Compliant, complacent or panicked? Investigating the problematisation of the Australian general public in pandemic influenza control

Ethics and Health Security in the Australian COVID-19 Context: A Critical Interpretive Literature Review

Background The concept of "health security" is often used to motivate public health responses, yet the ethical values that underpin this concept remain largely unexamined. The recent Australian responses to COVID-19 serve as an important case study by which we can analyse the pre-existing literature to see what ethical values shaped, and continue to shape, Australia's response. Methods We conducted a critical interpretive literature review of academic and grey literatures within key databases, resulting in 2,220 sources. After screening for duplicates and relevance, we analysed ninety-six sources. Results First, risk and uncertainty are a leading focus, with a heavy concentration on risks to life and health. Second, free movement, safety, and security were recurringly emphasized, albeit narrowly focused upon the safety of the population. Third, legitimacy was a recurring theme, and it is here that discussions of "health security" figured highly. Conclusion Discussions of harm from government and associated official bodies fail to adequately distinguish between various senses of harm. Moreover, while the literature often discusses the balancing of rights, the steps involved in the weighing of these rights is rarely adequately explained and defended. We suggest that decision-makers should endeavour to clearly identify and defend the values undergirding their decisions in the public sphere.

Knowledge, Perception, and Attitudes during the COVID-19 Pandemic in the Peruvian Population

BACKGROUND

Latin American countries have been profoundly affected by COVID-19. Due to the alarming incidence of identified cases, we intended to explore which psychosocial elements may influence poor adherence to the mandatory control measures among the population.

OBJECTIVE

We aimed to assess Peruvians' knowledge, attitudes, and vulnerability perception during the coronavirus outbreak.

METHOD

We collected data from 225 self-selected participants using a web-based cross-sectional survey.

RESULTS

The overall respondents were between 18 and 29 years old (56.8%), female (59.5%), belonged to educated groups, and graduated professionals (69.3%), most of them. Logistic regression showed that Knowledge is highly associated with education (p = 0.031), occupation (p = 0.002), and age (p = 0.016). Our study identified that, although people reported adequate Knowledge by identifying expected symptoms and virus transmission ways in COVID-19 disease. There is a significant perceived susceptibility to contracting the mentioned virus, displaying stigmatized behavior (59.1%) and fear of contracting the virus from others (70.2%). Additionally, it is reported to lack people's confidence in national health authorities regarding sanitary responses (62.7%), preparedness for the disease (76.9%), and the lack of adequate measures to deal with it (51.1%).

CONCLUSION

We found that age, education, and occupation modulate Knowledge. At the same time, only age affected Perception and Attitude. Public policies should consider specific guidelines on knowledge translation and risk communication strategies for both containing psychological responses promptly and ensuring compliance with general control measures by the population.

Information clarity about Covid-19 in Indonesia: does media exposure matter?

Background

Confusion of information has also colored the course of the Covid-19 pandemic in Indonesia. The study analyzes the relationship between media exposure and information clarity about Covid-19 in Indonesia.

Methods

The study collected extensive data (n = 5,397). The study determines information clarity about Covid-19 based on respondents' admissions. There were four types of media exposure analyzed: frequency of reading a newspaper/magazine, frequency of listening to a radio, frequency of watching television, and frequency of internet use. The study carried out a binary logistic regression test in the final stage.

Results

The results show read a newspaper/magazine every day is 1.670 times more likely than reading a newspaper/magazine > five days a week to get precise information about Covid-19. Reading a newspaper/magazine 2–3 days a week is 1.386 times more likely than reading a newspaper/magazine > five days a week to get precise information about Covid-19. Reading a newspaper/magazine 4–5 days a week is 1.470 times more likely than reading a newspaper/magazine > five days a week to get precise information about Covid-19. Watching television 2 to 3 days a week is 1.601 times more likely than watching television > five days a week to get clear details about Covid-19. Watching television 4 to 5 days a week are 1.452 times more likely than watching television > five days a week to get precise information about Covid-19.

Conclusion

The study concluded two types of media exposure related to information clarity about Covid-19 in Indonesia: the frequency of reading newspapers and watching television.

The psychological reassurance effect of mobile tracing apps in Covid-19 Era

As part of their public health policies, most countries have launched mobile tracing applications (apps) to reduce the spread of the COVID-19 virus and reassure their citizens. To the best of our knowledge, no study has explored the importance of 'well-being' and 'trust in the future' in the context of digital contact-tracing apps. This is an important gap, especially given the importance of citizens' acceptance of a mobile tracing app and its role in reassuring citizens. Therefore, we study the French government's tracing app-StopCovid-as experienced by a sample of 832 participants from France. The results establish strong links between perceived value and trust in government, well-being, and trust in the future, which are considered the key features of the reassurance effect in a pandemic context. In addition, a multigroup analysis (MGA) allows us to compare the effect of several moderators on the overall model, such as the users versus nonusers of tracking apps or infected versus noninfected with COVID-19. The study provides practical implications by highlighting how governments should deploy mobile tracing apps to contribute to public health and reassure their citizens during the pandemic.

Radicalization to Violence: A View from Cultural Psychiatry

This article introduces a thematic issue of Transcultural Psychiatry with selected papers from the McGill Advanced Study Institute in Cultural Psychiatry on "Pluralism and Polarization: Cultural Contexts and Dynamics of Radicalization," which took place June 20-22, 2017. The ASI brought together an interdisciplinary group scholars to consider the role of social dynamics, cultural contexts and psychopathology in radicalization to violent extremism. Papers addressed four broad topics: (1) current meanings and uses of the term radicalization; (2) personal and social determinants of violent radicalization, including individual psychology, interpersonal dynamics, and wider social-historical, community and network processes; (3) social and cultural contexts and trajectories of radicalization including the impact of structural and historical forces associated with colonization and globalization as well as contemporary political, economic and security issues faced by youth and disaffected groups; and (4) approaches to community prevention and clinical intervention to reduce the risk of violent radicalization. In this introductory essay, we revisit these themes, define key terms, and outline some of the theoretical and empirical insights in the contributions to this issue. Efforts to prevent violent radicalization face challenges because social media and the Internet allow the rapid spread of polarizing images and ideas. The escalation of security measures and policies also serves to confirm the worldview of conspiracy theory adherents. In addition to addressing the structural inequities that fuel feelings of anger and resentment, we need to promote solidarity among diverse communities by building a pluralistic civil society that offers a meaningful alternative to the violent rhetorics of us and them.

Social distancing measures: barriers to their implementation and how they can be overcome - a systematic review

BACKGROUND

Despite their central role in the global response to the COVID-19 pandemic and previous infectious disease outbreaks, factors influencing the acceptability and implementation of social distancing measures are poorly understood. This systematic review aims to identify such factors drawing on qualitative literature.

METHODS

A systematic search was carried out in eleven databases. Papers were included in the review if they reported on qualitative studies of factors influencing the implementation of social distancing measures in potentially epidemic infectious diseases. An adapted meta-ethnographical approach was used for synthesis. Review findings were assessed for strength and reliability using GRADE-CERQual.

RESULTS

Twenty-nine papers were included from the systematic search that yielded 5620 results, and supplementary methods. The review identifies two broad categories of barriers to social distancing measures: individual- or community-level psychosocial phenomena, and shortcomings in governmental action or communication. Based on this, 25 themes are identified that can be addressed to improve the implementation of social distancing.

CONCLUSION

Among other findings, the review identifies the need for good communication as well as the need for authorities to provide comprehensive support as two key opportunities to increase acceptability and adherence. Further important enablers of adherence are adequate preparedness and appropriate legislation, the presence of community involvement, solidarity within communities and trust in governments and authorities.

Global adoption of personal and social mitigation behaviors during COVID-19: The role of trust & confidence

What influences the adoption of SARS-CoV-2 mitigation behaviors-both personal, such as mask wearing and frequent handwashing, and social, such as avoiding large gatherings and physical contact-across countries? Understanding why some individuals are more willing to change their behavior to mitigate the spread of a pandemic will not only help us to address the current SARS-CoV-2 pandemic but also to respond to future ones. Researchers have pointed to a variety of factors that may influence individual adoption of personal and social mitigation behaviors, including social inequality, risk perception, personality traits, and government policies. While not denying the importance of these factors, we argue that the role of trust and confidence has received insufficient attention to date. Our study explores whether there is a difference in the way trust and confidence in particular leaders and organizations affect individual compliance and whether this effect is consistent across different types of mitigation behaviors. Specifically, we utilize an original cross-national survey conducted during the first wave of the SARS-CoV-2 pandemic (May-June 2020) to investigate how trust in scientists, medical professionals, politicians, and religious leaders and confidence in global, national, and local health organizations affects individual compliance in 16 countries/territories across five world regions. Our analyses, which control for the aforementioned factors as well as several others, suggest that trust in politicians and confidence in national health ministries have the most consistent influence on whether individuals adopt both personal and social mitigation behaviors. Across our sample, we find that greater trust in politicians is associated with lower levels of individual compliance with public health directives, whereas greater confidence in the national health ministry is associated with higher levels of individual compliance. Our findings suggest the need to understand trust and confidence as among the most important individual level characteristics driving compliance when developing and delivering messaging about the adoption of mitigation behaviors. The content of the message, it seems, will be most effective when citizens across countries trust its source. Trusted sources, such as politicians and the national health ministry, should thus consider working closely together when determining and communicating recommended health behaviors to avoid contradicting one another.

Self-reported psychological problems and coping strategies: a web-based study in Peruvian population during COVID-19 pandemic

BACKGROUND

The Coronavirus pandemic has disrupted health systems across the world and led to major shifts in individual behavior by forcing people into isolation in home settings. Its rapid spread has overwhelmed populations in all corners of Latin-American countries resulting in individual psychological reactions that may aggravate the health crisis. This study reports on demographics, self-reported psychological disturbances and associated coping styles during the COVID-19 pandemic for the Peruvian population.

METHODS

This cross-sectional study uses an online survey with snowball sampling that was conducted after the state of emergency was declared in Perú (on April 2nd). The General Health Questionnaire (GHQ-28) was used to identify somatic symptoms, incidence of anxiety/ insomnia, social dysfunction and depression and the Coping Strategy Questionnaire (COPE-28) mapped personal strategies to address recent stress.

RESULTS

434 self-selected participants ranging in age from 18 to 68 years old (Mean age = 33.87) completed the survey. The majority of participants were women (61.30%), aged between 18 and 28 (41.70%), well-educated (> = 85.00%), Peruvian (94.20%), employed (57.40%) and single (71.20%). 40.8% reported psychological distress, expressing fear of coronavirus infection (71.43%). Regression analysis shows that men had lower somatic-related symptom (β = - 1.87, 95%, CI: - 2.75 to -.99) and anxiety/insomnia symptom (β = - 1.91, 95% CI: - 2.98 to 0.84) compared to women. The risk for depression and social dysfunction are less likely with increasing age. Educational status was protective against developing psychological conditions (p < 0.05). While active responses (acceptance and social support) are scarcely used by individuals with psychological distress; passive strategies (such as denial, self-distraction, self-blame, disconnection, and venting) are more commonly reported.

CONCLUSION

This study provides a better understanding of the psychological health impact occurring during the COVID-19 pandemic on the Peruvian population. About half of the respondents reported psychological distress and poor coping responses. This evidence informs the need for broader promotional health policies focused on strengthening individual's active strategies aiming at improving emotional health and preventing psychiatric conditions, during and after the COVID-19 pandemic.

Using a Bayesian Network Predictive Model to Understand Vulnerability of Australian Sheep Producers to a Foot and Mouth Disease Outbreak

To maintain and strengthen Australia's competitive international advantage in sheep meat and wool markets, the biosecurity systems that support these industries need to be robust and effective. These systems, strengthened by jurisdictional and livestock industry investments, can also be enhanced by a deeper understanding of individual producer risk of exposure to animal diseases and capacity to respond to these risks. This observational study developed a Vulnerability framework, built from current data from Australian sheep producers around behaviors and beliefs that may impact on their likelihood of Exposure and Response Capacity (willingness and ability to respond) to an emergency animal disease (EAD). Using foot and mouth disease (FMD) as a model, a cross-sectional survey gathered information on sheep producers' demographics, and their practices and beliefs around animal health management and biosecurity. Using the Vulnerability framework, a Bayesian Network (BN) model was developed as a first attempt to develop a decision making tool to inform risk based surveillance resource allocation. Populated by the data from 448 completed questionnaires, the BN model was analyzed to investigate relationships between variables and develop producer Vulnerability profiles. Respondents reported high levels of implementation of biosecurity practices that impact the likelihood of exposure to an EAD, such as the use of appropriate animal movement documentation (75.4%) and isolation of incoming stock (64.9%). However, adoption of other practices relating to feral animal control and biosecurity protocols for visitors were limited. Respondents reported a high uptake of Response Capacity practices, including identifying themselves as responsible for observing (94.6%), reporting unusual signs of disease in their animals (91.0%) and daily/weekly inspection of animals (90.0%). The BN analysis identified six Vulnerability typologies, with three levels of Exposure (high, moderate, low) and two levels of Response Capacity (high, low), as described by producer demographics and practices. The most influential Exposure variables on producer Vulnerability included adoption levels of visitor biosecurity and visitor access protocols. Findings from this study can guide decisions around resource allocation to improve Australia's readiness for EAD incursion and strengthen the country's biosecurity system.

The goat industry in Australia: Using Bayesian network analysis to understand vulnerability to a foot and mouth disease outbreak

Australia's goat industry is one of the largest goat product exporters in the world, managing both farmed and wild caught animals. To protect and maintain the competitive advantage afforded to the Australian goat industry by the absence of many diseases endemic elsewhere, it is important to identify the vulnerability of producers to livestock disease incursions. This study developed a framework of producer vulnerability built from the beliefs and practices of producers that may impact on their likelihood of exposure and response capacity to an emergency animal disease (EAD), using foot and mouth disease as a model. A cross-sectional questionnaire gathered information on producer/enterprise demographics, animal health management and biosecurity practices, with 107 participating in the study. The biosecurity measures that were most commonly implemented by producers were always using animal movement documentation for purchased stock (74.7 %) and isolating new stock (73.1 %). However, moderate to low uptake of biosecurity protocols related to visitors to the property were reported. Response capacity variables such as checking animals daily (72.0 %) and record keeping (91.7 %) were reported by the majority of respondents, with 40.7 % reporting yearly veterinary inspection of their animals. Using the vulnerability framework, a Bayesian Network model was developed and populated by the survey data, and the relationships between variables were investigated. Six vulnerability profiles were developed, with three levels of exposure (high, moderate, low) and two levels of response capacity (high, low), as described by producer demographics and practices. The most sensitive exposure variables on producer vulnerability included implementation of visitor biosecurity and control of feral animals. Results from this study can inform risk based perspectives and decisions around biosecurity and surveillance resource allocation within the goat industry. The results also highlight opportunities for improving Australia's preparedness for a future EAD incursion by considering producer behaviour and beliefs by applying a vulnerability framework.

Improving the impact of non-pharmaceutical interventions during COVID-19: examining the factors that influence engagement and the impact on individuals

BACKGROUND

During an evolving outbreak or pandemic, non-pharmaceutical interventions (NPIs) including physical distancing, isolation, and mask use may flatten the peak in communities. However, these strategies rely on community understanding and motivation to engage to ensure appropriate compliance and impact. To support current activities for COVID-19, the objectives of this narrative review was to identify the key determinants impacting on engagement.

METHODS

An integrative narrative literature review focused on NPIs. We aimed to identify published peer-reviewed articles that focused on the general community (excluding healthcare workers), NPIs (including school closure, quarantine, isolation, physical distancing and hygiene behaviours), and factors/characteristics (including social, physical, psychological, capacity, motivation, economic and demographic) that impact on engagement.

RESULTS

The results revealed that there are a range of demographic, social and psychological factors underpinning engagement with quarantine, school closures, and personal protective behaviours. Aside from the factors impacting on acceptance and compliance, there are several key community concerns about their use that need to be addressed including the potential for economic consequences.

CONCLUSION

It is important that we acknowledge that these strategies will have an impact on an individual and the community. By understanding the barriers, we can identify what strategies need to be adopted to motivate individuals and improve community compliance. Using a behavioural framework to plan interventions based on these key barriers, will also ensure countries implement appropriate and targeted responses.

Understanding the vulnerability of beef producers in Australia to an FMD outbreak using a Bayesian Network predictive model

Effective and adaptable biosecurity and surveillance systems are crucial for maintaining and increasing Australia's competitive advantages in international markets, and for the production of high quality, safe animal products. These systems are continuously strengthened by ongoing government and industry investment. However, a better understanding of evolving disease risks and the country's capacity to respond to these risks is needed. This study developed a vulnerability framework based on characteristics and behaviours of livestock producers that impact exposure and response capacity to an emergency animal disease (EAD) outbreak among beef producers in Australia, with a focus on foot and mouth disease (FMD). This framework articulated producer vulnerability typologies to better inform surveillance resource allocation and future research direction. A cross-sectional study of beef producers in Australia was conducted to gather information on producers' demographics, husbandry characteristics, biosecurity and animal health management practices and beliefs, including those specific to FMD risk and response capacity. A Bayesian Network (BN) model was developed from the vulnerability framework, to investigate the complex interrelationships between variables and identify producer typologies. A total of 375 usable responses were obtained from the cross-sectional study. Regarding EAD exposure, producers implemented appropriate biosecurity practices for incoming stock, such as isolation (72.0 %), inspection for disease (88.7 %) and the use of vendor declarations (78.5 %); however, other biosecurity practices were limited, such as restriction of visitor access, visitor biosecurity requirements or feral animal control. In relation to response capacity, a moderate uptake of practices was observed. Whilst daily or weekly visual inspection of animals was reported by most producers (90.1 %), physical inspection was less frequent. Most producers would call a private veterinarian in response to unusual signs of disease in their cattle; however, over 40 % of producers did not cite calling a government veterinarian as a priority action. Most producers believe an FMD outbreak would have extremely serious consequences; however, their level of concern was moderate and their confidence in identifying FMD symptoms was low. The BN analysis identified six vulnerability typologies, with three levels of exposure (high, moderate, low) and two levels of response capacity (high, low), as described by producer demographics and practices. The model identified property size, number of cattle and exposure variables as the most influential to the overall producer vulnerability. Results from this study can inform how to best use current biosecurity and surveillance resources and identify where opportunities exist for improving Australia's preparedness for future EAD incursions.

Whose crisis? Pandemic flu, 'communication disasters' and the struggle for hegemony

Public health authorities in Germany regard communication as a crucial part of infectious disease prevention and control strategies. Communication becomes even more important during public health crises such as pandemics. Drawing on Briggs and Hallin’s concept of biocommunicability, we analysed the German National Pandemic Plan and key informant interviews with public health experts, critical infrastructure providers and ambulance services. We examined the projected expectations towards the behaviour of the audiences and the projected ways of information circulation informing public health communication strategies during a pandemic. Participants shared the expectation that the population would react towards an influenza pandemic with panic and fear due to a lack of information or a sensationalist media coverage. They associated the information uptake of their target audience with trust in their expertise. While our informants from public health conceptualised trust in terms of a face-to-face interaction, they sought to gain trust through transparency in their respective institutional settings. Our analysis suggests that this moved health information into a political register where their medical authority was open to debate. In response to this, they perceived the field of communication as a struggle for hegemony.

Don't be the "Fifth Guy": Risk, Responsibility, and the Rhetoric of Handwashing Campaigns

In recent years, outbreaks such as H1N1 have prompted heightened efforts to manage the risk of infection. These efforts often involve the endorsement of personal responsibility for infection risk, thus reinforcing an individualistic model of public health. Some scholars-for example, Peterson and Lupton (1996)-term this model the "new public health." In this essay, I describe how the focus on personal responsibility for infection risk shapes the promotion of hand hygiene and other forms of illness etiquette. My analysis underscores the use of constitutive and stigmatizing rhetoric to depict individual bodies, rather than environments, as prime sources of infection. Common among workplaces, this rhetoric provides the impetus for encouraging individual behavior change as a hedge against infection risk. I argue, though, that the mandating of personal responsibility for infection risk galvanizes a culture of stigma and blame that may work against the aims of public health.

Uncertainty and Immunity in Public Communications on Pandemics

This chapter examines uncertainty in the expert advice on pandemics given to members of the general public. The chapter draws on research conducted in Australia and Scotland on public engagements with the 2009 influenza (swine flu) pandemic and discusses implications for communications on more recent infectious disease outbreaks, including Ebola and Zika. It shows how public health messages aim to achieve a workable balance of warning and reassurance and deflect problems of trust in experts and science. The chapter considers how uncertainties which prevail in pandemics reinforce the personalization of responses to pandemic risk, in ways that undermine the cooperation and collective action which are also needed to respond effectively to pandemics.

"Why won't they just vaccinate?" Horse owner risk perception and uptake of the Hendra virus vaccine

BACKGROUND

Hendra virus is a paramyxovirus that causes periodic serious disease and fatalities in horses and humans in Australia first identified in 1994. Pteropid bats (commonly known as flying-foxes) are the natural host of the virus, and the putative route of infection in horses is by ingestion or inhalation of material contaminated by flying-fox urine or other bodily fluids. Humans become infected after close contact with infected horses. Horse owners in Australia are encouraged to vaccinate their horses against Hendra virus to reduce the risk of Hendra virus infection, and to prevent potential transmission to humans. After the vaccine was released in 2012, uptake by horse owners was slow, with some estimated 11-17% of horses in Australia vaccinated. This study was commissioned to examine barriers to vaccine uptake and potential drivers to future adoption of vaccination by horse owners.

METHODS

This study examined qualitative comments from respondents to an on-line survey, reporting reasons for not vaccinating their horses. The study also investigated scenarios in which respondents felt they might consider vaccinating their horses.

RESULTS

Self-reported barriers to uptake of the Hendra virus vaccine by horse owners (N = 150) included concerns about vaccine safety, cost, and effectiveness. Reduction in vaccination costs and perception of immediacy of Hendra virus risk were reported as being likely to change future behaviour. However, the data also indicated that horse owners generally would not reconsider vaccinating their horses if advised by their veterinarian.

CONCLUSION

While changes to vaccine costs and the availability data supporting vaccine safety and efficacy may encourage more horse owners to vaccinate, this study highlights the importance of protecting the relationship between veterinarians and horse owners within the risk management strategies around Hendra virus. Interactions and trust between veterinarians and animal owners has important implications for management of and communication around Hendra virus and other zoonotic disease outbreaks.

Sources of Information During the 2014 West Virginia Water Crisis: A Cross-Sectional Survey

Objective

On January 9, 2014, a faulty storage tank leaked 10,000 gallons of an industrial coal-processing liquid into the Elk River in West Virginia, contaminating the drinking water of 9 counties collectively known as the Kanawha Valley. In the context of this event, we explored the relationship between social determinants and (1) the timeliness with which residents learned about the crisis, (2) the source of information, (3) opinions on the source of information, (4) information-seeking behaviors, and (5) knowledge acquired.

Methods

Between February 7 and 26, 2014, we conducted a survey of 690 adult residents of West Virginia. Descriptive statistics and multivariable statistical models were performed.

Results

Information about water contamination spread quickly, with 88% of respondents from the affected counties hearing about the incident on the same day it occurred. Most people received the information from local television news (73%); social media users had 120% increased odds of knowing about the recommended behaviors. People who had a favorable opinion of the source of information demonstrated better knowledge of recommended behaviors.

Conclusions

The use of local television news during a crisis is important for timely dissemination of information. Information exposure across segments of the population differed on the basis of the population’s background characteristics. (Disaster Med Public Health Preparedness. 2017;11:196–206)

A systematic review of factors affecting intended and actual adherence with antiviral medication as treatment or prophylaxis in seasonal and pandemic flu

The aim of this review was to identify factors predicting actual or intended adherence to antivirals as treatment or prophylaxis for influenza. Literature from inception to March 2015 was systematically reviewed to find studies reporting predictors of adherence to antivirals and self‐reported reasons for non‐adherence to antivirals. Twenty‐six studies were included in the review; twenty identified through the literature search and six through other means. Of these studies, 18 assessed predictors of actual adherence to antivirals, whereas eight assessed predictors of intended adherence. The most commonly found predictor of, and self‐reported reason for, non‐adherence was the occurrence of side effects. Other predictors include perceptions surrounding self‐efficacy, response efficacy and perceived personal consequences as well as social influences of others' experiences of taking antivirals. Predictors identified in this review can be used to help inform communications to increase adherence to antivirals in both seasonal and pandemic influenza.

Beyond resistance: social factors in the general public response to pandemic influenza

Background

Influencing the general public response to pandemics is a public health priority. There is a prevailing view, however, that the general public is resistant to communications on pandemic influenza and that behavioural responses to the 2009/10 H1N1 pandemic were not sufficient. Using qualitative methods, this paper investigates how members of the general public respond to pandemic influenza and the hygiene, social isolation and other measures proposed by public health. Going beyond the commonly deployed notion that the general public is resistant to public health communications, this paper examines how health individualism, gender and real world constraints enable and limit individual action.

Methods

In-depth interviews (n = 57) and focus groups (ten focus groups; 59 individuals) were conducted with community samples in Melbourne, Sydney and Glasgow. Participants were selected according to maximum variation sampling using purposive criteria, including: 1) pregnancy in 2009/2010; 2) chronic illness; 3) aged 70 years and over; 4) no disclosed health problems. Verbatim transcripts were subjected to inductive, thematic analysis.

Results

Respondents did not express resistance to public health communications, but gave insight into how they interpreted and implemented guidance. An individualistic approach to pandemic risk predominated. The uptake of hygiene, social isolation and vaccine strategies was constrained by seeing oneself ‘at risk’ but not ‘a risk’ to others. Gender norms shape how members of the general public enact hygiene and social isolation. Other challenges pertained to over-reliance on perceived remoteness from risk, expectation of recovery from infection and practical constraints on the uptake of vaccination.

Conclusions

Overall, respondents were engaged with public health advice regarding pandemic influenza, indicating that the idea of public resistance has limited explanatory power. Public communications are endorsed, but challenges persist. Individualistic approaches to pandemic risk inhibit acting for the benefit of others and may deepen divisions in the community according to health status. Public communications on pandemics are mediated by gender norms that may overburden women and limit the action of men. Social research on the public response to pandemics needs to focus on the social structures and real world settings and relationships that shape the action of individuals.

Public media communications about H1N1, risk perceptions and immunization behaviours: A Quebec-France comparison

During the H1N1 pandemic, governments tailored their communications plans in order to influence risk perception and promote public compliance with the public health plan measures. Considering the volume and the content of calls to flu information centres as indicators of the public risk perception, this mixed method study compares the relation between public communications, risk perception and immunization behaviour in Quebec and France. Results suggest that advocating for clear information and coordination between health authorities and the media promotes adherence to preventive behaviour. However, over-exaggerating the risks and minimizing the population's agency may undermine health authority credibility.

Unresolved issues in risk communication research: the case of the H1N1 pandemic (2009-2011)

The 2009 H1N1 pandemic had considerable impact on risk perceptions, vaccination campaigns, and global health governance. In this context, risk communication issues have been probably the most puzzling and the least understood in retrospect. This article reviews the current knowledge on the following issues: risk and pandemic perceptions; vaccination perceptions and practices; rumors and rumor propagation; and health risk communication. It also highlights the research gaps in these areas that remain to be further explored in the future.

'We had to do what we thought was right at the time': retrospective discourse on the 2009 H1N1 pandemic in the UK

For a few weeks in 2009 it was not certain whether the world faced a lethal influenza pandemic. As it turned out, the H1N1 pandemic was less severe than anticipated, though the infection did affect groups not usually susceptible to influenza. The deep uncertainties of this pandemic moment were associated with immense practical, scientific and political challenges for public health agencies around the world. We examine these challenges by drawing on the sociology of uncertainty to analyse the accounts given by UK public health practitioners who managed local responses to the pandemic. We discuss the retrospective and mitigating discourse; 'we had to do what we thought was right at the time', used by interviewees to explain their experience of articulating plans for a severe pandemic influenza with one that turned out to be mild. We explore the importance of influenza's history and imagined future for pandemic management and, relatedly, how pandemic response and control plans disrupted the normal ways in which public health exercises its authority. We conclude by suggesting that difficulties in the management of pandemic influenza lie in its particular articulation of precautions, that is, securing a safe future against that which cannot be predicted.