Disease Risk Perception Research Articles

Perceptions of Heart-Healthy Behaviors among African American Adults: A Mixed Methods Study.

African Americans have a disproportionately higher risk of chronic conditions such as cardiovascular disease (CVD), type 2 diabetes, and hypertension than other ethnic or racial groups. Data regarding CVD-related perceptions and beliefs among African Americans are limited, particularly in the Southwest US. Assessment of current views regarding health and health behaviors is needed to tailor interventions to meet the unique needs of specific populations. We sought to examine knowledge, attitudes, and perceptions of African Americans living in Arizona toward CVD and etiological factors associated with health behaviors and chronic disease development to inform state health agency program development. Transcripts from 14 focus groups (n = 103) were analyzed using Grounded Theory for perceived disease risk, knowledge of CVD risk factors, nutrition, preventative behaviors, and barriers and motivators to behavior change. Participants identified CVD, stroke, and diabetes as leading health concerns among African-Americans but were less certain about the physiological consequences of these diseases. Diet, stress, low physical activity, family history, hypertension, and stroke were described as key CVD risk factors, but overweight and obesity were mentioned rarely. Participants described low socio-economic status and limited access to healthy foods as contributors to disease risk. Focus group members were open to modifying health behaviors if changes incorporated their input and were culturally acceptable. Respondents were 41% male and 59% female with a mean age of 46 years. This study provides insight into CVD and associated disease-related perceptions, knowledge, and attitudes among African Americans in the Southwest and recommendations for interventions to reduce CVD risk.

A Qualitative Exploration of Women's Experiences with a Community Health Volunteer-Led Cervical Cancer Educational Module in Migori County, Kenya.

Detection and treatment of human papillomavirus (HPV) and cervical precancer through screening programs is an effective way to reduce cervical cancer deaths. However, high cervical cancer mortality persists in low- and middle-income countries. As screening programs become more widely available, it is essential to understand how knowledge about cervical cancer and perceived disease risk impacts screening uptake and acceptability. We evaluated women's experiences with a cervical cancer education strategy led by community health volunteers (CHVs) in Migori County, Kenya, as part of a cluster randomized controlled trial of cervical cancer screening implementation strategies. The educational modules employed simple language and images and sought to increase understanding of the relationship between HPV and cervical cancer, the mechanisms of self-collected HPV testing, and the importance of cervical cancer screening. Modules took place in three different contexts throughout the study: (1) during community mobilization; (2) prior to screening in either community health campaigns or health facilities; and (3) prior to treatment. Between January and September 2016, we conducted in-depth interviews with 525 participants to assess their experience with various aspects of the screening program. After the context-specific educational modules, women reported increased awareness of cervical cancer screening and willingness to screen, described HPV- and cervical cancer-related stigma and emphasized the use of educational modules to reduce stigma. Some misconceptions about cervical cancer were evident. With effective and context-specific training, lay health workers, such as CHVs, can help bridge the gap between cervical cancer screening uptake and acceptability.

Exploring reasons for vaccine-hesitancy among higher-SES parents in Perth, Western Australia.

The increasing prevalence among higher-socioeconomic (higher-SES) parents in Perth, Western Australia (WA), to be vaccine-hesitant (VH) is placing herd immunity at risk. Eighteen one-on-one interviews were conducted; (n=11) parents who earned >$125000pa and expressed ever having concerns surrounding vaccination; (n=7) health care professionals (HCPs), who provided clinical services. Using grounded theory methodology, data were analysed by constant coding and comparison until themes emerged and an explanatory model was developed. Four main areas leading to vaccine-hesitancy emerged from the data: We are Educated; We Control our Health; Safe from Disease, At Risk from Vaccines; and What We Want. Parents believed themselves capable of making good vaccination decisions based on their higher education levels and self-sourced vaccination information, yet frequently sought reassurance. Healthism concepts were adopted and parents believed lifestyle factors could control for vaccine-preventable diseases (VPD). Risk perception of disease was low and influenced by the remote geographic location of Perth, whilst perceived negative consequences of vaccination were high. A reduced concept of the social responsibility for vaccination and understanding of herd immunity emerged. Parents called for vaccine contents to be listed and requested more information on why vaccination was necessary. Four areas of VH emerged and reflected parents' belief that higher educational and socioeconomic status, previous successes in life and where they live would result in positive health outcomes and reduce the risk of contracting VPDs. SO WHAT?: This study provides new research into the perceptions among higher-SES VH parents who live in Perth, WA. It provides a model that fills a significant gap in information that could be used effectively for future health promotion interventions.

Spatial and temporal risk as drivers for adoption of foot and mouth disease vaccination

Identifying the drivers of vaccine adoption decisions under varying levels of perceived disease risk and benefit provides insight into what can limit or enhance vaccination uptake. To address the relationship of perceived benefit relative to temporal and spatial risk, we surveyed 432 pastoralist households in northern Tanzania on vaccination for foot-and-mouth disease (FMD). Unlike human health vaccination decisions where beliefs regarding adverse, personal health effects factor heavily into perceived risk, decisions for animal vaccination focus disproportionately on dynamic risks to animal productivity. We extended a commonly used stated preference survey methodology, willingness to pay, to elicit responses for a routine vaccination strategy applied biannually and an emergency strategy applied in reaction to spatially variable, hypothetical outbreaks. Our results show that households place a higher value on vaccination as perceived risk and household capacity to cope with resource constraints increase, but that the episodic and unpredictable spatial and temporal spread of FMD contributes to increased levels of uncertainty regarding the benefit of vaccination. In addition, concerns regarding the performance of the vaccine underlie decisions for both routine and emergency vaccination, indicating a need for within community messaging and documentation of the household and population level benefits of FMD vaccination.

Qualitative Exploration of Ebola Risk Perception among Mortuary Workers in Ibadan Metropolis, Nigeria


 
 
 
 Aim: To explore the risk perception of Ebola virus disease (EVD) among mortuary workers in Nigeria.
 Study Design: A qualitative research approach method, using Focus Group Discussions (FGDs), conducted among 36 mortuary workers in Ibadan.
 Place and Duration of Study: This study was conducted between October and November 2014 in Ibadan, Oyo state, Nigeria.
 Methodology: A structured moderating approach with a non-directive style was developed. A Focus Group Discussion (FGD) guide was used to explore participants’ ideas and opinions. The FGD guide consisted of five sections. Each section was framed to probe into the following issues: (1). Knowledge of EVD (2). Participant’s attitude to EVD (3). Adherence to infection control practices (4). Risk perception of EVD; and (5). Behavioural predisposition to the risk of mortuary-related infections. A total of six FGD sessions were conducted among 36 mortuary attendants, drawn from two government and four private health facilities in Ibadan. Six participants made up each focus group and one focus group discussion was conducted at a time in the respective health facilities.
 Results: The qualitative exploration of mortuary workers revealed gaps in the knowledge of workers with regards to EVD, the high-risk perception of mortuary workers to Ebola virus disease and the unavailability of PPE in conducting autopsies and daily operations. In addition, a poor attitude to convalescent individuals and certain harmful behavioural practices in the morgue were revealed as key findings.
 Conclusion: Efforts at bridging the knowledge gaps concerning EVD among mortuary workers should be sustained, despite the decline in Ebola outbreaks. It is also recommended that standard precautions should be followed when handling corpses due to the risk of infection.
 
 
 
 

Key actors in driving behavioural change in relation to on-farm biosecurity; a Northern Ireland perspective

BackgroundAgriculture and farming are valued contributors to local economy in Northern Ireland (NI). There is limited knowledge about farmers’ behaviours and attitudes towards disease biosecurity measures. As part of a larger project, a scenario-based workshop with key stakeholders was organised by the Agri-Food and Biosciences Institute (AFBI)-NI in December 2015.ResultsA total of 22 participants belonging to 12 different institutions took part in the workshop. Participants were presented with an overview of previously conducted biosecurity research in NI and England. In small groups, participants were subsequently asked to discuss and give their opinions about a series of questions across four key areas in a semi-structured approach with an external facilitator. The key areas were 1- disease risk perception at the farm level; 2-perceived barriers to implementing on farm biosecurity measures; 3- avenues to successful behaviour change and 4-key industry responsibilities and roles. The discussion showed that training in biosecurity for farmers is important and necessary. Training was recommended to be provided by veterinary surgeons, preferably via a face-to-face format. The discussion addressing disease disclosure proved particularly challenging between those who were prospective buyers of cattle, and those who sold cattle.ConclusionsThis workshop provided a unique and invaluable insight into key issues regarding farm level biosecurity activities. From a policy perspective, delivering improved on-farm biosecurity must be addressed via a multidisciplinary approach. This can only be achieved with active involvement, commitment and support of a number of key industry and government stakeholders.

Hunters and Non-hunters Chronic Wasting Disease Risk Perceptions over Time

We examined risk perceptions of chronic wasting disease (CWD) over time (2004 vs. 2012), and among hunters and non-hunters. Data were obtained from two mailed surveys in 2004 that included random samples of hunters (n = 1879) and non-hunters (n = 1122). We conducted two additional mail surveys in 2012 that also included random samples of hunters (n = 3391) and non-hunters (n = 1615). Based on the psychometric paradigm, we hypothesized that CWD risk perceptions will: (1) decline over time (2004 vs. 2012, Hypothesis 1), and (2) be higher for hunters than non-hunters (Hypothesis 2). We also predicted that study year (2004 vs. 2012) and sample (hunters vs. non-hunters) will interact (Hypothesis 3). Results supported hypothesis 1; CWD risk perceptions declined over time. Hypothesis 2 was also supported as hunters reported higher risk perceptions than non-hunters. Year and sample interacted to influence perceived risk; supporting hypothesis 3.

It's Complicated: The 2014-2015 U.S. Measles Outbreak and Parents' Vaccination Beliefs, Confidence, and Intentions.

While it seems intuitive that highly visible vaccine-preventable disease outbreaks should impact perceptions of disease risk and facilitate vaccination, few empirical studies exist to confirm or dispel these beliefs. This study investigates the impact of the 2014-2015 Disneyland measles outbreak on parents' vaccination attitudes and future vaccination intentions. The analysis relies on a pair of public opinion surveys of American parents with at least one child under the age of six (N = 1,000 across each survey). Controlling for basic demographics, we found higher levels of reported confidence in the safety and efficacy of childhood vaccinations in our follow-up data collection. However, this confidence was also accompanied by elevated levels of concern toward childhood vaccines among American parents. We then examined how different subgroups in the population scored on these measures before and after the outbreak. We found that parents with high levels of interest in the topic of vaccines and a child who is not fully upto date with the recommended vaccination schedule reported more supportive attitudes toward vaccines. However, future intentions to follow the recommended vaccination schedule were not positively impacted by the outbreak. Possible explanations for these results and implications for vaccination outreach are discussed.

Perceptions related to cardiovascular disease and physical activity behavior in Arab men: A qualitative study

ObjectivesTo describe the daily physical activity of Arab men living in the United States and to understand how perceptions of cardiovascular disease (CVD) risk influence their inclusion of physical activity into their daily routine. MethodsA qualitative descriptive method using a semi-structured face-to-face interview with each participant was conducted. Twenty young college males (age 26 ± 4 years) were recruited from Arab American community centers. ResultsThe qualitative inductive content analysis revealed three main themes: impact of perceived CVD risk on physical activity behavior and perceived barriers and motivators to be physically active. Arab men primarily perceived gaining weight as the most important CVD risk factor that could promote their physical activity behavior. ConclusionsThese findings demonstrate that unawareness about CVD risk and barriers to regular physical activity must be considered in any intervention to engage Arab men in regular physical activity.

Sudden transitions in coupled opinion and epidemic dynamics with vaccination

This work consists of an epidemic model with vaccination coupled with an opinion dynamics. Our objective was to study how disease risk perception can influence opinions about vaccination and therefore the spreading of the disease. Differently from previous works we have considered continuous opinions. The epidemic spreading is governed by an SIS-like model with an extra vaccinated state. In our model individuals vaccinate with a probability proportional to their opinions. The opinions change due to peer influence in pairwise interactions. The epidemic feedback to the opinion dynamics acts as an external field increasing the vaccination probability. We performed Monte Carlo simulations in fully-connected populations. Interestingly we observed the emergence of a first-order phase transition, besides the usual active-absorbing phase transition presented in the SIS model. Our simulations also show that with a certain combination of parameters, an increment in the initial fraction of the population that is pro-vaccine has a twofold effect: it can lead to smaller epidemic outbreaks in the short term, but it also contributes to the survival of the chain of infections in the long term. Our results also suggest that it is possible that more effective vaccines can decrease the long-term vaccine coverage. This is a counterintuitive outcome, but it is in line with empirical observations that vaccines can become a victim of their own success.

Prevention of Type 2 diabetes after gestational diabetes directed at the family context: a narrative review from the Danish Diabetes Academy symposium

In this review, we aim to summarize knowledge about gestational diabetes mellitus (GDM) after delivery; with special focus on the potential of preventing Type 2 diabetes in a family context. The review expands on the key messages from a symposium held in Copenhagen in May 2017 and highlights avenues for future research. A narrative review of the symposium presentations and related literature is given. GDM is associated with increased short- and long-term adverse outcomes including Type 2 diabetes for both mother and offspring. Interestingly, GDM in mothers also predicts diabetes in the fathers. Thus, although GDM is diagnosed in pregnant women, the implications seem to affect the whole family. Structured lifestyle intervention can prevent or delay the onset of Type 2 diabetes. In this review, we show how numerous challenges are present in the target group, when such interventions are sought and implemented in real-world settings. Although interlinked and interacting, barriers to maintaining a healthy lifestyle post-partum can be grouped into those pertaining to diabetes beliefs, the family context and the healthcare system. Health literacy level and perceptions of health and disease risk may modify these barriers. There is a need to identify effective approaches to health promotion and health service delivery for women with prior GDM and their families. Future efforts may benefit from involving the target group in the development and execution of such initiatives as one way of ensuring that approaches are tailored to the needs of individual women and their families.

6.5-O2Knowledge, attitude and risk perception of Ebola Virus Disease amongst a predominant Hausa/Fulani Ethnic rural community in North Western Nigeria

6.5-O2Knowledge, attitude and risk perception of Ebola Virus Disease amongst a predominant Hausa/Fulani Ethnic rural community in North Western Nigeria

Loss of risk perception to zoonoses and the figure of community dog

Dogs may cause zoonoses and damages; especially when we accept as normal some dangerous behavior, losing the perception of disease risk. The purpose of this review was to demonstrate that the presence of stray dogs as well as community dogs, are public health hazard. Through sustainable epidemiological information, we believe this measure could prevent it from spreading. Dog's aggressiveness regulates its social relationships through submission or dominance; those characteristics are difficult to be recognized by human population. In Chile, 327.150 people were bitten by dogs, between years 2003 and 2012 with a cost of USD$22.7 to USD$177,9 million in addition to the USD$3,13 million for the surgical intervention of 767 human subjects of Hydatidosis during 2012. However zoonosis more dangerous is Rabies with death results. As a conclusion we state that the presence of stray and community dogs in the streets cannot be tolerated. This measure must have a sustainable technical of Health and Public safety because population have lost its ability of recognize the risk of contracting zoonotic diseases, with high costs for the health care system, besides the economical decline and psychological damage to the affected individuals.

Patient-reported adherence to statin therapy, barriers to adherence, and perceptions of cardiovascular risk.

BackgroundPatient reports of their adherence behaviors, concerns about statins, and perceptions of atherosclerotic cardiovascular disease (ASCVD) risk could inform approaches for improving adherence to statin therapy. We examined these factors and their associations with adherence.MethodsWe conducted telephone interviews among a stratified random sample of adults receiving statins within an integrated delivery system (N = 730, 81% response rate) in 2010. We sampled equal numbers of individuals in three clinical risk categories: those with 1) coronary artery disease; 2) diabetes or other ASCVD diagnosis; and 3) no diabetes or ASCVD diagnoses. We assessed 15 potential concerns about and barriers to taking statins, and perceived risk of having a heart attack in the next 10 years (0–10 scale). We calculated the proportion of days covered (PDC) by statins in the last 12 months using dispensing data and used multivariate logistic regression to examine the characteristics associated with non-adherence (PDC<80%). Analyses were weighted for sampling proportions.ResultsSixty-one percent of patients with PDC<50% reported not filling a new prescription, splitting or skipping statins, or stopping refilling statins in the last 12 months vs. 15% of those with PDC≥80% (p<0.05). The most commonly reported concerns about statins were preferring to lower cholesterol with lifestyle changes (66%), disliking medications in general (59%), and liver or kidney problems (31%); having trouble remembering to take statins (9%) was the most common reason for taking less than prescribed. In multivariate analyses, clinical risk categories were not significantly associated with odds of non-adherence; however, those with higher perceived risk of heart attack were less likely to be non-adherent.ConclusionsPatient-reported medication-taking behaviors were correlated with statin PDC and those with lower perceived cardiovascular risk were less likely to be adherent. These findings highlight the importance of eliciting from and educating patients on their adherence behaviors and ASCVD risks.

Accuracy of self-perceived risk for common conditions.

Background:Accurate awareness of common disease risk is necessary to promote healthy lifestyles and to prevent unnecessary anxiety and evaluation. Our objective is to identify characteristics of patients who do not accurately perceive their risk of developing coronary heart disease (CHD), diabetes (DM), breast cancer (BC) and colorectal cancer (CRC).Methods:Using personalized disease risk reports and risk perception surveys, subjects (n = 4703) were classified as high or low/average risk and high or low/average perceived risk for each condition. Models were used to examine factors associated with risk under-estimation by high risk patients and risk over-estimation by low/average risk patients.Results:Patients at high risk for DM, BC and CRC often (60%−75% of the time) under-estimated their risk, while low/average risk patients overestimated their risk 13%−40% of the time. For CHD, under-estimation by high risk individuals approximated over-estimation by low/average individuals. Compared to normal weight patients at high risk for cancer, obese patients were more likely to under-estimate their risk for BC (OR 3.1, CI 1.9–5.0) and CRC (2.6, 1.5–4.5) as were overweight patients. Overweight and obese patients at low/average risk of DM or CHD were more likely than normal weight patients to over-estimate their risk. Low/average risk women were more likely than men to over-estimate their risk of DM (1.3, 1.1–1.5) and CHD (1.8, 1.5–2.1).Conclusions:Our data show that body mass index is the factor most consistently associated with incorrect risk perceptions for several common conditions.

Breaking down the monolith: Understanding flu vaccine uptake among African Americans

Black adults are significantly less likely to be immunized for seasonal influenza when compared to Whites. This persistent disparity contributes to increased influenza-related morbidity and mortality in the African American population. Most scholarship on vaccine disparities has compared Whites and Blacks. Employing Public Health Critical Race Praxis, this study seeks to shift the focus to explore differences within the Black population. Utilizing a nationally-representative 2015 survey of US Black adults (n = 806), we explore differences by gender, age, income, and education across vaccine-related measures (e.g., perceived risk, knowledge, attitudes) and racial factors (e.g. racial salience, racial fairness, perceived discrimination). We also explore differences by vaccine behavior in the past five years among those who vaccinate every year, most years but not all, once or twice, and never. Greater frequency of flu vaccine uptake was associated with better self-reported vaccine knowledge, more positive vaccine attitudes, more trust in the flu vaccine and the vaccine process, higher perceived disease risk, lower perceived risk of vaccine side effects, stronger subjective and moral norms, lower general vaccine hesitancy, higher confidence in the flu vaccine, and lower perceived barriers. Logistic regression results highlighted other significant differences among the groups, emphasizing areas to target for improved vaccination rates. We find great diversity within the Black community related to influenza immunization decisions, highlighting the need to “break down the monolith” in future research.

Relationships between livestock grazing practices, disease risk, and antimicrobial use among East African Agropastoralists

AbstractLivestock health is economically important for agropastoral households whose wealth is held partly as livestock. Households can invest in disease prevention and treatment, but livestock disease risk is also affected by grazing practices that result in inter-herd contact and disease transmission in regions with endemic communicable diseases. This paper examines the relationships between communal grazing and antimicrobial use in Maasai, Chagga and Arusha households in northern Tanzania. We develop a theoretical model of the economic connection between communal grazing, disease transmission risk, risk perceptions, and antimicrobial use, and derive testable hypotheses about these connections. Regression results suggest that history of disease and communal grazing are associated with higher subjective disease risk and greater antimicrobial use. We discuss the implications of these results in light of the potential for relatively high inter-herd disease transmission rates among communal grazers and potential contributions to antimicrobial resistance due to antimicrobial use.

Diabetes prevention among American Indians: the role of self-efficacy, risk perception, numeracy and cultural identity

BackgroundAccording to the Risk Perception Attitude (RPA) framework, classifying people according to their perceptions of disease risk and their self-efficacy beliefs allows us to predict their likelihood for engaging in preventive behaviors. Health interventions can then be targeted according to RPA group. We applied the framework to type 2 diabetes prevention behaviors among American Indians and expanded it to include culture and numeracy.MethodsUsing a cross-sectional study design, we surveyed a sample of Northern Plains American Indians in a reservation community setting on self-reported perceptions of diabetes risk, objective diabetes risk, self-efficacy, engagement in healthy behaviors, knowledge of diabetes risk factors, and covariates including demographics, numeracy, and cultural identity. We used the RPA framework to classify participants into four groups based on their perceptions of risk and self-efficacy. Analyses of variance and covariance estimated inter-group differences in behaviors associated with type 2 diabetes prevention.ResultsAmong 128 participants, our only finding consistent with the RPA framework was that self-efficacy and risk perception predicted knowledge about diabetes risk factors. We found limited evidence for the influence of cultural identity within the RPA framework. Overall, participants had lower numeracy skills which tended to be associated with inaccurate perceptions of higher levels of risk.ConclusionsThe theoretical framework may benefit from inclusion of further contextual factors that influence these behaviors. Attention to numeracy skills stands out in our study as an important influence on the RPA framework, highlighting the importance of attending to numeracy when targeting and tailoring risk information to participants segmented by the RPA framework.

Evaluation of clinicians’ reporting proficiency and their risk perceptions of Ebola virus disease in Ebonyi State, Nigeria

Ebola virus disease (EVD) is a highly contagious infection with a high case fatality rate. Thus, there is a crucial need for early detection and reporting of any individual suspected to have EVD in order to facilitate containment strategies. The aim of our study was to evaluate clinicians' reporting proficiency and their risk perceptions of EVD in Ebonyi State, Nigeria. We performed a descriptive cross-sectional study conducted among clinicians. Consenting clinicians completed a structured questionnaire on the reporting of and their risk perceptions about EVD. Predictors of reporting proficiency and risk perceptions of EVD were identified using multivariable logistic regression analysis. A total of 398 clinicians completed the survey, 312 (78.4%) were male. The average duration of the respondent's clinical practice was 5.0, 8.0, and 8.9 years for those working in primary, secondary and tertiary hospitals, respectively. The overall mean±SD knowledge score for proficiency in reporting was 4.4±0.6 (out of a maximum of 5), and 380 (95.5%) of the respondents had a good knowledge of the modalities of reporting suspected EVD cases. The overall mean±SD risk perception score was 5.6±1.2 (out of a maximum of 10) and only 202 (50.8%) of the respondents had accurate risk estimates towards EVD control. Only male sex was a predictor of accurate risk perception of EVD (aOR 1.7, 95%CI: 1.1-2.9). There was a high level of knowledge of reporting modalities regarding EVD among the clinicians; however, only approximately half of them had accurate risk perception towards EVD. The gaps identified should inform post-EVD control strategies.

Understanding framings and perceptions of spillover

PurposeBats provide many ecosystem services and have intrinsic value. They also act as host reservoirs for some viruses. Several studies have linked zoonotic diseases to bats, raising questions about the risks bats pose, especially to people living close to bat roosts. Through a series of case studies undertaken in three communities, the purpose of this paper is to explore the various ways in which framings and perceptions of bats can influence a potential spillover of bat-borne viruses to humans in Ghana. It assesses the social, cultural and economic factors that drive human-bat interactions and posits that understanding the socio-economic contexts in which human-bat interactions occur is key to the success of future communication strategies.Design/methodology/approachPrimary data collection methods included participatory landscape mappings, transect walks, focus group discussions and questionnaire surveys.FindingsPerceptions of bats vary and are influenced by personal beliefs, the perceived economic benefits derived from bats and the location of bat roosts. Activities that put people at risk include bat hunting, butchering and consumption of poorly prepared bat meat. Those who live and work close to bat roosts, and bat hunters, for example, are more at risk of bat-borne zoonotic disease spillover. Disease risk perceptions were generally low, with high levels of uncertainty, indicating the need for clearer information about personal protective practices.Originality/valueThe results of the study may well inform future risk communication strategies as well as help in developing effective responses to zoonotic disease risk, disease outbreaks and the conservation of bats in communities.