College students’ knowledge,attitudes and adherence to public service announcements on Ebola in Nigeria: Suggestions for improving future Ebola prevention education programmes

Abstract

Introduction:

Apprehension over a possible recurrence of Ebola remains pervasive among college students in Nigeria. Prevention education continues to be carried out through public service announcements (PSAs) on radio, television and in the social media. However, little is known about college students’ knowledge, attitudes and adherence to PSAs on Ebola virus. The purpose of this study was to investigate college students’ knowledge and attitude about Ebola and factors that predict adherence to Ebola education information mediated through PSAs.

Methods:

A total of 211 copies of structured questionnaire were administered to a multi-stage sample drawn from a medium-sized private university in Nigeria.

Results:

The majority of the participants responded correctly to the questions related to Ebola virus transmission. Nearly 86% of students agreed that Ebola can be contracted through the body secretions of a sick person, 83% students identified the basic symptoms of Ebola as fatigue and vomiting, while 82% agreed that regular washing of hands and use of hand sanitisers can prevent transmission of Ebola. Knowledge and attitudes emerged as significant predictors of students’ adherence to PSA advice on Ebola disease (p < .05).

Discussion:

Misconceptions about the causes and transmission of Ebola abound in spite of the high awareness about the virus, suggesting that the Ebola PSAs may not have succeeded in dispelling some strongly held beliefs about Ebola virus disease. The findings suggest that a considerable percentage of college students no longer follow the advice contained in Ebola-related PSAs. It may be that the declaration that Nigeria is Ebola free by World Health Organization (WHO) has given rise to a lax attitude towards the disease.

Conclusion:

In spite of their shortcomings, PSAs remains an important vehicle for conveying Ebola prevention education to college students.

Keywords

Adherence attitude college students Ebola knowledge Nigeria public service announcements

Introduction

Concern over a re-emergence of Ebola Virus Disease (EVD) remains pervasive in Nigeria, particularly among college students given that most of the universities are located in areas that are susceptible to rapid spread of communicable diseases (Ayenigbara, 2014). A sizeable percentage of Nigeria’s population is concentrated in urban slums and informal peri-urban settlements characterised by unsanitary conditions that facilitate the rapid spread of Ebola virus (Ayenigbara, 2014). College students whose institutions are situated close to these densely populated urban areas fear that an episode of Ebola may erupt suddenly from nearby slums, triggering another round of Ebola epidemic. Fears appear to have been heightened by the reported resurgence of the EVD in Sierra Leone in 2016 and the re-emergence of polio in some parts of northern Nigeria. The Ministry of Health had in August 2016 reported an outbreak of two wild polio virus (WPV) in two local government areas of Borno State in northern Nigeria, triggering a national public health emergency (World Health Organization [WHO], 2016). EVD, also known as Ebola haemorrhagic fever, made its first entrance into Nigeria in 2014 when health care workers made contact with an infected Liberian traveller in Lagos, Nigeria’s economic capital (Courage, 2014; Dixon and Schafer, 2014).

The Ebola virus was first detected in 1976 in Zaire, now the Democratic Republic of Congo, after an outbreak in the village of Yambuku along the Ebola River (WHO, 1978; Zimmerman and Zimmerman, 2003). There have been intermittent outbreaks of EVD since its discovery (Willett, 2003) especially, in sub-Saharan Africa resulting in high mortality (Lee-Kwan et al., 2014). The 2014 outbreak, however, was the largest and ranks among the most lethal to date. By the close of December 2015 when Guinea, the host of the last known vestige of the virus was declared Ebola free, the highly contagious and fatal pandemic had claimed 2,536 lives in Guinea; 4,809 in Liberia; 3,955 in Sierra Leone and 8 lives in Nigeria (WHO, 2015). Four other outbreaks of Ebola have been reported in Sudan (1976/1979), Tai Forest, Côte d’Ivoire (1994), Bundibugyo, Uganda (2007/2008) and Philippines (1996) (Chigbu and Ntiador, 2014).

EVD is contracted through contact with the body fluids or secretions of infected or dead person, or through contaminated clothes and bed sheets. Symptoms of EVD range from fever to severe headache, muscle pain, weakness, fatigue, diarrhoea, vomiting, abdominal pain and unexplained haemorrhaging (Centers for Disease Control and Prevention [CDC], 2015). Transmission of Ebola infection in some African countries is said to be aggravated by certain deep-seated cultural practices which expose people to unprotected contact with diseased bodies. In many African communities, for instance, corpses are bathed before burial and relatives of the dead are expected to keep vigil or watch the dead body overnight. In some communities, dead bodies are buried at home heightening the risk of exposure (Ayenigbara, 2014). Social and economic factors such as overpopulation and unhygienic conditions have also been linked to rapid spread of the disease (Ayenigbara, 2014). Although the epidemic was successfully contained in Nigeria and the country was officially certified free from Ebola by WHO (2014), fears of a possible resurgence of the disease persist especially since mistaken beliefs about the causes and cures of the disease are yet to be completely dispelled (Ayenigbara, 2014; Iliyasu et al., 2015).

Overview of Ebola PSAs in Nigeria

Following the death of the first indexed Ebola patient in a private hospital and confirmation that he may have potentially exposed about 72 persons at the hospital and the Lagos international airport from where he made entry into Nigeria, a high-level meeting involving all State Governors, the Minister of Health and State Commissioners of Health was held. It led to the Federal Ministry of Health in consultation with the Nigeria Centre for Disease Control (NCDC) declaring EVD a public health emergency (Faisal et al., 2014; Heen, 2016). This development ignited a considerable amount of apprehension among the citizenry, and the situation was aggravated by the spread of false information and myths concerning the Ebola virus (Gidado et al., 2015; Iliyasu et al., 2015; Shittu et al., 2015). For instance, in the wake of the Ebola outbreak, it was rumoured that people could contract the Ebola virus through the consumption of meat from wild animals.

These kinds of rumours led to the establishment of the Presidential Inter-ministerial Committee charged with developing a Communication Strategy for Ebola Virus Disease Prevention and Containment chaired by the then Minister of Information. The committee was ostensibly established to stem the hysteria over the Ebola virus and counter the rapidly spreading false information and misconceptions about the disease and its victims (Chukwu, 2014). Initially, the Emergency Operations Centre (EOC) set up by the Federal Ministry of Health, the Lagos State government and a couple of international partners, provided pockets of information about the virus. However, as new cases were reported, the EOC evolved into several teams which tackled the EVD outbreaks from a specific area of focus (Faisal et al., 2014). While the EOC served as the hub of rapid response to the EVD outbreak (Faisal et al., 2014), the social mobilisation and public enlightenment team provided the body of knowledge and direction that helped in shaping PSAs in Nigeria. The aim of these Ebola PSAs was fourfold:

To educate the public about the causes of EVD and preventive measures. The PSAs sought to enlighten the people on precautionary actions to take to avoid coming into contact with the Ebola virus. The PSAs informed the public on how Ebola is transmitted. To avoid becoming infected, the PSAs advised people to avoid body contact with infected people especially contact with urine, blood, saliva, stools, semen and sweat.

To create awareness on the symptoms and treatment. The Ebola PSAs explained to the public the symptoms to look out for when they were suspicious about a likely Ebola infection and where to go to get treatment. For instance, people who developed sudden fever, diarrhoea or vomiting were encouraged to immediately report to the health facility nearest to them, since early detection increases the chances of survival.

To tackle misconceptions and myths. A major aim of the Ebola PSAs was to disabuse the public about inaccuracies and myths which have developed around the virus. For instance, the PSA sought to correct the mistaken belief that Ebola is transmitted through air and, more especially, to assure the public that those who were infected with Ebola and survived could no longer transmit the virus to others. In addition, the PSAs addressed the issue of immunity and erroneous treatment procedures which people were using as a safeguard against the Ebola virus. For instance, some people erroneously believed they were immune to contracting the virus (Iliyasu et al., 2015). Many people also believed in the rumour that consuming large amount of salt water and bathing with salt water would prevent Ebola virus infection (Heen, 2016).

Call to action. The ultimate aim of the PSA was to galvanise citizens to participate in saving the lives of innocent people by educating one another on the signs and symptoms of Ebola. Such knowledge it was believed would, in the long run, stem the spread of the disease.

Virtually all the public service announcements (PSAs) that were disseminated through television, radio jingles and social media including the Ebola dedicated website – http://ebolaalert.org – were geared towards educating people about the causes, symptoms, preventive measures and treatment of EVD. The PSAs were delivered in Nigeria’s four predominant languages, Pidgin English, Hausa, Igbo and Yoruba (Heen, 2016) and ran from the wake of the outbreak in July 2014 to the third quarter of 2015. Although the PSAs were still aired albeit intermittently on some government owned radio stations during the last quarter of 2015, the campaign appeared to have petered out in 2016.

Studies suggest that awareness of EVD is generally high in Nigeria. About 92.5% of Nigerians are reported to have heard of EVD (Shittu et al., 2015). A considerable percentage of the population (70%) considers the disease a public health issue (Iliyasu et al., 2015). In the main, however, the number of people with broad knowledge of the disease is low. Nearly 40% have poor knowledge of the causes and preventive measures to take against contacting EVD (Shittu et al., 2015). An earlier study indicated that only 24.35% of Nigerians had knowledge of and exhibited positive attitudes towards EVD (Iliyasu et al., 2015).

Misconceptions and myths about the causes and treatment of EVD still linger among the general public (Gidado et al., 2015; Iliyasu et al., 2015; Shittu et al., 2015). One study, for instance, indicated that 61% of Nigerians believe they cannot contract the disease, while nearly 65% will not shake hands or hug a successfully treated EVD patient (Iliyasu et al., 2015). There is also very poor knowledge about how Ebola virus is transmitted. The study by Shittu et al. (2015) indicated that only 22.2% of the population was aware that Ebola is virus-related.

As a means of addressing these gaps in EVD-related knowledge and perceptions, federal and state health authorities as well as non-governmental bodies have implemented educational initiatives aimed at ramping up awareness and knowledge about EVD and changing undesirable attitudes and habits that may be inimical to EVD prevention. PSAs are one of these tools, and take the form of non-commercial advertising aimed at creating awareness and improving attitude or behaviour towards a phenomenon.

Purpose

The primary aim of the Ebola PSAs was to create awareness and educate the public on the preventive measures to take in order to avoid infection. College students have been an integral part of the target audience of the numerous Ebola PSAs deployed on various media platforms by government and non-governmental agencies. However, little is known about how such students perceive Ebola PSAs or what role PSAs play in EVD-related knowledge among college students. Given that PSAs offer a pervasive channel for disseminating information on Ebola it is imperative to investigate knowledge gaps about EVD (if any) and attitudes college students have towards these media. It is important to determine the knowledge, attitudes and perceptions (KAP) of this influential target population at this point in time so as to mitigate the risk of future outbreaks. Students come from communities were knowledge of and myths about Ebola still prevail. A knowledgeable student population is likely to cultivate positive steps to avert Ebola infection or its spread on campuses. Students who are well educated about the Ebola virus can in turn become change agents in their families and communities ensuring readiness and social adaptability in the event of an Ebola outbreak.

Existing studies on Ebola have focused on awareness, attitudes and knowledge about EVD among adults in urban and peri-urban populations (Ayenigbara, 2014; CPP, 2014; Gidado et al., 2015; Iliyasu et al., 2015; Shittu et al., 2015; United Nations Children’s Fund [UNICEF], 2014, 2015). There appears to be dearth of research examining attitudes of populations in environment such as universities. This study addresses the gap in knowledge in the literature, by assessing the KAP of college students to health communication messages on Ebola virus delivered through PSAs and determining to what extent college students adhere to Ebola PSAs.

The link between attitudes and behaviour

Social scientists, especially psychologists, generally tend to describe an attitude from the standpoint of evaluation. Vogel et al (2014), for instance, describe an attitude ‘as a summary evaluation of an object of thought’ (p. 5). Similarly, Eagly and Chaiken (2007) describe an attitude as ‘a psychological tendency that is expressed by evaluating a particular entity with some degree of favour or disfavor’ (p. 598). The decision by an individual to act one way or the other towards an object is to a degree predicted by that individual’s evaluation of the attitude object (Fishbein and Ajzen, 2005). Some scholars, however, argue against the conception of attitude from this binary or dualistic view. Clayton and Myers (2009) argue that attitudes go beyond merely evaluating an attitude object as favourable or unfavourable. Main (2004) posits that individuals can, in fact, hold positive and negative attitude simultaneously. In the same vein, people can be conflicted or ambivalent with regard to their feelings towards an attitude object.

The fact that an individual has a positive or negative attitude towards an object does not automatically translate to actual behaviour (Clayton and Myers, 2009). An individual, for instance, may be favourably predisposed to Ebola prevention, yet his actions may not reflect or equate to this favourable disposition. Blake (1999) describes the situation where an individual’s attitude does not translate to action as ‘value-action gap’ which he attributes to a variety of social and contextual factors. An individual who has direct encounter with an attitude object is likely to develop strong attitude towards that object and is more likely to perceive the attitude object as important and this, ultimately, influences his or her behaviour to the object (Clayton and Myers, 2009; Crano and Prislin, 2006).

In the Theory of Planned Behaviour (TPB), Icek Ajzen (1991) identifies ‘intention’ or motivation to act or ‘engage in the behaviour’ as the principal factor underpinning behaviour. Here, the intention to engage in an action is said to be predicated on three intervening variables, namely: attitudes, subjective norms and perceived behavioural control (PBC). Subjective norms refer to how individuals perceive ‘social support’ from important others for their actions. PBC on the other hand describes the degree to which individuals think that a certain action is within their control or is something they can accomplish effortlessly (Russell and Fielding, 2010). The TPB suggests that when individuals have a favourable attitude towards an object such as Ebola prevention, and receive some kind of ‘social support’ or approval for doing so, and feel that an action is within their control, they are likely to be motivated to act and to actually carry out Ebola preventive actions.

Methods

Participants

The total population of the study consisted of the 10,361 undergraduates of Babcock University, South West Nigeria as captured in the register of students for the 2015 academic year. The university has two colleges and seven schools. Multi-stage sampling was used to select a sample from the more populous of the two colleges and two schools located in the main campus: the College of Management and Social Sciences, School of Computing and Engineering Sciences and Nursing Sciences. The population distribution was College of Management and Social Sciences: 3,979, School of Computing and Engineering: 1,685 and School of Nursing Sciences: 647. Using (Saunders et al., 2009) formula, a sample size of 211 was derived.¹ Table 1, provides a summary of the distribution of the participants. As can be seen each school/college had an almost equal representation with College of Management and Social Sciences being the highest, 73 (34.6%), followed by Computing and Engineering Sciences, 71 (34.4%) and thereafter Nursing Sciences, 67 (31%).

Table1.

Percentage distribution of respondents.

	Frequency	Percent
Management and Social Sciences	73	34.6
Computing and Engineering Sciences	71	34.4
Nursing Sciences	67	31
Total	211	100

Procedures

A total of 211 copies of questionnaire were distributed to the sample population personally by the researcher and three volunteers. Participants were asked to provide their cellphone numbers which assisted follow-up. Given that no monetary incentives were provided, respondents were left to complete the questionnaire at their convenience but within a negotiated period of five working days. The research instrument was pre-tested in a pilot study involving 22 respondents from the same study location and then the instrument was comprehensively revised. Following insights gained during the pilot testing, the questionnaire was divided into three sections. Survey questions asked were based on the content of the PSAs, and dealt with (1) knowledge about the causes and symptoms of Ebola, (2) attitudes to PSAs on Ebola and (3) adherence to guidance provided in PSAs on Ebola. Relying on the insight gathered the pilot testing, responses to questions were narrowed to two options (yes/no and agree/disagree). The scale for each variable in the attitude measure ranged from 1 strongly agree to 5 strongly disagree. Cronbach’s (1951) alpha was used to estimate the reliability of individual scale and only the items with the strongest alpha were included. The result −0.850 indicates that the research instrument was highly reliable.

Analysis

Data were analysed using SPSS and presented as simple frequencies and cross tabulations. SPSS was used to analyse participants’ demographics, knowledge of causes and symptoms of Ebola, and attitudes and adherence to Ebola PSAs. Linear regression analysis was used to predict the influence of Ebola-related knowledge on the attitudes of college students and adherence to PSAs on Ebola.

Results

Out of the 211 copies of questionnaires administered, 208 were returned, representing a 98% response rate. The response rate was high owing to the procedure employed to distribute questionnaires and the follow-up participants. In all, the survey involved 122 (57%) women and 89 (42%) men. Three quarter of the participants were second year students, while postgraduate students accounted for 11% of the total sample. As can be seen from Table 2, Ebola PSAs cut across a wide variety of media platforms however, television emerged as college students’ primary source of access to PSAs on Ebola (83.9%), followed by radio (76.3%). The proportion of students who accessed Ebola PSAs through Internet platforms stood at 75%, while 72% reported accessing EBOLA PSAs by SMS. This is similar to the proportion that had access to Ebola PSAs through the traditional medium of newspapers (70%). In a separate section, participants were asked whether they had seen or heard about Ebola and almost everyone (98%) stated they were aware of EVD. This represents an increase in the awareness of EVD compared to an earlier study which reported EVD awareness of 92.5% (Shittu et al., 2015).

Table 2.

Respondents’ reported access to different sources of Ebola PSA.

Sources	Yes % (frequency)
Television	83.9 (177)
Radio	76.3 (160)
Internet	75.4 (159)
SMS	72.0 (151)
Newspapers	70.0 (147)
Posters	65.9 (139)
Billboards	61.1 (128)

PSA: public service announcement.

Respondents’ knowledge of causes and symptoms of Ebola

As Table 3 shows, college students agreed that the chances of survival from an Ebola attack were very slim (77.3%). Nearly, 86% agreed that Ebola can be contracted through the body secretions of a sick person, while 61.7% thought close contact with an infected person would lead to infection. The majority of students (82.9%) identified the basic symptoms of Ebola as fatigue and vomiting, while 66.9% and 62.5% listed feverishness and muscle pains as critical symptoms of Ebola. With regard to preventive measures, 82% of students agreed that regular washing of hands and use of hand sanitisers can prevent the transmission of Ebola. As can be seen, there are still misconceptions about the causes and mode of transmission of Ebola. For instance, nearly 78% of students agreed that consumption of wildlife is a source of Ebola infection, while 59.8% thought Ebola is an airborne disease. This is consistent with previous findings (Shittu et al., 2015). The results also show that nearly 77% of college students agreed that Ebola had been completely eradicated in Nigeria. Interestingly, 35% of respondents did not agree that the country had seen the last of the Ebola outbreak.

Table 3.

College students’ knowledge of causes and symptoms of Ebola.

Statement	Agreement % (frequency)
Ebola can be contracted through contact with body fluid of infected or dead person	85.5 (180)
Fatigue and vomiting are symptoms of Ebola	82.9 (175)
Ebola is still present in some African countries	82.0 (173)
Regular washing of hands and use of hand sanitisers can prevent me from contracting Ebola	82.0 (173)
Ebola can be contracted through consumption of wild animals	77.8 (164)
Chance of surviving Ebola attack is slim	77.3 (163)
Ebola has been completely eradicated from Nigeria	76.7 (162)
Feverishness is a symptom of Ebola	66.9 (141)
Ebola is not a communicable disease	64.0 (135)
I still know the number to call in case of suspicions symptoms of Ebola	63.0 (133)
Muscle pain is a sign of Ebola infection	62.5 (132)
Close contact with infected person exposes me to Ebola	61.7 (130)
Ebola virus is airborne	59.8 (126)
Nigeria has not seen the last of Ebola epidemic	34.6 (73)

College students’ attitudes towards Ebola PSAs

Students were asked whether or not they agreed with a series of 11 statements based on the contents of Ebola PSAs. Table 4 provides the agreement levels for each of the statements in descending order.

Table 4.

Respondent attitudes to Ebola PSAs.

Statement	Agree % (frequency)
I think PSAs on Ebola should continue	83.9 (177)
PSAs on Ebola gives me confidence it can be contained	83.9 (177)
Reporting suspected cases of Ebola is important	83.0 (175)
I think exposure to PSA on Ebola made me more fearful	73.9 (156)
PSA on Ebola should be intensified	73.4 (155)
Use of hand sanitisers is still relevant	73.4 (155)
I make cautious effort to avoid body fluids	69.6 (147)
I don’t think eating wildlife should be stopped	61.6 (130)
I no longer follow PSAs on Ebola	54.0 (113)
I don’t think Ebola will occur in Nigeria again	50.2 (106)
I still know the Ebola helplines	37.0 (78)

PSA: public service announcement.

Overall, students indicated having positive attitudes to PSAs with 83.9% agreeing that the campaigns should be sustained, while 83.9% stated that PSAs gave them confidence that Ebola can be contained. A large portion of students stated that reporting suspected cases was important (83%), while 73.4% believed the use of hand sanitisers was still important. Additionally, the majority of students admitted that they became more fearful of Ebola after being exposed to Ebola PSAs (73.9%). This may explain why nearly 70% of the respondents stated that they still make a conscious effort to avoid exposure to body fluid or secretion. While more than half of the students (50.2%) did not see the likelihood of another outbreak of Ebola, an almost equivalent percentage (49.8%) thought the re-emergence of Ebola was a possibility. The results however, did not indicate whether this opinion was based on knowledge or attitudes. The results show that more than half of the students (54%) no longer followed Ebola PSAs, while many had forgotten the Ebola helpline numbers (63%). This is in contrast to previous studies which reported that only 4% (Shittu et al., 2015) and 28% (CPP, 2014) knew the helplines to call.

College students’ adherence to Ebola PSAs

Students were asked whether or not they adhered to a series of 8 Ebola prevention measures as promoted in most PSAs on the epidemic. As presented in Table 5, the majority of students (82%) stated that they washed their hands regularly, with nearly 82% agreeing that they would seek medical help on suspicion of symptoms of Ebola. Similarly, 83% of respondents felt it was important to report any suspicious cases of Ebola to the authorities. The result shows that more than half of the students (59.2%) used hand sanitisers and 51.2% admitted that they made a conscious effort to avoid body contact with sick persons. The findings compare favourably with previous results from Shittu et al. (2015). However, this finding suggests that adherence to Ebola PSAs has waned considerably as more than half of the students (54%) admitted that they no longer follow Ebola PSAs. Similarly, only 46% of participants stated that they have the Ebola helpline numbers saved on their cellphones. It is possible that the disappearance of PSAs on the radio and other channels may have downplayed the urgency and importance of storing the Ebola helplines on cellphones.

Table 5.

College students’ reported adherence to Ebola PSAs.

Statement	Agree % (frequency)
I wash my hands regularly	82.0 (173)
I will seek medical help immediately I develop fever, severe headache or vomiting	81.5 (172)
I will report any suspicious case of Ebola to the authorities	78.2 (165)
I will readily submit to screening if need be	75.9 (160)
I have continued the use of hand sanitisers	59.2 (125)
I no longer consume wildlife	53.0 (112)
I avoid body contact with infected or dead persons	51.2 (108)
I know and have saved on my phone Ebola helplines	46.0 (97)

PSA: public service announcement.

Influence of Ebola-related knowledge on college students’ attitude towards Ebola

In order to examine the assumption that knowledge of Ebola will influence college students’ attitudes and adherence to Ebola PSAs, a two-step regression analysis was carried out: the first model examined the relationship between knowledge of Ebola on the attitudes of college students, and the second assessed knowledge as a predictor of college students’ adherence to Ebola PSAs. It was found that knowledge of Ebola health messages derived from PSAs had significant influence on college students’ attitudes towards Ebola (p < .05). The high correlation coefficient (β = 0.703) suggests that increased knowledge of Ebola health messages led to a proportionate increase in positive attitude of college students towards Ebola PSAs. Similarly, knowledge of Ebola health messages significantly predicted college students’ adherence to Ebola PSAs (p < .05, β = 0.555). Additionally, having a positive attitude and good knowledge of Ebola emerged as significant predictors of adherence to PSAs on Ebola.

As shown in Table 6, college students’ attitude towards Ebola PSAs was positive (p < .05, B = 0.468, β = 0.610). However, the attitudes of students towards PSAs were positively influenced by their knowledge of Ebola virus (p < .05, B = 0.322, β = 0.421). Overall, the result suggests that college students’ attitudes to and knowledge of Ebola via PSAs positively influenced adherence to Ebola PSAs. The combination of attitudes towards and knowledge of Ebola messages explained 41% of the variance in student’s adherence to Ebola PSAs.

Table 6.

Regression analysis predicting students’ adherence to Ebola PSAs (n = 211).

		B	SE B	β	R ²
1	Students’ attitude to Ebola PSAs	0.468	0.043^a	0.610^b	0.372
2	Students’ attitude to Ebola PSAs	0.322	0.059^a	0.421^b
	Students’ knowledge of Ebola health messages	0.182	0.052^a	0.271^c	0.410

p < .05.

p < .001.

p < .01.

Discussion

The purpose of this study was to assess college students’ knowledge and attitudes towards Ebola health messages in PSAs. Additionally, the study aimed to assess the extent to which college students adhered to the information provided in Ebola PSAs. Findings indicate that majority of college students (77.3%) were aware that people infected with Ebola disease have very slight chance of surviving. A large percentage (86%) knew that Ebola can be contracted through the body fluids of a sick person or close contact with an infected person (61.1%). Nearly 83% of the respondents listed fatigue and vomiting as the basic symptoms of Ebola. More than half (66.9% and 62.5%) identified feverishness and muscle pain, as other important symptoms of Ebola.

Mistaken belief about the causes and transmission, however, still abound. More than half of the college students (59.8%) believed Ebola is airborne. The analysis of results indicated that attitudes and knowledge of Ebola health messages significantly influenced college students’ adherence to PSAs on Ebola (p < .05, β = 0.555). The findings indicate that a sizeable percentage (54%) of college students no longer follow Ebola-related PSAs. This is a major shift from the findings from previous studies which showed a much lower proportion (CPP, 2014; Shittu et al., 2014).

The fact that more than half of college students no longer remember the number of Ebola helplines represents a major concern. In case of an emergency, many college students may be unable to reach the authorities promptly. As noted in a previous study late reporting of suspicious symptoms was identified as one reason making it difficult for health officials to quickly identify the EVD ultimately leading to the spread of the disease in some communities (Gidado et al., 2015). The fact that there is still some lingering misconceptions about the causes and mode of transmission of Ebola among college students, who are expected to be better informed, suggests that the PSAs do not resonate with a proportion of this population. This raises questions about the effectiveness of PSAs in dispelling strongly held views about Ebola. Previous studies have reported persistent misconception about Ebola among the general public. The best way to address these misunderstandings may be to provide targeted communication to increase knowledge levels and ultimately remove deep-seated beliefs and misconceptions.

As with previous studies, the electronic media, television and radio emerged as major sources of accessing public health information including Ebola PSA (Iliyasu et al., 2015). However, the results suggest that the Internet and SMS could be valuable platforms through which to disseminate future Ebola PSAs. The good news as indicated in this finding is that many students are aware of the preventive measures necessary to avoid contracting Ebola and are willing to follow them as reported in previous studies (CPP, 2014; Shittu et al., 2015).

Limitations and future research

The major limitation of this study is that the findings are not representative of all college students in Nigeria given that the sample was drawn from a single and relatively small private university. Although students’ age and gender were fairly representative of demographics of typical Nigerian university students, the sample generally does not reflect the ethnic and socio-economic diversity that characterises public universities. A larger and more diverse sample from public colleges across the nation would offer more useful findings.

Although the study presented interesting findings concerning knowledge Ebola gained through PSAs, the findings did not provide information with regard to which of the media platforms was the most effective or the preferred platform for delivering PSAs. Future studies could consider examining which of the media platforms is most effective in conveying PSA information especially to a university community. It would be beneficial to measure how PSAs delivered through SMS compared with more traditional media platforms such as television and radio.

The study findings suggest that knowledge of Ebola correlated with students’ attitudes towards Ebola PSAs. However, there may be other extraneous and exogenous factors that impact the interaction between knowledge and attitudes leading to adherence, such as the manner in which EVD information or PSAs were presented, the salience attached to the EVD phenomenon and, prevailing ‘descriptive norms’ dictating the behavioural expectations people follow (Cialdini et al., 1990). In particular, individuals may be motivated to perform a behaviour if they hold the perception that others are doing so (Fishbein and Ajzen, 2005). Moreover, as Clayton and Myers (2009) have noted, attitudes are more likely to influence behaviour if the attitude is strong, grounded on first-hand knowledge and the attitude object is perceived as important. Familiarity with the ‘attitude object’ increases the prominence and subsequently the strength of that attitude, and the probability of that attitude ultimately influencing behaviour (Crano and Prislin, 2006). Future studies could therefore benefit from examining the relationship among factors such as subjective norms, PBC and demographics such as age and gender of college students in adherence to Ebola PSAs.

Conclusion

This study sought to determine prevailing knowledge, attitude and perceptions of EVD among college students and to assess college students’ adherence to Ebola PSAs. Findings generally suggest that students are aware of the causes, symptoms and treatments of EVD and are willing to take preventive actions to avoid contracting or spreading the disease. There is also evidence that Ebola PSAs are generally accessible to students and that there is strong association between Ebola knowledge and the attitudes of college students towards the disease. The findings suggest that college students’ knowledge of Ebola is high even though gaps in EVD-related knowledge and misconceptions still persist. These findings have important implications for PSAs and prevention education initiatives for EbolaGoing forward, Ebola PSAs and other prevention education initiatives must address misconceptions, and also pay particular attention to the false sense of security. There is need for a proactive communication strategy to counter the growing belief that Ebola cannot resurface in Nigeria.

Unless the Ebola PSAs and other sources of health-related information are sustained, many students are likely to abandon the preventive actions and habits they have acquired or relapse into unhealthy practices, a situation that could greatly undermine the progress made in eradicating the Ebola virus in 2014.

Footnotes

Funding

The author(s) received no financial support for the research, authorship and/or publication of this article.

Notes

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