Healthcare workers’ willingness to respond to duty during infectious disease outbreaks in low- and middle-income countries in the Western Pacific Region: a pilot study in Papua New Guinea

Introduction

Infectious disease outbreaks and emergencies are on the rise worldwide and are hazardous to the health and well-being of the community.¹ Health care workers (HCWs) are frontline responders who play a critical role during infectious disease outbreaks and are highly exposed to causative pathogens at work as well as in the community. They are thus at a higher risk of becoming infected.^2–4 Health care workers may be willing to work despite the risks, but often hesitate to respond to duty when they realise that the health emergencies they are dealing with can endanger their lives or those of their colleagues or family members.^3,5 Their willingness to work may also depend on the risk assessments and awareness relayed to them by their employers.⁵ During disease outbreaks, the willingness to respond (WTR) by this workforce is of paramount importance because they provide the care, safety precautions, and awareness to patients and the general population needed to reduce the severity of the outbreak.^1,6,7

Studies have shown that the barriers and enablers that influence HCWs WTR depend on the type of job, the disease and causative pathogen, post-exposure experiences, and the job description during the disease outbreak emergency.^1,2,4 Also influencing HCWs WTR is the extent to which a country may be affected, as different countries have different healthcare systems, social and cultural norms, and the capacity to deal with the outbreak.^4,8 In addition, psychological aspects can affect the willingness of HCWs to respond to duty.⁹ The fear of contracting and spreading the disease to their patients and family members due to inadequate personal protective equipment, uneven distribution of equipment and support, lack of guidelines or regular communication, and the frequent revision of policies and procedures have affected their psychological status.^4,10 Workplace preparedness, appropriate education, and adequate training on infection prevention and control are vital to enhance their willingness to work as these also reduce work-related psychological pressure and the fear of infecting family members.^11,12 It is therefore difficult to determine the willingness of HCWs to respond to duty during infectious disease emergencies.^6,8,10

The reported factors influencing HCWs WTR have been primarily identified from studies performed in high-income countries (HIC).^1,2,12,13 The challenges encountered by HCWs in HIC are also faced by HCWs in low- and middle-income countries (LMICs), however, these challenges may be worse in LMICs as already overstretched health systems struggle to deal with new disease outbreaks.^4,10,14 There is very limited literature on WTR in LMIC settings, with only one recent study available. A recent study discussed HCWs WTR to duty during an infectious disease outbreak but did not explore the factors that influence HCWs WTR.¹⁵ Very little is known about HCWs WTR during infectious disease outbreaks in Papua New Guinea and other LMICs.

The aim of this study was to assess the suitability of a survey tool previously deployed in a HIC context for deployment in LMIC settings (such as Papua New Guinea and other countries in the Western Pacific Region), to identify factors influencing HCWs WTR to duty during infectious disease outbreak.

Method

A cross-sectional study design was undertaken utilising a pre-existing survey tool, with the permission of the original author.¹⁶ It was modified by the research team to be used in a LMIC setting to identify factors influencing HCWs WTR.¹⁶ The modified survey tool focused on sociodemographic characteristics and factors influencing WTR, and the tool suitability was evaluated in a LMIC setting.

Results

Discussion

This study has demonstrated that a survey initially deployed in a high-income setting can be successfully deployed in a LMIC context. Based on the available literature, this survey is the first pilot study trialled in a LMIC setting to examine HCW’s attitudes and perceptions and identify factors influencing their WTR during an infectious disease outbreak. The survey was disseminated to the participants manually as this was convenient for data generation in the setting. Most of the HCWs revealed that this study was an eye-opening experience for them and allowed them to express their opinions freely. All the respondents accepted the survey because it was simplified and translated into a language that is well understood, and the tool was found to be appropriate and suitable to use in a LMIC setting.

During infectious disease outbreaks WTR by the healthcare workforce depends on their perceptions and understanding of multiple factors which allows them to decide whether to respond to work or not. Factors influencing HCWs WTR have been previously identified from studies performed in HIC.¹⁹ Willingness to respond depends on the type of job, the type of disease outbreak or health emergency, and influencing factors such as concerns about personal and family safety, and workplace preparedness.¹ This study highlighted that almost three quarters of the HCWs would report to work if directed by their employer during a disease outbreak, similar to a previous study from the United States of America (USA).⁸

Furthermore, most respondents believed that it is their responsibility to go to work during a disease outbreak. This study has highlighted that HCWs believe it is unethical to refuse to work during infectious disease outbreaks and they are willing to respond to duty. Previous studies have highlighted that a sense of duty and professional obligation motivates HCWs to respond despite the challenges they may encounter during disease outbreak emergencies, a theme repeated here.^3–5 The study presented here has shown that HCWs believed that their role would be important during a disease outbreak at a higher rate than reported in the USA, suggesting that it is important to inform HCWs about what is expected of them and of their responsibilities. ⁸

Interestingly, more than 60% of respondents were unsure if their co-workers would attend work. This matches previous results despite the higher rate of respondents here reporting that they themselves would attend work.⁸ Over half stated that they are prepared to work long hours although at lower rates than previous studies done in Saudi Arabia (74.3%) and the USA (75.5%).^8,9 These findings show HCWs believe that their employer would provide them with adequate supply of personal protective equipment. This has been previously identified as important with a study from the United Kingdom reporting that 97.2% of staff indicated that for them to work, it is the responsibility of the employer to provide personal protective equipment for HCWs.⁵ Less than half of the HCWs in this study agreed that they felt safe performing their normal duties during disease outbreaks because most HCWs are concerned about their personal safety and the fear of infecting their family members, which has been reported frequently in other studies.^14,19,20 Apart from providing adequate personal protective equipment and other necessary equipment, many respondents in this study highlighted that their WTR would be enhanced if they were provided with transport, temporary accommodation, paid incentives, appropriate care if infected during their work, and if proper infection prevention and control measures were in place. This is similar to previous studies.^{5,8–10,13,19} It has also been reported that by providing extra training, staff would be willing to undertake extra duties during disease outbreaks, a sentiment repeated here.^6,7,20

Healthcare worker WTR can improve if their welfare and the welfare of their families are catered for, such as providing appropriate vaccines, medications, and psychological support. Findings arising from this study indicate that HCW WTR was high if provided with medication and vaccines to prevent illness during the course of their duty. Studies undertaken in Saudi Arabia and the USA reported similar findings. ^8,9 Previous studies have also highlighted that provision of appropriate medications, antiviral therapy, and prophylaxis for HCWs and their family to prevent illness would enhance their WTR.^1,2,8,13

Conclusion

Healthcare workers WTR can be a challenge during an infectious disease outbreak and with increasing numbers of outbreaks, HCWs’ attitudes and perceptions change due to the fear of being infected or potentially spreading the disease to their family members. Factors that influence their willingness, such as availability of personal protective equipment, transport, temporary accommodation and provision of training, appropriate medications, and vaccines are important predictors that can be used to support planning. The survey tool utilised in this pilot study has been shown to be convenient and appropriate for use in Papua New Guinea and potentially other LMIC. This study has highlighted that many issues are similar to those in high-income settings and are essential for policy makers to consider when developing preparedness plans for future outbreaks.