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13 October 2023

Engaged and informed communities are more likely to adapt their behaviour during disease outbreaks

New research from a team led by Dr Louise Smith and Professor James Rubin from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London, working with the UK Health Security Agency, explored society’s understanding of, and attitudes toward, the 2022 mpox outbreak and people’s intention to adhere to self-isolation requests and protective behaviours.

image of a rash on a person's hands and arms

The research, published in BMJ Open, found that men who are gay, bisexual or who have sex with men (GBMSM) had a better understanding of mpox, its symptoms and risks, and were significantly more likely than the general population to intend to engage in most protective behaviours, except for self-isolation. Researchers suggest this demonstrates the effectiveness of targeted messaging from community-based organisations and charities to raise awareness of mpox in the most affected populations.

Implementing protective behaviours including self-isolation, contact tracing and vaccination uptake were a key aspect of the public health response to the COVID-19 pandemic, with uptake varying within the general population throughout the course of the pandemic. With the mpox outbreak of 2022 most significantly affecting the GBMSM population, community outreach and government messaging specifically targeted this group, placing a distinct focus on promoting understanding and protective behaviours, in contrast to attempting to engage with the whole population at once, as was the case during the COVID-19 pandemic.

Researchers sampled 5164 people, including those specifically recruited through Grindr and Meta (Instagram and Facebook) as well as via market research organisations. Respondents completed an online, anonymous survey. Those surveyed were asked about their intentions to self-isolate, seek medical help, stop all sexual contact, share details of recent sexual contacts and accept vaccination as well as their understanding and beliefs about mpox, and detailed demographic data.

Researchers found that responses and demographic details differed by sample, with respondents from Grindr and Meta more likely to be working, highly educated, and have less financial hardship. They were also more likely to intend to immediately seek help and completely stop sexual behaviour if they developed mpox symptoms and intend to be vaccinated. Broadly, the GBMSM sample showed a significantly greater understanding of the disease and how it spreads, compared with the general population, and a stronger willingness to enact protective behaviours, reflecting the targeted public health efforts and engagement with this group.

Efforts to directly inform and educate the GBMSM community around mpox appear to have been successful, with a greater understanding of the disease present. This could be usefully applied in the case of any future outbreaks, with targeted messages to at risk groups.

Professor James Rubin

The general population results show a more significant skew relating to financial security and gender when considering protective actions. Generally speaking, women, older people, and those who were more financially secure showed a stronger intention to carry out protective behaviours such as self-isolation if they were contacted by public health officials and told that they needed to self-isolate. This suggests that providing financial support to affected groups may help enable them to engage in challenging behaviours such as self-isolating for extended periods of time.

Changing our behaviour to reduce the risk of spreading an illness is an important part of managing an outbreak of any disease, and one that relies heavily on the population themselves. Our intention was to understand how beliefs and knowledge about mpox affected intended behaviours, and whether this differed between the general population and GBMSM, given the different communication approach to this group.

Dr Louise Smith

Overall, education, targeted communication and financial stability appear to be the most effective elements encouraging protective behaviour in the wider community. Avoiding stigmatising the disease or a particular section of society would be beneficial in encouraging uptake of protective actions and vaccination.

This study was possible thanks to the National Institute for Health and Care Research Health Protection Research Unit in Emergency Preparedness and Response, a partnership between the UK Health Security Agency, King’s College London and the University of East Anglia.

Did mpox knowledge, attitudes, and beliefs affect intended behaviour in the general population and men who are gay, bisexual, and who have sex with men? An online cross-sectional survey in the UK (DOI (Louise E Smith, Henry WW Potts, Julii Brainard, Tom May, Isabel Oliver, Richard Amlôt, Lucy Yardley, G James Rubin) was published in BMJ Open.

For more information, please contact Emily Webb (School Communications Manager)

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James Rubin

Professor of Psychology & Emerging Health Risks