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.

Methodology/principal findings: 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/significance: 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.

Figure 1. Extended Parallel Process Model.

Witte's Extended Parallel Process Model (EPPM) describes how people, when faced with a potential hazard, will sequentially appraise the threat and efficacy content of related health and safety protection messages, and will respond accordingly. The first appraisal is for threat [threat appraisal]. The threat appraisal has two components: severity and susceptibility. If, in the threat appraisal, the message recipient personally perceives the hazard to be of negligible consequence (low severity) or improbable (low susceptibility), any related message content encouraging a desired protection-oriented response or behavior will be rejected. If, however, the message passes the threat appraisal, the message recipient will next process the message's content for efficacy [efficacy appraisal]. The efficacy appraisal contains two components: self-efficacy and response efficacy. If the message recipient does not find the message's targeted behavior to be achievable (low self-efficacy) or efficacious (low response efficacy), the message recipient will engage in undesirable responses such as denial and avoidance in order to manage fear (described as “fear control” in the EPPM); this will be accompanied by message rejection. If, however, the efficacy appraisal is also passed, message acceptance will result, leading to adoption of the message's intended protective behavior change outcomes by taking desirable steps to minimize personal risk against the actual hazard (described as “danger control” in the EPPM).