Weber, E. A Domain-specific risk-attitude scale: Measuring risk perceptions and risk behaviors. Journal of Behavioral Decision Making, 15, People differ in the way they resolve decisions involving risk and uncertainty, and these differences are often described as differences in risk attitude. Risk attitude is the parameter that differentiates between the utility functions of different individuals e.
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Despite the continuing growth of international tourism, very little research has been done on the link between individual risk attitudes and health behaviours during travel. Our study uses a validated risk-taking questionnaire Domain-Specific Risk-Taking Scale DOSPERT and data from a smartphone application to study the association between pre-travel risk attitudes and the occurrence of behaviours during travel.
A prospective cohort of travellers to Thailand used a smartphone application to answer a daily questionnaire about health behaviours and events. Multiple linear regression models were used to model the relationship between DOSPERT risk-taking subdomain score and health behaviour. Of the 75 travellers that completed the study, 70 Men, backpackers and young travellers reported a higher willingness to take recreational risks than women, luxury travellers and older travellers.
In our study, individual scores on risk-taking in the health and safety subdomain of the DOSPERT questionnaire seem to be predictive of health behaviours both during travel and at home. By pairing new methods of data collection with questionnaires such as DOSPERT that identify key traveller characteristics to intervene on, travel medicine doctors will be able to provide more specialised health advice, ensuring that all travellers receive well-rounded advice about the full range of health challenges they will face during travel.
As tourism grows globally, topping 1. While infectious disease prevention during travel has been well addressed in both research and clinical practice e. The limited evidence base for providing effective behavioural health advice and targeting it to the appropriate travellers means that many are unprepared for the health risks they may face during travel.
Risk-taking attitudes and risk perception have been clearly linked in several studies to health behaviour, 14 and tools have been developed by psychologists to measure the risk-taking attitude of individuals in different domains. While some research has been done on risk perception among travellers, 16 , 17 our study is the first to our knowledge to be able to link information on risk attitudes to prospective data on actual incidence of health events and health risk behaviours during travel.
In this analysis, we aimed 1 to describe risk perception and risk taking among travellers to Thailand, especially differences in demographic subgroups, and 2 determine if the results of a validated risk perception questionnaire are predictive of health risk behaviours during travel. A prospective cohort of travellers to Thailand was recruited from the travel clinics of Zurich and Basel Switzerland between January and June of To participate in the study, travellers agreed to 1 complete a pre-travel questionnaire with complete self-reported demographic and medical information, 2 complete a pre-travel questionnaire assessment of risk perception and 3 download the study smartphone application TRAVEL app and complete a daily electronic questionnaire on health risk behaviours and health events during travel Figure 1.
Study participants were considered to have completed the study when they had completed at least one survey during travel and did not ask to be removed from the study. Study recruitment, questionnaire development and study methodology are described in detail elsewhere. To assess perception of risk among the study travellers, a literature search was conducted to identify a validated questionnaire capable of assessing risk perception among travellers. Participants were asked to fill out the same DOSPERT questionnaire twice, first rating their likelihood to engage in the behaviour, and on the second pass to rate their perception of how risky the behaviour is.
To interpret the scores of the study population, the overall subdomain means are compared with the scores of the general population in a DOSPERT validation study. Participants were also asked in the written pre-travel demographic and medical information questionnaire to report on the following risk activities in Switzerland: routine seatbelt use in automobiles, helmet use during bicycling and whether they had a sports injury in the past year.
While using seatbelts in an automobile in Switzerland is mandatory, helmet use during bicycling is not. Smoking status, age and sex were also recorded.
During study design, key health risk behaviours and health events during travel were identified by focus groups with experts and developed into a questionnaire using cognitive debriefings with previous travellers to Thailand. The risk behaviour domains identified included food and drink risk behaviours e. Study participants were then asked to answer the resulting questionnaire about health behaviour in Thailand daily during their trips using a smartphone application the TRAVEL app developed for study purposes.
To calculate an overall incidence measure for each risk behaviour domain, the total number of risk behaviours reported per day was summed up over the course of the trip and then divided by the total number of questionnaire-days the participant completed during their trip.
The domain-specific means and their standard deviations are reported for the study population as a whole, and for relevant subgroups e. To model the relationship between health behaviour domain outcome and DOSPERT risk-taking subdomain score predictor , multiple linear regression models were used. Regression coefficients and P -values were reported. All models were adjusted by age and sex. Of the eligible participants who enrolled in the study, 75 completed the study.
Participants spent a median of The full study cohort is described in greater detail elsewhere. Of these 70 participants, 69 Of the 70 participants, 61 filled out the DOSPERT risk perception scale completely and 9 were missing one item each from the ethical and financial domains. Study Flow Diagram. Data collection points pre- and during travel.
Questionnaires administered included the DOSPERT assessment prior to travel and a health behaviour and symptoms questionnaire daily during the trip. Overall means for willingness to take risks are calculated across the five subdomains in Table 1 , with the lowest scores on the ethical subdomain This overall pattern is similar to that found in the validation study, but Swiss travellers scored lower on their willingness to take risks in every subdomain except recreational; Swiss travellers scored particularly low on their willingness to take ethical or financial risks Figure 2.
Table 1. A higher score indicates a higher willingness to take the risk or higher perception of how risky that activity is, with possible scores ranging from a minimum of 6 to a maximum of The validation study means are included to compare scores of Swiss travellers to those of the general population.
Radar Plot. The overall means were much closer to those of the validation study Figure 2 , with only the financial domain showing more than two points of difference Swiss perception of the riskiness of financial decisions was on average 2. A post hoc Tukey test showed that the willingness to take social risks, the highest overall mean Recreational risk taking, the second highest score on average The differences in risk attitudes in several key subgroups are summarised in Table 2.
Between men and women, the main difference is that men report greater willingness to take recreational risks Willingness to take recreational risks was highest in the youngest cohort and dropped in each successive older age group. Similarly, backpackers were much more likely to be willing to take recreational risks than luxury travellers Those who did not wear a helmet while bicycling in Switzerland were also more likely to take health and safety risks and recreational risks than those who always wore a helmet while biking.
Table 2. Higher score indicates a greater willingness to take risks in that category. Key differences between subgroups are shown in boxes and bolded.
Only health and safety, recreational and social risk-taking scores were considered as predictors, as ethical and financial risk-taking among this cohort was very low. When incidence of drug and alcohol risk behaviours e. Table 3. The risk-taking scale scores are based on willingness to take risks in that category.
To determine whether the health and safety risk-taking score is associated with actual risk taking behaviours at home in Switzerland, a linear regression model was used to predict health and safety risk-taking score outcome based on smoking status, seatbelt use in automobiles, sports injury in the past year and helmet use while bicycling.
Sports injuries and helmet use were not associated with the health and safety score. These results suggest that the health and safety subdomain test of DOSPERT may be a useful tool for identifying travellers likely to engage in high risk health behaviours during travel; in particular, the high association of risk behaviours in Switzerland with DOSPERT score on risk-taking indicates that this is a robust measure of willingness to engage in risky behaviours. Some risks during travel, such as drinking to the point of inebriation or taking drugs, were more closely associated with the score on this subdomain than with demographic predictors such as age or gender.
It has been shown that behavioural interventions can reduce risk behaviours while at home. In addition, clear demographic subgroups of different attitudes towards risk emerged: men, backpackers and young travellers showed a higher willingness to take recreational risks than women, luxury travellers and older travellers Table 2.
Smokers and those who did not wear a helmet while bicycling in Switzerland showed a higher willingness to take health and safety risks than non-smokers or those who always wore a helmet. The comparison of Swiss scores to those of the DOSPERT validation study suggest that Swiss travellers have a similar perception of risk to those of other populations e. Swiss travellers appear to have a high willingness to engage in social and recreational risk taking, a lower willingness to take health and safety risks, and very low willingness to engage in ethical or financial risk behaviours, a pattern that is overall similar to that found in previous studies using DOSPERT Additionally, it may be that the self-selected group of travellers willing to answer a questionnaire daily during travel may be more risk averse than the general population.
The rate of missing items was very low on the risk-taking DOSPERT scale, so taking the questionnaire once appears to be acceptable among participants in the study, who were overall representative of the general travel clinic population. This also suggests that the other subdomain tests, while relevant in other areas of research, may not be useful in the travel clinic setting for predicting traveller health behaviour.
Simplifying the questionnaire to only the health and safety subdomain has the added advantage of reducing the burden and time costs. The six questions that make up the health and safety subdomain could be easily added to the pre-travel consultation registration form to help travel medicine practitioners quickly identify those travellers most in need of preventative behavioural advice.
This study has limitations. Although we were impressed by the plethora of various issues reported by those few travellers, a larger prospective cohort should provide even more conclusive results. In particular, a larger cohort would allow the association of specific risk behaviours with risk-taking scores; in this cohort, categories were of necessity collapsed into larger categories e.
The incidence of itching from mosquitoes, while presumed to be related to mosquito protection behaviours, may also reflect individual susceptibility to mosquito bites or location-based risks; however, the high association of itching from mosquitoes with health and safety attitude scores prior to the trip suggests that health behaviours also play a large role in risk of bites. In addition, while the results here indicate that there is an association between psychological risk profiles and health behaviours during travel, more research is needed on how and which behavioural advice is most effective in preventing risky travel behaviours in those with high risk-taking scores on the DOSPERT questionnaire.
Prospective randomised testing of behavioural advice with a similar tracking tool to that used in this study would help to identify the advice that is most useful and effective for travellers, and which advice is routinely ignored. While the study population is overall representative of the underlying clinic population, the proportion of women was slightly higher in the study 62 vs.
The use of a smartphone application such as the TRAVEL application during travel to track the health behaviours and outcomes of travellers in almost real time allows travel medicine researchers to look at health outcomes during travel in greater detail than ever before.
In addition, the use of the DOSPERT health and safety risk-taking scale in clinical practice shows great promise in identifying travellers with high likelihood of engaging in behaviours during travel that link to important health risks, such as exposure to STIs, accidents, injuries and other infectious diseases.
By pairing new methods of data collection with questionnaires such as DOSPERT that identify key traveller characteristics to intervene on, travel medicine doctors will be able to provide more specialised health advice than ever before, ensuring that travellers receive well-rounded advice about the full range of health challenges they will face during travel. The study sponsors had no role in study design or the collection, analysis and interpretation of data, and the writing of the article and the decision to submit it for publication.
We thank all participants for their compliance and commitment. We are grateful to Sarah Ziegler and Rosalie Zimmerman for their invaluable assistance with recruitment. AF drafted the manuscript and carried out the statistical analysis. All authors critically revised the manuscript for important intellectual content.
World Tourism Organization, Vaccine-preventable travel health risks: what is the evidence—what are the gaps? J Travel Med ; 22 : 1 — Google Scholar. Medical considerations before International Travel. N Engl J Med ; : — Steffen R , Wilson ME. Fifty years of travel medicine epidemiology: what have we learnt? Int Health ; 7 : — 6.
A Domain-Specific Risk-Taking (DOSPERT) Scale
A Domain-Specific Risk-Taking (DOSPERT) scale for adult populations