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Carter P, Megnin-Viggars O, Rubin GJ. What Factors Influence Symptom Reporting and Access to Healthcare During an Emerging Infectious Disease Outbreak? A Rapid Review of the Evidence. Health Secur 2021; 19:353-363. [PMID: 33416425 PMCID: PMC8403196 DOI: 10.1089/hs.2020.0126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
During any emerging infectious disease outbreak, people with symptoms of the illness are asked to report to a health service immediately to facilitate contact tracing. Several factors may influence a person's willingness to report symptoms and their ability to access healthcare services. Understanding these factors has become urgent during the COVID-19 pandemic. To determine which factors influence symptom reporting during an emerging infectious disease outbreak, we conducted a rapid review of the evidence. Studies included in the review were based on primary research, published in a peer-reviewed journal, written in English, included factors associated with symptom reporting or accessing healthcare, and were related to a major public health incident involving an infectious disease outbreak. Five themes were identified as facilitators of symptom reporting or accessing healthcare: accurate and informative communication about the disease and the need to seek help, symptom severity, concern about disease exposure, ease of access to healthcare facilities, and relationship with the healthcare provider. Seven themes were identified as barriers to symptom reporting or accessing healthcare: lack of knowledge of the disease and its treatment, fear of the disease and fear of subsequent treatments or requirements, stigmatization attached to having a disease, invasion of privacy, low concern about symptoms, economic consequences of disease diagnosis, and challenges related to attending a healthcare facility. For contract tracing services to be effective, members of the public need to have the capability, opportunity, and motivation to use them. The themes identified should be used to evaluate information provided to the public to ensure as many people as possible with relevant symptoms report them to a healthcare provider.
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Affiliation(s)
- Patrice Carter
- Patrice Carter, PhD, and Odette Megnin-Viggars, PhD, are Senior Systematic Reviewers; both at the Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK. Patrice Carter is also a Senior Systematic Reviewer, Health Economics & Outcomes Research Ltd, Cardiff, UK. G. James Rubin, PhD, is Assistant Director, Health Protection Unit in Emergency Preparedness and Response, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Odette Megnin-Viggars
- Patrice Carter, PhD, and Odette Megnin-Viggars, PhD, are Senior Systematic Reviewers; both at the Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK. Patrice Carter is also a Senior Systematic Reviewer, Health Economics & Outcomes Research Ltd, Cardiff, UK. G. James Rubin, PhD, is Assistant Director, Health Protection Unit in Emergency Preparedness and Response, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - G James Rubin
- Patrice Carter, PhD, and Odette Megnin-Viggars, PhD, are Senior Systematic Reviewers; both at the Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK. Patrice Carter is also a Senior Systematic Reviewer, Health Economics & Outcomes Research Ltd, Cardiff, UK. G. James Rubin, PhD, is Assistant Director, Health Protection Unit in Emergency Preparedness and Response, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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Prue CE, Williams PN, Joseph HA, Johnson M, Wojno AE, Zulkiewicz BA, Macom J, Alexander JP, Ray SE, Southwell BG. Factors That Mattered in Helping Travelers From Countries With Ebola Outbreaks Participate in Post-Arrival Monitoring During the 2014-2016 Ebola Epidemic. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2019; 56:46958019894795. [PMID: 31847642 PMCID: PMC6920593 DOI: 10.1177/0046958019894795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
During the 2014-2016 Ebola epidemic in West Africa, the US Centers for Disease Control and Prevention (CDC) developed the CARE+ program to help travelers arriving to the United States from countries with Ebola outbreaks to meet US government requirements of post-arrival monitoring. We assessed 2 outcomes: (1) factors associated with travelers’ intention to monitor themselves and report to local or state public health authority (PHA) and (2) factors associated with self-reported adherence to post-arrival monitoring and reporting requirements. We conducted 1195 intercept in-person interviews with travelers arriving from countries with Ebola outbreaks at 2 airports between April and June 2015. In addition, 654 (54.7%) of these travelers participated in a telephone interview 3 to 5 days after intercept, and 319 (26.7%) participated in a second telephone interview 2 days before the end of their post-arrival monitoring. We used regression modeling to examine variance in the 2 outcomes due to 4 types of factors: (1) programmatic, (2) perceptual, (3) demographic, and (4) travel-related factors. Factors associated with the intention to adhere to requirements included clarity of the purpose of screening (B = 0.051, 95% confidence interval [CI], 0.011-0.092), perceived approval of others (B = 0.103, 95% CI, 0.058-0.148), perceived seriousness of Ebola (B = 0.054, 95% CI, 0.031-0.077), confidence in one’s ability to perform behaviors (B = 0.250, 95% CI, 0.193-0.306), ease of following instructions (B = 0.053, 95% CI, 0.010-0.097), and trust in CARE Ambassador (B = 0.056, 95% CI, 0.009-0.103). Respondents’ perception of the seriousness of Ebola was the single factor associated with adherence to requirements (odds ratio [OR] = 0.81, 95% CI, 0.673-0.980, for non-adherent vs adherent participants and OR = 0.86, 95% CI, 0.745-0.997, for lost to follow-up vs adherent participants). Results from this assessment can guide public health officials in future outbreaks by identifying factors that may affect adherence to public health programs designed to prevent the spread of epidemics.
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Affiliation(s)
| | | | | | | | - Abbey E Wojno
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - John Macom
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Sarah E Ray
- RTI International, Research Triangle Park, NC, USA
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Public Health Resilience Checklist for High-Consequence Infectious Diseases-Informed by the Domestic Ebola Response in the United States. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2019; 24:510-518. [PMID: 29595573 DOI: 10.1097/phh.0000000000000787] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
CONTEXT The experiences of communities that responded to confirmed cases of Ebola virus disease in the United States provide a rare opportunity for collective learning to improve resilience to future high-consequence infectious disease events. DESIGN Key informant interviews (n = 73) were conducted between February and November 2016 with individuals who participated in Ebola virus disease planning or response in Atlanta, Georgia; Dallas, Texas; New York, New York; or Omaha, Nebraska; or had direct knowledge of response activities. Participants represented health care; local, state, and federal public health; law; local and state emergency management; academia; local and national media; individuals affected by the response; and local and state governments. Two focus groups were then conducted in New York and Dallas, and study results were vetted with an expert advisory group. RESULTS Participants focused on a number of important areas to improve public health resilience to high-consequence infectious disease events, including governance and leadership, communication and public trust, quarantine and the law, monitoring programs, environmental decontamination, and waste management. CONCLUSIONS Findings provided the basis for an evidence-informed checklist outlining specific actions for public health authorities to take to strengthen public health resilience to future high-consequence infectious disease events.
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Joseph HA, Wojno AE, Winter K, Grady-Erickson O, Hawes E, Benenson GA, Lee A, Cetron M. The Check and Report Ebola (CARE+) Program to Monitor Travelers for Ebola After Arrival to the United States, 2014-2016. Public Health Rep 2019; 134:592-598. [PMID: 31600452 PMCID: PMC6832084 DOI: 10.1177/0033354919878165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The 2014-2016 Ebola epidemic in West Africa influenced how public health officials considered migration and emerging infectious diseases. Responding to the public's concerns, the US government introduced enhanced entry screening and post-arrival monitoring by public health authorities to reduce the risk of importation and domestic transmission of Ebola while continuing to allow travel from West Africa. This case study describes a new initiative, the Check and Report Ebola (CARE+) program that engaged travelers arriving to the United States from countries with Ebola outbreaks. The Centers for Disease Control and Prevention employed CARE ambassadors, who quickly communicated with incoming travelers and gave them practical resources to boost their participation in monitoring for Ebola. The program aimed to increase travelers' knowledge of Ebola symptoms and how to seek medical care safely, increase travelers' awareness of monitoring requirements, reduce barriers to monitoring, and increase trust in the US public health system. This program could be adapted for use in future outbreaks that involve the potential importation of disease and require the education and active engagement of travelers to participate in post-arrival monitoring.
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Affiliation(s)
- Heather A. Joseph
- Division of Global Migration and Quarantine, Centers for Disease Control and
Prevention, Atlanta, GA, USA
| | - Abbey E. Wojno
- Division of Global Migration and Quarantine, Centers for Disease Control and
Prevention, Atlanta, GA, USA
| | - Kelly Winter
- Division of Global Migration and Quarantine, Centers for Disease Control and
Prevention, Atlanta, GA, USA
| | - Onalee Grady-Erickson
- Division of Global Migration and Quarantine, Centers for Disease Control and
Prevention, Atlanta, GA, USA
| | - Erin Hawes
- Eagle Medical Services, LLC, for Division of Global Migration and
Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gabrielle A. Benenson
- Division of Global Migration and Quarantine, Centers for Disease Control and
Prevention, Atlanta, GA, USA
| | - Amanda Lee
- Division of Global Migration and Quarantine, Centers for Disease Control and
Prevention, Atlanta, GA, USA
| | - Martin Cetron
- Division of Global Migration and Quarantine, Centers for Disease Control and
Prevention, Atlanta, GA, USA
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Active monitoring versus direct active monitoring for Ebola virus disease in the United States: experiences and perceptions of former persons under monitoring in the District of Columbia and Indiana. Public Health 2019; 173:9-16. [DOI: 10.1016/j.puhe.2019.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/12/2019] [Accepted: 04/27/2019] [Indexed: 11/22/2022]
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Saffa A, Tate A, Ezeoke I, Jacobs-Wingo J, Iqbal M, Baumgartner J, Fine A, Perri BR, McIntosh N, Levy Stennis N, Lee K, Peterson E, Jones L, Helburn L, Heindrichs C, Guthartz S, Chamany S, Starr D, Scaccia A, Raphael M, Varma JK, Vora NM. Active Monitoring of Travelers for Ebola Virus Disease-New York City, October 25, 2014-December 29, 2015. Health Secur 2018; 16:8-13. [PMID: 29406796 DOI: 10.1089/hs.2017.0077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The CDC recommended active monitoring of travelers potentially exposed to Ebola virus during the 2014 West African Ebola virus disease outbreak, which involved daily contact between travelers and health authorities to ascertain the presence of fever or symptoms for 21 days after the travelers' last potential Ebola virus exposure. From October 25, 2014, to December 29, 2015, the New York City Department of Health and Mental Hygiene (DOHMH) monitored 5,359 persons for Ebola virus disease, corresponding to 5,793 active monitoring events. Most active monitoring events were in travelers classified as low (but not zero) risk (n = 5,778; 99%). There were no gaps in contact with DOHMH of ≥2 days during 95% of active monitoring events. Instances of not making any contact with travelers decreased after CDC began distributing mobile telephones at the airport. Ebola virus disease-like symptoms or a temperature ≥100.0°F were reported in 122 (2%) active monitoring events. In the final month of active monitoring, an optional health insurance enrollment referral was offered for interested travelers, through which 8 travelers are known to have received coverage. Because it is possible that active monitoring will be used again for an infectious threat, the experience we describe might help to inform future such efforts.
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