Risk perception during the 2014–2015 Ebola outbreak in Sierra Leone

Abstract

Background Perceived susceptibility to a disease threat (risk perception) can influence protective behaviour. This study aims to determine how exposure to information sources, knowledge and behaviours potentially influenced risk perceptions during the 2014–2015 Ebola Virus Disease outbreak in Sierra Leone. Methods The study is based on three cross-sectional, national surveys (August 2014, n = 1413; October 2014, n = 2086; December 2014, n = 3540) that measured Ebola-related knowledge, attitudes, and practices in Sierra Leone. Data were pooled and composite variables were created for knowledge, misconceptions and three Ebola-specific behaviours. Risk perception was measured using a Likert-item and dichotomised into ‘no risk perception’ and ‘some risk perception’. Exposure to five information sources was dichotomised into a binary variable for exposed and unexposed. Multilevel logistic regression models were fitted to examine various associations. Results Exposure to new media (e.g. internet) and community-level information sources (e.g. religious leaders) were positively associated with expressing risk perception. Ebola-specific knowledge and hand washing were positively associated with expressing risk perception (Adjusted OR [AOR] 1.4, 95% Confidence Interval [CI] 1.2–1.8 and AOR 1.4, 95% CI 1.1–1.7 respectively), whereas misconceptions and avoiding burials were negatively associated with risk perception, (AOR 0.7, 95% CI 0.6–0.8 and AOR 0.8, 95% CI 06–1.0, respectively). Conclusions Our results illustrate the complexity of how individuals perceived their Ebola acquisition risk based on the way they received information, what they knew about Ebola, and actions they took to protect themselves. Community-level information sources may help to align the public’s perceived risk with their actual epidemiological risk. As part of global health security efforts, increased investments are needed for community-level engagements that allow for two-way communication during health emergencies.

Public and health professional epidemic risk perceptions in countries that are highly vulnerable to epidemics: a systematic review

“…internet, text messages), and accessed three or more information sources. Television, radio, house visits by health workers and government campaigns, and using two or less information sources appeared to have no influence on perceived risk [ 68 ]. Two studies showed inconsistent effects of newspapers, brochures and billboards on risk perception [ 60 , 68 ].…”

“…Television, radio, house visits by health workers and government campaigns, and using two or less information sources appeared to have no influence on perceived risk [ 68 ]. Two studies showed inconsistent effects of newspapers, brochures and billboards on risk perception [ 60 , 68 ]. Previous community experience of disease [ 55 ] and exposure to a new and unfamiliar disease [ 67 ] were associated with increased risk perception.…”

“…Demographic factors showed inconsistent influences on risk perception across countries and diseases. Education level [ 54 , 60 , 62 , 65 , 68 ], disease-specific knowledge [ 44 , 54 , 68 , 69 ], rural or urban residence [ 41 , 42 , 62 ], marital status [ 54 , 62 ], income level [ 54 , 62 ], gender [ 41 , 54 , 62 , 68 , 69 ] and age [ 42 , 54 , 62 , 68 , 69 ], variably showed positive, negative or no association with epidemic risk perception across different studies. Larger family size [ 62 ] and certain occupations [ 60 , 62 ] were associated with increased perceived risk in two studies.…”

“…Disease case fatality ratios and infection risks seemed to influence risk perception, indicating the role of numeracy skills [ 39 ]. The phase of an outbreak also seemed influential: an ongoing outbreak of typhoid fever was associated with a grave concern that cases would continue to increase [ 39 ], while the likelihood of acknowledging the risk of acquiring infection decreased as an EVD outbreak progressed [ 68 ]. Some disease attributes were associated with an increased risk perception among participants, specifically diseases perceived as hard to control through community infection control measures [ 38 ], unfamiliar diseases [ 67 ], and severe diseases [ 39 , 67 ].…”

“…Another study found that vaccination against EVD lowered perceived likelihood and alleviated worry [ 70 ]. However, the relationship between risk perception and protective behaviours against EVD was not consistent; for example, one study reported that while handwashing had a positive association with risk perception, avoiding burials was negatively associated with risk perception, and avoiding physical contact with a suspected EVD case not associated with risk perception [ 68 ].…”