Healthcare workers' willingness to work during an influenza pandemic: a systematic review and meta‐analysis

Abstract

To estimate the proportion of healthcare workers (HCWs) willing to work during an influenza pandemic and identify associated risk factors, we undertook a systematic review and meta-analysis compliant with PRISMA guidance. Databases and grey literature were searched to April 2013, and records were screened against protocol eligibility criteria. Data extraction and risk of bias assessments were undertaken using a piloted form. Random-effects meta-analyses estimated (i) pooled proportion of HCWs willing to work and (ii) pooled odds ratios of risk factors associated with willingness to work. Heterogeneity was quantified using the I2 statistic, and publication bias was assessed using funnel plots and Egger's test. Data were synthesized narratively where meta-analyses were not possible. Forty-three studies met our inclusion criteria. Meta-analysis of the proportion of HCWs willing to work was abandoned due to excessive heterogeneity (I2 = 99·2%). Narrative synthesis showed study estimates ranged from 23·1% to 95·8% willingness to work, depending on context. Meta-analyses of specific factors showed that male HCWs, physicians and nurses, full-time employment, perceived personal safety, awareness of pandemic risk and clinical knowledge of influenza pandemics, role-specific knowledge, pandemic response training, and confidence in personal skills were statistically significantly associated with increased willingness. Childcare obligations were significantly associated with decreased willingness. HCWs' willingness to work during an influenza pandemic was moderately high, albeit highly variable. Numerous risk factors showed a statistically significant association with willingness to work despite significant heterogeneity between studies. None of the included studies were based on appropriate theoretical constructs of population behaviour.

Nurses' experiences of care for patients with Middle East respiratory syndrome-coronavirus in South Korea

“…19 The reason nurses with children did not want to volunteer could be related to this. 20 In this situation, the only strength was support from friends and family. Participants were close to each other and even expressed support at the time owing to comradery.…”

[Comment] COVID-19 pandemic and its impact on mental health of healthcare professionals

“…Experience in our hospitals in the past few weeks, although anecdotal, is concordant with these reports. The disruption of routine clinical practice, the sense of loss of control and the subsequent fear of potential destabilization of the health services, has provoked 'overflowing' anxiety and depression among healthcare professionals, a feature which is not uncommon of epidemics (9,11). Depression is associated with poor medication adherence (12) which may increase morbidity among older healthcare professionals with coexisting medical conditions.…”

Anxiety and Work Avoidance among Intensive Care Workers during an Influenza A/H1N1 Outbreak

“…Despite their professional duties, 28% of hospital health care employees surveyed at a German university hospital considered it acceptable not to report for work during a viral pandemic [19]. Similarly, in a qualitative study that explored the views of 64 HCWs in the UK about working during an influenza pandemic, the perceived factors related to unwillingness to work included child care responsibilities, concern about the wellbeing of family members, lack of information about the risks of infection, no clear role during the crisis, and lack of trust in the health organization [20][21][22]. Our results were consistent with these previous reports [19,20,22], as we found that previously caring for patients with same disease and good perception of infection control measures were associated with a lesser tendency to adopt an escape behavior.…”

“…Similarly, in a qualitative study that explored the views of 64 HCWs in the UK about working during an influenza pandemic, the perceived factors related to unwillingness to work included child care responsibilities, concern about the wellbeing of family members, lack of information about the risks of infection, no clear role during the crisis, and lack of trust in the health organization [20][21][22]. Our results were consistent with these previous reports [19,20,22], as we found that previously caring for patients with same disease and good perception of infection control measures were associated with a lesser tendency to adopt an escape behavior. On the other hand, the more worried the HWC was for self and family members, and the more fearful he/she was about vaccination side effects or being assigned to care for an infected patient, the more he/she was likely to avoid work and reschedule work shifts.…”

“…This could be related to the fact that gaining knowledge through actual involvement with patients with the condition can reduce uncertainty and encourage positive, problem-focused coping measures [20].…”