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Objective To evaluate how public perceptions and trust in government communications affected the adoption of protective behaviour in Singapore during the coronavirus disease 2019 (COVID-19) pandemic. Methods We launched our community-based cohort to assess public perceptions of infectious disease outbreaks in mid-2019. After the first case of COVID-19 was reported in Singapore on 23 January, we launched a series of seven COVID-19 surveys to both existing and regularly enrolled new participants every 2 weeks. As well as sociodemographic properties of the participants, we recorded changing responses to judge awareness of the situation, trust in various information sources and perceived risk. We used multivariable logistic regression models to evaluate associations with perceptions of risk and self-reported adopted frequencies of protective behaviour. Findings Our cohort of 633 participants provided 2857 unique responses during the seven COVID-19 surveys. Most agreed or strongly agreed that information from official government sources (99.1%; 528/533) and Singapore-based news agencies (97.9%; 522/533) was trustworthy. Trust in government communication was significantly associated with higher perceived threat (odds ratio, OR: 2.2; 95% confidence interval, CI: 1.6-3.0), but inversely associated with perceived risk of infection (OR: 0.6; 95% CI: 0.4-0.8) or risk of death if infected (OR: 0.6; 95% CI: 0.4-0.9). Trust in government communication was also associated with a greater likelihood of adopting protective behaviour. Conclusion Our findings show that trust is a vital commodity when managing an evolving outbreak. Our repeated surveys provided real-time feedback, allowing an improved understanding of the interplay between perceptions, trust and behaviour. [phrase omitted] Objectif Evaluer dans quelle mesure la perception du public et la confiance envers les communications du gouvernement ont influence l'adoption d'un comportement de protection a Singapour durant la pandemie de maladie a coronavirus (COVID-19). Methodes Nous avons lance notre cohorte communautaire afin d'identifier la maniere dont le public percevait les epidemies de maladies infectieuses au milieu de l'annee 2019. Apres l'annonce du premier cas de COVID-19 a Singapour le 23 janvier, nous avons debute une serie de sept sondages sur la COVID-19 aupres de participants existants et de nouveaux inscrits a intervalles reguliers, toutes les deux semaines. Nous avons pris note des caracteristiques sociodemographiques de ces participants ainsi que de l'evolution des reponses afin de determiner le degre de sensibilisation a la situation, la confiance vis-a-vis de diverses sources d'information et le risque pergu. Nous avons employe des modeles de regression logistique multivariee pour examiner les liens qui existent entre la perception du risque et la frequence a laquelle les repondants declarent avoir adopte un comportement de protection. Resultats Notre cohorte de 633 participants a fourni 2857 reponses uniques lors des sept sondages sur la COVID-19. La plupart etaient d'accord ou totalement d'accord pour dire que les informations provenant de sources gouvernementales officielles (99,1%; 528/533) et d'agences de presse etablies a Singapour (97,9%; 522/533) etaient fiables. La confiance envers la communication du gouvernement etait etroitement liee a l'intensite de la menace ressentie (odds ratio, OR: 2,2; intervalle de confiance de 95%, IC: 1,6--3,0), mais inversement proportionnelle au risque d'infection pergu (OR: 0,6; IC de 95%: 0,4-0,8) ou au risque de deces en cas d'infection (OR: 0,6; IC de 95%: 0,4-0,9). Cette confiance etait egalement associee a une probabilite accrue d'adoption d'un comportement de protection. Conclusion Nos resultats montrent que la confiance est un outil indispensable pour gerer la progression d'une epidemie. Les multiples etudes realisees par nos soins ont livre un retour d'experience en temps reel qui a permis de mieux comprendre les interactions entre perception, confiance et comportement. [phrase omitted] Objetivo Evaluar como las percepciones y la confianza del publico en las comunicaciones del gobierno influyeron en la adopcion de un comportamiento protector en Singapur durante la pandemia de la enfermedad por coronavirus de 2019 (COVID-19). Metodos A mediados de 2019, se inicio el estudio de cohorte de la poblacion local para evaluar la percepcion que tiene el publico sobre los brotes epidemicos de las enfermedades infecciosas. Tras la notificacion del primer caso de la COVID-19 en Singapur el 23 de enero, se iniciaron una serie de siete sondeos sobre la COVID-19, tanto a personas que ya estaban participando como a personas nuevas que se inscribian con regularidad, cada dos semanas. Ademas de las propiedades sociodemograficas de las personas participantes, se registraron las nuevas respuestas para juzgar el conocimiento de la situacion, la confianza en las diversas fuentes de informacion y la percepcion del riesgo. Se emplearon modelos de regresion logistica multivariante para evaluar las asociaciones con las percepciones de riesgo y las frecuencias adoptadas de comportamientos protectores que facilitaron las personas participantes. Resultados La cohorte de esta investigacion integrada por 633 personas aporto 2857 respuestas unicas durante los siete sondeos de la COVID-19. La mayoria estuvo de acuerdo o muy de acuerdo en que la informacion de las fuentes oficiales del gobierno (99,1 %; 528/533) y de las agencias de noticias con sede en Singapur (97,9 %; 522/533) era fiable. La confianza en las comunicaciones del gobierno se asocio de manera significativa con una mayor percepcion de amenaza (oportunidad relativa, OR: 2,2; intervalo de confianza del 95 %, IC: 1,6-3,0), pero se asocio de manera inversa con la percepcion de riesgo de infeccion (OR: 0,6; IC del 95 %: 0,4-0,8) o de riesgo de muerte si habia contagio (OR: 0,6; IC del 95 %: 0,4-0,9). La confianza en las comunicaciones del gobierno tambien se asocio con una mayor probabilidad de adoptar comportamientos protectores. Conclusion Los resultados indican que la confianza es un elemento vital para gestionar un brote epidemico en evolucion. Los estudios que se realizaron de manera repetida aportaron informacion en tiempo real, lo que permitio mejorar la comprension de la interaccion entre las percepciones, la confianza y el comportamiento., Introduction The emergence of coronavirus disease 2019 (COVID-19) in China in December 2019 resulted in a global and rapidly rising number of cases and deaths. (1) Many countries responded with [...]

Objective: This study investigated the extent to which the efficacy of a hypertension awareness programme in Singapore may differ based on age, gender, race and housing type (as proxy for income). Method: Pre- and post-programme survey responses on blood pressure (BP) knowledge and beliefs from 9,960 grade 5 students were assessed. Post-programme responses from 5,361 adult family members were also evaluated. Results: Female students were more likely to show better BP knowledge and beliefs. As compared to Chinese students, Malay students had lower levels of BP knowledge and attitudes, while Indian students possessed stronger attitudes. Programme efficacy among students in the most affordable housing was the least favourable. In the adult family member sample, Malay and Indian adults had higher self-confidence and intention to measure their BP in the future than the Chinese. Adult respondents in the most affordable housing possessed the least favourable beliefs towards BP measurement. Older adults, men, Malays and residents in affordable housing types had higher odds of being found with hypertension when tested at home. Conclusion: Despite the same hypertension education programme being implemented, disparities in programme impact were apparent in both student and adult sample across race, housing type and, to a lesser extent, gender. Future interventions should consider these disparities when developing health education programmes.

Challenges posed by infectious disease outbreaks have led to a range of participatory mobile phone-based innovations that use the power of crowdsourcing for disease surveillance. However, the dynamics of participatory behavior by crowds in such interventions have yet to be examined. This article reports results from a baseline evaluation of one such intervention called "Mo-Buzz", a mobile-based crowdsource-driven socially mediated system developed to address gaps in dengue surveillance and education in Colombo, Sri Lanka. We conducted a 30-minute cross-sectional field survey (N = 404) among potential users of "Mo-Buzz" in Colombo. We examined individual, institutional, and cultural factors that influence their potential intention-to-use "Mo-Buzz" and assessed if these factors varied by demographic factors. Descriptive analysis revealed high perceived ease-of-use (PEOU; M = 3.81, SD = 0.44), perceived usefulness (PU; M = 4.01, SD = 0.48), and intention-to-use (PI; M = 3.91, SD = 0.46) among participants. Analysis of variance suggested participants in the 31 to 40 years age group reported highest PEOU, whereas the oldest group reported high perceived institutional efficacy (M = 3.59, SD = 0.64) and collectivistic tendencies. Significant differences (at the p < 0.05 level) were also found by education and income. Regression analysis demonstrated that PU, behavioral control, institutional efficacy, and collectivism were significant predictors of PI. We concluded that despite high overall PI, future adoption and use of "Mo-Buzz" will be shaped by a complex mix of factors at different levels of the public health ecology. Implications of study findings from theoretical and practical perspectives related to the future adoption of mobile-based participatory systems in public health are discussed and ideas for a future research agenda presented.

This article focuses on a novel social media-based system that addresses dengue prevention through an integration of three components: predictive surveillance, civic engagement and health education. The aim was to conduct a potential receptivity assessment of this system among smartphone users in the city of Colombo, the epicenter of the dengue epidemic in the island country of Sri Lanka. Grounded in Protection Motivation Theory (PMT) and using a convenience sampling approach, the cross-sectional survey assessed perceived severity (PSe), perceived susceptibility (PSu), perceived response efficacy (PRE), perceived self-efficacy (PSE) and intention-to-use (IU) among 513 individuals. The overall receptivity to the system was high with a score of >4.00 on a five-point scale. Participants belonging to younger, better educated and higher income groups reported significantly better perceptions of the efficaciousness of the system, were confident in their ability to use the system, and planned to use it in the future. PMT variables contributed significantly to regression models predicting IU. We concluded that a social media-based system for dengue prevention will be positively received among Colombo residents and a targeted, strategic health communication effort to raise dengue-related threat perceptions will be needed to encourage greater adoption and use of the system.

Background: Low awareness about palliative care among the global public and healthcare communities has been frequently cited as a persistent barrier to palliative care acceptance. Given that knowledge shapes attitudes and encourages receptiveness, it is critical to examine factors that influence the motivation to increase knowledge. Health information-seeking from individuals and media has been identified as a key factor, as the process of accessing and interpreting information to enhance knowledge has been shown to positively impact health behaviours. Objective: Our study aimed to uncover public sentiments toward palliative care in Singapore. A conceptual framework was additionally developed to investigate the relationship between information-seeking preferences and knowledge, attitudes, receptiveness of palliative care, and comfort in death discussion. Design and Methods: A nationwide survey was conducted in Singapore with 1226 respondents aged 21 years and above. The data were analysed through a series of hierarchical multiple regression to examine the hypothesised role of information-seeking sources as predictors. Results: Our findings revealed that 53% of our participants were aware of palliative care and about 48% were receptive to receiving the care for themselves. It further showed that while information-seeking from individuals and media increases knowledge, attitudes and receptiveness to palliative care, the comfort level in death conversations was found to be positively associated only with individuals, especially healthcare professionals. Conclusion: Our findings highlight the need for public health authorities to recognize people's deep-seated beliefs and superstitions surrounding the concept of mortality. As Asians view death as a taboo topic that is to be avoided at all costs, it is necessary to adopt multipronged communication programs to address those fears. It is only when the larger communicative environment is driven by the media to encourage public discourse, and concurrently supported by timely interventions to trigger crucial conversations on end-of-life issues between individuals, their loved ones, and the healthcare team, can we advance awareness and benefits of palliative care among the public in Singapore. Plain language summary: A nationwide survey to understand public sentiments and the extent that information-seeking preferences can increase knowledge, attitudes, receptiveness of palliative care, and comfort level in death discussion in Singapore Low awareness of palliative care is a barrier that persistently hinders palliative care acceptance among populations in developing and developed countries. As knowledge shapes attitudes and encourages receptiveness, it is vital that researchers uncover factors that influence the motivation to increase knowledge. Health information-seeking is a factor that deserves greater attention in palliative care research because the process of seeking out information on health concerns from other people or the media can greatly increase individuals' knowledge. As such, this nationwide survey involving 1226 participants was carried out in Singapore to understand the public sentiments toward palliative care. It further statistically analyzed if information-seeking (from individuals and the media) will increase knowledge, attitudes, receptiveness toward palliative care, and comfort level in death discussion. Our findings indicated that 53% of our participants were aware of palliative care and about 48% were receptive to receiving the care for themselves. Furthermore, while information-seeking from individuals and media increases knowledge, attitudes, and receptiveness to palliative care, people are only comfortable to engage in death discussion with individuals, especially healthcare professionals. Exposure to media alone is not enough to encourage individuals to want to talk about end-of-life issues including palliative care. As Asians view death as a taboo topic, it is important for public health authorities to recognize people's deep-seated beliefs and superstitions surrounding the concept of mortality. A multipronged communication program is therefore needed to address these fears. It is only when the larger communicative environment driven by the media to encourage public discourse, and concurrently supported by timely interventions to trigger crucial conversations on end-of-life issues between individuals, their loved ones, and the healthcare team, can we advance awareness and benefits of palliative care among the public in Singapore. [ABSTRACT FROM AUTHOR]

Objective: Examining factors influencing food label use among Singapore's supermarket shoppers using the Theory of Planned Behavior. Design: A point-of-purchase survey among general shoppers in 2 supermarkets. Setting: Singapore, a country whose population is exposed to a wide range of food labeling formats because of the import-dependent nature of the food industry. Participants: A total of 200 shoppers (Chinese [75.5%], Malays [8.5%], and Indians [7.0%]) participated in the survey. Main Outcome Measures: Independent variables composed of attitudes and subjective norms (both 5-point Likert); perceived behavioral control and diet-health concern (both 5-point semantic differential); and knowledge (18-item index). Dependent variables were intention to use food labels (5-point differential scale) and actual use of food labels (19-item index). Analysis: Data were analyzed using descriptive statistics, mean analysis, and multivariate linear regression. Results: Low levels of knowledge and health literacy were found. Attitudes, subjective norms, and behavioral control differed significantly by age and ethnicity. Subjective norms and diet-health concern were significant predictors of intention to use food labels. Conclusions and Implications: Lack of knowledge but positive attitudes toward food labels make Singapore's consumers vulnerable to misusing or being misled by food label information. Demographic differences demonstrate the need to develop targeted educational interventions and enhance awareness of and ability to use food labels. (Contains 7 tables.)

Online harassment is a widespread phenomenon with consequential implications, especially for adolescents, who tend to engage in high-risk behavior online. Through the use of Protection Motivation Theory (PMT), we examine the predictors motivating the intention of youths to adopt protection behavior against online harassment. A survey was conducted with 537 youths from a stratified sample in Singapore. Regression analyses showed that perceived severity of online harassment, response efficacy and self efficacy of online protective behavior were significant predictors of behavioral intention with varying weights. The sole exception was perceived susceptibility to online harassment, which did not significantly predict behavioral intention. Gender and age were also found to moderate adolescents' uptake of protective behavior. The results suggest that public service programs targeted at educating youths should aim to increase coping appraisals and emphasize the severity of online harassment. Targeted educational programs could include those aimed at specific age or gender groups. (Contains 3 tables and 3 figures.)