Knowledge, attitudes and practices towards pandemic influenza among cases, close contacts, and healthcare workers in tropical Singapore: a cross-sectional survey

Abstract

BackgroundEffective influenza pandemic management requires understanding of the factors influencing behavioral changes. We aim to determine the differences in knowledge, attitudes and practices in various different cohorts and explore the pertinent factors that influenced behavior in tropical Singapore.MethodsWe performed a cross-sectional knowledge, attitudes and practices survey in the Singapore military from mid-August to early-October 2009, among 3054 personnel in four exposure groups - laboratory-confirmed H1N1-2009 cases, close contacts of cases, healthcare workers, and general personnel.Results1063 (34.8%) participants responded. The mean age was 21.4 (SE 0.2) years old. Close contacts had the highest knowledge score (71.7%, p = 0.004) while cases had the highest practice scores (58.8%, p < 0.001). There was a strong correlation between knowledge and practice scores (r = 0.27, p < 0.01) and knowledge and attitudes scores (r = 0.21, p < 0.01). The significant predictors of higher practice scores were higher knowledge scores (p < 0.001), Malay ethnicity (p < 0.001), exposure group (p < 0.05) and lower education level (p < 0.05). The significant predictors for higher attitudes scores were Malay ethnicity (p = 0.014) and higher knowledge scores (p < 0.001). The significant predictor for higher knowledge score was being a contact (p = 0.007).ConclusionKnowledge is a significant influence on attitudes and practices in a pandemic, and personal experience influences practice behaviors. Efforts should be targeted at educating the general population to improve practices in the current pandemic, as well as for future epidemics.

A systematic review of factors affecting intended and actual adherence with antiviral medication as treatment or prophylaxis in seasonal and pandemic flu

“…In the United States, larger household size was a predictor of intended adherence to antiviral medication for the treatment of pandemic influenza, whereas in the Netherlands, intention to take antivirals as prophylaxis was associated with not having children in the household . Other predictors of intended adherence to antivirals included higher risk perception of catching pandemic influenza, knowledge of pandemic influenza and its associated risks and perceived personal consequences of influenza as well as amount of information received about pandemic influenza, increased attention to information and information seeking behaviours . In the United States, trust in the government was also associated with acceptance of antivirals for oneself and one's children .…”

“…Six additional articles were identified through other search engines such as ScienceDirect and in review articles on the topic area. For one of our included studies, additional information was obtained from the author (Phern‐Chern, personal communication).…”

“…Studies showing higher risk of bias (selection bias, detection bias, reporting bias and other sources of bias) are identified in Table and . Many studies did not clearly report response rates or eligibility criteria to ensure that the sample was representative . Additionally, four studies had small sample sizes .…”

“…Main potential confounders were not taken into account in ten studies . Fourteen studies also did not address appropriate or clearly focused questions …”

The Cognitive Mediation Model: Factors Influencing Public Knowledge of the H1N1 Pandemic and Intention to Take Precautionary Behaviors

“…Several theories such as the theory of planned behavior (Ajzen, 1991) and the health belief model (Rosenstock, 1974), which relied on the knowledge-attitude-practice sequence, have also highlighted the role of knowledge as a precursor to the formation of attitudes and practices. Although studies that applied the knowledge-attitude-practice sequence have shown that attitudes tend to mediate the influence of knowledge on behaviors (e.g., Sessa, Giuseppe, Albano, & Angelillo, 2011;Wang et al, 2010), empirical evidence have also demonstrated that knowledge can have a direct (albeit small) effect on health behaviors (Chew et al, 2002;Morgan & Miller, 2002;Viswanath, 2006;Yap, Lee, Yau, Ng, & Tor, 2010). For example, Yap and colleagues (2010) demonstrated that knowledge has a significant influence on attitudes and behavioral changes among Singaporeans during the H1N1 pandemic.…”