Pandemic Survey Finds 1 in 6 Public Health Workers Unlikely to Respond

Approximately 1 in 6 public health workers said they would not report to work during a pandemic flu emergency regardless of its severity, according to a survey led by researchers at the Johns Hopkins Bloomberg School of Public Health.

The findings are a significant improvement over a 2005 study conducted by the same research team, in which more than 40 percent of public health employees said they were unlikely to report to work during a pandemic emergency. The new study suggests ways for improving the response of the public health workforce. The results are published in the July 24 edition of the journal PLoS ONE.

"Employee response is a critical component of preparedness planning, yet it is often overlooked. Our study is an attempt to understand the underlying factors that determine an employee's willingness to respond in an emergency," said Daniel Barnett, MD, MPH, lead author of the study and assistant professor in the Department of Environmental Health Sciences at the Bloomberg School of Public Health. "Overall, 16 percent of the workers surveyed said they would not report regardless of the severity of the outbreak."

The online survey was conducted among 1,835 public health workers in Minnesota, Ohio and West Virginia from November 2006 to December 2007. The survey analysis was based on the Extended Parallel Process Model (EPPM), which postulates that willingness to follow instructions in an emergency is based on an individual's perception of a threat's validity and belief that the actions taken can be feasibly accomplished and will have a positive impact on the threat.

According to the survey, public health workers who were both "concerned" about the threat posed by a pandemic, and who were "confident" that they could fulfill their response roles and that their roles would have a meaningful impact on the situation, were 31 times more likely to respond to work in an emergency than those who perceived the threat low, and had low levels of confidence. Workers whose perception of the threat was "low" but who strongly believed in the efficacy of their job were 18 times more likely to say they would respond compared to those in the "low threat/low efficacy" group.

"We found belief in the importance of one's work was strongly associated with a willingness to report to work in an emergency. Our results could help preparedness planners to identify workforce needs and develop strategies for improving worker response," co-author said Ran Balicer, MD, Ph.D., MPH, senior lecturer in the Epidemiology Department at the Ben-Gurion University of the Negev in Israel, and Joint Editor of the Israeli Ministry of Health Pandemic Preparedness Plan.

"This study is important in that it both documents the problem and points the way towards specific interventions--those that increase both concern and confidence--to increase willingness to respond," said Jonathan Links, Ph.D., professor in the Bloomberg School's Department of Environmental Health Sciences and director of the Public Health Preparedness Programs.

Additional authors of "Assessment of Local Public Health Workers' Willingness to Respond to Pandemic Influenza through Application of the Extended Parallel Process Model" are Carol B. Thompson. J. Douglas Storey, Saad B. Omer, Natalie L. Semon, Steve Bayer, V. Lorraine Cheek, Kerry W. Gateley, Kathryn M. Lanza, Jane A. Norbin, Catherine C. Slemp and Jonathan Links.

The research was funded by CDC's Centers for Public Health Preparedness program, and by CDC's Preparedness and Emergency Response Research Centers program.

In a June 24 press briefing, Dr. Anne Schuchat, director of CDC's National Center for Immunization and Respiratory Diseases, recommend that health care workers get the 2009-10 seasonal flu vaccine and also the H1N1 vaccine when it's ready."I want to make a special reminder to health care workers," Schuchat said. "This year in particular, we want to keep health care workers healthy" so they can help people who do become sick, she said. It's "very likely" health care workers will be included among the groups for which the government will recommend the H1N1 flu vaccine when it is available this fall.

CDC recommends about 83 percent of the U.S. population should get the 2009-10 seasonal flu vaccine, but only 40 percent were vaccinated last year.

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