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Characterizing public health emergency perceptions and influential modifiers of willingness to respond among pediatric healthcare staff
Abstract
The aim of this study was to characterize the public health emergency perceptions and willingness to respond (WTR) of hospital-based pediatric staff and to use these findings to propose a methodology for developing an institution-specific training package to improve response willingness.
A prospective anonymous web-based survey was conducted at the Johns Hopkins Hospital, including the 180-bed Johns Hopkins Children's Center, between January and March 2009. In this survey, participants' attitudes/beliefs regarding emergency response to a pandemic influenza and a radiological dispersal device (RDD or "dirty bomb") event were assessed.
Of the 1,620 eligible pediatric staff 246 replies (15.2 percent response rate) were received, compared with an overall staff response rate of 18.4 percent. Characteristics of respondent demographics and professions were similar to those of overall hospital staff. Self-reported WTR was greater for a pandemic influenza than for an RDD event if required (84.6 percent vs 75.1 percent), and if asked, but not required (74.4 percent vs 64.5 percent). The majority of pediatric staff were not confident in their safety at work (pandemic influenza: 51.8 percent and RDD: 76.6 percent), were far less likely to respond if personal protective equipment was unavailable (pandemic influenza: 33.5 percent and RDD: 21.6percent), and wanted furtherpre-event preparation and training (pandemic influenza: 89.6 percent and RDD: 82.6 percent). The following six distinct perceived attitudes / beliefs were identified as having institution-specific high impact on response willingness: colleague response, skill mastery, safety getting to work, safety at work, ability to perform duties, and individual response efficacy.
Children represent a uniquely vulnerable population in public health emergencies, and pediatric hospital staff accordingly represent a vital subset of responders distinguished by specialized education, training, clinical skills, and disaster competencies. Even though the majority of pediatric hospital staff report WTR, nearly 15 percent for a pandemic influenza emergency and 25 percent for an RDD event would not respond if required. Other institutions can apply the methodology used here to identify particularly influential response willingness modifiers for pediatric care providers. These insights can inform customized preparedness training for pediatric healthcare workers, through identification of high-impact attitudes/beliefs, and training initiatives focused on addressing these modifiers.
... Previous researchers have shown that factors affecting staff willingness to work during disasters are multidimensional, complex, and vary across occupations (1)(2)(3). In particular, previous studies have identified the following factors as having an impact on workers' ability and willingness to work during disasters: type of disaster, with workers being less willing to work during a biological or radiological event; occupation; perceived importance of job role during disaster response; concern for family; and perceived confidence that the employing hospital will provide worker protection during an event (1,2,(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). ...
... Instruments used in past willingness to work during disaster surveys were used to develop this study's questionnaire (1,2,(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). The instrument measured staff willingness, ability, and barriers to working during both pandemic influenza and earthquake scenarios. ...
... The following was assessed for the pandemic and earthquake scenarios: 1) willingness to work; 2) ability to work; 3) perceived responsibility to work; 4) perceived job importance; 5) perceived barriers to working; and 6) intent to work for scheduled and unscheduled shifts. Ten perceived barriers were prospectively identified and assessed: 1) transportation; 2) childcare; 3) elder care; 4) pet care; 5) concern for family; 6) fear of personal harm; 7) fear of lawsuit; 8) different role in disaster response; 9) fear of losing job; and 10) second job responsibility (10). In addition, a follow-up question regarding willingness to work during a pandemic was asked after respondents were told that a pandemic vaccine was now available. ...
Background:
Research indicates that licensed health care workers are less willing to work during a pandemic and that the willingness of nonlicensed staff to work has had limited assessment.
Objective:
We sought to assess and compare the willingness to work in all hospital workers during pandemics and earthquakes.
Methods:
An online survey was distributed to Missouri hospital employees. Participants were presented with 2 disaster scenarios (pandemic influenza and earthquake); willingness, ability, and barriers to work were measured. T tests compared willingness to work during a pandemic vs. an earthquake. Multivariate linear regression analyses were conducted to describe factors associated with a higher willingness to work.
Results:
One thousand eight hundred twenty-two employees participated (15% response rate). More willingness to work was reported for an earthquake than a pandemic (93.3% vs. 84.8%; t = 17.1; p < 0.001). Significantly fewer respondents reported the ability to work during a pandemic (83.5%; t = 17.1; p < 0.001) or an earthquake (89.8%; t = 13.3; p < 0.001) compared to their willingness to work. From multivariate linear regression, factors associated with pandemic willingness to work were as follows: 1) no children ≤3 years of age; 2) older children; 3) working full-time; 4) less concern for family; 5) less fear of job loss; and 6) vaccine availability. Earthquake willingness factors included: 1) not having children with special needs and 2) not working a different role.
Conclusion:
Improving care for dependent family members, worker protection, cross training, and job importance education may increase willingness to work during disasters.
... Among healthcare workers, findings from previous research indicate that willingness to respond to a radiological disaster scenario ranges from 39% to 76%; the findings from the current study are consistent with the upper end of this range. 4,5,7,9,[14][15][16] Similar to the findings from Balicer et al 9 and Watson et al, 16 the findings from this study identified significant differences in response willingness for radiological disaster scenarios if requested versus if required to respond by the employer. Approximately 85% of first responders in this study were willing to respond to a dirty bomb scenario if required by their employer, but that number decreased to 68% if they were only requested to respond. ...
... Among healthcare workers, findings from previous research indicate that willingness to respond to a radiological disaster scenario ranges from 39% to 76%; the findings from the current study are consistent with the upper end of this range. 4,5,7,9,[14][15][16] Similar to the findings from Balicer et al 9 and Watson et al, 16 the findings from this study identified significant differences in response willingness for radiological disaster scenarios if requested versus if required to respond by the employer. Approximately 85% of first responders in this study were willing to respond to a dirty bomb scenario if required by their employer, but that number decreased to 68% if they were only requested to respond. ...
... Similar to the findings of earlier studies, 6,9,16 normative beliefs were strong determinants of response behavior. A belief that there is a responsibility to work during a radiological disaster was the largest predictor of response willingness for both radiological disaster scenarios used in this study; first responders who agreed with this statement were 9 times more likely to work during the dirty bomb scenario than those who disagreed, and they were almost 18 times more likely to work during the landfill scenario than those who disagreed. ...
During radiological disasters, firefighters and emergency medical services personnel are expected to report to work and engage in response activities; however, prior research exploring willingness to respond to radiological disasters among first responders has considered only radiological terrorism scenarios and not nonterrorism radiological scenarios. The goal of this study was to compare willingness to respond to terrorism and nonterrorism radiological disaster scenarios among first responders in St. Louis, Missouri, and to explore determinants of willingness to respond. Firefighters and emergency medical services personnel were surveyed about their willingness to respond to a dirty bomb detonation (terrorism) and a radioactive landfill fire (nonterrorism). McNemar's tests were used to assess differences in individual willingness to respond between the 2 scenarios and differences if requested versus required to respond. Chi-square tests were used to identify significant individual predictors of willingness to respond. Multivariate logistic regressions were used to determine final models of willingness to respond for both scenarios. Willingness to respond was lower for the dirty bomb scenario than the landfill scenario if requested (68.4% vs 73.0%; P < .05). For both scenarios, willingness to respond was lower if requested versus required to respond (dirty bomb: 68.4% vs 85.2%, P < .001; landfill: 73.0% vs 87.3%, P < .001). Normative beliefs, perceived susceptibility, self-efficacy, and perceived barriers were significant predictors of willingness to respond in the final models. Willingness to respond among first responders differed significantly between terrorism and nonterrorism radiological disasters and if requested versus required to respond. Willingness to respond may be increased through interventions targeting significant attitudinal and belief predictors and by establishing organizational policies that define expectations of employee response during disasters.
... This low rate of willingness to work during outbreaks improves with decreased sense of risk, however, such as with provision of vaccine and adequate personal protective equipment.4 Willingness is also impacted by perceived role and relevance to the disaster, as well as perceived value of the employee to the institution [6][7][8][9]. ...
... All emergency medicine residents were eligible to participate. Questionnaires used in past willingness to work during disaster surveys were used to develop this study's instrument [2,[5][6][7][11][12][13][14]. Participants were presented with two disaster scenarios: an earthquake and an influenza pandemic. ...
... 4,25 For providers who live and work within harm's way of a disaster, this would mean reporting to work despite likely personal obstacles. [26][27][28] Such providers would be followed and augmented by additional volunteer providers, as needed, to assist in the disaster's wake. Ideally, all providers functioning during crisis situations when resources may be scarce and demands for health care may exceed capacity would be able to care for patients without fear of facing unreasonable liability risks. ...
... Evidence reveals that concern or confusion about various legal protections during public health emergencies may interfere with providers' responsiveness and willingness to volunteer. 2,7,11,26,[29][30][31][32][33][34][35] Ethically, providing necessary medical care should not be hampered by legal considerations. ...
Although most health care providers will go through their careers without experiencing a major disaster in their local communities, if one does occur, it can be life and career altering. The American Academy of Pediatrics has been in the forefront of providing education and advocacy on the critical importance of disaster preparedness. From experiences over the past decade, new evidence and analysis have broadened our understanding that the concept of preparedness is also applicable to addressing the unique professional liability risks that can occur when caring for patients and families during a disaster. Concepts explored in this technical report will help to inform pediatric health care providers, advocates, and policy makers about the complexities of how providers are currently protected, with a focus on areas of unappreciated liability. The timeliness of this technical report is emphasized by the fact that during the time of its development (ie, late summer and early fall of 2017), the United States went through an extraordinary period of multiple, successive, and overlapping disasters within a concentrated period of time of both natural and man-made causes. In a companion policy statement (www.pediatrics.org/cgi/doi/10.1542/peds.2018-3892), recommendations are offered on how individuals, institutions, and governments can work together to strengthen the system of liability protections during disasters so that appropriate and timely care can be delivered with minimal fear of legal reprisal or confusion.
... The questionnaire was based on existing studies examining willingness to report to work, influenza pandemic training, and risk perceptions related to pandemics, bioterrorism, and emerging pathogens (5,8,10,11,(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). Twelve U.S. pandemic preparedness researchers provided feedback on instrument content validity. ...
Objective Identify determinants of emergency medical service (EMS) personnel’s willingness to work during an influenza pandemic.
Background Little is known about the willingness of EMS personnel to work during a future influenza pandemic or the extent to which they are receiving pandemic training.
Methods EMS personnel were surveyed in July 2018 – Feb 2019 using a cross-sectional approach; the survey was available both electronically and on paper. Participants were provided a pandemic scenario and asked about their willingness to respond if requested or required; additional questions assessed their attitudes and beliefs and training received. Chi-square tests assessed differences in attitude/belief questions by willingness to work. Logistic regressions were used to identify significant predictors of response willingness when requested or required, controlling for gender and race.
Results 433 individuals completed the survey (response rate = 82.9%). A quarter (26.8%, n = 116) received no pandemic training; 14.3% (n = 62) participated in a pandemic exercise. Significantly more EMS personnel were willing to work when required versus when only requested (88.2% vs 76.9%, X² = 164.1, p < .001). Predictors of willingness to work when requested included believing it is their responsibility to work, believing their coworkers were likely to work, receiving prophylaxis for themselves and their family members, and feeling safe working during a pandemic.
Discussion Many emergency medical services personnel report lacking training or disaster exercises related to influenza pandemics, and a fair percentage are unwilling to work during a future event. This may limit healthcare surge capacity and could contribute to increased morbidity and mortality. Findings from this study indicate that prehospital staff’s attitudes and beliefs about pandemics influence their willingness to work. Pre-event training and planning should address these concerns.
... The proximity of the hospital administrators' residence to their workplace was also identified as important, as it allows the hospital administrators to ensure their timely presence in a disaster situation. A study by Watson et al. (32) showed that one barrier to the rapid arrival of healthcare workers to a hospital at the time of a disaster was the lack of a safe means of reaching their workplace. ...
Background:
Hospital administrators play a key role in the effective management of surge capacity in disasters, but there is little information available about the characteristics required to manage this.
Objectives:
In this study, we aimed to identify characteristics of hospital administrators that are important in the effective management of surge capacity in disasters.
Materials and methods:
This was a qualitative study. Semi-structured purposive interviews were conducted with 28 hospital administrators who had experience working in surge situations in hospitals during disasters. Framework analysis was used to analyze the data.
Results:
Three themes and 12 subthemes were identified. The themes were as follows: 1) crisis managerial characteristics, 2) personal characteristics, and 3) specific requirements.
Conclusions:
In this study, some characteristics that had a positive impact on the success of a manager in a hospital surge situation were identified. These characteristics ought to be taken into account when appointing hospital administrators and designing training programs for hospital administrators with the aim of being better prepared to face disasters.
... Instruments used in past research examining willingness to work during disasters were used to develop this study's questionnaire. 2,4,[7][8][9]11,[13][14][15][16][17][18] The instrument measured the impact of childcare needs on ability to work during 2 scenarios (an influenza pandemic and earthquake), using a continuum of 0 to 100 (with 0 indicating complete disagreement and 100 indicating complete agreement with that statement). For each scenario, participants were also asked to separately rate their anticipated need and anticipated use of an on-site hospital-provided EC during both scheduled and unscheduled shifts. ...
Objectives:
The objectives were to determine the impact of emergency childcare (EC) needs on health care workers' ability and likelihood to work during a pandemic versus an earthquake as well as to determine the anticipated need and expected use of an on-site, hospital-provided EC program.
Methods:
An online survey was distributed to all employees of an academic, urban pediatric hospital. Two disaster scenarios were presented (pandemic influenza and earthquake). Ability to work based on childcare needs, planned use of proposed hospital-provided EC, and demographics of children being brought in were obtained.
Results:
A total of 685 employees participated (96.6% female, 79.6% white), with a 40% response rate. Those with children (n = 307) reported that childcare needs would affect their work decisions during a pandemic more than an earthquake (61.1% vs 56.0%; t = 3.7; P < 0.001). Only 28.0% (n = 80) of those who would need childcare (n = 257) report an EC plan. The scenario did not impact EC need or planned use; during scheduled versus unscheduled shifts, 40.7% versus 63.0% reported need for EC, and 50.8% versus 63.2% reported anticipated using EC.
Conclusions:
Hospital workers have a high anticipated use of hospital-provided EC. Provisions for EC should be an integral part of hospital disaster planning.
... When they do occur, they cause a disproportionate amount of fear and concern in the public and emergency responders, including emergency physicians. [2][3][4] This fact is combined with a suboptimal amount of health care provider knowledge about the evaluation and care of victims as supported by several previous studies. 5,6 Radioactive material exists in a solid, liquid, or gaseous physical form. ...
After a radiation emergency that involves the dispersal of radioactive material, patients can become externally and internally contaminated with 1 or more radionuclides. Internal contamination can lead to the delivery of harmful ionizing radiation doses to various organs and tissues or the whole body. The clinical consequences can range from acute radiation syndrome to the long-term development of cancer. Estimating the amount of radioactive material absorbed into the body can guide the management of patients. Treatment includes, in addition to supportive care and long term monitoring, certain medical countermeasures like Prussian blue, calcium diethylenetriamine pentaacetic acid (DTPA) and zinc DTPA.
Copyright © 2015 Elsevier Inc. All rights reserved.
... Instruments used in past willingness to work disaster surveys were used to develop this study's questionnaire [1][2][3][4][5][6]9,11,12,14,21,22 ; however, this specific survey was not validated before it was distributed. The 52-item instrument (see Supplementary material at www.liebertonline.com) ...
In 2011, an EF5 tornado hit Joplin, MO, requiring complete evacuation of 1 hospital and a patient surge to another. We sought to assess the resilience of healthcare workers in these hospitals as measured by number reporting to work, willingness to work, personal disaster preparedness, and childcare responsibilities following the disaster. In May 2013, a survey was distributed to healthcare workers at both Joplin hospitals that asked them to report their willingness to work and personal disaster preparedness following various disaster scenarios. For those with childcare responsibilities, scheduling, costs, and impact of hypothetical alternative childcare programs were considered in the analyses. A total of 1,234 healthcare workers completed the survey (response rate: 23.4%). Most (87.8%) worked the week following the Joplin tornado. Healthcare workers report more willingness to work during a future earthquake or tornado compared to their pre-Joplin tornado attitudes (86.2 vs 88.4%, t=-4.3, p<.001; 88.4 vs 90%, t=-3.1, p<.01, respectively), with no change during other scenarios. They expressed significantly higher post-tornado personal disaster preparedness, but only preevent preparedness was a significant predictor of postevent preparedness. Nearly half (48.5%, n=598) had childcare responsibilities; 61% (n=366) had childcare needs the week of the tornado, and 54% (n=198) required the use of alternative childcare. If their hospital had provided alternative childcare, 51% would have used it and 42% felt they would have been more willing to report to work. Most healthcare workers reported to work following this disaster, demonstrating true resilience. Disaster planners should be aware of these perceptions as they formulate their own emergency operation plans.
The purpose of this study was to identify factors that motivate public health workers to deploy to the field during an emergency event. We conducted 25 semistructured interviews with employees at the US Centers for Disease Control and Prevention, all of whom had deployed to the field for the 2014-2016 Ebola, 2016-2017 Zika, and 2017 hurricane responses. We used a grounded theory approach in our analysis of the data. Themes that emerged from the interviews related to responder autonomy, competence, and relatedness, which are consistent with self-determination theory. Motivating factors included having clarity about the response role, desire to be challenged, ability to apply existing skills in the field (or apply new skills learned during deployment to their home office), desire to be helpful, and feeling rewarded by working with affected populations, communities, and other response staff. These preliminary findings suggest that introjected and identified motivating factors may form the foundation of willingness among public health workers to assist during an emergency event. Understanding what motivates staff at public health agencies to participate in emergency deployment can inform the development of recruitment strategies, strengthen effectiveness of response activities, and improve overall agency preparedness.
Introduction
Hazardous material (HAZMAT) protocols require health care providers to wear personal protective equipment (PPE) when caring for contaminated patients. Multiple levels of PPE exist (level D - level A), providing progressively more protection. Emergent endotracheal intubation (ETI) of victims can become complicated by the cumbersome nature of PPE.
Study Objective
The null hypothesis was tested that there would be no difference in time to successful ETI between providers in different types of PPE.
Methods
This randomized controlled trial assessed time to ETI with differing levels of PPE. Participants included 18 senior US Emergency Medicine (EM) residents and attendings, and nine US senior Anesthesiology residents. Each individual performed ETI on a mannequin (Laerdal SimMan Essential; Stavanger, Sweden) wearing the following levels of PPE: universal precautions (UP) controls (nitrile gloves and facemask with shield); partial level C (PC; rubber gloves and a passive air-purifying respirator [APR]); and complete level C (CC; passive APR with an anti-chemical suit). Primary outcome measures were the time in seconds (s) to successful intubation: Time 1 (T1) = inflation of the endotracheal tube (ETT) balloon; Time 2 (T2) = first ventilation. Data were reported as medians with Interquartile Ranges (IQR, 25%-75%) or percentages with 95% Confidence Intervals (95%, CI). Group comparisons were analyzed by Fisher’s Exact Test or Kruskal-Wallis, as appropriate (alpha = 0.017 [three groups], two-tails). Sample size analysis was based upon the power of 80% to detect a difference of 10 seconds between groups at a P = .017; 27 subjects per group would be needed.
Results
All 27 participants completed the study. At T1, there was no statistically significant difference (P = .27) among UP 18.0s (11.5s-19.0s), PC 21.0s (14.0s-23.5s), or CC 17.0s (13.5s-27.5s). For T2, there was also no significant (P = .25) differences among UP 24.0s (17.5s-27.0s), PC 26.0s (21.0s-32.0s), or CC 24.0s (19.5s-33.5s).
Conclusion
There were no statistically significant differences in time to balloon inflation or ventilation. Higher levels of PPE do not appear to increase time to ETI.
In 2008, at the request of the Centers for Disease Control and Prevention (CDC), the Institute of Medicine (IOM) prepared a report identifying knowledge gaps in public health systems preparedness and emergency response and recommending near-term priority research areas. In accordance with the Pandemic and All-Hazards Preparedness Act mandating new public health systems research for preparedness and emergency response, CDC provided competitive awards establishing nine Preparedness and Emergency Response Research Centers (PERRCs) in accredited U.S. schools of public health. The PERRCs conducted research in four IOM-recommended priority areas: (1) enhancing the usefulness of public health preparedness and response (PHPR) training, (2) creating and maintaining sustainable preparedness and response systems, (3) improving PHPR communications, and (4) identifying evaluation criteria and metrics to improve PHPR for all hazards. The PERRCs worked closely with state and local public health, community partners, and advisory committees to produce practice-relevant research findings. PERRC research has generated more than 130 peer-reviewed publications and nearly 80 practice and policy tools and recommendations with the potential to significantly enhance our nation's PHPR to all hazards and that highlight the need for further improvements in public health systems.
Hypertension as the primary reason for hospitalization is often used to indicate failure of the outpatient health-care system to prevent and control high blood pressure. Investigators have reported increased rates of these preventable hospitalizations for black people compared with white people; however, none have mapped them nationally by race.
We used Medicare Part A data to estimate preventable hypertension hospitalizations from 2004-2009 using technical specifications published by the Agency for Healthcare Research and Quality. Rates per 100,000 beneficiaries were age- and sex-standardized to 2000 U.S. Census data. We mapped county-level rates by race and identified clusters of counties with extreme rates.
Black people had higher crude rates of these hospitalizations than white people for every year studied, and the test for an increasing linear time trend for the standardized rates was significant for both black and white people; that is, the gap between the races increased over time. For both races, clusters of high-rate counties occurred primarily in parts of Oklahoma, Texas, Southern Alabama, and Louisiana. High rates for white people were also found in parts of Appalachia. Large differences in rates among black and white people were found in a number of large urban areas and in parts of Florida and Alabama.
Racial disparities in preventable hospitalizations for hypertension persisted through 2009. The gap between black and white people is increasing, and these inequities exist unevenly across the country. Although this study was intended to be purely descriptive, future studies should use multivariate analyses to examine reasons for these unequal distributions.
: Study findings suggest ways that employers can ensure an adequate workforce during crises.
This study examined potential predictors of nurses' intentions to work during the 2009 influenza A (H1N1) pandemic.
A questionnaire was mailed to a random sample of 1,200 nurses chosen from all RNs and LPNs registered with the Maine State Board of Nursing during the second wave of the flu andemic.
Of the 735 respondents, 90% initially indicated that they intended to work during a flu pandemic.Respondents were significantly more likely to work if provided with adequate personal protective equipment (PPE) but significantly less likely without adequate PPE or if they feared family members could become ill with pandemic flu. They were also significantly less likely to work if assigned to direct care of a flu patient; if a colleague were quarantined for or died of pandemic flu; if they feared their own family members might die of pandemic flu; if they themselves were ill for any reason; if a family member or loved one were sick at home and needed care; if they lacked a written family protection plan; or if certain incentives were offered: antiviral medication or vaccine for nurse and family, double pay, or free room and board at work. About 7% of RNs reported that they would not be willing to work during a flu pandemic, regardless of incentives or other factors.An inverse relationship was found between the perceived level of threat posed by a flu pandemic and nurses' willingness to work.
To maintain an adequate nursing workforce during a flu pandemic, employers should ensure that policies and procedures include providing adequate PPE for nurses and safeguarding the health of nurses and their families. The level of perceived threat is likely to affect the proportion of nurses willing to work. Some nurses will not work during a flu pandemic no matter what protections and incentives are offered; efforts intended to force or entice all nurses to work are unlikely to succeed.
In the aftermath of the detonation of a radiological dispersal device (RDD), or "dirty bomb," a large influx of children would be expected to present to the emergency department, including many patients not directly affected by the event who present with concerns regarding radiation exposure. Our objective was to develop an algorithm for efficiently and effectively triaging and appropriately treating children based on the likelihood of their having been contaminated or exposed.
The hospital's disaster preparedness committee with the help of disaster planning experts engaged in an iterative process to develop a triage questionnaire and patient flow algorithm for a pediatric hospital following an RDD event. The questionnaire and algorithm were tested using hypothetical patients to ensure that they resulted in appropriate triage and treatment for the full range of anticipated patient presentations and were then tested in 2 live drills to evaluate their performance in real time.
The triage questionnaire reduced triage times and accurately sorted children into groups based on the type of intervention they required. Nonmedical personnel were able to administer the triage questionnaire effectively with minimal training, relieving professional staff. The patient flow algorithm and supporting materials provided direction to staff about how to appropriately treat patients once they had been triaged.
In the event of the detonation of an RDD, the triage questionnaire and patient flow algorithm presented would enable pediatric hospitals to direct limited resources to children requiring intervention due to injury, contamination, or exposure.
Introduction:
Responding to a vaccine-related public health emergency involves a broad spectrum of provider types, some of whom may not routinely administer vaccines including obstetricians, pharmacists and other specialists. These providers may have less experience administering vaccines and thus less confidence or self-efficacy in doing so. Self-efficacy is known to have a significant impact on provider willingness to respond in emergency situations.
Methods:
We conducted a survey of 800 California vaccine providers to investigate standard of care, willingness to respond, and how vaccine-related standard of care impacts willingness to respond among these providers. We used linear regression to examine how willingness to respond was impacted by vaccine-related standard of care.
Results:
Forty percent of respondents indicated that they had participated in emergency preparedness training, actual disaster response, or surge capacity initiatives with significant differences among provider types for all measures (p=0.007). When asked to identify barriers to responding to a public health emergency, respondents indicated that staff size or capacity, training and resources were the top concerns. Respondents in practices with a higher vaccine-related standard of care had a higher willing to respond index (β=0.190, p=0.001). Respondents who had participated in emergency training or actual emergency response had a higher willing to respond index (β=1.323, p<0.0001).
Conclusion:
Our study suggests that concerns about staff size and surge capacity need to be more explicitly addressed in current emergency preparedness training efforts. In the context of boosting response willingness, larger practice environments stand to benefit from self-efficacy focused training and exercise efforts that also incorporate standard of care.
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