title: Psychosocial support and resilience building among health workers in Sierra Leone: interrelations between coping skills, stress levels, and interpersonal relationships.
abstract: BACKGROUND
  In low- and middle-income countries, a shortage of properly trained, supervised, motivated and equitably distributed health workers often hinder the delivery of lifesaving interventions. Various health workforce bottlenecks can be addressed by tackling well-being and interpersonal relationships of health workers with their colleagues and clients. This paper uses data from the Helping Health Workers Cope (HHWC) project in a rural district of Sierra Leone to achieve three objectives. First, we describe the effect of counseling and psychosocial training on coping skills, stress levels, and provider-provider and provider-client relationships. Second, we examine whether a change in coping skills is associated with a change in relationships. Finally, we qualitatively identify key ways through which the uptake of coping skills is linked to a change in relationships.
  
  
  METHODS
  The HHWC project was implemented from February 2012 to June 2013 in Kono district in the Eastern province of Sierra Leone, with the neighboring district of Tonkolili selected as the control site. The evaluation followed a mixed-methods approach, which included a quantitative survey, in-depth interviews and focus group discussions with health workers and clients. Mean values of the variables of interest were compared across sub-populations, and correlation analyses were performed between changes in coping skills, stress levels, and changes in relationships.
  
  
  RESULTS
  Overall, the results demonstrate that the HHWC intervention had a positive effect on coping skills, stress levels and provider-provider and provider-client relationships. Furthermore, associations were observed between changes in coping skills and changes in relationships as well as changes in stress management skills and changes in relationships.
  
  
  CONCLUSIONS
  Psychosocial education can have major impacts on health worker well-being and the quality of health care delivery. Integrating psychosocial counseling and training interventions into health worker pre-service and in-service curricula would allow the positive effects of the HHWC intervention to be scaled up across Sierra Leone and beyond. A roll out of the HHWC approach alongside health system strengthening initiatives could have major implications for improving health and chances of survival.
authors.forename: Linda
authors.initials: L
authors.lastname: Vesel
authors.forename: Kathryn
authors.initials: K
authors.lastname: Waller
authors.forename: Justine
authors.initials: J
authors.lastname: Dowden
authors.forename: Jean Christophe
authors.initials: JC
authors.lastname: Fotso
mesh_terms: D000223:Adaptation, Psychological; D003376:Counseling / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000458:organization & administration; D017144:Focus Groups; D006282:Health Personnel / Q000193:education* / Q000523:psychology*; D006801:Humans; D007398:Interpersonal Relations; D011203:Poverty; D055500:Resilience, Psychological; D012424:Rural Population; D012807:Sierra Leone; D012944:Social Support; D013315:Stress, Psychological / Q000517:prevention & control*; D011795:Surveys and Questionnaires