The Study On Management Strategy Of Public Health Emergency Based On The Adjustment Of Systematic Strain

BackgroundSince the year of 2000, we are facing a tough problem of preventing and controlling Public Health Emergency (PHE) all the time. In the year 2003, SARS epidemics swept the world and also started our innovation of Public Health Emergency (PHE) management system. After undergoing SARS epidemic, our coping and management system of PHE had overcame many problems, and made tremendous improvement.Nowadays, the studies on management policy of PHE usually care only macroscopical level such as government, society level. But we believed individuals were the subjects who were coping with PHE. Many researches had showed that PHE can increase people's strain level, which can easily bring a public panic. In the tensional situation, people's strain will be magnify and bring many harms to body, and it also can diminish ability of judgement and rational behavior. Pubic panic may lead to the disorder of society, even to a social crisis, which will be not good for the controlling of PHE. Therefore, how to adjust people's strain will be an important task. Studies on this field still focus on describing and deducing psychological rensponse from the perspective of sociology and psychology, even the demonstration study is also lack of certain research links.Any macroscopical policies are used on individuals eventually, so the study on policy of PHE management should start from individuals to show our managing ideal of "people be the most important".ObjectivesWe induct the "systemic strain" (nervous and out-of-control situation and mental state when stress events occur) as our research link. Combining with literature and other theory research, we supposed the hypothetical frame. The aim was to validate the supposed frame, and explore the relationship among related factors and strain, furthermore study the interaction between strain and situation. Based on the above studies, we would educe several proposes for the policy for PHE management strategies. Methods1. Literature research. We reviewed the related literature related to Public Health Emergency (PHE), management strategies for PHE and systematic strain. Then combined with the theory of Health Belief and Stain, we supposed a hypothetical model of the research.2. Practical research. We chose SARS as our research example and conducted a retrospective survey.1) The samples were from the communities of Hangzhou city and the villages in its suburbs. About 800 samples were selected based on experts' experience.2) Sampling methods. We used purpose sampling. We chose a community where there were SARS case existing and a community where there were no SARS cases. Then we chose and interviewed randomly about 100 citizens in each community. Synchronously we chose 2 villages in the suburbs. Similarly we interviewed randomly about 100 citizens in each village. Then we surveyed about 180 industry workers, 140 people from service industries and 90 students in Hangzhou city based on the occupational proportion in 2004. All the samples were about 800.3) The questionnaire includes the questions about the demographics status, respondents' cognition and risk perception of SARS, positive coping behaviors and measurement of strain during SARS epidemic. We measure respondent' strain during SARS via CPSS (Chinese Psychological Scale of Stain).4) Survey was conducted in April, 2006. Citizens' data were obtained randomly via family interview. Professionals' data were obtained via collective answering.5) Data analysis, a. Cronbach's alpha parameter and factor analysis were used to test the reliability and validity of the questionnaire, b. Descriptive statistical methods were used to analysis the samples' demographic data, respondents' cognition and risk perception of SARS, positive coping behaviors and measurement of strain during SARS epidemic, c. One-Way ANOVA and Kruskal Wallis Test were used to analyse the differences within the data between different demographic, cognitive and psychological characteristics. Multiple Regression was used to analysis the factors which affects respondents' positive coping behavior and strain during SARS epidemic, d. Structural Equation Modeling was used to validate the hypothesis model which had been established before and explored the relationship between the factors. Results:850 questionnaires were sent, and 827 returned (response rate 97.3%). 814 questionnaires were proven valid, valid rate is 98.8%.1. Self assessment about cognition of the Public Health Emergency (SARS). When SARS happened, above 75% individuals thought themselves had a good understanding about SARS; 42.6% individuals felt "much fear or very fear" for SARS, but 57.4% felt "no fear or little fear"; more than half thought SARS was much severe or very severe; over 85% thought they "trust" or "very trust" the prevention measures of SARS.2. Positive coping behavior score of the respondents during SARS epidemic: the average score (30) was relatively high (Highest score=40).3. Strain score during SARS epidemic. The average score (22.89) was relatively low (highest score=56). But 39.7% respondents' strain was higher than the dangerous standard.4. Results from reason analysis for strain. Education stage, rural-urban factor, job, cognition of SARS and risk perception of SARS affects respondents' strain during the SARS epidemic.5. Results from reason analysis for positive coping behavior. Job, education stage, rural-urban factor, cognition of SARS, risk perception of SARS, confidence in prevention measures of SARS affects respondents' coping behaviors during SARSepidemic. Strain is negative factor of coping behaviors. In other words, the higher the strain is, the worse the respondents' coping behavior is.6. Model analysis. After several processes of modeling, two models were fit well (GFI=0.8576, 0.8913; RMR=0.1034, 0.0943) based on the standard of whether there were SARS cases existing in the samples' community. Both the two models indicates that strain is the key link in the positive coping behavior adoption process, and cognition of SARS and risk perception affect indirectly coping behavior via influencing strain. Cognition is the negative factor, and risk perception is the positive factor of strain. Meantime, they also have direct effect on coping behavior. Conclusion and ProposalsWe drew several conclusions based on our research: 1. Public Health Emergency affects people's strain a lot; 2. Strain is; the key link in people's positive coping behavior adoption process; 3. Situation is an important factor we cannot neglect in PHE's controlling and management; 4. People can cope with PHE positively, but they need government's guidance; 5. People's cognitions and risk perceptions of PHE are important factors of strain; 6. There are differences among different populations.According to the two models, we put forward our proposals about the control and management of Public Health Emergency based on the adjustment of systematic strain. We suggested we should enhance the training plan of crisis consciousness and crisis management before the emergency happen. We should exert media's effect of "voltage stabilizer", and guide public consensus to a correct way. We need to deliver appropriate amount, reliable information to persons in time when PHE happens. We should encourage all individuals organically participate in PHE's management and control. We must pay more attentions to public's psycho-intervention. We also should avoid the stimulus which can cause a nervous situation.