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An intervention for enhancing public health crisis response willingness among local health department workers: A qualitative programmatic analysis

Krista L. Harrison, PhD, Nicole A. Errett, MSPH, Lainie Rutkow, JD, PhD, MPH, Carol B. Thompson, MS, MBA, Marilyn K. Anderson, MHE, Justin L. Ferrell, MS, Jennifer M. Freiheit, MA, MCHES, Robert Hudson, MSN, Michelle M. Koch, PHN, RN, Mary McKee, MSW, LCSW, Alvaro Mejia-Echeverry, MD, MPH, ARNP, James B. Spitzer, MBA, MS, CEM, Doug Storey, PhD, Daniel J. Barnett, MD, MPH


Objectives: This study evaluated the impact of a novel multimethod curricular intervention using a trainthe-trainer model: the Public Health Infrastructure Training (PHIT). PHIT was designed to 1) modify perceptions of self-efficacy, response efficacy, and threat related to specific hazards and 2) improve the willingness of local health department (LHD) workers to report to duty when called upon.

Methods: Between June 2009 and October 2010, eight clusters of US LHDs (n = 49) received PHIT. Two rounds of focus groups at each intervention site were used to evaluate PHIT. The first round of focus groups included separate sessions for trainers and trainees, 3 weeks after PHIT. The second round of focus groups combined trainers and trainees in a single group at each site 6 months following PHIT. During the second focus group round, participants were asked to self-assess their preparedness before and after PHIT implementation.

Setting: Focus groups were conducted at eight geographically representative clusters of LHDs.

Participants: Focus group participants included PHIT trainers and PHIT trainees within each LHD cluster.

Main outcome measure(s): Focus groups were used to assess attitudes toward the curricular intervention and modifications of willingness to respond (WTR) to an emergency; self-efficacy; and response efficacy.

Results: Participants reported that despite challenges in administering the training, PHIT was well designed and appropriate for multiple management levels and disciplines. Positive mean changes were observed for all nine self-rated preparedness factors (p < 0.001). The findings show PHIT's benefit in improving self-efficacy and WTR among participants.

Conclusions: The PHIT has the potential to enhance emergency response willingness and related self-efficacy among LHD workers.


emergency preparedness, local health department, willingness to respond, EPPM, self-efficacy

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