Determinants of risk behaviors in the containment of highly pathogenic avian influenza
Kreslake, Jennifer M
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Background: Highly pathogenic avian influenza (H5N1) is endemic among poultry in Indonesia, where routine contact with live poultry is common. This dissertation describes the relationship between attitudinal predictors, social or structural covariates, and behavioral outcomes in routine (“maintenance”) conditions, rather than outbreaks. Recommendations inform risk communications encouraging vigilance and preventing complacency. Methods: Cross-sectional surveys of Indonesian households (n=2,843) and poultry workers (n=1,404) in 2009 were used. Study #1 measured the association between attitudinal predictors (risk perception [RP] defined as perceived susceptibility and perceived severity; self-efficacy [SE]) and behavioral outcomes. Study #2 tested the association between audience segments and behavioral outcomes. Audience segments: responsives (high RP, high SE), proactives (low RP, high SE), avoidants (high RP, low SE), indifferents (low RP, low SE). Study #3 measured associations between workers’ attitudinal predictors (same as earlier studies, plus collective efficacy) and features of the occupational environment with behavioral outcomes. Multilevel random effects regression models were used, controlling for covariates. Results for subdistricts with no recent incidence of H5N1 in poultry (“maintenance”) are presented. Results: Study #1: Greater perceived susceptibility was positively associated with high-risk and protective behaviors. Self-efficacy was positively associated protective behaviors. Perceived severity was not a significant predictor of behaviors. Study #2: Audience segments differed significantly by income and age. Responsives had the highest likelihood of protective behaviors of any cluster. Indifferents were least likely to perform several protective behaviors of any cluster. Avoidants had the lowest income and had a greater likelihood of high-risk behavior than responsives. Study #3: High collective efficacy was positively associated with multiple protective behaviors. High self-efficacy was inconsistent in predicting behavioral outcomes. Workplaces providing supplies was positively associated with protective behaviors. Conclusions: Audience segmentation provides a clearer picture of determinants of risk/protective behaviors in maintenance conditions compared to tests of each attitudinal variable. Behavioral outcomes are best among household respondents with high RP and high SE, and poor among the indifferent majority. Proactives are vulnerable to overconfidence, while avoidants may require structural interventions. For poultry workers, providing supplies will improve protective actions. Emphasizing RP and SE is not recommended for poultry workers, but community efficacy and occupational norms can encourage behavioral vigilance.