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      Demographic and attitudinal determinants of protective behaviours during a pandemic: A review

      1 , 2 , ,   1 , 2
      British Journal of Health Psychology
      Blackwell Publishing Ltd

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          Purpose. A new strain of H1N1 influenza, also known as swine flu was confirmed in the UK in May 2009 and has spread to over 100 countries around the world causing the World Health Organization to declare a global flu pandemic. The primary objectives of this review are to identify the key demographic and attitudinal determinants of three types of protective behaviour during a pandemic: preventive, avoidant, and management of illness behaviours, in order to describe conceptual frameworks in which to better understand these behaviours and to inform future communications and interventions in the current outbreak of swine flu and subsequent influenza pandemics.

          Methods. Web of Science and PubMed databases were searched for references to papers on severe acute respiratory syndrome, avian influenza/flu, H5N1, swine influenza/flu, H1N1, and pandemics. Forward searching of the identified references was also carried out. In addition, references were gleaned from an expert panel of the Behaviour and Communications sub‐group of the UK Scientific Pandemic Influenza Advisory Group. Papers were included if they reported associations between demographic factors, attitudes, and a behavioural measure (reported, intended, or actual behaviour).

          Results. Twenty‐six papers were identified that met the study inclusion criteria. The studies were of variable quality and most lacked an explicit theoretical framework. Most were cross‐sectional in design and therefore not predictive over time. The research shows that there are demographic differences in behaviour: being older, female and more educated, or non‐White, is associated with a higher chance of adopting the behaviours. There is evidence that greater levels of perceived susceptibility to and perceived severity of the diseases and greater belief in the effectiveness of recommended behaviours to protect against the disease are important predictors of behaviour. There is also evidence that greater levels of state anxiety and greater trust in authorities are associated with behaviour.

          Conclusions. The findings from this review can be broadly explained by theories of health behaviour. However, theoretically driven prospective studies are required to further clarify the relationship between demographic factors, attitudes, and behaviour. The findings suggest that intervention studies and communication strategies should focus on particular demographic groups and on raising levels of perceived threat of the pandemic disease and belief in the effectiveness of measures designed to protect against it.

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          Most cited references27

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          Early Assessment of Anxiety and Behavioral Response to Novel Swine-Origin Influenza A(H1N1)

          Background Since late April, 2009, a novel influenza virus A (H1N1), generally referred to as the “swine flu,” has spread around the globe and infected hundreds of thousands of people. During the first few days after the initial outbreak in Mexico, extensive media coverage together with a high degree of uncertainty about the transmissibility and mortality rate associated with the virus caused widespread concern in the population. The spread of an infectious disease can be strongly influenced by behavioral changes (e.g., social distancing) during the early phase of an epidemic, but data on risk perception and behavioral response to a novel virus is usually collected with a substantial delay or after an epidemic has run its course. Methodology/Principal Findings Here, we report the results from an online survey that gathered data (n = 6,249) about risk perception of the Influenza A(H1N1) outbreak during the first few days of widespread media coverage (April 28 - May 5, 2009). We find that after an initially high level of concern, levels of anxiety waned along with the perception of the virus as an immediate threat. Overall, our data provide evidence that emotional status mediates behavioral response. Intriguingly, principal component analysis revealed strong clustering of anxiety about swine flu, bird flu and terrorism. All three of these threats receive a great deal of media attention and their fundamental uncertainty is likely to generate an inordinate amount of fear vis-a-vis their actual threat. Conclusions/Significance Our results suggest that respondents' behavior varies in predictable ways. Of particular interest, we find that affective variables, such as self-reported anxiety over the epidemic, mediate the likelihood that respondents will engage in protective behavior. Understanding how protective behavior such as social distancing varies and the specific factors that mediate it may help with the design of epidemic control strategies.
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            Risk Perceptions Related to SARS and Avian Influenza: Theoretical Foundations of Current Empirical Research

            Background The outbreak of severe acute respiratory syndrome in 2003 and the subsequent emergence of the H5N1 virus have highlighted the threat of a global pandemic influenza outbreak. Planning effective public health control measures for such a case will be highly dependent on sound theory-based research on how people perceive the risks involved in such an event. Purpose The present article aims to review theoretical models and concepts underlying current empirical research on pandemic influenza risk perception. Method A review was conducted based on 28 empirical studies from 30 articles which were published between 2003 and 2007. Results Concepts of risk perception mostly seemed more pragmatic than theory-based and were highly heterogeneous, for instance, in terms of conceptualizing risk perception as an exclusively cognitive or as a cognitive and emotional phenomenon or whether the concept was dominated by expectancy or expectancy and value components. Similarly, the majority of studies investigating risk perceptions and protective behaviors were not model-based. Conclusions The current body of knowledge can only provide preliminary insights. Unlike the reviewed studies, which were mostly launched as a rapid response to outbreak situations, future research will have to invest more strongly into theoretical work to provide sounder evidence.
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              A meta-analysis of studies of the Health Belief Model with adults.

              The Health Belief Model (HBM) relates a socio-psychologic theory of decision making to individual health-related behaviors. We conducted a meta-analysis of the relationships between four HBM dimensions (Susceptibility, Severity, Benefits and Costs) and health behavior on 16 studies that measured all four of the dimensions, measured a behavioral dependent variable and included some measures of reliability, minimal criteria for establishing the validity of the dimensions. Mean effect sizes were computed for all the studies, subgroupings representing studies of screening, risk reduction and adherence to medical regimen, and prospective and retrospective study designs. Of 24 mean effect sizes, 22 were found to be positive and statistically significant. The actual variance accounted for ranged from 0.001 to 0.09. Homogeneity was rejected for 15 of the 22, however, suggesting that the same underlying construct was not measured. Retrospective studies were found to have significantly large effect sizes for benefits and costs and smaller effect sizes for severity when compared to prospective studies. The weak effect sizes and lack of homogeneity indicate that it is premature to draw conclusions about the predictive validity of the HBM as operationalized in these studies. Our finding of only 16 studies meeting minimal criteria for valid representation of the HBM dimensions indicates that future studies should focus more on such issues.

                Author and article information

                Br J Health Psychol
                Br J Health Psychol
                British Journal of Health Psychology
                Blackwell Publishing Ltd (Oxford, UK )
                24 December 2010
                November 2010
                : 15
                : 4 ( doiID: 10.1111/bjhp.2010.15.issue-4 )
                : 797-824
                [ 1 ]Health Psychology Unit, Centre for Outcome Research and Effectiveness (CORE), University College London, UK
                [ 2 ]Research Department of Clinical, Educational and Health Psychology, University College London, UK
                Author notes
                [*] [* ] Correspondence should be addressed to Dr Alison Bish, Health Psychology Unit, Centre for Outcome Research and Effectiveness (CORE), University College London, 1–19 Torrington Place, London WC1E 7HB, UK (e‐mail: alisonbish@ 123456onetel.com ).
                2010 The British Psychological Society

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                : 21 October 2009
                : 21 December 2009
                Page count
                links-crossref: 217, Figures: 3, Tables: 1, Equations: 0, References: 63, Pages: 28
                Custom metadata
                November 2010
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.0 mode:remove_FC converted:15.04.2020


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