Understanding the Complexity of Healthcare Staff Responses to Collective Personal and Occupational Stress Using the Adversity-Activated Development Reflection Tool

The adversity-activated development reflection tool (AART) has been used therapeutically to capture personal growth arising during adversity. Our mixed-methods study used this tool to assess adversity-activated growth in 854 mental and community healthcare workers during the COVID-19 pandemic. Participants used the tool to describe the positive and negative effects of the COVID-19 pandemic in different life domains (self, family, work, and community). Through an ideal-type analysis of 133 purposively subsampled AARTs, we derived three levels of adversity-activated development (AAD): none, minimal, and deep. Higher levels of AAD were associated with spending more time connecting with friends and family (OR = 1.83, 95% CI 1.23 to 2.75, p < 0.01) and skill development in mental health care (OR = 1.63, 95% CI 1.16 to 2.28, p < 0.01). Deep development was characterised by changes in life priorities, changes in coping, realising strengths and capabilities, and making stronger connections with others. The AART can usefully assess both positive and negative growth, enabling respondents to convey the complexities of their experiences in their own words, whilst allowing the levels of overall self-development to be distilled. Our findings reinforce the value of promoting social connectedness and skill development to facilitate employee growth during collective occupational stress.