title: Assessment of local public health workers' willingness to respond to pandemic influenza through application of the extended parallel process model.
abstract: BACKGROUND
  Local public health agencies play a central role in response to an influenza pandemic, and understanding the willingness of their employees to report to work is therefore a critically relevant concern for pandemic influenza planning efforts. Witte's Extended Parallel Process Model (EPPM) has been found useful for understanding adaptive behavior in the face of unknown risk, and thus offers a framework for examining scenario-specific willingness to respond among local public health workers. We thus aim to use the EPPM as a lens for examining the influences of perceived threat and efficacy on local public health workers' response willingness to pandemic influenza.
  
  
  RESULTS
  We administered an online, EPPM-based survey about attitudes/beliefs toward emergency response (Johns Hopkins approximately Public Health Infrastructure Response Survey Tool), to local public health employees in three states between November 2006-December 2007. A total of 1835 responses were collected for an overall response rate of 83%. With some regional variation, overall 16% of the workers in 2006-7 were not willing to "respond to a pandemic flu emergency regardless of its severity". Local health department employees with a perception of high threat and high efficacy--i.e., those fitting a 'concerned and confident' profile in the EPPM analysis--had the highest declared rates of willingness to respond to an influenza pandemic if required by their agency, which was 31.7 times higher than those fitting a 'low threat/low efficacy' EPPM profile.
  
  
  CONCLUSIONS
  In the context of pandemic influenza planning, the EPPM provides a useful framework to inform nuanced understanding of baseline levels of--and gaps in--local public health workers' response willingness. Within local health departments, 'concerned and confident' employees are most likely to be willing to respond. This finding may allow public health agencies to design, implement, and evaluate training programs focused on emergency response attitudes in health departments.
authors.affiliation: Johns Hopkins Center for Public Health Preparedness, Baltimore, Maryland, United States of America. dbarnett@jhsph.edu
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Barnett
authors.forename: Ran D
authors.initials: RD
authors.lastname: Balicer
authors.forename: Carol B
authors.initials: CB
authors.lastname: Thompson
authors.forename: J Douglas
authors.initials: JD
authors.lastname: Storey
authors.forename: Saad B
authors.initials: SB
authors.lastname: Omer
authors.forename: Natalie L
authors.initials: NL
authors.lastname: Semon
authors.forename: Steve
authors.initials: S
authors.lastname: Bayer
authors.forename: Lorraine V
authors.initials: LV
authors.lastname: Cheek
authors.forename: Kerry W
authors.initials: KW
authors.lastname: Gateley
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Lanza
authors.forename: Jane A
authors.initials: JA
authors.lastname: Norbin
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Slemp
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Links
mesh_terms: D001291:Attitude of Health Personnel; D006801:Humans; D007251:Influenza, Human / Q000453:epidemiology*; D015980:Public Health Practice; D014481:United States / Q000453:epidemiology