Abstract
BackgroundFew studies have investigated associations between psychological and behavioral indices throughout a major epidemic. This study was aimed to compare the strength of associations between different cognitive and affective measures of risk and self-reported protective behaviors in a series of ten cross-sectional surveys conducted throughout the first wave of influenza A/H1N1 pandemic.MethodsAll surveys were conducted using questionnaire-based telephone interviews, with random digit dialing to recruit adults from the general population. Measures of anxiety and worry (affective) and perceived risk (cognitive) regarding A/H1N1 were made in 10 serial surveys. Multivariate logistic regression models were used to estimate the cognitive/affective-behavioral associations in each survey while multilevel logistic models were conducted to estimate the average effects of each cognitive/affective measure on adoption of protective behaviors throughout the ten surveys.ResultsExcepting state anxiety, other affective measures including “anticipated worry”, “experienced worry” and “current worry” specific to A/H1N1 risk were consistently and strongly associated with adoption of protective behaviors across different survey periods. However, the cognitive-behavioral associations were weaker and inconsistent across the ten surveys. Perceived A/H1N1 severity relative to SARS had stronger associations with adoption of protective behaviors in the late epidemic periods than in the early epidemic periods.ConclusionRisk-specific worries appear to be significantly associated with the adoption of protective behaviors at different epidemic stages, whereas cognitive measures may become more important in understanding people’s behavioral responses later in epidemics. Future epidemic-related psycho-behavioral research should include more affective-loaded measures of risk.
Highlights
Few studies have investigated associations between psychological and behavioral indices throughout a major epidemic
Observed variation in the strength of specific psycho-behavioral associations across an epidemic introduces avoidable measurement error in the target cognitive/affective measure which will subsequently influence its association with behavioral change, reducing the apparent reliability of risk assessments as predictors of behavior change during respiratory infectious disease epidemics (RIDEs)
The patterns of psycho-behavior associations were similar for the three types of health protective behaviors
Summary
Few studies have investigated associations between psychological and behavioral indices throughout a major epidemic. This study was aimed to compare the strength of associations between different cognitive and affective measures of risk and self-reported protective behaviors in a series of ten cross-sectional surveys conducted throughout the first wave of influenza A/H1N1 pandemic. Previous studies found that in the RIDE situation when personal threat is highly uncertain, affective measures of risk more powerfully predict protective behavior uptake than do cognitive measures [6,10] Both cognitive and affective components of risk appear to be relevant to understanding RIDEs-related population behavior [1]. The objectives of this study were to compare the strength and stability of associations between affective and cognitive measures of risk and the adoption of RIDE-related health protective behaviors This was assessed by comparing the associations between health protective behaviors against A/H1N1 and different cognitive/affective measures of risk used for each of the ten cross-sectional surveys
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