Skrip Laura A, Weller Malcom B, Dukuly Sheikh, Candy Neima, Harmon-Gray Wahdae-Mai, Clarke Adolphus, Dahn Bernice T
School of Public Health, College of Health Sciences, University of Liberia, 1000-10, Monrovia, Liberia.
Expanded Program on Immunization Unit, Ministry of Health, Monrovia, Liberia.
BMC Glob Public Health. 2024 Apr 1;2(1):22. doi: 10.1186/s44263-024-00054-5.
The burden of the COVID-19 pandemic in terms of morbidity and mortality differentially affected populations. Between and within populations, behavior change was likewise heterogeneous. Factors influencing precautionary behavior adoption during COVID-19 have been associated with multidimensional aspects of risk perception; however, the influence of lived experiences during other recent outbreaks on behavior change during COVID-19 has been less studied.
To consider how the direct disease experience ("near misses") and behavior change during the 2014-2016 Ebola virus disease (EVD) outbreak may have impacted behavior change during the early waves of the COVID-19 outbreak in West Africa, we analyzed data from a mixed-methods study that included a phone-based survey and in-depth interviews among vaccinated Liberian adults. Logistic regression via generalized estimating equations with quasi-likelihood information criterion (QIC)-based model selection was conducted to evaluate the influence of the interaction between and individual effects of the outbreak (EVD and COVID-19) and the "near-miss" experience on adoption of individual precautionary behaviors. Thematic analysis of interview transcripts explored reasons for differential behavior adoption between the two outbreaks.
At the population level, being a "near miss" was not associated with significantly different behavior during COVID-19 versus Ebola; however, overall, people had lower odds of adopting precautionary behaviors during COVID-19 relative to during Ebola. Participants who report near miss experiences during Ebola were significantly more likely to report having a household member test positive for COVID-19 (p<0.001). Qualitatively, participants often reflected on themes around more proximal and personal experiences with Ebola than with COVID-19; they also commented on how EVD led to better preparedness at the systems level and within communities for how to behave during an outbreak, despite such awareness not necessarily translating into action during COVID-19.
The results suggest that perceived proximity and intensity to disease threats in space and time affect behavioral decisions. For successive disease threats, comparisons of the present outbreak to past outbreaks compound those effects, regardless of whether individuals were directly impacted via a "near-miss" experience. Measures, such as risk communication and community engagement efforts, that gauge and reflect comparisons with previous outbreaks should be considered in response strategies to enhance the adoption of precautionary behavior.
2019年冠状病毒病（COVID-19）大流行在发病率和死亡率方面给不同人群带来了不同程度的负担。在不同人群之间以及同一人群内部，行为变化同样存在异质性。影响COVID-19期间预防行为采纳的因素与风险认知的多维度方面相关；然而，近期其他疫情期间的实际经历对COVID-19期间行为变化的影响研究较少。
为了探讨2014 - 2016年埃博拉病毒病（EVD）疫情期间的直接疾病经历（“侥幸脱险”）和行为变化可能如何影响西非COVID-19疫情早期的行为变化，我们分析了一项混合方法研究的数据，该研究包括对利比里亚接种疫苗的成年人进行的电话调查和深入访谈。通过基于广义估计方程和基于拟似然信息准则（QIC）的模型选择进行逻辑回归，以评估疫情（EVD和COVID-19）之间的相互作用以及个体效应和“侥幸脱险”经历对个体预防行为采纳的影响。对访谈记录进行主题分析，探讨两次疫情期间行为采纳差异的原因。
在人群层面，“侥幸脱险”与COVID-19期间和埃博拉期间的行为差异无显著关联；然而，总体而言，与埃博拉期间相比，人们在COVID-19期间采纳预防行为的几率较低。在埃博拉疫情期间有“侥幸脱险”经历的参与者报告家庭成员COVID-19检测呈阳性的可能性显著更高（p<0.001）。从定性角度来看，参与者经常反思与埃博拉相比，围绕COVID-19的更直接和个人经历的主题；他们还评论了EVD如何在系统层面和社区内使人们在疫情期间如何行动方面有了更好的准备，尽管这种意识在COVID-19期间不一定转化为行动。
结果表明，在空间和时间上对疾病威胁的感知接近程度和强度会影响行为决策。对于连续的疾病威胁，将当前疫情与过去疫情进行比较会加剧这些影响，无论个体是否通过“侥幸脱险”经历受到直接影响。在应对策略中应考虑采取诸如风险沟通和社区参与等措施，这些措施衡量并反映与先前疫情的比较，以促进预防行为的采纳。
