From Information to Acceptance: How Social Research Improves Mpox Response in Europe

The WHO mpox research shows that controlling outbreaks depends less on spreading information and more on whether communities trust, accept and act on public health messages. Using social research and the IDEA model, it demonstrates that values, political identity, trust and stigma, not demographics alone shape behaviour and must guide future outbreak communication.

A research was produced by the WHO Regional Office for Europe in collaboration with the WHO Collaborating Centre on Risk Communication, Community Engagement and Infodemic Management at Kristiania University of Applied Sciences in Norway, with input from the European Centre for Disease Prevention and Control, national public health agencies, and civil society organizations. It responds to a central lesson from the 2022–2024 mpox outbreaks: outbreaks are not controlled by medical knowledge alone, but by whether people trust, accept and act on public health advice. While Europe’s response showed the power of community-led behaviour change, it also exposed persistent problems such as stigma, misinformation, privacy fears and low risk perception, especially among communities most affected by mpox.

From information to message acceptance

The document shifts the focus of public health communication away from simply providing information and toward what it calls “message acceptance.” Message acceptance means that people believe guidance is relevant to them, trust the source, understand why it matters and feel able to follow it. To support this, the guide uses the IDEA model: Internalization, Distribution, Explanation and Action. Internalization asks whether people feel mpox matters to their lives. Distribution looks at whether messages come through trusted channels. Explanation focuses on whether people understand not just what to do, but why. Action measures whether recommended behaviours feel realistic and effective. Together, these elements help practitioners design communication that people are actually willing to follow.

Looking beyond demographics to understand behaviour

One of the guide’s strongest findings is that basic demographics such as age or gender are poor predictors of behaviour on their own. Instead, the research shows that “identifications” matter more. These include political orientation, personal values, religiosity and trust in institutions. In the pilot study conducted in Belgium, the Netherlands and the United Kingdom, political identification was the strongest single predictor of whether people accepted public health recommendations, followed by values related to social responsibility and then religiosity. This challenges traditional approaches to audience segmentation and encourages public health teams to better understand how people see the world, not just who they are on paper.

Evidence from the pilot study

The toolkit was tested on more than 1,800 people across three countries, and the results were striking. By combining demographics, identifications and IDEA-related factors, the model explained about 68% of people’s willingness to adopt mpox self-protective behaviours. Incorrect medical beliefs about mpox emerged as the strongest barrier to acceptance, stronger than conspiracy beliefs or general distrust. Surprisingly, people who believed they already knew a lot about mpox were often less willing to follow guidance, showing that overconfidence can reduce openness to new information. Trust in experts and official health institutions consistently increased acceptance, while fear of stigma, loss of privacy, or lack of support reduced willingness to report symptoms or seek care.

Practical lessons for future outbreaks

The report emphasizes that preparedness research should happen before outbreaks, not only during crises. Research done in advance helps build trust, improve health literacy and prevent misinformation from spreading. During outbreaks, shorter response research can be used to adjust messages in real time. The document repeatedly stresses the importance of ethics: protecting anonymity, avoiding stigmatizing language and working with trusted community actors. It also promotes a “small steps” approach, showing that encouraging one manageable protective behaviour can lead to broader compliance. Above all, the guide concludes that successful public health communication depends less on how loudly messages are broadcast and more on whether communities feel respected, informed and supported enough to accept them. Mpox, the document makes clear, offers a wider lesson for public health in Europe: trust and acceptance are as critical as science in controlling disease.