Public policy, public health workers, and infectious disease response: An analysis of focus group data

Local public health workers are critical to emergency responses as they sit at the hub of the public health emergency preparedness system. During responses to infectious disease events ranging from seasonal influenza to Ebola, local public health workers face varied legal and ethical challenges involving personal and professional considerations. We sought to better understand local public health workers’ perceptions of the legal and ethical dilemmas, and potential resolutions, that arise when responding to an infectious disease emergency. From April to July 2014, we conducted four focus groups with local public health line staff and managers (n=44). Each focus group was facilitated in accordance with a focus group guide that was developed in consultation with an interdisciplinary project advisory committee. Each session, which lasted 60 to 75 minutes, was recorded and transcribed. Transcripts were repeatedly reviewed and matrices were created to identify recurring themes and patterns in the data. Focus group responses fell into four areas: concerns about the disease agent; concerns about family; indications of employer commitment to employees; and employee-specific considerations. Within the agent category, themes addressed disease severity, transmissibility, and uncertainty. Within the family category, themes concerned obligations to children, older relatives, and pets. Within the employer commitment category, themes addressed previous training for an outbreak, health department leadership, and post-response feedback. Within the employee category, themes concerned job requirements and professional obligations. We will discuss the implications of our findings for policy-makers seeking to support a legal environment that promotes rapid, effective responses to infectious disease events.