intervention settings.

Despite it’s effectiveness in controlling the scourge of HIV/ AIDS, a major challenge associated with VCT is burnout among personnel, especially counselors. Personnel involved in VCT work are particularly susceptible to the development of burnout, mainly because of the nature and the emotional demands of their job (Feeley, Rosen, Fox, Macwangi & Mazimba, 2004; UNAIDS 2002; 2000; 1997; Ito & Brotheridge, 2001).
              Burnout is a serious problem, which can greatly undermine the efficiency and effectiveness of any organization.  Burnout may lead to depression, anxiety, substance abuse, and impaired work performance.  Among the reasons contributing to the development of burnout are the following: the time that personnel spend for the clients’ care (Brodaty, 2004; Adali & Priami, 2002; Cronin – Stubbs & Brophy, 1985), contact with clients having poor prognosis (Adali & Priami, 2002; Hare, Pratt & Andrews, 1988),  contact with clients having increased emotional demands (Brodaty, 2004; Adali & Priami, 2002), work load (Adali & Priami, 2002; Maslach, Shaufeli & Leiter 2001); Maslach & Jackson, 1997; Maslach, 1982), ambiguity and role conflict (Maslach, Shaufeli & Leiter, 2001; Landsbergis, 1988), lack of support on the part of the supervisor and colleagues (Ogden, 2003; Taylor, 2001), lack of job satisfaction (Dolan, 1987) and fear of death (Mallett, Price, Jurs & Slenker, 1991).
        Despite these problems, little or nothing is being done on the issue in the aspects of research and intervention, a tendency which portends great dangers to the fight against HIV/ AIDS. The present study represents an attempt at throwing more light on this important issue with a view to sensitizing researchers and policy makers towards giving the issue of burnout among HIV/AIDS counsellors its deserved attention. Specifically, we hypothesized that burnout will be considerably high among HIV/AIDS counsellors and that certain socio-demographic factors will play important roles.


Methodology
Participants
       Participants were 170 female and 70 male HIV/AIDS counsellors conveniently selected from across private and public VCT centers in Lagos state.  Participants’ average age was 34.19 years with a standard deviation of 6.82. Majority of the counsellors who participated in the study (76.7%) were from private non-governmental organizations while 23.3% were from government-owned establishments such as designated Departments in General Hospitals and Teaching Hospitals. One hundred and seventeen (48.8%) of  participants were University graduates or Higher National Diploma (HND) holders, 43 (17.9%) were holders of the National Diploma or its equivalent, 53 (22.1%) were registered nurses, while 27 (11.3%) were Secondary School Certificate holders. Work experience ranged from one year to 21 years, with a mean of 3.29 and standard deviation of 2.73. With regards to marital status, 99 (41.3%) of participants were married, 87 (36.3%) were single, 24 (10.0%) were divorced, 19 (7.9%) were widowed, and 11 (4.6%) were separated.

Instrument
       Demographic Variables consisted of those variables which in the literature are shown as related to emotional exhaustion (age, sex, work setting, year of professional experience, marital status and educational status). These were assessed with items in the first section of the research questionnaire
       Burnout was assessed with Maslach Burnout Inventory (MBI: Maslach, Jackson, & Leiter, 1996), the most widely used measure of burnout (Plana, Fabregat, & Gassio, 2003; Adali & Priami, 2002).  The inventory contains 22 items to be responded to on a 7 – point scale: “never” (O), “a few times a year or less” (1), “once a month” (2), “a few times a month” (3), “once a week” (4), “a few times a week” (5), “everyday” (6).  The items are distributed in three dimensions: emotional exhaustion (EE; feelings of being emotionally sapped), depersonalization (DP; feelings of impersonal response towards recipients of the service, care, treatment or instruction), and personal accomplishment (PA; diminished feelings of competence and success in working with people).  With regard to reliability, coefficients of internal consistency of the three scales varied between .82 and .90 for EE, .56 and .79 for DP, and .57 and .71 (Plana et al, 2003; Aluja, 1997; Maslach et al; 1996). In the present study, alpha coefficients were .94, .87, and .96 for emotional exhaustion, depersonalization and personal accomplishment respectively.



Procedure
       Questionnaire was personally administered to the participants in their various centers by the researcher and two trained assistants over a six-week period. The Directory of Organisations Implementing HIV/AIDS Activities in Lagos State (Lagos State AIDS Control Agency: LSACA; 2006), was used as guide. Out of the eighty organisations involved in VCT in Lagos State, fifty-six were covered in this study. The reason for visiting so many organisations is that the average counsellor per center was four (although with some organisations having just two while some have as many as eight counsellors). Consent to participate in the study was implied by the voluntary completion of the questionnaire. Out of the 300 questionnaire administered, 240 were returned with usable data, representing 80% return rate.

Results
       The hypothesis that HIV/AIDS counsellors will be high on burnout was tested by comparing participants’ scores with the demographic norm values (mean score for 11000 human service employees) outlined in the MBI test manual. The mean score on the EE subscale for respondents was 30.18 compared to the demographic norm of 20.99. The mean score for respondents on depersonalization was 20.81 as against the demographic norm of 8.73. On PA; respondents’ mean score was 17.08 compared to the demographic norm of 34.58. It is important to stress that high scores on both EE and DP connote high level of burnout while high scores on PA connote low level of burnout. The scores of respondents in this study, therefore, indicate a high level of burnout in the three dimensions because their mean scores clearly put them in that category (going by the cut-off points from the MBI manual.
          The hypothesis that sex and work setting will significantly influence burnout among HIV/AIDS counsellors was tested with 2x2 ANOVA as presented in Table 1.As can be seen in Table 1, neither the sex of the counsellor nor the work setting has any significant influence on burnout. Although both male and female counsellors reported high levels of burnout; there was no significant difference between their scores on emotional exhaustion, {F(1,236)= 0.29; P NS}; depersonalisation, {F(1,236)= 0.73;P NS} and personal accomplishment, {F(1,36)=1.88; P NS}. Work setting (private versus public) also appears not to make any difference in respondents’ level of burnout as scores of the two groups were not significantly different on emotional exhaustion, {F(1,236)=1.75; P NS}; depersonalisation, {F(1,236)=0.85; P NS}; and personal accomplishment {F(1,236)= 2.23; P NS}.The interaction effect was also not significant across the three dimensions of burnout.



Table 1

Summary 2X2 ANOVA Showing the Influence of Sex and Work Setting on EE, DP and PA.

DV

IV

 SS

df

MS

F

P

 

EE

Sex (A)
Setting(B)
A x B
Error
Total

41.08
245.44
29.25
33102.01
33390.65

1
1
1
236
239

41.08
245.44
29.25
140.26

0.29
1.75
0.21

NS
NS
NS

 

DP

Sex (A)
Setting(B)
A x B
Error
Total

37.16
43.20
12.97
12039.53
12247.18

1
1
1
236
239

37.16
43.20
12.97
51.02

0.73
0.85
0.25

NS
NS
NS

 

PA

Sex (A)
Setting(B)
A x B
Error
Total

236.07
279.78
9.12
29612.87
30248.65

1
1
1
236
239

236.07
279.78
9.12
125.48

1.88
2.23
0.07

NS
NS
NS

   


As can be seen in Table 4.1, neither the sex of the counsellor nor the work setting has any significant influence on burnout. Although both male and female counsellors reported high levels of burnout; there was no significant difference between their scores on emotional exhaustion, {F(1,236)= 0.29; P NS}; depersonalisation, {F(1,236)= 0.73;P NS} and personal accomplishment, {F(1,36)=1.88; P NS}. Work setting (private versus public) also appears not to make any difference in respondents’ level of burnout as scores of the two groups were not significantly different on emotional exhaustion, {F(1,236)=1.75; P NS}; depersonalisation, {F(1,236)=0.85; P NS}; and personal accomplishment {F(1,236)= 2.23; P NS}.The interaction effect was also not significant across the three dimensions of burnout.
      Age, education and years of work experience were regressed on each of the three dimensions of burnout in order to determine the extent to which these variables will predict burnout. As shown in Table 2, age, education and work experience significantly independently and jointly predicted emotional exhaustion{R=.50;F=26.01;P<.01}, depersonalisation{R=.45;F=20.48;P<.01}and personal accomplishment {R=.46;F=20.64;P <.01}. Results also showed that about 25% of the variances in emotional exhaustion, 21% in depersonalisation and 21% in personal accomplishment were accounted for by age, education and work experience. In order words, the older a counsellor is, the lower his or her level of burnout. Also, the higher the educational status of a counsellor, the lower his or her level of burnout. Furthermore, the longer a counsellor has been working in that profession, the lower his or her level of burnout. The only exception is age, which did not significantly independently predict personal accomplishment, {β=.13;t=1.91;P NS}.

 

Table 2:          Summary Table of Multiple Regression of Age, Education and Years of Experience on Emotional Exhaustion, Depersonalisation and Personal Accomplishment


DV

Predictors

β

t

P

R

R 2

F

P

 

EE

Age
Educ.
Exp.

-.28
-.20
-.20

-4.03
-3.55
-2.97

<.01
<.05
<.05

 

.50

 

.25

 

26.01

 

<.01

 

DP

Age
Educ.
Exp.

-.26
-.16
-.19

-3.69
-2.72
-2.73

<.05
<.05
<.05

 

.45

 

.21

 

20.48

 

<.01

 

PA

Age
Educ.
Exp.

.13
.25
.26

1.91
4.25
3.64

NS
<.05
<.05

 

.46

 

.21

 

20.64

 

<.01

 

The influence of marital status on burnout was also examined through the use of Univariate ANOVA and Scheffe’s post hoc test. Results indicated that there was a significant influence of marital status on emotional exhaustion, {F(4,235)=7.83; P<.01 }, with single (yet to marry) counsellors scoring significantly higher (mean=35.23) than married (mean=27.92), divorced (mean=25.50), and separated (mean=22.45) but not significantly higher than widowed counsellors. There was also a significant influence of marital status on depersonalization, {F(4,235)=4.85 P<.05}, with single counsellors being significantly higher on depersonalisation (mean=23.21) than married (mean=20.00) and divorced (mean= 18.21).All the other mean differences were not significant at the .05 level. Finally, there was a significant influence of marital status on personal accomplishment, {F(4,235)=5.88; P <.05}, with single counsellors reporting a more reduced level of personal accomplishment, (mean=13.31) than married (mean=20.15) while all other mean differences were not significant.

Discussion
       The present study investigated burnout among counsellors in HIV/AIDS settings and the roles of certain demographic variables. It was found that burnout was very high among this group of people as evident in elevated scores on the various dimensions of burnout. The finding was not unexpected because researchers have highlighted the fact that counsellors are among the populations at high risk for burnout (Brodaty, 2004; Adali & Priami, 2002). Considering the nature of HIV/AIDS and its associated psychosocial care-related demands and challenges, potential for burnout in HIV/AIDS counselling is particularly high (Feeley, Rosen, Fox, Macwangi & Mazimba, 2004; UNAIDS 2002; 2000; 1997; Ito & Brotheridge, 2001). The fact that there were just eighty counselling centers with an average of four counsellors per centers in a thickly-populated state like Lagos must have contributed to the problem.
        It was also found that age, education and work experience predicted burnout. The prediction of age could be due to a feeling among relatively younger counsellors that the care-related demands of HIV/AIDS counselling are age-inappropriate and causing intrusions into their lifestyles and activities. Relatively older persons are less likely to be emotionally sapped by caring role than their younger counterparts because as people grow older, they tend to be more nurturing and more others-oriented. These are tendencies are consistent with counselling work. The role of education is also understandable since higher educational status is synonymous with better understanding of the disease and many aspects of it as well as better perceptual and coping abilities. Similarly, the longer a person works in a particular setting, the greater his or her ability to cope with various work-related and psychosocial demands of the work, thus less likelihood of burnout.

Single counsellors were found to be significantly higher on burnout than their married counterparts while divorced, separated and widowed counsellors were neither significantly higher on burnout nor different from other categories of counsellors. The most plausible explanation for this is that the network of social support (and the benefits therefrom) available to single counsellors was not as extensive as that of married people. The impact of social support in attenuating burnout and other negative outcomes have been emphasizes by researchers time and again (Maslach, Shaufeli & Leiter 2001; Sarason & Duck 2001; Greenglass, Fiksenbaum & Burke 1994).
       Finally, it was found that sex and work setting did not significantly influence burnout. Traditionally, females were considered the more nurturing sex and would, ordinarily, have been expected to be significantly lower on burnout than males. The finding could be due to the nature of HIV/AIDS counselling which imposes the same enormous demands on males and females alike and irrespective of whether it is in private or public setting. 
       Findings of the present study have shown clearly that burnout is quite high among HIV/AIDS counsellors. The high rates of burnout in this representative sample demonstrate that burnout needs to be a focus of attention rather than merely a topic of casual conversation or the target of study of convenience samples of professionals. If psychologists, researchers, practitioners,  and other stakeholders all begin to take burnout seriously, addressing it actively rather than just accepting it as ubiquitous but impervious to intervention, they could likely improve both the lives of the concerned professionals and the quality of the services they provide. Psychologists must become more informed about burnout’s related personal and occupational variables so that they can more effectively prevent or address it as needed. Although the literature typically suggests personal stress-reduction techniques for workers experiencing burnout, counsellors and managers of HIV/AIDS counselling centers should also engage in informed advocacy efforts to change the features of the workplace that may be contributing to burnout in themselves and their colleagues.
 
References
Adali, E. & Priami, M. (2002).  Burnout among Carers in Intensive Care Units, Internal Medicine Wards and Emergency Departments in Greek Hospital.  ICU and Nursing Web Journal, 11, 1 – 19.
Aluja, A. (1997).  Burnout among Mental Health Professional Caregivers.  Boletin de Pricologia, 55, 47 – 61.
Brodaty, H. (2004).  Interventions with Caregivers.  New York: Springer Publishing Company, Inc.

Dolan, N. (1987).  The Relationship between Burnout and Job Satisfaction in Carers.  Journal of Advance Nursing, 12, 3 – 12.

Feeley, R.; Rosen, S.; Fox, M.; Macwangi, M. & Mazimba, A. (2004).  The Costs of HIV/AIDS among Professional Staff in the Zambian Health Sector.  Center for International Health and Development (CIHD), Boston University School of Public Health, Boston, MA.
Greenglass ER, Fiksenbaum L, & Burke RJ. (1994).The relationship between social support and burnout over time in teachers. Journal of Social Behaviour Perspectives; 9: 219-230.
Hare, J.; Pratt, C.C. & Andrews, D. (1988).  Predictors of Burnout in Professional and Paraprofessional Carers Working in Hospitals and Nursing Homes.  International Journal of Nursing Studies, 25(2), 105 – 115.



Ito, J.K. & Brotheridge, C.M. (2001).  An Examination of the Roles of Career Uncertainty, Flexibility and Control in Predicting Emotional Exhaustion.  Journal of Vocational Behaviour, 59, 406 – 424.

Lagos State AIDS Control Agency (LSACA) (2006). Directory of Organisations implementing HIV/AIDS activities in Lagos State. Lagos: LSACA.

Landsbergis, P.A. (1988).  Occupational Stress among Healthcare Workers: A Test of the Job Demand – Control Model.  Journal of Organisational Behaviour, 9, 217 – 239.
Mallett, K.; Price, J.; Jurs, S.G. & Slenker, S. (1991).  Relationship among Burnout, Death Anxiety, and Social Support in Hospice and Critical Care Carers.  Psychological Report, 68, 1347 – 1359.
Maslach, C. (1982). Burnout: The cost of caring. Englewood Cliffs, NJ: Prentice-Hall.
Maslach, C., & Leiter, M. P. (1997). The truth about burnout. San Francisco: Jossey-Bass.
Maslach, C. & Jackson, S.E. (1997).  MBI.  Inventario “Burnout” de Maslach.  Sindrome del “quemado” por estres laboral asistencial.  Madrid: TEA Ediciones, S.A.

Maslach, C.; Jackson, S.E. & Leiter, M.P. (1996).  Maslach Burnout Inventory Manual (3rd ed.).  Palo Alto, C.A.: Consulting Psychologists Press, Inc.
Maslach C, & Leiter MP.(1997). The truth about burnout: How organizations cause personal stress and what to do about it. San Francisco: Josey - Bass.
Maslach C, Shaufeli B, & Leiter MP (2001). Job Burnout. Annual Review of Psychology; 52: 397-422.
Ogden, J. (2003).  Health Psychology: A Textbook (2nd edition).  Buckingham: Open University Press.

Plana, A.B.; Fabregat, A.A. & Gassio, J.B. (2003).  Burnout Syndrome and Coping Strategies: A Structural Relation Model.  Psychology in Spain, 7(1), 46 – 55.
Sarason B, & Duck S. (2001). Personal Relationship: Implications for Clinical and Community Psychology. Chichester (England): John Wiley & Sons Ltd.
Taylor, S.E. (2001).  Toward a Biology of Social Support.  In C.R. Snydor & S.J. Lopez Eds.), Handbook of Positive Psychology.  New York: Oxford University Press.

UNAIDS (1997).  Counselling and HIV/AIDS – (Technical Update).  Geneva: UNAIDS.

UNAIDS (2000).  Voluntary Counselling and Testing (Technical Update).  Geneva: UNADIS.

UNAIDS (2001).  AIDS Epidemic Update.  Geneva: UNAIDS.
UNAIDS (2002).  HIV Voluntary Counselling and Testing: a Gateway to Prevention and Care.  Five Case Studies Related to Prevention of Mother-to-Child Transmission of HIV, Tuberculosis, Young People and Reaching General Population Groups.  Best Practice Collection.  Geneva: UNAIDS.