EPPM and willingness to respond: the role of risk and efficacy communication in strengthening public health emergency response systems

Challenges in Media Attention toward COVID-19-Preventive Behaviors: Dual Roles of Threat and Perceived Capability for Information Systems and Health Care

Based on the extended parallel process model, this study investigated the relationship between young adults' media exposure to COVID-19 and their adoption of protective behaviors. This study surveyed 141 college students and found that increased risk perceptions led to greater intentions to engage in COVID-19-preventive behaviors and that these intentions were mediated by normative beliefs. There was no significant difference in risk perceptions between traditional media and social media. The results showed that college students took precautions against COVID-19 because they perceived themselves to be both vulnerable and capable.

Boil water notices as health-risk communication: risk perceptions, efficacy, and compliance during winter storm Uri

Winter Storm Uri was a disaster that impacted much of the United States during February of 2021. During and after the storm, Texas and Oklahoma experienced massive power grid failures. This led to cascading impacts, including water system disruptions and many boil water notices (BWNs). The breakdown of some communication channels and the inability to enact protective actions due to power outages, as well as travel limitations on public roads, complicated the dissemination and implementation of notifications. This research examined individuals' perceptions of risk, water quality, and BWNs during Uri. Additionally, this study sought to understand if previous experience with a BWN influenced compliance during Uri and how perceived efficacy impacted these variables. Surveying 893 Texans and Oklahomans revealed that most Uri-affected respondents believed the risks associated with BWNs were severe. Income and race were two factors that influenced BWN compliance. Age, gender, and level of education did not influence compliance. Previous experience with BWNs did not increase risk perceptions. Higher levels of perceived efficacy correlated to higher levels of compliance, perceptions of risk, and water quality, much of which support propositions of the Extended Parallel Process Model. Results suggest that pre-disaster planning and communication are imperative to helping reduce risk(s) and enhancing efficacy during a disaster, especially for novel disasters that have cascading risks, like Winter Storm Uri.

Enhancing a Willingness to Respond to Disasters and Public Health Emergencies Among Health Care Workers, Using mHealth Intervention: A Multidisciplinary Approach

Health care workers (HCWs) are increasingly faced with the continuous threat of confronting acute disasters, extreme weather-related events, and protracted public health emergencies. One of the major factors that determines emergency-department-based HCWs' willingness to respond during public health emergencies and disasters is self-efficacy. Despite increased public awareness of the threat of disasters and heightened possibility of future public health emergencies, the emphasis on preparing the health care workforce for such disasters is inadequate in low-and-middle-income countries (LMICs). Interventions for boosting self-efficacy and response willingness in public health emergencies and disasters have yet to be implemented or examined among emergency HCWs in LMICs. Mobile health (mHealth) technology seems to be a promising platform for such interventions, especially in a resource-constrained setting. This paper introduces an mHealth-focused project that demonstrates a model of multi-institutional and multidisciplinary collaboration for research and training to enhance disaster response willingness among emergency department workers in Pakistan.

Emergency Preparedness for the COVID-19 Pandemic: Social Determinants Predicting the Community Pharmacists’ Preparedness and Perceived Response in Malaysia

Background: Pandemic preparedness of healthcare providers helps to mitigate future threats such as spread and fatality rates, as well as the management of the disease. Pharmacists are key partners with public health agencies, and the role of community pharmacists is becoming increasingly recognised in this COVID-19 pandemic. The study aimed to explore the emergency preparedness of community pharmacists (CPs) for COVID-19. Methods: A cross-sectional study was performed among community pharmacists using cluster sampling followed by convenient sampling. A self-administered questionnaire was formulated using references from the previous literature and the WHO preparedness checklist. Descriptive analysis was undertaken for the participants’ socio-demographic characteristics. All the data collected were entered into the Statistical Package for Social Sciences version 24 (SPSS V.24), (IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp.) for analysis. Results: Most of the CPs had five or fewer years of practice experience, and they had all the mandatory information relating to the needs of their communities regarding the disease. The participants knew where to acquire these resources whenever needed. They were able to recognise the signs and symptoms of the disease. Most participants felt that they were confident to provide patient education and carry out their duties during these challenging times. There was a strong position correlation between preparedness and the perceived response of the participants. Conclusion: The community pharmacists in Malaysia are prepared enough for COVID-19 pandemic management and perceive that they can respond during any unprecedented situations, such as COVID-19. Community pharmacists were aware of the challenges that they need to face in their community regarding COVID-19.

COVID-19 Vaccine-related Information Seeking and Scanning: A Test of Mediators between Information Acquisition and Vaccination Intention among Unvaccinated Black Americans

Health information seeking and scanning are two important information acquisition strategies that can influence subsequent health behaviors. This research was contextualized in COVID-19 vaccinations and examined the effects of information seeking and scanning on vaccination intention among unvaccinated Black Americans (N = 1,278). Moreover, this research conceptualized perceived risk and efficacy as the intervening factors for the relationship between information acquisition and behavioral intention. The results indicated that information seeking had a significant effect on vaccination intention, whereas information scanning had no effect. Perceived susceptibility and response efficacy mediated the relationship between information seeking and vaccination intention. The proposed mediators did not mediate the relationship between information scanning and vaccination intention. Theoretical and practical implications are offered.

Fear of disasters within the risk communication network of foreign students in Japan amid the COVID-19 pandemic crisis: A cohort design

The main objective of this study is to examine the role of risk communication during the COVID-19 crisis, which is often neglected in studies investigating the outbreak of the pandemic. The study is based on survey data from a group of international (non-Japanese) students in Japan and the theoretical foundation of fear appeal theory. The results, which are based on the panel data structure, show that individually, (1) the act of seeking out others to discuss risks in depth in the current pandemic context or (2) the observed adoption of advocated precautionary health behaviours is not necessarily a good indicator of mental management, but (3) the combined effect of (1) and (2) unexpectedly suggests a conciliatory effect on the fear of disasters. Moreover, this evidence-based finding (3) suggests that a reciprocal relationship exists between threat and efficacy in terms of mediating fear under the framework and theory of fear appeals, indirectly challenging the fear control response proposition of the extended parallel process model. Our empirical findings emphasize the role of risk discourse and information sharing combined with preventive health behaviours adopted within a community in the context of global health crises.

Empowering Parents to Protect Children during COVID-19 with Message Strategy Based on Efficacy, Threat Levels, and Channel Preferences

A national survey (n = 500) was administered in March 2020 at the peak of COVID-19uncertainty to access parents' perceived abilities to protect children during the COVID-19 pandemic. Using the threat/efficacy matrix in Witte's (1992) extended parallel processing model (EPPM), parents' behavioral intentions to protect children from coronavirus and their perceived COVID-19 knowledge levels are examined based on their positions within the matrix. The results indicated that (1) there is a positive relationship between the perceived threat of COVID-19 to parents and to their children; (2) parents' behavioral intentions and knowledge levels varied depending on their perceived threat/efficacy levels; (3) perceived threat level was the bigger motivator to use channels for COVID-19 information. Theoretical and practical implications are discussed.

Developing Public Health Emergency Response Leaders in Incident Management: A Scoping Review of Educational Interventions

During emergency responses, public health leaders frequently serve in incident management roles that differ from their routine job functions. Leaders' familiarity with incident management principles and functions can influence response outcomes. Therefore, training and exercises in incident management are often required for public health leaders. To describe existing methods of incident management training and exercises in the literature, we queried 6 English language databases and found 786 relevant articles. Five themes emerged: (1) experiential learning as an established approach to foster engaging and interactive learning environments and optimize training design; (2) technology-aided decision support tools are increasingly common for crisis decision-making; (3) integration of leadership training in the education continuum is needed for developing public health response leaders; (4) equal emphasis on competency and character is needed for developing capable and adaptable leaders; and (5) consistent evaluation methodologies and metrics are needed to assess the effectiveness of educational interventions.These findings offer important strategic and practical considerations for improving the design and delivery of educational interventions to develop public health emergency response leaders. This review and ongoing real-world events could facilitate further exploration of current practices, emerging trends, and challenges for continuous improvements in developing public health emergency response leaders.

Motivators of Continued Participation in Public Health Emergency Response Among Federal Public Health Workers: A Qualitative Study

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.

Medical Staff Work Burnout and Willingness to Work during COVID-19 Pandemic Situation in Pakistan

Medical staff is vital for helping society through a health crisis, human-made or natural disaster, and pandemic. This study aims to investigate the medical staff's work-related burnout during Covid-19 and their willingness to work when they are most needed. The cross-sectional design was used, and an online survey was conducted through snowball sampling. Sample comprised on 250 participants (male = 89 & female= 161). The study's inclusion criteria were that only those medical staff of different hospitals was approached to collect data performed inwards isolated for Covid-19 treatment corona isolation wards. Maslach burnout inventory (MBI-HSS) and willingness to work (WTW) tools were used to collect data. Descriptive and Partial least square analysis was utilized to evaluate the relationships. The Coefficient of determination or R-Square value was 0.299, which means 29.9% or 30% of the work burnout variation was due to the impact of emotional exhaustion and personal accomplishment. Perceived danger, Role Competence, Self-Efficacy, and Sense of duty significantly impacted the willingness to work. Despite the workload and perceived risk, 42.6% of participants agreed to work if their department had to need their services, while 55.2% of participants agreed to work whether their department asked them or not. Government and hospital management should adopt a proactive and positive response during the pandemic to eradicate the employee stress and adopt adequate steps to improve the willingness to work with medical staff.

How Times of Crisis Serve as a Catalyst for Creative Action: An Agentic Perspective

The human experience is punctuated by times of crisis. Some crises are experienced at a personal level (e.g., the diagnosis of a life-threatening disease), organizational level (e.g., a business facing bankruptcy), and still others are experienced on a societal or global level (e.g., COVID-19 pandemic). Although crises can be deeply troubling and anxiety provoking, they can also serve as an important catalyst for creative action and innovative outcomes. This is because during times of crisis our typical forms of reasoning and action may no longer serve us. It is precisely during such times that new ways of thought, action and leadership are needed. A key question for researchers to consider is: Why and how times of crisis serve as an impetus for creative actions and outcomes? The purpose of this paper is to address this question. I open by briefly discussing the features of a crisis. I then introduce an empirically testable, process model that outlines various pathways, factors, and outcomes associated with different ways people and organizations respond during times of crisis. I close by briefly outlining future directions for creativity theory and research.

Applying the Ready, Willing, and Able Framework to Assess Agency Public Health Emergency Preparedness: The CDC Perspective

Public health emergencies in the United States have been complex, frequent, and increasingly costly in the past decade, at times overwhelming government agencies that are primarily resourced for routine, nonemergency health functions. Emergencies are not always predictable, and adequate resources are not always available to prepare staff in advance for emergency response roles and to mobilize them quickly when a new threat emerges. Additionally, real-world data that connect preparedness levels to response outcomes may be difficult to obtain, further limiting continuous quality improvement efforts by public health officials. In this article, we apply the Ready, Willing, and Able (RWA) framework to identify areas for improvement related to organizational and staff readiness, willingness, and ability to respond during a public health emergency. We share emergency response deployment, training, and personnel data collected as part of emergency response activations (2008 to 2018) at the Centers for Disease Control and Prevention to illustrate how the framework may be applied at government agencies to improve response processes and effectiveness. Additionally, we propose potential metrics aligned with the framework constructs that may help emergency managers consistently assess agency preparedness and, over time, be incorporated into broader standardized measurement methods. We conclude that the RWA framework is a practical tool that can complement other preparedness approaches currently in use at government public health agencies.

The Effects of Governmental and Individual Predictors on COVID-19 Protective Behaviors in China: A Path Analysis Model

The COVID-19 pandemic has plunged the world into a crisis. To contain this crisis, it is essential to build full cooperation between the government and the public. However, it is unclear which governmental and individual factors are determinants and how they interact with protective behaviors against COVID-19. To resolve this issue, this study builds a multiple mediation model. Findings show that government emergency public information such as detailed pandemic information and positive risk communication had greater impact on protective behaviors than rumor refutation and supplies. Moreover, governmental factors may indirectly affect protective behaviors through individual factors such as perceived efficacy, positive emotions, and risk perception. These findings suggest that systematic intervention programs for governmental factors need to be integrated with individual factors to achieve effective prevention and control of COVID-19 among the public.

Applying the Haddon Matrix to Hospital Earthquake Preparedness and Response

Since its 1960s origins, the Haddon matrix has served as a tool to understand and prevent diverse mechanisms of injuries and promote safety. Potential remains for broadened application and innovation of the matrix for disaster preparedness. Hospital functionality and efficiency are particularly important components of community vulnerability in developed and developing nations alike. Given the Haddon matrix's user-friendly approach to integrating current engineering concepts, behavioral sciences, and policy dimensions, we seek to apply it in the context of hospital earthquake preparedness and response. The matrix's framework lends itself to interdisciplinary planning and collaboration between social and physical sciences, paving the way for a systems-oriented reduction in vulnerabilities. Here, using an associative approach to integrate seemingly disparate social and physical science disciplines yields innovative insights about hospital disaster preparedness for earthquakes. We illustrate detailed examples of pre-event, event, and post-event engineering, behavioral science, and policy factors that hospital planners should evaluate given the complex nature, rapid onset, and broad variation in impact and outcomes of earthquakes. This novel contextual examination of the Haddon matrix can enhance critical infrastructure disaster preparedness across the epidemiologic triad, by integrating essential principles of behavioral sciences, policy, law, and engineering to earthquake preparedness.

Strategic science communication as planned behavior: Understanding scientists' willingness to choose specific tactics

Strategic science communicators need to select tactics that can help them achieve both their short-term communication objectives and long-term behavioral goals. However, little previous research has sought to develop theory aimed at understanding what makes it more likely that a communicator will prioritize specific communication tactics. The current study aims to advance the development of a theory of strategic science communication as planned behavior based on the Integrated Behavioral Model. It does so in the context of exploring Canadian scientists' self-reported willingness to prioritize six different tactics as a function of attitudinal, normative, and efficacy beliefs. The results suggest that scientists' beliefs about ethicality, norms, response efficacy, and self-efficacy, are all meaningful predictors of willingness to prioritize specific tactics. Differences between scientists in terms of demographics and related variables provide only limited benefit in predicting such willingness.

Using the Extended Parallel Process Model to Frame E-Professionalism Instruction in Healthcare Education

Issue: With the proliferation of social media and the blurring of online and real-world lives, today's healthcare professionals must constantly work to protect and manage their online reputation. Unfortunately, they are often not taught this skill as part of their healthcare education. Although many healthcare educators agree that this topic needs to be taught to students, researchers have not presented a formalized pathway to support this type of instruction. Evidence: Research on e-professionalism, a concept that addresses an individual's online professional image, was originally presented in 2009 and has continued to be investigated with research supporting its importance. Scholars in the field have found that the cost of having a nonexistent or poor online reputation can cause a lack of trust in the patient-provider relationship and, in extreme situations, can cause healthcare providers to face criminal charges, lose their jobs, or be expelled from healthcare programs. For example, in 2014 an emergency room nurse posted a photo to Instagram of an empty trauma room and was fired from her position for what the hospital called "insensitivity." These types of social media posts have occurred consistently over the last decade, highlighting the need for formalized online professionalism instruction in healthcare education. Implications: This article suggests the use of the extended parallel process model as a guide for healthcare educators to use when creating instruction on issues related to e-professionalism and online reputation management. The extended parallel process model has been successfully used to create health campaigns since the 1970s and is a respected and frequently used health communication model. This article shows that the extended parallel process model supports a systematic approach to e-professionalism instruction that allows it to be easily integrated into existing healthcare curricula.

Public Health Emergency Preparedness System Evaluation Criteria and Performance Metrics: A Review of Contributions of the CDC-Funded Preparedness and Emergency Response Research Centers

OBJECTIVES

The US Centers for Disease Control and Prevention (CDC)-funded Preparedness and Emergency Response Research Centers (PERRCs) conducted research from 2008 to 2015 aimed to improve the complex public health emergency preparedness and response (PHEPR) system. This paper summarizes PERRC studies that addressed the development and assessment of criteria for evaluating PHEPR and metrics for measuring their efficiency and effectiveness.

METHODS

We reviewed 171 PERRC publications indexed in PubMed between 2009 and 2016. These publications derived from 34 PERRC research projects. We identified publications that addressed the development or assessment of criteria and metrics pertaining to PHEPR systems and describe the evaluation methods used and tools developed, the system domains evaluated, and the metrics developed or assessed.

RESULTS

We identified 29 publications from 12 of the 34 PERRC projects that addressed PHEPR system evaluation criteria and metrics. We grouped each study into 1 of 3 system domains, based on the metrics developed or assessed: (1) organizational characteristics (n = 9), (2) emergency response performance (n = 12), and (3) workforce capacity or capability (n = 8). These studies addressed PHEPR system activities including responses to the 2009 H1N1 pandemic and the 2011 tsunami, as well as emergency exercise performance, situational awareness, and workforce willingness to respond. Both PHEPR system process and outcome metrics were developed or assessed by PERRC studies.

CONCLUSIONS

PERRC researchers developed and evaluated a range of PHEPR system evaluation criteria and metrics that should be considered by system partners interested in assessing the efficiency and effectiveness of their activities. Nonetheless, the monitoring and measurement problem in PHEPR is far from solved. Lack of standard measures that are readily obtained or computed at local levels remains a challenge for the public health preparedness field. (Disaster Med Public Health Preparedness. 2019;13:626-638).

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

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 virus disease, and Zika virus disease. 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 semistructured interviews with local health department directors, preparedness staff, and nonpreparedness staff.

SETTING

Interviews were conducted with individuals throughout the United States.

PARTICIPANTS

We interviewed 28 individuals across 3 groups: local health department directors (n = 8), preparedness staff (n = 10), and nonpreparedness 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 vaccines 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.

CONCLUSION

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. As LHDs face the persistent threat of infectious diseases, they must account for response willingness when planning for and fielding emergency responses. Our findings highlight opportunities for local health departments to revisit their internal policies and engage in strategies likely to promote response willingness to infectious disease emergencies among their staff.

Qualitative Assessment of a Novel Efficacy-Focused Training Intervention for Public Health Workers in Disaster Recovery

Objective

We trained local public health workers on disaster recovery roles and responsibilities by using a novel curriculum based on a threat and efficacy framework and a training-of-trainers approach. This study used qualitative data to assess changes in perceptions of efficacy toward Hurricane Sandy recovery and willingness to participate in future disaster recoveries.

Methods

Purposive and snowball sampling were used to select trainers and trainees from participating local public health departments in jurisdictions impacted by Hurricane Sandy in October 2012. Two focus groups totaling 29 local public health workers were held in April and May of 2015. Focus group participants discussed the content and quality of the curriculum, training logistics, and their willingness to engage in future disaster recovery efforts.

Results

The training curriculum improved participants’ understanding of and confidence in their disaster recovery work and related roles within their agencies (self-efficacy); increased their individual- and agency-level sense of role-importance in disaster recovery (response-efficacy); and enhanced their sense of their agencies’ effective functioning in disaster recovery. Participants suggested further training customization and inclusion of other recovery agencies.

Conclusion

Threat- and efficacy-based disaster recovery trainings show potential to increase public health workers’ sense of efficacy and willingness to participate in recovery efforts. (Disaster Med Public Health Preparedness. 2016;10:615–622)

Examining Public Health Workers' Perceptions Toward Participating in Disaster Recovery After Hurricane Sandy: A Quantitative Assessment

OBJECTIVE

We aimed to quantitatively gauge local public health workers' perceptions toward disaster recovery role expectations among jurisdictions in New Jersey and Maryland affected by Hurricane Sandy.

METHODS

An online survey was made available in 2014 to all employees in 8 Maryland and New Jersey local health departments whose jurisdictions had been impacted by Hurricane Sandy in October 2012. The survey included perceptions of their actual disaster recovery involvement across 3 phases: days to weeks, weeks to months, and months to years. The survey also queried about their perceptions about future involvement and future available support.

RESULTS

Sixty-four percent of the 1047 potential staff responded to the survey (n=669). Across the 3 phases, 72% to 74% of the pre-Hurricane Sandy hires knew their roles in disaster recovery, 73% to 75% indicated confidence in their assigned roles (self-efficacy), and 58% to 63% indicated that their participation made a difference (response efficacy). Of the respondents who did not think it likely that they would be asked to participate in future disaster recovery efforts (n=70), 39% indicated a willingness to participate.

CONCLUSION

The marked gaps identified in local public health workers' awareness of, sense of efficacy toward, and willingness to participate in disaster recovery efforts after Hurricane Sandy represent a significant infrastructural concern of policy and programmatic relevance. (Disaster Med Public Health Preparedness. 2016;10:371-377).

The analysis of factors affecting municipal employees' willingness to report to work during an influenza pandemic by means of the extended parallel process model (EPPM)

Background

The management of pandemics with highly infectious diseases in modern urban habitats depends largely on the maintenance of public services. Understanding the factors that influence municipal employees’ willingness to come to work during a pandemic is therefore a basic requirement for adequate public health preparedness. In this study the extended parallel process model (EPPM) is applied to investigate how the readiness of municipal employees to report to work during an influenza pandemic (IP) is affected by individual attitudes and environmental conditions.

Methods

1.566 employees of a major German city participated in a cross-sectional online survey. The questions of the survey covered the dimensions of risk perception, role competence, self-efficacy, role importance, sense of duty, and willingness to report to work in the case of an IP. Data were analysed by means of path analyses.

Results

Data suggest that up to 20 % of the public service workers were not willing to come to work during an IP. Willingness to report to work was increased by the perception of a high working role competence, a high assessment of role importance, high self-efficacy expectations, and a high sense of duty. Negative effects on willingness to report to work were identified as the perception of a high risk to become infected at work and the perceived risk to infect family members. The decomposition of direct and indirect effects provided important insights into the interrelationships between model variables.

Conclusions

Measures to increase municipal workers’ willingness to report to work in case of an infectious pandemic should include communication strategies to inform employees clearly about their particular tasks during such critical events and training exercises to increase their confidence in their competences and skills to fulfil these tasks.

Attitudinal Determinants of Local Public Health Workers' Participation in Hurricane Sandy Recovery Activities

Local health departments play a critical role in short-, intermediate-, and long-term recovery activities after a public health emergency. However, research has not explored attitudinal determinants of health department workers' participation in the recovery phase following a disaster. Accordingly, this qualitative investigation aims to understand perceived facilitators and barriers to performing recovery-related activities following Hurricane Sandy among local health department workers. In January 2014, 2 focus groups were conducted in geographically representative clusters of local health departments affected by Hurricane Sandy (1 cluster in Maryland and 1 cluster in New Jersey). Focus groups were recorded, transcribed verbatim, and analyzed to qualitatively assess attitudes toward Hurricane Sandy recovery activities. This analysis identified 5 major thematic categories as facilitators and barriers to participation in recovery activities: training, safety, family preparedness, policies and planning, and efficacy. Systems that support engagement of health department personnel in recovery activities may endeavor to develop and communicate intra- and interjurisdictional policies that minimize barriers in these areas. Development and implementation of evidence-informed curricular interventions that explain recovery roles may also increase local health department worker motivation to participate in recovery activities.

Willingness of the local health department workforce to respond to infectious disease events: empirical, ethical, and legal considerations

According to the Institute of Medicine, the local health department workforce is at the hub of the public health emergency preparedness system. A growing body of research has pointed to troubling attitudinal gaps among local health department workers, a vital response cohort, regarding willingness to respond to emergent infectious disease threats, ranging from naturally occurring pandemics to bioterrorism events. A summary of relevant literature on the empirical evidence, ethical norms, and legal standards applicable to the willingness of public health professionals to respond to an infectious disease emergency is presented. Recommendations are proposed for future work to be done to bring the relevant empirical, ethical, and legal considerations together to develop practical guidance for the local response to infectious disease emergencies.