Public Health System Research in Public Health Emergency Preparedness in the United States
Part 1
1.Enhance the Usefulness of Trainings
We included 31 empirical studies in the evidence synthesis that describe research regarding the enhancement and usefulness of training in emergency preparedness. We identifified 4 major themes in this area: (1) development of training programs, (2) evaluation of training, (3) use of drills and exercises, and (4) development of partnerships in support of training.
On the basis of the literature, the inclusion of the use of a curriculum-planning process with integrated competency frameworks, the use of training needs assessments, and the integration of participant feedback into the training development process enhance the usefulness of training.
The selection of appropriate training delivery methods and instructional activities is also important to accommodate differences in learning styles and overcome the challenge of engaging adult learners. For example, flflexible training formats, such as online modules and blended e-learning models, have been studied as effective alternatives to traditional classroom learning.
The literature reveals several useful methods for evaluating the effectiveness of training. Pre- and posttraining quizzes can measure changes in participantsrsquo; subject matter knowledge, observers can assess participant performance, and surveys and focus group discussions can capture participantsrsquo; reactions and level of satisfaction following training, measure changes in levels of confifidence before and after training activities, and assess learnersrsquo; training needs.
Specifific evaluation tools can be used to assess training quality and the long-term impact of participation in training activities. Cost and costeffectiveness analysis are also useful approaches for guiding the development of training.
Drills and exercises, as proxies for real emergencies, are well-accepted means of increasing participant engagement in training and identifying gaps in participantsrsquo; knowledge and skills. A few studies examine the effectiveness of including embedded videos and using geographic mapping tools to enhance the effectiveness of simulations. Discussion-based tabletop exercises are recognized as methods to enhance decisionmaking capabilities and help clarify the roles and responsibilities of responders during a disaster. Full-scale exercises present valuable opportunities for testing coordination and command across organizations responding to an emergency and provide an operationsbased learning environment for participants. Full-scale exercises may be useful for administering just-in-time training to participants in narrowly focused, task-based learning environments. Just-in-time training has also been recognized as useful for volunteer groups, including dentists and public health nursing students.
2.Improving Timely Emergency Communications
Thirty-six peer-reviewed articles describe the current state of science in addressing strategies for improving communications in preparedness and response. We identifified 4 major themes: (1) the improvement of knowledge, attitudes, and practice; (2) the use of information channels and access to information; (3) the role of communication in preparing the public health and health care workforce for threats; and (4) the inflfluence of content, format, and delivery methods of messages regarding information sharing.
During emergency situations, knowledge and attitudes regarding a specifific threat differ across various segments of the population, characterized by age, gender, race, and social determinants, such as socioeconomic position and interpersonal networks—which potentially impact compliance with recommended behaviors. Those who do not feel personally at risk or do not trust the messenger are less likely to adopt recommended behaviors. Concern about oneself or family members being affected by a health threat is a better predictor of behavioral compliance than are individual perceptions of threat severity and susceptibility, especially regarding compliance with immunization practices. During the H1N1 pandemic, higher socioeconomic position individuals, those with higher news exposure, those with higher levels of pH1N1-related knowledge, and those possessing information-seeking behaviors were less likely to engage in incorrect preventive behaviors. Furthermore, the literature shows that communication effectiveness depends partly on an individualrsquo;s preexisting values, risk perceptions, previous trust in leaders and government, and community characteristics; these factors may change over the course of the emergency and are inflfluenced by the severity of the situation.
Individual access to information and information-seeking behaviors differ across population groups on the basis of socio demographic characteristics. The literature describes the negative impact of online information seeking resulting from frustration in determining accurate information or oversaturation of messages, which may lead to increased fear and an attitude of information avoidance. The Internet and traditional media, such as radio, television news, and newspapers, are often reported as primary sources of information regarding risk, whereas family doctors,television news, and local public health offificials are often considered the most trusted information sources. During the H1N1 pandemic, willingness to comply with preventive behaviors was positively correlated with the number of H1N1 inflfluenza news articles individuals viewed and with information-seeking behaviors. Timely release of information was positively associated with the adoption of recommended behaviors. Data on the use of social media during an emergency situation are currently very limited, with Twitter being the only platform studied to date.
Local health departments often experience diffificulties
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