Abstract
BackgroundLocal public health agencies play a central role in response to an influenza pandemic, and understanding the willingness of their employees to report to work is therefore a critically relevant concern for pandemic influenza planning efforts. Witte's Extended Parallel Process Model (EPPM) has been found useful for understanding adaptive behavior in the face of unknown risk, and thus offers a framework for examining scenario-specific willingness to respond among local public health workers. We thus aim to use the EPPM as a lens for examining the influences of perceived threat and efficacy on local public health workers' response willingness to pandemic influenza.Methodology/Principal FindingsWe administered an online, EPPM-based survey about attitudes/beliefs toward emergency response (Johns Hopkins∼Public Health Infrastructure Response Survey Tool), to local public health employees in three states between November 2006 – December 2007. A total of 1835 responses were collected for an overall response rate of 83%. With some regional variation, overall 16% of the workers in 2006-7 were not willing to “respond to a pandemic flu emergency regardless of its severity”. Local health department employees with a perception of high threat and high efficacy – i.e., those fitting a ‘concerned and confident’ profile in the EPPM analysis – had the highest declared rates of willingness to respond to an influenza pandemic if required by their agency, which was 31.7 times higher than those fitting a ‘low threat/low efficacy’ EPPM profile.Conclusions/SignificanceIn the context of pandemic influenza planning, the EPPM provides a useful framework to inform nuanced understanding of baseline levels of – and gaps in – local public health workers' response willingness. Within local health departments, ‘concerned and confident’ employees are most likely to be willing to respond. This finding may allow public health agencies to design, implement, and evaluate training programs focused on emergency response attitudes in health departments.
Highlights
The anticipated worldwide morbidity, mortality, and social disruption from an influenza pandemic [1] require detailed and tested approaches to staffing and resource allocation in public health systems [2]
Willingness to respond is a critical component of effective public health system readiness and sustainability in emergencies
Our study results suggest that this response willingness is not to be taken for granted in the public health arena
Summary
The anticipated worldwide morbidity, mortality, and social disruption from an influenza pandemic [1] require detailed and tested approaches to staffing and resource allocation in public health systems [2]. The willingness of health responders to report to duty during an influenza pandemic is a highly salient concern given the ‘‘inevitable’’nature of this threat [3] and its associated challenges. Despite the evidence for fundamental distinctions between ability and willingness to respond [7,13], there remains a gap in the public health preparedness literature on training approaches that explicitly address response willingness (attitude) as a discrete outcome. Witte’s Extended Parallel Process Model (EPPM) has been found useful for understanding adaptive behavior in the face of unknown risk, and offers a framework for examining scenario-specific willingness to respond among local public health workers. We aim to use the EPPM as a lens for examining the influences of perceived threat and efficacy on local public health workers’ response willingness to pandemic influenza
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