We used an Interpretative Phenomenological Analysis (IPA) design for the qualitative in-depth interviews and focus group discussions. This approach enables the description of participants’ detailed lived experiences and the identification of common themes among them (33, 34). IPA does not generate accounts based on pre-existing theoretical preconceptions that have already been prescribed, but rather the accounts are generated based on the lived experiences on their terms. According to Neuman, this approach allows individuals to create meanings in their worlds (35). These meanings are created through interaction with other people within their environment. Although the IPA focuses on how individuals make meanings of their words, the research is dynamic, with the researcher taking an active role in the process by getting close to the participants’ world (36). The phenomenon being examined in this study is how the lived experiences of Kayayei impact their mental and physical health. Thus, using an IPA enabled us to capture descriptions and meanings that a group of Kayayei had about their experiences of being Kayayei. To meet the requirement for IPA, we conducted interviews and focus group discussions among the Kayayei and analysed data based on the ‘what’ and ‘how’ of participants’ experiences (34, 37).

Participants for the study consisted of 21 Kayayei for in-depth interviews and another 10 Kayayei for focus group discussions recruited from the Agbogbloshie Market in Greater Accra, the Capital of Ghana. We used purposive sampling to select participants for the study. Purposive sampling is often used to select participants based on preselected criteria relevant to a particular subject matter being studied which will provide important information on the phenomenon being investigated (38, 39). For inclusion in the study, the participant had to have been a Kayayei, be operating at the Agbogbloshie market, be in Accra for more than 6 months, and be 18 years and older. We did not predetermine the sample size for the study, we however reached saturation by the 21st participant for the in-depth interviews. In qualitative research, saturation is reached when no new information is added to those that previous participants have already provided as outlined by Braun and Clarke (40). Two groups of five new participants were selected for focus group discussions (FGD). FGDs allow for the development of knowledge and co-constructed meanings at the group level (41, 42). FGD also helps to ascertain whether participants behave differently when they are in a group setting as compared to the one-on-one interview with the researcher. The study selected Kayayei from different age groups and experiences to share their lived experiences on the Kayayei business to generate broad overviews of the phenomenon. The combination of FGDs and individual interviews gave clearer insight into the lived experiences of the Kayayei (43–46).

The Kayayei were approached through the leadership of the Kayayei Association to participate in the study. The president of the Kayayei Association called them for a meeting and allowed the researchers to explain the purpose of the meeting to them. After the detailed explanation about the aim of the study, a few declined to take part but most of them agreed to take part on a convenient day. Phone numbers of those who were not available were collected and were subsequently called and those who were reached through the phone were briefed on the purpose of the study. After participants agreed to take part in the study, the date, time, and locations that were most convenient to them were decided on for the interviews.

A semi-structured in-depth interview guide was used to guide the interviews aligned to the objectives of the study. Semi-structured interviews offer a framework while giving the interviewer flexibility to elicit more information or seek clarification using follow-up questions or probes (47). While some key questions appeared in the interview guide, it was flexible enough to allow the researchers to probe with follow-up questions. The interview guide had three sections. Each section has major questions with several probes to obtain further clarification and follow-up. Interviews were conducted predominantly in English since 71.4% of participants had high school education, the rest were conducted in Twi and Sisala. The interviews were conducted by the first author and two research assistants with support from interpreters. Data was collected between July and August 2018. With permission from participants, the interviews were audio recorded. The interviews lasted between 1 h-to-1 h 20 min.

FGDs are discussions that are organized to explore a specific set of related issues and experiences (48). The collective activity of the group provides added dimensions of the interaction among members (48, 49) In this study, the FGD was facilitated by the first author and one research assistant using an FGD guide. The FGD guide consists of three sections including background characteristics, work-related challenges, and coping strategies. The purpose of the FDG is to ascertain whether participants behave differently when they are in a group setting as compared to the one-on-one interview with the researcher. The FGD discussions lasted between 1 h 30 min to 2 h.

The audiotapes were transcribed verbatim by two research assistants with the exact details about voice intonation and meaning. Steps were taken to minimize bias by using multiple people in the coding process, checking for alternative explanations, and reviewing the findings with peers as suggested by Giorgi (47). The interviews conducted in English were transcribed by playing the audio recordings over and over to make sure nothing was missed. Interviews conducted in the other languages were transcribed into English. The analysis followed the guidelines stipulated in IPA as outlined by Storey (48) in three steps. Step one entailed initial reading and re-reading of transcripts to identify initial codes which were combined to form sub-themes within the data. In step two, the individual themes were linked to create thematic clusters. Step three involved the creation of a thematic table that had various themes.

The first Author and the two research assistants reviewed the transcripts several times and identified emerging themes titles and transforming them into phrases that captured themes found in the transcripts (35). Emerging themes were listed using the questions in the interview guide, while connections between them were identified and patterns of meaning across the datasets were made to provide in-depth understanding. Patterns were identified through a thorough process of data familiarization, coding, and theme development and revision. The authors then identified thematic clusters and subordinate concepts. In the third stage, a summary table was created to illustrate the emerging main themes and sub-themes identified with quotes to substantiate the issues as suggested by Clarke and Braun (49). The reliability of qualitative data is determined by the extent to which data is the correct representation of the variables measured (50). For the data to be reliable, the lead author and one coder independently assessed the reliability of the coding process by applying the themes and sub-themes to each participant’s transcript. The coders indicated (0) when a particular theme is absent and (1) when the theme is present. We calculated the agreement between the coders by the number of times they agreed on each sub-theme. The overall interrater agreements ranged between 85 to 100%. We, therefore, determined that our reported data is the actual representation of the variables measured.

Table 1 presents the socio-demographic characteristics of participants. The findings show that the oldest participant was 40 years old while the youngest was 18 years. The findings further indicated that 38.1 percent (n = 8) of the participants had completed Senior High School (SHS). Most of the participants 19 (90.5%) were Muslims, while the majority 8 (38.1%) were Mamprusi.

The participants in the study shared their typical working day challenges and demands that posed stressors to their health and well-being. In this regard, four sub-themes emerged, i.e., physical health, mental health, accommodation, and social challenges.

The Kayayei use various coping strategies such as taking refuge in religious teachings, engaging in recreational activities, and seeking social support from family and friends as well as supporting each other as job resources at their disposal to mitigate job demands. Some participants mentioned using multiple strategies to cope with the problems associated with their work as head porters.

Recreational activities are used as coping mechanisms, they participate actively used recreational activities to reduce specific stressors related to their activities. Three participants said they engage their friends in conversations and listen to music or watch movies to cope with challenges associated with their work. For instance, a 19-year-old Kayayei stated, “I join people who are watching movies and laughing. Some of their narratives are captured in the following quotes:

This study also found that the presence of social support helped the Kayayei to cope with their situation even though only a few of them stated that they had no social support.

Five participants revealed that friends play an important role in helping Kayayei manage their difficulties through words of encouragement. For instance, a single 18-year-old participant put it this way, “I have a friend so anytime I am in difficulty, I call her”. A 26-year-old married participant put it this way, “I stay among friends, and when we converse, I get back happy.

In narrating their daily struggles and coping strategies, it was evident that the Kayayei demonstrated some level of resilience which enabled them to persevere in the difficult situations they find themselves in.

Participants demonstrated resilience through patience and self-control. Four participants shared their positive emotions, optimism and hope for each day:

It seems that a few of the participants use self-regulating practices for self-care as a way to cope by deliberately involving themselves in activities that enhance their emotional, mental, and physical health, thus to destress. One participant shared her self-care strategy:

Five participants noted that due to the physical nature of the Kayayei business and the frequent physical pain they experience, they often resort to self-medication to cope with the pain.

Instead of going to the health facilities for proper diagnoses, most of the participants rely on painkillers to relieve them of the constant pain they experience. Below is a quote that summarizes their narratives:

Individuals have different reasons for migrating to the city areas with the most common reason being the quest to earn an income to sustain their own and families’ livelihoods (51–53). This is no different for the Kayayei, however, female migrants might have additional stressors in their quest to earn a sustainable income (54, 55). The work-related challenges viewed as job demands, in the absence of adequate resources, pose major stressors to the Kayayei. These seem to impact their physical health and well-being, as suggested by the JD-R model (19, 20).

The study found that the physical nature of the work exposes the Kayayei to various physical health challenges, e.g., injuries through motorcycles and vehicle accidents, buckling under the weight of the load and fatigue due to walking long distances. These result in backache, pains in the neck, chest, legs and joints due to the strenuous work of carrying heavy loads over long distances, similar to findings reported in previous studies (11, 56, 57). The alleviation of these physical symptoms seems to diminish some of the daily earnings of the Kayayei as they spend their money on buying medication to mitigate the pain and enable them to manage the job demands of the next day. The seemingly high prevalence of self-medication or even other illegal drug abuse among the Kayayei is of concern, especially as they appear unable to access regular medical care from qualified health professionals. Aspects such as time constraints and affordability of basic health care are common problems of informal workers as indicated by Sánchez (58). This study’s findings are corroborated by a previous study of Yeboah (59), where the poor working conditions, coupled with little rest and not earning enough income, put the Kayayei at risk of various physical health conditions. Furthermore, the incidence of abuse, exploitation, and working under unsafe working conditions have been found to negatively impact the physical health of informal workers in Ghana (13, 31).

According to the World Health Organization (WHO) (60), mental health is an essential part of an individual’s ability to lead a fulfilling life, i.e., the ability to form and maintain relationships, study, work, and make other important decisions in life. Factors that impact mental well-being thus impede the optimal functioning of not only the individual but also have negative outcomes for the family and the society at large (60). The mental health challenges reported by the Kayayei is suggestive of depression, anxiety, and stress. Other studies have also reported mental health challenges among migrant workers, e.g., Li and colleagues (61) reported higher levels of depression among migrants than non-migrants in Shanghai. Similarly, mental health challenges among migrants were also reported by Yang et al. (62) and Komesuor and Meyer-Weitz (13).

It has been argued that the migration process predisposes migrants to mental health distress in various ways. The change in socio-cultural settings (63–65) often lead to a loss of cultural identity and difficulty adapting to the new social norms as well as navigating the local environment (51, 66). The disruptions of the normal social norms and networks may have a profound effect on the mental health of the Kayayei as observed by Kirmayer et al. (67). However, it is difficult to imagine and measure the costs of loss in friendships, family, and social networks, and the difficulties in establishing new relationships in places where the societal norms are very different (51, 68). The extent of the mental health challenges among the Kayayei could also be due to discrimination and perceived social inequity they witness in their host cities, primarily as a result of being women (68–70). The lack of national policies regulating and protecting the rights of informal workers, particularly female workers, and other self-employed individuals in Ghana (71), is an issue that is of critical importance to be addressed within Ghana and elsewhere.

Migration may therefore result in isolation, a lack of money and other socio-economic challenges including a lack of accommodation in the new host community (7). The lack of accommodation in general and particularly decent accommodation, was highlighted by the Kayayei in this study as a source of distress and anxiety. Previous studies have also reported that the Kayayei find it difficult to obtain affordable accommodation upon their arrival in their host cities (11, 72, 73). This reality forced many participants to find shelter in front of Kiosks with little or no security nor safety as they reported being attacked by armed robbers, sexual violence including abduction by predators.

The Kayayei in this study reported experiencing sexual and physical harassment, sexual assaults, as well as discrimination and negative attitudes of clients. This confirms previous findings of sexual violence against female migrant workers (74, 75). Maltreatment and discrimination against migrant workers have also been reported in various other studies (76, 77). It should also be noted that migrant women who engage in informal work might be more vulnerable to abuse and maltreatment because they often hold jobs for which there is little protection under social legislation (78, 79). It seems that in most countries, women do not have the same rights and opportunities for employment as men do, while they are often also expected to take responsibility for the survival of the whole family by searching for sources of income, no matter the circumstances (80, 81). While all these challenges and experiences may explain Kayayei’s mental distress, they also self-regulate to de-stress and demonstrate resilience by remaining committed to finding ways to cope in their quest for a livelihood.

The Kayayei adopted multiple coping strategies, which served as important personal resources to mitigate the job demands they faced and enhance their resilience to continue working. Bakker and De Vries (23) integrated perspectives of adaptive self-regulation in the theory underlying the JD-S in combination with personal resources as critical in buffering against job strains and thus burnout. The study findings show how the Kayayei employ various strategies to cope with the adversity they experience in daily work. These include reliance on their religion that gives them hope for a better life, engaging in self-regulation strategies such as recreational activities and self-care practices; self-medication to continue work despite the pain; seeking and giving social support to their fellow Kayayei and demonstrating resilience in managing their daily lived experiences while remaining committed to their goals of earning an income.

The Kayayei self-regulate their work strain through self-care by engaging in recreational activities such as listening to music or watching movies. The study by Henneh and Amu (82) indicated that creative arts such as music, dance, and movies play a significant role in the promotion of psychological well-being. In the case of internal migrants, the adoption of creative art like movies or comedy clips plays a crucial role in their lives in mitigating the various challenges they face as they are used as ways of replenishing the emotional and cognitive exhaustion, they experience (83) in job stress recovery through adaptive self-regulatory strategies (23). Seeking social support from others in sharing their lived experiences with their friends fosters social capital among fellow Kayayei that serves as an important social resource in times of difficulty (84).

Religion was found to play a major role as a coping strategy for most Kayayei in dealing with their daily working and living experiences and challenges. Their internalized religious beliefs and prayers help them to cope with stressful situations and bring hope and confidence that they will be able to overcome their difficulties. Religious coping strategies used among women were found to be protective against depressive symptoms (85). The study participants showed tolerance to suffering while their faith helped to make their challenges understandable and bearable (86). The finding of this study that most of the Kayayei adopted prayer as an essential coping strategy for their daily lived experiences was not surprising as religion plays a significant role in Ghanaian society (87).

In this study, the Kayayei demonstrated tremendous resilience in the face of the challenges they face. Their determination to continue trying to make a living for themselves and their families despite the daily adversity they experience and to remain hopeful for a better future seem to serve as inner resources that buffer their well-being (88). The Kayayei, view migration as essential in providing them with the financial and material gains that they lacked before migrating and are therefore determined to achieve this goal (89). The determination, motivation and goal-directedness displayed by the Kayayei in this study seemed to enable them to persevere and remain hopeful that their lives will soon change for the better despite the difficulties they experience. Positive emotions such as hope and optimism enhance resilience by expanding one’s range of thoughts, and actions for better coping and problem-solving as well as greater well-being as suggested by the broaden-and-build theory of positive emotions by Fredrickson (90).

However, maladaptive coping by the Kayayei in the form of self-medication for physical pain as outlined above and avoidance coping, e.g., drug use was also found. The physical and mental job demands of the Kayayei, just like other stressful jobs, predispose them to the abuse of over-the-counter drugs (91). Another predisposing reason is that they can hardly afford to fall sick or feel weak and miss out on a day’s work. The practice of self-medication often leads to drug dependence and abuse (92) The lack of health information and education on the consequences of self-medication among the Kayayei could also be a driving force of their self-medication. it is therefore important for health authorities to provide the Kayayei with relevant health promotion information to better understand the impact of their physical work on their mental and physical health and in particular ways to manage the build-up of lactic acid in the muscles to get relief instead of their reliance on self-medication (93).

The findings of the present study suggest the urgent need to strengthen the available personal resources of the Kayayei to buffer the job demands in their informal and unregulated work context. The multi-level JD-R model with a self-regulation perspective outlined by Bakker and de Vries (23) is useful to understand the interplay of the job demands and resources necessary to support the health and wellbeing of the Kayayei. The model specifically addresses personal resources and alludes to elements of psychological capital, i.e., self-efficacy, hope, optimism and resilience as developed by Lufthans et al. (94). These personal resources are viewed to be motivational and to help employees reach their goals (23) as also evident in this study. The findings highlight the current coping strategies employed by the Kayayei and call for the strengthening of their agency and inner resources, i.e., psychological capital as well as other resources, e.g., networking and social support to draw from in times of difficulties.