93 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 with the preventive measures against Covid-19?” (question 15 in “Questionnaire administered to the population” section of Appendix A), the study sought to understand what the community respondents felt were constraints on the ability of the population to comply with COVID-19 preventive measures. The reasons, associated with CC/messaging, in verbatim, included “ . . . poor government communication . . .,” “ . . . insufficient sensitization . . .,” “ . . . stigmatization of patients with illnesses by the government and lack of adequate knowledge on prevention,” “ignorance,” “lack of information,” “The government politicized the whole thing . . . lots of doubts,” and “population is not getting enough credible information on real cases.” The following statements from the respondents indicate the consequences of improper messaging: “ . . . lack of transparency . . .,” “ . . . state media tagged people who died from other illnesses and hurriedly buried them when their families knew they had been suffering from other ailments . . .,” “ . . . disbelief on the existence of COVID in Cameroon,” “population distrust . . .,” “ . . . nonconfidence in public information . . .,” “lack of trust in government . . .,” and “some are in doubt if the disease exist.” These expressions paint a good image of CC lapses that impede the pandemic response. Stigmatization is also a handicap to the implementation of COVID-19 prevention measures. The community respondents were asked to ascertain through a Likert scale, the extent to which COVID-19 patients were stigmatized (question 18 in “Questionnaire administered to the population” section of Appendix A). The analysis (Figure 7) indicates that most COVID-19 patients are somewhat stigmatized to very stigmatized. This relatively high percentage of stigmatized patients was confirmed when triangulated with the healthcare informants who were asked the same question. 96.4 percent (n = 27) agreed that stigmatization of COVID-19 patients is prevalent in Cameroon. The implication, they said, is that COVID19 patients are avoiding treatment. DISCUSSION This paper has demonstrated how the IDEA model of IHRCC can be applied to investigate a novel health crisis by analyzing CC during the COVID-19 pandemic in Cameroon using the four central building blocks of the framework (IDEA). “Timing” is a cornerstone to CC that needs improvement. Swift action to institute lockdown measure could have slowed the spread of the virus. Likewise, delay in providing treatment protocols/ guidance had implications for effective healthcare interventions. The authorities could make their messages/speeches more compassionate to assure the populace that their feelings and worries are recognized and taken seriously. This helps in building public trust in government pandemic management.48 The conspicuous lack of proximity messages is concerning since physical closeness to the virus is a potential risk.49 Messages about the most prevalent virus locations will facilitate risk avoidance behavior. The use of apps that can detect close proximity with infected persons can also serve as a virus infection tracing tool. “Distribution” is encouraging, albeit improvements are required. The government has no control over information on other social media online platforms. Trust building in government sources of information is, therefore, required. This may demand that the authorities be able to provide timely, consistent, accurate, and credible crisis messages to huge swathes of the population. Although research evidence indicates satisfactory messaging on the symptoms, transmission, and infection of coronavirus, more sanitization is required in rural areas. To expedite healthcare provision, it is imperative for the government to be swift, concise, clear, and use the Figure 7. Stigmatization of COVID-19 patients. 07-SA-Weston-JEM#210071.indd 93 14/03/22 7:40 PM
94 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 appropriate language (English or French) to communicate with healthcare workers. Being proactive allows more information control and establishes credibility by demonstrating transparency.20 “Explanation” is an important aspect of CC that needs attention. When there are conflicting messages from diverse sources, suspicion of government information increases. Persuasive communication through different media outreach with clear and regularly updated messages that demonstrate honesty, empathy, transparency, and dedication may be required to gain public trust and credibility.7,9,32 Cameroon’s bilingualism, demographic structure, and cultural diversity should be inculcated in CC planning. Communicating effectively with populations in rural areas using their ethnic languages is essential to minimize illness and deaths in elderly people. Messages may be regularly updated on government websites, but only a fraction of Cameroonians (23.2 percent) have internet access.50 The implication is that more than 75 percent of the population may not have accessed updated coronavirus information. Even before switching to online only messages, not all Cameroonians had access to TV/radio signals. Although public TV has the best terrestrial network coverage in Cameroon, it covers only 65 percent of the country,51 implying many people do not watch TV irrespective of living within network coverage. This underscores the relevance of multiple information sources. “Action” is a critical component that has several constraints, which must be dealt with for CC to be effective. The rural populations may not be accessing official messages posted online due to the limited use of local languages. Upscaling the use of indigenous languages in CC would mitigate this issue. Stigmatization has harmful consequences and could fuel infection rates if left unchecked. It is vital that community cohesion remains strong in order to provide the enabling environment for strong mental health and bond of support required to boost morale among potentially infected persons during a health crisis. This can be achieved through tailored community education aimed at eliminating stigmatization. The core IDEA elements not only are relevant for assessing CC but also influence each other, especially “Action,” which arguably, is the ultimate aim of “Internalization,” “Distribution,” and “Explanation.” Resolving the identified issues with these three elements will enhance compliance to instructional messages or “Action.” The identified IDEA challenges in this study give room for further lines of inquiry. Considering the informants to this research live in areas with internet access, the validity and credibility of this study could be explored further by extending the research to rural areas. Subsequent participatory CC research that targets informants in areas without access to the internet and TV/radio network would enhance the generalizability of the study in Cameroon and other developing countries. CONCLUSION AND RECOMMENDATIONS This paper has applied the IDEA model for IRCC to the COVID-19 pandemic in Cameroon by adapting the framework for a novel health crisis (IDEA model for IHRCC). The critical elements of the new health communication model, “Initialization,” “Distribution,” “Explanation,” and “Action,” have been discussed in a systematic order to point-out Cameroon’s efforts and challenges in communicating the COVID-19 pandemic. Informed and guided by the IDEA model for IHRCC, the critical role of CC in crisis response has been underscored in this paper by diagnosing the challenges in Cameroon’s CC during the coronavirus pandemic and making recommendations that could inform governance, policy, research, and professional practice in CC. Table 1 shows a summary of the key findings, corresponding recommendations and ranking of the respective CC themes based on a scale ranked subjectively from Abysmal to Excellent (Abysmal, Awful, Bad, Poor, Mediocre, Fair, Good, Great, and Excellent). Overall, the various sub-CC themes fall in the range “Poor” to “Good,” and Cameroon’s COVID-19 CC can be classified fair. This provides opportunities for Cameroon to turn the identified limitations into a catalyst for effect CC as recommended in Table 1. This research serves as a powerful reminder of the need to inculcate CC into crisis response planning in developing countries. The identified challenges could 07-SA-Weston-JEM#210071.indd 94 14/03/22 7:40 PM
95 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 indicate lack of rationality and other stereotypes in dealing with pandemics. It also demonstrates insufficient understanding of local circumstances during health crisis in resource limited settings where the use of information technology is still minimal, yet relevant for effective CC. Hence, this paper contributes to literature and concept building in the field of CC, especially in health domain in Cameroon and developing countries. Henry Ngenyam Bang, PhD, Disaster Management Centre, Bournemouth University, Dorset, Poole, United Kingdom. ORCID: https://orcid.org/0000-0002-1850-857X. REFERENCES 1. Coombs T: Ongoing Crisis Communication: Planning, Managing, and Responding. Thousand Oaks, CA: Sage, 2016. 2. Mayhon C, McLaughlin A: Warning the world of extreme events: A global perspective on risk communication for natural and technological disaster. Saf Sci. 2014; 61: 43-50. DOI: 10.1016/j. ssci.2012.04.014. 3. Ulmer R, Sellnow T, Seeger M: Effective Crisis Communication: Moving from Crisis to Opportunity. Los Angeles: Sage, 2018. 4. Merchang R, Elmer S, Lurie N: Integrating social media into emergency preparedness efforts. N Engl J Med. 2011; 365(4): 289- 291. DOI: 10.1056/NEJMp1103591. 5. Moorhead A, Hazlett D, Harrison L, et al.: A new dimension of health care: Systematic review of the uses, benefits and limitations of social media for health communication. J Med Internet Res. 2013; 15(4): e85. DOI: 10.2196/jmir.1933. 6. Jin X: Exploring crisis communication and information dissemination on social media: Social network analysis of Hurricane Irma tweets. J Int Crisis Risk Commun. 2020; 3(2): 179-210. DOI: 10.30658/jicrcr.3.2.3. 7. Reynolds B, Quinn S: Effective communication during an influenza pandemic: The value of using a crisis and emergency risk communication framework. Health Promot Pract. 2008; 9(4): 13-17. DOI: 10.1177%2F1524839908325267. 8. Söderblom H: Six tips for preparing and managing the most effective response. Available at https://www.4cstrategies.com/news/building-crisis-communication-capability/. Accessed December 14, 2020. 9. Mendy A, Stewart M, VanAkin K: A leader’s guide: Communicating with teams, stakeholders, and communities during COVID19. Available at https://www.mckinsey.com/business-functions/ organization/our-insights/a-leaders-guide-communicating-withteams-stakeholders-and-communities-during-covid-19. Accessed November 26, 2020. 10. Sellnow D, Sellnow T: The IDEA model for effective instrumental risk and crisis communication by emergency managers and other key spokespersons. J Emerg Manag. 2019; 17(1): 67. DOI: 10.5055/jem.2019.0399. 11. Sellnow D, Sellnow T: Effective communication in times of risk and crisis: The IDEA model for translating science to the public. Research Outreach, 115. Available at https://researchoutreach.org/ articles/effective-communication-risk-crisis-idea-model-translatingscience-public/. Accessed December 21, 2020. 12. MPH: Donate. Available at http://covid19.minsante.cm. Accessed August 12, 2020. 13. OCHA: Cameroon: COVID-19 emergency situation report no. 03. 2020. Available at https://reliefweb.int/sites/reliefweb.int/files/ resources/cameroon_covid19_emergency_situation_report_no._03. pdf. Accessed September 16, 2020. 14. Bang H, Mbah M, Ndi H, et al.: Gauging Cameroon’s resilience to the COVID-19 pandemic: Implications for enduring a novel health crisis. Trans Gov People Process Policy. 2020. DOI: 10.1108/ TG-08-2020-0196. 15. UN: World most vulnerable countries lack the capacity to respond to a global pandemic. Available at https://www.un.org/ohrlls/news/ world’s-most-vulnerable-countries-lack-capacity-respond-globalpandemic-credit-mfdelyas-alwazir. Accessed December 28, 2020. 16. Bang H, Miles L, Gordon R: Disaster risk reduction in Cameroon: Are contemporary disaster management frameworks accommodating the Sendai framework agenda 2030? Int J Disaster Risk Sci. 2019; 10: 462-477. DOI: 10.1007/s13753-019-00238-w. 17. Bang H: Disaster management in Cameroon: The lake Nyos disaster experience. Disaster Prev Manag. 2012; 21(4): 489-506. DOI: 10.1108/09653561211256189. 18. Bang H: General overview of the disaster management framework in Cameroon. Disaster. 2014; 38(3): 562-586. DOI: 10.1111/ disa.12061. 19. Miles L, Gordon R, Bang H: Blaming active volcanoes or active volcanic blame? Volcanic CC and Blame Management in the Cameroon. In Fearnley J, Bird K, Haynes K, et al. (eds.): Observing the Volcano World. Advances in Volcanology. Switzerland: Springer Nature, 2017: 395-409. DOI: 10.1007/11157_2017_2. 20. Quinn P: Crisis communication in public health emergencies: The limits of ‘legal con- trol’ and the risks for harmful outcomes in a digital age. Life Sci Soc Policy. 2018; 14(4): 2-40. DOI: 10.1186/ s40504-018-0067-0. 21. Rossmann C, Meyer L, Schulz P: The mediated amplification of a crisis: Communicating the a/H1N1 pandemic in press releases and press coverage in Europe. Risk Anal. 2018; 38: 357-375. DOI: 10.1111/risa.12841. 22. Fearn-Banks K: Crisis Communications: A Casebook Approach. Vol. 3. Mahwah, NJ/London: Lawrence Erlbaum Associates, 2010. 23. Coombs T, Halladay S: The Handbook of Crisis Communication. Oxford, UK: Wiley-Blackwell, 2010. 24. Howlett M: Government communication as a policy tool: A framework analysis. Can J Polit Sci. 2009; 3(2): 23-37. Available at https:// www.academia.edu/17691925/Government_Communication_as_a_ Policy_Tool_A_Framework_for_Analysis. Accessed November 29, 2020. 25. Cho H, Salmon C: Unintended effects of health communication campaigns. J Commum. 2007; 57(2): 293-317. DOI: 10.1111/j.1460- 2466.2007.00344.x. 26. UNISDR: Sendai framework for disaster risk reduction 2015- 2030. UNISDR. Available at www.preventionweb.net/files/43291_ sendaiframeworkfordrren.pdf. Accessed June 21, 2020. 27. Murphy N: Context, not content: Medium-based press clause restrictions on government speech in the internet age. Univ Denver Sports Entertain Law J. 2009; 7: 26-61. Available at https:// papers.ssrn.com/sol3/papers.cfm?abstract_id=1576726. Accessed November 18, 2020. 28. Glik D: Risk communication for public health emergencies. Annu Rev Public Health. 2007; 28(1): 33-54. DOI: 10.1146/annurev. publhealth.28.021406.144123. 29. Perry P, Donini-Lenhoff F: Stigmatization complicates infectious disease management. Virtual Mentor. 2010; 12(3): 225-230. DOI: 10.1001/virtualmentor.2010.12.3.mhst1-1003. 30. Chesney M, Smith A: Critical delays in HIV testing and care: The potential role of stigma. Am Behav Sci. 1999; 42(7): 1162-1174. DOI: 10.1177/00027649921954822. 07-SA-Weston-JEM#210071.indd 95 14/03/22 7:40 PM
96 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 31. Fischhoff B: The realities of risk-cost-benefit analysis. Science. 2015; 350(6260). DOI: 10.1126/science.aaa6516 32. Malecki K, Keating J, Safdar N: Crisis communication and public perception of COVID-19 risk in the era of social media. Clin Infect Diseases. 2021; 72: 697-702. DOI: 10.1093/cid/ciaa758. 33. Sellnow D, Lane D, Sellnow T, et al.: The IDEA model as a best practice for effective instructional risk and crisis communication. Commun Stud. 2017; 68(5): 552-567. DOI: 10.1080/10510974.2017.1375535. 34. Liehr P, Smith M: Middle range theory: Spinning research and practice to create knowledge for the new millenium. Adv Nurs Sci. 1999; 21(4): 81-91. DOI: 10.1097/00012272-199906000-00011. 35. Hammarberg K, Kirkman M, Lacey S: Qualitative research methods: When to use them and how to judge them. Hum Reprod. 2016; 31(3): 498-501. DOI: 10.1093/humrep/dev334. 36. Reiter B: Theory and methodology of exploratory social sciences research. Hum J. 2017; 5(4): 130-150. Available at http://ijsrm. humanjournals.com/theory-and-methodology-of-exploratory-socialscience-research/. Accessed July 25, 2020. 37. Rapley T: Some pragmatics of qualitative data analysis. In Silverman D (ed.): Qualitative Research: Theory, Method & Practice. Los Angeles: Sage, 2016. 38. Tih F: Cameroon confirms first coronavirus case. Available at https://www.aa.com.tr/en/africa/cameroon-confirms-first-coronavirus-case/1756866. Accessed August 20, 2020. 39. Republic of Cameroon: Special statement by Prime Minister, Head of Government of 9.April 2020. Available at https://www.spm. gov.cm/site/sites/default/files/special_statement_of_the_pmhg_on_ the_9_april_2020_scan.pdf. Accessed August 12, 2020. 40. Kindzeka E: Cameroon eases coronavirus lockdown, but neighbors block access. Available at https://www.voanews.com/covid19-pandemic/cameroon-eases-coronavirus-lockdown-neighborsblock-access. Accessed August 14, 2020. 41. Krishnan R: “Absentee” Cameroon President reappears after 35 days as opposition demanded a replacement. Available at https:// theprint.in/world/absentee-cameroon-president-reappears-after35-days-as-opposition-demanded-a-replacement/403549/. Accessed July 25, 2020. 42. Cameroon Tribune: Commutation, remission of sentences: Implementation of presidential decree awaited. Available at https:// www.cameroon-tribune.cm/article.html/31859/en.html/commutation-remission-of-sentences-implementation-of-presidential-decree#. Accessed August 23, 2020. 43. Republic of Cameroon: Head of State message to the Nation on the eve of the National Day, 20 May 2020. Available at https:// www.prc.cm/en/news/speeches-of-the-president/4272-head-of-state-smessage-to-the-nation-on-the-eve-of-the-national-day-20-may-2020. Accessed November 11, 2020. 44. Nyamnjoh F: Mass Media and Democratisation in Cameroon in the Early 1990s. Cameroon: African Books Collection, 2011. 45. Tasnim S, Hossain M, Mazumder H: Impact of rumors and misinformation on COVID-19 in social media. J Prev Med Public Health. 2020; 53(3): 171-174. DOI: 10.3961/jpmph.20.094. 46. APA: Cameroon’s health ministry stops daily COVID-19 reports. Available at http://apanews.net/en/news/cameroons-health-ministry-stops-daily-covid-19-reports. Accessed July 28, 2020. 47. CRTV: COVID-19: Public health and communication ministers face the press with latest facts and figures. Available at http://www. crtv.cm/2020/03/covid-19-public-health-and-communication-ministers-face-the-press-with-latest-facts-and-figures/. Accessed July 26, 2020. 48. Joubert M, Metcalfe J: Three key drivers of good messaging in a time of crisis: Expertise, empathy and timing. The Conversation. Available at https://theconversation.com/three-keydrivers-of-good-messaging-in-a-time-of-crisis-expertise-empathyand-timing-135866. Accessed December 21, 2020. 49. Benzell S, Collis A, Nicolaides C: Rationing social contact during the COVID-19 pandemic: Transmission risk and social benefits of US locations. Proc Natl Acad Sci USA. 2020; 117(26): 14642-14644. DOI: 10.1073/pnas.2008025117. 50. World Bank: Individuals using the internet (% of population) in Cameroon. Available at https://data.worldbank.org/indicator/ IT.NET.USER.ZS?locations=CM. Accessed December 28, 2020. 51. Bolvine F: The changes in Cameroon’s public television in the advent of digital switchover: The impact of technological innovation on audio-visual public policies. Adv J Commun. 2017; 5: 1-22. DOI: 10.4236/ajc.2017.51001. 52. Vaismoradi M: Content analysis and descriptive analysis: Implications for conducting a qualitative descriptive study. Nurs Health Sci. 2013; 15: 398-405. DOI: 10.1111/nhs.12048. 53. Sangoseni O, Hellman M, Hill C: Development and validation of a questionnaire to assess the effect of online learning on behaviors, attitude and clinical practices of physical therapists in United States regarding of evidence-based practice. Internet J Allied Health Sci Pract. 2013; 11: 1-12. Available at https://nsuworks.nova. edu/cgi/viewcontent.cgi?article=1439&context=ijahsp&httpsredir=1 &referer=. Accessed July 20, 2021. 54. Bölenius K, Brulin C, Grankvist K, et al.: A content validated questionnaire for assessment of self-reported venous blood sampling practices. BMC Res Notes. 2012; 5: 39. DOI: 10.1186/1756- 0500-5-39. 55. Kember D, Leung D: Establishing the validity and reliability of course evaluation questionnaires. Assess Eval High Educ. 2008; 33: 341-353. DOI: 10.1080/02602930701563070. 56. Wong L, Ong F, Kuek Y: Constructing a survey questionnaire to collect data on service quality of business academics. Eur J Soc Sci. 2012; 29: 209-221. Available at http://eprints.utar.edu. my/860/1/6343.pdf. Accessed July 20, 2021. 57. Sandelowski M: What’s in a name? Qualitative description revisited. Res Nurs Health. 2010; 33: 77-84. 07-SA-Weston-JEM#210071.indd 96 14/03/22 7:40 PM
97 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 This CC research is exploratory and mainly qualitative. The conviction is that it has the potential to unveil multiple realities and report the findings in a literary style rich with valuable insights from informant commentaries and researcher’s analysis as required in qualitative research.52 QUESTIONNAIRE DESIGN/DEVELOPMENT When the COVID-19 started, the author and colleagues from universities in the UK and Cameroon (acknowledged) formed a research consortium to investigate various aspects of the pandemic that aligned with their research interest. Jointly, they designed the questionnaire for both groups of respondents through a multistage process that allowed the development of questions, which gauged the experiences, opinions, and behaviors of the informants on various aspects of the pandemic, including CC. The questions on CC relevant to achieve the research aims/objectives of this article have been shaded (“Questionnaire administered to the population” and “Questionnaire administered to health workers” sections) and are articulated at the appropriate sections in the findings. In anticipation of a large sample size, this study incorporated both open-ended and close-ended questions. The close-ended questions collected facts on CC issues from the survey takers since they could choose from a list of answers and were divided into ordinal and multiple-choice categories. In order to assess specific options on the themes under investigation, the multiple-choice questions were framed using a Likert scale, checklist, and rank order categories. To dig into the reasons behind the closed-ended questions, openended questions that enabled informants to respond in their own words were used to comprehend why the informants gave specific ratings or feedback on the closed-ended questions. Through open-ended questions, the survey takers also had the opportunity to cover themes/scenarios or gaps not addressed in the closed-ended questions or enquiries. The design took into consideration the fact that questions asked earlier in the survey may influence how the informants respond to later questions. This research ascertained the validity and reliability of the survey questionnaire. The initial idea to establish the validity and reliability of the survey questionnaire through a pilot/field test was dropped since this research was conducted during one of the worst global pandemics in history, where health workers and the population were preoccupied with ways to deal with or survive the pandemic risks, rather than responding severally to research enquiries. The research team, therefore, had one opportunity to access the respondents and maximized it to collect the research data. Hence, representational (content) validity was the best alternative means to establish validity of the data collection instrument. Content validity was conducted by the author, as an expert on the subject of CC through rational analysis of the appropriate questions in the questionnaire and agreeing that they are a valid measure of CC concepts and the traits in the IHRCC model.53,54 This study can be replicated elsewhere if the questionnaires are similar to the applicable ones used in this article, have a definite purpose that is related to the aims and objectives of this research, and administered electronically as was done in this research.55,56 QUESTIONNAIRE ADMINISTRATION PROCESS The survey was developed and administered online using google forms. A link to the survey was shared to informants through different online platforms using their phone numbers and/or email addresses. This facilitated the data collection process since the respondent could respond to the questions from almost any web browser, including that of tablets and mobile phones—important in developing countries where few people have access to PCs and laptops. The responses were also received instantaneously via google forms and spreadsheets, which facilitated the analysis. DATA ANALYSIS The data analysis was mainly qualitative and quantitative. Using content analysis, the data were analyzed both qualitatively and quantitatively.36,37,52 Appendix A: Supplementary information on methodology 07-SA-Weston-JEM#210071.indd 97 14/03/22 7:40 PM
98 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 The qualitative analysis utilized textual responses provided by open-ended questions. Qualitative analysis using content analysis is suitable for answering the research enquires required to understand the key IDEA features of IHRCC as demonstrated in the model (Figure 3). This analytical approach aims to detect and examine patterns/themes, trends, and frequencies in the data, which is then fragmented into relatively small units of content and subjected into descriptive and analytic treatment. The assumption is that the collected data are more or less an accurate representation of CC reality37,57 in Cameroon as experienced during the unfolding COVID-19 pandemic. The analytical process involved systematic coding and categorizing of textual information in the empirical, primary, and secondary data to determine themes, patterns/trends of words used, their relationship, and frequency, including the discourses of communication.35,37,52 The characteristics of speeches questionnaires/transcript’s content were described by examining government’s pandemic messages from the PM’s office to identify what was said, by whom and to which target audience. The indicative sequence of analytical stages, including in the findings and recommendations, is shown in the following flow diagram. It should be noted, however, that the sequence of analytical process provides a simple, lucid, and straightforward method of data analysis. Although the process described in the flow diagram looks linear, it was recursive with frequent reviews. The interpretation of quantified counts of the codes during content analysis and responses to close-ended questions were used to produce the quantitative analysis. Such questions gauged clear trends on various CC themes due to their distinct responses that made it easy to compare the responses of the survey findings. The quantitative analysis employed in this article, however, is simple basic statistics in percentages. Questionnaire administered to the population—Only the applicable questions (shaded) were used in this article No Questions 1 What is your gender? Please tick that which apply: (A) Male; (B) Female 2 What is your age? Please tick that which apply: (A) 18-30; (B) 31-40; (C) 51-50; (D) 51-60; (E) Above 60 3 What is your level of education? Please tick that which apply: (A) O-level certificate; (B) A level certificate; (C) Undergraduate degree; (D) Post graduate degree; (E) No formal education; (F) Primary school certificate/diploma; (G) Others (please mention) 4 What is your job or profession? 5 What region do you live in? 6 Please rate whether you think sensitization and/or community education on COVID-19 was adequate: (A) Somewhat adequate; (B) Not adequate; (C) Slightly adequate; (D) Fair; (E) Completely adequate 7 Which languages are being used for sensitization and/or to educate the population on COVID-19? 8 Which other language(s) will you want to be used for sensitization and/or community education on COVID-19? Please also explain this preference 9 What agencies/organizations contributed the most to sensitization/community education on COVID-19? Select the two best options: (A) Government agencies; (B) Religious institutions; (C) NGOs; (D) Social media; (E) State TV (CRTV); (F) Private TV channels; (G) State radio; (H) Private radio channels 10 Which sources provided you with the most credible information about COVID-19? Please check the relevant boxes: (A) Internet; (B) Associations; (C) Door to door sensitization; (D) Community sensitization; (E) Family members; (F) Radio; (G) Friends; (H) Phone networks; (I) Main state TV (CRTV); (J) Social media; (K) Private TV channels; (I) Others, please mention them 07-SA-Weston-JEM#210071.indd 98 14/03/22 7:40 PM
99 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 Questionnaire administered to the population—Only the applicable questions (shaded) were used in this article (continued) No Questions 11 What key messages on transmission of COVID-19 were passed on? Please check the relevant boxes: (A) Respiratory droplets generated by coughing and sneezing; (B) Contact with contaminated surfaces; (C) Avoid crowded places; (D) Greeting people with contaminated hands; (E) Social distancing; (F) Sanitization; (G) Wearing masks; (H) Others, please specify 12 What key messages on symptoms of COVID-19 were passed on? Please check the right boxes: (A) High temperatures; (B) A new continuous cough; (C) A loss or change to your sense of smell or taste; (D) Cool, feverishness; (E) Sore throat; (F) Sneezing; (G) Running nose; (I) Breathing difficulty; (J) Others, please mention 13 What key messages on prevention of COVID-19 were passed on? Please check the relevant boxes: (A) Social distancing; (B) Wearing of face masks; (C) Washing of hands with soap and water often; (D) Using hand sanitizer gel if soap and water are not available; (E) Avoid cool food; (F) No handshakes; (G) Stay indoors; (I) Others. please mention 14 Please rate how you feel the public responded to the preventive measures against COVID-19 selected. Please tick that which apply: (A) Not responsive; (B) Slightly responsive; (C) Somewhat responsive; (D) Moderately responsive; (E) Highly responsive 15 What are some of the challenges that affected the ability of the population to comply with the preventive measures against COVID-19? 16 Have you ever had a COVID-19 test? Please tick that which apply: (A) Yes; (B) No 17 Have you ever tested positive for COVID-19? Please tick that which apply: (A) Yes; (B) No 18 Please rate the extent to which COVID-19 patients are stigmatized (disregarded) in Cameroon. Please tick that which apply: (A) Very stigmatized; (B) Stigmatized; (C) Somewhat stigmatized; (D) Slightly stigmatized; (E) Not stigmatized 19 Please rate how confident you are in COVID-19 designated treatment centers’ capacity to help someone recover from COVID-19: (A) Somewhat confident; (B) Not confident; (C) Slightly confident; (D) Fairly confident; (E) Completely confident 20 Please mention some of the good aspects about COVID-19 management by the Cameroon government 21 Please mention some of the limitations associated with COVID-19 management by the Cameroon government 22 What do you think are some of the positive changes in the society that have come about as a result of COVID-19? 23 What measures have you taken personally to protect yourself from COVID-19? Tick the two that apply the most: (A) Avoiding visiting others; (B) Modifying my diet to boost my immune system; (C) Avoiding inviting others home; (D) Avoiding attending social events; (E) Regular washing of hands and the wearing of facemasks; (F) Others. Please mention them 24 How has COVID-19 affected you in general? Please select the relevant options: (A) Lost my job; (B) Fall in my business revenue; (C) Disruption of my education; (D) Loss of loved one; (E) Others, please mention 25 What other information would you like to provide? 07-SA-Weston-JEM#210071.indd 99 14/03/22 7:40 PM
100 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 Questionnaire administered to health workers—Only the applicable questions (shaded) were used in this article No Questions 1 What is your age range? Please tick that which apply: (A) 20-30 yrs; (B) 21-30 yrs; (C) 31-40 yrs; (D) 41-50 yrs; (E) 51-60 yrs; (F) Above 60 yrs 2 What is your gender? Please tick that which apply: (A) Male; (B) Female 3 Where do you work? Please tick that which apply: (A) Government facility; (B) Private facility; (C) Mission facility; (D) Organization 4 If government facility, what level is your health service? Please tick that which apply: (A) General hospital; (B) Regional hospital; (C) University hospital; (D) District hospital; (E) Health center; (F) Divisional/sub-divisional hospital; (G) Others 5 In which region of the country do you work? That would be one of Cameroon’s 10 administrative regions 6 What is your job and job title? 7 How many years’ experience do you have in that role? Please tick that which apply: (A) Less than 2 yrs; (B) 2-5 yrs; (C) 6-10 yrs; (D) 11-20 yrs; (E) Above 20 yrs 8 Have you played a role in the treatment/management of COVID-19 patients? Please tick that which apply: (A) Yes; (B) No 9 If your answer to question 8 is yes, what role did you play? Please explain 10 What is the main profile of patients you deal with on a regular basis? 11 Overall, what is your view on the management of COVID-19 by the government and your health facility? Do you think it has been adequate? 12 Does your facility have any treatment guidelines/protocols for COVID-19 patients? Please tick that which apply: (A) Yes; (B) No. If yes what are these? Were they handed down in a timely manner? 13 If you answered yes to the above question, do you think the guidance was comprehensive enough or had vital information? 14 Have you been allowed or had the right channel to voice your concerns regarding the pandemic? Please tick that which apply: (A) Yes; (B) No, please explain 15 Have you received feedback on concerns voiced? Do you think the response actions were appropriate and timely? Please explain 16 Since the pandemic started, have you received adequate training on how to diagnose and treat COVID-19 patients? Please tick that which apply: (A) Yes; (B) No 17 If you have been trained, how was the training organized? Please tick that which apply: (A) Locally; (B) At another health facility; (C) Remotely, ie, via webinar; (D) Others, please mention them 18 Have you received training on how to wear personal protection equipment (PPE) correctly? Please tick that which apply: (A) Yes; (B) No 19 Do you think you need more training? Please briefly explain 20 In your facility, what is the criteria for screening patients for COVID-19, ie, what symptoms will require a test. Please tick all that apply: (A) Shortness of breath; (B) Loss of smell and/or taste; (C) Fever; (D) Cough; (E) Temperature check; (F) Others, please explain 21 Do you screen all patients presenting with any of the above symptoms? Please tick that which apply: (A) Yes; (B) No 07-SA-Weston-JEM#210071.indd 100 14/03/22 7:40 PM
101 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 Questionnaire administered to health workers—Only the applicable questions (shaded) were used in this article (continued) No Questions 22 Do you currently test all patients admitted to your facility? Regardless of whether or not they have COVID-19 symptoms? Please tick that which apply: (A) Yes; (B) No 23 If you answered no to the above question, why is that the case? 24 How many suspected COVID-19 patients have you met, seen, or treated since the pandemic started? Can give an approximate number. This includes patients with fever, cough, shortness of breath, loss of taste, or smell 25 How many confirmed COVID-19 patients have you met, seen, or treated since the pandemic started? 26 If you treat COVID-19 patients, are the medications always available? Please tick that which apply: (A) Yes; (B) No; (C) Sometimes; (D) Unavailable before, available now 27 Has oxygen always been available at your facility? (A) Never; (B) Always; (C) A few times; (D) Most of the time 28 Does your hospital have the ability to manage patients needing intensive care? Ability includes anesthetists, ICU nurses, incubators, and ventilators. Please tick that which apply: (A) Yes (B) No 29 Have there been any major changes in patient care/management since the pandemic began until now? Please tick that which apply: (A) Yes; (B) No. If yes, what are the changes? 30 What effort has been made by the government to educate/sensitize or inform the community or Cameroonians on the risks posed by COVID-19? Please explain briefly 31 Do you think the measures have been appropriate or sufficient? Please explain 32 From your interaction with the public and your COVID-19 patients, what are your thoughts about their knowledge or understanding of the virus and the risks posed by it? 33 What challenges do you think patients face during the pandemic regarding accessing healthcare? 34 Do patients feel stigmatized having when diagnosed with COVID-19? 35 Do you think the public or community where you live have been following government’s instructions designed to prevent the spread of the virus? If yes, what has enabled this? If not, what are your concerns? 36 Please rate how you feel the public responded to the preventive measures against COVID-19: (A) Slightly responsive; (B) Somewhat responsive; (C) Not responsive; (D) Fairly responsive; (E) Completely responsive 37 What are the main difficulties/challenges in the response to COVID-19 and what opportunities can be derived from this experience? 38 What other comments would you like to say concerning the overall COVID-19 pandemic crisis management in Cameroon? 07-SA-Weston-JEM#210071.indd 101 14/03/22 7:40 PM
102 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 DATA ANALYSIS AND REPORTING PROCESS 07-SA-Weston-JEM#210071.indd 102 14/03/22 7:40 PM
Bring America’s Foremost Disaster Medicine Experts To Your Next Disaster Call. DISASTER MEDICINE A MERICAN JOURNAL OF Original Articles • Disaster medicine: A history ................125 Geoff Williams • The impact of natural disasters on the elderly ........................133 E. Paul Cherniack, MD • A unique role for dental school faculty: Telephone triage training and integration into a health departments’ emergency response planning ..............................141 Jill B. Fernandez, RDH, MPH David L. Glotzer, DDS Marc M. Triola, MD Walter J. Psoter, DDS, PhD • The impact of the Tsunami on hospitalizations at the tertiary care hospital in the Southern Province of Sri Lanka ........................................147 Truls Østbye, MD, PhD Thyagi Ponnamperuma, MBBS Nayana Fernando, MBBS, MSc Vathsala Abeygunawardena, MSc W. A. A. Wijayasiri, MBBS, MSc Jodi J. Chen, MD Christopher W. Woods, MD, MPH • The performance-level model of hospital decontamination preparedness......................................157 Scot Phelps, JD, MPH Garrett Doering, MS • The impact of correctional institutions on public health during a pandemic or emerging infection disaster ..................................165 Rachel D. Schwartz, PhD • Hospital-based disaster preparedness for pediatric patients: How to design a realistic set of drill victims ....................................171 Shana Ballow, DO Solomon Behar, MD Ilene Claudius, MD Kathleen Stevenson, RN Robert Neches, PhD Jeffrey S. Upperman, MD, FAAP, FACS • International Disaster Response Law: An introduction ..............................181 Lewis W. Marshall, Jr, MS, MD, JD Official Journal of the American Society of Disaster Medicine Vol. 3, No. 3–May/June 2008 ISSN 1932-149X TM CONTENTS Leading the Way in Disaster Medicine e American Journal of Disaster Medicine is edited, written and peer-reviewed by the most impressive and knowledgeable names in the eld, including the leading innovator in disaster medicine, Susan Briggs, M.D., our editor-in-chief. So you know you’re getting the most accurate, up-to-date and relevant information in every issue. Indexed in PubMed and Medline, no other publication o ers this level of expertise in this unique specialty. Specializing in Your Specialty Published quarterly, every issue of the American Journal of Disaster Medicine provides in-depth coverage on injuries and illnesses most physicians have never seen—like blast wounds and post-explosion injuries, biological weapons contamination and mass physical and psychological trauma. Getting the Edge in Saving Lives Put America’s leading experts in disaster medicine on your disaster medicine team. Subscribe to the American Journal of Disaster Medicine by calling 1-800-743-7206, visiting www.disastermedicinejournal.com or lling out the enclosed form. Subscribe today! Learn from the Leading Innovators in Disaster Medicine, with the American Journal of Disaster Medicine WEB www.disastermedicinejournal.com PHONE 800-743-7206 x108 (Toll Free) 781-899-2702 x108 (Outside USA) MAIL 470 Boston Post Road, Weston, MA 02493 FAX 781-899-4900 (24 hours/day) 4 WAYS TO SUBSCRIBE: JEM_V20N2_AJDM_Layout 1 3/28/2022 12:09 PM Page 1
URNA p JO Pre AL OF EMERGENCY paring You Y MANAGEMENT u for Ind exed in PUBMED/NLM M/DMIRC/SCOPUS Prep Wha The M in Our Every issu aring a p You atever Dis ost Pressing Issues Industry e of Journal of Emergency Mana for m u aster Co agement is mes Your W Way Every issu peer-revie and insigh Emergen Disaster Emergen Risk ma Emergen 6HYHUH Z e of Journal of Emergency Mana wed and packed with invaluable i ht. Published bi-monthly, topics in ncy planning and response r recovery and business continuity ncy preparedness and response l nagement ncy management today, tomorrow a ZHDWKHU ÁRRG DQG KXUULFDQH VWXG agement is nformation clude: y planning egislation and the future LHV The Le The Journ peer-revie foremost eader in Emergency nal of Emergency Management is ewed by an internationally recogniz hands-on EM experts. They includ Management s written, edited and zed team of the de top professionals (PHUJHQ Continui Preparat Cross-tra And muc Ava QF\ QRWLÀFDWLRQ DQG FRPPXQLFDWLR ty of operations and infrastructur tion and evacuation of special popu aining in emergency management ch more, including the latest on CO ailable in print, online and site licens RQ re protection ulations OVID-19 from the p experienc who provi studies. T and usefu And, Jour for indexin PUBMED The M e access p y public and private sectors who offe ce and practical solutions, as well a ide perspective and analysis on th Together, they bring you the most t ul source of information on emerge rnal of Emergency Management ng in the National Library of Medic database as well as the DMIRC an ost Important Thing Yo p p er real world as leading academics e latest research and horough, relevant ency management. has been accepted cine’s prestigious nd SCOPUS. ou Can The M Do for Make sure Subscribe or visit ww Subscribe 4 Ways ost Important Thing Yo Yourself and Your EM e you and your team stay one step a e today by calling 1-800-743-7206 ww.emergencymanagementjourn now, and be prepared for anything! s to Subscribe ou Can Team ahead of disaster. nal.com. www e WEB PHO Mai Fax B emergencymanagement www.emergencymanagem ONE 800-743-7206 x108 (Toll 781-899-2702 x108 (Outs l 470 Boston Post Road, Wes 781-899-4900 (24 hours/ m tjournal com entjournal.co Free) side USA) ston, MA 02493 /day) IS SSN 1543-5865 www.e emergencymanagement tjournal.com JEM_V19N2_JEM_Cover4 4/22/2021 12:23 PM Page 1