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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Influence of trust on two different risk perceptions as an affective and cognitive dimension during Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak in South Korea: serial cross-sectional surveys</title><author><name sortKey="Jang, Won Mo" sort="Jang, Won Mo" uniqKey="Jang W" first="Won Mo" last="Jang">Won Mo Jang</name><affiliation><nlm:aff id="aff1"><institution content-type="department">Health Review and Assessment Committee</institution>,<institution>Health Insurance Review and Assessment Service</institution>,<addr-line content-type="city">Wonju</addr-line>,<country>South Korea</country></nlm:aff></affiliation></author><author><name sortKey="Kim, Un Na" sort="Kim, Un Na" uniqKey="Kim U" first="Un-Na" last="Kim">Un-Na Kim</name><affiliation><nlm:aff id="aff2"><institution content-type="department">Division of Suicide Prevention Policy</institution>,<institution>Ministry of Health and Welfare</institution>,<addr-line content-type="city">Sejong</addr-line>,<country>South Korea</country></nlm:aff></affiliation><affiliation><nlm:aff id="aff3"><institution content-type="department">Department of Health Policy and Management</institution>,<institution>Seoul National University College of Medicine</institution>,<addr-line content-type="city">Seoul</addr-line>,<country>South Korea</country></nlm:aff></affiliation></author><author><name sortKey="Jang, Deok Hyun" sort="Jang, Deok Hyun" uniqKey="Jang D" first="Deok Hyun" last="Jang">Deok Hyun Jang</name><affiliation><nlm:aff id="aff4"><institution content-type="department">Research Analytics and Communications</institution>,<institution>Gallup Korea</institution>,<addr-line content-type="city">Seoul</addr-line>,<country>South Korea</country></nlm:aff></affiliation></author><author><name sortKey="Jung, Hyemin" sort="Jung, Hyemin" uniqKey="Jung H" first="Hyemin" last="Jung">Hyemin Jung</name><affiliation><nlm:aff id="aff1"><institution content-type="department">Health Review and Assessment Committee</institution>,<institution>Health Insurance Review and Assessment Service</institution>,<addr-line content-type="city">Wonju</addr-line>,<country>South Korea</country></nlm:aff></affiliation><affiliation><nlm:aff id="aff3"><institution content-type="department">Department of Health Policy and Management</institution>,<institution>Seoul National University College of Medicine</institution>,<addr-line content-type="city">Seoul</addr-line>,<country>South Korea</country></nlm:aff></affiliation></author><author><name sortKey="Cho, Sanghyun" sort="Cho, Sanghyun" uniqKey="Cho S" first="Sanghyun" last="Cho">Sanghyun Cho</name><affiliation><nlm:aff id="aff3"><institution content-type="department">Department of Health Policy and Management</institution>,<institution>Seoul National University College of Medicine</institution>,<addr-line content-type="city">Seoul</addr-line>,<country>South Korea</country></nlm:aff></affiliation></author><author><name sortKey="Eun, Sang Jun" sort="Eun, Sang Jun" uniqKey="Eun S" first="Sang Jun" last="Eun">Sang Jun Eun</name><affiliation><nlm:aff id="aff5"><institution content-type="department">Department of Preventive Medicine</institution>,<institution>Chungnam National University College of Medicine</institution>,<addr-line content-type="city">Daejeon</addr-line>,<country>South Korea</country></nlm:aff></affiliation></author><author><name sortKey="Lee, Jin Yong" sort="Lee, Jin Yong" uniqKey="Lee J" first="Jin Yong" last="Lee">Jin Yong Lee</name><affiliation><nlm:aff id="aff3"><institution content-type="department">Department of Health Policy and Management</institution>,<institution>Seoul National University College of Medicine</institution>,<addr-line content-type="city">Seoul</addr-line>,<country>South Korea</country></nlm:aff></affiliation><affiliation><nlm:aff id="aff6"><institution content-type="department">Department of Public Health and Community Medicine</institution>,<institution>Seoul Metropolitan Government – Seoul National University Boramae Medical Center</institution>,<addr-line content-type="city">Seoul</addr-line>,<country>South Korea</country></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">32139484</idno><idno type="pmc">7059523</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7059523</idno><idno type="RBID">PMC:7059523</idno><idno type="doi">10.1136/bmjopen-2019-033026</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000B03</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000B03</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Influence of trust on two different risk perceptions as an affective and cognitive dimension during Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak in South Korea: serial cross-sectional surveys</title><author><name sortKey="Jang, Won Mo" sort="Jang, Won Mo" uniqKey="Jang W" first="Won Mo" last="Jang">Won Mo Jang</name><affiliation><nlm:aff id="aff1"><institution content-type="department">Health Review and Assessment Committee</institution>,<institution>Health Insurance Review and Assessment Service</institution>,<addr-line content-type="city">Wonju</addr-line>,<country>South Korea</country></nlm:aff></affiliation></author><author><name sortKey="Kim, Un Na" sort="Kim, Un Na" uniqKey="Kim U" first="Un-Na" last="Kim">Un-Na Kim</name><affiliation><nlm:aff id="aff2"><institution content-type="department">Division of Suicide Prevention Policy</institution>,<institution>Ministry of Health and Welfare</institution>,<addr-line content-type="city">Sejong</addr-line>,<country>South Korea</country></nlm:aff></affiliation><affiliation><nlm:aff id="aff3"><institution content-type="department">Department of Health Policy and Management</institution>,<institution>Seoul National University College of Medicine</institution>,<addr-line content-type="city">Seoul</addr-line>,<country>South Korea</country></nlm:aff></affiliation></author><author><name sortKey="Jang, Deok Hyun" sort="Jang, Deok Hyun" uniqKey="Jang D" first="Deok Hyun" last="Jang">Deok Hyun Jang</name><affiliation><nlm:aff id="aff4"><institution content-type="department">Research Analytics and Communications</institution>,<institution>Gallup Korea</institution>,<addr-line content-type="city">Seoul</addr-line>,<country>South Korea</country></nlm:aff></affiliation></author><author><name sortKey="Jung, Hyemin" sort="Jung, Hyemin" uniqKey="Jung H" first="Hyemin" last="Jung">Hyemin Jung</name><affiliation><nlm:aff id="aff1"><institution content-type="department">Health Review and Assessment Committee</institution>,<institution>Health Insurance Review and Assessment Service</institution>,<addr-line content-type="city">Wonju</addr-line>,<country>South Korea</country></nlm:aff></affiliation><affiliation><nlm:aff id="aff3"><institution content-type="department">Department of Health Policy and Management</institution>,<institution>Seoul National University College of Medicine</institution>,<addr-line content-type="city">Seoul</addr-line>,<country>South Korea</country></nlm:aff></affiliation></author><author><name sortKey="Cho, Sanghyun" sort="Cho, Sanghyun" uniqKey="Cho S" first="Sanghyun" last="Cho">Sanghyun Cho</name><affiliation><nlm:aff id="aff3"><institution content-type="department">Department of Health Policy and Management</institution>,<institution>Seoul National University College of Medicine</institution>,<addr-line content-type="city">Seoul</addr-line>,<country>South Korea</country></nlm:aff></affiliation></author><author><name sortKey="Eun, Sang Jun" sort="Eun, Sang Jun" uniqKey="Eun S" first="Sang Jun" last="Eun">Sang Jun Eun</name><affiliation><nlm:aff id="aff5"><institution content-type="department">Department of Preventive Medicine</institution>,<institution>Chungnam National University College of Medicine</institution>,<addr-line content-type="city">Daejeon</addr-line>,<country>South Korea</country></nlm:aff></affiliation></author><author><name sortKey="Lee, Jin Yong" sort="Lee, Jin Yong" uniqKey="Lee J" first="Jin Yong" last="Lee">Jin Yong Lee</name><affiliation><nlm:aff id="aff3"><institution content-type="department">Department of Health Policy and Management</institution>,<institution>Seoul National University College of Medicine</institution>,<addr-line content-type="city">Seoul</addr-line>,<country>South Korea</country></nlm:aff></affiliation><affiliation><nlm:aff id="aff6"><institution content-type="department">Department of Public Health and Community Medicine</institution>,<institution>Seoul Metropolitan Government – Seoul National University Boramae Medical Center</institution>,<addr-line content-type="city">Seoul</addr-line>,<country>South Korea</country></nlm:aff></affiliation></author></analytic><series><title level="j">BMJ Open</title><idno type="eISSN">2044-6055</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objectives</title><p>This study aimed to assess the affective and cognitive risk perceptions in the general population of Middle East respiratory syndrome (MERS) during the 2015 MERS coronavirus (MERS-CoV) outbreak in South Korea and the influencing factors.</p></sec><sec><title>Design</title><p>Serial cross-sectional design with four consecutive surveys.</p></sec><sec><title>Setting</title><p>Nationwide general population in South Korea.</p></sec><sec><title>Participants</title><p>Overall 4010 respondents (aged 19 years and over) from the general population during the MERS-CoV epidemic were included.</p></sec><sec><title>Primary and secondary outcome measures</title><p>The main outcome measures were (1) affective risk perception, (2) cognitive risk perception, and (3) trust in the government. Multivariate logistic regression models were used to identify factors (demographic, socioeconomic, area and political orientation) associated with risk perceptions.</p></sec><sec><title>Results</title><p>Both affective and cognitive risk perceptions decreased as the MERS-CoV epidemic progressed. Proportions of affective risk perception were higher in all surveys and slowly decreased compared with cognitive risk perception over time. Females (adjusted OR (aOR) 1.72–2.00; 95% CI 1.14 to 2.86) and lower self-reported household economic status respondents were more likely to perceive the affective risk. The older the adults, the higher the affective risk perception, but the lower the cognitive risk perception compared with younger adults. The respondents who had low trust in the government had higher affective (aOR 2.19–3.11; 95 CI 1.44 to 4.67) and cognitive (aOR 3.55–5.41; 95 CI 1.44 to 9.01) risk perceptions.</p></sec><sec><title>Conclusions</title><p>This study suggests that even if cognitive risk perception is dissolved, affective risk perception can continue during MERS-CoV epidemic. Risk perception associating factors (ie, gender, age and self-reported household economic status) appear to be noticeably different between affective and cognitive dimensions. It also indicates that trust in the government influences affective risk perception and cognitive risk perception. There is a need for further efforts to understand the mechanism regarding the general public’s risk perception for effective risk communication.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Ro, J S" uniqKey="Ro J">J-S Ro</name></author><author><name sortKey="Lee, J S" uniqKey="Lee J">J-S Lee</name></author><author><name sortKey="Kang, S C" uniqKey="Kang S">S-C Kang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Choi, Jw" uniqKey="Choi J">JW Choi</name></author><author><name sortKey="Kim, Kh" uniqKey="Kim K">KH Kim</name></author><author><name sortKey="Moon, Jm" uniqKey="Moon J">JM Moon</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kim, Ey" uniqKey="Kim E">EY Kim</name></author><author><name sortKey="Liao, Q" uniqKey="Liao Q">Q Liao</name></author><author><name sortKey="Yu, Es" uniqKey="Yu E">ES 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uniqKey="Moore H">HA Moore</name></author><author><name sortKey="Williams, Ja" uniqKey="Williams J">JA Williams</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Johnson, Bb" uniqKey="Johnson B">BB Johnson</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">BMJ Open</journal-id><journal-id journal-id-type="iso-abbrev">BMJ Open</journal-id><journal-id journal-id-type="hwp">bmjopen</journal-id><journal-id journal-id-type="publisher-id">bmjopen</journal-id><journal-title-group><journal-title>BMJ Open</journal-title></journal-title-group><issn pub-type="epub">2044-6055</issn><publisher><publisher-name>BMJ Publishing Group</publisher-name><publisher-loc>BMA House, Tavistock Square, London, WC1H 9JR</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">32139484</article-id><article-id pub-id-type="pmc">7059523</article-id><article-id pub-id-type="publisher-id">bmjopen-2019-033026</article-id><article-id pub-id-type="doi">10.1136/bmjopen-2019-033026</article-id><article-categories><subj-group subj-group-type="heading"><subject>Infectious Diseases</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>1506</subject><subject>1706</subject></subj-group><series-title>Original research</series-title></article-categories><title-group><article-title>Influence of trust on two different risk perceptions as an affective and cognitive dimension during Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak in South Korea: serial cross-sectional surveys</article-title></title-group><contrib-group><contrib id="author-70258650" contrib-type="author"><name><surname>Jang</surname><given-names>Won Mo</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib id="author-71444934" contrib-type="author"><name><surname>Kim</surname><given-names>Un-Na</given-names></name><xref ref-type="aff" rid="aff2">2</xref><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib id="author-71444957" contrib-type="author"><name><surname>Jang</surname><given-names>Deok Hyun</given-names></name><xref ref-type="aff" rid="aff4">4</xref></contrib><contrib id="author-70258687" contrib-type="author"><name><surname>Jung</surname><given-names>Hyemin</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib id="author-71445017" contrib-type="author"><name><surname>Cho</surname><given-names>Sanghyun</given-names></name><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib id="author-69480506" contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0001-5868-1679</contrib-id><name><surname>Eun</surname><given-names>Sang Jun</given-names></name><xref ref-type="aff" rid="aff5">5</xref></contrib><contrib id="author-70257195" contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0002-7752-2697</contrib-id><name><surname>Lee</surname><given-names>Jin Yong</given-names></name><xref ref-type="aff" rid="aff3">3</xref><xref ref-type="aff" rid="aff6">6</xref></contrib></contrib-group><aff id="aff1"><label>1</label><institution content-type="department">Health Review and Assessment Committee</institution>,<institution>Health Insurance Review and Assessment Service</institution>,<addr-line content-type="city">Wonju</addr-line>,<country>South Korea</country></aff><aff id="aff2"><label>2</label><institution content-type="department">Division of Suicide Prevention Policy</institution>,<institution>Ministry of Health and Welfare</institution>,<addr-line content-type="city">Sejong</addr-line>,<country>South Korea</country></aff><aff id="aff3"><label>3</label><institution content-type="department">Department of Health Policy and Management</institution>,<institution>Seoul National University College of Medicine</institution>,<addr-line content-type="city">Seoul</addr-line>,<country>South Korea</country></aff><aff id="aff4"><label>4</label><institution content-type="department">Research Analytics and Communications</institution>,<institution>Gallup Korea</institution>,<addr-line content-type="city">Seoul</addr-line>,<country>South Korea</country></aff><aff id="aff5"><label>5</label><institution content-type="department">Department of Preventive Medicine</institution>,<institution>Chungnam National University College of Medicine</institution>,<addr-line content-type="city">Daejeon</addr-line>,<country>South Korea</country></aff><aff id="aff6"><label>6</label><institution content-type="department">Department of Public Health and Community Medicine</institution>,<institution>Seoul Metropolitan Government – Seoul National University Boramae Medical Center</institution>,<addr-line content-type="city">Seoul</addr-line>,<country>South Korea</country></aff><author-notes><corresp><label>Correspondence to</label> Dr Sang Jun Eun; <email>zepplin7@cnu.ac.kr</email>; Dr Jin Yong Lee; <email>jylee2000@gmail.com</email></corresp></author-notes><pub-date pub-type="collection"><year>2020</year></pub-date><pub-date pub-type="epub"><day>4</day><month>3</month><year>2020</year></pub-date><volume>10</volume><issue>3</issue><elocation-id>e033026</elocation-id><history><date date-type="received"><day>17</day><month>7</month><year>2019</year></date><date date-type="rev-recd"><day>12</day><month>1</month><year>2020</year></date><date date-type="accepted"><day>17</day><month>1</month><year>2020</year></date></history><permissions><copyright-statement>© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</copyright-statement><copyright-year>2020</copyright-year><license license-type="open-access"><ali:license_ref start_date="2020-03-04">http://creativecommons.org/licenses/by-nc/4.0/</ali:license_ref><license-p>This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/">http://creativecommons.org/licenses/by-nc/4.0/</ext-link>.</license-p></license></permissions><self-uri xlink:title="pdf" xlink:href="bmjopen-2019-033026.pdf"></self-uri><self-uri content-type="reviewers-comments-pdf" xlink:href="bmjopen-2019-033026.reviewer_comments.pdf"></self-uri><self-uri content-type="draft-revisions-pdf" xlink:href="bmjopen-2019-033026.draft_revisions.pdf"></self-uri><abstract><sec><title>Objectives</title><p>This study aimed to assess the affective and cognitive risk perceptions in the general population of Middle East respiratory syndrome (MERS) during the 2015 MERS coronavirus (MERS-CoV) outbreak in South Korea and the influencing factors.</p></sec><sec><title>Design</title><p>Serial cross-sectional design with four consecutive surveys.</p></sec><sec><title>Setting</title><p>Nationwide general population in South Korea.</p></sec><sec><title>Participants</title><p>Overall 4010 respondents (aged 19 years and over) from the general population during the MERS-CoV epidemic were included.</p></sec><sec><title>Primary and secondary outcome measures</title><p>The main outcome measures were (1) affective risk perception, (2) cognitive risk perception, and (3) trust in the government. Multivariate logistic regression models were used to identify factors (demographic, socioeconomic, area and political orientation) associated with risk perceptions.</p></sec><sec><title>Results</title><p>Both affective and cognitive risk perceptions decreased as the MERS-CoV epidemic progressed. Proportions of affective risk perception were higher in all surveys and slowly decreased compared with cognitive risk perception over time. Females (adjusted OR (aOR) 1.72–2.00; 95% CI 1.14 to 2.86) and lower self-reported household economic status respondents were more likely to perceive the affective risk. The older the adults, the higher the affective risk perception, but the lower the cognitive risk perception compared with younger adults. The respondents who had low trust in the government had higher affective (aOR 2.19–3.11; 95 CI 1.44 to 4.67) and cognitive (aOR 3.55–5.41; 95 CI 1.44 to 9.01) risk perceptions.</p></sec><sec><title>Conclusions</title><p>This study suggests that even if cognitive risk perception is dissolved, affective risk perception can continue during MERS-CoV epidemic. Risk perception associating factors (ie, gender, age and self-reported household economic status) appear to be noticeably different between affective and cognitive dimensions. It also indicates that trust in the government influences affective risk perception and cognitive risk perception. There is a need for further efforts to understand the mechanism regarding the general public’s risk perception for effective risk communication.</p></sec></abstract><kwd-group><kwd>Middle East respiratory syndrome coronavirus</kwd><kwd>risk and perception</kwd><kwd>epidemics</kwd><kwd>surveys</kwd></kwd-group><custom-meta-group><custom-meta><meta-name>special-feature</meta-name><meta-value>unlocked</meta-value></custom-meta></custom-meta-group></article-meta></front><body><boxed-text id="BX1" position="float" orientation="portrait"><caption><title>Strengths and limitations of this study</title></caption><list list-type="bullet"><list-item><p>This is the first study to evaluate the difference in risk perception between the affective and cognitive dimensions during Middle East respiratory syndrome coronavirus outbreak in South Korea.</p></list-item><list-item><p>We used four consecutive cross-sectional surveys using nationwide representative samples.</p></list-item><list-item><p>The validity of the questionnaire used in the survey was not evaluated because of the urgency of the outbreak.</p></list-item><list-item><p>This study could not confirm causal relationship between personal characteristics and risk perception due to the limitation of the cross-sectional study design.</p></list-item></list></boxed-text><sec id="s1"><title>Background</title><p>Newly emerging contagious diseases have created a novel chance to examine how people perceive risk during an epidemic. In South Korea, since the occurrence of the index case of Middle East respiratory syndrome (MERS) on 20 May 2015, a total of 186 persons were diagnosed with the disease, 38 of whom had died and 16 693 patients were quarantined.<xref rid="R1" ref-type="bibr">1</xref> The epidemic of MERS coronavirus (MERS-CoV) has had its largest outbreak outside of the Middle East in South Korea.<xref rid="R2" ref-type="bibr">2</xref> The occurrence of multiple transmissions after the first secondary infection and the failure of the government on risk communication resulted in the increased concern of the general public.<xref rid="R3" ref-type="bibr">3–6</xref> The Korean government did not disclose timely information about the outbreak of MERS-CoV, such as lists of affected medical institutions.<xref rid="R7" ref-type="bibr">7</xref> Due to increased public anxiety about MERS-CoV, the trust in the Korean government had fallen and the image of the Korean president as a leader had been damaged.<xref rid="R8" ref-type="bibr">8 9</xref></p><p>During contagious disease epidemics, perceived risk can have a significant impact on precautionary behaviours that might affect disease transmission.<xref rid="R10" ref-type="bibr">10–12</xref> A relevant empirical study emphasised that informing public about the disease outbreak, such as the Ebola virus, could reduce worry about contracting the virus and take more preventive measures.<xref rid="R13" ref-type="bibr">13</xref> The evaluation of public risk perception of disease helps us to know what knowledge the public needs. Therefore, understanding the characteristics of risk perception and factors relating to how people perceive the risk is important in terms of minimising the impact of spread of infectious disease.</p><p>Given that external stimuli are extreme events, two different reactions can occur: the affective reaction (risk as feelings) and cognitive reaction (risk as analysis).<xref rid="R14" ref-type="bibr">14–16</xref> Previous studies suggest that affective reaction is quick, intuitive and automatic, while cognitive reaction is slow, deliberate and probably calculative. In the early phase of the outbreak, people may experience challenges when attempting to quantify the risk, which may lead to an affective reaction.<xref rid="R12" ref-type="bibr">12 17</xref> In contrast, cognitive reaction may occur during the late stage of the epidemic.</p><p>Most people may not conduct deliberate risk analysis when they cope with lack of knowledge about risk, such as new disease outbreak, but rely on simple heuristics.<xref rid="R18" ref-type="bibr">18 19</xref> Heuristic processing can be understood as simple decision rule of thumb or mental shortcut that can reduce the complexity of decision-making. When risk management decisions are needed, trust in the institutions can be used as one of the heuristics.<xref rid="R20" ref-type="bibr">20</xref> People having trust in the responsible risk manager, such as the government, may perceive less risk in a particular situation than people not having trust.<xref rid="R21" ref-type="bibr">21 22</xref> Regarding the MERS epidemic in South Korea, less trust in the government affected increasing number of individuals’ risk perception.<xref rid="R23" ref-type="bibr">23–25</xref> Trust is known to be related to cognitive risk perception and to affective risk perception.<xref rid="R26" ref-type="bibr">26 27</xref></p><p>However, when assessing the influence of trust in risk perception, many studies have not distinguished between affective and cognitive reactions regarding contagious diseases during outbreaks.<xref rid="R3" ref-type="bibr">3 12 23 24 28–30</xref> We hypothesised that (1) affective risk perception would increase and decrease faster than cognitive risk perception over time and that (2) low trust in government would be related with high-risk perception (both affective and cognitive).</p></sec><sec sec-type="methods" id="s2"><title>Methods</title><sec id="s2-1"><title>Participants</title><p>Between 9 June and 2 July 2015, a total of 4010 participants who were 19 years and older were monitored using a serial cross-sectional study design in four consecutive surveys, covering the MERS epidemic. All surveys were conducted using mobile (85%) or landline (15%) random digit dialling numbers in eight regions which was representative of nationwide. Samples were selected after stratification by gender, age and province. The total number of weighted cases in this survey equals the total number of unweighted cases at the national level. The weights were normalised in order to calculate proportions and ratios; however; not for estimating the number of the subtotal populations. Trained interviewers conducted all interviews using computer-assisted telephone interviewing. The first survey was conducted between 9 and 11 June 2015 after the 1 June 2015 occurrence of the first tertiary infected case. The last was conducted just 2 days before the last confirmed patient on 4 July 2015. The surveys were conducted by Gallup Korea, an affiliation of Gallup International. Details including period, number of respondents successfully interviewed and response rate for each of the four surveys are provided in <xref rid="T1" ref-type="table">table 1</xref>.</p><table-wrap id="T1" orientation="portrait" position="float"><label>Table 1</label><caption><p>Details of four consecutive surveys regarding the 2015 MERS-CoV outbreak in South Korea</p></caption><table frame="hsides" rules="groups"><thead><tr><td align="left" valign="bottom" rowspan="1" colspan="1">Survey</td><td align="left" valign="bottom" rowspan="1" colspan="1">Period</td><td align="left" valign="bottom" rowspan="1" colspan="1">Respondents sampled, n</td><td align="left" valign="bottom" rowspan="1" colspan="1">Respondents successfully interviewed, n</td><td align="left" valign="bottom" rowspan="1" colspan="1">Response rate (%)</td></tr></thead><tbody><tr><td align="char" char="." valign="top" rowspan="1" colspan="1">1</td><td align="left" valign="top" rowspan="1" colspan="1">9–11 June</td><td align="char" char="." valign="top" rowspan="1" colspan="1">5482</td><td align="char" char="." valign="top" rowspan="1" colspan="1">1002</td><td align="char" char="." valign="top" rowspan="1" colspan="1">18.3</td></tr><tr><td align="char" char="." valign="top" rowspan="1" colspan="1">2</td><td align="left" valign="top" rowspan="1" colspan="1">16–18 June</td><td align="char" char="." valign="top" rowspan="1" colspan="1">5585</td><td align="char" char="." valign="top" rowspan="1" colspan="1">1000</td><td align="char" char="." valign="top" rowspan="1" colspan="1">17.9</td></tr><tr><td align="char" char="." valign="top" rowspan="1" colspan="1">3</td><td align="left" valign="top" rowspan="1" colspan="1">23–25 June</td><td align="char" char="." valign="top" rowspan="1" colspan="1">5680</td><td align="char" char="." valign="top" rowspan="1" colspan="1">1004</td><td align="char" char="." valign="top" rowspan="1" colspan="1">17.7</td></tr><tr><td align="char" char="." valign="top" rowspan="1" colspan="1">4</td><td align="left" valign="top" rowspan="1" colspan="1">30 June to 2 July</td><td align="char" char="." valign="top" rowspan="1" colspan="1">5345</td><td align="char" char="." valign="top" rowspan="1" colspan="1">1004</td><td align="char" char="." valign="top" rowspan="1" colspan="1">18.8</td></tr></tbody></table><table-wrap-foot><fn id="T1_FN1"><p>MERS-CoV, Middle East respiratory syndrome coronavirus.</p></fn></table-wrap-foot></table-wrap><p>Demographic factors evaluated as respondents’ characteristics included gender, age, educational attainment, occupation, self-reported household economic status, residential area, and trust in president, party identification. Age was classified into six levels (19–29, 30s, 40s, 50s, 60s, 70 years and older). Educational attainment was classified into four levels (less than middle school, high school, university, graduate school or higher). Occupation was classified as either unemployed, farming/forestry/fishery, self-employed, blue-collar worker, white-collar worker, full-time home maker or student. Self-reported household economic status was classified into five levels (lower, lower middle, middle, upper middle, upper). Respondents were classified as either metropolitan or non-metropolitan residents; and distinguished by whether they resided in an area where MERS had occurred or not. Party identification was classified based on the support for the political parties. Support for the party identification was assessed based on alignment either with the ruling party (Saenuri party), with the opposition party or no opinion.</p></sec><sec id="s2-2"><title>Survey instruments</title><p>The interviews were conducted based on two aspects of the risk perception, which are affective and cognitive risk perceptions (see <xref ref-type="supplementary-material" rid="SP1">online supplementary material</xref>). Affective risk perception was assessed using the question ‘How much worried are you that you could get MERS?’ Responses were assessed on a 4-point scale, with 4 points indicating ‘very much worried’ and 1 point indicating ‘not worried at all’ (reclassified as 1–2 points=‘not worried’; 3–4 points=‘worried’). Affective risk perception proportion was defined as the number of participants who were ‘worried’ by the number of eligible respondents. Cognitive risk perception was evaluated using the question ‘Do you think MERS epidemic will settle down in the next few days or spread further?’ and required the following responses: ‘will settle down’, ‘will spread further’. Cognitive risk perception proportion was defined as the number of participants whose response was ‘will spread further’ by the number of eligible respondents. Trust in government was assessed using presidential job approval rating. Trust in government includes expectations of government’s competence to prevent people from risk and develop and implement follow-up measures.<xref rid="R31" ref-type="bibr">31</xref> This trust concept can be termed competence-based trust.<xref rid="R32" ref-type="bibr">32 33</xref> We tried to assess the competence-based trust in the government using presidential job approval rating. Presidential job approval was evaluated using the question ‘Do you approve or disapprove of the way President Park Geun-hye is handling her job as president?’ and required the following responses: ‘approval’, ‘disapproval’. The development of questionnaires on risk perception and trust in the government had not gone through a validity procedure due to the urgency of the outbreak. We also imposed survey items on existing questionnaire developed by Gallup Korea, an affiliation of Gallup International.</p><supplementary-material content-type="local-data" id="SP1"><object-id pub-id-type="doi">10.1136/bmjopen-2019-033026.supp1</object-id><label>Supplementary data</label><p><inline-supplementary-material id="SS1" xlink:href="bmjopen-2019-033026supp001.pdf" mime-subtype="pdf" mimetype="application" content-type="local-data"></inline-supplementary-material></p></supplementary-material></sec><sec id="s2-3"><title>Analysis</title><p>Response rates according to affective or cognitive risk perceptions were calculated over time. Univariate analyses using χ<sup>2</sup> test were performed in the four consecutive surveys, entirely and respectively, to identify the relationships between risk perception and each demographic variable. We used multivariable logistic regression analyses to explore factors influencing risk perceptions (affective and cognitive) in the four surveys, entirely and respectively. Multivariable logistic regression model was adjusted for gender, age, educational attainment, occupation, self-reported household economic status, affected area, residential area, presidential job approval and party identification. The self-reported household economic status was excluded in survey 4 model with cognitive risk perception. These exclusions were because there was small sample size of those who perceived cognitive risk in the upper economic level in survey 4. Missing values of any variable were ≤2.7%. Using logistic regression analysis for each affective and cognitive risk perception, ‘y=1’ was used respectively when ‘worried’ in affective and when ‘spread’ in cognitive, otherwise ‘y=0’ was used.</p></sec><sec id="s2-4"><title>Patient and public involvement</title><p>No patient or public was involved in the design or planning of this study.</p></sec></sec><sec sec-type="results" id="s3"><title>Results</title><sec id="s3-1"><title>Demographic factors</title><p>The general characteristics of the participants are shown in <xref rid="T2" ref-type="table">table 2</xref>. There were no statistically significant differences between surveys except self-reported household economic status, affective risk perception and cognitive risk perception. Nearly half of the participants were female, aged <50 years, educated up to high school or below, from the affected area and showed disapproval of the president or the ruling party. Majority of the participants were employed, of middle economic status and metropolitan. More than half of participants were worried but had views that the epidemic would subside.</p><table-wrap id="T2" orientation="portrait" position="float"><label>Table 2</label><caption><p>Basic characteristics of the participants</p></caption><table frame="hsides" rules="groups"><thead><tr><td align="left" valign="top" rowspan="1" colspan="1">Variables</td><td align="left" valign="top" rowspan="1" colspan="1">Overall</td><td align="left" valign="top" rowspan="1" colspan="1">Survey 1</td><td align="left" valign="top" rowspan="1" colspan="1">Survey 2</td><td align="left" valign="top" rowspan="1" colspan="1">Survey 3</td><td align="left" valign="top" rowspan="1" colspan="1">Survey 4</td></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">Gender</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Male</td><td rowspan="1" align="char" char="." colspan="1">49.5</td><td rowspan="1" align="char" char="." colspan="1">49.4</td><td rowspan="1" align="char" char="." colspan="1">49.6</td><td rowspan="1" align="char" char="." colspan="1">49.7</td><td rowspan="1" align="char" char="." colspan="1">49.5</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Female</td><td rowspan="1" align="char" char="." colspan="1">50.5</td><td rowspan="1" align="char" char="." colspan="1">50.6</td><td rowspan="1" align="char" char="." colspan="1">50.4</td><td rowspan="1" align="char" char="." colspan="1">50.3</td><td rowspan="1" align="char" char="." colspan="1">50.5</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Age (years)</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 19–29</td><td rowspan="1" align="char" char="." colspan="1">17.6</td><td rowspan="1" align="char" char="." colspan="1">18.2</td><td rowspan="1" align="char" char="." colspan="1">17.1</td><td rowspan="1" align="char" char="." colspan="1">17.8</td><td rowspan="1" align="char" char="." colspan="1">17.3</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 30–39</td><td rowspan="1" align="char" char="." colspan="1">18.6</td><td rowspan="1" align="char" char="." colspan="1">18.2</td><td rowspan="1" align="char" char="." colspan="1">18.5</td><td rowspan="1" align="char" char="." colspan="1">18.8</td><td rowspan="1" align="char" char="." colspan="1">19.1</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 40–49</td><td rowspan="1" align="char" char="." colspan="1">21.7</td><td rowspan="1" align="char" char="." colspan="1">20.7</td><td rowspan="1" align="char" char="." colspan="1">22.5</td><td rowspan="1" align="char" char="." colspan="1">21.5</td><td rowspan="1" align="char" char="." colspan="1">22.1</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 50–59</td><td rowspan="1" align="char" char="." colspan="1">19.6</td><td rowspan="1" align="char" char="." colspan="1">20.0</td><td rowspan="1" align="char" char="." colspan="1">19.4</td><td rowspan="1" align="char" char="." colspan="1">19.4</td><td rowspan="1" align="char" char="." colspan="1">19.7</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 60–69</td><td rowspan="1" align="char" char="." colspan="1">13.0</td><td rowspan="1" align="char" char="." colspan="1">14.0</td><td rowspan="1" align="char" char="." colspan="1">13.1</td><td rowspan="1" align="char" char="." colspan="1">11.8</td><td rowspan="1" align="char" char="." colspan="1">13.1</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> ≥70</td><td rowspan="1" align="char" char="." colspan="1">9.4</td><td rowspan="1" align="char" char="." colspan="1">8.9</td><td rowspan="1" align="char" char="." colspan="1">9.4</td><td rowspan="1" align="char" char="." colspan="1">10.8</td><td rowspan="1" align="char" char="." colspan="1">8.7</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Educational attainment</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Middle school or below</td><td rowspan="1" align="char" char="." colspan="1">15.1</td><td rowspan="1" align="char" char="." colspan="1">13.6</td><td rowspan="1" align="char" char="." colspan="1">15.4</td><td rowspan="1" align="char" char="." colspan="1">15.7</td><td rowspan="1" align="char" char="." colspan="1">15.6</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> High school</td><td rowspan="1" align="char" char="." colspan="1">28.1</td><td rowspan="1" align="char" char="." colspan="1">27.2</td><td rowspan="1" align="char" char="." colspan="1">28.9</td><td rowspan="1" align="char" char="." colspan="1">27.5</td><td rowspan="1" align="char" char="." colspan="1">29.0</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> University</td><td rowspan="1" align="char" char="." colspan="1">50.2</td><td rowspan="1" align="char" char="." colspan="1">53.9</td><td rowspan="1" align="char" char="." colspan="1">48.5</td><td rowspan="1" align="char" char="." colspan="1">50.0</td><td rowspan="1" align="char" char="." colspan="1">48.4</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Graduate school</td><td rowspan="1" align="char" char="." colspan="1">6.6</td><td rowspan="1" align="char" char="." colspan="1">5.3</td><td rowspan="1" align="char" char="." colspan="1">7.2</td><td rowspan="1" align="char" char="." colspan="1">6.8</td><td rowspan="1" align="char" char="." colspan="1">7.0</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Occupation</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Unemployed</td><td rowspan="1" align="char" char="." colspan="1">8.7</td><td rowspan="1" align="char" char="." colspan="1">8.9</td><td rowspan="1" align="char" char="." colspan="1">8.7</td><td rowspan="1" align="char" char="." colspan="1">7.8</td><td rowspan="1" align="char" char="." colspan="1">9.3</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Farming/forestry/fishery</td><td rowspan="1" align="char" char="." colspan="1">3.9</td><td rowspan="1" align="char" char="." colspan="1">3.6</td><td rowspan="1" align="char" char="." colspan="1">3.2</td><td rowspan="1" align="char" char="." colspan="1">5.0</td><td rowspan="1" align="char" char="." colspan="1">3.6</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Self-employed</td><td rowspan="1" align="char" char="." colspan="1">15.3</td><td rowspan="1" align="char" char="." colspan="1">13.6</td><td rowspan="1" align="char" char="." colspan="1">14.1</td><td rowspan="1" align="char" char="." colspan="1">18.7</td><td rowspan="1" align="char" char="." colspan="1">14.7</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Blue-collar</td><td rowspan="1" align="char" char="." colspan="1">11.7</td><td rowspan="1" align="char" char="." colspan="1">11.8</td><td rowspan="1" align="char" char="." colspan="1">12.4</td><td rowspan="1" align="char" char="." colspan="1">10.8</td><td rowspan="1" align="char" char="." colspan="1">11.7</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> White-collar</td><td rowspan="1" align="char" char="." colspan="1">28.2</td><td rowspan="1" align="char" char="." colspan="1">28.9</td><td rowspan="1" align="char" char="." colspan="1">26.8</td><td rowspan="1" align="char" char="." colspan="1">29.1</td><td rowspan="1" align="char" char="." colspan="1">28.0</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Home maker</td><td rowspan="1" align="char" char="." colspan="1">23.3</td><td rowspan="1" align="char" char="." colspan="1">23.1</td><td rowspan="1" align="char" char="." colspan="1">26.1</td><td rowspan="1" align="char" char="." colspan="1">19.6</td><td rowspan="1" align="char" char="." colspan="1">24.3</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Student</td><td rowspan="1" align="char" char="." colspan="1">9.1</td><td rowspan="1" align="char" char="." colspan="1">10.1</td><td rowspan="1" align="char" char="." colspan="1">8.7</td><td rowspan="1" align="char" char="." colspan="1">9.0</td><td rowspan="1" align="char" char="." colspan="1">8.4</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Self-reported household economic status*</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Upper</td><td rowspan="1" align="char" char="." colspan="1">1.8</td><td rowspan="1" align="char" char="." colspan="1">1.9</td><td rowspan="1" align="char" char="." colspan="1">1.9</td><td rowspan="1" align="char" char="." colspan="1">2.1</td><td rowspan="1" align="char" char="." colspan="1">1.2</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Upper middle</td><td rowspan="1" align="char" char="." colspan="1">10.9</td><td rowspan="1" align="char" char="." colspan="1">13.0</td><td rowspan="1" align="char" char="." colspan="1">11.4</td><td rowspan="1" align="char" char="." colspan="1">8.5</td><td rowspan="1" align="char" char="." colspan="1">10.8</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Middle</td><td rowspan="1" align="char" char="." colspan="1">42.8</td><td rowspan="1" align="char" char="." colspan="1">44.5</td><td rowspan="1" align="char" char="." colspan="1">43.0</td><td rowspan="1" align="char" char="." colspan="1">39.3</td><td rowspan="1" align="char" char="." colspan="1">44.5</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Lower middle</td><td rowspan="1" align="char" char="." colspan="1">25.7</td><td rowspan="1" align="char" char="." colspan="1">24.2</td><td rowspan="1" align="char" char="." colspan="1">26.6</td><td rowspan="1" align="char" char="." colspan="1">27.5</td><td rowspan="1" align="char" char="." colspan="1">24.6</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Lower</td><td rowspan="1" align="char" char="." colspan="1">18.8</td><td rowspan="1" align="char" char="." colspan="1">16.4</td><td rowspan="1" align="char" char="." colspan="1">17.1</td><td rowspan="1" align="char" char="." colspan="1">22.6</td><td rowspan="1" align="char" char="." colspan="1">18.9</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">MERS-CoV-affected area</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Non-affected area</td><td rowspan="1" align="char" char="." colspan="1">48.8</td><td rowspan="1" align="char" char="." colspan="1">47.6</td><td rowspan="1" align="char" char="." colspan="1">49.5</td><td rowspan="1" align="char" char="." colspan="1">49.0</td><td rowspan="1" align="char" char="." colspan="1">49.0</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Affected area</td><td rowspan="1" align="char" char="." colspan="1">51.2</td><td rowspan="1" align="char" char="." colspan="1">52.4</td><td rowspan="1" align="char" char="." colspan="1">50.5</td><td rowspan="1" align="char" char="." colspan="1">51.0</td><td rowspan="1" align="char" char="." colspan="1">51.0</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Residential area</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Non-metropolitan</td><td rowspan="1" align="char" char="." colspan="1">29.3</td><td rowspan="1" align="char" char="." colspan="1">28.4</td><td rowspan="1" align="char" char="." colspan="1">28.4</td><td rowspan="1" align="char" char="." colspan="1">29.2</td><td rowspan="1" align="char" char="." colspan="1">31.0</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Metropolitan</td><td rowspan="1" align="char" char="." colspan="1">70.7</td><td rowspan="1" align="char" char="." colspan="1">71.6</td><td rowspan="1" align="char" char="." colspan="1">71.6</td><td rowspan="1" align="char" char="." colspan="1">70.8</td><td rowspan="1" align="char" char="." colspan="1">69.0</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Presidential job approval rating</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Approval</td><td rowspan="1" align="char" char="." colspan="1">32.3</td><td rowspan="1" align="char" char="." colspan="1">33.1</td><td rowspan="1" align="char" char="." colspan="1">29.1</td><td rowspan="1" align="char" char="." colspan="1">32.6</td><td rowspan="1" align="char" char="." colspan="1">34.2</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Disapproval</td><td rowspan="1" align="char" char="." colspan="1">58.6</td><td rowspan="1" align="char" char="." colspan="1">57.6</td><td rowspan="1" align="char" char="." colspan="1">60.6</td><td rowspan="1" align="char" char="." colspan="1">58.4</td><td rowspan="1" align="char" char="." colspan="1">57.9</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> No opinion</td><td rowspan="1" align="char" char="." colspan="1">9.1</td><td rowspan="1" align="char" char="." colspan="1">9.3</td><td rowspan="1" align="char" char="." colspan="1">10.3</td><td rowspan="1" align="char" char="." colspan="1">9.0</td><td rowspan="1" align="char" char="." colspan="1">7.9</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Party identification</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Ruling party</td><td rowspan="1" align="char" char="." colspan="1">39.8</td><td rowspan="1" align="char" char="." colspan="1">39.9</td><td rowspan="1" align="char" char="." colspan="1">39.7</td><td rowspan="1" align="char" char="." colspan="1">39.6</td><td rowspan="1" align="char" char="." colspan="1">40.2</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Opposition party</td><td rowspan="1" align="char" char="." colspan="1">28.6</td><td rowspan="1" align="char" char="." colspan="1">26.2</td><td rowspan="1" align="char" char="." colspan="1">28.5</td><td rowspan="1" align="char" char="." colspan="1">29.4</td><td rowspan="1" align="char" char="." colspan="1">30.2</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> No opinion</td><td rowspan="1" align="char" char="." colspan="1">31.6</td><td rowspan="1" align="char" char="." colspan="1">33.9</td><td rowspan="1" align="char" char="." colspan="1">31.8</td><td rowspan="1" align="char" char="." colspan="1">31.0</td><td rowspan="1" align="char" char="." colspan="1">29.6</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Affective risk perception*</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Worried</td><td rowspan="1" align="char" char="." colspan="1">53.8</td><td rowspan="1" align="char" char="." colspan="1">55.0</td><td rowspan="1" align="char" char="." colspan="1">62.8</td><td rowspan="1" align="char" char="." colspan="1">52.2</td><td rowspan="1" align="char" char="." colspan="1">44.9</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Not worried</td><td rowspan="1" align="char" char="." colspan="1">46.2</td><td rowspan="1" align="char" char="." colspan="1">45.0</td><td rowspan="1" align="char" char="." colspan="1">37.2</td><td rowspan="1" align="char" char="." colspan="1">47.8</td><td rowspan="1" align="char" char="." colspan="1">55.1</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Cognitive risk perception*</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Spread further</td><td rowspan="1" align="char" char="." colspan="1">30.3</td><td rowspan="1" align="char" char="." colspan="1">35.4</td><td rowspan="1" align="char" char="." colspan="1">52.6</td><td rowspan="1" align="char" char="." colspan="1">26.3</td><td rowspan="1" align="char" char="." colspan="1">9.0</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Settle down</td><td rowspan="1" align="char" char="." colspan="1">69.7</td><td rowspan="1" align="char" char="." colspan="1">64.6</td><td rowspan="1" align="char" char="." colspan="1">47.4</td><td rowspan="1" align="char" char="." colspan="1">73.7</td><td rowspan="1" align="char" char="." colspan="1">91.0</td></tr></tbody></table><table-wrap-foot><fn id="T2_FN1"><p>*P<0.05 calculated by χ<sup>2</sup> test.</p></fn><fn id="T2_FN2"><p>MERS-CoV, Middle East respiratory syndrome coronavirus.</p></fn></table-wrap-foot></table-wrap></sec><sec id="s3-2"><title>Epidemic curve and time trends of risk perception</title><p><xref ref-type="fig" rid="F1">Figure 1</xref> reports how the outbreak proceeded, with three overlapping transmission periods, the timing of the four independent surveys and the risk perception rates. Differences were investigated between affective and cognitive risk proportions throughout the epidemic periods. Overall risk perception of the four surveys at affective proportion (53.8%) was nearly two times higher than at cognitive dimension (30.3%). Affective risk perception proportions were always higher than cognitive dimension during the present study periods. Of the affective risk perception, proportion was initially high during survey 1 (55.0%), rose during survey 2 (62.8%) and declined again during surveys 3 and 4 (52.2% and 44.9%, respectively). A similar trend was observed in the cognitive risk perception proportions. The percentages of respondents who reported as being ‘worried’ or ‘spread further’ decreased gradually after survey 2. Cognitive risk perception proportions decreased more rapidly than affective aspect, over time, from 52.6% and 62.8% in survey 2 to 9.0% and 44.9% in survey 4, respectively. At the beginning of the occurrences of tertiary and quaternary cases, we identified high perceived risk in both the affective and cognitive aspect proportions.</p><fig id="F1" orientation="portrait" position="float"><label>Figure 1</label><caption><p>Epidemiologic curve of MERS-CoV, timing of surveys and affective and cognitive risk perceptions. MERS-CoV, Middle East respiratory syndrome coronavirus.</p></caption><graphic xlink:href="bmjopen-2019-033026f01"></graphic></fig></sec><sec id="s3-3"><title>Factors associated with the affective risk perception</title><p><xref rid="T3" ref-type="table">Table 3</xref> shows the association between variables and risk perception of MERS-CoV at the affective dimension. The result showed that gender, age, educational attainment, self-reported household economic status, area, presidential job approval rating and party identification were significantly associated with affective risk perception. Women (adjusted OR (aOR) 1.72–2.00; 95% CI 1.14 to 2.86) were more likely to perceive MERS-CoV risk at affective dimension, which decreased with time, and subsequently increased again. Groups of older than 40 years were less aware of the risk (aOR 0.58–0.76; 95% CI 0.28 to 1.56) in survey 1; however, they perceived the risk more over time (aOR 2.84–3.29; 95% CI 1.27 to 6.66) in survey 4. The association of education with affective risk perception was non-significant except university degree in the overall survey (aOR 0.73; 95% CI 0.55 to 0.96). Lower economic status and those living in metropolitan cities paid more attention to the affective risk of MERS-CoV in the overall model. Those who disapproved of the president and the ruling party had higher risk perception at the affective dimension; the peak of disapproval was found in survey 1.</p><table-wrap id="T3" orientation="portrait" position="float"><label>Table 3</label><caption><p>Factors associated with affective risk perception of MERS-CoV</p></caption><table frame="hsides" rules="groups"><thead><tr><td align="left" valign="bottom" rowspan="2" colspan="1">Variables</td><td align="left" valign="bottom" rowspan="1" colspan="1">Overall</td><td align="left" valign="bottom" rowspan="1" colspan="1">Survey 1</td><td align="left" valign="bottom" rowspan="1" colspan="1">Survey 2</td><td align="left" valign="bottom" rowspan="1" colspan="1">Survey 3</td><td align="left" valign="bottom" rowspan="1" colspan="1">Survey 4</td></tr><tr><td align="left" valign="bottom" rowspan="1" colspan="1">aOR (95% CI)</td><td align="left" valign="bottom" rowspan="1" colspan="1">aOR (95% CI)</td><td align="left" valign="bottom" rowspan="1" colspan="1">aOR (95% CI)</td><td align="left" valign="bottom" rowspan="1" colspan="1">aOR (95% CI)</td><td align="left" valign="bottom" rowspan="1" colspan="1">aOR (95% CI)</td></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">Gender</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Male</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Female</td><td align="left" valign="top" rowspan="1" colspan="1">1.78* (1.49 to 2.13)</td><td align="left" valign="top" rowspan="1" colspan="1">1.83* (1.26 to 2.66)</td><td align="left" valign="top" rowspan="1" colspan="1">1.72* (1.14 to 2.60)</td><td align="left" valign="top" rowspan="1" colspan="1">1.72* (1.26 to 2.42)</td><td align="left" valign="top" rowspan="1" colspan="1">2.00* (1.40 to 2.86)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Age (years)</td><td align="left" valign="top" rowspan="1" colspan="1"> </td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 19–29</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 30–39</td><td align="left" valign="top" rowspan="1" colspan="1">1.76* (1.30 to 2.40)</td><td align="left" valign="top" rowspan="1" colspan="1">0.80 (0.41 to 1.56)</td><td align="left" valign="top" rowspan="1" colspan="1">1.81 (0.94 to 3.46)</td><td align="left" valign="top" rowspan="1" colspan="1">2.19* (1.17 to 4.10)</td><td align="left" valign="top" rowspan="1" colspan="1">3.21* (1.76 to 5.85)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 40–49</td><td align="left" valign="top" rowspan="1" colspan="1">1.57* (1.17 to 2.11)</td><td align="left" valign="top" rowspan="1" colspan="1">0.76 (0.40 to 1.45)</td><td align="left" valign="top" rowspan="1" colspan="1">1.60 (0.88 to 2.90)</td><td align="left" valign="top" rowspan="1" colspan="1">1.72 (0.95 to 3.11)</td><td align="left" valign="top" rowspan="1" colspan="1">3.00* (1.64 to 5.51)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 50–59</td><td align="left" valign="top" rowspan="1" colspan="1">1.36 (1.00 to 1.84)</td><td align="left" valign="top" rowspan="1" colspan="1">0.58 (0.30 to 1.11)</td><td align="left" valign="top" rowspan="1" colspan="1">1.85 (0.96 to 3.55)</td><td align="left" valign="top" rowspan="1" colspan="1">1.10 (0.59 to 2.03)</td><td align="left" valign="top" rowspan="1" colspan="1">2.93* (1.54 to 5.54)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 60–69</td><td align="left" valign="top" rowspan="1" colspan="1">1.35 (0.95 to 1.92)</td><td align="left" valign="top" rowspan="1" colspan="1">0.73 (0.34 to 1.56)</td><td align="left" valign="top" rowspan="1" colspan="1">1.42 (0.69 to 2.93)</td><td align="left" valign="top" rowspan="1" colspan="1">0.86 (0.42 to 1.75)</td><td align="left" valign="top" rowspan="1" colspan="1">3.29* (1.62 to 6.66)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> ≥70</td><td align="left" valign="top" rowspan="1" colspan="1">1.67* (1.13 to 2.48)</td><td align="left" valign="top" rowspan="1" colspan="1">0.66 (0.28 to 1.52)</td><td align="left" valign="top" rowspan="1" colspan="1">2.60* (1.13 to 5.98)</td><td align="left" valign="top" rowspan="1" colspan="1">1.55 (0.71 to 3.38)</td><td align="left" valign="top" rowspan="1" colspan="1">2.84* (1.27 to 6.36)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Educational attainment</td><td align="left" valign="top" rowspan="1" colspan="1"> </td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Middle school or below</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> High school</td><td align="left" valign="top" rowspan="1" colspan="1">0.78 (0.60 to 1.01)</td><td align="left" valign="top" rowspan="1" colspan="1">0.68 (0.39 to 1.19)</td><td align="left" valign="top" rowspan="1" colspan="1">1.25 (0.74 to 2.09)</td><td align="left" valign="top" rowspan="1" colspan="1">0.66 (0.40 to 1.08)</td><td align="left" valign="top" rowspan="1" colspan="1">0.68 (0.41 to 1.15)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> University</td><td align="left" valign="top" rowspan="1" colspan="1">0.73* (0.55 to 0.96)</td><td align="left" valign="top" rowspan="1" colspan="1">0.64 (0.36 to 1.15)</td><td align="left" valign="top" rowspan="1" colspan="1">1.22 (0.68 to 2.17)</td><td align="left" valign="top" rowspan="1" colspan="1">0.59 (0.34 to 1.03)</td><td align="left" valign="top" rowspan="1" colspan="1">0.60 (0.34 to 1.07)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Graduate school</td><td align="left" valign="top" rowspan="1" colspan="1">0.77 (0.52 to 1.12)</td><td align="left" valign="top" rowspan="1" colspan="1">0.89 (0.38 to 2.05)</td><td align="left" valign="top" rowspan="1" colspan="1">0.94 (0.44 to 2.00)</td><td align="left" valign="top" rowspan="1" colspan="1">0.67 (0.30 to 1.49)</td><td align="left" valign="top" rowspan="1" colspan="1">0.64 (0.31 to 1.35)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Occupation</td><td align="left" valign="top" rowspan="1" colspan="1"> </td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Unemployed</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Farming/forestry/fishery</td><td align="left" valign="top" rowspan="1" colspan="1">0.89 (0.55 to 1.42)</td><td align="left" valign="top" rowspan="1" colspan="1">0.99 (0.35 to 2.81)</td><td align="left" valign="top" rowspan="1" colspan="1">0.65 (0.23 to 1.85)</td><td align="left" valign="top" rowspan="1" colspan="1">1.53 (0.62 to 3.78)</td><td align="left" valign="top" rowspan="1" colspan="1">0.69 (0.27 to 1.08)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Self-employed</td><td align="left" valign="top" rowspan="1" colspan="1">0.84 (0.61 to 1.17)</td><td align="left" valign="top" rowspan="1" colspan="1">0.90 (0.47 to 1.72)</td><td align="left" valign="top" rowspan="1" colspan="1">0.56 (0.28 to 1.11)</td><td align="left" valign="top" rowspan="1" colspan="1">1.53 (0.78 to 3.03)</td><td align="left" valign="top" rowspan="1" colspan="1">0.68 (0.36 to 1.31)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Blue-collar</td><td align="left" valign="top" rowspan="1" colspan="1">1.21 (0.87 to 1.70)</td><td align="left" valign="top" rowspan="1" colspan="1">1.20 (0.59 to 2.45)</td><td align="left" valign="top" rowspan="1" colspan="1">1.08 (0.54 to 2.18)</td><td align="left" valign="top" rowspan="1" colspan="1">2.08 (1.0 to 4.35)</td><td align="left" valign="top" rowspan="1" colspan="1">0.84 (0.44 to 1.64)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> White-collar</td><td align="left" valign="top" rowspan="1" colspan="1">1.10 (0.81 to 1.51)</td><td align="left" valign="top" rowspan="1" colspan="1">1.26 (0.68 to 2.35)</td><td align="left" valign="top" rowspan="1" colspan="1">0.86 (0.44 to 1.68)</td><td align="left" valign="top" rowspan="1" colspan="1">1.84 (0.92 to 3.66)</td><td align="left" valign="top" rowspan="1" colspan="1">0.81 (0.44 to 1.46)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Home maker</td><td align="left" valign="top" rowspan="1" colspan="1">1.03 (0.74 to 1.44)</td><td align="left" valign="top" rowspan="1" colspan="1">1.01 (0.53 to 1.92)</td><td align="left" valign="top" rowspan="1" colspan="1">1.01 (0.49 to 2.09)</td><td align="left" valign="top" rowspan="1" colspan="1">1.81 (0.89 to 3.67)</td><td align="left" valign="top" rowspan="1" colspan="1">0.62 (0.32 to 1.18)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Student</td><td align="left" valign="top" rowspan="1" colspan="1">1.01 (0.66 to 1.54)</td><td align="left" valign="top" rowspan="1" colspan="1">0.55 (0.24 to 1.30)</td><td align="left" valign="top" rowspan="1" colspan="1">0.78 (0.33 to 1.85)</td><td align="left" valign="top" rowspan="1" colspan="1">1.66 (0.64 to 4.34)</td><td align="left" valign="top" rowspan="1" colspan="1">1.46 (0.64 to 3.33)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Self-reported household economic status</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Upper</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Upper middle</td><td align="left" valign="top" rowspan="1" colspan="1">1.91* (1.05 to 3.50)</td><td align="left" valign="top" rowspan="1" colspan="1">1.95 (0.59 to 6.48)</td><td align="left" valign="top" rowspan="1" colspan="1">1.71 (0.63 to 4.70)</td><td align="left" valign="top" rowspan="1" colspan="1">2.20 (0.62 to 7.85)</td><td align="left" valign="top" rowspan="1" colspan="1">2.14 (0.51 to 8.93)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Middle</td><td align="left" valign="top" rowspan="1" colspan="1">1.84* (1.03 to 3.27)</td><td align="left" valign="top" rowspan="1" colspan="1">1.83 (0.57 to 5.89)</td><td align="left" valign="top" rowspan="1" colspan="1">1.91 (0.74 to 4.96)</td><td align="left" valign="top" rowspan="1" colspan="1">2.60 (0.79 to 8.55)</td><td align="left" valign="top" rowspan="1" colspan="1">1.84 (0.46 to 7.35)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Lower middle</td><td align="left" valign="top" rowspan="1" colspan="1">2.14* (1.19 to 3.85)</td><td align="left" valign="top" rowspan="1" colspan="1">1.97 (0.60 to 6.47)</td><td align="left" valign="top" rowspan="1" colspan="1">2.12 (0.81 to 5.58)</td><td align="left" valign="top" rowspan="1" colspan="1">2.94 (0.88 to 9.78)</td><td align="left" valign="top" rowspan="1" colspan="1">2.30 (0.56 to 9.40)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Lower</td><td align="left" valign="top" rowspan="1" colspan="1">2.28* (1.25 to 4.14)</td><td align="left" valign="top" rowspan="1" colspan="1">2.24 (0.66 to 7.64)</td><td align="left" valign="top" rowspan="1" colspan="1">2.78* (1.10 to 7.65)</td><td align="left" valign="top" rowspan="1" colspan="1">3.45* (1.02 to 11.69)</td><td align="left" valign="top" rowspan="1" colspan="1">1.98 (0.48 to 8.14)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">MERS-CoV-affected area</td><td align="left" valign="top" rowspan="1" colspan="1"> </td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Non-affected area</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Affected area</td><td align="left" valign="top" rowspan="1" colspan="1">0.92 (0.77 to 1.09)</td><td align="left" valign="top" rowspan="1" colspan="1">1.10 (0.76 to 1.59)</td><td align="left" valign="top" rowspan="1" colspan="1">0.93 (0.65 to 1.32)</td><td align="left" valign="top" rowspan="1" colspan="1">1.01 (0.71 to 1.43)</td><td align="left" valign="top" rowspan="1" colspan="1">0.74 (0.53 to 1.02)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Residential area</td><td align="left" valign="top" rowspan="1" colspan="1"> </td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Non-metropolitan</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Metropolitan</td><td align="left" valign="top" rowspan="1" colspan="1">1.26* (1.04 to 1.54)</td><td align="left" valign="top" rowspan="1" colspan="1">1.15 (0.77 to 1.72)</td><td align="left" valign="top" rowspan="1" colspan="1">1.83* (1.21 to 2.76)</td><td align="left" valign="top" rowspan="1" colspan="1">0.99 (0.66 to 1.49)</td><td align="left" valign="top" rowspan="1" colspan="1">1.19 (0.82 to 1.74)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Presidential job approval rating</td><td align="left" valign="top" rowspan="1" colspan="1"> </td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Approval</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Disapproval</td><td align="left" valign="top" rowspan="1" colspan="1">2.63* (2.17 to 3.20)</td><td align="left" valign="top" rowspan="1" colspan="1">3.11* (2.07 to 4.67)</td><td align="left" valign="top" rowspan="1" colspan="1">2.19* (1.44 to 3.33)</td><td align="left" valign="top" rowspan="1" colspan="1">2.69* (1.81 to 4.01)</td><td align="left" valign="top" rowspan="1" colspan="1">2.88* (1.93 to 4.30)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> No opinion</td><td align="left" valign="top" rowspan="1" colspan="1">1.59* (1.19 to 2.12)</td><td align="left" valign="top" rowspan="1" colspan="1">2.40* (1.32 to 4.37)</td><td align="left" valign="top" rowspan="1" colspan="1">0.86 (0.49 to 1.53)</td><td align="left" valign="top" rowspan="1" colspan="1">1.78 (0.93 to 3.41)</td><td align="left" valign="top" rowspan="1" colspan="1">1.74 (0.97 to 3.14)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Party identification</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Ruling party</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Opposition party</td><td align="left" valign="top" rowspan="1" colspan="1">1.68* (1.36 to 2.08)</td><td align="left" valign="top" rowspan="1" colspan="1">2.06* (1.30 to 3.25)</td><td align="left" valign="top" rowspan="1" colspan="1">2.37* (1.48 to 3.79)</td><td align="left" valign="top" rowspan="1" colspan="1">1.15 (0.75 to 1.76)</td><td align="left" valign="top" rowspan="1" colspan="1">1.56* (1.01 to 2.40)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> No opinion</td><td align="left" valign="top" rowspan="1" colspan="1">1.19 (0.98 to 1.44)</td><td align="left" valign="top" rowspan="1" colspan="1">1.17 (0.78 to 1.74)</td><td align="left" valign="top" rowspan="1" colspan="1">1.64* (1.10 to 2.46)</td><td align="left" valign="top" rowspan="1" colspan="1">0.98 (0.66 to 1.46)</td><td align="left" valign="top" rowspan="1" colspan="1">1.07 (0.72 to 1.60)</td></tr></tbody></table><table-wrap-foot><fn id="T3_FN1"><p>*P<0.05.</p></fn><fn id="T3_FN2"><p>aOR, adjusted OR; MERS-CoV, Middle East respiratory syndrome coronavirus.</p></fn></table-wrap-foot></table-wrap></sec><sec id="s3-4"><title>Factors associated with the cognitive risk perception</title><p>Unlike the cognitive risk perception, no difference was found by gender in the cognitive risk perception (<xref rid="T4" ref-type="table">table 4</xref>). Furthermore, respondents aged 30 years and older were consistently less aware of the cognitive risk during MERS-CoV epidemic. Generally, no not statistically significant association was found with educational attainment, occupation, self-reported household economic status, MERS-CoV-affected area and metropolitan area. Similar to the affective dimension, those who disapproved of the president and the ruling party had higher risk perceptions at the cognitive dimension.</p><table-wrap id="T4" orientation="portrait" position="float"><label>Table 4</label><caption><p>Factors associated with cognitive risk perception of MERS-CoV</p></caption><table frame="hsides" rules="groups"><thead><tr><td align="left" valign="bottom" rowspan="2" colspan="1">Variables</td><td align="left" valign="bottom" rowspan="1" colspan="1">Overall</td><td align="left" valign="bottom" rowspan="1" colspan="1">Survey 1</td><td align="left" valign="bottom" rowspan="1" colspan="1">Survey 2</td><td align="left" valign="bottom" rowspan="1" colspan="1">Survey 3</td><td align="left" valign="bottom" rowspan="1" colspan="1">Survey 4†</td></tr><tr><td align="left" valign="bottom" rowspan="1" colspan="1">aOR (95% CI)</td><td align="left" valign="bottom" rowspan="1" colspan="1">aOR (95% CI)</td><td align="left" valign="bottom" rowspan="1" colspan="1">aOR (95% CI)</td><td align="left" valign="bottom" rowspan="1" colspan="1">aOR (95% CI)</td><td align="left" valign="bottom" rowspan="1" colspan="1">aOR (95% CI)</td></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">Gender</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Male</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Female</td><td align="left" valign="top" rowspan="1" colspan="1">0.98 (0.80 to 1.20)</td><td align="left" valign="top" rowspan="1" colspan="1">1.14 (0.73 to 1.70)</td><td align="left" valign="top" rowspan="1" colspan="1">0.97 (0.64 to 1.46)</td><td align="left" valign="top" rowspan="1" colspan="1">0.81 (0.54 to 1.21)</td><td align="left" valign="top" rowspan="1" colspan="1">1.19 (0.63 to 2.25)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Age (years)</td><td align="left" valign="top" rowspan="1" colspan="1"> </td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 19–29</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 30–39</td><td align="left" valign="top" rowspan="1" colspan="1">0.76 (0.55 to 1.05)</td><td align="left" valign="top" rowspan="1" colspan="1">0.26* (0.13 to 0.54)</td><td align="left" valign="top" rowspan="1" colspan="1">1.26 (0.67 to 2.37)</td><td align="left" valign="top" rowspan="1" colspan="1">0.91 (0.47 to 1.75)</td><td align="left" valign="top" rowspan="1" colspan="1">0.84 (0.33 to 2.11)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 40–49</td><td align="left" valign="top" rowspan="1" colspan="1">0.64* (0.47 to 0.88)</td><td align="left" valign="top" rowspan="1" colspan="1">0.21* (0.10 to 0.42)</td><td align="left" valign="top" rowspan="1" colspan="1">0.99 (0.53 to 1.83)</td><td align="left" valign="top" rowspan="1" colspan="1">0.81 (0.42 to 1.57)</td><td align="left" valign="top" rowspan="1" colspan="1">0.65 (0.27 to 1.57)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 50–59</td><td align="left" valign="top" rowspan="1" colspan="1">0.44* (0.32 to 0.62)</td><td align="left" valign="top" rowspan="1" colspan="1">0.12* (0.06 to 0.25)</td><td align="left" valign="top" rowspan="1" colspan="1">1.19 (0.63 to 2.28)</td><td align="left" valign="top" rowspan="1" colspan="1">0.35* (0.17 to 0.72)</td><td align="left" valign="top" rowspan="1" colspan="1">0.25* (0.08 to 0.73)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 60–69</td><td align="left" valign="top" rowspan="1" colspan="1">0.30* (0.20 to 0.46)</td><td align="left" valign="top" rowspan="1" colspan="1">0.13* (0.06 to 0.31)</td><td align="left" valign="top" rowspan="1" colspan="1">0.35* (0.16 to 0.77)</td><td align="left" valign="top" rowspan="1" colspan="1">0.26* (0.11 to 0.65)</td><td align="left" valign="top" rowspan="1" colspan="1">0.17* (0.04 to 0.69)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> ≥70</td><td align="left" valign="top" rowspan="1" colspan="1">0.26* (0.16 to 0.44)</td><td align="left" valign="top" rowspan="1" colspan="1">0.08* (0.03 to 0.23)</td><td align="left" valign="top" rowspan="1" colspan="1">0.61 (0.26 to 1.41)</td><td align="left" valign="top" rowspan="1" colspan="1">0.20* (0.06 to 0.63)</td><td align="left" valign="top" rowspan="1" colspan="1">0.12* (0.02 to 0.65)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Educational attainment</td><td align="left" valign="top" rowspan="1" colspan="1"> </td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Middle school or below</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> High school</td><td align="left" valign="top" rowspan="1" colspan="1">0.81 (0.58 to 1.13)</td><td align="left" valign="top" rowspan="1" colspan="1">0.58 (0.30 to 1.12)</td><td align="left" valign="top" rowspan="1" colspan="1">1.41 (0.75 to 2.68)</td><td align="left" valign="top" rowspan="1" colspan="1">0.45* (0.21 to 0.97)</td><td align="left" valign="top" rowspan="1" colspan="1">0.56 (0.20 to 1.55)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> University</td><td align="left" valign="top" rowspan="1" colspan="1">0.93 (0.65 to 1.32)</td><td align="left" valign="top" rowspan="1" colspan="1">0.47* (0.24 to 0.95)</td><td align="left" valign="top" rowspan="1" colspan="1">2.11 (1.06 to 4.21)</td><td align="left" valign="top" rowspan="1" colspan="1">0.73 (0.34 to 1.57)</td><td align="left" valign="top" rowspan="1" colspan="1">0.42 (0.13 to 1.36)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Graduate school</td><td align="left" valign="top" rowspan="1" colspan="1">0.92 (0.58 to 1.46)</td><td align="left" valign="top" rowspan="1" colspan="1">0.12* (0.04 to 0.38)</td><td align="left" valign="top" rowspan="1" colspan="1">1.83 (0.78 to 4.34)</td><td align="left" valign="top" rowspan="1" colspan="1">1.27 (0.47 to 3.43)</td><td align="left" valign="top" rowspan="1" colspan="1">0.64 (0.17 to 2.37)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Occupation</td><td align="left" valign="top" rowspan="1" colspan="1"> </td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Unemployed</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Farming/forestry/fishery</td><td align="left" valign="top" rowspan="1" colspan="1">1.51 (0.85 to 2.68)</td><td align="left" valign="top" rowspan="1" colspan="1">1.72 (0.59 to 5.06)</td><td align="left" valign="top" rowspan="1" colspan="1">1.52 (0.49 to 4.68)</td><td align="left" valign="top" rowspan="1" colspan="1">3.04 (0.93 to 1.0)</td><td align="left" valign="top" rowspan="1" colspan="1">1.12 (0.22 to 5.75)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Self-employed</td><td align="left" valign="top" rowspan="1" colspan="1">0.94 (0.63 to 1.40)</td><td align="left" valign="top" rowspan="1" colspan="1">1.08 (0.49 to 2.35)</td><td align="left" valign="top" rowspan="1" colspan="1">0.92 (0.43 to 1.96)</td><td align="left" valign="top" rowspan="1" colspan="1">1.76 (0.70 to 4.38)</td><td align="left" valign="top" rowspan="1" colspan="1">0.31 (0.09 to 1.12)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Blue-collar</td><td align="left" valign="top" rowspan="1" colspan="1">1.22 (0.81 to 1.84)</td><td align="left" valign="top" rowspan="1" colspan="1">1.38 (0.61 to 3.15)</td><td align="left" valign="top" rowspan="1" colspan="1">1.07 (0.51 to 2.22)</td><td align="left" valign="top" rowspan="1" colspan="1">1.75 (0.66 to 4.67)</td><td align="left" valign="top" rowspan="1" colspan="1">0.84 (0.28 to 2.56)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> White-collar</td><td align="left" valign="top" rowspan="1" colspan="1">1.05 (0.72 to 1.52)</td><td align="left" valign="top" rowspan="1" colspan="1">1.46 (0.71 to 3.02)</td><td align="left" valign="top" rowspan="1" colspan="1">0.94 (0.48 to 1.87)</td><td align="left" valign="top" rowspan="1" colspan="1">1.64 (0.68 to 3.95)</td><td align="left" valign="top" rowspan="1" colspan="1">0.56 (0.21 to 1.55)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Home maker</td><td align="left" valign="top" rowspan="1" colspan="1">1.22 (0.81 to 1.83)</td><td align="left" valign="top" rowspan="1" colspan="1">1.23 (0.55 to 2.74)</td><td align="left" valign="top" rowspan="1" colspan="1">1.37 (0.65 to 2.92)</td><td align="left" valign="top" rowspan="1" colspan="1">1.86 (0.71 to 4.92)</td><td align="left" valign="top" rowspan="1" colspan="1">0.85 (0.29 to 2.50)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Student</td><td align="left" valign="top" rowspan="1" colspan="1">0.81 (0.51 to 1.30)</td><td align="left" valign="top" rowspan="1" colspan="1">0.68 (0.26 to 1.75)</td><td align="left" valign="top" rowspan="1" colspan="1">0.78 (0.33 to 1.84)</td><td align="left" valign="top" rowspan="1" colspan="1">1.01 (0.34 to 2.98)</td><td align="left" valign="top" rowspan="1" colspan="1">0.47 (0.12 to 1.84)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Self-reported household economic status</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Upper</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">u.a.</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Upper middle</td><td align="left" valign="top" rowspan="1" colspan="1">0.96 (0.51 to 1.81)</td><td align="left" valign="top" rowspan="1" colspan="1">1.17 (0.34 to 4.05)</td><td align="left" valign="top" rowspan="1" colspan="1">0.71 (0.27 to 1.85)</td><td align="left" valign="top" rowspan="1" colspan="1">0.71 (0.19 to 2.61)</td><td align="left" valign="top" rowspan="1" colspan="1">u.a.</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Middle</td><td align="left" valign="top" rowspan="1" colspan="1">0.81 (0.44 to 1.47)</td><td align="left" valign="top" rowspan="1" colspan="1">1.26 (0.39 to 4.05)</td><td align="left" valign="top" rowspan="1" colspan="1">0.59 (0.25 to 1.40)</td><td align="left" valign="top" rowspan="1" colspan="1">0.86 (0.26 to 2.87)</td><td align="left" valign="top" rowspan="1" colspan="1">u.a.</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Lower middle</td><td align="left" valign="top" rowspan="1" colspan="1">1.22 (0.66 to 2.25)</td><td align="left" valign="top" rowspan="1" colspan="1">1.76 (0.53 to 5.86)</td><td align="left" valign="top" rowspan="1" colspan="1">0.98 (0.40 to 2.38)</td><td align="left" valign="top" rowspan="1" colspan="1">1.13 (0.33 to 3.88)</td><td align="left" valign="top" rowspan="1" colspan="1">u.a.</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Lower</td><td align="left" valign="top" rowspan="1" colspan="1">1.06 (0.57 to 1.99)</td><td align="left" valign="top" rowspan="1" colspan="1">2.22 (0.64 to 7.74)</td><td align="left" valign="top" rowspan="1" colspan="1">0.82 (0.32 to 2.12)</td><td align="left" valign="top" rowspan="1" colspan="1">1.12 (0.32 to 4.0)</td><td align="left" valign="top" rowspan="1" colspan="1">u.a.</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">MERS-CoV-affected area</td><td align="left" valign="top" rowspan="1" colspan="1"> </td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Non-affected area</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Affected area</td><td align="left" valign="top" rowspan="1" colspan="1">1.05 (0.86 to 1.28)</td><td align="left" valign="top" rowspan="1" colspan="1">1.43 (0.94 to 2.19)</td><td align="left" valign="top" rowspan="1" colspan="1">0.79 (0.54 to 1.16)</td><td align="left" valign="top" rowspan="1" colspan="1">1.02 (0.69 to 1.52)</td><td align="left" valign="top" rowspan="1" colspan="1">1.18 (0.66 to 2.11)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Residential area</td><td align="left" valign="top" rowspan="1" colspan="1"> </td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Non-metropolitan</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Metropolitan</td><td align="left" valign="top" rowspan="1" colspan="1">0.91 (0.72 to 1.14)</td><td align="left" valign="top" rowspan="1" colspan="1">0.57* (0.35 to 0.93)</td><td align="left" valign="top" rowspan="1" colspan="1">1.34 (0.84 to 2.12)</td><td align="left" valign="top" rowspan="1" colspan="1">1.08 (0.67 to 1.75)</td><td align="left" valign="top" rowspan="1" colspan="1">0.69 (0.38 to 1.33)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Presidential job approval rating</td><td align="left" valign="top" rowspan="1" colspan="1"> </td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Approval</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Disapproval</td><td align="left" valign="top" rowspan="1" colspan="1">3.55* (2.77 to 4.55)</td><td align="left" valign="top" rowspan="1" colspan="1">5.41* (3.25 to 9.01)</td><td align="left" valign="top" rowspan="1" colspan="1">3.00 (1.96 to 4.59*)</td><td align="left" valign="top" rowspan="1" colspan="1">3.77* (2.13 to 6.68)</td><td align="left" valign="top" rowspan="1" colspan="1">4.05* (1.44 to 11.41)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> No opinion</td><td align="left" valign="top" rowspan="1" colspan="1">1.75* (1.22 to 2.52)</td><td align="left" valign="top" rowspan="1" colspan="1">2.00 (0.96 to 4.16)</td><td align="left" valign="top" rowspan="1" colspan="1">0.94 (0.49 to 1.80)</td><td align="left" valign="top" rowspan="1" colspan="1">3.26 (1.46 to 7.30)</td><td align="left" valign="top" rowspan="1" colspan="1">1.55 (0.37 to 6.45)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Party identification</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Ruling party</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td><td align="left" valign="top" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Opposition party</td><td align="left" valign="top" rowspan="1" colspan="1">1.38* (1.09 to 1.75)</td><td align="left" valign="top" rowspan="1" colspan="1">2.01* (1.19 to 3.39)</td><td align="left" valign="top" rowspan="1" colspan="1">1.86* (1.21 to 2.88)</td><td align="left" valign="top" rowspan="1" colspan="1">1.09 (0.65 to 1.84)</td><td align="left" valign="top" rowspan="1" colspan="1">1.08 (0.48 to 2.45)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> No opinion</td><td align="left" valign="top" rowspan="1" colspan="1">1.23 (0.98 to 1.55)</td><td align="left" valign="top" rowspan="1" colspan="1">1.55 (0.97 to 2.48)</td><td align="left" valign="top" rowspan="1" colspan="1">1.82* (1.20 to 2.76)</td><td align="left" valign="top" rowspan="1" colspan="1">0.79 (0.47 to 1.34)</td><td align="left" valign="top" rowspan="1" colspan="1">0.91 (0.40 to 2.08)</td></tr></tbody></table><table-wrap-foot><fn id="T4_FN1"><p>*P<0.05.</p></fn><fn id="T4_FN2"><p>†There was small sample size of those who perceived cognitive risk in the upper economic level in survey 4, the self-reported household economic status was excluded from the survey 4 model.</p></fn><fn id="T4_FN3"><p>aOR, adjusted OR; MERS-CoV, Middle East respiratory syndrome coronavirus; u.a., unavailable data.</p></fn></table-wrap-foot></table-wrap></sec></sec><sec sec-type="discussion" id="s4"><title>Discussion</title><p>The aims of the present study were to explore the differences in risk perception at affective and cognitive dimensions and examine the relationship between trust in government and both risk perceptions. To do this end, we investigated the pattern of affective and cognitive risk perception proportions during MERS-CoV epidemic, respectively; analysed the correlations of presidential job approval rating and risk perceptions (affective and cognitive).</p><p>First, we found that affective risk perception responded faster and lasts longer. The affective risk perception proportions were always higher than at the cognitive dimension. Risk perception increased with new generations of transmission, such as with the tertiary and quaternary infections. Both risk perceptions tended to decrease over time and the cognitive risk perception declined more rapidly.</p><p>However, our results that affective reaction tends to decrease before cognitive reaction are inconsistent with those of previous studies.<xref rid="R12" ref-type="bibr">12 17</xref> Relevant research in risk perception have proposed that affective reaction is fast, efficient, automatic and experiential compared with cognitive reaction.<xref rid="R14" ref-type="bibr">14–16</xref> We can consider the possibility that damaged trust in government as a responsible risk manager might have further evoked the emotional risk perception.<xref rid="R8" ref-type="bibr">8 9 23–25</xref> While the affective or cognitive reaction does not individually have an impact on the different stages of the epidemic, they can, however, affect it together, simultaneously, indicating both affective and cognitive risk perceptions.<xref rid="R12" ref-type="bibr">12 17 26 29</xref> Additional research is needed to understand why the affective risk perception was higher and lasted longer than that of the cognitive risk perception during MERS-CoV epidemic in South Korea.</p><p>Second, our study shows that low trust in government had influenced both affective and cognitive risk perceptions. After party identification was adjusted for, we examined correlation with trust and risk perception. It is consistent with previous studies that trust in government could shape the public’s risk perception (both affective and cognitive).<xref rid="R21" ref-type="bibr">21 22 26 27</xref> However, the previous studies have not distinguished between affective and cognitive reactions when evaluating the impact of trust regarding contagious diseases during outbreaks.<xref rid="R3" ref-type="bibr">3 12 23 24 28–30</xref> Our findings suggest that trust in government is correlated with both affective and cognitive risk perceptions and it is important to understand the relationship between trust in government and two different aspects of risk perceptions. Those who did not support the president were reported to have had higher risk perception in both the affective and cognitive levels. In the group that did not approve of the president, the probabilities of risk perception were higher at the cognitive dimension than at affective dimension. In the early days of the MERS-COV outbreak, the government did not specify details regarding scientifically uncertain information in order to reduce public anxiety over the crisis, nor did the government disclose which hospitals the confirmed patients had visited. This resulted in increased public distrust in the government.<xref rid="R4" ref-type="bibr">4 5 8 9</xref> Similar patterns of distrust in the government were associated with the spread of infection, during the outbreak of Ebola.<xref rid="R34" ref-type="bibr">34 35</xref> Those who disapproved of the ruling party had also higher risk perceptions. Identification of party can be classified in the political aspect of trust.<xref rid="R36" ref-type="bibr">36</xref> There is need to investigate further comprehensive understanding of trust’s effect on risk perception.</p><p>Third, we found that gender, age, self-reported household economic status, residential area and party identification correlated significantly with risk perception. According to multiple logistic regression analyses, being female predisposed to greater risk perception at the affective risk perception, but not at the cognitive dimension. Previous studies that investigated risk perception by gender also showed that a lower risk perception was associated with the male gender.<xref rid="R3" ref-type="bibr">3 28 37–39</xref> A possible explanation for lower perception of risk by males is that males have more to gain from risky behaviours.<xref rid="R40" ref-type="bibr">40</xref> However, previous studies did not distinguish between the levels of risk perception. Further research is needed to determine why the same female group showed differences in perceived risk for affective and cognitive levels. The older the respondents, the lower the perceived cognitive dimension, but the opposite occurred weakly in the affective risk perception. The correlation with age and affective risk perception was not significant in most models (survey 1, survey 2 and survey 3 models). After trust in government was adjusted for, we found correlation between older age and lower cognitive risk perception. Further research is needed as to why the effect of trust in the government had not been shown in the affective risk perception.</p><p>Given that some hierarchy-specific trends in income level were observed only in the overall model of affective risk perception, these results were consistent with previous studies.<xref rid="R41" ref-type="bibr">41–43</xref></p><p>The location effect on risk perception also was evaluated in this study, but it was not clear on the correlation with risk proximity and risk perception.<xref rid="R44" ref-type="bibr">44</xref> There were no significant differences in the proportions of those with risk perception according to the major socioeconomic characteristics (education, income level, occupation). It is necessary to further investigate the correlation with demographic factors and risk perception.</p><p>This study, which used a serial cross-sectional study design, had some limitations. First, the study used a cross-sectional study design. Thus, causal relations between personal characteristics and risk perceptions could not be determined—rather, it could only suggest their relevance. Second, this study could not evaluate the intensity of risk perception, because it only included questions focusing on whether or not participants recognised the risk at the different levels. It would be useful to evaluate risk perceptions of respondents qualitatively if questions about the circumstances and characteristics of risk perception were surveyed in future studies. Third, because of the rapidly evolving epidemic, this study could not evaluate the validity of the questionnaire using a test–retest design. Fourth, small sample size of some variables once stratified (eg, self-reported household economic status) led to the exclusion of major socioeconomic characteristics from further analyses.</p></sec><sec sec-type="conclusions" id="s5"><title>Conclusions</title><p>This study is the first to evaluate the differences in risk perception at affective and cognitive dimensions and the relationship between trust in the government and both risk perceptions during the MERS-CoV outbreak in South Korea. The study also reported various factors influencing risk perception. We found that affective risk perception responded faster and lasts longer; and low trust in the government influenced both affective and cognitive risk perceptions. Quality of risk communication can create conditions for modulating the easy spread of emerging contagious diseases. To prevent the failure of epidemic management, further efforts are needed to understand the mechanism behind the general public’s risk perception, the governmental public health sector, as well as the society of academy. Planning and implementation of strategies that consider the risk awareness mechanism will be a significant step in the right direction during national infectious disease crises.</p></sec><sec sec-type="supplementary-material"><title>Supplementary Material</title><supplementary-material content-type="local-data" id="d35e255"><caption><title>Reviewer comments</title></caption><media mimetype="application" mime-subtype="pdf" xlink:href="bmjopen-2019-033026.reviewer_comments.pdf"></media></supplementary-material><supplementary-material content-type="local-data" id="d35e256"><caption><title>Author's manuscript</title></caption><media mimetype="application" mime-subtype="pdf" xlink:href="bmjopen-2019-033026.draft_revisions.pdf"></media></supplementary-material></sec></body><back><ack><p>We thank Gallup Korea, an affiliation of Gallup International, for supporting surveys and data collection for this manuscript.</p></ack><fn-group><fn fn-type="other"><p><bold>Contributors:</bold> WMJ participated and analysed the data, interpreted the data, drafted and amended the manuscript. UNK, SC and HJ contributed to the analysis of the data, interpreted the data, drafted and amended the manuscript. DHJ contributed to questionnaire design, coordinated data collection and data interpretation. SJE and JYL contributed to study design, supervised the research, data interpretation and amended the manuscript.</p></fn><fn fn-type="other"><p><bold>Funding:</bold> The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.</p></fn><fn fn-type="COI-statement"><p><bold>Competing interests:</bold> None declared.</p></fn><fn fn-type="other"><p><bold>Patient consent for publication:</bold> Not required.</p></fn><fn fn-type="other"><p><bold>Ethics approval:</bold> This study was reviewed and approved by the Institutional Review Board (IRB) of Seoul Metropolitan Government–Seoul National University Boramae Medical Center (IRB No 20190515/07-2019-11/062). The need for informed consent was waived by the board.</p></fn><fn fn-type="other"><p><bold>Provenance and peer review:</bold> Not commissioned; externally peer reviewed.</p></fn><fn fn-type="other"><p><bold>Data availability statement:</bold> No data are available. 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