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

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