title: Comprehensive systematic review of healthcare workers' perceptions of risk and use of coping strategies towards emerging respiratory infectious diseases.
abstract: OBJECTIVE
  To determine healthcare workers' perceptions of risk from exposure to emerging acute respiratory infectious diseases and the perceived effectiveness of strategies used to facilitate healthy coping in acute hospital and community healthcare settings.
  
  
  METHODS
  Electronic databases (Cumulative Index to Nursing and Allied Health Literature, Ovid, PubMed, ScienceDirect, Scopus and Wiley InterScience) were searched using a three-step search strategy to identify the relevant quantitative and qualitative studies published in English from 1997 to 2009. The grey literature was not included in the review. The identified studies were evaluated using the Meta-Analysis of Statistics, Assessment and Review Instrument and the Qualitative Assessment and Review Instrument from the Joanna Briggs Institute. Fourteen quantitative studies were included and the findings included in a narrative summary. The findings from the two qualitative studies were categorised into a meta-synthesis that generated two synthesised findings.
  
  
  RESULTS
  Findings indicated that healthcare workers perceived personal and familial health risks and stigmatisation from their exposure to emerging acute respiratory infectious diseases, but the majority were accepting of these risks. Organisational implementation of infection control measures, avoidance of patients and complying with personal protective equipment were identified as risk-mitigating strategies. Demographic, individual and organisational factors were found to influence their risk perceptions and their adoption of strategies to mitigate the risk.
  
  
  CONCLUSIONS
  It appears that healthcare workers' risk perceptions can influence their behaviour towards patients with emerging acute respiratory infectious diseases as well as their use of risk-mitigating strategies. Institutions need to ensure that appropriate infection control safeguards are in place to protect workers and their families. Institutions can also offer incentives to encourage healthcare workers to comply with the policies and procedures introduced to mitigate risk.
  
  
  CONCLUSIONS
  Institutions and government need to ensure that policies and procedures are communicated and adequate institutional measures (i.e. personal protective equipment; education and training; and personal support) are implemented to safeguard healthcare workers during and after pandemic outbreaks.
  
  
  CONCLUSIONS
  Future research needs to examine how perception of risk related to acute emerging respiratory infectious diseases, epidemic or pandemic, and the factors that would influence healthcare workers': decisions to stay within the workforce and provide care or resign from the workforce and compliance with institutional and government policies and procedures, as well as compliance to use of personal protective equipment.
authors.affiliation: Alice Lee Center for Nursing Studies, National University of Singapore, Singapore School of Population Health, The University of Western Australia, Australia. yiwenkoh87@gmail.com
authors.forename: Yiwen
authors.initials: Y
authors.lastname: Koh
authors.forename: Desley Gail
authors.initials: DG
authors.lastname: Hegney
authors.forename: Vicki
authors.initials: V
authors.lastname: Drury
mesh_terms: D000223:Adaptation, Psychological; D001291:Attitude of Health Personnel; D004196:Disease Outbreaks; D005239:Fear; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D011369:Professional-Patient Relations; D012141:Respiratory Tract Infections / Q000523:psychology; D012306:Risk; D045169:Severe Acute Respiratory Syndrome / Q000523:psychology*; D012938:Social Perception; D013315:Stress, Psychological