# Stress Levels Among Primary Health Care Workers in Almaty, Kazakhstan: A Cross-Sectional Study

## TL;DR

This study finds high stress levels among primary health care workers in Almaty, especially general practitioners, and identifies factors like age and alcohol abstinence that may protect against stress.

## Contribution

The study provides novel citywide evidence on stress levels and associated factors among primary health care workers in Central Asia.

## Key findings

- General practitioners in Almaty experience disproportionately higher stress levels compared to nurses.
- Younger workers and alcohol abstainers are less likely to experience high stress.
- Organizational interventions are recommended to reduce stress and maladaptive coping behaviors.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Occupational stress among primary health care (PHC) workers is a growing public health concern that affects workforce stability, quality of care, and patient safety.Evidence on stress and coping behaviors among PHC workers in Central Asia remains limited, despite ongoing health system reforms.

Occupational stress among primary health care (PHC) workers is a growing public health concern that affects workforce stability, quality of care, and patient safety.

Evidence on stress and coping behaviors among PHC workers in Central Asia remains limited, despite ongoing health system reforms.

Public health significance—Why is this work of significance to public health?
This study provides citywide evidence of a high prevalence of perceived stress among PHC workers in Almaty, with general practitioners (GPs) disproportionately affected.The findings identify professional role, age, and alcohol abstinence as key factors associated with stress, highlighting vulnerable subgroups within the PHC workforce.

This study provides citywide evidence of a high prevalence of perceived stress among PHC workers in Almaty, with general practitioners (GPs) disproportionately affected.

The findings identify professional role, age, and alcohol abstinence as key factors associated with stress, highlighting vulnerable subgroups within the PHC workforce.

Public health implications—What are the key implications or messages for practitioners, policy makers, and/or researchers in public health?
Organizational interventions aimed at reducing role-related and administrative burden, particularly for GPs, should be prioritized in PHC settings.Public health strategies addressing maladaptive coping behaviors, including alcohol use, are needed to support workforce well-being and health system sustainability.

Organizational interventions aimed at reducing role-related and administrative burden, particularly for GPs, should be prioritized in PHC settings.

Public health strategies addressing maladaptive coping behaviors, including alcohol use, are needed to support workforce well-being and health system sustainability.

Ongoing health system reforms in Kazakhstan have transformed the working environment of primary health care (PHC) staff and may increase workload and psychosocial stress. This study aimed to assess perceived stress among PHC workers in Almaty and its associations with socio-demographic characteristics and health-related behaviors. A cross-sectional survey was conducted in October–November 2023 across all 36 state-funded PHC facilities in Almaty. General practitioners (GPs) and family nurses employed in these facilities were invited to participate. In total, 1484 respondents completed a standardized questionnaire in Kazakh or Russian administered electronically via Google Forms. Perceived stress was assessed using PSS-10, physical activity using IPAQ-SF, alcohol consumption using AUDIT-C, and tobacco use through items aligned with STEPS/GATS. Statistical analyses were performed using SAS. Associations between variables were evaluated using χ2 and Fisher’s exact tests, and multivariable logistic regression models were applied. Statistical significance was set at p < 0.05. Higher stress levels were more common among GPs than nurses (OR = 2.58; p < 0.0001) and less common in younger workers (18–29 vs. 50–59: OR = 0.504; p = 0.017) and alcohol abstainers (OR = 0.587; p = 0.0004). Kazakh ethnicity showed a borderline protective association (OR = 0.472; p = 0.057), while physical activity was not a significant predictor. Perceived stress is highly prevalent in Almaty PHC and disproportionately affects GPs; younger age and alcohol abstinence are protective. The findings support prioritizing organizational measures to reduce role-related burden and maladaptive coping behaviors.