General population perspectives of dementia risk reduction and the implications for intervention: A systematic review and thematic synthesis of qualitative evidence

Background Evidence for the potential prevention of dementia through lifestyle risk factor modification is growing and has prompted examination of implementation approaches. Understanding the general population’s perspectives regarding dementia risk reduction is key to implementation. This may provide useful insights into more effective and efficient ways to help people change relevant beliefs, motivations and behaviour patterns. We conducted a systematic review and thematic synthesis of qualitative evidence to develop an integrated model of general population dementia risk reduction perspectives and the implications for intervention in research and implementation contexts. Methods and findings We searched electronic databases, supplemented by lateral search techniques, to identify studies published since 1995 reporting qualitative dementia risk reduction perspectives of the non-expert general population who do not have dementia. Thematic synthesis, incorporating an expert panel discussion, was used to identify overarching themes and develop an integrated model to guide intervention to support individuals to adopt and maintain dementia risk reduction behaviour patterns. Quality of included studies and confidence in review findings were systematically appraised. We included 50 papers, reflecting the views of more than 4,500 individuals. Main themes were: 1) The need for effective education about a complex topic to prevent confusion and facilitate understanding and empowerment; 2) Personally relevant short- and long-term benefits of dementia risk reduction behaviour patterns can generate value and facilitate action; 3) Individuals benefit from trusted, reliable and sensitive support to convert understanding to personal commitment to relevant behaviour change; 4) Choice, control and relevant self-regulatory supports help individuals take-action and direct their own progress; 5) Collaborative and empowering social opportunities can facilitate and propagate dementia risk reduction behaviour change; 6) Individual behaviour patterns occur in social contexts that influence beliefs through heuristic processes and need to be understood. Findings indicate that, for intervention: 1) education is key, but both content and delivery need to be tailored; 2) complementary interventions to support self-regulation mechanisms and social processes will increase education effectiveness; 3) co-design principles should guide intervention design and delivery processes; 4) all interventions need to be supported by context-specific data. Conclusions This systematic review and thematic synthesis provides a comprehensive, integrated model of the dementia risk reduction perspectives of the general population and intervention approaches to support behaviour change that can be applied in clinical trial and real-world implementation settings. Findings extend existing knowledge and may assist more effective intervention design and delivery.

A flood-risk-oriented, dynamic protection motivation framework to explain risk reduction behaviours

Private risk reduction behaviours can significantly reduce the negative impacts of flooding and flash floods. Over the past decades, researchers have used various socio-cognitive models or threat and coping mechanisms to explain individual protective behaviours. However, these models ignore the fact that people are not equally ready to act upon a danger, and they (the models) give limited insights into the effectiveness of communication strategies to foster risk reduction behaviours. Therefore, we explored the current state of homeowners' readiness to undertake risk reduction behaviours in flood risk areas by applying a dynamic protection motivation framework. We conducted a survey in an Italian municipality that experienced severe flash flooding in September 2018. The results show that people are motivated by different factors in prompting risk reduction behaviour based on their chosen types of protective measures. For example, people that undertook structural or avoidance measures are more likely to be motivated to protect themselves by increased perceptions of vulnerability and response efficacy and are less worried about expected flood losses compared to people that undertook only basic emergency measures. In this paper, we argue how these new insights contribute to targeting flood risk communication strategies to groups of individuals characterized by different readiness stages and motivations to protect themselves.

A flood risk oriented dynamic protection motivation framework to explain risk reduction behaviours

Private risk reduction behaviours can significantly reduce the negative impacts of flooding and flash floods. Over the past decades, researchers have used various socio-cognitive models or threat/coping mechanisms to explain individual protective behaviours. However, these models ignore that people are not equally ready to act upon a danger and they give limited insights into the effectiveness of communication strategies to foster risk reduction behaviours. Therefore, we explored the current state of homeowner's readiness to undertake risk reduction behaviours in flood risk areas by applying a dynamic protection motivation framework. We conducted a survey in an Italian municipality that experienced severe flash flooding in September 2018. The results show that people are motivated by different factors in prompting risk reduction behaviour based on their type of protective measures. For example, people that undertook structural or avoidance measures are more likely to be motivated to protect themselves by increased perceptions of vulnerability and response efficacy, and are less worried about expected flood losses compared to people that undertook only basic emergency measures. In this paper, we argue how these new insights contribute to target flood risk communication strategies to groups of individuals characterized by different readiness stages and motivations to protect themselves.

Novel outreach settings to enhance sexually transmitted infection/HIV awareness, diagnosis and treatment in hard-to-reach populations

Despite recent rises in the number of cases of sexually transmitted infections (STIs) such as syphilis and gonorrhoea in England and increasing rates of HIV diagnosis among several men who have sex with men populations, many individuals are still not engaging with sexual health services. The John Hunter Clinic for Sexual Health, Chelsea and Westminster Hospital, London set up outreach clinics at the two world’s largest adult lifestyle exhibitions in 2013 and 2015. This was the first time that a sexual health screening and promotion service was available at these large-scale (over 10,000 attendees at each) adult lifestyle events. A total of 381 individuals underwent STI screening across the two events. Nineteen (5.0%) patients were diagnosed with an infection. Twelve (3.1%) patients with Chlamydia trachomatis, three (0.8%) patients with syphilis, one (0.3%) patient with Neisseria gonorrhoeae, one (0.3%) patient with HIV, one (0.3%) patient with hepatitis B and one (0.3%) patient with hepatitis C. All 19 patients were promptly contacted with their results and had arrangements made for treatment or were referred for specialist follow up. Where possible, contact tracing was also performed. Implementing such outreach-based projects is challenged by lack of on-site laboratory support, high staffing demands and potentially high costs. However, we achieved a total HIV screening uptake rate of 94.5% amongst our outreach clinic attendees (versus 67% nationally in conventional sexual health clinic attendees) with an HIV positivity rate of 0.3% (versus 0.2% nationally in high HIV prevalence band populations). Additionally, 30.7% had never been tested for HIV previously (versus 20.7% nationally). Our work demonstrates that these strategies can help to address issues related to lack of STI/HIV screening in hard-to-reach populations and promote risk reduction behaviour.

Parental risk perception of mycotoxins and risk reduction behaviour

Purpose – The purpose of this paper is to analyse the parental risk perception of mycotoxins (mould toxins) related to child health in Germany. It ascertains the parental risk reduction behaviour operationalised as parental additional willingness to pay (aWTP) for special child products. It investigates the interrelationships between parental risk perceptions and risk reduction behaviour. Design/methodology/approach – Altogether, 771 questionnaires were sent to 17 day-care centres in Lower Saxony, Germany. A total of 238 questionnaires were completed. The Perceived Food Risk Index was used to identify the main dimensions of parental risk perception of mycotoxins. Open and closed questions measured aWTP for risk reduction and parental risk estimates. Findings – The respondents believed that mycotoxins posed a moderate health risk for children in Germany. However, parental risk assessment was found to be subjected to an optimistic bias. Nevertheless, the parents were willing to pay a premium to protect their children's health against mycotoxins. Parental risk perception of mycotoxins could be described by two dimensions named “Dread” and “Control”. “Dread” and “Control” predicted aWTP for risk reduction as well as being involved in the genesis of optimistic bias. Research limitations/implications – Information regarding mycotoxins provided in the questionnaire probably influenced parental responses. This limits the generalisation of the findings. Originality/value – This research provides initial findings regarding parental risk perceptions of mycotoxins and its impact on risk reduction behaviour. The results are useful for the development of effective risk management and thus for the protection of child health.