Determinants of Mental Health and Practice Behaviors of General Practitioners During COVID-19 Pandemic in Bali, Indonesia A Cross-sectional Study

Purpose: We aim to study the level of mental health distress and COVID-19 prevention in practice behaviors among general practitioners (GPs) in Bali, Indonesia, as well as their determinants. Methods: We conducted a cross-sectional online survey. Survey recruitment material was disseminated by purposive snowballing through regional professional association as well as research team’s personal acquaintances. The survey measured mental health status by DASS-21 questionnaire and practice behavior by a questionnaire based on WHO recommendations for hand hygiene and PPE use during the COVID-19 pandemic. We conducted multivariate analyses to identify independent determinants for mental health and practice behavior. Results: Analyses included 635 (41.75%) of GPs in Bali. Mental health status was relatively good with prevalence of depression, anxiety, and stress of 13.2%, 19.7%, and 11% respectively, lower than previous studies in Indonesia and elsewhere. Practice behavior, however, was not considerably lower with only 65.4% and 32.1% reported consistent hand hygiene and recommended PPE use respectively. Routine optional PPE use was reported by 23.6% of respondents. Long working hours and fear of COVID-19 was identified as detrimental to mental health while consistent hand hygiene improved it. Meanwhile, workplace, work setting, and fear of COVID-19, were identified as determinants for PPE use. GPs working in primary health centers and private hospitals were also found to have less adherence to hand hygiene protocols. Conclusion: Our results showed relatively good mental health status along with inadequate infection prevention in practice behavior of GPs in Bali, Indonesia. Intervention should be made to improve practice behavior. Determinants of practice behavior identified in this study could help to pinpoint intervention targets.