Perceptions and Plans for Prevention of Ebola: Results From a National Survey

Bridget Kelly; Linda Squiers; Carla Bann; Alexander Stine; Heather Hansen; Molly Lynch


BMC Public Health. 2015;15(1136) 

In This Article


In the fall of 2014, the Ebola outbreak in West Africa was ongoing, with cases stabilizing in Guinea and beginning to decline in Liberia, but "gathering pace" in Sierra Leone.[1] At that time, West Africa had confirmed more than 18,000 cases and 6800 deaths. U.S. health officials had treated one patient diagnosed in the U.S., two healthcare workers infected in the U.S., and several U.S. citizens infected in West Africa and brought to the U.S. for treatment. The news media covered the epidemic heavily; one report indicated that between October 3 and November 5, the major news networks aired 1000 Ebola segments.[2]

The U.S. public often turns to media, and particularly television, in an emergency. Depending on the content and framing of news stories, media coverage can have a significant impact on those who are exposed to it. Several theories of news media effects provide insight about how such effects occur. According to agenda setting theory, the media tells us what to think about by varying the prominence of certain issues in the news. Second-level agenda setting suggests the tone and perception used to cover an issue can also impact how we think about that particular issue.[3–5] The media may also use different frames to present issues in ways that will be most likely to resonate with their audience.[6] For example, a disease outbreak could be framed in terms of its economic impact, rather than its immediate health consequences. Social amplification of risk theory suggests that hazards or risks interact with psychological, social, institutional, and cultural processes in ways that may amplify or attenuate public responses to the risk.[7] Signals about risk are processed by individual and social amplification stations, including the news media and interpersonal networks. Attributes of information that may influence the social amplification include volume and the extent of dramatization,[7] both particularly relevant in the case of Ebola news coverage.

In some cases, when content is complete and accurate, it can reduce levels of fear and anxiety.[8] However, some literature provides empirical evidence for social amplification, showing that overly frequent news coverage can lead to distorted perceptions of susceptibility and severity,[9] essential constructs of the Health Belief Model.[10] In a 2008 experiment at McMaster University in Ontario, researchers asked undergraduates and medical students their impressions of ten infectious diseases. Five of the diseases had received more media coverage than the other five. The "high-media frequency" diseases were rated as more serious than the more obscure diseases. Both groups overestimated the chances they would get one of the frequently reported diseases.[11]

In extreme cases, media coverage can increase fear to the level of panic. For example, in a 1994 outbreak of plague in India, the announcement of the disease provoked many people to flee the state of Surat, carrying the disease to other parts of the country.[12]

Although news coverage may increase perceived susceptibility and severity, its effects on knowledge are more complex. Several studies have highlighted the high prevalence of misconceptions or low levels of knowledge despite seemingly ubiquitous news coverage.[11] Following the H1N1 pandemic, a survey of Arizona residents found 34 % were unaware the terms "swine flu" and "H1N1" referred to the same virus. Results of a systematic review of community response studies during that same period found awareness of the pandemic was high, although knowledge levels were only moderate.[13]

Even less is known about preparedness behaviors during outbreaks. Literature on previous pandemics shows behavioral intentions for recommended behaviors like hand washing, can be high.[14] Many of these studies have been limited to specific geographic areas.

It is unclear what effect news coverage of Ebola in 2014 might have had on the American public. Although a number of polls conducted by news agencies have investigated the perceived threat, there remains a paucity of peer-reviewed literature on knowledge, perceptions, and behaviors related to Ebola in the U.S. The purpose of the survey described here was to determine what Americans knew about Ebola, how they perceived the threat, and what steps they had taken to protect themselves and their family members during the winter 2014 holiday season. Based on the literature and relevant theory, we hypothesized that Americans may have had higher levels of perceived threat than were warranted by actual risk. We measured attitudes and intentions as described in the Theory of Reasoned Action.[15] In addition, we assessed perceptions and beliefs about possible Ebola-related policies, such as mandatory quarantine and travel bans.