Assessing Knowledge, Attitudes, and Behaviors Toward West Nile Virus Prevention Among Adults ≥ 60 Years Old in Maryland: An Application of the Health Belief Model

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West Nile Virus (WNV) is a mosquito-borne virus and the leading cause of arboviral (arthropod-borne) disease in the U.S. While most WNV cases are asymptomatic, 20% of infected people develop WNV fever and < 1% develop severe neurologic disease. Individuals over 50 years old are at greatest risk of severe disease and death. Dramatic increases in WNV activity in 2012 underscored its unpredictable nature and highlighted concerns for adverse effects on older adults. It is important to understand factors that influence this population's engagement in WNV prevention.

This study analyzed data collected by the Maryland Department of Health and Mental Hygiene (DHMH) via cross-sectional survey to identify barriers to WNV prevention among adults ≥60 years of age. Subjects were recruited via stratified random sample of 1,700 households from counties with ≥ two WNV cases, enrolling 211 Maryland adults ≥ 60 years old. Six constructs of the Health Belief Model (HBM)--perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy--were examined to assess how they predicted attitudes and behaviors toward WNV prevention.

Univariate, bivariate and multivariate analyses examined the utility of the HBM for explaining WNV preventive behaviors in Maryland adults. Multivariate logistic regression models tested 36 hypotheses examining associations between HBM constructs and six outcomes: (1) avoiding the outdoors at dusk and dawn, (2) dressing in long-sleeved shirts and long pants when outdoors, (3) using insect repellent on exposed skin, (4) draining standing water from objects around one's property, (5) acceptance of a WNV vaccine, and (6) support for community mosquito control programs.

Findings showed high WNV knowledge and awareness but low perceptions of personal risk for WNV infection. Perceived susceptibility to WNV predicted use of insect repellent, draining of standing water from objects around the home, and acceptance of a WNV vaccine; perceived benefits were associated with draining standing water and support for mosquito control programs. Feelings of worry about WNV may inform future WNV interventions and risk communication to older adults. Findings have implications for theory-based research, which could probe applications of the HBM and other theories in understanding WNV attitudes and behaviors.