Healthcare workers (HCW) in general are considered to be at high risk during epidemics. Their training for Ebola provided by Médecins sans frontières (MSF) is presently based on imparting factual information, which does not necessarily translate into knowledge or appropriate practices. We aimed to understand the importance of risk perception during training. A total of 130 MSF-trained HCW travelling to Africa during the Ebola epidemic of 2014–2015 participated in this longitudinal cohort study. Their baseline knowledge was good but did not significantly increase after training except for minor symptoms, case fatality rate and wearing personal protective equipment as a preventive measure. Additionally, they underestimated their likelihood for contracting Ebola compared to their colleagues of same age and sex, and despite their high-risk status, they showed little concern about contracting Ebola during their mission. Our findings suggest that the use of individualized risk feedback during training in appraising erroneous perceptions will increase adherence to preventive measures.
Risk perception involves two components: likelihood and severity. Severity estimate is given by the perception of severity of the disease like mortality and morbidity. Likelihood estimates are influenced by psychological components like emotions (e.g. worry, concern), illusion of control (the tendency to overestimate one’s personal control over events) and comparative optimism (CO) (the tendency to consider that bad events are more likely to happen to others than to oneself). An illusion of control over adverse events can decrease anxiety; as a result, a person can become more relaxed and engage in risky behaviours. Comparative optimism, which is also called unrealistic optimism because it refers to the erroneous estimate that one’s personal risk is less than that of the average peer of the same sex and age, has been documented in over a thousand studies and for various undesirable events such as diseases and natural disasters. In general, optimistic biases lead to underestimation of risks, and those who perceive lower risks are routinely less likely to show interest in taking preventive action. Personal control and CO play an important role in risk perceptions and risk acceptability. As such, they are important constructs to understand health behaviour.