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

项目总结 医护人员在疫情和其他突发公共卫生事件中报到的意愿 灾害是国家、地区和全球卫生安全的基本前提 扩大自然和人为紧急威胁的范围。有据可查的案例报告和研究要点 对突发公共卫生事件和灾害的应对意愿存在重大和令人担忧的差距， 包括以低收入和中等收入国家为基础的卫生工作者。此外，LMIC迄今的研究 而其他环境突出了医务工作者的自我效能感，认为这是他们回应意愿的主要预测因素 (WTR)在这种危机期间。较高的自我效能感水平对动机、回应意愿有正向影响 并采取行动，在遇到挑战时坚持不懈，包括表现出团队合作， 表达敏感，管理政治，处理压力。按研究成员划分的先前研究 伴随着训练干预，团队的自我效能感显著提高， 前线医务工作者中的值班WTR。然而，此培训旨在进行面对面的培训， 长达数小时，这对繁忙的急诊部卫生工作者来说是一个困难的后勤挑战。可 移动健康(MHealth)技术提供了一种有效的培训和支持方法，以增强自我效能和 提高基于LMIC的卫生工作者的WTR？据我们所知，从来没有一个移动健康 解决自我效能感和WTR的产品或干预。因此，这一差距提供了一个机会 开发新的mHealth应用程序，以提高基于LMIC的前线医护人员的自我效能和 在突发公共卫生事件和灾难期间进行WTR。推而广之，这样的移动健康干预可以 加强低收入国家面临资源挑战的卫生系统的人员配备激增能力，从而支持关键的 卫生保障方面的差距。 本研究的目的是首先评估加强自我效能感和应对意愿的可行性 应对突发公共卫生事件，包括大流行和急诊科临床灾难 LMIC环境中的人员(R21)；如果可行，进行一项试验，以确认该方法的有效性 关于巴基斯坦卡拉奇的结果(R33)[见下文]。我们的R21组件特定目标(SA)包括： SA1：表征和测量基于LMIC的急救医务人员(HCW)基线自我 在流行病和其他公共卫生领域履行与工作相关的角色和期望的有效性 紧急情况和灾害，以及随之而来的对在这种情况下作出反应的意愿的看法。 SA2：开发和试点测试一种新的移动健康干预(IRise)[“干预(用于)显著响应 紧急情况“])在一组基于LMIC的急诊科卫生工作者中，以确定其可接受性， 在忙碌的紧急情况下，以文化敏感和适当的方式提供可靠性和感知的有用性 LMIC设置中的部门卫生工作人员。 SA3：发展当地LMIC合作伙伴的mHealth研究能力，并为有效性试验做准备。 在这一目标下，我们将重点加强卫生专业人员基于mHealth的研究能力 支持在巴基斯坦进行试验、数字数据收集和备灾。 如果发现可行，以下是我们的R33具体目标： SA4：衡量这本小说的短期(1个月)、中期(6个月)和长期(1年)的影响 IRise mHealth应用程序对基于LMIC的卫生工作者在公共卫生期间的自我效能和应对意愿的影响 紧急情况和灾难。 SA 5：进一步完善mHealth应用程序，以增强其对基于LMIC的卫生工作者的态度和相关影响 突发公共卫生事件中的自我效能感和应对意愿。

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.