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      Risk Perceptions Related to SARS and Avian Influenza: Theoretical Foundations of Current Empirical Research

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          Abstract

          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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          Most cited references44

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          Risk as analysis and risk as feelings: some thoughts about affect, reason, risk, and rationality.

          Modern theories in cognitive psychology and neuroscience indicate that there are two fundamental ways in which human beings comprehend risk. The "analytic system" uses algorithms and normative rules, such as probability calculus, formal logic, and risk assessment. It is relatively slow, effortful, and requires conscious control. The "experiential system" is intuitive, fast, mostly automatic, and not very accessible to conscious awareness. The experiential system enabled human beings to survive during their long period of evolution and remains today the most natural and most common way to respond to risk. It relies on images and associations, linked by experience to emotion and affect (a feeling that something is good or bad). This system represents risk as a feeling that tells us whether it is safe to walk down this dark street or drink this strange-smelling water. Proponents of formal risk analysis tend to view affective responses to risk as irrational. Current wisdom disputes this view. The rational and the experiential systems operate in parallel and each seems to depend on the other for guidance. Studies have demonstrated that analytic reasoning cannot be effective unless it is guided by emotion and affect. Rational decision making requires proper integration of both modes of thought. Both systems have their advantages, biases, and limitations. Now that we are beginning to understand the complex interplay between emotion and reason that is essential to rational behavior, the challenge before us is to think creatively about what this means for managing risk. On the one hand, how do we apply reason to temper the strong emotions engendered by some risk events? On the other hand, how do we infuse needed "doses of feeling" into circumstances where lack of experience may otherwise leave us too "coldly rational"? This article addresses these important questions.
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            The affect heuristic in judgments of risks and benefits

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              Risk perception and impact of Severe Acute Respiratory Syndrome (SARS) on work and personal lives of healthcare workers in Singapore: what can we learn?

              Healthcare workers (HCWs) were at the frontline during the battle against Severe Acute Respiratory Syndrome (SARS). Understanding their fears and anxieties may hold lessons for handling future outbreaks, including acts of bioterrorism. We measured risk perception and impact on personal and work life of 15,025 HCWs from 9 major healthcare institutions during the SARS epidemic in Singapore using a self-administered questionnaire and Impact of Events Scale and analyzed the results with bivariate and multivariate statistics. From 10,511 valid questionnaires (70% response), we found that although the majority (76%) perceived a great personal risk of falling ill with SARS, they (69.5%) also accepted the risk as part of their job. Clinical staff (doctors and nurses), staff in daily contact with SARS patients, and staff from SARS-affected institutions expressed significantly higher levels of anxiety. More than half reported increased work stress (56%) and work load (53%). Many experienced social stigmatization (49%) and ostracism by family members (31%), but most (77%) felt appreciated by society. Most felt that the personal protective measures implemented were effective (96%) and that the institutional policies and protocols were clear (93%) and timely (90%). During epidemics, healthcare institutions have a duty to protect HCWs and help them cope with their personal fears and the very stressful work situation. Singapore's experience shows that simple protective measures based on sound epidemiological principles, when implemented in a timely manner, go a long way to reassure HCWs.
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                Author and article information

                Contributors
                aleppin@health.sdu.dk
                Journal
                Int J Behav Med
                Int J Behav Med
                International Journal of Behavioral Medicine
                Springer US (Boston )
                1070-5503
                1532-7558
                12 February 2009
                2009
                : 16
                : 1
                : 7-29
                Affiliations
                GRID grid.10825.3e, ISNI 0000000107280170, University of Southern Denmark, Institute of Public Health, Unit for Health Promotion, ; Niels Bohrs Vej 9, 6700 Esbjerg, Denmark
                Article
                9002
                10.1007/s12529-008-9002-8
                7090865
                19214752
                b9e05aa8-aa7a-4c43-b0a5-4e1312bec833
                © International Society of Behavioral Medicine 2009

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 29 September 2008
                Categories
                Review
                Custom metadata
                © International Society of Behavioral Medicine 2009

                Clinical Psychology & Psychiatry
                severe acute respiratory syndrome (sars),avian influenza,risk perception,theory,models

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