This article forms part of a larger degree-related study conducted in partial fulfilment of the requirements for the Master of Radiography degree. The study was conducted at two tertiary hospitals in Chipata District, Eastern province of Zambia (Bwalya 2025), both of which were designated COVID-19 treatment centres at the peak of the pandemic in 2020. Hospital A’s bed capacity was estimated at 500, while hospital B’s bed capacity was estimated at 100. At the time of the study, both hospitals were equipped with X-ray imaging services, including mobile radiography units used widely for chest imaging of suspected COVID-19 patients. The radiographers, although in limited numbers of approximately 21 experienced a high demand for chest X-ray examinations during the COVID-19 pandemic. This study adopted a qualitative approach with exploratory and descriptive research designs because these designs are well-suited for uncovering insights into radiographers’ experiences and work practices during the COVID-19 pandemic. Such an approach enabled the researchers to explore an understudied phenomenon and describe it within its real-world context (Creswell & Poth 2018; Saunders, Lewis & Thornhill 2023).

The target population for the study comprised all 21 radiographers across the two selected hospitals. Using purposive sampling, radiographers were recruited to participate voluntarily in face-to-face interviews, with 11 participants included once information redundancy was reached (Bwalya 2025). Furthermore, following preliminary data analysis, a panel of experts comprising six diagnostic radiographers was purposely invited to provide inputs aimed at strengthening and refining the strategies proposed by the researchers in this study. The panel reviewed the draft strategies derived from the interview findings and provided feedback through structured discussions, which informed the final recommendations. Purposive sampling was used because it allowed the researcher to deliberately select participants who possess specific knowledge, experience or characteristics relevant to the study (Ahmad & Wilkins 2025; Tajik et al. 2024).

An interview guide was developed based on relevant literature and the study objectives. The guide was piloted with two radiographers who met the inclusion criteria but was not included in the final sample. Feedback from the pilot interview informed minor refinements to question wording to enhance clarity and relevance prior to formal data collection.

Following the pilot, the researcher visited two research sites and invited participants after introducing the study and its objectives in the meeting. Thereafter, the participants who were available and willing to take part in the study were given an information letter and an informed consent form to sign. The interviews were conducted in a private room at each hospital, each of the 11 interviews lasting approximately 30 min. No incentives were provided to the participants. The central research question that opened the interviews was: What were your work experiences as a radiographer during the COVID-19 pandemic? The probing questions used during the interviews included the following:

Data saturation was determined after the ninth interview, where no new codes were identified from the experiences shared by the participants; therefore, the two subsequent interviews yielded no new information to answer the research question (Alordiah & Oji 2024; Fusch & Ness 2015; LaDonna, Artino & Balmer 2021). All the interviews were audio-recorded with participants’ consent, and field notes were taken to capture nonverbal cues and contextual observations.

The recorded interviews were transcribed verbatim within 72 h by an independent transcriber who signed a confidentiality agreement to maintain confidentiality. The authors then conducted data analysis using Braun and Clarke’s six-step thematic analysis approach, which involved familiarisation with the data, coding, developing initial themes, reviewing and refining these themes, naming them, and producing the final report (Braun & Clarke 2021; Naeem et al. 2023). Field notes were used to supplement the interview data by capturing contextual observations and non-verbal cues, which helped the researchers to understand the meanings of the participants’ experiences. The interview transcripts were imported into ATLAS.ti 2024, where the data were coded and categories of codes were developed. An open coding approach was employed to generate codes, which were then organised into related categories. Before uploading the transcripts into ATLAS.ti 2024, for coding, all identifying information was removed to protect the anonymity of the participants and the hospitals involved. The theme and subthemes were developed based on the categories of codes in ATLAS.ti (Braun & Clarke 2021; Naeem et al. 2023; Williams & Moser 2019).

Credibility, dependability, confirmability and transferability are important criteria for applying trustworthiness in qualitative research (see Table 1). Credibility ensures that findings are believable and accurate, and provide a realistic report of participants’ experiences (Lincoln & Guba 1985; Shenton 2004). Dependability addresses the stability and consistency of the research process over time, thereby suggesting that similar results could be achieved under comparable settings (Denzin et al. 2024; Haq Kaka et al. 2023). Confirmability highlights the extent to which findings are shaped by participants rather than researcher bias or interest (Denzin et al. 2024; Lincoln & Guba 1985), while transferability defines the applicability of research findings to other settings with similar characteristics (see Table 1) (Drisko 2025; Lincoln & Guba 1985; Stalmeijer, Brown & O’Brien 2024).

Ethical clearance for the study was granted in 2023 by the Lusaka Apex Medical University Biomedical Research Ethics Committee (LAMUBREC). The ethical clearance number is 00463-23. Data collection commenced on 01 November 2023 following receipt of ethics approval and gatekeeper permissions from the participating hospitals earlier that month. The researcher obtained informed consent from all participants for both participation in the study and audio recording of their interviews. The recordings were transcribed by an independent professional who signed a confidentiality agreement and agreed to delete the recordings upon completing the transcriptions. To ensure data security and protect participant privacy, all transcribed files were stored on a password-protected laptop and cloud storage system at the Central University of Technology, Free State. This research study was conducted in accordance with the principles outlined in the Declaration of Helsinki (1975, revised in 2013) (Shrestha & Dunn 2020). Participants were informed that they could withdraw from the interview at any time without any consequence. Contact details for professional support services were provided in case of distress.

This theme captures the acute psychological, emotional, trauma, anxiety, fear and occupational difficulties participants faced during the COVID-19 pandemic (Bwalya 2025). The radiographers reported having to manage increased workloads, staff shortages, severe resource constraints, particularly during the peaks of the pandemic, and the possibility of infecting their families with COVID-19. These feelings were worsened by witnessing colleagues falling ill or dying, which led to occupational stress and mental fatigue. These challenges were presented across the following themes.

This theme relates to the way radiographers rapidly adjusted their clinical practices, work schedules and infection control measures to respond to the unprecedented demands of the COVID-19 pandemic and minimise risk of infection. The report also addresses how triaging was implemented. The following subtheme highlights these changes.

This theme highlights the essential role played by hospital management in supporting radiographers and other frontline healthcare workers during the COVID-19 pandemic. Management interventions extended beyond maintaining operations to protecting staff health, safety and well-being (Bwalya 2025). The following subthemes highlight how radiographers’ wellness and information support was implemented.

This theme addresses participants’ reflections on how X-ray departments should position themselves to respond to future health crises. Participants highlighted experiences from the COVID-19 pandemic informed a proactive approach to preparedness. Preparation was thus seen as an ongoing, multifaceted process aimed at ensuring the resilience and readiness of X-ray imaging services in the face of emerging health challenges (Bwalya 2025). The following subthemes present these reflections.

Strategies to support continuity of X-ray imaging during future pandemics were developed based on the study’s findings and relevant COVID-19 literature. A panel of six radiography experts, each with at least 5 years of clinical or academic experience and holding a master’s or PhD, was purposively selected to review the draft strategies. Eligible participants received formal invitations outlining the study’s purpose, session logistics and ethical considerations. A virtual review session was held on 26 June 2025 via Microsoft Teams, during which the principal researcher presented the study’s objectives, key findings and draft strategies. Participants provided implied informed consent by voluntarily agreeing to participate after being fully informed about the study. Expert feedback was collected immediately afterwards using a structured Google Forms survey to assess clarity, relevance, applicability and validity of the proposed strategies.

The authors drew on radiographers’ work experiences and practices during the COVID-19 pandemic, along with their suggestions for future preparedness, to synthesise strategies that ensure the continuity of X-ray imaging services in the event of a similar health crisis. These strategies are intended not only to support radiographers in maintaining essential imaging services but also to advise health authorities on strengthening the readiness of X-ray departments to respond effectively to future public health emergencies requiring imaging interventions (see Table 3).

To improve the responsiveness of radiography services during pandemics, radiographers must be equipped with specialised knowledge and skills through targeted education. This strategy proposes the introduction of workshops or short courses about emergency imaging, infection prevention and control and patient triage, as well as enhancing interprofessional education for radiographers to enable them to work as part of a multidisciplinary team with other healthcare professionals. The proposed workshops should be practice-oriented and use case-based learning and simulations. The responsibility of introducing these workshops should be carried by training institutions and professional bodies such as the Radiological Society of Zambia and the Society of Radiographers of South Africa. This guideline proposes that hospital management implement periodic emergency drills to assess staff preparedness for responding to public health emergencies.

To prepare for continuity and safe X-ray imaging services during pandemics, hospitals should regularly review and update their public health emergency response policies. These reviews should include alignment of infection prevention and control protocols with current national guidelines and World Health Organization standards. Radiographers, as frontline imaging professionals, rely on clearly defined, department-specific procedures, such as prescriptions for appropriate PPE usage, equipment disinfection and staff scheduling to minimise infection risks while maintaining service delivery.

Radiographers’ active participation in the development and review of emergency policies is crucial not only to strengthen their knowledge of outbreak protocols but also to affirm their vital role as frontline responders. Because they are directly involved in patient screening through chest X-ray imaging, engaging radiographers in policy processes enhances their role clarity, accountability and recognition within multidisciplinary emergency response teams. Hospitals are therefore encouraged to establish clear institutional emergency plans that explicitly incorporate X-ray imaging services. For instance, each facility’s emergency response task team should be structured and readily activated to address any unforeseen public health crisis.

To enhance mental health support, the authors propose that a dedicated wellness centre for frontline healthcare professionals be established outside the premises of the public hospital where they work, to ensure their freedom and comfort. A wellness centre should offer structured, confidential and accessible mental health services, such as trauma and psychological counselling and stress relief programmes, facilitated by trained personnel such as social workers and clinical psychologists. This guideline is supported by the insights of Evanoff et al. (2020) and Mosadeghrad et al. (2024), which emphasise the value of mental health support that addresses the well-being of healthcare professionals during public health emergencies.

The hospital wellness clinic should have ongoing awareness and engagement initiatives to promote a supportive, stigma-free work culture that is free of any form of discrimination or violence, as noted during COVID-19. Appointing radiographers as wellness champions will encourage peer-led support, enhance mental health advocacy and foster a culture of inclusivity and resilience in radiography departments. Over time, these efforts are seen to have the potential to contribute to higher job satisfaction, reduced absenteeism and a more emotionally resilient X-ray workforce.

The national health ministry should prioritise dedicated emergency response funding in reserves to enable the swift acquisition of essential resources during public health emergencies. These funds should support the procurement of consumables, doing short-term infrastructure upgrades and hiring additional administrative staff and radiographers to meet increased demands for patient care and support services. Simultaneously, the ministry should invest in upgrading radiology infrastructure to enhance the capacity of imaging departments to handle unprecedented requests for X-ray examinations. Key interventions include expanding imaging rooms to meet safety standards, procuring adequate portable X-ray units for mobile radiography, installing reliable backup power systems to ensure uninterrupted operations and transitioning to digital technologies such as picture archiving and communication systems to facilitate teleradiology and remote image interpretation.

A key strength of this study is that one-on-one interviews enabled the collection of rich, personal accounts from radiographers who worked during the pandemic. However, the study was limited to diagnostic radiographers from two major hospitals in Zambia’s Eastern province. As is characteristic of qualitative research, the findings are not intended to be statistically generalisable but may be transferable to contexts with similar health system structures, resource constraints and professional practices. The reliance on self-reported interview data also introduces potential bias, but the interviewer’s positionality has been clarified in Table 1.