Health-Promoting Leadership during an Infectious Disease Outbreak: A Cross-sectional Study of US Soldiers Deployed to Liberia

Abstract

Background Infectious disease outbreaks are uniquely stressful for non-medical essential employees. Promoting the health of these workers is vital to minimize their distress and to ensure they are able to continue in their professional capacity. One way to support worker health is for supervisors to engage in behaviors that promote their employees’ behavioral health, wellbeing, and attitudes towards preventive medicine practices. Methods The present study examined if health-promoting leadership contributes to these outcomes in employees operating in an epidemic. Active-duty soldiers (N = 173) deployed to provide non-medical support in Liberia during the 2014 Ebola crisis completed surveys assessing posttraumatic stress disorder (PTSD), depression, anxiety, sleep problems, burnout, morale and attitudes, and rating their leaders on health-promoting behaviors. An exploratory factor analysis identified two leadership factors, one focused on psychological health and one on preventive medicine behaviors. Results Using mixed effects logistic regression, after adjusting for general leadership and soldier rank, health-promoting leadership focused on psychological health was associated with decreased odds of PTSD, depression, anxiety, and burnout, and increased odds of high morale and avoiding unnecessary risk. Health-promoting leadership behaviors focused on preventive medicine were associated with decreased odds of depression and anxiety, and increased odds of high morale, understanding the level of risk from disease, positive attitudes towards the deployment and preventive practices, and avoiding unnecessary risk. Conclusions Findings suggest health-promoting leadership behaviors could be valuable for employees responding to infectious disease outbreaks. Future research should examine whether training leaders in these skills can improve outcomes for non-medical employees in both military and civilian settings.

COVID-19 Vaccination Attitudes and Intentions Among U.S. Soldiers: Results from the U.S. Army Behavioral Health Advisory Team (BHAT)

“…This finding suggests that leaders may be a particularly valuable resource for supporting public health messaging. This result is consistent with other studies of behavioral health leadership [17,18] and represents a cost-effective method for increasing vaccination uptake among active-duty soldiers. This analysis is subject to numerous limitations.…”

“…Finally, Social Learning Theory posits that people learn by observing others' actions and the associated benefits of those actions. In a military setting, leadership behaviors specific to health-related outcomes (e.g., sleep leadership) [16], above and beyond general leadership qualities, appear to be a robust mechanism for positive health behavior engagement [17,18]. We examined whether leadership encouragement of vaccinations, above and beyond general leadership, was related to vaccination attitudes and behaviors.…”