iRise: Willingness of Low-and Middle-Income Country-based Health Workers to Respond to Public Health Emergencies and Disasters - an mHealth Intervention Study

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PROJECT SUMMARY Healthcare workers’ (HCWs’) willingness to report to work in pandemics and other public health emergencies and disasters is a foundational prerequisite for national, regional and global health security amidst an ever- broadening array of natural and manmade emergent threats. Well-documented case reports and research point to significant and concerning gaps in response willingness toward public health emergencies and disasters, including among low- and middle- income country (LMIC)-based HCWs. Further, research to date in LMIC and other settings has highlighted HCWs’ self-efficacy as leading predictor of their willingness to respond (WTR) during such crises. Higher levels of self-efficacy positively influence motivation, willingness to respond and take action, and to persevere when challenges are encountered, including exhibiting teamwork, expressing sensitivity, managing politics and handling pressure. Prior studies by membership of the research team have been accompanied by training interventions that yielded significant increases in self-efficacy, and attendant WTR, among frontline HCWs. However, this training was designed to be in-person and several hours long, which presents a difficult logistical challenge for busy Emergency Department HCWs. Could mobile health (mHealth) technology offer an efficient approach to training and support to enhance self-efficacy and increase WTR among LMIC-based HCWs? To the very best of our knowledge, there has never been a mHealth product or intervention to address self-efficacy and WTR. Accordingly, this gap presents an opportunity to generate a novel mHealth application to enhance frontline LMIC-based healthcare workers' self-efficacy and WTR during public health emergencies and disasters. By extension, such a mHealth intervention could strengthen staffing surge capacity in resource-challenged health systems in LMICs, and thus shore up critical gaps in health security. The study's purpose is first to assess the feasibility of strengthening self-efficacy and response willingness toward public health emergencies, including pandemics, and disasters in emergency department clinical personnel in a LMIC setting (R21); and, if feasible, carry out a trial to confirm the effectiveness of the approach on outcomes (R33) [see below] in Karachi, Pakistan. Our R21-component specific aims (SA) are: SA1: Characterize and measure LMIC-based emergency medicine healthcare workers' (HCWs') baseline self- efficacy toward fulfillment of work-related roles and expectations in pandemics and other public health emergencies and disasters, and their attendant perceptions regarding willingness to respond in such contexts. SA2: Develop and pilot-test a novel mHealth intervention (iRise ["intervention (for) response in significant emergencies"]) among a group of LMIC-based emergency department HCWs to determine its acceptability, reliability, and perceived usefulness in a culturally sensitive and appropriate manner for busy emergency department HCWs in LMIC settings. SA3: Develop local LMIC-based partners' mHealth research capacity and prepare for an effectiveness trial. Under this aim we would focus on strengthening mHealth-based research capacity among health professionals to support conducting trials, digital data collection, and disaster preparedness in Pakistan. If found feasible, the following are our R33 specific aims: SA4: Gauge short-term (1-month), medium-term (6-months), and longer-term (1-year), impacts of this novel iRise mHealth app on LMIC-based HCWs' self-efficacy and willingness to respond during public health emergencies and disasters. SA 5: Further refine the mHealth app to enhance its attitudinal and related impacts on LMIC-based HCWs’ self-efficacy and response willingness in public health emergencies and disasters.