Factors That Mattered in Helping Travelers From Countries With Ebola Outbreaks Participate in Post-Arrival Monitoring During the 2014-2016 Ebola Epidemic

Abstract

During the 2014-2016 Ebola epidemic in West Africa, the US Centers for Disease Control and Prevention (CDC) developed the CARE+ program to help travelers arriving to the United States from countries with Ebola outbreaks to meet US government requirements of post-arrival monitoring. We assessed 2 outcomes: (1) factors associated with travelers’ intention to monitor themselves and report to local or state public health authority (PHA) and (2) factors associated with self-reported adherence to post-arrival monitoring and reporting requirements. We conducted 1195 intercept in-person interviews with travelers arriving from countries with Ebola outbreaks at 2 airports between April and June 2015. In addition, 654 (54.7%) of these travelers participated in a telephone interview 3 to 5 days after intercept, and 319 (26.7%) participated in a second telephone interview 2 days before the end of their post-arrival monitoring. We used regression modeling to examine variance in the 2 outcomes due to 4 types of factors: (1) programmatic, (2) perceptual, (3) demographic, and (4) travel-related factors. Factors associated with the intention to adhere to requirements included clarity of the purpose of screening (B = 0.051, 95% confidence interval [CI], 0.011-0.092), perceived approval of others (B = 0.103, 95% CI, 0.058-0.148), perceived seriousness of Ebola (B = 0.054, 95% CI, 0.031-0.077), confidence in one’s ability to perform behaviors (B = 0.250, 95% CI, 0.193-0.306), ease of following instructions (B = 0.053, 95% CI, 0.010-0.097), and trust in CARE Ambassador (B = 0.056, 95% CI, 0.009-0.103). Respondents’ perception of the seriousness of Ebola was the single factor associated with adherence to requirements (odds ratio [OR] = 0.81, 95% CI, 0.673-0.980, for non-adherent vs adherent participants and OR = 0.86, 95% CI, 0.745-0.997, for lost to follow-up vs adherent participants). Results from this assessment can guide public health officials in future outbreaks by identifying factors that may affect adherence to public health programs designed to prevent the spread of epidemics.

Exploring the predictors of health-protective behavior during the COVID-19 pandemic: A multi-country comparison

“…Moreover, this study found that self-efficacy does not encourage Indian individuals to comply with protective action recommendations in the case of the COVID-19 pandemic. The present finding is not consistent with studies set in Thailand, the United States, and Hong Kong which reported that the individual's self-efficacy is a significant antecedent of compliance with recommended behaviors ( Payaprom et al, 2011 ; Prue et al, 2019 ; Ng et al, 2020 ). It may be that a higher increase in an individual's ability to avoid crowds in India does not necessarily lead to greater adoption of preventive health actions against the COVID-19 infection.…”

“…As expected, the ANN results showed that perception of the COVID-19 severity is the most important factor with a significant positive effect on the adoption of protective behavior among Moroccan residents. This is consistent with the findings of studies conducted in the United States and South Korea that support the strong influence of perceived severity on the behavioral responses to health-related recommendations ( Prue et al, 2019 ; Lee and You, 2020 ). In Morocco, this may imply that the greater individual's assessment of the negative consequences of COVID-19 such as death, leads to a higher level of compliance with the health-protective measures.…”

“…An examination of existing works also reveals that considerable effort has been invested to further the current knowledge on the behavioral determinants that influence adherence to protective measures. In particular, perceived benefits ( Liao et al, 2011a ; Gaygısız et al, 2012 ), anticipated regret ( Liao et al, 2011b ; Penţa et al, 2020 ), knowledge ( Liao et al, 2011a ; Zottarelli et al, 2012 ), self-efficacy ( Payaprom et al, 2011 ; Prue et al, 2019 ), subjective norm ( Yardley et al, 2011 ; Ng et al, 2020 ), perceived susceptibility ( Zottarelli et al, 2012 ; Liao et al, 2013 ), cues to action ( Ho et al, 2013 ; Zhang et al, 2015 ), attitude ( Ahmad et al, 2020 ; Bae and Chang, 2020 ), trust ( Yang et al, 2014 ; D'Antoni et al, 2019 ), and perceived severity ( Lee and You, 2020 ; Penţa et al, 2020 ) were among the most salient factors in shaping the adoption of health recommendations.…”