title: Knowledge, Attitudes, and Practices Regarding Avian Influenza A (H7N9) Among Mobile Phone Users: A Survey in Zhejiang Province, China.
abstract: BACKGROUND
  Understanding people's knowledge, attitudes, and practices (KAP) regarding a new infectious disease is crucial to the prevention and control of it. Human infection with avian influenza A (H7N9) was first identified on March 31, 2013 in China. Out of the total number of 134 cases confirmed from March to September 2013 in China, Zhejiang Province saw the greatest number (46 cases).
  
  
  OBJECTIVE
  This study employed a mobile Internet survey to assess KAP regarding H7N9 among mobile phone users in Zhejiang Province. This study intended to examine KAP by region and the association between sociodemographic variables and KAP.
  
  
  METHODS
  An anonymous questionnaire was designed by Zhejiang Provincial Center for Disease Control and Prevention (CDC). A cross-sectional survey was executed through a mobile Internet application platform of China Unicom in 5 regions in Zhejiang Province. Stratified and clustered sampling methods were applied and mobile phone users were invited to participate in the study voluntarily.
  
  
  RESULTS
  A total of 9582 eligible mobile phone users participated in the survey with a response rate of 1.92% (9582/5,000,000). A total of 9105 valid responses (95.02%) were included for statistical analysis. Generally, more than three-quarters of the participants had some basic knowledge of H7N9 and held the attitude recommended by the Zhejiang CDC toward eating cooked poultry (77.55%, 7061/9105) and visiting a hospital at the occurrence of symptoms (78.51%, 7148/9105). Approximately half of the participants worried about contracting H7N9, and took preventive practices recommended by the Zhejiang CDC. But only 14.29% (1301/9105) of participants kept eating cooked poultry as usual. Although worry about H7N9 infection did not differ by region, Hangzhou saw the largest proportion of participants with knowledge of H7N9, which was probably because Hangzhou had the greatest number of H7N9 cases. KAP varied by some sociodemographic variables. Female participants were more likely to know about symptoms of H7N9 (OR 1.32, 95% CI 1.08-1.61), to worry about contracting it (OR 1.15, 95% CI 1.04-1.27), and to report their lives being influenced by it (OR 1.27, 95% CI 1.15-1.41). They were also more likely to take the recommended precautions. Male participants and younger participants were less likely to comply with advocated protective practices.
  
  
  CONCLUSIONS
  The results suggest that health education should be customized depending on sociodemographic variables to achieve more effective behavioral outcomes.
authors: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China.
authors: Hua
authors: http://orcid.org/0000-0001-5032-7253
authors: H
authors: Gu
authors: Zhenggang
authors: http://orcid.org/0000-0003-4004-8845
authors: Z
authors: Jiang
authors: Bin
authors: http://orcid.org/0000-0002-3761-0465
authors: B
authors: Chen
authors: Jueman Mandy
authors: http://orcid.org/0000-0002-2653-5914
authors: JM
authors: Zhang
authors: Zhengting
authors: http://orcid.org/0000-0002-8211-396X
authors: Z
authors: Wang
authors: Xinyi
authors: http://orcid.org/0000-0002-3181-4256
authors: X
authors: Wang
authors: Jian
authors: http://orcid.org/0000-0002-0098-9678
authors: J
authors: Cai
authors: Yongdi
authors: http://orcid.org/0000-0001-8651-6478
authors: Y
authors: Chen
authors: Dawei
authors: http://orcid.org/0000-0003-2568-8270
authors: D
authors: Zheng
authors: Jianmin
authors: http://orcid.org/0000-0003-3563-4006
authors: J
authors: Jiang
keywords: attitude; influenza A virus, subtype H7N9; knowledge; surveillance
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