Santosh Vijaykumar

Determinants of Food Label Use among Supermarket Shoppers: A Singaporean Perspective

OBJECTIVE Examining factors influencing food label use among Singapores supermarket shoppers using the Theory of Planned Behavior. DESIGN A point-of-purchase survey among general shoppers in 2 supermarkets. SETTING Singapore, a country whose population is exposed to a wide range of food labeling formats because of the import-dependent nature of the food industry. PARTICIPANTS A total of 200 shoppers (Chinese [75.5%], Malays [8.5%], and Indians [7.0%]) participated in the survey. MAIN OUTCOME MEASURES Independent variables composed of attitudes and subjective norms (both 5-point Likert); perceived behavioral control and diet-health concern (both 5-point semantic differential); and knowledge (18-item index). Dependent variables were intention to use food labels (5-point differential scale) and actual use of food labels (19-item index). ANALYSIS Data were analyzed using descriptive statistics, mean analysis, and multivariate linear regression. RESULTS Low levels of knowledge and health literacy were found. Attitudes, subjective norms, and behavioral control differed significantly by age and ethnicity. Subjective norms and diet-health concern were significant predictors of intention to use food labels. CONCLUSIONS AND IMPLICATIONS Lack of knowledge but positive attitudes toward food labels make Singapores consumers vulnerable to misusing or being misled by food label information. Demographic differences demonstrate the need to develop targeted educational interventions and enhance awareness of and ability to use food labels.

Addressing the Challenge of Informed Decision Making in Prostate Cancer Community Outreach to African American Men

African American men are disproportionately affected by prostate cancer. This project adopted a community-based participatory approach to design and pilot test an educational outreach strategy that promotes informed decision making about screening among African American men in community settings in St. Louis, Missouri. Interviews with local subject matter experts informed the design of the strategy. The revised curriculum was pilot tested in 2009 with 63 men who completed pre- and posttest surveys that measured knowledge, norms, beliefs, decision self-efficacy, and screening intention. The intervention resulted in statistically significant improvement in prostate cancer knowledge, decreased perceived risks and barriers, and increased screening decision self-efficacy. The educational outreach strategy offered in community settings was effective in improving knowledge, beliefs, and decision self-efficacy related to prostate cancer screening. This project sought to devise a screening outreach strategy that struck a balance between the imperatives of informed decision-making goals and the pragmatics of community settings. The findings suggest the need for further research to assess the effectiveness of community-based outreach efforts in enhancing engagement of men in decision making related to screening, diagnostics, and treatment.

Digital Participatory Surveillance and the Zika Crisis: Opportunities and Caveats.

Managing the global threat of Zika requires innovative solutions. This article examines the potential of Digital Participatory Surveillance to support the management of global disease outbreaks by enabling citizens to report signs of infection. We discuss the status of the current evidence-base, contextual factors influencing user engagement and data quality, challenges for evaluation, and unique aspects of Zika with implications for design. We also suggest priorities for research, development and practice, to help translate the theoretical benefits of these methods into meaningful improvements in outbreak monitoring and public health.

Social Media and the Virality of Risk: The Risk Amplification through Media Spread (RAMS) Model

Abstract Social media have transformed traditional configurations of how risk signals related to an infectious disease outbreak (IDO) are transmitted from public health authorities to the general public. However, our understanding of how social media might influence risk perceptions during these situations, and the influence of such processes on ensuing societal responses remains limited. This paper draws on key ideas from the Social Amplification of Risk Framework (SARF), Socially Mediated Crisis Communication (SMCC) model and a case study of the US Centers for Disease Control and Prevention’s (CDC) social media management of the 2009 H1N1 pandemic to propose a new conceptual model. The Risk Amplification through Media Spread (RAMS) model brings clarity to the new complexities in media management of IDOs by delineating the processes of message diffusion and risk amplification through communication channels that are often highly integrated due to social media. The model offers recommendations for communication priorities during different stages of an IDO. The paper concludes with a discussion of the RAMS model from theoretical and applied perspectives, and sets the direction for future conceptual refinement and empirical testing.

A Social Media mHealth Solution to Address the Needs of Dengue Prevention and Management in Sri Lanka

Background Sri Lanka has witnessed a series of dengue epidemics over the past five years, with the western province, home to the political capital of Colombo, bearing more than half of the dengue burden. Existing dengue monitoring prevention programs are exhausted as public health inspectors (PHIs) cope with increasing workloads and paper-based modes of surveillance and education, characterizing a reactive system unable to cope with the enormity of the problem. On the other hand, the unprecedented proliferation and affordability of mobile phones since 2009 and a supportive political climate have thus far remained unexploited for the use of mobile-based interventions for dengue management. Objective To conduct a needs assessment of PHIs in Colombo with respect to their dengue-related tasks and develop a new mobile-based system to address these needs while strengthening existing systems. Methods One-on-one in-depth interviews were conducted with 29 PHIs to a) gain a nuanced, in-depth understanding of the current state of surveillance practices, b) understand the logistical, technological and social challenges they confront, and c) identify opportunities for mobile-based interventions. Quantitative analysis included simple descriptive statistics while qualitative analysis comprised textual analysis of 209 pages of transcripts (or nearly 600 minutes of conversations) using grounded theory approaches. Results Current paper-based data collection practices for dengue surveillance involved a circuitous, time consuming process that could take between 7-10 days to officially report and record a single case. PHIs confronted challenges in terms of unreliable, standalone GIS devices, delays in registering mosquito breeding sites and lack of engagement from communities while delivering dengue education. These findings, in concert with a high motivation to use mobile-based systems, informed the development of Mo-Buzz, a mobile-based system that integrates three components – digitized surveillance, dynamic disease mapping and digitized dengue education – on a common platform. The system was developed through an iterative, evolutionary, collaborative process, consistent with the Spiral model of software development and is currently being used by all 55 PHIs in the CMC system. Conclusions Given the entrenched nature of existing paper-based systems in PHIs’ work habits, we expect a gradual adoption curve for Mo-Buzz in the future. Equally, we expect variable adoption of the system with respect to its specific components, and specific PHI sub-groups (younger versus older). The Mo-Buzz intervention is a response to multiple calls by the global mHealth community for collaborations in the area of mobile interventions for global health. Our experience revealed that the benefits of this paradigm lies in alleviating country-specific public health challenges through a commonly shared understanding of cultural mores, and sharing of knowledge and technologies. We call upon future researchers to further dissect the applicability of the Spiral Model of software development to mHealth interventions and contribute to the mHealth evidence debate from theoretical and applied perspectives.

Baseline Evaluation of a Participatory Mobile Health Intervention for Dengue Prevention in Sri Lanka

Challenges posed by infectious disease outbreaks have led to a range of participatory mobile phone–based innovations that use the power of crowdsourcing for disease surveillance. However, the dynamics of participatory behavior by crowds in such interventions have yet to be examined. This article reports results from a baseline evaluation of one such intervention called Mo-Buzz, a mobile-based crowdsource-driven socially mediated system developed to address gaps in dengue surveillance and education in Colombo, Sri Lanka. We conducted a 30-minute cross-sectional field survey (N = 404) among potential users of Mo-Buzz in Colombo. We examined individual, institutional, and cultural factors that influence their potential intention-to-use Mo-Buzz and assessed if these factors varied by demographic factors. Descriptive analysis revealed high perceived ease-of-use (PEOU; M = 3.81, SD = 0.44), perceived usefulness (PU; M = 4.01, SD = 0.48), and intention-to-use (PI; M = 3.91, SD = 0.46) among participants. Analysis of variance suggested participants in the 31 to 40 years age group reported highest PEOU, whereas the oldest group reported high perceived institutional efficacy (M = 3.59, SD = 0.64) and collectivistic tendencies. Significant differences (at the p < .05 level) were also found by education and income. Regression analysis demonstrated that PU, behavioral control, institutional efficacy, and collectivism were significant predictors of PI. We concluded that despite high overall PI, future adoption and use of Mo-Buzz will be shaped by a complex mix of factors at different levels of the public health ecology. Implications of study findings from theoretical and practical perspectives related to the future adoption of mobile-based participatory systems in public health are discussed and ideas for a future research agenda presented.

Social Media-Based Civic Engagement Solutions for Dengue Prevention in Sri Lanka: Results of Receptivity Assessment.

This article focuses on a novel social media-based system that addresses dengue prevention through an integration of three components: predictive surveillance, civic engagement and health education. The aim was to conduct a potential receptivity assessment of this system among smartphone users in the city of Colombo, the epicenter of the dengue epidemic in the island country of Sri Lanka. Grounded in Protection Motivation Theory (PMT) and using a convenience sampling approach, the cross-sectional survey assessed perceived severity (PSe), perceived susceptibility (PSu), perceived response efficacy (PRE), perceived self-efficacy (PSE) and intention-to-use (IU) among 513 individuals. The overall receptivity to the system was high with a score of >4.00 on a five-point scale. Participants belonging to younger, better educated and higher income groups reported significantly better perceptions of the efficaciousness of the system, were confident in their ability to use the system, and planned to use it in the future. PMT variables contributed significantly to regression models predicting IU. We concluded that a social media-based system for dengue prevention will be positively received among Colombo residents and a targeted, strategic health communication effort to raise dengue-related threat perceptions will be needed to encourage greater adoption and use of the system.

'It's effective but should I bother?' A study of personal protection measures against Malaria in urban India.

OBJECTIVES Malaria affects millions of people in urban and rural India every year. This study addresses two main gaps in current research: 1) attitudes towards personal protective strategies against Malaria among urban populations; and 2) understanding of the extent to which urban health information seeking preferences shape preventive behaviours. STUDY DESIGN Cross-sectional face-to-face surveys using stratified sampling design. METHODS A 60-min survey was carried out to 1000 middle-of-pyramid (MOP) population in five main cities in India by trained interviewers. Variables assessed included perceived effectiveness and actual practice of 14 scientific and indigenous personal protection methods, Malaria-related attitudes (susceptibility, severity and response efficacy) and health information seeking preferences. RESULTS Actual practice of Malaria preventive behaviours was found to be significantly lower than the perceived effectiveness of each of the fourteen scientific and indigenous methods. Television, newspapers, and mobile phones were reported as the top three preferred media for seeking public health information. Lastly, perceived susceptibility, response efficacy, and health-related media use were found to play significant roles in predicting actual practice behaviours. CONCLUSIONS Our study highlights a need for health authorities to focus on translating positive attitudes to actual practice of preventive behaviours. Communication efforts may focus on the use of TV, newspapers and mobile phones for greater reach and efficacy. Other implications for Malaria prevention programs are discussed.

“Natural” and “Fresh”: An Analysis of Food Label Claims in Internationally Packaged Foods in Singapore

Food claims invite controversies on account of their potential to mislead consumers while at times masquerading as health information devices. In the United States, Europe, and Australia/New Zealand, scholars have extensively studied the prevalence of food claims, the regulatory repercussions, and effects of such claims on consumers’ food perceptions and dietary choices. Our study is an attempt to address a gap in related research focused on Asia by situating the inquiry in Singapore where consumers are exposed to a wide variety of such claims due to the universality of food imports. This study examines the state of food claims by the food product’s region of origin, and focus specifically on the use of terms “natural” and “fresh” on food labels. We present recommendations for food marketing policymakers and practitioners.

Comparing State Legislative Aides’ Perspectives on Tobacco Policymaking in States With Strong and Weak Policies A Qualitative Study

Purpose: The study compared perceptions of state legislative aides about tobacco policymaking in states with strong and weak tobacco control policies. Approach: Qualitative in-depth interviews carried out in 2009. Setting: The US states were ranked on a combination of tobacco prevention funding, taxes, and presence of smoke-free policies. States at the top and bottom of the rankings were chosen. Participants: Interviews were conducted with 10 legislative aides in 5 states with strong tobacco control policies and 10 aides in 7 states with weak policies. Method: Twenty semistructured interviews were conducted, coded, and analyzed using a consensus coding process. Results: Tobacco control was a lower priority in states with weak policies, and respondents from these states listed more barriers to tobacco control policymaking than those from states with strong policies. Successful arguments for tobacco control emphasized operational applications, for example, enhanced revenue from tobacco taxes or safety of children and employees. Conclusion: Our findings support propositions posited in the Advocacy Coalition Framework. They point to the preeminence of contextual factors, notably political leanings and economic climate on success of policy change efforts. Lessons learned from participants from states with strong policy nonetheless show promise for success in states with weak policy.