Knowledge, perceptions and media use of the Dutch general public and healthcare workers regarding Ebola, 2014.

BACKGROUND: The Ebola outbreak in West-Africa triggered risk communication activities to promote adequate preventive behaviour in the Netherlands. Our study investigated the level of knowledge, perceptions, and media use regarding Ebola. METHODS: In December 2014, an online questionnaire was administered to the Dutch population (n = 526) and Health Care Workers (HCW) (n = 760). RESULTS: The mean knowledge score (range 0-15) of HCW (m = 13.3;SD = 1.4) was significantly higher than the general public (m = 10.8;SD = 2.0). No significant difference was found in perceived severity and susceptibility. Perceived fear of the general public (m = 2.5; SD = 0.8) was significantly higher than among HCW (m = 2.4; SD = 0.7). Respondents primarily used television to obtain information. CONCLUSIONS: While Ebola was perceived severe, it did not lead to excessive fear or perceived susceptibility for developing the disease. Nonetheless, our research showed that knowledge with respect to human-to-human transmission is low, while this is crucial to complying with preventive measures. Our study reveals priorities for improving risk communication.

Perceptions and behavioral responses of the general public during the 2009 influenza A (H1N1) pandemic: a systematic review.

The public plays an important role in controlling the spread of a virus by adopting preventive measures. This systematic literature review aimed to gain insight into public perceptions and behavioral responses to the 2009 influenza A (H1N1) pandemic, with a focus on trends over time and regional differences. We screened 5498 articles and identified 70 eligible studies from PubMed, Embase, and PsychINFO. Public misconceptions were apparent regarding modes of transmission and preventive measures. Perceptions and behaviors evolved during the pandemic. In most countries, perceived vulnerability increased, but perceived severity, anxiety, self-efficacy, and vaccination intention decreased. Improved hygienic practices and social distancing were practiced most commonly. However, vaccination acceptance remained low. Marked regional differences were noted. To prevent misconceptions, it is important that health authorities provide up-to-date information about the virus and possible preventive measures during future outbreaks. Health authorities should continuously monitor public perceptions and misconceptions. Because public perceptions and behaviors varied between countries during the pandemic, risk communication should be tailored to the specific circumstances of each country. Finally, the use of health behavior theories in studies of public perceptions and behaviors during outbreaks would greatly facilitate the development of effective public health interventions that counter the effect of an outbreak.

Developing requirements for a mobile app to support citizens in dealing with ticks and tick bites via end-user profiling.

Tick bites and tick-borne infections are an increasingly large problem. There is a wide range of precautions that citizens can take, but compliance is low. Mobile technology can offer a solution here, as they allow citizens to access health information in context. In this article, we discuss the development of requirements for a mobile app to support citizens in dealing with ticks and tick bites. First, we identified organizational stakeholders based on relevant protocols, and primary end-users via a systematic risk determination procedure. Then, we profiled end-users based on 25 in-depth interviews. We consulted organizational stakeholders via a focus group. The mobile app should primarily motivate citizens to check themselves for tick bites after visiting a risk area. The app should also include a tick radar, alerts to remind people to check for tick bites, and the possibility to document tick bites. Our experiences underline the necessity of thoroughly investigating the designated end-users and their context of use in order to tailor preventive health advice, and we demonstrate how this can be done. Finally, this case shows the need to create persuasive health technology in order to maximize citizen compliance.

Determinants and protective behaviours regarding tick bites among school children in the Netherlands: a cross-sectional study.

BACKGROUND: Lyme borreliosis (LB) is the most common tick-borne disease in the United States and Europe. The incidence is 13.4 per 100,000 inhabitants in the United States and more than 300 per 100,000 inhabitants in Europe. Children are at highest risk of LB. In the Netherlands in 2007, the incidence of tick bites in children between 10-14 years varied from 7,000 -11,000 per 100,000, depending on age. This study among Dutch school children aimed to examine the knowledge, perceived threat, and perceived importance of protective behaviour in relation to tick bites and their potential consequences. METHODS: In April 2012, the municipal health services (MHS) contacted primary schools to recruit children 9-13 years by telephone, e-mail, or advertisement in MHS newsletters. In total, 1,447 children from 40 schools participated in this study by completing a specifically developed and pretested compact paper questionnaire. Regression models were used to determine which covariates (e.g. forest cover, previous education, knowledge) are associated with our response variables. RESULTS: 70% (n = 1,015) of the children answered at least six out of seven knowledge questions correctly. The vast majority (93%; n = 1345) regarded body checks as very or somewhat important, 18% (n = 260) was routinely checked by their parents. More frequent body checks were associated with good knowledge about ticks and tick-borne diseases and knowing persons who got ill after tick bite. Children in areas with a higher forest cover were more likely to be checked frequently. CONCLUSIONS: Most children have a good knowledge of ticks and the potential consequences of tick bites. Knowing persons who personally got ill after tick-bite is associated with a good knowledge score and leads to higher susceptibility and better appreciation of the need for body checks. Perceived severity is associated with a good knowledge score and with knowing persons who got ill after tick-bite. Is seems to be useful to additionally address children in health education regarding ticks and tick-borne diseases. The relationship between health education programs for children (and their parents) about ticks and their possible consequences and prevention of these deserves further study.

Why mobile health app overload drives us crazy, and how to restore the sanity.

BACKGROUND: Smartphones and tablet computers have become an integral part of our lives. One of their key features is the possibility of installing third-party apps. These apps can be very helpful for improving health and healthcare. However, medical professionals and citizens are currently being overloaded with health apps. Consequently, they will have difficulty with finding the right app, and information and features are fragmented over too many apps, thereby limiting their usefulness. DISCUSSION: In order to combat health app overload, suppliers of apps need to do three things. One, join the open source movement, so that a few apps can work as gateway to medical information by incorporating information from different sources. Two, standardize content, so that the information provided via apps is readable. And third, in order to prevent information overload from occurring within an app, content should be personalized towards an individual's characteristics and context. SUMMARY: Suppliers of medical information and features need to join the open source movement and must make use of standardized medical information formats, in order to allow third parties to create valuable, mobile gateway apps. This can prevent the occurrence of health app overload. By going along in these trends, we can make health apps achieve the impact on healthcare quality and citizens' health many of us envision.

Should health organizations use web 2.0 media in times of an infectious disease crisis? An in-depth qualitative study of citizens' information behavior during an EHEC outbreak.

BACKGROUND: Web 2.0 media (eg, Facebook, Wikipedia) are considered very valuable for communicating with citizens in times of crisis. However, in the case of infectious disease outbreaks, their value has not been determined empirically. In order to be able to take full advantage of Web 2.0 media in such a situation, the link between these media, citizens' information behavior, and citizens' information needs has to be investigated. OBJECTIVE: The goal of our study was to assess citizens' Web 2.0 media use during an infectious disease outbreak and to determine which Web 2.0 medium is used for which goal. With this information, we wanted to formulate recommendations for health organizations that consider using Web 2.0 media as part of their communication strategy during an infectious disease outbreak. METHODS: A total of 18 student participants kept an information diary for 4 weeks during the 2011 enterohemorrhagic E. coli (EHEC) outbreak in Germany. Of them, 9 lived at the epicenter of the outbreak and 9 of them at some distance. The diaries were supplemented by a qualitative pre-survey (demographics) and postsurvey (questioning their satisfaction with information provision during the outbreak). RESULTS: The Internet appeared to be the most popular medium for passively receiving EHEC-related information, with news websites and websites of newspapers as the most consulted sources. Twitter was used for receiving information to a small degree, while Facebook played virtually no role. Participants indicated that they thought information posted on Twitter or Facebook was not reliable or was out of place. When actively seeking information, online newspapers and wikis were important sources. Several causes for (dis)satisfaction with information provision were uncovered: source credibility, contradicting messages, and a need for closure. CONCLUSIONS: During an infectious disease outbreak, our small sample of students did not see social media (like Facebook and Twitter) as suitable or reliable sources for communicating information, but primarily viewed them as a tool for communicating with friends. Wikis, however, did fill several information needs, especially when citizens are actively searching for information. For many, source credibility is an important asset of information usefulness. Finally, we provide several general recommendations for communicating with citizens during an infectious disease outbreak.

Why did patients with cardiovascular disease in the Netherlands accept Q fever vaccination?

This study examines patient's reasons for accepting Q fever vaccination, including risk perception, feelings of doubt, social influence, information-seeking behavior, preventive measures taken, and perceptions regarding received information and governmental action. Data was obtained from exit interviews conducted after Q fever vaccination, between January and April 2011. A total of 413 patients with specific cardiovascular conditions in the Netherlands participated in exit interviews; 70% were older than 60 years. Most reported reasons for accepting Q fever vaccination were: "I am at an increased risk for developing (chronic) Q fever" (69%) and "my general practitioner recommends Q fever vaccination for me" (34%). The majority (86%) reported a high perceived severity of Q fever, and only 6% felt vulnerable to Q fever after vaccination. One-third had doubts about getting vaccinated, primarily related to fears of side effects and practical barriers. Fifty-two percent solicited advice from their social networks; of these, 67% reported influence on their vaccination decision. General practitioners and family were the most reported sources of advice. Thirty percent actively sought information about Q fever vaccination. Twenty-two percent of all respondents had taken other preventive measures, such as avoiding contact with goats and sheep (74%), and cancelling or postponing visits to Q fever-affected areas (36%). Almost one-half of all respondents reported negative feelings regarding governmental action to control Q fever. Significant differences were observed regarding feelings of doubt, information-seeking behavior, perceived vulnerability, preventive measures taken, and perceptions regarding received information and governmental action regarding gender, age, educational level, and/or employment status. Vaccination decision-making may differ among socio-demographic subgroups. When preparing future vaccination campaigns, it is important to obtain greater insight into these differences and take these aspects into account in risk communication strategies by tailoring information to specific target groups.

Pandemic influenza A (H1N1) vaccination in The Netherlands: parental reasoning underlying child vaccination choices.

INTRODUCTION: During the 2009 influenza A (H1N1) pandemic, parents in the Netherlands were recommended to vaccinate healthy children between six months and five years of age. The aim of this study was to examine reasons for (non-)acceptance, risk perception, feelings of doubt and regret, influence of the social network, and information-seeking behavior of parents who accepted or declined H1N1 vaccination. METHODS: Data on accepters were collected via exit interviews following the second-dose vaccination round in December 2009 (n=1227). Data on decliners were gathered in June and July 2010 with questionnaires (n=1900); 25 parents participated in in-depth interviews. RESULTS: The most reported reasons for parental acceptance of H1N1 vaccination were "I don't want my child to become sick" (43%), "Mexican flu can be severe" (10%), "the government advises it, so I do it" (6%), and "if I don't do it, I will regret it" (6%). The most reported reasons declining the vaccination were "fear of side effects/harmful consequences" (51%), "just having a bad feeling about it" (46%), and "the vaccine was not thoroughly tested" (39%). More decliners than accepters experienced feelings of doubt about the vaccination decision (decliners 63% versus accepters 51%, p<0.001), and decliners reported more often information-seeking behavior (decliners 76% versus accepters 56%, p<0.001). Decliners more frequently solicited advice from their social network than accepters (decliners 72% versus accepters 61%, p<0.001). Furthermore, accepters more often reported social influence on their vaccination decision (accepters 58% versus decliners 38%, p<0.001) and experienced more negative feelings after their vaccination decision (accepters 8% versus decliners 2%, p<0.001). Immigrant accepters and decliners more often had feelings of doubt and regret about the vaccination decision, solicited advice more often from their social network, and were more often influenced by this advice compared to native Dutch parents. CONCLUSION: To optimize response rates in future vaccination campaigns, health authorities should provide more information on vaccine benefits and possible risks, tailoring this information to specific risk groups. Health authorities should also invest in the development and implementation of effective vaccine risk/benefit communication tools.

Risks, trust and knowledge: determinants of pregnant women's decisions regarding participation in a future Q fever screening and treatment program during a large epidemic in The Netherlands.

OBJECTIVE: Contracting Q fever during pregnancy carries a risk of developing obstetric complications. The aim of this study was to gain insight into pregnant women's decisions regarding participation in a future Q fever screening and treatment program. METHODS: Pregnant women (N = 148) in Q fever high-risk areas in The Netherlands were recruited via midwives' practices and via an online panel for a cross-sectional questionnaire survey. The outcome measures included intention to participate in the program, Q fever exposure risk, perceived Q fever risk, trust in health professionals and authorities, disease-related knowledge and additional outcome measures. RESULTS: Fifty-six percent of the respondents intended to participate in the screening and treatment program. The sole determinant of a higher intended program uptake was a more positive appraisal of program efficacy and convenience. This appraisal was in turn associated with perceived risk and knowledge. CONCLUSION: Women's appraisal of program efficacy and convenience, their disease-related knowledge and perceived Q fever risk seem to be crucial for their intended program uptake. A successful implementation of a Q fever screening and treatment program may thus depend on the benefits and downsides of the program, and on securing that women are aware of the risks of the disease.

[Mexican flu: risk perception in the general public, precautionary measures and trust in information provided by the government]. / Mexicaanse griep: risicoperceptie bij de bevolking, eigen maatregelen en vertrouwen in overheidsinformatie.

OBJECTIVE: To gain insight into how the Dutch general public viewed the risk during the course of the recent pandemic, into how many and which people took precautionary measures, and into the extent to which people trust the information provided by the government. DESIGN: Online survey, cross-sectional (the first two measurements) and follow-up investigations (the last two measurements). METHOD: Between 10 and 17 November 2009, 754 people completed the online questionnaire. Earlier survey rounds were held in May (n = 572), June (n = 620) and August (n = 934). RESULTS: In November 2009, 38% of respondents considered the Mexican flu a serious disease and 36% viewed themselves as vulnerable to this flu. Feelings of anxiety had decreased versus earlier survey rounds. Of the respondents, 73% took precautionary measures against the disease. This concerned mainly hygiene measures, which were most frequently taken by people who were anxious, found hygiene measures effective, paid considerable attention to the media information on flu, and found information from the government reliable and those without children living at home. More than fifty percent (58%) of respondents indicated that they would be willing to have the vaccination if they would be eligible for this. Of the other 315 respondents, 40% indicated that they feared serious side effects, 35% that they doubted the effectiveness of the vaccine and 33% that they considered the vaccine to be insufficiently tested. Almost half of the respondents had read the information leaflet 'Fight the flu', which was sent to every home in the country. One third had seen the television campaign. Governmental institutions, notably the Ministry of Health, Welfare and Sport and the National Institute for Public Health and the Environment, were the most important sources of information and more than half of the respondents trusted this information. CONCLUSION: During the course of the 2009 influenza A (H1N1) pandemic, anxiety among the Dutch general public decreased progressively, while people increasingly considered themselves more vulnerable to the flu. The public therefore had a realistic view of the situation. Three quarters of the general public had taken precautionary measures against the flu. More than fifty percent would be willing to have the vaccination if they would be eligible for this. The most important reason for not wanting the vaccination was fear of serious side effects and doubts about the effectiveness of the vaccine. This is a point of attention for the development of public information campaigns about vaccinations in the future.

[Mexican flu: public reaction to news coverage measured using an internet panel]. / De Mexicaanse griep: reacties van het publiek op de berichtgeving, gemeten met een internetpanel.

OBJECTIVE: To determine the reaction of the general public on the information regarding the Mexican flu. DESIGN: Online panel interview. METHOD: From April 30 to May 4 2009, 572 people filled out an online questionnaire. RESULTS AND CONCLUSION: 88% of the respondents had sufficient general knowledge about the Mexican flu. This information was mostly acquired by watching television (69%). More information was desired regarding the symptoms of the flu and those personal measures that could be taken to avoid infection.