Examining the knowledge, attitudes and practices of domestic and international university students towards seasonal and pandemic influenza

Cross-language validation of COVID-19 Compliance Scale in 28 languages

Although compliance scales have been used to assess compliance with health guidelines to reduce the spread of COVID-19, no scale known to us has shown content validity regarding global guidelines and reliability across an international sample. We assessed the validity and reliability of a Compliance Scale developed by a group of over 150 international researchers. Exploratory factor analysis determined reliable items on the English version. Confirmatory factor analysis confirmed the reliability of the six-item scale and convergent validity was found. After invariance testing and alignment, we employed a novel R code to run a Monte Carlo simulation for alignment validation. This scale can be employed to measure compliance across multiple languages, and our alignment validation method can be conducted with future cross-language surveys.

Place of distancing measures in containing epidemics: a scoping review

Distancing is one of the barrier measures in mitigating epidemics. We aimed to investigate the typology, effectiveness, and side effects of distancing rules during epidemics. Electronic searches were conducted on MEDLINE, PubMed in April 2020, using Mesh-Terms representing various forms of distancing ('social isolation', 'social distancing', 'quarantine') combining with 'epidemics'. PRISMA-ScR statement was consulted to report this review. A total of 314 titles were identified and 93 were finally included. 2009 influenza A and SARS-CoV-2 epidemics were the most studied. Distancing measures were mostly classified as case-based and community-based interventions. The combination of distancing rules, like school closure, home working, isolation and quarantine, has proven to be effective in reducing R0 and flattening the epidemic curve, also when initiated early at a high rate and combined with other non-pharmaceutical interventions. Epidemiological and modeling studies showed that Isolation and quarantine in the 2009 Influenza pandemic were effective measures to decrease attack rate also with high level of compliance but there was an increased risk of household transmission. lockdown was also effective to reduce R0 from 2.6 to 0.6 and to increase doubling time from 2 to 4 days in the covid-19 pandemic. The evidence for school closure and workplace distancing was moderate as single intervention. Psychological disorder, unhealthy behaviors, disruption of economic activities, social discrimination, and stigmatization were the main side effects of distancing measures. Earlier implementation of combined distancing measures leads to greater effectiveness in containing outbreaks. Their indication must be relevant and based on evidence to avoid adverse effects on the community. These results would help decision-makers to develop response plans based on the required experience and strengthen the capacity of countries to fight against future epidemics. Mesh words: Physical Distancing, Quarantine, Epidemics, Public Health, Scoping Review.

Fieldwork without the field: Navigating qualitative research in pandemic times

More than ever before, the COVID-19 pandemic has required qualitative researchers to develop open-ended, flexible, and creative approaches to continuing their work. This reality includes the adoption of open-ended research goals, a willingness to continually adapt to unpredictable and changing (viral) circumstances, and a commitment to opening toward and adhering to participants' preferences. This ethos is entrenched in a web of moral responsibility and a future anteriorized ethics. We reflect on pandemic-era ethical and methodological considerations in light of Fortun's studies of toxic contamination, research conducted in conflict settings, and researcher experiences during the early stages of COVID-19. Drawing from our own experiences and bearing in mind our own entangled web(s) of moral responsibility, we explore the future anteriorized ethics and methodological landscape of the “new normal” pandemic (potentially endemic) era. We reflect on what data we are able to gather and what data we dare to gather in the context of COVID-19, ultimately asking how qualitative researchers can maintain a safe and ethical environment for conducting research. To this end, we emphasize a recognition of our obligations to our research partners and ourselves in order to reduce risk by turning doubts and concerns into opportunities during project development and fieldwork and transforming participants into collaborators in spaces of uncertainty. Through targeted reflections on our processes of adaptation in research, we examine how scholars can perform relatedness, knowledge, reasonableness, and care in the midst of a risky, compromised research context.

Using nasal sprays to prevent respiratory tract infections: a qualitative study of online consumer reviews and primary care patient interviews

OBJECTIVES

Nasal sprays could be a promising approach to preventing respiratory tract infections (RTIs). This study explored lay people's perceptions and experiences of using nasal sprays to prevent RTIs to identify barriers and facilitators to their adoption and continued use.

DESIGN

Qualitative research. Study 1 thematically analysed online consumer reviews of an RTI prevention nasal spray. Study 2 interviewed patients about their reactions to and experiences of a digital intervention that promotes and supports nasal spray use for RTI prevention (reactively: at 'first signs' of infection and preventatively: following possible/probable exposure to infection). Interview transcripts were analysed using thematic analysis.

SETTING

Primary care, UK.

PARTICIPANTS

407 online customer reviews. 13 purposively recruited primary care patients who had experienced recurrent infections and/or had risk factors for severe infections.

RESULTS

Both studies identified various factors that might influence nasal spray use including: high motivation to avoid RTIs, particularly during the COVID-19 pandemic; fatalistic views about RTIs; beliefs about alternative prevention methods; the importance of personal recommendation; perceived complexity and familiarity of nasal sprays; personal experiences of spray success or failure; tolerable and off-putting side effects; concerns about medicines; and the nose as unpleasant and unhygienic.

CONCLUSIONS

People who suffer disruptive, frequent or severe RTIs or who are vulnerable to RTIs are interested in using a nasal spray for prevention. They also have doubts and concerns and may encounter problems. Some of these may be reduced or eliminated by providing nasal spray users with information and advice that addresses these concerns or helps people overcome difficulties.

Future Acceptability of Respiratory Virus Infection Control Interventions in General Population to Prevent Respiratory Infections

Background and Objectives: In both pandemic and non-pandemic situations, nonpharmaceutical public health measures may offer easy, low-cost, and effective means of reducing the spread and impact of acute respiratory infections. It is unknown whether such measures would be acceptable to the Saudi community beyond the current pandemic. Materials and Methods: A validated survey was used to test community acceptance of the measures. Respondents were asked which infection control practices they planned to maintain and which they believed should be policies for the community as a whole after the COVID-19 pandemic has subsided. Results: The survey was completed by 2057 people (95% completion rate), 1486 (72%) of whom were female, 259 (12.5%) of whom were current smokers, and 72 (3.5%) of whom had chronic lung disease. The most prevalent age groups were 18−30 years (933; 45.4%) and 31−40 years (483; 23.5%), with 641 individuals over 40 years old. Of the responses, 93% indicated that they would continue washing their hands more often; 92% wanted both clinicians and patients to wear masks in hospitals; 86% would continue avoiding smoking in indoor and outdoor areas; 73% would continue wearing a face covering on public transportation; 70% indicated that they would continue wearing a face covering in indoor public places. Regarding the respiratory virus infection control measures, 85% (11/13) received significant support (≥70% acceptability level) for continuation as policies in the future. Wearing face coverings outdoors and social distancing outdoors received little support (45% and 66%, respectively). Of the respiratory virus infection control measures, 54% received less support from current smokers than non-smokers (acceptability level < 70%). People with chronic respiratory disease supported 77% of the measures being regarded as policies in the future. Conclusion: The Saudi community supports nonpharmacological respiratory infection control measures that reduce the likelihood of infection. Public health campaigns should target smokers to increase awareness of the importance of these measures in lowering infections. Based on the findings of this study, nonpharmacological treatments should be presented and included in future recommendations for both the public and patients diagnosed with chronic respiratory diseases.

Effects of Population Knowledge, Perceptions, Attitudes, and Practices on COVID-19 Infection Prevention and Control in NUST

The global COVID-19 pandemic has had a major impact on the education sector of most countries. One of the basic CDC prevention guidelines is the implementation of non-pharmaceutical interventions (NPIs) to protect the health of students and staff members to curve the spread of COVID-19. The current study aimed to examine the knowledge, perceptions, attitudes, and practices of students at the Namibia University of Technology toward the COVID-19 pandemic. A cross-sectional descriptive survey was conducted using a closed-ended questionnaire. Data were collected from full-time students who were on campus during the COVID-19 pandemic between 29 January to 14 February 2021. The average knowledge about the modes of transmission, protective measures, and clinical symptoms ranged from 78% to 96%. About 31% of student respondents believed the virus was created in a laboratory, and 47% believed the vaccine has negative side effects and therefore, refused to take it. The three main sources of information about COVID-19 were social media (75%), television (63%), and friends and family (50%). The students had an overall positive attitude towards the implementation of NPIs. However, the importance of vaccine safety must be emphasized. Lockdowns should be lifted gradually to reduce the amount of time students are spending on online content. Reopening of classrooms for face-to-face study will bring unquestionable benefits to students and the wider economy.

Patient perceptions of vulnerability to recurrent respiratory tract infections and prevention strategies: a qualitative study

OBJECTIVES

Respiratory tract infections (RTIs) are extremely common, usually self-limiting, but responsible for considerable work sickness absence, reduced quality of life, inappropriate antibiotic prescribing and healthcare costs. Patients who experience recurrent RTIs and those with certain comorbid conditions have higher personal impact and healthcare costs and may be more likely to suffer disease exacerbations, hospitalisation and death. We explored how these patients experience and perceive their RTIs to understand how best to engage them in prevention behaviours.

DESIGN

A qualitative interview study.

SETTING

Primary care, UK.

METHODS

23 participants who reported recurrent RTIs and/or had relevant comorbid health conditions were interviewed about their experiences of RTIs. Interviews took place as the COVID-19 pandemic began. Data were analysed using inductive thematic analysis.

RESULTS

Three themes were developed: Understanding causes and vulnerability, Attempting to prevent RTIs, Uncertainty and ambivalence about prevention, along with an overarching theme; Changing experiences because of COVID-19. Participants' understandings of their susceptibility to RTIs were multifactorial and included both transmission via others and personal vulnerabilities. They engaged in various approaches to try to prevent infections or alter their progression yet perceived they had limited personal control. The COVID-19 pandemic had improved their understanding of transmission, heightened their concern and motivation to avoid RTIs and extended their repertoire of protective behaviours.

CONCLUSIONS

Patients who experience frequent or severe RTIs are likely to welcome and benefit from advice and support regarding RTI prevention. To engage people effectively, those developing interventions or delivering health services must consider their beliefs and concerns about susceptibility and prevention.

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.

Belief in Protecting Others and Social Perceptions of Face Mask Wearing Were Associated With Frequent Mask Use in the Early Stages of the COVID Pandemic in the UK

Face masks are now seen as a key tool in the world's recovery from the COVID-19 pandemic. However, during the early stages of the outbreak, face mask use in the United Kingdom (UK) was significantly lower than that of countries equally impacted by the virus. We were interested to explore whether social cognitions played a role in levels of mask wearing. A cross-sectional online survey of UK adults (n=908) was conducted in July 2020. Estimated face mask use and thoughts about wearing face masks were assessed using measures developed for this study. Participants also answered questions about their general mood, social anxiety and basic demographic data. Multiple regression was used to examine factors associated with mask wearing. Participants' estimated mask wearing was low when in public spaces, such as the park (17%) or walking on the high street (36%). However, broadly fitting with UK guidance at the time, rates were considerably higher when in situations of closer proximity to others, such as on public transport (94%), in a shop or café (62%), when speaking to somebody in an enclosed public space (67%) or in a busy area when social distancing was not possible (79%). When looking at estimated mask wearing when in proximity to others, positive social cognitions (e.g., I'll look confident and competent wearing a mask) were associated with more wearing, whereas negative social cognitions (e.g., I'll look anxious, I'll look foolish) were associated with less wearing. These results remained after controlling for factors that have indicated increased risk from COVID-19 (age, gender, ethnicity, presence of a health condition or pregnancy), belief about the health benefit for others and levels of depression and social anxiety. The largest predictors of mask wearing were the amount of people believed wearing a mask would keep others safe and the presence of an underlying health condition. The study findings indicate that future public health campaigns would benefit from a focus on strengthening beliefs about the protective benefits of masks, but also promoting positive social messages about wearing in public (e.g., mask wearing means you are confident and competent).

Influenza and influenza vaccination from the perspective of Czech pre-service teachers: knowledge and attitudes

OBJECTIVES

Influenza is a widespread respiratory disease with a potentially risky course. Vaccination is considered the most effective method of prevention. However, only a small portion of the population is vaccinated. Teachers work in a high-risk environment and they have a significant impact on the population through student education. Therefore, the aim of this study was to find out the knowledge and attitudes of pre-service teachers about influenza and vaccination.

METHODS

A questionnaire survey was conducted to find out what knowledge, attitudes and behaviour pre-service teachers (N = 373) show in relation to influenza and influenza vaccination. It was statistically tested whether there were differences between students with respect to their field of study.

RESULTS

The majority of pre-service teachers have a good knowledge of influenza symptoms, however, they often mistaken it for other respiratory diseases. The field of study plays only a partial role in the knowledge. The respondents perceive influenza as an easily spread disease, but they have negative attitudes towards vaccination, and most pre-service teachers think that its disadvantages outweigh the advantages. This was stated primarily by pre-services science teachers. These attitudes are also reflected in the low vaccination rate of the sample (6%).

CONCLUSIONS

Relatively good knowledge of teachers is not reflected in their attitudes and behaviour. Negative attitudes towards vaccination are most held by pre-service teachers, whose field primarily includes teaching this topic. It can have a significant effect on students' attitudes not only toward influenza vaccines but also to other vaccinations.

Hand Hygiene Practices and the Risk of Human Coronavirus Infections in a UK Community Cohort

Background: Hand hygiene may mitigate the spread of COVID-19 in community settings; however, empirical evidence is limited. Given reports of similar transmission mechanisms for COVID-19 and seasonal coronaviruses, we investigated whether hand hygiene impacted the risk of acquiring seasonal coronavirus infections. Methods: Data were drawn from three successive winter cohorts (2006-2009) of the England-wide Flu Watch study.  Participants ( n=1633) provided baseline estimates of hand hygiene behaviour. Coronavirus infections were identified from nasal swabs using RT-PCR. Poisson mixed models estimated the effect of hand hygiene on personal risk of coronavirus illness, both unadjusted and adjusted for confounding by age and healthcare worker status. Results: Moderate-frequency handwashing (6-10 times per day) predicted a lower personal risk of coronavirus infection (adjusted incidence rate ratio (aIRR) =0.64, p=0.04). There was no evidence for a dose-response effect of handwashing, with results for higher levels of hand hygiene (>10 times per day) not significant (aIRR =0.83, p=0.42). Conclusions: This is the first empirical evidence that regular handwashing can reduce personal risk of acquiring seasonal coronavirus infection. These findings support clear public health messaging around the protective effects of hand washing in the context of the current COVID-19 pandemic.

Barriers Associated with the Uptake Ratio of Seasonal Flu Vaccine and Ways to Improve Influenza Vaccination Coverage among Young Health Care Workers in Poland

Despite not being full-time health care workers, annual flu vaccination is nevertheless an important consideration for medical students. This study examined the reasons for refusing flu vaccination among medical students, a group characterized by low vaccination coverage, despite the fact that the flu vaccine is arguably the most effective way of preventing serious flu complications. A cross-sectional survey was performed of 1313 students at the Medical University of Lodz. The findings indicate that the main sites of vaccination were primary care centers, and main source of information about influenza vaccination (about 90% of cases) was the general practitioner (GP). The most common motivations for vaccination were a recommendation by the family doctor or the belief that it was an important factor for protection against influenza. Most students reported various adverse effects after vaccination, usually mild pain at the site of vaccination, malaise, or fever. The main reasons for rejecting influenza vaccination were the apparent low risk of disease, the need for annual vaccination, the need to pay for it, lack of time or opportunity, lack of vaccination promotion, negative attitudes toward the flu vaccine, or the belief that there are other methods of preventing flu. To increase long-term vaccine acceptance and increase the vaccination rate among medical students and qualified health care workers, there is a need to adapt the health system and to initiate ongoing promotion programs at university to raise consciousness, promote vaccinations, and develop clinical skills for immunization.

Handwashing Message Type Predicts Behavioral Intentions in the United States at the Beginning of the Global COVID-19 Pandemic

Handwashing has been widely recommended to reduce the spread of COVID-19. Despite this, handwashing behavior remains low in the general public. Social marketing has been employed as a successful health promotion strategy for changing many health behaviors in the past. The present study examines if message framing influences the effectiveness of a handwashing health promotion messages at the early stages of the COVID-19 pandemic. In a between-subjects cross-sectional experiment, participants (N = 344) in the United States were randomly assigned to view one of four handwashing messages or a control message before completing self-report measures of attitudes, emotions, readiness to change, and behavioral intentions around handwashing. Simple handwashing messages were presented with different framings, including a simple exchange message, a gain message, a social norm appeal, and a guilt appeal. Results revealed that message type influenced handwashing behavioral intentions and emotions. Post-hoc comparisons revealed that the simple exchange message produced significantly higher intentions than other messages and that only the simple exchange message significantly differed from the control message on emotions regarding handwashing. Mediational analyses showed handwashing emotions fully mediated the relationship between messaging and handwashing intentions. This mediation effect was moderated by age, such that it occurred for the younger and middle age participants, but not older participants. These results suggest that even simple, brief, and easily conveyable messages can positively impact behavioral intentions around handwashing during the early stages of a health crisis. Consistent with recent research comparing affective and cognitive pathways for health behavior, the mediational analysis suggests that effect of the simple exchange message on intentions was due to increased positive emotions around handwashing.

Impact of COVID-19 on paramedicine students: A mixed methods study

Background

Viral epidemics have negative and sometimes extreme impacts on psychological well-being, particularly in health care workers. Studies have reported higher levels of depression, anxiety, insomnia, stress, distress, fear, burnout, and post-traumatic symptoms.

Objective

This research aimed to explore the psychological impacts of COVID 19 on paramedicine students.

Methods

A convergent mixed method design study was undertaken using self-reporting instruments and qualitative interviews.

Results

Responses were received from 151 students (38.3% responses rate). Most students experienced some level of anxiety (62%), although severe levels were only reported by 6% of respondents. Students had significantly greater odds (OR = 2.05, p = 0.045, 95% CI: 1.02, 4.12) of higher anxiety levels if they were female. Thematic analysis of the interviews largely supported these results, with themes focused on changing approaches to study, financial situation, social support, University adaptation, acceptance and career pathway choice.

Conclusions

This study identified and explored the anxiety and coping strategies in an undergraduate paramedicine cohort when faced with a viral epidemic. Although most of the responding paramedic students reported above normal levels of anxiety in the initial stages of the COVID-19 outbreak, many students, with the help of learning, financial and social support, and a range of positive coping strategies, have adapted well to the impact of the pandemic and associated lockdown period.

The prevalence of preventive behaviors and associated factors during the early phase of the COVID-19 pandemic among Iranian People: Application of a Health Belief Model

INTRODUCTION

Coronavirus disease 2019 (COVID-19) has developed into a severe public health concern. The present study was aimed to evaluate the related preventive behaviors to COVID-19, and associated factors among Iranians based on the constructs of the Health Belief Model (HBM).

METHODS

This cross-sectional study was conducted between March and April 2020 among Iranians. Data of 1,020 people were collected by a self-administered questionnaire based on the constructs of HBM and also a demographics questionnaire. Simple and multivariable linear regression models were used to determine the predictors of preventive behaviors concerning COVID-19. A P-value of less than 0.05 was considered significant.

RESULTS

The mean score of preventive behaviors concerning COVID-19 was 4.27 (standard deviation = 0.60). 40.6% (95% CI: 38.6-43.7%), and 56.5% (95% CI: 53.4-59.5%) of the participants exhibited a high, and moderate level of preventive behaviors, respectively. 75.1% of the participants would always/often wear face masks out home or in crowded places. The most common preventive behaviors were using of personal belongings in the workplace or at home (96.1%) and staying at home except for very necessary or for work (92.9%). Results showed that all six HBM constructs, i.e., perceived susceptibility (B = 0.07, P < 0.001), perceived severity (B = 0.08, P < 0.001), perceived benefits (B = 0.25, P < 0.001), perceived barriers (B = -0.12, P = 0.001), cues to action (B = 0.07, P < 0.001), and self-efficacy (B = 0.26, P < 0.001) were significant predictors of related preventive behaviors to COVID-19. Female gender was another predictor of preventive behaviors (B = 0.18, P < 0.001).

CONCLUSIONS

This study demonstrated the effectiveness of HBM constructs in predicting COVID-19 preventive behaviors. Therefore, the model as a framework for designing training programs for improving health behaviors among Iranians during the COVID-19 pandemic seems to be helpful.

Knowledge, socio-cognitive perceptions and the practice of hand hygiene and social distancing during the COVID-19 pandemic: a cross-sectional study of UK university students

BACKGROUND

During the first wave of the COVID-19 pandemic, social distancing and hand hygiene have been the primary means of reducing transmission in the absence of effective treatments or vaccines, but understanding of their determinants is limited. This study aimed to investigate knowledge and socio-cognitive perceptions, and their associations with such protective behaviours, in UK university students.

METHODS

A cross-sectional online survey of 293 students was undertaken on 13 May 2020. Survey questions addressed demographics, knowledge of the disease and effectiveness of the protective measures, risk perception, socio-cognitive perceptions (e.g. attitude, social support, and self-efficacy), habit, time factors and trust, as well as the hand hygiene and social distancing behaviours. Multiple linear regression was used to identify the strongest associations of potential determinants with behaviour.

RESULTS

Participants reported high levels of social distancing with 88.9% answering "Mostly" or "Always" for every activity, but only 42.0% reporting the same for all hand hygiene activities. Knowledge of the effectiveness of each activity in preventing transmission was high, with 90.7% and 93.5% respectively identifying at least 7 of 8 hand hygiene or 9 of 10 social distancing activities correctly. Habit (β = 0.39, p = 0.001) and time factors (β = 0.28, p = 0.001) were the greatest contributors to unique variance in hand hygiene behaviour, followed by ethnicity (β = - 0.13, p = 0.014) and risk perception (β = 0.13, p = 0.016). For social distancing behaviour, the determinants were self-efficacy (β = 0.25, p < 0.001), perceived advantages (β = 0.15, p = 0.022), trust in policy (β = 0.14, p = 0.026) and gender (β = - 0.14, p = 0.016). Regression models explained 40% hand hygiene and 25% social distancing variance.

CONCLUSIONS

This study indicated that communications about effectiveness of hand hygiene and social distancing behaviours had been effective in terms of knowledge acquisition. However, in the light of likely second waves of COVID-19, attention to maintaining social distancing behaviour and improving hand hygiene behaviour may need to address more difficult areas of changing habits, overcoming time factors and building trust, as well as interventions to increase self-efficacy and address risk perception concerns.

Knowledge, Beliefs and Attitudes towards the Influenza Vaccine among Future Healthcare Workers in Poland

The flu vaccine is the best treatment for avoiding the flu and its complications. The aim of the study was to evaluate the knowledge of the flu vaccine and attitude towards the influenza vaccine among medical students in four majors of study (Nursing, Midwifery, Pharmacy, and Public health) in all years of study. A total number of 1137 subjects took part in the study. Most of the vaccinated students assessed the flu vaccine positively (78.5%, 73.7%, 60.7%, and 65.1%, according to their respective majors) and reported that they did not get the flu during the period of vaccination (90.4%, 92.1%, 87.4%, and 97.7%, respectively). Therefore, 65% of the students of Pharmacy, 78% of Midwifery, and 83% of Nursing who were vaccinated once in the last three years recommended the influenza vaccination, and 100% of all students received a regular vaccination every year. The univariate and multivariate logistic regressions showed that a maximum of four factors had a significant impact on the students’ knowledge of the influenza vaccine. Knowledge about the flu vaccine was the highest among Pharmacy students and lowest among Public health students. Final-year students answered the questions better than the younger ones (p < 0.05). Their place of residence and flu vaccination status also appeared to influence their answers. Although all students demonstrated good knowledge of the flu vaccine and demonstrated positive attitudes towards the vaccine, their rate of immunization was low. Therefore, health promotion programs are needed to improve immunization coverage among medical students who are future healthcare workers.

Development of a Haddon Matrix Framework for Higher Education Pandemic Preparedness: Scoping Review and Experiences of Malaysian Universities During the COVID-19 Pandemic

Managing education and research during pandemics has increased in importance since the onset of epidemics such as avian flu, SARS and now CoViD-19. Successful management in times of crisis ensures business continuity and institutional survival, making preparedness preceding an impending pandemic essential. Institutions of higher education (IHEs) must maintain balance between academic continuity and preventing morbidity during a pandemic crisis. To date, however, no general pandemic preparedness frameworks exist for IHEs. The aim of this paper is to report on the development of a Haddon matrix framework for IHE pandemic preparedness based on a scoping literature review of past IHE responses including pre-, during and post-pandemic phases. First, a review of previous global responses by IHEs during past pandemics was carried out. The review findings were then collated into a new IHE-centric Haddon matrix for pandemic preparedness. The content of the matrix is then illustrated through the documented responses of Malaysian universities during the early stages of the COVID-19 pandemic. The resulting IHE Haddon matrix can be used by universities as a general guide to identify preparedness gaps and intervention opportunities for business continuity during pandemics.

Effect of prosocial public health messages for population behaviour change in relation to respiratory infections: a systematic review protocol

INTRODUCTION

The COVID-19 pandemic represents a major societal challenge that requires large-scale behaviour change, widespread collective action and cooperation to reduce viral transmission. Existing literature indicates that several messaging approaches may be effective, including emphasising the benefits to the recipient, aligning with the recipient's moral values and focusing on protecting others. Current research suggests that prosocial public health messages that highlight behaviours linked to societal benefits (eg, protecting 'each other'), rather than focusing on behaviours that protect oneself (eg, protecting 'yourself'), may be a more effective method for communicating strategies related to infectious disease. To investigate this we will conduct a systematic review that will identify what messages and behaviour change techniques have the potential to optimise the effect on population behaviour in relation to reducing transmission of respiratory infections.

METHODS AND ANALYSIS

A systematic literature search of published and unpublished studies (including grey literature) in electronic databases will be conducted to identify those that meet our inclusion criteria. The search will be run in four electronic databases: MEDLINE, EMBASE, PsycINFO and Scopus. We will also conduct supplementary searches in databases of 'grey' literature such as PsycEXTRA, Social Science Research Network and OSF PREPRINTS, and use the Google Scholar search engine. A systematic approach to searching, screening, reviewing and data extraction will be applied based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Titles, abstracts and full texts for eligibility will be examined independently by researchers. The quality of the included studies will be assessed using the Cochrane Risk of Bias Tool and the Risk of Bias in Non-randomized Studies-of Interventions tool. Disagreements will be resolved by a consensus procedure.

ETHICS AND DISSEMINATION

This protocol has been registered with PROSPERO. No ethical approval is required, as there will be no collection of primary data. The synthesised findings will be disseminated through peer-reviewed publication.

PROSPERO REGISTRATION NUMBER

CRD42020198874.

University students' perceptions of airborne infection control: exploratory study using Q methodology

Background

International cooperation for infection control is important to prevent global pandemics. University students were difficult groups to manage of infection control measures. They often had overconfidence to their health, ineffective personal hygiene, and active social activities. Their misperceptions and inappropriate preventive behaviors increase the infection risks to university and community. Understanding university students’ perceptions of airborne infection management will contribute to the establishment of relevant policies and health education programs.

Method

This study explored subjective perceptions of airborne infection among university students in South Korea using Q-methodology. Forty university students representing different majors ranked a set of 33 statements reflecting their perceptions of airborne infection. They sorted the statements into a distribution on seven scales ranging from “strongly disagree” to “strongly agree.” Collected data were analyzed by the PC-QUANL program. The subjective perception types were extracted by using the principal component analysis.

Results

Four type are derived regardingperception of airborne infection: Type I (Government responsibility), Type II (Personal responsibility in self-management), Type III (Strict external management) and Type IV (Comprehensive countermeasures management). Thesefour types accounted for 45.6% of the total variance, and the individual contributions of Types I, II, III, and IV were 27.7, 7.6, 6.2, and 4.1%, respectively.

Conclusion

The major contribution of this study is to clarify university students’ perceptions of airborne infection. These findings can be used in formulating effective strategies for health education, media reporting, and public health policy to improve airborne infection management.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-09909-6.

An Otorhinolaryngologists Perspective on Using Face Masks by Health Care Professionals Based on an Online Survey

Acute respiratory infections pose a constant threat to society and health care professionals. The effectiveness of face masks covering mouth and nose in reducing aerosol spread and curbing respiratory infection acquisition is well-studied. Despite enough beneficial evidence in favour of wearing masks, general population and the health care workers needs to be convinced to wear it and often enforcement is required for the same. This study was designed to study various barriers perceived and experienced with poor mask usage among hospital staff from an otorhinolaryngological perspective. An online survey was conducted to study the awareness of health care professionals and other hospital staff about advantages and disadvantages of mask use. Total 100 questionnaire based responses were obtained using this method. The participants included the ministerial staff, nursing and paramedical staff and faculty and residents of various medical and surgical specialties. The data thus collected was analyzed to identify the perceived benefits and limitations in mask usage. The participants wore surgical mask more commonly (50%) as compared to N95 respirator and cloth mask. 58% of the participants were using masks due to professional need. Majority (40%) used masks for a period ranging from 4 to 8 h in a day. Most of the participants realized that the masks offered protection from aerosols (90%) and more than 60% also mentioned that it helped in avoiding touching the face inadvertently. 62% participants complained of fogging of vision while wearing masks and approximately 50% reported pain due to tight elastic bands, difficulty breathing through mask and excessive sweating in the masked area In non-pharmaceutical measures to contain the aerosol-associated pandemics, face masks play an important precautionary role. It is cheap, easy to use and protects against respiratory infections, pollution and allergies. Certain minor issues like fogging of spectacles, and difficulty breathing through mask may need revisions in mask fabric and design.

Awareness of H1N1 influenza among Pakistani pharmacy students

Aim — This study was aimed to investigate knowledge and attitudes of H1N1 influenza among pharmacy students. Material and Methods — A cross-sectional study was carried out among undergraduate and postgraduate students of the Punjab University College of Pharmacy, University of the Punjab, Lahore from February-May 2018. A self-administered questionnaire was used to evaluate knowledge and attitudes of H1N1 influenza. All data were analyzed using SPSS 22. Results — The median age of study participants (N=420) was 20 years, with majority of females (72.4%), undergraduate students (96.7%) belonging to middle economic class (89.8%). The median knowledge score was 18, with 38.1% having poor, 55.7% moderate and 6.2% excellent knowledge score (score <17, 17-25, and 26-34, respectively). The median attitude score was 47 (9); around 52% of the participants were found to have positive attitudes. Initially, there was a significant difference of knowledge score, not attitude, among age categories. However, in post hoc analysis, after Bonferroni adjustment (P<0.017), individuals > 26 years of age had better knowledge scores than 21-25 years (p=0.015) and ≤20 years (p=0.005) age categories. Gender had no significant influence on the knowledge as well as attitude score. Futhermore, postgraduate students had signifcanlty better knowledge scores, not attitude, than undergraduates (p=0.002). Conclusions — Our findings highlight the need to equip pharmacy students with comprehensive knowledge of H1N1 influenza so that in future they can help increase the public awareness at community pharmacies, hospitals or the communities they reside.

Travel health risk perceptions of Chinese international students in Australia - Implications for COVID-19

BACKGROUND

International students frequently return to their country of origin to visit friends and relatives (VFR), and are at increased risk of travel-associated infections. Little is known of their travel health seeking behaviours. China is the biggest source of international students studying in Australia and the unprecedented epidemic of COVID-19 in China makes this an important area of research.

METHODS

Focus groups of Chinese international students were conducted to explore travel health-related knowledge, attitudes and practices. Eligible participants were studying in Sydney, and had travelled to China and Hong Kong to visit friends and relatives in the preceding 18 months. A variety of topics were explored, using a focus group guide. Thematic analysis was undertaken on the transcripts using nVivo software. The list of codes and themes were not pre-determined but developed through content analysis.

RESULTS

Two focus groups were held with a total of 28 participants. Risk perception about VFR travel was generally low among Chinese international students. Pre-travel healthcare was not sought. Students strongly relied on the Internet, social media, parents and friends in China for travel health advice.

CONCLUSION

This research provides insights into Chinese international students as VFR travellers. It confirms students could be a risk population for importations of infections such as COVID-19 because of low risk perception and lack of seeking travel health advice. This can inform health promotion strategies for students.

Hand Hygiene Practices and the Risk of Human Coronavirus Infections in a UK Community Cohort

Background: Hand hygiene may mitigate the spread of COVID-19 in community settings; however, empirical evidence is limited. Given reports of similar transmission mechanisms for COVID-19 and seasonal coronaviruses, we investigated whether hand hygiene impacted the risk of acquiring seasonal coronavirus infections. Methods: Data were drawn from three successive winter cohorts (2006-2009) of the England-wide Flu Watch study.  Participants ( n=1633) provided baseline estimates of hand hygiene behaviour. Coronavirus infections were identified from nasal swabs using RT-PCR. Poisson mixed models estimated the effect of hand hygiene on personal risk of coronavirus illness, both unadjusted and adjusted for confounding by age and healthcare worker status. Results: Moderate-frequency handwashing (6-10 times per day) predicted a lower personal risk of coronavirus infection (adjusted incidence rate ratio (aIRR) =0.64, p=0.04). There was no evidence for a dose-response effect of handwashing, with results for higher levels of hand hygiene (>10 times per day) not significant (aIRR =0.83, p=0.42). Conclusions: This is the first empirical evidence that regular handwashing can reduce personal risk of acquiring seasonal coronavirus infection. These findings support clear public health messaging around the protective effects of hand washing in the context of the current COVID-19 pandemic.

Laypersons' perception of common cold and influenza prevention-a qualitative study in Austria, Belgium and Croatia

Background: Common cold and influenza result in an increased number of primary care consultations, significant work/school absences and cause a socio-economic burden. Laypeople’s perceptions and knowledge regarding common cold and influenza prevention is poorly understood and under-researched.

Objectives: Our study explores laypeople’s knowledge of prevention of common cold and influenza across three European countries. Furthermore, it investigates if there is any distinction between prevention activities focussing on reasons impacting the attitude towards influenza vaccination as well as investigating cross-country variation.

Methods: In total, 85 semi-structured individual interviews were performed across three European countries (Austria n = 31, Belgium n = 30, Croatia n = 24). Qualitative thematic content analysis was performed.

Results: Most participants across all three countries made no distinction between the prevention of the common cold and influenza and referenced the same preventative measures for both conditions. They mainly expressed negative attitudes towards influenza vaccination possibly effective but only intended for high-risk groups (bedridden/older people, chronic patients or health workers). There were very few cross-country differences in results.

Conclusion: The perception of health risk of contracting influenza and a primary healthcare physicians’ recommendation played an important role in shaping participants’ decisions towards vaccination. Primary healthcare physicians are invited to assess and if necessary adjust inappropriate prevention behaviour through their everyday patient consultations as well as add to the knowledge about influenza severity and influenza vaccination benefits to their patients.

Community perception about swine flu in an urban slum of Haryana: A cross-sectional study

BACKGROUND

Swine flu caused by influenza virus and it's a respiratory disease of pigs. The people like farmers and pork processors working in close proximity with pigs are at higher risk of getting swine flu. In India, a total of 117 deaths and 1,154 cases have been reported in the first two months of year 2018.

OBJECTIVES

To assess the community perception about Swine flu among adults in an urban slum of District Rohtak.

METHODOLOGY

The study was a community based epidemiological study with cross-sectional design and carried out by visiting house to house. The study recruited 500 adults of age 18-60 years.

RESULTS

The study found that there was no significant difference between gender and age with heard of swine flu while education wise (p= 0.002) and caste wise (p=0.011) awareness of swine flu was found to be statistically significant.

CONCLUSION AND RECOMMENDATION

The study concluded that the majority of subjects heard about swine flu and majority of subjects said that swine flu spread after coughing or sneezing. The study recommends that health care functionaries should spread awareness about signs and symptoms of swine flu.

Swine Flu: Knowledge, Attitude, and Practices Survey of Medical and Dental Students of Karachi

Introduction

Pakistan is extremely susceptible to an influenza outbreak, as it shares borders with the most affected countries, namely China and India. The medical and dental students come into direct contact with the affected population and should be aware of the risk factors and signs and symptoms pertaining to swine influenza virus (SIV). Hence, this survey was conducted to assess the knowledge, perceptions and self-care practices of the medical and dental students with regards to this pandemic.

Methods

A descriptive, cross-sectional study was conducted to evaluate the swine flu-related knowledge, attitudes and practices of the medical and dental students at various institutions in Karachi, Pakistan. We approached 613 students that were available on the dates of this survey, keeping a medical to dental student ratio of 75:25. All students from first to final year comprised of the study population, and no internists or medical personnel were included. The questionnaire was divided into three sections, namely knowledge, attitudes and, practices. All questions were based on a multiple choice format. The data were entered and interpreted using the IBM Statistical Package for the Social Sciences 23.0 (IBM Corp., Armonk, New York).

Results

The majority of the students were aware that the swine flu is a transmittable disease (n=485, 80.8%). Most students identified the signs and symptoms correctly; however, diarrhea (15.5%) and vomiting (32.2%) were the least correct answers (n=93, n=193 respectively). Most of the preventative measures were reported accurately by the participants. Despite this, only 15.5% students (n=93) reported the use of a facemask when suffering from fever, cough and a runny nose.

Conclusion

There is a dire need for the routine integration of the awareness and management programs in the medical and dental schools. There exists a gap between the policy and practice, and it is high time we bridge the divide. The students should also be vaccinated annually for influenza A.

Zika virus knowledge, attitudes, and vaccine interest among university students

BACKGROUND

Zika virus vaccine development is underway. We examined interest in receiving a Zika virus vaccine (after one becomes commercially available) among students at a large public university in Northern Virginia.

METHODS

An online survey of Zika virus-related knowledge, attitudes, and interest in receiving a Zika vaccine was completed by 619 undergraduate students in April, 2016. Stepwise logistic regression with backward elimination was used to identify the variables most strongly associated with interest in being vaccinated against Zika virus.

RESULTS

More than half of participants (52.8%) reported that they would be likely or very likely to be vaccinated against Zika virus. Vaccination interest was significantly higher among participants who received an influenza vaccine in the past year (p=0.002), had higher levels of knowledge about Zika virus (p=0.046), reported knowing where to access information about Zika virus (p=0.041), had higher perceived susceptibility to Zika virus (p<0.001), and believed that the U.S. Government should prioritize actions to control Zika virus (p=0.001).

CONCLUSIONS

Communication and intervention strategies encouraging vaccine uptake may benefit from increasing knowledge of Zika virus, addressing perceived susceptibility, and reaching students, travelers, and others who may be seeking information about prevention of Zika virus and other emerging infectious diseases.

The use of facemasks to prevent respiratory infection: a literature review in the context of the Health Belief Model

INTRODUCTION

Acute respiratory infections are prevalent and pose a constant threat to society. While the use of facemasks has proven to be an effective barrier to curb the aerosol spread of such diseases, its use in the local community is uncommon, resulting in doubts being cast on its effectiveness in preventing airborne infections during epidemics. We thus aimed to conduct a literature review to determine the factors that influence the use of facemasks as a primary preventive health measure in the community.

METHODS

A search for publications relating to facemask usage was performed on Medline, PubMed, Google, World Health Organization and Singapore government agencies' websites, using search terms such as 'facemask', 'mask', 'influenza', 'respiratory infection', 'personal protective equipment', 'disease prevention', 'compliance' and 'adherence'. Findings were framed under five components of the Health Belief Model: perceived susceptibility, perceived benefits, perceived severity, perceived barriers and cues to action.

RESULTS

We found that individuals are more likely to wear facemasks due to the perceived susceptibility and perceived severity of being afflicted with life-threatening diseases. Although perceived susceptibility appeared to be the most significant factor determining compliance, perceived benefits of mask-wearing was found to have significant effects on mask-wearing compliance as well. Perceived barriers include experience or perception of personal discomfort and sense of embarrassment. Media blitz and public health promotion activities supported by government agencies provide cues to increase the public's usage of facemasks.

CONCLUSION

Complex interventions that use multipronged approaches targeting the five components of the Health Belief Model, especially perceived susceptibility, are needed to increase the use of facemasks in the community. Further studies are required to evaluate the effectiveness of implemented interventions.

Perception of the A/H1N1 influenza pandemic and acceptance of influenza vaccination by Université Claude Bernard Lyon 1 staff: A descriptive study

We assessed the perception and attitudes of university staff, including medical school and other science specialties, toward the 2009 A/H1N1 influenza pandemic and influenza vaccination program. A cross-sectional online survey was conducted among 4,529 university personnel on October 19-20, 2009. Seven hundred (15%) employees participated in the study. Only 18% were willing to be vaccinated, men more than women (29% versus 9%, P < 0.001), and professors/researchers more than administrative/technical staff (30% vs. 6%, P < 0.001). Intention to be vaccinated was insufficient. Additional efforts are needed to improve information dissemination among university staff. Medical university personnel should receive more information to increase vaccine coverage and protect them as well as patients.

Using participatory action research to identify strategies to improve pandemic vaccination

OBJECTIVE

Developing and implementing effective strategies to increase influenza vaccination rates among health care personnel is an ongoing challenge, especially during a pandemic. We used participatory action research (PAR) methodology to identify targeted vaccination interventions that could potentially improve vaccine uptake in a medical center.

METHODS

Front-line medical center personnel were recruited to participate in 2 PAR teams (clinical and nonclinical staff). Data from a recent medical center survey on barriers and facilitators to influenza (seasonal, pandemic, and combination) vaccine uptake were reviewed, and strategies to increase vaccination rates among medical center personnel were identified.

RESULTS

Feasible, creative, and low-cost interventions were identified, including organizational strategies that differed from investigator-identified interventions. The recommended strategies also differed by team. The nonclinical team suggested programs focused on dispelling vaccination-related myths, and the clinical team suggested campaigns emphasizing the importance of vaccination to protect patients.

CONCLUSIONS

PAR methodology was useful to identify innovative and targeted recommendations for increasing vaccine uptake. By involving representative front-line workers, PAR may help medical centers improve influenza vaccination rates across all work groups.

Public perceptions of non-pharmaceutical interventions for reducing transmission of respiratory infection: systematic review and synthesis of qualitative studies

Background

Non-pharmaceutical public health interventions may provide simple, low-cost, effective ways of minimising the transmission and impact of acute respiratory infections in pandemic and non-pandemic contexts. Understanding what influences the uptake of non-pharmaceutical interventions such as hand and respiratory hygiene, mask wearing and social distancing could help to inform the development of effective public health advice messages. The aim of this synthesis was to explore public perceptions of non-pharmaceutical interventions that aim to reduce the transmission of acute respiratory infections.

Methods

Five online databases (MEDLINE, PsycINFO, CINAHL, EMBASE and Web of Science) were systematically searched. Reference lists of articles were also examined. We selected papers that used a qualitative research design to explore perceptions and beliefs about non-pharmaceutical interventions to reduce transmission of acute respiratory infections. We excluded papers that only explored how health professionals or children viewed non-pharmaceutical respiratory infection control. Three authors performed data extraction and assessment of study quality. Thematic analysis and components of meta-ethnography were adopted to synthesise findings.

Results

Seventeen articles from 16 studies in 9 countries were identified and reviewed. Seven key themes were identified: perceived benefits of non-pharmaceutical interventions, perceived disadvantages of non-pharmaceutical interventions, personal and cultural beliefs about infection transmission, diagnostic uncertainty in emerging respiratory infections, perceived vulnerability to infection, anxiety about emerging respiratory infections and communications about emerging respiratory infections. The synthesis showed that some aspects of non-pharmaceutical respiratory infection control (particularly hand and respiratory hygiene) were viewed as familiar and socially responsible actions to take. There was ambivalence about adopting isolation and personal distancing behaviours in some contexts due to their perceived adverse impact and potential to attract social stigma. Common perceived barriers included beliefs about infection transmission, personal vulnerability to respiratory infection and concerns about self-diagnosis in emerging respiratory infections.

Conclusions

People actively evaluate non-pharmaceutical interventions in terms of their perceived necessity, efficacy, acceptability, and feasibility. To enhance uptake, it will be necessary to address key barriers, such as beliefs about infection transmission, rejection of personal risk of infection and concern about the potential costs and stigma associated with some interventions.

The Role of Public Trust During Pandemics

The present review examined the importance of trust when preparing for and during a pandemic. The reviewed literature suggests that trust in health agencies positively influenced people’s willingness to adopt recommended behavior. Most of these studies are atheoretical, and due to the lack of a common framework for trust and its antecedents, finding commonalities among the studies may seem difficult. The trust, confidence, and cooperation model was used to uncover the commonalities among the various studies on trust. This framework suggests that a distinction between values and past performance may be helpful to better understand the impact of trust on risk perception and behavior. Based on the reviewed literature, the following five recommendations relevant for crisis communication during pandemics were identified: A diverse set of experts should be used as communicators, medical personnel need to model the recommended behavior, a transparent information strategy should be used, the focus should be not only on trust but also on confidence, and establishing trust in health authorities before a pandemic occurs is important. Furthermore, research gaps were identified that should be addressed to better understand the role of trust when dealing with pandemics.

A/H1N1 vaccine intentions in college students: an application of the theory of planned behavior

OBJECTIVE

To test the applicability of the Theory of Planned Behavior (TPB) in college students who have not previously received the A/H1N1 vaccine.

PARTICIPANTS

Undergraduate communication students at a metropolitan southern university.

METHODS

In January-March 2010, students from voluntarily participating communication classes completed a hardcopy survey assessing TPB and clinically significant constructs. Hierarchical regression equations predicted variance in vaccine intentions of students who had not received a flu shot (N=198; 70% Caucasian).

RESULTS

The TPB model explained 51.7% (p<.001) of variance in vaccine intentions. Controlling for side effects, self-efficacy and perceived comparative susceptibility predicted intentions when entered in the first block, whereas attitudes, subjective norms, and perceived behavioral control significantly contribute when entered in the second block.

CONCLUSIONS

For students who have not previously received a flu vaccine, vaccine communication should utilize self-efficacy and perceived comparative susceptibility to employ the TPB to promote vaccine intentions.