Abstract
To estimate the proportion of healthcare workers (HCWs) willing to work during an influenza pandemic and identify associated risk factors, we undertook a systematic review and meta-analysis compliant with PRISMA guidance. Databases and grey literature were searched to April 2013, and records were screened against protocol eligibility criteria. Data extraction and risk of bias assessments were undertaken using a piloted form. Random-effects meta-analyses estimated (i) pooled proportion of HCWs willing to work and (ii) pooled odds ratios of risk factors associated with willingness to work. Heterogeneity was quantified using the I2 statistic, and publication bias was assessed using funnel plots and Egger's test. Data were synthesized narratively where meta-analyses were not possible. Forty-three studies met our inclusion criteria. Meta-analysis of the proportion of HCWs willing to work was abandoned due to excessive heterogeneity (I2 = 99·2%). Narrative synthesis showed study estimates ranged from 23·1% to 95·8% willingness to work, depending on context. Meta-analyses of specific factors showed that male HCWs, physicians and nurses, full-time employment, perceived personal safety, awareness of pandemic risk and clinical knowledge of influenza pandemics, role-specific knowledge, pandemic response training, and confidence in personal skills were statistically significantly associated with increased willingness. Childcare obligations were significantly associated with decreased willingness. HCWs' willingness to work during an influenza pandemic was moderately high, albeit highly variable. Numerous risk factors showed a statistically significant association with willingness to work despite significant heterogeneity between studies. None of the included studies were based on appropriate theoretical constructs of population behaviour.
Highlights
Records excluded (n = 140): Ineligible outcome: n = 89 Study not related to pandemic influenza: n = 23 Participants not Healthcare workers (HCWs): n = 13 Abstract only: n = 9 Duplicate study: n = 5 Sub-analysis of the same study: n = 1
As important as our specific results themselves, is the fact that we identified a multiplicity of approaches to studying the issue of HCW willingness to work during a pandemic; mainly small, ad hoc enquiries, not based on any consistent scenarios or theoretical approaches
Numerous risk factors are associated with willingness of HCWs to work during an influenza pandemic, revealing potential points of intervention to increase willingness to work
Summary
Variable in severity,[1,2] one consistent feature of pandemic influenza is a surge in demand for health care.[3,4] Hospitalization due to influenza A(H1N1)pdm[09] in the USA was estimated at approximately 274 000 cases between April 2009 and April 20105 contrasting with 95 000 annual influenza-associated primary hospitalizations from 1979 to 2001.6 In 2009–10, the availability of intensive care unit beds came under pressure in most national health systems.[1,7] Healthcare workers (HCWs) play key roles during an influenza pandemic, but a serious shortage of personnel may occur at peak times or in severe pandemics because of absenteeism due to illness, caring for family members who are ill, or refusal to work.[8] Effective preparation for the pandemic requires estimates of HCWs’ willingness to work and an understanding of influencing factors. Three published reviews reported that similar factors would be associated with willingness to work during an influenza pandemic,[12,13,14] but the data were not summarized quantitatively
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
