Abstract
Background
Understanding how people’s emotions influence their health decisions and behaviours at a population level is fundamental to designing effective communication strategies and public health interventions for infectious disease outbreaks. This review identifies relevant research to assess the role of emotional determinants and their impact on public responses to the risk of infectious disease outbreaks, specifically in relation to the uptake of public health interventions.
Methods
A comprehensive systematic review was conducted exploring the differences in public responses by emotion, infection, outcome and region. A basic consensus approach was followed in which emotional stimuli were categorised as being either pleasant or unpleasant, and predisposing people to bivalent behaviour (i.e., approach or withdrawal). All primary research studies published in five global databases between 1988-2019 were eligible for inclusion. Binomial tests (against a test proportion of 0.5 or 50% for each study outcome) were performed using the direction of effect observed in each study, i.e., either favouring or not favouring intervention uptake.
Results
A total of 75 studies from 28 different nations were eligible for inclusion in the review. A total of 97 correlations were made between 12 emotions, 10 infectious diseases, and the uptake of seven types of public health interventions. Unpleasant emotions were evoked much more often than pleasant following public health risk communications, with fear and anxiety being the most common. Overall, moderate anxiety-related emotions (worry, anxiety, stress, concern) seemed to be much more significant motivators for public action compared to extreme unpleasant emotions (fear, panic, hopelessness, shame), which had a statistically significantly negative effect on the uptake of public health interventions in several cases. Pleasant emotions (empathy, hope) also showed promise as motivators for public health intervention uptake, but more research is needed to corroborate this.
Conclusions
The results of this review show that the public’s emotional responses to epidemics in the past 30 years have played a clear role in determining how successful the rollout of public health interventions has been. Emotions need to be considered in crisis communications, and these research findings can help inform communications strategies in the evolving context of the COVID-19 pandemic and future infectious disease outbreaks.