CMV Awareness: What Are We Really Measuring?

CMV Awareness: What Are We Really Measuring?

Author: Kathleen M. Muldoon & Seth D. Dobson
Because there is currently no CMV vaccine, it is important that women are informed of behaviors that can help to prevent CMV infection during pregnancy. CMV infection in mothers is preventable. Yet, most women have never heard of the virus. Estimates of the percentage of women that have heard of CMV range from 9-20%, globally.
 
While CMV awareness might seem like a straightforward thing to measure, we believe that published estimates of awareness probably overestimate true levels of knowledge for two main reasons.
  • First, survey respondents often exaggerate what they know about a subject because of social desirability bias.
  • Second, CMV awareness does not necessarily correlate with an understanding of the behavioral adjustments needed to reduce the risk of infection (health-risk knowledge).


Social desirability bias
 
Social desirability bias is the tendency to answer questions in a way that will be viewed favorably by others. For example, people typically say that they always wash their hands after using the restroom. But the actual percentage of people who always wash their hands is much lower than what is self-reported. Similarly, published CMV awareness estimates are based on questions about levels of knowledge, such as: “Have you heard of the following?” or “Are you aware of CMV?” Social desirability bias might lead some respondents to say “yes” to these questions, even if the true answer is “no,” because they don’t want to be viewed as uninformed.
 
The problem with awareness
 
Awareness is a basic form of knowledge that reflects whether a person has heard of a subject. This is what most estimates of CMV awareness measure. However, a person might have heard of CMV, but not know anything useful about it. For example, a survey respondent who is aware of CMV might be unable to accurately describe the ways that the virus is transmitted. Health-risk knowledge of CMV, not just awareness, is needed to prevent infection while pregnant.
 
Health-risk knowledge

Health-risk knowledge of CMV can be estimated in survey respondents by assessing their ability to correctly identify the main behavioral modes of CMV transmission:
  • kissing
  • contact with wet diapers
  • sharing utensils
  • sharing food and/or drink
  • handling toys
In a study published in 2017, we estimated CMV awareness (self-reported familiarity) and health-risk knowledge in a sample of 230 physical and occupational therapists. Although 52% of the therapists in our study had heard of CMV, only 18% could correctly identify behavioral modes of transmission of the virus!

More recently, we extended this study by using statistical simulations to estimate the degree of health-risk knowledge in the general population. We presented our findings at the CMV Public Health and Policy Conference in Burlington, Vermont in 2018. According to our data, at best 5% of women in the general population have health-risk knowledge of CMV. This estimate is much lower than the estimate of 9% that is often cited for CMV awareness.

Conclusion
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The gap between CMV awareness and health-risk knowledge related to CMV transmission is significant and worrisome. It is important to address this knowledge gap through educational initiatives and public health messaging. Increasing health-risk knowledge can promote adoption of preventative behaviors, thereby reducing the impact of congenital CMV on families. It is not enough that women have heard of CMV. They must also gain understanding of the behavioral adjustments need to prevent the infection in order for public health interventions to be successful.

About the Authors

Dr. Kathleen M. Muldoon (Midwestern University, CMV Mom)
Dr. Muldoon received her PhD (Anthropology) from Washington University in St. Louis. She is Associate Professor of Anatomy at Midwestern University, Glendale, AZ, where she teaches anatomy and embryology to medical and allied health students. Dr. Muldoon maintains several distinct areas of scholarly research, including anatomy education with interest in the effectiveness of teaching innovations on knowledge retention and public health knowledge. Her research interests include evaluating methods for prevention of congenital cytomegalovirus (CMV) infection through professional education, and promotion of CMV awareness and behavioral interventions in the community. Dr. Muldoon's research has been funded by the National Science Foundation, National Geographic Society, and American Philosophical Society, among others. She has given research seminars and outreach workshops nationally and internationally. Her work has been featured on National Public Radio. Dr. Muldoon and her husband Dr. Seth Dobson are the proud parents of three children: her five-year-old son has multiple disabilities due to congenital CMV. 

Dr. Seth D. Dobson (Artful Analytics, LLC, CMV Dad)
Seth Dobson received his PhD in Anthropology from Washington University in St. Louis. He is currently an analytics consultant for a marketing technology firm. He has industry expertise as a data analyst in financial services and telecommunications. Before joining the corporate world, Dr. Dobson was assistant professor of anthropology at Dartmouth College. His academic research focused on primate communication and brain evolution. Dr. Dobson and his wife Dr. Kathleen Muldoon live with their three beautiful children in sunny Phoenix, AZ. His middle son was born with congenital cytomegalovirus and is multiply-disabled as a result.