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MacKrill K, Witthöft M, Wessely S, Petrie KJ. Health Scares: Tracing Their Nature, Growth and Spread. CLINICAL PSYCHOLOGY IN EUROPE 2023; 5:e12209. [PMID: 38357430 PMCID: PMC10863677 DOI: 10.32872/cpe.12209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/18/2023] [Indexed: 02/16/2024] Open
Abstract
Background Health scares are highly publicised threats to health that increase public concern and protective behaviours but are later shown to be unfounded. Although health scares have become more common in recent times, they have received very little research attention. This is despite the fact that health scares often have negative outcomes for individuals and community by affecting health behaviours and causing high levels of often unnecessary anxiety. Method In this paper we undertook a review and analysis of the major types of health scares as well as the background factors associated with health scares and their spread. Results We found most health scares fell into seven main categories; environmental contaminants, food, malicious incidents, medical treatments, public health interventions, radiation from technology and exotic diseases. For most health scares there are important background factors and incident characteristics that affect how they develop. Background factors include conspiracy theories, trust in governmental agencies, anxiety, modern health worries and wariness of chemicals. Incident characteristic include being newly developed, not understood or unseen, man-made rather than natural and whether the incident is out of personal control. We also identified the aspects of traditional and social media that exacerbate the rapid spread of health scares. Conclusion More research is needed to identify the characteristics of media stories that intensify the levels of public concern. Guidelines around the media's reporting of health incidents and potential health threats may be necessary in order to reduce levels of public anxiety and the negative public health impact of health scares.
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Affiliation(s)
- Kate MacKrill
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Simon Wessely
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Keith J. Petrie
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Li C, Alves Dos Reis A, Ansari A, Bertelli L, Carr Z, Dainiak N, Degteva M, Efimov A, Kalinich J, Kryuchkov V, Kukhta B, Kurihara O, Antonia Lopez M, Port M, Riddell T, Rump A, Sun Q, Tuo F, Youngman M, Zhang J. Public health response and medical management of internal contamination in past radiological or nuclear incidents: A narrative review. ENVIRONMENT INTERNATIONAL 2022; 163:107222. [PMID: 35378442 PMCID: PMC9749825 DOI: 10.1016/j.envint.2022.107222] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 05/03/2023]
Abstract
Following a radiological or nuclear emergency, workers, responders and the public may be internally contaminated with radionuclides. Screening, monitoring and assessing any internal contamination and providing necessary medical treatment, especially when a large number of individuals are involved, is challenging. Experience gained and lessons learned from the management of previous incidents would help to identify gaps in knowledge and capabilities on preparedness for and response to radiation emergencies. In this paper, eight large-scale and five workplace radiological and nuclear incidents are reviewed cross 14 technical areas, under the broader topics of emergency preparedness, emergency response and recovery processes. The review findings suggest that 1) new strategies, algorithms and technologies are explored for rapid screening of large populations; 2) exposure assessment and dose estimation in emergency response and dose reconstruction in recovery process are supported by complementary sources of information, including 'citizen science'; 3) surge capacity for monitoring and dose assessment is coordinated through national and international laboratory networks; 4) evidence-based guidelines for medical management and follow-up of internal contamination are urgently needed; 5) mechanisms for international and regional access to medical countermeasures are investigated and implemented; 6) long-term health and medical follow up programs are designed and justified; and 7) capabilities and capacity developed for emergency response are sustained through adequate resource allocation, routine non-emergency use of technical skills in regular exercises, training, and continuous improvement.
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Affiliation(s)
| | | | - Armin Ansari
- Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Zhanat Carr
- World Health Organization, Geneva, Switzerland
| | | | - Marina Degteva
- Urals Research Center for Radiation Medicine, Chelyabinsk, Russia
| | - Alexander Efimov
- State Unitary Enterprise Southern Urals Biophysics Institute of Federal Medical Biological Agency, Ozyorsk, Russia
| | - John Kalinich
- Armed Forces Radiobiology Research Institute, Uniformed Services University, Bethesda, USA
| | - Victor Kryuchkov
- State Research Center - Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
| | - Boris Kukhta
- State Research Center - Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
| | - Osamu Kurihara
- National Institutes of Quantum and Radiological Science and Technology, Chiba, Japan
| | - Maria Antonia Lopez
- Centro de Investigaciones Energéticas, Medioambientales y Tecnolόgicas, Madrid, Spain
| | - Matthias Port
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | | | - Alexis Rump
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - Quanfu Sun
- National Institute for Radiological Protection, Beijing, China
| | - Fei Tuo
- National Institute for Radiological Protection, Beijing, China
| | | | - Jianfeng Zhang
- National Institute for Radiological Protection, Beijing, China
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3
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Mowbray F, Woodland L, Smith LE, Amlôt R, Rubin GJ. Is My Cough a Cold or Covid? A Qualitative Study of COVID-19 Symptom Recognition and Attitudes Toward Testing in the UK. Front Public Health 2021; 9:716421. [PMID: 34485238 PMCID: PMC8416344 DOI: 10.3389/fpubh.2021.716421] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/26/2021] [Indexed: 01/09/2023] Open
Abstract
Objective: Key to reducing the spread of COVID-19 in the UK is increased use of the NHS Test and Trace (NHSTT) system. This study explored one of the main issues that determine whether people engage with NHSTT, how people understand symptoms that may indicate the presence of COVID-19 and that should trigger a request for a test. Methods: In this qualitative study, a series of semi-structured telephone interviews were conducted with 40 people (21 members of the general population, 19 students). There was nearly an equal split between male and female participants in both samples. Data were collected between 30 November and 11 December 2020 and explored using thematic analysis. There was substantial similarity in responses for both populations so we combined our results and highlighted where differences were present. Results: Participants generally had good knowledge of the main symptoms of COVID-19 (high temperature, new, persistent cough, anosmia) but had low confidence in their ability to differentiate them from symptoms of other illnesses. Attribution of symptoms to COVID-19 was most likely where the symptoms were severe, many symptoms were present, symptoms had lasted for some time and when perceived risk of exposure to infection was high due to previous contact with others. Participants felt encouraged to engage in testing where symptoms were present and had persisted for several days, though, many had concerns about the safety of testing centres and the accuracy of test results. Students had mixed feelings about mass asymptomatic testing, seeing it as a way to access a more normal student experience, but also a potential waste of resources. Conclusions: This study offers novel insights into how people attribute symptoms to COVID-19 and barriers and facilitators to engaging with NHSTT. Participants had positive views of testing, but there is a need to improve not just recognition of each main symptom, but also understanding that even single, mild symptoms may necessitate a test rather than a “wait and see” approach, and to address concerns around test accuracy to increase testing uptake.
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Affiliation(s)
- Fiona Mowbray
- Weston Education Centre, King's College London, London, United Kingdom
| | - Lisa Woodland
- Weston Education Centre, King's College London, London, United Kingdom
| | - Louise E Smith
- Weston Education Centre, King's College London, London, United Kingdom
| | - Richard Amlôt
- Emergency Response Department, Public Health England, Salisbury, United Kingdom
| | - G James Rubin
- Weston Education Centre, King's College London, London, United Kingdom
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Denford S, Martin AF, Love N, Ready D, Oliver I, Amlôt R, Yardley L, Rubin GJ. Engagement With Daily Testing Instead of Self-Isolating in Contacts of Confirmed Cases of SARS-CoV-2: A Qualitative Analysis. Front Public Health 2021; 9:714041. [PMID: 34414160 PMCID: PMC8369371 DOI: 10.3389/fpubh.2021.714041] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/08/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: In December 2020 and January 2021 Public Health England (PHE) with NHS Test and Trace conducted a study to explore the feasibility and acceptability of daily testing as an alternative to self-isolation following close contact with a confirmed COVID-19 case. This qualitative paper aims to identify factors influencing uptake among those offered daily testing, and the subsequent impact on behaviour. Methods: We conducted in-depth interviews with 52 participants who had taken part in the feasibility study. Participants were asked about their experiences of daily testing or self-isolating, their reasons for choosing to test or isolate, and their behaviour during the study period. Data were analysed using inductive thematic analysis. Results: Results are presented under two main headings: (1) factors influencing acceptance of testing and (2) impact of test results. Participants appeared highly motivated to engage in behaviours that would protect others from the virus. Factors influencing the decision to accept testing included (1) needing to avoid self-isolation, (2) concerns about test sensitivity, and (3) perceived benefits of detecting infection. Participants who were taking tests reported: (1) positive consequences following confirmation of COVID status, (2) engaging in essential activities, (3) uncertainty, and (4) self-isolating whilst testing. Conclusions: This study has identified a range of factors that appear to influence the decision to engage in daily testing or to self-isolate following close contact with a positive case, many of which could be addressed by clear communications. Covid-19 infection rates and government restrictions influenced experiences, and so further research is needed to explore perceptions of daily testing and behaviour following close contact with a positive case among a wider range of individuals, in the context of lower rates of COVID-19, few government restrictions on general population behaviour and more widespread testing.
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Affiliation(s)
- Sarah Denford
- Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Alex F. Martin
- Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, United Kingdom
| | - Nicola Love
- National Infection Service, Public Health England, Bristol, United Kingdom
| | - Derren Ready
- Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
- National Infection Service, Public Health England, Bristol, United Kingdom
| | - Isabel Oliver
- Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
- National Infection Service, Public Health England, Bristol, United Kingdom
| | - Richard Amlôt
- Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
- Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, United Kingdom
- Behavioural Science Team, Emergency Response Department Science and Technology, Public Health England, Salisbury, United Kingdom
| | - Lucy Yardley
- Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
- School of Psychology, University of Southampton, Southampton, United Kingdom
| | - G. James Rubin
- Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, United Kingdom
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Bonsu A, Walker P, Edey J, Rea P, Kaski D, Kheradmand A, Saman Y, Staab JP, Arshad Q. Time to consider the role of rationalisation in health psychology. Public Health 2021; 196:59-61. [PMID: 34147997 DOI: 10.1016/j.puhe.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/26/2021] [Accepted: 05/12/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to determine the interaction between psychological factors, belief systems, and engagement around public health initiatives. STUDY DESIGN We conducted a longitudinal observational study, utilising convenience sampling to examine illness-related perception in the immediate and medium-term stages of the first wave of the SARS-CoV-2 pandemic in the UK. METHODS Weekly questionnaires assessed our primary measure, illness-related perception, using The Health Anxiety Inventory. Other psychological measures included apathy, loneliness, depersonalisation, state anxiety, trait anxiety as well as personality traits. Multiple regressions were performed to determine which psychological factors predicted the variance of health anxiety every week using the enter method. RESULTS A combination of psychological variables that varied over time and were modulated by external events predicted the evolution of illness-related perception and associated aversion to perceived threat. CONCLUSION Our findings highlight how in the face of a public health crisis, psychological factors play a determining role in the synthesis of beliefs as well as guiding human behaviour.
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Affiliation(s)
- A Bonsu
- Division of Brain Sciences, Department of Medicine, Charing Cross Hospital Campus, Imperial College London, W6 8RF, UK
| | - P Walker
- InAmind Laboratory, Department of Psychology, Neuroscience and Behaviour, University of Leicester, Leicester, UK
| | - J Edey
- InAmind Laboratory, Department of Psychology, Neuroscience and Behaviour, University of Leicester, Leicester, UK
| | - P Rea
- InAmind Laboratory, Department of Psychology, Neuroscience and Behaviour, University of Leicester, Leicester, UK
| | - D Kaski
- Department of Clinical and Motor Neurosciences, UCL, Institute of Neurology, WC1N 3BG, UK
| | - A Kheradmand
- Department of Neurology, Johns Hopkin University, USA
| | - Y Saman
- InAmind Laboratory, Department of Psychology, Neuroscience and Behaviour, University of Leicester, Leicester, UK
| | - J P Staab
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
| | - Q Arshad
- Division of Brain Sciences, Department of Medicine, Charing Cross Hospital Campus, Imperial College London, W6 8RF, UK; InAmind Laboratory, Department of Psychology, Neuroscience and Behaviour, University of Leicester, Leicester, UK.
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Carter P, Megnin-Viggars O, Rubin GJ. What Factors Influence Symptom Reporting and Access to Healthcare During an Emerging Infectious Disease Outbreak? A Rapid Review of the Evidence. Health Secur 2021; 19:353-363. [PMID: 33416425 PMCID: PMC8403196 DOI: 10.1089/hs.2020.0126] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
During any emerging infectious disease outbreak, people with symptoms of the illness are asked to report to a health service immediately to facilitate contact tracing. Several factors may influence a person's willingness to report symptoms and their ability to access healthcare services. Understanding these factors has become urgent during the COVID-19 pandemic. To determine which factors influence symptom reporting during an emerging infectious disease outbreak, we conducted a rapid review of the evidence. Studies included in the review were based on primary research, published in a peer-reviewed journal, written in English, included factors associated with symptom reporting or accessing healthcare, and were related to a major public health incident involving an infectious disease outbreak. Five themes were identified as facilitators of symptom reporting or accessing healthcare: accurate and informative communication about the disease and the need to seek help, symptom severity, concern about disease exposure, ease of access to healthcare facilities, and relationship with the healthcare provider. Seven themes were identified as barriers to symptom reporting or accessing healthcare: lack of knowledge of the disease and its treatment, fear of the disease and fear of subsequent treatments or requirements, stigmatization attached to having a disease, invasion of privacy, low concern about symptoms, economic consequences of disease diagnosis, and challenges related to attending a healthcare facility. For contract tracing services to be effective, members of the public need to have the capability, opportunity, and motivation to use them. The themes identified should be used to evaluate information provided to the public to ensure as many people as possible with relevant symptoms report them to a healthcare provider.
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Affiliation(s)
- Patrice Carter
- Patrice Carter, PhD, and Odette Megnin-Viggars, PhD, are Senior Systematic Reviewers; both at the Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK. Patrice Carter is also a Senior Systematic Reviewer, Health Economics & Outcomes Research Ltd, Cardiff, UK. G. James Rubin, PhD, is Assistant Director, Health Protection Unit in Emergency Preparedness and Response, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Odette Megnin-Viggars
- Patrice Carter, PhD, and Odette Megnin-Viggars, PhD, are Senior Systematic Reviewers; both at the Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK. Patrice Carter is also a Senior Systematic Reviewer, Health Economics & Outcomes Research Ltd, Cardiff, UK. G. James Rubin, PhD, is Assistant Director, Health Protection Unit in Emergency Preparedness and Response, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - G James Rubin
- Patrice Carter, PhD, and Odette Megnin-Viggars, PhD, are Senior Systematic Reviewers; both at the Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK. Patrice Carter is also a Senior Systematic Reviewer, Health Economics & Outcomes Research Ltd, Cardiff, UK. G. James Rubin, PhD, is Assistant Director, Health Protection Unit in Emergency Preparedness and Response, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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Rubin GJ, Webster R, Amlot R, Carter H, Weston D, Wessely S. Public responses to the Salisbury Novichok incident: a cross-sectional survey of anxiety, anger, uncertainty, perceived risk and avoidance behaviour in the local community. BMJ Open 2020; 10:e036071. [PMID: 32978184 PMCID: PMC7520835 DOI: 10.1136/bmjopen-2019-036071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Malicious incidents involving chemical agents sometimes trigger high public concern. We aimed to (1) identify levels of emotion, perceived risk and behaviour change with regard to visiting Salisbury, 1 month after three people were poisoned with a nerve agent; and (2) test whether factors including receipt of information, beliefs about personal exposure and trust in government were associated with these outcomes. DESIGN A cross-sectional telephone survey of a random sample of Salisbury residents. SETTING Conducted between 5 and 13 April 2018. PARTICIPANTS 500 residents aged 18 or over. OUTCOME MEASURES Self-reported anxiety, anger, uncertainty, perceived risk to self and avoidance of Salisbury. RESULTS Any degree of anxiety, anger and uncertainty was reported by 40.6%, 29.8% and 30.6% of participants, respectively. For the majority, the level of emotion reported was mild. Only 7.0% met the criteria for high anxiety and 5.2% reported feeling any risk to their health, whereas 18.6% reported avoiding Salisbury. Factors associated with avoidance of Salisbury included being female, unable to rule out exposure for oneself or of loved ones, believing the incident was targeted against the general public, and lower trust in the government and responding agencies. Hearing a lot or a little about the recovery support (eg, financial packages), as opposed to nothing at all, and being satisfied with this information were associated with reduced avoidance. CONCLUSIONS Although the March 2018 Salisbury incident had a relatively modest impact on emotion and risk perception in the community, the number who reported avoiding the city was notable. In this, and in future incidents, assuring people that contamination resulted from a targeted, rather than indiscriminate, incident; demonstrating that contamination is contained within specific areas; improving communication about any financial support; and promoting trust in responding agencies should help provide additional reassurance to the community.
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Affiliation(s)
- G James Rubin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rebecca Webster
- Department of Psychology, The University of Sheffield, Sheffield, UK
| | - Richard Amlot
- Emergency Response Department, Public Health England Porton, Salisbury, Wiltshire, UK
| | - Holly Carter
- Emergency Response Department, Public Health England Porton, Salisbury, Wiltshire, UK
| | - Dale Weston
- Emergency Response Department, Public Health England Porton, Salisbury, Wiltshire, UK
| | - Simon Wessely
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Dickmann P, Keeping S, Döring N, Schmidt AE, Binder C, Ariño-Blasco S, Gil J. Communicating the Risk of MRSA: The Role of Clinical Practice, Regulation and Other Policies in Five European Countries. Front Public Health 2017; 5:44. [PMID: 28367432 PMCID: PMC5355491 DOI: 10.3389/fpubh.2017.00044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 02/24/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The threat posed by Meticillin-resistant Staphylococcus aureus (MRSA) has taken on an increasingly pan-European dimension. This article aims to provide an overview of the different approaches to the control of MRSA adopted in five European countries (Austria, Germany, Netherlands, Spain, and the UK) and discusses data and reporting mechanisms, regulations, guidelines, and health policy approaches with a focus on risk communication. Our hypothesis is that current infection control practices in different European countries are implicit messages that contribute to the health-related risk communication and subsequently to the public perception of risk posed by MRSA. A reporting template was used to systematically collect information from each country. DISCUSSION Large variation in approaches was observed between countries. However, there were a number of consistent themes relevant to the communication of key information regarding MRSA, including misleading messages, inconsistencies in content and application of published guidelines, and frictions between the official communication and their adoption on provider level. SUMMARY The variability of recommendations within, and across, countries could be contributing to the perception of inconsistency. Having inconsistent guidelines and practices in place may also be affecting the level at which recommended behaviors are adopted. The discrepancy between the official, explicit health messages around MRSA and the implicit messages stemming from the performance of infection control measures should, therefore, be a key target for those wishing to improve risk communication.
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Affiliation(s)
- Petra Dickmann
- London School of Economics and Political Science (LSE), LSE Health, London, UK; dickmann risk communication (drc), London, UK; Department for Anaesthesiology and Critical Care Medicine, Jena University Hospital, Jena, Germany
| | - Sam Keeping
- London School of Economics and Political Science (LSE), LSE Health , London , UK
| | - Nora Döring
- Department of Health Services Research, School for Public Health and Primary Care (Caphri) of the Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Claudia Binder
- European Centre for Social Welfare Policy and Research , Vienna , Austria
| | - Sergio Ariño-Blasco
- Universitat Internacional de Catalunya Hospital General Granollers , Granollers , Spain
| | - Joan Gil
- Universitat Internacional de Catalunya Hospital General Granollers, Granollers, Spain; Department of Economics and BEAT Research Institute, University of Barcelona, Barcelona, Spain
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Dickmann P, Bhatiasevi A, Chaib F, Baggio O, Banluta C, Hollenweger L, Maaroufi A. Biological Risks to Public Health: Lessons from an International Conference to Inform the Development of National Risk Communication Strategies. Health Secur 2016; 14:433-440. [PMID: 27875654 PMCID: PMC5175421 DOI: 10.1089/hs.2016.0050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Biological risk management in public health focuses on the impact of outbreaks on health, the economy, and other systems and on ensuring biosafety and biosecurity. To address this broad range of risks, the International Health Regulations (IHR, 2005) request that all member states build defined core capacities, risk communication being one of them. While there is existing guidance on the communication process and on what health authorities need to consider to design risk communication strategies that meet the requirements on a governance level, little has been done on implementation because of a number of factors, including lack of resources (human, financial, and others) and systems to support effective and consistent capacity for risk communication. The international conference on “Risk communication strategies before, during and after public health emergencies” provided a platform to present current strategies, facilitate learning from recent outbreaks of infectious diseases, and discuss recommendations to inform risk communication strategy development. The discussion concluded with 4 key areas for improvement in risk communication: consider communication as a multidimensional process in risk communication, broaden the biomedical paradigm by integrating social science intelligence into epidemiologic risk assessments, strengthen multisectoral collaboration including with local organizations, and spearhead changes in organizations for better risk communication governance. National strategies should design risk communication to be proactive, participatory, and multisectoral, facilitating the connection between sectors and strengthening collaboration.
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10
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Carter H, Amlôt R. Mass Casualty Decontamination Guidance and Psychosocial Aspects of CBRN Incident Management: A Review and Synthesis. PLOS CURRENTS 2016; 8. [PMID: 27790383 PMCID: PMC5061579 DOI: 10.1371/currents.dis.c2d3d652d9d07a2a620ed5429e017ef5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Mass casualty decontamination is an intervention employed by first responders at the scene of an incident involving noxious contaminants. Many countries have sought to address the challenge of decontaminating large numbers of affected casualties through the provision of rapidly deployable temporary showering structures, with accompanying decontamination protocols. In this paper we review decontamination guidance for emergency responders and associated research evidence, in order to establish to what extent psychosocial aspects of casualty management have been considered within these documents. The review focuses on five psychosocial aspects of incident management: likely public behaviour; responder management style; communication strategy; privacy/ modesty concerns; and vulnerable groups. METHODS Two structured literature reviews were carried out; one to identify decontamination guidance documents for first responders, and another to identify evidence which is relevant to the understanding of the psychosocial aspects of mass decontamination. The guidance documents and relevant research were reviewed to identify whether the guidance documents contain information relating to psychosocial issues and where it exists, that the guidance is consistent with the existing evidence-base. RESULTS Psychosocial aspects of incident management receive limited attention in current decontamination guidance. In addition, our review has identified a number of gaps and inconsistencies between guidance and research evidence. For each of the five areas we identify: what is currently presented in guidance documents, to what extent this is consistent with the existing research evidence and where it diverges. We present a series of evidence-based recommendations for updating decontamination guidance to address the psychosocial aspects of mass decontamination. CONCLUSIONS Effective communication and respect for casualties' needs are critical in ensuring decontamination is completed quickly and effectively. We identify a number of areas requiring further research including: identifying effective methods for communicating in an emergency; better understanding of the needs of vulnerable groups during decontamination; effective training for emergency responders on psychosocial issues, and pre-incident public education for incidents involving emergency decontamination. It is essential that the psychosocial aspects of mass decontamination are not neglected in the pursuit of solely technical solutions.
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Affiliation(s)
- Holly Carter
- Emergency Response Department, Public Health England, Salisbury, UK
| | - Richard Amlôt
- Emergency Response Department, Public Health England, Salisbury, UK
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11
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Dickmann P, McClelland A, Gamhewage GM, Portela de Souza P, Apfel F. Making sense of communication interventions in public health emergencies – an evaluation framework for risk communication. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/17538068.2015.1101962] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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12
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Krieger K, Amlôt R, Rogers MB. Understanding public responses to chemical, biological, radiological and nuclear incidents--driving factors, emerging themes and research gaps. ENVIRONMENT INTERNATIONAL 2014; 72:66-74. [PMID: 24856235 DOI: 10.1016/j.envint.2014.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 04/16/2014] [Accepted: 04/23/2014] [Indexed: 06/03/2023]
Abstract
This paper discusses the management of public responses to incidents involving chemical, biological, radiological and nuclear materials (CBRN). Given the extraordinary technical and operational challenges of a response to a CBRN release including, but not limited to, hazard detection and identification, casualty decontamination and multi-agency co-ordination, it is not surprising that public psychological and behavioural responses to such incidents have received limited attention by scholars and practitioners alike. As a result, a lack of understanding about the role of the public in effective emergency response constitutes a major gap in research and practice. This limitation must be addressed as a CBRN release has the potential to have wide-reaching psychological and behavioural impacts which, in turn, impact upon public morbidity and mortality rates. This paper addresses a number of key issues: why public responses matter; how responses have been conceptualised by practitioners; what factors have been identified as influencing public responses to a CBRN release and similar extreme events, and what further analysis is needed in order to generate a better understanding of public responses to inform the management of public responses to a CBRN release.
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Affiliation(s)
| | - Richard Amlôt
- Emergency Response Department, Public Health England, Porton Down, UK
| | - M Brooke Rogers
- King's College London, Department of War Studies, London, UK
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Responding to a Radiological Crisis: Experiences of British Foreign Office Staff in Japan After the Fukushima Nuclear Meltdown. Disaster Med Public Health Prep 2014; 8:397-403. [DOI: 10.1017/dmp.2014.98] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectivesTo identify factors that affected well-being among British embassy staff based in Japan after the 2011 earthquake, tsunami, and nuclear meltdown.MethodsIn-depth qualitative interviews were conducted with 36 members of staff 8 to 9 months after the earthquake.ResultsParticipants described their crisis work as stressful, exciting, and something of which they were proud. Aside from disaster-specific stressors, factors identified as stressful included unclear roles, handing over work to new personnel, being assigned to office-based work, feeling that work was not immediately beneficial to the public, not taking good-quality breaks, and difficulties with relatives. The radiation risk provoked mixed feelings, with most participants being reassured by contact with senior scientists.ConclusionsInterventions to safeguard the well-being of personnel during crisis work must consider the impact of a broad range of stressors.(Disaster Med Public Health Preparedness. 2014;0:1-7)
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Risk communication and crisis communication in infectious disease outbreaks in Germany: what is being done, and what needs to be done. Disaster Med Public Health Prep 2014; 8:206-211. [PMID: 24804970 DOI: 10.1017/dmp.2014.36] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Risk communication plays a central role in the management of infectious disease. The World Health Organization's 2005 International Health Regulations have highlighted the need for countries to strengthen their capacities in this area to ensure effective responses to public health emergencies. We surveyed laboratories, hospitals, and public health institutions in Germany to detail the current situation regarding risk communication and crisis management and to identify which areas require further development. METHODS A mixed methods approach was adopted. An initial questionnaire was distributed to relevant persons in laboratories and hospitals, and semistructured interviews were conducted with selected participants. Representatives from state public health authorities, federal agencies, and media also were interviewed to add additional contextual information to the questionnaire responses. RESULTS Based on the responses received, the universal sense among key stakeholders was that risk communication and crisis communication measures must be improved. Collaborative working was a consistent theme, with participants suggesting that a partnering strategy could help to improve performance. This approach could be achieved through better coordination between groups, for example, through a knowledge-sharing policy. CONCLUSIONS More research is needed on how such collaboration might be implemented, along with a general conceptual framework for risk communication to underpin the overall strategy.
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Abstract
The 7 July 2005 bombings in London caused heightened levels of distress among some in the general community. This distress was most notable in Muslims and members of ethnic minority groups. These effects were transient for most. An estimated 30% of those who were more affected by the attacks, including victims and witnesses, developed psychiatric disorders as a result. An outreach program was set up to screen those who were exposed to potentially traumatic events and to offer them evidence-based treatment. This article discusses what lessons might be learned from studies of the general community and the screen-and-treat approach.
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Affiliation(s)
- G James Rubin
- King's College London, Department of Psychological Medicine, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK.
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Rogers MB, Amlôt R, Rubin GJ. The impact of communication materials on public responses to a radiological dispersal device (RDD) attack. Biosecur Bioterror 2013; 11:49-58. [PMID: 23510306 DOI: 10.1089/bsp.2012.0059] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
It is a common assumption that, in the event of a chemical, biological, radiological, or nuclear (CBRN) attack, a well-prepared and informed public is more likely to follow official recommendations regarding the appropriate safety measures to take. We present findings from a UK study investigating the ability of crisis communication to influence perceptions of risk and behavioral intentions in the general public in response to CBRN terrorism. We conducted a focus group study involving a scenario presented in mock news broadcasts to explore levels of public knowledge, information needs, and intended behavioral reactions to an attack involving an overt radiological dispersal device (RDD), or dirty bomb. We used the findings from these focus groups to design messages for the public that could be presented in a short leaflet. We then tested the effects of the leaflet on reactions to the same scenario in 8 further focus groups. The impact of the new messages on levels of knowledge, information needs, and intended compliance with official recommendations was assessed. The provision of information increased the perceived credibility of official messages and increased reported levels of intended compliance with advice to return to normal/stop sheltering, attend a facility for assessment and treatment, and return to a previously contaminated area after decontamination of the environment has taken place. Should a real attack with an RDD occur, having pretested messages available to address common concerns and information needs should facilitate the public health response to the attack.
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Affiliation(s)
- M Brooke Rogers
- King’s College London, Department of War Studies, Strand, London WC2R 2LS, UK.
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Communicating with the Public Following Radiological Terrorism: Results from a Series of Focus Groups and National Surveys in Britain and Germany. Prehosp Disaster Med 2012; 28:110-9. [DOI: 10.1017/s1049023x12001756] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractIntroductionIncidents involving the exposure of large numbers of people to radiological material can have serious consequences for those affected, their community and wider society. In many instances, the psychological effects of these incidents have the greatest impact. People fear radiation and even incidents which result in little or no actual exposure have the potential to cause widespread anxiety and behavior change. The aim of this study was to assess public intentions, beliefs and information needs in the UK and Germany in response to a hidden radiological exposure device. By assessing how the public is likely to react to such events, strategies for more effective crisis and risk communication can be developed and designed to address any knowledge gaps, misperceptions and behavioral responses that are contrary to public health advice.MethodsThis study had three stages. The first stage consisted of focus groups which identified perceptions of and reactions to a covert radiological device. The incident was introduced to participants using a series of mock newspaper and broadcast injects to convey the evolving scenario. The outcomes of these focus groups were used to inform national telephone surveys, which quantified intended behaviors and assessed what perceptions were correlated with these behaviors. Focus group and survey results were used to develop video and leaflet communication interventions, which were then evaluated in a second round of focus groups.ResultsIn the first two stages, misperceptions about the likelihood and routes of exposure were associated with higher levels of worry and greater likelihood of engaging in behaviors that might be detrimental to ongoing public health efforts. The final focus groups demonstrated that both types of misunderstanding are amenable to change following targeted communication.ConclusionShould terrorists succeed in placing a hidden radiological device in a public location, then health agencies may find that it is easier to communicate effectively with the public if they explicitly and clearly discuss the mechanisms through which someone could be affected by the radiation and the known geographical spread of any risk. Messages which explain how the risk from a hidden radiological device “works” should be prepared and tested in advance so that they can be rapidly deployed if the need arises.PearceJM, RubinGJ, SelkeP, AmlôtR, MowbrayF, RogersMB. Communicating with the public following radiological terrorism: results from a series of focus groups and national surveys in Britain and Germany. Prehosp Disaster Med. 2013;28(2):1-10.
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Rubin GJ, Chowdhury AK, Amlôt R. How to communicate with the public about chemical, biological, radiological, or nuclear terrorism: a systematic review of the literature. Biosecur Bioterror 2012; 10:383-95. [PMID: 23216210 DOI: 10.1089/bsp.2012.0043] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A deliberate attack involving chemical, biological, radiological, or nuclear (CBRN) material has the potential to cause substantial fear among the public. This presents problems for communicators, who will need to provide information quickly after an attack while ensuring that their messages are easily understood and likely to be attended to by members of the public. Identifying in advance what people would want to know, where they would get information from, and how messages should be presented might allow communicators to ensure that their messages have the best chance of having their desired effect. In this review, we identified all peer-reviewed studies that have assessed communication strategies or information needs using hypothetical CBRN scenarios or in actual CBRN incidents. We identified 33 relevant studies. Their results support existing psychological models of why people engage in health protective behaviors, with information about the severity of the incident, the likelihood of being exposed, the efficacy and costs or risks of recommended behaviors, and the ability of individuals to perform recommended behaviors being sought by the public. Trust plays a crucial role in ensuring that people attend to messages. Finally, while a large variety of spokespeople and sources were identified as being turned to in the event of an incident, the use of multiple information sources was also common, affirming the importance of communicating a consistent message through multiple channels. Further research is required to extend these predominantly US-based findings to other countries and to confirm the findings of research using hypothetical scenarios.
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Affiliation(s)
- G James Rubin
- King's College London, Department of Psychological Medicine, London, UK.
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Rubin GJ, Amlôt R, Page L, Pearce J, Wessely S. Assessing perceptions about hazardous substances (PATHS): the PATHS questionnaire. J Health Psychol 2012; 18:1100-13. [PMID: 23104995 PMCID: PMC3785320 DOI: 10.1177/1359105312459096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
How people perceive the nature of a hazardous substance may determine how they respond
when potentially exposed to it. We tested a new Perceptions AbouT Hazardous Substances
(PATHS) questionnaire. In Study 1 (N = 21), we assessed the face validity
of items concerning perceptions about eight properties of a hazardous substance. In Study
2 (N = 2030), we tested the factor structure, reliability and validity of
the PATHS questionnaire across four qualitatively different substances. In Study 3
(N = 760), we tested the impact of information provision on Perceptions
AbouT Hazardous Substances scores. Our results showed that our eight measures demonstrated
good reliability and validity when used for non-contagious hazards.
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Affiliation(s)
- G James Rubin
- Department of Psychological Medicine , King's College London, UK.
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Rubin GJ, Amlôt R, Page L. The London polonium incident: lessons in risk communications. HEALTH PHYSICS 2011; 101:545-550. [PMID: 21979538 DOI: 10.1097/hp.0b013e3182259a61] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Public responses to large-scale radiological incidents are often thought to be disproportionate to the objective risk and can involve widespread societal disruption. Recent experiences of the (200)Po incident in central London suggest that public responses depend heavily on the nature of the incident and the effectiveness of risk communication efforts. This paper describes the outcome of several studies done in the aftermath of the (200)Po incident that suggest the reaction of the public on this occasion was muted, even for those directly affected. However, the desire for accurate, up-to-date and individually-tailored information was strong, and satisfaction with the efforts of the responding agencies was mediated by this information provision. A small minority of individuals was difficult to reassure effectively. This group may confer a particular drain on resources. Lessons for the risk communication efforts of public health responders are identified, in particular the importance of helping individuals to identify their risk of exposure, understand the difference between acute and chronic effects of exposure, and appreciate the meaning of any test results. Attempts at providing reassurance in the absence of specific information are likely to be counterproductive in any future radiological incident.
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Affiliation(s)
- G James Rubin
- King's College London, Department of Psychological Medicine, (PO62), Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK.
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Tausczik Y, Faasse K, Pennebaker JW, Petrie KJ. Public anxiety and information seeking following the H1N1 outbreak: blogs, newspaper articles, and Wikipedia visits. HEALTH COMMUNICATION 2011; 27:179-185. [PMID: 21827326 DOI: 10.1080/10410236.2011.571759] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Web-based methodologies may provide a new and unique insight into public response to an infectious disease outbreak. This naturalistic study investigates the effectiveness of new web-based methodologies in assessing anxiety and information seeking in response to the 2009 H1N1 outbreak by examining language use in weblogs ("blogs"), newspaper articles, and web-based information seeking. Language use in blogs and newspaper articles was assessed using Linguistic Inquiry and Word Count, and information seeking was examined using the number of daily visits to H1N1-relevant Wikipedia articles. The results show that blogs mentioning "swine flu" used significantly higher levels of anxiety, health, and death words and lower levels of positive emotion words than control blogs. Change in language use on blogs was strongly related to change in language use in newspaper coverage for the same day. Both the measure of anxiety in blogs mentioning "swine flu" and the number of Wikipedia visits followed similar trajectories, peaking shortly after the announcement of H1N1 and then declining rapidly. Anxiety measured in blogs preceded information seeking on Wikipedia. These results show that the public reaction to H1N1 was rapid and short-lived. This research suggests that analysis of web behavior can provide a source of naturalistic data on the level and changing pattern of public anxiety and information seeking following the outbreak of a public health emergency.
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Affiliation(s)
- Yla Tausczik
- Department of Psychology, University of Texas, USA
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Elam G, Oakley K, Connor N, Hewitt P, Ward HJT, Zaman SMA, Chow Y, Marteau TM. Impact of being placed at risk of Creutzfeldt-Jakob disease: a qualitative study of blood donors to variant CJD cases and patients potentially surgically exposed to CJD. Neuroepidemiology 2011; 36:274-81. [PMID: 21757956 DOI: 10.1159/000328646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 04/19/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The study objective was to describe the emotional and behavioural responses to Creutzfeldt-Jakob disease (CJD) risk notification. METHODS A qualitative study using 11 participants' interviews, which were analysed thematically with Framework Analysis. PARTICIPANTS Six participants purposively selected from people exposed to surgical instruments used previously on patients with or at risk of CJD (any type; n = 60), and 5 participants from a cohort of blood donors to patients who subsequently developed variant CJD (n = 110). RESULTS Notification was initially a shocking event, but with no lasting emotional impact. Those notified were convinced they were at extremely low risk of CJD and coped by not thinking about the information. Disclosure outside the immediate family was limited by fears of stigma. All expressed concern about the possibility of onward transmission and agreed notification was appropriate. Individual adherence to public health precautions varied from those who did nothing, apart from not donating blood, to those who consistently followed all advice given. This variation was informed by an assumption that information was always shared among health professionals. CONCLUSIONS Factors contributing to minimising emotional distress following notification of CJD risk were evident. We found little evidence of sustained emotional distress. However, implementation of behaviours to minimise onward transmission, particularly in health care settings, was variable - this requires further investigation.
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Affiliation(s)
- Gillian Elam
- University College London, Mortimer Market Centre, London, UK
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Psychosocial impact of the summer 2007 floods in England. BMC Public Health 2011; 11:145. [PMID: 21371296 PMCID: PMC3062606 DOI: 10.1186/1471-2458-11-145] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 03/03/2011] [Indexed: 11/10/2022] Open
Abstract
Background The summer of 2007 was the wettest in the UK since records began in 1914 and resulted in severe flooding in several regions. We carried out a health impact assessment using population-based surveys to assess the prevalence of and risk factors for the psychosocial consequences of this flooding in the United Kingdom. Methods Surveys were conducted in two regions using postal, online, telephone questionnaires and face-to-face interviews. Exposure variables included the presence of flood water in the home, evacuation and disruption to essential services (incident management variables), perceived impact of the floods on finances, house values and perceived health concerns. Validated tools were used to assess psychosocial outcome (mental health symptoms): psychological distress (GHQ-12), anxiety (GAD-7), depression (PHQ-9) and probable post-traumatic stress disorder (PTSD checklist-shortform). Multivariable logistic regression was used to describe the association between water level in the home, psychological exposure variables and incident management variables, and each mental health symptom, adjusted for age, sex, presence of an existing medical condition, employment status, area and data collection method. Results The prevalence of all mental health symptoms was two to five-fold higher among individuals affected by flood water in the home. People who perceived negative impact on finances were more likely to report psychological distress (OR 2.5, 1.8-3.4), probable anxiety (OR 1.8, 1.3-2.7) probable depression (OR 2.0, 1.3-2.9) and probable PTSD (OR 3.2, 2.0-5.2). Disruption to essential services increased adverse psychological outcomes by two to three-fold. Evacuation was associated with some increase in psychological distress but not significantly for the other three measures. Conclusion The psychosocial and mental health impact of flooding is a growing public health concern and improved strategies for minimising disruption to essential services and financial worries need to be built in to emergency preparedness and response systems. Public Health Agencies should address the underlying predictors of adverse psychosocial and mental health when providing information and advice to people who are or are likely to be affected by flooding.
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Knowles E, O'Cathain A, Nicholl J. Patients' experiences and views of an emergency and urgent care system. Health Expect 2011; 15:78-86. [PMID: 21281414 DOI: 10.1111/j.1369-7625.2010.00659.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Surveys of patients' experiences and views of health care usually focus on single services. During an unexpected episode of ill health, patients may make contact with different services and therefore experience care within an emergency and urgent care system. We developed the Urgent Care System Questionnaire and used it to describe patients' experiences and views of an emergency and urgent care system in England. METHODS A market research company used quota sampling and random digit dialling to undertake a telephone survey of 1000 members of the general population in July 2007. RESULTS 15% (151/1000) of the population reported using the emergency and urgent care system in the previous 3 months. Two thirds of users (68%, 98/145) contacted more than one service for their most recent event, with a mean of 2.0 services per event. Users entered the system through a range of services: the majority contacted a daytime GP in the first instance (59%, 85/145), and 12% (18/145) contacted either a 999 emergency ambulance or an emergency department. Satisfaction with all aspects of care diminished when four or more services had been contacted. CONCLUSIONS This is the first study to describe patients' experiences and views of the emergency and urgent care system. The majority of patients experienced a system of care rather than single service care. There was an indication that longer pathways resulted in lower levels of patient satisfaction. Health care organisations can undertake similar surveys to identify problems with their system or to assess the impact of changes made to their system.
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Affiliation(s)
- Emma Knowles
- Medical Care Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK.
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Assessing public health risk in the London polonium-210 incident, 2006. Public Health 2010; 124:313-8. [PMID: 20542303 DOI: 10.1016/j.puhe.2010.03.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 02/10/2010] [Accepted: 03/23/2010] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Mr Alexander Litvinenko died in a London hospital on 23 November 2006, allegedly from poisoning with the radionuclide polonium-210 ((210)Po). Associated circumstances required an integrated response to investigate the potential risk of internal contamination for individuals exposed to contaminated environments. STUDY DESIGN Descriptive study. METHODS Contaminated locations presenting a potential risk to health were identified through environmental assessment by radiation protection specialists. Individuals connected with these locations were identified and assessed for internal contamination with (210)Po. RESULTS In total, 1029 UK residents were identified, associated with the 11 most contaminated locations. Of these, 974 were personally interviewed and 787 were offered urine tests for (210)Po excretion. Overall, 139 individuals (18%) showed evidence of probable internal contamination with (210)Po arising from the incident, but only 53 (7%) had assessed radiation doses of 1mSv or more. The highest assessed radiation dose was approximately 100mSv. CONCLUSIONS Although internal contamination with (210)Po was relatively frequent and was most extensive among individuals associated with locations judged a priori to pose the greatest risk, a high degree of assurance could be given to UK and international communities that the level of health risk from exposure to the radionuclide in this incident was low.
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Nemhauser JB. The polonium-210 public health assessment: the need for medical toxicology expertise in radiation terrorism events. J Med Toxicol 2010; 6:355-9. [PMID: 20499224 PMCID: PMC3550481 DOI: 10.1007/s13181-010-0090-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jeffrey B Nemhauser
- Radiation Studies Branch, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mail Stop F-58, Atlanta, GA 30341, USA.
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Dickmann P, Rubin GJ, Gaber W, Wessely S, Wicker S, Serve H, Gottschalk R. New influenza A/H1N1 ("swine flu"): information needs of airport passengers and staff. Influenza Other Respir Viruses 2010; 5:39-46. [PMID: 21138539 PMCID: PMC4941653 DOI: 10.1111/j.1750-2659.2010.00168.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Please cite this paper as: Dickmann et al. (2010) New Influenza A/H1N1 (“Swine Flu”): information needs of airport passengers and staff. . Influenza and Other Respiratory Viruses 5(1), 39–46. Background Airports are the entrances of infectious diseases. Particularly at the beginning of an outbreak, information and communication play an important role to enable the early detection of signs or symptoms and to encourage passengers to adopt appropriate preventive behaviour to limit the spread of the disease. Objectives To determine the adequacy of the information provided to airport passengers and staff in meeting their information needs in relation to their concerns. Methods At the start of the influenza A/H1N1 epidemic (29–30 April 2009), qualitative semi‐structured interviews (N = 101) were conducted at Frankfurt International Airport with passengers who were either returning from or going to Mexico and with airport staff who had close contact with these passengers. Interviews focused on knowledge about swine flu, information needs and fear or concern about the outbreak. Results The results showed that a desire for more information was associated with higher concern – the least concerned participants did not want any additional information, while the most concerned participants reported a range of information needs. Airport staff in contact with passengers travelling from the epicentre of the outbreak showed the highest levels of fear or concern, coupled with a desire to be adequately briefed by their employer. Conclusions Our results suggest that information strategies should address not only the exposed or potentially exposed but also groups that feel at risk. Identifying what information these different passenger and staff groups wish to receive will be an important task in any future infectious disease outbreak.
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Affiliation(s)
- P Dickmann
- Johann Wolfgang Goethe-University Frankfurt am Main, Germany
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Reassuring and managing patients with concerns about swine flu: qualitative interviews with callers to NHS Direct. BMC Public Health 2010; 10:451. [PMID: 20678192 PMCID: PMC2919480 DOI: 10.1186/1471-2458-10-451] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 08/02/2010] [Indexed: 11/28/2022] Open
Abstract
Background During the early stages of the 2009 swine flu (influenza H1N1) outbreak, the large majority of patients who contacted the health services about the illness did not have it. In the UK, the NHS Direct telephone service was used by many of these patients. We used qualitative interviews to identify the main reasons why people approached NHS Direct with concerns about swine flu and to identify aspects of their contact which were reassuring, using a framework approach. Methods 33 patients participated in semi-structured interviews. All patients had telephoned NHS Direct between 11 and 14 May with concerns about swine flu and had been assessed as being unlikely to have the illness. Results Reasons for seeking advice about swine flu included: the presence of unexpectedly severe flu-like symptoms; uncertainties about how one can catch swine flu; concern about giving it to others; pressure from friends or employers; and seeking 'peace of mind.' Most participants found speaking to NHS Direct reassuring or useful. Helpful aspects included: having swine flu ruled out; receiving an alternative explanation for symptoms; clarification on how swine flu is transmitted; and the perceived credibility of NHS Direct. No-one reported anything that had increased their anxiety and only one participant subsequently sought additional advice about swine flu from elsewhere. Conclusions Future major incidents involving other forms of chemical, biological or radiological hazards may also cause large numbers of unexposed people to seek health advice. Our data suggest that providing telephone triage and information is helpful in such instances, particularly where advice can be given via a trusted, pre-existing service.
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O'Cathain A, Knowles E, Nicholl J. Testing survey methodology to measure patients' experiences and views of the emergency and urgent care system: telephone versus postal survey. BMC Med Res Methodol 2010; 10:52. [PMID: 20534151 PMCID: PMC2905427 DOI: 10.1186/1471-2288-10-52] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 06/09/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To address three methodological challenges when attempting to measure patients' experiences and views of a system of inter-related health services rather than a single service: the feasibility of a population survey for identifying system users, the optimal recall period for system use, and the mode of administration which is most feasible and representative in the context of routine measurement of system performance. METHODS Postal survey of a random sample of 900 members of the general population and market research telephone survey of quota sample of 1000 members of the general population. RESULTS Response rates to the postal and market research telephone population surveys were 51% (457 out of 893 receiving the questionnaire) and 9% (1014 out of 11924 contactable telephone numbers) respectively. Both surveys were able to identify users of the system in the previous three months: 22% (99/457) of postal and 15% (151/1000) of telephone survey respondents. For both surveys, recall of event occurrence reduced by a half after four weeks. The telephone survey more accurately estimated use of individual services within the system than the postal survey. Experiences and views of events remained reasonably stable over the three month recall time period for both modes of administration. Even though the response rate was lower, the telephone survey was more representative of the population, was faster and cheaper to undertake, and had fewer missing values. CONCLUSIONS It is possible to identify users of a health care system using a population survey. A recall period of three months can be used to estimate experiences and views but one month is more accurate for estimating use of the system. A quota sample market research telephone survey gives a low response rate yet is more representative and accurate than a postal survey of a random sample of the population.
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Affiliation(s)
- Alicia O'Cathain
- Medical Care Research Unit, School of Health and Related Research, University of Sheffield, Regent Street, Sheffield S1 4DA, UK.
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The international follow-up of individuals potentially exposed to polonium-210 in London 2006. Public Health 2010; 124:319-25. [PMID: 20580977 DOI: 10.1016/j.puhe.2010.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 02/15/2010] [Accepted: 03/11/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Following a death from polonium-210 ((210)Po), contamination was found at several sites in London. This paper describes the UK Health Protection Agency's follow-up and assessment of individuals resident overseas who were potentially exposed to (210)Po. STUDY DESIGN Descriptive follow-up study. METHODS Individuals were classified into three exposure groups (higher, lower and unknown). Presence and degree of internal contamination were measured by 24-h urinary (210)Po activity (mBq/day). Results over 30mBq/day were taken to indicate probable contact with (210)Po in this incident. Dose assessments were conducted to determine degree of exposure and to identify individuals requiring further follow-up. RESULTS Overall, 664 potentially exposed persons from 52 countries and territories were identified. Of these, 157 (24%) were in the higher exposure category, and urinary measurements were reported for 31% (48/157). Results for 19% (9/48) of those at higher exposure were more than 30mBq/day. For those at lower exposure, the percentage was 4% (3/68). Results above 30mBq/day were significantly more likely to be reported for the higher exposure category than the lower exposure category (Fisher's exact test P=0.010). Reported dose assessments suggested that identified individuals were not at increased health risk in the long term. Challenges and practical lessons were identified during the investigation. CONCLUSION The results suggest that it is unlikely that any overseas resident had significant internal contamination with (210)Po. However, this incident clearly demonstrated the scale of international involvement likely to be necessary in other public health emergencies in large cities. The lessons identified have implications for the international health community, particularly with regard to the follow-up of individuals exposed to radiation in one country who then travel to another.
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Taylor-Robinson D, Elders K, Milton B, Thurston H. Students' attitudes to the communications employed during an outbreak of meningococcal disease in a UK school: a qualitative study. J Public Health (Oxf) 2009; 32:32-7. [PMID: 19675024 DOI: 10.1093/pubmed/fdp080] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Following an outbreak of meningococcal disease in a school in the North West of England, the communication methods employed by the Health Protection Agency (HPA) were evaluated in order to explore ways of improving communication with the public. METHODS Qualitative questionnaires were distributed to Year 12 (sixth form) students. The Framework approach was used to analyse the data, which were coded, and emergent themes identified. RESULTS In the absence of clear communication from official sources, many participants suggested that circulating rumours caused confusion and anxiety in the student population. Rumours were spread through informal networks in person or through text and MSN messaging. It was generally perceived that accurate information in this period would have been useful to allay potentially unfounded anxiety. Most students surveyed reported that they were sufficiently aware of the situation prior to receiving official announcements. The information provided by the HPA through the school was generally perceived as being useful, but it came too late. CONCLUSION In outbreak situations, rumours will spread rapidly in the absence of early communication, and this can be a significant cause of anxiety. The use of digital communication strategies should be considered, since they can seed dependable information that will disseminate rapidly through peer groups.
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Affiliation(s)
- David Taylor-Robinson
- Division of Public Health, School of Population, Community and Behavioural Sciences, University of Liverpool, Liverpool L69 3GB, UK.
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Rubin GJ, Amlôt R, Page L, Wessely S. Public perceptions, anxiety, and behaviour change in relation to the swine flu outbreak: cross sectional telephone survey. BMJ 2009; 339:b2651. [PMID: 19574308 PMCID: PMC2714687 DOI: 10.1136/bmj.b2651] [Citation(s) in RCA: 654] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess whether perceptions of the swine flu outbreak predicted changes in behaviour among members of the public in England, Scotland, and Wales. DESIGN Cross sectional telephone survey using random digit dialling. SETTING Interviews by telephone between 8 and 12 May. PARTICIPANTS 997 adults aged 18 or more who had heard of swine flu and spoke English. MAIN OUTCOME MEASURES Recommended change in behaviour (increases in handwashing and surface cleaning or plans made with a "flu friend") and avoidance behaviours (engaged in one or more of six behaviours such as avoiding large crowds or public transport). RESULTS 37.8% of participants (n=377) reported performing any recommended behaviour change "over the past four days . . . because of swine flu." 4.9% (n=49) had carried out any avoidance behaviour. Controlling for personal details and anxiety, recommended changes were associated with perceptions that swine flu is severe, that the risk of catching it is high risk, that the outbreak will continue for a long time, that the authorities can be trusted, that good information has been provided, that people can control their risk of catching swine flu, and that specific behaviours are effective in reducing the risk. Being uncertain about the outbreak and believing that the outbreak had been exaggerated were associated with a lower likelihood of change. The strongest predictor of behaviour change was ethnicity, with participants from ethnic minority groups being more likely to make recommended changes (odds ratio 3.2, 95% confidence interval 2.0 to 5.3) and carry out avoidance behaviours (4.1, 2.0 to 8.4). CONCLUSIONS The results support efforts to inform the public about specific actions that can reduce the risks from swine flu and to communicate about the government's plans and resources. Tackling the perception that the outbreak has been "over-hyped" may be difficult but worthwhile. Additional research is required into differing reactions to the outbreak among ethnic groups.
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Affiliation(s)
- G James Rubin
- King's College London, Institute of Psychiatry, Department of Psychological Medicine, Weston Education Centre, London SE5 9RJ.
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Rubin GJ, Amlôt R, Page L, Wessely S. Methodological challenges in assessing general population reactions in the immediate aftermath of a terrorist attack. Int J Methods Psychiatr Res 2008; 17 Suppl 2:S29-35. [PMID: 19035438 PMCID: PMC6879084 DOI: 10.1002/mpr.270] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Assessing mental health needs following a disaster is important, particularly within high-risk groups such as first responders or individuals who found themselves directly caught up in the incident. Particularly following events involving widespread destruction, ingenuity and hard work are required to successfully study these issues. When considering responses among the general population following less devastating events such as a conventional terrorist attack, or following an event involving a chemical, biological, radiological or nuclear agent, other variables may become more relevant for determining the population's overall psychosocial well-being. Trust, perceived risk, sense of safety, willingness to take prophylaxis and unnecessary attendance at medical facilities will all be important in determining the overall psychological, medical, economic and political impact of such attacks. Assessing these variables can help government agencies and non-governmental organizations to adjust their communication and outreach efforts. As there is often a need to provide these data quickly, telephone surveys using short time-windows for data collection or which use quota samples are often required. It is unclear whether slower, more conventional and more expensive survey methods with better response rates would produce results different enough to these quicker and cheaper methods to have a major impact on any resulting policy decisions. This empirical question would benefit from further study.
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Affiliation(s)
- G James Rubin
- King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, UK.
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Abstract
Disasters, whether man-made or naturally occurring, require complex responses across multiple government agencies and private sector elements, including the media. These factors mandate that, for effective disaster management and because of the unpredictability of such events, response structures must be in place in advance, ready to be activated on short notice, with lines of responsibility clearly delineated and mechanisms for coordination of efforts already established. Disaster response experiences in the USA and the UK were reviewed at a conference convened by the New York Academy of Medicine and the Royal Society of Medicine in June 2007. Lessons to be drawn from these comparisons were sought. The importance of careful advance planning, clear delineation of spheres of responsibility and response roles, effective mechanisms for communication at all levels, and provision for adequate communication with the public were all identified as key elements of effective response mechanisms.
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Abstract
Providing detailed, comprehensible, and relevant health information is essential
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