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Interventions to Improve the Mental Health of UK Doctors through Self-Care

Promotion: Methodological and Analytical Considerations (Critical Review)

Students Name

Institutional Affiliation

Date
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Introduction

Background

Health professionals have a legal duty that is profound and sensitive than any other

career. Thus, they have the responsibility to willingly and fully contribute to the effective

running of the healthcare institutions and overall healthcare sector to ensure patients' quality of

life. While the health of individuals is prioritized, the well-being of doctors is also at stake. As

stated in synoptic project 1, this has increasingly gained traction by researchers and professionals

in the medical field. The primary interest aims at understanding the mental, emotional and

physical burnout in healthcare workers. Imo, (2017) argues that “medical career is one of the

most demanding industries, and even though the prevalence of burnout is alarmingly high among

doctors,” and minimum response to the condition is experienced. Burnout holds adverse health

effects including mental illnesses that impacts their productivity and their social life (Imo,

2017).

The overall research question regarding the “Interventions to improve the mental health

of UK doctors through self-care promotion” is "What can be done to reduce possible barriers

(like stigma), promote self-care, and create more effective intervention strategies to improve the

well-being of the doctors?” (and to minimize the risk of other serious diseases). The type of

synoptic project 2 comprises a critical review that aims at critiquing the peer-reviewed articles

earlier mentioned in section 1 and the methods and procedures they have employed. Discussed in

the project are the controversies, comparisons, and limitations of the existing methods. The

methods and procedure section also proposes the most effective design employed throughout the

articles in the healthcare field.

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The second section of the project includes the analysis and reporting. The statistics used

in the peer articles are reviewed, and the studies used are analyzed. The paper also focuses on

reporting the results and critically evaluates the data to analyze the strengths, weaknesses, and

limitations of the data the papers report. We also discuss the clinical implications of data

exceptionally and provide detailed conclusions highlighting the interventions and alternatives

employed in the field.

Methods and Procedures

This section discusses the various methods and procedures used by researchers in

collecting data for the sources used in this study. Different study methods include Observations,

questionnaires, interviews, conducting of tests, and role-play, among others (Cohen & Harrison

2007). Most of the works incorporated online academic resources as secondary sources, while

the mainly used primary sources were questionnaires and surveys. The questionnaires were

divided into face-to-face and email correspondence questionnaires, while the surveys were

purposely conducted on medical personnel. The peer-reviewed sources that involved

questionnaires include Mooney et al. (2020) and Imo (2017). Imo (2017) used questionnaires to

get information on psychiatric morbidity. This is because questionnaires allow someone to gather

minor details that would not be collected by the use of other methods of data collection. Rogers

(2014) utilized a Web-based survey to assess the occurrence of work-related burnout and

depression cases, while BMA (2020) utilized a study. Most of the used resources have employed

the use of questionnaires and survey both offline and online. The sources that used

questionnaires in gathering the information could acquire some minor details that would be hard

to gather by using a survey. The sources have also used secondary sources like peer-reviewed
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articles and approved journals in gathering the necessary information. The use of secondary

sources compliments surveys and questionnaires.

The survey helps bring a significant representation of the population under study and

therefore helping in gaining more inclusive information. For example, using a survey in studying

United Kingdom doctors' mental health helped the researchers study many doctors. It, therefore,

provided a large data that gives the study a good statistical significance. Survey also helps save

the cost of the research because it does not require massive spending like in interviews and

questionnaires. The researchers usually study the general population, which is an advantage on

the researcher's side. There are various ways of conducting surveys, for example, online and

offline, making them convenient and easy to conduct. Survey also helps in eliminating researcher

biases and therefore increasing the reliability of the results. However, due to the generalization of

information, the respondent may fail to provide accurate answers. Also, surveys may need a lot

of training to prevent biases which may be financially costly to the researcher. Also, surveys do

not provide visual aids that act as proof and may not be reliable. Also, due to little personal

interaction with the respondents, the researcher may fail to achieve a rapport with the

respondents.

On the other hand, the researchers who utilize questionnaires enjoy several advantages,

including getting quick results. In a questionnaire, various respondents can answer the questions

simultaneously and therefore would help save the time a researcher would use in waiting for a

person to be done to move to another respondent. Questionnaires are practical and can provide

tangible evidence that can be used for future reference. Also, using questionnaires is easy to

compare, for example, the differences in the emotional impact of work on younger doctors with

older doctors. Moreover, questionnaires make the process of data analysis easier as it is easy to
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compare different data. However, the use of questionnaires results in several unanswered

questions and various dishonest answers. The research on the mental health of health workers

involved a large population, and therefore both surveys and questionnaires are relevant.

Limitations

When using questionnaires, data collection takes longer because the respondents need

time to fill the questionnaire. Therefore, the time taken in the questionnaire filling made the work

last longer and sometimes making a person extend the time allocated for the research process.

Also, questionnaires need a person to analyze data which makes the process take even longer.

In addition, the research was about mental health, and there was a need for the

researchers to capture emotions that need a verbal response. Unfortunately, questionnaires do not

involve verbal responses, and therefore they limited the researchers from obtaining the feelings

of the doctors and medical students.

Moreover, most people do not answer all questions in the questionnaires, leaving the

questionnaires with inadequate information in preparing a report. Also, even after providing the

respondents with a document showing that the information provided will be used specifically for

research purposes, some people still feel insecure and are reluctant to provide accurate

information on their mental health. Therefore, withholding information and failure to answer

some questions leaves the researcher with inadequate data, making it hard to provide a

completely reliable report.

Also, questionnaires are an expensive data collection method because it costs money to

print and distribute the questionnaires to research respondents. The cost can make it hard for the

researcher to achieve the main goal (Adamou et al. 2020). Therefore, a method that requires a lot
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of money to accomplish may not be favorable to some researchers. Also, doctors are usually very

busy, and it is hard to find a free and ready doctor to fill your questionnaire at your convenient

time.

A survey is the second method of data collection that most researchers on the topic chose.

The technique is efficient, but it contains several limitations which may hinder a person from

getting accurate results. First, insecurities in some areas may restrict a researcher from accessing

a population of concern, leading to inadequate data collection. Second, lack of data from some

areas may lead to inaccuracy of results.

Secondly, a survey needs a lot of time to undertake, and lack of enough time may hinder

the researcher from being effective in data collection. Also, it sometimes hinders a researcher

from completing their research on time.

Undertaking a survey is expensive as it requires a person to invest money, such as

traveling to the marked areas. Lack of funds may hinder a researcher from being effective in the

research process. Furthermore, the survey takes a long time, and therefore the researcher may

prioritize argent tasks at the expense of the survey. Choosing to finish the urgent tasks first may

lead to inadequate time for the research process (Smith et al., 2016). If a survey is not accorded

ample time, it may generate insufficient information, which may lead to inaccurate results.

Inaccurate results tamper with the fundamental research, therefore making it lose its primary

purpose.

In addition, online surveys require time for the respondents to send their responses. Doctors are

usually busy and overloaded with work, and they would therefore take time before responding to

the survey.
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Using secondary sources may lead to a generation of inaccurate information, primarily

when a person used a non-peer-reviewed source (Rogers et al., 2014). Also, data used from

secondary sources may be out of date. For example, research papers require a person to apply

sources published recently for the accuracy of data. However, most online sources used in the

secondary resources applied were published more than five years ago.

Validity and Reliability

The most appropriate data collection methods in the research include surveys,

questionnaires, and secondary sources.

The secondary sources applied in accumulating data for the researches are peer-reviewed,

meaning the information provided is reliable. Also, the information in the sources is valid

because it was written by experts who provided a list of references to the information sources.

The use of peer-reviewed sources means that the written report is approved and recommended

for academic use. In contrast, a list of references and citations indicates that the data used is

accurate.

The questionnaires were well structured with general and personal questions on the

mental health effects of doctors' busy schedules. The information gathered from the

questionnaires is therefore specific and relevant. In addition, relevance makes the data reliable.

The design of the questionnaires was done with the help of experts who assisted in ensuring the

questions relate to what happens in the real world.

Most studies maximize on face-to-face questionnaires. When questionnaires are

distributed personally, it is easy to guide the respondent through the response process. Directing
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the respondent ensures they can answer the questions correctly and therefore making the

information reliable.

In addition, the survey was conducted on doctors and medical students. The results of the study

were therefore gathered from the population of interest, increasing its reliability.

Analysis and Reporting

Amoafo et al. (2017) applied the inclusion and exclusion model where they identified 47

suitable articles. In the articles, a sizeable number suggest that there are a more significant

number of females who experience burnouts, especially those specializing in surgery. In a

questionnaire study distributed to 7858 surgeons, 43% of the females suffered from burnouts

compared to 39% of their male counterparts. The types of analyses used included 40 cross-

sectional papers, “2 prospective, 2 mixed methods, 1 literature review, 1 case study, and 1 letter

totaling 47” (Amoafo et al. 2017). The majority of these studies used the MBI to cover different

groups of participants and ensure validity. Amofao and colleagues reveal that women have a

higher risk of developing burnout due to work-home conflicts.

In a Snapchat survey conducted to more than 6000 doctors by BMA, among the 4,000

doctors who responded to the questionnaires, 44% of them admitted to suffering from depression

and related mental illnesses (British Medical Association 2020). Most of the mental illnesses

were attributed to the unprecedented challenges the medical professionals have been facing

during the pandemic. One of the strengths in the data and results in the study is that they reflect

the most challenging times in the healthcare sector, hence bringing out the ideal situation that has

been in disguise even before the pandemic (Talbot & Dean, 2018). Compared to other papers,
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the results and data hold massive significance because it indicates the relationship between

challenging working conditions and mental health issues, especially in healthcare workers.

Clarke and friends conduct a qualitative analysis on 2459 respondents regarding the

adherence to the European Working Time Directive (EWTD). 279 of the respondents that

comprised 11% stated that they made unprompted references to EWTD. The analysis indicated

that 270 of the 279 of the responses were very critical (2014). The major limitation in the data is

that medical graduates' comments and opinions were expressed in the UK from 1993-2009 and

were surveyed in 2010, which was the first year of implementation of the EWTD, thus not

entirely effective. Additionally, the report expresses the subjective opinions of the doctors and

alienates the objective effect of the 'EWTD' on the senior healthcare professionals and 'National

Health Service' (NHS).

Fitzpatrick and colleagues (2019), in a survey involving 269 medical students designed

a model to measure burnout, its impacts on mental conditions in the medical cohorts, found out

that 39% indicated a prevalence of depression cases regarding the score of ≥6 on the ‘BDI=-

FS’. The study also compares the prevalence of depressive cases in preclinical years and clinical

years. In clinical years the rate of burnout is 35%, compared to 26% in preclinical years. 13% of

the overall prevalence of depression was in the low burnout class. Those in the mid class showed

a “38% prevalence and those in the high category had a 66% prevalence of depression”

(Fitzpatrick et al. 2019). Two factors were found to increase the odds of being complacent about

seeking medical help for mental health problems. One was growing emotional exhaustion and

decreasing academic efficacy.

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Gagnon et al. (2016) conducted a survey to investigate “the relationship between 'self-

regulation capacity, psychological well-being, and burnout”. The participants of the study were

37 Canadian medical students and 25 health professionals. The study employed regression

analysis which indicates that “self-regulation capacity” positively reflected the “psychological

well-being” of the participants and negatively showed burnout in participants (Gagnon et al.

2016). The major limitation of the statistics and data used to arrive at the results is that the

environmental mastery and the aspects of purpose in life were biased since they specifically

addressed the physicians' depressive states.

Fig 1: Internal consistency and descriptive statistics

Hall and colleagues (2017) conducted a study that used focus groups to explore "whether

primary care physicians (general practitioners [GPs]) perceive burnout and well-being to impact
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on the quality and safety of patient care” and (2) “to determine potential mechanisms behind

these associations." The focus groups had 25 practicing groups which were carried out in

England. Participants, through interviews, were asked about how they perceive burnout and poor

well-being on the impacts of patient care delivery. According to the results, GP practitioners

believed that the quality of care for patients is highly affected by poor well-being and burnout.

The results indicate validity because the participants themselves voiced their own opinions that

indicated poor-wellbeing and burnout could have adverse effects on patients' safety. This is also

reflected in Paice and colleagues' study (2013). This is also reliable because it reflects the first-

hand experiences of the participants.

Imo (2017), in a study aimed at systematically reviewing the prevalence and interlinked

elements of stress-related psychiatric disorders and burnout among UK physicians, suggested

that there is a “high rate of 'burnout and psychiatric morbidity among UK doctors”. According to

the results, “the levels of psychiatric morbidity ranged from 17% to 52%” (Imo, 2017). Three

factors were considered, including emotional exhaustion, depersonalization, and low personal

accomplishments. Respectively, these elements scored 31% to 54.3%, 17.4% to 44.5% and 6%

to 39.6%. The controversies in the study area on the clinical implications characterize the

worrying high trend of burnout and 'psychiatric morbidity among the doctors. The implications

indicate that this trend could have adverse effects on healthcare quality provision.

Rich et al. (2016) conducted a study that aimed to investigate physicians' ‘work-life

balance’ in training in the UK. The research participants were 41 trainers and 96 trainees, and the

design used was qualitative semi-structured focus groups and interviews. According to the

results, the work-life balance students post-graduate training. The post-graduate trainees'

personal lives were disrupted because of the shifting workplaces and tasks; it led to emotional
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and social distance between friends and families. This also made it challenging to have social

support structures that enabled them to cope with stress or depressive situations. However, the

issue with the sample and participants offers bias because some trainees may prefer changing

workplaces to reduce monotony and redundancy (West & Coia, 2019). The issue of work-life

balance is relative; studies have shown that as much as work-life balance sounds good, it is a

scam on a perspective that some people regard their workmates as their friends and families and

the workplaces as their homes. Additionally, another limitation with the data is conflicting

arising from personal issues and cultural biases.

The implications of the Data

The implication of the data obtained from the research on improving the mental health of

UK doctors through self-care promotion is that doctors are among the most affected people by

poor health. They fail to take care of their own health since they focus on our health, and their

careers. They are at the forefront of improving other people's health while failing to take care of

them. They also work for more hours with less rest which predisposes them to mental health

complications. The complications are caused by work overload and having less time for

relaxation. Health wise, the mind, and the body need rest front the daily routine to rejuvenate

them. Also, doctors' working areas, hospitals can be traumatizing since they deal with all types of

conditions that can overwhelm them and make the mind too crowded to function correctly.

For this reason, there should be interventions for doctors to deal with their mental health.

Doctor's mental health is more important than any other's career persons since doctors directly

focus on saving and improving lives. When a patient visits a hospital for treatment and is

attended by a mentally ill person, they are less likely to treat the patient in the right way. Patients
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depend on their doctors to improve their health conditions without considering their mental

conditions since they are used to being attended by mentally healthy doctors. However, this

should be the case since the patient should not be worried about their health and their doctor's. It

is the government's responsibility to ensure their workers are mentally stable and capable of

handling patients without any chances of providing poor services. Doctors are essential persons

in a country and need to be taken care of. They seem to be the most strong career persons but are

on the verge of mental breakdowns as opposed to the majority's notion. The widespread notion

leads to stigma against doctors.

According to a majority, doctors are not allowed to have a mental breakdown. Instead,

they are expected to have the most stable minds, which can merely break down or be affected by

any outside force. Therefore, doctors need to have a self-care promotion where they promote

their health before it affects them majorly. Taking care of themselves before their health

conditions deteriorates is essential since they are mandated to improve people's lives, including

theirs. Taking care of themselves can avoid any complications such as stigma and lack of health

personnel to trust to improve their health. Their mental health can also be in a safe condition

since continuous taking care of them is better than waiting to treat it.

g) By the end of the critical review, you should have a good indication of the best methods and

analysis to approach a study if you were to run it.

In the data collection methods, the most used were surveys and questionnaires. They are

the best since they can be detailed depending on the researcher. The questionnaires can either be

open or closed-ended. The open-ended questionnaire is the best in the event a researcher wants
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detailed response from the respondents. The researcher directs the direction in which the

respondent should follow.

In contrast, the respondent controls the responses since they can choose to provide correct or

incorrect responses in which the researcher has no power over. The survey and questionnaires

are better since the researcher can review the survey by redoing the survey after some time to

verify the research outcomes. Questions are also the best methods since, even though they are

time-consuming, they work with the respondents' schedule, which gives the respondents time to

respond unhurriedly, which can make them detailed and accurate. As opposed to interviews,

questionnaires give the respondents time and ensure they respond in their own free time. In

interviews, the interviewee can be in a hurry leading to answer the questions they only deem

necessary and hurriedly answering with no essential details. The interviews also take too much

time for the respondents, which can make them uncomfortable responding to all the required

research questions. In any data collection method, it is essential to make the respondent

comfortable providing correct answers to the research questions. Since the respondent is the

information holder, the researcher should ensure their data collection methods are respondent-

friendly.

Conclusion

The research methods include surveys and questionnaires. The best methods that were

used were questionnaires and surveys. Questionnaires are the best since they give more detailed

results and are respondent-friendly. It is expensive and time-consuming due to the printing out of

the questionnaires, traveling to take the questionnaires to the respondents, and traveling back to
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collect the questionnaires. However, they give the respondents time to respond to the survey

since they are given ample time to respond to them. They are different from interviews where the

interviewer is not given ample time to respond to the questions. Some questions also need some

privacy while answering them, making the interviews uncomfortable than surveys and

questionnaires. The best method is supposed to make the respondent more comfortable to answer

their questions. The research questions should also be straightforward and not too many to

ensure the respondents do not get tired of responding to them. Straight forward questions avoid

misinterpretation and provision of wrong answers. The research analyzed the data received and

found out that doctors need to take care of their health as they take care of their patient's health.

The doctors' health should be protected since their absence from work can lead to many fatalities.

They are essential in saving lives and are essential in a country since they facilitate a healthy

society.

a) Intervention and Measure:

Due to high cases of suicidal thoughts among doctors, cognitive behavioral therapy is

essential to help doctors fight the thoughts that are ultimately caused by depression. Mental

health is critical, and there needs to have a way of fighting it. The best way of fighting it is by

getting help from qualified personnel who can help them deal with depression. The

questionnaires would be administered in every healthcare center to determine how prevalent

depression is in a specific hospital. After the survey, cognitive behavioral therapy programs

would then be available in hospitals with more cases of depression. These programs would be

available to doctors only to avoid stigma. In the event the doctors are expected to participate in
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the program in the presence of their patients, it would be less likely for them to take part due to

stigma and their level in life.

b) Rationale:

This study is essential in raising awareness of the importance of “Interventions to

Improve the Mental Health of UK doctors through self-care promotion”. Doctors are essential

pillars in a country and need to be protected by all means. Their health is our concern since it

determines the quality of medication we get from them. Their mental health deterioration can

lead to the poor quality of our health. They are essential in bettering our health and should

promote theirs too since they are capable of it. Prevention is better than cure, making the self-

care promotion better than any other form of health promotion.

c) Limitations:

The current literature has limitations since it used secondary sources in the research. The

use of secondary sources can lead to inaccurate results due to their vagueness and generalities.

For this reason, the results presented in this literature can be wrong and misinterpreted.

Moreover, the data can be out of date. Secondary sources are not up to date, which makes this

literature bound to errors and misinformation. Future researchers can improve by using all

sources of data to improve the accuracy of the research.

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