# Psychological health and motivational factors of health workers and community volunteers in preventive chemotherapy programs for neglected tropical diseases control in Ekiti State, Nigeria

## TL;DR

This study examines the mental health and motivation of health workers and volunteers in Nigeria during a disease prevention program, before and during the pandemic.

## Contribution

The study provides insights into psychological and motivational factors of health workers in neglected tropical disease programs in Nigeria.

## Key findings

- High levels of stress, anxiety, and depression were reported among health workers and volunteers before and during the pandemic.
- Teachers experienced a significant increase in stress and anxiety during the pandemic.
- Community trust and recognition were key motivators, while organizational factors failed to motivate health workers.

## Abstract

Mass Drug Administration (MDA) remains a key tool for elimination of Neglected Tropical Diseases (NTDs) and relies on the effort of health workers and community volunteers. Little is known about the mental health and motivation of these health workers to support better programming. This study assesses the psychological well-being of these implementers at two time periods (before and during the 2019 COVID-19 pandemic) to inform sustainable program strategies.

We conducted a cross-sectional study in three pre-selected communities with a history of poor MDA performance in Ekiti State. We recruited 35 experienced implementers (health workers (n = 12), teachers (n = 11) and Community Drug Distributors (CDDs) (n = 12)) and assessed their psychological well-being using Perceived Stress Scale (PSS), Generalized Anxiety Disorder scale (GAD-7), and the Patient Health Questionnaire (PHQ-9), alongside motivational factors at intrinsic, societal, and organizational levels. Data were analyzed in R software, employing descriptive statistics, chi-square/Fisher’s exact tests, and Wilcoxon signed-rank tests to explore psychological and motivational changes before and during the pandemic.

Our findings show high self-reported levels of stress (86% vs. 94.3%, p > 0.05), anxiety (63% vs. 71%, p > 0.05), and depression (91.4% vs. 100%, p > 0.05) before and during the pandemic, respectively. Overall, CDDs were the most affected group, followed by health workers and teachers (p = 0.057). However, teachers showed a significant increase in stress (66.7% to 91.7%, p < 0.05) and anxiety (41.3% to 75%, p < 0.05) during the pandemic. Implementers were primarily motivated by community trust, opportunities to gain knowledge, help communities, and access to information. At the community level, admiration, support, recognition, and respect from friends and community members served as key motivators. However, organizational-level factors did not motivate health workers.

The findings from this study highlight the need to promote psychosocial support through mental health resources and stress management to improve retention and effectiveness of MDA programs. Also, programs should explore how to tap into values such as community trust, support and recognition, alongside addressing organizational gaps to sustain participation and reduce burnout.