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Zika: Health Education as Prevention

— An epidemiologist details The Health Belief Model

MedpageToday

As the spread of the Zika virus disease escalates in the United States, the uncertainty surrounding this virus is becoming increasingly evident. In addition to the severe fetal defects (particularly microcephaly) linked to maternal infection, the fact that the Zika virus can be sexually transmitted adds to the growing concern among public health authorities.

Nonetheless, the perceived threat is being tempered by epidemiological estimates that the virus will be a non-event for most -- that is, about 80% of those who become infected will be asymptomatic (and recover, never knowing they were infected). Asymptomatic infection, however, can still propagate the spread of the Zika virus; hence the need for more effective health education messages.

Any Zika-infected person, symptomatic or not, is a reservoir for the virus. Moreover, it is quite plausible that when the mosquito season is over, Zika virus disease could become endemic in the U.S., particularly because of sexual transmission -- a situation that could persist until an effective vaccine is discovered (probably 2-3 years from now) and becomes widely available.

While the current vaccine research efforts are commendable, greater importance needs to be given to another primary prevention strategy: targeted health education. There is a large body of psychosocial research on the control and prevention of infectious diseases, which provides a firm basis for the design and implementation of evidence-based health education campaigns.

Nonetheless, the very interventional approach that failed us in the past is being repeated -- that is, the thinking that mere knowledge about something equals positive behavior change. Facts are necessary but not sufficient to effect meaningful behavioral change; rather, the information needs to be framed to address certain beliefs and concerns that are critical to individual decision-making to engage in health protective behaviors.

(HBM) is particularly instructive in this context. It posits that some illness perceptions are salient to the decision-making process for initiating and maintaining behaviors conducive to health. Foremost in this regard is that an individual's perception of susceptibility (or risk of becoming infected) coupled with the perception of the severity of the disease, underpins the perception of personal threat, which in turn determines the person's level of engagement in health protective behaviors.

In general, individuals perform a cost-benefit analysis when they perceive a threat to their health. If the perceived benefits of the recommended protective measures outweigh the perceived barriers or cost (psychological or material, including inconvenience, stress, discomfort, loss of pleasure, loss of time, financial loss, etc.), then people are more likely to take action to protect themselves.

However, even when there is a favorable cost-benefit analysis toward engaging in the protective behavior, this still may not occur if perceived self-efficacy (or beliefs about one's capability to effectively adopt the recommended behaviors) is lacking. Selected strategies -- referred to as cues to action -- can be implemented to enhance interest in the recommended behaviors, and move people to action.

The illness perception dimensions of the HBM are known to be moderated by various personal, cultural, and socio-demographic factors.

For health education campaigns to be effective, therefore, the messages have to be group- and context-specific, as well as timely, in order for the information to be meaningful to the audience. Ideally, the content of the message should be informed by prior research evidence from the target group.

Here is an example of the operationalization of the HBM for the design of a health education message. Note the target group and objective.

While we work to discover an effective vaccine, let's give health education a chance.

Rossi A. Hassad, PhD, MPH, is an epidemiologist, and professor at Mercy College, in Dobbs Ferry, N.Y. He is a member of the American College of Epidemiology, and a Fellow and Chartered Statistician of the Royal Statistical Society, U.K.