Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
International Journal of Behavioral Medicine
Published in: International Journal of Behavioral Medicine 1/2009

01-03-2009 | Review

Risk Perceptions Related to SARS and Avian Influenza: Theoretical Foundations of Current Empirical Research

Authors: Anja Leppin, Arja R. Aro

Published in: International Journal of Behavioral Medicine | Issue 1/2009

Login to get access

Abstract

Background

The outbreak of severe acute respiratory syndrome in 2003 and the subsequent emergence of the H5N1 virus have highlighted the threat of a global pandemic influenza outbreak. Planning effective public health control measures for such a case will be highly dependent on sound theory-based research on how people perceive the risks involved in such an event.

Purpose

The present article aims to review theoretical models and concepts underlying current empirical research on pandemic influenza risk perception.

Method

A review was conducted based on 28 empirical studies from 30 articles which were published between 2003 and 2007.

Results

Concepts of risk perception mostly seemed more pragmatic than theory-based and were highly heterogeneous, for instance, in terms of conceptualizing risk perception as an exclusively cognitive or as a cognitive and emotional phenomenon or whether the concept was dominated by expectancy or expectancy and value components. Similarly, the majority of studies investigating risk perceptions and protective behaviors were not model-based.

Conclusions

The current body of knowledge can only provide preliminary insights. Unlike the reviewed studies, which were mostly launched as a rapid response to outbreak situations, future research will have to invest more strongly into theoretical work to provide sounder evidence.
Footnotes
1
The term pandemic influenza will be used as a generic term for life-threatening respiratory infectious diseases with epidemic–pandemic potential, of which SARS and H5NI are only two examples, which might be succeeded by further outbreaks of other viruses.
 
2
In two cases, publications clearly seemed to be based on the same study. These were therefore counted as one study each; however, in both cases, for the information in Table 1, all four articles were used.
 
3
For the report on the number of studies within different categories of operationalization, it should be noted (1) that the categories are not always mutually exclusive, i.e., as many studies contained more than one measure of risk, the respective studies were also counted in more than one category, (2) that unless otherwise specified the numbers and percentages given pertain to the quantitative studies only (N = 26), while results of the qualitative studies (N = 2) will be reported separately.
 
Literature
1.
Smith RD. Responding to global infectious disease outbreaks: lessons from SARS on the role of risk perception, communication and management. Soc Sci Med. 2006;63:3113–3.PubMedCrossRef
2.
Savage L. The foundations of statistics. New York: Wiley; 1954.
3.
Fischhoff B, Slovic P, Lichtenstein S, Read S, Combs B. How safe is safe enough? A psychometric study of attitudes towards technological risks and benefits. Policy Sci. 1978;9:127–52.CrossRef
4.
Slovic P. The perception of risk. London: Earthscan; 2000.
5.
Rosenstock IM. Why people use health services. Milbank Mem Fund Q. 1966;44(Suppl):127–36.
6.
Becker MH, Rosenstock IM. Comparing social learning theory and the health belief model. In: Ward WB, editor. Advances in health education and promotion. Greenwich: JAI; 1987. p. 245–9.
7.
Rogers R. A protection motivation theory of fear appeals and attitude change. J Psychol. 1975;91:93–114.
8.
Rogers R. Attitude change and information integration in fear appeals. Psychol Rep. 1985;56:182.
9.
Chaiken S. The heuristic model of persuasion. In: Zanna K, Olson J, Herman C, editors. Social influence: the Ontario Symposium. 5th ed. Hillsdale: Erlbaum; 1987. p. 3–39.
10.
Petty R, Cacioppo J. The elaboration likelihood model of persuasion. In: Berkowitz L, editor. Advances in experimental social psychology. Burlington: Academic; 1986. p. 123–205.
11.
Damasio AR. Descartes’ error: emotion, reason, and the human brain. New York: Avon; 1994.
12.
Forgas JP. Affect in social judgments and decisions: a multiprocess model. Adv Exp Soc Psychol. 1992;25:227–75.CrossRef
13.
Forgas JP. Mood and judgment: the affect infusion model (AIM). Psychol Bull. 1995;177:39–66.CrossRef
14.
Schwarz N. Feelings as information: informational and motivational functions of affective states. In: Sorrentino RM, Higgins ET, editors. Handbook of motivation and cognition: foundations of social behaviour. New York: Guilford; 1990. p. 527–61.
15.
Finucane ML, Holup JL. Psychosocial and cultural factors affecting the perceived risk of genetically modified food: an overview of the literature. Soc Sci Med. 2006;60:1603–12.CrossRef
16.
Finucane ML, Peters E, Slovic P. Judgment and decision making: the dance of affect and reason. In: Schneider SL, Shanteau J, editors. Emerging perspectives on judgment and decision research. Cambridge: Cambridge University Press; 2003. p. 326–64.
17.
18.
Finucane ML, Alkahani A, Slovic P, Johnson SM. The affect heuristic in judgements of risks and benefits. J Behav Decis Mak. 2000;13:1–17.CrossRef
19.
Slovic P, Finucane ML, Peters E, MacGregor DG. Risk as analysis and risk as feelings: some thoughts about affect, reason, risk, and rationality. Risk Anal. 2004;24:311–22.PubMedCrossRef
20.
Lazarus R, Folkman S. Stress, appraisal and coping. New York: Springer; 1984.
21.
Roseman IJ, Antoniou AA, Jose PE. Appraisal determinants of emotion: constructing a more accurate and comprehensive theory. Cogn Emot. 1996;10:241–77.CrossRef
22.
Irwin A, Wynne B. Conclusions. In: Irwin A, Wynne B, editors. Misunderstanding science: the public reconstruction of science and technology. Cambridge: Cambridge University Press; 1996. p. 213–21.
23.
Moscovici S. Why a theory of social representations. In: Deaux K, Philogene G, editors. Representations of the social. Oxford: Blackwell; 2001. p. 8–35.
24.
Kasperson R, Kasperson J. The social amplification and attenuation of risk. Ann Am Acad Polit Soc Sci. 1996;545:95–105.CrossRef
25.
Pidgeon RE, Kasperson RE, Slovic P, editors. The social amplification of risk. Cambridge: Cambridge University Press; 2003.
26.
Brewer NT, Weinstein ND, Cuite CL, Herrington JE. Risk perceptions and their relation to risk behavior. Annals Behav Med. 2004;27:125–30.CrossRef
27.
Brewer NT, Chapman GB, Gibbons FX, Gerrard McCaul KD, Weinstein ND. Meta-analysis of the relationship between risk perception and health behavior: the example of vaccination. Health Psychol. 2007;26:136–45.PubMedCrossRef
28.
Ajzen I. The theory of planned behavior. Org Behav Human Decis Process. 1991;50:179–211.CrossRef
29.
Fishbein M, Ajzen I. Belief, attitude, intention, and behavior: an introduction to theory and research. Reading: Addison Wesley; 1975.
30.
Brown SL. Relationships between risk-taking behaviour and subsequent risk perceptions. Br J Psychol. 2005;96:155–64.PubMedCrossRef
31.
Eiser JR, Miles S, Frewer LJ. Trust, perceived risk, and attitudes toward food technologies. J Appl Soc Psychol. 2002;32:2423–33.CrossRef
32.
Cava MA, Fay KE, Beanlands HJ, McCay EA, Wignall R. Risk perception and compliance with quarantine during the SARS outbreak. J Nurs Sch. 2005;37:343–7.CrossRef
33.
Rambaldini G, Wilson K, Rath D, Lin Y, Gold WL, Kapral MK, et al. The impact of severe acute respiratory syndrome on medical house staff: a qualitative study. J Gen Intern Med. 2005;20:381–5.PubMedCrossRef
34.
Chong M-Y, Wang W-C, Hsieh W-C, Lee C-Y, Chiu N-M, Yeh W-C, et al. Psychological impact of severe acute respiratory syndrome on health workers in a tertiary hospital. Br J Psychiatry. 2004;185:127–33.PubMedCrossRef
35.
Imai T, Takahashi K, Hoshuyama T, Hasegawa N, Lim M-K, Koh D. SARS risk perceptions in healthcare workers, Japan. Emerg Infect Dis. 2005;11:404–10.PubMed
36.
Tam DKP, Lee S, Lee SS. Impact of SARS on avian influenza preparedness in healthcare workers. Infection 2007;35:320–5.PubMedCrossRef
37.
Shiao JS-C, Koh D, Lo L-H, Lim M-K, Guo L. Factors predicting nurses’ consideration of leaving their job during the SARS outbreak. Nurs Ethics. 2007;14:5–17.PubMedCrossRef
38.
Tang CSK, Wong C-Y. Factors influencing the wearing of facemasks to prevent the severe acute respiratory syndrome among adult Chinese in Hong Kong. Prev Med. 2004;39:1187–93.PubMedCrossRef
39.
Tang CSK, Wong C-Y. Psychosocial factors influencing the practice of preventive behaviors against the severe acute respiratory syndrome among older Chinese in Hong Kong. J Aging Health. 2005;17:490–506.PubMedCrossRef
40.
deZwart O, Veldhuijzen IK, Elam G, Aro AR, Abraham T, Bishop GD, et al. Avian influenza risk perception, Europe and Asia. Emerg Infect Dis. 2007;13:290–3.CrossRef
41.
Lau JTF, Yang X, Wong E, Tsui H. Prevalence and factors associated with social avoidance of recovered SARS patients in the Hong Kong general population. Health Educ Res. 2006;21:662–73.PubMedCrossRef
42.
Ji L-J, Zhang Z, Usborne E, Guan Y. Optimism across cultures: in response to the SARS outbreak. Asian J Soc Psychol. 2004;7:25–34.CrossRef
43.
Fielding R, Lam WW, Ho EY, Lam H, Hedley AJ, Leung GM. Avian influenza risk perception, Hong Kong. Emerg Infect Dis. 2005;11:677–82.PubMed
44.
Brug J, Aro AR, Oenema A, de Zwart O, Richardus JH, Bishop GD. SARS risk perception, knowledge, precautions, and information sources, the Netherlands. Emerg Infect Dis. 2004;10:1486–9.PubMed
45.
Leung GM, Ho L-M, Chan SKK, Ho S-Y, Bacon-Shone J, Choy RYL, et al. Longitudinal assessment of community psychobehavioral responses during and after the 2003 outbreak of severe acute respiratory syndrome in Hong Kong. Clin Infect Dis. 2005;40:1713–20.PubMedCrossRef
46.
Nickell LA, Crighton EJ, Tracy CS, Al-Enazy H, Bolaji Y, Hanjrah S, et al. Psychosocial effects of SARS on hospital staff: survey of a large tertiary care institution. Can Med Assoc J. 2004;170:793–8.CrossRef
47.
Kristiansen IS, Halvorsen PA, Gyrd-Hansen D. Influenza pandemic: perception of risk and individual precautions in a general population. Cross-sectional study. BMC Public Health. 2007;7:48–54.PubMedCrossRef
48.
Lau JTF, Yang X, Tsui HY, Pang E. SARS related preventive and risk behaviours practised by Hong Kong-mainland China cross border travellers during the outbreak of the SARS epidemic in Hong Kong. J Epidemiol Community Health. 2004;58:988–96.PubMedCrossRef
49.
Leung GM, Quah S, Ho L-M, Ho S-Y, Hedley AJ, Lee H-P, et al. A tale of two cities: community psychobehavioral surveillance and related impact on outbreak control in Hong Kong and Singapore during the severe acute respiratory syndrome epidemic. Infect Control Hosp Epidemiol. 2004;25:1033–41.PubMedCrossRef
50.
Abbate R, Di Giuseppe G, Marinelli P, Angelillo IF. Knowledge, attitudes, and practices of avian influenza, poultry workers, Italy. Emerg Infect Dis. 2006;12:1762–5.PubMed
51.
Lau JTF, Yang X, Tsui HY, Pang E, Kim JH. SARS preventive and risk behaviours of Hong Kong air travellers. Epidemiol Infect. 2004;132:727–36.PubMedCrossRef
52.
Leung GM, Lam T-H, Ho L-M, Ho S-Y, Chan BHY, Wong IOL, et al. The impact of community psychological responses on outbreak control for severe acute respiratory syndrome in Hong Kong. J Epidemiol Community Health. 2003;57:857–63.PubMedCrossRef
53.
Hong S, Collins A. Societal responses to familiar versus unfamiliar risk: comparisons of influenza and SARS in Korea. Risk Anal. 2006;26:1247–57.PubMedCrossRef
54.
Koh D, Lim MK, Chia SE, Ko SM, Qian F, Ng V, et al. Risk perception and impact of Severe Acute Respiratory Syndrome (SARS) on work and personal lives of healthcare workers in Singapore: What can we learn? Health Med Care Serv Rev. 2005;43:676–82.
55.
Koh D, Takahashi K, Lim MK, Imai T, Chia SE, Qian F, et al. SARS risk perception and preventive measures, Singapore and Japan. Emerg Infect Dis. 2005;11:641–2.PubMed
56.
Lau JTF, Yang X, Tsui H, Kim JH. Monitoring community responses to the SARS epidemic in Hong Kong: from day 10 to day 62. J Epidemiol Community Health. 2003;57:864–70.PubMedCrossRef
57.
Chang C-S, Du P-L, Huang I-C. Nurses’ perceptions of severe acute respiratory syndrome: relationship between commitment and intention to leave nursing. J Adv Nurs. 2006;54:171–9.PubMedCrossRef
58.
Weinstein ND. Optimistic biases about personal risks. Science 1989;8:1232–3.CrossRef
59.
Bandura A. Self-efficacy: the exercise of control. New York: Freeman; 1997.
60.
Weinstein ND, Sandman PM. A model of the precaution adoption process: evidence form home radon testing. Health Psychol. 1992;11:170–80.PubMedCrossRef
61.
Smith VK, Johnson FR. How do risk perceptions respond to information: the case of radon. Rev Econ Stat. 1988;70:1–8.CrossRef
62.
Viscusi WK, Evans WN. Estimation of revealed probabilities and utility functions for product safety decisions. Rev Econ Stat. 1998;80:28–33.CrossRef
63.
Tang CSK, Wong C-Y. An outbreak of the severe acute respiratory syndrome: predictors of health behaviours and effect of community prevention measures in Hong Kong, China. Am J Public Health. 2003;93:1887–8.PubMedCrossRef
64.
Kobbeltveld T, Brun W, Johnsen BH, Eid J. Risk as feelings or risk and feelings? A cross-lagged panel analysis. J Risk Res. 2005;8:417–37.CrossRef
65.
Borkovec TD, Robinson E, Pruzinsky T, DePree JA. Preliminary exploration of worry, some characteristics and processes. Behav Res Ther. 1983;21:9–16.PubMedCrossRef
66.
Morris LW, Davis MA, Hutchings CH. Cognitive and emotional components of anxiety: literature review and a revised worry-emotionality scale. J Educ Psychol. 1981;73:541–55.PubMedCrossRef
67.
Harris P, Middleton W. The illusion of control and optimism about health: on being less at risk but no more in control than others. Br J Soc Psychol. 1994;33:3269–386.
68.
Siu JY-M. The SARS-associated stigma of SARS victims in the post SARS era of Hong Kong. Qual Health Res. 2008;18:729–38.PubMedCrossRef
69.
Yj S. From an epidemic to mass panic: the role of social and cultural elements in infection control of SARS in Hong Kong. Paper presented at the 38th APACPH (Asia-Pacific Academic Consortium for Public Health) Conference 2006 Bangkok, Thailand; 2006.
70.
Lai JC, Tao J. Perception of environmental hazards in Hong Kong Chinese. Risk Anal. 2003;23:669–84.PubMedCrossRef
71.
Beck U. Risk society: towards a new modernity. London: Sage; 1992.
72.
Beck U. World risk society. Cambridge: Polity Press; 1999.
73.
Wu JT, Riley S, Fraser C, Leung GM. Reducing the impact of the next influenza pandemic using household-based public health interventions. PLoS Med. 2006;3:e361.PubMedCrossRef
74.
Weber EU, Hsee CK. Models and mosaics: investigating cross-cultural differences in risk perception and risk preference. Psychon Bull Rev. 1999;6:611–7.PubMed
75.
76.
77.
Moscona A. Oseltamivir resistance–disabling our influenza defenses. N Engl J Med. 2005;353:2633–6.PubMedCrossRef
78.
79.
Singer AC, Nunn MA, Gould EA, Johnson AC. Potential risks associated with the proposed widespread use of Tamiflu. Environ Health Perspect. 2007;115:102–6.PubMedCrossRef
80.
Barennes H, Martinez-Aussel B, Vongphrachanh P, Strobel M. Avian influenza risk perceptions, Laos. Emerg Infect Dis. 2007;13:1126–8.PubMed
81.
Peltz R, Avisar-Shohat G, Bar-Dayan Y. Difference in public emotions, interest, sense of knowledge and compliance between the affected area and the nationwide general population during the first phase of a bird flu outbreak in Israel. J Infect. 2007;55:545–50.PubMedCrossRef
82.
Quah SR, Hin-Peng L. Crisis prevention and management during SARS outbreak, Singapore. Emerg Infect Dis. 2004;10:364–8.PubMed
Metadata
Title
Risk Perceptions Related to SARS and Avian Influenza: Theoretical Foundations of Current Empirical Research
Authors
Anja Leppin
Arja R. Aro
Publication date
01-03-2009
Publisher
Springer US
Published in
International Journal of Behavioral Medicine / Issue 1/2009
Print ISSN: 1070-5503
Electronic ISSN: 1532-7558
DOI
https://doi.org/10.1007/s12529-008-9002-8

Other articles of this Issue 1/2009

International Journal of Behavioral Medicine 1/2009 Go to the issue

Editorial

Risk Perceptions and Behaviour: Towards Pandemic Control of Emerging Infectious Diseases

OriginalPaper

False Heart Rate Feedback and the Perception of Heart Symptoms in Patients with Congenital Heart Disease and Anxiety

OriginalPaper

Willingness to Take Travel-Related Health Risks—A Study among Finnish Tourists in Asia during the Avian Influenza Outbreak

Editorial

Heralding the New Publisher: Strategic Alliance and Improved Service

OriginalPaper

The Perceived Threat of SARS and its Impact on Precautionary Actions and Adverse Consequences: A Qualitative Study Among Chinese Communities in the United Kingdom and the Netherlands

OriginalPaper

Increases in Positive Reappraisal Coping During a Group-Based Mantram Intervention Mediate Sustained Reductions in Anger in HIV-Positive Persons