Living with nuclear power: A Q-method study of local community perceptions

The issue of new nuclear power is once again high up on the public policy agenda in many countries, and candidate sites for new civilian stations are likely to include those that have existing nuclear facilities. A common assumption is that existing nuclear communities will be more accepting of new build because of the direct economic and other benefits nuclear power already makes to a local area. Surprisingly, there is a dearth of contemporary data on perceptions of the risks, benefits, and values associated with nuclear power within such communities. This study uses Q-methodology to investigate the perspectives on living with nuclear risk among people (n = 84) drawn from communities near to two nuclear power stations in the United Kingdom. Both stations, at Bradwell-on-Sea and Oldbury-on-Severn, had been in operation for over 40 years. The Q-analysis identified four main perspectives, or points of view, accounting for 53% of total variance. These were interpreted as: Beneficial and Safe; Threat and Distrust; Reluctant Acceptance; and There's No Point Worrying. We conclude that the "landscape of beliefs" about nuclear power in such communities is both subtle and complex, avoiding simplistic bipolar dichotomies such as "for" or "against," and that there is a need for extensive and meaningful dialogue with such communities over any new build plans. The usefulness of Q-methodology for investigating the ways in which people live with risk is highlighted, as are the implications of the results for theories of risk and trust.

Response to noise from modern wind farms in The Netherlands

The increasing number and size of wind farms call for more data on human response to wind turbine noise, so that a generalized dose-response relationship can be modeled and possible adverse health effects avoided. This paper reports the results of a 2007 field study in The Netherlands with 725 respondents. A dose-response relationship between calculated A-weighted sound pressure levels and reported perception and annoyance was found. Wind turbine noise was more annoying than transportation noise or industrial noise at comparable levels, possibly due to specific sound properties such as a "swishing" quality, temporal variability, and lack of nighttime abatement. High turbine visibility enhances negative response, and having wind turbines visible from the dwelling significantly increased the risk of annoyance. Annoyance was strongly correlated with a negative attitude toward the visual impact of wind turbines on the landscape. The study further demonstrates that people who benefit economically from wind turbines have a significantly decreased risk of annoyance, despite exposure to similar sound levels. Response to wind turbine noise was similar to that found in Sweden so the dose-response relationship should be generalizable.

How People on Social Assistance Perceive, Experience, and Improve Oral Health

Oral diseases are highly prevalent among people on social assistance. Despite benefiting from public dental coverage in North America, these people rarely consult the dentist. One possible reason is rooted in their perception of oral health and the means to improve it. To respond to this question, largely unexplored, we conducted qualitative research through 8 focus groups and 15 individual interviews in Montreal (Canada). Thematic analysis revealed that people on social assistance: (a) define oral health in a social manner, placing tremendous value on dental appearance; (b) complain about the decline of their dental appearance and its devastating impact on self-esteem, social interaction, and employability; and (c) feel powerless to improve their oral health and therefore contemplate extractions and complete dentures. Our research demonstrates that perception of oral health strongly influences treatment preference and explains low and selective use of dental services in this disadvantaged population.

What infection control measures will people carry out to reduce transmission of pandemic influenza? A focus group study

BACKGROUND

Pandemic influenza poses a future health threat against which infection control behaviours may be an important defence. However, there is little qualitative research examining perceptions of infection control measures in the context of pandemic influenza.

METHODS

Eight focus groups and one interview were conducted with a purposive sample of 31 participants. Participants were invited to discuss their perceptions of infection transmission and likely adherence to infection control measures in both non-pandemic and pandemic contexts. Infection control measures discussed included handwashing, social distancing and cough hygiene (e.g. covering mouth, disposing of tissues immediately etc.).

RESULTS

Thematic analysis revealed that although participants were knowledgeable about infection transmission, most expressed unfavourable attitudes toward control behaviours in non-pandemic situations. However, with the provision of adequate education about control measures and appropriate practical support (e.g. memory aids, access to facilities), most individuals report that they are likely to adhere to infection control protocols in the event of a pandemic. Of the behaviours likely to influence infection transmission, handwashing was regarded by our participants as more feasible than cough and sneeze hygiene and more acceptable than social distancing.

CONCLUSION

Handwashing could prove a useful target for health promotion, but interventions to promote infection control may need to address a number of factors identified within this study as potential barriers to carrying out infection control behaviours.

An exploration of parents' food purchasing behaviours

A qualitative study explored factors that influence parents' food purchasing behaviours in supermarkets and away-from-home settings, particularly the role played by nutrition information. Individual in-depth interviews were conducted with 15 parents of young children in a provincial city in New Zealand. A semi-structured protocol was used to elicit factors influencing food purchases and explore the understanding and influence of existing nutrition labels. Thematic analysis revealed that while parents wish to select good food for their families, practical factors dominate their decisions. Nutrition labels had little reported influence on food choice, largely because parents face competing demands when selecting food for their families. These factors militate against use of detailed nutrition information, especially formats that require considerable effort to comprehend.

Exploring attitudes of the general public to stress, depression and help seeking

Many people delay or never seek professional help for stress and depression. There is limited research on this topic using qualitative methodologies, but even less exploring the attitudes of the general population.This study explores the attitudes and preferences of the general population about when and where help is sought for stress and depression through the Somerset Health Panels. These comprised 12 two‐hour panels held across Somerset, England, involving a total of 96 people. This study reveals that a positive and non‐judgemental view of depression and stress exists within the general population. The response and support from friends and family is critical in seeking other sources of help, for which the GP is perceived as a gatekeeper. A preferred hierarchy of professional and nonprofessional sources of help exists, which is not entirely consistent with the arrangement of current services. This research adds to our understanding of how to engage with communities more generally and helps understand a general population perspective on mental health issues ‐ in particular, the way services are currently arranged does not always reflect the hierarchy in which people would prefer to seek help, and that stigma is evident but does not always act as a barrier to eventual help‐seeking.

Doing change and continuity: age identity and the micro–macro divide

This paper is a study of the discursive management of notions of change and continuity in interview talk. It presents selected short empirical examples from interviews with 22 Finnish baby-boomers, and discusses the methodological and theoretical issues that arise. Following a review of the major approaches to the study of age identity, the analytic intersection between qualitative gerontology and discursive psychology is explored. The analysis identifies how the frequent use of a ‘provisional continuity device’ enables speakers simultaneously both to acknowledge and to distance themselves from factual notions of physical or psychological lifespan change. The key methodological argument is that the discursive analysis of age-in-interaction cannot necessarily be achieved through the myopic micro-study of discursive strategies, but rather two suggestions are made. First, it is argued that analytically-anchored and rigorous discursive gerontology that both systematically draws on and contributes to the broad field of discursive research provides a means by which to test empirically post-modern conceptualisations of age identity. Second, it is suggested that analyses of age-talk in everyday and institutional settings provide an analytical and theoretical middle-ground between the macroversusmicro or ‘microfication’ debate in gerontology.

[Healing effects of the forest experience on alcoholics]

PURPOSE

The purpose of this study was to explore and describe healing effects of the forest on alcoholics through a forest experience program.

METHODS

The qualitative data was gathered from one focus group discussion with 6 alcoholics and individual interviews with 8 alcoholics. They had all participated in a "healing forest" program. All interviews were recorded and transcribed according to thematic content analysis processes.

RESULTS

The four main themes on the attributes of forest were "a lively living being", "placidity and tranquility", "acceptive atmosphere", and "beautifulness as it is" which revealed the participants' perceived nature of the forest which was attributed to the healing effects. Eight other themes on participants' positive changes included "revived senses", "aspired to live", "relieved and relaxed from being tense", "gaining insight on self", "having an acceptive attitude", "becoming compliant with his/her life", "learning that life is being together" and "recognizing the value of one's existence".

CONCLUSION

The findings of the study illustrated the participants' self-healing processes through interactions with the nature of the forest. Nursing interventions utilizing healing atmospheres such as "healing forest" programs can be considered helpful in providing a venue to alcoholics to reflect on their lives affirmatively.

Policy discourse, people's internal frames, and declared aircraft noise annoyance: an application of Q-methodology

Aircraft noise annoyance is studied extensively, but often without an explicit theoretical framework. In this article, a social approach for noise annoyance is proposed. The idea that aircraft noise is meaningful to people within a socially produced discourse is assumed and tested. More particularly, it is expected that the noise policy discourse influences people's assessment of aircraft noise. To this end, Q-methodology is used, which, to the best of the authors' knowledge, has not been used for aircraft noise annoyance so far. Through factor analysis five distinct frames are revealed: "Long live aviation!," "aviation: an ecological threat," "aviation and the environment: a solvable problem," "aircraft noise: not a problem," and "aviation: a local problem." It is shown that the former three frames are clearly related to the policy discourse. Based on this observation it is argued that policy making is a possible mechanism through which the sound of aircraft is turned into annoyance. In addition, it is concluded that the experience of aircraft noise and, in particular, noise annoyance is part of coherent frames of mind, which consist of mutually reinforcing positions and include non-acoustical factors.

Functions of health fatalism: fatalistic talk as face saving, uncertainty management, stress relief and sense making

Much research on fatalism assumes that fatalistic statements represent a global outlook that conflicts with belief in the efficacy of health behaviours. Other scholars have suggested a more contextual approach, suggesting that fatalism fulfils personal and social functions. This study analyses 96 in-depth lay interviews in the US, most with low-income members of the general public, about four diseases: heart disease, lung cancer, diabetes and depression. Within these interviews, fatalistic statements always occurred alongside statements endorsing the utility of behaviours for protecting health. This usage pattern suggests that these statements may have useful functions, rather than being simply a repudiation of the utility of health choices. We examine four functions that are suggested by previous researchers or by the participants' comments: stress relief, uncertainty management, sense making and (less strongly) face saving. As these themes indicate, individuals often make fatalistic statements to express an understanding of locally or broadly limiting factors for health efficacy, including genes, spiritual agents, prior behaviours, personality, and other factors.

Health and social care responses to the Department of Health Heatwave Plan

BACKGROUND

The increasing risk of heatwaves in England poses a particular threat to the health of elderly people. A National Heatwave Plan has been produced to ensure that adaptation plans are established. The objective was to explore the perceptions of frontline statutory and voluntary sector staff on the feasibility of implementing the Heatwave Plan for elderly people in the community.

METHODS

Semi-structured interviews and focus groups with 109 health, social care and voluntary staff from three London Boroughs.

RESULTS

Few frontline staff were aware of the Plan. Most respondents did not perceive heatwaves to be a sufficiently frequent event to require prioritization within their routine summer workloads. They highlighted the complexities associated with defining vulnerability and identifying vulnerable individuals as well as barriers to implementation of the Plan. Respondents suggested a multi-faceted approach to interventions including a public health campaign, community engagement and increasing the responsiveness of statutory services.

CONCLUSION

The issues highlighted could hinder effective implementation of the Heatwave Plan. Ensuring continuity of care so that timely information can be recorded and disseminated may address the problems associated with shifting vulnerability. Best practice with respect to inter-sectoral collaboration should be identified and innovative multi-faceted interventions should be designed and evaluated.

Transition to adult services among behaviorally infected adolescents with HIV--a qualitative study

OBJECTIVES

The present study aimed to describe the experiences of youth with behaviorally acquired HIV who transitioned to adult care, to identify difficulties encountered, and to explore areas for improvement.

METHODS

Semi-structured interviews were conducted with 10 young adults ranging from 24 to 29 years old. Themes were derived from coding participant interviews.

RESULTS

Participants experienced adolescent care providers as an important source of support, felt anxiety about transition, provided recommendations for improving the process, and described significant changes associated with adult HIV care.

CONCLUSIONS

Findings support the development of a clear and structured transition process to address patients' fears and worries through early communication, planning, and coordination for adult healthcare, highlighting the need for future research in this area.

Strength through adversity: Bereaved cancer carers' accounts of rewards and personal growth from caring

Objective:

Many studies have identified negative and distressing consequences experienced by informal cancer carers, but less attention has been given to positive and beneficial aspects of caring. This qualitative study examined the positive aspects of caring as subjectively constructed by bereaved informal cancer carers, a group of individuals who are in a position to make sense of their caring experiences as a coherent whole.

Method:

Twenty-three bereaved informal cancer carers were interviewed, and their accounts were analyzed using a thematic analytical approach from a phenomenological perspective.

Results:

The participants were able to identify positive and beneficial aspects of caring. These included the discovery of personal strength, through adversity, acceptance, and necessity; the deepening of their relationship with the person for whom they cared; and personal growth through altered relationships with others and altered perspectives on living. Many participants gave accounts of focusing on these positive benefits when they reflected on their caring experiences.

Significance of results:

We concluded that benefit finding in the face of adverse events serves an important function in allowing individuals to incorporate difficult experiences into their worldview in a meaningful way, thus maintaining positive beliefs about the world. This has implications for the development of interventions for informal cancer carers and for those who are bereaved following caring.

Negotiating 'depression' in primary care: a qualitative study

Psychiatry has provided primary care physicians with tools for recognising and labelling mild, moderate or severe 'depression'. General practitioners (GPs) in the UK have been guided to manage depression within primary care and to prescribe anti-depressants as a first-line treatment. The present study aimed to examine how GPs would construct 'depression' when asked to talk about those anomalous patients for whom the medical frontline treatment did not appear to be effective. Twenty purposively selected GPs were asked in an interview to talk about their experience and management of patients with depression who did not respond to anti-depressants. GPs initially struggled to identify a group, but then began to construct a category of person with a pre-medicalised status characterised by various deviant features such as unpleasant characters and personalities, manipulative tendencies, people with entrenched social problems unable to fit in with other people and relate to people normally. GPs also responded in non-medical ways including feeling unsympathetic, breaking confidentiality and prescribing social interventions. In effect, in the absence of an effective medical treatment, depression appeared to become demedicalised. The implications of this process are discussed in relation to patients' subsequent access or lack of access to services and the way in which these findings highlight the processes by which medicine frames disease.

Participants' Experiences of Mindfulness-Based Cognitive Therapy: “It Changed Me in Just about Every Way Possible”

Background: Mindfulness-Based Cognitive Therapy (MBCT) is a promising approach to help people who suffer recurrent depression prevent depressive relapse. However, little is known about how MBCT works. Moreover, participants' subjective experiences of MBCT as a relapse prevention treatment remain largely unstudied. Aim: This study examines participants' representations of their experience of MBCT and its value as a relapse-prevention program for recurrent depression. Method: Twenty people who had participated in MBCT classes for recurrent depression within a primary care setting were interviewed 12 months after treatment. The focus of the interview was on participants' reflections on what they found helpful, meaningful and difficult about MBCT as a relapse prevention program. Thematic analysis was used to identify the key patterns and elements in participants' accounts. Results and conclusions: Four overarching themes were extracted: control, acceptance, relationships and struggle. The theoretical, clinical and research implications are discussed.

Hazards faced by young designated drivers: in-car risks of driving drunken passengers

This qualitative study explored the risk in the practice of young designated drivers transporting drunken peers. Young drivers 18–29 years old in Alberta, Canada participated in 12 focus groups (N = 146). Interviews were semi-structured. A key finding is that when highly intoxicated youth are driven by a designated driver who is a peer, they are likely to behave in ways that are unsafe. Unsafe actions of drunken passengers in the vehicle include physical “rough-housing” with the driver, creating stress for the driver that leads to high risk driving situations and disrupting safe driving through nausea and in-car vomiting.

Pregnant women's attitudes towards alcohol consumption

Background

There is uncertainty as to whether there is a safe threshold for drinking alcohol during pregnancy. We explored pregnant women's attitudes towards drinking alcohol in pregnancy and their attitudes towards sources of information about drinking in pregnancy following recent changes in UK government guidance.

Methods

A qualitative study involving individual, semi-structured interviews with 20 pregnant women recruited from community organisations in the UK. Interview transcripts were analysed qualitatively using thematic analysis.

Results

Most women found information and advice about safe levels of drinking in pregnancy confusing and lacking in evidence and detail. Although most women considered that there were risks involved with drinking in pregnancy and these perceptions influenced their behaviour, only six women reported abstinence. Women reported being influenced by advice from family and friends and their experiences of previous pregnancies. Many had received no individual advice from general practitioners or midwives relating to drinking during pregnancy.

Conclusion

Pregnant women wished to take responsibility for their own health and make choices based on informed advice. In order to do so, they require clear and consistent advice about safe levels of drinking from policy makers and health professionals. This is an important issue as women might drink socially during their pregnancy.

A qualitative study on the acceptability and preference of three types of long-lasting insecticide-treated bed nets in Solomon Islands: implications for malaria elimination

Background

In March 2008, the Solomon Islands and Vanuatu governments raised the goal of their National Malaria Programmes from control to elimination. Vector control measures, such as indoor residual spraying (IRS) and long-lasting insecticidal bed nets (LLINs) are key integral components of this programme. Compliance with these interventions is dependent on their acceptability and on the socio-cultural context of the local population. These factors need to be investigated locally prior to programme implementation.

Method

Twelve focus group discussions (FGDs) were carried out in Malaita and Temotu Provinces, Solomon Islands in 2008. These discussions explored user perceptions of acceptability and preference for three brands of long-lasting insecticide-treated bed nets (LLINs) and identified a number of barriers to their proper and consistent use.

Results

Mosquito nuisance and perceived threat of malaria were the main determinants of bed net use. Knowledge of malaria and the means to prevent it were not sufficient to guarantee compliance with LLIN use. Factors such as climate, work and evening social activities impact on the use of bed nets, particularly in men. LLIN acceptability plays a varying role in compliance with their use in villages involved in this study. Participants in areas of reported high and year round mosquito nuisance and perceived threat of malaria reported LLIN use regardless of any reported unfavourable characteristics. Those in areas of low or seasonal mosquito nuisance were more likely to describe the unfavourable characteristics of LLINs as reasons for their intermittent or non-compliance. The main criterion for LLIN brand acceptability was effectiveness in preventing mosquito bites and malaria. Discussions highlighted considerable confusion around LLIN care and washing which may be impacting on their effectiveness and reducing their acceptability in Solomon Islands.

Conclusion

Providing LLINs that are acceptable will be more important for improving compliance in areas of low or seasonal mosquito nuisance and malaria transmission. The implications of these findings on malaria elimination in Solomon Islands are discussed.

Accident-related risk behaviors associated with motivations for motorcycle use in Iran: a country with very high traffic deaths

BACKGROUND

Injuries caused by motor vehicle accidents in Middle East countries are among the highest in the world. Several successful interventions preventing road traffic injuries in developed countries have been practiced; however, these interventions have not been tailored to the cultural, behavioral, and environmental milieu of low- and middle-income countries. Scientifically based efforts to understand risk factors for traffic injury in these countries are needed and they must be translated into prevention programs that are well designed and assessed. This qualitative study is designed to delineate motorcycle use among Iranian motorcyclists and identify motivational correlates for risk behaviors that may result in accidental injury and death.

METHODS

Focus groups and in-depth interviews were conducted among motorcyclists, motorcycle passengers, and police officers.

RESULTS

Seven accident-related risk behaviors were identified: (1) performing stunts, (2) disobeying traffic rules, (3) driving while under the influence of drugs or alcohol, (4) riding without proper skills or qualifications, (5) illegally transporting passengers, (6) illegally transporting cargo, and (7) not wearing a helmet. These behaviors correspond with four main motivational themes for motorcycle-riding that emerged from our data: (1) convenient commuting, (2) occupational transportation, (3) recreation and sensation seeking, and (4) criminal activity.

CONCLUSION

This study indicates that Iranian motorcyclists can be categorized into distinct groups according to motivation for motorcycle use. The results of this study indicate that motorcyclist risky behaviors are related to motivational factors. Furthermore, regardless of the motivational factors, disobedience of traffic rules was a common risk behavior among all four motivational groups. The relationship between motivation to ride and associated risk behaviors is important because it begins to build a general framework that will help researchers target specific groups that are most in need of interventions to reduce motorcycle accidents in Iran.

Cyberbullying among students with intellectual and developmental disability in special education settings

OBJECTIVE

To explore the types, prevalence and associated variables of cyberbullying among students with intellectual and developmental disability attending special education settings.

METHODS

Students (n = 114) with intellectual and developmental disability who were between 12-19 years of age completed a questionnaire containing questions related to bullying and victimization via the internet and cellphones. Other questions concerned sociodemographic characteristics (IQ, age, gender, diagnosis), self-esteem and depressive feelings.

RESULTS

Between 4-9% of students reported bullying or victimization of bullying at least once a week. Significant associations were found between cyberbullying and IQ, frequency of computer usage and self-esteem and depressive feelings. No associations were found between cyberbullying and age and gender.

CONCLUSIONS

Cyberbullying is prevalent among students with intellectual and developmental disability in special education settings. Programmes should be developed to deal with this issue in which students, teachers and parents work together.

Measuring melancholia: the utility of a prototypic symptom approach

BACKGROUND

Melancholia has long resisted classification, with many of its suggested markers lacking specificity. The imprecision of depressive symptoms, in addition to self-report biases, has limited the capacity of existing measures to delineate melancholic depression as a distinct subtype. Our aim was to develop a self-report measure differentiating melancholic and non-melancholic depression, weighting differentiation by prototypic symptoms and determining its comparative classification success with a severity-based strategy.

METHOD

Consecutively recruited depressed out-patients (n=228) rated 32 symptoms by prototypic or 'characteristic' relevance (using the Q-sort strategy) and severity [using the Severity-based Depression Rating System (SDRS) strategy]. Clinician diagnosis of melancholic/non-melancholic depression was the criterion measure, but two other formal measures of melancholia (Newcastle and DSM-IV criteria) were also tested.

RESULTS

The prevalence of 'melancholia' ranged from 20.9% to 54.2% across the subtyping measures. The Q-sort measure had the highest overall correct classification rate in differentiating melancholic and non-melancholic depression (81.6%), with such decisions supported by validation analyses.

CONCLUSIONS

In differentiating a melancholic subtype or syndrome, prototypic symptoms should be considered as a potential alternative to severity-based ratings.

Introducing peer-group clinical supervision: an action research project

Clinical supervision (CS) has been found to be beneficial in the role development of nurses and can contribute to increased job satisfaction and reduced burnout. However, implementing CS can be resource intensive, and there are few accounts of it being implemented in developing countries. Ten psychiatric nurses in Trinidad engaged in an action research project over a 5-month period to develop, implement, and undertake an initial evaluation of a model of peer-group CS for use in routine practice. The participants were involved in undertaking peer-group CS and contributing to monthly focus groups to reflect on the practices and further refine the model. This inexpensive form of CS was perceived by participants to have positive effects on the way they viewed and practiced nursing. An outline of the model and initial evaluation is presented, but further research is necessary to establish the sustainability of the model in practice.

Developing assistive web‐base technologies for adults with age‐related cognitive impairments

Purpose

Little systematic applied research has been conducted on how age‐related cognitive impairments might affect older adults' usage of web service and this paper aims to fill some of that gap.

Design/methodology/approach

An analysis of the relationship between the cognitive changes of aging and the usage of web services. Supported by field research with the key stakeholders, including older adults and organisations that provide services for older adults. This consists of focus group sessions with key stakeholders and individual interviews with older adult users. Older adult users also complete an online form using a think aloud protocol. The data are analysed using a thematic content analysis technique.

Findings

Issues around older adults' relationship with technology and the challenges they face along with the strengths and weaknesses of online forms and means to improve them. In particular, there are issues of fear and frustration, inconsistency and visual clutter, and a feeling of neglect by service providers. Users also identify a strong need for human rather than machine support when struggling with the technology.

Research limitations/implications

The findings only now being applied to an existing system in the Delivering Inclusive Access to Disabled and Elderly Members (DIADEM) project and it still needs to evaluate of usability of DIADEM. Further research also needs to consider the technology adoption model for system like DIADEM.

Practical implications

The findings have implications in form design and transaction delivery for online services.

Originality/value

The perception of neglect by service providers is new and this with the needs for consistency and for human support lead to novel approaches in the DIADEM system.

Patterns of perception toward influenza pandemic among the front-line responsible health personnel in southern Thailand: a Q methodology approach

Background

Thailand has joined the World Health Organization effort to prepare against a threat of an influenza pandemic. Regular monitoring on preparedness of health facilities and assessment on perception of the front-line responsible health personnel has never been done. This study aimed to document the patterns of perception of health personnel toward the threat of an influenza pandemic.

Methods

Q methodology was applied to a set of 385 health personnel in charge of influenza pandemic preparedness in the three southernmost provinces of Thailand. Subjects were asked to rank 33 statements about various issues of influenza pandemic according to a pre-designed score sheet having a quasi-normal distribution on a continuous 9-point bipolar scale ranging from -4 for strongly disagree to +4 for strongly agree. The Q factor analysis method was employed to identify patterns based on the similarity and dissimilarity among health personnel.

Results

There were three main patterns of perception toward influenza pandemic with moderate correlation coefficients between patterns ranging from 0.37 to 0.55. Pattern I, health personnel, which we labeled pessimistic, perceived themselves as having a low self-efficacy. Pattern II, which we labeled optimistic, perceived the threat to be low severity and low vulnerability. Pattern III, which we labeled mixed, perceived low self-efficacy but low vulnerability. Across the three patterns, almost all the subjects had a high expectancy that execution of recommended measures can mitigate impacts of the threat of an influenza pandemic, particularly on multi-measures with high factor scores of 4 in all patterns. The most conflicting area was vulnerability on the possible impacts of an influenza pandemic, having factor scores of high (3), low (-4), and neutral (0) for patterns I, II, and III, respectively.

Conclusion

Strong consistent perceptions of response efficacy against an influenza pandemic may suggest a low priority to convince health personnel on the efficacy of the recommended measures. Lack of self-efficacy in certain sub-groups indicates the need for program managers to improve self-confidence of health personnel to participate in an emergency response.