Community Knowledge, Perceptions, and Associated Factors of Mpox in Ethiopia: Application of Extended Parallel Process Model. A community-based cross-sectional study

Community Knowledge, Perceptions, and Associated Factors of Mpox in Ethiopia: Application of Extended Parallel Process Model. 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A community-based cross-sectional study Yibeyin Mulualem, Mohammed Hasen Badeso, Melaku Abebe, Aemro Yibeltal, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8647071/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Mpox remains a public health threat in Africa affecting many countries. Ethiopia declare Mpox outbreak on May-26-2025. Understanding community knowledge and perception is vital for tailoring Mpox behavioral interventions. However, there is limited evidence on community knowledge and perceptions of Mpox. Therefore, this study aimed to assess community knowledge and perceptions of Mpox using the Extended Parallel Process Model in Ethiopia, 2025. Methods A community-based cross-sectional study was conducted in Ethiopia using multi-stage systematic random sampling. A household members adults (>18years) were interviewed, health worker households were excluded. Data were collected using interviewer-administered questionnaires on socio-demographics, Mpox knowledge, and perceived threat. We used Extended Parallel Process Model (EPPM) to assess perceived-threat and perceived-efficacy. Data were analyzed with descriptive and inferential statistics (ANOVA, logistic regression) using SPSS-v26 Results The median age was 35years (IQR: 28–44), and 50.8% (392/782) were male. Only 24.6% (192/782) had good Mpox knowledge. Positive perceived threat was 45.1% and positive efficacy was 79.9% (625/782). Threat–efficacy interaction significantly predicted knowledge (p<0.001, η²=0.030); positive threat (AOR=1.73, 95%CI:1.21-2.47), can’t read/write (AOR = 0.163: 95% CI: 0.046-0.579), read and write on formal education (AOR = 0.192: 95% CI: 0.074-0.501), farmers (AOR = 0.199: 95% CI: 0.079-0.501), and housewife (AOR = 0.274: 95% CI: 0.138-0.543). The preferred sources of information 62.4% (488/782) mainstream media followed by social media 23.3% (182/782). Conclusions The Mpox knowledge among community was low implies need for robust public health interventions. Factors such as educational level, occupation and perceived threat had a significant association with the Mpox knowledge of the community. The perceived threat and perceived efficacy interact to shape Mpox knowledge. It is recommended that address knowledge and perception gaps especially considering interventions that reach all audiences, pairing perceived-threat with perceived-efficacy, and leverage mass and social media Figures Figure 1 Figure 2 Background Mpox is a re-emerging zoonotic disease caused by the Mpox virus, a member of the Orthopoxvirus genus in the family Poxviridae. It is historically endemic in Central and West Africa countries. However, in recent years, the Mpox outbreak expanding beyond endemic countries. The World Health Organization (WHO) to declare the first Mpox Public Health Emergency of International Concern (PHEIC) in July 2022 and Africa CDC declared Mpox a Public Health Emergency of Continental Security (PHECS) on August 13, 2024 and followed by the second WHO PHEIC declaration on August 14, 2024 (1,2). The rising global incidence of mpox underscores the crucial need for effective prevention, and response strategies, including enhancing comprehensive public knowledge, accurate risk perception, and confidence in prevention measures and implementation of actions (3)(4). Ethiopia declare Mpox outbreak on May-26-2025 (5). This spread beyond historically endemic regions including Ethiopia, has highlighted critical need for tailored and effective public health interventions. The robust RCCE interventions needed to ensure public understanding, reduce fear and stigma, and promote healthy behaviors. So, evidence-based interventions to enhance community knowledge, perception of Mpox, and utilize preferred sources of information are critical for effective outbreak prevention and control (6)(7) In Ethiopia, historically the Mpox was not reported and there is evidence gap about the population’s awareness, perceptions concerning Mpox, and trusted information sources. Therefore, understanding communities’ knowledge, perceptions, behaviors and information sources essential for; first to identify what communities know or not know about Mpox, second to address misinformation and disinformation through mapping the trusted sources of information, and third to design evidence based RCCE interventions strategies to control and prevent Mpox outbreak. So, this study aimed to assess community knowledge, perceptions, and sources of information regarding Mpox in Ethiopia. Methods Study design and setting A community-based cross-sectional study was conducted in Ethiopia using multi-stage systematic random sampling. This study was conducted from July 7–27, 2025, in seven selected towns of Ethiopia to assess community knowledge and associated factors, perceptions about Mpox, and preferred sources of information. Study population and participants The target populations were residents of towns aged 18 years and above living in the selected towns for at least six months. The study participants were household members aged 18 years and above, randomly selected from households within randomly sampled kebele. Selection criteria and Exclusion criteria Eligible participants were household member aged above 18 years at selected households who provided consent. The health worker households and absent after repeated visit was excluded. Sampling The seven towns were randomly selected from towns identified as high-risk for Mpox due to high population mobility. The sample size determination was calculated both for prevalence of knowledge and perception of Mpox followed by the larger sample size used. We applied the single population proportion formula considered prevalence of Mpox knowledge (p= 33.7%) and perception (p=57.3%) from the study conducted in Bahir Dar town, Northwest Ethiopia [13]. We considered 95% confidence interval and 5% degree of precision. We considered design effect for multistage sampling. Finally, the larger sample size (n=782) was determined. The sample size was proportionally distributed to each town and sub-towns based their administration report total number of households in the 2024/25 fiscal year. Households were randomly selected using the town mayor’s household list as the sampling frame. From each selected household, one member aged 18 years or older was randomly selected and interviewed (Figure 1). Data collection and Procedures Data were collected using structured, interviewer-administered questionnaires on sociodemographic information, Mpox transmission, signs/symptoms, prevention and control measures, Perception and preferred source of information. We used Extended Parallel Process Model (EPPM) to assess perceived threat (perceived severity and perceived susceptibility) and perceived efficacy (response efficacy and self-efficacy). The data collectors were trained on tools before deployed to data collection. The tools were tested on 5% of sample size and revised based on the feedback. The data were collected using Kobo Collect and imported into SPSS for analysis. Statistical analysis The data was checked for completeness and clarity. Statistical Package for the Social Sciences (SPSS) version 26 was used for data analysis. In this study, a total of 14 item questions include 6 sign and symptoms, 04 transmission, and 04 preventions measures were used to assess the Mpox knowledge of the community. Respondents who correctly answered 50% or more of the questions were classified as having a good level of knowledge. The perceived threat (6-items), and efficacy (6-items) were scored using Likert scale and computed mean to categorize perception levels as negative perception: mean ≤ 2.5; Neutral Perception: 2.6 – 3.5; Positive perception: ≥ 3.6, (8,9). Overall, the mean > 3.6 were used to categorized positive perceived threat and positive perceived efficacy. Binary and multivariate logistic regression analyses was conducted to identify factors influencing participants’ knowledge toward Mpox. The Shapiro–Wilk, Levene’s and Cronbach’s Alpha test were conducted to test normality, homogeneity, and reliability of the data respectively. A candidate variable with adjusted odds ratios (AORs) and 95%CI was calculated to identify variables independently associated with Mpox knowledge. The inferential statistics ANOVA analysis was conducted to assess the perceived threat and perceived efficacy interaction to predict Mpox knowledge. Results Socio-Demographic characteristics Among the total respondents, 50.8% (397/782) were male and 32.7% (256/782) age groups 25-34 years, followed by the 35-44 years' group 29.7% (232/782) of respondents. Regarding educational status of respondents, 44.1% (345/782) had attained a diploma or/and degree, while only 42.6% (333/782) respondents were only able to read and write that attained formal education. The majority of respondents were married 64.8% (507/782) followed by single 30.3% (237/782). Also, more than one fourth of the study participants were merchants 26.2% (205/782) followed by government employee 25.3% (198/782) and housewife 19.6% (153/782). Knowledge of Mpox The study revealed that only 192 (24.6%) of study participants demonstrated good knowledge of Mpox. The majority of respondents 94.4% (738/782) were know rash was the sign/or symptoms of MPox and 76.7% (600/782) of respondents were identified skin-to-skin contact as a primary method. Regarding the prevention measures, avoid close contact with anyone who has Mpox, including sexual contact reported by 80.2% (627/782) of respondents. Among 782 respondents, 18.7% (146), 27.9% (218) and 41.7% (326) were recognized Pregnant women, Immunocompromised individuals, and Children as the high risk for the severity and complication of MPox respectively. More than half participants, 52.9% (414/782), indicated they have awareness that treatment options exist for MPox. However, 39.4% (308/782) don’t know the existence of treatment for Mpox and 7.7% (60/782) believed that there is no treatment for Mpox. The majority of participants, 93.9% (734/782), reported that they would go to a health facility if they themselves or someone else developed signs and symptoms of Mpox. But, 2.7% (21/782) reported they would stay at home and 2.3% (18/782) go to a traditional healer (Table 1) Table 1: Community knowledge, perceptions, and associated factors of Mpox regarding participants’ responses on signs, symptoms, and prevention measures, August 2025. Participants responses regarding knowledge of the signs and symptoms of Mpox Category Response Frequency Percent Fever Yes 333 42.6 No 449 57.4 Headache Yes 213 27.2 No 569 72.8 Fatigue/exhaustion Yes 81 10.4 No 701 89.6 Swollen lymph nodes Yes 68 8.7 No 714 91.3 Rash Yes 738 94.4 No 44 5.6 Muscle pain Yes 75 9.6 No 707 90.4 I don’t know Yes 30 3.8 No 752 96.2 Participants responses regarding how a person can acquire and transmit Mpox Skin-to-skin (such as touching or sex and kissing Yes 600 76.7 No 182 23.3 Talking or breathing close to one another Yes 228 29.2 No 554 70.8 Pregnancy to the fetus/transplacental Yes 50 6.4 No 732 93.6 Physical contact with an animal that carries the virus Yes 209 26.7 No 573 73.3 I don’t know about the way of transmission of Mpox Yes 130 16.6 No 652 83.4 The participants response regarding the action they take to avoid being infected with Mpox. Avoid close contact with anyone who has Mpox, including sexual contact. Yes 627 80.2 No 155 19.8 Clean your hands frequently with soap and water Yes 347 44.4 No 435 55.6 Disinfect hands with chlorine solutions/sanitizer Yes 121 15.5 No 661 84.5 Not sharing bedding, clothing, towels, or utensils with sick people Yes 151 19.3 No 631 80.7 Perception of Mpox disease Perceived Threat: Perceived susceptibility (SUS) and Perceived severity (SEV) Among respondents, 47.1% (368/782) agreed on the possibility that they will get Mpox, whereas 37.1% (290/782) disagreed on the possibility of getting Mpox infection. Regard the risk for getting Mpox, 43.6% (341/782) of the participants perceived that they were at risk of getting Mpox and 37.4% (292/782) did not agree on risk for getting MPox. The majority participants 72% (563/782) responded that they believe that Mpox is a severe disease that can cause serious health problems. Similarly, 72.2% (564/782) of participants believed that Mpox infections often lead to hospitalization or long-term scarring, but, 5.4% (42/782) did not believe in the hospitalization or long-term scarring of Mpox disease. In addition, 65.1% (509/782) of the respondents believe that Mpox can be life-threatening for some people, whereas only 6.5% (51/782) did not agree. The overall prevalence of perceived threat component shows that 45.1% (353/782) of the study participants have positive perceived threat and 54.9% (429/782) have low perceived threat. Perceived Efficacy: Response Efficacy (RE) and Self-Efficacy (SE) Among respondents, 88.7% (693/782), 86.3% (675/782) and 81.9% (641/782) agreed on the effectiveness of avoiding close contact with infected people, washing hands frequently with soap and water and not sharing bedding, clothing, towels, or utensils with sick people prevent MPox transmission respectively. Among respondents, 67.8% (530/782), were agreed that they are confident in avoiding close contact with Mpox cases to prevent themselves, 81.7% (639/782) were believe that they have the resources (soap, sanitizer) to wash hands regularly were and 73.3% (573/782) were believes that they can easily identify and avoid sharing contaminated items (bedding, clothing, towels, or utensils). Overall majority of study participants have positive perceived efficacy 79.9% (625/782) while the rest is low perceived efficacy (Table 2) Table 2: The study participants response for perception questions on Mpox in Ethiopia, August 2025 Perceived threat category Frequency (n=782) Percent Negative Perceived Susceptibility (SUS) 288 36.8 Neutral Perceived Susceptibility (SUS) 144 18.4 Positive Perceived Susceptibility (SUS) 350 44.8 Negative Perceived Severity (SEV) 36 4.6 Neutral Perceived Severity (SEV) 194 24.8 Positive Perceived Severity (SEV) 552 70.6 Overall Perceived Threat response Low Perceived Threat 429 54.9 Positive Perceived Threat 353 45.1 Perceived efficacy category Negative Perceived Response Efficacy (RE) 23 2.9 Neutral Perceived Response Efficacy (RE) 77 9.8 Positive Perceived Response Efficacy (RE) 682 87.2 Negative Perceived Self Efficacy (SE) 24 3.1 Neutral Perceived Self Efficacy (SE) 180 23.0 Positive Perceived Self Efficacy (SE) 578 73.9 Overall Perceived efficacy response Low Perceived Efficacy 157 20.1 Positive Perceived Efficacy 625 79.9 Threat–Efficacy Interaction The quadrants of EPPM indicated, 321 (41%) respondents fell into the high efficacy and high threat group, 304 (38.9%) were in the high efficacy and low threat category, 125 (16%) fell into low efficacy and low threat and 4.1% reported low efficacy and high threat (Figure 2). The finding indicated interaction between perceived threat and perceived efficacy on MPox knowledge is statistically significant ( F(1,778) =17.89, p<.001, ηp2=.022) Source of Information for Mpox The finding showed, 85.9% (672/782) respondents reported using mass medias followed by social media platforms, 41.8% (327/782). Print media is rarely used with only 4.6% (36/782) participants. Among social media user, 42% (138/327) reported using Facebook, followed by Tiktok 33% (107/327), 14% (45/327) Telegram, and 5% (15/327) WhatsApp. The finding indicated that 62.4% (488/782) mentioned mainstream media including TV and Radio as the most preferred, followed by social media 23.3% (182/782), and 13.7% (107/782) health facility, village health workers or community health workers. The print media accounts only 0.6% (5/782) as preferred source of information. Factors Associated with Knowledge Toward MPox The bivariate regression analysis indicated that Sex, educational level, occupation, and perceived threat were statistically associated with knowledge of MPox (p<0.25). After multivariable logistic regression analysis, educational level, occupation and Perceived threat showed a significant association with Mpox knowledge (p<0.05). Regarding educational level, community members who can’t read/write are 83.7% less likely (AOR = 0.163: 95% CI: 0.046-0.579), and who read and write on formal education are 80.8% less likely (AOR = 0.192: 95% CI: 0.074-0.501) to have good MPox knowledge compared to master degree and above. Regarding the occupation, community members who were farmers are 80.1% less likely (AOR = 0.199: 95% CI: 0.079-0.501), being housewife was 72.6% lower odds (AOR = 0.274: 95% CI: 0.138-0.543) and merchants were 69.0% less likely (AOR = 0.310: 95% CI: 0.170-0.566) to have good MPox knowledge compared to unemployed. Moreover, community members with positive perceived threat were almost 2 times (AOR = 1.73: 95% CI: 1.21–2.47) more likely to have a good mpox knowledge than those with low perceived threat (Table 3). Table 3: Binary Logistic Regression Analyses for Factors Associated with Mpox Knowledge Among community members in selected towns of Ethiopia, 2025 (n = 782) Variables Mpox Knowledge Poor Good COR AOR (95% CI) Sig. Sex Female 304 (79.0% 81(21.0% .687 (0.494, 0.954) 0.805(0.544, 1.193) 0.28 Male 286 (72.0% 111 (28.0% 1 Educational Status Can’t read and write 49 (89.1% 6 (10.9% .079 (.024, .259) .163 (.046, .579) .005* Diploma and Degree 225 (65.2% 120 (34.8% .343 (.144, .815) .430 (.175, 1.058) .066 Read and write on formal education 284 (85.3% 49 (14.7% .111 (.046, .270) .192 (.074, .501) .001* Others 23 (88.5% 3 (11.5% .084 (.019, .363) .067 (.014, .320) .001 Master and above 9 (39.1% 14 (60.9% 1 Occupation Farmer 76 (91.6% 7 (8.4% .181 (0.075, 0.440) .199 (.079, .501) .001* Government Employee 112 (56.6% 86 (43.4% 1.511 (0.902, 2.530) .778 (.433, 1.396) .400 Housewife 132 (86.3% 21 (13.7% .313 (0.166, 0.589) .274 (.138, .543) .000* Merchant 169 (82.4% 36 (17.6% .419 (0.239, 0.736) .310 (.170, .566) .000* Others 40 (78.4% 11 (21.6% .541 (0.244, 1.198) .368 (.158, .858) .021 Unemployed 61 (66.3% 31 (33.7% 1 Perceived Threat Low Perceived Threat 342 (79.7% 87 (20.3% 1 Positive Perceived Threat 248 (70.3% 105 (29.7% 1.664 (1.199, 2.310) 1.726 (1.205, 2.47) .003* Discussion The expansion of the Mpox outbreak beyond historically endemic countries, including into Ethiopia, highlights the need to generate evidence to guide evidence-based interventions (5). Thus, this study findings provide valuable insights about community knowledge, Perceptions, and associated factors that inform risk communication and community engagement interventions for Mpox outbreak response in Ethiopia. This study found that 24.6% of community demonstrated good knowledge about Mpox. This level of knowledge appears comparatively low when compared the study among healthcare workers conducted in Gondar reported 48.4%)(10), Injibara indicated 38.5% (11), a national multi-site showed 56.5%(12) and in Debre Tabor presented 28.13%(13). This difference may be due to the fact that healthcare professionals are more frequently exposed to Mpox-related information through their training, and direct involvement in health service delivery. The community-based study in Bahir Dar have highlighted limited knowledge of Mpox, which is consistent with our finding (14). This indicates a substantial knowledge gap in the community regarding Mpox, about three out of every four respondents lacking adequate understanding about the Mpox. The studies conducted among healthcare workers in Cameroon 42%(15) and in Nigeria 52%(16), in Jordan 53.9%(17), and in Turkey 37.7%(18) again suggesting a better knowledge levels among health professionals compared to the current finding. This implies that the community members may not adequately reached by Mpox awareness activities, highlighting the need for more targeted communication strategies. In addition, the evidence related to broader community remains insufficient, thus, our study contributed to fill this evidence gaps. The current study finding indicated educational status was significantly associated with MPox knowledge with can’t read/write are 83.7% less likely (AOR = 0.163: 95% CI: 0.046-0.579) to have good MPox knowledge. This finding supported by the studies conducted in Ethiopia, Bahir Dar(14), Injibara(11), Gondar(10), Congo(19), Cameron(15) and in Nigeria(16) which indicated educational status associated with Mpox knowledge. Additionally, the current study finding indicated occupation was significantly associated with MPox knowledge, being employed lower odds to have good MPox knowledge compared to unemployed. This finding supported by study conducted in Gondar(10), Cameron(15), and systematic review(20). This might be due to unemployed people may have more time to follow media, attend different awareness creation campaign. Moreover, the current study finding indicated that positive perceived threat was significantly associated with good knowledge of MPox. Similarly, studies conducted in Bahir Dar (14), Gondar(10), Injibara(11), Nigeria(16), Cameroon(15), systematic review(20), Jordan(17) and Turkey(18) consistent with the current finding. Likewise, the behavioral models indicated that perceived threat is a key motivator driving people to seek health information and improve knowledge during outbreaks(21). This study applied the Extended Parallel Process Model (EPPM) to understand community perceptions of Mpox in Ethiopia. The evidence indicated that the Extended Parallel Process Model (EPPM) provides a comprehensive framework for understanding both perceived threat (severity and susceptibility) and perceived efficacy (response effectiveness and self-confidence) (22–24) The current finding showed the positive perception of Mpox severity, which is consistent with the findings from other infectious diseases studies (9) (8) (24), implies that severity is generally easier for individuals to accept(23). However, the 44.8% susceptibility perceptions indicated that many participants underestimated their personal risk. This finding is consistent with study conducted on influenza vaccination and HIV prevention, which found that individuals often acknowledge disease seriousness but deny their own vulnerability(9) (8) (24). This implies it might be decreasing perceived threat, weakening motivation for protective behavior. The current study indicated encouraging perceived efficacy, as both response efficacy and self-efficacy were high. This supported by study conducted on Ebola and COVID-19 showed communities mostly trust preventive behaviors and feel capable of performing them (9) (21). Positive efficacy perceptions are crucial, as EPPM predicts that efficacy determines whether individuals engage in constructive danger control or defensive fear control(23). The EPPM quadrant analysis finding highlights that most respondents (41.0%) are in the high threat/high efficacy group that are positioned in adaptive action. However, the 38.9% respondents in the high efficacy/low threat group poses a concern. Although they believe prevention works and feel capable, but, their low susceptibility perception may result in problems. Similar finding reported in studies conducted on noise-induced hearing loss prevention and influenza vaccination(22) (24). This implies the risk communication should emphasize personal susceptibility through local case stories, and tailored key messages to strengthen motivation(25). The small but important respondents in the low efficacy/high threat group attempt risks maladaptive fear control responses. Evidence indicated that the interventions for this group should focus on building self-efficacy, simplifying recommended actions, and ensuring access to necessary resources(23). The current finding showed that the interaction between perceived threat and perceived efficacy affects MPox knowledge. This threat-efficacy interaction finding consistent with EPPM evidences from COVID-19, Ebola, and influenza outbreaks showed that threat perception and self-efficacy interact to influence disease knowledge(26–28). Regarding source of information, this study findings indicated that Mass media (TV/radio) and social media were the most common sources of information. This highlights the predominant influence of digital sources of information. Mass media remains the most preferred channel for health information and followed by social media. This has almost a similar finding with the studies conducted in Bahir Dar City (10,11,14), Gondar(10), and Injibara(11). This might be due to the urban residents were widely access to TV/radio and social media platforms to get health and related information. These implies that mass media and digital platforms are important channels for public health emergency communication in Ethiopia. Additionally, the studies conducted in Nigeria(16), Cameroon(15), and congo(19) consistent with the current finding. This implies the critical need for leveraging digital platforms in public health emergency risk communication and community engagement. Although our research contributes to addressing significant community-level evidence gaps on Mpox and informs targeted interventions, it has certain limitations. This study focuses only on urban communities; rural communities may have different perceptions, knowledge and sources of information. Also, with natural weakness of cross-sectional study design which is limit the ability to assess cause-and-effect relationships and face-to-face interview which may have tendencies toward social desirability bias. Additionally, the inherent limitations of the cross-sectional study design don’t have the ability to assess cause-and-effect relationships, and the use of face-to-face interviews may introduce social desirability bias. Conclusions The Mpox knowledge among community was low implies need for robust risk communication and community engagement. Factors such as educational level, occupation and perceived were significantly associated with Mpox knowledge. The threat perceptions were low, specifically for perceived susceptibility, this highlighting the need to bridge the gap in community threat perception of Mpox. The perceived threat and perceived efficacy interact to shape Mpox knowledge. Moreover, this study indicated that community access to variety sources of information, but, mostly mass media and social media were priority and preferred source of information. It is recommended that address knowledge and perception gaps especially considering interventions that reach all audiences, pairing perceived-threat with perceived-efficacy, and leverage mass and social media. Additionally, we recommend conducting research that includes rural communities to generate further evidence on Mpox, as their risks and perceptions may differ from urban populations. Abbreviations AOR: Adjusted odds ratio, CDC: Centers for Disease Control and Prevention, CI: Confidence interval, COR: Crude odds ratio, EPHI: Ethiopian Public Health Institute, EPPM: Extended Parallel Process Model, HIV: Human Immunodeficiency Virus, IQR: Inter-quartile Range, PHEIC: Public Health Emergency of International Concern, PHECS: Public Health Emergency of Continental Security, RCCE: Risk Communication and Community Engagement, SPSS: Statistical Package for the Social Sciences, TV: Television, WHO: World Health Organization. Declarations Ethics approval and consent to participate The Ethiopian Public Health Institute (EPHI) has the mandate to lead and coordinate national public health emergency preparedness, response, and recovery and rehabilitation efforts in Ethiopia. Hence, the EPHI has been legally authorized to implement evidence-based public health emergency response interventions. This work was conducted to provide evidence-oriented interventions during the MPox outbreak in Ethiopia. The official approval letter was issued by the Ethiopian Public Health Institute (Ref. Number: 4.1/778). The verbal consent was obtained from all participants after described the consent form, which detailed the purpose, volunteer for participation. Participants provided verbal agreement to proceed with the interview, and the interviewer documented consent by marking a designated section on the form. Consent for publication Not applicable Availability of data and materials The datasets used for study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests Funding No funding available for this study. Authors' contributions YM and MH are equally contributed as conception of the study, data curation, conducted analysis, draft manuscript, and review and edit the final manuscript. MA, YH, and GH data curation, conducted analysis, draft manuscript, and review and edit the final manuscript. AY, KM, EF, IF and YA conducted analysis, draft manuscript, and review and edit the final manuscript. MW and MA overall monitoring, draft manuscript, and review and edit the final manuscript. All authors read and approved the final manuscript`` Acknowledgements We would like to thank Ethiopia Public Health Institute for the support throughout the process of this study. Additionally, we would like to thank all subnational RCCE experts supported the data collection process for this study. Finally, we are grateful to the data collectors. References World Health Organization (WHO). (2022). Multi-country monkeypox outbreak: Situation update. Retrieved from https://www.who.int. 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Community based cross-sectional study. SAGE Open Nurs. 2025 Jan;11. Nka AD, Bouba Y, Fokam J, Ka’e AC, Gabisa JE, Mandeng N, et al. Current knowledge of human Mpox viral infection among healthcare workers in Cameroon calls for capacity-strengthening for pandemic preparedness. Front Public Health. 2024;12. Uche Eze NOGOKNCAIRAPISECOKBUAEMAAI. Assessment of the knowledge of healthcare workers on monkeypox in Nigeria. Al Meslamani AZ, Abu-Naser D, Al-Rifai RH. Readiness, knowledge, and attitudes of healthcare professionals in Jordan toward Monkeypox: a cross-sectional survey. Sci Rep. 2025 Dec 1;15(1). Arayici ME, Dolu S, Sayilir HO, Simsek H, Kose S. Assessment of MPOX infection-related knowledge levels, concerns, and associated factors: a community-based cross-sectional study. BMC Public Health. 2025 Dec 1;25(1). Lemaille C, Halbrook M, Merritt S, Anta Y, Lunyanga L, Mukadi PK, et al. Assessing mpox knowledge and sexual behaviours within high-risk populations in the Democratic Republic of the Congo [Internet]. 2025. Available from: http://medrxiv.org/lookup/doi/10.1101/2025.04.20.25326123 Jahromi AS, Jokar M, Sharifi N, Kashkooli S, Rahmanian K, Rahmanian V. Global knowledge and attitudes towards mpox (monkeypox) among healthcare workers: a systematic review and meta-analysis. Vol. 16, International Health. Oxford University Press; 2024. p. 487–98. Jose R, Narendran M, Bindu A, Beevi N, L M, Benny P V. Public perception and preparedness for the pandemic COVID 19: A Health Belief Model approach. Clin Epidemiol Glob Health. 2021 Jan 1;9:41–6. Kotowski MR, Smith SW, Johnstone PM, Pritt E. Using the Extended Parallel Process Model to create and evaluate the effectiveness of brochures to reduce the risk for noise-induced hearing loss in college students. Noise Health. 2011 Jul;13(53):261–71. Witte K (1998). Fear as Motivation, Fear as Inhibition: Using the Extended Parallel Process Model to Explain Fear Appeal Successes and Failures (pp. 423-450) In: Handbook of communication and emotion: Research, theory, applications, and contexts. Peter A. Anderson & Laura K. Guerrero (eds.) Academic Press. Prati G PLZB. Influenza vaccination: The persuasiveness of messages among people aged 65 and older. Health Communication, 2012, 27(5); 413-420. WHO. Risk communication and community engagement (RCCE) for monkeypox outbreaks Interim guidance [Internet]. 2022 [cited 2025 Sep 6]. Available from: https://iris.who.int/bitstream/handle/10665/357184/WHO-MPX-RCCE-2022.1-eng.pdf?sequence=1 Silva SB, de Oliveira Souza F, de Sousa Pinho P, Santos DV. Health Belief Model in studies of influenza vaccination among health care workers. Vol. 21, Revista Brasileira de Medicina do Trabalho. University of Buckingham Press; 2023. Yoon H, You M, Shon C. An application of the extended parallel process model to protective behaviors against COVID-19 in South Korea. PLoS One. 2022 Mar 1;17(3 March). Winters M, Jalloh MF, Sengeh P, Jalloh MB, Zeebari Z, Nordenstedt H. Risk perception during the 2014-2015 Ebola outbreak in Sierra Leone. BMC Public Health. 2020 Oct 12;20(1). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8647071","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":578965157,"identity":"936886d6-2d27-4ee7-9463-068554724364","order_by":0,"name":"Yibeyin Mulualem","email":"","orcid":"","institution":"Ethiopian Public Health Institute","correspondingAuthor":false,"prefix":"","firstName":"Yibeyin","middleName":"","lastName":"Mulualem","suffix":""},{"id":578965158,"identity":"a2c319bb-11fb-44a7-b5cf-e9c92b44cc6b","order_by":1,"name":"Mohammed Hasen Badeso","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYDCCwwwMzGAGewOQMLAgRQvPAZAWCSK0HIBpkUgAk4R18B3nffi4oKZOzlzy+dUNPwokGPjbuxPwapE8zG5sPOPYYWPL2TllN3uADpM4c3YDXi0Gh9nYpHnYDiRuuJ2TdoMHqMVAIpegFvbfPP/q6jfcPJN28w+RWtiYeduYEwxusB+7TZQtkofZmKV5+w4bbjiTw3ZbxkCCh6Bf+M4fY/zM861O3uD48Wc33/yxkeNv78WvBQnwGIBJYpWDAPsDUlSPglEwCkbBCAIAOcZFKjG6o5IAAAAASUVORK5CYII=","orcid":"","institution":"Ethiopian Public Health Institute","correspondingAuthor":true,"prefix":"","firstName":"Mohammed","middleName":"Hasen","lastName":"Badeso","suffix":""},{"id":578965159,"identity":"e68a64c6-256e-40ab-ad2f-af2e09cc5a97","order_by":2,"name":"Melaku Abebe","email":"","orcid":"","institution":"Ethiopian Public Health Institute","correspondingAuthor":false,"prefix":"","firstName":"Melaku","middleName":"","lastName":"Abebe","suffix":""},{"id":578965160,"identity":"17591b91-78d2-40a3-86ac-c44fc2c965d0","order_by":3,"name":"Aemro Yibeltal","email":"","orcid":"","institution":"Ethiopian Public Health Institute","correspondingAuthor":false,"prefix":"","firstName":"Aemro","middleName":"","lastName":"Yibeltal","suffix":""},{"id":578965161,"identity":"048c4d3c-53a1-43bf-993b-86a785629e70","order_by":4,"name":"Ketema Misganaw","email":"","orcid":"","institution":"Ethiopian Public Health Institute","correspondingAuthor":false,"prefix":"","firstName":"Ketema","middleName":"","lastName":"Misganaw","suffix":""},{"id":578965162,"identity":"e5ef9b6d-4d64-4d30-b1ae-29be06230d1f","order_by":5,"name":"Ebsa File","email":"","orcid":"","institution":"Ethiopian Public Health 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Institute","correspondingAuthor":false,"prefix":"","firstName":"Ikram","middleName":"","lastName":"Faris","suffix":""},{"id":578965166,"identity":"a23a61d9-ddc6-4107-8385-41aee7356220","order_by":9,"name":"Girma Hailamariam","email":"","orcid":"","institution":"United Nations Children's Fund (UNICEF)","correspondingAuthor":false,"prefix":"","firstName":"Girma","middleName":"","lastName":"Hailamariam","suffix":""},{"id":578965167,"identity":"9439e66f-ec70-43f8-8bdc-b13ebfa7a8b9","order_by":10,"name":"Mesfin Wosen","email":"","orcid":"","institution":"Ethiopian Public Health Institute","correspondingAuthor":false,"prefix":"","firstName":"Mesfin","middleName":"","lastName":"Wosen","suffix":""},{"id":578965168,"identity":"85ba7bf3-c290-4536-b794-6d3ee05c65f8","order_by":11,"name":"Melkamu Abte","email":"","orcid":"","institution":"Ethiopian Public Health Institute","correspondingAuthor":false,"prefix":"","firstName":"Melkamu","middleName":"","lastName":"Abte","suffix":""}],"badges":[],"createdAt":"2026-01-20 09:07:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8647071/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8647071/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101398221,"identity":"da21f732-4c29-4ee5-bf53-62ce8458e205","added_by":"auto","created_at":"2026-01-29 09:40:21","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":166304,"visible":true,"origin":"","legend":"\u003cp\u003eProportional sample size distribution for the study on community knowledge, perceptions, and associated factors of Mpox in Ethiopia, August 2025\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8647071/v1/54df7e4ec9c8199b951f00d8.png"},{"id":101380409,"identity":"e94aa6e1-16a1-4db8-9cfa-1839ead0dce2","added_by":"auto","created_at":"2026-01-29 06:06:22","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":38358,"visible":true,"origin":"","legend":"\u003cp\u003eThe Extended Parallel Process Model (EPPM) quadrant showing the four response combinations of perceived threat and perceived efficacy on Mpox in Ethiopia, 2025\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8647071/v1/0a979414dba2ad6128de059d.png"},{"id":101399730,"identity":"c4fac6d5-d985-4678-80a9-885fc9562987","added_by":"auto","created_at":"2026-01-29 09:55:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1165970,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8647071/v1/ed5fa239-c8cd-4790-9edc-68bc48dfc97c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Community Knowledge, Perceptions, and Associated Factors of Mpox in Ethiopia: Application of Extended Parallel Process Model. A community-based cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003eMpox is a re-emerging zoonotic disease caused by the Mpox virus, a member of the Orthopoxvirus genus in the family Poxviridae. It is historically endemic in Central and West Africa countries. However, in recent years, the Mpox outbreak expanding beyond endemic countries. The World Health Organization (WHO) to declare the first Mpox Public Health Emergency of International Concern (PHEIC) in July 2022 and Africa CDC declared Mpox a Public Health Emergency of Continental Security (PHECS) on August 13, 2024 and followed by the second WHO PHEIC declaration on August 14, 2024 (1,2). The rising global incidence of mpox underscores the crucial need for effective prevention, and response strategies, including enhancing comprehensive public knowledge, accurate risk perception, and confidence in prevention measures and implementation of actions (3)(4).\u003c/p\u003e\n\u003cp\u003eEthiopia declare Mpox outbreak on May-26-2025 (5). This spread beyond historically endemic regions including Ethiopia, has highlighted critical need for tailored and effective public health interventions. The robust RCCE interventions needed to ensure public understanding, reduce fear and stigma, and promote healthy behaviors. So, evidence-based interventions to enhance community knowledge, perception of Mpox, and utilize preferred sources of information are critical for effective outbreak prevention and control (6)(7)\u003c/p\u003e\n\u003cp\u003eIn Ethiopia, historically the Mpox was not reported and there is evidence gap about the population\u0026rsquo;s awareness, perceptions concerning Mpox, and trusted information sources. Therefore, understanding communities\u0026rsquo; knowledge, perceptions, behaviors and information sources essential for; first to identify what communities know or not know about Mpox, second to address misinformation and disinformation through mapping the trusted sources of information, and third to design evidence based RCCE interventions strategies to control and prevent Mpox outbreak. So, this study aimed to assess community knowledge, perceptions, and sources of information regarding Mpox in Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design and setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA community-based cross-sectional study was conducted in Ethiopia using multi-stage systematic random sampling. This study was conducted from July 7\u0026ndash;27, 2025, in seven selected towns of Ethiopia to assess community knowledge and associated factors, perceptions about Mpox, and preferred sources of information.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy population and participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe target populations were residents of towns aged 18 years and above living in the selected towns for at least six months. The study participants were household members aged 18 years and above, randomly selected from households within randomly sampled kebele.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSelection criteria and Exclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEligible participants were household member aged above 18 years at selected households who provided consent. The health worker households and absent after repeated visit was excluded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe seven towns were randomly selected from towns identified as high-risk for Mpox due to high population mobility. The sample size determination was calculated both for prevalence of knowledge and perception of Mpox followed by the larger sample size used. We applied the single population proportion formula considered prevalence of Mpox knowledge (p= 33.7%) and perception (p=57.3%) from the study conducted in Bahir Dar town, Northwest Ethiopia [13]. We considered 95% confidence interval and 5% degree of precision. We considered design effect for multistage sampling. Finally, the larger sample size (n=782) was determined.\u003c/p\u003e\n\u003cp\u003eThe sample size was proportionally distributed to each town and sub-towns based their administration report total number of households in the 2024/25 fiscal year. Households were randomly selected using the town mayor\u0026rsquo;s household list as the sampling frame. From each selected household, one member aged 18 years or older was randomly selected and interviewed (Figure 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection and Procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected using structured, interviewer-administered questionnaires on sociodemographic information, Mpox transmission, signs/symptoms, prevention and control measures, Perception and preferred source of information. We used Extended Parallel Process Model (EPPM) to assess perceived threat (perceived severity and perceived susceptibility) and perceived efficacy (response efficacy and self-efficacy). The data collectors were trained on tools before deployed to data collection. The tools were tested on 5% of sample size and revised based on the feedback. The data were collected using Kobo Collect and imported into SPSS for analysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data was checked for completeness and clarity. Statistical Package for the Social Sciences (SPSS) version 26 was used for data analysis. In this study, a total of 14 item questions include 6 sign and symptoms, 04 transmission, and 04 preventions measures were used to assess the Mpox knowledge of the community. Respondents who correctly answered 50% or more of the questions were classified as having a good level of knowledge. The perceived threat (6-items), and efficacy (6-items) were scored using Likert scale and computed mean to categorize perception levels as negative perception: mean \u0026le; 2.5; Neutral Perception: 2.6 \u0026ndash; 3.5; Positive perception: \u0026ge; 3.6, (8,9). Overall, the mean \u003cu\u003e\u0026gt;\u003c/u\u003e3.6 were used to categorized positive perceived threat and positive perceived efficacy. Binary and multivariate logistic regression analyses was conducted to identify factors influencing participants\u0026rsquo; knowledge toward Mpox. The Shapiro\u0026ndash;Wilk, Levene\u0026rsquo;s and Cronbach\u0026rsquo;s Alpha test were conducted to test normality, homogeneity, and reliability of the data respectively. A candidate variable with adjusted odds ratios (AORs) and 95%CI was calculated to identify variables independently associated with Mpox knowledge. The inferential statistics ANOVA analysis was conducted to assess the perceived threat and perceived efficacy interaction to predict Mpox knowledge.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSocio-Demographic characteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the total respondents, 50.8% (397/782) were male and 32.7% (256/782) age groups 25-34 years, followed by the 35-44 years\u0026apos; group 29.7% (232/782) of respondents. Regarding educational status of respondents, 44.1% (345/782) had attained a diploma or/and degree, while only 42.6% (333/782) respondents were only able to read and write that attained formal education. The majority of respondents were married 64.8% (507/782) followed by single 30.3% (237/782). Also, more than one fourth of the study participants were merchants 26.2% (205/782) followed by government employee 25.3% (198/782) and housewife 19.6% (153/782).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKnowledge of Mpox\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study revealed that only 192 (24.6%) of study participants demonstrated good knowledge of Mpox. The majority of respondents 94.4% (738/782) were know rash was the sign/or symptoms of MPox and 76.7% (600/782) of respondents were identified skin-to-skin contact as a primary method. Regarding the prevention measures, avoid close contact with anyone who has Mpox, including sexual contact reported by 80.2% (627/782) of respondents. Among 782 respondents, 18.7% (146), 27.9% (218) and 41.7% (326) were recognized Pregnant women, Immunocompromised individuals, and Children as the high risk for the severity and complication of MPox respectively.\u003c/p\u003e\n\u003cp\u003eMore than half participants, 52.9% (414/782), indicated they have awareness that treatment options exist for MPox. However, 39.4% (308/782) don\u0026rsquo;t know the existence of treatment for Mpox and 7.7% (60/782) believed that there is no treatment for Mpox. The majority of participants, 93.9% (734/782), reported that they would go to a health facility if they themselves or someone else developed signs and symptoms of Mpox. But, 2.7% (21/782) reported they would stay at home and 2.3% (18/782) go to a traditional healer (Table 1)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1: Community knowledge, perceptions, and associated factors of Mpox regarding participants\u0026rsquo; responses on signs, symptoms, and prevention measures, August 2025.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"618\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 618px;\"\u003e\n \u003cp\u003eParticipants responses regarding knowledge of the signs and symptoms of Mpox\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 360px;\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003eResponse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eFever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e42.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e449\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e57.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eHeadache\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e27.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e569\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e72.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eFatigue/exhaustion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e701\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e89.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eSwollen lymph nodes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e714\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e91.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eRash\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e738\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e94.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eMuscle pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e9.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e707\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e90.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e752\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e96.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 618px;\"\u003e\n \u003cp\u003eParticipants responses regarding how a person can acquire and transmit Mpox\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eSkin-to-skin (such as touching or sex and kissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e76.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e23.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eTalking or breathing close to one another\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e29.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e554\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e70.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003ePregnancy to the fetus/transplacental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e732\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e93.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003ePhysical contact with an animal that carries the virus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e26.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e573\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e73.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know about the way of transmission of Mpox\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e16.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e652\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e83.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 618px;\"\u003e\n \u003cp\u003eThe participants response regarding the action they take to avoid being infected with Mpox.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eAvoid close contact with anyone who has Mpox, including sexual contact.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e627\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e80.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e19.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eClean your hands frequently with soap and water\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e347\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e44.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e435\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e55.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eDisinfect hands with chlorine solutions/sanitizer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e15.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e661\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e84.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003eNot sharing bedding, clothing, towels, or utensils with sick people\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e19.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e631\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e80.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003ePerception of Mpox disease\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerceived Threat:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ePerceived susceptibility (SUS) and Perceived severity (SEV)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong respondents, 47.1% (368/782) agreed on the possibility that they will get Mpox, whereas 37.1% (290/782) disagreed on the possibility of getting Mpox infection. Regard the risk for getting Mpox, 43.6% (341/782) of the participants perceived that they were at risk of getting Mpox and 37.4% (292/782) did not agree on risk for getting MPox. The majority participants 72% (563/782) responded that they believe that Mpox is a severe disease that can cause serious health problems. Similarly, 72.2% (564/782) of participants believed that Mpox infections often lead to hospitalization or long-term scarring, but, 5.4% (42/782) did not believe in the hospitalization or long-term scarring of Mpox disease. \u0026nbsp; In addition, 65.1% (509/782) of the respondents believe that Mpox can be life-threatening for some people, whereas only 6.5% (51/782) did not agree. The overall prevalence of perceived threat component shows that 45.1% (353/782) of the study participants have positive perceived threat and 54.9% (429/782) have low perceived threat.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerceived Efficacy: Response Efficacy (RE) and\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eSelf-Efficacy (SE)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong respondents, 88.7% (693/782), 86.3% (675/782) and 81.9% (641/782) agreed on the effectiveness of avoiding close contact with infected people, washing hands frequently with soap and water and not sharing bedding, clothing, towels, or utensils with sick people prevent MPox transmission respectively. Among respondents, 67.8% (530/782), were agreed that they are confident in avoiding close contact with Mpox cases to prevent themselves, 81.7% (639/782) were believe that they have the resources (soap, sanitizer) to wash hands regularly were and 73.3% (573/782) were believes that they can easily identify and avoid sharing contaminated items (bedding, clothing, towels, or utensils). Overall majority of study participants have positive perceived efficacy 79.9% (625/782) while the rest is low perceived efficacy (Table\u0026nbsp;2)\u003c/p\u003e\n\u003cp\u003eTable 2: The study participants response for perception questions on Mpox in Ethiopia, August 2025\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"618\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 408px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerceived threat category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n=782)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 408px;\"\u003e\n \u003cp\u003eNegative Perceived Susceptibility (SUS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e36.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 408px;\"\u003e\n \u003cp\u003eNeutral Perceived Susceptibility (SUS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e18.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 408px;\"\u003e\n \u003cp\u003ePositive Perceived Susceptibility (SUS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e350\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e44.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 408px;\"\u003e\n \u003cp\u003eNegative Perceived Severity (SEV)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 408px;\"\u003e\n \u003cp\u003eNeutral Perceived Severity (SEV)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e24.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 408px;\"\u003e\n \u003cp\u003ePositive Perceived Severity (SEV)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e552\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e70.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 408px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall Perceived Threat response\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 408px;\"\u003e\n \u003cp\u003eLow Perceived Threat\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e429\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e54.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 408px;\"\u003e\n \u003cp\u003ePositive Perceived Threat\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e353\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e45.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 408px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerceived efficacy category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 408px;\"\u003e\n \u003cp\u003eNegative Perceived Response Efficacy (RE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 408px;\"\u003e\n \u003cp\u003eNeutral Perceived Response Efficacy (RE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 408px;\"\u003e\n \u003cp\u003ePositive Perceived Response Efficacy (RE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e682\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e87.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 408px;\"\u003e\n \u003cp\u003eNegative Perceived Self Efficacy (SE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 408px;\"\u003e\n \u003cp\u003eNeutral Perceived Self Efficacy (SE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e23.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 408px;\"\u003e\n \u003cp\u003ePositive Perceived Self Efficacy (SE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e578\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e73.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 618px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall Perceived efficacy response\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 408px;\"\u003e\n \u003cp\u003eLow Perceived Efficacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e20.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 408px;\"\u003e\n \u003cp\u003ePositive Perceived Efficacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e625\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e79.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eThreat\u0026ndash;Efficacy Interaction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe quadrants of EPPM indicated, 321 (41%) respondents fell into the high efficacy and high threat group, 304 (38.9%) were in the high efficacy and low threat category, 125 (16%) fell into low efficacy and low threat and 4.1% reported low efficacy and high threat (Figure 2). The finding indicated interaction between perceived threat and perceived efficacy on MPox knowledge is statistically significant\u003cstrong\u003e\u0026nbsp;(\u003c/strong\u003eF(1,778) =17.89, p\u0026lt;.001, \u0026eta;p2=.022)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSource of Information for Mpox\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe finding showed, 85.9% (672/782) respondents reported using mass medias followed by social media platforms, 41.8% (327/782). Print media is rarely used with only 4.6% (36/782) participants. Among social media user, 42% (138/327) reported using Facebook, followed by Tiktok 33% (107/327), 14% (45/327) Telegram, and 5% (15/327) WhatsApp. The finding indicated that 62.4% (488/782) mentioned mainstream media including TV and Radio as the most preferred, followed by social media 23.3% (182/782), and 13.7% (107/782) health facility, village health workers or community health workers. The print media accounts only 0.6% (5/782) as preferred source of information.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors Associated with Knowledge Toward MPox\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe bivariate regression analysis indicated that Sex, educational level, occupation, and perceived threat were statistically associated with knowledge of MPox (p\u0026lt;0.25). After multivariable logistic regression analysis, educational level, occupation and Perceived threat showed a significant association with Mpox knowledge (p\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003eRegarding educational level, community members who can\u0026rsquo;t read/write are 83.7% less likely (AOR = 0.163: 95% CI: 0.046-0.579), and who read and write on formal education are 80.8% less likely (AOR = 0.192: 95% CI: 0.074-0.501) to have good MPox knowledge compared to master degree and above. \u0026nbsp; Regarding the occupation, community members who were farmers are 80.1% less likely (AOR = 0.199: 95% CI: 0.079-0.501), being housewife was 72.6% lower odds (AOR = 0.274: 95% CI: 0.138-0.543) and merchants were 69.0% less likely (AOR = 0.310: 95% CI: 0.170-0.566) to have good MPox knowledge compared to unemployed. Moreover, community members with positive perceived threat were almost 2 times (AOR = 1.73: 95% CI: 1.21\u0026ndash;2.47) more likely to have a good mpox knowledge than those with low perceived threat (Table 3).\u003c/p\u003e\n\u003cp\u003eTable 3: Binary Logistic Regression Analyses for Factors Associated with Mpox Knowledge Among community members in selected towns of Ethiopia, 2025 (n = 782)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 185px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; Mpox Knowledge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePoor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGood\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAOR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSig.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e304 (79.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e81(21.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.687 (0.494, 0.954)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.805(0.544, 1.193)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e286 (72.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e111 (28.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eCan\u0026rsquo;t read and write\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e49 (89.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e6 (10.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.079 (.024, .259)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e.163 (.046, .579)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e.005*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eDiploma and Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e225 (65.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e120 (34.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.343 (.144, .815)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e.430 (.175, 1.058)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e.066\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eRead and write on formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e284 (85.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e49 (14.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.111 (.046, .270)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e.192 (.074, .501)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e23 (88.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e3 (11.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.084 (.019, .363)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e.067 (.014, .320)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eMaster and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e9 (39.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e14 (60.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e76 (91.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e7 (8.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.181 (0.075, 0.440)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e.199 (.079, .501)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eGovernment Employee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e112 (56.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e86 (43.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1.511 (0.902, 2.530)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e.778 (.433, 1.396)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e.400\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eHousewife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e132 (86.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e21 (13.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.313 (0.166, 0.589)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e.274 (.138, .543)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e.000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eMerchant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e169 (82.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e36 (17.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.419 (0.239, 0.736)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e.310 (.170, .566)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e.000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e40 (78.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e11 (21.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.541 (0.244, 1.198)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e.368 (.158, .858)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e61 (66.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e31 (33.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerceived Threat\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eLow Perceived Threat\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e342 (79.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e87 (20.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003ePositive Perceived Threat\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e248 (70.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e105 (29.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1.664 (1.199, 2.310)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.726 (1.205, 2.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e.003*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe expansion of the Mpox outbreak beyond historically endemic countries, including into Ethiopia, highlights the need to generate evidence to guide evidence-based interventions (5). Thus, this study findings provide valuable insights about community knowledge, Perceptions, and associated factors that inform risk communication and community engagement interventions for Mpox outbreak response in Ethiopia.\u003c/p\u003e\n\u003cp\u003eThis study found that 24.6% of community demonstrated good knowledge about Mpox. This level of knowledge appears comparatively low when compared the study among healthcare workers conducted in Gondar reported 48.4%)(10), Injibara indicated 38.5% (11), \u0026nbsp;a national multi-site showed 56.5%(12) and in Debre Tabor presented 28.13%(13). This difference may be due to the fact that healthcare professionals are more frequently exposed to Mpox-related information through their training, and direct involvement in health service delivery. The community-based study in Bahir Dar have highlighted limited knowledge of Mpox, which is consistent with our finding (14). This indicates a substantial knowledge gap in the community regarding Mpox, about three out of every four respondents lacking adequate understanding about the Mpox. The studies conducted among healthcare workers in Cameroon 42%(15) and in Nigeria 52%(16), in Jordan 53.9%(17), and in Turkey 37.7%(18) again suggesting a better knowledge levels among health professionals compared to the current finding. This implies that the community members may not adequately reached by Mpox awareness activities, highlighting the need for more targeted communication strategies. In addition, the evidence related to broader community remains insufficient, thus, our study contributed to fill this evidence gaps.\u003c/p\u003e\n\u003cp\u003eThe current study finding indicated educational status was significantly associated with MPox knowledge with can’t read/write are 83.7% less likely (AOR = 0.163: 95% CI: 0.046-0.579) to have good MPox knowledge. This finding supported by the studies conducted in Ethiopia, Bahir Dar(14), Injibara(11), Gondar(10), Congo(19), Cameron(15) and in Nigeria(16) which indicated educational status associated with Mpox knowledge. Additionally, the current study finding indicated occupation was significantly associated with MPox knowledge, being employed lower odds to have good MPox knowledge compared to unemployed. This finding supported by study conducted in Gondar(10), Cameron(15), and systematic review(20). This might be due to unemployed people may have more time to follow media, attend different awareness creation campaign. \u0026nbsp;Moreover, the current study finding indicated that positive perceived threat was significantly associated with good knowledge of MPox. Similarly, studies conducted in Bahir Dar (14), Gondar(10), Injibara(11), Nigeria(16), Cameroon(15), systematic review(20), Jordan(17) and Turkey(18) consistent with the current finding. Likewise, the behavioral models indicated that perceived threat is a key motivator driving people to seek health information and improve knowledge during outbreaks(21).\u003c/p\u003e\n\u003cp\u003eThis study applied the Extended Parallel Process Model (EPPM) to understand community perceptions of Mpox in Ethiopia. The evidence indicated that the Extended Parallel Process Model (EPPM) provides a comprehensive framework for understanding both perceived threat (severity and susceptibility) and perceived efficacy (response effectiveness and self-confidence) (22–24)\u003c/p\u003e\n\u003cp\u003eThe current finding showed the positive perception of Mpox severity, which is consistent with the findings from other infectious diseases studies (9) (8) (24), implies that severity is generally easier for individuals to accept(23). However, the 44.8% susceptibility perceptions indicated that many participants underestimated their personal risk. This finding is consistent with study conducted on influenza vaccination and HIV prevention, which found that individuals often acknowledge disease seriousness but deny their own vulnerability(9) (8) (24). This implies it might be decreasing perceived threat, weakening motivation for protective behavior. The current study indicated encouraging perceived efficacy, as both response efficacy and self-efficacy were high. This supported by study conducted on Ebola and COVID-19 showed communities mostly trust preventive behaviors and feel capable of performing them (9) (21). Positive efficacy perceptions are crucial, as EPPM predicts that efficacy determines whether individuals engage in constructive danger control or defensive fear control(23).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe EPPM quadrant analysis finding highlights that most respondents (41.0%) are in the high threat/high efficacy group that are positioned in adaptive action. However, the 38.9% respondents in the high efficacy/low threat group poses a concern. Although they believe prevention works and feel capable, but, their low susceptibility perception may result in problems. Similar finding reported in studies conducted on noise-induced hearing loss prevention and influenza vaccination(22) (24). This implies the\u0026nbsp;risk communication should emphasize personal susceptibility through local case stories, and tailored key messages to strengthen motivation(25). The small but important respondents in the low efficacy/high threat group attempt risks maladaptive fear control responses. Evidence indicated that the interventions for this group should focus on building self-efficacy, simplifying recommended actions, and ensuring access to necessary resources(23). The current finding showed that the interaction between perceived threat and perceived efficacy affects MPox knowledge. This threat-efficacy interaction finding consistent with EPPM evidences from COVID-19, Ebola, and influenza outbreaks showed that threat perception and self-efficacy interact to influence disease knowledge(26–28).\u003c/p\u003e\n\u003cp\u003eRegarding source of information, this study findings indicated that Mass media (TV/radio) and social media were the most common sources of information. This highlights the predominant influence of digital sources of information. Mass media remains the most preferred channel for health information and followed by social media. This has almost a similar finding with the studies conducted in Bahir Dar City (10,11,14), Gondar(10), and Injibara(11). This\u0026nbsp;might be due to the urban residents were widely access to TV/radio and social media platforms to get health and related information. These implies that mass media and digital platforms are important channels for public health emergency communication in Ethiopia. Additionally, the studies conducted in Nigeria(16), Cameroon(15), and congo(19) consistent with the current finding. This implies the critical need for leveraging digital platforms in public health emergency risk communication and community engagement.\u003c/p\u003e\n\u003cp\u003eAlthough our research contributes to addressing significant community-level evidence gaps on Mpox and informs targeted interventions, it has certain limitations. This study focuses only on urban communities; rural communities may have different perceptions, knowledge and sources of information. Also, with natural weakness of cross-sectional study design which is limit the ability to assess cause-and-effect relationships and face-to-face interview which may have tendencies toward social desirability bias. Additionally, the inherent limitations of the cross-sectional study design don’t have the ability to assess cause-and-effect relationships, and the use of face-to-face interviews may introduce social desirability bias.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe Mpox knowledge among community was low implies need for robust risk communication and community engagement. Factors such as educational level, occupation and perceived were significantly associated with Mpox knowledge. The threat perceptions were low, specifically for perceived susceptibility, this highlighting the need to bridge the gap in community threat perception of Mpox. The perceived threat and perceived efficacy interact to shape Mpox knowledge. Moreover, this study indicated that community access to variety sources of information, but, mostly mass media and social media were priority and preferred source of information. It is recommended that address knowledge and perception gaps especially considering interventions that reach all audiences, pairing perceived-threat with perceived-efficacy, and leverage mass and social media. Additionally, we recommend conducting research that includes rural communities to generate further evidence on Mpox, as their risks and perceptions may differ from urban populations.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAOR: Adjusted odds ratio, CDC: Centers for Disease Control and Prevention, CI: Confidence interval, COR: Crude odds ratio, EPHI: Ethiopian Public Health Institute, EPPM: Extended Parallel Process Model, HIV: Human Immunodeficiency Virus, IQR: Inter-quartile Range, PHEIC: Public Health Emergency of International Concern, PHECS: Public Health Emergency of Continental Security, RCCE: Risk Communication and Community Engagement, SPSS: Statistical Package for the Social Sciences, TV: Television, WHO: World Health Organization.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Ethiopian Public Health Institute (EPHI) has the mandate to lead and coordinate national public health emergency preparedness, response, and recovery and rehabilitation efforts in Ethiopia. Hence, the EPHI has been legally authorized to implement evidence-based public health emergency response interventions. This work was conducted to provide evidence-oriented interventions during the MPox outbreak in Ethiopia. The official approval letter was issued by the Ethiopian Public Health Institute (Ref. Number: 4.1/778). The verbal consent was obtained from all participants after described the consent form, which detailed the purpose, volunteer for participation. Participants provided verbal agreement to proceed with the interview, and the interviewer documented consent by marking a designated section on the form.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used for study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding available for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYM and MH are equally contributed as conception of the study, data curation, conducted analysis, draft manuscript, and review and edit the final manuscript. MA, YH, and GH data curation, conducted analysis, draft manuscript, and review and edit the final manuscript. AY, KM, EF, IF and YA conducted analysis, draft manuscript, and review and edit the final manuscript. MW and MA overall monitoring, draft manuscript, and review and edit the final manuscript. All authors read and approved the final manuscript``\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank Ethiopia Public Health Institute for the support throughout the process of this study. Additionally, we would like to thank all subnational RCCE experts supported the data collection process for this study. Finally, we are grateful to the data collectors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization (WHO). (2022). Multi-country monkeypox outbreak: Situation update. 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University of Buckingham Press; 2023.\u003c/li\u003e\n\u003cli\u003eYoon H, You M, Shon C. An application of the extended parallel process model to protective behaviors against COVID-19 in South Korea. PLoS One. 2022 Mar 1;17(3 March).\u003c/li\u003e\n\u003cli\u003eWinters M, Jalloh MF, Sengeh P, Jalloh MB, Zeebari Z, Nordenstedt H. Risk perception during the 2014-2015 Ebola outbreak in Sierra Leone. BMC Public Health. 2020 Oct 12;20(1).\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8647071/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8647071/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Background\nMpox remains a public health threat in Africa affecting many countries. Ethiopia declare Mpox outbreak on May-26-2025. Understanding community knowledge and perception is vital for tailoring Mpox behavioral interventions. However, there is limited evidence on community knowledge and perceptions of Mpox. Therefore, this study aimed to assess community knowledge and perceptions of Mpox using the Extended Parallel Process Model in Ethiopia, 2025.\nMethods\nA community-based cross-sectional study was conducted in Ethiopia using multi-stage systematic random sampling. A household members adults (\u003e18years) were interviewed, health worker households were excluded. Data were collected using interviewer-administered questionnaires on socio-demographics, Mpox knowledge, and perceived threat. We used Extended Parallel Process Model (EPPM) to assess perceived-threat and perceived-efficacy. Data were analyzed with descriptive and inferential statistics (ANOVA, logistic regression) using SPSS-v26\nResults\nThe median age was 35years (IQR: 28–44), and 50.8% (392/782) were male. Only 24.6% (192/782) had good Mpox knowledge. Positive perceived threat was 45.1% and positive efficacy was 79.9% (625/782). Threat–efficacy interaction significantly predicted knowledge (p\u003c0.001, η²=0.030); positive threat (AOR=1.73, 95%CI:1.21-2.47), can’t read/write (AOR = 0.163: 95% CI: 0.046-0.579), read and write on formal education (AOR = 0.192: 95% CI: 0.074-0.501), farmers (AOR = 0.199: 95% CI: 0.079-0.501), and housewife (AOR = 0.274: 95% CI: 0.138-0.543). The preferred sources of information 62.4% (488/782) mainstream media followed by social media 23.3% (182/782).\nConclusions\nThe Mpox knowledge among community was low implies need for robust public health interventions. Factors such as educational level, occupation and perceived threat had a significant association with the Mpox knowledge of the community. The perceived threat and perceived efficacy interact to shape Mpox knowledge. It is recommended that address knowledge and perception gaps especially considering interventions that reach all audiences, pairing perceived-threat with perceived-efficacy, and leverage mass and social media","manuscriptTitle":"Community Knowledge, Perceptions, and Associated Factors of Mpox in Ethiopia: Application of Extended Parallel Process Model. 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