Ethics & Engagement across the Wellcome Trust Major Overseas Programmes

Risk Perception and Vulnerability to Perceived Threat of COVID-19


My great passion is health service improvement for young people through the integration of public health palliative care in mainstream care. My work is focused on the personal experiences of these young people and their families and promoting long and healthy lives by affording them the chance to develop adaptive skills. Working with young people has increased my interest in participatory research approaches, which I find helpful in eliciting and engaging participants. It also increases collaborative work and co-production of knowledge. 

Project Summary:


Late 2019, the world was confronted with an infectious disease causing a global pandemic which necessitated the World Health Organisation (WHO) declaring it a global pandemic on 11 March 2020. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed as the virus that led to a disease widely known as COVID-19 which to date is continuing to spread throughout the world with a devastating effect, leading to approximately 1,287,095 total cases and 70,523 deaths globally as of 6th April 2020.

As of 18 March 2020, the mortality rate of COVID-19 was 4% with no cure or vaccine in sight. The most effective strategies to stop transmission include identification of suspect cases, testing and quarantine of infected individuals, handwashing and physical distancing 1. These strategies largely depend on the behaviour of individuals and their willingness to follow these recommendations. This precautionary behaviour that local authorities and states advise on should take into consideration the public’s risk perception and how people perceive these strategies to be effective. The analysis of behaviour and environment risk factors is an essential step and part of the planned health education and health promotion model which can help get a better understanding of why people may or may not adopt precautionary practices2. The effectiveness of these non-pharmaceutical interventions have been proven effective while we await the development and distribution of vaccines and antiviral drugs, however, largely dependent on the public’s cooperation3,4.

The long-term goal of this project is to develop counter measures to increase risk communication, reduce misinformation and promote the adoption and adherence of precautionary behaviour. This will be done by gaining more insight into risk perceptions and their relationship with the adoption of precautionary behaviours as well as the implications of these in public health preparedness, response and prevention interventions.

Study Objectives
1. To understand how the risk of COVID-19 is perceived in a rural district, South Africa.
2. To investigate the importance of risk perception and how it informs behaviours (actions) in relation to precautionary actions.
3. To investigate how greater vulnerability (e.g. age, gender, comorbidities) is understood and how it informs behaviours (actions) in relation to precautionary actions.
4. To identify ethical dilemmas posed by COVID-19 recommended precautionary behaviours (i.e. physical distancing, handwashing etc) in resource-limited settings where services are not accessible.
5. To describe the community resources and actions that can be harnessed in the COVID19 response.

The study will be conducted in the Population Intervention Programme Demographic Surveillance Area (PIPSA) of the Africa Health Research Institute (AHRI), situated in one of the poorest districts in South Africa with 98% of the population living in rural homesteads; 22% have access to safe water; and 10 % of households are within 15 min’ travel time (driving) of a health clinic 5. Most households derive livelihoods from subsistence agriculture and social grants.

Sampling and recruitment
To reduce social interactions, 30 -45-minute telephone interviews with five groups of people across the age groups will be conducted.

1) Authority leaders - Traditional/Tribal, CABs/Religious leaders/Traditional health practitioners/municipal and war rooms (n=10).
2) Migrants/mobile individuals (n=10).
3) Older people > 50 years classified as being more at risk (n = 10).
4) People living with HIV (n = 10).
5) Adolescents and young adults as well as local youth leaders (n = 10).

The potential participants (Groups 2-5) will be identified through the AHRI PIPSA database using the above group classifications. We will also use some of the existing community-based studies as a sampling frame. Group 1 participants will be recruited following the appropriate chain of command, by first seeking permission from the King ‘Inkosi’ and Great Chief ‘uNdunankulu’ and then approaching the tribal authority members ‘Izinduna’. This will be facilitated by our operations and public engagement departments who have longstanding relationship and understanding with the local tribal authority. This group of participants is quite important as the local community has great respect and are governed by the tribal authority who can be influential in such situations. All respondents will be given the opportunity to take part in follow up interviews.

1. Li Q, Guan X, Wu P, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia. N Engl J Med. January 2020. doi:10.1056/nejmoa2001316
2. Brug J, Te Velde SJ, Chinapaw MJM, et al. Evidence-based development of school-based and family-involved prevention of overweight across Europe: The ENERGY-project’s design and conceptual framework. BMC Public Health. 2010;10:276. doi:10.1186/1471-2458-10-276
3. Davey VJ, Glass RJ, Min JH, Beyeler WE, Glass LM. Effective, robust design of community mitigation for pandemic influenza: A systematic examination of proposed US guidance. PLoS One. 2008;3(7):e2606. doi:10.1371/journal.pone.0002606
4. Poletti P, Ajelli M, Merler S. The effect of risk perception on the 2009 H1N1 pandemic influenza dynamics. PLoS One. 2011;6(2). doi:10.1371/journal.pone.0016460
5. Hlabano B. Perceptions of Traditional Healers on Collaborating With Biomedical Health Professionals in Umkhanyakude District of Kwazulu Natal. 2013;(December).

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