Healthy Clinical Trial
Official title:
Improving Communication During a Pandemic Flu Outbreak
During the last pandemic influenza antivirals were prescribed both as prophylaxis and treatment. However, adherence rates were suboptimal. This study assessed the effect of theory-based and evidence-based health messages, which promoted the use of antivirals as prophylaxis for pandemic influenza, on intentions to use antivirals. Using hypothetical scenarios, the investigators tested whether written health communications about pandemic flu and recommended preventative medication (i.e. a prophylactic treatment with antivirals) had an effect on study participants' beliefs about the pandemic flu and the advice received, and their intention to adhere to the recommendation. In particular, the investigators assessed the behavioural impact of health messages presented in four different linguistic formats, defined by a 2×2 (agency assignment × attribute framing) factorial design. The originality of this study relies on the attempt to maximise the behavioural impact of written health messages by combining the agency assignment and attribute framings, which have never been tested together, and by systematically targeting specific predictors of adherence intentions through these messages. The findings of this study may be used to improve the behavioural impact of health communications to the general public in case of a pandemic flu outbreak in the UK.
Background: In 2009, a new strain of influenza virus, called pandemic influenza A(H1N1)pdm09,
was detected in humans. During the pandemic in 2009/2010, antiviral medications were
prescribed both as prophylaxis and treatment for influenza. However, many people, including
those with chronic health conditions, did not used the antivirals as prescribed. This study
focused on adherence to antivirals used as prophylaxis, as this is a key preventative stage
before any vaccine can be available to the public. To ensure protection of public health
during public health emergencies, such as pandemic flu, it is essential that the general
public follow the health advice received. Therefore, future risk communications about the use
of antivirals for pandemic influenza will need to address the barriers and facilitators of
adherence.
This study investigated the effect of theory-based and evidence-based health messages, which
promoted the use of antivirals as prophylaxis for pandemic influenza, on intentions to use
antivirals. In particular, using hypothetical scenarios, the investigators tested whether
written health communications about pandemic flu and recommended preventative medication
(i.e. a prophylactic treatment with antivirals) had an effect on study participants' beliefs
about the pandemic flu and the advice received, and their intention to adhere to the
recommendation.
The linguistic manipulation used in the present study was based on an adaptation of a
successful manipulation carried out by McGlone et al. (2013), who found that using the virus
agency assignment in medical factsheets increased students' perception of susceptibility to
and worry about the virus A/H1N1, perception of the severity of the consequences of catching
the virus, perception of efficacy of the vaccine and reported intention to get the vaccine
compared to the human agency assignment. The investigators wanted to test whether these
results could be replicated in the context of taking antivirals for pandemic flu, using a
more representative sample of the general population and controlling for baseline intentions.
For what concerns the framing of the side effects, research shows that the way information on
medication side-effects is presented affects people's intentions to accept the recommended
medications. The same side-effect likelihood can be expressed in a positively framed message
(i.e. 90% of people will not develop side-effects) or in negatively framed message (i.e. 10%
of people will develop side-effects). Although a previous meta-analysis (Moxey et al. 2003)
found no significant framing effect on either actual immunization or behavioural intention,
it found that positively framed information increased positive attitudes toward immunization
and perception of the benefits of immunization, decreased expectation of side-effects and led
to a more realistic understanding of the side-effects of influenza vaccines.
In addition, the health messages used in this study targeted specific variables, which have
been in the past associated with higher adherence to antivirals for pandemic influenza. In
particular, a recently published systematic review (Smith et al. 2016) investigated the
factors affecting adherence to antivirals for influenza, including pandemic flu. They
included 26 studies, of which 23 assessed pandemic influenza. Although many of the reviewed
studies had serious methodological flaws, the review identified several psychosocial factors
associated with adherence to antivirals prescribed as prophylaxis for pandemic flu. In
particular, 11 studies investigated actual adherence to prophylactic antivirals. These
studies showed that actual adherence was associated with previous adherence to other
preventative measures for pandemic flu, beliefs that the recommended prophylactic measures
were necessary and having discussed taking oseltamivir, a commonly used antiviral, with
someone who had not experienced side effects. Although only one study found that the presence
of side-effects was a significant predictor of non-adherence, the occurrence of side-effects
was the most commonly self-reported reason for the discontinuation of oseltamivir. The review
also included 8 studies investigating psychosocial predictors of intention to adhere: for
instance, higher perceived susceptibility to the pandemic flu, higher perceived severity of
pandemic flu, knowledge of pandemic flu, higher self-efficacy and response efficacy, and
having previously accepted the flu vaccine were all associated with higher adherence
intentions.
Methods: In May/June 2016 the investigated conducted an online experiment. After reading a
hypothetical pandemic flu scenario, 349 adult UK residents were randomly allocated to one of
four conditions, defined by a 2x2 (agency assignment × attribute framing of side effects)
factorial design. Each condition presented messages describing the pandemic flu using
linguistic expressions that assigned agency to either the humans (HA: human agency) or the
virus itself (VA: virus agency), whilst describing the antivirals side effects in terms of
the chances of either experiencing (NF: negative framing) or not experiencing side effects
(PF: positive framing). Although presented with different framings the health messages
provided equivalent information that targeted specific predictors of adherence. Participants
were blinded to group assignment. Intentions to use the antivirals and potential mediating
factors were measured. The aim was to understand the potential behavioural impact of the four
health messages developed and to better understand the factors influencing adherence
intentions.
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