key: cord-0792335-1rq612hm
authors: Wong, L. P.; Wu, Q. h.; Chen, X.; Chen, Z.; Alias, H.; Shen, M.; Hu, J. c.; Duan, S.; Zhang, J. j.; Han, L.
title: The role of institutional trust in preventive and treatment-seeking behaviors during the 2019 novel coronavirus (2019-nCoV) outbreak among residents in Hubei, China
date: 2020-02-21
journal: nan
DOI: 10.1101/2020.02.15.20023333
sha: b2d17404926d143c3643a718b87b33127a034b2b
doc_id: 792335
cord_uid: 1rq612hm

Background Since December 2019, pneumonia associated with the 2019 novel coronavirus (2019-nCoV) has emerged in Wuhan, China. The exponential increase of the confirmed number of cases of 2019n-CoV is of great concern to the global community. The fears and panic among residents in the epicenters have prompted diverse responses, which are understudied. During such a crisis, community trust and support for the government and health authorities are important to contain the outbreak. We aimed to investigate the influence of institutional trust on public responses to the 2019-nCoV outbreak. Methods An anonymous Internet-based, cross-sectional survey was administered on January 29, 2020. The study population comprised all residents currently residing or working in the province of Hubei, where Wuhan is the capital city. The level of trust in information provision and preventive instructions, individual preventive behaviors and treatment-seeking behaviors were queried. Findings The majority of the participants expressed a great extent of trust in the information and preventive instructions provided by the central government than by the local government. A high uptake of 2019-nCoV preventive measures was found, particularly among people who had been placed under quarantine. Being under quarantine (adjusted odds ratio [OR] = 2.35, 95% confidence interval [CI] 1.80 to 3.08) and having a high institutional trust score (OR = 2.23, 95% CI 1.96 to 2.53) were both strong and significant determinants of higher preventive behavior scores. The majority of study participants (85.7%, n = 3,640) reported that they would seek hospital treatment if they suspected themselves to have been infected with 2019 n-CoV. Few of the participants from Wuhan (16.6%, n = 475) and those participants who were under quarantine (13.8%, n = 550) expressed an unwillingness to seek hospital treatment. Similarly, being under quarantine (OR = 2.36, 95% CI 1.80 to 3.09) and having a high institutional trust score (OR = 2.20, 95% CI 1.96 to 2.49) were two strong significant determinants of hospital treatment-seeking. Interpretation The results of this study suggest that institutional trust is an important factor influencing adequate preventive behavior and seeking formal medical care during an outbreak. In view of the 2019-nCoV being highly pathogenic and extremely contagious, our findings also underscore the importance of public health intervention to reach individuals with poor adherence to preventive measures and who are reluctant to seek treatment at formal health services. Funding National Key R&D Program of China, Ningbo Health Branding Subject Fund, Sanming Project of Medicine in Shenzhen, K.C. Wong Magna Fund in Ningbo University, National Natural Science Foundation of China, Fundamental Research Funds for the Central Universities, China Postdoctoral Science Foundation, and Natural Science Basic Research Program of Shanxi Province. Keywords: 2019-nCoV; institutional trust; preventive behaviors

quarantine (13.8%, n = 550) expressed an unwillingness to seek hospital treatment. 25 Similarly, being under quarantine (OR = 2.36, 95% CI 1.80 to 3.09) and having a high 26 institutional trust score (OR = 2.20, 95% CI 1.96 to 2.49) were two strong significant 27 determinants of hospital treatment-seeking. 28 Interpretation The results of this study suggest that institutional trust is an important 29 factor influencing adequate preventive behavior and seeking formal medical care 30 during an outbreak. In view of the 2019-nCoV being highly pathogenic and extremely 31 contagious, our findings also underscore the importance of public health intervention 32 to reach individuals with poor adherence to preventive measures and who are reluctant 33 to seek treatment at formal health services. We searched PubMed on January 28, 2020, for articles that describe the trust, 48 preventive practices and health-seeking behaviors related to the 2019 novel coronavirus 49 (2019-nCoV) in China, using the search terms "novel coronavirus," "institutional trust," 50 "behavioral change," "protective behaviors," and "treatment-seeking" with no The questionnaire was developed in English and translated into Chinese. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint Figure 3 shows the treatment-seeking behaviours of the study population. Most 204 participants (85.7%, n = 3,640) reported that they would seek treatment at the hospital, 205 whereas 42% (n = 1,782) reported that they would seek traditional healing, and 62.4% 550) of participants who were in the quarantine area reported no intention of seeking 215 treatment in the hospital. In the multivariable analysis, similarly, being quarantined 216 (OR = 2.36, 95% CI 1.80-3.09) and having a high institutional trust score (OR = 2.20, 217 95% CI 1.96-2.49) were two strong significant determinants of treatment-seeking in 218 the hospital.

With the aim of understanding the public behaviour in prevention measures in this crisis 221 that has now become a worldwide concern, this study collected data at the 2019n-CoV 222 outbreak epicentres during a period of exponential growth of the epidemic. This study 223 found a considerably high level of institutional trust among the public in the epicenters. 224 However, trust in the local authority was lower than that in the provincial and central (11, 12) . Healthcare providers can be strong advocates for outbreak prevention efforts 231 in these communities, considering that many expressed a high level of trust in them.

On a positive note, this study revealed that the people in the epicenters adopted a 233 high level of prevention measures. As noted, however, a relatively small proportion 234 reported using face masks at home when they were around household members. overseas countries such as Germany, Japan, and Vietnam, the community in Hubei 239 province and the epicenters should be made aware of the essential importance of 240 wearing face masks when they are around other household members.

The main strength of this study is the finding of the strong influence of institutional 242 trust on overall preventive behaviors, in good agreement with previous studies (8, 11) . 243 As the 2019-nCoV epidemic is still growing exponentially, continued strengthening of 244 institutional trust, and in particular, increasing the trust in the local authority, is essential 245 for emergency management. outbreak control.

The study also found that uptake of prevention practices was poorer among older 247 members of the public, which warrants serious attention. It has been found that older 248 adults affected by 2019-nCoV are likely to have a higher risk of complications and 249 mortality (4). There is a need to find out whether a lack of appropriate prevention 250 practices among people of older age is due to knowledge deficiency or to their being 251 out-of-reach of current public health intervention.

The finding that nearly 15% of people would be reluctant to seek treatment in the 253 hospital if they were suspected to have been infected with 2019-nCoV is clinically 254 important and worrisome. Of utmost importance, a proportion of those participants are 255 in the city of Wuhan and currently under quarantine. The preference for using 256 traditional healing among a minority of the older respondents is also of concern. Refusal 257 to seek hospital treatment not only leads to progress to serious respiratory distress and 258 can be life-threatening, but also increases the chances of spreading the disease. People CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint . https://doi.org/10.1101/2020.02.15.20023333 doi: medRxiv preprint importance of building trust between the public and the government authorities.

This current study has several limitations that should be considered. The first 265 pertains to the cross-sectional nature of the study. Thus, it cannot be used to infer 266 causality. Second, the responses were based on self-report and may be subject to self-267 reporting bias and a tendency to report socially desirable responses. Therefore, the is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint 

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We thank the study participants for their prompt responses. Special acknowledgment for participants who have helped to share the survey link to others in their contact lists.Funding: National Key R&D Program of China, Ningbo Health Branding Subject F

Currently, over a month since the onset of the 2019-nCoV, the epidemic is still Demographic