Psychosocial and demographic predictors of adherence and non-adherence to health advice accompanying air quality warning systems: a systematic review
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Volume
16
Publisher
DOI
10.1186/s12940-017-0307-4
Journal
ENVIRONMENTAL HEALTH
Metadata
Show full item recordAbstract
Background: Although evidence shows that poor air quality can harm human health, we have a limited understanding
about the behavioural impact of air quality forecasts. Our aim was to understand to what extent air quality warning
systems influence protective behaviours in the general public, and to identify the demographic and psychosocial factors
associated with adherence and non-adherence to the health advice accompanying these warnings.
Method: In August 2016 literature was systematically reviewed to find studies assessing intended or actual adherence to
health advice accompanying air quality warning systems, and encouraging people to reduce exposure to air pollution.
Predictors of adherence to the health advice and/or self-reported reasons for adherence or non-adherence were also
systematically reviewed. Studies were included only if they involved participants who were using or were aware of these
warning systems. Studies investigating only protective behaviours due to subjective perception of bad air quality alone
were excluded. The results were narratively synthesised and discussed within the COM-B theoretical framework.
Results: Twenty-one studies were included in the review: seventeen investigated actual adherence; three investigated
intended adherence; one assessed both. Actual adherence to the advice to reduce or reschedule outdoor activities
during poor air quality episodes ranged from 9.7% to 57% (Median = 31%), whereas adherence to a wider range of
protective behaviours (e.g. avoiding busy roads, taking preventative medication) ranged from 17.7% to 98.1%
(Median = 46%). Demographic factors did not consistently predict adherence. However, several psychosocial
facilitators of adherence were identified. These include knowledge on where to check air quality indices, beliefs
that one’s symptoms were due to air pollution, perceived severity of air pollution, and receiving advice from health care
professionals. Barriers to adherence included: lack of understanding of the indices, being exposed to health messages that
reduced both concern about air pollution and perceived susceptibility, as well as perceived lack of self-efficacy/locus of
control, reliance on sensory cues and lack of time.
Conclusion: We found frequent suboptimal adherence rates to health advice accompanying air quality alerts.
Several psychosocial facilitators and barriers of adherence were identified. To maximise their health effects,
health advice needs to target these specific psychosocial factors.