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Raude J, MCColl K, Flamand C, Apostolidis T. Understanding health behaviour changes in response to outbreaks: Findings from a longitudinal study of a large epidemic of mosquito-borne disease. Soc Sci Med 2019; 230:184-193. [PMID: 31030009 DOI: 10.1016/j.socscimed.2019.04.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 02/19/2019] [Accepted: 04/07/2019] [Indexed: 02/07/2023]
Abstract
RATIONALE Although greater attention has been recently given to the ecological determinants of health behaviours, we still do not know much about the behavioural changes induced by the spread of infectiousdiseases. OBJECTIVE In this study, we took advantage of a large epidemic of chikungunya, an emerging mosquito-borne disease, in French Guiana to examine the dynamic interaction between risk-related perceptions and behaviours that occurs in response to a disease outbreak. In particular, we tested empirically the assumption that both risk perceptions and health behaviours were elastic with respect to prevalence of chikungunya. METHODS A representative sample of French Guianan (N=434) was interviewed in January 2015 just after the peak of the epidemic, and again 2 months later. Participants were asked about their perceptions of the threat, as well as their engagement in a range of protective behaviours promoted by the regional health authorities to control the spread of the disease. RESULTS The surveys showed that (1) the frequency of some health behaviours - those related to visible control methods - significantly increased with the subjective and objective prevalence of the disease, (2) perceived risk of infection for oneself tended to decrease considerably over time, and (3) the risk reappraisal hypothesis failed to account for this paradoxical trend in the people's response to the risk of contracting the disease. CONCLUSION These findings suggest that people may fail to adjust their risk perceptions, and to a lesser extent their health protective behaviours, to the course of an epidemic. Notably, the prevalence elasticity of preventive action found in previous studies of behavioural response to infectious diseases differed substantially according to the type of intervention (personal versus environmental methods). This paradoxical trend may be attributed to risk habituation effects, which seem to vary significantly according to the social visibility of thepreventive actions.
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Affiliation(s)
- Jocelyn Raude
- EHESP Rennes, Université Sorbonne Paris Cité, France; Unité des Virus Emergents (UVE: Aix-Marseille Univ - IRD 190 - Inserm 1207 - IHU Méditerranée Infection), Marseille, France.
| | - Kathleen MCColl
- EHESP Rennes, Université Sorbonne Paris Cité, France; Unité des Virus Emergents (UVE: Aix-Marseille Univ - IRD 190 - Inserm 1207 - IHU Méditerranée Infection), Marseille, France
| | - Claude Flamand
- Institut Pasteur de Guyane, Unité D'Epidémiologie, Cayenne, France
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Raude J, Peretti-Watel P, Ward J, Flamand C, Verger P. Are Perceived Prevalences of Infection also Biased and How? Lessons from Large Epidemics of Mosquito-Borne Diseases in Tropical Regions. Med Decis Making 2018; 38:377-389. [PMID: 29436309 DOI: 10.1177/0272989x17750845] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although people are likely to underestimate the frequencies of risks to health from common diseases and overestimate those from rare diseases, we still do not know much about reasons for this systematic bias, which is also referred to as "primary bias" in the literature. In this study, we take advantage of a series of large epidemics of mosquito-borne diseases to examine the accuracy of judgments of risk frequencies. In this aim, we assessed the perceived v. observed prevalence of infection by Zika, chikungunya or dengue fever during these outbreaks, as well as their variations among different subpopulations and epidemiological settings. METHODS We used data drawn from 4 telephone surveys, conducted between 2006 and 2016, among representative samples of the adult population in tropical regions (Reunion, Martinique, and French Guiana). The participants were asked to estimate the prevalence of these infections by using a natural frequency scale. RESULTS The surveys showed that 1) most people greatly overestimated the prevalence of infection by arbovirus, 2) these risk overestimations fell considerably as the actual prevalence of these diseases increased, 3) the better-educated and male participants consistently yielded less inaccurate risk estimates across epidemics, and 4) these biases in the perception of prevalence of these infectious diseases are relatively well predicted by the probability weighting function developed in the field of behavioral decision making. CONCLUSIONS These findings suggest that the primary bias, which has been found in laboratory experiments to characterize a variety of probabilistic judgments, equally affects perception of prevalence of acute infectious diseases in epidemic settings. They also indicate that numeracy may play a considerable role in people's ability to transform epidemiological observations from their social environment to more accurate risk estimates.
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Affiliation(s)
- Jocelyn Raude
- EHESP Rennes, Université Sorbonne Paris Cité, France.,Aix Marseille University, IRD French Institute of Research for Development, EHESP French School of Public Health, UMR_D 190 Emergence des Pathologies Virales, Marseille, France.,UMR PIMIT, INSERM 1187, CNRS 9192, IRD 249. Plateforme Technologique CYROI, Université de La Réunion, Réunion, France
| | - Patrick Peretti-Watel
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Jeremy Ward
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France.,Université Paris-Diderot, CNRS, LIED, Interdisciplinary Laboratory of Tomorrow's Energies, Paris, France
| | - Claude Flamand
- Institut Pasteur de Guyane, Unité d'Epidémiologie, Cayenne, France
| | - Pierre Verger
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
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