Public Trust in Healthcare System and Its Correlates during the COVID-19 Epidemic in Iran

Background: Public trust in the healthcare system is a critical necessity of management in public health crises such as the COVID-19 pandemic. To rapidly assess the public trust in the healthcare system during the COVID-19 epidemic and its correlates in Iran.Methods: A cross-sectional rapid assessment was conducted in Iran during the COVID-19 epidemic in the country. A probability proportional to size multistage random sampling was applied. Sampling was done in 15 provinces. We collected data on public perceived fear, public trust in health system and socio-demographics. Ordinary least square regression modeling was applied to identify correlates of public trust.Results: A total of 5250 adults (response rate: 76%) were participated in the study. Mean of reported trust scores was 50.3±22.8, and of fear scores was 72.0±17.8. Being male (p=0.006), higher levels of education (p<0.001) and socio-economic status (p<0.001), and higher fear scores (p<0.001) were independently correlated with trust in healthcare system. Conclusion: At the time of the COVID-19 epidemic in Iran, public trust in healthcare system is low. A dynamic public epidemic communication with appropriate strategies to communicate with higher social classes is urgent in Iran. Rapid assessments to identify appropriate strategies are needed. These results might be generalizable to the other similar countries during the COVID-19 pandemic.

Public Adults Information Seeking Behaviors During Early Weeks of COVID-19 Epidemic: Early Lessons for Improvement of Epidemic Communication

Background: Public support plays a crucial in managing public health crises. Communicating with the public during a pandemic has a major role in gaining public support. Public information-seeking behaviors are the core element of epidemic communication.. Objectives: The current study aimed to investigate the Iranian information-seeking behaviors during the first three weeks of the COVID-19 pandemic in Iran. Methods: In this cross-sectional study, the use of web search queries to monitor the COVID-19 pandemic in Iran from December 2019 to March 1 2020, is investigated. The Iranian search queries for COVID-19 were evaluated from December 30, 2019, to March 1, 2020. Google trend reports were used to retrieve data on the number of search queries. Queries were categorized into “epidemic news”, “necessary protective equipment”, “prevention strategies”, and “treatment”. To analyze the data, segmented regression was applied. Also, the daily percent change (DPI) was estimated. Results: The frequency of Google searches for COVID19-related queries first increased during the period of 18 - 23 February 2020 (DPC: 34.0; P value < 0.001), and then declined to March 1, 2020 (DPS: -3.9; P value < 0.001). The most prevalent query was “Epidemic news” (54%), followed by “necessary equipment” (33%). The frequency of these two queries increased from 18 - 23 February. "Prevention strategies" was the most common search category on March 1. Conclusions: When an epidemic begins to spread, people try to get the “latest news” and “what they need to protect themselves”.

The relative power of individual distancing efforts and public policies to curb the COVID-19 epidemics

Lockdown curbs the COVID-19 epidemics but at huge costs. Public debates question its impact ompared with reliance on individual responsibility. We aim at understanding how rationally chosen self-protective behavior impacts the spread of the epidemics. We want to, first, assess the value of lockdown compared to a counterfactual that incorporates self-protection efforts under unknown disease prevalence; and second, assess how individual behavior modify the epidemic dynamics when mandatory policies are relaxed. We couple an SLIAR model, that includes asymptomatic transmission, with utility maximization: Individuals trade off economic and wellbeing costs from physical distancing with a lower infection risk. Effort depends on risk aversion, perceptions, and the value of contacts. In a Nash equilibrium, individual uncoordinated efforts yield average contact intensity, which drives epidemic transmission. Equilibrium effort differs markedly from constant, stochastic or proportional contacts reduction. It adjusts to reported cases in a way that creates a slightly decreasing plateau in epidemic prevalence. Calibration on French data shows that the number of deaths with no lockdown but equilibrium efforts is only 1/6 to 1/10 of the number predicted with business-as-usual. However, lockdown saves at least 50% more lives than individual efforts alone. Prolonged weaker restrictions prevent an exponential rebound. Public policies post-lockdown have a limited impact as they partly crowd out individual efforts. Compulsory mask wearing helps resume activity but has no impact on the epidemic. Communication that increases risk salience is more effective.

Three Acts of Resistance during the 2014–16 West Africa Ebola Epidemic

Community engagement is commonly regarded as a crucial entry point for gaining access and securing trust during humanitarian emergencies. In this article, we present three case studies of community engagement encounters during the West African Ebola outbreak. They represent strategies commonly implemented by the humanitarian response to the epidemic: communication through comités de veille villageois in Guinea, engagement with NGO-affiliated community leadership structures in Liberia and indirect mediation to chiefs in Sierra Leone. These case studies are based on ethnographic fieldwork carried out before, during and after the outbreak by five anthropologists involved in the response to Ebola in diverse capacities. Our goal is to represent and conceptualise the Ebola response as a dynamic interaction between a response apparatus, local populations and intermediaries, with uncertain outcomes that were negotiated over time and in response to changing conditions. Our findings show that community engagement tactics that are based on fixed notions of legitimacy are unable to respond to the fluidity of community response environments during emergencies.