Competencies of occupational health professionals for disaster management based on their own experiences

Abstract

Introduction: This study aims to clarify whether the competencies required of occupational health professionals for disaster management, identified from experiences in a single disaster, can be agreed upon by occupational health professionals with experience in other disaster responses. Methods: This study employed a quantitative study design using a questionnaire. The participants were occupational health professionals. The questionnaire included 29 competencies identified from the experiences of occupational health activities conducted during the Kumamoto earthquake. Items were rated from 1 (not necessary at all) to 5 (very necessary) by the participants. Exploratory factor analysis of the responses was performed. Result: The participants were 334 (29.9%), of which 97 (29.0%) answered that they had disaster response experience. Factor analysis was performed by setting three factors for 22 items. Factors 1, 2, and 3 were labeled “skills about coordinating within the organization,” “practical ability to respond to changing situations,” and “consistency as occupational health professionals,” respectively. Discussion: In the event of a disaster, occupational health professionals are required to ensure their own safety, grasp the occupational health needs changing over time, and make decisions based on changing situations. The study suggests that a disaster response is a rare experience even for specialists in occupational health. To enable them to appropriately play their roles in occupational health response during disasters, a system of education aimed at maintaining coherence as the occupational health profession and demonstrating coordinating and practical skills in the event of a disaster should be established.

Introduction

In Japan, people experience various natural disasters¹⁾. Various natural, biological, and man-made disasters affect business activities^2,3). Following the Great East Japan Earthquake in 2011⁴⁾, it was reconfirmed that supporting both workers’ health and business continuity in the event of a disaster was an occupational health problem to be addressed by occupational health professionals²⁾. Employees are exposed to unusual health risks, but companies are required to continue business. Several studies have reported that the needs for occupational health in disasters have been verified and the role of occupational health professionals have been required when a disaster occurred^2,5,6). In the event of a disaster, occupational health professionals are required to flexibly respond to employees’ conditions and the occupational health needs, that change over time^5,6). We are able to learn from experiences with past large-scale disasters the occupational health needs that occur during disasters. On the other hand, occupational health functions should be incorporated into crisis management organizations, and human resources who can respond to occupational health activities in the event of a disaster should be developed^2,7). Such issues are urgent and enable occupational health professionals to play a role in the workplace during disasters. To realize effective and efficient provision of occupational health services and support the restoration and reconstruction of business establishments in the event of a disaster, it is necessary to improve competencies^8,9,10) such as knowledge and skills, behavioral characteristics that occupational health professionals must have.

Based on the competencies required of occupational health professionals in the event of a disaster, it is possible to build educational programs necessary for improvement of skills and abilities and propose an occupational health system that should be prepared for the event of a disaster^11,12,13,14). However, no reports were found describing the competencies of occupational health professionals in the event of a disaster. There are some reports describing the competencies required of disaster medicine or public health workers in times of crisis^{11,12,13,14,15,16,17,18)}. These reports are the results of literature reviews or studies of the Delphi method, and do not fully explain the evidences that they are practical findings. Further, these previous studies focus on the competencies required for activities of health workers for the general population and patients, and the competencies were focused on triage and shelter management during the acute phase of a disaster. Therefore, the disaster response in occupational health activities for employees and workplaces has not been clarified.

Our previous studies identified the competencies required by occupational health staff based on experiences with regard to occupational health activities in companies after the Kumamoto earthquakes¹⁹⁾. In the previous survey, occupational physicians and occupational health nurses who responded to occupational health needs during the Kumamoto earthquake were interviewed. The survey identified competencies which were structured into 9 categories and 29 subcategories. Whether the competencies identified from the experiences in a single disaster can be agreed upon by occupational health professionals who had responded in the event of disasters seems necessary to verify. The current study aims to clarify the competencies required of occupational health professionals in disaster management with reference to these 29 competencies.

Subjects and Methods

Procedures and participants

An anonymous self-administered questionnaire survey was conducted from December 2019 to February 2020. The participants were Certified Senior Occupational Physicians, Certified Occupational Physicians, Certified Senior Occupational Health Nurses/Public Health Nurses, and Certified Occupational Health Nurses/ Public Health Nurses certified by the Japan Society for Occupational Health, who had practical experiences in occupational health activities during disasters.

A questionnaire designed by the researchers was used in this study. The questionnaire was conducted in Japanese. The participants were first asked to answer in the questionnaire whether they had experienced an occupational health activity during a disaster. Only participants who had experienced a disaster also answered the following questions. The backgrounds of the participants were asked about the age and gender, occupation, years of experience. The questionnaire included 29 items, shown in Table 1. The 29 items are based on a study that investigated the competencies required of professionals in occupational health disasters¹⁹⁾. These competencies were rated from 1 to 5 (1: not necessary at all, 2: not necessary, 3: neither, 4: necessary, 5: very necessary) by the participants. Factor analysis was performed to identify the structure of competencies regarded as necessary by participants.

Table 1. The items of the questionnaire; 29 competencies required to occupational health professional in disaster management, based on the experience of occupational health activities in companies after the Kumamoto earthquakes¹⁸⁾

Categories	Subcategories
Grasping the overall of the health impacts caused by disasters and understanding the essence	1.	Comprehensively understanding the background of employees’ health issues and grasping the essence
	2.	Sensitively perceiving and sympathizing with the feelings and situations of employees who are victims of a disaster
	3.	Understanding the impact of disasters on employees and the workplace, including long-term effects
Deciding priority of duties while properly grasping the situation that changes over time	4.	Accurately assess ever-changing situations and identifying potential occupational health risks occurring over time
	5.	Collecting necessary information and data to the extent possible and utilizing them for analysis
	6.	Identifying potential needs and communicating them to employees and the company
	7.	Estimating in current resources and mobility, prioritizing and assembling duties
Starting from what one can do while ensuring one’s own health and safety	8.	Performing one’s duties while taking into consideration one’s own situation as a victim of a disaster
	9.	Doing what one should do now
	10.	Preparing means and methods to keep in touch in an emergency
Continuing to practice occupational health by devising efficient approaches while flexibly responding to the situation	11.	Confirming the chain of command in disaster response and dividing the roles and working
	12.	Thinking and practicing mechanisms to ensure that information reaches employees
	13.	Promoting efficient occupational health activities while responding flexibly to disaster phases and situations
Creating an environment for enabling occupational health team members to fulfill each role	14.	Aligning goals and directions to increase the effectiveness of the occupational health team’s activities
	15.	Assigning roles to occupational health team members based on their abilities and characteristics
	16.	Trusting on occupational health team members and leaving the roles to them
	17.	Making and implementing mechanisms for information sharing within the occupational health team
	18.	Creating a system to support each other within the occupational health team
Coordinating the position of the occupational health department within the company and utilizing the network	19.	Coordinating the position of the occupational health department required to respond to the workplace’s needs
	20.	Identify the damage and reconstruction status of the workplace and developing strategies to facilitate the decision-making of the organization
	21.	Encouraging employees and the company to become independent even in the event of a disaster
	22.	Using and building networks that help the achievement of objectives
Having the personal characteristics that are essential for occupational health professionals	23.	Appropriately recognizing the role of the occupational health professional and having a consistent attitude as a profession
	24.	Reflecting on one’s own words, actions, and decisions, and connecting to the next duty
	25.	Understanding one’s characteristics and limitations and making a choice
Establishing relationships of trust with employees and the company	26.	Establishing relationships of trust with employees and the company
Making use of disaster experience for future occupational health practice	27.	Recording the findings and knowledge gained from the disaster experience
	28.	Preparing to maximize the power of the occupational health department in the event of a disaster
	29.	Making use of disaster experience for occupational health practice in normal times

Statistical analysis

The responses obtained were analyzed by applying IBM^® SPSS^® Statistics 22.0 packages for Windows (IBM Corp, Armonk, NY, USA). Two-tailed significance level was set to p<0.05.

For the answers to each item, the frequency, range, mean, and standard deviation were calculated. Participants were divided into two groups: occupational physicians (Certified Senior Occupational Physician, Certified Occupational Physician) and occupational health nurses (Certified Senior Occupational Health Nurse/Public Health Nurse, and Certified Occupational Health Nurse/ Public Health Nurse), and the median between the two groups was compared using the Mann-Whitney U test.

Then, the ceiling effect, floor effect, and correlation between items were verified for 29 items. Prior to factor analyses, quality control for the dataset was conducted using the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy. Exploratory factor analysis of the results was further performed to confirm factor loading and inter-factor correlation. The factor analysis with maximum likelihood method was performed using promax rotation. Factor analysis was conducted by setting the number of factors determined using a scree plot. The items with factor loading of 0.3 or less and showing double loading were deleted from the 29 items. For each factor analysis, we checked a scree plot and factor loading and determined the number of factors and items. Last, Cronbach’s α was used to calculate the internal consistency for each factor revealed by analysis.

Ethical considerations

This study was conducted according to the Ethical Guidelines for Epidemiological Studies as established by the Japanese government. The Ethics Committee of the Japanese Red Cross College of Nursing (2019-081) approved the research protocol. The aims and procedures of this study were explained in the questionnaire and consent was obtained from each participant when completing the questionnaire.

Results

There were 1,183 subjects (427 Certified Senior Occupational Physicians, 193 Certified Occupational Physicians, 89 Certified Senior Occupational Health Nurses/Public Health Nurses, and 476 Certified Occupational Health Nurses/Public Health Nurses, excluding 2 overseas residents). We mailed them the questionnaire: 66 were unaddressed and 1,117 were surveyed. Of the 1,117 subjects, the questionnaire was replied by 334 (29.9%). Of the responses, 97 (29.0%) participants had disaster response experiences. The basic characteristics of study participants are shown in Table 2. Sixty-two (63.9%) participants had experienced a natural disaster, 26 (26.8%) experienced a man-made disaster, and 9 (9.3%) experienced a biological disaster. The average scores for the 29 competencies are shown in Table 3-1. Table 3-2 shows the median value of the two groups (occupational physicians and occupational health nurses) and the p-value calculated using the Mann-Whitney U test.

Table 2. Basic characteristics of study participants

		Number	%	Average value	SD
Disaster response experience (N=334)
	Yes	97	29.0
	No	237	71.0
	No answers	0	0.0

		Number	%	Average value	SD
Number of disaster response experience (N=97)
	Responses	86	88.7	1.71	±1.06
	No answers	11	11.3
Age, years
	20s	1	1.0
	30s	19	19.6
	40s	29	29.9
	50s	40	41.2
	60s	8	8.2
Sex
	Men	40	41.2
	Women	44	45.4
	No answers	13	13.4
Occupation
	Exclusive occupational physician	32	33.0
	Commission occupational physician	25	25.8
	Full-time nurse	33	34.0
	Part-time nurse	4	4.1
	Other	3	3.1
Types of disasters
	Natural disasters	62	63.9
	Biological disaster	9	9.3
	A man-made disaster	26	26.8
Years of experience after graduation (N=97)				23.5	±8.96
Years of occupational health experience to date (N=97)				19.2	±8.29

Table 3-1. The average scores for the 29 competencies

Competencies		Average	Range	SD		Average +1SD	Average −1SD
1.	Comprehensively understanding the background of employees’ health issues and grasping the essence	4.58	(1.0−5.0)	±	0.69	5.27*	3.89
2.	Sensitively perceiving and sympathizing with the feelings and situations of employees who are victims of a disaster	4.48	(3.0−5.0)	±	0.54	5.03*	3.94
3.	Understanding the impact of disasters on employees and the workplace, including long-term effects	4.59	(3.0−5.0)	±	0.54	5.12*	4.05
4.	Accurately assess ever-changing situations and identifying potential occupational health risks occurring over time	4.54	(1.0−5.0)	±	0.69	5.23*	3.84
5.	Collecting necessary information and data to the extent possible and utilizing them for analysis	4.22	(2.0−5.0)	±	0.70	4.91	3.52
6.	Identifying potential needs and communicating them to employees and the company	4.51	(1.0−5.0)	±	0.71	5.21*	3.80
7.	Estimating in current resources and mobility, prioritizing and assembling duties	4.22	(1.0−5.0)	±	0.77	4.98	3.45
8.	Performing one’s duties while taking into consideration one’s own situation as a victim of a disaster	4.33	(1.0−5.0)	±	0.75	5.08*	3.58
9.	Doing what one should do now	3.91	(1.0−5.0)	±	0.89	4.80	3.02
10.	Preparing means and methods to keep in touch in an emergency	4.46	(2.0−5.0)	±	0.72	5.19*	3.74
11.	Confirming the chain of command in disaster response and dividing the roles and working	4.55	(2.0−5.0)	±	0.60	5.14*	3.95
12.	Thinking and practicing mechanisms to ensure that information reaches employees	4.28	(1.0−5.0)	±	0.84	5.12*	3.44
13.	Promoting efficient occupational health activities while responding flexibly to disaster phases and situations	4.36	(1.0−5.0)	±	0.74	5.10*	3.62
14.	Aligning goals and directions to increase the effectiveness of the occupational health team’s activities	4.03	(2.0−5.0)	±	0.76	4.79	3.27
15.	Assigning roles to occupational health team members based on their abilities and characteristics	4.18	(1.0−5.0)	±	0.82	4.99	3.36
16.	Trusting on occupational health team members and leaving the roles to them	3.87	(1.0−5.0)	±	0.95	4.82	2.91
17.	Making and implementing mechanisms for information sharing within the occupational health team	4.32	(1.0−5.0)	±	0.74	5.06*	3.58
18.	Creating a system to support each other within the occupational health team	4.22	(1.0−5.0)	±	0.92	5.13*	3.30
19.	Coordinating the position of the occupational health department required to respond to the workplace’s needs	4.39	(3.0−5.0)	±	0.60	5.00	3.79
20.	Identify the damage and reconstruction status of the workplace and developing strategies to facilitate the decision-making of the organization	3.90	(1.0−5.0)	±	0.80	4.69	3.10
21.	Encouraging employees and the company to become independent even in the event of a disaster	3.57	(2.0−5.0)	±	0.84	4.41	2.73
22.	Using and building networks that help the achievement of objectives	4.11	(1.0−5.0)	±	0.83	4.94	3.29
23.	Appropriately recognizing the role of the occupational health professional and having a consistent attitude as a profession	4.37	(1.0−5.0)	±	0.77	5.14*	3.60
24.	Reflecting on one’s own words, actions, and decisions, and connecting to the next duty	4.22	(2.0−5.0)	±	0.68	4.90	3.54
25.	Understanding one’s characteristics and limitations and making a choice	4.32	(2.0−5.0)	±	0.69	5.00*	3.63
26.	Establishing relationships of trust with employees and the company	4.66	(3.0−5.0)	±	0.52	5.18*	4.14
27.	Recording the findings and knowledge gained from the disaster experience	4.46	(3.0−5.0)	±	0.60	5.06*	3.87
28.	Preparing to maximize the power of the occupational health department in the event of a disaster	4.23	(2.0−5.0)	±	0.73	4.96	3.50
29.	Making use of disaster experience for occupational health practice in normal times	4.21	(1.0−5.0)	±	0.78	4.98	3.43

SD, standard deviation. *16 items showed the ceiling effect(≥5.0), but none showed the floor effect.

Table 3-2. The average scores for the 29 competencies between occupations

	Competencies	occupational physicians (n=59)					occupational health nurses (n=38)
		Average ±SD			Median (interquartile range)		Average ±SD			Median (interquartile range)		p-value#
1	Comprehensively understanding the background of employees’ health issues and grasping the essence	4.61	±	0.77	5.0	(4.0−5.0)	4.53	±	0.56	5.0	(4.0−5.0)	0.216
2	Sensitively perceiving and sympathizing with the feelings and situations of employees who are victims of a disaster	4.48	±	0.50	4.0	(4.0−5.0)	4.50	±	0.60	5.0	(4.0−5.0)	0.633
3	Understanding the impact of disasters on employees and the workplace, including long-term effects	4.59	±	0.56	5.0	(4.0−5.0)	4.58	±	0.50	5.0	(4.0−5.0)	0.741
4	Accurately assess ever-changing situations and identifying potential occupational health risks occurring over time	4.56	±	0.53	5.0	(4.0−5.0)	4.50	±	0.89	5.0	(4.0−5.0)	0.816
5	Collecting necessary information and data to the extent possible and utilizing them for analysis	4.30	±	0.62	4.0	(4.0−5.0)	4.08	±	0.78	4.0	(4.0−5.0)	0.180
6	Identifying potential needs and communicating them to employees and the company	4.46	±	0.82	5.0	(4.0−5.0)	4.58	±	0.50	5.0	(4.0−5.0)	0.695
7	Estimating in current resources and mobility, prioritizing and assembling duties	4.22	±	0.81	4.0	(4.0−5.0)	4.21	±	0.70	4.0	(4.0−5.0)	0.809
8	Performing one’s duties while taking into consideration one’s own situation as a victim of a disaster	4.30	±	0.81	4.0	(4.0−5.0)	4.37	±	0.63	4.0	(4.0−5.0)	0.875
9	Doing what one should do now	3.92	±	0.84	4.0	(3.0−5.0)	3.90	±	0.98	4.0	(3.0−5.0)	0.901
10	Preparing means and methods to keep in touch in an emergency	4.56	±	0.65	5.0	(4.0−5.0)	4.32	±	0.81	4.5	(4.0−5.0)	0.133
11	Confirming the chain of command in disaster response and dividing the roles and working	4.56	±	0.60	5.0	(4.0−5.0)	4.53	±	0.60	5.0	(4.0−5.0)	0.790
12	Thinking and practicing mechanisms to ensure that information reaches employees	4.34	±	0.84	4.0	(4.0−5.0)	4.18	±	0.83	4.0	(4.0−5.0)	0.305
13	Promoting efficient occupational health activities while responding flexibly to disaster phases and situations	4.42	±	0.56	4.0	(4.0−5.0)	4.26	±	0.95	4.0	(4.0−5.0)	0.645
14	Aligning goals and directions to increase the effectiveness of the occupational health team’s activities	4.14	±	0.68	4.0	(4.0−5.0)	3.87	±	0.84	4.0	(3.0−4.0)	0.133
15	Assigning roles to occupational health team members based on their abilities and characteristics	4.25	±	0.63	4.0	(4.0−5.0)	4.05	±	1.04	4.0	(4.0−5.0)	0.602
16	Trusting on occupational health team members and leaving the roles to them	4.05	±	0.73	4.0	(4.0−5.0)	3.58	±	1.18	4.0	(3.0−4.0)	0.054
17	Making and implementing mechanisms for information sharing within the occupational health team	4.48	±	0.54	4.0	(4.0−5.0)	4.08	±	0.94	4.0	(4.0−5.0)	0.022*
18	Creating a system to support each other within the occupational health team	4.24	±	0.84	4.0	(4.0−5.0)	4.18	±	1.04	4.0	(4.0−5.0)	0.890
19	Coordinating the position of the occupational health department required to respond to the workplace’s needs	4.42	±	0.59	4.0	(4.0−5.0)	4.34	±	0.63	4.0	(4.0−5.0)	0.542
20	Identify the damage and reconstruction status of the workplace and developing strategies to facilitate the decision-making of the organization	4.03	±	0.72	4.0	(4.0−5.0)	3.68	±	0.87	4.0	(3.0−4.0)	0.056
21	Encouraging employees and the company to become independent even in the event of a disaster	3.51	±	0.84	3.0	(3.0−4.0)	3.66	±	0.85	3.0	(3.0−4.0)	0.484
22	Using and building networks that help the achievement of objectives	4.20	±	0.66	4.0	(4.0−5.0)	3.97	±	1.03	4.0	(4.0−5.0)	0.433
23	Appropriately recognizing the role of the occupational health professional and having a consistent attitude as a profession	4.32	±	0.88	4.0	(4.0−5.0)	4.45	±	0.55	4.0	(4.0−5.0)	0.775
24	Reflecting on one’s own words, actions, and decisions, and connecting to the next duty	4.20	±	0.71	4.0	(4.0−5.0)	4.24	±	0.63	4.0	(4.0−5.0)	0.931
25	Understanding one’s characteristics and limitations and making a choice	4.32	±	0.71	4.0	(4.0−5.0)	4.32	±	0.66	4.0	(4.0−5.0)	0.870
26	Establishing relationships of trust with employees and the company	4.64	±	0.55	5.0	(4.0−5.0)	4.68	±	0.47	5.0	(4.0−5.0)	0.863
27	Recording the findings and knowledge gained from the disaster experience	4.41	±	0.59	4.0	(4.0−5.0)	4.55	±	0.60	5.0	(4.0−5.0)	0.192
28	Preparing to maximize the power of the occupational health department in the event of a disaster	4.22	±	0.70	4.0	(4.0−5.0)	4.24	±	0.79	4.0	(4.0−5.0)	0.773
29	Making use of disaster experience for occupational health practice in normal times	4.25	±	0.82	4.0	(4.0−5.0)	4.13	±	0.70	4.0	(4.0−5.0)	0.250

SD, standard deviation.

# The medians of the two groups were compared by the Mann-Whitney U test and the p-values were calculated. * Two-tailed significance level was set to p<0.05.

To verify bias in the response, the study examined ceiling and floor effects. An average value of +1SD ≥5 (maximum value) was considered the ceiling effect, whereas an average value of −1SD ≤1 (minimum value) was set as the floor effect. The ceiling effect was observed in 16 items, but none for the floor effect (Table 3-1). The items showing the ceiling effect seem to be agreed upon by the participants as the competencies required of occupational health professionals in the event of a disaster. This survey does not aim to develop a questionnaire, but to identify the factors latent in the obtained items. Therefore, factor analysis was performed using all 29 items.

The corresponding KMO value was 0.865, indicating that the sampling was adequate. The result of exploratory factor analysis using promax rotation showed that 22 items on the competencies required for occupational professionals in disaster management was comprised of 3 factors. The process for determining the number of factors and items were as follows. First, a factor analysis was performed on the 29 items with 6 factors from scree plot characteristics. Then, item 13 and 19, which had a factor loading of 0.3 or less as the result were deleted, and a factor analysis was performed again with 6 factors. Similarly, a total of 5 factor analyses were performed and 7 items were deleted because of low factor loading (items 2, 9, 13, 19, and 21), double loading (item 25), or more than 1.0 factor loading (item 1). The Cronbach’s α was calculated to confirm internal consistency. The Cronbach’s alpha coefficients were 0.91, 0.85, and 0.82 for factors 1, 2, and 3, respectively. The internal consistency coefficients were good at acceptable levels. Table 4 presents the factor names.

Table 4. The result of factor analysis about the competencies required to occupational professionals in disaster management

“The name of factors” (Cronbach α) Items			Factor lording
			Factor 1	Factor 2	Factor 3
Factor 1. “Skills about coordination within the organization” (α=0.91)
17.	Making and implementing mechanisms for information sharing within the occupational health team		0.913	−0.022	−0.076
15.	Assigning roles to occupational health team members based on their abilities and characteristics		0.793	−0.013	0.145
16.	Trusting on occupational health team members and leaving the roles to them		0.739	−0.097	0.157
18.	Creating a system to support each other within the occupational health team		0.697	−0.260	0.279
20.	Identify the damage and reconstruction status of the workplace and developing strategies to facilitate the decision-making of the organization		0.585	−0.048	0.152
10.	Preparing means and methods to keep in touch in an emergency		0.584	0.235	−0.269
5.	Collecting necessary information and data to the extent possible and utilizing them for analysis		0.580	0.317	−0.035
14.	Aligning goals and directions to increase the effectiveness of the occupational health team’s activities		0.577	0.213	0.063
12.	Thinking and practicing mechanisms to ensure that information reaches employees		0.511	0.323	−0.291
22.	Using and building networks that help the achievement of objectives		0.371	0.261	0.200
Factor 2. “Practical ability to respond to changing situations” (α=0.85)
11.	Confirming the chain of command in disaster response and dividing the roles and working		0.036	0.708	−0.134
4.	Accurately assess ever-changing situations and identifying potential occupational health risks occurring over time		0.113	0.647	−0.140
3.	Understanding the impact of disasters on employees and the workplace, including long-term effects		−0.053	0.639	0.077
28.	Preparing to maximize the power of the occupational health department in the event of a disaster		0.057	0.592	0.207
6.	Identifying potential needs and communicating them to employees and the company		0.020	0.533	0.005
24.	Reflecting on one’s own words, actions, and decisions, and connecting to the next duty		−0.144	0.516	0.431
27.	Recording the findings and knowledge gained from the disaster experience		−0.053	0.496	0.271
26.	Establishing relationships of trust with employees and the company		−0.038	0.471	0.190
7.	Estimating in current resources and mobility, prioritizing and assembling duties		0.129	0.456	0.073
Factor 3. “Consistency as occupational health professionals” (α=0.82)
29.	Making use of disaster experience for occupational health practice in normal times		0.120	0.036	0.790
8.	Performing one’s duties while taking into consideration one’s own situation as a victim of a disaster		0.106	−0.158	0.755
23.	Appropriately recognizing the role of the occupational health professional and having a consistent attitude as a profession		−0.120	0.262	0.645
Interactor correlation		1	−	0.616	0.450
		2	−	−	0.470
		3	−	−	−

Factor analysis was performed using promax rotation by setting 3 factors for 22 items, after 6 items with a factor loading of 0.3 or less and 1 item showing double loading were deleting from 29 items.

Factor 1 consisted of 10 competencies. These include elements, such as establishing an information sharing system, creating an environment where each role of staffs can be fulfilled within the occupational health team, and utilizing strategies and network to draw out decisions within the organization. These competencies are related to coordination within the organization to enable the efficient performance of the occupational health professionals.

Factor 2 consisted of 9 competencies. These include the elements, such as anticipating occupational health needs and prioritizing operations in situations that change over time and continuing to provide occupational health services from a long-term perspective that leads not only to the acute phase of a disaster but also to normal times from recovery and reconstruction.

Factor 3 consisted of three competencies. These included items, such as presenting a consistent attitude as an occupational health professional fulfilling responsibility while ensuring one’s own safety and health. This competency is related to demonstrating professional coherence.

Discussion

In the event of a disaster, while flexibly responding to ever-changing situations, occupational health professionals are required to work on daily practice from a medium- to long-term perspective while ensuring their own safety and health^5,6). Occupational health professionals play a role in providing professional support for the independent occupational health activities of business operators and workers. However, in the event of a disaster, measures that differ from normal times are necessary, such as identifying potential occupational health needs related to disaster response and supporting decision-making regarding occupational health in crisis management¹⁹⁾. The results of our study suggest that the 29 competencies required of occupational health professionals for disaster management as identified from a single disaster, the Kumamoto earthquake, are agreed upon by occupational health professionals who experienced another disaster. Further, any differences between the occupations with regards to these competencies were not shown, except for one.

Item 26, “Establishing relationships of trust with employees and the company,” was the most agreed. The top 10 of the 29 competencies were related to assessment skills and roles of occupational health professionals. Although 16 items showed a ceiling effect, assuming that it was agreed that 29 items are important competencies for occupational health in disasters, factor analysis was performed on all 29 items. According to the factor analysis, three factors were identified: “skills about coordinating within the organization,” “practical ability to respond to changing situations,” and “consistency as occupational health professionals.” “Skills about coordinating within the organization” pertained to coordination within the occupational health team and between occupational health staff and the company or workers.

Of the seven items excluded from the three factors, “Comprehensively understanding the background of employees’ health issues and grasping the essence” had an average score of 4.58 and a high factor loading. Therefore, it was suggested that this competency is important. Six other items provided small factor loadings, but average scores were ≥3.57. The participants seemed to deem these factors necessary.

These 29 competencies and three factors supported the findings of previous studies about the competencies required to occupational health professionals^2,4,5,6). In other words, decision-making and collecting and sharing information are important elements in responding to needs in the event of a disaster. In addition, occupational health professionals can identify occupational health needs that change over time during a disaster and need to clarify their roles and act.

Previous studies reported on the competencies required of disaster medicine or public health workers in disaster response^{11,12,13,14,15,16,17,18)}, but these studies did not fully explain the rationale based on practice. Furthermore, studies on the required competencies of occupational health professionals are lacking.

The present study has its limitations. According to some recommendations, the sample size in factor analysis should be at least 100^20,21). Further, some recommendations suggest that the subject-to-variable ratio should not be lower than 5^20,22). We needed to divide the participants into two groups (occupational physicians vs. occupational health nurses). However, there were only 97. Therefore, we analyzed participants as one group (occupational professionals). In addition, as a result of factor analysis, three items included in the top 10 items were excluded from the three factors. This result seems influenced by the small number of responses. The small number of respondents may also limit the generalizability and applicability of the results.

Competencies^8,9,10) are defined as “measurable knowledge, skills, abilities, behaviors and other trait patterns required by an individual to successfully perform a job role or function”. With this definition, “job performance to achieve high results,” “assessment skills,” “management skills,” and “communication skills” are deemed common competencies required to occupational health professionals in disaster management^5,6,19) and normal occupational practice^{23,24,25,26,27,28)}. One the other side, in the event of a disaster, occupational health staff are required^5,6,19) to ensure their own safety, grasp occupational health needs that change over time, and make decisions according to changing situations. These can be said to be different from normal times. The result suggests that, based on occupational health activities in normal times, occupational health professionals are required to respond to the needs associated with changes over time during disasters. In this study, the competencies were not compared between occupational physicians and occupational health nurses. A United Kingdom study reports that the competencies of those occupations in normal occupational practice are almost the same²⁷⁾. Although the results of the survey in the United Kingdom cannot be simply referred to, as it has different occupational health systems, there is no research on the competencies of occupational health professionals in Japan regarding the differences between occupations. Hence, we think it is necessary to continue considering the differences between the two.

To develop efficient occupational health practices during disaster response, building networks and relationships of trust through daily occupational health activities is important, and establishing preparatory measures for disasters during normal practice is necessary. Disasters are unpredictable, such that occupational health needs during disasters are highly context-dependent and difficult to reproduce³⁾. Therefore, sharing experiences in disaster response seems difficult. In addition, the total number of subjects was 97 in the present study, that was 29.0% of the participants. The sample size is a limitation of this study in statistical analysis. However, the result suggests that a disaster response is a rare experience even for specialists in occupational health with certain levels of practical occupational health activities. Although the response rate for the questionnaire was 29.9%, the responses collected were considered to be valuable data. As such, we consider that this study of competencies with 97 participants is worthy of reporting.

Occupational health staff are required to work with their expertise in ensuring the safety and health of workers and the business continuity in the event of a disaster. In order that occupational health professionals are able to play a role in occupational health response during disasters which are rarely experienced repeatedly, formulating an education system and developing manuals and guidelines are necessary. This study suggests that the education is desirable to be aimed at maintaining coherence as an occupational health professional and training coordinating skills and practical skills required during disasters. The competencies that were clarified by this study required of occupational health professionals in disaster management are based on practice and are expected to be a useful reference for the construction of educational systems and development of manuals.

Acknowledgments

The authors thank all participants. We also thank Enago (https://www.enago.jp/) for the English language editing of this manuscript. This research was supported by the Health and Labour Sciences Research Grants, the Ministry of Health, Labour, and Welfare (H30-roudou-ippan-007), Japan.

Conflicts of Interest

The authors declare no conflicts of interest associated with this manuscript.

References

• 1.  Disaster Management in Japan, Cabinet Office Japan. White Paper on Disaster Management 2019: http://www.bousai.go.jp/kaigirep/hakusho/pdf/R1_hakusho_english.pdf
• 2.   Mori  K. Occupational health in disasters: valuable knowledge gained from experience with the Fukushima Daiichi Nuclear Power Plant accident. J Occup Health. 2019; 61(6): 429-430.
• 3.   Igarashi  Y,  Mori  K. [A Literature Review of Health Effects on Workers in Disasters]. J UOEH. 2015; 37(3): 203-216. in Japanese.
• 4.  Disaster Management in Japan, Cabinet Office Japan. White Paper on Disaster Management 2011 Executive Summary: http://www.bousai.go.jp/kaigirep/hakusho/pdf/WPDM2011_Summary.pdf
• 5.   Tateishi  S,  Igarashi  Y,  Hara  T, et al. What Occupational Health Needs Arise in Workplaces Following Disasters? A Joint Analysis of Eight Cases of Disaster in Japan. J Occup Environ Med. 2015; 57(8): 836-844.
• 6.   Anan  T,  Mori  K,  Kajiki  S,  Tateishi  S. Emerging Occupational Health Needs at a Semiconductor Factory Following the 2016 Kumamoto Earthquakes: Evaluation of Effectiveness and Necessary Improvements of List of Postdisaster Occupational Health Needs. J Occup Environ Med. 2018; 60(2): 198-203.
• 7.   Mori  K,  Tateishi  S,  Hiraoka  K, et al. How Occupational Health can contribute in a disaster and what we should prepare for the future—lessons learned through support activities of a medical school at the Fukushima Daiichi Nuclear Power Plant in Summer 2011. J Occup Health. 2013; 55(1): 6-10.
• 8.   McClelland  DC. Testing for competence rather than for “intelligence”. Am Psychol. 1973; 28(1): 1-14.
• 9.   Boam  R,  Sparrow  P. Designing and achieving competency: a competency-based approach to developing people and organizations. McGraw-Hill; 1992.
• 10.   Spencer  LM,  Spencer  PSM. Competence at Work models for superior performance. John Wiley & Sons; 2008.
• 11.   Ablah  E,  Tinius  AM,  Horn  L,  Williams  C,  Gebbie  KM. Community health centers and emergency preparedness: an assessment of competencies and training needs. J Community Health. 2008; 33(4): 241-247.
• 12.   Cranmer  H,  Chan  JL,  Kayden  S, et al. Development of an evaluation framework suitable for assessing humanitarian workforce competencies during crisis simulation exercises. Prehosp Disaster Med. 2014; 29(1): 69-74.
• 13.   Olu  O,  Usman  A,  Kalambay  K, et al. What should the African health workforce know about disasters? Proposed competencies for strengthening public health disaster risk management education in Africa. BMC Med Educ. 2018; 18(1): 60.
• 14.   Hsu  EB,  Thomas  TL,  Bass  EB,  Whyne  D,  Kelen  GD,  Green  GB. Healthcare worker competencies for disaster training. BMC Med Educ. 2006; 6(1): 19.
• 15.   Gebbie  K,  Merrill  J. Public health worker competencies for emergency response. J Public Health Manag Pract. 2002; 8(3): 73-81.
• 16.   Daily  E,  Padjen  P,  Birnbaum  M. A review of competencies developed for disaster healthcare providers: limitations of current processes and applicability. Prehosp Disaster Med. 2010; 25(5): 387-395.
• 17.   Walsh  L,  Subbarao  I,  Gebbie  K, et al. Core competencies for disaster medicine and public health. Disaster Med Public Health Prep. 2012; 6(1): 44-52.
• 18.   Peller  J,  Schwartz  B,  Kitto  S. Nonclinical core competencies and effects of interprofessional teamwork in disaster and emergency response training and practice: a pilot study. Disaster Med Public Health Prep. 2013; 7(4): 395-402.
• 19.   Yoshikawa  E,  Abe  H,  Yokogawa  T,  Kubo  T,  Tateishi  S,  Mori  K. Competencies required for occupational health professionals in disaster management based on their personal experiences of workplaces damaged by the Kumamoto earthquakes. Sangyo Eiseigaku Zasshi. Published online January 7, 2021. Updated March 2, 2021; in Japanese.
• 20.   Gorsuch  RL. Factor analysis. Hillsdale, NJ: Lawrence Erlbaum Associates; 1983.
• 21.   MacCallum  RC,  Widaman  KF,  Preacher  KJ,  Hong  S. Sample size in factor analysis. Psychol Methods. 1999; 4(1): 84-99.
• 22.   Everitt  BS. Multivariate analysis: the need for data, and other problems. Br J Psychiatry. 1975; 126(3): 237-240.
• 23.  WHO European Centre for Environment and Health. Occupational Medicine in Europe: Scope and Competencies. 2000: 31-40.
• 24.   Macdonald  EB,  Ritchie  KA,  Murray  KJ,  Gilmour  WH. Requirements for occupational medicine training in Europe: a Delphi study. Occup Environ Med. 2000; 57(2): 98-105.
• 25.  American Association of Occupational Health Nurses Inc. Competencies in occupational and environmental health nursing. AAOHN journal: official journal of the American Association of Occupational Health Nurses. 2007; 55: 442.
• 26.   Lalloo  D,  Demou  E,  Kiran  S,  Cloeren  M,  Mendes  R,  Macdonald  EB. International perspective on common core competencies for occupational physicians: a modified Delphi study. Occup Environ Med. 2016; 73(7): 452-458.
• 27.   Lalloo  D,  Demou  E,  Stevenson  M,  Gaffney  M,  Macdonald  EB. Comparison of competency priorities between UK occupational physicians and occupational health nurses. Occup Environ Med. 2017; 74(5): 384-386.
• 28.   Kono  K,  Goto  Y,  Hatanaka  J,  Yoshikawa  E. Competencies required for occupational health nurses. J Occup Health. 2017; 59(6): 562-571.