The two outcome variables—stress and burnout—were measured using validated psychosocial measures. Stress was assessed using the 10-item Cohen perceived stress scale, which captures people’s feelings and thoughts in the past month [42]. Questions relate to how nervous or stressed, unpredictable, uncontrollable, and overloaded respondents find their lives (S1 Appendix). Each question is on a scale of 0 (never) to 4 (very often). Burnout was assessed using the 14-item Shirom-Melamed Burnout measure (SMBM), which assesses feelings at work in the past month [43]. Questions capture three domains of burnout: physical fatigue, emotional exhaustion, and cognitive weariness, with responses options ranging from 1 (never or almost never) to 7 (always or almost always) (S2 Appendix).

The key predictor in this analysis is perceived preparedness to respond to COVID-19, which was assessed using a 15-item scale developed by our team. The questions capture personal, facility, and psychological preparedness for prevention, diagnoses, management, and education regarding COVID-19. Each question has response options from 0 (not prepared at all) to 3 (very prepared), with options for “I don’t know about this (4), and “Not applicable to my role” (5) (S3 Appendix). The scale development process is described elsewhere [41].

Other independent variables included feeling of appreciation, support, and communication from management; family support, ability to isolate at home without exposing family, fear of contracting COVID-19, confidence in being cared for if infected, COVID-19 training; availability of PPE, isolation ward, and protocols for COVID-19; perceived knowledge of how to manage COVID-19 (S4 Appendix), and provider and facility characteristics.

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