Assessing radiation risk perception by means of a European stakeholder survey

This first part of the public survey consisted of general questions relating to personal information about the responder, such as sex, age, place and country of residence, job and level of education, as well as the level of experience within the ionising radiation and RP fields.

All the fields of this section provided valuable information about the background profile of the responder, and for this reason it was set as non-mandatory for privacy and ethical reasons.

This section represented the core part of the public survey. It provided essential information about individual perception of radiation risk. For this reason, all the fields were mandatory. The section included questions about the respondent's attitudes towards science and technology, satisfaction with the bodies and actors in the domain of RP and the actions undertaken by RP authorities and opinions on the communication channels about radiological and nuclear risk. A final question was added to the general section in order to prepare for future consultation on the results of the research roadmap to help ensure that future scientific work is consistent with societal priorities. The drafting of a unified roadmap for RP research was the responsibility of CONCERT EJP's WP3. The willingness of the respondents to give their opinion on this topic was investigated.

After the general part, respondents were invited to fill certain specific subsections, according to their roles and/or experience in matters relating to ionising radiation and the RP field. The subsections were addressed to the following categories of respondent:

• (a)  
  S1—occupational exposure.
• (b)  
  S2—medical exposure.
• (c)  
  S3—duty holders/decision-makers.
• (d)  
  S4—specific categories of potentially exposed populations.
• (e)  
  S5—cultural involvement or interest in RP issues.

The bar graph in figure 1(a) shows the percentage of responses coming from people living in different countries, independent of the language version they used. These data are different from the number of answers for language (previously reported), as expected. In particular, the English version of the questionnaire was filled in by people from the United Kingdom but also from Norway (34 replies).

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The most responses (number of replies >200) were from Italy, Spain and Finland, but from figure 1(b), where the number of replies per million citizens is shown, it is clear that the response rate from the different countries is quite heterogeneous, an issue that must be taken into consideration in the analysis.

For example, although Italy, Spain and Finland had the highest number of responses, Estonia, Finland and Croatia are better represented. The category 'Other (Europe)' includes replies from Belgium, Netherlands, Sweden, Ireland, Slovenia, Serbia, Hungary, Cyprus, Denmark and Romania, which belong to the European Community. The category 'Other (not EU)' includes replies from Switzerland, Japan, United States of America, Australia, Canada, Algeria, Colombia and Argentina.

Half of the respondents declared that they came from a big city and 21.7% declared that they had lived close to a NPP (within a radius of 20 km) at some point in their lifetime. Of course, this percentage is strongly dependent on the country of origin of the respondent (e.g. nuclear versus non-nuclear energy countries). As an example, only 5.6% of Italians answered affirmatively to the question, as Italy has been a non-nuclear energy country since 1987. In Finland, 30.6% of respondents said that they live or have lived within 20 km of a NPP. However, Finland is sparsely populated and NPPs are typically located in remote areas and have fewer people living in the surrounding areas compared with other countries. Rossi [13] reports that there are fewer than 10 000 inhabitants within the 10 km zone around the two sites in Finland, whereas there can be close to a million in some other countries. This means that there is a very strong bias towards respondents living close to NPPs.

The sample was characterised by a very high level of education; indeed, 77% of the respondents have a university or post-university qualification. Among these, 84.5% have a degree in a scientific/technical subject, while the remaining 14.5% hold degrees in an arts/humanities/social science discipline. Of course, this high level of education amongst those responding makes the sample different from the 39.1% of those aged 30–34 years in the European Union (EU) who have completed tertiary education (data from 2016) [14]; thus our sample was biased, most likely due to the chosen routes of dissemination of the questionnaire.

A specific question about the level of training in the ionising radiation and RP fields was asked and the results are shown in figure 2. Forty-one per cent of respondents declared they had received more than one form of training (selecting multiple answers). It is worth noting that, analysing the responses to a direct question ('Have you ever had a job that involved the use or exposure to ionising radiation?'), 49% of all respondents declared themselves to have a job involving the use of ionising radiation. This indicates a possible bias in the sample, which clearly includes many experts on ionising radiation.

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An overview of the composition of the respondents and their roles in RP is illustrated in figure 3, from which it is clear that many respondents (about 59.5%) had been subject to a medical exposure.

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A significant portion of the respondents (almost half) answered that they were subject to occupational exposure (once again, a bias due to the sampling, including many researchers and hospital personnel working in the field of ionising radiation) and about 27% declared having a cultural involvement or personal interest. About 43.8% of the respondents indicated more than one option and 6% indicated none of the options.

Section S1 of the questionnaire was aimed at workers who are occupationally exposed to ionising radiation: 830 respondents out of 1961 declared themselves to belong to this category and consequently replied to this section.

From the answers received, it emerges that for both the implementation of provisional RP plans and for professional training in RP, the majority of respondents declared themselves to be satisfied. Nonetheless, for both questions there were still about 22% who declared they were rather or very unsatisfied or did not answer at all (SP1 and SP2, figure 10).

Respondents indicated that they were satisfied with the different learning materials used, in particular with official documents and books, but also with practical experience in the field (figure 10). Nonetheless, as in the previous question, there are still about 30% or even 35% of respondents who declared themselves to be rather or very unsatisfied and the percentage of 'do not know/no answer' is in some cases very high. The option 'other' was removed from the graph. Moreover, to the specific question SP4 a very high percentage of respondents (73%) declared that they considered the guidelines a useful working tool.

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Finally, from the responses to question SP5 it emerged that occupationally exposed workers think that issues concerning regulations, early and late radiation effects and the use of personal and collective protective equipment require further attention in professional training. This suggests that there are opportunities to improve and increase the provision of training for professionals in each of these areas (figure 10).

The most frequent request emerging from the answers to question SP6 (open comments about SP5, 'What's the field you feel more necessary to be deepened in the professional training?', 575 total responses) was the strong desire for more information concerning early, intermediate and late effects caused by acute and chronic radiation exposure. This need is particularly felt by physicians who are often questioned about this issue and do not feel confident in giving clear and indisputable answers.

Another issue concerns individual and collective protection devices, which are often misused or not used at all, mainly because of a lack of appropriate practical training. It was observed by some respondents that professional trainers are sometimes expert in RP but not very familiar with practical aspects of the use of protection devices. In addition, the need was identified for more education and training in verification of radiological safety plans and real-time simulations in case of radiological emergencies.

Besides practical training about protection devices, the need for a deeper knowledge and understanding of RP rules emerged, possibly following the updates of the RP laws in order to keep workers constantly aware of the legal scope of the actions taken. An important issue linked to this aspect is accessibility to the RP norms, too often written exclusively in English thus not easily accessible to everyone. In this respect, it was also indicated that an increase in communication between RP experts, journalists, non-governmental organisations and the public could help give a clear and wider explanation of the rules of RP.

Section S2 of the questionnaire was aimed at investigating opinions and attitudes related to medical exposure to ionising radiation, and only people (860 out of 1961) who declared themselves to belong to this category in BG10 or in answering BG7 replied to this section.

The table in figure 11 shows the percentage satisfaction with the different steps of the informed consent process (question SP7).

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Informed consent is a process for obtaining permission before conducting a healthcare intervention on a patient, for conducting some form of research on a patient or for disclosing information about a patient. The most significant fact is that 40.1% of the respondents consider themselves rather satisfied with the description of the clinical issue and suggested treatment. This percentage decreased with regard to other aspects, for example 'Discussion on alternatives to the suggested treatment (including the option of no treatment)', 'Discussion on risks and benefits of the suggested treatment (and comparing them to the risks and benefits of alternatives)', 'Assessment of the understanding of the information provided, and thereby consent'. In particular, the percentage who are satisfied is very similar to the percentage who are dissatisfied. Question SP8 (figure 11) asked which procedures, among those listed, respondents would like to have more information on. It transpired that the percentage was higher than 40% for each procedure. In particular, the diagnostic tests for which respondents would like to receive more information were CT scans (60.9%) followed by medical x-rays (55.5%) and interventional radiology (48,5%). Interestingly, PET is the procedure with the lowest percentage of responses (43.7%).

Section S3 of the questionnaire was aimed at duty holders and decision-makers (e.g. general practitioners, industrial managers, regulators etc.), and only people who declared themselves as belonging to this category in BG10 replied to this section.

Out of 257 respondents, 51.0% considered themselves satisfied and 12.1% very satisfied with the communication channels with the scientific research field (SP9, table in figure 12), while 4.3% and 22.2% are very and rather unsatisfied, respectively (10.5% of respondents did not know); a very high percentage (80.0%) think that a correct RP culture among the population would improve the quality of their work (SP10); only 10% of respondents think that there would be no advantage and another 10% did not provide any answer (option 'do not know/no answer').

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Moreover, it was considered that more direct involvement of the population, already in the early stage, could make the RP decision process easier and more efficient (54.1%). In this case, the number of people who did not provide a specific answer was slightly higher (15.4%) (SP11, figure 12).

While these responses can be viewed as generally encouraging with respect to communication to decision-makers, there is clearly room for improvement by reducing the numbers indicating 'very' or 'rather' unsatisfied, which amount to more than 25% of respondents.

Among those who answered yes to question SP11 (140 respondents), 46.3% considered a forum the most useful tool (SP12, figure 12(c)) to actively involve the population compared with meetings, working groups or round tables (lowest percentage, 13.6%).

A total of 254 people out of 1961 declared themselves to belong to the potentially exposed category (e.g. people living near a NPP). Regarding the degree of satisfaction in relation to the quantity and quality of information about radiation risk received from the authorities, 34.5% and 31.2% of the respondents (229 and 230, respectively) consider themselves rather unsatisfied (figures 13(a) and (b)). Nevertheless, 59.9% of respondents felt adequately protected from ionising radiation and 45% said they were not in contact with others in the same situation of potential exposure (questions SP15 and SP16, data not shown).

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Finally, the last question SP17 'If you answered yes to SP16 question, in which way you exchange information with the association?' allowed multiple answers. Of those who answered affirmatively to question SP16 (87 respondents) 56% selected only one option and 22% did not respond. Most of the respondents declared to be in contact with others in the same situations of possible exposure to ionising radiation through social media secondarily with periodical meetings and mailing lists (figure 13(c)).

A total of 551 people out of 1961 declared themselves to belong to a category with cultural involvement or interest in RP issues: 71% of these respondents use scientific journals as their main source of information, perhaps suggesting that respondents are largely drawn from a professional/scientific background; 56% use websites, blogs and e-magazines for science dissemination (figure 14(a)). Only 344 respondents answered question SP19 'What is the most important criterion do you use to decide whether a source is trustworthy or not?'. For these respondents the main criterion was 'competence' (63.4%, as shown by the pie graph in figure 14(b)) Finally, out of 514 respondents to question SP20 'Do you generally find sources of comprehensible and reliable information about RP and radiation risk?', 43% find the sources comprehensible and reliable 'sometimes' and 37.7% 'often' (figure 14(c)). Surprisingly, only 1.8% answered that the sources of information are never comprehensible and reliable.

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