These questions were posted on NIOSH’s free-to-access portal on March 13, 2020, where subscribing customers were able to copy and make these questions available to their employees. One example of such a company was the National Accreditation Alliance of Medical Transport Application (NAAMTA), an organization that provides best practices for medical transport services. NAAMTA developed its own platform for subscribing customers in emergency response and transport, long-term care and hospital networks. Five of their subscribing companies took advantage of these questions, where individual employees had the option to open their phone application and respond during their daily work tasks at any point until May 1, 2020. NIOSH received blinded data from subscribed organizations that had already established a data use agreement to share deidentified data for research purposes.

Regarding perceived risks toward SARS-CoV-2, a one-way ANOVA showed no significant difference among the five work groups at the p < 0.05 level: F (4, 106) = 0.392, p = 0.814. All work groups felt somewhat susceptible to COVID-19: healthcare administration (n = 27, M = 3.72, SD = 1.18); management (n = 28, M = 4.05, SD = 0.96); frontline healthcare positions (n = 14; M = 3.89, SD = 0.88); EMS personnel (n = 33, M = 3.94; SD = 1.04); and other healthcare service roles (n = 9, M = 3.78; SD = 1.12). Although work groups may have varying reasons that influenced their perceptions, risk susceptibility across the sample was neutral. Therefore, tailored COVID-19 materials for workers in various healthcare and public safety settings may not significantly influence perceptions and subsequent health-protective behaviors.

Although the results did not show differences among work groups, they did reveal age as a significant factor in the perceived susceptibility of COVID-19. Specifically, a one-way between-groups ANOVA showed that perceived susceptibility to contracting SARS-CoV-2 increased with age, at the p < 0.05 level: F (4, 114) = 2.35, p = 0.058. Generally, as age increased so did perceived susceptibility to contracting SARS-CoV-2: 18 to 30 years old (n = 36, M = 3.64, SD = 1.42); 31 to 40 years old (n = 26, M = 3.96, SD = 1.00); 41 to 50 years old (n = 35; M = 4.43, SD = 1.10); 51 to 60 years old (n = 15, M = 4.33; SD = 1.18); and 60 or more years old (n = 7, M = 4.57; SD = 1.72). However, post-hoc comparisons did not indicate statistically significant differences among the groups.

Additionally, a one-way between-groups ANOVA explored the impact of age on feelings or self-efficacy of being able to protect oneself from getting the virus that causes COVID-19. This was also statistically significant at the p < 0.05 level: F (4, 76) = 2.691, p = 0.038. Table 4 shows the post hoc results, indicating that those who were 31 to 40 felt they could protect themselves from getting COVID-19 more than those who were 18 to 30 or 41 to 50.

A one-way between-groups ANOVA explored the relationship between work group and confidence in PPE protection against COVID-19. There was a statistically significant difference at the p < 0.05 level: F (4, 69) = 2.66, p = 0.04. Post-hoc comparisons using Tukey’s HSD test indicated that the mean score for field healthcare workers (M = 4.77, SD = 0.927) and the mean score for management (M = 3.54, SD = 0.660) were statistically significantly different from each other. That is, frontline healthcare workers such as nurses and physicians were significantly more confident that their PPE would protect them from the virus that causes COVID-19 than those respondents who were in management. Previous research has demonstrated the effectiveness of PPE in protecting workers while caring for COVID-19-positive patients whether in a hospital setting or during patient transport (e.g., Bartoszko et al., 2020; Cook, 2020).

This finding is thought-provoking in that those who routinely wore PPE as a part of their job prior to the COVID-19 pandemic (e.g., physicians, nurses) had significantly higher levels of confidence in PPE protecting them from COVID-19 than those in management who may have had less experience routinely using PPE to protect themselves at work. Based on these results, the authors can speculate that individuals in frontline healthcare roles likely received and retained valuable PPE training and have experienced the protective efficacy of PPE in other routine or emergency situations.

To the authors’ knowledge, this is the first study that assessed differences in perceived effectiveness of PPE between organizational levels in healthcare and sheds light on perceptual differences that may have existed across the country at the onset of the pandemic. Specifically, the results show that those employees who lacked experience in routinely using PPE had less trust in its protection, which we can extrapolate to others who lacked the same PPE experiences prior to the pandemic. For example, those occupations besides healthcare and emergency response who were routinely wearing PPE as a part of their job roles (e.g., construction, mining) may have been more amenable to wearing respiratory protection on the job versus other occupations, such as customer service roles in retail, hospitality and tourism.

This finding is important because potential negative outcomes of low confidence in company policies, such as those around PPE, include low morale, productivity and absenteeism. For these reasons, it is important for every level of management to understand PPE form, function and use. Additionally, it may be useful to involve the entire workforce in aspects of the company safety culture and respiratory protection resources so that all employees understand and perceive a strong commitment to safety (Dejoy et al., 1995; Gershon, Karkashian et al., 2000; Gershon, Vlahov et al., 1995).

Finally, respondents could answer open-ended items about the processes or practices executed by employers during the pandemic. Respondents were asked to state what should continue as a routine part of safety and health management after the pandemic. These responses were content analyzed and grouped into themes or codes to help identify patterns in the data around 1. individual’s health-protective behaviors during the pandemic; and 2. actions taken by their employer (Boyatzis, 1998; Patton, 2002). Cues to action in combination with perceived benefits and barriers are among the strongest predictors of initiating health-protective behaviors (Carpenter, 2010). Consequently, it is worth highlighting the open-ended data that mentioned supportive organizational practices employed during the pandemic.

The open-ended data revealed respondents’ support toward changes in communication and risk management protocols as viable cues to action. Respondents indicated that organizational communication was a relevant cue to action and that effective communication strategies have been underutilized in routine scenarios. Specifically, a trend in the qualitative data illustrated that communication and information being shared was welcome and should occur not only in a crisis capacity but also in a routine capacity so that informed decisions could be made daily. Additionally, there was a trend in qualitative feedback among respondents across all organizational levels—from those who check in patients to those who operate an emergency response apparatus—that communication, for the first time, was holistic and equally distributed to every level of their organization.

In response to the increase in communication quality and quantity, respondents noted being more situationally aware of how suggested disinfection and decontamination practices and processes were relevant to their own health-protective behaviors at work. For any type of persuasive communication strategy to be effective, all key individuals within an organization must comply, which makes understanding the attitudes of individual workers critical to prevention efforts (Fisher, 1991). Additionally, research has shown that transparent communication at work during the COVID-19 pandemic can support employees’ safety and health behaviors (Kim et al., 2020). The current results align with these findings, indicating that transparent communication provides confidence in the protective actions taken by organizations to protect employees. Considering these results, it may be useful for organizations to conduct an internal analysis of communication strategies initiated during the COVID-19 pandemic and determine which of these can remain a principal part of their safety and health management plan and, consequently, a strong cue to action for their workers in the future.

These results were able to apply constructs from a well-validated behavioral theory, the HBM, to reveal response strategies that may resonate with individual workers, regardless of occupation, during an emergency. Specifically, results offer useful information and provide retrospective lessons learned for the future regarding organizational communication during times of increased ambiguity. Factors including age, confidence in PPE and individual health-protective behaviors accounted for significant relationships identified in the data. Other research has found that individual characteristics were more predictive of attitudes and behaviors related to the COVID-19 pandemic and, to a lesser extent, social amplification about the virus (Dryhurst et al., 2020). Importantly, the results from the current sample of respondents show the need to engage management in messaging around PPE and that administrative control knowledge, attitudes and skills are critical to help increase the effectiveness of emergency response plans. Future research should also seek to better understand workers’ perceptions toward PPE since this belief has predicted eventual respiratory protective behaviors (e.g., Robertson et al., 2018).

Results also show the role of consistent communication practices as a reliable cue to action for employees. Consequently, organizations can consider improving workplace interventions that focus on fostering communication and promoting organizational safety culture. Previous empirical research has identified the promotion of sociability and interpersonal relationships to increase employee resilience when employee-held attitudes are heterogenous (Welbourne et al., 2015). Thus, it may behoove management to communicate with workers about their perceptions and individual behaviors immediately during such emergencies. If deemed necessary, management can address or mitigate knowledge and attitudes as needed to prevent at-risk scenarios through additional communication, training, performance feedback, and social approval or disapproval from coworkers or management (Moore et al., 2005).

However, communication cannot serve as the only impetus for individual health-protective behaviors and compliance at work. To illustrate, respondents indicated in qualitative feedback that there were inconsistencies in promoting or enforcing COVID-19 response plans. Even if working close to someone is an expected, unavoidable part of one’s job, there was a theme identified in the responses that a difference in perceptions among coworkers caused tension at work and, without consistent monitoring from management, there was a lack of buy-in to the newly disseminated procedures. Thus, consistent implementation and role modeling on behalf of management remain critical for employee buy-in to new procedures and directives. This finding underscores the importance of organizational management during the COVID-19 pandemic, specifically, their confidence in PPE and other protective strategies in preventing infection.

This study utilized a sample of employees in various healthcare and public safety occupations to collect perceptions in real time at the onset of the COVID-19 pandemic. Although these data may assist in improving future emergency response efforts, they are not without limitations. First, the sample size is small and in no way can be generalized to other healthcare and public safety employees nor other occupations. The small sample size also hindered more sophisticated analyses to further study specific interaction effects that may have revealed additional insights. Also, the data are self-reported and subject to social desirability bias particularly because those who completed the survey were likely engaged in the pandemic response to some degree. Participants also tended to be younger, and this could be due to familiarity and comfort in using mobile phone apps, limiting responses from older employees. Future work with additional samples is needed to further validate the findings reported.