Disease Risk Perception Research Articles

A discrete population game model of vaccination exploring the role of individuals' risk perceptions in the invasion of a mutant strain

Novel strains emerge every year and cause seasonal flu epidemic. These variants exhibit differences in antigenicity and may escape immunity from vaccines and thus invade the population. Here, we devise a discrete population game model of vaccination and transmission of two strains – a resident and a relatively rare mutant – to explain the influence of social behaviour, specifically vaccinating behaviour on the emergence of the mutant strain in the population. Our integrated framework of behaviour-prevalence model exhibits time evolution of two strategic interactions such as individuals' perceived vaccination risk and probability of infection, where both declines as more and more individuals vaccinate in the population. Numerical simulation and analysis of the model show that the predominant Nash strategy allows invasion of the mutant strain under very disparate individuals perceived disease risks from these two pathogens and relatively lower vaccine efficacy against the mutant. The model also demonstrates that invasion of the mutant has a nonlinear dependence on epidemiological characteristics such as the relative force of infection, cross-immunity, perceived cost of treatment and vaccine efficacy. This study exemplifies that adaptive social behaviour is an important component of public health strategic decision-making during the control of the flu-like epidemic.

Public perceptions of Lyme disease and climate change in southern Manitoba, Canada: making a case for strategic decoupling of climate and health messages

BackgroundDespite scientific evidence that climate change has profound and far reaching implications for public health, translating this knowledge in a manner that supports citizen engagement, applied decision-making, and behavioural change can be challenging. This is especially true for complex vector-borne zoonotic diseases such as Lyme disease, a tick-borne disease which is increasing in range and impact across Canada and internationally in large part due to climate change. This exploratory research aims to better understand public risk perceptions of climate change and Lyme disease in order to increase engagement and motivate behavioural change.MethodsA focus group study involving 61 participants was conducted in three communities in the Canadian Prairie province of Manitoba in 2019. Focus groups were segmented by urban, rural, and urban-rural geographies, and between participants with high and low levels of self-reported concern regarding climate change.ResultsFindings indicate a broad range of knowledge and risk perceptions on both climate change and Lyme disease, which seem to reflect the controversy and complexity of both issues in the larger public discourse. Participants in high climate concern groups were found to have greater climate change knowledge, higher perception of risk, and less skepticism than those in low concern groups. Participants outside of the urban centre were found to have more familiarity with ticks, Lyme disease, and preventative behaviours, identifying differential sources of resilience and vulnerability. Risk perceptions of climate change and Lyme disease were found to vary independently rather than correlate, meaning that high climate change risk perception did not necessarily indicate high Lyme disease risk perception and vice versa.ConclusionsThis research contributes to the growing literature framing climate change as a public health issue, and suggests that in certain cases climate and health messages might be framed in a way that strategically decouples the issue when addressing climate skeptical audiences. A model showing the potential relationship between Lyme disease and climate change perceptions is proposed, and implications for engagement on climate change health impacts are discussed.

What health policy makers need to know about mismatches between public perceptions of disease risk, prevalence and severity: a national survey

Objectives The aim of this study was to assess people’s perceptions of their personal risk, population prevalence and perceived severity in relation to three key health conditions (cancer, heart disease and hearing loss), gauge the size of any misperceptions, and identify correlates of such misperceptions. Design This study was a cross-sectional survey. Study sample A total of 10,401 adults representative of the UK population were participated in the study. Results Clear majorities of people incorrectly believe that they are at greater personal risk of cancer (>75%), that cancer is more prevalent in the population (>50%) and that cancer is more disabling (>65%), than either heart disease or hearing loss. In turn, people consistently regard their personal risk of hearing loss, the population prevalence of hearing loss and the severity of hearing loss as lower than either cancer or heart disease. Multiple regression analyses showed inconsistent patterns of relationships between people’s beliefs, sociodemographic characteristics and their health behaviours. Conclusions Accuracy in beliefs about cancer, heart disease and hearing loss is low, and the relationships between these beliefs, their potential antecedents and consequences are complex. Policy makers should ensure close adherence to evidence or risk-making decisions that are costly both in financial terms and in terms of suboptimal population subjective well-being.

Assessing thromboembolic disease burden, risk perception, management, and management outcomes in Ghana

Assessing thromboembolic disease burden, risk perception, management, and management outcomes in Ghana

Gender and Ebola in Eastern Democratic Republic of the Congo: Pathways to Protective Behavioral Outcomes During the 2018-2020 Ebola Outbreak

Background: The Democratic Republic of the Congo (DRC) witnessed the world’s second largest Ebola Virus Disease (EVD) outbreak killing 2290 individuals, with women disportionately infected (57% of all cases) despite no evidence on differential biological risk for EVD. We assessed if men and women differ in personal protective behaviors (vaccine acceptance, health-seeking behaviors, physical distancing) and the mediating role of gender differences in levels of EVD information and knowledge, perceived disease risk, and social relations. Methods: We conducted a multi-stage cluster survey of 1395 individuals in North Kivu between 20 April – 10 May, 2019, a period of high transmission in the sampled region of DRC. We conducted path analyses using a structural equation modeling framework to examine associations among variables as hypothesized. Findings: We found associations between gender and all EVD preventive behavioral outcomes, with evidence for the mediating role of EVD knowledge and belief in rumors. Men reported greater EVD accuracy compared to women. Greater EVD knowledge accuracy was associated with increases in vaccine acceptance, formal care seeking, and self-protection behaviors. Lower belief in rumors led to greater vaccine acceptance, and greater EVD information awareness led to increased adoption of self-protection behaviors. Interpretation: In any response to infectious disease, such as the current COVID-19 pandemic, it is critical to not only design gender-sensitive communication and vaccination strategies, but also to engage women and the community as a whole in the response.Funding: The Enhanced Learning and Research for Humanitarian Assistance (ELRHA) and United Nations Development Programme (UNDP) provided funding for the study.Declaration of Interest: We declare no competing interests.Ethical Approval: The survey was approved by Brigham and Women’s Hospital Human Research Committee and the Research Center on Democracy and Development in Africa, Free university of the Great Lakes Countries in the Democratic Republic of the Congo.

Knowledge, Attitude, and Practice Regarding Zoonotic Risk in Wildlife Trade, Southern China.

Current wildlife trade practices in China lead to significant interactions between humans and animals and drive the emergence of zoonotic diseases. The at-risk behaviors, knowledge, and attitudes that influence health-related behaviors in relation to animal contact and safety measures in the trade remain poorly understood. A self-administered questionnaire survey was conducted among 947 adult Internet users in three provinces in southern China to assess knowledge, perceived disease risks, at-risk behaviors, and the association of these factors with other demographic factors among the target population. Few of the participants possessed sufficient knowledge of zoonotic diseases. Although most participants were opposed to the use of wild animal resources, many reported keeping wild animals as pets (30.7%) and eating wild animals (30.5%). The majority of participants (76.3%) believed the disease transmission via wildlife trade, but few connected contact with animals to sickness (18.5%) and only slightly more than half sought post-exposure treatment (54.4%). These results reveal low levels of knowledge and perceived risk regarding disease emergence from the animal–human interactions in wildlife trade and uncover the gaps in knowledge and attitudes as key challenges to the development of health behavior change interventions pertaining to wildlife trade.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10393-021-01532-0.

Community-driven citizen science approach to explore cardiovascular disease risk perception, and develop prevention advocacy strategies in sub-Saharan Africa: a programme protocol

BackgroundIn sub-Saharan Africa (SSA), which experiences a disproportionately high cardiovascular disease (CVD) burden, population-based screening and prevention measures are hampered by low levels of knowledge about CVD and associated risk factors, and inaccurate perceptions of severity of risk.MethodsThis protocol describes the planned processes for implementing community-driven participatory research, using a citizen science method to explore CVD risk perceptions and to develop community-specific advocacy and prevention strategies in the rural and urban SSA settings. Multi-disciplinary research teams in four selected African countries will engage with and train community members living in rural and urban communities as citizen scientists to facilitate conceptualization, co-designing of research, data gathering, and co-creation of knowledge that can lead to a shared agenda to support collaborative participation in community-engaged science. The emphasis is on robust community engagement, using mobile technology to support data gathering, participatory learning, and co-creation of knowledge and disease prevention advocacy.DiscussionContextual processes applied and lessons learned in specific settings will support redefining or disassembling boundaries in participatory science to foster effective implementation of sustainable prevention intervention programmes in Low- and Middle-income countries.

Customers' risk perception and dine-out motivation during a pandemic: Insight for the restaurant industry.

The restaurant industry is one of the most affected businesses during the outbreak of COVID-19. The customer choice regarding whether or not to dine in a restaurant have changed due to this unprecedented global pandemic. Integrated with the affective decision-making framework, meta-theoretic model of motivation (3M), and optimistic bias theory, this conceptual paper proposes a theoretical scheme for understanding constructs that affect consumer motivation while considering the significance of consumers' risk perceptions of the novel coronavirus disease. This research aims to delineate the role of loyalty, trust, and transparency on resuming in-restaurant dining during and after the pandemic. By identifying the link between each construct and addressing the unparalleled food-/health related risks, this study suggests that restaurants who accumulated more customer trust by fostering transparency are likely to have more business and quickly recover from the shock.

The Eco-Bio-Social Factors That Modulate Aedes aegypti Abundance in South Texas Border Communities

Simple SummaryThe Aedes aegypti mosquito is distributed worldwide and has become a major public health concern due to its proclivity for the urban environment, human feeding behavior, and ability to transmit agents of diseases such as Zika, chikungunya, and dengue. In the continental United States, the region known as the Lower Rio Grande Valley is one of the few areas with local mosquito transmission of these pathogens transmitted by Ae. aegypti. With limited resources for mosquito control in this region, understanding the ecological, biological, and social factors that affect Ae. aegypti population can help guide and improve current control efforts. We were able to observe widespread knowledge regarding Zika, but with very low importance given to mosquitoes as a problem. We found that the presence of window-mounted air conditioning units, number of windows and doors, characteristics of the property, and presence of children in the household all influenced the abundance of Ae. aegypti. The current results not only show a need for improved community engagement for increasing disease and mosquito risk awareness, but also provide risk factors that can guide current vector control activities. Aedes aegypti control requires dedicated resources that are usually scarce, limiting the reach and sustainability of vector control programs. This generates a need to focus on areas at risk of disease transmission and also understand the factors that might modulate local mosquito abundance. We evaluated the eco-bio-social factors that modulate indoor and outdoor relative abundance of female Ae. aegypti in communities of South Texas. We conducted housing quality and Knowledge Attitudes and Practices surveys in households that were part of a weekly mosquito surveillance program in November of 2017 and 2018. Our results showed widespread knowledge of mosquitoes and Zika virus by our participants. However, less than 35% considered them as serious problems in this region. The presence of window-mounted air conditioning units increased the risk of female mosquito relative abundance indoors. An increase in outdoor relative abundance was associated with larger properties and a higher number of children between 6 to 17 years of age. Interestingly, we observed that an increasing number of children <5 years of age modulated both indoor and outdoor relative abundance, with a 52% increase indoors and 30% decrease outdoors. The low perception of mosquito and disease risk highlights engagement needs for vector-borne disease prevention in this region. The identified risk factors can help guide public health officials in their efforts to reduce human and vector contact.

Psychopathy and COVID-19: Triarchic model traits as predictors of disease-risk perceptions and emotional well-being during a global pandemic

This study extended recent research showing that perceptions of disease risk are associated with emotional well-being during COVID-19 by examining how psychopathic traits of boldness, meanness, and disinhibition influence these perceptions and psychological outcomes. During the Italian national lockdown, a large community sample (Mage = 31.3 years) completed online questionnaire measures of the triarchic psychopathic traits, perceptions of disease susceptibility and danger, and recent well-being. Path analyses revealed differing roles for the triarchic traits: boldness and meanness predicted greater well-being (lower stress, higher positive affect) and disinhibition predicted lower well-being. Further, boldness and meanness were linked to well-being through distinct indirect pathways of low perceived susceptibility to infection (boldness) and low perceived dangerousness of COVID-19 (boldness and meanness). Findings speak to the triarchic model's utility in explaining socioemotional phenomena during times of crisis and support the distinct biobehavioral conceptualizations of boldness as low threat sensitivity, meanness as low affiliative capacity, and disinhibition as deficient affective and behavioral control.

Conflicts, informality and risk perception about foodborne diseases in small family and non-family run restaurants

ABSTRACT This study aimed to analyze the risk perception of foodborne disease, practices, and conflicts related to food safety based on the speech of food handlers and managers of small and medium-sized (SMS) family and non-family-run restaurants. Ten restaurants were evaluated through participant observation, where food handlers and managers participated in in-depth, semi-structured interviews. Data were analyzed using a qualitative approach of thematic content analysis. Several violations of food safety laws were observed, mainly in family-run restaurants, which exhibited a higher number of violations when compared to non-family run restaurants. Cognitive aspects, such as optimistic bias and low-risk perception, were identified in the speech of respondents from both types of restaurants. Informality and amateurism were observed in family-run restaurants; Some examples of this were transforming the work environment into the home environment, use of home leftovers in restaurants, conflicts between workers and family members, and lack of. Our results show that nepotism could lead to informality, reduce risk perceptions, and increase the risk of food safety violations. In family-run restaurants, the difficulty of following food safety regulations may be greater than in non-family SMS restaurants. It is suggested that managers and owners of family-run restaurants seek professional support regarding food safety. For policy-makers it is recommended a policy to encourage self-evaluation and special attention to this type of business.

Farmers’ preference and willingness to pay for a multivalent lumpy skin disease and Rift Valley fever novel vaccine: A discrete choice experiment in the Free State province, South Africa

Rift Valley fever and lumpy skin disease are infectious ruminant diseases that are endemic in most African countries. The most cost-effective method of prevention and control is through annual vaccination. However, unlike lumpy skin disease, annual vaccination against Rift Valley fever is not practiced by many farmers due to its sporadic occurrences and shortcoming of the existing vaccines. This necessitates development of novel vaccines that would provide dual protection against a Rift Valley fever and a more prevalent disease. In this study, a discrete choice experiment was undertaken to guide vaccine development by examining the value smallholder livestock farmers place on different vaccine attributes and related attribute levels. The attributes considered are target-species, thermotolerance, nature of the vaccine, efficacy and price. The study was carried out with 164 smallholder livestock farmers in the Free State province. Results indicate that thermostaility is not a major deciding attribute to smallholder farmer’s choice of vaccine. Farmers prefer multivalent vaccines, which are highly efficacious with about 90–100 % efficacy levels. Farmers were found to be heterogeneous in preference. The heterogeneity is explained by socio-economic factors such as type of livestock owned, income level, gender and perceived disease risk. Farmers were also willing to pay for preferred attribute levels. However, for less favourable levels such as multispecies, female farmers were willing to accept a lower compensation than males. These findings present a favourable potential for development of a novel multivalent vaccine and also provide vaccine research and development scientists with evidence based knowledge for development of vaccines that cater for the needs of smallholder farmers.

Perceived Threat of Unhealthy and Unsafe Eating Behaviors in Iranian Adolescent Girls: A Qualitative Study

Background: Perceived threat is particularly important in health-related behaviors. The aim of this study was to explain the perceived threat of unhealthy and unsafe eating behaviors in Iranian adolescent girls. Materials and Methods: In this qualitative study, directed content analysis was used and participants were selected by purposeful sampling. Data were collected using focus groups and semi-structured, in-depth individual interviews with 60 girl students of the eighth grade who studied in the government schools of Shiraz City, Iran in 2019. Sampling continued until data saturation was achieved. Data were analyzed by Graneheim and Lundman's approach of conventional content. Results: From the data analysis, five categories were drawn. Perceived susceptibility comprised of (1) disease risk-increasing factors and (2) disease risk-decreasing factors and perceived severity consisted of (3) individual, (4) familial, and (5) social consequences of the disease. The perceived susceptibility consisted of the subcategories, namely, biological susceptibility or body's protective mechanisms, individual behaviors, and risky or protective environmental factors for food and health safety. Perceived severity included the subcategories: physical, mental, educational, and medical problems for the individual, psychosocial problems, and imposing heavy treatment costs on family, economic, and social problems for the community. Conclusion: The perceived threat of unhealthy and unsafe eating behaviors in adolescents includes perceptions of disease risk increasing and disease risk-decreasing factors, as well as personal, familial, and social consequences following disease development. Understanding these perceptions can help adolescents engage in health-promoting eating behaviors.

The Association Between Chronic Disease and Serious COVID-19 Outcomes and Its Influence on Risk Perception: Survey Study and Database Analysis.

BackgroundCOVID-19, a viral respiratory disease first reported in December 2019, quickly became a threat to global public health. Further understanding of the epidemiology of the SARS-CoV-2 virus and the risk perception of the community may better inform targeted interventions to reduce the impact and spread of COVID-19.ObjectiveIn this study, we aimed to examine the association between chronic diseases and serious outcomes following COVID-19 infection, and to explore its influence on people’s self-perception of risk for worse COVID-19 outcomes.MethodsThis study draws data from two databases: (1) the nationwide database of all confirmed COVID-19 cases in Portugal, extracted on April 28, 2020 (n=20,293); and (2) the community-based COVID-19 Barometer survey, which contains data on health status, perceptions, and behaviors during the first wave of COVID-19 (n=171,087). We assessed the association between relevant chronic diseases (ie, respiratory, cardiovascular, and renal diseases; diabetes; and cancer) and death and intensive care unit (ICU) admission following COVID-19 infection. We identified determinants of self-perception of risk for severe COVID-19 outcomes using logistic regression models.ResultsRespiratory, cardiovascular, and renal diseases were associated with mortality and ICU admission among patients hospitalized due to COVID-19 infection (odds ratio [OR] 1.48, 95% CI 1.11-1.98; OR 3.39, 95% CI 1.80-6.40; and OR 2.25, 95% CI 1.66-3.06, respectively). Diabetes and cancer were associated with serious outcomes only when considering the full sample of COVID-19–infected cases in the country (OR 1.30, 95% CI 1.03-1.64; and OR 1.40, 95% CI 1.03-1.89, respectively). Older age and male sex were both associated with mortality and ICU admission. The perception of risk for severe COVID-19 disease in the study population was 23.9% (n=40,890). This was markedly higher for older adults (n=5235, 46.4%), those with at least one chronic disease (n=17,647, 51.6%), or those in both of these categories (n=3212, 67.7%). All included diseases were associated with self-perceptions of high risk in this population.ConclusionsOur results demonstrate the association between some prevalent chronic diseases and increased risk of worse COVID-19 outcomes. It also brings forth a greater understanding of the community’s risk perceptions of serious COVID-19 disease. Hence, this study may aid health authorities to better adapt measures to the real needs of the population and to identify vulnerable individuals requiring further education and awareness of preventive measures.

Monogamy as a Barrier to Human Papillomavirus Catch-Up Vaccination.

Background: Human papillomavirus (HPV) is the most prevalent sexually transmitted infection (STI) in the United States. Although a vaccine to prevent HPV infection exists, only 53.7% of females 13-17 years of age were up-to-date on the HPV vaccination series in 2018. There is a catch-up period of vaccination for females 18-26 years of age that shows consistent underparticipation. A potential barrier to vaccination is relationship status, as long-term relationships may negatively impact HPV risk perception. This study examined monogamy as a risk factor for nonvaccination and explored how risk perception may influence this association. Materials and Methods: An electronic survey was distributed to females 18-26 years of age who attended a large public university in the mid-Atlantic region (n = 629). Multivariable and descriptive statistics were estimated using SAS 9.4 to explore the likelihood of vaccination during the catch-up period by relationship status. Results: Most participants had received the HPV vaccine, a small proportion of whom received it during the catch-up period. After adjusting for confounders, women who were in monogamous relationships were significantly less likely to have participated in HPV catch-up vaccination compared to women who were single and dating (adjusted odds ratio: 0.36, 95% confidence interval: 0.15, 0.87). Women in monogamous relationships had a lower average sexually transmitted disease (STD) risk perception compared to women who were single and dating (p < 0.0001). Conclusions: A decreased risk perception may present a barrier to participating in catch-up vaccination for monogamous women. Practitioners and the public health community should focus on communicating HPV risk to women in monogamous relationships, especially given the recently expanded age range for HPV vaccination.

An epidemiological model with voluntary quarantine strategies governed by evolutionary game dynamics.

During pandemic events, strategies such as social distancing can be fundamental to reduce simultaneous infections and mitigate the disease spreading, which is very relevant to the risk of a healthcare system collapse. Although these strategies can be recommended, or even imposed, their actual implementation may depend on the population perception of the risks associated with a potential infection. The current COVID-19 crisis, for instance, is showing that some individuals are much more prone than others to remain isolated. To better understand these dynamics, we propose an epidemiological SIR model that uses evolutionary game theory for combining in a single process social strategies, individual risk perception, and viral spreading. In particular, we consider a disease spreading through a population, whose agents can choose between self-isolation and a lifestyle careless of any epidemic risk. The strategy adoption is individual and depends on the perceived disease risk compared to the quarantine cost. The game payoff governs the strategy adoption, while the epidemic process governs the agent’s health state. At the same time, the infection rate depends on the agent’s strategy while the perceived disease risk depends on the fraction of infected agents. Our results show recurrent infection waves, which are usually seen in previous historic epidemic scenarios with voluntary quarantine. In particular, such waves re-occur as the population reduces disease awareness. Notably, the risk perception is found to be fundamental for controlling the magnitude of the infection peak, while the final infection size is mainly dictated by the infection rates. Low awareness leads to a single and strong infection peak, while a greater disease risk leads to shorter, although more frequent, peaks. The proposed model spontaneously captures relevant aspects of a pandemic event, highlighting the fundamental role of social strategies.

Increased knowledge makes a difference! – general practitioners’ experiences of pictorial information about subclinical atherosclerosis for primary prevention: an interview study from the VIPVIZA trial

Objectives To explore how pictorial information on subclinical atherosclerosis affects GPs’ perception of patient cardiovascular disease (CVD) risk, their communication with patients, and GPs’ attitude to the treatment of CVD risk factors. Design, setting and subjects Fifteen individual interviews were conducted between March 2014 and December 2016, with GPs who had received pictorial information regarding their patients’ subclinical atherosclerosis. The pictorial information was also received by the patients together with written information regarding atherosclerosis and CVD risk prior to the appointment with their GP. The interviews were recorded, transcribed and analyzed using qualitative content analysis. Results Three categories were identified in the analysis. Increased knowledge makes a difference: When patients had more in-depth knowledge regarding atherosclerosis, the consultation became more patient-centered and moved towards shared decision making. This is real, not just a number: GPs described their risk assessment and the patient’s risk perception as more accurate with pictorial information about subclinical atherosclerosis. How to deal with the result – A passive to active approach: Some GPs acted promptly on the pictorial information while others took no action. Conclusion and implications Pictorial information regarding patients’ subclinical atherosclerosis affected GPs’ assessment of CVD risk. The communication shifted towards shared decision-making although the GPs’ attitude to the result and treatment of CVD risk factors varied. Informing patients about examination results, both in writing and pictures, prior to a consultation can facilitate shared decision making and enhance preventive measures. Trial registration https://clinicaltrials.gov/ct2/show/NCT01849575. KEY POINTS Providing pictorial information about carotid ultrasound results and information regarding atherosclerosis to GPs and patients affects primary prevention: •Informing patients about examination results prior to a consultation can be useful in clinical practice to enhance preventive measures •GPs experienced that increased patient knowledge resulted in a more patient-centered consultation and improved shared decision-making •GPs described their risk assessment and patients’ risk perception as more accurate with pictorial information about subclinical atherosclerosis

Factors Affecting Disease Risk Perception and Self-Management Behaviors among Japanese Long-Term Overseas Volunteers

Introduction: Many overseas volunteers have worked in low and middle-income countries. However traveling abroad and staying in an unfamiliar environment with inadequate medical infrastructure exposes volunteers to a wide range of health risks. The aim of this study was to clarify the relationships among disease knowledge and symptoms, disease risk perception, and self-management skills. Methods: This was a questionnaire survey of 189 Japanese who were preparing to volunteer abroad. A factor analysis was conducted on 13 items (six general risk events and seven major diseases) of risk perception. Correlation analysis was performed between the identified risk perception factors and disease knowledge and symptoms. Risk perception scores by factors from the seven disease items were compared between the Self-management Score (SMS) group and disease knowledge and risk of symptoms group, using T-tests. St. Luke’s International University Ethics Committee (19-A092) approved this study. Results: Many participants expected to suffer from digestive diseases (69.3%) and dermatitis (55%) in the field. On the other hand, few expected high risk of malaria (26.5%) or dengue fever (36%). Factor analysis yielded robust factor loadings creating a “Dread” and an “Unknown” factor accounting for 62.2% of total variance. Strong correlation was not found between SMS and disease risk perception. A weak negative correlation was observed in dengue fever, digestive disorders, and dermatitis (r = −0.20 to −0.25, p < 0.001) on the “Unknown” factor. A high SMS score was associated with a lower “Unknown” factor score for malaria, diarrhea, dermatitis, and dental disorders. In addition, higher disease knowledge was significantly associated with higher “Dread” factor score for dental disorders. Conclusions: Self-management skills and disease knowledge will enable higher risk awareness of common diseases and high lethality diseases.

Formative Evaluation of the Families SHARE Disease Risk Tool among Low-Income African Americans

Introduction: Family Health Histories (FHH) have been endorsed by the surgeon general as a powerful yet underutilized tool for identifying individuals at risk for complex chronic diseases such as diabetes, heart disease, and cancer. FHH tools provide a mechanism for increasing communication about disease history and motivating behavior change to reduce disease risk. A critical gap in translation efforts includes a lack of research that adapts and evaluates tools for low-income, minority populations who experience disparities in chronic disease. Methods: This study is a formative mixed-methods evaluation of an evidence-based FHH intervention called “Families SHARE” among African Americans residing in low-income neighborhoods. Participants (N = 51) completed assessments before and 6 weeks after receiving the intervention, including surveys and focus groups. We evaluated (a) their use, understanding, and perceived value of the tool; (b) if the intervention led to increased intentions to adopt disease risk-reducing behaviors among those with heightened disease risk, given their FHH; and (c) acceptability of and recommendations for the tool. Results: The quantitative and qualitative data indicated that this population valued and used the tool, and it prompted communication about FHH with family, friends, and others. Receipt of the intervention resulted in mixed accuracy of their perceived disease risk, and it did not shift intentions to change health behaviors. Qualitative data provide insights for future iterations of the Families SHARE tool. Conclusion: Families SHARE is an engaging FHH tool that can be further tailored to optimize its value and benefits for low-income African Americans.

Backfire effect of salient information on vaccine take-up experimental evidence from scared-straight intervention in rural northern Nigeria

ABSTRACT Vaccination is the most cost-effective way to prevent mothers and infants from contracting tetanus. However, developing countries struggle with the persistent low take-up of vaccination. The low risk perceptions of disease can be one of the barriers to vaccination. One way to increase the risk perceptions of disease is to use salient loss-framed messages to highlight negative consequences of not getting vaccinated. We conducted a randomized controlled trial among 1,660 women in 80 villages in northeastern Nigeria. Respondents were randomly assigned to view one of two flipcharts: (1) control flipcharts, which contained written explanation about the severity of the disease, or (2) `scared-straight’ flipcharts that contain the salient information about the disease severity in addition to the written explanation about the severity of the disease. Additionally, respondents were provided randomly assigned amounts of cash incentives. The scared-straight intervention backfired among women with no previous experience of tetanus vaccination: it decreased their vaccine take-up by 3.7–6.1 percentage points, even though it increased their perceived risk of disease and their fear level. The negative effect of the scared-straight intervention is the most prevalent among women who received the lowest amount of cash incentive. Women without experience of tetanus vaccination might have responded to the scared-straight flipcharts by denying the information provided because the flipcharts were too frightening. The use of the scared-straight tactic is not recommended to aim for the improved take-up of vaccination in developing countries where people might face budget constraints for achieving desirable behaviors. Trial Registration: The trial was registered at ISRCTN registry (ID: ISRCTN95083356).