Perceived Facilitators and Barriers to Local Health Department Workers' Participation in Infectious Disease Emergency Responses

Abstract

Context Local health departments play a key role in emergency preparedness and respond to a wide range of threats including infectious diseases such as seasonal influenza, tuberculosis, H1N1, Ebola, and Zika. To successfully respond to an infectious disease outbreak, local health departments depend upon the participation of their workforce yet studies indicate that sizable numbers of workers would not participate in such a response. The reasons why local health department workers participate, or fail to participate, in infectious disease responses are not well understood. Objective To understand why local health department workers are willing, or not willing, to report to work during an infectious disease response. Design From April 2015 to January 2016 we conducted 28 semi-structured interviews with local health department directors, preparedness staff, and non-preparedness staff. Setting Interviews were conducted with individuals throughout the U.S. Participants We interviewed 28 individuals across three groups: local health department directors (n=8), preparedness staff (n=10), and non-preparedness staff (n=10). Main Outcome Measures Individuals’ descriptions of why local health department workers are willing, or not willing, to report to work during an infectious disease response. Results Factors that facilitate willingness to respond to an infectious disease emergency included: availability of vaccinations and personal protective equipment; flexible work schedule and childcare arrangements; information sharing via local health department trainings; and perceived commitments to one’s job and community. Factors that hinder willingness to respond to an infectious disease emergency included: potential disease exposure for oneself and one’s family; logistical considerations for care of children, the elderly, and pets; and perceptions about one’s role during an infectious disease response. Conclusions Our findings highlight opportunities for local health departments to revisit their internal policies and engage in strategies likely to promote willingness to respond among their staff.

Factors Influencing Health Care Workers’ Willingness to Respond to Duty during Infectious Disease Outbreaks and Bioterrorist Events: An Integrative Review

“…Of the 40 studies identified, 33 (n = 33; 82.5%) identified specific barriers to willingness (Table 2). 2,4,[8][9][10][11][13][14][15][16][17][18][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] The barriers to willingness could be categorized into the following four groups: concern and perceived risk, interpersonal factors, job-level factors, and outbreak characteristics.…”

“…2,14 Worker Support Systems-Six (n = 6; 15.0%) studies identified worker support systems to help facilitate willingness. 2,14,16,28,35,39 Valued supports included telephone and email access, 2 transportation support, 2,14,39 provision of food 2 and accommodation, 2,14 and guaranteed financial supports, such as life and/or disability insurance or hazard pay. 14,39 A study of WTR among nursing students further supported the value of providing food, opportunities for rest and personal hygiene (eg, showers), and organizational programs to support mental and spiritual health, such as available chaplains.…”

“…20 Finally, seven (n = 7, 17.5%) studies suggested that health department employees were willing to respond to biological emergencies. 12,13,22,24,35,36,43 A series of studies conducted by a research group at Johns Hopkins University (Baltimore, Maryland USA) found that fifty-four percent to ninety-four percent of local health department employees in the US were willing to respond to pandemic influenza. 12,22,24 A study of county health department employees in Florida found that 92.3% (n = 2,228/2,414) were willing to respond to pandemic influenza, although when asked about performing high-risk tasks, willingness dropped to 56.2% (n = 1,357/2,414).…”

Factors affecting hospital response in biological disasters: A qualitative study

“…Previous studies have shown that male gender, being a physician, having a full-time job, self-protection, and communication equipment for staff, and basic needs such as water have a positive impact on the willingness to work in such events (55,60,61). Motivation facilitators for working in infectious emergencies include access to vaccination and personal protective equipment, flexible work shift, taking care of staff children, and information sharing (57).…”

Priorities, Barriers, and Facilitators towards International Guidelines for the Delivery of Supportive Clinical Care during an Ebola Outbreak: A Cross-Sectional Survey

“…During the 2014–2016 West Africa EVD outbreak, the provision of supportive care varied across ETUs and over time. While previous reports identified factors that motivated or hindered the mobilization of health professionals [ 6 , 7 ], there were no clinical practice guidelines on a core set of supportive care measures that should be guaranteed to all patients treated in ETUs.…”