Emotional determinants of public responses to the risk of epidemics and pandemics: a systematic review (preprint)

Background: Understanding how people’s emotions influence their health decisions and behaviours at a population level is fundamental to designing effective communication strategies and public health interventions for infectious disease outbreaks. This review identifies relevant research to assess the role of emotional determinants and their impact on public responses to the risk of infectious disease outbreaks, specifically in relation to the uptake of public health interventions. Methods A comprehensive systematic review was conducted exploring the differences in public responses by emotion, infection, outcome and region. A basic consensus approach was followed in which emotional stimuli were categorised as being either pleasant or unpleasant, and predisposing people to bivalent behaviour ( i.e. , approach or withdrawal). All primary research studies published in five global databases between 1988-2019 were eligible for inclusion. Binomial tests (against a test proportion of 0.5 or 50% for each study outcome) were performed using the direction of effect observed in each study, i.e. , either favouring or not favouring intervention uptake. Results A total of 75 studies from 28 different nations were eligible for inclusion in the review. A total of 97 correlations were made between 12 emotions, 10 infectious diseases, and the uptake of seven types of public health interventions. Unpleasant emotions were evoked much more often than pleasant following public health risk communications, with fear and anxiety being the most common. Overall, moderate anxiety-related emotions (worry, anxiety, stress, concern) seemed to be much more significant motivators for public action compared to extreme unpleasant emotions (fear, panic, hopelessness, shame), which had a statistically significantly negative effect on the uptake of public health interventions in several cases. Pleasant emotions (empathy, hope) also showed promise as motivators for public health intervention uptake, but more research is needed to corroborate this. Conclusions The results of this review show that the public’s emotional responses to epidemics in the past 30 years have played a clear role in determining how successful the rollout of public health interventions has been. Emotions need to be considered in crisis communications, and these research findings can help inform communications strategies in the evolving context of the COVID-19 pandemic and future infectious disease outbreaks.

Willingness and Uptake of the COVID-19 Testing and Vaccination in Urban China: An Online Cross-Sectional Survey at Early 2021 (preprint)

Background: Regular testing and vaccination are effective measures to mitigate the ongoing COVID-19 pandemic. Few studies have focused on COVID-19 testing and vaccination uptake may change as the pandemic continues. This study aims to examine willingness and uptake of COVID-19 testing and vaccination during a low-risk period of the COVID-19 pandemic in urban China. Methods: : A cross-sectional online survey was conducted among 2244 adults in urban China. Descriptive analyses were performed to compare the respondents’ willingness and uptake of COVID-19 testing and vaccination. Multivariate logistic regressions were fitted to investigate the factors associated with willingness and uptake of the two measures. Findings: In early 2021, 52.45% of the respondents had received or scheduled a COVID-19 test at least once, and a majority (95.63%) were willing to receive testing. 63.28% of the respondents had received/scheduled or were willing to receive a COVID-19 vaccine. Willingness and uptake of COVID-19 testing were not associated with socio-demographic characteristics, except for occupation. Being of older age, migrants, having higher educational attainment and secure employment were associated with a higher uptake of COVID-19 vaccination among the surveyed respondents, while willingness to vaccinate was consistent across socio-demographic characteristics among those who had not been vaccinated. Interpretation: Chinese adults expressed almost universal willingness of COVID-19 testing and relatively low willingness of COVID-19 vaccination at the low-risk period of the COVID-19 pandemic, independent from their socio-demographic characteristics. Maintaining willingness of COVID-19 vaccination are key especially when the pandemic evolved into a low-risk period.

Willingness and Uptake of the COVID-19 Testing and Vaccination in Urban China: An Online Cross-Sectional Survey at Early 2021 (preprint)

Background: Regular testing and vaccination are effective measures to mitigate the ongoing COVID-19 pandemic. Few studies have focused on COVID-19 testing and vaccination uptake may change as the pandemic continues. This study aims to examine willingness and uptake of COVID-19 testing and vaccination during a low-risk period of the COVID-19 pandemic in urban China.Methods: A cross-sectional online survey was conducted among 2244 adults in urban China. Descriptive analyses were performed to compare the respondents’ willingness and uptake of COVID-19 testing and vaccination. Multivariate logistic regressions were fitted to investigate the factors associated with willingness and uptake of the two measures.Findings: In early 2021, 52.45% of the respondents had received or scheduled a COVID-19 test at least once, and a majority (95.63%) were willing to receive testing. 63.28% of the respondents had received/scheduled or were willing to receive a COVID-19 vaccine. Willingness and uptake of COVID-19 testing were not associated with socio-demographic characteristics, except for occupation. Being of older age, migrants having higher educational attainment and secure employment were associated with a higher uptake of COVID-19 vaccination among the surveyed respondents, while willingness to vaccinate was consistent across socio-demographic characteristics among those who had not been vaccinated.Interpretation: Chinese adults expressed almost universal willingness of COVID-19 testing and relatively low willingness of COVID-19 vaccination at the low-risk period of the COVID-19 pandemic, independent from their socio-demographic characteristics. Maintaining willingness of COVID-19 vaccination are key especially when the pandemic evolved into a low-risk period.Funding Information: ZH acknowledges financial support from the National Natural Science Foundation of China (No. 71874034) and the Three-Year Initiative Plan for Strengthening Public Health System Construction in Shanghai (2020-2022) (GWV-10.1-XK23). Declaration of Interests: None.Ethics Approval Statement: The study was approved by the Institutional Review Board of the School of Public Health, Fudan University (IRB#2020-12-0861). Respondents provided e-consent for their participation in the survey.

Confidence, Acceptance and Willingness to Pay for the COVID-19 Vaccine Among Migrants in Shanghai, China: A Cross-Sectional Study (preprint)

Background: Vaccine hesitancy became one of the top ten threats to global health. This study aimed to assess the acceptance and willingness to pay (WTP) for COVID-19 vaccine among migrants in Shanghai, China.Methods: A cross-sectional study was conducted among 2,126 migrants in Shanghai during November 1-20th, 2020. A questionnaire was used to measure confidence in, acceptance of and WTP for COVID-19 vaccine. Multivariable (ordered) logistic regressions were used to examine factors associated with acceptance and WTP of COVID-19 vaccine.Findings: Most (89.1%) migrants stated that they would accept COVID-19 vaccination. Over 90.0% migrants perceived COVID-19 vaccine as important, while only 75.0% and 77.7% perceived vaccines safe and effective. Socio-demographic factors were not significantly associated with vaccine acceptance, but confidence in the importance, safety and effectiveness of COVID-19 vaccine was significantly associated with vaccine acceptance. The top reasons for vaccine hesitancy were lack of vaccine information and confidence. Proportion of those definitely willing to get COVID-19 vaccine was 20% lower if paid by themselves than free vaccination. Migrants were willing to pay a median amount of US$ 46 for COVID-19 vaccine.Interpretation: A high acceptance of COVID-19 vaccine was universal among migrants in Shanghai, China. Concerns about vaccine safety and effectiveness as well as high costs of the COVID-19 vaccine may hinder their uptake in the future. Effective health communication to build confidence in the COVID-19 vaccine and subsidies toward the prohibitive costs of these vaccines are needed to improve uptake.Funding: National Natural Science Foundation of China (No. 71874034).Declaration of Interests: We declare no competing interests.Ethics Approval Statement: This study was approved by Ethics Committee at the Fudan University School of Public Health [IRB#2020-12-0861].

Parenting and Emotional and Behavioral Responses of Children and Adolescents to the COVID-19 Epidemic: A Cross-sectional Survey in China (preprint)

To investigate parenting and children’s emotional and lifestyle responses to the COVID-19 epidemic, we conducted an online survey of random, representative sample of residents with children aged 3–17 years in mid-March, 2020 in China. 1655 parents were surveyed with 80.1% response rate. During the epidemic, half (49%) of children had stress symptoms and 10% had emotional problems; children had higher screen time, less exercise and worse sleep than before. Socially disadvantaged children were more vulnerable to the epidemic. Children whose parents communicated about the epidemic more frequently, who had irritable parents and experienced worse parent-child closeness had higher probabilities of emotional problems, stress symptoms and worse lifestyles. Improve parenting skills and communication quality is necessary during the epidemic.