The barriers and enablers of outbreak reporting in the Asia-Pacific region: A mixed methods study of field epidemiologists

Outbreak reporting is thought to be subject to technical, or capacity, barriers that physically hinder reporting and non-technical barriers, such as the threat of economic losses, that discourage governments from reporting. While technical barriers to reporting have been extensively explored, there is less evidence for the effects of non-technical barriers, particularly at the subnational level. To better understand the impact of both technical and non-technical barriers at the subnational level, we conducted an explanatory sequential mixed methods study involving field epidemiology training program (FETP) trainees and graduates in the Asia-Pacific region. We first surveyed study participants on the importance of putative outbreak reporting barriers and enablers using a three-point Likert scale and free text responses. We then interviewed respondents to more deeply explore key factors affecting outbreak reporting that were elicited from the survey. We calculated counts and percentages for all survey variables, and we coded free text responses from the survey and the interview transcripts. We then used thematic analysis to derive common themes from our findings. Fifty-six FETP trainees or graduates completed the survey, representing 19 Asia-Pacific countries and territories; of these respondents, we interviewed 16. The barrier noted by most survey respondents to have a high reporting impact was lack of staff (28, 50.0%). The enablers noted by most survey respondents to have a high reporting impact were training about what and how to report an outbreak (40, 71.4%) and sufficient surveillance resources (40, 71.4%). Based on our survey and interview findings, we elicited four thematic barriers - lack of capacity, behavioural barriers, political and socioeconomic barriers, and bureaucratic barriers - and three thematic enablers - building capacity, building a culture of reporting, and political and bureaucratic support. Although lack of capacity was found to disrupt reporting at the subnational level, several non-technical barriers also impacted reporting, particularly economic and reputational concerns. Future studies should explore these barriers beyond the Asia-Pacific region.