In a flu pandemic 1 in 6 health workers will not report for work

Jul 28 2009

With hospitals around Australia struggling to cope with the added burden of swine flu cases researchers say 1 in 6 health workers will not report in for work in a flu pandemic.

The researchers from Ben-Gurion University of the Negev (BGU) in Israel and John Hopkins Bloomberg School of Public Health say willingness to report in an emergency is strongly associated with belief in the importance of one's work.

In a study conducted among 1,835 public health workers in Minnesota, Ohio and West Virginia from November 2006 to December 2007 the researchers say the indication is that approximately 16% of public health care workers will not report for work in a pandemic flu emergency, regardless of the severity.

Dr. Ran Balicer, senior lecturer in the Department of Epidemiology at BGU says the results could help planners identify workforce needs and develop strategies for improving worker response in a pandemic.

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 fulfil their response roles and 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 importance of their job were 18 times more likely to say they "would respond" compared to those in the "low threat/low efficacy" group.

The survey analysis was based on Witte's Extended Parallel Process Model (EPPM), used for understanding adaptive behaviour in the face of unknown risk which examines the relative influences of perceived threat and efficacy on public health workers' response willingness to pandemic influenza.

Dr. Balicer says the willingness of health workers to report to duty during an influenza pandemic is a major concern given the "inevitable" nature of the threat and its associated challenges, including worldwide morbidity, mortality and social disruption.

The researchers say in the context of pandemic influenza planning, the EPPM provides a useful framework for an understanding of baseline levels of - and gaps in - local public health workers' response willingness.

They say within local health departments, "concerned and confident" employees are most likely to be willing to respond and this finding may allow public health agencies to design, implement and evaluate training programs focused on emergency response attitudes in health departments.

Dr. Daniel Barnett, co-author of the study and assistant professor in the Department of Environmental Health Sciences at the Bloomberg School of Public Health, says employee response is a critical component of preparedness planning, yet it is often overlooked and the study is an attempt to understand the underlying factors that determine an employee's willingness to respond in an emergency.

The researchers also offer some recommendations saying any amount of additional assistance will make a difference in response to an influenza pandemic and they say public health workers need to be better educated and better motivated about their designated roles during the emergency scenario so they understand how they can make a difference.

The researchers say downplaying the threat of the scenario to calm the fears of the workers is not an advisable approach as a sense of threat is an important component in the workers' motivation to prepare for the event and to respond to it.

They also say personal safety assurances of workers can and should be provided as part of training and note that 24% of the respondents did not perceive their work environment as safe, and 15% felt they could not safely arrive to work.

According to the researchers despite growing research examining the willingness to respond to large-scale emergencies, there remains a gap in public health preparedness literature on training approaches that explicitly address response willingness as a discrete outcome.

The research was funded by the U.S. Center for Disease Control's (CDC) Centers for Public Health Preparedness program, and by CDC's Preparedness and Emergency Response Research Centers program and is published in the peer-reviewed online journal PLOS ONE.