title: Concerns, perceived impact and preparedness in an avian influenza pandemic--a comparative study between healthcare workers in primary and tertiary care.
abstract: BACKGROUND
  With the potential threat of an avian influenza (AI) pandemic, healthcare workers (HCWs) are expected to play important roles, and they encounter significant stress levels from an expected increase in workload. We compared the concerns, perceived impact and preparedness for an AI pandemic between HCWs working in public primary care clinics and a tertiary healthcare setting.
  
  
  METHODS
  An anonymous, self-administered questionnaire was given to 2459 HCWs working at 18 public polyclinics (PCs) and a tertiary hospital (TH) in Singapore from March to June 2006. The questionnaire assessed work-related and non-work-related concerns, perceived impact on personal life and work as well as workplace preparedness.
  
  
  RESULTS
  We obtained responses from 986 PC and 873 TH HCWs (response rate: 74.6% and 76.7%). The majority in both groups were concerned about the high AI risk from their occupation (82.7%) and falling ill with AI (75.9%). 71.9% accepted the risk but 25.5% felt that they should not be looking after AI patients with 15.0% consider resigning. HCWs also felt that people would avoid them (63.5%) and their families (54.1%) during a pandemic. The majority expected an increased workload and to feel more stressed at work. For preparedness, 74.2% felt personally prepared and 83.7% felt that their workplaces were prepared for an outbreak. TH HCWs were more likely to be involved in infection-control activities but the perception of infection-control preparedness in both groups was high (>80.0%).
  
  
  CONCLUSIONS
  HCWs in both public primary and tertiary healthcare settings felt prepared, personally and in their workplaces, for a pandemic. Their main concerns were risks of falling ill from exposure and the possibility of social ostracism of themselves and their families. Preparedness levels appeared high in the majority of HCWs. However, concerns of HCWs could affect their overall effectiveness in a pandemic and should be addressed by incorporating strategies to manage them in pandemic planning.
authors.affiliation: Department of Community, Occupational and Family Medicine, National University of Singapore, Singapore. cofwty@nus.edu.sg
authors.forename: Teck Yee
authors.initials: TY
authors.lastname: Wong
authors.forename: Gerald Ch
authors.initials: GCh
authors.lastname: Koh
authors.forename: Seng Kwing
authors.initials: SK
authors.lastname: Cheong
authors.forename: Heow Yong
authors.initials: HY
authors.lastname: Lee
authors.forename: Yuke Tien
authors.initials: YT
authors.lastname: Fong
authors.forename: Meena
authors.initials: M
authors.lastname: Sundram
authors.forename: Kelvin
authors.initials: K
authors.lastname: Koh
authors.forename: Sin Eng
authors.initials: SE
authors.lastname: Chia
authors.forename: David
authors.initials: D
authors.lastname: Koh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D001291:Attitude of Health Personnel; D001717:Birds; D004189:Disaster Planning; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control; D053124:Influenza A Virus, H5N1 Subtype / Q000472:pathogenicity; D005585:Influenza in Birds / Q000635:transmission*; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission / Q000821:virology; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012846:Singapore