sarscontrol wp5 risk perceptions survey report def · pdf file ·...

SARSControl: Effective and acceptable strategies for the control of SARS and new

emerging infections in China and Europe, a European Commission project funded

within the Sixth Framework Programme, Thematic Priority Scientific Support to

Policies, Contract number: SP22-CT-2004-003824

Work package 5: Risk Perceptions

Risk Perceptions Survey

I. Veldhuijzen, O. de Zwart, H. Voeten and J. Brug

Municipal Public Health Service Rotterdam Area, Rotterdam, The Netherlands

Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

August 2006

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Contents

Report 1 General description and international comparison

Introduction .............................................................................................................................................. 3 Methods ................................................................................................................................................... 5

Procedure and respondents................................................................................................................. 5 Questionnaire....................................................................................................................................... 5 Statistical analysis................................................................................................................................ 5

Results..................................................................................................................................................... 6 Response and general characteristics................................................................................................. 6 Risk perception .................................................................................................................................... 6 Knowledge ........................................................................................................................................... 7 Efficacy beliefs ..................................................................................................................................... 7 Information ........................................................................................................................................... 7 Associations ......................................................................................................................................... 7

Discussion ............................................................................................................................................... 8 Conclusion ............................................................................................................................................... 8 References .............................................................................................................................................. 9 Tables and graphs................................................................................................................................. 10 Report 2 Country reports

Country report 1 DENMARK…………………………………………………………………………. 23

Country report 2 POLAND .......……………………………………………………………………… 28

Country report 3 THE NETHERLANDS…………………………………………………………..… 33

Country report 4 GREAT BRITAIN………………………………………………………………….. 38

Country report 5 SPAIN………………………………………………………………………………. 43

Country report 6 CHINA ...…………………………………………………………………………… 48

Country report 7 HONG KONG……………………………………………………………………… 53

Country report 8 SINGAPORE………………………………………………………………………. 58

Annexe

Questionnaire………………………………………………………………………………………………….. 63

Explanation of diseases………………………………………………………………………………………. 73

List of definitions………………………………………………………………………………………………. 74

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Report 1


GENERAL DESCRIPTION AND

INTERNATIONAL COMPARISON




August 2006

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Introduction

Risk perceptions are regarded as an important determinant of protection motivation, especially in the early stages of behaviour change. Risk perception may especially influence behaviour when the risk is perceived to be acute, serious, when personal vulnerability is perceived as high and when people feel confident that they can indeed do something to avoid the risk. Risk perceptions are often biased and people may be unrealistically optimistic as well as unrealistically pessimistic about certain risks.(1,2) Optimism often occurs related to familiar risks that are perceived to be largely under volitional control.(3) Pessimism, sometimes leading to mass scares, is more likely to occur related to new risks that are perceived as largely uncontrollable.(4) Since unrealistic optimism may lead to a false feeling of security and unrealistic pessimism may result in unwarranted non-rational actions as well as stigmatisation, it is important to promote realistic risk perceptions in order to make a first step toward inducing effective precautionary behaviours among the populations. For SARS there is some preliminary evidence that three different phases occur in reaction to a SARS outbreak: − Early stage: neglecting protection; − Middle stage: over-fear: over protection, shopping rush, obsession, compulsivity, hypochondria,

discrimination towards SARS patients / suspected patients, avoiding healthcare settings; and − Late stage: off guard, discrimination towards recovered patients. To promote realistic risk perceptions, effective communication is essential.(5-7) People may use different information sources to learn about new health risks, such as government agencies, health officials, different popular media, the internet, as well as information from friends and acquaintances. In order for future procedures to be successful, the acceptability of the information and advice provided, and trust in the provider needs to be present. Successful implementation of future procedures depends on the public’s willingness to support public health interventions, and for that information needs to be clear and timely. Up to now, however, hardly any research has been done into risk perception and communication of infectious diseases (in contrast to research done on risk perception related to environmental risks, food scares and other potential adverse events and apart from research into risk perception of HIV). For an effective European public health policy, especially related to SARS and other expected possible future outbreaks of infectious diseases, it is crucial to have insight in risk perception and precautionary practices, as well as determinants of variance in these perceptions in order to be able to develop targeted communication strategies that induce effective precautionary behaviour of communities and thus can help limiting the effects of an outbreak of SARS or another infectious diseases. Workpackage 5 of the SARSControl study deals with risk perceptions of SARS and other infectious diseases in Europe and Asia. In this report we will describe the findings of the risk perceptions survey in 8 different countries that was part of the activities of workpackage 5. In the methods section the procedure, respondents, questionaire and statistical analyses are described. Overall results are presented and an international comparison is made for both SARS and influenza pandemic. The results for the individual countries are presented in 8 separate country reports.

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Methods Procedure and respondents Data were collected using Computer Assisted Telephone Interviewing (CATI). The telephone interviews were conducted by a company in the Netherlands and for a part of the Asian interviews by a company in Asia. The interviewers were all native speakers. Telephone numbers were created by random digit dialling (RDD). If unanswered, numbers were tried again up to five times and when possible call back appointments were made. Interviews were conducted from 20 September to 22 November 2005 in eight different countries, five in Europe representing regions in North, West, South and East Europe (Denmark, the Netherlands, Great Britain, Spain, and Poland) and three countries in East Asia (Singapore, China and Hong Kong). In China, the survey was conducted in the province of Guangdong. Respondents aged 18 to 75 were eligible to participate. To choose one eligible respondent within a household the last-birthday method was used but if the person with the last birthday was unavailable the person who was being spoken to was asked to participate. Questionnaire The questionnaire focused on risk perception of SARS, influenza and other (infectious) diseases, precautionary behaviour and use of information sources and took on average 16 minutes to complete. It was developed in English and translated in Dutch and pre tested in Great Britain and the Netherlands using cognitive interviewing. The translations into Danish, Dutch, Spanish, Polish, Mandarin and Cantonese were checked by native speakers. Respondents were asked for 9 different diseases (Diabetes, Common cold, HIV, High blood pressure, SARS, Tuberculosis, Heart attack, Flu from a new flu virus, Food poisoning) how serious it would be for them to get the disease in the next year (on a scale from 1 to 10). For each disease a short description was available for the interviewer to explain if the respondent did not know a disease. For SARS and flu from a new flu virus the explanation was always given to each respondent. The explanation for SARS was ‘SARS is a severe acute breathing related illness caused by a previously unkown virus’ and for flu ‘A new type of flu virus can arise from avian flu, it causes serious illness and spreads easily in the population’. Vulnerability was measured by asking how likely the respondent thought he or she was to get the diseases in the next year (scale very unlikely (1) to very likely (5)). For SARS and flu the question was asked a second time for the situation of an outbreak in the respondents country. To measure comparative risk perception it was asked how likely the respondent thought he or she was to get the diseases in the next year compared to other men/women of his/her age in the country (scale much less likely (1) to much more likely (5)). To measure response efficacy for SARS, flu and a common cold it was asked to what extent the respondent thought people in general could take actions to prevent getting these diseases in case of an outbreak (not at all, a little bit, quite a bit, definitely). For self efficacy the question was “how confident are you yourself that you can prevent getting flu from a new flu virus in case of an outbreak (not confident (1) to very confident (4)). A knowledge score was constructed based on three SARS knowledge questions. Questions on the use of and confidence in different sources of information were included and socio-demographics of the respondent. Statistical analysis Differences in the distribution of general characteristics (gender, age, area and education) between Europe and Asia were assessed with (linear) Chi-qsuare tests or t-tests. A measure of risk perception was constructed based on the perceived seriousness (scale 1-10) and vulnerability (scale 1-5). To make the scales comparable seriousness was first divided by 2 and then multiplied with vulnerability. To normalise the skewed distribution of the new variable a square root transformation was performed

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which resulted in a measure of risk perception on a scale from 1 (low) to 5 (high). Mean scores and standard deviations (SD) were calculated for seriousness, vulnerability, risk perception, comparative risk perception, response efficacy and self efficacy in the different countries and for all countries combined. Differences in mean scores between countries were tested pair wise with the Bonferroni post-hoc test in Univariate Analysis of Variance (ANOVA). General linear models were developed to predict risk perception for SARS and flu with country, gender and age group as dependent variables and including possible interactions between country and gender, country and age group, and sex and age group. Graphs of the predicted risk perception by sex and age group for the different countries, corrected for interaction effects were made. Associations of risk perceptions and response- and self-efficacy were tested with Pearsons correlation tests. Results Response and general characteristics In the European countries 16% of the numbers created by RDD could not be used (either a fax number or not a private number) and 26% of the numbers could not be reached after five times. 17.8% of the people reached by phone did not meet the inclusion criteria. Of the people eligible for participation 40.2% completed the interview and 59.8% refused. Participation rates varied from 21.3% in the UK, 34.3% in Spain, 43.7% in the Netherlands, 58.0% in Denmark to 81.1% in Poland. For the Asian countries limited participation rates are available as a large part of the interviews were conducted by an agency in Asia that did not collect information on participation. Of the people eligible for participation in Asia phoned by the Dutch agency 12.9% participated, 62.4% refused and 24.6% had a language problem. In total 3,436 respondents were interviewed. Data on background variables in the different participating countries are provided in Table 1. A majority of respondents was female (58%). European respondents were significantly older than Asian respondents (t=16,2; df=3351; p=0.000) Substantially more respondents in Asia lived in a city, due to the fact that both Hong Kong and Singapore were included (p<0.001). Asian respondents were higher educated than European respondents (p<0.001). Risk perception SARS was rated third on seriousness with a score of 8,3. A common cold was perceived least serious and HIV most serious. See table 2 and figure 1 for the mean and distribution of perceived seriousness for SARS and eight other diseases. 31% of respondents thought they were (very) likely to get SARS if there would be an outbreak of SARS in their country. The perceived vulnerabilty to SARS and flu from a new virus in case of an outbreak is high, only getting a common cold was perceived as more likely. See table 3 and figure 2 for the mean and distribution of perceived vulnerabilty for SARS and eight other diseases. Risk perception as a combination of perceived seriousness and vulnerability was highest for SARS and flu from a new flu virus, especially when people were asked to envision a situation of an outbreak. Risk perception for a common cold and HIV was low. See table 4 and figure 3 for the mean and distribution of risk perception for SARS and eight other diseases. When risk perceptions for SARS and two other diseases, high blood pressure and diabetes, were compared in the different countries, the pattern between diseases appear to be similar across countries although the levels of risk perception differ between countries. See figure 4. Comparative risk perception was measured by asking if the respondents thought they were less or more likely to get SARS compared to other people in their own country. In table 5 the mean and distribution of comparative risk perception for SARS and eight other diseases is given. In figure 5 comparative risk perception for SARS is shown for each country and varies from 1,7 in Denmark to 2,5 in Hong Kong on a scale from 1 to 5. This means that average respondents think that their risk is lower

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than that of compatriots. Figure 6 is similar to figure 5 but in the event of an outbreak of SARS in the country of residence; comparative risk perceptions are higher in that case. An optimistic bias in SARS risk perception was present as the proportion of people who think they are less likely to get SARS compared to others is bigger than the proportion of people thinking they are more likely. To asses the most important correlates of risk perception, a general linear model was developed with risk perception for SARS as independent variable and country, gender and age group as dependent variables and including possible interactions between country and gender, country and age group, and sex and age group. Country, gender and age group were independent significant factors and a significant interaction between country and gender was present. Figure 7 shows mean SARS-related risk perceptions according to age in men and women in eight countries. Risk perception was higher in women than in men, except in Singapore. Risk perception in both men and women was lowest in Denmark, Singapore and Britain and highest in Poland, Hong Kong and the Netherlands. In the age group 31-45 years risk perception was slightly lower compared to the other age groups. In the multivariate analysis for risk perception of flu from a new flu virus country, gender and age group remained independent significant factors and a significant interaction between region and gender and between country and age group was present. Figure 8 shows risk perception per country by gender for four age groups. In all countries, except Singapore, risk perception among women was higher than among men but this gender difference was smaller in the Asian countries compared to Europe. The effects of age also varied by country, with higher mean risk perception levels in older age groups in Europe, but not in Asia. Knowledge Knowledge about SARS was measured with an open question and two propositions. On the open question “Can you name the most important symptom of SARS”, 47% of the European respondents and 87% of the Asian respondents were able to name a symptom (p<0.001), see figure 9. The distribution of answers to the two propositions are shown in figure 10 and 11. A knowledge score of 0-3 was constructed based on the number of correct answers on the 3 knowledge items; 35% of respondents had 0 or 1 points, 41% had 2 points and 24% had 3 points. Efficacy beliefs Response and self efficacy beliefs were assessed for SARS, flu from a new virus in case of an outbreak and a common cold. Self efficacy was lower than respons efficacy for all three diseases and in all countries. Both respons and self efficacy were higher in the Asian countries compared to European countries (p<0.001), see figure 12-14. Self efficacy for flu was especially low in the Netherlands. Information The amount of information respondents received about new infectious diseases from different sources and the perceived credibilty of the sources of information was assessed. People reported to get most info from the traditional mass media such as television and the newspaper. There was not much variation in the level of trust between information sources. During the SARS outbreak the amount of information and the level of confidence in the information was higher in Asia compared to Europe ( Table 6, figure 15-18). Associations In table 7 pearson’s associations are shown between the different SARS related risk perception factors. More information is associated with higher levels of knowledge, more confidence in the information, higher risk perceptions and higher efficacy beliefs. A higher level of confidence is

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associated with higher response and self efficacy. A higher level of vulnerability is associated with lower response and self efficacy. Discussion Differences between Asia and Europe could be seen, especially in SARS related response and self efficacy; beliefs were higher in Asia. This might be explained by the fact that Asia lived through the SARS epidemic in 2003 and the experience with the SARS epidemic may have resulted in the notion that new epidemics of infectious diseases can be controlled. The low level of self efficacy in the European countries may not be surprising since no specific measures were communiciated. The lower level of risk perception in Denmark seems part of a Scandinavian tendency to perceive risks lower than in other countries. One of the explanations for this tendency is that the media in Scandinavia reports risks differently, with less attention to risk inside the country and more to risks abroad. (8) This result is also in line with a lower risk perception of SARS among Finns compared to Dutch. (9) In interpreting the results of the present study certain limitations should be acknowledged. The response rate varied between countries from 21,3% to 81,1%, especially the low response rates in Asia have probably led to highly non-representative samples. Extensive pre-testing with cognitive interviewing was restricted to two European countries. We therefore do not know whether all concepts used were understood in the same way in all participating countries. Conclusion • The pattern of risk perception between diseases appears to be similar across countries. • Risk perceptions for SARS and a new influenza virus are high, especially when people are asked

to envision a situation of an outbreak in their country of residence. • Risk perceptions for SARS and influenza differ between countries and region and vary according

to gender and age. − Risk perception of SARS was highest in Poland, Hong Kong and the Netherlands, in both

women and men. It was lowest in Singapore, the UK and Denmark. − In line with most research on risk perceptions, women have higher risk perceptions than men

for all diseases assessed. • Self efficacy was lower than response efficacy in all countries. Both were relatively high in the

Asian countries. • The low self efficacy in some of the European countries has possible consequences for risk

communication. • Information: traditional mass media such as TV and newspapers are used most often, with high

level of trust. During the SARS outbreak the amount of information and the level of confidence in the information was higher in Asia compared to Europe.

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References 1. Beardsworth AD. Trans-science and moral panics: Understanding food scares. British Food

Journal 1990;92(5):11-16. 2. Weinstein ND. Reducing unrealistic optimism about illness susceptibility. American Psychological

Assn 1983;2(1):11-20. 3. Weinstein ND. Why it won't happen to me: perceptions of risk factors and susceptibility. Health

Psychology 1984;3(5):431-457. 4. Sjoberg L. Factors in risk perception. Risk analysis 2000;20(1):1-11. 5. Eiser JR. Communication and interpretation of risk. British Medical Bulletin 1998;54(4):779-90. 6. Fischhoff B, Bostrom A, Jacobs Quadrel M. Risk perception and communication. Annual Review

of Public Health 1993;14:183-203. 7. Liu S, Huang J, Brown GL. Information and risk perception: a dynamic adjustment process. Risk

analysis 1998;18(6):689-99. 8. Mullet E, . Lazreg C, Candella C, Neto F. The Scandinavian way of perceiving societal risks.

Journal of Risk Research 2005, 8(1): 19-30. 9. Aro AR, Aalto A-M, Oenema A, Brug J, De Zwart O, Turtiainen P, Bishop G, Uutela A. Risk

perception, information needs, and risk communication related to SARS. European Journal of Public Health 2005;15 (suppl 1):70-71 (abstract)

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Tables and graphs Table 1: Participation rates and distribution of general characteristics in the study population

DNK POL NLD GBR ESP CHN HKG SGP Europe Asia Total % % % % % % % % % % %

TOTAL n 463 502 403 401 427 409 401 430 2196 1240 3436 % 13 15 12 12 12 12 12 13 64 36 100 Participation rate 58 81 44 21 34 - - - 40 13 - Gender Male 40 38 42 41 41 47 44 43 40 45 42 Female 60 62 58 59 59 53 56 57 60 55 58 Age group 18-30 13 17 9 13 17 42 27 35 14 35 22 31-45 31 30 31 35 34 33 34 31 32 33 32 44-60 36 32 37 31 32 19 26 20 33 22 29 61-75 20 21 23 21 17 5 12 14 20 10 17 Area City 26 22 8 20 46 87 90 81 24 85 46 Town 38 25 36 45 41 9 4 17 37 10 27 Village/Countryside 37 53 55 36 13 4 6 2 39 4 26 Education Primary or lower 17 8 5 2 22 5 13 3 11 7 10 Low 31 22 28 20 9 19 20 11 22 16 20 Intermediate 38 43 35 35 31 35 32 37 37 35 36 High 13 28 33 43 38 42 35 48 30 42 34 (DNK = Denmark, POL = Poland, NLD = the Netherlands, GBR= Britain, ESP = Spain, CHN = China, HKG = Hong Kong, SGP = Singapore)

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Table 2: Perceived seriousness for SARS and eight other diseases: means (scale 1-10) and standard deviations (SD).

'On a scale from 1 to 10, how serious would it be for you to get ….....in the next year?

mean SD HIV 9,1 2,1 Heart attack 8,4 2,1 SARS 8,3 2,1 Tuberculosis 7,3 2,3 Flu from a new flu virus 6,9 2,5 Diabetes 6,8 2,5 High blood pressure 6,4 2,2 Food poisoning 5,6 2,5 Common cold 2,8 2,1 Figure 1: Distribution of perceived seriousness for SARS and eight other diseases

0%

20%

40%

60%

80%

100%

cold

food p

high bp

diabete

s flu TBsa

rs

h.atta

ck hiv

5

4

3

2

1

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Table 3: Perceived vulnerability for SARS and eight other diseases: proportions of respondents, means (scale 1-5) and standard deviations (SD).

'Are you likely or unlikely to get …....in the next year? very

unlikely (%)

unlikely (%)

not likely /not

unlikely (%)

likely (%)

very likely (%) mean SD

HIV 72 19 5 2 1 1,4 0,8 Tuberculosis 39 37 12 10 2 2,0 1,0 Diabetes 40 35 13 9 3 2,0 1,1 SARS, outbreak outside country 37 33 14 13 3 2,1 1,1 High blood pressure 29 31 17 18 6 2,4 1,2 Heart attack 26 30 19 20 5 2,5 1,2 Food poisoning 19 33 20 24 4 2,6 1,2 SARS, outbreak in country 20 28 22 26 5 2,7 1,2 Flu from a new flu virus 15 26 24 31 5 2,9 1,2 Flu from new virus, OB in country 12 20 23 37 8 3,1 1,2 Common cold 7 9 13 43 28 3,8 1,2 Figure 2: Distribution of perceived vulnerability for SARS and eight other diseases

0%

20%

40%

60%

80%

100%

hiv TB

diabe

tes sars

high b

p

h.att

ack

food

p

sars

ob fluflu

ob cold

54321

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Table 4: Riskperception for SARS and eight other diseases: means (scale 1-5) and standard deviations (SD).

mean SD SARS, outbreak in country 3,2 0,9 Flu from new virus, OB in country 3,1 0,9 Heart attack 3,1 0,9 Flu from a new flu virus 3,0 0,9 SARS, outbreak outside country 2,8 0,9 High blood pressure 2,7 0,9 Tuberculosis 2,6 0,8 Food poisoning 2,6 0,9 Diabetes 2,5 0,9 HIV 2,4 0,7 Common cold 2,1 0,9 Figure 3: Distribution of risk perceptions for SARS and eight other diseases

0%

20%

40%

60%

80%

100%

cold hiv

diabe

tes

food p TB

high b

psa

rs flu

h.atta

ckflu

ob

sars

ob

54321

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Figure 4: Risk perception of SARS and 2 other diseases in 8 countries

2,02,22,42,62,83,03,23,43,6

Denmark

Poland

NetherlandsUnited KingdomSpain

China

Hong KongSingapore

mea

n ri

skpe

rcep

tion

sars outbreak high blood pressure diabetes

Table 5: Comparative risk perception for SARS and eight other diseases:

proportions of respondents, means (scale 1-5) and standard deviations (SD).

'Compared to the average ….... Are you more, less or as likely to get ……..in the next year?

much less likely (%)

less likely (%)

as likely (%)

more likely (%)

much more likely (%)

mean SD

HIV 58 26 13 2 1 1,6 0,8 Tuberculosis 30 36 27 5 1 2,1 0,9 SARS, outbreak outside country 29 34 30 6 1 2,2 1,0 Diabetes 26 35 29 7 2 2,2 1,0 Food poisoning 20 32 38 8 2 2,4 1,0 High blood pressure 25 29 31 11 5 2,4 1,1 Heart attack 21 28 35 12 3 2,5 1,1 SARS, outbreak in country 17 25 45 11 2 2,6 1,0 Flu from a new flu virus 14 23 47 13 3 2,7 1,0 Flu from new virus, OB in country 13 20 49 14 4 2,8 1,0 Common cold 7 18 47 19 9 3,0 1,0

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Figure 5: Comparative risk perception for SARS in case of an outbreak outside the country

0% 20% 40% 60% 80% 100%

Denmark: 1,7

United Kingdom: 2,1

Singapore: 2,1

China: 2,1

Netherlands: 2,2

Poland: 2,2

Spain: 2,4

Hong Kong: 2,5

1-m less likely 2-less likely 3-as likely 4-more likely 5-m more likely

Figure 6: Comparative risk perception for SARS in case of a global outbreak, also in the country

0% 20% 40% 60% 80% 100%

Singapore: 2,2

Denmark: 2,3

China: 2,4

United Kingdom: 2,5

Hong Kong: 2,7

Spain: 2,8

Netherlands: 2,8

Poland: 2,8

1-m less likely 2-less likely 3-as likely 4-more likely 5-m more likely

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Figure 7: Mean SARS-related risk perceptions according to age in men and women in eight countries

SARS risk perception in WOMEN

2,6

2,8

3,0

3,2

3,4

3,6

3,8

18-30 31-45 46-60 61-75

agegroup

POL

HKG

NLD

ESP

CHN

GBR

DNK

SGP

SARS risk perception in MEN

2,6

2,8

3,0

3,2

3,4

3,6

3,8

18-30 31-45 46-60 61-75

agegroup

POL

HKG

NLD

ESP

CHN

GBR

DNK

SGP

17

Figure 8: Mean flu-related risk perceptions according to age and gender in eight countries. Lines: predicted means, Dots: observed means

Denmark

2,4

2,6

2,8

3,0

3,2

3,4

3,6

3,8

18-30 31-45 46-60 61-75

agegroup

femalemale

Poland

2,4

2,6

2,8

3,0

3,2

3,4

3,6

3,8

18-30 31-45 46-60 61-75

agegroup

femalemale

Netherlands

2,4

2,6

2,8

3,0

3,2

3,4

3,6

3,8

18-30 31-45 46-60 61-75

agegroup

femalemale

Great Brittain

2,4

2,6

2,8

3,0

3,2

3,4

3,6

3,8

18-30 31-45 46-60 61-75

agegroup

femalemale

Spain

2,4

2,6

2,8

3,0

3,2

3,4

3,6

3,8

18-30 31-45 46-60 61-75

agegroup

femalemale

China

2,4

2,6

2,8

3,0

3,2

3,4

3,6

3,8

18-30 31-45 46-60 61-75

agegroup

femalemale

Hongkong

2,4

2,6

2,8

3,0

3,2

3,4

3,6

3,8

18-30 31-45 46-60 61-75

agegroup

femalemale

Singapore

2,4

2,6

2,8

3,0

3,2

3,4

3,6

3,8

18-30 31-45 46-60 61-75

agegroup

femalemale

18

Figure 9: “Can you name the most important symptom of SARS”

0% 20% 40% 60% 80% 100%

Denmark

Poland

Netherlands

United Kingdom

Spain

China

Hong Kong

Singapore

knows symptom doesn't know any symptom

Figure 10: SARS is a communicable disease

0% 20% 40% 60% 80% 100%

Denmark

Poland

Netherlands

United Kingdom

Spain

China

Hong Kong

Singapore

True False Don't know

Figure 11: Somebody can have SARS without having symptoms

0% 20% 40% 60% 80% 100%

Denmark

Poland

Netherlands

United Kingdom

Spain

China

Hong Kong

Singapore

True False Don't know

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Figure 12: SARS related efficacy beliefs

1,5

2,0

2,5

3,0

3,5

Denmark

Poland

Nether

lands

United

King

dom

Spain

China

Hong K

ong

Singap

ore

overa

ll

mea

n e

ffic

acy

response efficacy

self efficacy

Figure 13: Flu related efficacy beliefs

1,5

2,0

2,5

3,0

3,5

Denmark

Poland

Nether

lands

United

King

dom

Spain

China

Hong K

ong

Singap

ore

overa

ll

mea

n e

ffic

acy

response efficacy

self efficacy

Figure 14: Common cold related efficacy beliefs

1,5

2,0

2,5

3,0

3,5

Denmark

Poland

Nether

lands

United

King

dom

Spain

China

Hong K

ong

Singap

ore

overa

ll

mea

n e

ffic

acy

response efficacy

self efficacy

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Table 6: Amount of information and confidence in the information from eight different sources:

means (scale 1-5) and standard deviations (SD). Amount of

information Confidence in information

Source of information mean SD mean SD Television 3,5 1,1 3,4 1,0 Newspapers 3,0 1,2 3,3 1,0 Radio 2,5 1,3 3,2 1,0 Family or friends 2,5 1,2 3,3 1,0 Internet websites 2,1 1,3 3,1 1,1 Government agencies 2,0 1,2 3,3 1,1 Your doctor 1,9 1,2 3,6 1,2 Consumer or patient interest groups 1,7 1,0 3,1 1,1 Information about SARS during the outbreak in 2003

3,3 1,4 3,7 1,0

Figure 15: Amount of information and confidence in information during SARS outbreak in 2003

1,5

2,0

2,5

3,0

3,5

4,0

4,5

Denmark

Poland

Nether

lands

United

King

dom

Spain

China

Hong K

ong

Singap

ore

mea

n

amount of informationconfidence in information

21

Figure 16: Amount of information and confidence in information about new and emerging infectious diseases from television in the past year

2,5

3,0

3,5

4,0

Denmark

Poland

Nether

lands

United

King

dom

Spain

China

Hong K

ong

Singap

ore

mea

n amount of informationconfidence in information

Figure 17: Amount of information and confidence in information about new and emerging infectious diseases from newspapers in the past year

2,5

3,0

3,5

4,0

Denmark

Poland

Nether

lands

United

King

dom

Spain

China

Hong K

ong

Singap

ore

mea

n

amount of informationconfidence in information

Figure 18: Amount of information and confidence in information about new and emerging infectious diseases from government agencies in the past year

1,0

1,5

2,0

2,5

3,0

3,5

4,0

Denmark

Poland

Nether

lands

United

King

dom

Spain

China

Hong K

ong

Singap

ore

mea

n amount of informationconfidence in information

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Table 7: Pearson’s association coefficients between SARS-related risk perception, efficacy, knowledge and information.

1 2 3 4 5 6 7 1 seriousness 1 2 vulnerability 0,098 ** 1 3 risk perc. measure 0,575 ** 0,855 ** 1 4 response efficacy -0,010 -0,057 ** -0,056 ** 1 5 self efficacy -0,017 -0,142 ** -0,126 ** 0,460 ** 1 6 knowledge -0,018 0,009 0,001 0,037 * 0,113 ** 1 7 amount of info -0,024 0,081 ** 0,051 ** 0,148 ** 0,171 ** 0,303 ** 1 8 confidence in info -0,006 -0,023 -0,030 0,125 ** 0,179 ** 0,121 ** 0,373 ** ** 0.01 level * 0.05 level

23







COUNTRY REPORT

DENMARK




August 2006

24

Background and Methods The background of the survey and the methods used are described in the separate report ‘general description and international comparison’. Results The Danish data were collected between 3 and 22 October 2005 by 9 interviewers. Of 798 persons eligible for participation, 463 (58,0%) responded. 39,6% refused to participate and in 19 cases (2,4%) there were language problems. 60% of repondents were women, 40% men. The mean age of the respondents was 48,0 years (SD 13,9; range 18-75 years). The general descriptives are given in table 1. Risk perception Risk perception for SARS and eight other diseases was assessed with 3 questionnaire items for each disease. First the respondents were asked to rate the seriousness of each disease (table 2). SARS was rated third on seriousness; HIV and a heart attack were rated as more serious, but, for example, diabetes and tubercolosis were rated as less serious. Vulnerability was measured by asking the respondents how they thought their chances were to get the disease themselves (table 3). Getting SARS in case of an outbreak outside Denmark was perceived unlikely, only preceded by HIV. In case of an outbreak, getting SARS was still considered quite unlikely. Risk perception was defined as the muliplication of seriousness and vulnerability. This combined measure shows that SARS-related risk perception was amongst the highest of the diseases for which risk perception was assessed (table 4). Comparative risk perceptions are shown in table 5. For SARS in case of an outbreak outside Denmark a positive (optimistic) bias in risk perception was present. This bias was lower in case of an outbreak of SARS in Denmark. Efficacy SARS related respons efficacy was comparable to that in most other European countries but lower than in Spain and the Asian countries. Self efficacy was lower than response efficacy (table 6). Information The respondent got most information about new infectious diseases like SARS from television and newspapers. Least information came from the respondents own doctor but confidence in this source was highest (table 7). The amount of information during the SARS outbreak in 2003 was relatively low compared to the other countries. Confidence in the information was high and comparable to the other Europpean countries. Conclusion Risk perceptions for SARS are high, especially when people are asked to envision a situation of an outbreak. Compared to other countries SARS risk perceptions are relatively low.

25

Appendix Country Report Denmark Table 1-1: General descriptives: Gender N % Male 183 39,5 Female 280 60,5 agegroup 18-30 59 12,7 31-45 145 31,3 46-60 166 35,9 61-75 93 20,1 Area City 120 25,9 Town 174 37,6 Village 128 27,6 Countryside 41 8,9 number in household 1 88 19,0 2 194 42,0 3 72 15,6 4 81 17,5 5 or more 27 5,8 Children in household Yes 125 33,3 No 250 66,7 Highest education Primary school or no education 80 17,3 Lower general secondary or

Lower vocational education 143 30,9

Intermediate/higher general secondary or Intermediate vocational education

178 38,4

Higher vocational education or University education

62 13,4

Ethnicity Danish or other European 454 98,1 Other 9 1,9 Overall health Very poor 2 0,4 Poor 14 3,0 Fair 43 9,3 Good 125 27,0 Very good 147 31,7 Excellent 132 28,5 Vaccinated against influenza Yes 61 13,2 No 402 86,8

26

Table 1-2: Perceived seriousness for SARS and eight other diseases: means (scale 1-10) and standard deviations (SD).

Seriousness 'On a scale from 1 to 10, how serious would it be for you to get ….....in the next year? mean SD HIV 9,5 1,3 Heart attack 8,9 1,6 SARS, outbreak outside country 8,7 1,8 Tuberculosis 7,6 2,2 Diabetes 6,3 2,4 Flu from a new flu virus 6,1 2,7 High blood pressure 5,9 2,1 Food poisoning 5,6 2,4 Common cold 1,7 1,4 Table 1-3: Perceived vulnerability for SARS and eight other diseases: proportions of respondents, means (scale 1-5) and standard deviations (SD).

'Are you likely or unlikely to get ….....in the next year? very

unlikely (%)

unlikely (%)

not likely not

unlikely (%)

likely (%)


HIV 88 10 1 1 0 1,2 0,5 SARS, outbreak outside country 62 28 6 3 1 1,5 0,9 Tuberculosis 61 27 6 4 2 1,6 0,9 Diabetes 51 33 8 5 2 1,7 1,0 SARS, outbreak in country 36 27 21 13 3 2,2 1,2 Heart attack 36 25 24 12 3 2,2 1,1 High blood pressure 31 29 21 13 6 2,3 1,2 Food poisoning 26 33 23 17 2 2,4 1,1 Flu from a new flu virus 16 30 27 23 5 2,7 1,1 Flu from new virus, OB in country 15 25 27 27 5 2,8 1,1 Common cold 5 7 12 33 43 4,0 1,1 Table 1-4: Riskperception for SARS and eight other diseases:

means (scale 1-5) and standard deviations (SD). mean SD Heart attack 3,0 0,8 SARS, outbreak in country 3,0 0,9 Flu from new virus, OB in country 2,7 0,9 Flu from a new flu virus 2,7 0,8 SARS, outbreak outside country 2,5 0,7 High blood pressure 2,5 0,8 Food poisoning 2,4 0,8 Tuberculosis 2,4 0,8 HIV 2,3 0,4 Diabetes 2,2 0,7 Common cold 1,7 0,6

27

Table 1-5: Comparative risk perception for SARS and eight other diseases: proportions of respondents, means (scale 1-5) and standard deviations (SD).



less likely (%)

as likely (%)

more likely (%)


mean SD

HIV 71 21 8 1 0 1,4 0,7 SARS, outbreak outside country 50 31 16 3 0 1,7 0,9 Tuberculosis 44 31 21 2 1 1,9 0,9 Diabetes 37 35 21 5 1 2,0 0,9 Food poisoning 28 31 36 5 1 2,2 0,9 High blood pressure 31 32 24 11 3 2,2 1,1 SARS, outbreak in country 28 25 40 6 1 2,3 1,0 Heart attack 29 29 32 9 2 2,3 1,0 Flu from a new flu virus 20 26 42 9 4 2,5 1,0 Flu from new virus, OB in country 20 22 45 10 4 2,6 1,0 Common cold 10 15 42 16 17 3,1 1,2 Table 1-6: Response- and self efficacy:

means (scale 1-4) and standard deviations (SD). Response

efficacy Self efficacy

mean SD mean SD Flu from new virus, OB in country 2,3 1,0 2,2 1,0 SARS, outbreak in country 2,4 1,1 2,0 1,1 Common cold 2,4 1,1 2,2 1,1 Table 1-7: Amount of information and confidence in the information from eight different sources:



Source of information mean SD mean SD Television 3,3 1,0 3,2 0,9 Newspapers 2,7 1,2 3,2 0,9 Radio 2,4 1,2 3,2 1,0 Family or friends 1,9 1,0 3,1 1,0 Internet websites 1,8 1,2 3,1 1,1 Government agencies 1,7 1,0 3,4 1,1 Consumer or patient interest groups 1,5 0,9 3,2 1,2 Your doctor 1,4 0,9 3,9 1,1 Information about SARS during the outbreak in 2003

1,7 1,1 4,0 1,7

28







COUNTRY REPORT

POLAND




August 2006

29

Background and Methods The background of the survey and the methods used are described in the separate report ‘general description and international comparison’. Results The Polish data were collected between 20 September and 2 November 2005 by 12 interviewers. Of 619 persons eligible for participation, 502 (81,1%) responded. 18,7% refused to participate and in 1 case (0,2%) there was language problem. 64% of repondents were women, 36% men. The mean age of the respondents was 47,0 years (SD 15,3; range 18-75 years). The general descriptives are given in table 1. Risk perception Risk perception for SARS and eight other diseases was assessed with 3 questionnaire items for each disease. First the respondents were asked to rate the seriousness of each disease (table 2). SARS was rated third on seriousness; HIV and a heart attack were rated as more serious, but, for example, flu from a new flu virus and tubercolosis were rated as less serious. Vulnerability was measured by asking the respondents how they thought their chances were to get the disease themselves (table 3). Getting SARS in case of an outbreak outside Poland was perceived unlikely, only preceded by HIV and tuberculosis. In case of an outbreak however, getting SARS was considered more likely but less likely than a common cold. Risk perception was defined as the muliplication of seriousness and vulnerability. This combined measure shows that SARS-related risk perception was amongst the highest of the diseases for which risk perception was assessed (table 4). Comparative risk perceptions are shown in table 5. For SARS in case of an outbreak outside Poland a positive (optimistic) bias in risk perception was present. This bias was lower in case of an outbreak of SARS in Poland. Efficacy SARS related respons efficacy was comparable to that in most other European countries but lower than in Spain and the Asian countries. Self efficacy was lower than response efficacy (table 6). SARS related self efficacy was lowest compared to other countries. Information The respondent got most information about new infectious diseases like SARS from television and confidence in this information was relatively high. Least information came from the respondents own doctor and confidence in this source was relatively low (table 7). Conclusion Risk perceptions for SARS are high, especially when people are asked to envision a situation of an outbreak. Self efficacy is relatively low.

30

Appendix Country Report Poland Table 2-1: General descriptives: Gender N % Male 193 38,4 Female 309 61,6 agegroup 18-30 87 17,3 31-45 151 30,1 46-60 161 32,1 61-75 103 20,5 Area City 108 21,5 Town 126 25,1 Village 152 30,3 Countryside 116 23,1 number in household 1 64 12,7 2 99 19,7 3 107 21,3 4 109 21,7 5 or more 123 24,5 Children in household Yes 138 31,5 No 300 68,5 Highest education Primary school or no education 39 7,8 Lower general secondary or

Lower vocational education 109 21,7 Intermediate/higher general

secondary or Intermediate vocational education 215 42,8

Higher vocational education or University education 139 27,7

Ethnicity Polish or other European 502 100,0 Other 0 0,0 Overall health Very poor 5 1,0 Poor 38 7,6 Fair 97 19,3 Good 238 47,4 Very good 97 19,3 Excellent 27 5,4 Vaccinated against influenza Yes 110 21,9 No 390 77,7

31


Seriousness 'On a scale from 1 to 10, how serious would it be for you to get ….....in the next year? mean SD HIV 9,4 1,8 Heart attack 8,6 2,0 SARS, outbreak outside country 8,4 2,0 Flu from a new flu virus 7,5 2,3 Tuberculosis 7,4 2,2 Diabetes 7,2 2,4 High blood pressure 6,8 2,3 Food poisoning 4,6 2,3 Common cold 3,1 2,1 Table 2-3: Perceived vulnerability for SARS and eight other diseases: proportions of respondents, means (scale 1-5) and standard deviations (SD).


unlikely (%)

unlikely (%)

not likely not

unlikely (%)

likely (%)


HIV 70 13 12 3 2 1,5 0,9 Tuberculosis 41 32 12 14 1 2,0 1,1 SARS, outbreak outside country 41 28 14 15 2 2,1 1,1 Diabetes 39 35 9 12 5 2,1 1,2 Food poisoning 22 23 15 31 9 2,8 1,3 High blood pressure 26 24 11 22 17 2,8 1,5 Heart attack 19 23 13 32 13 3,0 1,4 SARS, outbreak in country 14 15 19 41 11 3,2 1,2 Flu from a new flu virus 8 14 20 48 10 3,4 1,1 Flu from new virus, OB in country 9 10 17 48 17 3,5 1,1 Common cold 7 6 9 45 32 3,9 1,2 Table 2-4: Riskperception for SARS and eight other diseases:

means (scale 1-5) and standard deviations (SD). mean SD SARS, outbreak in country 3,5 1,0 Flu from new virus, OB in country 3,5 1,0 Heart attack 3,4 1,0 Flu from a new flu virus 3,4 0,9 High blood pressure 2,9 1,1 SARS, outbreak outside country 2,8 0,9 Tuberculosis 2,6 0,9 Diabetes 2,6 0,9 HIV 2,6 0,8 Food poisoning 2,4 0,9 Common cold 2,3 0,9

32




less likely (%)

as likely (%)

more likely (%)


mean SD








3,1 1,1 3,9 1,4

33







COUNTRY REPORT

THE NETHERLANDS




August 2006

34

Background and Methods The background of the survey and the methods used are described in the separate report ‘general description and international comparison’. Results The Dutch data were collected between 20 September and 24 October 2005 by 16 interviewers. Of 922 persons eligible for participation, 403 (43,7%) responded. 55,7% refused to participate and in 5 cases (0,5%) there was language problem. 58% of repondents were women, 42% men. The mean age of the respondents was 49,5 years (SD 13,5; range 18-75 years) and was similar for men (49,9) and women (49,2). The general descriptives are given in table 1. Risk perception Risk perception for SARS and eight other diseases was assessed with 3 questionnaire items for each disease. First the respondents were asked to rate the seriousness of each disease (table 2). SARS was rated third on seriousness; HIV and a heart attack were rated as more serious, but, for example, diabetes and tubercolosis were rated as less serious. Vulnerability was measured by asking the respondents how they thought their chances were to get the disease themselves (table 3). Getting SARS in case of an outbreak outside the Netherlands was perceived unlikely, only preceded by diabetes and HIV. In case of an outbreak however, getting SARS was considered more likely but less likely than a common cold. Risk perception was defined as the muliplication of seriousness and vulnerability. This combined measure shows that SARS-related risk perception was amongst the highest of the diseases for which risk perception was assessed (table 4). Comparative risk perceptions are shown in table 5. For SARS in case of an outbreak outside the Netherlands a positive (optimistic) bias in risk perception was present. This bias was lower in case of an outbreak of SARS in the Netherlands. Efficacy SARS related respons efficacy was comparable to that in most other European countries but lower than in Spain and the Asian countries. Self efficacy was lower than response efficacy (table 6). SARS related self efficacy was among the lowest compared to other countries. Information The respondent got most information about new infectious diseases like SARS from television and newspapers. Least information came from the respondents own doctor but confidence in this source was highest (table 7). The amount of information during the SARS outbreak in 2003 was relatively high compared to the other European countries. Conclusion Risk perceptions for SARS are high, especially when people are asked to envision a situation of an outbreak. Self efficacy is relatively low.

35

Appendix Country Report The Netherlands Table 3-1: General descriptives: N % Gender Male 171 42,4 Female 232 57,6 Age group 18-30 38 9,4 31-45 123 30,5 46-60 148 36,7 61-75 94 23,3 Area City 34 8,4 Town 147 36,5 Village 189 46,9 Countryside 33 8,2 Number of people per household 1 49 12,2 2 157 39,1 3 50 12,4 4 94 23,4 5 or more 52 12,9 Children in household (if >1 in househ) Yes 108 30,5 No 246 69,5 Highest education Primary school or no education 21 5,2 Lower general secondary or Lower

vocational education 111 27,5

Intermediate/higher general secondary or Intermediate vocational education

140 34,7


131 32,5

Ethnicity Dutch or other European 395 98,0 Other 8 2,0 Overall health Very poor 3 0,7 Poor 18 4,5 Fair 61 15,1 Good 191 47,4 Very good 74 18,4 Excellent 56 13,9 Vaccinated against influenza Yes 68 16,9 No 334 82,9

36


'On a scale from 1 to 10, how serious would it be for you to get ….....in the next year?

mean SD HIV 9,4 1,2 Heart attack 8,9 1,4 SARS 8,5 1,4 Flu from a new flu virus 7,7 2,0 Tuberculosis 7,5 1,9 Diabetes 7,1 2,0 High blood pressure 6,3 2,0 Food poisoning 5,7 2,2 Common cold 2,3 1,8 Table 3-3: Perceived vulnerability for SARS and eight other diseases: proportions of respondents, means (scale 1-5) and standard deviations (SD).

'Are you likely or unlikely to get …....in the next year? very

unlikely (%)

unlikely (%)

not likely /not

unlikely (%)

likely (%)


HIV 80 18 2 0 0 1,2 0,5 Diabetes 36 50 9 4 1 1,8 0,8 SARS, outbreak outside country 39 45 10 5 1 1,8 0,8 Tuberculosis 32 52 12 4 0 1,9 0,8 Food poisoning 18 53 20 8 1 2,2 0,9 High blood pressure 24 39 25 9 3 2,3 1,0 Heart attack 20 40 24 15 2 2,4 1,0 Flu from a new flu virus 10 38 31 19 2 2,7 1,0 SARS, outbreak in country 12 29 26 29 5 2,9 1,1 Flu from new virus, OB in country

5 22 30 37 6 3,2 1,0

Common cold 7 14 18 45 16 3,5 1,1 Table 3-4: Riskperception for SARS and eight other diseases:

means (scale 1-5) and standard deviations (SD). mean SD SARS, outbreak in country 3,4 0,8 Flu from new virus, OB in country 3,4 0,8 Heart attack 3,2 0,8 Flu from a new flu virus 3,1 0,8 SARS, outbreak outside country 2,7 0,7 Tuberculosis 2,6 0,7 High blood pressure 2,6 0,7 Diabetes 2,5 0,7 Food poisoning 2,4 0,7 HIV 2,4 0,4 Common cold 1,9 0,7

37




less likely (%)

as likely (%)

more likely (%)


mean SD

HIV 46 44 8 3 0 1,7 0,7 SARS, outbreak outside country 17 51 27 5 0 2,2 0,8 Tuberculosis 15 51 29 5 0 2,3 0,8 Food poisoning 11 51 34 3 0 2,3 0,7 Diabetes 9 53 30 8 1 2,4 0,8 High blood pressure 9 44 33 12 2 2,5 0,9 Heart attack 7 37 41 13 2 2,7 0,9 SARS, outbreak in country 6 26 52 14 2 2,8 0,8 Flu from a new flu virus 5 27 52 15 2 2,8 0,8 Flu from new virus, OB in country 2 19 56 20 3 3,0 0,8 Common cold 3 22 47 25 4 3,1 0,9 Table 3-6: Response- and self efficacy:







3,6 1,0 3,4 1,2

38







COUNTRY REPORT

GREAT BRITAIN




August 2006

39

Background and Methods The background of the survey and the methods used are described in the separate report ‘general description and international comparison’. Results The British data were collected between 20 September and 28 October 2005 by 25 interviewers. Of 1883 persons eligible for participation, 401 (21,3%) responded. 78,2% refused to participate and in 9 cases (0,5%) there was language problem. 59% of repondents were women, 41% men. The mean age of the respondents was 47,0 years (SD 15,3; range 18-75 years). The general descriptives are given in table 1. Risk perception Risk perception for SARS and eight other diseases was assessed with 3 questionnaire items for each disease. First the respondents were asked to rate the seriousness of each disease (table 2). SARS was rated third on seriousness; HIV and a heart attack were rated as more serious, but, for example, flu from a new flu virus and tubercolosis were rated as less serious. Vulnerability was measured by asking the respondents how they thought their chances were to get the disease themselves (table 3). Getting SARS in case of an outbreak outside the UK was perceived unlikely, only preceded by HIV. In case of an outbreak however, getting SARS was considered more likely but less likely than a common cold or flu from a new flu virus. Risk perception was defined as the muliplication of seriousness and vulnerability. This combined measure shows that SARS-related risk perception was amongst the highest of the diseases for which risk perception was assessed (table 4). Comparative risk perceptions are shown in table 5. For SARS in case of an outbreak outside the UK a positive (optimistic) bias in risk perception was present. This bias was lower in case of an outbreak of SARS in the UK. Efficacy SARS related respons efficacy was comparable to that in most other European countries but lower than in Spain and the Asian countries. Self efficacy was lower than response efficacy (table 6). Information The respondent got most information about new infectious diseases like SARS from television and confidence in this information was relatively high. Least information came from consumer and patients interests groups and confidence in this source was relatively low (table 7). Conclusion Risk perceptions for SARS are high, especially when people are asked to envision a situation of an outbreak.

40

Appendix Country Report Great Britain Table 4-1: General descriptives: Gender N % Male 163 40,6 Female 238 59,4 Agegroup 18-30 51 12,7 31-45 141 35,2 46-60 124 30,9 61-75 85 21,2 Area City 79 19,7 Town 179 44,6 Village 96 23,9 Countryside 47 11,7 number in household 1 74 18,5 2 138 34,4 3 73 18,2 4 75 18,7 5 or more 41 10,2 Children in household Yes 110 33,6 No 217 66,4 Highest education Primary school or no

education 9 2,2

Lower general secondary or Lower vocational education

82 20,4

Intermediate/higher gen sec or Intermed voc education

139 34,7


171 42,6

Ethnicity British or other European 386 96,3 other 15 3,7 Overall health Very poor 6 1,5 Poor 18 4,5 Fair 42 10,5 Good 110 27,4 Very good 143 35,7 Excellent 82 20,4 Vaccinated against influenza Yes 88 21,9 No 310 77,3 Don't know 3 0,7

41


Seriousness 'On a scale from 1 to 10, how serious would it be for you to get ….....in the next year? mean SD HIV 9,3 1,8 Heart attack 8,9 1,7 SARS, outbreak outside country 8,3 2,0 Tuberculosis 7,8 2,0 Flu from a new flu virus 7,4 2,3 Diabetes 6,7 2,5 High blood pressure 6,5 2,2 Food poisoning 5,7 2,4 Common cold 2,3 1,9 Table 4-3: Perceived vulnerability for SARS and eight other diseases: proportions of respondents, means (scale 1-5) and standard deviations (SD).


unlikely (%)

unlikely (%)

not likely not

unlikely (%)

likely (%)


HIV 80 18 0 1 1 1,2 0,6 SARS, outbreak outside country 46 40 4 7 2 1,8 1,0 Tuberculosis 40 49 4 6 2 1,8 0,9 Diabetes 44 40 9 4 2 1,8 0,9 Heart attack 24 47 11 15 3 2,3 1,1 High blood pressure 26 45 11 15 4 2,3 1,1 Food poisoning 15 49 13 20 4 2,5 1,1 SARS, outbreak in country 18 42 11 23 5 2,5 1,2 Flu from a new flu virus 14 43 14 25 4 2,6 1,1 Flu from new virus, OB in country 11 33 15 34 7 2,9 1,2 Common cold 6 10 6 40 37 3,9 1,2 Table 4-4: Riskperception for SARS and eight other diseases:

means (scale 1-5) and standard deviations (SD). mean SD Flu from new virus, OB in country 3,2 0,9 SARS, outbreak in country 3,1 0,9 Heart attack 3,1 0,8 Flu from a new flu virus 3,0 0,9 High blood pressure 2,6 0,9 SARS, outbreak outside country 2,6 0,7 Tuberculosis 2,5 0,7 Food poisoning 2,5 0,8 Diabetes 2,4 0,8 HIV 2,3 0,5 Common cold 1,9 0,8

42




less likely (%)

as likely (%)

more likely (%)


mean SD

HIV 57 31 10 2 1 1,6 0,8 SARS, outbreak outside country 30 40 26 4 1 2,1 0,9 Tuberculosis 26 43 26 4 1 2,1 0,9 Diabetes 22 40 31 5 2 2,3 0,9 Food poisoning 14 37 40 7 2 2,4 0,9 High blood pressure 18 35 33 10 4 2,5 1,0 Heart attack 15 36 38 9 2 2,5 0,9 SARS, outbreak in country 13 31 46 8 1 2,5 0,9 Flu from a new flu virus 10 31 50 7 2 2,6 0,8 Flu from new virus, OB in country 8 28 51 10 3 2,7 0,9 Common cold 6 17 55 14 7 3,0 0,9 Table 4-6: Response- and self efficacy:






Source of information mean SD mean SD Television 3,4 1,2 3,1 1,1 Newspapers 2,8 1,3 2,9 1,0 Radio 2,4 1,2 2,8 1,1 Family or friends 2,1 1,1 2,9 1,0 Your doctor 1,8 1,2 3,4 1,3 Internet websites 1,8 1,2 2,9 1,2 Government agencies 1,7 1,0 2,8 1,1 Consumer or patient interest groups 1,5 0,8 2,6 1,0 Information about SARS during the outbreak in 2003

3,2 1,4 3,5 1,0

43







COUNTRY REPORT

SPAIN




August 2006

44

Background and Methods The background of the survey and the methods used are described in the separate report ‘general description and international comparison’. Results The Spanish data were collected between 20 September and 20 October 2005 by 16 interviewers. Of 1244 persons eligible for participation, 427 (34,3%) responded. 65,4% refused to participate and in 4 cases (0,3%) there was language problem. 59% of repondents were women, 41% men. The mean age of the respondents was 45,5 years (SD 14,3; range 18-75 years). The general descriptives are given in table 1. Risk perception Risk perception for SARS and eight other diseases was assessed with 3 questionnaire items for each disease. First the respondents were asked to rate the seriousness of each disease (table 2). SARS was rated third on seriousness; HIV and a heart attack were rated as more serious, but, for example, diabetes and tubercolosis were rated as less serious. Vulnerability was measured by asking the respondents how they thought their chances were to get the disease themselves (table 3). Getting SARS in case of an outbreak outside Spain was perceived unlikely, only preceded by HIV. In case of an outbreak, getting SARS was still considered quite unlikely. Risk perception was defined as the muliplication of seriousness and vulnerability. This combined measure shows that SARS-related risk perception was amongst the highest of the diseases for which risk perception was assessed (table 4). Comparative risk perceptions are shown in table 5. For SARS in case of an outbreak outside Spain a positive (optimistic) bias in risk perception was present. This bias was lower in case of an outbreak of SARS in Spain. Efficacy SARS related respons efficacy was relatively high compared to other European countries but lower than in the Asian countries. Self efficacy was lower than response efficacy (table 6). SARS related self efficacy was highest compared to the other European countries. Information The respondent got most information about new infectious diseases like SARS from television and confidence in this information was relatively high. Least information came from consumer and patients interests groups (table 7). The amount of information during the SARS outbreak in 2003 was relatively low compared to the other countries. Confidence in the information was high and comparable to the other Europpean countries. Conclusion Risk perceptions for SARS are high, especially when people are asked to envision a situation of an outbreak.

45

Appendix Country Report Spain Table 5-1: General descriptives: Gender N % Male 174 40,7 Female 253 59,3 Agegroup 18-30 72 16,9 31-45 146 34,2 46-60 136 31,9 61-75 73 17,1 Area City 195 45,7 Town 177 41,5 Village 52 12,2 Countryside 3 0,7 number in household 1 21 4,9 2 104 24,4 3 108 25,4 4 139 32,6 5 or more 54 12,7 Children in household Yes 104 25,6 No 302 74,4 Highest education Primary school or no

education 94 22,0 Lower general secondary or

Lower vocational education 38 8,9 Intermediate/higher gen sec

or Intermed voc education 134 31,4 Higher vocational education or

University education 161 37,7 Ethnicity British or other European 404 98,5 other 6 1,5 Overall health Very poor 6 1,4 Poor 18 4,2 Fair 77 18,0 Good 207 48,5 Very good 79 18,5 Excellent 40 9,4 Vaccinated against influenza Yes 81 19,0 No 345 80,8 Don't know 1 0,2

46


Seriousness 'On a scale from 1 to 10, how serious would it be for you to get ….....in the next year? mean SD HIV 9,5 1,2 Heart attack 9,1 1,5 SARS, outbreak outside country 8,2 1,6 Tuberculosis 7,8 1,9 Diabetes 7,1 2,2 Flu from a new flu virus 6,8 2,4 High blood pressure 6,5 1,9 Food poisoning 5,7 2,2 Common cold 2,8 2,0 Table 5-3: Perceived vulnerability for SARS and eight other diseases: proportions of respondents, means (scale 1-5) and standard deviations (SD).


unlikely (%)

unlikely (%)

not likely not

unlikely (%)

likely (%)


HIV 46 48 3 3 1 1,7 0,8 Diabetes 30 49 6 13 2 2,1 1,0 SARS, outbreak outside country 25 52 11 10 2 2,1 1,0 Tuberculosis 23 56 9 11 1 2,1 0,9 High blood pressure 19 40 10 26 5 2,6 1,2 SARS, outbreak in country 11 41 17 27 4 2,7 1,1 Heart attack 13 36 15 31 6 2,8 1,2 Food poisoning 9 35 14 39 4 3,0 1,1 Flu from a new flu virus 5 27 17 44 7 3,2 1,1 Flu from new virus, OB in country 4 22 11 50 12 3,4 1,1 Common cold 2 7 6 52 33 4,1 0,9 Table 5-4: Riskperception for SARS and eight other diseases:

means (scale 1-5) and standard deviations (SD). mean SD Heart attack 3,5 0,9 Flu from new virus, OB in country 3,3 0,9 SARS, outbreak in country 3,3 0,8 Flu from a new flu virus 3,2 0,9 SARS, outbreak outside country 2,9 0,7 Tuberculosis 2,8 0,7 High blood pressure 2,8 0,8 Food poisoning 2,8 0,8 HIV 2,7 0,6 Diabetes 2,6 0,8 Common cold 2,2 0,8

47




less likely (%)

as likely (%)

more likely (%)


mean SD







Source of information mean SD mean SD Television 3,1 1,2 3,3 1,1 Newspapers 2,7 1,3 3,4 1,0 Radio 2,5 1,3 3,3 1,1 Family or friends 2,3 1,2 3,3 1,1 Your doctor 1,9 1,2 3,9 1,2 Government agencies 1,9 1,2 3,5 1,3 Internet websites 1,7 1,1 3,0 1,3 Consumer or patient interest groups 1,6 1,0 3,2 1,3 Information about SARS during the outbreak in 2003

2,3 1,3 4,6 2,5

48







COUNTRY REPORT

CHINA




August 2006

49

Background and Methods The background of the survey and the methods used are described in the separate report ‘general description and international comparison’. Results The Chinese data were collected between 27 September and 15 November 2005 by 27 interviewers. In total 409 respondents participated. 53% of repondents were women, 47% men. The mean age of the respondents was 35,8 years (SD 13,4; range 18-73 years). The general descriptives are given in table 1. Risk perception Risk perception for SARS and eight other diseases was assessed with 3 questionnaire items for each disease. First the respondents were asked to rate the seriousness of each disease (table 2). SARS was rated second on seriousness; only HIV was rated as more serious, but, for example, a heart attack and tubercolosis were rated as less serious. Vulnerability was measured by asking the respondents how they thought their chances were to get the disease themselves (table 3). Getting SARS was perceived relatively likely, there was no difference when respondents were asked to envision the situation of an outbreak. Risk perception was defined as the muliplication of seriousness and vulnerability. This combined measure shows that SARS-related risk perception was the highest of the diseases for which risk perception was assessed (table 4). Comparative risk perceptions are shown in table 5. For SARS in case of an outbreak outside China a positive (optimistic) bias in risk perception was present. This bias was lower in case of an outbreak of SARS in China. Efficacy SARS related respons and self efficacy were highest compared to the other countries. Self efficacy was only slightly lower than response efficacy (table 6). Information The respondents got most information about new infectious diseases like SARS from television and confidence in this information was relatively high. Least information came from the respondents own doctor (table 7). The amount of information and confidence in the information during the SARS outbreak in 2003 were comparable to the other Asian countries and relatively high compared to the European countries. Conclusion Risk perceptions for SARS are high, and response and self efficacy are relatively high too.

50

Appendix Country Report China Table 6-1: General descriptives: Gender N % Male 194 47,4 Female 215 52,6 Agegroup 18-30 173 42,3 31-45 137 33,5 46-60 79 19,3 61-75 20 4,9 Area City 354 86,6 Town 38 9,3 Village 10 2,4 Countryside 7 1,7 number in household 1 11 2,7 2 35 8,6 3 157 38,4 4 87 21,3 5 or more 119 29,1 Children in household Yes 153 38,4 No 245 61,6 Highest education Primary school or no





51


Seriousness 'On a scale from 1 to 10, how serious would it be for you to get ….....in the next year? mean SD HIV 9,3 1,8 SARS, outbreak outside country 8,4 2,2 Heart attack 7,8 2,2 Tuberculosis 7,1 2,5 Diabetes 6,9 2,7 High blood pressure 6,7 2,2 Food poisoning 6,7 2,6 Flu from a new flu virus 6,6 2,5 Common cold 3,1 2,0 Table 6-3: Perceived vulnerability for SARS and eight other diseases: proportions of respondents, means (scale 1-5) and standard deviations (SD).


unlikely (%)

unlikely (%)

not likely not

unlikely (%)

likely (%)


HIV 77 18 4 0 1 1,3 0,6 Diabetes 47 27 18 6 1 1,9 1,0 Tuberculosis 38 33 14 14 1 2,1 1,1 High blood pressure 40 31 14 12 4 2,1 1,2 Heart attack 40 27 16 14 2 2,1 1,2 SARS, outbreak outside country 26 30 19 21 4 2,5 1,2 SARS, outbreak in country 20 28 24 24 3 2,6 1,2 Food poisoning 17 28 25 26 4 2,7 1,1 Flu from a new flu virus 18 20 28 30 5 2,9 1,2 Flu from new virus, OB in country 16 22 25 31 5 2,9 1,2 Common cold 3 8 16 51 22 3,8 1,0 Table 6-4: Riskperception for SARS and eight other diseases:

means (scale 1-5) and standard deviations (SD). mean SD SARS, outbreak in country 3,2 1,0 SARS, outbreak outside country 3,1 1,0 Flu from new virus, OB in country 2,9 1,0 Flu from a new flu virus 2,9 0,9 Food poisoning 2,9 0,9 Heart attack 2,7 0,9 Tuberculosis 2,6 0,9 High blood pressure 2,5 0,9 Diabetes 2,4 0,9 HIV 2,4 0,6 Common cold 2,3 0,8

52




less likely (%)

as likely (%)

more likely (%)


mean SD

HIV 71 18 9 1 0 1,4 0,7 Diabetes 41 35 20 3 1 1,9 0,9 Tuberculosis 40 33 20 5 2 2,0 1,0 Heart attack 39 29 21 10 1 2,1 1,0 High blood pressure 40 26 23 9 2 2,1 1,1 SARS, outbreak outside country 33 30 27 9 1 2,1 1,0 Diabetes 25 28 32 12 2 2,4 1,1 SARS, outbreak in country 25 28 32 11 3 2,4 1,1 Flu from new virus, OB in country 21 26 37 12 4 2,5 1,1 Flu from a new flu virus 20 24 39 14 3 2,6 1,0 Common cold 6 15 53 19 8 3,1 0,9 Table 6-6: Response- and self efficacy:






Source of information mean SD mean SD Television 3,4 1,1 3,6 1,0 Newspapers 3,1 1,2 3,5 1,0 Family or friends 2,8 1,2 3,5 1,0 Internet websites 2,5 1,4 3,1 1,1 Radio 2,1 1,2 3,2 1,1 Government agencies 2,0 1,1 3,4 1,2 Consumer or patient interest groups 1,8 1,0 3,1 1,1 Your doctor 1,8 1,1 3,6 1,2 Information about SARS during the outbreak in 2003

4,0 1,0 3,9 1,0

53







COUNTRY REPORT

HONG KONG




August 2006

54

Background and Methods The background of the survey and the methods used are described in the separate report ‘general description and international comparison’. Results The Hong Kong data were collected between 22 September and 22 November 2005 by 38 interviewers. In total 401 respondents participated. 56% of repondents were women, 44% men. The mean age of the respondents was 41,3 years (SD 15,1; range 18-75 years). The general descriptives are given in table 1. Risk perception Risk perception for SARS and eight other diseases was assessed with 3 questionnaire items for each disease. First the respondents were asked to rate the seriousness of each disease (table 2). SARS was rated second on seriousness; only HIV was rated as more serious, but, for example, a heart attack was rated as less serious. Vulnerability was measured by asking the respondents how they thought their chances were to get the disease themselves (table 3). Getting SARS was perceived relatively likely, there was no difference when respondents were asked to envision the situation of an outbreak. Risk perception was defined as the muliplication of seriousness and vulnerability. This combined measure shows that SARS-related risk perception was the highest of the diseases for which risk perception was assessed (table 4). Comparative risk perceptions are shown in table 5. For SARS in case of an outbreak outside Hong Kong a positive (optimistic) bias in risk perception was present. This bias was slightly lower in case of an outbreak of SARS in Hong Kong. Efficacy SARS related respons efficacy was high compared to the other countries. Self efficacy was lower than response efficacy (table 6). Information The respondent got most information about new infectious diseases like SARS from television and confidence in this information was relatively high. Least information came from the respondents own doctor and from consumer groups (table 7). The amount of information and confidence in the information during the SARS outbreak in 2003 were comparable to the other Asian countries and relatively high compared to the European countries. Conclusion Risk perceptions for SARS are high, and self efficacy is relatively high too.

55

Appendix Country Report Hong Kong Table 7-1: General descriptives: Gender N % Male 177 44,1 Female 224 55,9 Agegroup 18-30 109 27,2 31-45 138 34,4 46-60 106 26,4 61-75 48 12,0 Area City 359 89,5 Town 17 4,2 Village 18 4,5 Countryside 7 1,7 number in household 1 27 6,7 2 61 15,2 3 80 20,0 4 110 27,4 5 or more 123 30,7 Children in household Yes 106 28,3 No 268 71,7 Highest education Primary school or no





56


Seriousness 'On a scale from 1 to 10, how serious would it be for you to get ….....in the next year? mean SD HIV 8,8 2,3 SARS, outbreak outside country 8,4 2,0 Heart attack 7,7 1,9 Flu from a new flu virus 7,0 2,1 Tuberculosis 6,8 2,3 Diabetes 6,7 2,2 High blood pressure 6,3 2,1 Food poisoning 5,6 2,3 Common cold 3,7 2,1 Table 7-3: Perceived vulnerability for SARS and eight other diseases: proportions of respondents, means (scale 1-5) and standard deviations (SD).


unlikely (%)

unlikely (%)

not likely not

unlikely (%)

likely (%)


HIV 73 17 6 2 1 1,4 0,8 Tuberculosis 24 28 25 21 2 2,5 1,1 Diabetes 21 29 30 17 3 2,5 1,1 High blood pressure 27 22 20 25 5 2,6 1,3 Heart attack 20 26 24 25 6 2,7 1,2 SARS, outbreak outside country 18 23 28 25 6 2,8 1,2 Food poisoning 14 19 31 33 2 2,9 1,1 SARS, outbreak in country 10 24 30 30 6 3,0 1,1 Flu from a new flu virus 11 16 31 37 5 3,1 1,1 Flu from new virus, OB in country 6 10 35 43 6 3,3 1,0 Common cold 5 9 22 48 16 3,6 1,0 Table 7-4: Riskperception for SARS and eight other diseases:

means (scale 1-5) and standard deviations (SD). mean SD SARS, outbreak in country 3,5 0,9 Flu from new virus, OB in country 3,3 0,8 SARS, outbreak outside country 3,3 0,9 Flu from a new flu virus 3,2 0,8 Heart attack 3,1 0,9 Diabetes 2,8 0,9 Tuberculosis 2,8 0,9 Food poisoning 2,7 0,9 High blood pressure 2,7 0,9 Common cold 2,4 0,8 HIV 2,4 0,7

57




less likely (%)

as likely (%)

more likely (%)


mean SD

HIV 72 13 13 2 1 1,5 0,8 Tuberculosis 27 28 34 9 2 2,3 1,0 High blood pressure 29 23 34 9 5 2,4 1,1 Diabetes 22 26 44 7 1 2,4 0,9 Heart attack 23 25 35 13 4 2,5 1,1 Food poisoning 20 25 42 10 3 2,5 1,0 SARS, outbreak outside country 22 21 42 12 4 2,5 1,1 SARS, outbreak in country 15 21 47 16 2 2,7 1,0 Flu from a new flu virus 13 20 47 17 3 2,8 1,0 Flu from new virus, OB in country 10 15 54 17 4 2,9 0,9 Common cold 7 15 54 19 6 3,0 0,9 Table 7-6: Response- and self efficacy:






Source of information mean SD mean SD Television 3,7 1,1 3,7 1,0 Newspapers 3,4 1,2 3,4 0,9 Radio 2,8 1,3 3,4 1,0 Government agencies 2,7 1,2 3,6 1,1 Family or friends 2,6 1,1 3,2 1,0 Internet websites 2,3 1,4 3,0 1,0 Your doctor 2,0 1,2 3,8 1,1 Consumer or patient interest groups 2,0 1,1 3,2 1,0 Information about SARS during the outbreak in 2003

4,2 0,9 4,1 0,9

58







COUNTRY REPORT

SINGAPORE




August 2006

59

Background and Methods The background of the survey and the methods used are described in the separate report ‘general description and international comparison’. Results The Singapore data were collected between 21 September and 20 November 2005 by 56 interviewers. In total 430 respondents participated, 57% of repondents were women, 43% men. The mean age of the respondents was 40,2 years (SD 15,9; range 18-75 years). The general descriptives are given in table 1. Risk perception Risk perception for SARS and eight other diseases was assessed with 3 questionnaire items for each disease. First the respondents were asked to rate the seriousness of each disease (table 2). SARS was rated second on seriousness; only HIV was rated as more serious, but, for example, a heart attack was rated as less serious. Vulnerability was measured by asking the respondents how they thought their chances were to get the disease themselves (table 3). Getting SARS was perceived relatively likely, there was no difference when respondents were asked to envision the situation of an outbreak. Risk perception was defined as the muliplication of seriousness and vulnerability. This combined measure shows that SARS-related risk perception was the highest of the diseases for which risk perception was assessed (table 4). Comparative risk perceptions are shown in table 5. For SARS in case of an outbreak outside Singapore a positive (optimistic) bias in risk perception was present. This bias was slightly lower in case of an outbreak of SARS in Singapore. Efficacy Respons and self efficacy were relatively low compared to the other Asian countries but high compared to the European countries. Self efficacy was slightly lower than response efficacy (table 6). Information The respondent got most information about new infectious diseases like SARS from television and confidence in this information was relatively high. Least information came from the respondents own doctor and from consumer groups (table 7). The amount of information and confidence in the information during the SARS outbreak in 2003 were comparable to the other Asian countries and relatively high compared to the European countries. Conclusion Risk perceptions for SARS are high, and self efficacy is relatively high too.

60

Appendix Country Report Singapore Table 8-1: General descriptives: Gender N % Male 187 43,5 Female 243 56,5 Agegroup 18-30 152 35,3 31-45 134 31,2 46-60 84 19,5 61-75 60 14,0 Area City 347 80,7 Town 73 17,0 Village 3 0,7 Countryside 7 1,6 number in household 1 5 1,2 2 44 10,2 3 80 18,6 4 126 29,3 5 or more 175 40,7 Children in household Yes 159 37,4 No 266 62,6 Highest education Primary school or no





61


Seriousness 'On a scale from 1 to 10, how serious would it be for you to get ….....in the next year? mean SD HIV 7,4 3,4 SARS, outbreak outside country 7,2 3,0 Heart attack 6,9 3,0 Flu from a new flu virus 6,6 2,9 High blood pressure 6,4 2,9 Diabetes 6,1 3,0 Tuberculosis 6,1 3,0 Food poisoning 5,1 2,8 Common cold 3,8 2,6 Table 8-3: Perceived vulnerability for SARS and eight other diseases: proportions of respondents, means (scale 1-5) and standard deviations (SD).


unlikely (%)

unlikely (%)

not likely not

unlikely (%)

likely (%)


HIV 64 15 14 6 1 1,7 1,0 Tuberculosis 44 26 20 7 3 2,0 1,1 Diabetes 44 22 19 13 3 2,1 1,2 Heart attack 37 22 23 14 4 2,3 1,2 SARS, outbreak outside country 34 20 24 16 5 2,4 1,3 High blood pressure 35 20 21 18 6 2,4 1,3 SARS, outbreak in country 31 19 25 20 5 2,5 1,3 Food poisoning 30 22 21 20 7 2,5 1,3 Flu from a new flu virus 32 18 23 21 6 2,5 1,3 Flu from new virus, OB in country 27 15 26 25 7 2,7 1,3 Common cold 16 14 13 36 21 3,3 1,4 Table 8-4: Riskperception for SARS and eight other diseases:

means (scale 1-5) and standard deviations (SD). mean SD SARS, outbreak in country 2,8 1,1 Flu from new virus, OB in country 2,8 1,1 SARS, outbreak outside country 2,8 1,1 Flu from a new flu virus 2,7 1,1 Heart attack 2,7 1,1 High blood pressure 2,6 1,1 Diabetes 2,4 1,0 Food poisoning 2,4 1,0 Tuberculosis 2,3 1,0 Common cold 2,3 1,0 HIV 2,3 0,9

62




less likely (%)

as likely (%)

more likely (%)


mean SD

HIV 59 26 9 3 2 1,6 0,9 Tuberculosis 46 33 16 3 2 1,8 1,0 Diabetes 43 28 18 7 4 2,0 1,1 Heart attack 37 28 23 8 3 2,1 1,1 SARS, outbreak outside country 34 30 26 6 3 2,1 1,1 High blood pressure 38 26 21 10 5 2,2 1,2 Food poisoning 32 31 27 7 3 2,2 1,1 SARS, outbreak in country 32 27 33 5 3 2,2 1,0 Flu from a new flu virus 36 23 31 6 4 2,2 1,1 Flu from new virus, OB in country 28 22 37 7 6 2,4 1,1 Common cold 19 24 30 15 12 2,8 1,3 Table 8-6: Response- and self efficacy:






Source of information mean SD mean SD Television 3,7 1,0 3,7 1,0 Newspapers 3,5 1,1 3,7 1,0 Family or friends 3,2 1,2 3,5 1,1 Government agencies 3,0 1,3 3,5 1,1 Internet websites 3,0 1,3 3,4 1,1 Radio 2,8 1,2 3,4 1,0 Your doctor 2,5 1,3 3,5 1,2 Consumer or patient interest groups 2,4 1,2 3,2 1,0 Information about SARS during the outbreak in 2003

4,0 1,0 4,1 0,9

63

Questionnaire

Risk Perception of Infectious Diseases

Introduction at the start of the interview

Good morning / afternoon / evening,

My name is …………, I am calling for the Health Protection Agency*. This is not a sales call. We are conducting an important international study of people’s opinions about several health issues, specifically about diseases like flu. Your telephone number has been selected at random.

[* if respondent wants to know what the HPA is: “The Health Protection Agency is an independent body that protects the health and well-being of everyone in the UK”]

We would like to talk to one person in the household. I would like to speak to the person aged 18 to 75 who had the most recent birthday. Is that you? [ -if answer is ‘no’, ask if you can speak to the person who is. If this person is not at home tell the person speaking to that in that case you can also talk to him/her. -If this other person is at home ask if you can speak to that person. Continue when talking to eligible person, if this is a new person introduce again]

This interview will take approximately 15 minutes. Your answers will help to improve public health services. This interview is anonymous and confidential. Answers to all questions are voluntary, and we will treat your answers with strict confidence. Would you like to participate? If it is not suitable at this moment, can we make another appointment?

If the repondent does not want to participate, record the sex and ask ‘may I ask you for the

reason you do not want to participate?’

N1 Sex (coded by interviewer)

1 male

2 female

N2 Reason for non-participation

1 not interested 5 not able to (e.g. language problem, ill) 2 no time 6 other reason 3 i don’t feel like it

4 the reason is none of your business

4 digits �� ID-number interviewer number

first digit for country

64

GENERAL 1

I would like to start with a few general questions about you and your household.

1 Gender (code gender, if unsure ask: ‘I have to read every question on my screen and now my computer wants me to ask if you are male or female’)

1 Male 2 Female 2 In what year were you born?

1

9

3 To which ethnic group do you consider yourself belonging to ?

countrycode 4 Would you describe the area in which you live as being a city, town, village, or the

countryside? 1 City 2 Town 3 Village 4 Countryside 5 How many people are living in your household, including you? → if answer is 1, skip next question 6 Are there children under the age of 12 living in your household?

1 Yes 2 No 6 Not applicable (Q5=1)

65

RISK PERCEPTION: SEVERITY / SERIOUSNESS

Now, I will list a number of diseases. For every disease I would like you to tell me how you would feel about getting this disease in the next year, how serious it would be for you. You can give me a number between 1 and 10, where 1 is ‘not serious’ and 10 ‘extremely serious’. If you don’t know the disease I have asked you about, please tell me. Or on the other hand if you happen to have the disease yourself, please let me know as well. 1= not serious → 10= extremely serious 66= not applicable, respondent doesn’t know the disease (NA) Do not read 88= don’t know (DK) Do not read 99= refused (RF) Do not read IF respondent has never heard of the disease explain using the explanatory sentence (see description of diseases). If respondent still doesn’t know the disease further questions about the disease are skipped. Separate data entry possibility for every disease to indicate if: A. a respondent knows the disease after the disease is mentioned (default is yes) B. the explanation was given (if answer to A is no) C. the respondent knows the disease after the explanation has been given (yes or no) D. the respondent has the disease On a scale from 1 to 10, how serious would it be for you to get diabetes in the next year? And how about a common cold? And so on…..

rating NA DK RF 7 Diabetes 66 88 99 8 A common cold 66 88 99 9 HIV 66 88 99 10 High blood pressure 66 88 99 11 SARS (give explanation first) 66 88 99 12 Tuberculosis 66 88 99

13 Heart attack 66 88 99 14 Flu from a new flu virus (explain first) 66 88 99 15 Food poisoning 66 88 99

66

RISK PERCEPTION: PERSONAL RISK

Now, I would like to ask you how likely you think it is that you will develop or contract these diseases yourself in the next year. I will name a disease and would like to know if you think you are likely or unlikely to get this disease in the next year. 1= very unlikely 8= don’t know (DK) Do not read 2= unlikely 9= refused (RF) Do not read 3= not likely / not unlikely 4= likely 5= very likely Interviewer note: ask question in 2 steps “Are you likely or unlikely to get [disease] in the next year?” Answer: unlikely, ask: “unlikely or very unlikely?” (code 1 or 2) Answer: likely, aks: “likely or very likely?” (code 4 or 5) Answer: not likely but also not unlikely (code 3)

very

unlikely unlikely not

likely / not

unlikely

likely very likely

DK RF

16 Diabetes 1 2 3 4 5 8 9 17 A common cold 1 2 3 4 5 8 9 18 HIV 1 2 3 4 5 8 9 19 High blood pressure 1 2 3 4 5 8 9 20 SARS, in case of an outbreak

outside the UK 1 2 3 4 5 8 9

21 SARS, in case of an outbreak in the UK

1 2 3 4 5 8 9

22 Tuberculosis 1 2 3 4 5 8 9 23 Heart attack 1 2 3 4 5 8 9 24 Flu from a new flu virus 1 2 3 4 5 8 9 25 Flu from a new flu virus, in case

of a global flu outbreak, also in the UK

1

2

3

4

5

8

9

26 Food poisoning 1 2 3 4 5 8 9

67

RISK PERCEPTION: PERSONAL COMPARATIVE RISK

Now, I would like to ask you how likely you think it is that you will develop or contract certain diseases in the next year compared to other [women/men] of your age in the UK. I will name a disease and would like to know if you feel you are more likely, as likely, or less likely to get this disease in the next year as compared to the average [women/men] of your age in the UK. 1= much less likely 8= don’t know (DK) Do not read 2= less likely 9= refused (RF) Do not read 3= as likely as others 4= more likely 5= much more likely Interviewer note: ask question in 2 steps “Compared to the average [women/men] of your age in the UK, do you think you are more, less or as likely to get [disease] in the next year?” Answer: less likely, ask: “less likely or much less likely?” (code 1 or 2) Answer: more likely, aks: “more likely or much more likely?” (code 4 or 5) Answer: as likely as others (code 3)

much

less likely

less likely

as likely more likely

much more likely

DK RF

27 Diabetes 1 2 3 4 5 8 9 28 A common cold 1 2 3 4 5 8 9 29 HIV 1 2 3 4 5 8 9 30 High blood pressure 1 2 3 4 5 8 9 31 SARS, in case of an outbreak

outside the UK 1 2 3 4 5 8 9


1 2 3 4 5 8 9

33 Tuberculosis 1 2 3 4 5 8 9 34 Heart attack 1 2 3 4 5 8 9 35 Flu from a new flu virus 1 2 3 4 5 8 9 36 Flu from a new flu virus, in case

of a global flu outbreak, also in the UK

1

2

3

4

5

8

9

37 Food poisoning 1 2 3 4 5 8 9

KNOWLEDGE

As you might know, there was an outbreak of SARS two years ago, in 2003, which started in China. I will now ask you some questions about SARS and the new flu virus.

38 Can you name the most important symptom of SARS? open question, code answer: 1 Cough 2 Pneumonia 3 Fever 4 Muscle pain 5 Flu-like symptoms 6 Other; namely: …………………. 8 Don’t know any symptoms of SARS 9 refused

68

I will now give you some short statements. I would like to know for each statement whether you think it’s true or false or whether you don’t know.

true false DK 39 SARS is a communicable disease 1 2 3 40 Somebody can have SARS without having symptoms 1 2 3 41 People can die of an infection with a new flu virus 1 2 3

RISK PERCEPTION: RESPONSE EFFICACY AND SELF EFFICACY

I will now ask you some questions about actions you can take to prevent getting 3 different diseases. First I would like to know if you think that people in general can take actions to prevent getting these diseases. And after that I will ask you if you yourself think that you can prevent getting these diseases.

For the first 3 questions I would like to know to what extent you think people can take actions: 1= not at all 8= don’t know (DK) Do not read 2= a little bit 9= refused (RF) Do not read 3= quite a bit 4= definitely In general, do you think that people can take actions to prevent getting a new flu virus in case of a flu outbreak in the UK? And what about SARS, in case of an outbreak in the UK? and so on…..

Question 42–44 in random order not at all a little bit quite a bit

definitely DK RF

42 Flu from a new flu virus, in case of a flu outbreak in the UK

1 2 3 4 8 9


1 2 3 4 8 9

44 A common cold 1 2 3 4 8 9 Now I would like to know how confident you are that you can prevent getting these diseases

yourself: 1= not confident at all 8= don’t know (DK) Do not read 2= somewhat confident 9= refused (RF) Do not read 3= quite confident 4= very confident How confident are you that you yourself can prevent getting a new flu virus in case of a flu outbreak in the UK? And how confident are you that you yourself can prevent getting SARS, in case of an outbreak in the UK?

Question 45–47 in random order not confident

somewhat confident

quite confident

very confident

DK RF

45 Flu from a new flu virus, in case of a flu outbreak in the UK

1 2 3 4 8 9


1 2 3 4 8 9

47 A common cold 1 2 3 4 8 9

69

SOURCES OF INFORMATION

I will now ask you some questions about different sources of information. I will name a source of information and would like to know how much information about new and emerging diseases you got from this source in the past year. 1= nothing 8= don’t know (DK) Do not read 2= little 9= refused (RF) Do not read 3= some 4= much 5= very much

nothing little some

much very

much

DK RF

48 Newspapers 1 2 3 4 5 8 9

49 Television 1 2 3 4 5 8 9

50 Radio 1 2 3 4 5 8 9

51 Internet websites 1 2 3 4 5 8 9

52 Your doctor 1 2 3 4 5 8 9

53 Governmental agencies

1 2 3 4 5 8 9

54 Consumer or patient interest groups

1 2 3 4 5 8 9

55 Family or friends 1 2 3 4 5 8 9

How much confidence did you have in information about new and emerging diseases you got from these sources in the past year? 1= none 8= don’t know (DK) Do not read 2= little 9= refused (RF) Do not read 3= some 4= much 5= very much

none little some

much very

much

DK RF

56 Newspapers 1 2 3 4 5 8 9

57 Television 1 2 3 4 5 8 9

58 Radio 1 2 3 4 5 8 9

59 Internet websites 1 2 3 4 5 8 9

60 Your doctor 1 2 3 4 5 8 9


1 2 3 4 5 8 9


1 2 3 4 5 8 9

63 Family or friends 1 2 3 4 5 8 9

Now I will ask you some questions about the outbreak of SARS two years ago, in march and april 2003.

64 How much have you heard about SARS at the time of the outbreak?

nothing little some much very much DK RF

1 2 3 4 5 8 9

70

65 From which source of information did you get most information about SARS at the time

of the outbreak? Open question: code answer

1 Newspapers

2 Television

3 Radio

4 Internet websites

5 Own doctor



8 Family or friends

9 Other source: …………………………………

88 DK

99 RF

66 How much confidence did you have in information about SARS from [source Q65]?

none little some much very much DK RF

1 2 3 4 5 8 9

Imagine an outbreak of a new serious infectious disease such as SARS or flu from a new flu

virus in your country in the next year.

67 What would you find most important to know in that situation? (open question)

1 How this disease is transmitted

2 How to recognize the symptoms of this disease

3 How you can prevent getting infected

4 The geographic areas in which this disease is present

5 The chances of catching this disease in [country]

6 How this disease is treated

7 Something else: ……………………………………………….

8 DK

9 RF

68 From what source would you most prefer to receive information in case of such an outbreak in the UK? Open question: code answer

1 Newspapers

2 Television

3 Radio

4 Internet websites

5 Own doctor



8 Family or friends

9 Other source: …………………………………

88 DK

99 RF

71

69 Imagine a global outbreak of flu from a new flu virus, also in the UK, bringing with it a sharp increase in hospitalizations and death from those who are infected. I will mention 3 places and would like to know where you think you run the greatest risk of infection. Mention 3 out of these 6 at random. ‘Is that [a], [b], or [c]?’ Code answer

1 On public transport (eg trains, buses, airplanes)

2 In entertainment enterprises, such as bars, restaurants, theatres or cinema

3 In shops

4 At work or school

5 In a hospital

6 At home or with friends and family

Imagine this outbreak from a new flu virus in the UK, in which in 5 weeks’ time, X people of all ages were seriously ill with flu, and Z people died in the UK. Which of the following 3 things would you do, if any? It is uncertain whether mouth masks prevent infection. This question is at random phrased with X and Z. UK: X=1,500,000 and Z=15,000 OR X=5,900,000 and Z=59,000 Only 3 out of these 8 actions are asked at random.

‘Would you ……..’ yes no DK RF

70 Avoid public transport (eg trains, buses, airplanes) 1 2 8 9

71 Avoid going out for entertainment, such as bars, restaurants, theatres, cinema

1 2 8 9

72 Limit shopping to the essentials 1 2 8 9

73 Take absence from work 1 2 8 9

74 Keep the children out of school (even if school is still open) [skip this question if answer to Q6=2 or Q6=6]

1 2 8 9

75 Limit physical contact with friends and family 1 2 8 9

76 Avoid seeing doctors, even when you're sick from something

unrelated to flu

1 2 8 9

77 Stay indoors at all times 1 2 8 9

GENERAL

The last few questions are general questions about yourself.

78 Overall, how would you rate your health during the past 4 weeks? Very poor Poor Fair Good Very good Excellent 1 2 3 4 5 6

79 Taking all things together, would you say that you are happy or unhappy? If happy: quite happy or very happy? If unhappy: quite unhappy or very unhappy?

very unhappy quite unhappy not happy, not unhappy

quite happy very happy

1 2 3 4 5

80 Have you been vaccinated against influenza in the last year? 1 Yes 2 No 3 Don’t know

72

81 Which category is best to describe your current employment? 1 Student 2 Teacher 3 Health care worker 4 Factory worker 5 Other type of employment 6 Unemployed 7 Housewife 8 Retired

9 (partly) disabled

82 What is the highest education you completed or are still following? 1 Primary school or no education 2 Lower general secondary education

or Lower vocational education 3 Intermediate/higher general secondary education

or Intermediate vocational education 4 Higher vocational education

or University education

83 What is your religion? (open question, code answer) 1 Not religious 2 Christianity: Roman Catholic 3 Christianity: Protestant and other Christianity 4 Islam 5 Hinduism 6 Buddhism 7 Chinese traditional religion (Taoism, Confucianism, Chinese Buddhism) 8 Judaism 9 Other Those are all the questions I have. Thank you very much for your cooperation.

Your answers will help to develop public health policy.

84 Would you like to get the address of a website where you can find more information about SARS and pandemic flu? If yes, give specific address for the country. UK: www.hpa.org.uk

85 Do you have any remarks you wish to add? 1 Yes: ……………………………………….. 2 No Once again thank you very much for your cooperation.

73

Short description of the diseases These can be read to the respondent if he or she does not know a disease when the questions about seriousness are asked (question 7-15). The description for ‘SARS’ and ‘flu from a new flu virus’ is always given. If the respondent still does not know the disease after the description is given, further questions on the disease are skipped. Diabetes Diabetes is a chronic disorder which leads to high levels of glucose, sugar, in

the blood.

A common cold A common cold is an infection of the nose and throat area, with symptoms like a running nose and coughing.

HIV HIV is the virus which causes AIDS, it affects the immune system.

High blood pressure

High blood pressure, or hypertension, usually has no symptoms but can increase the risk for heart and blood vessel diseases.

SARS SARS is a severe acute breathing related illness caused by a previously unkown virus.

Tuberculosis Tuberculosis, or TB, is an infection with a bacteria that mainly affects the lungs.

Heart attack A heart attack is a sudden and severe episode of heart disease.

Flu from a new flu virus

A new type of flu virus can arise from avian flu, it causes serious illness and spreads easily in the population.

Food poisoning Food poisoning is an acute stomach and gut disorder caused by bacteria or virusses with symptoms like vomiting and diarrhoea.

74

List of definitions

Variable Definition (D) and question (Q) Seriousness D One’s judgment on the magnitude of the perceived obnoxiousness of the

disease. Q How serious would it be for you to get ….. in the next year Vulnerability D One’s judgment on the degree to which an individual feels the disease will

occur to him/herself Q How likely do you think it is that you will get …. in the next year Risk perception � (seriousness / 2) * vulnerability Comparative risk perception

D One’s judgment on the relative degree to which an individual feels the disease will occur to him/herself as compared to others

Q How likely do you think it is that you will get …. in the next year compared to other [women/men] of your age in [country]

Response efficacy D One’s belief that preventive actions will be effective Q Do you think that people in general can take actions to prevent getting…. Self-efficacy D One’s belief in his or her capability to carry out preventive actions Q How confident are you that you yourself can prevent getting….

sarscontrol wp5 risk perceptions survey report def · pdf file ·...

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