The Role of Risk Perception in Acceptance of Public Health Service : Focus on Water Fluoridation in Incheon City

Abstract

The scope of public health services is expanding in the complex modern society. Health-related information spread rampantly, especially the issues surrounding health safety and effectiveness. Water fluoridation is one example. Initiated in the United States (U.S.) in 1945, the Korean government also implemented this service and the controversy about its political, moral, ethical, and safety issues still remain elusive in many countries that have taken the measures including the U.S. and South Korea. Many studies have conducted the analysis of health benefit/risk, cost-effectiveness, and awareness of water fluoridation, but much less have been focused on the in-depth investigation into sociological reasons behind the two opposing views. It is important to know how the public perceives water fluoridation and find the effective ways of proper public health communication. Therefore, this study is focused on the risk perception of water fluoridation and its effects on the public in deciding whether to accept or reject the service. The data were collected with an online cross-sectional questionnaire survey on 527 Korean citizens in October, 2015. The participants were residents in the city of Incheon who are 20 to 59 in age. The components of the survey include individual characteristics (knowledge, experience, and worldview), media, outrage factor, trust, risk perception, and the acceptance level of water fluoridation service. Correlation analysis and multiple regression analyses were performed to explore the factors influencing water fluoridation risk perception and the acceptance level of water fluoridation service. The mediating effect of water fluoridation risk perception was validated by hierarchical multiple regression analysis and sobel test. The mean age of the study participants was 40 years, with the proportion of men (51%) and women (49%). The mean water fluoridation risk perception was 4.12 (out of 7 interval scale), 59% (ratio scale), with 0.69 standard deviation (SD). The mean acceptance level of water fluoridation was 4.12 (out of 7 interval scale), 59% (ratio scale), with 1.29 SD. Analysis showed that media, outrage factor, and trust were significantly predictive of water fluoridation risk perception and the service acceptance. Moreover, risk perception of water fluoridation partially mediated the service acceptance. This is the first study in South Korea which attempted to determine the influencing factors of acceptance level of water fluoridation service and its risk perception through the analysis of a survey in the city where controversy exists. The findings suggest that considering the risk perception of the individuals is critical in the process of developing public health services and policies. Also planning health communication strategies are necessary to build an effective public health system.