자연주의적 탐구조사(Naturalistic Inquiry)

Summary Background The current outbreak of Ebola in eastern DR Congo, beginning in 2018, emerged in a complex and violent political and security environment. Community-level prevention and outbreak control measures appear to be dependent on public trust in relevant authorities and information, but little scholarship has explored these issues. We aimed to investigate the role of trust and misinformation on individual preventive behaviours during an outbreak of Ebola virus disease (EVD). Methods We surveyed 961 adults between Sept 1 and Sept 16, 2018. We used a multistage sampling design in Beni and Butembo in North Kivu, DR Congo. Of 412 avenues and cells (the lowest administrative structures; 99 in Beni and 313 in Butembo), we randomly selected 30 in each city. In each avenue or cell, 16 households were selected using the WHO Expanded Programme on Immunization's random walk approach. In each household, one adult (aged ≥18 years) was randomly selected for interview. Standardised questionnaires were administered by experienced interviewers. We used multivariate models to examine the intermediate variables of interest, including institutional trust and belief in selected misinformation, with outcomes of interest related to EVD prevention behaviours. Findings Among 961 respondents, 349 (31·9%, 95% CI 27·4–36·9) trusted that local authorities represent their interest. Belief in misinformation was widespread, with 230 (25·5%, 21·7–29·6) respondents believing that the Ebola outbreak was not real. Low institutional trust and belief in misinformation were associated with a decreased likelihood of adopting preventive behaviours, including acceptance of Ebola vaccines (odds ratio 0·22, 95% CI 0·21–0·22, and 1·40, 1·39–1·42) and seeking formal health care (0·06, 0·05–0·06, and 1·16, 1·15–1·17). Interpretation The findings underscore the practical implications of mistrust and misinformation for outbreak control. These factors are associated with low compliance with messages of social and behavioural change and refusal to seek formal medical care or accept vaccines, which in turn increases the risk of spread of EVD. Funding The Harvard Humanitarian Initiative Innovation Fund.

Institutional trust and misinformation in the response to the 2018-19 Ebola outbreak in North Kivu, DR Congo: a population-based survey.

BACKGROUND: The effective implementation of government policies and measures for controlling the coronavirus disease 2019 (COVID-19) pandemic requires compliance from the public. This study aimed to examine cross-sectional and longitudinal associations of trust in government regarding COVID-19 control with the adoption of recommended health behaviours and prosocial behaviours, and potential determinants of trust in government during the pandemic. METHODS: This study analysed data from the PsyCorona Survey, an international project on COVID-19 that included 23 733 participants from 23 countries (representative in age and gender distributions by country) at baseline survey and 7785 participants who also completed follow-up surveys. Specification curve analysis was used to examine concurrent associations between trust in government and self-reported behaviours. We further used structural equation model to explore potential determinants of trust in government. Multilevel linear regressions were used to examine associations between baseline trust and longitudinal behavioural changes. RESULTS: Higher trust in government regarding COVID-19 control was significantly associated with higher adoption of health behaviours (handwashing, avoiding crowded space, self-quarantine) and prosocial behaviours in specification curve analyses (median standardised s = 0.173 and 0.229, p < 0.001). Government perceived as well organised, disseminating clear messages and knowledge on COVID-19, and perceived fairness were positively associated with trust in government (standardised s = 0.358, 0.230, 0.056, and 0.249, p < 0.01). Higher trust at baseline survey was significantly associated with lower rate of decline in health behaviours over time (p for interaction = 0.001). CONCLUSIONS: These results highlighted the importance of trust in government in the control of COVID-19.

Trust in government regarding COVID-19 and its associations with preventive health behaviour and prosocial behaviour during the pandemic: a cross-sectional and longitudinal study.

Objectives. We conducted the first empirical examination of disparities in H1N1 exposure, susceptibility to H1N1 complications, and access to health care during the H1N1 influenza pandemic.

Methods. We conducted a nationally representative survey among a sample drawn from more than 60 000 US households. We analyzed responses from 1479 adults, including significant numbers of Blacks and Hispanics. The survey asked respondents about their ability to impose social distance in response to public health recommendations, their chronic health conditions, and their access to health care.

Results. Risk of exposure to H1N1 was significantly related to race and ethnicity. Spanish-speaking Hispanics were at greatest risk of exposure but were less susceptible to complications from H1N1. Disparities in access to health care remained significant for Spanish-speaking Hispanics after controlling for other demographic factors. We used measures based on prevalence of chronic conditions to determine that Blacks were the most susceptible to complications from H1N1.

Conclusions. We found significant race/ethnicity-related disparities in potential risk from H1N1 flu. Disparities in the risks of exposure, susceptibility (particularly to severe disease), and access to health care may interact to exacerbate existing health inequalities and contribute to increased morbidity and mortality in these populations.

Racial disparities in exposure, susceptibility, and access to health care in the US H1N1 influenza pandemic.

Context
Although health care-related distrust may contribute to racial disparities in health and health care in the US, current evidence about racial differences in distrust is often conflicting, largely limited to measures of physician trust, and rarely linked to multidimensional trust or distrust.

/pdf/differences-in-the-patterns-of-health-care-system-distrust-1sg7xdtv9y.pdf

Differences in the Patterns of Health Care System Distrust Between Blacks and Whites

Objectives: Public health departments' effectiveness during catastrophic bioterrorism will require trust on the part of diverse communities. This study describes variations in perceptions that the public health system will respond fairly to one's needs in a bioterrorist event, regardless of race/ethnicity, income, or other characteristics. Methods: Using the Los Angeles County Health Survey, a random-digit, population-based, telephone survey, we conducted multivariate logistic regression of race/ethnicity on perceived fairness, adjusting for demographic factors and perceived neighborhood safety. We performed similar analyses stratified by race/ethnicity subgroup. Results: Overall, 72.7% of respondents perceived that the public health system will respond fairly in a bioterrorist event. African Americans (AA) and Asian/Pacific Islanders (API) reported the lowest perceived fairness (AA 63.0%, API 68.2%, Latino 73.1%, White 76.6%, p = 0.005 for group differences). Adjusting for demographic factors and neighbo...

/pdf/will-public-health-s-response-to-terrorism-be-fair-racial-q3b2esjn2r.pdf

Will public health's response to terrorism be fair? Racial/ethnic variations in perceived fairness during a bioterrorist event

https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2007.124206

Terrorism-RelatedFearandAvoidanceBehavior inaMultiethnicUrbanPopulation

Differences in Individual-Level Terrorism Preparedness in Los Angeles County

This study builds on recent work describing African Americans' low trust in public health regarding terrorism preparedness by identifying the specific components of trust (fiduciary responsibility, honesty, competency, consistency, faith) that may influence community response to a bioterrorist attack. We used qualitative analysis of data from 75 African American adults living in Los Angeles County who participated in focus group discussions. Groups were stratified by socioeconomic status (SES; up to vs. above 200% of federal poverty guidelines) and age (18-39 years old vs. 40-65 years old). Discussions elicited reactions to information presented in escalating stages of a bioterrorism scenario. The scenario mimicked the events and public health decisions that might occur under such a scenario. Honesty and consistency of information from public health officials were the components most frequently identified as determining trust or distrust. Patterns of trust varied according to the scenario stage; honesty was most important upon initially hearing of a public health crisis, whereas fiduciary responsibility and consistency were important upon confirmation of a smallpox outbreak and the ensuing public health response. Findings can help public health officials design communications that address distrust and enhance trust during a bioterrorist event.

Trust influences response to public health messages during a bioterrorist event.

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Will public health's response to terrorism be fair? Racial/ethnic variations in perceived fairness during a bioterrorist event

Terrorism-RelatedFearandAvoidanceBehavior inaMultiethnicUrbanPopulation

Differences in Individual-Level Terrorism Preparedness in Los Angeles County

Trust influences response to public health messages during a bioterrorist event.