Optimizing health care workers’ (HCWs) willingness to respond (WTR) is critical in low-and-middle-income countries (LMICs) for proper health system functioning during extreme weather events. Pakistan frequently experiences weather-related disasters, but limited evidence is available to examine HCW willingness. Our study examined the association between WTR and behavioral factors among emergency department HCWs.

A cross-sectional survey was conducted from August to September 2022 among HCWs from 2 hospitals in Karachi, Pakistan. Non-probability purposive sampling was used to recruit participants. A survey tool was informed by Witte’s Extended Parallel Process Model (EPPM). Multivariate logistic regression analyses were performed to examine the association between WTR and attitudes/beliefs as well as EPPM profiles.

Twenty-nine percent of HCWs indicated a low WTR. HCWs using public transportation had a higher WTR. Perceived knowledge and skills, self-efficacy, and perceived impact of one’s response showed positive associations with WTR if required. Perception that one’s colleagues would report to work positively predicted WTR if asked. Consistent with the EPPM, HCWs with high efficacy and perceived threat were willing to respond to weather disasters.

Our findings highlight the need of strengthening WTR by promoting self-efficacy and enhancing accurate risk perception as a response motivator, among emergency department HCWs in Pakistan.

Infectious disease emergencies are increasingly becoming part of the health care delivery landscape, having implications to not only individuals and the public, but also on those expected to respond to these emergencies. Health care workers (HCWs) are perhaps the most important asset in an infectious disease emergency, yet these individuals have their own barriers and facilitators to them being willing or able to respond.

The purpose of this review was to identify factors affecting HCW willingness to respond (WTR) to duty during infectious disease outbreaks and/or bioterrorist events.

An integrative literature review methodology was utilized to conduct a structured search of the literature including CINAHL, Medline, Embase, and PubMed databases using key terms and phrases. PRISMA guidelines were used to report the search outcomes and all eligible literature was screened with those included in the final review collated and appraised using a quality assessment tool.

A total of 149 papers were identified from the database search. Forty papers were relevant following screening, which highlighted facilitators of WTR to include: availability of personal protective equipment (PPE)/vaccine, level of training, professional ethics, family and personal safety, and worker support systems. A number of barriers were reported to prevent WTR for HCWs, such as: concern and perceived risk, interpersonal factors, job-level factors, and outbreak characteristics.

By comprehensively identifying the facilitators and barriers to HCWs’ WTR during infectious disease outbreaks and/or bioterrorist events, strategies can be identified and implemented to improve WTR and thus improve HCW and public safety.

Firefighting is an important profession during disasters. Firefighters are on duty for many vital functions, including fire extinguishing, search and rescue work, and evacuation of disaster victims to a safe zone. In case of a disaster situation, it is vital to have willing personnel to work in disasters. In the literature, type of disaster, individual demographic factors, family factors, and workplace factors have been identified as factors that influence health care personnel’s willingness to work during a disaster. However, little is known about firefighters and firefighter candidates’ willingness to work in a disaster.

This study was aimed to identify the willingness of civil defense and firefighting program students to work in different disasters after graduation and the factors associated with their willingness.

The universe of this descriptive, epidemiological study was 1,116 students of civil defense and firefighting programs in Turkey. They were from 11 different universities. In the research study, a sample was not chosen as it was aimed at reaching the whole universe. A standardized survey form of 58 questions, prepared by researchers, was used to gather data.

The rate of participation was 65.5%. Of the students, 82.8% said that after graduation they would like to work in disasters, whereas 16.2% were indecisive. The students were less willing to work in nuclear accidents (42.4%) and epidemic disasters (32.1%). In chi-square analysis, “willingness of students to work in disasters after graduation” (dependent variable) and the independent variables: “university of student,” “exercising regularly,” “having a hobby related to disaster,” “having been educated about disaster,” and “being satisfied from the received education” were found statistically significant. When students’ willingness to work in disasters after graduation (ref=unwilling) was analyzed with multi-variate analysis, only “university of students” and “having a hobby related to disasters” were found statistically significant.

Overall, 16.2% of the students stated that they were indecisive to work in disasters in the future, and 1.0% of them stated that they did not want to work in disasters. Moreover, willingness of students to work in nuclear accident and contagious disease disasters has been found to be lower compared to other disaster types.

KayaE, AltintasH. Willingness of Firefighting Program Students to Work in Disasters—Turkey. Prehosp Disaster Med. 2018;33(1):13–22.

For effective responses to emergencies, individuals must have the ability to respond and also be willing to participate in the response. A growing body of research points to gaps in response willingness among several occupational cohorts with response duties, including the Emergency Medical Services (EMS) workforce. Willingness to respond is particularly important during an influenza or other pandemic, due to increased demands on EMS workers and the potential for workforces to be depleted if responders contract influenza or stay home to care for sick dependents. State emergency preparedness laws are one possible avenue to improve willingness to respond.

Presence of certain state-level emergency preparedness laws (ie, ability to declare a public health emergency; requirement to create a public health emergency plan; priority access to health resources for responders) is associated with willingness to respond among EMS workers.

Four hundred twenty-one EMS workers from the National Registry of Emergency Medical Technicians’ (NREMT's) mid-year Longitudinal EMT Attributes and Demographics Study (LEADS) were studied. The survey, which included questions about willingness to respond during an influenza pandemic, was fielded from May through June 2009. Survey data were merged with data about the presence or absence of the three emergency preparedness laws of interest in each of the 50 US states. Unadjusted logistic regression analyses were performed with the presence/absence of each law and were adjusted for respondents’ demographic/locale characteristics.

Compared to EMS workers in states that did not allow the government to declare a public health emergency, those in states that permitted such declarations were more likely to report that they were willing to respond during an influenza pandemic. In adjusted and unadjusted analyses, this difference was not statistically significant. Similar results were found for the other state-level emergency preparedness laws of interest.

While state-level emergency preparedness laws are not associated with willingness to respond, recent research suggests that inconsistencies between the perceived and objective legal environments for EMS workers could be an alternative explanation for this study's findings. Educational efforts within the EMS workforce and more prominent state-level implementation of emergency preparedness laws should be considered as a means to raise awareness of these laws. These types of actions are important steps toward determining whether state-level emergency preparedness laws have the potential to promote response willingness among EMS workers.

RutkowL , VernickJS , ThompsonCB , PirralloRG , BarnettDJ . Emergency Preparedness Law and Willingness to Respond in the EMS Workforce. Prehosp Disaster Med. 2014;29(4):1-6.