Cultivating collaborative solutions: co-developing a preventative intervention for burnout among doctors working in a...

Burnout among healthcare workers, especially in maternity units, is prevalent globally and exacerbated in resource-constrained contexts, contributing to decreased quality of care. Doctors in a maternity care unit (MCU) in a large Namibian public hospital complex were found to be at high risk of burnout, indicating need for intervention. Existing burnout interventions are predominantly individually-focused, created in a top-down manner and devised in high-resource settings. A dearth of research exists on burnout interventions that are contextually-fitted to low- and middle-resource settings in sub-Saharan Africa. This research aimed to explore how a burnout intervention could be co-created with local stakeholders in a Namibian public hospital MCU through an Interactive Learning and Action (ILA) approach.

A research team comprising doctors of varying clinical levels was recruited and senior management figures were consulted throughout the ILA process. The iterative action-research process consisted of workshops with specific objectives, a training session, dialogue sessions and evaluative interviews.

Based on a needs assessment, the research team devised ideas for six interventions. Priority setting of these interventions selected a mentorship programme to be fully developed and implemented. Outputs of each co-creation session created inputs for the next. After initial implementation of the intervention, adaptations were made based on input from end-users. End-evaluation showed the intervention's potential to prevent and mitigate burnout by stimulating increased feelings of support, strengthening social relationships, and building trust. Barriers to uptake included distant mentorship style, lack of accountability, and perception of the intervention as an increased workload. Facilitators encompassed enthusiastic and personal mentorship style and positive perceptions of the intervention as helpful with matters like case management.

Co-creating and implementing a context-specific intervention to address healthcare worker burnout appeared feasible in a sub-Saharan African context without funding. By leveraging local knowledge and skills, co-researchers collaboratively devised solutions addressing the needs of various levels of staff, created ownership of the intervention, and proactively integrated accommodations to contextual constraints into its design and implementation. Embracing local- and user-led co-creation in intervention development offers a promising avenue for addressing complex challenges.