Community knowledge, risk perceptions, and determinants of mpox in Ethiopia: An application of the Extended Parallel Process Model

Introduction: Mpox remains a public health threat in Africa, affecting many countries. Ethiopia declared an mpox outbreak on May 26, 2025. Understanding community knowledge and perception is vital for tailoring mpox behavioural interventions. However, there is limited evidence on community knowledge and perceptions of mpox. The Extended Parallel Process Model provides a comprehensive framework for understanding both perceived threat and perceived efficacy. Therefore, this study assessed 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. Adult household members (>18 years) were interviewed; health worker households were excluded. Data were collected using interviewer-administered questionnaires on socio-demographics, mpox knowledge, and perceived threat. We used the Extended Parallel Process Model (EPPM) to assess perceived threat and perceived efficacy. Data were analysed with descriptive and inferential statistics (ANOVA, logistic regression) using SPSS v26. Results: The median age was 35 years (IQR: 28–44), and 50.8% (397/782) 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, ηp2=0.022); 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 were mainstream media at 62.4% (488/782), followed by social media at 23.3% (182/782). Conclusions: The Mpox knowledge among the community was low, implying a 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 interventions address knowledge and perception gaps, especially considering interventions that reach all audiences, pairing perceived threat with perceived efficacy, and leveraging mass and social media.