Competencies in Prevention, Control and Response to Public Health Hazard of Field

Epidemiologists –Thailand, 2016 Anupong Sirirungreung, Kanthika Thintip, Nirundorn Yimchoho, Vanlayasetapanai, Nipapan Saridapirak, Kumnuan Ungchusak, Tanarak Plipat,

Mathuros Tipayamongkholgul, Wirin Kittipichai

7 Feb 2017

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Source: Center of Disease Control and Prevention, USA.2

Distribution of confirmed MERS cases by place of probable infection, as of 27 August 2015 (n=1 511)

Source: European Centre for Disease Prevention and Control (update, 27 August 2015)3

Source: Center of Disease Control and Prevention, USA.4

Source: Pendergrast M. Inside the outbreak.

Epidemiologist

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Competency Iceberg Model

7Source: http://www.managementstudyguide.com/competency-iceberg-model.htm

Thailand Epidemiologist Training and Development

• Field Epidemiology Training Program (FETP) since 1980

• National plan for International Health Regulation, 2005

• Field Epidemiology and Management Training (FEMT) since 2005

• Other short-courses for Surveillance and Rapid Response Team (SRRT)• SRRT Standard guideline 2012

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Objectives

1. Measure current status of competencies including prevent, protect and response to public health hazards among field epidemiologists of Thailand, 2016

2. Identify the specific training needs of each competency topics

3. Explore the associations between personal factors and overall competency score

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Methods

• Cross-sectional study

• Study period: March to April 2016

• Target population: • Provincial field epidemiologists

• FETP graduated persons

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Questionnaire

•Questionnaire component:•General characteristics: 23 questions

•Competency and training needs score measuring in 5-rating scale: 42 questions

•Standardization:•Content validity by epidemiology experts of Thailand

•Reliability evaluation• Pilot study among SRRT members of Department of Disease Prevention and

Control, Ministry of Public health

• Cronbach’s alpha = 0.98

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Competencies in Prevention, Control and Response to Public Health Hazard1. Law and public health policy

2. Communication and coordination

3. Epidemiologic surveillance

4. Response

5. Preparedness

6. Risk communication

7. Human resource management

8. Laboratory coordination

9. Publication 12

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SRRT

N = 300

n = 219

(Response rate = 73%)

Study Population

• Non response = 78

• Incomplete form = 3

FETP

N = 206

n = 94

(Response rate = 46%)

• Non response = ???

• Incomplete form = 3

Total n = 313

(Overall response rate = 62%)

General Characteristics of field epidemiologists – Thailand, 2016

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General Characteristics n (%)

Sex

Male 177 (56.7)

Female 135 (43.9)

Age group, median (IQR) = 46 (38 – 51) years

< 40 years 87 (28.2)

40 – 50 years 116 (37.5)

≥ 50 years 106 (34.3)

Epidemiology working duration, median (IQR) = 10 (5 – 18.3) years

< 5 years 57 (18.2)

5 – 10 years 79 (25.2)

10 – 15 years 66 (21.1)

≥ 15 years 111 (35.5)

Number of education attainment level among field epidemiologists – Thailand, 2016 (n = 312)

Education attainment n (%)

Doctoral degree 21 (6.7)

Master degree 162 (51.9)

Doctor of medicine 30 (9.6)

Doctor of veterinary medicine 6 (1.9)

Bachelor degree of nursing 9 (2.9)

Bachelor degree of public health 79 (25.3)

Other bachelor degree 5 (1.6)15

Number of epidemiologic training experience among field epidemiologists – Thailand, 2016 (n = 313)

Epidemiologic training program Yes (% yes) (% response)

Never been trained 25 (8.0) (4.3)

PhD of epidemiology or DrPH 21 (6.7) (3.6)

Epidemiological board certificated 98 (31.3) (16.8)

MPH, MSPH, Master degree of epidemiology 107 (34.2) (18.4)

Graduated FETP 58 (18.5) (9.9)

Graduated FEMT 87 (27.8) (14.9)

BA, BS in epidemiology 10 (3.2) (1.7)

Short course training by Bureau of Epidemiology 140 (44.7) (24.0)

Short course training by university 37 (11.8) (6.3)16

Top 5 of high to very high competency proportion

• Effectively use the communication technology (66.4)

• Report the important information about outbreak and public health hazard to authorized organization (59.4)

• Suggest the disease prevention and control measure for community (58.3)

• Analyze and identify the surveillance data for outbreak and public health hazard detection (55.7)

• Conduct outbreak investigation and setup the hypothesis for investigation (53.2)

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Top 5 of low to very-low competency proportion

• No.18: Collection death body specimen (63.6%)

• No.15: Composing report for emergency situation (45.8%)

• No.34: Disease control law explanation (41.5%)

• No.40: Publishing academic articles (40.1%)

• No.33: Describing and applying the ethic guideline (33.3%)

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Top 5 of high to very-high training-need proportion

•No.8: Risk assessment (71.6%)

•No.21: Performing inferential analysis (71.3%)

•No.15: Composing report for emergency situation (69.6%)

•No.7: Conducting surveillance evaluation (69.0%)

•No.14: Emergency need assessment (68.7%)

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Top 5 of lowest training need by proportion of low to very low training need self-evaluation

•Effectively use the communication technology (21.4%)

•Collect the specimen from death body following the standard guideline (20.7%)

•Coordinate with the laboratory for specimen collection and transport following standard guideline (18.0%)

•Communicate the outbreak investigation and surveillance finding to the community (17.8%)

•Suggest the disease prevention and control measure for community (17.4%) 20

Specific competencies needed to be developed

• No.15: Composing report for emergency situation

• No.14: Emergency need assessment

• No.35: Disease control law explanation

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Associations between overall competency score and personal factors among field epidemiologists – Thailand, 2016

Personal factors n Mean±S.D. p-value

Sex

Male 163 135.4±28.3 0.145

Female 123 130.4±28.3

Age (years)

< 40 years 81 132.1±28.0 0.373

40 – 50 years 108 131.7±27.7

≥ 50 years 94 136.9±29.3

Education attainment

Bachelor degree 91 124.2±28.7 <0.001

Master degree and over (included MD) 195 137.4±27.322

Associations between overall competency score and personal factors among field epidemiologists – Thailand, 2016

Personal factors n Mean±S.D. p-value

Epidemiological training experience

[1] Never passed any epidemiological training 21 104.4±28.0 < 0.001

[2] Passed the short course of epidemiological training

or graduated bachelor degree of epidemiology102 129.6±24.8

[3] Passed FETP or FEMT or master degrees of public

health or epidemiology164 139.0±28.0

Epidemiology working duration (years)

Less than 5 years 52 118.8±29.0 < 0.001

5 – 9 years 71 134.1±24.7

10 years and over 164 137.3±28.3

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Associations between overall competency score and personal factors among field epidemiologists – Thailand, 2016

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Personal factors n Mean±S.D. p-value

Working region

Central 116 134.7±30.0 0.574

North 51 134.6±25.7

Northeast 73 133.4±26.4

South 43 127.9±28.2

English proficiency

Less (couldn’t communicate) 39 120.3±27.3 < 0.001

Basic (partially communicate) 121 126.6±28.5

Intermediate (Could communicate well) and above 126 143.5±26.1

Discussion

•Strength•Very first nation wide survey on individual epidemiologic

competency

•Good response rate (61%) compared to previous study conducted by CSTE (response rate = 58%)

•Limitation•Bias due to self-evaluation competency

•Difficulty to identify the overall field epidemiologists

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Conclusion

•The specific competencies which should be developed were • Composing report for emergency situation

• Emergency need assessment

• Disease control law explanation

• Higher education and training associated with higher epidemiology competency as well as the English language skill

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