Disease Risk Perception Research Articles

Level of knowledge, and risk perception of Mpox disease among Primary healthcare workers in Nigeria: a cross-sectional study of Jigawa, Oyo and Lagos

Level of knowledge, and risk perception of Mpox disease among Primary healthcare workers in Nigeria: a cross-sectional study of Jigawa, Oyo and Lagos

Intersectional Microaggressions and Cardiovascular Disease Risk Perception in Bisexual Black, Indigenous, and People of Color

Cardiovascular diseases (CVDs), or heart diseases, are the leading cause of morbidity and mortality nationwide. Separate bodies of research indicate that Lesbian, Gay, and Bisexual (LGB) individuals and Black, Indigenous, and People of Color (BIPOC) demonstrate high risk for CVD and report greater levels of intersectional microaggressions compared with their Heterosexual White and BIPOC counterparts. Within LGB communities, Bisexual individuals report more discrimination that is associated with more CVD risk factors compared with their Heterosexual and Lesbian and Gay (LG) counterparts. Research has not examined differences in the rates of CVD risk factors between Bisexual and LG BIPOC or the associations between intersectional microaggressions and heart disease risk perception in LGB BIPOC, a relevant construct correlated with health behavior and objective risk. Participants (N= 264) self-identified as LGB BIPOC and filled out measures on their CVD risk factors, CVD risk perception, and experiences of intersectional microaggressions or intersectional minority stress. Results showed that Bisexual and LG BIPOC reported similar odds for CVD risk factors. Intersectional minority stress and CVD risk perception were positively associated with Bisexual participants only. Findings underscore the importance of extending beyond traditional biomedical frameworks of CVD risk and recognizing the unique contribution of intersectional microaggressions for LGB BIPOC, with strong associations of intersectional minority stress for Bisexual BIPOC heart health.

Barriers and Facilitators to Risk Reduction of Cardiovascular Disease in Hypertensive Patients in Nigeria.

In Sub-Saharan Africa (SSA), the prevalence of hypertension is increasing due to many factors like rapid population growth, globalization, stress, and urbanization. We aimed to characterize the perceptions of cardiovascular disease (CVD) risk among individuals with hypertension living in Nigeria and identify barriers and facilitators to optimal hypertension management. This cross-sectional survey study was conducted at a large teaching hospital in Lagos, Nigeria. We used a convenient sample of males and females, aged 18 or older, with a diagnosis of hypertension who presented for outpatient visits in the cardiology, nephrology, or family medicine clinics between November 1 and 30, 2020. A semiquantitative approach was utilized with a survey consisting of closed and open-ended questionnaires focused on patient knowledge, perceptions of CVD risk, and barriers and facilitators of behavioral modifications to reduce CVD risk. There were 256 subjects, and 62% were female. The mean age was 58.3 years (standard deviation (SD) = 12.6). The mean duration of the hypertension diagnosis was 10.1 years. Most participants were quite knowledgeable about hypertension; however, we observed some knowledge gaps, including a belief that too much "worrying or overthinking" was a major cause of hypertension and that an absence of symptoms indicated that hypertension was under control. Barriers to hypertension management include age, discomfort or pain, and lack of time as barriers to exercise. Tasteless meals and having to cook for multiple household members were barriers to decreasing salt intake. Cost and difficulty obtaining medications were barriers to medication adherence. Primary facilitators were family support or encouragement and incorporating lifestyle modifications into daily routines. We identified knowledge gaps about hypertension and CVD among our study population. These gaps enable opportunities to develop targeted interventions by healthcare providers, healthcare systems, and local governments. Our findings also help in the promotion of community-based interventions that address barriers to hypertension control and promote community and family involvement in hypertension management in these settings.

Cardiovascular disease risk perceptions and influencing factors among Chinese systemic lupus erythematosus patients.

Systemic Lupus Erythematosus patients (SLE) are at a higher risk of cardiovascular events than the general population. This study aimed to investigate the risk perception of cardiovascular disease (CVD) and to analyze its influence factors among Chinese SLE patients. This was a cross-sectional study. Convenience sampling was used to select 201 patients with SLE who had attended the outpatient and inpatient departments of the Department of Rheumatology and Immunology at the First Affiliated Hospital of the University of Science and Technology of China from November 2022 to March 2023. The following were used in the study: the Chinese version of the Attitudes and Beliefs about Cardiovascular Disease Risk Questionnaire, the Social Support Rating Scale, the Connor-Davidson Resilience Scale, the General Self-Efficacy Scale, the Hospital Anxiety and Depression Scale, the Health Literacy Management Scale, and sociodemographic and disease-related data. The mean (standard deviation) risk perception score of CVD patients with SLE was 57.18 ± 13.02. A Pearson correlation analysis showed that CVD risk perceptions were positively correlated with health literacy (r = 0.152, p < .05) and depression (r = 0.277, p < .05), and negatively correlated with social support (r = -0.393, p < .05) and psychological resilience (r = -0.374, p < .05). A multiple linear regression analysis showed that body mass index (BMI), family history, health literacy, depression, social support, and psychological resilience were the main factors influencing CVD risk perceptions among Chinese SLE patients (p < .05). Body mass index, family history, health literacy, depression, social support, and psychological resilience influenced CVD risk perceptions among Chinese SLE patients. Healthcare workers should objectively and accurately assess the levels of CVD risk perception among SLE patients, identify the risk factors of CVD, adopt effective health risk communication strategies to help patients develop appropriate risk perceptions, and raise risk awareness to adopt active coping approaches to reduce risk.

Mothers’ perceptions and attitudes about HPV vaccination initiation among 9- and 10-year-olds

ABSTRACT HPV vaccination has potential to prevent 90% of HPV-associated cancers. The Advisory Committee on Immunization Practices recommends HPV vaccination for 11- and 12-year-olds, but vaccine initiation can start at age 9. The purpose of this study was to explore perceptions about starting HPV vaccination at a younger age to inform future interventions that promote initiation at ages 9 and 10 years. This was part of a larger study about vaccine hesitancy among racially/ethnically diverse parents of adolescents in the Greater Newark Area of New Jersey. We thematically analyzed transcripts from 16 interviews with English- and Spanish-speaking mothers who had at least one child ≤ 10 years. Analyses focused on perceptions of HPV-related disease risk, attitudes toward HPV vaccination need, and vaccine confidence specifically for 9- and 10-year-olds. Few parents with young adolescents reported receiving vaccination recommendations, and only one reported series initiation before age 11. Mothers’ hesitation about younger HPV vaccination initiation revolved around: 1) low perceived necessity among English-speaking mothers due to young adolescents not being sexually active, 2) concerns about potential side effects associated with vaccinating prepubescent adolescents, and 3) a desire for adolescents to be old enough to provide assent. Participants were not opposed to younger initiation but wanted and relied on pediatricians to inform them about vaccination for younger adolescents. These findings suggest mothers are willing to vaccinate at younger ages after clear provider recommendations. Equipping providers with evidence about vaccine safety and cancer prevention communication strategies may promote initiation and timely completion at younger ages.

Improving the communication between farmers and veterinarians to enhance the acceptability of bovine tuberculosis eradication programmes.

France and Spain have been fighting against bovine tuberculosis (bTB) for years, even though new outbreaks continue to appear on both sides of the border, generating misconceptions about the disease and social distrust in the eradication programme and competent authorities. The perceived disease risk and the commitment of all interested parties are key factors for the successful implementation of control programmes, as they might influence the acceptability of recommended measures. Effective communication can contribute to increasing knowledge, trust and stakeholders' engagement, thus ensuring the acceptability of the eradication programme. This study was conducted in Catalonia (Spain) and Pyrenees-Atlantiques (France) in the frame of the INNOTUB project (https://innotub.eu/) to characterise the communication on bTB in the trans-Pyrenees region and provide recommendations to improve it. The communication on bTB was characterised by analysing 153 (Spain) and 66 (France) online freely available texts, published between 2018 and 2020, through Content Analysis and Critical Metaphor Analysis. Moreover, six farmers and four veterinarians were in-depth interviewed in each area to gather information about the communication on bTB. Interviews were made in original languages and analysed using a qualitative thematic approach. A pilot participatory intervention inspired by the Systematic Tool for Behavioural Assumption Validation and Exploration (STAVE) method was used to develop a list of proposals to improve communication and to promote the creation of territorial networks/committees on bTB prevention and control. It included three focus groups with farmers and veterinarians, a meeting with representatives of the regional veterinary services, and a final deliberative workshop. Results highlight the existence of a controversial debate on bTB and a heterogeneous understanding between stakeholders. Institutional and scientific communication mainly focus on bTB detection and control while other aspects are left in the background. On the contrary, farmers extend their communication to a greater variety of topics. The metaphorical framing strongly differed among actors, while veterinary services and researchers "fight" against bTB and "progress" toward the eradication, farmers place themselves in a framework of "sacrifice" and, particularly in Spain, they play a passive role. The proposals developed by the participants to improve the current communication on bTB included: (i) create participatory meeting spaces to share opinions and information; (ii) improve data accessibility (on epidemiological situations); (iii) develop clearer and written protocols and informative visual material; (iv) redesign the training courses (v) increase the stakeholders' participation in the design of protocols.

The Outrage Effect of Personal Stake, Effect on Children, Dread, and Controllability on COVID-19 Risk Perception Moderated by Media Use

ABSTRACT Public response to the COVID-19 pandemic provides a unique opportunity to study how lay people’s risk perception involves their emotive responses. We investigated how outrage factors as emotional responses to risk influence levels of risk perception in the context of the pandemic disease. Furthermore, how media use influences the perception of outrage factors is also examined. A nationwide online survey (n = 1,000) was conducted in South Korea. The survey results indicated that pandemic risk perception was connected to the generic intensity of perceived outrage factors as measured by averaging the perception of multiple outrage factors. Individual outrage factors such as personal stake, effect on children, dread, and controllability directly influenced risk perception regarding COVID-19. When the intensity of media use was considered, individuals with heavy media use perceived outrage factors more intensely than those who used media less frequently. Media use also moderated the outrage effect of catastrophic potential and moral nature on the perception of risk associated with the pandemic disease. For heavy media users, the outrage effect of moral nature was increased, while that of catastrophic potential decreased. The implications of the outrage effect on the pandemic disease risk perception are addressed. Finally, we discuss the meaning of heavy media users’ varying levels of vulnerability to outrage effect by moral nature and catastrophic potential.

User perceptions of COVID-19 telemedicine testing services, disease risk, and pandemic preparedness: findings from a private clinic in Hong Kong.

During the coronavirus disease 2019 (COVID-19) pandemic, telemedicine has been regarded as a method for providing safe access to healthcare. Here, we explored the experiences of individuals using telemedicine in Hong Kong during the COVID-19 pandemic to understand their risk perceptions and preparedness measures. We conducted a cross-sectional online survey of telemedicine users of private clinic-based COVID-19 testing services from 6 April to 11 May 2020. All users were invited to complete an anonymous online survey regarding COVID-19 risk perception and preparedness measures. The results of the survey were compared with the findings of a previous territory-wide survey. In total, 141 of 187 telemedicine users agreed to participate; the response rate was 75.4%. Of the participants, 95.1% (116/122) believed that telemedicine consultations were useful. Nearly half of the participants (49.0%) agreed or strongly agreed that telemedicine consultations were appropriate during the COVID-19 pandemic. Most participants believed that telemedicine consultations could perform the functions of 'health protection, promotion and disease prevention' (73.6%) and 'diagnosis' (64.0%). Concerning the choice of telemedicine provider, almost all participants (99.2%) were willing to consult medical doctors; more than half of the participants (54.1%) were willing to consult registered nurses, but only 13.1% were willing to consult non-clinical staff who had been trained to provide telemedicine services. The use of telemedicine for screening and patient education can be encouraged during the COVID-19 pandemic in Hong Kong.

Risk perception and intended behavior change after uninformative genetic results for adult-onset hereditary conditions in unselected patients.

Population genetic screening for preventable adult-onset hereditary conditions may improve disease management and morbidity but most individuals will receive uninformative results that do not indicate higher risk for disease. Investigation into subsequent psychosocial health and behaviors is necessary to inform population screening feasibility, effectiveness, and cost considerations. We conducted a prospective survey study of unselected University of Washington Medicine patients enrolled in a genetic research study screening for pathogenic variation in medically important genes. Survey questions adapted from the Feelings About genomiC Testing Results (FACToR) questionnaire and designed to understand perceived disease risk change and planned health behaviors were administered after receipt of results. Overall, 2761 people received uninformative results and 1352 (49%) completed survey items. Respondents averaged 41 years old, 62% were female, and 56% were Non-Hispanic Asian. Results from the FACToR instrument showed mean (SD) scores of 0.92 (1.34), 7.63 (3.95), 1.65 (2.23), and 0.77 (1.50) for negative emotions, positive emotions, uncertainty, and privacy concerns, respectively, suggesting minimal psychosocial harms from genetic screening. Overall, 12.2% and 9.6% of survey respondents believed that their risk of cancer or heart disease, respectively, had changed after receiving their uninformative genetic screening results. Further, 8.5% of respondents planned to make healthcare changes and 9.1% other behavior changes. Future work is needed to assess observed behavior changes attributable to uninformative screening results and if small changes in behavior among this population have large downstream impacts.

The dynamics of the risk perception on a social network and its effect on disease dynamics

The perceived infection risk changes individual behaviors, which further affects the disease dynamics. This perception is influenced by social communication, including surveying their social network neighbors about the fraction of infected neighbors and averaging their neighbors’ perception of the risk. We model the interaction of disease dynamics and risk perception on a two-layer random network that combines a social network layer with a contact network layer. We found that if information spreads much faster than disease, then all individuals converge on the true prevalence of the disease. On the other hand, if the two dynamics have comparable speeds, the risk perception still converges to a value uniformly on the network. However, the perception lags behind the true prevalence and has a lower peak value. We also study the behavior change caused by the perception of infection risk. This behavior change may affect the disease dynamics by reducing the transmission rate along the edges of the contact network or by breaking edges and isolating the infectious individuals. The effects on the basic reproduction number, the peak size, and the final size are studied. We found that these two effects give the same basic reproduction number. We find edge-breaking has a larger effect on reducing the final size, while reducing the transmission rate has a larger effect on reducing the peak size, which is true for both scale-free and Poisson networks.

Examining outpatients' hand hygiene behaviour and its relation to COVID-19 infection prevention measures

The increasing demand for outpatient care is associated with a higher risk of infection transmission in these settings. However, there is limited research on infection prevention and control practices in ambulatory clinics, and none focuses on patients. This study aims to examine outpatients' hand hygiene behaviours, their determinants, and their associations with other infection prevention measures during the COVID-19 pandemic. We observed the hand hygiene behaviour of one cohort of patients in one outpatient clinic and surveyed a separate sample in five clinics about their hand hygiene practice in outpatient facilities. A questionnaire based on the Theoretical Domains Framework (TDF) was used to examine predictors of the behaviour. Moreover, patients indicated their compliance with COVID-19 infection prevention measures, vaccination status, disease risk perception, and vaccine hesitancy. Observed hand hygiene rates among 618 patients were low (12.8%), while 67.3% of the 300 surveyed patients indicated sanitising their hands upon entering the clinic. The TDF domains memory, attention, and decision processes, and emotions significantly predicted both current (today's) and general hand hygiene behaviour in outpatient clinics. Hand hygiene behaviour and compliance with COVID-19 infection prevention showed a positive association; however, no significant connection was found with patients' vaccination status, suggesting different behavioural motivators. Hand hygiene among outpatients should be improved through interventions focusing on helping patients remember to clean their hands. More research on infection prevention in outpatient facilities is needed to ensure patient safety.

Perceived Cardiovascular Disease Risk Following Preeclampsia: A Cross-Sectional Study.

Preeclampsia has been linked to an increased risk of cardiovascular disease (CVD), and the preeclamptic women were unaware of this link. Therefore, this study aims to assess women's knowledge and perception of future CVD after preeclampsia. This study used a cross-sectional descriptive design. Two hundred and forty-six women with a preeclampsia history were recruited from the Al Salam MCH Center and Suez Canal University Hospital. Data were collected during March 2022 using a socio-demographic questionnaire, an Adapted Coronary Heart disease knowledge tool for preeclamptic women, and The Perception of Risk of Heart Disease Scale (PRHDS). Most women (96%) were unaware of the relationship between CVD and preeclampsia. The women had a low CVD knowledge level (10.26 ± 6.08) as well as a low perception of cardiovascular disease risk (37.15 ± 7.22). There was a significant positive correlation between CVD knowledge and CVD risk perception (r = 0.434, p = 0.000). This study found that preeclampsia survivors underestimated their CVD risk. Based on these findings, preeclamptic women should receive health education sessions on CVD risk and prevention from their nurses and obstetricians. The hospital pre-discharge plan must contain these sessions in written and electronic formats to help women remember and follow CVD risk reduction measures.

Risk perception of coronavirus disease 2019 and career adaptability among college students: the mediating effect of hope and sense of mastery.

The Coronavirus Disease 2019 (COVID-19) pandemic has not only caused widespread economic recession but also had a serious negative impact on the employment of college students. However, little is known about the relationship and mechanisms between the risk perception of COVID-19 and career adaptability. This study aimed to examine whether the risk perception of COVID-19 is associated with career adaptability directly and indirectly through hope and a sense of mastery in college students. A questionnaire survey was conducted among 594 Chinese college students aged 16 to 25, who completed assessments on risk perception of COVID-19, career adaptability, hope, and sense of mastery. The results showed that susceptibility was negatively associated with career confidence, control, and curiosity; moreover, susceptibility indirectly affected career adaptability (including concern, confidence, control, and curiosity) through the sense of mastery; uncontrollable indirectly affected career concern through hope; and uncontrollable indirectly affected career adaptability (including concern, confidence, control, and curiosity) through hope and the sense of mastery. The findings emphasize the role of hope and a sense of mastery in the career adaptability of college students and reveal the necessity of improving hope and a sense of mastery to promote college students' career development. "Implications and limitations are discussed".

The Relationship Between Risk Perception, Physical Activity, and Adolescent Mental Health: A Cross-Lagged Analysis.

During the novel coronavirus pandemic, the prevalence of anxiety and depressive symptoms among adolescents rose dramatically to 31% and 34%, respectively. This study aims to elucidate the relationship between perceived disease risk, physical activity, and adolescent mental health, questioning whether physical activity maintains its protective role amidst heightened disease risk. In a longitudinal study design, questionnaires were administered twice, in December 2022 and January 2023, to a cohort of students across five high schools. These questionnaires measured adolescents' perception of disease risk, their physical activity levels, and their mental health status during the pandemic. A total of 344 students participated in this study. The data revealed significant gender differences in risk perception, with gender difference effects of 0.255 (d=0.416) and 0.195 (d=0.402) across both indicators, and in mental health, with gender difference effects of 0.159 (d=0.262) and 0.179 (d=0.278). Risk perception at Time 1 was found to be a significant predictor of both physical activity and mental health (β values of 0.28 and 0.19, P < 0.01, respectively). Physical activity at Time 1 was also a significant predictor of mental health at Time 2 (β = 0.33, P < 0.01). Moreover, physical activity mediated the relationship between risk perception and mental health, as suggested by a significant indirect effect (mediator effect of 0.012, Z value of 0.112, and a Bootstrap 95% CI excluding 0). This study underscores a longitudinal relationship between adolescents' perception of disease risk, physical activity, and mental health. It highlights the potential benefits of promoting physical activity awareness among adolescents as a strategy to improve mental health outcomes during pandemics.

Hunter Willingness-to-Pay for Disease Testing: Evidence from Chronic Wasting Disease in White-Tailed Deer

AbstractUsing the case of chronic wasting disease (CWD) in white-tailed deer, we estimated hunters’ willingness-to-pay (WTP) for testing their game and determined how their perception of disease risk, trust, and confidence in wildlife agency affected hunter participation in ongoing disease surveillance. The average WTP for testing was $23.75 per deer, and it was positively related to trust and confidence in the wildlife agency and the perception of risk about deer populations in the declining area and the pathogen spreading to other areas. These findings imply that implementing active outreach programs can improve hunter participation in user-paid systems for CWD surveillance.

Assessing the Impact of the COVID-19 Pandemic on Population Heat in Urban Green Spaces in China

Using mobile positioning data, the study assessed the impact of the COVID-19 pandemic on population heat in urban green spaces (UGSs) in Beijing, Shanghai, and Qingdao, China. The results were summarized as follows. The range of the spatial distribution of population heat in the three cities expanded in 2020 compared with that in 2019. Moreover, the shape of the hourly curve of population heat in UGSs changed from an inverted U-shape to a flat shape due to the impact of the COVID-19 pandemic. Restricted–non-fee-paying UGSs were least affected by the COVID-19 pandemic. Last, regression analysis revealed a significant influence of the change in population heat in hotel accommodation within UGS service areas on the change of population heat in UGSs. These findings provided new insights into the responses of recreational populations to policy decisions, risk perception of an infectious disease, and resilience to crises of different types of UGSs.

Relationship between animal health and livestock farmers’ wellbeing in Ghana: beyond zoonoses

IntroductionLivestock production is a key livelihood source for many people in developing countries. Poor control of livestock diseases hamper livestock productivity, threatening farmers’ wellbeing and food security. This study estimates the effect of livestock mortalities attributable to disease on the wellbeing of livestock farmers.MethodsOverall, 350 ruminant livestock farmers were randomly selected from three districts located in the north, middle and southern belts of Ghana. Mixed-effect linear regression models were used to estimate the relationship between animal health and farmer wellbeing. Farmer wellbeing was assessed using the WHOQOL-BREF tool, as the mean quality-of-life in four domains (physical, psychological, social, and environmental). Animal health was assessed as annual livestock mortalities to diseases adjusted for herd size, and standardized in tropical livestock units to account for different ruminant livestock species. We adjusted for the potential confounding effect of farmers’ age, sex, educational attainment, farmland size, socio-economic status, perception of disease risk to herd, satisfaction with health, previous experience of disease outbreaks in herds, and social support availability by including these as fixed effects, and community as random effects, in a pre-specified model.ResultsOur results showed that farmers had a median score of 65.5 out of 100 (IQR: 56.6 to 73.2) on the wellbeing scale. The farmers’ reported on average (median) 10% (IQR: 0 to 23) annual herd mortalities to diseases. There was a significantly negative relationship between increasing level of animal disease-induced mortality in herds and farmers’ wellbeing. Specifically, our model predicted an expected difference in farmers’ wellbeing score of 7.9 (95%CI 1.50 to 14.39) between a farmer without any herd mortalities to diseases compared to a (hypothetical) farmer with 100% of herd mortalities caused by diseases in a farming year. Thus, there is a reduction of approximately 0.8 wellbeing points of farmers, for the average of 10% disease-induced herd mortalities experienced.ConclusionsDisease-induced livestock mortalities have a significant negative effect on farmers’ wellbeing, particularly in the physical and psychological domains. This suggests that veterinary service policies addressing disease risks in livestock, could contribute to improving the wellbeing of livestock dependent populations, and public food security.

Disease perception and preventive behavior: The vaccination response to local measles outbreaks

BackgroundThis paper examines the role of perceived disease risk in vaccination behavior. Using health insurance claims data, I estimate the effect of local measles outbreaks in Germany on first- and second-dose measles vaccinations in children as well as catch-up vaccinations in adults. MethodsIn my analytic strategy, I exploit the variation in timing and location of regional disease outbreaks and estimate a two-way fixed effects model with birth cohort and region fixed effects. The basic underlying assumption is that measles outbreaks alter perceptions regarding the disease risk. The robustness of this approach concerning possible bias due to heterogeneous treatment effects under differential treatment timing is assessed through the use of alternative estimators. ResultsMeasles outbreaks within a region increase the share of children who receive their vaccination on time by 0.8 percentage points for both the first and second vaccination. This corresponds to a reduction in the share of not timely vaccinated children of about 1.0% and 1.6% for the first and second doses, respectively. Results further show an increase in the rate of monthly catch-up vaccinations in adults by about 10% for the age group 20–30 to up to 46% for those at ages 40–50 in the first six months after an outbreak. One important finding is that regional outbreaks do not lead to increases in vaccinations in other regions even if public attention extends beyond the affected region. ConclusionsThese results suggest that behavioral responses are driven by affective rather than deliberative risk perception. Also, vaccination effects can be observed only in the few months following the outbreak, which indicates that changes in the perceived disease risk due to a local measles outbreak are short-lived and fade away quickly once the disease outbreak is over.

Risk Perception Scale of Disease Aggravation for older patients with non-communicable diseases: Instrument development and cross-sectional validation study.

The present study aimed to develop the Risk Perception Scale of Disease Aggravation for older patients with non-communicable diseases and evaluate its psychometric properties. Instrument development and cross-sectional validation study were conducted. This study contained four phases. In phase I, a systematic literature review was conducted to identify the conception of disease aggravation and risk perception. In phase II, a draft scale was formulated from face-to-face semi-structured in-depth interviews by Colaizzi's seven-step qualitative analysis method and group discussions among the researchers. In phase III, domains and items of the scale were revised in accordance with the suggestions from Delphi consultation and patient feedback. In phase IV, psychometric properties were evaluated. Exploratory and confirmatory factor analyses determined four structural factors. Convergent and discriminant validities were acceptable because the average variance extracted coefficients ranged from .622 to .725, and the square roots of the average variance extracted coefficients for the four domains were larger than those of bivariate correlations between domains. The scale also exhibited excellent internal consistency and test-retest reliability (Cronbach's alpha coefficient = .973, intraclass correlation coefficient = .840). Risk Perception Scale of Disease Aggravation is a new instrument that measures the risk perception of disease aggravation for older patients with non-communicable diseases, including possible reason, serious outcome, behaviour control and affection experience. The scale contains 40 items that are scored on a 5-point Likert scale, and it has acceptable validity and reliability. The scale is applied to identify different levels of risk perception of disease aggravation for older patients with non-communicable diseases. Clinical nurses can provide targeted interventions to improve older patients' risk perception of disease aggravation based on levels of risk perception during hospitalization and the period before discharge. Experts provided suggestions for revising the scale dimensions and items. Older patients participated in the scale revision process to improve the wording of the scale.

Ingroup favoritism on perceived risk of infectious diseases.

Humans live in social groups; thus, infectious diseases may threaten human health and safety. Do individuals exhibit ingroup favoritism or ingroup devaluation when faced with varying risks of infectious diseases? We generated relatively realistic disease scenarios to examine this question. We reported the results from three experiments in which we tested individuals' perceived disease risk from ingroup and outgroup members under high- and low-risk conditions. Experiment 1 used a realistic influenza scenario, and Experiments 2 and 3 used a realistic scenario of exposure to coronavirus disease 2019 (COVID-19). All three experiments showed that perceived disease risk was significantly lower from ingroup members than from outgroup members and significantly lower in low-risk conditions than in high-risk conditions. Furthermore, the perceived disease risk was significantly lower from ingroup members than from outgroup members in high-risk conditions but did not significantly differ in low-risk conditions, as in Experiment 1's influenza scenario and Experiment 2's COVID-19 vaccination scenario. This suggests that ingroup favoritism is flexible. The results support ingroup favoritism and the functional flexibility principle in response to disease threats according to perceived disease risk.