1. Public Health Emergency Response: Who’s Ready, Willing, and Able?
Ran Balicer, MD, MPH, Daniel Barnett, MD, MPH,
Saad B. Omer, MD, MPH, PhD, Natalie Semon, MSEd
Douglas J. Storey, PhD, Jonathan Links, PhD
Johns Hopkins Center for Public Health Preparedness
Ben-Gurion University of the Negev, Israel

2. Public Health Challenges

3. Public Health Workers: Willingness to Respond
Lack of published data on public health employees’ willingness to respond
Recent alarm bells
Hurricane Katrina (local police)
> 80 New Orleans police officers fired for failing to report or abandoning posts
NYC healthcare workers crisis response willingness (non-public health)
SARS: lowest willingness rate (48%)
Sources: USA Today, April 7, 2006 ; Qureshi et al. The Journal of Urban Health, 82, 3, Sept. 2005

4. Willingness Vs. Ability to Respond

5. Potential Risk Perception Modifiers
Perceived threats to family well-being
Misunderstanding of risks
Uncertainty regarding working environment safety
Unclear understanding of role-specific expectations
Perceptions of relevance to agency response
Lacking stress management techniques
Source: Barnett DJ, Balicer RD, Blodgett DW et al. JPHMP 2005; Nov (Suppl) S33-S37

6. Pandemic Influenza

7. Public Health Infrastructure Response Survey Tool (PHIRST): Phase I
Conducted May – July 2005
3 Local Health Departments in MD
Anonymous paper survey
n = 308
58% response rate
Focus on pandemic flu response
Source: BMC

8. PHIRST Phase I: Results
Nearly 50% (140/303) indicated they would not likely report to work during influenza pandemic
Perception of the importance of one’s role in the agency’s overall response was the single most influential factor associated with willingness to report
Multivariate OR: 9.5; CI 4.6–19.9

9. PHIRST Phase I: Results (cont.)
Only 33% felt knowledgeable about PH impact
Technical/support staff 2.5 times less likely to report to duty

10. PHIRST Phase II: Online Survey
Tool Expanded to include four scenarios:
Weather-related
Pandemic Influenza
Dirty Bomb
Inhalational Anthrax

11. PHIRST Phase II: Online Survey
State and Local health departments Nation-wide
Case presented:
7 local health departments in Minnesota capital region
November 2006
89% Response rate
N=655

12. PHIRST Phase II: The Extended Parallel Process Model
How do you frame messages to get people to take care of themselves?
Behavior
Change
Message
Accepted
1st Appraisal
2nd Appraisal
High
Message
Components
Threat
Efficacy
Threat
Appraisal
Susceptibility
- Severity
Efficacy
Appraisal
Self-efficacy
Response efficacy
Yes
Low No
Fear
Message
Rejected
Message
Rejected

13. PHIRST Phase II: “Concerned and Confident”
Three broad categories identified in the JH ~ PHIRST assessment tool:
Low Concern
Educate that the threat is realistic and dangerous
High Concern / Low Confidence
Improve skill, modify attitudes and behaviors related to their roles/responsibilities during a response
High Concern / High Confidence
Educate to reinforce comprehension of risk and maintain a high level of efficacy

14. Minnesota PHIRST Analysis: Willingness to Report –by Scenario
Reporting to Duty
Weather
Pandemic Influenza
Dirty Bomb
Anthrax
Required by agency
89%
88%
75%
83%
Asked, but not required by agency
84%
80%
62%
71%
Demographic characteristics not significantly associated with attitudes regarding public health emergencies

15. Minnesota PHIRST Analysis: Willingness to report if required
Extended Parallel Processing Model Category
Low threat, Low Efficacy
Low threat, High Efficacy
High threat, Low Efficacy
High threat, High Efficacy n %
Weather
169
83.3
110
94.8
138
95.8
126
96.9
Pan Flu
156
81.3 96 98
103
93.6
166
97.1
Dirty Bomb
140
74.9 88
90.7 81
83.5
127
91.4
Anthrax

16. Extended Parallel Processing Model Category
Minnesota PHIRST Analysis: Willingness to report if asked but not required
Extended Parallel Processing Model Category
Low threat, Low Efficacy
Low threat, High Efficacy
High threat, Low Efficacy
High threat, High Efficacy n %
Weather
162 79
100
89.3
131
92.9
120
95.2
Pan Flu
144 75 88
92.6 93
83.8
150
93.2
Dirty Bomb
63.8 68
70.8 71
72.5
103 78
Anthrax
143
70.1 80 86
81.6
109
85.2

17. Minnesota PHIRST Analysis: Frequencies of Attitudes and Beliefs -by scenario
Weather
Pan flu
Dirty bomb
Anthrax
Knowledgeable about PH impact
74%
78.8%
41.2%
59.3%
Awareness of role-specific responsibilities
46.7%
63.9%
31.9%
51.4%
Psychologically prepared
75.6%
72.5%
44.5%
61.2%
Ability to safely get to work
63.8%
37.9%
61.4%
Confidence in safety at work
71.8%
32.5%
53.7%
Family prepared
74.2%
68.9%
47.2%
57.6%
Health Department's perceived ability to provide timely information
80.1%
61.5%
69.8%
Ability to address public questions
67.6%
67.3%
32.7%
51.6%
Importance of one's role in the agency's overall response
73.1%
75.3%
58.3%
68.1%

18. Minnesota PHIRST Analysis: Conclusions
People who are willing to report (OR for dirty bomb scenario):
Think their role is important (OR=17.37)
Psychologically prepared (OR=16.01)
Have higher self-efficacy (OR=14.26)
Feel family can function in their absence (OR=12.6)
Able to get to work safely (OR=11.6)
Confident in their personal safety at work (OR=10.51)

19. Minnesota PHIRST Analysis: Potential Interventions
Increased skills in understanding and communicating risk
Improved knowledge of dirty bombs
Family/personal preparedness in a dirty bomb event
Pre-/Post-event mental health preparedness
Protective measures to reach jobsite and perform safely
Responder duties as defined by agency preparedness plan
Review/Increase/Reinforce responsibilities and skills required to respond, to boost self-efficacy

20. Johns Hopkins Center for Public Health Preparedness: Mitigation Strategies1. 2.
Psychological First Aid 3.

21. Conclusions People who are willing to report:
Think their role is important
Psychologically prepared
Able to get to work safely
Confident in their personal safety at work
Have higher self-efficacy
Feel family is prepared to function in their absence
Psychological First Aid

22. Special Acknowledgments
Jane Norbin
St. Paul-Ramsey County Department of Public Health
Participating Minnesota local health departments

23. Thank You Questions? Join the PHIRST study: