title: Differing community responses to similar public health threats: a cross-disciplinary systematic literature review.
abstract: BACKGROUND
  The way in which different communities respond to similar threats to their health can vary, from outrage to indifference and public health agencies are often taken by surprise leading to potential loss of public confidence. The objective of this systematic literature review was to seek to better understand the community-level drivers that might explain the variability in response.
  
  
  METHODS
  A vigorous systematic cross-disciplinary literature review was undertaken searching thirteen bibliographic databases and a variety of grey sources were screened. The social amplification of risk framework and the risk perception management theoretical models were used to assess evidence and data were synthesised by Narrative review.
  
  
  RESULTS
  Sixteen studies meeting the agreed inclusion criteria described eleven different threats ranging from: infectious disease outbreaks to environmental disasters to cancer clusters, affecting two or more communities were identified from medical, psychological, social science and environmental science literature. There was wide heterogeneity between the type and quality of the studies. There was a general absence of theoretical underpinning community responses. Most studies did not report sufficient data to allow an appropriate amount of validity. Very low response rates in particular were common. Potential explanatory drivers suggested included, prior experience and visibility of threat, sociodemographic characteristics, volume and type of media coverage, government reaction and availability of social support.
  
  
  CONCLUSIONS
  This review confirmed that there are significant differences. Further work is needed to develop theoretical models that apply to the community level and do not assume that a community's response is simply the aggregate of individual level responses.
authors.affiliation: Institute of Primary Care and Public Health, Cardiff University, Cardiff CF14 4YS, UK.
authors.forename: Giles
authors.initials: G
authors.lastname: Greene
authors.affiliation: Support Unit for Research Evidence, Cardiff University, Cardiff CF14 4YS, UK.
authors.forename: Ruth
authors.initials: R
authors.lastname: Turley
authors.affiliation: Support Unit for Research Evidence, Cardiff University, Cardiff CF14 4YS, UK.
authors.forename: Mala
authors.initials: M
authors.lastname: Mann
authors.affiliation: Emergency Response Department, Health Protection Agency, Building H11, HPA, Porton Down, Salisbury SP4 0JG UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Amlôt
authors.affiliation: King's College London, Institute of Psychiatry, 3rd Floor, Weston Education Centre, 10 Cutcombe Road, London SE5 9RJ, UK.
authors.forename: Lisa
authors.initials: L
authors.lastname: Page
authors.affiliation: Institute of Primary Care and Public Health, Cardiff University, Cardiff CF14 4YS, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Palmer
mesh_terms: D055884:Chemical Hazard Release; D004196:Disease Outbreaks; D006801:Humans; D010465:Perception; D011634:Public Health / Q000379:methods*; D012308:Risk Management / Q000379:methods*; D012942:Social Sciences
keywords: Community; Man-made disasters; Natural disasters; Risk perception