Making Sense of Compassion Fatigue Among Frontline HIV Prevention Workers

Background and Purpose: Many providers – social workers, health educators, nurses – work under stressful conditions and limited resources to assist clients with multiple needs. Providers often experience a severe state of preoccupation with the plight of clients and develop symptoms akin to those of someone facing traumatic stress, namely compassion fatigue (CF). Research on this subject is lacking, even though provider CF symptomatology may have negative implications for how effectively they can treat their clients. This pilot study aims to contextualize CF and uncover the extent of CF in a sample of HIV workers, with an eye toward developing and testing a behavioral intervention to help providers address CF symptoms.

Methods: Sequential mixed methods included surveys with 54 providers in 10 cities (15 agencies) in Michigan and focus groups of nine participants. We recruited community agencies and Health Departments supported by the Michigan Department of Health and Human Services. CF was measured using the 30-item scale, Compassion Satisfaction, Burnout & Compassion Fatigue Secondary Trauma. We calculated descriptive means for CF and subsequently stratified the sample into two groups, [low CF (n=4); high CF (n=5)] and conducted two focus groups to explore new factors influencing CF and contextualize the factors indicated by the CF measurement. Focus groups were recorded and transcribed verbatim. Questions aimed to uncover data about provider description of and how they address CF symptoms. Participants were also asked about acceptability of and content for future training. Drawing on Job Characteristics Theory, independent researchers coded the data for themes across the two focus groups, using NVIVO software, to capture how job roles and resources influenced CF.

Results: Quantitative sample (n=54): 34 females; 24 whites, 23 African-Americans, 5 mixed-race, and 1 Asian American. Focus group samples: Group A (2 males; 2 African-Americans and 2 whites); Group B (3 males; 3 African-Americans, 1 white, and 1 mixed-race). Seventy-two percent of the sample reported moderate to high levels of CF. Data revealed that providers described CF in a similar manner despite their reported degree of CF (measure by the CF survey). Focus group themes included: personal attachment to work (”We get into these jobs because we like people … it’s why we get into doing what we do”); self-care practices (... I work in the bar sometimes. That has made me step back from what I do sometimes”), and (“The care for us is that we get a certain amount of personal time per pay period”). Providers were agreeable to training on techniques to abate CF, including self-care strategies.

Conclusions: This pilot study used a small sample, a limitation, but given the high percentage of participants reporting moderate to high levels of CF, our data suggests that CF may be widespread among HIV prevention workers; epidemiological research is needed to confirm this. Results will form the basis of an intervention to decrease CF, which will need to address compassion fatigue with strategies to improve healthy detachment from job roles, self-care and concrete support (e.g., lower caseloads and time off) from organizations.