Assessment of local public health workers' willingness to respond to pandemic influenza through application of the extended parallel process model

Challenges in Media Attention toward COVID-19-Preventive Behaviors: Dual Roles of Threat and Perceived Capability for Information Systems and Health Care

Based on the extended parallel process model, this study investigated the relationship between young adults' media exposure to COVID-19 and their adoption of protective behaviors. This study surveyed 141 college students and found that increased risk perceptions led to greater intentions to engage in COVID-19-preventive behaviors and that these intentions were mediated by normative beliefs. There was no significant difference in risk perceptions between traditional media and social media. The results showed that college students took precautions against COVID-19 because they perceived themselves to be both vulnerable and capable.

Applying the extended parallel process model to understand households' responses to tornado and earthquake risks in Oklahoma

Oklahoma is a multihazard environment where both natural (e.g., tornadoes) and technological hazards (e.g., induced seismicity) are significant, making Oklahoma a unique setting to better understand how to manage and prepare for multiple hazards. While studies have attempted to understand drivers of hazard adjustments, few have focused on the overall number of adjustments undertaken instead of individual adjustments or adjustments in a multihazard environment. To address these gaps, we employ a survey sample of 866 households in Oklahoma to understand households' danger control responses (protective hazard adjustments) for tornado and earthquake risks in Oklahoma. We apply the extended parallel processing model (EPPM) to categorize respondents according to their relative level of perceived threat and efficacy of protective actions in predicting the number of hazard adjustments they intend to or have adopted in response to tornadoes and induced earthquakes. In line with the EPPM, we found that households have the highest number of danger control responses when their perceived threat and efficacy are both high. Counter to the EPPM literature, we found low threat coupled with high efficacy moved some individuals toward the adoption of danger control responses in response to both tornadoes and earthquakes. When households have high efficacy, threat appraisals matter in tornado danger control responses but not in earthquake danger control responses. This EPPM categorization opens new research approaches for studies of natural and technological hazards. This study also provides information for local officials and emergency managers making mitigation and preparedness investments and policies.

Assessment of Physicians' Willingness to Work with Patients Not Yet Diagnosed with COVID-19 in a Romanian Sample

BACKGROUND

The risk to physicians who worked with patients without confirmed COVID-19 testing during the pandemic has been little studied. However, they were at high risk.

METHODS

In the summer of 2020, 1285 Romanian physicians participated in a single-center study. Participants (mean age = 48.21 years; 302 males and 982 females, all specialties) completed a series of single-item measures adapted from previous studies on work ethics and responsibility. This study used Mann-Whitney comparisons between physicians who reported that they knowingly had direct contact with COVID patients and those who did not regarding their willingness to work.

RESULTS

Compared with their colleagues, physicians who reported not knowingly having direct contact with COVID patients reported less access to protective equipment, less overall willingness to respond when asked to work with infected patients, more likely to work out of fear of losing their jobs, and fear of legal repercussions. They received less training in the use of protective equipment.

CONCLUSIONS

Physicians who worked with patients not yet diagnosed with COVID-19 were significantly less willing to work. The perception of invisible risk may explain the observed differences.

What drives the vaccination intention against COVID-19? Application of EPPM, TAM, and theories of risk assessment

Vaccines are widely used to fight against COVID-19. However, COVID-19 vaccine hesitancy appears as some individuals are concerned with COVID-19 vaccines. This study investigates the vaccination intention against COVID-19 in China with the Extended Parallel Process Model (EPPM), Technology Acceptance Model (TAM), and theories of risk information assessment. Results showed that the formation mechanism of vaccination intention could be considered a psychological process, as subjective knowledge was a primary influence on correspondents' weighting of both the potentially positive (usefulness) and negative effects (threat) of vaccination. This unequal consideration then resulted in different levels of fear arousal between subjects. Driven by usefulness/threat perception and fear, people conducted different decision strategies, so-called analytical assessment, and experiential assessment to make vaccination decision. In addition to the direct effects of experiential assessment on vaccination intention, two decision strategies and fear arousal also affected people's vaccination intention through the mediation role of vaccination attitude. For policymakers and stakeholders, this study provides a knowledge base for confidence-building, and emotional guidance concerning against COVID-19 vaccination.

Navigating a Pandemic: Leadership Dynamics and Challenges within Infection Prevention and Control Units in Israel

This study investigates the impact of the coronavirus disease 2019 (COVID-19) pandemic on leadership within infection prevention and control (IPC) units across public hospitals in Israel. Through qualitative interviews with ten IPC managers from nine hospitals, equivalent to 30% of the country's acute care facilities, the research uncovers significant changes in managerial approaches due to the health crisis. The results reveal four main themes: (1) Enhanced managerial autonomy and leadership skills, with a noted rise in self-efficacy against the pandemic's backdrop; (2) Shifted perceptions of IPC units by upper management, recognizing their strategic value while identifying the need for a more profound understanding of IPC operations; (3) The increased emphasis on adaptability and rapid decision-making for effective crisis management; (4) The dual effect on job satisfaction and well-being, where greater commitment coincides with risks of burnout. The study underscores the essential nature of effective IPC leadership during emergencies, highlighting the need for clear communication, prompt action, and empathetic leadership. The conclusions point to the necessity for continuous research into IPC leadership, promoting strategic advancements in management to bolster IPC units against future health threats.

The Role of Self-Efficacy and Risk Perception in the Willingness to Respond to Weather Disasters Among Emergency Medicine Health Care Workers in Pakistan

OBJECTIVE

Optimizing health care workers' (HCWs) willingness to respond (WTR) is critical in low-and-middle-income countries (LMICs) for proper health system functioning during extreme weather events. Pakistan frequently experiences weather-related disasters, but limited evidence is available to examine HCW willingness. Our study examined the association between WTR and behavioral factors among emergency department HCWs.

METHODS

A cross-sectional survey was conducted from August to September 2022 among HCWs from 2 hospitals in Karachi, Pakistan. Non-probability purposive sampling was used to recruit participants. A survey tool was informed by Witte's Extended Parallel Process Model (EPPM). Multivariate logistic regression analyses were performed to examine the association between WTR and attitudes/beliefs as well as EPPM profiles.

RESULTS

Twenty-nine percent of HCWs indicated a low WTR. HCWs using public transportation had a higher WTR. Perceived knowledge and skills, self-efficacy, and perceived impact of one's response showed positive associations with WTR if required. Perception that one's colleagues would report to work positively predicted WTR if asked. Consistent with the EPPM, HCWs with high efficacy and perceived threat were willing to respond to weather disasters.

CONCLUSIONS

Our findings highlight the need of strengthening WTR by promoting self-efficacy and enhancing accurate risk perception as a response motivator, among emergency department HCWs in Pakistan.

Hospital disaster preparedness in sub-Saharan Africa: a systematic review of English literature

BACKGROUND

Disasters are increasing worldwide, with Sub-Saharan Africa (SSA) being one of the most prone regions. Hospitals play a key role in disasters. This study provides a systematic review of the evidence on disaster preparedness by hospitals in SSA countries based on English literature.

METHODS

A systematic literature review was conducted of articles published between January 2012 and July 2022. We searched PubMed, Elsevier, Science Direct, Google Scholar, the WHO depository library and CDC sites for English language publications. The key inclusion criteria were: publications should have been published in the above period, deal with hospital disaster preparedness in SSA, the full paper should have been available, and studies should have presented a comparison between hospitals and/or a single hospital.

RESULTS

Results indicate improvements in disaster preparedness over time. However, health systems in SSA are generally considered vulnerable, and they find it difficult to adapt to changing health conditions. Inadequately skilled healthcare professionals, underfunding, poor knowledge, the absence of governance and leadership, lack of transparency and bureaucracy are the main preparedness barriers. Some countries are in an infancy stage of their health system development, while others are among the least developed health system in the world. Finally, a major barrier to disaster preparedness in SSA countries is the inability to collaborate in disaster response.

CONCLUSIONS

Hospital disaster preparedness is vulnerable in SSA countries. Thus, improvement of hospital disaster preparedness is highly needed.

Physicians' Trust in Relevant Institutions during the COVID-19 Pandemic: A Binary Logistic Model

Little research has been done on professionals' perceptions of institutions and governments during epidemics. We aim to create a profile of physicians who feel they can raise public health issues with relevant institutions during a pandemic. A total of 1285 Romanian physicians completed an online survey as part of a larger study. We used binary logistic regression to profile physicians who felt they were able to raise public health issues with relevant institutions. Five predictors could differentiate between respondents who tended to agree with the trust statement and those who tended to disagree: feeling safe at work during the pandemic, considering the financial incentive worth the risk, receiving training on the use of protective equipment, having the same values as colleagues, and enjoying work as much as before the pandemic. Physicians who trusted the system to raise public health issues with the appropriate institutions were more likely to feel that they shared the same values as their colleagues, to say they were trained to use protective equipment during the pandemic, to feel that they were safe at work during the pandemic, to enjoy their work as much as before the pandemic, and to feel that the financial bonus justified the risk.

Danger control and fear control during public health emergencies: Considering the roles of fear and hope in the EPPM across different levels of trust

Public health emergencies pose considerable threats to global health and safety. The control of these emergencies requires the efforts of healthcare professionals and calls for the public to take protective actions. The present study not only puts fear back in the extended parallel process model (EPPM) but also considers another similarly productive emotion: hope. We examined the mechanisms behind the effects of four cognitive perceptions on protective actions (i.e., danger control) and information avoidance (i.e., fear control). A national online survey was conducted with 1676 participants during the outbreak of COVID-19 in China from February 1 to 29, 2020. The results revealed that perceived severity and susceptibility could lead to fear, positively affecting protective actions. On the other hand, perceived response efficacy and self-efficacy induced hope, which was positively associated with protective actions but negatively associated with information avoidance. Furthermore, the mechanisms behind the relationships among cognitions, emotions, and behaviors varied across levels of trust in healthcare systems.

Workplace Violence and the Mental Health of Public Health Workers During COVID-19

INTRODUCTION

During the COVID-19 pandemic, public health workers were at an increased risk for violence and harassment due to their public health work and experienced adverse mental health conditions. This article quantifies the prevalence of job-related threats, harassment, and discrimination against public health workers and measures the association of these incidents with mental health symptoms during the COVID-19 pandemic.

METHODS

A nonprobability convenience sample of state, local, and tribal public health workers completed a self-administered, online survey in April 2021. The survey link was emailed to members of national public health associations and included questions on workplace violence, demographics, workplace factors, and mental health symptoms. Mental health symptoms were measured using standardized, validated tools to assess depression, anxiety, post-traumatic stress disorder, and suicidal ideation. Multivariable Poisson models calculated adjusted prevalence ratios of mental health symptoms, with workplace violence as the primary risk factor. Analyses were conducted in 2021-2022.

RESULTS

Experiencing any type or combination of workplace violence was significantly associated with an increased likelihood of reporting depression symptoms (prevalence ratio=1.21, 95% CI=1.15, 1.27), anxiety (prevalence ratio=1.21, 95% CI=1.15, 1.27), post-traumatic stress disorder (prevalence ratio=1.31, 95% CI=1.25, 1.37), and suicidal ideation (prevalence ratio=1.26, 95% CI=1.14, 1.38), after adjusting for confounders. A dose‒response relationship was found between the number of workplace violence events experienced by a public health worker and the likelihood of reporting mental health symptoms.

CONCLUSIONS

Violence targeted at the public health workforce is detrimental to workers and their communities. Ongoing training, workplace support, and increased communication after a workplace violence incident may be helpful. Efforts to strengthen public health capacities and support the public health workforce are also needed.

Factors associated with medical radiation and imaging professionals' willingness to work during the SARS-COV-2 pandemic: A cross-sectional study

BACKGROUND

Resilient health systems effectively respond to health crises and coordinate post-event recovery. Central to a resilient system is the willingness of its workforce to work in high-risk scenarios. This study explored traits that may affect Medical Radiation and Imaging Professionals (MRIPs) willingness to work during a pandemic. Specifically, intrapersonal traits of compassion, empathy, and resilience were examined. Understanding such relationships can inform interventions that enhance individuals' willingness and health system resilience (HSR).

METHODS

In Fall 2020, a cross-sectional survey of Nova Scotian MRIPs was conducted. Witte's Extended Parallel Process Model, Professional Quality of Life, Intrapersonal Reactivity Index and Adult Resilience Measures-17 tools were used to assess willingness, compassion, empathy, and resilience. Statistical tests included chi-square, binomial, and multinomial logistic regression.

RESULTS

MRIPs were willing to report to work during the SARS-CoV-2 pandemic if required (92%); asked but not required (89%); or regardless of severity (94%). Individuals with very high levels of willingness reported lower personal distress (a facet of empathy) compared to those with high (p=.018) or moderate levels (p=.005). MRIPs with < 10 years experience were more likely to report high personal distress (p≤.37). Job role was associated with willingness (p<.001). There were no significant associations between level of willingness, and gender, age, experience, education, or the intrapersonal traits resilience and compassion.

CONCLUSION

Willingness was associated with job role and levels of personal distress. Personal distress was higher in participants with less years of practice. Interventions to reduce personal distress in early career MRIPs may enhance willingness to work during crises and thereby support HSR.

Exploring U.S. Food System Workers' Intentions to Work While Ill during the Early COVID-19 Pandemic: A National Survey

With "stay at home" orders in effect during early COVID-19, many United States (U.S.) food system workers attended in-person work to maintain national food supply chain operations. Anecdotally, many encountered barriers to staying home despite symptomatic COVID-19 illness. We conducted a national, cross-sectional, online survey between 31 July and 2 October 2020 among 2535 respondents. Using multivariable regression and free-text analyses, we investigated factors associated with workers' intentions to attend work while ill (i.e., presenteeism intentions) during the early COVID-19 pandemic. Overall, 8.8% of respondents intended to attend work with COVID-19 disease symptoms. Almost half (41.1%) reported low or very low household food security. Workers reporting a higher workplace safety climate score were half as likely to report presenteeism intentions (adjusted odds ratio [aOR] 0.52, 95% confidence interval (CI) 0.37, 0.75) relative to those reporting lower scores. Workers reporting low (aOR 2.06, 95% CI 1.35, 3.13) or very low (aOR 2.31, 95% CI 1.50, 3.13) household food security levels had twice the odds of reporting presenteeism intentions relative to those reporting high/marginal food security. Workplace culture and safety climate could enable employees to feel like they can take leave when sick during a pandemic, which is critical to maintaining individual and workplace health. We stress the need for strategies which address vulnerabilities and empower food workers to make health-protective decisions.

Psychological impact of COVID-19 on nurses caring for patients during COVID-19 pandemic in Gaborone

AIM

Nurses as front liners have direct contact with COVID-19 patients during the pandemic. Carrying the heavy burden during the pandemic has a mental health toll on healthcare professionals. The study explored nurses' experiences of psychological distress during the COVID-19 pandemic in Botswana's two COVID-19 special care centres.

DESIGN

The study used qualitative case study research to solicit nurses' experiences caring for patients with COVID-19 in selected COVID-19 centres in Gaborone.

METHOD

Researchers purposively recruited nurses from two COVID-19 centres in Botswana. Data were collected using semi-structured telephone interviews and analysed through inductive thematic analysis. Various institutional review boards ethically cleared the study.

RESULTS

Six themes emerged from the thematic analysis: feelings of fear and anxiety, hopelessness and helplessness, loneliness, physical distress, support mechanism and commitment to care.

PUBLIC CONTRIBUTION

The results offer important insights into the nurses' experiences during the COVI-19 pandemic.

Impacts of gain versus loss frame messages about beverages on boy students, an application of extended parallel process model

Background

Unhealthy diet including consumption of high amounts of sugar-sweetened beverages is a key modifiable risk factor for obesity and NCDs which begin in childhood and adolescence. The study aimed to compare the effect of gain frame vs. loss frame messages on SSBs consumption intention and behavior of high school boy students.

Methods

In this quasi-experimental study, 270 students from three boy’s high schools were selected through a multistage random sampling. Data collection was done through a 15 items self-reported questionnaire before and two months after the intervention. Each of the two intervention groups received one of the two types of gain frame or loss frame designed pamphlets inspired with extended parallel process model. The control group received no pamphlet.

Results

In control, GFM and LFM groups 91, 86 and 89 students participated in the study, respectively. After the intervention, significant differences were observed in perceived efficacy and threat of the GFM group and perceived efficacy, threat and intention in the LFM group compared with before the intervention. The GFM group had higher perceived self-efficacy than the control group and lower perceived severity than the LFM group. Intention to consume SSBs reduced significantly in LFM group, compared with the control group.

Conclusions

A combination of LFM and GFM messages could more effectively lead to nutritional behavior change regarding the consumption of SSBs. Results help to design messages for educational programs and nutritional campaigns.

COVID-19 Pandemic Response Preparedness and Risk Perceptions Among Peruvian Veterinarians and Animal Care Workers

Peruvian veterinarians and animal care workers (VACW) are primary responders in the event of disasters or emergencies, yet they face unique concerns that could impede or block their essential functions in public health preparedness in comparison with VACWs in other countries. In this study, we used the Ready, Willing, and Able model via electronic survey to evaluate the perception of risks and barriers that Peruvian VACWs faced when deciding whether to continue working during the COVID-19 pandemic between July and December 2020. We used logistic regression models to evaluate associations between demographic characteristics, perceived role, and contact scores with 8 outcomes: knowledge of COVID-19; confidence in safety protocols; perceived threat; perceived job efficacy; perceived barriers; and readiness, willingness, and ability to respond to the COVID-19 pandemic. Less than 50% of respondents reported barriers to report to work during the pandemic. Respondents who reported higher contact with coworkers had an increased confidence in safety protocols (OR 5.16; 95% CI, 1.36 to 19.61) and willingness (OR 3.76; 95% CI, 1.14 to 12.47) to respond to the pandemic. Close contacts with essential workers and higher economic income were associated with higher reported knowledge of COVID-19. Respondents with higher perceived job efficacy had higher odds of reporting being ready, willing, and able to respond to COVID-19, while those who identified more barriers to report to work had lower odds of being ready, willing, and able to respond. The findings from this study, which showed differences from VACWs in the United States, can be used by individuals designing programs to improve pandemic and disaster preparedness in this essential, yet understudied and vulnerable, workforce.

Risk Awareness and Impediments to Disaster Preparedness of Foreign Residents in the Tokyo Metropolitan Area, Japan

The likelihood of a mega-earthquake, the COVID-19 pandemic, and the threat of other disasters in the Tokyo Metropolitan area have necessitated collective responsibilities to take all possible actions to reduce their impacts. The experiences from past disasters have, however, highlighted the plight of foreign residents in coping with disasters and have reinvigorated calls for rigorous counteractions. As the population of foreign residents continues to increase in the metropolis, this research examines their awareness of risks and the obstacles that hinder disaster preparedness in the wake of future disasters. An Extended Parallel Process Model is utilized to analyze both secondary and primary data sources, and the results reveal that 65% perceive the severity of disaster as a threat and believe in a likelihood of occurrence in the city; however, the confidence to undertake some recommended countermeasures are lacking (with low efficacy of 70%). This is causing many to control their fear by not actively seeking further risk information or participating in disaster prevention activities. In consideration of these instances, the study recommends a collective approach built upon the merits of stakeholder engagements to provide vicarious experiences, verbal persuasions, and mastery experiences to boost the response capacities of foreign residents for disaster preparedness. This will be relevant for city authorities to enhance risk communication and foster foreigner-Japanese community integration.

Willingness to Work during Public Health Emergencies: A Systematic Literature Review

The identification of the factors underlying the willingness or lack thereof to respond to public health emergencies is paramount to informing more capable health services. The interest in this topic appears renewed with each surge of threat, either referring to natural disasters, man-made violence, or epidemic and pandemics. However, there is no systematic approach to the research patterns and related main findings concerning individual and contextual determinants. The present article contributes to this theme through a systematic literature review of a sample of 150 articles published in the last 30 years on the subject of willingness and preparedness of health professionals to deal with public health threats. Our findings show that the research is mainly phenomena and contextual driven, responding to whichever emergency threat is more salient in a given period. Geographically, research on this topic is led by USA and China, mostly solely, while European countries invest in collaborations that are more international. Universities, including health institutes and schools, and researchers at hospitals conduct most of the research on the topic. The main research areas are medicine, psychology, and psychiatry. Pandemics, including COVID-19, influenza, and natural disasters, are the phenomena gauging more attention as opposed to terrorism events and biological accidents. The specific role of health professionals within the institution, their belief in ethical duties, preparation training, and concerns regarding infection of self and family are the main variables influencing the willingness and ability to report to work in public health emergencies.

An application of the extended parallel process model to protective behaviors against COVID-19 in South Korea

This study applied the extended parallel process model (EPPM) to investigate the factors affecting people's preventive behaviors against COVID-19, and thereby, draw relevant policy implications for current and future other epidemics. The EPPM was used to examine the danger control and fear control responses, along with the separate effects of their sub-factors (perceived susceptibility, perceived severity, response efficacy, and self-efficacy) on personal hygiene behaviors, social distancing measures, and fatalism. In total, data from an online survey of 813 adults were analyzed. The results of multiple regression analysis showed a strong effect of self-efficacy on danger control (ß = 0.23 for personal hygiene behaviors, β = 0.26 for social distancing) and fear control responses (ß = -0.13 for fatalism). However, based on the type of control response, the effect of perceived susceptibility and perceived severity, which were the main factors in threat appraisal, was insignificant or marginally significant. Further, a higher perceived severity was associated with higher fatalism in the fear control response (ß = 0.09). Those who were currently employed performed fewer social distancing measures compared to those who did not (ß = -0.11), whereas there was no difference in personal hygiene behaviors. These results suggest that risk communication in emerging infectious disease crises should provide customized information on people who are hard to comply with social distancing. Besides delivering the message of self-efficacy, policies should be implemented to create a social environment in which individuals can practice social distancing without constraints.

Assessing COVID-19 Pandemic Risk Perception and Response Preparedness in Veterinary and Animal Care Workers

Veterinary and animal care workers perform critical functions in biosecurity and public health, yet little has been done to understand the unique needs and barriers these workers face when responding during a pandemic crisis. In this article, we evaluated the perceived risks and roles of veterinary and animal care workers during the COVID-19 pandemic and explored barriers and facilitators in their readiness, ability, and willingness to respond during a pandemic. We deployed a survey targeting US veterinary medical personnel, animal shelter and control workers, zoo and wildlife workers, and other animal care workers. Data were collected on respondents' self-reported job and demographic factors, perceptions of risk and job efficacy, and readiness, ability, and willingness to respond during the pandemic. We found that leadership roles and older age had the strongest association with decreased perceived risk and improved job efficacy and confidence, and that increased reported contact level with others (both coworkers and the public) was associated with increased perceived risk. We determined that older age and serving in leadership positions were associated with improved readiness, willingness, and ability to respond. Veterinary and animal care workers' dedication to public health response, reflected in our findings, will be imperative if more zoonotic vectors of SARS-CoV-2 arise. Response preparedness in veterinary and animal care workers can be improved by targeting younger workers not in leadership roles through support programs that focus on improving job efficacy and confidence in safety protocols. These findings can be used to target intervention and training efforts to support the most vulnerable within this critical, yet often overlooked, workforce.

Fear of disasters within the risk communication network of foreign students in Japan amid the COVID-19 pandemic crisis: A cohort design

The main objective of this study is to examine the role of risk communication during the COVID-19 crisis, which is often neglected in studies investigating the outbreak of the pandemic. The study is based on survey data from a group of international (non-Japanese) students in Japan and the theoretical foundation of fear appeal theory. The results, which are based on the panel data structure, show that individually, (1) the act of seeking out others to discuss risks in depth in the current pandemic context or (2) the observed adoption of advocated precautionary health behaviours is not necessarily a good indicator of mental management, but (3) the combined effect of (1) and (2) unexpectedly suggests a conciliatory effect on the fear of disasters. Moreover, this evidence-based finding (3) suggests that a reciprocal relationship exists between threat and efficacy in terms of mediating fear under the framework and theory of fear appeals, indirectly challenging the fear control response proposition of the extended parallel process model. Our empirical findings emphasize the role of risk discourse and information sharing combined with preventive health behaviours adopted within a community in the context of global health crises.

Empowering Parents to Protect Children during COVID-19 with Message Strategy Based on Efficacy, Threat Levels, and Channel Preferences

A national survey (n = 500) was administered in March 2020 at the peak of COVID-19uncertainty to access parents' perceived abilities to protect children during the COVID-19 pandemic. Using the threat/efficacy matrix in Witte's (1992) extended parallel processing model (EPPM), parents' behavioral intentions to protect children from coronavirus and their perceived COVID-19 knowledge levels are examined based on their positions within the matrix. The results indicated that (1) there is a positive relationship between the perceived threat of COVID-19 to parents and to their children; (2) parents' behavioral intentions and knowledge levels varied depending on their perceived threat/efficacy levels; (3) perceived threat level was the bigger motivator to use channels for COVID-19 information. Theoretical and practical implications are discussed.

Testing Extended Parallel Processing Model in the Korean COVID-19 Context: Effect of Moral Intuitions as Moderators

Despite the possible social implications of the coronavirus disease 2019 (COVID-19), previous studies of the extended parallel processing model (EPPM) in the context of COVID-19 overlooked the emotional aspects when processing fear-inducing COVID-19-related messages. Drawing upon the moral foundation theory (MFT), this study aimed to (a) apply EPPM in the Korean COVID-19 context, (b) introduce MFT and explain why moral intuitions can be related to the processing of COVID-19 messages, and (c) examine the moderating role of moral intuitions in the EPPM model. Based on the theoretical backgrounds, this study tested EPPM hypotheses and also tested whether moral intuition can moderate the relationship between perceived self-efficacy, perceived threat, fear of COVID-19, and health compliance behavioral intention. This study conducted an online survey using measurements of perceived self-efficacy, perceived threat, MFQ-20, fear of COVID, and health compliance. Our study showed three main findings. First, our study found the main effects of (a) self-efficacy on health compliance behavioral intention and (b) perceived threat on health compliance behavioral intention. Second, our study found that morality moderated the main effects of self-efficacy or perceived threat and also moderated EPPM interaction on fear of COVID. Third, the moderation of morality in the relationship between self-efficacy and health compliance behavioral intention showed that health compliance intention decreased as morality increased. Our findings suggest that people can consider COVID-19 as a social and moral issue that involves protecting others.

Burnout and peritraumatic distress of healthcare workers in the COVID-19 pandemic

BACKGROUND

To evaluate the current status of emotional exhaustion and peritraumatic distress of healthcare workers (HCWs) in the COVID-19 pandemic, and identify factors associated with their mental health status.

METHODS

An online survey involving 1068 of consented HCWs that included nurses, physicians, and public health officers was conducted in May 2020. Descriptive statistics and multivariate regression analyses were performed on the collected data.

RESULTS

Although no significant difference in peritraumatic distress was observed among the surveyed HCWs, the workers' experience of emotional exhaustion varied according to work characteristics. Respondents who were female, older, living with a spouse, and/or full-time workers reported higher levels of emotional exhaustion. Public health officers and other medical personnel who did not have direct contact with confirmed patients and full-time workers had a higher level of peritraumatic distress. Forced involvement in work related to COVID-19, worry about stigma, worry about becoming infected, and perceived sufficiency of organizational support negatively predict emotional exhaustion and peritraumatic distress.

CONCLUSIONS

Job-related and emotional stress of HCWs should not be neglected. Evidence-based interventions and supports are required to protect HCWs from mental illness and to promote mental health of those involved in the response to the COVID-19 pandemic.

Wildfire Smoke Risk Communication Efficacy: A Content Analysis of Washington State's 2018 Statewide Smoke Event Public Health Messaging

CONTEXT

Wildfire events are increasing in prevalence and intensity in the Pacific Northwest. Effective communication of health risks and actions to reduce exposure to wildfire smoke is imperative.

OBJECTIVE

We assessed the content of wildfire smoke risk messages from government organizations and mainstream media during a major wildfire smoke event in August 2018.

DESIGN

We conducted a content analysis of wildfire smoke risk information communicated by local and state government organizations and the mainstream media.

SETTING

Eight Washington State counties during a statewide wildfire smoke event in August 2018.

MAIN OUTCOME MEASURE

Leveraging the Extended Parallel Process Model and information in the existing literature on wildfire smoke and health, we assessed messages for the presence of information regarding health risk, personal interventions, administrative interventions, vulnerable populations, and trusted sources of information. Summary statistics were calculated to identify common messages about recommended interventions, vulnerable populations cited, and trusted sources of public health information.

RESULTS

Of the 273 identified government and media messages on wildfire smoke, the majority (71% and 66%) contained information about health risks. However, only 46% and 33% of government and media messages contained information about personal interventions to reduce risk, and 37% and 14% of government and media messages contained information about administrative interventions to reduce risk. Less than half of government and media messages (28% and 31%) contained information specific to vulnerable populations, and 58% and 46% of government and media messages contained any reference to a trusted source of information.

CONCLUSIONS

While information about wildfire smoke and health risks was communicated during Washington's August 2018 wildfire smoke event, there remains considerable opportunity to include additional information about interventions, vulnerable populations, and trusted sources of information. We recommend several opportunities to improve and evaluate risk communication and risk reduction before, during, and after future wildfire smoke events.

Developing Public Health Emergency Response Leaders in Incident Management: A Scoping Review of Educational Interventions

During emergency responses, public health leaders frequently serve in incident management roles that differ from their routine job functions. Leaders' familiarity with incident management principles and functions can influence response outcomes. Therefore, training and exercises in incident management are often required for public health leaders. To describe existing methods of incident management training and exercises in the literature, we queried 6 English language databases and found 786 relevant articles. Five themes emerged: (1) experiential learning as an established approach to foster engaging and interactive learning environments and optimize training design; (2) technology-aided decision support tools are increasingly common for crisis decision-making; (3) integration of leadership training in the education continuum is needed for developing public health response leaders; (4) equal emphasis on competency and character is needed for developing capable and adaptable leaders; and (5) consistent evaluation methodologies and metrics are needed to assess the effectiveness of educational interventions.These findings offer important strategic and practical considerations for improving the design and delivery of educational interventions to develop public health emergency response leaders. This review and ongoing real-world events could facilitate further exploration of current practices, emerging trends, and challenges for continuous improvements in developing public health emergency response leaders.

Risk perceptions and attitudinal responses to COVID-19 pandemic: an online survey in Ethiopia

BACKGROUND

Effective risk communication is one of the critical strategies in the response to COVID-19. This study examined risk perceptions and attitudinal responses to COVID-19 among the educated section of the society in Ethiopia.

METHODS

An internet-based survey was conducted from April 22 to May 04, 2020, in Ethiopia. A questionnaire addressing the perception of health threat-combination of perceived vulnerability (PV) and perceived seriousness (PS), and perceived efficacy-combinations of perceived response efficacy (PRE), perceived self-efficacy (PSE), and perceived collective efficacy (PCE). The data were analyzed using SPSS 21.0. Descriptive statistics were computed after the standardization of the scores. The scores for overall efficacy and threat were split by median value and response classifications were generated through threat by efficacy interactions. For statistical significance, 95% CI and p-value < 0.05 were used.

RESULTS

A total of 929 respondents submitted their responses. Eight hundred and twenty-eight (89.1%) of the respondents were male and 753 (81.1%) were Christian. The perceived threat to COVID-19 was generally low (median = 58.3). The median score for overall efficacy, PRE, and PSE were 79.8, 87.5, and 80.0, respectively. However, the median value (66.7) for PCE was relatively low. Perceived threat significantly varied by age, education, occupation, and place of residence (p < 0.05). Perceived efficacy significantly differed by gender, residence, and use of some sources of information (p < 0.05). In terms of response to COVID-19, 290 (31.2%), 239 (25.7%), 175 (18.8%) and 225 (24.2%) of the respondents were in the responsive, pro-active, avoidant, and indifferent attitudinal categories, respectively. The avoidant and indifferent groups constituted a fear control response (mal-adaptive motivation towards COVID-19 protective behavior) whereas responsive and pro-active categories formed a danger control response (self-protective motivation). These responses varied significantly by residence, region, religion, and sources of information (p < 0.05).

CONCLUSIONS

Understanding people's perceived health threat and efficacy is a critical step toward creating risk communication campaigns. Hence, this study provided an insight that has the potential to inform the COVID-19 risk communication campaigns targeting the educated section of the society, by ensuring a balanced combination of threat appeals and efficacy messages for improved self-protective responses.

Predictors of Health-Care Workers' Unwillingness to Continue Working During the Peak of COVID-19 in Western Ethiopia: An Extended Parallel-Process Model Study

Purpose

Willingness to work in disasters is context-specific and corresponds to the nature, magnitude, and threats posed by a particular public health emergency. None us is certain that our health professionals will continue to provide service should the COVID-19 pandemic crisis climb to its worst level. It was with this uncertainty in mind that this study was done to assess predictors of the unwillingness of health-care workers (HCWs) to continue providing their professional services during the climax of the COVID-19 crisis.

Methods

This was a facility-based descriptive cross-sectional study undertaken among 633 HCWsin western Ethiopia.

Results

Overall, 205 (32.4%) providers said that they would be unwilling to continue work if COVID-19 peaked. Of these, 176 (27.9%) respondents reported that they would stop going in to work before they were at greatest risk. Statistical analysis performed to predict HCWs unwillingness’ to continue work at peak COVID-19 showed male sex (AOR 11.4, 95% CI 8.32–12.6), younger age (AOR 25.3, 95% CI 4.61–40.67), lack of experience in handling similar pandemics (AOR 5.15, 95% CI 1.1–255), and low perceived level of hospital preparedness (AOR 2.05, 95% CI 0.80–5.21) were predictors of unwillingness. In accordance with the extended parallel-process model, higher threat perception (P≤0.001) and low efficacy perception (P≤0.040) were associated with unwillingness of the HCWs to continue working.

Conclusion

The proportion of HCWs unwilling to continue their job during COVID-19 is sufficient to affect efforts tof fight the pandemic. As the question of whether our HCWs must risk themselves to treat COVID-19 patients does not have a uniform answer, working on predictors of potential unwillingness is of paramount importance.

Factors Influencing Health Care Workers' Willingness to Respond to Duty during Infectious Disease Outbreaks and Bioterrorist Events: An Integrative Review

BACKGROUND

Infectious disease emergencies are increasingly becoming part of the health care delivery landscape, having implications to not only individuals and the public, but also on those expected to respond to these emergencies. Health care workers (HCWs) are perhaps the most important asset in an infectious disease emergency, yet these individuals have their own barriers and facilitators to them being willing or able to respond.

AIM

The purpose of this review was to identify factors affecting HCW willingness to respond (WTR) to duty during infectious disease outbreaks and/or bioterrorist events.

METHODS

An integrative literature review methodology was utilized to conduct a structured search of the literature including CINAHL, Medline, Embase, and PubMed databases using key terms and phrases. PRISMA guidelines were used to report the search outcomes and all eligible literature was screened with those included in the final review collated and appraised using a quality assessment tool.

RESULTS

A total of 149 papers were identified from the database search. Forty papers were relevant following screening, which highlighted facilitators of WTR to include: availability of personal protective equipment (PPE)/vaccine, level of training, professional ethics, family and personal safety, and worker support systems. A number of barriers were reported to prevent WTR for HCWs, such as: concern and perceived risk, interpersonal factors, job-level factors, and outbreak characteristics.

CONCLUSIONS

By comprehensively identifying the facilitators and barriers to HCWs' WTR during infectious disease outbreaks and/or bioterrorist events, strategies can be identified and implemented to improve WTR and thus improve HCW and public safety.

Understanding the Impact of COVID-19 on Physician Moms

Objective:

This study evaluates the personal and professional experiences of physician mothers during the coronavirus disease 2019 (COVID-19) pandemic and the impact of the pandemic on the lives of physician mothers.

Methods:

Using social media to reach a broad range of physicians, a convenience sample of physician mothers completed an on-line survey posted between April 27 and May 11. Members were encouraged to repost on social media and share with personal contacts resulting in a passive snowball sampling effect.

Results:

A total of 2709 physician mothers from 48 states, Puerto Rico, and 19 countries representing more than 25 medical specialties completed the survey. Most were between 30 and 39 y of age, 67% self-identified as white, 17% as Asian, 4% as African American. Most had been working for 11-16 y. A total of 91% had a spouse/partner of the opposite sex. Over half were practicing in an area they identified as high COVID-19 density, while 50% had personally cared for a person with COVID-19. Physician mothers were most concerned about exposing their children to COVID-19 and about the morale and safety of their staff.

Conclusions:

This is one of the first studies to explore the personal and professional challenges facing physician mothers during a pandemic. Physician mothers were most concerned about exposing their families to COVID-19. Mothers continued to work and at times increased their work, despite having domestic, childcare, and schooling responsibilities.

COVID-19 Prevention Behaviors among Health Staff: Data from a Large Survey in the West of Iran

Background: Hospital staffs are at high risk of Novel Coronavirus (2019-nCoV preventive behaviors play a peculiar role in the reduction of the incidence and mortality of this infection. Therefore, the present study aimed to assess the prevention behaviors of COVID-19 among health staff based on the Extended Parallel Model (EPPM) in western Iran.

Study design: It was a cross-sectional study.

Methods: The present study was performed in the west of Iran in April 2020. In total, 1,664 cases were enrolled in this study via multi-stage sampling. The data were collected using a questionnaire, including the demographic characteristics of participants and EPPM constructs. All analyses were conducted in Stata software (version 14) at a 5% significant level.

Results: As evidenced by the obtained results, 1,523 (91.53%), 1,226 (73.68%), 1,526 (91.71%), 893 (53.67%), and 862 (51.86%) of health staff wear gloves, use masks, avoid contact with others, maintain a good distance from other people, and wash their hands frequently with water and soap, respectively. In terms of using gloves and avoiding contacts with others, participants with high perceived threat had higher odds of observing health behaviors (OR= 3.14, 95% CI: 2.08, 4.73; P<0.001) and (OR= 3.1, 95% CI: 2.04, 4.69; P<0.001), respectively. In all categories of EPPM, the participants with high efficacy had higher odds of exhibiting health behaviors, compared to those with low efficacy (P<0.001).

Conclusion: The results of the present study demonstrated that health workers are expected to be at the highest level of threat and efficiency. Moreover, the findings emphasized the effectiveness of the recommended strategies in the prevention of COVID-19 disease.

Nurses' Self-Efficacy, Confidence and Interaction With Patients With COVID-19: A Cross-Sectional Study

OBJECTIVE

The aim was to evaluate nurses' self-efficacy, confidence, and nurse-patient interaction during caring of patients with coronavirus disease 2019 (COVID-19).

METHODS

A cross-sectional design with online survey was used with a Self-efficacy scale, Self-confidence scale, and Caring nurse-patient interaction scale: 23-item Version-Nurse (CNPI-23 N).

RESULTS

A sample of 120 nurses participated in the current study. The results showed that the participants had a moderate level of self-efficacy, self-confidence and interaction (M = 28.84 (SD = 7.7), M = 47.41 (SD = 9.0), and M = 93.59 (SD = 16.3), respectively). Positive relationships were found between nurse' self-efficacy, self-confidence, and nurse-patient interaction (r = 0.81; P < 0.0001 and 0.79; P < 0.0001, respectively). Significant differences were found in self-efficacy according to years of experience, academic qualifications and position (F = 2.10; P = 0.003; F = 3.60; P = 0.002, and F = 2.60; P =0.007, respectively). Furthermore, the results indicated that there was a significant difference in self-confidence and nurse-patient interaction also.

CONCLUSION

Nurse educators and administrators should develop and implement further strategies, such as continuing education and training, compensatory payment, organizational support, and availability of protective measures to increase their self-efficacy, self-confidence, and interaction with COVID-19 patients.

Impact of Information Exposure on Perceived Risk, Efficacy, and Preventative Behaviors at the Beginning of the COVID-19 Pandemic in the United States

This online survey took place on March 7, 2020 at the beginning of the COVID-19 outbreak in the United States. Participants (n = 698) completed an online survey in which they were asked to reflect on their mediated and interpersonal information consumption, in addition to reporting on risk perceptions, general efficacy perceptions, and preventative behaviors specific to COVID-19 in the past seven days. Participant age and chronic condition status were controlled for in all analyses. Time spent consuming news, social media, and health website information was not related to risk perceptions. Time spent on health websites predicted time spent having interpersonal conversations about COVID-19, as well as general efficacy levels. Following the Extended Parallel Process Model, perceived severity, perceived susceptibility, and general perceived efficacy predicted preventative behaviors. The vast majority of participants did report taking preventative action against COVID-19, most commonly in the form of hand washing, with many enacting stronger preventative behaviors that had yet to be recommended for the general population. Overall, mediated and interpersonal information exposure had minimal effects on perceived risk and perceived general efficacy, which in turn predicted 27.5% of the variance in preventative behavior. Efficacy was the most powerful among these predictors, and health websites, specifically governmental websites, appeared to be underutilized resources with the potential to promote efficacy during outbreaks. Further research is needed to understand causation in these relationships and to assist in successful message transmission.

Psychosocial support for providers working high-risk exposure settings during a pandemic: A critical discussion

Psychological first aid is a form of support designed to lessen disaster‐related distress. In a pandemic, providers may need such support but with the high risk of exposure, such a program is offered only virtually. The research is scant for traditional post‐disaster support and non‐existent for virtual; therefore, by using related research this discussion considers the likelihood of providers accessing and benefiting from this program. The virtual platform is heralded as the responsible way to provide support in a pandemic but this standard may be ineffective and is inherently inequitable. As a global event, pandemics require containment strategies applicable on an international level; therefore, psychosocial support should also be developed with an international audience in mind. Online psychosocial support falls short of being such a strategy as it incorrectly assumes global internet access. Many low‐income areas such as Sub‐Saharan Africa will need support strategies which compliment local frontline staff and fit with community‐driven initiatives, whereas wealthier countries may use a combination of onsite and online support. Provider psychosocial support needs in a pandemic, if articulated, are globally similar but how this support is offered requires contextually sensitive considerations not yet found in the literature.

The lasting footprint of COVID-19 on surgical education: A resident and attending perspective on the global pandemic

Background

The COVID-19 pandemic has impacted surgical training nationwide. Our former curricula will likely not return, and training will need to adapt, so we are able to graduate residents of the same caliber as prior to the pandemic.

Methods

A survey evaluating perceptions of changes made in surgical training was conducted on surgery residents and attendings.

Results

Disaster medicine training has become more relevant and 85% residents and 75% attendings agreed it should be incorporated into the curriculum. Safety of family was the most significant concern of residents. Virtual curriculum was perceived to be acceptable by 82% residents and only 22% attendings (p < 0.01). Residents (37%) were less concerned than attendings (61%) of falling behind on their overall training (p = 0.04). Both groups agreed operative skills would be adversely affected (56%vs72%; p = 0.37).

Conclusions

To maintain an effective surgical curriculum, programs will need to implement new educational components to better prepare residents to become surgeons of the future.

Applying the Ready, Willing, and Able Framework to Assess Agency Public Health Emergency Preparedness: The CDC Perspective

Public health emergencies in the United States have been complex, frequent, and increasingly costly in the past decade, at times overwhelming government agencies that are primarily resourced for routine, nonemergency health functions. Emergencies are not always predictable, and adequate resources are not always available to prepare staff in advance for emergency response roles and to mobilize them quickly when a new threat emerges. Additionally, real-world data that connect preparedness levels to response outcomes may be difficult to obtain, further limiting continuous quality improvement efforts by public health officials. In this article, we apply the Ready, Willing, and Able (RWA) framework to identify areas for improvement related to organizational and staff readiness, willingness, and ability to respond during a public health emergency. We share emergency response deployment, training, and personnel data collected as part of emergency response activations (2008 to 2018) at the Centers for Disease Control and Prevention to illustrate how the framework may be applied at government agencies to improve response processes and effectiveness. Additionally, we propose potential metrics aligned with the framework constructs that may help emergency managers consistently assess agency preparedness and, over time, be incorporated into broader standardized measurement methods. We conclude that the RWA framework is a practical tool that can complement other preparedness approaches currently in use at government public health agencies.

Personality and perceived stress during COVID-19 pandemic: Testing the mediating role of perceived threat and efficacy

Prolonged stress is associated with poor physical and mental health outcomes. Understanding the mediators between personality and stress is critical for developing effective stress management interventions during a pandemic. Our study explored whether perceptions of threat from COVID-19 and efficacy to follow government recommendations for preventing COVID-19 would mediate the relationships between personality traits (e.g., neuroticism, conscientiousness-goal-striving, extroversion-activity and sociability) and perceived stress. In an online survey of a representative sample of Canadian adults (n = 1055), we found that higher neuroticism and extroversion were associated with higher levels of stress during the pandemic and a greater increase in stress levels compared to levels before the pandemic. Perceived threat and efficacy significantly mediated the relationship between neuroticism and stress, which suggested that individuals with higher neuroticism experienced higher levels of stress due to higher levels of perceived threat and lower levels of efficacy. Perceived threat did not mediate the relationship between extroverts and stress, which suggested that the source of stress may stem from elsewhere (e.g., inability to socialize). Our findings highlighted that personality traits could be an important factor in identifying stress-prone individuals during a pandemic and that stress management interventions need to be personality specific.

Fear control and danger control amid COVID-19 dental crisis: Application of the Extended Parallel Process Model

OBJECTIVES

There is high risk of contamination with COVID-19 virus during routine dental procedures and infection control is crucial. The aim of this study was to determine the factors associated with Covid-19 preventive behaviors among oral health care providers using an extended parallel process model (EPPM).

METHODS

In a cross-sectional study, short text message invite surveys were sent to 870 oral health care providers in west part of Iran. Data were collected through validated self-report EPPM questionnaires. Descriptive statistics, Chi-square and Fishers exact tests were used for data analysis.

RESULTS

In total, 300 completed questionnaires were received and the mean age of respondents was 29.89 ± 11.17 years (range: 20-75 years). Among the study population, 284 (94.67%) perceived the threat of infection highly. Washing hands frequently with water and soap and use of hand sanitizer was reported by 93.33%, of participants. Age (P = 0.010), sex (P = 0.002) and occupation field (P = 0.010) were significantly associated with danger control responses. Data identified that those oral health care providers that were on the danger control response adopted preventive behaviors more strictly than those on fear control response.

CONCLUSION

The results of this study showed how degrees of perceived threat and perceived efficacy influenced oral health providers' willingness to perform recommended health behaviors. These findings can assist public health agencies in developing educational programs specifically designed for promoting preventive behaviors among oral health providers in pandemic situations.

Emergency Medical Services Personnel's Pandemic Influenza Training Received and Willingness to Work during a Future Pandemic

Objective: Identify determinants of emergency medical service (EMS) personnel's willingness to work during an influenza pandemic. Background: Little is known about the willingness of EMS personnel to work during a future influenza pandemic or the extent to which they are receiving pandemic training. Methods: EMS personnel were surveyed in July 2018 - Feb 2019 using a cross-sectional approach; the survey was available both electronically and on paper. Participants were provided a pandemic scenario and asked about their willingness to respond if requested or required; additional questions assessed their attitudes and beliefs and training received. Chi-square tests assessed differences in attitude/belief questions by willingness to work. Logistic regressions were used to identify significant predictors of response willingness when requested or required, controlling for gender and race. Results: 433 individuals completed the survey (response rate = 82.9%). A quarter (26.8%, n = 116) received no pandemic training; 14.3% (n = 62) participated in a pandemic exercise. Significantly more EMS personnel were willing to work when required versus when only requested (88.2% vs 76.9%, X² = 164.1, p < .001). Predictors of willingness to work when requested included believing it is their responsibility to work, believing their coworkers were likely to work, receiving prophylaxis for themselves and their family members, and feeling safe working during a pandemic. Discussion: Many emergency medical services personnel report lacking training or disaster exercises related to influenza pandemics, and a fair percentage are unwilling to work during a future event. This may limit healthcare surge capacity and could contribute to increased morbidity and mortality. Findings from this study indicate that prehospital staff's attitudes and beliefs about pandemics influence their willingness to work. Pre-event training and planning should address these concerns.

Are we prepared? The development of performance indicators for public health emergency preparedness using a modified Delphi approach

BACKGROUND

Disasters and emergencies from infectious diseases, extreme weather and anthropogenic events are increasingly common. While risks vary for different communities, disaster and emergency preparedness is recognized as essential for all nation-states. Evidence to inform measurement of preparedness is lacking. The objective of this study was to identify and define a set of public health emergency preparedness (PHEP) indicators to advance performance measurement for local/regional public health agencies.

METHODS

A three-round modified Delphi technique was employed to develop indicators for PHEP. The study was conducted in Canada with a national panel of 33 experts and completed in 2018. A list of indicators was derived from the literature. Indicators were rated by importance and actionability until achieving consensus.

RESULTS

The scoping review resulted in 62 indicators being included for rating by the panel. Panel feedback provided refinements to indicators and suggestions for new indicators. In total, 76 indicators were proposed for rating across all three rounds; of these, 67 were considered to be important and actionable PHEP indicators.

CONCLUSIONS

This study developed an indicator set of 67 PHEP indicators, aligned with a PHEP framework for resilience. The 67 indicators represent important and actionable dimensions of PHEP practice in Canada that can be used by local/regional public health agencies and validated in other jurisdictions to assess readiness and measure improvement in their critical role of protecting community health.

Local Preparedness for Infectious Disease Outbreaks: A Qualitative Exploration of Willingness and Ability to Respond

As ecologic, social, and economic conditions continue to facilitate the emergence and transmission of infectious diseases, local health department workers' willingness to respond will remain vital to the United States' ability to recognize and respond to new and emerging disease threats. As demonstrated by heavy occupational morbidity and mortality associated with the 2014 Ebola outbreak, infectious disease response can pose serious risks to the health workforce and presents many ethical and logistical challenges. To explore willingness to respond to an infectious disease outbreak among local health departments-the hub of the public health emergency preparedness system-we conducted focus groups with 46 local health department staff attending 2 national conferences. We examined perspectives from our participants on how local health department employees learn about and articulate their professional commitment to the department, the ways in which local health department leaders support local health department employees in responding to an outbreak, and how local health department staff articulate their responsibilities to their families. We conclude with a proposal for how a web of ethical commitments likely influences willingness to respond. These commitments and their relationship to willingness to respond should be explored further.

A Conflict of Values: Nurses' Willingness to Work Under Threatening Conditions

PURPOSE

The purpose of this study was to determine the willingness of Israeli registered nurses to work under threatening conditions, their perceived level of threat, and perceptions of peer willingness to report to work.

DESIGN

This descriptive study was based on a convenience sample of registered nurses working in four hospitals throughout Israel from internal medicine, surgical, emergency, and intensive care units.

METHODS

A questionnaire designed by the investigators was administered to registered nurses while on duty. The questionnaire consisted of three sections: personal characteristics, perceived level of personal threat from five situations (caring for a patient with a dangerous infection, terror attack, war, radiation or chemical disaster, or natural disaster), and perceived personal and peer willingness to work under these threats.

FINDINGS

A convenience sample of 249 registered nurses from four hospitals responded. The highest level of perceived threat was a natural disaster (earthquake; M = 2.15, SD = 0.9). Terror (M = 0.83, SD = 0.6) and war (M = 1.01, SD = 0.6) received the lowest mean perceived threat scores. Most respondents were not willing to work during a natural disaster but were willing to care for patients with dangerous infections and during times of war. Weak positive statistically significant correlations were found between the level of perceived threat and willingness to work for all of the threats, except for terror (Spearman rank correlation = .16-.35).

CONCLUSIONS

Local culture, perceptions of the level of threat, and perceived peer responsiveness are associated with registered nurses' willingness to work under threat.

CLINICAL RELEVANCE

When faced with a threat to personal safety or security, many registered nurses might not be willing to work as usual. What is perceived as threatening is influenced by the local culture and environment. Therefore, managers should be aware of potential cultural and peer influences on this possible conflict of values.

Perceived Facilitators and Barriers to Local Health Department Workers' Participation in Infectious Disease Emergency Responses

CONTEXT

Local health departments play a key role in emergency preparedness and respond to a wide range of threats including infectious diseases such as seasonal influenza, tuberculosis, H1N1, Ebola virus disease, and Zika virus disease. To successfully respond to an infectious disease outbreak, local health departments depend upon the participation of their workforce; yet, studies indicate that sizable numbers of workers would not participate in such a response. The reasons why local health department workers participate, or fail to participate, in infectious disease responses are not well understood.

OBJECTIVE

To understand why local health department workers are willing, or not willing, to report to work during an infectious disease response.

DESIGN

From April 2015 to January 2016, we conducted 28 semistructured interviews with local health department directors, preparedness staff, and nonpreparedness staff.

SETTING

Interviews were conducted with individuals throughout the United States.

PARTICIPANTS

We interviewed 28 individuals across 3 groups: local health department directors (n = 8), preparedness staff (n = 10), and nonpreparedness staff (n = 10).

MAIN OUTCOME MEASURES

Individuals' descriptions of why local health department workers are willing, or not willing, to report to work during an infectious disease response.

RESULTS

Factors that facilitate willingness to respond to an infectious disease emergency included availability of vaccines and personal protective equipment; flexible work schedule and childcare arrangements; information sharing via local health department trainings; and perceived commitments to one's job and community. Factors that hinder willingness to respond to an infectious disease emergency included potential disease exposure for oneself and one's family; logistical considerations for care of children, the elderly, and pets; and perceptions about one's role during an infectious disease response.

CONCLUSION

Our findings highlight opportunities for local health departments to revisit their internal policies and engage in strategies likely to promote willingness to respond among their staff. As LHDs face the persistent threat of infectious diseases, they must account for response willingness when planning for and fielding emergency responses. Our findings highlight opportunities for local health departments to revisit their internal policies and engage in strategies likely to promote response willingness to infectious disease emergencies among their staff.

Corrélation entre la qualité de la réponse aux appels d’un Samu-Centre 15 et les effectifs d’assistants de régulation médicale — Étude QRAARM

Introduction : Le taux d’occupation des lignes téléphoniques d’un Samu-Centre 15 conditionne la fluidité de la gestion des appels et donc sa capacité de répondre à l’urgence. La disponibilité des assistants de régulation médicale (ARM) et des médecins régulateurs est déterminante. Nous nous sommes interrogés sur l’impact du nombre d’ARM sur la prise en charge des appels d’un Samu-Centre 15.

Méthodes : Le taux d’appels raccrochés (par l’appelant) après 15 secondes a été retenu comme critère de jugement principal. Il a été analysé en fonction de l’effectif « réel » d’ARM. L’effectif théorique d’ARM a été pris comme référence. Deux analyses ont été réalisées, la première portant sur 672 périodes d’un quart d’heure de la semaine 51 de l’année 2016 (en période d’épidémie de grippe) et la seconde sur 3 624 périodes d’une heure sur les cinq premiers mois de l’année 2017.

Résultats : Sur la première période, le nombre médian d’appels raccrochés après 15 secondes était de 1 (0–3) par quart d’heure. Il variait de 0 (0–1) à 3 (1–5) selon l’effectif d’ARM auquel il était parfaitement inversement corrélé (p < 0,001). Sur la seconde période, le nombre médian d’appels raccrochés était de 4 (1–8) par heure. Il variait de 2 (1–6) à 10 (6–16) selon l’effectif d’ARM auquel il était parfaitement inversement corrélé (p < 0,001).

Conclusion : Le taux d’appels raccrochés après 15 secondes était parfaitement corrélé à l’effectif (plus précisément au sous-effectif) d’ARM. Sur une année, le nombre estimé d’appels perdus ainsi était proche de 50 000 ! Prendre en considération l’effectif des ARM est une nécessité absolue.

Brief, Web-based Education Improves Lay Rescuer Application of a Tourniquet to Control Life-threatening Bleeding

OBJECTIVE

The objective was to determine whether brief, Web-based instruction several weeks prior to tourniquet application improves layperson success compared to utilizing just-in-time (JiT) instructions alone.

BACKGROUND

Stop the Bleed is a campaign to educate laypeople to stop life-threatening hemorrhage. It is based on U.S. military experience with lifesaving tourniquet use. While previous research shows simple JiT instructions boost laypeople's success with tourniquet application, the optimal approach to educate the public is not yet known.

METHODS

This is a prospective, nonblinded, randomized study. Layperson participants from the Washington, DC, area were randomized into: 1) an experimental group that received preexposure education using a website and 2) a control group that did not receive preexposure education. Both groups received JiT instructions. The primary outcome was the proportion of subjects that successfully applied a tourniquet to a simulated amputation. Secondary outcomes included mean time to application, mean placement position, ability to distinguish bleeding requiring a tourniquet from bleeding requiring direct pressure only, and self-reported comfort and willingness to apply a tourniquet.

RESULTS

Participants in the preexposure group applied tourniquets successfully 75% of the time compared to 50% success for participants with JiT alone (p < 0.05, risk ratio = 1.48, 95% confidence interval = 1.21-1.82). Participants place tourniquets in a timely fashion, are willing to use them, and can recognize wounds requiring tourniquets.

CONCLUSIONS

Brief, Web-based training, combined with JiT education, may help as many as 75% of laypeople properly apply a tourniquet. These findings suggest that this approach may help teach the public to Stop the Bleed.

Who Participates in Building Disaster Resilient Communities: A Cluster-Analytic Approach

CONTEXT

The Los Angeles County Community Disaster Resilience project is a community-based program to improve disaster resilience. We collected baseline measures of resilience-related attitudes and practices among targeted communities prior to the implementation of the intervention.

OBJECTIVES

This study identified community disaster resilience behavior patterns and assessed their associations with sociodemographic and social cognitive characteristics.

DESIGN

Telephone surveys during summer 2013.

SETTING

Sixteen communities in Los Angeles County (2 per service planning area).

PARTICIPANTS

The address-based sample of adults (≥18) was selected to be representative of 2010 census tracts in each of the communitiesMAIN OUTCOME MEASURES:: We examined relationships between sociodemographic characteristics, social cognitive factors, and participation in community disaster resilience activities.

RESULTS

Three clusters of community resilience behavior patterns emerged. Cluster distribution significantly differed across several sociodemographic and social cognitive factors. Participants who were African American, Hispanic, had higher education, income, self-efficacy, trust in the public health department, civic engagement, and social capital were significantly associated with being in the cluster most active in resilience-building activities.

CONCLUSIONS

The results confirm that there are distinct community resilience behavior patterns. These patterns vary according to population characteristics, which supports audience segmentation approaches and developing a range of emergency preparedness programs targeted to the strengths and weaknesses of the different audience segments.

The role of risk perception in willingness to respond to the 2014-2016 West African Ebola outbreak: a qualitative study of international health care workers

Background

The 2014–2016 West Africa Ebola Virus Disease (EVD) outbreak was an unprecedented public health event, and in addition to claiming over 11,000 lives, it resulted in the deaths of more healthcare workers than any outbreak in recent history. While a cadre of willing and able health workers is essential for an effective epidemic response, health workforce capacity in times of crisis may be significantly impacted by how risks are perceived by health staff. This study aimed to explore how risk perceptions influenced healthcare workers’ willingness to respond during this outbreak.

Methods

Through in-depth interviews with 11 front-line international health care workers who chose to respond to the West Africa outbreak, this qualitative study explores how perceptions of risk developed and subsequently mediated the decision to respond to the outbreak. Data was thematically organized using NVivo 10.

Results

We found that numerous individual and social-level factors played a role in modifying risk perception in health workers. Institutional trust emerged as a key risk attenuator, as did past experience, self-efficacy, duty of care, humanitarian ethos, and cognitive heuristics. Feelings of risk were amplified by infections of co-workers, and risk perceptions of family members and the public, which were mainly informed by media reports, also hampered willingness to respond in some cases.

Conclusions

Understanding the risk perceptions of health workers, institutions, and the public, while complex and interdependent, are each crucial to understand for an effective public health response to epidemics, and as such should be taken into consideration in future program planning and research.

Hospital Administration and Nursing Leadership in Disasters: An Exploratory Study Using Concept Mapping

Strong leadership is critical in disaster situations when "patient surge" challenges a hospital's capacity to respond and normally acceptable patterns of care are disrupted. Activation of the emergency operations plan triggers an incident command system structure for leadership decision making. Yet, implementation of the emergency operations plan and incident command system protocols is ultimately subject to nursing and hospital leadership at the service- and unit level. The results of these service-/unit-based leadership decisions have the potential to directly impact staff and patient safety, quality of care, and ultimately, patient outcomes. Despite the critical nature of these events, nurse leaders and administrators receive little education regarding leadership and decision making during disaster events. The purpose of this study is to identify essential competencies of nursing and hospital administrators' leadership during disaster events. An integrative mixed-methods design combining qualitative and quantitative approaches to data collection and analysis was used. Five focus groups were conducted with nurse leaders and hospital administrators at a large urban hospital in the Northeastern United States in a collaborative group process to generate relevant leadership competencies. Concept Systems Incorporated was used to sort, prioritize, and analyze the data (http://conceptsystemsinc.com/). The results suggest that participants' institutional knowledge (of existing resources, communications, processes) and prior disaster experience increase leadership competence.

Anesthesiologists and Disaster Medicine: A Needs Assessment for Education and Training and Reported Willingness to Respond

BACKGROUND

Anesthesiologists provide comprehensive health care across the emergency department, operating room, and intensive care unit. To date, anesthesiologists' perspectives regarding disaster medicine and public health preparedness have not been described.

METHODS

Anesthesiologists' thoughts and attitudes were assessed via a Web-based survey at 3 major academic institutions. Frequencies, percentages, and odds ratios (ORs) were used to assess self-reported perceptions of knowledge and skills, as well as attitudes and beliefs regarding education and training, employee development, professional obligation, safety, psychological readiness, efficacy, personal preparedness, and willingness to respond (WTR). Three representative disaster scenarios (natural disaster [ND], radiological event [RE], and pandemic influenza [PI]) were investigated. Results are reported as percent or OR (95% confidence interval).

RESULTS

Participants included 175 anesthesiology attendings (attendings) and 95 anesthesiology residents (residents) representing a 47% and 51% response rate, respectively. A minority of attendings indicated that their hospital provides adequate pre-event preparation and training (31% [23-38] ND, 14% [9-21] RE, and 40% [31-49] PI). Few residents felt that their residency program provided them with adequate preparation and training (22% [14-33] ND, 16% [8-27] RE, and 17% [9-29] PI). Greater than 85% of attendings (89% [84-94] ND, 88% [81-92] RE, and 87% [80-92] PI) and 70% of residents (81% [71-89] ND, 71% [58-81] RE, and 82% [70-90] PI) believe that their hospital or residency program, respectively, should provide them with preparation and training. Approximately one-half of attendings and residents are confident that they would be safe at work during response to a ND or PI (55% [47-64] and 58% [49-67] of attendings; 59% [48-70] and 48% [35-61] of residents, respectively), whereas approximately one-third responded the same regarding a RE (31% [24-40] of attendings and 28% [18-41] of residents). Fewer than 40% of attendings (34% [26-43]) and residents (38% [27-51]) designated who would take care of their family obligations in the event they were called into work during a disaster. Regardless of severity, 79% (71-85) of attendings and 73% (62-82) of residents indicated WTR to a ND, whereas 81% (73-87) of attendings and 70% (58-81) of residents indicated WTR to PI. Fewer were willing to respond to a RE (63% [55-71] of attendings and 52% [39-64] of residents). In adjusted logistic regression analyses, those anesthesiologists who reported knowing one's role in response to a ND (OR, 15.8 [4.5-55.3]) or feeling psychologically prepared to respond to a ND (OR, 6.9 [2.5-19.0]) were found to be more willing to respond. Similar results were found for RE and PI constructs. Both attendings and residents were willing to respond in whatever capacity needed, not specifically to provide anesthesia.

CONCLUSIONS

Few anesthesiologists reported receiving sufficient education and training in disaster medicine and public health preparedness. Providing education and training and enhancing related employee services may further bolster WTR and help to build a more capable and effective medical workforce for disaster response.

The Role of Fear-Related Behaviors in the 2013-2016 West Africa Ebola Virus Disease Outbreak

The 2013-2016 West Africa Ebola virus disease pandemic was the largest, longest, deadliest, and most geographically expansive outbreak in the 40-year interval since Ebola was first identified. Fear-related behaviors played an important role in shaping the outbreak. Fear-related behaviors are defined as "individual or collective behaviors and actions initiated in response to fear reactions that are triggered by a perceived threat or actual exposure to a potentially traumatizing event. FRBs modify the future risk of harm." This review examines how fear-related behaviors were implicated in (1) accelerating the spread of Ebola, (2) impeding the utilization of life-saving Ebola treatment, (3) curtailing the availability of medical services for treatable conditions, (4) increasing the risks for new-onset psychological distress and psychiatric disorders, and (5) amplifying the downstream cascades of social problems. Fear-related behaviors are identified for each of these outcomes. Particularly notable are behaviors such as treating Ebola patients in home or private clinic settings, the "laying of hands" on Ebola-infected individuals to perform faith-based healing, observing hands-on funeral and burial customs, foregoing available life-saving treatment, and stigmatizing Ebola survivors and health professionals. Future directions include modeling the onset, operation, and perpetuation of fear-related behaviors and devising strategies to redirect behavioral responses to mass threats in a manner that reduces risks and promotes resilience.