Understanding health behavior changes in response to outbreaks: findings from a longitudinal study of a large epidemic of mosquito-borne disease.

Abstract

Rationale. Although greater attention has been recently given to the ecological determinants of health behaviours, we still do not know much about the behavioural changes induced by the spread of infectious diseases. Objective. In this study, we took advantage of a large epidemic of chikungunya, an emerging mosquito-borne disease, in French Guiana to examine the dynamic interaction between risk-related perceptions and behaviours that occurs in response to a disease outbreak. In particular, we tested empirically the assumption that both risk perceptions and health behaviours were elastic with respect to prevalence of chikungunya. Methods. A representative sample of French Guianan (N=434) was interviewed in January 2015 just after the peak of the epidemic, and again 2 months later. Participants were asked about their perceptions of the threat, as well as their engagement in a range of protective behaviours promoted by the regional health authorities to control the spread of the disease. Results. The surveys showed that (1) the frequency of some health behaviours – those related to visible control methods – significantly increased with the subjective and objective prevalence of the disease, (2) perceived risk of infection for oneself tended to decrease considerably over time, and (3) the risk reappraisal hypothesis failed to account for this paradoxical trend in the people’s response to the risk of contracting the disease. Conclusion. These findings suggest that people may fail to adjust their risk perceptions, and to a lesser extent their health protective behaviours, to the course of an epidemic. Notably, the prevalence elasticity of preventive action found in previous studies of behavioural response to infectious diseases differed substantially according to the type of intervention (personal versus environmental methods). This paradoxical trend may be attributed to risk habituation effects, which seem to vary significantly according to the social visibility of the preventive actions.

A review and agenda for integrated disease models including social and behavioural factors

“…ocial and behavioural factors are critical to the emergence, spread and containment of human disease and are key determinants of the course, duration and outcomes of outbreaks. The feasibility and acceptability of adopting recommended health behaviours are intertwined with social, economic, environmental and political complexities that affect individuals, communities and societies [1][2][3][4] . Individuals and communities have vital roles in reducing transmission during outbreak response 5 by maintaining preventive behaviours, and actively contributing to response design, implementation and monitoring.…”

On the Use of Theories in Study of Personal Health Behavior During Epidemics/Pandemics.

“…[14], occupation [15], and underlying medical condition [16,17]. Another factor that can have an effect on health behavior is the duration of the pandemic or epidemic and the perception that the risk of infection can decrease over time [18].…”