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Knowledge of Childhood Infectious Diseases and Perceived Barriers to Effective Preventions: Preliminary Results from Hong Kong Parents
Crystal Jiang
Meily M. F. Cheung (HSMC)
Infectious Disease Prevention and Control in Hong Kong
Challenges: – Globally connected city
– Dense population
– Close interpersonal contact – Subtropical weather
Epidemic Trend of Infectious Diseases Number of Notifiable Diseases
60000
Swine influenza
50000
40000
Chickenpox
30000
Scarlet Fever
Chickenpox
20000
10000
Chickenpox
Rubella
SARS (n = 1755)
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Source: Centre of Health Protection
Young Children as a High‐risk Group
• Young children aged between 3‐12 are vulnerable to infectious diseases in general – Swine flu was a major cause for children’s morality and hospitalization in 2009
• Childhood‐specific diseases are identified as major contributing infectious diseases – Chickenpox: 11,932 cases per year, increased by 11.4% in the past five years
660.5% increase
Parents as a Prevention Agent •
•
•
•
Primary Prevention (from Arising)
Strengthening immunity
Vaccination
Hygiene control Avoid contact with infected Secondary Prevention •
•
(from Spreading)
Early detection & treatment
Refrain sick kids from public
Study Aims
• To develop baseline knowledge to guide survey design • Specifically, to achieve a comprehensive understanding of Hong Kong parents’ beliefs about childhood infectious diseases:
– Knowledge about infectious diseases
– Adoption of prevention measures
– Information sources
Framework‐ Fear Communication
• Fear of a disease can be a great motivator to cultivate health awareness and change behaviors
• A group of theories suggests that threat perceptions and efficacy perceptions are critical to motivating behavior changes – Health Belief Model – Protection Motivation Theory – Extended Parallel Processing Model
Central Theoretical Constructs
Concept
Perceived severity Definition
Research Questions Perceived seriousness of a health disease
RQ1: To what extent are the parents able to distinguish different childhood infectious diseases and rate them in terms of severity and susceptibility? Perceived Perceived likelihood of susceptibility contracting a health disease
Response efficacy
Self‐efficacy
Assessing the effectiveness of the promoted responses
RQ2: What are the preventive measures the parents have or have not adopted, and how do they Assessing personal ability to evaluate these measures in terms of effectively adapt the responses response efficacy and self‐efficacy?
RQ3: How do parents’ efficacy perceptions ( response/self‐ efficacy) interrelate with their threat perceptions (perceived severity/susceptibility) towards infectious diseases?
Methods
• Three focus group interviews • 20 participants
• Focus group protocol
– Consulted governmental reports and a senior doctor for target childhood infectious diseases – Protocol asked the participants to:
1) identify common childhood infectious diseases (worksheet) 2) rate diseases in terms of susceptibility and severity (worksheet)
3) evaluate the preventive measures they have used
4) identify and evaluate the preventive measures recommended by the government (worksheet)
5) identify the major information sources for disease prevention. • Data analysis
– Ground theory approach – Line by line coding to identify common themes Target Disease
Infection channel
Vaccine
Suggested Prevention
Chickenpox 水痘
Droplet & air‐borne
Available; 90% •
effective Scarlet Fever 猩紅
熱
Droplet & air‐borne
NA
Influenza 流感
Droplet & air‐borne
Available＊
HiB 乙型流感嗜血
桿菌感染
Droplet & air‐borne
Available
Hepatitis A & E
甲肝&戊肝
Food‐ & water‐borne Only for type A •
•
•
EV 71 & HFMD
Food‐ & water‐borne NA
腸病毒及手足口病
•
Bacillary dysentery 桿菌性痢疾
•
Food‐ & water‐borne NA
Personal and environmental hygiene
Avoiding staying in crowded or poorly ventilated spaces Refraining sick children from public Personal and environmental hygiene
Safe food‐handling practices
Refraining sick children from public (Para)Typhoid fever Food‐ & water‐borne Available
傷寒及副傷寒
CA‐MRSA 社區型金 Direct contact with wounds and infected
黃葡萄球菌感染
NA
Avoid contact; safe use of antibiotics
Knowledge Assessment • Limited knowledge: – Only half identified 4+ common infectious diseases among HK children – Top four: Influenza (20/20), EV71 (19/20), chickenpox (18/20), and scarlet fever (14/20)
– The rest received very few mentions
Parental Disease Perceptions
Perceived Susceptibility Depends on
• Personal experience
– 17 reported influenza, 11 chickenpox, 7 EV71
• Source‐based heuristic
– frequently mentioned by media, school and government = high susceptibility Perceived Severity Depends on
• Health literacy & knowledge –
–
–
–
Misperception of influenza and cold
Misperceptions about EV71
Perceived severity (e.g., deaths)
Treatment efficacy
• Face judgment and familiarity‐based judgment – Associate unfamiliar names and jargons with high severity
– Organ‐related diseases are perceived as more severe
Perceived Effective Preventions
• Maintain household and personal hygiene
– All reported cleaning floors, furniture and toys and maintaining good ventilation – More than half followed the government recommendations to clean and disinfect with diluted bleach. – All recognized good hand hygiene and sneezing manner as key prevention methods
– About half reported preparing masks, wet wipes and sanitizers for school use. Paradox: Cleanness makes vulnerable?
• Overprotection might reduce children’s immunity
– Different parenting styles across generations
• Rely on children’s self‐efficacy (e.g., resistance)
• Over‐emphasis on hygiene intervenes social life Resistance to Vaccination
• Vaccination may have side‐effects
– Immune‐compromising effects (influenza)
– Risks associated with vaccination
• Vaccines have low response efficacy
– Vaccination doesn’t fully prevent infection: – Vaccination can’t handle disease variants
– Comparison effects
Alternative Prevention Measures
• Strong preference for Chinese herbal tea and soup (heat‐clearing and detoxicating effects. However, they don’t agree with the specifics.
• Some indicated preferences for nutrition supplements, but they are not confident about the effects. But other parents argued against artificial intakes. Discussion & Conclusion
• Limited health literacy and a narrow scope of knowledge
– Information conveyed through the major information stakeholders (e.g., media, school, doctors, and government) may be inadequate • Paradoxical health beliefs for both recommended and self‐selected preventions
– Control vs. natural development – May be related to parenting styles • Implications for message design
Future Research • Large‐scale survey on parental beliefs with regard to the top four childhood infectious diseases • Experiments that address paradoxical health beliefs (e.g., vaccination) • Target at grassroots and minorities