Challenges in Working Conditions and Well-Being of Early Childhood Teachers by Teaching Modality during the COVID-19 Pandemic
Abstract
:1. Introduction
The Present Study
2. Method
2.1. Participants and Settings
2.2. Research Procedure and Analysis
2.3. Measures
2.3.1. Working Conditions
2.3.2. Teacher Well-Being
Construct | Study Variables | Instruments | Instrument Characteristics | Psychometric Properties |
---|---|---|---|---|
Job Demands | Job demands | The physical demand, skill discretion, and decision authority subscale of the Job Content Questionnaire (JCQ) [34] | JCQ consists of 11 items in three domains of stress: demands (4 items), skill discretion (related to skill variety) (3 items), and decision authority (related to job control) (4 items). Subscales measure participants’ rating on how each statement was true of their work in ECE settings based on a 5-point scale: 1 (strongly disagree) to 5 (strongly agree). | The internal consistency for the scales of the original JCQ range Cronbach’s α = 0.65 to 0.79 [43]. Our study: JCQ physical demands subscale Cronbach’s α = 0.71. |
Job Resources | Instrumental resources (wages and health insurance) | Questionnaire | One question asking teachers to report how they were paid (i.e., fully paid, partially paid, not paid) and one question asking teachers if they had health insurance covered by their employer during the pandemic (yes/no). | |
Profess. Well-Being | Work commitment | Questionnaire from Early Childhood Job Satisfaction Survey (ECJSS) on work commitment [42] | ECJSS questions the range of personal and organizational factors related to employee satisfaction and work commitment in center-based ECE programs. Scores could range from 0 (low) to 10 (high levels of work commitment). | Overall consistency: Cronbach’s α = 0.89 [44]. Internal consistency for the commitment section: Cronbach’s α = 0.80 [45]. Our study: α = 0.74. |
Intent to leave | Questionnaire | Three questions that asked participants to rate their intent to leave the field on a 5-point scale (1 (very unlikely) to 5 (very likely)). | Our study: Factor loadings = 0.84 for all three items. Cronbach’s α = 0.82. | |
Psych. Well-Being | Depressive symptoms | Center for Epidemiologic Studies of Depression Short Form (CES-D-10) [35]—shortened version [46] | 10-item screening test asking respondents to reflect on the previous week and rate the frequency of symptoms on a scale of 0 (not at all or less than 1 day) to 3 (5–7 days). | CES-D-10; Cronbach’s α = 0.65–0.91; [47,48]. Our study: Cronbach’s α = 0.75. |
Personal stress | The Perceived Personal Stress Scale (PSS) [36] | PSS items include questions about stress and examine how unpredictable, uncontrollable, and overloaded respondents find their lives. Other items ask participants about feelings during the last month, and the frequency of their feelings on a 5-point scale (1 = rarely/never to 5 = very often). | PSS; Cronbach’s α = 0.84; test-retest reliability Pearson r = 0.85 [36]. Our study: Cronbach’s α = 0.85. | |
Life satisfaction | Satisfaction with Life Scale [38] | Five items measuring global cognitive judgments of a person’s life satisfaction on a 7-point scale based on how much they agree (1 = strongly disagree to 7 = strongly agree). | Test–retest reliability: Cronbach’s α = 0.82, coefficient Cronbach’s α = 0.87 [38] Internal consistency Cronbach’s α = 0.74 [49]. | |
Secondary trauma | A Subscale of Professional Quality of Life Scale (PROQOL) [39] | Thirty items organized in 3 subscales (compassion satisfaction, burnout, and secondary traumatic stress) that measure the negative and positive effects of helping others who experience suffering and trauma. Our study used the subscale of secondary traumatic stress. | Secondary traumatic stress scale Cronbach’s α = 0.81 [39]. | |
Brief Resiliency | Brief Resilience Scale [37] | Six items that assess one’s ability to bounce back or recover from stress measured on a 5-point scale (1 (strongly disagree) to 5 (strongly agree)). | Internal consistency Cronbach’s α = 0.80–0.91; test–retest reliability r = 0.62 [37]. | |
Physical Well-Being | General health risk | General Health Indicator Composite | Eleven binary items (no = 0 and yes = 1) Items ask about doctor-diagnosed symptoms (e.g., anxiety, depression, infectious disease, heart disease). Our study used a total score of health conditions by combining all items. | |
Ergonomic Pain | Modified Work-Related Musculoskeletal Disorders Scale (WMDS) [41] | Five binary items (no = 0 and yes = 1) that ask about experienced pain in neck, back, shoulder, knee, and other. Our study used a total score by combining all items. | WMDS; Cronbach’s α (entire questionnaire) = 0.90; test–retest reliability Pearson r > 0.75 [41]. Our study: Cronbach’s α = 0.80. | |
Food Security | Modified Food Security Measure (USDA) [26] | Five items that identify food-insecure households and households with very low food security with reasonably high specificity and sensitivity. Participants can score as high or marginally good security (0–1), low food security (2–3), very low food security (4–5). Two categories of “low food security” and “very low food security” mean food insecurity. | Reliability α = 0.75, Cronbach’s α = 0.91 [50]. | |
Obesity | Body Mass Index (CDC) [40] | Body Mass Index (BMI) is a person’s weight in kilograms divided by the square of height in meters. | ||
Physical Activity | Questionnaire | Questions ask how many days and hours are spent on vigorous physical activities and how much time is spent sitting on a weekday. |
2.4. Data Analysis
3. Results
3.1. Working Conditions and Needs by Teaching Modality during the Pandemic
I work with infants. Wearing a mask makes it difficult to show them facial expressions. Infants love to see people smile at them… The infants don’t know the new teachers and don’t feel as safe as they would with their original teacher.
I have to go through and to breathe and communicate clearly with the face mask on. The gloves I feel are acceptable but the mask that the company provided is not appropriate. It is a t-shirt that someone made., It is super thin almost see-through if you put up to the light. When I have it on and breathe the clothing goes into my mouth. Not sure if it is protective enough.
Connecting with young children over the screen is HARD. We are not able to address their needs/goals regarding behavior or social emotional play skills. It’s all artificial. We are missing out on teaching them and addressing their needs during critical windows of development. Many of these kids just started getting services (special needs) and are going to kindergarten in the fall. It’s just yucky all around.
Parents were totally overwhelmed by more demands and school expectations and they weren’t able to do all the Zoom meetings and lesson activities. I felt like I tried to focus most of my support on the parents and let them know that I believe they are doing their best and that is OK.
3.2. Early Childhood Teachers’ Well-Being by Teaching Modality during the Pandemic
There is constant anxiety. Not knowing if I will lose more families; if I will be able to replace the ones I did lose any time soon; if I or someone in my family gets the virus and unemployment errors cause delays, will we survive financially?
I have gained about 20 pounds (during the pandemic). The added weight has affected my mobility. I have an increased level of discomfort with what formally was very mild aches and pains. I haven’t been to the doctor, but I’m sure my blood pressure is out of whack. These may be contributing to what I believe is mild depression.
I’m a very productive person typically. Being cooped up at home has been very challenging to my happiness. Some days, I don’t want to get off the couch. Some days, I am very productive and get everything done! I try to spend time in my yard and growing things in my garden. But when I run out of things to do, I get sad… It is difficult for me to put my foot down and refuse to go out when pressured by others as well.
3.3. Addressing Challenges: Teachers’ Reported Needs for Support
4. Discussion
4.1. Differences in Working Conditions and Well-Being by Modality
4.2. Differences in Well-Being by Teacher and Center Characteristics, Modality
4.3. Limitations
4.4. Implications for Practice and Policy
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Categories | Percentage OR Mean (Range) |
---|---|
Sample Demographics | |
Teachers with Associates Degree or Higher | 73% |
Teachers by Center Type | |
Family Childcare Home | 5.6% |
Childcare Center/Pre-K | 34.4% |
Head Start | 42.8% |
Public School | 14% |
Private School | 3.2% |
Teachers by Modality | |
In Person | 29.2% |
Online | 27.5% |
Closed | 43.3% |
Teacher Race | |
Black | 14.3% |
Hispanic | 21.4% |
White | 58.3% |
Other | 6% |
Psychological Well-Being | |
Changes in Psych. Well-Being Due to Pandemic | |
Mostly Positive | 7.7% |
Somewhat Positive | 11.2% |
No Change | 32.8% |
Somewhat Negative | 43.0% |
Mostly Negative | 4.7% |
Diagnosed with Depression | 23% |
Brief Resiliency | 2.91 (1–5) |
Life Satisfaction | 24.64 (5–35) |
Perceived Stress | 25.60 (1–47) |
Depressive Symptoms | 8.38 (0–30) |
Secondary Trauma | 19.29 (3–50) |
Physical Well-Being/Health | |
Teachers with At Least One Area of Ergonomic Pain | 79% |
Total Reported Ergonomic Pain ª | 3.49 (0–19) |
In-Person Teachers | 3.91 (0–15) |
Online Teachers | 3.59 (0–19) |
Closed Teachers | 3.08 (0–14) |
Changes in Health Due to Pandemic | |
Mostly Positive | 5.2% |
Somewhat Positive | 7.7% |
No Change | 66.5% |
Somewhat Negative | 17.7% |
Mostly Negative | 1.9% |
Currently Overweight or Obese | 76% |
Diagnosed with Anxiety | 31% |
Diagnosed with High Blood Pressure | 26% |
Diagnosed with Asthma | 20% |
Experiencing Food Insecurity | 1.07(0–5) |
Professional Well-Being | |
Work Commitment | 8.51 (1–10) |
Intent to Leave | 2.19 (1–5) |
Job Demands and Resources | |
Physical Job Demands | 2.91 (1–5) |
Skill Discretion | 3.93 (1–5) |
Decision Authority | 3.35 (1–5) |
Employer-Paid Health Insurance During Pandemic | 59% |
Wages—Full Pay During Pandemic (Partial Pay) | 83% (12%) |
In-Person Teaching Group | Online Teaching Group | School Closed Group | ||||||
---|---|---|---|---|---|---|---|---|
Challenges in Work (or Job Demands) | ||||||||
Rank | Freq | Content | Rank | Freq | Content | |||
1 | 19.57% | Working with children and families during a pandemic | 1 | 34.52% | Difficulty supporting children via online teaching | |||
2 | 18.40% | Financial hardship | 2 | 24.30% | Difficulty with parent involvement | |||
3 | 16.63% | COVID-19 fear and uncertainty | 3 | 13.55% | Technology issues | |||
4 | 14.48% | Additional job demand | 4 | 11.51% | Social isolation/feeling of disconnection | |||
5 | 13.89% | Too frequent changes in regulations and circumstances | 5 | 9.21% | Barriers to resources and preparation for online teaching | |||
Needs for Work | ||||||||
Rank | Freq | Content | Rank | Freq | Content | |||
1 | 19.91% | More COVID-19 resources | 1 | 20.34% | Improved access and resources | |||
2 | 14.13% | Financial support | 2 | 16.16% | Better parent involvement | |||
3 | 13.06% | More consistency | 3 | 12.26% | Improved curriculum | |||
4 | 10.92% | None | 4 | 9.96% | Improved communication and guidelines | |||
5 | 6.42% | More support for teacher | 5 | 7.94% | More training | |||
Challenge in Psychological Well-Being | ||||||||
Rank | Freq | Content | Rank | Freq | Content | Rank | Freq | Content |
1 | 52.64% | Anxiety and fear of COVID-19 | 1 | 32.98% | Anxiety and fear of COVID-19 | 1 | 50.48% | Anxiety and fear of COVID-19 |
2 | 9.97% | Social disconnection | 2 | 23.11% | Social disconnection | 2 | 21.40% | Social disconnection |
3 | 9.66% | Financial concern | 3 | 10.92% | Depression and sadness | 3 | 11.18% | Depression and sadness |
4 | 5.61% | Additional job demands | 4 | 6.09% | Loss of purpose | 4 | 7.99% | Financial concern |
5 | 4.67% | Lack of support | 5 | 5.67% | Additional job demands | 5 | 2.88% | Concern for students |
Challenges in Physical Well-Being | ||||||||
Rank | Freq | Content | Rank | Freq | Content | Rank | Freq | Content |
1 | 22.68% | Stress/anxiety | 1 | 31.82% | Weight gain | 1 | 27.52% | Stress/anxiety |
2 | 19.59% | Other illness syndrome | 2 | 20.78% | Stress/anxiety | 2 | 23.85% | Other illness syndrome |
3 | 18.56% | Weight gain | 3 | 14.29% | Other illness syndrome | 2 | 23.85% | Weight gain |
4 | 13.40% | Energy change | 4 | 13.64% | Lack of physical activity | 4 | 8.26% | Lack of physical activity |
5 | 8.25% | Lack of physical activity | 5 | 5.84% | Sleep change | 5 | 7.34% | Sleep change |
5 | 8.25% | Sleep change | 5 | 5.84% | Energy change |
Brief | Life | Perceived | Depressive | Secondary | Work | Intent to | Ergonomic | Physic. Job | Skill | Decision | |
---|---|---|---|---|---|---|---|---|---|---|---|
Resiliency | Satisfaction | Stress | Symptoms | Trauma | Commit. | Leave | Pain | Demands | Discretion | Authority | |
Constant | 0.113 | −0.308 ** | 0.139 | 0.241 ** | −0.075 | 0.203 * | −0.128 | 0.012 | 0.042 | −0.287 ** | 0.021 |
(0.081) | (0.080) | (0.080) | (0.080) | (0.080) | (0.081) | (0.081) | (0.082) | (0.082) | (0.081) | (0.078) | |
≥Associates degree | −0.050 | 0.227 ** | −0.054 | −0.112 | 0.138 * | −0.082 | 0.089 | −0.023 | −0.118 | 0.244 ** | 0.200 ** |
(0.064) | (0.064) | (0.064) | (0.064) | (0.063) | (0.065) | (0.064) | (0.065) | (0.065) | (0.064) | (0.062) | |
Childcare/Pre-K | (reference) | ||||||||||
Family childcare | 0.044 | 0.103 | −0.099 | −0.081 | −0.214 | 0.083 | −0.057 | −0.019 | 0.103 | 0.105 | 0.850 ** |
(0.126) | (0.125) | (0.125) | (0.125) | (0.123) | (0.126) | (0.126) | (0.127) | (0.127) | (0.125) | (0.121) | |
Head Start | 0.096 | 0.096 | −0.097 | −0.168 * | 0.047 | 0.094 | −0.068 | −0.024 | −0.011 | 0.168* | −0.337 ** |
(0.074) | (0.074) | (0.074) | (0.074) | (0.073) | (0.074) | (0.074) | (0.075) | (0.075) | (0.074) | (0.072) | |
Public school | 0.078 | 0.277 ** | 0.043 | −0.106 | 0.366 ** | −0.029 | −0.019 | 0.110 | −0.158 | 0.408 ** | −0.149 |
(0.096) | (0.096) | (0.096) | (0.096) | (0.095) | (0.097) | (0.096) | (0.097) | (0.098) | (0.096) | (0.093) | |
Private school | −0.201 | 0.179 | −0.086 | −0.163 | −0.137 | −0.053 | −0.139 | −0.541 ** | −0.250 | 0.047 | 0.312 * |
(0.162) | (0.161) | (0.161) | (0.161) | (0.160) | (0.164) | (0.163) | (0.164) | (0.165) | (0.162) | (0.157) | |
School closed | (reference) | ||||||||||
School in-person | 0.019 | 0.004 | 0.084 | −0.003 | 0.089 | −0.298 ** | 0.219 ** | 0.155 * | 0.139 | −0.038 | −0.017 |
(0.075) | (0.074) | (0.074) | (0.074) | (0.074) | (0.075) | (0.075) | (0.076) | (0.076) | (0.075) | (0.072) | |
School online | −0.081 | 0.011 | 0.081 | 0.100 | 0.097 | −0.107 | −0.034 | 0.052 | 0.046 | 0.076 | −0.041 |
(0.067) | (0.067) | (0.067) | (0.067) | (0.067) | (0.068) | (0.067) | (0.068) | (0.068) | (0.067) | (0.065) | |
White teacher | (reference) | ||||||||||
Black teacher | −0.299 ** | −0.009 | −0.359 ** | −0.275 ** | −0.194 * | −0.201 * | 0.218 ** | −0.200 * | 0.042 | −0.018 | −0.009 |
(0.081) | (0.081) | (0.081) | (0.081) | (0.080) | (0.082) | (0.081) | (0.082) | (0.082) | (0.081) | (0.079) | |
Hispanic teacher | −0.343 ** | 0.326 ** | −0.296 ** | −0.309 ** | −0.467 ** | −0.136 | 0.020 | −0.092 | 0.024 | −0.166 * | −0.174 * |
(0.074) | (0.074) | (0.074) | (0.074) | (0.073) | (0.075) | (0.074) | (0.075) | (0.075) | (0.074) | (0.072) | |
Other race | 0.063 | −0.162 | 0.088 | 0.113 | −0.114 | −0.158 | 0.291 * | 0.158 | 0.007 | −0.120 | −0.040 |
(0.115) | (0.115) | (0.116) | (0.115) | (0.115) | (0.118) | (0.116) | (0.117) | (0.118) | (0.116) | (0.112) |
Brief Resiliency | Life Satisfaction | Perceived Personal Stress | Depressive Symptoms | Secondary Trauma | Work Commitment | Intent to Leave | Ergonomic Pain | Physical Job Demands | Skill Discretion | Decision Authority | |
---|---|---|---|---|---|---|---|---|---|---|---|
Intercept | 0.0905 | −0.353 * | 0.170 * | 0.284 ** | −0.085 | 0.170 * | −0.115 | 0.059 | 0.027 | −0.297 ** | 0.019 |
(0.085) | (0.085) | (0.085) | (0.085) | (0.084) | (0.086) | (0.085) | (0.086) | (0.092) | (0.085) | (0.083) | |
≥Associates deg. | −0.043 | 0.239 ** | −0.049 | −0.111 † | 0.144 * | −0.088 | 0.094 | −0.029 | −0.116 † | 0.249 ** | 0.201 ** |
(0.064) | (0.063) | (0.064) | (0.063) | (0.063) | (0.064) | (0.064) | (0.065) | (0.063) | (0.064) | (0.062) | |
Childcare Center/Pre-K | (reference) | ||||||||||
Family CC home | 0.064 | 0.076 | −0.116 | −0.088 | −0.241 † | 0.073 | −0.055 | −0.001 | 0.105 | 0.126 | 0.826 ** |
(0.126) | (0.126) | (0.126) | (0.126) | (0.124) | (0.127) | (0.127) | (0.128) | (0.099) | (0.126) | (0.122) | |
Head Start | 0.089 | 0.097 | −0.092 | −0.166 * | 0.045 | 0.083 | −0.060 | −0.019 | −0.013 | 0.166 * | −0.339 ** |
(0.073) | (0.073) | (0.073) | (0.073) | (0.073) | (0.074) | (0.074) | (0.075) | (0.081) | (0.074) | (0.071) | |
Public school | 0.054 | 0.279 ** | 0.029 | −0.117 | 0.366 ** | −0.020 | −0.035 | 0.104 | −0.157 | 0.390 ** | −0.130 |
(0.097) | (0.096) | (0.096) | (0.096) | (0.096) | (0.098) | (0.097) | (0.098) | (0.098) | (0.097) | (0.094) | |
Private school | −0.221 | 0.194 | −0.103 | −0.183 | −0.140 | −0.041 | −0.148 | −0.551 ** | −0.246 | 0.035 | 0.321 * |
(0.162) | (0.161) | (0.162) | (0.162) | (0.161) | (0.164) | (0.164) | (0.164) | (0.174) | (0.163) | (0.157) | |
School closed | (reference) | ||||||||||
School in-person | 0.017 | 0.059 | 0.001 | −0.087 | 0.104 | −0.197 * | 0.153 † | 0.074 | 0.163† | −0.058 | 0.015 |
(0.090) | (0.089) | (0.090) | (0.089) | (0.089) | (0.090) | (0.090) | (0.091) | (0.093) | (0.090) | (0.087) | |
School online | 0.011 | 0.076 | 0.065 | 0.056 | 0.108 | −0.086 | −0.009 | −0.005 | 0.066 | 0.136 | −0.087 |
(0.088) | (0.088) | (0.088) | (0.088) | (0.088) | (0.089) | (0.089) | (0.090) | (0.089) | (0.089) | (0.086) | |
White teacher | (reference) | ||||||||||
Black | −0.335 ** | 0.003 | −0.545 ** | −0.458 ** | −0.299 * | 0.009 | 0.152 | −0.238 † | 0.056 | −0.033 | −0.084 |
(0.122) | (0.121) | (0.122) | (0.121) | (0.121) | (0.123) | (0.122) | (0.124) | (0.138) | (0.122) | (0.118) | |
Hispanic | −0.251 * | 0.404 ** | −0.306 ** | −0.355 ** | −0.395 ** | −0.107 | 0.004 | −0.229 * | 0.044 | −0.149 | −0.144 |
(0.100) | (0.100) | (0.099) | (0.100) | (0.099) | (0.101) | (0.101) | (0.102) | (0.102) | (0.101) | (0.097) | |
Other | 0.153 | 0.042 | −0.004 | 0.055 | −0.066 | −0.081 | 0.213 | 0.153 | 0.121 | −0.002 | −0.012 |
(0.176) | (0.178) | (0.178) | (0.178) | (0.177) | (0.180) | (0.178) | (0.181) | (0.184) | (0.179) | (0.173) | |
Black * In-person | 0.073 | 0.117 | 0.425 * | 0.362 † | 0.264 | −0.357 † | 0.187 | 0.042 | −0.019 | 0.04 | 0.115 |
(0.187) | (0.187) | (0.188) | (0.187) | (0.185) | (0.189) | (0.187) | (0.189) | (0.197) | (0.188) | (0.182) | |
Hispanic * In-person | 0.143 | −0.381 * | 0.116 | 0.242 | −0.228 | −0.286 | 0.134 | 0.443 * | −0.046 | 0.211 | −0.245 |
(0.187) | (0.187) | (0.187) | (0.187) | (0.186) | (0.189) | (0.189) | (0.191) | (0.201) | (0.188) | (0.182) | |
Other * In-person | −0.256 | −0.186 | 0.131 | −0.036 | −0.194 | −0.229 | 0.332 | 0.001 | −0.193 | −0.174 | −0.180 |
(0.263) | (0.263) | (0.263) | (0.263) | (0.262) | (0.267) | (0.265) | (0.268) | (0.259) | (0.265) | (0.257) | |
Black * Online | 0.059 | −0.189 | 0.204 | 0.268 | 0.099 | −0.384 † | 0.012 | 0.077 | −0.021 | 0.003 | 0.173 |
(0.204) | (0.203) | (0.205) | (0.202) | (0.200) | (0.204) | (0.203) | (0.205) | (0.227) | (0.203) | (0.196) | |
Hispanic * Online | −0.405 * | −0.039 | −0.099 | −0.034 | −0.123 | 0.138 | −0.079 | 0.187 | −0.027 | −0.197 | 0.061 |
(0.159) | (0.159) | (0.159) | (0.159) | (0.158) | (0.161) | (0.160) | (0.162) | (0.154) | (0.161) | (0.156) | |
Other * Online | 0.002 | −0.596 * | 0.202 | 0.299 | 0.103 | 0.023 | −0.158 | 0.001 | −0.198 | −0.250 | 0.159 |
(0.298) | (0.298) | (0.298) | (0.298) | (0.302) | (0.308) | (0.296) | (0.303) | (0.263) | (0.300) | (0.291) |
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Kwon, K.-A.; Ford, T.G.; Tsotsoros, J.; Randall, K.; Malek-Lasater, A.; Kim, S.G. Challenges in Working Conditions and Well-Being of Early Childhood Teachers by Teaching Modality during the COVID-19 Pandemic. Int. J. Environ. Res. Public Health 2022, 19, 4919. https://doi.org/10.3390/ijerph19084919
Kwon K-A, Ford TG, Tsotsoros J, Randall K, Malek-Lasater A, Kim SG. Challenges in Working Conditions and Well-Being of Early Childhood Teachers by Teaching Modality during the COVID-19 Pandemic. International Journal of Environmental Research and Public Health. 2022; 19(8):4919. https://doi.org/10.3390/ijerph19084919
Chicago/Turabian StyleKwon, Kyong-Ah, Timothy G. Ford, Jessica Tsotsoros, Ken Randall, Adrien Malek-Lasater, and Sun Geun Kim. 2022. "Challenges in Working Conditions and Well-Being of Early Childhood Teachers by Teaching Modality during the COVID-19 Pandemic" International Journal of Environmental Research and Public Health 19, no. 8: 4919. https://doi.org/10.3390/ijerph19084919
APA StyleKwon, K. -A., Ford, T. G., Tsotsoros, J., Randall, K., Malek-Lasater, A., & Kim, S. G. (2022). Challenges in Working Conditions and Well-Being of Early Childhood Teachers by Teaching Modality during the COVID-19 Pandemic. International Journal of Environmental Research and Public Health, 19(8), 4919. https://doi.org/10.3390/ijerph19084919