Abstract
BackgroundHospital-based providers' willingness to report to work during an influenza pandemic is a critical yet under-studied phenomenon. Witte's Extended Parallel Process Model (EPPM) has been shown to be useful for understanding adaptive behavior of public health workers to an unknown risk, and thus offers a framework for examining scenario-specific willingness to respond among hospital staff.MethodsWe administered an anonymous online EPPM-based survey about attitudes/beliefs toward emergency response, to all 18,612 employees of the Johns Hopkins Hospital from January to March 2009. Surveys were completed by 3426 employees (18.4%), approximately one third of whom were health professionals.ResultsDemographic and professional distribution of respondents was similar to all hospital staff. Overall, more than one-in-four (28%) hospital workers indicated they were not willing to respond to an influenza pandemic scenario if asked but not required to do so. Only an additional 10% were willing if required. One-third (32%) of participants reported they would be unwilling to respond in the event of a more severe pandemic influenza scenario. These response rates were consistent across different departments, and were one-third lower among nurses as compared with physicians. Respondents who were hesitant to agree to work additional hours when required were 17 times less likely to respond during a pandemic if asked. Sixty percent of the workers perceived their peers as likely to report to work in such an emergency, and were ten times more likely than others to do so themselves. Hospital employees with a perception of high efficacy had 5.8 times higher declared rates of willingness to respond to an influenza pandemic.ConclusionsSignificant gaps exist in hospital workers' willingness to respond, and the EPPM is a useful framework to assess these gaps. Several attitudinal indicators can help to identify hospital employees unlikely to respond. The findings point to certain hospital-based communication and training strategies to boost employees' response willingness, including promoting pre-event plans for home-based dependents; ensuring adequate supplies of personal protective equipment, vaccines and antiviral drugs for all hospital employees; and establishing a subjective norm of awareness and preparedness.
Highlights
Hospital-based providers’ willingness to report to work during an influenza pandemic is a critical yet under-studied phenomenon
We have recently found that Witte’s Extended Parallel Process Model (EPPM) [10] – a behavioral model based on decades of fear appeal research – can offer a useful lens for understanding how healthcare providers’ perceptions of threat and efficacy may positively or negatively influence their willingness to fulfill response expectations [11]
Consistent with results in public health workers [11], we have found that individuals who had a perception of high threat and high efficacy - i.e., those who fit a ‘concerned and confident’ profile in the EPPM framework - had a high rate of declared selfreported willingness to respond to pandemic flu, which was about nine times [OR(95%CI): 9.25 (5.94, 14.40)] higher than those fitting a ‘low threat/low efficacy’ EPPM profile
Summary
Hospital-based providers’ willingness to report to work during an influenza pandemic is a critical yet under-studied phenomenon. With regard to hospital workers’ views toward pandemic influenza response, for example, a 2006 survey conducted among employees at a Level II trauma center revealed that 42% of respondents answered “maybe” and 8% answered “no” to a question on willingness to respond to this threat [8] These ambivalent or negative responses suggest that hospital workforce absenteeism may be due, in substantial measure, to attitudinal and related perceptual factors apart from direct illness. Such findings point toward the need for enhanced understanding of response willingness among other responder cohorts whose failure to report to work (for reasons other than illness), could further compromise the surge capacity of an alreadystrained healthcare system [9]
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