Preparedness and Response Strategies for Chemical, Biological, Radiological, and Nuclear Incidents in the Middle East and North Africa: An Artificial Intelligence-Enhanced Delphi Approach.

OBJECTIVE: Chemical, biological, radiological, and nuclear (CBRN) incidents require meticulous preparedness, particularly in the Middle East and North Africa (MENA) region. This study evaluated CBRN response operational flowcharts, tabletop training scenarios methods, and a health sector preparedness assessment tool specific to the MENA region. METHODS: An online Delphi survey engaging international disaster medicine experts was conducted. Content validity indices (CVIs) were used to validate the items. Consensus metrics, including interquartile ranges (IQRs) and Kendall's W coefficient, were utilized to assess the panelists' agreement levels. Advanced artificial intelligence computing methods, including sentiment analysis and machine-learning methods (t-distributed stochastic neighbor embedding [t-SNE] and k-means), were used to cluster the consensus data. RESULTS: Forty experts participated in this study. The item-level CVIs for the CBRN response flowcharts, preparedness assessment tool, and tabletop scenarios were 0.96, 0.85, and 0.84, respectively, indicating strong content validity. Consensus analysis demonstrated an IQR of 0 for most items and a strong Kendall's W coefficient, indicating a high level of agreement among the panelists. The t-SNE and k-means identified four clusters with greater European response engagement. CONCLUSIONS: This study validated essential CBRN preparedness and response tools using broad expert consensus, demonstrating their applicability across different geographic areas.

Knowledge, attitude, and practice of Iranian health care workers about infodemic management: a cross-sectional descriptive study.

BACKGROUND: Misinformation (infodemics) can hinder effective healthcare delivery. This study assessed Iranian healthcare workers' (HCWs) knowledge, attitude, and practice (KAP) regarding infodemic management (IM). METHOD: A cross-sectional survey using a self-reported questionnaire (KAPIM) distributed via convenience sampling to 1890 HCWs across all Iranian Medical Sciences Universities. RESULTS: The results showed that healthcare workers demonstrated overall KAP scores with a mean of 3.38 out of 5. Knowledge scores were 63.01%, attitude scores were 74.23%, and practice scores were lower at 55.76%. There were positive correlations between age and work experience with both knowledge and attitude scores. CONCLUSION: These findings suggest a gap between HCWs' knowledge/attitude and practice regarding IM. Targeted interventions emphasizing practical skills are needed. Considering demographics and regional variations is crucial when developing training programs for enhanced infodemic preparedness across the Iranian healthcare system.

ChecKAP: A Checklist for Reporting a Knowledge, Attitude, and Practice (KAP) Study.

INTRODUCTION: The Knowledge, Attitudes, and Practices (KAP) model is a foundational tool in public health research. KAP surveys play a vital role in this process by gauging a population's current level of knowledge about a specific health issue. Rigorous evaluation is essential for ensuring the validity and reliability of KAP studies. Therefore, in this study, a comprehensive checklist for reporting Knowledge, Attitude, and Practices (KAP) Studies was developed. METHODOLOGY: This study was conducted using a systematic six-step roadmap. A comprehensive review of available relevant quality assessment tools led to the development of specific new items. An expert panel reviewed the initial draft, and after corrections were made, the second draft was finalized and subjected to psychometric analysis by experts. RESULTS: The development of ChecKAP (Checklist for Reporting Items for Knowledge, Attitude, and Practice) represents a significant contribution to KAP studies. The final tool consists of 46 items across 8 fields: title (1 item), abstract (6 items), keywords (1 item), introduction (6 items), method (11 items), findings (7 items), discussion (15 items), and conclusion (1 item). CONCLUSION: ChecKAP assesses the inherent complexity of KAP research methods and ensures consistent reporting. It fills an important gap in the KAP research literature and serves a dual purpose. First, it acts as a quality assessment tool for reviewers, enabling them to evaluate the methodological rigor and clarity of submitted manuscripts. Second, it serves as a guideline for authors, promoting a more systematic and transparent approach to reporting.

Design and psychometric evaluation of health system intervention assessment tools for children in floods.

BACKGROUND: Flood is one of the most frequent disasters in Iran, which has highly affected the population and consequences on the health system. Children as the most vulnerable group too need to receive health services during floods. The aim of the present study was to develop a national tool for evaluating the provision of health services to children in floods. MATERIAL AND METHODS: This study is a sequential-exploratory mixed method study that consists of two qualitative and quantitative stages. The qualitative part includes the analysis of documents and panel of experts while the quantitative part includes the design and validation of the tools. RESULTS: In this study, organizations providing health services to children were first identified, and according to their mission the relevant items were extracted and the initial checklist was designed. Then validity and reliability of the tools were done. The content validity ratio and content validity index for the tool were 59 and 98%, respectively. Cronbach's alpha and intraclass correlation coefficient were determined as 0.7 and 0.964, respectively. The final tool was presented with 64 items. CONCLUSIONS: The response program, the scope of interventions, service coverage, and the effectiveness of the response after the flood can help reduce the risk of disasters in children. Using the assessment tool of evaluating the health services to children can assist the stakeholder organizations to meet the standards and best quality of services. Assessing the needs of the children affected by floods, identifying the strengths and weaknesses of health services, and proposing corrective strategies according to the information extracted from this tool are other achievements of this study.

Design and psychometric properties of a tool to assess the knowledge, attitude and practice of health care workers for infodemic management (KAPIM-Tool).

BACKGROUND: Infodemics, defined as the rapid spread of misinformation during an epidemic or pandemic, can have serious public health consequences. Healthcare workers(HCWs) play a critical role in managing infodemics, but their knowledge, attitudes, and practices(KAP) related to infodemic management are not well understood. This study aimed to design and validate a tool to assess healthcare workers' KAP related to infodemic management. METHODS: The knowledge, attitude, and practice of HCWs for the infodemic management assessment tool were designed through exploratory factor analysis. At first, primary items were extracted through two separate studies (face-to-face interviews with 17 participants and a systematic review). Then Face validity, Content validity, and Construct validity were done with the 15 participants of healthcare workers who had sufficient knowledge and experience. The content validity ratio (CVR) and content validity index (CVI) was checked for each item. The construct validity of the tool was also calculated through exploratory factor analysis with the participation of 250 healthcare workers (6.25 participants per item). The intraclass correlation coefficient (ICC), and Cronbach's alpha was calculated to evaluate the reliability of the findings using IBM SPSS Statistics V21.0. RESULTS: The primary KAPIM (Knowledge, Attitude, and Practice) of healthcare workers in (the Infodemics Management) tool has 53 items, in content, face, and construct validity 13 items were removed. Factor analysis revealed three factors: knowledge (24 items), attitudes (8 items), and practice (8 items). The overall reliability of the tool was reported as adequate with a Cronbach's alpha of 0.905. The ICC of the entire tool was calculated as 0.827. CONCLUSION: The KAPIM tool is a valid and reliable tool for assessing healthcare workers' knowledge, attitudes, and practices related to infodemic management with 40 items. The tool can inform targeted interventions to improve healthcare workers' preparedness and response to infodemics.

Design and psychometrics of risk assessment tool for makeshift hospitals: Focusing on pandemics.

Pandemics caused a change in the health service delivery system. In disasters with massive injuries or epidemic, the capacity to admit the injured and infected patients to provide health services faces the challenges. Covid-19 virus is a respiratory disease that from its emergence until January 18, 2023, the Covid-19 virus has infected more than 672 million people worldwide. In most countries, makeshift hospital has been set up as intermediate medical centers to keep people who are likely to be carriers of the disease to control communicable diseases. Most makeshift hospitals already have alternative uses and, have changed into temporary or intermediate care centers. Based on the search of research team, any standard tools were found to assess the makeshift hospitals safety. All the safety assessment tools were related to the hospital, but since makeshift hospitals are mostly non-hospital structures, the research team has designed and validate a makeshift hospital safety assessment tool for the first time in this study. The present study is a mixed method that was conducted in 3 phases including; a document review, explaining the components affecting non-structural and functional safety of the makeshift hospital, designing makeshift hospital safety assessment tools and analyzing the results and validating it in 2022. Content validity and reliability were measured by CVR and CVI, ICC and Cronbach's alpha. In the fourth phase, with the participation of 15 specialists, managers, experts, qualitative and quantitative validity of content was done. Data were analyzed by SPSS version 21 software. The final tool contains 186 items and a 5-point Likert designed for very low safety (1), low safety (2), moderate safety (3), good safety (4), and very good safety (5). The scores of each makeshift hospital were calculated based on the items and the degree of safety. Cronbach's alpha coefficient for tool was 0.98. Retesting the questionnaire after two weeks confirmed the stability of tool (ICC = 0.98). The validity and reliability of this tool were confirmed with 186 items in 2 factors and 26 subcategories including risk of disaster, non-structural safety, safety of windows and shutters, hospital access, information and communication management, patient safety and hygiene and etc. All centers providing health services, whether temporarily or permanently, must have safety to continue their activities in disaster and maintain the safety and health of staff and inpatients. The makeshift hospital safety tool can be a suitable tool for assessing the risk and eliminating their vulnerabilities, and it can also provide important indicators for the design and set up of the makeshift hospital to policymakers and executives in the field of health.

Process and components of disaster risk communication in health systems: A thematic analysis.

Risk communication (RC) is one of the necessary functions in disaster management. Establishing communication processes such as planning, transparency of policies and guidelines, RC expert training, providing communication infrastructure and evaluation in the shortest period reduces confusion and management inconsistency. One of the existing challenges is not knowing the exact dimensions of risk communication and its components in disasters. The aim was to identify the components of disaster risk communication in the health system. This research was conducted by systematic review and searching of the databases of PubMed, Scopus, Web of Science, ProQuest, Google Scholar and ScienceOpen 2000-2021 to identify the components of disaster risk communication in the health system. Thematic content analysis was used for data analysis. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 chart was used for systematic search, and a modified Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was used for quality determination. Out of 12 342 articles extracted, 25 studies were included for analysis. The components of disaster risk communication were analysed in 6 categories and 19 subcategories. These categories include communication (communication processes, communication features and infrastructure), information (content production, content characteristics and publishing), risk communication management (risk perception assessment, planning, coordination and logistics), monitoring and control (monitoring and evaluation, accreditation, documentation), education and training (public and organisational) and ethics and values (culture and social beliefs, ethics and trust). According to this research, the establishment of communication infrastructure and advanced equipment such as various structured formats for communication and artificial intelligence; online and offline communication support systems; and timely and accurate notice can help achieve goals such as coordination and organisation in the health system and increase social participation. Contribution: This study has clarified and explained all the main components and measures of risk communication that can be used for planning scientifically.

Post-Hospital Discharge Strategy for COVID-19 Treatment and Control: Focus on Fangcang Hospitals.

OBJECTIVE: One of the concerns of health managers in Iran in case COVID-19 reached a new peak is a shortage of hospital beds. In response, the country designed and created intermediate treatment centers, known as fangcang hospitals, which are prepared quickly at low cost and with high capacity. The aim of this study is to provide health managers with an effective post-hospital discharge strategy for COVID-19 patients. METHOD: The study was conducted from April 2020 to June 2020, with a narrative case study design. Setting up a fangcang hospital was based on a narrative analysis of 2 in-depth interviews with 4 fangcang hospital managers in Iran, a field visit of these places, and a review of their protocols and guidelines. RESULT: The patient flow for screening, treatment, and follow-up includes the following: Patients will be hospitalized if their symptoms are severe. If they are infected with mild symptoms, they will be referred to a fangcang hospital and admitted there if necessary, to prevent further spread of the disease. Patients will be monitored regularly and treated with routine health services. At the end of the 14-day quarantine period, patients approved for discharge are sent home. CONCLUSION: Traditional hospitals and fangcang hospitals are working together under the supervision of the Iran University of Medical Sciences. Our experience can serve as guidance for other clinics and recovery shelters. Having guidelines in place assists health care workers and managers in responding quickly to patients' needs during times of a disaster.

Challenges and barriers of humanitarian aid management in 2017 Kermanshah earthquake: a qualitative study.

BACKGROUND: Examining various problems after disasters is important for the affected people. Managing humanitarian aid and donations among the affected people is considered as one of the most important problems after disasters. Therefore, the present study aimed to evaluate the challenges and barriers of humanitarian aid management in 2017 Kermanshah Earthquake. METHODS: This study was conducted from November 2017 to January 2018, with qualitative case study design. The population included 21 people including 6 humanitarian aid manager, 6 volunteers, 4 aid workers, and 5 affected people. The data were collected through semi-structured interviews and purposeful sampling, which continued until saturating the data. The strategies recommended by Guba were used for evaluating the trustworthiness of the data. The data was analyzed with conventional content analysis method according to method suggested by Graneheim and Lundman. RESULTS: Based on the results, two themes, nine categories, and 19 sub-categories were identified considering the challenges and barriers of humanitarian aid and donors' management during the 2017 Kermanshah Earthquake. The categories included education, command and coordination, communication and information, rules, security, traffic and overcrowding, assessment, providing system, and cultural setting. Also, two themes including managerial and structural barriers were extracted. CONCLUSION: Adopting an effective management and appropriate policies with respect to humanitarian aid and modifying structural and managerial barriers can improve the performance and management of humanitarian aid.