1.
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Integrative Review
of Factors Associated with the Willingness
of Health Care Personnel to Work during
Influenza Public Health Emergency
Dr. Mahesh Devnani
Prof. Anil Kumar Gupta
Post Graduate Institute of Medical Education and Research
Chandigarh, India
@Mahesh_Devnani

2.
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Influenza Pandemics
• Periodically, novel influenza viruses emerge resulting in worldwide epidemics
or pandemics.
• In the 20th century alone, there were three overwhelming pandemics
– 1918, H1N1 (Spanish flu) - 20–50 million more deaths
– 1957 H2N2 (Asian flu)
– 1968, H3N2 (Hong Kong flu)
• Mortality associated with the 1957 “Asian Flu” (A/H2N2) and the 1968 “Hong
Kong Flu” (A/H3N2) pandemics was less severe. However, considerable
morbidity, social disruption and economic loss occurred during both of these
pandemics

3.
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Major Influenza Public Health Emergencies
(Last Decade)
• Severe acute respiratory syndrome (SARS), 2002-2003
• Avian flu, 2006
• Influenza A H1N1 pandemic influenza, 2009-2010
– Tens of millions to 200 million case
– 18,500 lab confirmed deaths by August 2010
• Other several local/regional outbreaks/epidemics
• Seasonal Influenza
– 3.5 million cases every year
– 250,000 to 500,000 deaths
(Report of WHO review committee on the functioning of IHR regulations in relation to
Pandemic (H1N1) 2009, May 2011)

4.
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Influenza Pandemic = Disaster
• Chaos
• Morbidity
• Mortality
• Social disruption
• Economic impact
• Overwhelmed health care facilities
• Demand and supply mismatch-drugs, consumables etc.
• Shortage of vaccine
• Ethical issues

5.
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Willingness of Healthcare workers to work in
Influenza PHE
• Obligations of health-care
workers to work during Influenza
emergency notwithstanding risks
to their own health and the health
of their families?
• How willing are they?
• What affects their willingness?

6.
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Methods
• Methodology for integrative review as described by
Whittemore et al, and Chaffee was adopted.
• Systemic literature review
• Relevant, peer-reviewed, quantitative, English language
studies
• Published from January 1, 2001 through June 30, 2010
(Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs
2005;52:546-553.
Chaffee M. Willingness of health care personnel to work in a disaster: an integrative
review of the literature. Disaster Med Public Health Prep 2009;3:42-56.)

7.
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Search strategies
• Search strategies included:
– Cochrane Library
– PubMed
– PubMed Central
– EBSCO Psychological and Behavioral Sciences Collection
– Google Scholar
– Ancestry searching of citations in relevant publications
– Information from individuals with a known interest in the topic

8.
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Outcome Measure
• Willingness to work in an influenza emergency/ pandemic/
epidemic or SARS epidemic or flu epidemic was measured.
• Variations of wording were accepted including-
– ‘‘willingness to report to work”
– ‘‘willingness to care for patients’’
– ‘‘willingness to work’’
– ‘‘willingness to respond’’
– ‘‘willingness to report’’
– ‘‘willingness to report to duty’’
– ‘‘willingness to provide care”

9.
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Results
• Number of studies that met inclusion criteria: 32
• Independent variable:-
– Influenza only: 28
– Influenza + other variables: 4
• Geographic distribution:
– USA - 41%
– Singapore - 12.5%
– Australia, China, and Taiwan - 9% each
– UK -6%
– Belgium, Germany, Canada, and Georgia - 3% each

10.
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Results
Healthcare Personnel (HCP) included in studies:
• Physicians
• Nurses
• Administrators
• Paramedical workers
• Ancillary staff
• Emergency health care workers
• Home health aides
• Home attendants
• Personal care workers
• Medical and nursing students
• Twenty-one of the studies included more than two categories of HCP.
• Five studies included only nurses, two studies included only physicians, and
two studies included only nurses and physicians.
• One study each included medical and nursing students only

11.
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Results
• New instruments were developed for use in 23 of the 32
studies
• Eleven studies reported conducting a pre-test or pilot test
• Five studies described the use of a conceptual or theoretical
framework
• Eight studies used random sampling and 23 used a
convenience sampling strategy. The sampling method was not
stated in one study
• Four studies evaluated non-response bias and found no
significant difference
• Two studies discussed the potential for social desirability bias
in their studies

12.
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Data Synthesis
Factors associated with a willingness to work during an
influenza public health emergency include:
• Being male
• Being a doctor or nurse
• Working in a clinical or emergency department
• Working full-time
• Prior influenza education and training
• Prior experience working during an influenza emergency
• The perception of value in response
• The belief in duty
• The availability of personal protective equipment (PPE)
• Confidence in one’s employer

13.
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Data Synthesis
Factors found to be associated with less willingness were:
• Being female
• Being in a supportive staff position
• Working part-time
• The peak phase of the influenza emergency
• Concern for family and loved ones
• Personal obligations: child care, elderly care, second job
obligations and pet care

14.
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Data Synthesis
• Less willing to work during influenza disaster than during a
disaster from other natural events and other causes
– Radiation
– Chickenpox
– Chemical events.
• Inconclusive
– Race
– Age
– Marital status
– Seniority

15.
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Data Synthesis
Interventions that resulted in the greatest increase in the HCP’s
willingness to work
• Preferential access to Tamiflu for the HCP and his/her family
• Provision of a vaccine for the individual and his/her family.
• Having employers accept liability for any mistakes made
• being able to work flexible hours
• Receiving a financial bonus commensurate with the level of
extra duties an individual may be asked to perform
• The provision of life/disability insurance

16.
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Conclusion
• Understanding the factors that contribute to the willingness
of HCP to report to work during an influenza public health
emergency is critical to emergency planning and
preparedness.
• The appropriate actions required to improve the willingness.
• Information from this review can guide emergency policy
makers, planners, and implementers in both understanding
and influencing the willingness of HCP to work during an
influenza public health emergency.

17.
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Limitations
• The actual behavior of HCP in real situations may or may not
be the same as that reported in the studies reviewed
• It is possible that one or more studies may have been missed
• Studies in languages other than English also may exist.

18.
6th
International Disaster and Risk Conference IDRC 2016
‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland
www.grforum.org
Thank You!
@Mahesh_Devnani