448 Family Physicians participated in the study. The average age of the participants in the study was 39.10 ± 9.59 (min 24, max 65).
Evaluation of Information about COVID-19 Pandemic, Contact and Protective Equipment Conditions
Family physicians participating in the study were asked to indicate their level of knowledge about the COVID-19 outbreak and preventive measures. Evaluation of the level of knowledge of family physicians about COVID-19 pandemic was 33.5% (n = 150) sufficient, 53.6% (n = 240) partially, 12.9% (n = 58) insufficient. In addition, assessment of their level of knowledge about preventive measures was 40.4% (n = 181) sufficient, 45.5% (n = 204) partially, 14.1% (n = 63) insufficient.
The most frequently source used by family physicians participating in the study to get information about COVID-19 pandemic and protection methods was academic sites (% 37,7)
Academic sites (37.7%) are the most frequently used sources for information about COVID-19 outbreak and prevention methods by the family physicians participating in the research, others were Covid-19 guide of Turkish ministry of health (%35,5), social media (%16,3), television (%4,7), social environment (%4,7).
The rate of contact history of the participants with a COVID-19 (+) individual was 32.8% (n = 147). While 9.8% (n = 44) of the family physicians participating in the study stated that they were provided with sufficient personal protective equipment, 51.1% (n = 229) said they were partially provided and 39.1% (n = 175) stated that sufficient personal protective equipment was not provided at all. When the participants were asked to list the first three personal protective equipment they lacked in order of importance, they stated the lack of disposable overalls in the first place. The three personal protective equipment deficiencies they experienced the most are given in Figure 1, respectively.
Evaluation of Sleep and Anxiety Status of Family Physicians During the Pandemic Process
While the rate of family physicians who evaluated sleep quality as very poor before the onset of the pandemic was 1.3% (n = 6), this rate increased to 13.8% during the pandemic process (n = 62). While the rate of those who reported sleep quality as poor before the pandemic was 12.7% (n = 57), this rate increased to 48.2% (n = 216) after the pandemic. While 65.4% (n = 293) of the family physicians participating in the study defined sleep quality as good before the pandemic, this rate decreased to 35.7% (n = 160) after the pandemic. While the rate of those who stated that the quality of sleep before pandemic was very good was 20.5% (n = 92), this rate decreased to 2.2% (n = 10) after the pandemic (p <0.001).
Thinking that personal protective measures were insufficient (p = 0.000) and working as a practitioner as a professional title were the most important factors affecting the deterioration of sleep quality (p = 0.004). Age, gender, marital status, having a child, the institution of employment, the years spent in the profession, and having contact history with Covid-19 positive cases were not effective in impairing sleep quality (p> 0.05).
The family physicians were asked to evaluate their anxiety levels before the pandemic on a scale of 100. The anxiety levels before the pandemic stated by the participants were an average of 20 out of 100. By accepting this value as the cut-off value, the level of anxiety after pandemic rose to an average of 70 out of 100. After the pandemic, there were 429 family physicians (95.8%) whose anxiety increased compared to before. While there were 10 (2.2%) people whose anxiety level did not change, there were 9 (2.0%) people whose anxiety level decreased. The anxiety levels of the participants increased after the pandemic, which was statistically significant at p <0.001.
The most important reason that the participating family physicians thought increased their anxiety was to infect the family members with a rate of 83.7% (n = 375) (Figure 2).
According to the changes expressed by the family physicians in their anxiety levels, the related factors were evaluated by dividing them into two groups (the same or decreasing anxiety level in the pandemic process, Group I; the increased anxiety level, Group II) (Table 1). Family physicians, whose anxiety level increased during the pandemic process, were found to be related to gender, positive contact history and sufficient knowledge level. Those who had a positive contact history and those with sufficient knowledge were less likely to have anxiety than women, those with no contact history, and partial or insufficient knowledge.
Assessment of Family Physicians' Working Status and Job Strain Score During Pandemic
50.7% (n = 227) of the family physicians participating in the study stated that their working hours decreased after the pandemic, 40.8% said (n = 183) it did not change, and 8.5% (n = 38) indicated that their working hours increased. .
The job strain average score of the family physicians participating in the study was 60.1 ± 6.4 (min 33, max 77) before the pandemic; after the pandemic, it was 61.6 ± 6.8 (min 36, max 82). The number of family physicians whose mean score of job strain increased in comparison to pre-pandemic period was 277 (61.8%). This group was named as Group 1 in the study. The number of family physicians whose job strain score did not change was 52 (11.6%).The number of family physicians whose job strain score decreased in the pandemic process was 119 (26.6%).Those whose job strain decreased and did not change were divided into a subgroup as Group 2. It was found that the job strain score increased significantly during the pandemic process (p <0.001).
The factors related to the change in the levels of job strain scores of the family physicians with respect to these two subgroups are given in Table 2. In the analysis of the factors affecting the change according to these subgroup, it was determined that there was no relation between the change and age, gender, marital status, having children, occupational title, institution of employment, time spent in the profession, being in contact with positive individuals during the pandemic process, having sufficient information about COVID-19 disease and the change in working hours during the pandemic.
In the examination of the subgroups of job strain scores, the first subgroup workload sub-dimension average before the pandemic was 3.37 ± 0.47 (min 1.60, max 4.80), while the average after the pandemic was 3.39 ± 0.52 (min 1.80, max 4. 80). During the pandemic, the number of family physicians whose workload dimension mean score increased was 187 (41.7%), while the number of family physicians with decreasing or not changing workload was 261 (58.3%). It was found that workload dimension change before and after pandemic increased significantly (p = 0.000). When the factors affecting the increase in the workload dimension were analyzed, they were found to be significantly higher in younger age family physicians (25-29 age group) than other age groups (p = 0.022).Family physicians, who indicated that the workload dimension increased, were family physicians who stated that they were provided and used personal protective equipment adequately (p = 0.001; p = 0.033, respectively).The physicians whose workload dimension increased were significantly higher in the family physician group who stated that their working hours increased (p = 0.049). Family physicians whose workload dimension increased were the family physicians whose sleep quality deteriorated and their anxiety level increased during the pandemic (p = 0.000; p = 0.000, respectively).
When the control dimension, which is the second sub-dimension of the job strain scale was examined, the 'Control' sub-dimension of the job strain before the pandemic was 3.39 ± 0.51 (min 1.67, max 4.67), while this average rose to 3.40 ± 0.53 after the pandemic. (min 1.67, max 5.00) This increase was statistically significant (p = 0.000). The number of family physicians whose control sub-dimension mean score increased was 131 (29.2%). This sub-dimension score increase was significantly higher in family physicians who thought that they were not provided with adequate protective equipment during the pandemic process and in family physicians who did not find their own personal protective equipment sufficient (p = 0.007; p = 0.022, respectively).
The third subgroup of the job strain scale, the 'Social support' dimension was 3.81 ± 0.56 (min 1.5, max 5.0) before the pandemic, while it regressed to 3.59 ± 0.63 (min 1.5, max 5.0) after the pandemic. The decrease in the social support sub-dimension of the job strain scale was statistically significant (p = 0.000). The number of family physicians whose social support sub-dimension scores increased was only 38 (8.5%). Those whose mean score of the social support sub-dimension of the scale increased were mostly married (p = 0.002).
In the pandemic process, there was no significant relationship between anxiety levels and job strain burden of the participants (p = 0.962), while there was a significant positive relationship between impaired sleep quality and increased job strain burden (p <0.001). No significant relation was found between impaired sleep quality and anxiety level increase in the pandemic process (p = 0.403).