# Stigma and fear during the COVID-19 pandemic: a qualitative study on the perceptions of healthcare workers in Canada and Singapore

## TL;DR

This study explores how healthcare workers in Canada and Singapore experienced stigma and fear during the COVID-19 pandemic, highlighting discrimination and its impact on health behaviors.

## Contribution

The study provides new insights into the intersection of occupation-based and race-based stigma among healthcare workers during the pandemic.

## Key findings

- Healthcare workers observed and experienced stigma directed at specific population groups in both Canada and Singapore.
- Fear of spreading the virus led healthcare workers to isolate from social circles.
- Stigma intersected with race-based prejudice in Canada for participants of Chinese ethnicity.

## Abstract

We sought to explore healthcare providers (HCPs)' perceptions of and experiences with stigma during the COVID-19 pandemic in Canada and Singapore.

We conducted a qualitative study (May 2020–February 2021) with HCPs in Canada and Singapore and developed a semi-structured interview guide rooted in the Health Stigma and Discrimination Framework (HSDF). We recruited participants online and through word of mouth via newsletters, blogs and social media. Participants were eligible to participate if they worked as a healthcare provider in Singapore or Canada during COVID-19. Following participant consent, data were recorded, transcribed verbatim, and coded using a framework approach. Coded data were charted into a framework matrix and used to compare themes in each country.

We conducted 51 interviews (23 in Canada; 28 in Singapore). HCPs perceived that patient fears coupled with mistrust of the health system impacted health behaviors. HCPs reported discrimination and stigmatization of population subsets. In Singapore, this included Chinese tourists and migrant workers and in Canada, this included people of Chinese ethnicity and people experiencing homelessness. This stigma was often attributed to pre-existing prejudices including perceptions that these populations were at increased risk of COVID-19 or not adhering to public health recommendations. HCPs feared spreading COVID-19 to family, peers and patients, often resulting in participants choosing to isolate from social circles. HCPs in both countries experienced occupation-based stigma, including stigma related to public health practices (masking, testing); in Canada, this intersected with race-based prejudice for participants of Chinese ethnicity. HCPs in both samples witnessed and experienced stigmatizing behavior; some participants also experienced discrimination.

Secondary stigma related to occupation was experienced by HCPs during COVID-19. HCPs experienced intersecting stigma based on race/ethnicity and observed stigmatization of marginalized patient populations. Most themes were consistent across Canada and Singapore. Strategies to mitigate COVID-19 related stigma toward HCPs and at-risk patient populations are warranted.