Inappropriate Expectations Research Articles

Seeing an apocalyptic post-antibiotic future lowers antibiotics expectations and requests

BackgroundAntibiotic resistance is an ongoing pandemic which represents a global public health threat. To encourage the judicious use of antibiotics, public health discourse and campaigns often engage in threat-based messaging depicting an apocalyptic post-antibiotic future. We studied the effectiveness of the strategy because of mixed evidence for its success, and because it is unclear how experiencing the COVID-19 pandemic might have influenced it.MethodsWe conducted a randomised controlled trial with 378 participants in three waves (before and during the pandemic in 2021 and 2022). Participants were randomly allocated to either the baseline arm, featuring a control film, or the intervention arm featuring a short film, Catch, depicting a post-antibiotic future. Participants expressed expectations and intended requests for antibiotics for a hypothetical ear infection and their adherence to a prescribed antibiotic for a hypothetical kidney infection. In waves 2 and 3, they also reported any COVID-19-related changes to their antibiotic desires.ResultsShowing participants a film about a post-antibiotic future substantially lowers clinically inappropriate expectations for antibiotics and their intended requests. Participants report that the experience of the COVID-19 pandemic decreased their desire for antibiotics but only when they watched the intervention film. The intervention slightly decreases participants’ adherence intentions towards a prescribed antibiotic treatment.ConclusionsPresenting a film about an apocalyptic post-antibiotic future lowers expectations and intended requests for antibiotics and therefore has the potential to encourage judicious use of them. However, the adverse effects of such messaging on adherence to a course of antibiotics should be proactively managed.

Do health literacy, physical health and past rehabilitation utilization explain educational differences in the subjective need for medical rehabilitation? Results of the lidA cohort study

BackgroundMedical rehabilitation can be helpful for maintaining workers’ health and work ability. Its contribution to longer working lives is of high economic relevance in aging populations. In Germany, individuals must apply for rehabilitative measures themselves. Therefore, the subjective need for rehabilitation (SNR) is a prerequisite for rehabilitation access. A low education level is associated with poor health, lower health literacy and more frequent utilization of health services. In the present study, we investigated whether lower educational levels are also associated with a greater SNR and whether health literacy, past rehabilitation utilization and physical health play a mediating role in this path in older employees.Methods3,130 socially insured older employees (born in 1959 or 1965) who participated in the German prospective lidA (leben in der Arbeit) cohort-study in 2011, 2014 and 2018 were included. A causal mediation analysis with an inverse odds weighting approach was performed with the SNR as the dependent variable; educational level as the independent variable; and health, health literacy and past rehabilitation utilization as the mediating variables. Sociodemographic variables were adjusted for.ResultsThe SNR was significantly greater in subjects with a low education level, poor physical health, inadequate health literacy and those who had utilized rehabilitation in the past. For health literacy, past rehabilitation utilization and physical health, a significant partial mediating effect on the SNR was found for employees with low compared to those with high education levels. However, the combined mediating effect of all the mediators was lower than the sum of their individual effects. Among those with medium or high education levels, none of the variables constituted a significant mediator.ConclusionsThe path between a low education level and a high SNR is mediated by inadequate health literacy, past rehabilitation utilization and poor physical health; these factors do not act independently of each other. Promoting health education may lower the SNR by improving physical health and health literacy. While improving physical health is beneficial for individuals, improved health literacy can be economically advantageous for the health system by reducing inappropriate expectations of rehabilitation benefits and subsequent applications for rehabilitation.

Communicating diagnostic uncertainty reduces expectations of receiving antibiotics: Two online experiments with hypothetical patients.

The overprescription of antibiotics due to diagnostic uncertainty and inappropriate patient expectations influence antimicrobial resistance. This research assesses (i) whether communicating diagnostic uncertainty reduces expectations of receiving antibiotics and (ii) which communication strategies minimise unintended consequences of such communication. In two experimental online studies conducted in January and April 2023, participants read a vignette describing a doctor consultation for an ear infection and expressed their expectations of receiving antibiotics, trust in their doctor, rated the doctor's reputation and provided their intention to get a second doctor's opinion. Study 1 (N = 2213) investigated whether communicating diagnostic uncertainty and social externalities of antibiotic use (the negative social impacts of developing antibiotic resistance) decreases expectations for antibiotics and explores potential unintended consequences on the doctor-patient relationship. In Study 2 (N = 527), we aimed to replicate and extend the findings by adding specific treatment recommendations. Disclosing diagnostic uncertainty (vs. certainty) and communicating (vs. not communicating) the social externalities of antibiotic overuse reduced patients' expectations of receiving antibiotics. Yet, communicating uncertainty impaired trust in the doctor and the doctor's reputation. Combining the communication of uncertainty with specific treatment recommendations-particularly delayed antibiotic prescriptions-showed important to prevent these unintended consequences.

Great expectations? GPs’ estimations of time required to deliver BMJ’s ‘10 minute consultations’

ObjectivesTo estimate the time required to undertake consultations according to BMJ’s 10-minute consultation articles.To quantify the tasks recommended in 10-minute consultation articles.To determine if, and to what extent, the time...

The UTH-UMB Global Health Education Collaboration: Building a Bidirectional Exchange Based on Equity and Reciprocity.

The global health exchange program between the University Teaching Hospitals (UTH) of Lusaka, Zambia and the University of Maryland, Baltimore (UMB) has been operating since 2015. As trainees and facilitators of this exchange program, we describe our experiences working in Lusaka and Baltimore, and strengths and challenges of the partnership. Since 2015, we have facilitated rotations for 71 UMB trainees, who spent four weeks on the Infectious Disease (ID) team at UTH. Since 2019 with funding from UMB, nine UTH ID trainee physicians spent up to six weeks each rotating on various ID consult services at University of Maryland Medical Center (UMMC). Challenges in global health rotations can include inadequate preparation or inappropriate expectations among high-income country trainees, low-value experiences for low- and middle-income country trainees, lack of appropriate mentorship at sites, and power imbalances in research collaborations. We try to mitigate these issues by ensuring pre-departure and on-site orientation for UMB trainees, cross-cultural mentored experiences for all trainees, and intentional sharing of authorship and credit on scientific collaborations. We present a description of our medical education collaboration as a successful model for building equitable and reciprocal collaborations between low- and middle-income countries and high-income countries, and offer suggestions for future program initiatives to enhance global health education equity among participants and organizations.

Expectation-based gist facilitation: Rapid scene understanding and the role of top-down information.

Scene meaning is processed rapidly, with "gist" extracted even when presentation duration spans a few dozen milliseconds. This has led some to suggest a primacy of bottom-up information. However, gist research has typically relied on showing successions of unrelated scene images, contrary to our everyday experience in which the world unfolds around us in a predictable manner. Thus, we investigated whether top-down information-in the form of observers' predictions of an upcoming scene-facilitates gist processing. Within each trial, participants (N = 370) experienced a series of images, organized to represent an approach to a destination (e.g., walking down a sidewalk), followed by a target scene either congruous or incongruous with the expected destination (e.g., a store interior or a bedroom). A series of behavioral experiments revealed that appropriate expectations facilitated gist processing; inappropriate expectations interfered with gist processing; sequentially-arranged scene images benefitted gist processing when semantically related to the target scene; expectation-based facilitation was most apparent when presentation duration was most curtailed; and findings were not simply the result of response bias. We then investigated the neural correlates of predictability on scene processing using event-related potentials (ERPs) (N = 24). Congruency-related differences were found in a putative scene-selective ERP component, related to integrating visual properties (P2), and in later components related to contextual integration including semantic and syntactic coherence (N400 and P600, respectively). Together, results suggest that in real-world situations, top-down predictions of an upcoming scene influence even the earliest stages of its processing, affecting both the integration of visual properties and meaning. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

“I never should have been a doctor”: a qualitative study of imposter phenomenon among internal medicine residents

IntroductionImposter phenomenon is common among medical trainees and may influence learning and professional development. The authors sought to describe imposter phenomenon among internal medicine residents.MethodsIn 2020, using emailed invites we recruited a convenience sample of 28 internal medicine residents from a teaching hospital in Baltimore, Maryland to participate in an exploratory qualitative study. In one-on-one interviews, informants described experiences of imposter phenomenon during residency training. Using thematic analysis to identify meaningful segments of text, the authors developed a coding framework and iteratively identified and refined themes. Informants completed the Clance Imposter Phenomenon Scale.ResultsInformants described feelings and thoughts related to imposter phenomenon, the contexts in which they developed and the impact on learning. Imposter phenomenon has profound effects on residents including: powerful and persistent feelings of inadequacy and habitual comparisons with others. Distinct contexts shaping imposter phenomenon included: changing roles with increasing responsibilities; constant scrutiny; and rigid medical hierarchy. Learning was impacted by inappropriate expectations, difficulty processing feedback, and mental energy diverted to impression management.DiscussionInternal medicine residents routinely experience imposter phenomenon; these feelings distort residents’ sense of self confidence and competence and may impact learning. Modifiable aspects of the clinical learning environment exacerbate imposter phenomenon and thus can be acted upon to mitigate imposter phenomenon and promote learning among medical trainees.

Дослідження реалізації освітніх потреб студентів (на прикладі 1 та 4 курсів ННІЖ КНУ імені Тараса Шевченка, 2019-2021 рр.)

Main objective of the study: to determine the level of accordance of the educational process at the Educational and Scientific Institute of Journalism to the expectations of its students. The study has the following tasks: to study the other scientific researches about the topic; to survey the students of the 1st and the 4th years of ESIJ; to interview the administration of the institute and the guarantors of educational programs. Methodology of the study. A questionnaire was conducted among the 1st and 4th year students of all educational programs of ESIJ. The questionnaire for the 1st year students was focused on the reasons for entering the institute and the expectations from their studying, and the 4th year students evaluated the educational process, demonstrated their impressions of the institute and the degree of realization of their expectations. Thus, with the help of methods of abstraction and extrapolation, we found out the opinions of all ESIJ students on the specified issue. At the same time, the interviews were conducted with the guarantors of the institute‘s educational programs and the representatives of its administration about their vision of the image of a ESIJ graduate, optimization of the educational process, communication with the students and presentation of the educational programs to the applicants. Therefore, a narrative analysis was applied to their comments, and with the help of the methods of interpretation and generalization, we singled out the common considerations for the representatives of this institute regarding this specified issue. Results and conclusions. The article analyzes and systematizes the students‘ expectations from the educational process, interaction with the university, and generally higher journalism education. It was found that at the time of entrance competition the students sometimes have the inappropriate expectations from their studying, and the 4th year students are more skeptical of obtaining higher journalism education than their younger colleagues. The guarantors of the programs put the emphasis on creating the favorable conditions for studying, developing creativity and providing the basic and professional knowledge. The researches of scientists show that satisfaction with studying at a higher education institution is a significant factor in a student‘s professional self-efficiency. There is also information that the 1st year students (more than 4th year ones), demonstrate an evident correlation between adaptation to higher education institution and attitude to their studying. There is a need to take the communication between higher education institutions and applicants/students to a more professional level in order to avoid formation of inappropriate expectations from studying at the university.

Understanding the Intergenerational Cycle of Trauma and Violence: Maternal Adverse Childhood Experiences and Parent-to-Child Aggression Risk.

Adverse childhood experiences (ACEs), such as exposure to maltreatment and household dysfunction, are major risk factors for physical and mental health problems across the lifespan. While the relationship between ACEs and health outcomes is well established, what effects ACEs might have on parent-to-child aggression are less known. The negative consequences of ACEs on parental aggression can be even more pronounced with multiple exposures to different patterns of ACEs. This study examined the association between patterns of maternal ACEs and subsequent parent-child aggression risk. A diverse sample of young women (N = 329; mean age = 26.3 years) was recruited at a large, urban university medical center. Participants completed self-report measures of the ACEs Questionnaire and the Adult-Adolescent Parenting Inventory-2. Latent class analysis was used to identify classes of women with similar patterns of exposure to ACEs and to examine the associations between ACEs classes and parent-to-child aggression risk. Three latent classes, characterized by distinct patterns of maternal ACEs, were identified: Low ACEs (63% of the sample), High Parental Separation/Divorce (20%), and High/Multiple ACEs classes (17%). Women in the High/Multiple ACEs class were more likely to report higher levels of parent-to-child aggression risk (i.e., inappropriate expectations, belief in corporal punishment, lack of empathy) than those in the other classes (Wald(2) = 8.63, p = .013). Preventive interventions targeting parental attitudes and behaviors among young women exposed to ACEs may decrease the risk for further perpetuation of aggression in the next generations.

Teaching the economics of sports

A course on the economics of sports provides a unique opportunity to the economics department but confronts the instructor with unique challenges. Students in such a class are likely to be more heterogeneous and more likely to enter the class with inappropriate expectations than is the case for a typical upper-level economics elective. The author of this article discusses the problems an instructor in an economics of sports course will encounter and how s/he might overcome them. Particular emphasis is placed on the use of technology in the classroom and on how an economics of sports class might enable the instructor to raise issues of inclusion/exclusion in a nonthreatening manner. A course on the economics of sports provides a unique opportunity to economics departments. Because of the outsized interest of the American public in sports, an undergraduate course in the economics of sports can be a magnet that attracts students who otherwise might shy away from an upper-level economics course. It is far more likely to attract non-majors than our traditional offerings in labor economics or monetary theory.

Effect of information on reducing inappropriate expectations and requests for antibiotics.

People often expect antibiotics when they are clinically inappropriate (e.g., for viral infections). This contributes significantly to physicians' decisions to prescribe antibiotics when they are clinically inappropriate, causing harm to the individual and to society. In two pre-registered studies employing UK general population samples (n1 =402; n2 =190), we evaluated the relationship between knowledge and beliefs with antibiotic expectations, and the effects of information provision on such expectations. We conducted a correlational study (study 1), in which we examined the role of antibiotic knowledge and beliefs and an experiment (study 2) in which we assessed the causal effect of information provision on antibiotic expectations. In study 1, we found that both knowledge and beliefs about antibiotics predicted antibiotic expectations. In study 2, a 2 (viral information: present vs. absent) × 2 (antibiotic information: present vs. absent) experimental between-subjects design, information about antibiotic efficacy significantly reduced expectations for antibiotics, but viral aetiology information did not. Providing antibiotic information substantially diminishes inappropriate expectations of antibiotics. Health campaigns might also aim to change social attitudes and normative beliefs, since more complex sociocognitive processes underpin inappropriate expectations for antibiotics.

Crossing Boundaries: Mentorship in Global Health.

* Abbreviation: GH — : global health On my first day in the NICU in Malawi, I helped care for an infant who suffered from severe lack of oxygen and trauma due to a difficult birthing process. Before this experience, I had felt ready to work at a Malawian hospital as a pediatric resident. I had taken a tropical medicine course, and my home institution mentor had run simulations and led discussions addressing the practicalities and ethics of practicing medicine within resource-limited settings. But that afternoon, when the infant became apneic, personally experiencing what had only been simulated felt much harder. The 1 available nurse and I performed compressions and manual breaths, but he never recovered spontaneous respirations. My host institution mentor arrived soon after we discontinued resuscitative efforts. With his guidance, I spoke to our patient’s family and witnessed the Malawian expression of grief in the form of wailing songs and prayers. Afterward, he and I discussed questions with which I was struggling, namely, at what point would I be causing more harm than good by continuing to resuscitate this child, knowing the limited long-term care resources available in Malawi? Both home and host institution mentors helped me navigate this clinical situation and process my patient’s death, ultimately enriching my global health (GH) experience and … Address correspondence to Maya I. Brasher, MD, Division of Neonatal-Perinatal Medicine, Department of Pediatrics, McGovern Medical School, UT Health Science Center at Houston, 6431 Fannin St, Suite MSB 3.244, Houston, TX 77030. E-mail: maya.i.brasher{at}uth.tmc.edu

Let’s do better: public representations of COVID-19 science

COVID science is being both done and circulated at a furious pace. While it is inspiring to see the research community responding so vigorously to the pandemic crisis, all this activity has also created a churning sea of bad data, conflicting results, and exaggerated headlines. With representations of science becoming increasingly polarized, twisted, and hyped, there is growing concern that the relevant science is being represented to the public in a manner that may cause confusion, inappropriate expectations, and the erosion of public trust. Here we explore some of the key issues associated with the representations of science in the context of the COVID-19 pandemic. Many of these issues are not new. But the COVID-19 pandemic has placed a spotlight on the biomedical research process and amplified the adverse ramifications of poor public communication. We need to do better. As such, we conclude with 10 recommendations aimed at key actors involved in the communication of COVID-19 science, including government, funders, universities, publishers, media, and the research communities.

Action bias in the public's clinically inappropriate expectations for antibiotics.

Clinical guidelines recommend that physicians educate patients about illnesses and antibiotics to eliminate inappropriate preferences for antibiotics. We expected that information provision about illnesses and antibiotics would reduce but not eliminate inappropriate preferences for antibiotics and that cognitive biases could explain why some people resist the effect of information provision. In 2 experiments, participants (n₁ = 424; n₂ = 434) either received incomplete information (about the viral etiology of their infection) or complete information (about viral etiology and the ineffectiveness and harms of taking antibiotics), before deciding to rest or take antibiotics. Those in the complete information conditions responded to items on 4 biases: action bias, social norm, source discrediting, and information neglect. In 2 follow-up experiments (n₁ = 150; n₂ = 732), we aimed to counteract the action bias by reframing the perception of the resting option as an action. Complete information provision reduced but did not eliminate inappropriate preferences for antibiotics. Around 10% of people wanted antibiotics even when informed they are harmful and offer no benefit and even when the alternative option (i.e., rest) was framed as an active treatment option. Results suggest an action bias underpins this preference but appears challenging to counteract. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

'Always take your doctor's advice': Does trust moderate the effect of information on inappropriate antibiotic prescribing expectations?

Objectives To reduce overprescribing, health campaigns urge physicians to provide people with information regarding appropriate antibiotic use and encourage the public to trust their physicians' prescribing decisions. We test (1) whether providing individuals withcomplete information about the viral aetiology of an illness and the ineffectiveness of antibiotics will reduce inappropriate antibiotic expectations, (2) whether individuals with greater trust in their physician will have lower expectations, and (3) whether individuals with greater trust in their physician will benefit more from the complete information provision and have lower expectations. Design Experiment 1 features a between-subjects design (information provision: baseline vs. complete information) with a general measure of participants' trust in their physician. Experiment 2 features a 2 (physician trustworthiness: low vs. high) × 2 (information provision: baseline vs. complete information) between-subjects design. Methods In Experiment 1, participants (n=366) reported their trust in their physician, read a vignette describing a hypothetical consultation with a physician for a viral cold and then expressed their expectations for antibiotics. In Experiment 2, participants (n=380) read a vignette of a consultation with a physician for a viral ear infection then expressed their expectations for antibiotics. Results In both experiments, the provision of complete information significantly reduced inappropriate expectations for antibiotics. Greater trust in physicians was associated with higher antibiotic expectations in Experiment 1, but lower expectations in Experiment 2. In both experiments, trust in physicians appeared to facilitate the effect of information provision, but this effect was weak and inconsistent. Conclusion Providing information about viral aetiology and the ineffectiveness and side effects of antibiotics reduces inappropriate antibiotic expectations. Further research into the effect of trust in physicians as a moderator of the effect information provision is required, particularly given the recent increase in trust-based antibiotic campaigns. Statement of contribution What is already known Inappropriate expectations for antibiotics encourage overprescribing in primary care. To reduce inappropriate expectations, interventions often aim to educate people about antibiotics andencourage them to trust their physician. What does this study add Causal evidence that clinical information provision reduces but does not eliminate inappropriate antibiotic expectations. We find that increased trust in physicians is not always associated with lower expectations for antibiotics. Although increased trust seemed to boost the effect of information provision, this effect was weak and inconsistent.

Spatio-temporal mapping of ecotourism activities in Buleleng conservation zone: a methodological review

In Bali, economic benefits from tourism in 2017 is IDR 50,241.07 billion and unfortunately still dominated by districts in the south and the east of Bali, e.g., Badung, Denpasar, and Karangasem. Better coastal environment conditions in Buleleng District, environmental problems related to water quality and domestic waste management in the south and the east of Bali, as well as Buleleng new airport planning in 2025, will undoubtedly be a turning point to economic competitiveness in this area. This review represents brief information of the methodology that can be used to identify and to map ecotourism activities spatially and temporally. With this review, the purpose is to give information and solution related to several methodologies, which can be used to address constraints that can lead to inappropriate expectation concerning the outcomes of the study of spatio-temporal mapping of ecotourism activities.

Supplemental Material for Action Bias in the Public’s Clinically Inappropriate Expectations for Antibiotics

Supplemental Material for Action Bias in the Public’s Clinically Inappropriate Expectations for Antibiotics

Demographic and Psychological Factors Associated with Feelings of Antibiotic Entitlement in New Zealand.

Patients’ expectations of being prescribed antibiotics can have an important influence on inappropriate prescribing. Therefore, it is important to understand the drivers of patients’ antibiotic expectations. The 2015/16 New Zealand Attitudes and Values Study measured sense of entitlement to antibiotics in a nationally representative sample of New Zealanders (n = 13,484). Participants were asked to rate their agreement with the statement “If I go to my doctor/GP with a minor illness (e.g., sore throat, cough, runny nose, etc.), I think that I should be prescribed antibiotics by default.” Eighty percent of participants showed low feelings of antibiotic entitlement, while 18.5% exhibited moderate and 3.7% high feelings of entitlement. People of ethnic minority, lower socio-economic status, and with diabetes expressed higher expectations of being prescribed antibiotics. This may be partially based on a higher risk of rheumatic fever or other complications. Men, religious people, those with lower educational attainment and self-rated health, but greater psychological distress and feelings of control over their health exhibited higher feelings of antibiotic entitlement. Those high on Extraversion, Conscientiousness, and Narcissism, but low on Agreeableness and Openness, also showed greater feelings of entitlement. Our findings help identify key characteristics of those more likely to express inappropriate expectations of antibiotic prescription.

Relational autonomy in action: Rethinking dementia and sexuality in care facilities.

Caregivers and administrators in long-term facilities have fragile moral work in caring for residents with dementia. Residents are susceptible to barriers and vulnerabilities associated with the most intimate aspects of their lives, including how they express themselves sexually. The conditions for sexual agency are directly affected by caregivers' perceptions and attitudes, as well as facility policies. This article aims to clarify how to approach capacity determinations as it relates to sexual activity, propose how to theorize about patient autonomy in this context, and suggest some considerations for finding an ethically responsible and practically feasible way to respect the sexual rights of this population. The focus is on residents with early to moderate dementia in states of daily dependency on professional caregivers. The article critically examines existing empirical research on sexuality among persons with dementia, caregivers' attitudes, and institutional roadblocks to enabling residents' sexuality. A relational lens and insights from disability studies are used in the philosophical analysis. No research participants were part of this analysis. This article offers a conceptual analysis and normative framework only. The analysis highlights the delicate balance that capacity assessments for sexual activity have to strike; while caregivers should protect those who cannot give adequate consent, the denial of sexuality among residents can cause deep, long-ranging harms. Sexual agency features into an ongoing sense of self for many individuals with dementia, and the imposition of inappropriate standards and expectations for sexual autonomy can lead to unwarranted obstacles to sexual activity. Recommendations include developing clear and inclusive institutional policies and practices of care, providing education for caregivers on how to discuss and document residents' sexual preferences over time, and taking advantage of ethics consultation services. This analysis establishes the need for more research and discussion on this sensitive topic. Future research should investigate the specific responsibilities of caregivers in furthering the sexual interests of residents, how exactly to modify existing capacity instruments, and how best to support historically marginalized patients in their sexual identities.

Best practice principles for communicating safety messages in national parks

Effective communication of safety information for visitors to national parks and other protected areas is essential, particularly where the potential consequences of incidents are severe. Signs are often the primary communication tool for safety messages in national parks. Compliance-based approaches to safety signs using standards drawn from occupational safety are common, though empirical research into the effectiveness of safety signs in national parks and protected areas generally remains limited. To encourage a more pro-active approach to visitor safety, this paper offers an alternative by proposing and field-testing best practice principles (BPPs) for safety signs in parks. It first presents a literature review of safety sign research that, together with consideration of the current policy and practice of leading protected area management agencies, underpinned the development of three sets of BPPs for communicating safety messages. The set of BPPs that focused on safety signs in national parks were then field-tested in two Australian states. The results point to the theoretical as well as the practical value of best practice principles. In particular, they help reveal why and how particular signs are effective at communicating safety messages. From a management perspective, the BPPs offer a holistic yet contextually-adaptable approach to benchmarking and evaluation. The three sets of BPPs also draw attention to the importance of both a coordinated interpretation and communication approach and an overarching risk management framework in which the use of safety signage is embedded. Management implications●The paper presents best practice principles for safety signage and communication for managing visitor risk in protected areas. In addition the following aspects should be considered to enhance the effectiveness of warning concepts:●Insights into the target audience including the respective awareness of risks and cultural differences in the various countries of origin.●Familiarity with and perception of possible risks within different visitor segments.●Familiarity with the presented communication means (illustrations, language, colors).●Information prior to the stay to avoid inappropriate expectations and increase the awareness of possible risks.