***Regional Avian Influenza Communications Studies***

+---+--------+------+------------+---------+-------------+-----------+
| * | **     | *    | **Outcome  | **      | **Results** | **Imp     |
| * | Title, | *Pur | Variables  | Demogra |             | lications |
| C | A      | pose | and Data   | phics** |             | for       |
| o | uthor, | of   | Collection |         |             | Future    |
| u | Date   | Wo   | Methods**  |         |             | Comm      |
| n | of     | rk** |            |         |             | unication |
| t | Stu    |      |            |         |             | Ca        |
| r | dy\*** |      |            |         |             | mpaigns** |
| y |        |      |            |         |             |           |
| * | *      |      |            |         |             |           |
| * | *\*may |      |            |         |             |           |
|   | be     |      |            |         |             |           |
|   | dif    |      |            |         |             |           |
|   | ferent |      |            |         |             |           |
|   | than   |      |            |         |             |           |
|   | date   |      |            |         |             |           |
|   | of     |      |            |         |             |           |
|   | p      |      |            |         |             |           |
|   | ublica |      |            |         |             |           |
|   | tion** |      |            |         |             |           |
+===+========+======+============+=========+=============+===========+
| C | Rumor  | To   | WHO's      | Not     | A total of  | Timely    |
| h | Survei | d    | Western    | appl    | 40 rumors   | diss      |
| i | llance | eter | Pacific    | icable. | were        | emination |
| n | and    | mine | Regional   |         | identified  | of        |
| a | Avian  | whe  | Office     |         | from        | accurate  |
| , | Inf    | ther | (WPRO)     |         | January 20  | in        |
| K | luenza | enha | designated |         | to February | formation |
| o | H5N1   | nced | an officer |         | 26, 2004 in | to reduce |
| r | (2004) | r    | to develop |         | 12          | misunde   |
| e |        | umor | and        |         | countries   | rstanding |
| a | S      | surv | implement  |         | and one     | and       |
| , | amaan, | eill | a 40-day   |         | special     | un        |
| L | Gina   | ance | rumor      |         | adm         | warranted |
| a | et al. | du   | su         |         | inistrative | concern,  |
| o |        | ring | rveillance |         | region. Of  | e         |
| P | <http  | the  | system for |         | the total   | specially |
| D | ://www | f    | avian      |         | rumors      | for       |
| R | .cdc.g | irst | influenza  |         | received    | rumors    |
| , | ov/nci | 40   | to assess  |         | 45% were    | reported  |
| T | dod/ei | days | media      |         | from the    | in the    |
| h | d/vol1 | of   | sources    |         | WHO         | media, is |
| a | 1no03/ | the  | and        |         | network,    | an        |
| i | 04-065 | Jan  | e          |         | 19% from    | important |
| l | 7.htm> | uary | mail-based |         | the media,  | part of   |
| a |        | 2004 | public     |         | 5% from     | rumor     |
| n |        | a    | health     |         | embassy     | surv      |
| d |        | vian | discussion |         | staff       | eillance. |
| , |        | i    | groups.    |         | living in   | Criteria  |
| V |        | nflu | Identified |         | affected    | for       |
| i |        | enza | rumors     |         | countries,  | d         |
| e |        | outb | were       |         | and 2% from | eveloping |
| t |        | reak | followed   |         | ProMED      | rumor     |
| n |        | in   | up by      |         | Digest      | sur       |
| a |        | Viet | email or   |         | (media      | veillance |
| m |        | nam: | telephone  |         | source as   | should    |
|   |        | off  | request to |         | origin).    | include:  |
|   |        | ered | the proper |         | 23% of      | clearly   |
|   |        | ti   | WHO        |         | rumors were | defined   |
|   |        | mely | country    |         | verified as | sur       |
|   |        | as   | office to  |         | true, 5 in  | veillance |
|   |        | sist | verify it, |         | China and   | goals in  |
|   |        | ance | who then   |         | one each in | which     |
|   |        | to   | sought     |         | Cambodia,   | each      |
|   |        | nat  | ve         |         | Japan,      | rumor     |
|   |        | ions | rification |         | Laos, and   | deserves  |
|   |        | pot  | from that  |         | South       | inve      |
|   |        | enti | country's  |         | Korea. 6    | stigation |
|   |        | ally | health     |         | rumors      | to        |
|   |        | a    | officials. |         | verified as | determine |
|   |        | ffec | Rumor      |         | incorrect   | its       |
|   |        | ted; | ve         |         | rumors were | veracity; |
|   |        | prom | rification |         | from        | apply     |
|   |        | pted | included   |         | mainland    | case      |
|   |        | c    | laboratory |         | China and 4 | de        |
|   |        | ount | testing    |         | from Hong   | finitions |
|   |        | ries | and/or     |         | Kong, 6 in  | with a    |
|   |        | to   | shipping   |         | Laos, 4 in  | high      |
|   |        | u    | of         |         | Vietnam, 3  | level of  |
|   |        | nder | isolates.  |         | in          | se        |
|   |        | take |            |         | Cambodia, 2 | nsitivity |
|   |        | prep | Inv        |         | in Germany, | (and      |
|   |        | ared | estigation |         | and one     | therefore |
|   |        | ness | outcomes   |         | each in     | a         |
|   |        | meas | were       |         | Bangladesh, | r         |
|   |        | ures | di         |         | Indonesia,  | elatively |
|   |        | app  | sseminated |         | Japan,      | lower     |
|   |        | ropr | to WHO and |         | Malaysia,   | spe       |
|   |        | iate | their      |         | Saudi       | cificity) |
|   |        | to   | outbreak   |         | Arabia, and | to        |
|   |        | t    | response   |         | Singapore.  | identify  |
|   |        | heir | team. For  |         |             | the event |
|   |        | l    | events     |         | 60% of      | of        |
|   |        | evel | reported   |         | rumors      | interest  |
|   |        | of   | in the     |         | related to  | early in  |
|   |        | r    | media WPRO |         | human       | the       |
|   |        | isk; | made       |         | outbreaks   | outbreak; |
|   |        | and, | i          |         | and 40% to  | clearly   |
|   |        | info | nformation |         | animals.    | define    |
|   |        | rmed | publicly   |         |             | the       |
|   |        | the  | available  |         | True rumors | process   |
|   |        | pu   | through    |         | resulted in | of        |
|   |        | blic | press      |         | public      | assessing |
|   |        | and  | releases,  |         | health      | validity  |
|   |        | the  | media      |         | action      | of        |
|   |        | i    | interviews |         | where       | rumors,   |
|   |        | nter | and the    |         | applicable  | criteria  |
|   |        | nati | WHO        |         | through     | for       |
|   |        | onal | website.   |         | guidelines, | deeming   |
|   |        | c    |            |         | technical   | the       |
|   |        | ommu |            |         | expertise,  | ver       |
|   |        | nity |            |         | and         | ification |
|   |        | a    |            |         | supplies.   | process   |
|   |        | bout |            |         |             | complete, |
|   |        | ev   |            |         |             | and       |
|   |        | ents |            |         |             | ethics    |
|   |        | rele |            |         |             | and       |
|   |        | vant |            |         |             | confid    |
|   |        | to   |            |         |             | entiality |
|   |        | the  |            |         |             | in        |
|   |        | o    |            |         |             | c         |
|   |        | utbr |            |         |             | onducting |
|   |        | eak. |            |         |             | invest    |
|   |        |      |            |         |             | igations; |
|   |        |      |            |         |             | clearly   |
|   |        |      |            |         |             | delineate |
|   |        |      |            |         |             | ap        |
|   |        |      |            |         |             | propriate |
|   |        |      |            |         |             | actions   |
|   |        |      |            |         |             | for true  |
|   |        |      |            |         |             | or false  |
|   |        |      |            |         |             | rumors,   |
|   |        |      |            |         |             | cr        |
|   |        |      |            |         |             | edibility |
|   |        |      |            |         |             | of        |
|   |        |      |            |         |             | verifying |
|   |        |      |            |         |             | orga      |
|   |        |      |            |         |             | nization; |
|   |        |      |            |         |             | delegate  |
|   |        |      |            |         |             | respo     |
|   |        |      |            |         |             | nsibility |
|   |        |      |            |         |             | for data  |
|   |        |      |            |         |             | co        |
|   |        |      |            |         |             | llection, |
|   |        |      |            |         |             | m         |
|   |        |      |            |         |             | anagement |
|   |        |      |            |         |             | of the    |
|   |        |      |            |         |             | rumor     |
|   |        |      |            |         |             | database, |
|   |        |      |            |         |             | and       |
|   |        |      |            |         |             | ver       |
|   |        |      |            |         |             | ification |
|   |        |      |            |         |             | to a      |
|   |        |      |            |         |             | person    |
|   |        |      |            |         |             | trained   |
|   |        |      |            |         |             | in        |
|   |        |      |            |         |             | sur       |
|   |        |      |            |         |             | veillance |
|   |        |      |            |         |             | and       |
|   |        |      |            |         |             | ensure    |
|   |        |      |            |         |             | they have |
|   |        |      |            |         |             | access to |
|   |        |      |            |         |             | relevant  |
|   |        |      |            |         |             | national  |
|   |        |      |            |         |             | and       |
|   |        |      |            |         |             | inte      |
|   |        |      |            |         |             | rnational |
|   |        |      |            |         |             | networks  |
|   |        |      |            |         |             | and       |
|   |        |      |            |         |             | ap        |
|   |        |      |            |         |             | propriate |
|   |        |      |            |         |             | ne        |
|   |        |      |            |         |             | gotiation |
|   |        |      |            |         |             | skills to |
|   |        |      |            |         |             | in        |
|   |        |      |            |         |             | vestigate |
|   |        |      |            |         |             | rumors;   |
|   |        |      |            |         |             | make sure |
|   |        |      |            |         |             | data      |
|   |        |      |            |         |             | sources   |
|   |        |      |            |         |             | include   |
|   |        |      |            |         |             | print and |
|   |        |      |            |         |             | e         |
|   |        |      |            |         |             | lectronic |
|   |        |      |            |         |             | media,    |
|   |        |      |            |         |             | the       |
|   |        |      |            |         |             | Global    |
|   |        |      |            |         |             | Public    |
|   |        |      |            |         |             | Health    |
|   |        |      |            |         |             | Int       |
|   |        |      |            |         |             | elligence |
|   |        |      |            |         |             | Network,  |
|   |        |      |            |         |             | national  |
|   |        |      |            |         |             | health    |
|   |        |      |            |         |             | aut       |
|   |        |      |            |         |             | horities, |
|   |        |      |            |         |             | and       |
|   |        |      |            |         |             | pro       |
|   |        |      |            |         |             | fessional |
|   |        |      |            |         |             | bodies    |
|   |        |      |            |         |             | and       |
|   |        |      |            |         |             | networks  |
|   |        |      |            |         |             | and       |
|   |        |      |            |         |             | consider  |
|   |        |      |            |         |             | m         |
|   |        |      |            |         |             | echanisms |
|   |        |      |            |         |             | for the   |
|   |        |      |            |         |             | public to |
|   |        |      |            |         |             | report    |
|   |        |      |            |         |             | rumors    |
|   |        |      |            |         |             | through a |
|   |        |      |            |         |             | hotline   |
|   |        |      |            |         |             | or email; |
|   |        |      |            |         |             | develop   |
|   |        |      |            |         |             | m         |
|   |        |      |            |         |             | echanisms |
|   |        |      |            |         |             | to        |
|   |        |      |            |         |             | provide   |
|   |        |      |            |         |             | regular   |
|   |        |      |            |         |             | updates   |
|   |        |      |            |         |             | on        |
|   |        |      |            |         |             | current   |
|   |        |      |            |         |             | ver       |
|   |        |      |            |         |             | ification |
|   |        |      |            |         |             | ac        |
|   |        |      |            |         |             | tivities, |
|   |        |      |            |         |             | the       |
|   |        |      |            |         |             | number of |
|   |        |      |            |         |             | rumors    |
|   |        |      |            |         |             | inve      |
|   |        |      |            |         |             | stigated, |
|   |        |      |            |         |             | and their |
|   |        |      |            |         |             | outcomes  |
|   |        |      |            |         |             | to the    |
|   |        |      |            |         |             | outbreak  |
|   |        |      |            |         |             | response  |
|   |        |      |            |         |             | team;     |
|   |        |      |            |         |             | provide   |
|   |        |      |            |         |             | regular   |
|   |        |      |            |         |             | feedback  |
|   |        |      |            |         |             | on the    |
|   |        |      |            |         |             | outcomes  |
|   |        |      |            |         |             | of        |
|   |        |      |            |         |             | inves     |
|   |        |      |            |         |             | tigations |
|   |        |      |            |         |             | to those  |
|   |        |      |            |         |             | who       |
|   |        |      |            |         |             | provided  |
|   |        |      |            |         |             | data, and |
|   |        |      |            |         |             | where     |
|   |        |      |            |         |             | app       |
|   |        |      |            |         |             | ropriate, |
|   |        |      |            |         |             | to the    |
|   |        |      |            |         |             | inte      |
|   |        |      |            |         |             | rnational |
|   |        |      |            |         |             | c         |
|   |        |      |            |         |             | ommunity; |
|   |        |      |            |         |             | and       |
|   |        |      |            |         |             | evaluate  |
|   |        |      |            |         |             | the       |
|   |        |      |            |         |             | e         |
|   |        |      |            |         |             | fficiency |
|   |        |      |            |         |             | and       |
|   |        |      |            |         |             | effe      |
|   |        |      |            |         |             | ctiveness |
|   |        |      |            |         |             | of the    |
|   |        |      |            |         |             | inves     |
|   |        |      |            |         |             | tigations |
|   |        |      |            |         |             | and       |
|   |        |      |            |         |             | upgrade   |
|   |        |      |            |         |             | the rumor |
|   |        |      |            |         |             | sur       |
|   |        |      |            |         |             | veillance |
|   |        |      |            |         |             | system    |
|   |        |      |            |         |             | through a |
|   |        |      |            |         |             | process   |
|   |        |      |            |         |             | of        |
|   |        |      |            |         |             | c         |
|   |        |      |            |         |             | ontinuous |
|   |        |      |            |         |             | quality   |
|   |        |      |            |         |             | imp       |
|   |        |      |            |         |             | rovement. |
+---+--------+------+------------+---------+-------------+-----------+
| H | Avian  | To   | Telephone  | Of the  | In the 78%  | Raising   |
| o | Inf    | d    | survey     | 986     | of          | p         |
| n | luenza | eter | using      | e       | households  | opulation |
| g | Risk   | mine | random     | ligible | reporting   | anxiety   |
| K | Perce  | po   | dig        | resp    | buying of   | levels    |
| o | ption, | pula | it-dialing | ondents | live        | through   |
| n | Hong   | tion | was        | who     | chickens,   | disease   |
| g | Kong   | k    | conducted  | co      | 13% of      | outbreak  |
| S | (2005) | nowl | from 10 am | mpleted | female and  | warnings  |
| A |        | edge | to 10 pm   | the     | 19% of male | only      |
| R | Fie    | of   | from       | survey  | respondents | produces  |
|   | lding, | risk | mi         | (44%    | reported    | t         |
|   | R      | and  | d-February | r       | touching    | ransient, |
|   | ichard | sel  | to         | esponse | live        | inco      |
|   | et al. | f-pr | mid-march  | rate),  | chickens    | nsistent, |
|   |        | otec | 2004, to   | 60%     | when        | and       |
|   | <http  | tion | assess     | were    | purchasing. | therefore |
|   | ://www | p    | Hong Kong  | female, | Only 30% of | in        |
|   | .cdc.g | ract | par        | 23%     | respondents | effective |
|   | ov/nci | ices | ticipants' | were    | reported    | results   |
|   | dod/EI | and  | knowledge, | 18-34   | "always" or | in        |
|   | D/vol1 | esti | attitudes, | years   | "usually"   | reducing  |
|   | 1no05/ | mate | and        | of age, | washing     | long-term |
|   | 04-122 | de   | behaviors  | 30%     | hands       | high-risk |
|   | 5.htm> | gree | regarding  | were    | afterwards. | behavior. |
|   |        | of   | purchasing | 35-44,  |             | However,  |
|   |        | po   | and        | 36%     | Overall,    | some      |
|   |        | pula | handling   | were    | 36% of all  | persons   |
|   |        | tion | poultry.   | 45-64,  | respondents | are       |
|   |        | expo | Pa         | and 10% | agreed with | willing   |
|   |        | sure | rticipants | were    | the         | to change |
|   |        | from | were       | age 65  | statement   | buying    |
|   |        | live | Cantone    | or      | "buying     | habits if |
|   |        | chi  | se-Chinese | over.   | live        | others    |
|   |        | cken | speakers   | 73% of  | chickens is | do.       |
|   |        | sa   | age 16-95  | resp    | risky to    | Cons      |
|   |        | les. | who had    | ondents | health."    | equently, |
|   |        |      | lived in   | were    | 34%         | health    |
|   |        |      | Hong Kong  | m       | considered  | warnings  |
|   |        |      | for more   | arried, | that they   | can       |
|   |        |      | than one   | 57%     | would       | produce   |
|   |        |      | year.      | were    | "never" or  | s         |
|   |        |      |            | born in | were "very  | hort-term |
|   |        |      | The survey | Hong    | unlikely"   | b         |
|   |        |      | consisted  | Kong,   | to get sick | ehavioral |
|   |        |      | of 6       | and 76% | from buying | changes   |
|   |        |      | sections   | had     | live        | that      |
|   |        |      | including  | more    | chickens;   | rapidly   |
|   |        |      | dem        | than a  | 15% thought | disappear |
|   |        |      | ographics, | primary | it was      | without   |
|   |        |      | Likert     | school  | "likely" or | increased |
|   |        |      | scale      | ed      | "very       | perceived |
|   |        |      | items of   | ucation | likely".    | threats;  |
|   |        |      | self-rated | (       | 53% of      | large     |
|   |        |      | health and | 6+years | respondents | group     |
|   |        |      | infl       | of      | perceived   | changes,  |
|   |        |      | uenza-like | scho    | the         | t         |
|   |        |      | symptoms,  | oling). | likelihood  | herefore, |
|   |        |      | questions  | 41% of  | of getting  | may be    |
|   |        |      | on         | resp    | sick from   | more      |
|   |        |      | household  | ondents | buying      | probable  |
|   |        |      | practices  | were    | chickens    | than      |
|   |        |      | and risk   | em      | below 26%;  | i         |
|   |        |      | perception | ployed. | only 9% of  | ndividual |
|   |        |      | of buying  |         | respondents | level     |
|   |        |      | live       |         | thought     | changes.  |
|   |        |      | birds, and |         | that the    |           |
|   |        |      | Likert     |         | risk of     |           |
|   |        |      | scale      |         | getting     |           |
|   |        |      | statements |         | sick        |           |
|   |        |      | addressing |         | exceeded    |           |
|   |        |      | attitudes, |         | 51%. 46% of |           |
|   |        |      | protection |         | all         |           |
|   |        |      | practices, |         | respondents |           |
|   |        |      | and        |         | reported    |           |
|   |        |      | p          |         | that their  |           |
|   |        |      | erceptions |         | friends     |           |
|   |        |      | of live    |         | were        |           |
|   |        |      | chicken    |         | worried     |           |
|   |        |      | sales.     |         | about       |           |
|   |        |      |            |         | catching    |           |
|   |        |      |            |         | avian       |           |
|   |        |      |            |         | influenza.  |           |
|   |        |      |            |         | Risk        |           |
|   |        |      |            |         | perception  |           |
|   |        |      |            |         | did not     |           |
|   |        |      |            |         | differ by   |           |
|   |        |      |            |         | age, sex,   |           |
|   |        |      |            |         | education,  |           |
|   |        |      |            |         | income, or  |           |
|   |        |      |            |         | occupation. |           |
|   |        |      |            |         |             |           |
|   |        |      |            |         | Independent |           |
|   |        |      |            |         | predictors  |           |
|   |        |      |            |         | of buying   |           |
|   |        |      |            |         | live        |           |
|   |        |      |            |         | chickens    |           |
|   |        |      |            |         | included    |           |
|   |        |      |            |         | travel,     |           |
|   |        |      |            |         | employment  |           |
|   |        |      |            |         | status,     |           |
|   |        |      |            |         | traditional |           |
|   |        |      |            |         | market      |           |
|   |        |      |            |         | practices,  |           |
|   |        |      |            |         | protective  |           |
|   |        |      |            |         | practice,   |           |
|   |        |      |            |         | willingness |           |
|   |        |      |            |         | to change   |           |
|   |        |      |            |         | buying      |           |
|   |        |      |            |         | habits if   |           |
|   |        |      |            |         | others do   |           |
|   |        |      |            |         | the same,   |           |
|   |        |      |            |         | and belief  |           |
|   |        |      |            |         | that        |           |
|   |        |      |            |         | cooking     |           |
|   |        |      |            |         | food        |           |
|   |        |      |            |         | thoroughly  |           |
|   |        |      |            |         | is the best |           |
|   |        |      |            |         | protection  |           |
|   |        |      |            |         | against     |           |
|   |        |      |            |         | bird flu.   |           |
|   |        |      |            |         | Independent |           |
|   |        |      |            |         | predictors  |           |
|   |        |      |            |         | of touching |           |
|   |        |      |            |         | chickens    |           |
|   |        |      |            |         | when buying |           |
|   |        |      |            |         | included    |           |
|   |        |      |            |         | place of    |           |
|   |        |      |            |         | birth and   |           |
|   |        |      |            |         | employment  |           |
|   |        |      |            |         | status.     |           |
|   |        |      |            |         | Independent |           |
|   |        |      |            |         | predictors  |           |
|   |        |      |            |         | of risk     |           |
|   |        |      |            |         | perceptions |           |
|   |        |      |            |         | of illness  |           |
|   |        |      |            |         | from        |           |
|   |        |      |            |         | purchased   |           |
|   |        |      |            |         | live        |           |
|   |        |      |            |         | chickens    |           |
|   |        |      |            |         | included    |           |
|   |        |      |            |         | age,        |           |
|   |        |      |            |         | concern     |           |
|   |        |      |            |         | about       |           |
|   |        |      |            |         | catching    |           |
|   |        |      |            |         | bird flu,   |           |
|   |        |      |            |         | animal      |           |
|   |        |      |            |         | husbandry   |           |
|   |        |      |            |         | risk,       |           |
|   |        |      |            |         | protective  |           |
|   |        |      |            |         | practices,  |           |
|   |        |      |            |         | and avian   |           |
|   |        |      |            |         | influenza   |           |
|   |        |      |            |         | anxiety.    |           |
+---+--------+------+------------+---------+-------------+-----------+
| H | F      | To   | Pa         | Of the  | 61.2% of    | Hig       |
| o | actors | d    | rticipants | 1329    | respondents | hlighting |
| n | Influ  | eter | were       | parti   | reported    | the       |
| g | encing | mine | recruited  | cipants | wearing     | global    |
| K | the    | the  | and        | su      | facemasks   | outbreak  |
| o | W      | fac  | surveyed   | rveyed, | c           | and       |
| n | earing | tors | through    | 40.2%   | onsistently | deb       |
| g | of     | as   | random     | were    | as a        | ilitating |
| S | Fac    | soci | dig        | male,   | preventive  | health    |
| A | emasks | ated | it-dialing | 66%     | behavior.   | con       |
| R | to     | with | of Chinese | were    | Women,      | sequences |
|   | P      | the  | residents  | m       | p           | of SARS   |
|   | revent | wea  | of Hong    | arried, | articipants | and the   |
|   | the    | ring | Kong age   | and     | age 50-59,  | lack of   |
|   | Severe | of   | 19 or      | 53.3%   | those with  | specific  |
|   | Acute  | f    | older. The | were    | university  | treatment |
|   | Respi  | acem | wearing of | e       | education,  | or        |
|   | ratory | asks | facemasks  | mployed | married     | vaccine   |
|   | Sy     | as a | was chosen | on at   | pa          | may       |
|   | ndrome | pr   | as the     | least a | rticipants, | increase  |
|   | among  | even | target     | pa      | and those   | people's  |
|   | Adult  | tive | behavior   | rt-time | with annual | p         |
|   | C      | mea  | for this   | basis.  | incomes     | erception |
|   | hinese | sure | study      | 20.2%   | over        | of their  |
|   | in     | aga  | because it | of      | \$5000US    | own       |
|   | Hong   | inst | was        | parti   | were more   | vuln      |
|   | Kong   | SARS | directly   | cipants | likely to   | erability |
|   | (2003) | a    | related to | were    | wear        | to the    |
|   |        | mong | SARS and   | age     | facemasks.  | disease   |
|   | Tang,  | a    | it         | 19-29   | There were  | and that  |
|   | CS and | dult | involved   | years,  | significant | they must |
|   | Wong,  | Chi  | deliberate | 46.7%   | a           | take      |
|   | C      | nese | effort on  | were    | ssociations | their own |
|   |        | with | the part   | 30-49,  | between     | pr        |
|   |        | d    | of         | 14.7%   | wearing     | ecautions |
|   |        | iffe | in         | were    | facemasks   | to        |
|   |        | rent | dividuals. | 50-59,  | and sex     | prevent   |
|   |        | dem  | R          | and     | (p\<0.05),  | getting   |
|   |        | ogra | espondents | 18.4%   | marital     | sick.     |
|   |        | phic | were asked | were 60 | status      | Public    |
|   |        | back | how often  | or      | (p\<0.05),  | education |
|   |        | grou | they had   | older.  | perceived   | and media |
|   |        | nds. | worn       | 21.5%   | sus         | campaigns |
|   |        | To   | facemasks  | of      | ceptibility | should be |
|   |        | test | in the     | parti   | to SARS     | conducted |
|   |        | the  | past week  | cipants | (           | regularly |
|   |        | effi | to prevent | had a   | p\<0.0001), | in        |
|   |        | cacy | being      | primary | perceived   | schools,  |
|   |        | of   | p          | school  | benefits of | wo        |
|   |        | the  | otentially | edu     | facemasks   | rkplaces, |
|   |        |      | infected   | cation; | (p\<0.05),  | and       |
|   |        | He   | by or      | the     | and         | community |
|   |        | alth | tr         | re      | en          | settings  |
|   |        | Be   | ansmitting | mainder | couragement | to        |
|   |        | lief | SARS.      | of      | on the part | di        |
|   |        | M    | R          | parti   | of the      | sseminate |
|   |        | odel | espondents | cipants | government  | the       |
|   |        | in   | were also  | had at  | or family   | latest    |
|   |        | pr   | asked to   | least a | to wear     | findings  |
|   |        | edic | assess, on | high    | facemasks   | of SARS.  |
|   |        | ting | 4 point    | school  | (           | Envi      |
|   |        | the  | scales,    | ed      | p\<0.0001). | ronmental |
|   |        | prac | perceived  | ucation |             | cues, in  |
|   |        | tice | susc       | or      |             | the form  |
|   |        | of   | eptibility | more.   |             | of signs  |
|   |        | the  | to and     | 14.3%   |             | and       |
|   |        | spec | severity   | of      |             | posters   |
|   |        | ific | of SARS    | parti   |             | reminding |
|   |        | pr   | perceived  | cipants |             | people to |
|   |        | even | benefits   | had an  |             | wear      |
|   |        | tive | of wearing | annual  |             | f         |
|   |        | b    | facemasks, | income  |             | acemasks, |
|   |        | ehav | and cues   | less    |             | should be |
|   |        | ior. | to action, | than    |             | placed in |
|   |        |      | including  | \$      |             | prominent |
|   |        |      | fear of    | 1000US, |             | areas in  |
|   |        |      | SARS,      | 59.3%   |             | schools,  |
|   |        |      | worry that | had     |             | w         |
|   |        |      | Hong Kong  | annual  |             | orksites, |
|   |        |      | would      | incomes |             | and       |
|   |        |      | become a   | of      |             | public    |
|   |        |      | q          | \$1000- |             | places.   |
|   |        |      | uarantined | 2500US, |             | Advice,   |
|   |        |      | city,      | 20% had |             | recomm    |
|   |        |      | vul        | annual  |             | endation, |
|   |        |      | nerability | incomes |             | or        |
|   |        |      | to SARS,   | of      |             | enco      |
|   |        |      | contact    | \$2501- |             | uragement |
|   |        |      | with       | 5000US, |             | from      |
|   |        |      | infected   | and     |             | health    |
|   |        |      | in         | 6.4%    |             | care      |
|   |        |      | dividuals, | had     |             | prof      |
|   |        |      | r          | annual  |             | essionals |
|   |        |      | espiratory | incomes |             | are also  |
|   |        |      | problems,  | over    |             | useful to |
|   |        |      | facemasks  | \$      |             | increase  |
|   |        |      | as a good  | 5000US. |             | ind       |
|   |        |      | prevention |         |             | ividual's |
|   |        |      | tool,      |         |             | l         |
|   |        |      | barriers   |         |             | ikelihood |
|   |        |      | to         |         |             | to wear   |
|   |        |      | obtaining  |         |             | f         |
|   |        |      | and        |         |             | acemasks. |
|   |        |      | wearing    |         |             | Policies  |
|   |        |      | facemasks, |         |             | that      |
|   |        |      | and        |         |             | require   |
|   |        |      | enc        |         |             | the       |
|   |        |      | ouragement |         |             | wearing   |
|   |        |      | by the     |         |             | of        |
|   |        |      | government |         |             | facemasks |
|   |        |      | and their  |         |             | in        |
|   |        |      | families   |         |             | certain   |
|   |        |      | to wear    |         |             | locations |
|   |        |      | facemasks. |         |             | (e.g.,    |
|   |        |      |            |         |             | inside    |
|   |        |      |            |         |             | h         |
|   |        |      |            |         |             | ospitals) |
|   |        |      |            |         |             | or for    |
|   |        |      |            |         |             | those who |
|   |        |      |            |         |             | have      |
|   |        |      |            |         |             | re        |
|   |        |      |            |         |             | spiratory |
|   |        |      |            |         |             | symptoms  |
|   |        |      |            |         |             | will also |
|   |        |      |            |         |             | ensure    |
|   |        |      |            |         |             | in        |
|   |        |      |            |         |             | dividuals |
|   |        |      |            |         |             | to        |
|   |        |      |            |         |             | practice  |
|   |        |      |            |         |             | the       |
|   |        |      |            |         |             | desired   |
|   |        |      |            |         |             | p         |
|   |        |      |            |         |             | reventive |
|   |        |      |            |         |             | b         |
|   |        |      |            |         |             | ehaviors. |
|   |        |      |            |         |             | Finally,  |
|   |        |      |            |         |             | it is     |
|   |        |      |            |         |             | also      |
|   |        |      |            |         |             | par       |
|   |        |      |            |         |             | ticularly |
|   |        |      |            |         |             | important |
|   |        |      |            |         |             | to target |
|   |        |      |            |         |             | SARS      |
|   |        |      |            |         |             | p         |
|   |        |      |            |         |             | revention |
|   |        |      |            |         |             | a         |
|   |        |      |            |         |             | ctivities |
|   |        |      |            |         |             | at those  |
|   |        |      |            |         |             | who are   |
|   |        |      |            |         |             | less      |
|   |        |      |            |         |             | likely to |
|   |        |      |            |         |             | practice  |
|   |        |      |            |         |             | these     |
|   |        |      |            |         |             | b         |
|   |        |      |            |         |             | ehaviors, |
|   |        |      |            |         |             | namely,   |
|   |        |      |            |         |             | men,      |
|   |        |      |            |         |             | single    |
|   |        |      |            |         |             | ind       |
|   |        |      |            |         |             | ividuals, |
|   |        |      |            |         |             | and       |
|   |        |      |            |         |             | younger   |
|   |        |      |            |         |             | people.   |
+---+--------+------+------------+---------+-------------+-----------+
| H | Fear   | To   | Sample 1   | Sample  | Respondents | A public  |
| o | of     | exa  | pa         | 1       | in sample 1 | education |
| n | Severe | mine | rticipants | co      | had         | campaign  |
| g | Acute  | the  | were       | nsisted | si          | may be    |
| K | Respi  | na   | recruited  | of 82   | gnificantly | needed to |
| o | ratory | ture | from       | health  | more fear   | address   |
| n | Sy     | of   | hospital   | care    | of          | the       |
| g | ndrome | SARS | staff      | w       | infection   | social    |
| S | (SARS) | -rel | attending  | orkers, | than        | and       |
| A | Among  | ated | training   | of      | respondents | e         |
| R | Health | fear | sessions   | which   | in sample 2 | mployment |
|   | Care   | a    | regarding  | 46 were | (p\<0.01).  | discr     |
|   | W      | mong | effective  | female  | Sample 2    | imination |
|   | orkers | he   | coping     | and 36  | p           | that some |
|   | (2003) | alth | strategies | were    | articipants | SARS      |
|   |        | care | during the | male.   | had with    | patients  |
|   | Ho,    | wor  | SARS       | All     | lower       | suffered. |
|   | Samuel | kers | outbreak,  | parti   | general     | More      |
|   | MY et  | and  | organized  | cipants | se          | research  |
|   | al.    | e    | by the     | had     | lf-efficacy | is needed |
|   |        | stab | Corporate  | uni     | had         | to look   |
|   |        | lish | Clinical   | versity | si          | into the  |
|   |        | a    | Psychology | ed      | gnificantly | long-term |
|   |        | b    | Services   | ucation | higher SARS | health    |
|   |        | asis | (CCPS) of  | levels  | Fear Scale  | and       |
|   |        | to   | the        | or      | insecurity  | psyc      |
|   |        | mea  | Hospital   | higher. | and         | hological |
|   |        | sure | Authority  | 31.7%   | instability | side      |
|   |        | sim  | between    | were    | scores      | effects   |
|   |        | ilar | April 5,   | d       | (p\<0.05    | of SARS   |
|   |        | fear | 2003 and   | octors, | for both).  | infection |
|   |        | for  | May 5,     | 25.6%   | Sample 2    | and       |
|   |        | fu   | 2003.      | were    | pa          | t         |
|   |        | ture | Sample 1   | nurses, | rticipants' | reatment, |
|   |        | e    | pa         | and     | SARS Fear   | as it has |
|   |        | pide | rticipants | 42.7%   | Scale       | been      |
|   |        | mics | completed  | were    | scores were | reported  |
|   |        |      | an 18-item | au      | positively  | in Hong   |
|   |        |      | SARS Fear  | xiliary | correlated  | Kong that |
|   |        |      | Scale      | staff.  | and         | recovered |
|   |        |      | (SFS)      | 12.25   | associated  | SARS      |
|   |        |      | prior to   | of      | with their  | patients  |
|   |        |      | the start  | parti   | Impact of   | have      |
|   |        |      | of the     | cipants | Event       | c         |
|   |        |      | training   | had     | scores      | omplained |
|   |        |      | sessions   | worked  | (p\<0.01).  | of aching |
|   |        |      | that       | for 5   |             | bones,    |
|   |        |      | assessed   | years   |             | lethargy, |
|   |        |      | par        | or less |             | and       |
|   |        |      | ticipants' | for the |             | weakness. |
|   |        |      | fears on a | H       |             | More      |
|   |        |      | 4-point    | ospital |             | research  |
|   |        |      | Likert     | Aut     |             | is        |
|   |        |      | scale,     | hority, |             | required  |
|   |        |      | including  | 46.3%   |             | to look   |
|   |        |      | items such | had     |             | into the  |
|   |        |      | as fear of | worked  |             | long-term |
|   |        |      | infection  | 6-10    |             | medical   |
|   |        |      | of self,   | years,  |             | side      |
|   |        |      | others,    | 28% had |             | effects   |
|   |        |      | and        | worked  |             | of SARS   |
|   |        |      | family,    | 11-20   |             | treatment |
|   |        |      | fear of    | years,  |             | and their |
|   |        |      | taking     | and     |             | psyc      |
|   |        |      | care of    | 13.4%   |             | hological |
|   |        |      | SARS       | had     |             | effects   |
|   |        |      | patients,  | worked  |             | on the    |
|   |        |      | and fear   | for     |             | patients  |
|   |        |      | of death.  | H       |             | c         |
|   |        |      |            | ospital |             | oncerned. |
|   |        |      | Sample 2   | Au      |             |           |
|   |        |      | pa         | thority |             |           |
|   |        |      | rticipants | for     |             |           |
|   |        |      | were       | more    |             |           |
|   |        |      | SAR        | than 21 |             |           |
|   |        |      | S-infected | years.  |             |           |
|   |        |      | hospital   |         |             |           |
|   |        |      | staff. In  | Sample  |             |           |
|   |        |      | addition   | 2       |             |           |
|   |        |      | to the     | co      |             |           |
|   |        |      | SFS,       | nsisted |             |           |
|   |        |      | sample 2   | of 97   |             |           |
|   |        |      | pa         | members |             |           |
|   |        |      | rticipants | of      |             |           |
|   |        |      | were also  | h       |             |           |
|   |        |      | surveyed   | ospital |             |           |
|   |        |      | for        | staff,  |             |           |
|   |        |      | perceived  | of whom |             |           |
|   |        |      | sel        | 82.5%   |             |           |
|   |        |      | f-efficacy | were    |             |           |
|   |        |      | and        | female  |             |           |
|   |        |      | post       | and     |             |           |
|   |        |      | -traumatic | 45.9%   |             |           |
|   |        |      | stress     | had     |             |           |
|   |        |      | (PTS)      | uni     |             |           |
|   |        |      | symptoms.  | versity |             |           |
|   |        |      | Perceived  | ed      |             |           |
|   |        |      | sel        | ucation |             |           |
|   |        |      | f-efficacy | level   |             |           |
|   |        |      | was        | or      |             |           |
|   |        |      | measured   | higher. |             |           |
|   |        |      | by the     | 4.1% of |             |           |
|   |        |      | Chinese    | these   |             |           |
|   |        |      | Sel        | parti   |             |           |
|   |        |      | f-Efficacy | cipants |             |           |
|   |        |      | Scale, a   | were    |             |           |
|   |        |      | 10-item,   | d       |             |           |
|   |        |      | 4-point    | octors, |             |           |
|   |        |      | Likert     | 52.6%   |             |           |
|   |        |      | scale      | were    |             |           |
|   |        |      | ques       | nurses, |             |           |
|   |        |      | tionnaire. | 8.2%    |             |           |
|   |        |      | Post       | were    |             |           |
|   |        |      | -traumatic | allied  |             |           |
|   |        |      | stress     | health  |             |           |
|   |        |      | symptoms   | profess |             |           |
|   |        |      | were       | ionals, |             |           |
|   |        |      | measured   | and     |             |           |
|   |        |      | through    | 35.1%   |             |           |
|   |        |      | the        | were    |             |           |
|   |        |      | Chinese    | support |             |           |
|   |        |      | Impact of  | staff.  |             |           |
|   |        |      | Event      | 33% had |             |           |
|   |        |      | Scale, a   | worked  |             |           |
|   |        |      | 5-point    | for 5   |             |           |
|   |        |      | Likert     | years   |             |           |
|   |        |      | scale tool | or less |             |           |
|   |        |      | to assess  | for the |             |           |
|   |        |      | intrusion, | H       |             |           |
|   |        |      | avoidance, | ospital |             |           |
|   |        |      | and        | Aut     |             |           |
|   |        |      | hyp        | hority, |             |           |
|   |        |      | er-arousal | 27.8%   |             |           |
|   |        |      | associated | for     |             |           |
|   |        |      | with PTS.  | 6-10    |             |           |
|   |        |      |            | years,  |             |           |
|   |        |      |            | 28.9%   |             |           |
|   |        |      |            | for     |             |           |
|   |        |      |            | 11-20   |             |           |
|   |        |      |            | years,  |             |           |
|   |        |      |            | and     |             |           |
|   |        |      |            | 10.3%   |             |           |
|   |        |      |            | for     |             |           |
|   |        |      |            | more    |             |           |
|   |        |      |            | than 21 |             |           |
|   |        |      |            | years.  |             |           |
+---+--------+------+------------+---------+-------------+-----------+
| H | The    | To   | Pa         | Of the  | 87.3% of    | There     |
| o | Impact | as   | rticipants | 1115    | respondents | were      |
| n | of     | sess | were       | resp    | reported no | si        |
| g | Com    | Hong | recruited  | ondents | contact     | gnificant |
| K | munity | Kong | and        | who     | history     | gaps in   |
| o | P      | re   | surveyed   | co      | with any    | the       |
| n | sychol | side | via random | mpleted | individuals | public's  |
| g | ogical | nts' | digit      | the     | potentially | knowledge |
| S | Res    | k    | dialing of | survey  | infected    | about     |
| A | ponses | nowl | all        | 57.1%   | with SARS;  | SARS such |
| R | on     | edge | land-based | were    | 1% had      | as        |
|   | Ou     | of,  | telephone  | female  | direct and  | tra       |
|   | tbreak | bel  | lines in   | and     | 2.7% had    | nsmission |
|   | C      | iefs | Hong Kong. | 64.7%   | indirect    | routes    |
|   | ontrol | ab   | The survey | were    | contact     | and risk  |
|   | for    | out, | was        | m       | with an     | p         |
|   | Severe | and  | conducted  | arried. | individual  | erception |
|   | Acute  | p    | from March | 14.1%   | with a      | was       |
|   | Respi  | sych | 29 to      | of      | confirmed   | strongly  |
|   | ratory | olog | April 6,   | resp    | case of     | a         |
|   | Sy     | ical | 2003.      | ondents | SARS. 79.5% | ssociated |
|   | ndrome | r    |            | were    | respondents | with      |
|   | in     | espo | The survey | age     | knew that   | deficits  |
|   | Hong   | nses | consisted  | 18-24,  | SARS was    | in the    |
|   | Kong   | to   | of 60      | 17%     | transmitted | adoption  |
|   | (2003) | S    | total      | were    | through     | of        |
|   |        | ARS. | questions, | 25-34,  | respiratory | prec      |
|   | Leung, |      | with 5     | 26.8%   | droplets.   | autionary |
|   | GM et  |      | multi-part | were    | 55.1% of    | measures  |
|   | al.    |      | questions. | 35-44,  | respondents | to        |
|   |        |      | R          | 21%     | believed    | prevent   |
|   | <h     |      | espondents | were    | that SARS   | the       |
|   | ttp:// |      | were       | 45-54,  | could be    | spread of |
|   | jech.b |      | surveyed   | 10.5%   | transmitted | SARS.     |
|   | mjjour |      | for their  | were    | through the | These are |
|   | nals.c |      | self       | 45-54,  | air and     | areas     |
|   | om/cgi |      | -perceived | and     | 62.3%       | where     |
|   | /conte |      | health     | 10.6%   | believed    | efforts   |
|   | nt/ful |      | status,    | were    | SARS could  | directed  |
|   | l/57/1 |      | febrile    | age 65  | be          | towards   |
|   | 1/857> |      | and        | or      | transmitted | health    |
|   |        |      | r          | over.   | via contact | education |
|   |        |      | espiratory | 21.1%   | with a      | and       |
|   |        |      | symptoms   | of      | c           | promotion |
|   |        |      | in the     | resp    | ontaminated | should be |
|   |        |      | past two   | ondents | object.     | r         |
|   |        |      | weeks,     | a       | 79.2% of    | edoubled. |
|   |        |      | general    | primary | respondents | Public    |
|   |        |      | anxiety    | school  | were very   | health    |
|   |        |      | (using the | ed      | or somewhat | messages  |
|   |        |      | Sta        | ucation | confident   | relayed   |
|   |        |      | te-Anxiety | level   | in their    | to the    |
|   |        |      | Scale of   | or      | physician's | community |
|   |        |      | the State  | less,   | ability to  | should    |
|   |        |      | Trait      | 47.8%   | recognize   | strike a  |
|   |        |      | Anxiety    | had     | SARS, while | delicate  |
|   |        |      | I          | some    | 13.9% were  | balance   |
|   |        |      | nventory), | se      | not very or | between   |
|   |        |      | use of     | condary | not at all  | being     |
|   |        |      | health     | school  | confident   | overly    |
|   |        |      | services   | edu     | in their    | r         |
|   |        |      | in the     | cation, | physician's | eassuring |
|   |        |      | last two   | and     | ability to  | or        |
|   |        |      | weeks,     | 20.3%   | diagnose    | no        |
|   |        |      | presence,  | had     | SARS. 30.1% | rmalizing |
|   |        |      | intensity, | ed      | of          | and       |
|   |        |      | and        | ucation | respondents | unne      |
|   |        |      | setting of | levels  | thought it  | cessarily |
|   |        |      | direct and | beyond  | very or     | alarmist. |
|   |        |      | indirect   | se      | somewhat    |           |
|   |        |      | contact    | condary | likely that | Targeting |
|   |        |      | with SARS  | school. | they could  | health    |
|   |        |      | patients,  | 6.6% of | contract    | promotion |
|   |        |      | perceived  | resp    | SARS while  | messages  |
|   |        |      | likelihood | ondents | 45.1%       | through   |
|   |        |      | of         | had a   | thought it  | inter     |
|   |        |      | c          | monthly | not very or | mediaries |
|   |        |      | ontracting | income  | not at all  | of female |
|   |        |      | and        | less    | likely that | si        |
|   |        |      | surviving  | than    | they could  | gnificant |
|   |        |      | SARS,      | \$      | contract    | others    |
|   |        |      | routes of  | 5000HK, | SARS. 74.6% | (for      |
|   |        |      | tra        | 28.8%   | of          | example,  |
|   |        |      | nsmission, | had     | respondents | mothers,  |
|   |        |      | confidence | monthly | thought it  | wives or  |
|   |        |      | in         | incomes | very or     | gir       |
|   |        |      | p          | between | somewhat    | lfriends) |
|   |        |      | hysicians' | \$5000- | likely that | who are   |
|   |        |      | ability to | 9999HK, | they could  | more      |
|   |        |      | diagnose   | 31% had | survive     | health-   |
|   |        |      | SARS, and  | monthly | SARS; only  | conscious |
|   |        |      | the extent | incomes | 4.8% of     | and risk  |
|   |        |      | of         | between | respondents | averse    |
|   |        |      | prevention | \$      | thought it  | might     |
|   |        |      | behaviors  | 10000-1 | not very or | raise the |
|   |        |      | practiced  | 9999HK, | not at all  | level of  |
|   |        |      | and        | 21% had | likely that | p         |
|   |        |      | lifestyle  | monthly | they could  | rotective |
|   |        |      | changes.   | incomes | survive     | pr        |
|   |        |      |            | between | SARS.       | ecautions |
|   |        |      |            | \$      |             | u         |
|   |        |      |            | 20000-3 | Most (78%)  | ndertaken |
|   |        |      |            | 9999HK, | respondents | male      |
|   |        |      |            | and     | reported    | in        |
|   |        |      |            | 6.6%    | covering    | dividuals |
|   |        |      |            | had a   | their       | less      |
|   |        |      |            | monthly | mouths when | likely to |
|   |        |      |            | income  | sneezing    | practice  |
|   |        |      |            | of      | and         | p         |
|   |        |      |            | \$      | coughing,   | reventive |
|   |        |      |            | 40000HK | washing     | measures. |
|   |        |      |            | or      | their hands | Specially |
|   |        |      |            | more.   | afterwards  | designed  |
|   |        |      |            | 19.1%   | (74.3%)     | target    |
|   |        |      |            | of      | with soap   | st        |
|   |        |      |            | resp    | and water   | rategies, |
|   |        |      |            | ondents | (74.5%),    | in        |
|   |        |      |            | lived   | and wearing | co        |
|   |        |      |            | in Hong | a facemask  | njunction |
|   |        |      |            | Kong,   | (75.8%).    | with      |
|   |        |      |            | 29.6%   | 33.7% of    | public    |
|   |        |      |            | lived   | respondents | health    |
|   |        |      |            | in      | tried to    | c         |
|   |        |      |            | K       | avoid       | ampaigns, |
|   |        |      |            | owloon, | direct      | using     |
|   |        |      |            | and     | contact     | social    |
|   |        |      |            | 51.3%   | with        | marketing |
|   |        |      |            | lived   | possible    | and       |
|   |        |      |            | in the  | c           | health    |
|   |        |      |            | New     | ontaminated | comm      |
|   |        |      |            | Terri   | objects and | unication |
|   |        |      |            | tories. | 65.3% would | t         |
|   |        |      |            |         | wash their  | echniques |
|   |        |      |            |         | hands       | should be |
|   |        |      |            |         | afterwards. | developed |
|   |        |      |            |         | 38.6% of    | and       |
|   |        |      |            |         | respondents | r         |
|   |        |      |            |         | used        | igorously |
|   |        |      |            |         | serving     | evaluated |
|   |        |      |            |         | utensils    | for their |
|   |        |      |            |         | during      | effe      |
|   |        |      |            |         | meals.      | ctiveness |
|   |        |      |            |         |             | in        |
|   |        |      |            |         | Moderate to | reaching  |
|   |        |      |            |         | high        | v         |
|   |        |      |            |         | anxiety     | ulnerable |
|   |        |      |            |         | levels      | groups    |
|   |        |      |            |         | among       | and       |
|   |        |      |            |         | respondents | fac       |
|   |        |      |            |         | were        | ilitating |
|   |        |      |            |         | significant | behavior  |
|   |        |      |            |         | predictors  | change.   |
|   |        |      |            |         | of          |           |
|   |        |      |            |         | practicing  |           |
|   |        |      |            |         | preventive  |           |
|   |        |      |            |         | measures    |           |
|   |        |      |            |         | (p\<0.001), |           |
|   |        |      |            |         | as were     |           |
|   |        |      |            |         | believing   |           |
|   |        |      |            |         | they were   |           |
|   |        |      |            |         | very to     |           |
|   |        |      |            |         | somewhat    |           |
|   |        |      |            |         | likely to   |           |
|   |        |      |            |         | contact     |           |
|   |        |      |            |         | SARS        |           |
|   |        |      |            |         | (p\<0.05),  |           |
|   |        |      |            |         | having a    |           |
|   |        |      |            |         | persistent  |           |
|   |        |      |            |         | fever with  |           |
|   |        |      |            |         | cough or    |           |
|   |        |      |            |         | difficulty  |           |
|   |        |      |            |         | breathing   |           |
|   |        |      |            |         | (p\<0.05),  |           |
|   |        |      |            |         | direct or   |           |
|   |        |      |            |         | indirect    |           |
|   |        |      |            |         | contact     |           |
|   |        |      |            |         | with a      |           |
|   |        |      |            |         | potential   |           |
|   |        |      |            |         | SA          |           |
|   |        |      |            |         | RS-infected |           |
|   |        |      |            |         | individual  |           |
|   |        |      |            |         | (p\<0.05),  |           |
|   |        |      |            |         | male gender |           |
|   |        |      |            |         | (p\<0.001), |           |
|   |        |      |            |         | age (35-54, |           |
|   |        |      |            |         | p\<0.001,   |           |
|   |        |      |            |         | 55 and      |           |
|   |        |      |            |         | older,      |           |
|   |        |      |            |         | p\<0.01),   |           |
|   |        |      |            |         | and         |           |
|   |        |      |            |         | education   |           |
|   |        |      |            |         | level       |           |
|   |        |      |            |         | (primary    |           |
|   |        |      |            |         | school,     |           |
|   |        |      |            |         | p\<0.05,    |           |
|   |        |      |            |         | secondary   |           |
|   |        |      |            |         | school and  |           |
|   |        |      |            |         | higher,     |           |
|   |        |      |            |         | p\<0.001).  |           |
+---+--------+------+------------+---------+-------------+-----------+
| H | The    | To   | Nurses     | Of the  | 62.9%,      | Difficult |
| o | Impact | as   | were       | 1312    | 52.6%, and  | and       |
| n | of     | sess | recruited  | respo   | 63.5% of    | uncertain |
| g | Work-R | the  | from 8 of  | ndents, | high,       | working   |
| K | elated | phys | the 42     | 91.7%   | moderate,   | c         |
| o | Risk   | ical | public     | were    | and low     | onditions |
| n | on     | and  | hospitals  | female  | risk        | during    |
| g | Nurses | p    | in Hong    | and     | nurses,     | the SARS  |
| S | During | sych | Kong. All  | 50.7%   | re          | outbreak  |
| A | the    | olog | ranks of   | were    | spectively, | -- such   |
| R | SARS   | ical | nurses who | m       | reported    | as        |
|   | Ou     | he   | could read | arried. | good to     | increased |
|   | tbreak | alth | Chinese    | 4.9% of | excellent   | number of |
|   | in     | sta  | were       | resp    | health in   | SARS      |
|   | Hong   | tus, | invited to | ondents | the past    | patients  |
|   | Kong   | k    | p          | were    | week.       | admitted, |
|   | (2003) | nowl | articipate | 18-24   | Mo          | chaotic   |
|   |        | edge | in the     | years   | derate-risk | hospital  |
|   | Chan,  | and  | study.     | of age, | nurses      | working   |
|   | SSC et | risk | R          | 44.7%   | (80.1%)     | env       |
|   | al.    | pe   | espondents | were    | were        | ironment, |
|   |        | rcep | a          | 25-34,  | si          | long      |
|   |        | tion | nonymously | 32.1%   | gnificantly | hours,    |
|   |        | of   | completed, | were    | more likely | extra     |
|   |        | S    | and        | 35-44,  | to report   | shifts    |
|   |        | ARS, | returned   | and     | often or    | and       |
|   |        | and  | via mail,  | 18.3%   | always      | co        |
|   |        | pr   | the SARS   | were    | feeling     | nsecutive |
|   |        | even | Nurses'    | age 45  | stress      | days      |
|   |        | tive | Survey     | or      | during the  | without   |
|   |        | meas | Que        | older.  | SARS        | rest,     |
|   |        | ures | stionnaire | 39.2%   | outbreak    | ina       |
|   |        | of   | which      | of      | (p\<0.001)  | dequately |
|   |        | hosp | included   | resp    | than high-  | trained   |
|   |        | ital | 133        | ondents | (74%) or    | nurses    |
|   |        | nu   | questions  | had     | low-risk    | deployed  |
|   |        | rses | grouped    | c       | (68.3%)     | to ICU,   |
|   |        | du   | into 7     | hildren | nurses.     | ins       |
|   |        | ring | c          | and     | Likewise,   | ufficient |
|   |        | the  | ategories: | 38.2%   | mo          | human     |
|   |        | 2003 | self-rated | lived   | derate-risk | r         |
|   |        | SARS | health,    | with    | nurses were | esources, |
|   |        | outb | health     | older   | si          | low       |
|   |        | reak | services   | adults  | gnificantly | nurse-t   |
|   |        |      | ut         | (≥65).  | more likely | o-patient |
|   |        |      | ilization, | 47.6%   | to          | ratio --  |
|   |        |      | contacts   | of      | sometimes   | may have  |
|   |        |      | with SARS  | resp    | or never    | increased |
|   |        |      | patients,  | ondents | feel able   | nurses'   |
|   |        |      | SARS       | had a   | to cope     | fear and  |
|   |        |      | pe         | high    | with stress | anxiety.  |
|   |        |      | rceptions, | school  | (p\<0.001)  | Unce      |
|   |        |      | preventive | ed      | than high-  | rtainties |
|   |        |      | measures,  | ucation | (45.6%) or  | related   |
|   |        |      | "degrees   | level   | low-risk    | to        |
|   |        |      | of hope",  | or      | (38.9%)     | diagnosis |
|   |        |      | and        | less,   | nurses.     | and       |
|   |        |      | d          | while   | 63.9% of    | treatment |
|   |        |      | emographic | 52.4%   | high-risk   | in the    |
|   |        |      | in         | had a   | nurses      | initial   |
|   |        |      | formation. | college | reported    | stage of  |
|   |        |      | Nurses     | ed      | using       | the       |
|   |        |      | were       | ucation | either      | outbreak  |
|   |        |      | grouped as | level   | Chinese or  | and       |
|   |        |      | high,      | or      | Western     | i         |
|   |        |      | moderate,  | higher. | over-       | ncreasing |
|   |        |      | or low     | 19.4%   | the-counter | number of |
|   |        |      | risk       | of      | (OTC)       | SARS      |
|   |        |      | according  | resp    | medicine in | -infected |
|   |        |      | to what    | ondents | the past    | h         |
|   |        |      | ward and   | worked  | two weeks,  | ealthcare |
|   |        |      | how        | in a    | compared to | workers   |
|   |        |      | closely    | des     | 29.6% of    | reduced   |
|   |        |      | they       | ignated | moderate    | nurses'   |
|   |        |      | worked     | SARS    | risk nurses | c         |
|   |        |      | with       | ho      | and 27.6%   | onfidence |
|   |        |      | suspected  | spital, | of low-risk | in        |
|   |        |      | or         | 43.7%   | nurses.     | ph        |
|   |        |      | confirmed  | worked  | 13.7% of    | ysicians' |
|   |        |      | SARS       | in an   | high risk,  | ability   |
|   |        |      | patients:  | acute   | 11.1% of    | to        |
|   |        |      | working in | h       | moderate    | diagnose  |
|   |        |      | a SARS     | ospital | risk, and   | SARS.     |
|   |        |      | ward or    | with a  | 15.2% of    | High-risk |
|   |        |      | SARS ICU,  | SARS    | low risk    | nurses'   |
|   |        |      | working in | ward,   | nurses      | self-qua  |
|   |        |      | a non-SARS | and     | reported    | rantining |
|   |        |      | ward with  | 36.9%   | going to a  | due to    |
|   |        |      | some       | worked  | primary     | their     |
|   |        |      | contacted  | in a    | care        | perceived |
|   |        |      | with       | n       | physician,  | susce     |
|   |        |      | suspected  | on-SARS | while 5.1%, | ptibility |
|   |        |      | or         | ho      | 7.4%, and   | to SARS   |
|   |        |      | confirmed  | spital. | 8.9% of     | may have  |
|   |        |      | SARS       | 13.4%   | high,       | psyc      |
|   |        |      | patients,  | of      | moderate,   | hological |
|   |        |      | or working | resp    | and low     | imp       |
|   |        |      | in a       | ondents | risk nurses | lications |
|   |        |      | non-SARS   | were    | reported    | due to    |
|   |        |      | ward with  | con     | going to a  | lack of   |
|   |        |      | no contact | sidered | Chinese     | family    |
|   |        |      | with       | high    | medicine    | and/or    |
|   |        |      | suspected  | risk,   | p           | social    |
|   |        |      | or         | ward,   | ractitioner | network   |
|   |        |      | confirmed  | 9.2%    | in the past | support.  |
|   |        |      | SARS       | were    | two weeks.  | Nurses    |
|   |        |      | patients,  | m       | Nurses in   | not       |
|   |        |      | res        | oderate | the high    | working   |
|   |        |      | pectively. | risk,   | risk group  | directly  |
|   |        |      |            | and     | (15.7%)     | with      |
|   |        |      |            | 77.4%   | were        | confirmed |
|   |        |      |            | were    | si          | SARS      |
|   |        |      |            | low     | gnificantly | patients  |
|   |        |      |            | risk.   | more likely | may have  |
|   |        |      |            |         | to visit an | increased |
|   |        |      |            |         | emergency   | stress in |
|   |        |      |            |         | department  | and       |
|   |        |      |            |         | (p\<0.001)  | around    |
|   |        |      |            |         | than        | patients  |
|   |        |      |            |         | moderate-   | with      |
|   |        |      |            |         | (6.7%) or   | uncertain |
|   |        |      |            |         | low-risk    | diagnoses |
|   |        |      |            |         | (2.8%). The | and less  |
|   |        |      |            |         | 36% of high | ava       |
|   |        |      |            |         | risk nurses | ilability |
|   |        |      |            |         | who         | of PPE. A |
|   |        |      |            |         | reported no | moderate  |
|   |        |      |            |         | health care | level of  |
|   |        |      |            |         | use in the  | stress    |
|   |        |      |            |         | past two    | may       |
|   |        |      |            |         | weeks was   | increase  |
|   |        |      |            |         | si          | the       |
|   |        |      |            |         | gnificantly | l         |
|   |        |      |            |         | lower than  | ikelihood |
|   |        |      |            |         | moderate-   | that      |
|   |        |      |            |         | and         | h         |
|   |        |      |            |         | low-risk    | ealthcare |
|   |        |      |            |         | nurses      | workers   |
|   |        |      |            |         | (p\<0.05).  | will      |
|   |        |      |            |         | Nurses in   | practice  |
|   |        |      |            |         | both the    | p         |
|   |        |      |            |         | high- (87%) | reventive |
|   |        |      |            |         | and         | and       |
|   |        |      |            |         | mo          | prec      |
|   |        |      |            |         | derate-risk | autionary |
|   |        |      |            |         | (80.7%)     | measures. |
|   |        |      |            |         | were        |           |
|   |        |      |            |         | si          | Hospitals |
|   |        |      |            |         | gnificantly | should    |
|   |        |      |            |         | more likely | institute |
|   |        |      |            |         | (p\<0.001)  | effective |
|   |        |      |            |         | than        | infection |
|   |        |      |            |         | low-risk    | control   |
|   |        |      |            |         | (65%)       | policies  |
|   |        |      |            |         | nurses to   | in order  |
|   |        |      |            |         | believe     | to reduce |
|   |        |      |            |         | they were   | the risk  |
|   |        |      |            |         | very or     | of staff  |
|   |        |      |            |         | somewhat    | infection |
|   |        |      |            |         | likely to   | and       |
|   |        |      |            |         | contract    | maintain  |
|   |        |      |            |         | SARS, with  | good      |
|   |        |      |            |         | 75.6% of    | staff     |
|   |        |      |            |         | high-,      | psyc      |
|   |        |      |            |         | 70.9% of    | hological |
|   |        |      |            |         | moderate-,  | health.   |
|   |        |      |            |         | and 69.4%   | Some      |
|   |        |      |            |         | of low-risk | suggested |
|   |        |      |            |         | nurses      | measures  |
|   |        |      |            |         | believing   | include:  |
|   |        |      |            |         | that it was | re        |
|   |        |      |            |         | very or     | arranging |
|   |        |      |            |         | somewhat    | hospital  |
|   |        |      |            |         | likely they | infra     |
|   |        |      |            |         | would       | structure |
|   |        |      |            |         | survive if  | through   |
|   |        |      |            |         | infected.   | rea       |
|   |        |      |            |         |             | ssignment |
|   |        |      |            |         | More than   | of wards, |
|   |        |      |            |         | 93% of      | etc;      |
|   |        |      |            |         | nurses in   | improving |
|   |        |      |            |         | all risk    | safety    |
|   |        |      |            |         | groups      | controls  |
|   |        |      |            |         | reported    | such as   |
|   |        |      |            |         | wearing     | ve        |
|   |        |      |            |         | surgical    | ntilation |
|   |        |      |            |         | masks and   | systems   |
|   |        |      |            |         | washing     | and       |
|   |        |      |            |         | hands after | reducing  |
|   |        |      |            |         | removing    | patient   |
|   |        |      |            |         | gloves or   | density;  |
|   |        |      |            |         | patient     | providing |
|   |        |      |            |         | contact.    | comp      |
|   |        |      |            |         | Most high   | rehensive |
|   |        |      |            |         | risk group  | protocols |
|   |        |      |            |         | nurses also | on        |
|   |        |      |            |         | wore        | p         |
|   |        |      |            |         | goggles or  | reventive |
|   |        |      |            |         | a face      | measures  |
|   |        |      |            |         | shield      | at        |
|   |        |      |            |         | (95.2%),    | depa      |
|   |        |      |            |         | surgical    | rtmental, |
|   |        |      |            |         | gowns       | ward, and |
|   |        |      |            |         | (88.9%),    | i         |
|   |        |      |            |         | gloves      | ndividual |
|   |        |      |            |         | (83.6%),    | levels;   |
|   |        |      |            |         | disposable  | re        |
|   |        |      |            |         | caps (82%), | assessing |
|   |        |      |            |         | and         | nursing   |
|   |        |      |            |         | refrained   | protocols |
|   |        |      |            |         | from eating | that may  |
|   |        |      |            |         | in the ward | increase  |
|   |        |      |            |         | pantry      | risk of   |
|   |        |      |            |         | (83.4%).    | i         |
|   |        |      |            |         | High-risk   | nfection; |
|   |        |      |            |         | nurses      | training  |
|   |        |      |            |         | (67.2%)     | and       |
|   |        |      |            |         | were        | r         |
|   |        |      |            |         | si          | etraining |
|   |        |      |            |         | gnificantly | health    |
|   |        |      |            |         | more like   | care      |
|   |        |      |            |         | than        | workers   |
|   |        |      |            |         | moderate-   | on        |
|   |        |      |            |         | (27.7%) or  | adherence |
|   |        |      |            |         | low-risk    | to        |
|   |        |      |            |         | (16.9%)     | infection |
|   |        |      |            |         | nurses to   | control   |
|   |        |      |            |         | practice    | policies, |
|   |        |      |            |         | all         | and;      |
|   |        |      |            |         | w           | provided  |
|   |        |      |            |         | ork-related | adequate  |
|   |        |      |            |         | preventive  | r         |
|   |        |      |            |         | measures    | esources, |
|   |        |      |            |         | specified   | PPE, etc  |
|   |        |      |            |         | in the      | to        |
|   |        |      |            |         | survey      | support   |
|   |        |      |            |         | (p\<0.001); | and       |
|   |        |      |            |         | they were   | ensure    |
|   |        |      |            |         | also        | adherence |
|   |        |      |            |         | si          | to        |
|   |        |      |            |         | gnificantly | infection |
|   |        |      |            |         | more likely | control   |
|   |        |      |            |         | to use      | policies. |
|   |        |      |            |         | serving     |           |
|   |        |      |            |         | utensils    |           |
|   |        |      |            |         | (p\<0.001)  |           |
|   |        |      |            |         | and use     |           |
|   |        |      |            |         | preventive  |           |
|   |        |      |            |         | measure     |           |
|   |        |      |            |         | with        |           |
|   |        |      |            |         | potentially |           |
|   |        |      |            |         | c           |           |
|   |        |      |            |         | ontaminated |           |
|   |        |      |            |         | objects     |           |
|   |        |      |            |         | (p\<0.01),  |           |
|   |        |      |            |         | wash hands  |           |
|   |        |      |            |         | after       |           |
|   |        |      |            |         | touching    |           |
|   |        |      |            |         | potentially |           |
|   |        |      |            |         | c           |           |
|   |        |      |            |         | ontaminated |           |
|   |        |      |            |         | objects     |           |
|   |        |      |            |         | (p\<0.05),  |           |
|   |        |      |            |         | lower the   |           |
|   |        |      |            |         | toilet lid  |           |
|   |        |      |            |         | before      |           |
|   |        |      |            |         | flushing    |           |
|   |        |      |            |         | (p\<0.001), |           |
|   |        |      |            |         | avoid using |           |
|   |        |      |            |         | public      |           |
|   |        |      |            |         | towels      |           |
|   |        |      |            |         | (p\<0.01),  |           |
|   |        |      |            |         | and         |           |
|   |        |      |            |         | practice    |           |
|   |        |      |            |         | all         |           |
|   |        |      |            |         | preventive  |           |
|   |        |      |            |         | measures    |           |
|   |        |      |            |         | frequently  |           |
|   |        |      |            |         | (p\<0.001)  |           |
|   |        |      |            |         | than        |           |
|   |        |      |            |         | moderate-   |           |
|   |        |      |            |         | and         |           |
|   |        |      |            |         | low-risk    |           |
|   |        |      |            |         | nurses.     |           |
|   |        |      |            |         |             |           |
|   |        |      |            |         | Risk group, |           |
|   |        |      |            |         | nursing     |           |
|   |        |      |            |         | rank,       |           |
|   |        |      |            |         | colleagues' |           |
|   |        |      |            |         | prevention  |           |
|   |        |      |            |         | practices,  |           |
|   |        |      |            |         | adequate    |           |
|   |        |      |            |         | supply of   |           |
|   |        |      |            |         | PPE, and    |           |
|   |        |      |            |         | S           |           |
|   |        |      |            |         | ARS-related |           |
|   |        |      |            |         | physical    |           |
|   |        |      |            |         | symptoms    |           |
|   |        |      |            |         | were all    |           |
|   |        |      |            |         | predictors  |           |
|   |        |      |            |         | of adoption |           |
|   |        |      |            |         | of SARS     |           |
|   |        |      |            |         | preventive  |           |
|   |        |      |            |         | measures at |           |
|   |        |      |            |         | work. Level |           |
|   |        |      |            |         | of risk,    |           |
|   |        |      |            |         | S           |           |
|   |        |      |            |         | ARS-related |           |
|   |        |      |            |         | physical    |           |
|   |        |      |            |         | symptoms,   |           |
|   |        |      |            |         | S           |           |
|   |        |      |            |         | ARS-related |           |
|   |        |      |            |         | stress, and |           |
|   |        |      |            |         | children    |           |
|   |        |      |            |         | were all    |           |
|   |        |      |            |         | predictors  |           |
|   |        |      |            |         | of adopting |           |
|   |        |      |            |         | preventive  |           |
|   |        |      |            |         | measures at |           |
|   |        |      |            |         | home.       |           |
+---+--------+------+------------+---------+-------------+-----------+
| H | Moni   | To   | 10 rounds  | Of the  | During the  | Affected  |
| o | toring | as   | of         | 1397    | initial     | countries |
| n | Com    | sess | telephone  | respo   | phase of    | should    |
| g | munity | per  | surveys,   | ndents, | the SARS    | regard    |
| K | Res    | cept | using      | 51.4%   | epidemic    | d         |
| o | ponses | ions | random     | were    | (March      | isclosure |
| n | to the | and  | digit      | male,   | 21-24),     | of        |
| g | SARS   | b    | dialing,   | 26.7%   | 90.5% of    | in        |
| S | Ep     | ehav | were       | were    | respondents | formation |
| A | idemic | iors | conducted  | between | were        | to be a   |
| R | in     | of   | between 6  | the     | actively    | means of  |
|   | Hong   | the  | and 10 pm  | ages of | seeking     | control   |
|   | Kong:  | gen  | on March   | 18-29,  | information | rather    |
|   | From   | eral | 21, 23,    | 25.2%   | about SARS  | than a    |
|   | Day 10 | pu   | 24, 28,    | were    | on a daily  | threat.   |
|   | to Day | blic | April 1,   | 30-39,  | basis.      | Both      |
|   | 62     | in   | 8, 11, 24, | 28.2%   | 89.8% of    | g         |
|   | (2003) | resp | and May    | were    | these       | overnment |
|   |        | onse | 12, 2003.  | 40-49,  | respondents | and       |
|   | Lau,   | to   |            | and 20% | got their   | community |
|   | JTF et | the  | Pa         | were    | information | efforts   |
|   | al.    | se   | rticipants | 50-60   | from the    | need to   |
|   |        | vere | were       | years.  | television, | be taken  |
|   | <h     | a    | surveyed   | 28.3%   | 71.1% from  | into      |
|   | ttp:// | cute | on their   | of      | newspapers, | account   |
|   | jech.b | res  | knowledge  | resp    | 27.1% from  | in order  |
|   | mjjour | pira | of the     | ondents | the radio,  | to bring  |
|   | nals.c | tory | sources of | had a   | 8.7% from   | an        |
|   | om/cgi | synd | SARS       | primary | friends,    | epidemic  |
|   | /conte | rome | infection  | school  | 4.9% from   | under     |
|   | nt/ful | (S   | and their  | ed      | clinicians, | control.  |
|   | l/57/1 | ARS) | SA         | ucation | and 3.3%    | G         |
|   | 1/864> | epid | RS-related | level   | from the    | overnment |
|   |        | emic | p          | or      | internet.   | efforts   |
|   |        | in   | erceptions | less;   |             | should    |
|   |        | Hong | and        | 27.1%   | 84.4% of    | not only  |
|   |        | K    | behaviors, | of      | respondents | be        |
|   |        | ong. | including  | resp    | believed    | limited   |
|   |        |      | perceived  | ondents | that SARS   | to        |
|   |        |      | susc       | had     | could be    | control   |
|   |        |      | eptibility | more    | transmitted | of        |
|   |        |      | to SARS,   | than a  | through     | hospital  |
|   |        |      | fear of    | se      | direct      | trans     |
|   |        |      | c          | condary | contact     | missions, |
|   |        |      | ontracting | educ    | with an     | surv      |
|   |        |      | SARS, and  | ational | infected    | eillance, |
|   |        |      | informati  | level.  | person and  | and       |
|   |        |      | on-seeking |         | through     | q         |
|   |        |      | behavior.  |         | respiratory | uarantine |
|   |        |      | A subgroup |         | droplets.   | e         |
|   |        |      | of         |         | The change  | xercises, |
|   |        |      | que        |         | in the      | but       |
|   |        |      | stionnaire |         | number of   | should    |
|   |        |      | items was  |         | respondents | include   |
|   |        |      | asked only |         | who         | promotion |
|   |        |      | in the     |         | believed    | of public |
|   |        |      | early part |         | SARS was    | health    |
|   |        |      | of the     |         | curable in  | p         |
|   |        |      | study and  |         | the first   | reventive |
|   |        |      | another    |         | and second  | b         |
|   |        |      | subgroup   |         | phases of   | ehaviors. |
|   |        |      | was asked  |         | the study   | Sur       |
|   |        |      | only in    |         | was         | veillance |
|   |        |      | the later  |         | st          | system    |
|   |        |      | part of    |         | atistically | should    |
|   |        |      | the study. |         | significant | include   |
|   |        |      | Interviews |         | (p\<0.001); | the       |
|   |        |      | lasted     |         | conversely  | number of |
|   |        |      | less than  |         | a           | cases and |
|   |        |      | 15         |         | si          | contacts, |
|   |        |      | minutes.   |         | gnificantly | in        |
|   |        |      |            |         | fewer       | addition  |
|   |        |      |            |         | number of   | to        |
|   |        |      |            |         | respondents | m         |
|   |        |      |            |         | believed    | onitoring |
|   |        |      |            |         | SARS to     | changes   |
|   |        |      |            |         | fatal       | in        |
|   |        |      |            |         | (p\<0.001)  | pe        |
|   |        |      |            |         | in the      | rceptions |
|   |        |      |            |         | second      | and       |
|   |        |      |            |         | phase of    | behaviors |
|   |        |      |            |         | the study   | by        |
|   |        |      |            |         | than the    | c         |
|   |        |      |            |         | first.      | onducting |
|   |        |      |            |         | Perceived   | s         |
|   |        |      |            |         | sus         | ystematic |
|   |        |      |            |         | ceptibility | and       |
|   |        |      |            |         | to SARS     | serial    |
|   |        |      |            |         | declined    | surveys.  |
|   |        |      |            |         | si          | These     |
|   |        |      |            |         | gnificantly | surveys   |
|   |        |      |            |         | from the    | should be |
|   |        |      |            |         | first phase | carried   |
|   |        |      |            |         | to the      | out from  |
|   |        |      |            |         | second      | the       |
|   |        |      |            |         | (p\<0.02),  | initial   |
|   |        |      |            |         | as well as  | onset of  |
|   |        |      |            |         | the number  | the       |
|   |        |      |            |         | of          | epidemic  |
|   |        |      |            |         | respondents | in real   |
|   |        |      |            |         | who were    | time and  |
|   |        |      |            |         | worried     | provide   |
|   |        |      |            |         | that they   | feedback  |
|   |        |      |            |         | or their    | to        |
|   |        |      |            |         | family      | pol       |
|   |        |      |            |         | members     | icymakers |
|   |        |      |            |         | might       | and the   |
|   |        |      |            |         | contract    | community |
|   |        |      |            |         | SARS        | to        |
|   |        |      |            |         | (p\<0.05),  | address   |
|   |        |      |            |         | and might   | areas of  |
|   |        |      |            |         | contract it | concern   |
|   |        |      |            |         | from a      | and       |
|   |        |      |            |         | public      | reinforce |
|   |        |      |            |         | place       | behavior. |
|   |        |      |            |         | (p\<0.001). | Proactive |
|   |        |      |            |         | A           | control   |
|   |        |      |            |         | significant | policies  |
|   |        |      |            |         | number of   | may need  |
|   |        |      |            |         | respondents | to be     |
|   |        |      |            |         | believed    | developed |
|   |        |      |            |         | that        | to        |
|   |        |      |            |         | traveling   | assuage   |
|   |        |      |            |         | to          | public    |
|   |        |      |            |         | Guangdong   | doubt.    |
|   |        |      |            |         | Province    |           |
|   |        |      |            |         | and         |           |
|   |        |      |            |         | mainland    |           |
|   |        |      |            |         | China put   |           |
|   |        |      |            |         | them at     |           |
|   |        |      |            |         | high risk   |           |
|   |        |      |            |         | for         |           |
|   |        |      |            |         | t           |           |
|   |        |      |            |         | ransmission |           |
|   |        |      |            |         | in the      |           |
|   |        |      |            |         | first       |           |
|   |        |      |            |         | (p=0.01)    |           |
|   |        |      |            |         | and second  |           |
|   |        |      |            |         | (p\<0.05)   |           |
|   |        |      |            |         | phases of   |           |
|   |        |      |            |         | the study,  |           |
|   |        |      |            |         | re          |           |
|   |        |      |            |         | spectively. |           |
|   |        |      |            |         | In the      |           |
|   |        |      |            |         | first       |           |
|   |        |      |            |         | stages of   |           |
|   |        |      |            |         | the study   |           |
|   |        |      |            |         | there were  |           |
|   |        |      |            |         | significant |           |
|   |        |      |            |         | increases   |           |
|   |        |      |            |         | in the      |           |
|   |        |      |            |         | number of   |           |
|   |        |      |            |         | respondents |           |
|   |        |      |            |         | who         |           |
|   |        |      |            |         | believed    |           |
|   |        |      |            |         | wearing a   |           |
|   |        |      |            |         | mask        |           |
|   |        |      |            |         | (p\<0.05),  |           |
|   |        |      |            |         | frequent    |           |
|   |        |      |            |         | h           |           |
|   |        |      |            |         | and-washing |           |
|   |        |      |            |         | (p\<0.001), |           |
|   |        |      |            |         | and home    |           |
|   |        |      |            |         | d           |           |
|   |        |      |            |         | isinfection |           |
|   |        |      |            |         | (p\<0.01)   |           |
|   |        |      |            |         | were        |           |
|   |        |      |            |         | effective   |           |
|   |        |      |            |         | means of    |           |
|   |        |      |            |         | prevention. |           |
|   |        |      |            |         | Respondents |           |
|   |        |      |            |         | in the      |           |
|   |        |      |            |         | second      |           |
|   |        |      |            |         | phase of    |           |
|   |        |      |            |         | the study   |           |
|   |        |      |            |         | were        |           |
|   |        |      |            |         | si          |           |
|   |        |      |            |         | gnificantly |           |
|   |        |      |            |         | more likely |           |
|   |        |      |            |         | to believe  |           |
|   |        |      |            |         | these       |           |
|   |        |      |            |         | methods to  |           |
|   |        |      |            |         | be          |           |
|   |        |      |            |         | effective   |           |
|   |        |      |            |         | in          |           |
|   |        |      |            |         | prevention  |           |
|   |        |      |            |         | of SARS     |           |
|   |        |      |            |         | (p\<0.05).  |           |
|   |        |      |            |         | In the      |           |
|   |        |      |            |         | first phase |           |
|   |        |      |            |         | of the      |           |
|   |        |      |            |         | study the   |           |
|   |        |      |            |         | percentage  |           |
|   |        |      |            |         | of          |           |
|   |        |      |            |         | respondents |           |
|   |        |      |            |         | practicing  |           |
|   |        |      |            |         | different   |           |
|   |        |      |            |         | prevention  |           |
|   |        |      |            |         | methods was |           |
|   |        |      |            |         | positively  |           |
|   |        |      |            |         | and highly  |           |
|   |        |      |            |         | correlated  |           |
|   |        |      |            |         | with the    |           |
|   |        |      |            |         | number of   |           |
|   |        |      |            |         | new cases   |           |
|   |        |      |            |         | in Hong     |           |
|   |        |      |            |         | Kong and    |           |
|   |        |      |            |         | the total   |           |
|   |        |      |            |         | number of   |           |
|   |        |      |            |         | cases       |           |
|   |        |      |            |         | reported on |           |
|   |        |      |            |         | the day     |           |
|   |        |      |            |         | before the  |           |
|   |        |      |            |         | survey      |           |
|   |        |      |            |         | (p\<0.05).  |           |
+---+--------+------+------------+---------+-------------+-----------+
| H | Social | To   | Pa         | Not     | The most    | One       |
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| g | tation | the  | recruited  |         | reactions   | of these  |
| K | of a   | so   | via        |         | to the      | findings  |
| o | Food   | cial | purposive  |         | avian flu   | is that   |
| n | Risk:  | rep  | sampling   |         | outbreak    | the       |
| g | the    | rese | from Hong  |         | were        | p         |
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| A | Kong   | ions | of Chinese |         | the origin  | for fresh |
| R | Avian  | of   | ethnicity  |         | of the flu  | food may  |
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|   |        |      | ques       |         | articipants | ncreasing |
|   |        |      | tionnaire. |         | linked it   | hygiene   |
|   |        |      |            |         | to past     | and       |
|   |        |      | Pa         |         | chicken     | purity.   |
|   |        |      | rticipants |         | plagues in  |           |
|   |        |      | were first |         | mainland    |           |
|   |        |      | asked for  |         | China, mad  |           |
|   |        |      | first      |         | cow, and    |           |
|   |        |      | reactions  |         | foot and    |           |
|   |        |      | to the     |         | mouth       |           |
|   |        |      | most       |         | diseases in |           |
|   |        |      | recent     |         | Britain and |           |
|   |        |      | avian flu  |         | Taiwan.     |           |
|   |        |      | outbreak,  |         |             |           |
|   |        |      | then were  |         | One third   |           |
|   |        |      | asked how  |         | of          |           |
|   |        |      | and where  |         | p           |           |
|   |        |      | they       |         | articipants |           |
|   |        |      | thought    |         | discussed   |           |
|   |        |      | the        |         | personal    |           |
|   |        |      | epidemic   |         | fear rooted |           |
|   |        |      | occurred,  |         | in the      |           |
|   |        |      | and how    |         | flu's       |           |
|   |        |      | and who it |         | potential   |           |
|   |        |      | has        |         | cause of    |           |
|   |        |      | affected.  |         | death and   |           |
|   |        |      |            |         | sickness    |           |
|   |        |      |            |         | for humans, |           |
|   |        |      |            |         | cruelty     |           |
|   |        |      |            |         | towards     |           |
|   |        |      |            |         | chickens,   |           |
|   |        |      |            |         | and empathy |           |
|   |        |      |            |         | for the     |           |
|   |        |      |            |         | plight of   |           |
|   |        |      |            |         | "innocent"  |           |
|   |        |      |            |         | chickens.   |           |
|   |        |      |            |         |             |           |
|   |        |      |            |         | P           |           |
|   |        |      |            |         | articipants |           |
|   |        |      |            |         | also        |           |
|   |        |      |            |         | expressed   |           |
|   |        |      |            |         | fear in     |           |
|   |        |      |            |         | thinking    |           |
|   |        |      |            |         | about or    |           |
|   |        |      |            |         | seeing the  |           |
|   |        |      |            |         | mass        |           |
|   |        |      |            |         | slaughter   |           |
|   |        |      |            |         | of          |           |
|   |        |      |            |         | chickens.   |           |
|   |        |      |            |         | Almost      |           |
|   |        |      |            |         | one-quarter |           |
|   |        |      |            |         | of          |           |
|   |        |      |            |         | p           |           |
|   |        |      |            |         | articipants |           |
|   |        |      |            |         | mentioned   |           |
|   |        |      |            |         | images of   |           |
|   |        |      |            |         | chickens    |           |
|   |        |      |            |         | being       |           |
|   |        |      |            |         | killed,     |           |
|   |        |      |            |         | suffering,  |           |
|   |        |      |            |         | and         |           |
|   |        |      |            |         | struggling. |           |
+---+--------+------+------------+---------+-------------+-----------+
| H | Impact | To   | Pa         | Of the  | Hong Kong   | Not       |
| o | on     | as   | rticipants | 705     | respondents | available |
| n | Ou     | sess | were       | Hong    | had         | at this   |
| g | tbreak | v    | recruited  | Kong    | si          | time.     |
| K | C      | iews | and        | respo   | gnificantly |           |
| o | ontrol | and  | surveyed   | ndents, | higher      |           |
| n | in     | bel  | using      | 57%     | levels of   |           |
| g | Hong   | iefs | random     | were    | anxiety     |           |
| S | Kong   | a    | digit      | female, | than        |           |
| A | and    | bout | dialing of | 15.3%   | Singapore   |           |
| R | Sin    | and  | all        | were    | respondents |           |
| , | gapore | psyc | land-based | 18-24   | (p\<0.001). |           |
| S | During | hobe | telephone  | years   | 92.3% of    |           |
| i | the    | havi | lines in   | of age, | Hong Kong   |           |
| n | Severe | oral | Hong Kong  | 28.2%   | respondents |           |
| g | Acute  | r    | and        | were    | and 96.7%   |           |
| a | Respi  | espo | Singapore. | 25-34,  | of          |           |
| p | ratory | nses | The        | 28.8%   | Singapore   |           |
| o | Sy     | to   | survey,    | were    | respondents |           |
| r | ndrome | SARS | conducted  | 35-44,  | reported no |           |
| e | Ep     |      | between    | 20.2%   | history of  |           |
|   | idemic |      | May 15 and | were    | contact     |           |
|   | (2003) |      | June 10,   | 45-54,  | with SARS   |           |
|   |        |      | 2003 in    | and     | patients.   |           |
|   | Leung, |      | Hong Kong  | 17.6%   | 93.2% and   |           |
|   | GM et  |      | and May 5  | were 55 | 91.8% of    |           |
|   | al.    |      | and 10,    | or      | Hong Kong   |           |
|   |        |      | 2003 in    | over.   | and         |           |
|   |        |      | Singapore, | 22.3%   | Singapore   |           |
|   |        |      | consisted  | of      | r           |           |
|   |        |      | of 60      | resp    | espondents, |           |
|   |        |      | questions, | ondents | re          |           |
|   |        |      | five with  | had a   | spectively, |           |
|   |        |      | multiple   | primary | were        |           |
|   |        |      | parts.     | school  | willing to  |           |
|   |        |      | Pa         | ed      | be          |           |
|   |        |      | rticipants | ucation | quarantined |           |
|   |        |      | were       | level   | if they had |           |
|   |        |      | surveyed   | or less | close       |           |
|   |        |      | for        | and     | contact     |           |
|   |        |      | self       | 49.8%   | with a SARS |           |
|   |        |      | -perceived | of      | patient.    |           |
|   |        |      | health     | resp    | Most        |           |
|   |        |      | status,    | ondents | respondents |           |
|   |        |      | febrile    | had     | in both     |           |
|   |        |      | and        | a       | Hong Kong   |           |
|   |        |      | r          | chieved | (86.7%) and |           |
|   |        |      | espiratory | a       | Singapore   |           |
|   |        |      | symptoms   | se      | (71.4%)     |           |
|   |        |      | in the     | condary | knew that   |           |
|   |        |      | last two   | school  | SARS could  |           |
|   |        |      | weeks,     | level   | be          |           |
|   |        |      | general    | of      | transmitted |           |
|   |        |      | anxiety    | edu     | through     |           |
|   |        |      | (using the | cation. | respiratory |           |
|   |        |      | Sta        | 61.6%   | droplets.   |           |
|   |        |      | te-Anxiety | of      | Hong Kong   |           |
|   |        |      | Scale of   | resp    | respondents |           |
|   |        |      | the State  | ondents | were        |           |
|   |        |      | Trait      | were    | si          |           |
|   |        |      | Anxiety    | m       | gnificantly |           |
|   |        |      | I          | arried, | more        |           |
|   |        |      | nventory), | 50.9%   | kn          |           |
|   |        |      | use of     | were    | owledgeable |           |
|   |        |      | health     | em      | about SARS  |           |
|   |        |      | services   | ployed, | routes of   |           |
|   |        |      | in the     | 30.3%   | t           |           |
|   |        |      | last two   | had     | ransmission |           |
|   |        |      | weeks,     | annual  | (p\<0.001). |           |
|   |        |      | presence,  | incomes | 23% of Hong |           |
|   |        |      | intensity, | less    | Kong and    |           |
|   |        |      | and        | than    | 11.9% of    |           |
|   |        |      | setting of | \       | Singapore   |           |
|   |        |      | direct and | $14,000 | respondents |           |
|   |        |      | indirect   | US, and | believed    |           |
|   |        |      | contact    | 41.3%   | that they   |           |
|   |        |      | with SARS  | had     | were very   |           |
|   |        |      | patients,  | annual  | or somewhat |           |
|   |        |      | perceived  | incomes | likely to   |           |
|   |        |      | likelihood | between | contract    |           |
|   |        |      | of         | \$14000 | SARS during |           |
|   |        |      | c          | and     | the current |           |
|   |        |      | ontracting | \$29999 | outbreak.   |           |
|   |        |      | and        | US.     | Singapore   |           |
|   |        |      | surviving  |         | respondents |           |
|   |        |      | SARS,      | Of the  | were        |           |
|   |        |      | routes of  | 1201    | si          |           |
|   |        |      | tra        | Si      | gnificantly |           |
|   |        |      | nsmission, | ngapore | more        |           |
|   |        |      | confidence | respo   | confident   |           |
|   |        |      | in         | ndents, | in          |           |
|   |        |      | p          | 50.1%   | physicians' |           |
|   |        |      | hysicians' | were    | ability to  |           |
|   |        |      | ability to | female, | diagnose    |           |
|   |        |      | diagnose   | 8.2%    | SARS than   |           |
|   |        |      | SARS,      | were    | Hong Kong   |           |
|   |        |      | practice   | 21-24   | respondents |           |
|   |        |      | of         | years   | (p\<0.001). |           |
|   |        |      | prevention | of age, | The         |           |
|   |        |      | behaviors, | 23.6%   | percentages |           |
|   |        |      | and        | were    | of Hong     |           |
|   |        |      | d          | 25-34,  | Kong        |           |
|   |        |      | emographic | 27.1%   | respondents |           |
|   |        |      | charac     | were    | practicing  |           |
|   |        |      | teristics. | 35-44,  | preventive  |           |
|   |        |      |            | 21.8%   | measures    |           |
|   |        |      |            | were    | was         |           |
|   |        |      |            | 45-54,  | si          |           |
|   |        |      |            | and     | gnificantly |           |
|   |        |      |            | 19.4%   | larger      |           |
|   |        |      |            | were 55 | (p\<.001)   |           |
|   |        |      |            | or      | than the    |           |
|   |        |      |            | over.   | percentages |           |
|   |        |      |            | 20.7%   | of          |           |
|   |        |      |            | of      | Singapore   |           |
|   |        |      |            | resp    | respondents |           |
|   |        |      |            | ondents | for 6 out   |           |
|   |        |      |            | had a   | of 7        |           |
|   |        |      |            | primary | pr          |           |
|   |        |      |            | school  | ecautionary |           |
|   |        |      |            | ed      | measures.   |           |
|   |        |      |            | ucation |             |           |
|   |        |      |            | level   | Level of    |           |
|   |        |      |            | or less | anxiety     |           |
|   |        |      |            | and     | among Hong  |           |
|   |        |      |            | 37.1%   | Kong        |           |
|   |        |      |            | of      | respondents |           |
|   |        |      |            | resp    | was         |           |
|   |        |      |            | ondents | si          |           |
|   |        |      |            | had     | gnificantly |           |
|   |        |      |            | a       | associated  |           |
|   |        |      |            | chieved | with        |           |
|   |        |      |            | a       | adopting    |           |
|   |        |      |            | se      | preventive  |           |
|   |        |      |            | condary | measures    |           |
|   |        |      |            | school  | (p\<0.01),  |           |
|   |        |      |            | level   | but recent  |           |
|   |        |      |            | of      | health and  |           |
|   |        |      |            | edu     | contact     |           |
|   |        |      |            | cation. | with SARS   |           |
|   |        |      |            | 73.6%   | patients    |           |
|   |        |      |            | of      | were not.   |           |
|   |        |      |            | resp    | Perceived   |           |
|   |        |      |            | ondents | likelihood  |           |
|   |        |      |            | were    | of          |           |
|   |        |      |            | m       | contracting |           |
|   |        |      |            | arried, | SARS and    |           |
|   |        |      |            | 66.4%   | knowledge   |           |
|   |        |      |            | were    | of SARS     |           |
|   |        |      |            | em      | t           |           |
|   |        |      |            | ployed, | ransmission |           |
|   |        |      |            | 40.9%   | routes were |           |
|   |        |      |            | had     | positive    |           |
|   |        |      |            | annual  | predictors  |           |
|   |        |      |            | incomes | of adopting |           |
|   |        |      |            | less    | preventive  |           |
|   |        |      |            | than    | measures in |           |
|   |        |      |            | \       | Hong Kong.  |           |
|   |        |      |            | $14,000 |             |           |
|   |        |      |            | US, and |             |           |
|   |        |      |            | 41.9%   |             |           |
|   |        |      |            | had     |             |           |
|   |        |      |            | annual  |             |           |
|   |        |      |            | incomes |             |           |
|   |        |      |            | between |             |           |
|   |        |      |            | \$14000 |             |           |
|   |        |      |            | and     |             |           |
|   |        |      |            | \$29999 |             |           |
|   |        |      |            | US.     |             |           |
+---+--------+------+------------+---------+-------------+-----------+
| J | Esti   | To   | Pa         | Of the  | No          | Due to    |
| a | mation | as   | rticipants | 821     | information | Japan's   |
| p | of the | sess | were       | valid   | is given on | universal |
| a | Impact | the  | recruited  | partic  | participant | health    |
| n | of     | ef   | at the     | ipants, | responses   | care on a |
|   | Pro    | fect | reception  | 53%     | concerning  | fee-fo    |
|   | viding | on   | desk of a  | were    | perceived   | r-service |
|   | Outpa  | the  | city       | female, | likelihood  | basis,    |
|   | tients | cont | hospital   | 89%     | of          | ap        |
|   | with   | inua | in Shiga   | were    | contracting | propriate |
|   | Infor  | tion | P          | pa      | SARS from   | in        |
|   | mation | of   | refecture, | tients, | direct or   | formation |
|   | about  | ou   | as they    | and 10% | indirect    | about     |
|   | SARS   | tpat | came to    | were    | contact and | SARS,     |
|   | Inf    | ient | request    | family  | fear of     | such as   |
|   | ection | vi   | outpatient | of      | dying from  | the       |
|   | C      | sits | care. For  | pa      | SARS.       | efficacy  |
|   | ontrol | to a | three days | tients. |             | of        |
|   | on     | c    | in Summer  | 23.3%   |             | infection |
|   | their  | ommu | 2003       | of      |             | control,  |
|   | Int    | nity | patients   | resp    |             | must be   |
|   | ention | h    | agreeing   | ondents |             | provided  |
|   | of     | ospi | to the     | were    |             | to        |
|   | Outp   | tal, | study      | less    |             | patients  |
|   | atient | a    | completed  | than 40 |             | so that   |
|   | Visit  | fter | an         | years   |             | the       |
|   | (2003) | p    | anonymous  | of age, |             | hospital  |
|   |        | rovi | self-ad    | 29.2%   |             | can       |
|   | Ish    | ding | ministered | were    |             | minimize  |
|   | izaki, | out  | que        | 40-59,  |             | the       |
|   | T et   | pati | stionnaire | 25.1%   |             | decrease  |
|   | al.    | ents | and        | were    |             | in number |
|   |        | with | returned   | 60-69,  |             | of        |
|   |        | inf  | it to a    | and     |             | o         |
|   |        | orma | collection | 22.4%   |             | utpatient |
|   |        | tion | box in the | were    |             | visits.   |
|   |        | a    | outpatient | age 70  |             | M         |
|   |        | bout | d          | or      |             | eanwhile, |
|   |        | the  | epartment. | older.  |             | health    |
|   |        | SARS |            | Resp    |             | au        |
|   |        | i    | The survey | ondents |             | thorities |
|   |        | nfec | was        | were    |             | should    |
|   |        | tion | designed   | using   |             | implement |
|   |        | con  | using key  | one of  |             | a system  |
|   |        | trol | concepts   | the     |             | which     |
|   |        | p    | of the     | fo      |             | co        |
|   |        | ract | Health     | llowing |             | mpensates |
|   |        | ices | Belief     | out     |             | for       |
|   |        | in   | Model.     | patient |             | deficits  |
|   |        | the  | R          | depar   |             | in        |
|   |        | in   | espondents | tments: |             | medical   |
|   |        | fect | were       | ga      |             | care      |
|   |        | ious | surveyed   | stroent |             | ex        |
|   |        | dis  | for        | erology |             | penditure |
|   |        | ease | perceived  | (       |             | a         |
|   |        | t    | likelihood | 22.8%), |             | ssociated |
|   |        | reat | of         | general |             | with SARS |
|   |        | ment | c          | i       |             | care at a |
|   |        | unit | ontracting | nternal |             | hospital. |
|   |        | of   | SARS from  | m       |             | Health    |
|   |        | that | direct or  | edicine |             | au        |
|   |        | h    | indirect   | (       |             | thorities |
|   |        | ospi | contact    | 18.3%), |             | should    |
|   |        | tal. | and fear   | ophtha  |             | provide   |
|   |        | To   | of dying   | lmology |             | both      |
|   |        | as   | from SARS. | (       |             | general   |
|   |        | sess | Pa         | 17.5%), |             | in        |
|   |        | the  | rticipants | orth    |             | formation |
|   |        | p    | then read  | opedics |             | about     |
|   |        | oten | i          | (       |             | SARS and  |
|   |        | tial | nformation | 15.6%), |             | in        |
|   |        | econ | on the     | car     |             | formation |
|   |        | omic | hospital's | diology |             | about the |
|   |        | im   | infection  | (       |             | efficacy  |
|   |        | pact | control    | 12.9%), |             | of        |
|   |        | of   | g          | OB/GYN  |             | control   |
|   |        | pati | uidelines, | (       |             | measures  |
|   |        | ents | and were   | 12.1%), |             | for SARS  |
|   |        | su   | then asked | derm    |             | p         |
|   |        | spen | about      | atology |             | revention |
|   |        | ding | perceived  | (       |             | to the    |
|   |        | ou   | likelihood | 11.4%), |             | public so |
|   |        | tpat | of         | urology |             | that they |
|   |        | ient | infection  | (9.7%), |             | can       |
|   |        | care | with SARS  | de      |             | easily    |
|   |        | at a | from the   | ntistry |             | u         |
|   |        | hosp | hospital   | (9.1%), |             | nderstand |
|   |        | ital | and        | neuro   |             | the value |
|   |        | with | perceived  | surgery |             | and       |
|   |        | an   | efficacy   | (8.3%), |             | meaning   |
|   |        | in   | of         | surgery |             | of the    |
|   |        | fect | hospital   | (6.7%). |             | inf       |
|   |        | ious | infection  | Psycho  |             | ormation. |
|   |        | dis  | control    | somatic |             | To        |
|   |        | ease | guidelines | m       |             | establish |
|   |        | t    | in         | edicine |             | effective |
|   |        | reat | preventing | (4.6%), |             | comm      |
|   |        | ment | SARS       | t       |             | unication |
|   |        | u    | tra        | horacic |             | between   |
|   |        | nit. | nsmission. | surgery |             | health    |
|   |        |      | R          | (4.1%), |             | au        |
|   |        |      | espondents | resp    |             | thorities |
|   |        |      | were also  | iratory |             | and the   |
|   |        |      | surveyed   | (3.3%), |             | public,   |
|   |        |      | for        | ped     |             | health    |
|   |        |      | intention  | iatrics |             | au        |
|   |        |      | of         | (2.3%), |             | thorities |
|   |        |      | continuing | resp    |             | must take |
|   |        |      | services   | iratory |             | into      |
|   |        |      | at the     | surgery |             | account   |
|   |        |      | hospital   | (0.5%), |             | both the  |
|   |        |      | if/when a  | and     |             | channels  |
|   |        |      | SARS       | other   |             | through   |
|   |        |      | patient    | (3.9%). |             | which     |
|   |        |      | was        |         |             | they can  |
|   |        |      | admitted,  |         |             | convey    |
|   |        |      | before and |         |             | in        |
|   |        |      | after      |         |             | formation |
|   |        |      | reading    |         |             | most      |
|   |        |      | the        |         |             | eff       |
|   |        |      | i          |         |             | ectively, |
|   |        |      | nformation |         |             | and the   |
|   |        |      | about SARS |         |             | timing of |
|   |        |      | infection  |         |             | the       |
|   |        |      | control at |         |             | in        |
|   |        |      | the        |         |             | formation |
|   |        |      | hospital.  |         |             | provided  |
|   |        |      |            |         |             | to have   |
|   |        |      |            |         |             | the most  |
|   |        |      |            |         |             | adv       |
|   |        |      |            |         |             | antageous |
|   |        |      |            |         |             | effect    |
|   |        |      |            |         |             | and       |
|   |        |      |            |         |             | avoids    |
|   |        |      |            |         |             | inciting  |
|   |        |      |            |         |             | fear in   |
|   |        |      |            |         |             | the       |
|   |        |      |            |         |             | general   |
|   |        |      |            |         |             | public    |
|   |        |      |            |         |             | due to    |
|   |        |      |            |         |             | poor      |
|   |        |      |            |         |             | comm      |
|   |        |      |            |         |             | unication |
|   |        |      |            |         |             | between   |
|   |        |      |            |         |             | health    |
|   |        |      |            |         |             | au        |
|   |        |      |            |         |             | thorities |
|   |        |      |            |         |             | and the   |
|   |        |      |            |         |             | mass      |
|   |        |      |            |         |             | media and |
|   |        |      |            |         |             | the       |
|   |        |      |            |         |             | public.   |
|   |        |      |            |         |             | Health    |
|   |        |      |            |         |             | au        |
|   |        |      |            |         |             | thorities |
|   |        |      |            |         |             | should    |
|   |        |      |            |         |             | pr        |
|   |        |      |            |         |             | oactively |
|   |        |      |            |         |             | share     |
|   |        |      |            |         |             | in        |
|   |        |      |            |         |             | formation |
|   |        |      |            |         |             | about     |
|   |        |      |            |         |             | SARS with |
|   |        |      |            |         |             | the mass  |
|   |        |      |            |         |             | media     |
|   |        |      |            |         |             | while     |
|   |        |      |            |         |             | con       |
|   |        |      |            |         |             | tinuously |
|   |        |      |            |         |             | m         |
|   |        |      |            |         |             | onitoring |
|   |        |      |            |         |             | public    |
|   |        |      |            |         |             | p         |
|   |        |      |            |         |             | erception |
|   |        |      |            |         |             | of SARS,  |
|   |        |      |            |         |             | including |
|   |        |      |            |         |             | perceived |
|   |        |      |            |         |             | severity, |
|   |        |      |            |         |             | suscep    |
|   |        |      |            |         |             | tibility, |
|   |        |      |            |         |             | and       |
|   |        |      |            |         |             | efficacy  |
|   |        |      |            |         |             | of        |
|   |        |      |            |         |             | control   |
|   |        |      |            |         |             | measures. |
+---+--------+------+------------+---------+-------------+-----------+
| M | An     | To   | Pa         | Parti   | Of the 201  | Ministry  |
| a | Eval   | as   | rticipants | cipants | respondents | of Health |
| l | uation | sess | were       | were    | 91% had     | education |
| a | of     | the  | recruited  | rural   | heard about | programs  |
| y | Infor  | l    | from \~50  | Mala    | SARS. Of    | must      |
| s | mation | evel | randomly   | ysians. | these       | increase  |
| i | D      | of   | selected   | Parti   | pa          | focus on  |
| a | issemi | kn   | sample     | cipants | rticipants, | educating |
|   | nation | owle | households | tended  | 90.2% had   | the rural |
|   | During | dge, | in 4       | to be   | heard about | community |
|   | the    | a    | villages   | heads   | SARS from   | about     |
|   | Severe | ttit | in rural   | of      | the         | disease   |
|   | Acute  | ude, | Malaysia.  | ho      | television  | and       |
|   | Respi  | and  | Data was   | usehold | and 98.3%   | public    |
|   | ratory | p    | collected  | or      | trusted the | health    |
|   | Sy     | ract | through    | adult   | information | concerns  |
|   | ndrome | ices | fa         | members | from this   | through   |
|   | (SARS) | of   | ce-to-face | of the  | source.     | increased |
|   | Ou     | r    | interview. | hou     | 2.2% had    | ed        |
|   | tbreak | ural |            | sehold. | heard about | ucational |
|   | Among  | Ma   | The        | 86.6%   | SARS from a | sessions  |
|   | Se     | lays | que        | of      | combination | and       |
|   | lected | ians | stionnaire | parti   | of health   | public    |
|   | Rural  | to   | consisted  | cipants | staff,      | talks.    |
|   | Commu  | mon  | of 4       | were    | friends,    | According |
|   | nities | itor | sections   | age 36  | and/or      | to the    |
|   | in     | and  | of open-   | or      | family      | study,    |
|   | Kuala  | eval | and        | older.  | members.    | p         |
|   | K      | uate | c          | 98%     | 90.7% of    | rime-time |
|   | angsar | SARS | lose-ended | were    | respondents | t         |
|   | (2003) | pu   | questions  | Malay   | believed    | elevision |
|   |        | blic | regarding  | and     | that SARS   | may be    |
|   | Ha     | e    | knowledge  | 1.5%    | is          | the most  |
|   | zreen, | duca | of and     | were    | contagious, | effective |
|   | AM et  | tion | attitudes  | Indian. | and 62.8%   | way of    |
|   | al.    | c    | toward     | 60.2%   | knew that   | reaching  |
|   |        | ampa | SARS,      | of      | SARS could  | this      |
|   |        | igns | health and | parti   | be          | audience. |
|   |        | as a | behavioral | cipants | transmitted |           |
|   |        | b    | practices, | were    | through the | More      |
|   |        | asis | and SARS   | female, | air. 29% of | research  |
|   |        | for  | i          | 54.7%   | respondents | into      |
|   |        | fur  | nformation | had at  | did not     | ed        |
|   |        | ther | sources.   | least a | know how    | ucational |
|   |        | e    |            | primary | SARS could  | s         |
|   |        | duca |            | school  | be          | trategies |
|   |        | tion |            | ed      | t           | may be    |
|   |        | p    |            | ucation | ransmitted. | needed to |
|   |        | rogr |            | and     | 84.7% of    | improve   |
|   |        | ams. |            | 36.3%   | respondents | behavior  |
|   |        |      |            | had a   | believed    | and       |
|   |        |      |            | se      | that SARS   | p         |
|   |        |      |            | condary | was         | reventive |
|   |        |      |            | edu     | preventable | practices |
|   |        |      |            | cation. | with 99.4%  | among     |
|   |        |      |            |         | of          | rural     |
|   |        |      |            |         | p           | v         |
|   |        |      |            |         | articipants | illagers. |
|   |        |      |            |         | believing   | Health    |
|   |        |      |            |         | that they   | personnel |
|   |        |      |            |         | could avoid | should be |
|   |        |      |            |         | contracting | trained   |
|   |        |      |            |         | SARS by not | and       |
|   |        |      |            |         | visiting    | pa        |
|   |        |      |            |         | SA          | rticipate |
|   |        |      |            |         | RS-affected | in        |
|   |        |      |            |         | countries.  | in        |
|   |        |      |            |         | 88.5% of    | teractive |
|   |        |      |            |         | respondents | education |
|   |        |      |            |         | felt that   | sessions. |
|   |        |      |            |         | SARS was a  |           |
|   |        |      |            |         | serious     |           |
|   |        |      |            |         | disease.    |           |
|   |        |      |            |         | 89.6% were  |           |
|   |        |      |            |         | worried     |           |
|   |        |      |            |         | about       |           |
|   |        |      |            |         | themselves  |           |
|   |        |      |            |         | or a family |           |
|   |        |      |            |         | member      |           |
|   |        |      |            |         | contracting |           |
|   |        |      |            |         | SARS, and   |           |
|   |        |      |            |         | of these,   |           |
|   |        |      |            |         | 96.7% said  |           |
|   |        |      |            |         | they would  |           |
|   |        |      |            |         | immediately |           |
|   |        |      |            |         | seek proper |           |
|   |        |      |            |         | medical     |           |
|   |        |      |            |         | treatment   |           |
|   |        |      |            |         | if they     |           |
|   |        |      |            |         | contracted  |           |
|   |        |      |            |         | SARS. 60.1% |           |
|   |        |      |            |         | of          |           |
|   |        |      |            |         | respondents |           |
|   |        |      |            |         | said that   |           |
|   |        |      |            |         | their lives |           |
|   |        |      |            |         | had not     |           |
|   |        |      |            |         | been        |           |
|   |        |      |            |         | affected by |           |
|   |        |      |            |         | SARS. Of    |           |
|   |        |      |            |         | the 36.6%   |           |
|   |        |      |            |         | who claimed |           |
|   |        |      |            |         | some effect |           |
|   |        |      |            |         | from SARS,  |           |
|   |        |      |            |         | 71.6% were  |           |
|   |        |      |            |         | affected    |           |
|   |        |      |            |         | e           |           |
|   |        |      |            |         | motionally, |           |
|   |        |      |            |         | 64.2% were  |           |
|   |        |      |            |         | affected    |           |
|   |        |      |            |         | socially,   |           |
|   |        |      |            |         | and 23.9%   |           |
|   |        |      |            |         | were        |           |
|   |        |      |            |         | affected    |           |
|   |        |      |            |         | ec          |           |
|   |        |      |            |         | onomically. |           |
|   |        |      |            |         | 66.7% of    |           |
|   |        |      |            |         | respondents |           |
|   |        |      |            |         | were        |           |
|   |        |      |            |         | satisfied   |           |
|   |        |      |            |         | with the    |           |
|   |        |      |            |         | information |           |
|   |        |      |            |         | provided by |           |
|   |        |      |            |         | the         |           |
|   |        |      |            |         | Ministry of |           |
|   |        |      |            |         | Health.     |           |
|   |        |      |            |         |             |           |
|   |        |      |            |         | P           |           |
|   |        |      |            |         | articipants |           |
|   |        |      |            |         | were also   |           |
|   |        |      |            |         | categorized |           |
|   |        |      |            |         | into low-   |           |
|   |        |      |            |         | and         |           |
|   |        |      |            |         | high-score  |           |
|   |        |      |            |         | groups to   |           |
|   |        |      |            |         | assess      |           |
|   |        |      |            |         | their level |           |
|   |        |      |            |         | of          |           |
|   |        |      |            |         | knowledge,  |           |
|   |        |      |            |         | attitudes,  |           |
|   |        |      |            |         | and         |           |
|   |        |      |            |         | practices.  |           |
|   |        |      |            |         | The         |           |
|   |        |      |            |         | difference  |           |
|   |        |      |            |         | in low- and |           |
|   |        |      |            |         | high-score  |           |
|   |        |      |            |         | was         |           |
|   |        |      |            |         | st          |           |
|   |        |      |            |         | atistically |           |
|   |        |      |            |         | significant |           |
|   |        |      |            |         | in          |           |
|   |        |      |            |         | a           |           |
|   |        |      |            |         | ssociations |           |
|   |        |      |            |         | between     |           |
|   |        |      |            |         | knowledge   |           |
|   |        |      |            |         | about SARS  |           |
|   |        |      |            |         | and         |           |
|   |        |      |            |         | practice of |           |
|   |        |      |            |         | preventive  |           |
|   |        |      |            |         | measures    |           |
|   |        |      |            |         | (p\<0.01),  |           |
|   |        |      |            |         | knowledge   |           |
|   |        |      |            |         | of SARS and |           |
|   |        |      |            |         | attitudes   |           |
|   |        |      |            |         | toward SARS |           |
|   |        |      |            |         | (p\<0.002), |           |
|   |        |      |            |         | and         |           |
|   |        |      |            |         | attitudes   |           |
|   |        |      |            |         | toward SARS |           |
|   |        |      |            |         | and         |           |
|   |        |      |            |         | practice of |           |
|   |        |      |            |         | preventive  |           |
|   |        |      |            |         | measures    |           |
|   |        |      |            |         | (p\<0.006). |           |
|   |        |      |            |         | The         |           |
|   |        |      |            |         | r           |           |
|   |        |      |            |         | elationship |           |
|   |        |      |            |         | between     |           |
|   |        |      |            |         | knowledge,  |           |
|   |        |      |            |         | attitudes,  |           |
|   |        |      |            |         | and         |           |
|   |        |      |            |         | practice    |           |
|   |        |      |            |         | and         |           |
|   |        |      |            |         | socio       |           |
|   |        |      |            |         | demographic |           |
|   |        |      |            |         | char        |           |
|   |        |      |            |         | acteristics |           |
|   |        |      |            |         | was only    |           |
|   |        |      |            |         | st          |           |
|   |        |      |            |         | atistically |           |
|   |        |      |            |         | significant |           |
|   |        |      |            |         | (p\<0.01)   |           |
|   |        |      |            |         | for age and |           |
|   |        |      |            |         | level of    |           |
|   |        |      |            |         | education.  |           |
+---+--------+------+------------+---------+-------------+-----------+
| S | Coping | To   | Ps         | Of the  | Respondents | During    |
| i | Res    | as   | ychosocial | 96      | reported    | the       |
| n | ponses | sess | measures   | respo   | si          | outbreak, |
| g | of     | the  | undertaken | ndents, | gnificantly | the study |
| a | Eme    | im   | by the     | 38 were | more use of | hospital  |
| p | rgency | pact | hospital   | phy     | emotion-    | i         |
| o | Phys   | of   | included:  | sicians | and         | ntroduced |
| r | icians | hosp | enhanced   | and 58  | prob        | inte      |
| e | and    | ital | comm       | were    | lem-focused | rventions |
|   | Nurses | psyc | unications | nurses. | coping than | with to   |
|   | to the | hoso | within the | 65.8%   | less-useful | help      |
|   | 2003   | cial | hospital   | of      | coping      | staff     |
|   | Severe | i    | such as    | phy     | strategies  | cope with |
|   | Acute  | nter | daily      | sicians | (p\<0.001)  | the       |
|   | Respi  | vent | e-mails    | were    | among all   | crisis.   |
|   | ratory | ions | from the   | male    | pa          | During    |
|   | Sy     | on   | chief      | and     | rticipants. | this      |
|   | ndrome | co   | executive  | 8.6% of | Physicians  | period,   |
|   | Ou     | ping | officer    | nurses  | were        | besides   |
|   | tbreak | me   | and        | were    | si          | co        |
|   | (2003) | chan | e          | male.   | gnificantly | ntrolling |
|   |        | isms | ducational | Mean    | more likely | the       |
|   | Phua,  | of   | sessions   | ph      | than nurses | spread of |
|   | DH et  | e    | on         | ysician | to use      | the       |
|   | al.    | merg | infection  | age was | humor as a  | disease,  |
|   |        | ency | control;   | 31.6    | coping      | the       |
|   |        | de   | enhanced   | years   | mechanism   | morale    |
|   |        | part | comm       | (range  | (p\<0.001)  | and       |
|   |        | ment | unications | 25-45); | than        | welfare   |
|   |        | he   | with the   | mean    | nurses.     | of ED     |
|   |        | alth | community  | nurse   | Filipinos   | staff     |
|   |        | care | and public | age was | were        | were      |
|   |        | wor  | relations  | 32.1    | si          | among the |
|   |        | kers | management | years   | gnificantly | top       |
|   |        | du   | such as    | (range  | more likely | priority  |
|   |        | ring | proactive  | 19-60). | to use      | for the   |
|   |        | the  | i          | 44.7%   | emot        | m         |
|   |        | 2003 | nitiatives | of      | ion-focused | anagement |
|   |        | SARS | to         | phy     | coping      | team of   |
|   |        | o    | acquaint   | sicians | (p=0.003),  | the ED    |
|   |        | utbr | the mass   | and     | especially  | and the   |
|   |        | eak. | media      | 63.8%   | religion    | hospital. |
|   |        |      | about what | of      | (p\>0.001), | Multiple  |
|   |        |      | was        | nurses  | than        | inte      |
|   |        |      | happening  | were    | p           | rventions |
|   |        |      | in the     | m       | articipants | were      |
|   |        |      | hospital,  | arried. | in other    | i         |
|   |        |      | television | Most    | ethnic      | nstituted |
|   |        |      | filming of | phy     | groups.     | in the ED |
|   |        |      | selected   | sicians |             | and       |
|   |        |      | clinical   | (71.1%) | 17.7% of    | hospital  |
|   |        |      | areas, and | and     | respondents | to allay  |
|   |        |      | meetings   | nurses  | had scores  | fears,    |
|   |        |      | with and   | (64.2%) | indicative  | prevent   |
|   |        |      | pro        | were    | of          | rumors,   |
|   |        |      | nouncement | Singa   | psychiatric | encourage |
|   |        |      | of support | porean, | morbidity   | or        |
|   |        |      | from       | with    | on the IES; | enforce   |
|   |        |      | political, | the     | these       | co        |
|   |        |      | community, | re      | respondents | mpliance, |
|   |        |      | and        | mainder | reported    | and       |
|   |        |      | business   | of      | si          | a         |
|   |        |      | leaders;   | parti   | gnificantly | meliorate |
|   |        |      | welfare,   | cipants | higher use  | the       |
|   |        |      | w          | from    | of          | austerity |
|   |        |      | ell-being, | the     | prob        | of the    |
|   |        |      | and        | Phili   | lem-focused | infection |
|   |        |      | psy        | ppines, | (p\<0.001), | control   |
|   |        |      | chological | Ma      | emot        | measures. |
|   |        |      | inte       | laysia, | ion-focused | These     |
|   |        |      | rventions, | and     | (p\<0.001), | inte      |
|   |        |      | such as    | China   | and         | rventions |
|   |        |      | assurance  | or      | less-useful | were      |
|   |        |      | of         | India.  | coping      | divided   |
|   |        |      | adequate   |         | (p\<0.05).  | into      |
|   |        |      | supply of  |         | 18.8% of    | general   |
|   |        |      | personal   |         | respondents | measures  |
|   |        |      | protective |         | had scores  | intended  |
|   |        |      | equipment  |         | indicative  | for all   |
|   |        |      | regardless |         | of          | staff     |
|   |        |      | of cost to |         | psychiatric | within    |
|   |        |      | the        |         | morbidity   | the       |
|   |        |      | hospital,  |         | on the GHQ; | hospital  |
|   |        |      | personal   |         | these       | and       |
|   |        |      | assistance |         | respondents | measures  |
|   |        |      | from top   |         | had         | unique to |
|   |        |      | management |         | si          | the ED.   |
|   |        |      | in seeking |         | gnificantly |           |
|   |        |      | a          |         | higher use  | In        |
|   |        |      | lternative |         | of          | planning  |
|   |        |      | acco       |         | less-useful | psy       |
|   |        |      | mmodations |         | coping      | chosocial |
|   |        |      | staff      |         | mechanisms  | inte      |
|   |        |      | evicted by |         | (p=0.002).  | rventions |
|   |        |      | their      |         |             | and       |
|   |        |      | landlords, |         |             | mental    |
|   |        |      | g          |         |             | health    |
|   |        |      | roup-based |         |             | st        |
|   |        |      | counseling |         |             | rategies, |
|   |        |      | sessions   |         |             | hospital  |
|   |        |      | for        |         |             | and       |
|   |        |      | nursing    |         |             | health    |
|   |        |      | staff, and |         |             | clinic    |
|   |        |      | the        |         |             | m         |
|   |        |      | setting up |         |             | anagement |
|   |        |      | of the     |         |             | should be |
|   |        |      | SARS       |         |             | cognizant |
|   |        |      | Courage    |         |             | that the  |
|   |        |      | Fund for   |         |             | study     |
|   |        |      | health     |         |             | results   |
|   |        |      | care       |         |             | show      |
|   |        |      | workers.   |         |             | health    |
|   |        |      | Hospital   |         |             | care      |
|   |        |      | management |         |             | workers'  |
|   |        |      | also       |         |             | p         |
|   |        |      | assured    |         |             | reference |
|   |        |      | staff that |         |             | for humor |
|   |        |      | all        |         |             | and       |
|   |        |      | medical    |         |             | religion  |
|   |        |      | expenses   |         |             | as coping |
|   |        |      | would be   |         |             | m         |
|   |        |      | taken care |         |             | echanisms |
|   |        |      | of should  |         |             | in times  |
|   |        |      | they       |         |             | of stress |
|   |        |      | contract   |         |             | such as   |
|   |        |      | SARS, and  |         |             | the SARS  |
|   |        |      | allowed    |         |             | epidemic. |
|   |        |      | staff to   |         |             |           |
|   |        |      | return     |         |             | Further   |
|   |        |      | home       |         |             | research  |
|   |        |      | rather     |         |             | could     |
|   |        |      | than       |         |             | evaluate  |
|   |        |      | qu         |         |             | whether   |
|   |        |      | arantining |         |             | inte      |
|   |        |      | them.      |         |             | rventions |
|   |        |      |            |         |             | to enable |
|   |        |      | Pa         |         |             | other     |
|   |        |      | rticipants |         |             | groups of |
|   |        |      | were       |         |             | health    |
|   |        |      | recruited  |         |             | care      |
|   |        |      | to the     |         |             | workers   |
|   |        |      | study      |         |             | to adopt  |
|   |        |      | during     |         |             | these     |
|   |        |      | hospital   |         |             | coping    |
|   |        |      | rounds.    |         |             | responses |
|   |        |      | Par        |         |             | might be  |
|   |        |      | ticipation |         |             | b         |
|   |        |      | was        |         |             | eneficial |
|   |        |      | voluntary  |         |             | to them.  |
|   |        |      | and        |         |             |           |
|   |        |      | anonymous; |         |             |           |
|   |        |      | completed  |         |             |           |
|   |        |      | surveys    |         |             |           |
|   |        |      | were       |         |             |           |
|   |        |      | returned   |         |             |           |
|   |        |      | to a       |         |             |           |
|   |        |      | designated |         |             |           |
|   |        |      | box in the |         |             |           |
|   |        |      | hospital.  |         |             |           |
|   |        |      | R          |         |             |           |
|   |        |      | espondents |         |             |           |
|   |        |      | completed  |         |             |           |
|   |        |      | a          |         |             |           |
|   |        |      | que        |         |             |           |
|   |        |      | stionnaire |         |             |           |
|   |        |      | that       |         |             |           |
|   |        |      | included   |         |             |           |
|   |        |      | the Coping |         |             |           |
|   |        |      | O          |         |             |           |
|   |        |      | rientation |         |             |           |
|   |        |      | to         |         |             |           |
|   |        |      | Problems   |         |             |           |
|   |        |      | E          |         |             |           |
|   |        |      | xperienced |         |             |           |
|   |        |      | (COPE) to  |         |             |           |
|   |        |      | assess     |         |             |           |
|   |        |      | coping     |         |             |           |
|   |        |      | s          |         |             |           |
|   |        |      | trategies, |         |             |           |
|   |        |      | the Impact |         |             |           |
|   |        |      | of Event   |         |             |           |
|   |        |      | Scale      |         |             |           |
|   |        |      | (IES) to   |         |             |           |
|   |        |      | assess     |         |             |           |
|   |        |      | psy        |         |             |           |
|   |        |      | chological |         |             |           |
|   |        |      | reactions, |         |             |           |
|   |        |      | and the    |         |             |           |
|   |        |      | General    |         |             |           |
|   |        |      | Health     |         |             |           |
|   |        |      | Que        |         |             |           |
|   |        |      | stionnaire |         |             |           |
|   |        |      | (GHQ) to   |         |             |           |
|   |        |      | measure    |         |             |           |
|   |        |      | p          |         |             |           |
|   |        |      | sychiatric |         |             |           |
|   |        |      | morbidity. |         |             |           |
|   |        |      | COPE       |         |             |           |
|   |        |      | consisted  |         |             |           |
|   |        |      | of 60      |         |             |           |
|   |        |      | items      |         |             |           |
|   |        |      | divided    |         |             |           |
|   |        |      | into 4     |         |             |           |
|   |        |      | sets of 15 |         |             |           |
|   |        |      | coping     |         |             |           |
|   |        |      | scales     |         |             |           |
|   |        |      | grouped    |         |             |           |
|   |        |      | into three |         |             |           |
|   |        |      | c          |         |             |           |
|   |        |      | ategories: |         |             |           |
|   |        |      | probl      |         |             |           |
|   |        |      | em-focused |         |             |           |
|   |        |      | coping     |         |             |           |
|   |        |      | (active    |         |             |           |
|   |        |      | coping,    |         |             |           |
|   |        |      | planning,  |         |             |           |
|   |        |      | in         |         |             |           |
|   |        |      | strumental |         |             |           |
|   |        |      | social     |         |             |           |
|   |        |      | support,   |         |             |           |
|   |        |      | competing  |         |             |           |
|   |        |      | a          |         |             |           |
|   |        |      | ctivities, |         |             |           |
|   |        |      | and        |         |             |           |
|   |        |      | restraint  |         |             |           |
|   |        |      | coping);   |         |             |           |
|   |        |      | emoti      |         |             |           |
|   |        |      | on-focused |         |             |           |
|   |        |      | coping     |         |             |           |
|   |        |      | (emotional |         |             |           |
|   |        |      | social     |         |             |           |
|   |        |      | support,   |         |             |           |
|   |        |      | religion,  |         |             |           |
|   |        |      | positive   |         |             |           |
|   |        |      | reinte     |         |             |           |
|   |        |      | rpretation |         |             |           |
|   |        |      | and        |         |             |           |
|   |        |      | growth,    |         |             |           |
|   |        |      | a          |         |             |           |
|   |        |      | cceptance, |         |             |           |
|   |        |      | and        |         |             |           |
|   |        |      | denial);   |         |             |           |
|   |        |      | less       |         |             |           |
|   |        |      | useful     |         |             |           |
|   |        |      | coping     |         |             |           |
|   |        |      | mechanisms |         |             |           |
|   |        |      | (focus on  |         |             |           |
|   |        |      | and        |         |             |           |
|   |        |      | venting of |         |             |           |
|   |        |      | emotion,   |         |             |           |
|   |        |      | mental,    |         |             |           |
|   |        |      | and        |         |             |           |
|   |        |      | behavioral |         |             |           |
|   |        |      | dise       |         |             |           |
|   |        |      | ngagement) |         |             |           |
|   |        |      | and;       |         |             |           |
|   |        |      | substance  |         |             |           |
|   |        |      | use and    |         |             |           |
|   |        |      | humor,     |         |             |           |
|   |        |      | which were |         |             |           |
|   |        |      | not        |         |             |           |
|   |        |      | grouped    |         |             |           |
|   |        |      | into any   |         |             |           |
|   |        |      | category.  |         |             |           |
|   |        |      | The IES    |         |             |           |
|   |        |      | consists   |         |             |           |
|   |        |      | of 15      |         |             |           |
|   |        |      | items that |         |             |           |
|   |        |      | measure    |         |             |           |
|   |        |      | psy        |         |             |           |
|   |        |      | chological |         |             |           |
|   |        |      | reactions  |         |             |           |
|   |        |      | to a       |         |             |           |
|   |        |      | stressful  |         |             |           |
|   |        |      | event. The |         |             |           |
|   |        |      | GHQ        |         |             |           |
|   |        |      | consists   |         |             |           |
|   |        |      | of 28      |         |             |           |
|   |        |      | items.     |         |             |           |
+---+--------+------+------------+---------+-------------+-----------+
| S | Crisis | To   | Pa         | Of the  | 81% of      | The SARS  |
| i | Prev   | as   | rticipants | 1202    | respondents | outbreak  |
| n | ention | sess | were       | respo   | reported    | in        |
| g | and    | the  | recruited  | ndents, | using soap  | Singapore |
| a | Mana   | effi | through    | 49.9%   | when        | cor       |
| p | gement | cacy | stratified | were    | washing     | roborated |
| o | during | of   | random     | male,   | their hands | the       |
| r | SARS   | pu   | sampling   | 75%     | and 72%     | u         |
| e | Out    | blic | of 90% of  | were    | reported    | sefulness |
|   | break, | he   | households | Malay,  | washing     | of public |
|   | Sin    | alth | in         | and 7%  | their hands | health    |
|   | gapore | inf  | Singapore. | were    | after       | and       |
|   | (2003) | orma | Ques       | Indian. | sneezing,   | envi      |
|   |        | tion | tionnaires | 19% of  | coughing,   | ronmental |
|   | Quah,  | and  | were       | resp    | or blowing  | reg       |
|   | SR and | cr   | completed  | ondents | their nose. | ulations. |
|   | Hin    | isis | via        | were    | Only 4%     |           |
|   | -Peng, | ma   | telephone. | ages    | reported    |           |
|   | L      | nage | Pa         | 21-29,  | wearing     |           |
|   |        | ment | rticipants | 26%     | masks but   |           |
|   | <htt   | in   | were       | were    | only when   |           |
|   | p://ww | rela | surveyed   | 30-39,  | visiting a  |           |
|   | w.cdc. | ying | for        | 26%     | clinic or   |           |
|   | gov/nc | inf  | preventive | were    | hospital or |           |
|   | idod/E | orma | measures,  | 40-49,  | as part of  |           |
|   | ID/vol | tion | perceived  | and 28% | a uniform.  |           |
|   | 10no2/ | to   | se         | were 50 | 22.4% of    |           |
|   | 03-041 | the  | lf-health, | or      | respondents |           |
|   | 8.htm> | gen  | knowledge  | over.   | reported    |           |
|   |        | eral | about      |         | having any  |           |
|   |        | pu   | SARS, and  |         | of the nine |           |
|   |        | blic | perception |         | health      |           |
|   |        | in   | of health  |         | complaints  |           |
|   |        | Si   | au         |         | in the      |           |
|   |        | ngap | thorities' |         | prior two   |           |
|   |        | ore. | crisis     |         | weeks; 2.9% |           |
|   |        |      | m          |         | of          |           |
|   |        |      | anagement. |         | respondents |           |
|   |        |      |            |         | reported    |           |
|   |        |      | Re         |         | high        |           |
|   |        |      | spondents' |         | anxiety.    |           |
|   |        |      | preventive |         | 68% of      |           |
|   |        |      | behavior   |         | respondents |           |
|   |        |      | in the 3   |         | believed    |           |
|   |        |      | days       |         | they were   |           |
|   |        |      | before the |         | not very    |           |
|   |        |      | interview  |         | likely or   |           |
|   |        |      | was        |         | not likely  |           |
|   |        |      | measured   |         | at all to   |           |
|   |        |      | in 8       |         | contract    |           |
|   |        |      | questions  |         | SARS. 80%   |           |
|   |        |      | that were  |         | of          |           |
|   |        |      | used to    |         | respondents |           |
|   |        |      | determine  |         | thought the |           |
|   |        |      | a high or  |         | official    |           |
|   |        |      | low number |         | SARS        |           |
|   |        |      | of         |         | information |           |
|   |        |      | p          |         | was         |           |
|   |        |      | recautions |         | accurate,   |           |
|   |        |      | taken.     |         | clear,      |           |
|   |        |      | Three sets |         | sufficient, |           |
|   |        |      | of         |         | timely, and |           |
|   |        |      | questions  |         | t           |           |
|   |        |      | measure    |         | rustworthy. |           |
|   |        |      | perceived  |         | 72% of      |           |
|   |        |      | se         |         | respondents |           |
|   |        |      | lf-health, |         | would       |           |
|   |        |      | including  |         | accept a    |           |
|   |        |      | nine       |         | 10-day      |           |
|   |        |      | health     |         | quarantine  |           |
|   |        |      | complaints |         | even in the |           |
|   |        |      | in the     |         | absence of  |           |
|   |        |      | previous   |         | symptoms or |           |
|   |        |      | two weeks, |         | contact     |           |
|   |        |      | a frame of |         | with a SARS |           |
|   |        |      | mind index |         | patient.    |           |
|   |        |      | based on   |         | Women and   |           |
|   |        |      | the        |         | p           |           |
|   |        |      | Clinical   |         | articipants |           |
|   |        |      | Anxiety    |         | 35 years of |           |
|   |        |      | Scale, and |         | age or over |           |
|   |        |      | perceived  |         | were more   |           |
|   |        |      | susc       |         | likely to   |           |
|   |        |      | eptibility |         | take        |           |
|   |        |      | to SARS.   |         | preventive  |           |
|   |        |      | SARS       |         | measures.   |           |
|   |        |      | knowledge  |         |             |           |
|   |        |      | was        |         |             |           |
|   |        |      | assessed   |         |             |           |
|   |        |      | by three   |         |             |           |
|   |        |      | questions  |         |             |           |
|   |        |      | scored     |         |             |           |
|   |        |      | correct or |         |             |           |
|   |        |      | incorrect. |         |             |           |
|   |        |      | Four sets  |         |             |           |
|   |        |      | of         |         |             |           |
|   |        |      | questions  |         |             |           |
|   |        |      | assessed   |         |             |           |
|   |        |      | re         |         |             |           |
|   |        |      | spondents' |         |             |           |
|   |        |      | attitudes  |         |             |           |
|   |        |      | toward     |         |             |           |
|   |        |      | crisis     |         |             |           |
|   |        |      | management |         |             |           |
|   |        |      | including  |         |             |           |
|   |        |      | opinions   |         |             |           |
|   |        |      | on         |         |             |           |
|   |        |      | i          |         |             |           |
|   |        |      | nformation |         |             |           |
|   |        |      | dis        |         |             |           |
|   |        |      | tribution, |         |             |           |
|   |        |      | openness   |         |             |           |
|   |        |      | of         |         |             |           |
|   |        |      | comm       |         |             |           |
|   |        |      | unication, |         |             |           |
|   |        |      | and public |         |             |           |
|   |        |      | acceptance |         |             |           |
|   |        |      | of         |         |             |           |
|   |        |      | quarantine |         |             |           |
|   |        |      | re         |         |             |           |
|   |        |      | gulations. |         |             |           |
+---+--------+------+------------+---------+-------------+-----------+
| S | Risk   | To   | All of the | Of the  | 66% of      | Candid    |
| i | Perc   | g    | employees  | 10511   | respondents | ackno     |
| n | eption | auge | of 9 major | valid   | reported    | wledgment |
| g | and    | fe   | health     | res     | high-risk   | of risks  |
| a | Impact | ars, | care       | ponses, | exposure to | and       |
| p | of     | an   | in         | 82% of  | SARS and    | timely    |
| o | Severe | xiet | stitutions | parti   | 76%         | imple     |
| r | Acute  | ies, | in         | cipants | reported    | mentation |
| e | Respi  | and  | Singapore  | were    | fear of     | of easy   |
|   | ratory | r    | were       | female, | potential   | to follow |
|   | Sy     | eact | mailed a   | 57%     | SARS        | p         |
|   | ndrome | ions | que        | were    | infection.  | rotective |
|   | (SARS) | of   | stionnaire | m       | 82% of      | measures  |
|   | on     | he   | to         | arried, | respondents | can ease  |
|   | Work   | alth | complete   | and     | worried     | the       |
|   | and    | care | an         | 43.2%   | about       | anxiety   |
|   | Pe     | wor  | onymously. | had no  | t           | of        |
|   | rsonal | kers | The        | ch      | ransmitting | hospital  |
|   | Lives  | in   | que        | ildren. | the disease | staff.    |
|   | of     | o    | stionnaire | Mean    | to their    | These     |
|   | Heal   | rder | consisted  | age was | friends,    | measures  |
|   | thcare | to   | of 88      | 36.6    | family, and | should be |
|   | W      | be   | single-    | years   | coworkers.  | seen as   |
|   | orkers | tter | and        | and     | 49% of      | p         |
|   | in     | pre  | multi      | mean    | respondents | rotecting |
|   | Sin    | pare | ple-choice | work    | thought     | health    |
|   | gapore | for  | and        | exp     | people      | care      |
|   |        | fu   | open-ended | erience | avoided     | workers   |
|   | <      | ture | questions  | was     | them due to | from harm |
|   | http:/ | in   | surveying  | 11.2    | their       | and       |
|   | /www.l | fect | par        | years.  | occupation  | helping   |
|   | ww-med | ious | ticipants' |         | and 31%     | them cope |
|   | icalca | dis  | perception |         | felt people | with      |
|   | re.com | ease | of risk of |         | avoided     | stressful |
|   | /pt/re | e    | exposure   |         | their       | work      |
|   | /medca | pide | to and     |         | family      | envi      |
|   | re/pdf | mics | infection  |         | members due | ronments. |
|   | handle | and  | with SARS, |         | to their    |           |
|   | r.0000 | acts | the impact |         | occupation. | Further   |
|   | 5650-2 | of   | of the     |         | Most        | studies   |
|   | 005070 | b    | SARS       |         | respondents | may be    |
|   | 00-000 | iote | outbreak   |         | felt        | needed to |
|   | 06.pdf | rror | on         |         | appreciated | improve   |
|   | ;jsess | ism. | personal   |         | by both     | the       |
|   | ionid= |      | and work   |         | their       | p         |
|   | DFxGt1 |      | life, and  |         | employ      | rotection |
|   | 2ePhR8 |      | the Impact |         | er/hospital | of        |
|   | 7rQOur |      | of Events  |         | (82%) and   | h         |
|   | 4Uexjv |      | Scale      |         | society     | ealthcare |
|   | qRHw5F |      | (IES) with |         | (77%). 56%  | workers   |
|   | W0ugY4 |      | 6-point    |         | of          | and       |
|   | THskJK |      | Likert     |         | respondents | improve   |
|   | bN8OBj |      | scale      |         | reported    | the       |
|   | 1Xj2!- |      | items.     |         | feeling     | comm      |
|   | 188924 |      |            |         | increased   | unication |
|   | 7203!- |      |            |         | stress at   | of safety |
|   | 949856 |      |            |         | work and    | measures, |
|   | 144!90 |      |            |         | increased   | so that   |
|   | 01!-1> |      |            |         | workload    | they can  |
|   |        |      |            |         | (53%). 96%  | be better |
|   |        |      |            |         | of          | prepared  |
|   |        |      |            |         | respondents | for       |
|   |        |      |            |         | felt that   | future    |
|   |        |      |            |         | preventive  | e         |
|   |        |      |            |         | measures    | pidemics. |
|   |        |      |            |         | established |           |
|   |        |      |            |         | at work     |           |
|   |        |      |            |         | were        |           |
|   |        |      |            |         | generally   |           |
|   |        |      |            |         | effective.  |           |
|   |        |      |            |         | 93% agreed  |           |
|   |        |      |            |         | that there  |           |
|   |        |      |            |         | were clear  |           |
|   |        |      |            |         | policies    |           |
|   |        |      |            |         | and         |           |
|   |        |      |            |         | protocols   |           |
|   |        |      |            |         | and 90%     |           |
|   |        |      |            |         | felt they   |           |
|   |        |      |            |         | were        |           |
|   |        |      |            |         | implemented |           |
|   |        |      |            |         | fairly      |           |
|   |        |      |            |         | quickly.    |           |
|   |        |      |            |         | 92% of      |           |
|   |        |      |            |         | staff       |           |
|   |        |      |            |         | complied    |           |
|   |        |      |            |         | c           |           |
|   |        |      |            |         | onsistently |           |
|   |        |      |            |         | with        |           |
|   |        |      |            |         | infection   |           |
|   |        |      |            |         | control     |           |
|   |        |      |            |         | procedures  |           |
|   |        |      |            |         | and 72%     |           |
|   |        |      |            |         | followed    |           |
|   |        |      |            |         | them with   |           |
|   |        |      |            |         | little      |           |
|   |        |      |            |         | difficulty. |           |
|   |        |      |            |         |             |           |
|   |        |      |            |         | The         |           |
|   |        |      |            |         | institution |           |
|   |        |      |            |         | where the   |           |
|   |        |      |            |         | respondent  |           |
|   |        |      |            |         | worked      |           |
|   |        |      |            |         | (SA         |           |
|   |        |      |            |         | RS-affected |           |
|   |        |      |            |         | hospitals), |           |
|   |        |      |            |         | occupation, |           |
|   |        |      |            |         | daily       |           |
|   |        |      |            |         | exposure to |           |
|   |        |      |            |         | SARS, and a |           |
|   |        |      |            |         | high score  |           |
|   |        |      |            |         | on the IES  |           |
|   |        |      |            |         | were all    |           |
|   |        |      |            |         | si          |           |
|   |        |      |            |         | gnificantly |           |
|   |        |      |            |         | associated  |           |
|   |        |      |            |         | with        |           |
|   |        |      |            |         | high-risk   |           |
|   |        |      |            |         | perception  |           |
|   |        |      |            |         | (p-values   |           |
|   |        |      |            |         | not given   |           |
|   |        |      |            |         | for any     |           |
|   |        |      |            |         | results).   |           |
|   |        |      |            |         | I           |           |
|   |        |      |            |         | nstitution, |           |
|   |        |      |            |         | daily       |           |
|   |        |      |            |         | exposure to |           |
|   |        |      |            |         | SARS,       |           |
|   |        |      |            |         | occupation  |           |
|   |        |      |            |         | (nurse),    |           |
|   |        |      |            |         | and married |           |
|   |        |      |            |         | p           |           |
|   |        |      |            |         | articipants |           |
|   |        |      |            |         | with        |           |
|   |        |      |            |         | children    |           |
|   |        |      |            |         | were all    |           |
|   |        |      |            |         | predictors  |           |
|   |        |      |            |         | of feeling  |           |
|   |        |      |            |         | increased   |           |
|   |        |      |            |         | stress at   |           |
|   |        |      |            |         | work.       |           |
+---+--------+------+------------+---------+-------------+-----------+
| S | The    | To   | The        | Of the  | Respondents | Basic     |
| i | Singa  | as   | national   | 853     | scored      | knowledge |
| n | porean | sess | prevention | respo   | highest on  | about     |
| g | Re     | SARS | and        | ndents, | knowledge   | SARS was  |
| a | sponse | kn   | control    | 53.7%   | of SARS     | high but  |
| p | to the | owle | strategy   | were    | treatment   | the       |
| o | SARS   | dge, | aimed to   | female, | and lowest  | overall   |
| r | Out    | conc | reduce     | 59%     | on          | knowledge |
| e | break: | erns | SARS       | were    | knowledge   | score     |
|   | Kno    | and  | tr         | C       | about       | remained  |
|   | wledge | a    | ansmission | hinese, | protective  | low. The  |
|   | Suffi  | nxie | through    | 18.4%   | measures.   | disparity |
|   | ciency | ties | enhanced   | were    | 58% of      | between   |
|   | Versus | rel  | infecti    | Malay,  | respondents | low       |
|   | Public | ated | on-control | and     | cited       | knowledge |
|   | Trust  | to   | practices  | 22.6%   | personal    | about     |
|   | (2003) | the  | in health  | were    | hygiene as  | SARS and  |
|   |        | SARS | care       | Indian. | a           | infection |
|   | Deu    | o    | in         | 16.1%   | protective  | control   |
|   | renber | utbr | stitutions | of      | measure,    | measures  |
|   | g-Yap, | eak, | and        | resp    | 23% cited   | and the   |
|   | M et   | and  | enhanced   | ondents | wearing a   | high      |
|   | al.    | co   | public     | were    | facemask,   | level of  |
|   |        | nfid | health     | between | and 21%     | public    |
|   | <      | ence | pr         | 19-29   | cited daily | trust in  |
|   | http:/ | in   | eventions, | years   | temperature | the       |
|   | /heapr | and  | education, | of age, | readings.   | g         |
|   | o.oxfo | opi  | and        | 29.8%   | 94% of      | overnment |
|   | rdjour | nion | screening  | were    | respondents | may       |
|   | nals.o | of   | campaigns, | 30-39,  | knew fever  | indicate  |
|   | rg/cgi | i    | in         | 33.2%   | was a       | that      |
|   | /repri | nfec | addition   | were    | symptom of  | in        |
|   | nt/dai | tion | to         | 40-49,  | SARS, one   | formation |
|   | 010v1> | con  | isolation, | and 21% | of the key  | su        |
|   |        | trol | qua        | were    | education   | fficiency |
|   |        | meas | rantining, | age 50  | campaign    | threshold |
|   |        | ures | and school | or      | messages.   | is low,   |
|   |        | to   | closures.  | older.  | Indian      | meaning   |
|   |        | cur  | An         | 23.6%   | respondents | Sin       |
|   |        | tail | intensive  | of      | scored      | gaporeans |
|   |        | the  | public     | resp    | si          | need very |
|   |        | sp   | education  | ondents | gnificantly | little    |
|   |        | read | campaign   | had a   | higher on   | in        |
|   |        | of   | was        | primary | SARS        | formation |
|   |        | S    | conducted  | school  | knowledge   | in order  |
|   |        | ARS. | between 30 | ed      | measures    | to feel   |
|   |        | To   | April and  | ucation | than the    | confident |
|   |        | un   | 13 May     | level   | Chinese or  | to cope   |
|   |        | ders | 2003 to    | or      | Malay       | with SARS |
|   |        | tand | educate    | less,   | respondents | or they   |
|   |        | the  | Si         | 44.8%   | (all tests  | do not    |
|   |        | dyna | ngaporeans | had a   | conducted   | see the   |
|   |        | mics | about      | se      | at the      | need to   |
|   |        | bet  | SARS, to   | condary | p\<0.05     | know all  |
|   |        | ween | encourage  | school  | s           | the       |
|   |        | k    | them to    | ed      | ignificance | control   |
|   |        | nowl | adopt      | ucation | level), as  | measures  |
|   |        | edge | a          | level,  | did younger | before    |
|   |        | suf  | ppropriate | and     | respondents | feeling   |
|   |        | fici | personal   | 30.5%   | regardless  | confident |
|   |        | ency | hygiene    | had     | of          | with what |
|   |        | and  | and        | further | ethnicity,  | the       |
|   |        | pu   | pre        | ed      | and all     | g         |
|   |        | blic | cautionary | ucation | respondents | overnment |
|   |        | t    | behaviors  | beyond  | with        | is doing  |
|   |        | rust | to prevent | se      | education   | to handle |
|   |        | in   | the spread | condary | levels      | the SARS  |
|   |        | i    | of SARS,   | school. | higher than | crisis.   |
|   |        | nfec | to         |         | secondary   |           |
|   |        | tion | encourage  |         | school.     | I         |
|   |        | con  | those with |         | Indian      | nstilling |
|   |        | tain | suspected  |         | respondents | public    |
|   |        | ment | SARS       |         | and those   | c         |
|   |        | meas | infection  |         | with        | ompliance |
|   |        | ures | to seek    |         | tertiary    | seemed to |
|   |        | in   | medical    |         | educations  | be        |
|   |        | stit | attention, |         | scored      | efficient |
|   |        | uted | and to     |         | si          | in        |
|   |        | by   | encourage  |         | gnificantly | helping   |
|   |        | the  | c          |         | higher on   | Sin       |
|   |        | st   | ooperation |         | infection   | gaporeans |
|   |        | ate, | with state |         | control     | cope with |
|   |        | and  | d          |         | knowledge   | the SARS  |
|   |        | how  | irectives. |         | measures.   | crisis.   |
|   |        | t    |            |         |             | Future    |
|   |        | hese | Pa         |         | 82% of      | ed        |
|   |        | in   | rticipants |         | respondents | ucational |
|   |        | turn | were       |         | expressed   | efforts   |
|   |        | af   | recruited  |         | confidence  | should    |
|   |        | fect | through a  |         | in the      | promote   |
|   |        | the  | telephone  |         | SARS        | personal  |
|   |        | gen  | survey.    |         | -designated | respo     |
|   |        | eral | The sample |         | hospital to | nsibility |
|   |        | sati | was chosen |         | deal with   | and       |
|   |        | sfac | based on   |         | the         | behavior  |
|   |        | tion | telephone  |         | disease,    | change,   |
|   |        | with | number,    |         | 63%         | using     |
|   |        | the  | name,      |         | expressed   | accurate  |
|   |        | hand | gender,    |         | confidence  | and       |
|   |        | ling | and        |         | in schools, | creative  |
|   |        | of   | ethnicity; |         | and 36%     | messages  |
|   |        | the  | results    |         | expressed   | to take   |
|   |        | SARS | were       |         | confidence  | into      |
|   |        | outb | weighted   |         | in nursing  | cons      |
|   |        | reak | to reflect |         | homes to    | ideration |
|   |        | by   | the actual |         | handle      | different |
|   |        | the  | di         |         | SARS. 48%   | s         |
|   |        | st   | stribution |         | to 56% of   | ituations |
|   |        | ate. | of         |         | respondents | within    |
|   |        |      | Chinese,   |         | expressed   | the       |
|   |        |      | Malay, and |         | confidence  | social    |
|   |        |      | Indian     |         | in the      | and       |
|   |        |      | ethnicity  |         | ability of  | cultural  |
|   |        |      | in the     |         | private     | context.  |
|   |        |      | Singapore  |         | hospitals,  |           |
|   |        |      | p          |         | workplaces, |           |
|   |        |      | opulation. |         | and public  |           |
|   |        |      | Pa         |         | transport   |           |
|   |        |      | rticipants |         | to handle   |           |
|   |        |      | were       |         | SARS; male  |           |
|   |        |      | surveyed   |         | respondents |           |
|   |        |      | on their   |         | and older   |           |
|   |        |      | knowledge  |         | respondents |           |
|   |        |      | of SARS    |         | were more   |           |
|   |        |      | symptoms,  |         | like to     |           |
|   |        |      | methods of |         | express     |           |
|   |        |      | tra        |         | confidence  |           |
|   |        |      | nsmission, |         | in these    |           |
|   |        |      | p          |         | org         |           |
|   |        |      | revention, |         | anizations. |           |
|   |        |      | treatment, |         | The         |           |
|   |        |      | and        |         | majority of |           |
|   |        |      | official   |         | respondents |           |
|   |        |      | government |         | were        |           |
|   |        |      | infection  |         | satisfied   |           |
|   |        |      | control    |         | with the    |           |
|   |        |      | measures.  |         | g           |           |
|   |        |      | Pa         |         | overnmental |           |
|   |        |      | rticipants |         | infection   |           |
|   |        |      | were also  |         | control     |           |
|   |        |      | surveyed   |         | measures.   |           |
|   |        |      | for their  |         | More than   |           |
|   |        |      | confidence |         | 90% of      |           |
|   |        |      | in         |         | respondents |           |
|   |        |      | in         |         | were        |           |
|   |        |      | stitutions |         | satisfied   |           |
|   |        |      | to handle  |         | with        |           |
|   |        |      | the        |         | hospital    |           |
|   |        |      | outbreak,  |         | infection   |           |
|   |        |      | opinions   |         | control     |           |
|   |        |      | about the  |         | measures.   |           |
|   |        |      | infection  |         | Overall     |           |
|   |        |      | control    |         | public      |           |
|   |        |      | measures,  |         | trust was   |           |
|   |        |      | and        |         | si          |           |
|   |        |      | sa         |         | gnificantly |           |
|   |        |      | tisfaction |         | correlated  |           |
|   |        |      | with       |         | with        |           |
|   |        |      | government |         | overall     |           |
|   |        |      | measures.  |         | knowledge,  |           |
|   |        |      |            |         | knowledge   |           |
|   |        |      |            |         | of SARS,    |           |
|   |        |      |            |         | and         |           |
|   |        |      |            |         | knowledge   |           |
|   |        |      |            |         | of          |           |
|   |        |      |            |         | infection   |           |
|   |        |      |            |         | control     |           |
|   |        |      |            |         | measures    |           |
|   |        |      |            |         | (p\<0.001   |           |
|   |        |      |            |         | for all).   |           |
|   |        |      |            |         | SARS        |           |
|   |        |      |            |         | knowledge   |           |
|   |        |      |            |         | and age     |           |
|   |        |      |            |         | were        |           |
|   |        |      |            |         | positive    |           |
|   |        |      |            |         | predictors  |           |
|   |        |      |            |         | for public  |           |
|   |        |      |            |         | trust.      |           |
+---+--------+------+------------+---------+-------------+-----------+
| S | A      | To   | Pa         | Of the  | 92.7% of    | Mass      |
| i | Study  | as   | rticipants | 593     | respondents | media     |
| n | on     | sess | were       | resp    | were aware  | should be |
| g | SARS   | the  | recruited  | ondents | of the      | the       |
| a | Awa    | e    | from       | who     | symptoms of | primary   |
| p | reness | ffec | patients   | co      | SARS. Of    | way to    |
| o | and    | tive | or         | mpleted | these       | di        |
| r | He     | ness | visitors   | the     | respondents | sseminate |
| e | alth-S | of a | attending  | survey, | more than   | in        |
|   | eeking | SARS | 9 National | 56.5%   | 90%         | formation |
|   | Beh    | pu   | Healthcare | were    | reported    | to the    |
|   | aviour | blic | Group      | female. | getting     | public    |
|   | --     | e    | P          | 74%     | that        | but it    |
|   | Fi     | duca | olyclinics | were    | information | may be    |
|   | ndings | tion | between    | C       | from        | i         |
|   | from a | camp | June 9 and | hinese, | television, | nadequate |
|   | S      | aign | 13, 2003.  | 12.8%   | ap          | in some   |
|   | ampled | on   | Every      | were    | proximately | cases.    |
|   | Popu   | SARS | fifth      | Malay,  | 70% got     | Different |
|   | lation | a    | patient in | 8.8%    | information | s         |
|   | Att    | ware | the main   | were    | from        | trategies |
|   | ending | ness | clinic     | Indian, | newspapers, | may be    |
|   | Na     | and  | line was   | and     | and         | needed to |
|   | tional | b    | selected   | 4.4%    | ap          | spe       |
|   | Heal   | ehav | for the    | were    | proximately | cifically |
|   | thcare | iors | study; if  | "       | 30%         | target    |
|   | Group  | of   | pa         | other", | received    | and reach |
|   | Polyc  | poss | rticipants | unsp    | information | ho        |
|   | linics | ible | were under | ecified | from the    | usewives, |
|   | (2003) | S    | 15 years   | rac     | radio       | blue      |
|   |        | ARS- | of age,    | e/ethni | (           | collar    |
|   | Seng,  | infe | the        | cities. | respondents | workers,  |
|   | SL et  | cted | ac         | 21.3%   | could       | retirees, |
|   | al.    | indi | companying | of      | record more | or        |
|   |        | vidu | visitor    | resp    | than one    | u         |
|   | <htt   | als. | was        | ondents | source of   | nemployed |
|   | p://an | To   | selected   | were    | in          | ind       |
|   | nals.e | pro  | instead.   | 15-29   | formation). | ividuals, |
|   | du.sg/ | vide | Pa         | years   | Other       | e         |
|   | pdf200 | poli | rticipants | of age, | sources of  | specially |
|   | 411/V3 | cyma | case files | 24.9%   | information | those     |
|   | 3N5p62 | kers | and        | were    | reported    | without   |
|   | 3.pdf> | with | location   | 30-44,  | were        | access to |
|   |        | the  | tracking   | 27.1%   | friends,    | t         |
|   |        | b    | slips were | were    | family,     | elevision |
|   |        | asis | tagged and | 45-59,  | work,       | and       |
|   |        | for  | in         | and     | pamphlets,  | ne        |
|   |        | i    | terviewers | 26.6%   | public      | wspapers. |
|   |        | mpro | followed   | were    | talks and   | Public    |
|   |        | ving | pa         | age 60  | forums, the | education |
|   |        | pu   | rticipants | or      | internet,   | should be |
|   |        | blic | through    | older.  | and other,  | coupled   |
|   |        | e    | their      | 20% of  | u           | with      |
|   |        | duca | visit at   | resp    | nspecified, | doo       |
|   |        | tion | the        | ondents | sources.    | r-to-door |
|   |        | c    | p          | had     | Respondents | g         |
|   |        | ampa | olyclinic. | profe   | unaware of  | rassroots |
|   |        | igns | Pa         | ssional | SARS        | efforts   |
|   |        | and  | rticipants | empl    | symptoms    | to reach  |
|   |        | to   | were       | oyment, | were        | these     |
|   |        | be   | surveyed   | 23.2%   | si          | pop       |
|   |        | tter | for their  | were    | gnificantly | ulations. |
|   |        | con  | awareness  | blue    | more likely | Hotlines  |
|   |        | trol | of SARS    | -collar | to be over  | should be |
|   |        | the  | symptoms   | w       | 60          | readily   |
|   |        | sp   | among the  | orkers, | (p\<0.001), | available |
|   |        | read | po         | 26%     | blue collar | to answer |
|   |        | of   | lyclinic's | were    | workers,    | public    |
|   |        | dise | patients   | hous    | housewives, | i         |
|   |        | ase. | or         | ewives, | retirees,   | nquiries. |
|   |        |      | ac         | and 14% | or          |           |
|   |        |      | companying | were    | unemployed  |           |
|   |        |      | friends or | r       | (p\<0.001   |           |
|   |        |      | family,    | etired. | for all),   |           |
|   |        |      | their main | 39% of  | living in   |           |
|   |        |      | sources of | resp    | three-,     |           |
|   |        |      | SARS       | ondents | four-, or   |           |
|   |        |      | in         | had     | five-room   |           |
|   |        |      | formation, | primary | public      |           |
|   |        |      | and        | school  | housing or  |           |
|   |        |      | responses  | ed      | other types |           |
|   |        |      | to two     | ucation | of housing  |           |
|   |        |      | scenarios: | levels  | (p\<0.05),  |           |
|   |        |      | first      | or      | and have    |           |
|   |        |      | action     | less,   | primary     |           |
|   |        |      | taken if   | 37.8%   | school      |           |
|   |        |      | p          | had     | education   |           |
|   |        |      | otentially | se      | or less     |           |
|   |        |      | infected   | condary | (p\<0.001). |           |
|   |        |      | by SARS    | edu     |             |           |
|   |        |      | and; mode  | cation, | Case        |           |
|   |        |      | of         | and     | Scenario 1: |           |
|   |        |      | tran       | 23.2%   | Of the      |           |
|   |        |      | sportation | had     | respondents |           |
|   |        |      | to the     | p       | aware of    |           |
|   |        |      | SARS-      | ost-sec | SARS        |           |
|   |        |      | designated | ondary, | symptoms,   |           |
|   |        |      | hospital.  | univ    | ap          |           |
|   |        |      | Responses  | ersity, | proximately |           |
|   |        |      | were       | or      | 33% would   |           |
|   |        |      | con        | g       | first visit |           |
|   |        |      | fidential. | raduate | their       |           |
|   |        |      |            | edu     | general     |           |
|   |        |      |            | cation. | p           |           |
|   |        |      |            | 43.3%   | ractitioner |           |
|   |        |      |            | of      | or company  |           |
|   |        |      |            | resp    | doctor, 23% |           |
|   |        |      |            | ondents | would visit |           |
|   |        |      |            | had     | the         |           |
|   |        |      |            | monthly | SARS        |           |
|   |        |      |            | incomes | -designated |           |
|   |        |      |            | of less | hospital,   |           |
|   |        |      |            | than    | and 20%     |           |
|   |        |      |            | \$2000  | would go to |           |
|   |        |      |            | and     | the         |           |
|   |        |      |            | 23.6%   | polyclinic  |           |
|   |        |      |            | had     | if they     |           |
|   |        |      |            | monthly | suspected   |           |
|   |        |      |            | incomes | they had    |           |
|   |        |      |            | more    | SARS. The   |           |
|   |        |      |            | than    | remainder   |           |
|   |        |      |            | \$4000. | of          |           |
|   |        |      |            | 84.3%   | SARS-aware  |           |
|   |        |      |            | of      | respondents |           |
|   |        |      |            | resp    | reported    |           |
|   |        |      |            | ondents | they would  |           |
|   |        |      |            | live in | either      |           |
|   |        |      |            | three-, | visit       |           |
|   |        |      |            | four-,  | another     |           |
|   |        |      |            | or      | hospital,   |           |
|   |        |      |            | fi      | call the    |           |
|   |        |      |            | ve-room | SARS        |           |
|   |        |      |            | public  | ambulance,  |           |
|   |        |      |            | h       | call the    |           |
|   |        |      |            | ousing; | SARS        |           |
|   |        |      |            | only    | hotline, or |           |
|   |        |      |            | 8.6% of | other. Of   |           |
|   |        |      |            | resp    | the         |           |
|   |        |      |            | ondents | respondents |           |
|   |        |      |            | live in | unaware of  |           |
|   |        |      |            | private | the         |           |
|   |        |      |            | h       | symptoms of |           |
|   |        |      |            | ousing. | SARS,       |           |
|   |        |      |            |         | ap          |           |
|   |        |      |            |         | proximately |           |
|   |        |      |            |         | 30% would   |           |
|   |        |      |            |         | go to the   |           |
|   |        |      |            |         | polyclinic, |           |
|   |        |      |            |         | 28% would   |           |
|   |        |      |            |         | visit the   |           |
|   |        |      |            |         | SARS        |           |
|   |        |      |            |         | -designated |           |
|   |        |      |            |         | hospital,   |           |
|   |        |      |            |         | and 18%     |           |
|   |        |      |            |         | would go to |           |
|   |        |      |            |         | their       |           |
|   |        |      |            |         | general     |           |
|   |        |      |            |         | p           |           |
|   |        |      |            |         | ractitioner |           |
|   |        |      |            |         | or company  |           |
|   |        |      |            |         | doctor if   |           |
|   |        |      |            |         | they        |           |
|   |        |      |            |         | suspected   |           |
|   |        |      |            |         | SARS        |           |
|   |        |      |            |         | infection.  |           |
|   |        |      |            |         |             |           |
|   |        |      |            |         | Case        |           |
|   |        |      |            |         | Scenario 2: |           |
|   |        |      |            |         | 84.9% of    |           |
|   |        |      |            |         | respondents |           |
|   |        |      |            |         | who were    |           |
|   |        |      |            |         | aware of    |           |
|   |        |      |            |         | SARS        |           |
|   |        |      |            |         | symptoms    |           |
|   |        |      |            |         | would take  |           |
|   |        |      |            |         | the         |           |
|   |        |      |            |         | appropriate |           |
|   |        |      |            |         | transport   |           |
|   |        |      |            |         | (designated |           |
|   |        |      |            |         | SARS        |           |
|   |        |      |            |         | ambulance   |           |
|   |        |      |            |         | or drive    |           |
|   |        |      |            |         | themselves) |           |
|   |        |      |            |         | to the SARS |           |
|   |        |      |            |         | hospital,   |           |
|   |        |      |            |         | 8.5% would  |           |
|   |        |      |            |         | take a      |           |
|   |        |      |            |         | taxi, and   |           |
|   |        |      |            |         | 2-5% would  |           |
|   |        |      |            |         | take a      |           |
|   |        |      |            |         | non-SARS    |           |
|   |        |      |            |         | ambulance,  |           |
|   |        |      |            |         | call a      |           |
|   |        |      |            |         | friend or   |           |
|   |        |      |            |         | relative,   |           |
|   |        |      |            |         | or take     |           |
|   |        |      |            |         | public      |           |
|   |        |      |            |         | transit.    |           |
|   |        |      |            |         | Ap          |           |
|   |        |      |            |         | proximately |           |
|   |        |      |            |         | 60% of      |           |
|   |        |      |            |         | respondents |           |
|   |        |      |            |         | who were    |           |
|   |        |      |            |         | unaware of  |           |
|   |        |      |            |         | SARS        |           |
|   |        |      |            |         | symptoms    |           |
|   |        |      |            |         | would take  |           |
|   |        |      |            |         | the         |           |
|   |        |      |            |         | designated  |           |
|   |        |      |            |         | SARS        |           |
|   |        |      |            |         | ambulance.  |           |
|   |        |      |            |         | Ap          |           |
|   |        |      |            |         | proximately |           |
|   |        |      |            |         | 15% of      |           |
|   |        |      |            |         | respondents |           |
|   |        |      |            |         | would call  |           |
|   |        |      |            |         | a friend or |           |
|   |        |      |            |         | relative,   |           |
|   |        |      |            |         | 15% would   |           |
|   |        |      |            |         | take a      |           |
|   |        |      |            |         | taxi, and   |           |
|   |        |      |            |         | 5% would    |           |
|   |        |      |            |         | take a      |           |
|   |        |      |            |         | non-SARS    |           |
|   |        |      |            |         | ambulance,  |           |
|   |        |      |            |         | drive       |           |
|   |        |      |            |         | themselves, |           |
|   |        |      |            |         | or take     |           |
|   |        |      |            |         | public      |           |
|   |        |      |            |         | transit.    |           |
|   |        |      |            |         |             |           |
|   |        |      |            |         | Respondents |           |
|   |        |      |            |         | aware of    |           |
|   |        |      |            |         | SARS        |           |
|   |        |      |            |         | symptoms    |           |
|   |        |      |            |         | were        |           |
|   |        |      |            |         | si          |           |
|   |        |      |            |         | gnificantly |           |
|   |        |      |            |         | more likely |           |
|   |        |      |            |         | to take the |           |
|   |        |      |            |         | appropriate |           |
|   |        |      |            |         | transit     |           |
|   |        |      |            |         | (SARS       |           |
|   |        |      |            |         | ambulance   |           |
|   |        |      |            |         | or drive    |           |
|   |        |      |            |         | themselves) |           |
|   |        |      |            |         | than        |           |
|   |        |      |            |         | respondents |           |
|   |        |      |            |         | not aware   |           |
|   |        |      |            |         | of SARS     |           |
|   |        |      |            |         | symptoms    |           |
|   |        |      |            |         | (p\<0.001). |           |
|   |        |      |            |         | Respondents |           |
|   |        |      |            |         | over 60     |           |
|   |        |      |            |         | (p\<0.05),  |           |
|   |        |      |            |         | those with  |           |
|   |        |      |            |         | only        |           |
|   |        |      |            |         | primary or  |           |
|   |        |      |            |         | no formal   |           |
|   |        |      |            |         | education   |           |
|   |        |      |            |         | (p\<0.05),  |           |
|   |        |      |            |         | and         |           |
|   |        |      |            |         | respondents |           |
|   |        |      |            |         | unaware of  |           |
|   |        |      |            |         | SARS        |           |
|   |        |      |            |         | symptoms    |           |
|   |        |      |            |         | (p\<0.01),  |           |
|   |        |      |            |         | were        |           |
|   |        |      |            |         | si          |           |
|   |        |      |            |         | gnificantly |           |
|   |        |      |            |         | more likely |           |
|   |        |      |            |         | not to use  |           |
|   |        |      |            |         | appropriate |           |
|   |        |      |            |         | transit to  |           |
|   |        |      |            |         | get to the  |           |
|   |        |      |            |         | SARS        |           |
|   |        |      |            |         | -designated |           |
|   |        |      |            |         | hospital.   |           |
+---+--------+------+------------+---------+-------------+-----------+
| T | SARS:  | To   | R          | No      | Five main   | Future    |
| a | Key    | as   | esearchers | demo    | factors     | studies   |
| i | F      | sess | reviewed   | graphic | were        | may want  |
| w | actors | hosp | archived   | info    | identified  | to        |
| a | in     | ital | crisis     | rmation | in this     | observe   |
| n | Crisis | cr   | management | is      | study that  | m         |
|   | Mana   | isis | materials  | given.  | allowed the | anagement |
|   | gement | ma   | of a       |         | hospital to | and       |
|   | (2003) | nage | regional   |         | effectively | p         |
|   |        | ment | teaching   |         | handle the  | rocedures |
|   | Tseng, | poli | hospital   |         | SARS        | during    |
|   | HC et  | cies | in Taipei  |         | epidemic:   | imple     |
|   | al.    | du   | City.      |         | good timing | mentation |
|   |        | ring | In-depth   |         | for crisis  | to have a |
|   |        | the  | fa         |         | management; | more      |
|   |        | 2003 | ce-to-face |         | careful     | accurate  |
|   |        | SARS | and        |         | decis       | picture   |
|   |        | o    | telephone  |         | ion-making; | of how    |
|   |        | utbr | i          |         | thorough    | hospitals |
|   |        | eak. | nterviews, |         | impl        | handle    |
|   |        |      | of 1.5 to  |         | ementation; | crises as |
|   |        |      | 3 hours in |         | good        | they      |
|   |        |      | duration,  |         | co          | arise and |
|   |        |      | were also  |         | mmunication | to        |
|   |        |      | conducted  |         | and; trust  | further   |
|   |        |      | with the   |         | between     | elaborate |
|   |        |      | director   |         | management  | on the    |
|   |        |      | of the     |         | and         | factors   |
|   |        |      | nursing    |         | employees.  | discussed |
|   |        |      | d          |         |             | in the    |
|   |        |      | epartment, |         | Protective  | study.    |
|   |        |      | the        |         | materials   |           |
|   |        |      | nursing    |         | were        |           |
|   |        |      | s          |         | available   |           |
|   |        |      | upervisor, |         | in the      |           |
|   |        |      | and four   |         | hospital    |           |
|   |        |      | head       |         | from the    |           |
|   |        |      | nurses of  |         | time of the |           |
|   |        |      | the ICU    |         | first SARS  |           |
|   |        |      | and the    |         | case in     |           |
|   |        |      | SARS       |         | Taiwan.     |           |
|   |        |      | units.     |         | Frontline   |           |
|   |        |      | Structured |         | staff were  |           |
|   |        |      | interviews |         | required to |           |
|   |        |      | included   |         | wear        |           |
|   |        |      | questions  |         | surgical    |           |
|   |        |      | regarding  |         | and N95     |           |
|   |        |      | quarantine |         | masks.      |           |
|   |        |      | p          |         | Staff also  |           |
|   |        |      | rocedures, |         | wore two    |           |
|   |        |      | body       |         | layers of   |           |
|   |        |      | t          |         | protective  |           |
|   |        |      | emperature |         | gowns. PPE  |           |
|   |        |      | as         |         | was ordered |           |
|   |        |      | sessments, |         | during the  |           |
|   |        |      | fever      |         | first month |           |
|   |        |      | screening  |         | after the   |           |
|   |        |      | p          |         | first SARS  |           |
|   |        |      | rocedures, |         | case in     |           |
|   |        |      | disposal   |         | Taiwan, and |           |
|   |        |      | p          |         | the         |           |
|   |        |      | rocedures, |         | hospital    |           |
|   |        |      | material   |         | ordered     |           |
|   |        |      | and        |         | from 6      |           |
|   |        |      | equipment  |         | different   |           |
|   |        |      | protection |         | suppliers   |           |
|   |        |      | p          |         | to ensure   |           |
|   |        |      | rocedures, |         | constant    |           |
|   |        |      | env        |         | provisions. |           |
|   |        |      | ironmental |         |             |           |
|   |        |      | p          |         | To prevent  |           |
|   |        |      | rotection, |         | any         |           |
|   |        |      | manpower,  |         | possible    |           |
|   |        |      | route      |         | SARS        |           |
|   |        |      | control,   |         | t           |           |
|   |        |      | team       |         | ransmission |           |
|   |        |      | dynamics,  |         | in the      |           |
|   |        |      | com        |         | hospital,   |           |
|   |        |      | munication |         | adm         |           |
|   |        |      | channels,  |         | inistration |           |
|   |        |      | accou      |         | not only    |           |
|   |        |      | ntability, |         | ordered     |           |
|   |        |      | education  |         | plenty of   |           |
|   |        |      | and        |         | supplies,   |           |
|   |        |      | training,  |         | but also    |           |
|   |        |      | and        |         | set up a    |           |
|   |        |      | bonuses    |         | reversed    |           |
|   |        |      | and        |         | ventilation |           |
|   |        |      | rewards.   |         | ward, six   |           |
|   |        |      |            |         | temporary   |           |
|   |        |      |            |         | quarantine  |           |
|   |        |      |            |         | rooms,      |           |
|   |        |      |            |         | alcohol     |           |
|   |        |      |            |         | wipes next  |           |
|   |        |      |            |         | to phones,  |           |
|   |        |      |            |         | twice daily |           |
|   |        |      |            |         | d           |           |
|   |        |      |            |         | isinfection |           |
|   |        |      |            |         | of          |           |
|   |        |      |            |         | doorknobs,  |           |
|   |        |      |            |         | desks,      |           |
|   |        |      |            |         | elevator    |           |
|   |        |      |            |         | buttons,    |           |
|   |        |      |            |         | and floors, |           |
|   |        |      |            |         | facemasks   |           |
|   |        |      |            |         | and hand    |           |
|   |        |      |            |         | sanitizer   |           |
|   |        |      |            |         | for         |           |
|   |        |      |            |         | patients,   |           |
|   |        |      |            |         | required    |           |
|   |        |      |            |         | employee    |           |
|   |        |      |            |         | seminars    |           |
|   |        |      |            |         | and SARS    |           |
|   |        |      |            |         | education,  |           |
|   |        |      |            |         | designation |           |
|   |        |      |            |         | of          |           |
|   |        |      |            |         | elevators   |           |
|   |        |      |            |         | and         |           |
|   |        |      |            |         | hospital    |           |
|   |        |      |            |         | one-way     |           |
|   |        |      |            |         | routes for  |           |
|   |        |      |            |         | staff,      |           |
|   |        |      |            |         | patients,   |           |
|   |        |      |            |         | and         |           |
|   |        |      |            |         | supplies,   |           |
|   |        |      |            |         | and         |           |
|   |        |      |            |         | protective  |           |
|   |        |      |            |         | measures    |           |
|   |        |      |            |         | for staff   |           |
|   |        |      |            |         | and         |           |
|   |        |      |            |         | patients.   |           |
|   |        |      |            |         | Top         |           |
|   |        |      |            |         | hospital    |           |
|   |        |      |            |         | staff also  |           |
|   |        |      |            |         | attended    |           |
|   |        |      |            |         | the         |           |
|   |        |      |            |         | National    |           |
|   |        |      |            |         | SARS        |           |
|   |        |      |            |         | Meetings,   |           |
|   |        |      |            |         | and other   |           |
|   |        |      |            |         | hospitals'  |           |
|   |        |      |            |         | meetings in |           |
|   |        |      |            |         | order to    |           |
|   |        |      |            |         | have the    |           |
|   |        |      |            |         | most        |           |
|   |        |      |            |         | complete    |           |
|   |        |      |            |         | and         |           |
|   |        |      |            |         | up-to-date  |           |
|   |        |      |            |         | i           |           |
|   |        |      |            |         | nformation, |           |
|   |        |      |            |         | and the     |           |
|   |        |      |            |         | hospital    |           |
|   |        |      |            |         | deci        |           |
|   |        |      |            |         | sion-making |           |
|   |        |      |            |         | team met    |           |
|   |        |      |            |         | twice       |           |
|   |        |      |            |         | daily.      |           |
|   |        |      |            |         | Information |           |
|   |        |      |            |         | from these  |           |
|   |        |      |            |         | meetings    |           |
|   |        |      |            |         | was         |           |
|   |        |      |            |         | d           |           |
|   |        |      |            |         | isseminated |           |
|   |        |      |            |         | via email   |           |
|   |        |      |            |         | and         |           |
|   |        |      |            |         | hospital    |           |
|   |        |      |            |         | policy to   |           |
|   |        |      |            |         | every       |           |
|   |        |      |            |         | department. |           |
|   |        |      |            |         | Hospital    |           |
|   |        |      |            |         | adm         |           |
|   |        |      |            |         | inistration |           |
|   |        |      |            |         | also        |           |
|   |        |      |            |         | d           |           |
|   |        |      |            |         | emonstrated |           |
|   |        |      |            |         | concern for |           |
|   |        |      |            |         | their       |           |
|   |        |      |            |         | employees'  |           |
|   |        |      |            |         | well-being. |           |
|   |        |      |            |         | All staff   |           |
|   |        |      |            |         | taking care |           |
|   |        |      |            |         | of SARS     |           |
|   |        |      |            |         | patients    |           |
|   |        |      |            |         | were in the |           |
|   |        |      |            |         | same        |           |
|   |        |      |            |         | quarantine  |           |
|   |        |      |            |         | area in the |           |
|   |        |      |            |         | building    |           |
|   |        |      |            |         | and were    |           |
|   |        |      |            |         | provided    |           |
|   |        |      |            |         | with        |           |
|   |        |      |            |         | clothes,    |           |
|   |        |      |            |         | meals,      |           |
|   |        |      |            |         | snacks,     |           |
|   |        |      |            |         | herbal      |           |
|   |        |      |            |         | tonics,     |           |
|   |        |      |            |         | vitamins,   |           |
|   |        |      |            |         | newspapers, |           |
|   |        |      |            |         | magazines,  |           |
|   |        |      |            |         | ref         |           |
|   |        |      |            |         | rigerators, |           |
|   |        |      |            |         | telephone   |           |
|   |        |      |            |         | services,   |           |
|   |        |      |            |         | and         |           |
|   |        |      |            |         | co          |           |
|   |        |      |            |         | mplimentary |           |
|   |        |      |            |         | physical    |           |
|   |        |      |            |         | exams.      |           |
|   |        |      |            |         | Ps          |           |
|   |        |      |            |         | ychiatrists |           |
|   |        |      |            |         | and social  |           |
|   |        |      |            |         | workers     |           |
|   |        |      |            |         | telephoned  |           |
|   |        |      |            |         | staff; the  |           |
|   |        |      |            |         | head of     |           |
|   |        |      |            |         | Dermatology |           |
|   |        |      |            |         | provided    |           |
|   |        |      |            |         | ointment to |           |
|   |        |      |            |         | those staff |           |
|   |        |      |            |         | whose       |           |
|   |        |      |            |         | facemasks   |           |
|   |        |      |            |         | were        |           |
|   |        |      |            |         | un          |           |
|   |        |      |            |         | comfortable |           |
|   |        |      |            |         | or caused   |           |
|   |        |      |            |         | rashes.     |           |
+---+--------+------+------------+---------+-------------+-----------+
| T | Severe | To   | Ques       | Of the  | 79% of      | Lack of   |
| a | Acute  | as   | tionnaires | 43      | respondents | knowledge |
| i | Respi  | sess | were       | phy     | reported    | of some   |
| w | ratory | the  | mailed to  | sicians | receiving   | SARS      |
| a | Sy     | kn   | physician  | who     | SARS        | g         |
| n | ndrome | owle | pa         | re      | training;   | uidelines |
|   | (      | dge, | rticipants | sponded | 14% rated   | and the   |
|   | SARS): | at   | who had    | to the  | their SARS  | disparity |
|   | Know   | titu | staffed a  | survey  | knowledge   | in the    |
|   | ledge, | des, | SARS fever | all     | as very     | level of  |
|   | Atti   | pr   | hotline    | were    | good and    | knowledge |
|   | tudes, | acti | from June  | cu      | 58% rated   | among the |
|   | Prac   | ces, | 1-10,      | rrently | their SARS  | hotline   |
|   | tices, | and  | 2003. The  | pra     | knowledge   | staff may |
|   | and    | sou  | survey     | cticing | as good.    | be due to |
|   | S      | rces | consisted  | in a    | All         | the       |
|   | ources | of   | of         | variety | respondents | different |
|   | of     | inf  | multiple   | of      | correctly   | medical   |
|   | Infor  | orma | choice and | spec    | identified  | and       |
|   | mation | tion | Likert     | ialties | the         | n         |
|   | among  | of   | scale      | inc     | causative   | onmedical |
|   | Phys   | ph   | questions  | luding, | agent and   | sources   |
|   | icians | ysic | about SARS | i       | 93% to 100% | of SARS   |
|   | Ans    | ians | i          | nternal | of          | in        |
|   | wering | a    | nformation | me      | respondents | formation |
|   | a SARS | nswe | sources,   | dicine, | recognized  | reported  |
|   | Fever  | ring | knowledge  | pedi    | different   | by        |
|   | H      | a    | about      | atrics, | potential   | ph        |
|   | otline | SARS | SARS, and  | s       | SARS signs  | ysicians. |
|   | S      | f    | attitudes  | urgery, | and         | P         |
|   | ervice | ever | and        | OB/GYN, | symptoms.   | hysicians |
|   | (2003) | hotl | beliefs    | and     | 98% of      | would     |
|   |        | ine. | about the  | family  | respondents | benefit   |
|   | Deng,  |      | SARS       | pr      | reported    | from      |
|   | JF et  |      | hotline.   | actice. | frequent    | sta       |
|   | al.    |      | Pa         | 88%     | handwashing | ndardized |
|   |        |      | rticipants | were    | as a        | training  |
|   |        |      | were also  | male    | preventive  | and       |
|   |        |      | presented  | and 79% | measure and | knowledge |
|   |        |      | with two   | had     | 88%         | a         |
|   |        |      | scenarios: | worked  | reported    | ssessment |
|   |        |      | scenario 1 | one to  | following   | before    |
|   |        |      | surveyed   | three   | infection   | staffing  |
|   |        |      | pa         | shifts  | control     | the       |
|   |        |      | rticipants | during  | guidelines. | hotline,  |
|   |        |      | about what | the     |             | to        |
|   |        |      | questions  | survey  | 95% of      | improve   |
|   |        |      | they would | period. | respondents | the       |
|   |        |      | ask a      |         | thought the | quality   |
|   |        |      | caller at  |         | SARS fever  | of        |
|   |        |      | low-risk   |         | hotline was | in        |
|   |        |      | for SARS   |         | a good idea | formation |
|   |        |      | who        |         | and 98%     | and the   |
|   |        |      | reported a |         | thought it  | e         |
|   |        |      | dry cough  |         | was a       | fficiency |
|   |        |      | and a      |         | useful      | of        |
|   |        |      | t          |         | source of   | telephone |
|   |        |      | emperature |         | information | triaging  |
|   |        |      | of 37.8°C; |         | for the     |           |
|   |        |      | scenario 2 |         | general     | Future    |
|   |        |      | surveyed   |         | public. 93% | research  |
|   |        |      | pa         |         | thought     | could     |
|   |        |      | rticipants |         | that        | focus on  |
|   |        |      | about      |         | physicians  | e         |
|   |        |      | triaging a |         | were the    | valuating |
|   |        |      | caller at  |         | right       | the       |
|   |        |      | high-risk  |         | people to   | content   |
|   |        |      | for SARS   |         | answer      | of the    |
|   |        |      | who        |         | hotline     | news      |
|   |        |      | reported a |         | calls. 63%  | media and |
|   |        |      | spouse     |         | of          | hospital  |
|   |        |      | that just  |         | respondents | gu        |
|   |        |      | returned   |         | said they   | idelines. |
|   |        |      | from       |         | would work  |           |
|   |        |      | Beijing    |         | on the      |           |
|   |        |      | and now    |         | hotline     |           |
|   |        |      | had a      |         | again.      |           |
|   |        |      | fever of   |         |             |           |
|   |        |      | 39.5°C and |         | 79% of      |           |
|   |        |      | shortness  |         | respondents |           |
|   |        |      | of breath. |         | received    |           |
|   |        |      |            |         | their SARS  |           |
|   |        |      |            |         | information |           |
|   |        |      |            |         | from        |           |
|   |        |      |            |         | hospital    |           |
|   |        |      |            |         | guidelines  |           |
|   |        |      |            |         | and the     |           |
|   |        |      |            |         | same number |           |
|   |        |      |            |         | also        |           |
|   |        |      |            |         | reported    |           |
|   |        |      |            |         | receiving   |           |
|   |        |      |            |         | SARS        |           |
|   |        |      |            |         | information |           |
|   |        |      |            |         | from news   |           |
|   |        |      |            |         | media. 65%  |           |
|   |        |      |            |         | of          |           |
|   |        |      |            |         | respondents |           |
|   |        |      |            |         | received    |           |
|   |        |      |            |         | their       |           |
|   |        |      |            |         | information |           |
|   |        |      |            |         | from the    |           |
|   |        |      |            |         | CDC-Taiwan  |           |
|   |        |      |            |         | website and |           |
|   |        |      |            |         | 49%         |           |
|   |        |      |            |         | received    |           |
|   |        |      |            |         | information |           |
|   |        |      |            |         | from the    |           |
|   |        |      |            |         | WHO         |           |
|   |        |      |            |         | website.    |           |
|   |        |      |            |         |             |           |
|   |        |      |            |         | In scenario |           |
|   |        |      |            |         | 1, 56% of   |           |
|   |        |      |            |         | respondents |           |
|   |        |      |            |         | identified  |           |
|   |        |      |            |         | all of the  |           |
|   |        |      |            |         | correct     |           |
|   |        |      |            |         | questions   |           |
|   |        |      |            |         | to ask that |           |
|   |        |      |            |         | type of     |           |
|   |        |      |            |         | caller. For |           |
|   |        |      |            |         | scenario 2, |           |
|   |        |      |            |         | 79% of      |           |
|   |        |      |            |         | respondents |           |
|   |        |      |            |         | identified  |           |
|   |        |      |            |         | the correct |           |
|   |        |      |            |         | triage      |           |
|   |        |      |            |         | steps for   |           |
|   |        |      |            |         | that type   |           |
|   |        |      |            |         | of caller.  |           |
+---+--------+------+------------+---------+-------------+-----------+
| T | N      | To   | Pa         | Of the  | Nurses      | Providing |
| a | urses' | as   | rticipants | 172     | surveyed    | adequate  |
| i | Profes | sess | were       | respo   | during the  | nurse     |
| w | sional | cha  | recruited  | ndents, | SARS        | training  |
| a | Care   | nges | through    | 99%     | epidemic    | in        |
| n | Obli   | in   | c          | were    | were        | disease   |
|   | gation | nur  | onvenience | female. | si          | knowledge |
|   | and    | ses' | samples of | Mean    | gnificantly | and       |
|   | Their  | per  | nurses     | age was | more likely | infection |
|   | Att    | cept | working in | 29.21   | to be older | control   |
|   | itudes | ions | 11         | years.  | than nurses | measures, |
|   | Toward | of   | hospital   | 13      | surveyed    | as well   |
|   | SARS   | t    | sites. The | resp    | after the   | as        |
|   | inf    | heir | ques       | ondents | epidemic    | adequate  |
|   | ection | prof | tionnaire, | had a   | (p=0.003).  | supplies  |
|   | C      | essi | in         | nursing | Nurses      | of PPE,   |
|   | ontrol | onal | Mandarin   | d       | surveyed    | would     |
|   | Me     | ob   | Chinese,   | iploma, | after the   | increase  |
|   | asures | liga | consisted  | 115 had | epidemic    | nurses'   |
|   | in     | tion | of 5 items | an      | had         | knowledge |
|   | Taiwan | to   | to assess  | asso    | si          | of SARS   |
|   | During | care | nurses'    | ciate's | gnificantly | and could |
|   | and    | for  | attitudes  | degree, | higher care | c         |
|   | After  | p    | towards    | 41 had  | obligations | ontribute |
|   | the    | oten | SARS       | a       | (p\<0.05)   | to more   |
|   | 2003   | tial | infection  | bach    | and better  | positive  |
|   | Ep     | SARS | control    | elor's, | attitudes   | attitudes |
|   | idemic | pati | measures,  | and 3   | towards     | towards   |
|   | (2003) | ents | including  | had     | infection   | perceived |
|   |        | and  | one        | g       | control     | risk,     |
|   | Tzeng, | t    | question   | raduate | measures    | personal  |
|   | HM     | heir | on         | d       | (p=0.002).  | safety,   |
|   |        | a    | pr         | egrees. | These       | and       |
|   |        | ttit | ofessional | 20      | nurses were | personal  |
|   |        | udes | o          | resp    | also        | effects   |
|   |        | to   | bligations | ondents | si          | of        |
|   |        | ward | and four   | had     | gnificantly | q         |
|   |        | i    | 5-point    | adminis | more likely | uarantine |
|   |        | nfec | Likert     | trative | to have     | policies. |
|   |        | tion | scale      | r       | less        | Hospital  |
|   |        | con  | items      | esponsi | p           | training  |
|   |        | trol | assessing  | bility. | rofessional | may also  |
|   |        | meas | nurses'    | Average | experience  | lower     |
|   |        | ures | attitudes  | profe   | and more    | fears of  |
|   |        | du   | towards    | ssional | education   | caring    |
|   |        | ring | SARS. The  | exp     | than the    | for SARS  |
|   |        | and  | survey     | erience | nurses      | patients. |
|   |        | a    | also       | was     | surveyed    |           |
|   |        | fter | included a | 7.41    | during the  | Future    |
|   |        | the  | health     | years.  | epidemic    | research  |
|   |        | Ta   | status     | 68      | (no         | should    |
|   |        | iwan | que        | resp    | p-values    | more      |
|   |        | SARS | stionnaire | ondents | given).     | clearly   |
|   |        | e    | for        | p       | Nurses in   | define    |
|   |        | pide | self-rated | rovided | the         | pro       |
|   |        | mic. | health     | direct  | post-SARS   | fessional |
|   |        |      | during the | care to | group were  | o         |
|   |        |      | previous   | p       | also more   | bligation |
|   |        |      | week,      | robable | willing to  | and       |
|   |        |      | based on   | or      | provide     | policies  |
|   |        |      | the SF-8   | co      | care for    | relating  |
|   |        |      | Health     | nfirmed | SARS        | to        |
|   |        |      | Survey and | SARS    | patients    | nursing   |
|   |        |      | assessed   | p       | and to      | practices |
|   |        |      | on 5-point | atients | agree more  | in        |
|   |        |      | Likert     | and 6   | with        | different |
|   |        |      | scales,    | had     | general     | c         |
|   |        |      | and        | been    | SARS        | ountries. |
|   |        |      | consisted  | quara   | control     | By        |
|   |        |      | of two     | ntined. | measures.   | co        |
|   |        |      | general    |         | Overall     | nsidering |
|   |        |      | health     |         | nurses'     | cultural  |
|   |        |      | items,     |         | attitudes   | and legal |
|   |        |      | four       |         | toward      | di        |
|   |        |      | physical   |         | infection   | fferences |
|   |        |      | health     |         | control     | across    |
|   |        |      | items, two |         | measures    | countries |
|   |        |      | psy        |         | and         | and       |
|   |        |      | chological |         | quarantine  | d         |
|   |        |      | health     |         | after       | eveloping |
|   |        |      | items, and |         | caring for  | a common  |
|   |        |      | two social |         | SARS        | ethical   |
|   |        |      | health     |         | patients    | norm for  |
|   |        |      | items for  |         | were        | nurses,   |
|   |        |      | their      |         | significant | the       |
|   |        |      | health     |         | predictors  | inte      |
|   |        |      | during the |         | of nurses'  | rnational |
|   |        |      | previous   |         | commitment  | nursing   |
|   |        |      | week.      |         | to their    | community |
|   |        |      |            |         | p           | could     |
|   |        |      |            |         | rofessional | help to   |
|   |        |      |            |         | o           | integrate |
|   |        |      |            |         | bligations. | different |
|   |        |      |            |         |             | per       |
|   |        |      |            |         |             | spectives |
|   |        |      |            |         |             | on        |
|   |        |      |            |         |             | pro       |
|   |        |      |            |         |             | fessional |
|   |        |      |            |         |             | care      |
|   |        |      |            |         |             | obl       |
|   |        |      |            |         |             | igations. |
+---+--------+------+------------+---------+-------------+-----------+
| T | Poul   | To   | Pa         | Of the  | Of the 98%  | Avian     |
| h | try-ha | as   | rticipants | 200     | of          | influenza |
| a | ndling | sess | were       | parti   | respondents | public    |
| i | Pra    | the  | recruited  | cipants | who had     | health    |
| l | ctices | eff  | through a  | i       | heard of    | education |
| a | During | ects | randomized | ncluded | bird flu,   | and       |
| n | Avian  | of   | community  | in the  | 91% first   | p         |
| d | Inf    | pu   | cluster    | sample  | heard of it | revention |
|   | luenza | blic | sample of  | popu    | on          | campaigns |
|   | Ou     | e    | 5 villages | lation, | television; | must      |
|   | tbreak | duca | in Nakhon  | median  | only 1% had | target    |
|   | (2004) | tion | Phanom     | age was | seen the    | children, |
|   |        | prog | province   | 50      | official    | who       |
|   | Olsen, | rams | to         | years   | website.    | account   |
|   | Sonja  | on   | measuring  | (range  | 76% of      | for half  |
|   | et al. | a    | si         | 22-87   | those who   | of the    |
|   |        | vian | gnificance | years). | had heard   | cases in  |
|   | <http  | flu  | of percent | 72%     | of bird flu | Thailand. |
|   | ://www | kn   | change in: | were    | recognized  | Public    |
|   | .cdc.g | owle | *          | women;  | that people | education |
|   | ov/nci | dge. | knowledge, | 61% had | could get   | and       |
|   | dod/EI |      | attitudes, | less    | it from     | b         |
|   | D/vol1 |      | and        | than a  | chicken or  | ehavioral |
|   | 1no10/ |      | p          | primary | other       | c         |
|   | 04-126 |      | ractices*. | school  | poultry.    | ounseling |
|   | 7.htm> |      |            | edu     |             | should    |
|   |        |      | Native     | cation. | Knowledge   | emphasize |
|   |        |      | Thai       | Median  | and         | p         |
|   |        |      | speakers   | number  | attitudes   | revention |
|   |        |      | from       | of      | regarding   | of avian  |
|   |        |      | provincial | persons | touching    | i         |
|   |        |      | health     | per     | sick or     | nfluenza, |
|   |        |      | offices    | ho      | dead birds  | through   |
|   |        |      | administer | usehold | with bare   | avoiding  |
|   |        |      | surveys    | was 4   | hands and   | high risk |
|   |        |      | from       | (range  | preparing   | behavior  |
|   |        |      | August     | 1-11);  | poultry to  | --        |
|   |        |      | 25-31,     | 55% had | eat changed | touching  |
|   |        |      | 2004.      | a child | si          | sick or   |
|   |        |      | Pa         | \<10    | gnificantly | dead      |
|   |        |      | rticipants | years   | in the time | poultry   |
|   |        |      | were asked | of age. | respondents | with bare |
|   |        |      | to recall  | 74%     | had heard   | hands.    |
|   |        |      | when they  | r       | about avian | Messages  |
|   |        |      | had first  | eported | flu         | should    |
|   |        |      | heard of   | having  | (p≤0.01)    | also      |
|   |        |      | avian      | poultry |             | include   |
|   |        |      | influenza  | in      | Practices   | in        |
|   |        |      | and then   | their   | regarding   | formation |
|   |        |      | answer     | ba      | adults      | on proper |
|   |        |      | questions  | ckyard. | touching    | hand      |
|   |        |      | regarding  |         | sick or     | pr        |
|   |        |      | their      |         | dead        | otection, |
|   |        |      | behaviors  |         | poultry     | such      |
|   |        |      | 6 months   |         | with bare   | wearing   |
|   |        |      | before to  |         | hands       | d         |
|   |        |      | 6 months   |         | changed     | isposable |
|   |        |      | after      |         | si          | gloves or |
|   |        |      | hearing of |         | gnificantly | using a   |
|   |        |      | it. Survey |         | as well     | plastic   |
|   |        |      | questions  |         | (p≤0.01),   | bag, and  |
|   |        |      | included   |         | and changed | disposal  |
|   |        |      | safety of  |         | somewhat    | methods   |
|   |        |      | touching   |         | si          | if        |
|   |        |      | sick or    |         | gnificantly | complete  |
|   |        |      | dead       |         | for         | avoidance |
|   |        |      | poultry    |         | preparing   | of sick   |
|   |        |      | with bare  |         | raw poultry | or dead   |
|   |        |      | hands      |         | and other   | poultry   |
|   |        |      | (adults    |         | foods on    | is        |
|   |        |      | and        |         | the same    | im        |
|   |        |      | children), |         | cutting     | possible. |
|   |        |      | preparing  |         | board       | Public    |
|   |        |      | raw        |         | (p≤0.08).   | campaigns |
|   |        |      | poultry    |         | However,    | can be    |
|   |        |      | and other  |         | there were  | effective |
|   |        |      | foods on   |         | no          | at        |
|   |        |      | the same   |         | significant | educating |
|   |        |      | cutting    |         | changes in  | rural     |
|   |        |      | board, and |         | other       | pop       |
|   |        |      | eating     |         | practices.  | ulations. |
|   |        |      | chicken    |         |             | Renewed   |
|   |        |      | that was   |         |             | efforts   |
|   |        |      | pink in    |         |             | are       |
|   |        |      | the middle |         |             | needed to |
|   |        |      | or eggs    |         |             | find      |
|   |        |      | with runny |         |             | practical |
|   |        |      | yolks.     |         |             | solutions |
|   |        |      |            |         |             | that will |
|   |        |      |            |         |             | induce    |
|   |        |      |            |         |             | b         |
|   |        |      |            |         |             | ehavioral |
|   |        |      |            |         |             | change.   |
+---+--------+------+------------+---------+-------------+-----------+

<http://www.paho.org/English/AD/DPC/CD/vir-flu-avian.htm>