What can Behavioral Medicine Contribute to Containing Ebola Domestically?

Ebola victims—of all ages--face existential threats from wrenching and rapid deaths. Their families and friends may face similar fates if exposed, unprotected, to the body fluids of their loved ones. Health care workers, in particular, face risks each day that they work with those diagnosed with Ebola Virus Disease (EVD), perhaps through improper doffing of personal protection equipment. Custodial staff in health care systems face exposure to waste that is difficult to disinfect. Others, unknown to the victim, fear possible exposure.

Misinformation abounds; research studies of EVD are limited and are often old, making them difficult to obtain and to apply to the present threat. Implementation lessons from our experiences with the previous H1N1 or SARS viral threats have not been applied effectively to the EVD threat. The confidence expressed by our political and health care leaders as EVD moved to the United States seemed overstated. And, our health care systems have seemed ill-prepared for the threat.

Fear abounds. As David Brooks opined, “[EVD has aroused a] a sour, existential fear. It’s a fear you feel when the whole environment seems hostile, when the things that are supposed to keep you safe, like national borders and national authorities, seem porous and ineffective, when some menace is hard to understand.”

We, in behavioral medicine, are familiar with these challenges, however. And, we have unique expertise to address them. We are expert at identifying and delivering support to victims and those at risk for health threats at multiple levels (patients, providers, communities); at leading interventions that increase coordination; and at service integration. We have conducted research on PTSD, have developed and tested effective risk communication interventions, and have implemented complex, multi-level, and multi-sectoral interventions to enrich social support.

Yet, at today’s Institute of Medicine (IOM) meeting (Research Priorities to Inform Public Health and Medical Practice for Domestic Ebola Virus Disease (EVD): A Workshop), other than stressing the importance of developing risk communication strategies, these critical psychosocial needs—that behavioral medicine is uniquely positioned to address—were mentioned infrequently. What does behavioral medicine have to offer from our clinical experience and our myriad programs of research on trauma, positive health, health behavior change, integrated behavioral health, and pain management, among others? Some ideas follow:

1. What are the support needs of partners, children, and families of EVD victims, those who are contained, and the larger communities of which they are a part? Who is meeting those needs and how? How is the stigma of the diagnosis being addressed?
2. What are the optimal approaches to communicating information to communities, providers, and individuals who are working in health care systems with those who are potentially infected?
3. How can we better address the fears of EVD, particularly among those who are at little risk of infection?
4. How can we leverage our expertise with integrating health, public health, housing, and social services programs to optimally “contain” victims and to address the needs of their families post-trauma?
5. What role can we play in the recruitment of individuals to clinical and pragmatic trials to address the post-trauma sequelae from the EVD outbreaks in the United States, and worldwide?
6. How can we contribute to the necessary coordination, integration, and regionalization within health care systems that is required both to effectively care for EVD patients and protect health care workers?
7. How can we apply our expertise in implementation science to the development of a “culture of preparedness” for EVD, other viral hemorrhagic fevers, and similar health threats?
8. What have we learned about knowledge and attitude/belief change from our studies of training community health workers and “detailing” health care providers that could apply to EVD control?

SBM asks that you share your thoughts in our related LinkedIn discussion. You can also answer a one-question poll and view the results.