Lay perceptions of the pandemic influenza threat

The impact of collective action dilemma on vaccine hesitancy: Evidence from China

Vaccine hesitancy has dramatically decreased the speed of vaccination and stalled global health development. While the factors influencing vaccine hesitancy and mitigation measures have been explored in depth by existing studies, research from the perspective of human interaction is lacking. Based on the theory of collective action, this paper analyzes how free riding behavior affects vaccine hesitancy and how the vaccine hesitancy caused by free riding behavior can be solved. Using 2,203 survey data sets from China, this paper examines the influence of the collective action dilemma - represented by free riding behavior - on COVID-19 vaccine hesitancy. The empirical results show that the existence of free riding behavior is an essential cause of vaccine hesitancy. Based on this conclusion, this paper discusses how to further alleviate the problem of vaccine hesitancy caused by collective action dilemmas by promoting cooperation. The findings of this paper may be helpful to promote various types of vaccines and further suggest that countries should assume the perspective of solving the collective action dilemma to achieve increased vaccination rates.

Exercise Participation during the COVID-19 Pandemic: Anxiety, Stress, and Precautionary Behavior

Understanding emotion is critical, as it influences behavioral responses. In particular, anxiety is one of the most significant factors affecting individuals' behavior during a pandemic situation. However, the effect of coronavirus anxiety on exercise behaviors has not been extensively explored in the extant literature. Therefore, this study examined the relationships among coronavirus anxiety, stress, precautionary behavior, and exercise participation. A total of 307 responses were collected from individuals who experienced the full length of the circuit breaker in Singapore. Data were analyzed using partial least squares structural equation modeling (PLS-SEM). Results showed that coronavirus anxiety had positive effects on stress and precautionary behavior. In addition, precautionary behavior played a mediating role in the relationships among coronavirus anxiety, stress, and exercise participation. The findings of this study identify how COVID-19 affected exercise participation during that period and suggest strategies to promote exercise participation, which would benefit individuals and governments.

Americans' Trust in COVID-19 Information from Governmental Sources in the Trump Era: Individuals' Adoption of Preventive Measures, and Health Implications

This study analyzes differences among Americans in their trust in COVID-19 information from governmental sources and how trust is associated with personal adoption of preventative measures under the Trump administration. Based on our analysis of data from a nationally representative survey conducted in October 2020 (effective sample size after weighting = 2615), we find that Americans in general have more trust in COVID-19 information from state/local governments than from the federal government. Variables such as age, party affiliation, religiosity, and race are significantly associated with Americans' trust or lack of trust in COVID-19 information from governmental sources. During the study period, Republicans had more trust in the federal government as a COVID-19 information source than Democrats did, while Democrats had more trust in state/local governments. African Americans had the least trust in the federal and state/local governments as COVID-19 information sources, while Asian Americans had the most trust in both institutions. Trust in the state/local governments as COVID-19 information sources was positively associated with physical distancing and mask-wearing while trust in the federal government as a COVID-19 information source was negatively associated with physical distancing and mask-wearing, suggesting the distinctive roles that state/local governments and the federal government played in mobilizing Americans to adopt preventive measures.

Non-adherence to COVID-19 lockdown: who are they? A cross-sectional study in Portugal

OBJECTIVES

The SARS-CoV-2 virus has spread worldwide, leading governments to implement mitigation measures. Understanding the reluctance to adhere to non-pharmacological interventions might help promote adherence to these measures. This study aimed to identify factors associated with non-adherence to the first lockdown in Portugal.

STUDY DESIGN

Cross-sectional study.

METHODS

This study used data from a Portuguese community-based survey entitled 'COVID-19 Barometer: Social Opinion'. Data were collected on risk perception, health status and social experiences using a snowball sampling technique. The event of interest corresponded to participants who reported not staying home during the lockdown period, serving as a proxy for non-adherence to lockdown. Logistic regression was used to identify factors associated with non-adherence to the first lockdown.

RESULTS

Responses from 133,601 individual questionnaires that were completed during the first week of the first lockdown in 2020 were analysed. A minority of participants (5.6%) reported non-adherence to lockdown (i.e. leaving home for reasons other than essential situations). Working in the workplace was the factor with the strongest association of non-adherence to the lockdown. Several other factors were also associated with non-adherence to the first lockdown; namely, being a man, being a student, having a low level of education, having a low income, living alone or with a high-infection-risk professional (e.g. doctor, nurse, pharmaceutical, health technician, firefighter, police officer, military, essential services worker), perceiving the risk of getting COVID-19 to be high, not having social support in case of infection, feeling agitated, sad or anxious every day, and considering the preventive measures to be unimportant or inadequate.

CONCLUSIONS

Non-adherence to lockdown was associated with socio-economic, trust and perception factors. Future research should investigate the mechanisms underlying these associations to help identify the population groups who are most at risk of non-adherence.

Using WhatsApp During the COVID-19 Pandemic and the Emotions and Perceptions of Users

Background

Purpose

Methods and Participants

Results

Conclusion

Assessing customer financial risk perception and attitude in the hotel industry: Exploring the role of protective measures against COVID-19

The COVID-19 pandemic has lead authorities from many countries to adopt crucial protective measures such as wearing face masks, lockdowns and social distancing. The purpose of the present study was to explore the relationships among the protective measures against virus handled by hotels with financial risk perception, customer attitude, satisfaction and behavioral intention. The study also calculates the mean comparison across the demographic variables of hotel customer satisfaction and behavioral intention. Results reported a significant contribution of the protective measures implemented by Chinese hotels against COVID-19 on financial risk perception, and a customer attitude. It also demonstrates significant and positive interaction with customer satisfaction and behavioral intention. However, financial risk perception and customer attitude did not show effects on satisfaction, while they had effects on behavioral intention. The results suggest that protective measures are an important aspect of encouraging people to visit hotels safely and continually.

Health Beliefs in Association with Behaviors in Compliance with COVID-19 Public Health Guidelines: A Cross-sectional Study

This study investigated the preventive health behaviors against the COVID-19 outbreak in Turkey according to the health belief model. The relationships between perceived susceptibility, severity, benefits, barriers, and preventive health behaviors were examined. 1401 participants consisting of 992 (70.8%) females and 409 (29.3%) males participated in an online survey. Independent groups t-test, hierarchical regression analysis and Process Macro were used for analyses. The findings showed that women perceived higher levels of severity of the disease and the benefits of preventive health behaviors than men. Men perceived more barriers to preventive health behaviors. The levels of anxiety and preventive health behaviors of women were higher than men. In regression analysis, male gender and perceived barriers were found as risk factors for preventive health behaviors. However, female gender, perceived severity, and benefits were protective factors for preventive health behaviors. People with low and moderate anxiety levels were more likely to comply with preventive health behaviors.

The Impacts of Perceived Risks on Information Search and Risk Reduction Strategies: A Study of the Hotel Industry during the COVID-19 Pandemic

This study examined the impacts of perceived risks on information search and risk reduction strategies as well as the relative importance of each risk reduction strategy. Multiple regression analysis was applied to analyze the sample of South Korean hotel customers and to test the hypotheses of the study. It was found that when hotel customers faced the same kind of risk, they adopted different information search strategies to reduce various risks during the COVID-19 pandemic. Moreover, ‘following hotel employee’s advice’ was perceived to be the most important information search strategy to reduce risks. This is the first study to compare the differences of perceived risk and information search strategies under the COVID-19 pandemic and normal conditions to help hotels to develop more effective strategies to recover from the pandemic. The results of the study should be interpreted with care since it was based on Korean hotel customers. The influence of cultural differences in perceived risk and information search strategy should be addressed in future studies. The study contributes to the tourism and hospitality information search and risk reduction strategy-related literature and recommends avenues for further research in the field.

A modified theory of planned behavioral: A case of tourist intention to visit a destination post pandemic Covid-19 in Indonesia

The Pandemic covid-19 spread globally has been given impact in the tourism industry, especially in the tourism destination. This study investigated to build the concept and theoretical framework that explains the decision of local tourist intention to visit a local destination in Indonesia post-pandemic covid-19. This study was considered the perception of Covid-19, non-pharmaceutical intervention and health consciousness by implying of Theory of Planned Behavior constructs. This study, health consciousness is the moderator variable to predict the decision of tourist to visit a destination. Structural Equation Model-Partial Least Square (SEM-PLS) was used to analyze the construct of study. The model found that the Theory of Planned Behavior was successfully broadened in making the decision of tourist to visit a destination post-covid-19 with considering non-pharmaceutical intervention and health consciousness. The results showed that generally the constructs of Theory Planned Behavior are significantly impacted in intention to visit a local destination in Indonesia, except Hypothesis of subjective norm and intention to visit was rejected. The variable health consciousness through intention to visit also was rejected. The framework also used moderating variable health consciousness between subjective norm and intention to visit was rejected. This study was given insight an issue of covid-19 in the tourism sector, and the implication was providing government, stakeholders, tourism marketers and policy-making with considering non-pharmaceutical and health consciousness during and post-pandemic covid-19.

The effect of information-seeking behaviours on prevention behaviour implementation during the COVID-19 pandemic: mediating effects of anxiety and fear

OBJECTIVES

Identifying determinants of prevention behaviours during the emergence of a new infectious disease is important. We investigated the associations between information-seeking and prevention behaviours during the coronavirus disease 2019 (COVID-19) pandemic and mediating effects of psychiatric factors.

METHODS

In total, 1,970 participants from the Cardiovascular and Metabolic Etiology Research Center cohort participated in an online survey 55 days after the first COVID-19 case in Korea was diagnosed. Time spent seeking information related to COVID-19; information sources; psychiatric factors, including anxiety, depression, post-traumatic stress symptoms (PTSS), and the fear of COVID-19; and prevention behaviours were examined. The mediating effect of psychiatric factors was estimated using mediation analysis.

RESULTS

Time spent seeking information and information sources affected several behavioural responses. In men, anxiety mediated associations between information-seeking and prevention behaviours, including purchasing sanitary supplies (effect size [ES], 0.038; 95% confidence interval [CI], 0.002 to 0.095) and hoarding (ES, 0.029; 95% CI, 0.002 to 0.068). The fear of COVID-19 also mediated associations between information-seeking and prevention behaviours including refraining from going out (men: ES, 0.034; 95% CI, 0.009 to 0.068; women: ES, 0.052; 95% CI, 0.030 to 0.080), wearing face masks (men: ES, 0.085; 95% CI, 0.031 to 0.184), avoiding public transportation (men: ES, 0.020; 95% CI, 0.000 to 0.044; women: ES, 0.031; 95% CI, 0.015 to 0.051), hoarding (women: ES, 0.051; 95% CI, 0.029 to 0.792), and trying alternative remedies (men: ES, 0.024; 95% CI, 0.004 to 0.053). Depressive symptoms and PTSS did not have any mediating effects.

CONCLUSIONS

While the availability of information related to COVID-19 can help prevent infections, it can also promote anxiety and fear, leading to negative behaviours such as hoarding and trying unverified alternative treatments.

Arab women feelings while seeking information during COVID-19 pandemic: applying PMT constructs

Purpose

This study investigates the effect of protection motivation theory (PMT) constructs on Arab women's feelings while seeking information during the COVID-19 pandemic.

Design/methodology/approach

The study has adopted a mixed-method approach using semi-structured interviews and a questionnaire to explore PMT constructs' impact on women's feelings while seeking information on COVID-19. Several tests, such as standard deviation, mean, skewness, kurtosis and persons, were used to check the reliability of data and inter-relationships between constructs.

Findings

The study results show a significant positive correlation between PMT constructs (perceived vulnerability, perceived severity, response efficacy, self-efficacy and response cost) with the feelings of Arab women during information seeking on COVID-19. However, the relationship between threat appraisal and feelings during information seeking was more substantial than coping appraisal and feelings during information seeking. The researchers hope that this study creates a baseline of cross-cultural studies on PMT constructs' effect on women's feelings while seeking health information.

Research limitations/implications

The current study was conducted on female participants only. While the study intended to examine Arab women's feelings during information seeking with PMT's application, the results may be affected by other factors that were not considered in the current study. Furthermore, the questionnaire was distributed in three Arab countries, which means that the results cannot be generalized in other geographical contexts. Therefore, similar studies need to be conducted in larger geographical areas as cultural factors may produce different results.

Originality/value

This study explores women's feelings while seeking COVID-19 information using the PMT constructs. As far as we know, this study is the first study to investigate Arab women's feelings while seeking health information during pandemics. PMT utilization is considered a new approach to discover and measure informational needs and feelings associated with it during pandemics.

The relationship between individuals' sources of information, perceptions, and anxiety regarding the COVID-19 pandemic in Turkey

The Coronavirus Disease 2019 (COVID-19) pandemic has led individuals to experience psychological distress as a result of their perceptions of the disease. This study aimed to determine the factors associated with these perceptions, the sources of information about the pandemic that may have contributed to them, and the level anxiety felt by adults living in Turkey in the initial phase of COVID-19, with a primary focus on generalized anxiety. The study had a web-based cross-sectional survey design 482 (327 female, 155 male) Turkish responders completed the Generalized Anxiety Disorder-7 (GAD-7) self-reported questionnaire, a measurement tool related to their perceptions of COVID-19 and questions about their sources of information about the pandemic between 3 and 19 April, 2020. Women experienced higher levels of anxiety than men. Those with severe symptoms of generalized anxiety disorder (GAD) believed that the COVID-19 pandemic would have a long duration, stated that the risk of transmission had had serious effects on their lives, felt little personal control with regard to the risk of transmission and did not believe that existing treatments would be effective against the risk of transmission. Moreover, those with severe GAD symptoms had little comprehension of how the disease was transmitted. Finally, it was concluded that those with severe GAD symptoms used the internet and, in particular, Instagram as their main sources of information about the pandemic. Although the anxiety levels were found to be moderate in general, women were more vulnerable. Using the internet and, in particular, Instagram as sources of information affected individuals’ perceptions of the pandemic, and led to psychological distress.

What factors promote vaccine hesitancy or acceptance during pandemics? A systematic review and thematic analysis

Examine the factors that promote vaccine hesitancy or acceptance during pandemics, major epidemics and global outbreaks. A systematic review and thematic analysis of 28 studies on the Influenza A/H1N1 pandemic and the global spread of Ebola Virus Disease. We found seven major factors that promote vaccine hesitancy or acceptance: demographic factors influencing vaccination (ethnicity, age, sex, pregnancy, education, and employment), accessibility and cost, personal responsibility and risk perceptions, precautionary measures taken based on the decision to vaccinate, trust in health authorities and vaccines, the safety and efficacy of a new vaccine, and lack of information or vaccine misinformation. An understanding of participant experiences and perspectives toward vaccines from previous pandemics will greatly inform the development of strategies to address the present situation with the COVID-19 pandemic. We discuss the impact vaccine hesitancy might have for the introduction and effectiveness of a potential COVID-19 vaccine. In particular, we believe that skepticism toward vaccines can still exist when there are no vaccines available, which is contrary to contemporary conceptualizations of vaccine hesitancy. We recommend conducting further research assessing the relationship between the accessibility and cost of vaccines, and vaccine hesitancy.

Associations of risk perception of COVID-19 with emotion and mental health during the pandemic

BACKGROUND

Although there are increasing concerns on mental health consequences of the COVID-19 pandemic, no large-scale population-based studies have examined the associations of risk perception of COVID-19 with emotion and subsequent mental health.

METHODS

This study analysed cross-sectional and longitudinal data from the PsyCorona Survey that included 54,845 participants from 112 countries, of which 23,278 participants are representative samples of 24 countries in terms of gender and age. Specification curve analysis (SCA) was used to examine associations of risk perception of COVID-19 with emotion and self-rated mental health. This robust method considers all reasonable model specifications to avoid subjective analytical decisions while accounting for multiple testing.

RESULTS

All 162 multilevel linear regressions in the SCA indicated that higher risk perception of COVID-19 was significantly associated with less positive or more negative emotions (median standardised β=-0.171, median SE=0.004, P<0.001). Specifically, regressions involving economic risk perception and negative emotions revealed stronger associations. Moreover, risk perception at baseline survey was inversely associated with subsequent mental health (standardised β=-0.214, SE=0.029, P<0.001). We further used SCA to explore whether this inverse association was mediated by emotional distress. Among the 54 multilevel linear regressions of mental health on risk perception and emotion, 42 models showed a strong mediation effect, where no significant direct effect of risk perception was found after controlling for emotion (P>0.05).

LIMITATIONS

Reliance on self-reported data.

CONCLUSIONS

Risk perception of COVID-19 was associated with emotion and ultimately mental health. Interventions on reducing excessive risk perception and managing emotional distress could promote mental health.

Evaluation of Cancer Patients with Older Adult for Awareness and Hospital Arrival Process of COVID-19 Pandemic During: A Cross-Sectional Study

The study aimed to evaluate the Coronavirus pandemic awareness of cancer patients ≥65 years of age, considered a vulnerable group, and their hospital arrival process, follow-ups and treatments during the pandemic. COVID-19 pandemic was found to increases the mortality and morbidity rates of individuals who aged 65 years and older. The research was conducted with a cross-sectional descriptive correlational design. The sample consist of 77 cancer patients aged 65 years and older adult. Participants were recruited through convenience sampling. In total, 77 patients from the Oncology Hospital located in Ankara from April 29, 2020 to May 20, 2020. Data were collected using a two-part form and a questionnaire. The study was undertaken in accordance with the STROBE checklist for observational studies. Of the participants, 59.7% were female, the mean age was 70 years, 79.2% resided in Ankara and 98.7% traveled to the hospital by car. Looking at the gender and the protective measures taken at home, female participants were found to perform a statistically significant higher level of protective measures. In conclusion, the study results suggest that the restrictions for older adult oncology patients during the pandemic did not negatively affect the delivery of health care.

How COVID-19 Triggers Our Herding Behavior? Risk Perception, State Anxiety, and Trust

People have felt afraid during the outbreak of coronavirus disease 2019 (COVID-19), because a virus is an invisible enemy. During the pandemic outbreak, society has become worried about the spread of infections and the shortage of protective equipment. This common fear among the public subsequently deepens each person's fear, increasing their belief in the content reported by the media and thus actively compelling these individuals to engage in the behavior of panic buying. In this study, we explored the effects of the public's risk perception, state anxiety, and trust in social media on the herding effect among individuals. The study was based on an online questionnaire survey and convenience sampling. The results showed that the public's risk perception increased their state anxiety and then deepened their willingness to wait in line for a purchase. In addition, the more people that trust the message delivered by the media, the more actively they will join the queue to buy goods. This study also found that anxiety had a greater impact on the public's willingness to wait for a purchase than trust in social media. Therefore, the top priority for the government should be to reduce the public's state anxiety and then reduce the herding effect.

Protective behaviors for COVID-19 among Brazilian adults and elderly living with multimorbidity: the ELSI-COVID-19 initiative

To measure the occurrence of protective behaviors for COVID-19 and sociodemographic factors according to the occurrence of multimorbidity in the Brazilian population aged 50 or over was the objective of this study. We used data from telephone surveys among participants of ELSI-Brazil (Brazilian Longitudinal Study of Aging), conducted between May and June 2020. The use of non-pharmacological prevention measures for COVID-19, reasons for leaving home according to the presence of multimorbidity and sociodemographic variables were evaluated. among 6,149 individuals. Multimorbidity was more frequent in females, married, aged 50-59 years and residents of the urban area. Most of the population left home between once and twice in the last week, increasing according to the number of morbidities (22.3% no morbidities and 38% with multimorbidity). Leaving home every day was less common among individuals with multimorbidity (10.3%) and 9.3% left home in the last week to access health care. Hand hygiene (> 98%) and always wearing a mask when leaving home (> 96%) were almost universal habits. Greater adherence to social isolation was observed among women with multimorbidity when compared to men (PR = 1.49, 95%CI: 1.23-1.79). This adherence increased proportionally with age and inversely with the level of education. The protective behavior in people with multimorbidity seems to be greater in relation to the others, although issues related to social isolation and health care deserve to be highlighted. These findings can be useful in customizing strategies for coping with the current pandemic.

Predictors of Non-Adherence to Public Health Instructions During the COVID-19 Pandemic in the Democratic Republic of the Congo

Background

Adherence to public health instructions for the COVID-19 is important for controlling the transmission and the pandemic's health and economic impacts. The aim of this study was to determine the associated factors of non-adherence to public health and social measures instructions.

Methods

This was a cross-sectional study conducted with 1913 participants in two provinces of DRC, Mbuji-Mayi, and Kamina. Predictors of non-adherence to COVID-19 preventive measures were identified using binary logistic regression analysis. P-value<0.05 was considered as a significant predictor.

Results

Among 1913 participants (1057 [55.3%] male, age 34.1 [14.9] years), 36.6% were defined as non-adherents. Non-adherence was associated with never studied and primary education level [adjusted odds ratio (aOR)=1.63, CI=1.31-2.03], unemployed status [aOR=1.29, CI=1.01-1.67], living in Kamina (Haut-Lomami province) [aOR=1.63, CI=1.31-2.03], female gender of head of household [aOR=1.53, CI=1.16-2.03], no attending lectures/discussions about COVID-19 [aOR=1.61, CI=1.08-2.40], not being satisfied with the measures taken by the Ministry of Health [aOR=2.26, CI=1.78-2.81], not been regularly informed about the pandemic [aOR=2.25, CI=1.80-2.03], and bad knowledge about COVID-19 [aOR=2.36, CI=1.90-2.93].

Conclusion

The rate of non-observance of preventive measures for the COVID-19 pandemic is high, and different factors contributed. The government has to counsel the permanent updating of messages taking into account the context and the progress of the pandemic by using several communication channels.

Public knowledge, attitudes and practices towards COVID-19: A cross-sectional study in Malaysia

In an effort to mitigate the outbreak of COVID-19, many countries have imposed drastic lockdown, movement control or shelter in place orders on their residents. The effectiveness of these mitigation measures is highly dependent on cooperation and compliance of all members of society. The knowledge, attitudes and practices people hold toward the disease play an integral role in determining a society's readiness to accept behavioural change measures from health authorities. The aim of this study was to determine the knowledge levels, attitudes and practices toward COVID-19 among the Malaysian public. A cross-sectional online survey of 4,850 Malaysian residents was conducted between 27th March and 3rd April 2020. The survey instrument consisted of demographic characteristics, 13 items on knowledge, 3 items on attitudes and 3 items on practices, modified from a previously published questionnaire on COVID-19. Descriptive statistics, chi-square tests, t-tests and one-way analysis of variance (ANOVA) were conducted. The overall correct rate of the knowledge questionnaire was 80.5%. Most participants held positive attitudes toward the successful control of COVID-19 (83.1%), the ability of Malaysia to conquer the disease (95.9%) and the way the Malaysian government was handling the crisis (89.9%). Most participants were also taking precautions such as avoiding crowds (83.4%) and practising proper hand hygiene (87.8%) in the week before the movement control order started. However, the wearing of face masks was less common (51.2%). This survey is among the first to assess knowledge, attitudes and practice in response to the COVID-19 pandemic in Malaysia. The results highlight the importance of consistent messaging from health authorities and the government as well as the need for tailored health education programs to improve levels of knowledge, attitudes and practices.

Public knowledge, attitudes and practices towards COVID-19: A cross-sectional study in Malaysia

In an effort to mitigate the outbreak of COVID-19, many countries have imposed drastic lockdown, movement control or shelter in place orders on their residents. The effectiveness of these mitigation measures is highly dependent on cooperation and compliance of all members of society. The knowledge, attitudes and practices people hold toward the disease play an integral role in determining a society’s readiness to accept behavioural change measures from health authorities. The aim of this study was to determine the knowledge levels, attitudes and practices toward COVID-19 among the Malaysian public. A cross-sectional online survey of 4,850 Malaysian residents was conducted between 27^th March and 3^rd April 2020. The survey instrument consisted of demographic characteristics, 13 items on knowledge, 3 items on attitudes and 3 items on practices, modified from a previously published questionnaire on COVID-19. Descriptive statistics, chi-square tests, t-tests and one-way analysis of variance (ANOVA) were conducted. The overall correct rate of the knowledge questionnaire was 80.5%. Most participants held positive attitudes toward the successful control of COVID-19 (83.1%), the ability of Malaysia to conquer the disease (95.9%) and the way the Malaysian government was handling the crisis (89.9%). Most participants were also taking precautions such as avoiding crowds (83.4%) and practising proper hand hygiene (87.8%) in the week before the movement control order started. However, the wearing of face masks was less common (51.2%). This survey is among the first to assess knowledge, attitudes and practice in response to the COVID-19 pandemic in Malaysia. The results highlight the importance of consistent messaging from health authorities and the government as well as the need for tailored health education programs to improve levels of knowledge, attitudes and practices.

Dust or disease? Perceptions of influenza in rural Southern Malawi

Influenza virus infections cause between 291 243 and 645 832 deaths annually, with the highest burden in low-income settings. Research in high-income countries has examined public understanding of influenza, but there is little information on views and behaviours about influenza in low-income countries. We explored communities' ideas about the severity, causes, prevention and treatment of influenza in Chikwawa district, Malawi. We conducted 64 in-depth interviews with parents of children aged <5 years, and 7 focus groups with community health workers, parents, and traditional healers. Data were analysed thematically and using a framework matrix to compare views between groups. Respondents held varied ideas about influenza, and many were uncertain about its causes and treatment. Some parents, traditional healers and health workers thought influenza was not severe because they felt it did not cause death or limit activities, but others disagreed. Many saw influenza as a symptom of other conditions, especially malaria and pneumonia, rather than as a disease of its own. Most mentioned dust as the main cause of influenza and believed influenza could be prevented by cleaning the home thoroughly. Treatment seeking for influenza followed different stages, usually starting with home remedies followed by purchasing drugs from groceries and then visiting a health centre. Seeking a clinician tended to be triggered by severe symptoms like high fever or difficulty breathing, and suspicions of malaria or pneumonia. Community health workers provide health education for communities, but some lacked understanding of influenza. Our findings suggest uncertainty about the causes and control of influenza among parents and varied levels of understanding among health providers. Strengthening the capacity of community health workers to provide relevant information about influenza prevention and treatment could address parents' interest in further information and support informed health seeking and engagement with future influenza interventions.

Emerging trends of Zika apprehension in an epidemic setting

Background

French Guiana is a territory that has a decades-long history of dengue outbreaks and more recently, in 2014, a chikungunya outbreak. Zika virus (ZIKV) emerged in late 2015 and subsequently led to an important outbreak.

Methodology/Principal findings

A cross-sectional phone survey was conducted among the general population during the outbreak in June 2016 with a total of 1,129 individuals interviewed to assess perceptions, knowledge and behaviors regarding zika infection. The population seemed aware of zika, and perceived the infection as a more serious health threat than other common mosquito-borne diseases. Furthermore, both the perceptions and behaviors related to zika and its prevention were found to vary considerably among different social groups, geographic areas and gender; less educated female participants were found to perceive the disease as more worrisome and were less likely to adopt protective behaviors. Moreover, female population has been particularly responsive to awareness campaigns and rapidly understood the extent of risks associated with ZIKV infection.

Conclusions/Significance

These results revealed that ZIKV appeared at the time of the survey as a new health threat that concerns the public more than chikungunya and dengue fever with differences observed among subgroups of population. These results have implications for the development of multifaceted infection control programs, including strategies for prevention and awareness, helping the population to develop an accurate perception of the threat they are facing and encouraging behavior changes.

Although dengue fever has been a focus of many awareness campaigns in Latin America, very little information is available about beliefs, attitudes and behaviors regarding vector-borne diseases among the population of French Guiana. Following the end of the first chikungunya outbreak and at the initial onset of the first zika outbreak, a quantitative survey was conducted among 1129 individuals aiming to study the emotional, cognitive and behavioral response to the risk of zika infection and assess variations among different groups of population. People from French Guiana were found to perceive zika substantially differently from other Aedes mosquito-borne diseases. Overall, ZIKV appeared at the time of the survey as a new health threat that makes the population more scared than chikungunya and dengue fever. Furthermore, both the beliefs and behaviors related to zika and its prevention were found to vary considerably among different social groups, gender and geographic areas. Education had an impact on perceptions and behaviors among women. Female population has been particularly responsive to awareness campaigns and rapidly understood the extent of risks associated with ZIKV infection. Overall, findings emphasize the importance of developing appropriate and relevant strategies helping population to engage in protective behaviors adapted to the health threat they are facing. Given the importance of the public response and precautionary actions to control the spread of an emergent threat, additional research on risk perceptions and other behavioral determinants is warranted.

Worry experienced during the 2015 Middle East Respiratory Syndrome (MERS) pandemic in Korea

Background

Korea failed in its risk communication during the early stage of the Middle East Respiratory Syndrome (MERS) outbreak; consequently, it faced difficulties in managing MERS, while disease-related worry increased. Disease-related worry can help disease prevention and management, but can also have a detrimental effect. This study measured the overall level of disease-related worry during the MERS outbreak period in Korea and the influencing factors and levels of disease-related worry during key outbreak periods.

Methods

The cross-sectional survey included 1,000 adults who resided in Korea. An ordinal logistic regression was performed for the overall level of MERS-related worry, and influencing factors of worry were analyzed. A reliability test was performed on the levels of MERS-related worry during key outbreak periods.

Results

The overall level of MERS-related worry was 2.44. Multivariate analysis revealed that women and respondents w very poor subjective health status had higher levels of worry. Respondents with very high stress in daily life had higher levels of worry than those who reported having little stress. The reliability test results on MERS-related worry scores during key outbreak periods showed consistent scores during each period.

Conclusion

Level of worry increased in cases having higher perceived susceptibility and greater trust in informal information, while initial stage of outbreak was closely associated with that at later stages. These findings suggest the importance of managing the level of worry by providing timely and accurate disease-related information during the initial stage of disease outbreak.

Lay perceptions of risk factors for Rift Valley fever in a pastoral community in northeastern Kenya

BACKGROUND

Human behavioral factors have been found to be central in the transmission of Rift Valley fever. Consumption of contaminated meat and milk in particular have been identified as one of the key risk factors for the transmission of Rift Valley fever in humans. In pastoral communities, livestock is the main source of livelihood from which many benefits such as food as well as economic and cultural services are derived. Zoonotic diseases therefore have a great impact on pastoral communities livelihoods. However, lay perceptions regarding the transmission of these diseases including Rift Valley fever hampers their effective control. This study investigated the lay perceptions of risks for Rift Valley fever transmission in a pastoral community in northeastern Kenya.

METHODS

A qualitative study was carried out in Ijara district, Kenya which was one of the hotspots of Rift Valley during the 2006/2007 outbreak. Data were collected using focus group discussions and narratives guided by checklists. Eight focus group discussions consisting of 83 participants and six narratives were conducted. Data was transcribed, coded and analysed according to Emergent themes.

RESULTS

The participants reported that they had experienced Rift Valley fever in their livestock especially sheep and in humans both in 1997/1998 and 2006/2007. However, they believed that infections in humans occurred as a result of mosquito bites and had little to do with their consumption of meat, milk and blood from infected livestock. The participants in this study indicated that they had heard of the risks of acquiring the disease through consumption of livestock products but their experiences did not tally with the information they had received hence to them, Rift Valley fever was not transmissible through their dietary practices.

CONCLUSIONS

Though the communities in this region were aware of Rift Valley fever, they did not have elaborate information regarding the disease transmission dynamics to humans. To avoid misconception about transmission of the disease, intervention strategies, require to be accompanied by comprehensive explanations of the dynamics of its transmission. It is necessary to develop appropriate interventions that take into consideration, lay perceptions of risk factors for the disease and communities' livelihood strategies.

Public risk perceptions and preventive behaviors during the 2009 H1N1 influenza pandemic

OBJECTIVE

This study examines the public perception of the 2009 H1N1 influenza risk and its association with flu-related knowledge, social contexts, and preventive behaviors during the second wave of the influenza outbreak in Arizona.

METHODS

Statistical analyses were conducted on survey data, which were collected from a random-digit telephone survey of the general public in Arizona in October 2009.

RESULTS

The public perceived different levels of risk regarding the likelihood and their concern about contracting the 2009 H1N1 flu. These measures of risk perception were primarily correlated with people of Hispanic ethnicity, having children in the household, and recent seasonal flu experience in the previous year. The perceived likelihood was not strongly associated with preventive behaviors, whereas the perceived concern was significantly associated with precautionary and preparatory behaviors. The association between perceived concern and precautionary behavior persisted after controlling for demographic characteristics.

CONCLUSIONS

Pandemic preparedness and response efforts need to incorporate these findings to help develop effective risk communication strategies that properly induce preventive behaviors among the public.

Determinants of the public intent to receive the seasonal influenza vaccine and protective behaviors: a population-based study in Taiwan

BACKGROUND AND STUDY AIMS

this study aims to identify the determinants of perceived changes in protective behaviors against seasonal influenza and the intent to receive the seasonal influenza vaccine among Taiwanese in 2011.

METHODS

During the early 2011-2012 influenza season, we conducted a nationwide survey with randomly stratified samples and collected 1400 self-reported questionnaires from respondents aged 15 years and above using the computer-aided telephone interviewing software in Taiwan.

RESULTS

One-third of the respondents intended to receive the seasonal influenza vaccine. Knowledge of protective behaviors against influenza was the most common predictor of perceived changes in different protective behaviors and the intent to receive the seasonal influenza vaccine. Older respondents were significantly more inclined to perceive changes in protective behaviors than younger respondents (adjusted odds ratio [AOR] ranging from 1.7 to 2.5). Female respondents were significantly more likely to change their behavior in wearing a face mask (AOR=1.5; 95% CI, 1.09 to 2.07) and buying antimicrobial products (AOR=1.45; 95% CI, 1.09 to 1.92) compared with males. Furthermore, recipients of past H1N1 (AOR=4.45; 95% CI, 3.03 to 6.53) and seasonal influenza vaccines (AOR=6.1; 95% CI, 3.31 to 11.23) were more likely to obtain the seasonal influenza vaccine. In contrast, individuals aged 30-49 (AOR=0.53; 95% CI, 0.38 to 0.74) and females (AOR=0.65; 95% CI, 0.48 to 0.87) were significantly less likely to intend to receive the seasonal influenza vaccine.

CONCLUSIONS

The findings suggest that the predictors of perceived changes in protective behaviors and intent to receive the seasonal influenza vaccine differ. We provide perspectives and suggestions for overcoming the perceived barriers and for developing targeted risk-communication campaigns.

Predictors of IV behaviors during and after the 2009 influenza pandemic in France

BACKGROUND

Controversies about the 2009 H1N1 pandemic influenza vaccination might have impacted the motivational processes that underlie individual immunization against seasonal influenza. The purpose of this article is to investigate correlates of vaccine uptake during and after the pandemic.

METHODS

Data from the 1174 subjects of the CoPanFlu France cohort aged 15 and over were used. We used logistic regression models to identify social and behavioral predictors of getting vaccinated against seasonal influenza in 2009-2010 and in 2010-2011 and against H1N1 influenza in 2009-2010.

RESULTS

This study points out that correlates of vaccination behaviors varied according to the vaccine. Respondents under 65 years who adopted the seasonal influenza vaccine were, as usual, more likely to belong to a target group and have a lower education, contrary to subjects who chose the pandemic vaccine. Exceptionally during the pandemic, a higher socioeconomic status also led to adoption of either vaccine. Motivational processes differed by vaccine. Uptaking the "new" pandemic vaccine was the result of a deliberative decision-making process, influenced by cognitive factors related to the pandemic context (such as perceived severity of the H1N1 flu strain and trust in public health authorities). In contrast, respondents got the seasonal flu vaccine without relying on explicit justifications, but instead through habit of performing this behavior in the past.

CONCLUSIONS

Target groups for seasonal influenza but not those for pandemic influenza were more likely to adopt the pandemic vaccine, which is a cause for great concern. This may be due to large extent to the automatic and habitual nature of influenza vaccination decisions. Public health authorities, should pay more attention to situational than informational cues to facilitate vaccine uptake among priority groups, especially in case of mild pandemic influenza.

Why the French did not choose to panic: a dynamic analysis of the public response to the influenza pandemic

To understand the French public's response to the 2009 pandemic A/H1N1 influenza health threat a sequence analysis framework has been employed mobilising different theoretical strands such as innovations diffusion theory, surprise theory and social representation theory. These tend to suggest that disease episodes, public health policy and the public's response should be considered within a larger socio-cognitive frame incorporating representations anchored by prior disease episodes and campaigns. It is suggested in this article that the public's response was greatly influenced by the pervasive anchoring of the social representations of the pandemic threat to the 1918 Spanish flu in the lay and scientific media. These representations were eventually seen not to match the reality of the disease and consequently the French public did not panic during the 2009 pandemic. This hypothesis has been tested empirically by examining retrospective media, bibliographical data and an analysis of risk perception carried out through three cross-sectional studies prior to and during the pandemic episode and one month after the launch of the vaccination campaign. These findings suggest that alarmist framings of health threats may be counterproductive since they may reduce the capacity of public health organisations to mobilise the public in the case of more serious emerging disease.

The impact of non-pharmaceutical interventions for 2009 H1N1 influenza on travel intentions: A model of goal-directed behavior

Theoretically, in the tourism context this study introduced a new concept of non-pharmaceutical intervention (NPI) for influenza, and tested the impact of NPI on the behavioral intention of potential international tourists. This study also extended the model of goal-directed behavior (MGB) by incorporating the new concepts of NPI, and the perception of 2009 H1N1. The model found that desire, perceived behavioral control, frequency of past behavior, and non-pharmaceutical interventions predicted tourists' intention but perceptions of 2009 H1N1 had nil effect on desire and intention. Personal non-pharmaceutical interventions were theorized as adaptive behavior of tourists intending to travel during a pandemic which should be supported by tourism operators on a system-wide basis. Practically, this study dealt with the issue of influenza 2009 H1N1 with the study findings and implications providing government agencies, tourism marketers, policy-makers, transport systems, and hospitality services with important suggestions for NPI and international tourism during pandemics.

Predicting the lay preventive strategies in response to avian influenza from perceptions of the threat

Background

The identification of patterns of behaviors that lay people would engage in to protect themselves from the risk of infection in the case of avian influenza outbreak, as well as the lay perceptions of the threat that underlie these risk reduction strategies.

Methodology/Principal Findings

A population-based survey (N = 1003) was conducted in 2008 to understand and describe how the French public might respond to a possible outbreak. Factor analyses highlighted three main categories of risk reduction strategies consisting of food quality assurance, food avoidance, and animal avoidance. In combination with the fear of contracting avian influenza, mental representations associated with the manifestation and/or transmission of the disease were found to significantly and systematically shape the behavioral responses to the perceived threat.

Conclusions/Significance

This survey provides insight into the nature and predictors of the protective patterns that might be expected from the general public during a novel domestic outbreak of avian influenza.

Parental knowledge, attitudes and behaviours towards influenza A/H1N1 in Italy

BACKGROUND

This study assesses the level of knowledge, the attitudes and the behaviours relating to influenza A/H1N1 among parents in Italy.

METHODS

A random sample of 1299 parents aged 26-65 years received a self-reported questionnaire including questions about socio-demographic characteristics, knowledge on modes of transmission and preventative measures, attitudes and behaviours relating to influenza A/H1N1.

RESULTS

A total of 781 subjects participated with a response rate of 60.1%. Only 32.3% of the respondents correctly identified the main modes of transmission and the main preventative measures, and the results of the multivariate logistic regression analysis showed that this knowledge was significantly higher in those with a higher level of education and working as health-care personnel. The average level of perceived risk of contracting influenza A/H1N1 was 4.6 and the multivariate linear regression model showed that a greater perceived risk was significantly associated with being unmarried, having more than one son, not working in the health-care setting and needing additional information about influenza A/H1N1. Less than one-third (28.8%) of the respondents had visited a physician at least once in 2 months preceding the survey for any reason related to the influenza A/H1N1 and the multivariate logistic regression model indicated that females and those with more than one son were more likely to have a visit.

CONCLUSION

Knowledge about influenza A/H1N1 is poor and the results could have significant implications for information provision and the targeting of future education programmes to this population.

Monitoring the level of government trust, risk perception and intention of the general public to adopt protective measures during the influenza A (H1N1) pandemic in The Netherlands

BACKGROUND

During the course of an influenza pandemic, governments know relatively little about the possibly changing influence of government trust, risk perception, and receipt of information on the public's intention to adopt protective measures or on the acceptance of vaccination. This study aims to identify and describe possible changes in and factors associated with public's intentions during the 2009 influenza A (H1N1) pandemic in the Netherlands.

METHODS

Sixteen cross-sectional telephone surveys were conducted (N = 8060) between April - November 2009. From these repeated measurements three consecutive periods were categorized based on crucial events during the influenza A (H1N1) pandemic. Time trends in government trust, risk perception, intention to adopt protective measures, and the acceptance of vaccination were analysed. Factors associated with an intention to adopt protective measures or vaccination were identified.

RESULTS

Trust in the government was high, but decreased over time. During the course of the pandemic, perceived vulnerability and an intention to adopt protective measures increased. Trust and vulnerability were associated with an intention to adopt protective measures in general only during period one. Higher levels of intention to receive vaccination were associated with increased government trust, fear/worry, and perceived vulnerability. In periods two and three receipt of information was positively associated with an intention to adopt protective measures. Most respondents wanted to receive information about infection prevention from municipal health services, health care providers, and the media.

CONCLUSIONS

The Dutch response to the H1N1 virus was relatively muted. Higher levels of trust in the government, fear/worry, and perceived vulnerability were all positively related to an intention to accept vaccination. Only fear/worry was positively linked to an intention to adopt protective measures during the entire pandemic. Risk and crisis communication by the government should focus on building and maintaining trust by providing information about preventing infection in close collaboration with municipal health services, health care providers, and the media.

Pandemic influenza is a strong motivator for participation in vaccine clinical trials among HIV-positive Canadian adults

BACKGROUND

HIV-positive patients represent an immunosuppressed population at risk for severe influenza. In the event of a pandemic, such as 2009 H1N1, rapid implementation of vaccine clinical trials in target populations will be critical. In the present paper, knowledge and attitudes of HIV-positive adults regarding seasonal/pandemic influenza vaccination were evaluated, and facilitators and barriers to participation in vaccine clinical trials were explored.

METHODS

A validated, 70-item, self-administered questionnaire was distributed to all HIV patients presenting for routine follow-up at eight Canadian Institutes of Health Research Canadian HIV Trials Network (CTN) sites from October 2008 to February 2009, as well as all participants in CTN trial 237. This study has representation from all Canadian provinces.

RESULTS

In total, 610 HIV-positive adults responded (298 CTN 237 participants; 312 non-CTN 237 participants). Most reported receiving influenza vaccine last season (83% of CTN 237 participants versus 83% non-CTN 237 participants; P not significant) and most would receive a pandemic influenza vaccine if offered (76% versus 73%; P not significant). A majority believed that it was important to include HIV patients in vaccine clinical trials (65% versus 53%; P<0.001) and would agree to participate in trials of a pandemic vaccine if invited (86% versus 51%; P≤0.0001). Predictors of willingness to participate in a pandemic vaccine trial were 'desire to be protected from pandemic flu', OR 4.5 (95% CI 2 to 8) and 'desire to help others', OR 2.3 (95% CI 1.3 to 4.5). 'Fear of needles', OR 0.49 (95% CI 0.1 to 1.5) and 'need for extra blood tests', OR 0.49 (95% CI 0.2 to 1.4) were key barriers to participation.

CONCLUSION

Most HIV-positive Canadian adults surveyed receive influenza vaccination. Protection from pandemic influenza is considered important and is a motivator for receiving influenza vaccine and future trial participation. Modifiable barriers to these objectives identified in the present study should be the focus of efforts to increase influenza immunization in this population.

Lay perceptions of collectives at the outbreak of the H1N1 epidemic: heroes, villains and victims

Lay perceptions of collectives (e.g., groups, organizations, countries) implicated in the 2009 H1N1 outbreak were studied. Collectives serve symbolic functions to help laypersons make sense of the uncertainty involved in a disease outbreak. We argue that lay representations are dramatized, featuring characters like heroes, villains and victims. In interviews conducted soon after the outbreak, 47 Swiss respondents discussed the risk posed by H1N1, its origins and effects, and protective measures. Countries were the most frequent collectives mentioned. Poor, underdeveloped countries were depicted as victims, albeit ambivalently, as they were viewed as partly responsible for their own plight. Experts (physicians, researchers) and political and health authorities were depicted as heroes. Two villains emerged: the media (viewed as fear mongering or as a puppet serving powerful interests) and private corporations (e.g., the pharmaceutical industry). Laypersons' framing of disease threat diverges substantially from official perspectives.

Attitudes and behaviors of international air travelers toward pandemic influenza

BACKGROUND

Air travelers play a significant role in the spread of novel strains of influenza viruses; however, little is understood about the knowledge, attitudes, and practices of international air travelers toward pandemic influenza in relation to public health interventions and personal protective behaviors at overseas destinations.

METHODS

Prior to the 2009 H1N1 influenza pandemic, we surveyed a convenience sample of 404 departing international travelers at Detroit Metropolitan Wayne County Airport. Presented with a hypothetical pandemic influenza scenario occurring overseas, the participants predicted their anticipated protective behaviors while abroad and recorded their attitudes toward potential screening measures at US ports of entry (POE). The survey also qualitatively explored factors that would influence compliance with health entry screening at POE.

RESULTS

Those who perceived pandemic influenza to be serious were more likely to state that they would be comfortable with screening (p = 0.006), and if they had influenza-like illness (ILI) overseas, would be more willing to see a physician and delay return travel (p = 0.006 and 0.002, respectively). Other demographic variables, including age and race, were associated with protective behaviors in response to ILI. Travelers also identified diverse information requirements which would influence their behavior in response to entry screening, including characteristics of the pandemic, severity of illness, and screening operations.

CONCLUSIONS

Demographic characteristics and perceived severity of illness are important factors that may influence the protective behaviors of travelers overseas. Our results indicate that educational material and advice directed to international travelers could be differentially tailored to traveler subpopulations.

Trust in medical organizations predicts pandemic (H1N1) 2009 vaccination behavior and perceived efficacy of protection measures in the Swiss public

Following the recent avian influenza and pandemic (H1N1) 2009 outbreaks, public trust in medical and political authorities is emerging as a new predictor of compliance with officially recommended protection measures. In a two-wave longitudinal survey of adults in French-speaking Switzerland, trust in medical organizations longitudinally predicted actual vaccination status 6 months later, during the pandemic (H1N1) 2009 vaccination campaign. No other variables explained significant amounts of variance. Trust in medical organizations also predicted perceived efficacy of officially recommended protection measures (getting vaccinated, washing hands, wearing a mask, sneezing into the elbow), as did beliefs about health issues (perceived vulnerability to disease, threat perceptions). These findings show that in the case of emerging infectious diseases, actual behavior and perceived efficacy of protection measures may have different antecedents. Moreover, they suggest that public trust is a crucial determinant of vaccination behavior and underscore the practical importance of managing trust in disease prevention campaigns.

[Public health surveillance and assessment of emerging infectious threats: method and criteria for risk analysis]

One of the objectives of the surveillance systems implemented by the French National Institute for Public Health Surveillance is to detect communicable diseases and to reduce their impact. For emerging infections, the detection and risk analysis pose specific challenges due to lack of documented criteria for the event. The surveillance systems detect a variety of events, or "signals" which represent a potential risk, such as a novel germ, a pathogen which may disseminate in a non-endemic area, or an abnormal number of cases for a well-known disease. These signals are first verified and analyzed, then classified as: potential public health threat, event to follow-up, or absence of threat. Through various examples, we illustrate the method and criteria which are used to analyze and classify these events considered to be emerging. The examples highlight the importance of host characteristics and exposure in groups at particular risk, such as professionals in veterinarian services, health care workers, travelers, immunodepressed patients, etc. The described method should allow us to identify future needs in terms of surveillance and to improve timeliness, quality of expertise, and feedback information regarding the public health risk posed by events which are insufficiently documented.

Perceived risk, anxiety, and behavioural responses of the general public during the early phase of the Influenza A (H1N1) pandemic in the Netherlands: results of three consecutive online surveys

Background

Research into risk perception and behavioural responses in case of emerging infectious diseases is still relatively new. The aim of this study was to examine perceptions and behaviours of the general public during the early phase of the Influenza A (H1N1) pandemic in the Netherlands.

Methods

Two cross-sectional and one follow-up online survey (survey 1, 30 April-4 May; survey 2, 15-19 June; survey 3, 11-20 August 2009). Adults aged 18 years and above participating in a representative Internet panel were invited (survey 1, n = 456; survey 2, n = 478; follow-up survey 3, n = 934). Main outcome measures were 1) time trends in risk perception, feelings of anxiety, and behavioural responses (survey 1-3) and 2) factors associated with taking preventive measures and strong intention to comply with government-advised preventive measures in the future (survey 3).

Results

Between May and August 2009, the level of knowledge regarding Influenza A (H1N1) increased, while perceived severity of the new flu, perceived self-efficacy, and intention to comply with preventive measures decreased. The perceived reliability of information from the government decreased from May to August (62% versus 45%). Feelings of anxiety decreased from May to June, and remained stable afterwards. From June to August 2009, perceived vulnerability increased and more respondents took preventive measures (14% versus 38%). Taking preventive measures was associated with no children in the household, high anxiety, high self-efficacy, more agreement with statements on avoidance, and paying much attention to media information regarding Influenza A (H1N1). Having a strong intention to comply with government-advised preventive measures in the future was associated with higher age, high perceived severity, high anxiety, high perceived efficacy of measures, high self-efficacy, and finding governmental information to be reliable.

Conclusions

Decreasing trends over time in perceived severity and anxiety are consistent with the reality: the clinical picture of influenza turned out to be mild in course of time. Although (inter)national health authorities initially overestimated the case fatality rate, the public stayed calm and remained to have a relatively high intention to comply with preventive measures.

Behavioral responses to the influenza A(H1N1) outbreak in Malaysia

In the setting of the new A(H1N1) outbreak, the study was conducted to assess: (1) fear of the A(H1N1) pandemic; (2) risk avoidance behavior; (3) health-protective behavior; and (4) psychosocial impact in the ethnically diverse population of Malaysia. A cross-sectional, computer-assisted telephone interview was conducted between July 11 and September 12, 2009. A total of 1,050 respondents were interviewed. Fear about the pandemic was high, with 73.2% of respondents reporting themselves as Slightly fearful/Fearful. High risk avoidance and health protective behavior were reported, with 78.0 and 99.0% reporting at least one avoidance and protective behavior respectively. Knowledge was a significant predictor for practice of healthprotective behavior across the three ethnic groups. Level of fear was significantly correlated with number of protective and avoidance behaviors. The study highlights the need for provision of accurate information that increases risk avoidance and health protective behaviors, while at the same time decreases fear or panic in the general public.

Avoidance behaviors and negative psychological responses in the general population in the initial stage of the H1N1 pandemic in Hong Kong

Background

During the SARS pandemic in Hong Kong, panic and worry were prevalent in the community and the general public avoided staying in public areas. Such avoidance behaviors could greatly impact daily routines of the community and the local economy. This study examined the prevalence of the avoidance behaviors (i.e. avoiding going out, visiting crowded places and visiting hospitals) and negative psychological responses of the general population in Hong Kong at the initial stage of the H1N1 epidemic.

Methods

A sample of 999 respondents was recruited in a population-based survey. Using random telephone numbers, respondents completed a structured questionnaire by telephone interviews at the 'pre-community spread phase' of the H1N1 epidemic in Hong Kong.

Results

This study found that 76.5% of the respondents currently avoided going out or visiting crowded places or hospitals, whilst 15% felt much worried about contracting H1N1 and 6% showed signs of emotional distress. Females, older respondents, those having unconfirmed beliefs about modes of transmissions, and those feeling worried and emotionally distressed due to H1N1 outbreak were more likely than others to adopt some avoidance behaviors. Those who perceived high severity and susceptibility of getting H1N1 and doubted the adequacy of governmental preparedness were more likely than others to feel emotionally distressed.

Conclusions

The prevalence of avoidance behaviors was very high. Cognitions, including unconfirmed beliefs about modes of transmission, perceived severity and susceptibility were associated with some of the avoidance behaviors and emotional distress variables. Public health education should therefore provide clear messages to rectify relevant perceptions.

[Population-based cross sectional study about vaccine acceptability and perception of the severity of A/H1N1 influenza: opinion of the general population and health professionals]

OBJECTIVES

To determine the intention of general population and health professionals to vaccinate against the H1N1 influenza A virus. To determine the perception of severity of the H1N1 influenza A in both groups compared to that of seasonal influenza.

METHODS

Cross-sectional telephone survey performed to a sample of population (obtained randomly from the Vitoria-Gasteiz telephone directory) and cross-sectional electronically-administered survey to a sample of health professionals from public health centres in Vitoria-Gasteiz, conducted between 6th and 16th November 2009. The relative and absolute frecuency of persons willing to be vaccinated and the proportion of those considering the H1N1 influenza A as a life-threatening risk were calculated in both groups.

RESULTS

219 (33%) persons out of 637 contacted telephone numbers answered the questionnaire, as well as 109 health professionals. 63.0% (n=138) of general population and 73.4% (n=80) of the professional group would not undergo vaccination, even if it was for free (p=0.595). If belonging to a high-risk group, the corresponding proportions of unwillingness were 14.6% (n=32) for general population and 40.4 (n=44) for professionals (p<0.001). The proportion of undecided persons is 25.6% (n=56) in general population, against 6.4% (n=7) among the professionals.

CONCLUSIONS

At the beginning of the vaccination campaign, the majority of population is unwilling to undergo immunization against the H1N1 influenza A virus. The proportion in general population is similar to that among the health professionals. However, when belonging to a high-risk group, there is a high proportion of undecided persons in general population.

Behavioural intentions in response to an influenza pandemic

Background

Little is known regarding which behavioural responses can be expected if an influenza pandemic were to occur.

Methods

A survey comprising questions based on risk perception theories, in particular PMT, was conducted with a Dutch sample.

Results

Although fear that an influenza pandemic may occur was high, participants do not feel well informed. General practitioners and local health authorities were considered trustworthy sources of information and the information considered most urgent pertained to which protective measures should be taken. Participants reported an intention to comply with recommendations regarding protective measures. However, response and self efficacy were low. Maladaptive behaviours can be expected. Increasing numbers of ill individuals and school closures are also expected to lead to a decreased work force. Participants indicated wanting antiviral drugs even if the supply were to be insufficient.

Conclusions

Messages regarding health protective behaviours from local health authorities should anticipate the balance between overreacting and underreacting. Also, when protective recommendations from health professionals conflict with company policies, it is unclear how employees will react.