Date of Degree


Document Type


Degree Name





Maureen A. Allwood

Committee Members

Brett G. Stoudt

Kevin L. Nadal

Adeyinka M. Akinsulure-Smith

Andrew Rasmussen

Subject Categories

Clinical Psychology | Nursing | Public Health


burnout, community-based research, low-resource setting, moral distress, rural healthcare, secondary traumatic stress


In the context of the global nursing shortage, and particularly in low-resource settings, nurses are at an increased risk for work-related stress problems like secondary traumatic stress (STS), burnout, and moral distress. These three work-related mental health consequences, sometimes associated with absenteeism and intent to leave the profession, could potentially contribute further to the shortage of nurses. This two-part study is a longitudinal examination of the work-related mental health consequences experienced by healthcare providers in rural Uganda. In Study 1, participants (n=208; 159 students and 49 experienced health workers) completed self-report, psychosocial measures at baseline and 134 of the students completed the measures again 13-months later. Study 1, which was primarily quantitative, assessed the prevalence of mental health consequences and common coping strategies and examined associations among coping strategies and symptoms over time. In Study 2, participants (n=13) completed in-depth qualitative interviews about their experiences as healthcare providers. Qualitative data from both studies were used to contextualize and illustrate quantitative findings. Almost all participants endorsed clinically significant symptoms of at least STS, burnout or moral distress. Participants reported most commonly utilizing religion, planning, and other active, problem-focused coping strategies such as improvising in order to cope with challenging work circumstances. However, based on follow-up data for students, symptoms of STS and burnout were stable across the 13 months and individual differences in coping strategies had little effect on the progression of symptoms. Findings underscore the need for increased mental health awareness and targeted stress reduction programs in addition to infrastructural changes within the healthcare and health education systems in rural Uganda and other low-resource settings. The implications and suggestions are discussed in light of Uganda’s cultural context and plans for development.