Perceptions on chronic respiratory diseases as predictors of respiratory risk behaviours in rural Crete, Greece: an observational FRESH AIR study

Introduction: Implementation of evidence-based interventions to effectively tackle chronic respiratory diseases (CRDs) in resource-limited settings requires knowledge of the local context. This study aimed to explore beliefs and perceptions towards CRDs and how these relate to preventable risk behaviours (smoking and indoor biomass burning) in rural Crete-Greece. Methods: An observational study was conducted among 200 community members from 20 randomly selected villages, as part of the Horizon2020 ‘FRESH AIR’ project. Data were collected through a questionnaire based on FRESH AIR’s SETTING tool. Binary logistic regression was used to examine how perceptions affected smoking and biomass burning behaviours. Results: Of 200 participants (46.5% men, median age: 60 years), 51.5% linked respiratory symptoms (cough, breathlessness) to a respiratory condition (perceived identity). While 67.5% strongly agreed that smoking causes symptoms, the respective percentage for HAP was 8.5% (perceived causes). Thirty-six percent reported they were fairly likely to develop respiratory symptoms (perceived susceptibility). About half (50.5%) would be fairly concerned about such symptoms and 55.5% mentioned that a respiratory condition would affect their lives fairly much (perceived severity). Overall, 73.5% were smokers, while 61.0% used biomass for household heating. Smoking behavior was inversely associated with the opinion of participants’ social environment on the importance of seeking medical help (OR=0.628, 95%CI: 0.401-0.985) and perceived disease duration (OR=0.742, 95%CI: 0.545-1.010), while it was positively associated with perceived susceptibility (OR=2.225, 95%CI: 1.401-3.534) and presence of CRD diagnosis (OR=2.992, 95%CI: 1.135-7.887). Biomass use was associated with perceived control over the disease (OR=1.537, 95%CI: 1.106-2.137). Conclusion: In this study, the opinion of the social environment and perceived disease severity were context-specific predictors of smoking behaviour and this may be useful to consider when designing respective actions. Results on biomass use also suggest that there might still be substantial space for raising public and stakeholder awareness on household air pollution.