Discussion
gonorrhoea reinfection
SMALLPOX, RECRUITMENT, INFLUENZA A H1N1, STIS, REINFECTED
We investigated mpox attitudes, beliefs and intended behaviours in a general population sample and three GBMSM samples. Samples differed by sociodemographic characteristics. This was reflected in intended behaviours, with GBMSM recruited from Grindr or Meta being more likely to intend to seek help immediately for mpox symptoms, completely stop sexual contact when symptomatic, and be vaccinated for smallpox if advised. High rates of smallpox vaccination in these samples perhaps reflect that they were mostly educated and working, and thus more likely to be health literate and engaged with services. This was also reflected in knowledge about mpox, with Grindr and Meta samples being more likely to correctly identify mpox transmission modes and the symptoms of mpox. Within the general population, rates of ‘don’t know’ answers were high, with 18.4% selecting ‘don’t know’ when asked what the main symptoms of mpox were, and 18.7%–24.2% selecting ‘don’t know’ for transmission modes (except for having sex with someone who has mpox, where 13.9% selected ‘don’t know’). This is similar to other surveys of the general population, where 24% of people were not sure if mpox usually spreads by close contact with an infected person.There were no effects of motivational messaging on our behavioural outcomes, except for in the Meta sample for intention to self-isolate, share details of all recent sexual contacts and be vaccinated for smallpox if advised. For these outcomes, intention to engage with protective behaviours was higher in the control group. In practice, however, intentions were very similar (means changed by 0.1–0.4) and this is unlikely to represent a meaningful difference. Another study investigating gonorrhoea reinfection in young adults has also found that those in the control group (who received monthly texts reminding them to update their contact details) were less likely to be reinfected than those in the intervention group (who received a series of texts that were educational and used behaviour change techniques).Generally, higher intentions were seen in the Grindr and Meta samples, except for self-isolation. However, rates should be interpreted with caution, as intended behaviour does not always translate to enacted behaviour.It is notable that 19% (Grindr, Meta) to 30% of people (general population, Savanta GBMSM) agreed that it is best to avoid physical contact with GBMSM because of the mpox outbreak, perhaps also reflecting a change in behaviour in this population. Recent decreases in some STIs in GBMSM, and the decline in mpox transmission in England, suggest this may be the case.Within the general population, women, people who were older and those with lower financial hardship were more likely to intend to carry out protective behaviours. This pattern was also widely seen during the COVID-19 pandemicIntention to engage in protective behaviours in the general population was also associated with psychological factors such as greater worry about mpox, perceived risk of mpox to others (but there was little evidence of an association with perceived risk to oneself), perceived susceptibility and severity of mpox, and greater knowledge about transmission. This pattern of results was also seen during the COVID-19 and influenza A H1N1 pandemics.Agreeing that the risks of mpox were being exaggerated was associated with lower intention to engage with protective behaviours. This was also the case in previous pandemics.Behaviour-specific beliefs were also associated with intentions. For self-isolation, greater intention was associated with greater social norms (thinking that others would also self-isolate). Greater social norms were associated with fewer outings during lockdownIn the UK, people with suspected mpox were directed to call sexual health services. Some people may have found this stigmatising as mpox is not a STI.In the Grindr sample, having been vaccinated for smallpox in 2022 was associated with having ever taken PrEP for HIV. This is probably due to how the vaccine was rolled out in the UK. GBMSM identified by sexual health services as being at highest risk of exposure—using markers similar to those used to assess eligibility for PrEP—were invited to be vaccinated.Strengths of the study include the collection of data from four large samples, including the general population and the population most affected by the recent mpox outbreak (GBMSM). We would also caution readers about several caveats for this study, including that participant sociodemographic characteristics differed by the recruitment method. Participants recruited through Grindr and Meta were more likely to be highly educated, higher socioeconomic grade and have less financial hardship. We are unsure whether this is representative of the sociodemographic characteristics of active Grindr and Meta users as we were unable to find, access or interpret published statistics of the sociodemographic profile of users.Other limitations relate to the survey and statistical measures used. The use of a cross-sectional survey means that answers may have been influenced by social desirability and recall bias, although the anonymity of a written survey may have mitigated these effects to some degree. Rates of intended behaviour are often higher than enacted behaviours.This study investigated mpox beliefs, knowledge and intended behaviours in a general population sample and in GBMSM (those most affected by the 2022 outbreak). Intended uptake of protective behaviours differed by behaviour. GBMSM generally had higher intention to engage with protective behaviours, apart from self-isolation. This may have been a function of sampling. Higher knowledge about mpox symptoms and transmission in GBMSM samples suggests that the public health messaging carried out by multiple stakeholders including the UK Health Security Agency, charities and via grass-roots community efforts has been successful and a similar model should be used in future outbreaks. There was no impact of additional motivational messaging on intended uptake of protective behaviours. Associations between increased financial hardship and lower intention to enact protective behaviours suggest that providing financial support to those affected in future outbreaks may increase uptake.