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

Impacts of COVID-19 on the oil and gas industry in Brazil

This study aimed to analyze the progression of COVID-19 cases on oil and gas workers in Brazil. This is a descriptive research based on secondary data available in the COVID-19 Monitoring Bulletins of the Ministry of Mines and Energy and news about outbreaks on digital media. The findings show that the numerous news reports published on digital media indicate unhealthy working conditions, and workers' representatives appear as the main source of these findings. Managers' failure in health surveillance of this working class were also observed as to the frequent omission of official data and compulsory notifications on the health and safety of oil and gas workers.

Survey on public awareness, attitudes and self-protective behavior adoption in different periods of COVID-19

Introduction

The outbreak and spread of the pandemics have been an issue of critical concern globally, posing a significant threat to the health sector globally. This study aimed to examine the basic knowledge and attitudes toward the recommended protective measures at different times, respond to the COVID-19 pandemic, and provide recommendations for developing targeted strategies and measures for preventing and controlling public health emergencies.

Methods

The study used self-filled questionnaires to examine the public's knowledge, attitudes, and practices on COVID-19 at two different period, from 20 to 31 March 2020 (the beginning period) and 22-27 April 2022 (the regular epidemic prevention and control period). Descriptive and quantitative analyses were used for statistical analysis.

Results and discussion

The survey collected 2375 valid questionnaires. A comparison of the two periods reveals that as the epidemic continued over a long period, the level of knowledge, attitudes toward preventive measures, risk perceptions, and adoption behavior of the respondents at the beginning of the epidemic were significantly higher than during the regular epidemic prevention and control period. With the upsurge in the spread of the epidemic, the public needs a multi-channel, targeted, and all-round guidance and information on prevention and control of the COVID-19, and internalizes knowledge into individual's behavior of actively responding to diseases.When the epidemic lasts for a long time, the relevant agencies should strengthen their monitoring role to promote public compliance with the recommended measures.

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.

Deep neural networks for simultaneously capturing public topics and sentiments during a pandemic. Application to a COVID-19 tweet dataset

Background

Public engagement is a key element for mitigating pandemics, and a good understanding of public opinion could help to encourage the successful adoption of public health measures by the population. In past years, deep learning has been increasingly applied to the analysis of text from social networks. However, most of the developed approaches can only capture topics or sentiments alone but not both together.

Objective

Here, we aimed to develop a new approach, based on deep neural networks, for simultaneously capturing public topics and sentiments and applied it to tweets sent just after the announcement of the COVID-19 pandemic by the World Health Organization (WHO).

Methods

A total of 1,386,496 tweets were collected, preprocessed, and split with a ratio of 80:20 into training and validation sets, respectively. We combined lexicons and convolutional neural networks to improve sentiment prediction. The trained model achieved an overall accuracy of 81% and a precision of 82% and was able to capture simultaneously the weighted words associated with a predicted sentiment intensity score. These outputs were then visualized via an interactive and customizable web interface based on a word cloud representation. Using word cloud analysis, we captured the main topics for extreme positive and negative sentiment intensity scores.

Results

In reaction to the announcement of the pandemic by the WHO, 6 negative and 5 positive topics were discussed on Twitter. Twitter users seemed to be worried about the international situation, economic consequences, and medical situation. Conversely, they seemed to be satisfied with the commitment of medical and social workers and with the collaboration between people.

Conclusions

We propose a new method based on deep neural networks for simultaneously extracting public topics and sentiments from tweets. This method could be helpful for monitoring public opinion during crises such as pandemics.

Changes in Preventive Behavior During the First 3 Months of the COVID-19 Outbreak in Iran

OBJECTIVES

Iran is facing a big challenge controlling the coronavirus disease 2019 (COVID-19) outbreak, and it is unclear to how individuals are engaging in preventive behaviors. This study aimed to investigate changes in preventive behaviors during the first 3 mo of the COVID-19 outbreak in Iran.

METHOD

This cross-sectional survey was conducted on 1477 adults aged 18 y and older in 31 provinces of Iran. Data were collected by an anonymous online questionnaire.

RESULT

Overall, engagement in preventive behaviors was relatively acceptable, and more than 45% of subjects always carried out all preventive behaviors. Engaging in all preventive behaviors had a peak in the second month and obviously declined during third month. Engagement in some preventive behaviors, such as "wearing a face mask" and "keeping a safe distance from others," was observed less than other behaviors. There was a statistically significant difference in the engagement in preventive behaviors by gender and occupation (P < 0.001).

CONCLUSIONS

Although engagement in preventive behaviors was relatively acceptable for the first 2 mo of the outbreak, it has declined gradually. This is a warning for public health decision makers. COVID-19 is still a crucial issue in Iran, and it is necessary that government decision be based on the fact that Iranian people must live with a coronavirus for months, with full caution and compliance toward all preventive care protocols.

Social distancing, trust and post-COVID-19 recovery

With the tourism and hospitality sector reopening post-lockdown of COVID-19, the recovery of customers' purchase intentions is essential to reboot the sector. This study aims to examine the relationship between social distancing measures and purchase intentions in the UK's restaurant and hotel sectors using a propensity score weighting experimental design method. The findings suggest that the impact of social distancing measures on purchase intentions is mediated by the trust in the targeted restaurant and hotel. Risk tolerance significantly moderates the influence of social distancing measures on trust; (non-) cash promotions have an insignificant impact on purchase intentions. The introduction of the propensity score weighting scheme addresses the endogeneity caused by the sampling bias in non-probability sampling experiment studies.

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.

A Web-Based Intervention (Germ Defence) to Increase Handwashing During a Pandemic: Process Evaluations of a Randomized Controlled Trial and Public Dissemination

Background

Washing hands helps prevent transmission of seasonal and pandemic respiratory viruses. In a randomized controlled trial (RCT) during the swine flu outbreak, participants with access to a fully automated, digital intervention promoting handwashing reported washing their hands more often and experienced fewer respiratory tract infections than those without access to the intervention. Based on these findings, the intervention was adapted, renamed as “Germ Defence,” and a study was designed to assess the preliminary dissemination of the intervention to the general public to help prevent the spread of seasonal colds and flu.

Objective

This study compares the process evaluations of the RCT and Germ Defence dissemination to examine (1) how web-based research enrollment procedures affected those who used the intervention, (2) intervention usage in the 2 contexts, and (3) whether increased intentions to wash hands are replicated once disseminated.

Methods

The RCT ran between 2010 and 2012 recruiting participants offline from general practices, with restricted access to the intervention (N=9155). Germ Defence was disseminated as an open access website for use by the general public from 2016 to 2019 (N=624). The process evaluation plan was developed using Medical Research Council guidance and the framework for Analyzing and Measuring Usage and Engagement Data. Both interventions contained a goal-setting section where users self-reported current and intended handwashing behavior across 7 situations.

Results

During web-based enrolment, 54.3% (17,511/32,250) of the RCT participants dropped out of the study compared to 36.5% (358/982) of Germ Defence users. Having reached the start of the intervention, 93.8% (8586/9155) of RCT users completed the core section, whereas 65.1% (406/624) of Germ Defence users reached the same point. Users across both studies selected to increase their handwashing in 5 out of 7 situations, including before eating snacks (RCT mean difference 1.040, 95% CI 1.016-1.063; Germ Defence mean difference 0.949, 95% CI 0.766-1.132) and after blowing their nose, sneezing, or coughing (RCT mean difference 0.995, 95% CI 0.972-1.019; Germ Defence mean difference 0.842, 95% CI 0.675-1.008).

Conclusions

By comparing the preliminary dissemination of Germ Defence to the RCT, we were able to examine the potential effects of the research procedures on uptake and attrition such as the sizeable dropout during the RCT enrolment procedure that may have led to a more motivated sample. The Germ Defence study highlighted the points of attrition within the intervention. Despite sample bias in the trial context, the intervention replicated increases in intentions to handwash when used “in the wild.” This preliminary dissemination study informed the adaptation of the intervention for the COVID-19 health emergency, and it has now been disseminated globally.

Trial Registration

ISRCTN Registry ISRCTN75058295; https://www.isrctn.com/ISRCTN75058295

Analysis of hand environment factors contributing to the hand surface infection barrier imparted by lactic acid

BACKGROUND

Organic acids on the surface of human hands contribute to the barrier against transient pathogens. This is the first study to explore the synergistic contribution of lactic acid and other hand environment-related features on the antibacterial properties of the hand surface.

MATERIALS AND METHODS

We estimated the contribution of fingerprint depth, skin pH, stratum corneum water content, skin temperature, and sweat rate of the hands to the infection barrier using an observational survey of 105 subjects. The relationship between each factor and the antibacterial activity of the hands was analyzed using Pearson's correlation coefficient. We performed molecular dynamics simulations to study the interaction between lactic acid and bacterial membranes.

RESULTS

The amount of lactic acid on the hands and skin temperature contributed positively to the antimicrobial activity (r = 0.437 and P = 3.18 × 10^-6 , r = 0.500 and P = 5.66 × 10^-8 , respectively), while the skin pH contributed negatively (r = -0.471, P = 3.99 × 10^-7 ). The predicted value of the combined antimicrobial effect of these parameters was [antimicrobial activity] = 0.21 × [lactic acid] - 0.25 × [skin pH] + 0.26 × [skin temperature] + 0.98. The coefficient of determination (R² ) was 0.50.

CONCLUSION

The increase in the amount of non-ionic lactic acid due to lower pH and improvement in the fluidity of the cell membrane due to higher temperatures enable the efficient transport of lactic acid into cells and subsequent antimicrobial activity. The proposed mechanism could help to develop an effective hand infection barrier technology.

The Influence of COVID-19 Information Sources on the Attitudes and Practices Toward COVID-19 Among the General Public of Saudi Arabia: Cross-sectional Online Survey Study

BACKGROUND

The COVID-19 pandemic has resulted in panic among the general public, leading many people to seek out information related to COVID-19 through various sources, including social media and traditional media. Identifying public preferences for obtaining such information may help health authorities to effectively plan successful health preventive and educational intervention strategies.

OBJECTIVE

The aim of this study was to examine the impact of the types of sources used for obtaining COVID-19 information on the attitudes and practices of the general public in Saudi Arabia during the pandemic, and to identify the socioeconomic and demographic factors associated with the use of different sources of information.

METHODS

This study used data from a cross-sectional online survey conducted on residents of Saudi Arabia from March 20 to 24, 2020. Data were analyzed using descriptive, bivariate, and multivariable logistic regression analyses. Bivariate analysis of categorical variables was performed to determine the associations between information sources and socioeconomic and demographic factors. Multivariable logistic regression analyses were employed to examine whether socioeconomic and demographic variables were associated with the source of information used to obtain information about COVID-19. Moreover, univariable and multivariable logistic regression analyses were conducted to examine how sources of information influence attitudes and practices of adhering to preventive measures.

RESULTS

In this analysis of cross-sectional survey data, 3358 participants were included. Most participants reported using social media, followed by the Ministry of Health (MOH) of the Kingdom of Saudi Arabia, as their primary source of information. Seeking information via social media was significantly associated with lower odds of having an optimistic attitude (adjusted odds ratio [aOR] 0.845, 95% CI 0.733-0.974; P=.02) and adhering to preventive measures (aOR 0.725, 95% CI 0.630-0.835; P<.001) compared to other sources of information. Participants who obtained their COVID-19 information via the MOH had greater odds of having an optimistic attitude (aOR 1.437, 95% CI 1.234-1.673; P<.001) and adhering to preventive measures (aOR 1.393, 95% CI 1.201-1.615; P<.001) than those who obtained information via other sources.

CONCLUSIONS

This study provides evidence that different sources of information influence attitudes and preventive actions differently within a pandemic crisis context. Health authorities in Saudi Arabia should pay attention to the use of appropriate social media channels and sources to allow for more effective dissemination of critical information to the public.

Attitudes Toward COVID-19 Vaccination Among Young Adults in Zurich, Switzerland, September 2020

Objectives: Young adults are essential to the effective mitigation of the novel coronavirus (SARS-CoV-2/COVID-19) given their tendency toward greater frequency of social interactions. Little is known about vaccine willingness during pandemics in European populations. This study examined young people's attitudes toward COVID-19 vaccines in Fall 2020. Methods: Data came from an ongoing longitudinal study's online COVID-19-focused supplement among young adults aged 22 in Zurich, Switzerland (N = 499) in September 2020. Logistic regressions examined young adults' likelihood of participating in COVID-19 immunization programs. Results: Approximately half of respondents reported being unlikely to get vaccinated against COVID-19. Compared to males, females were more likely to oppose COVID-19 vaccination (p < 0.05). In multivariate models, Sri Lankan maternal background and higher socioeconomic status were associated with a greater likelihood of getting vaccinated against COVID-19 (p < 0.05). Respondents were more likely to report a willingness to get vaccinated against COVID-19 when they perceived 1) an effective government response (p < 0.05) and 2) their information sources to be objective (p < 0.05). Conclusion: This study communicates aspects important to the development of targeted information campaigns to promote engagement in COVID-19 immunization efforts.

Community engagement for outbreak preparedness and response in high-income settings: A systematic review

BACKGROUND

This review aims to (i) identify and critique existing methods of community engagement for outbreak preparedness and response in high-income settings, and (ii) understand community members' experiences of community engagement, and their views and concerns towards pandemic planning/response.

METHODS

Following the PRISMA guidelines, a systematic review was conducted by searching Medline, Embase, PubMed, Global Health, CINAHL Plus and Scopus for publications from 2004 to June 2019. Potential literature was screened using explicit inclusion and exclusion criteria. Included studies were appraised using the Critical Appraisal Skills Programme Qualitative Research checklist. Those using deliberative approaches were appraised using additional criteria for judging deliberation quality. Thematic synthesis was then conducted.

RESULTS

Primary studies employed participatory research approaches, deliberative forums, interviews/focus groups to engage community members on pandemic planning/response with varying degrees of involvement and methodological rigour. This review indicates such endeavours must take into account instrumental and relational considerations: socioeconomic pressures; agency and capacity; diversity and divergent views; educate, communicate and engage; trust and transparency.

CONCLUSION

Community engagement for pandemic planning/response requires clear methods, processes and who 'community' constitutes. Instrumental and relational considerations must be addressed concurrently in pandemic planning/response to enhance preparedness for public health emergencies.

Exploring the social and emotional representations used by students from the University of the Basque Country to face the first outbreak of COVID-19 pandemic

In 2020, COVID-19, a new emerging infectious disease (EID), was spread throughout the world, including Europe. Spain, in particular, witnessed a significant outbreak of the pandemic. In consequence, all classes were cancelled and the Government declared a state of emergency, ordering the lockdown of the entire population from March to May. The aim of this research is to explore the impact of the COVID-19 outbreak on the representations of young university students from the University of the Basque Country and their emotional response when the crisis started. A free-association exercise was completed by 503 students from the University of the Basque Country (UPV/EHU) (Northern Spain). To analyze the content, the Reinert method was used with the Iramuteq software for lexical analysis. The results showed that students placed COVID-19 at a distance from the self, pointing out issues related to social response and disinformation, while showing concerns for self-related issues that are linked to negative emotions, academic consequences, and potentially close victims. The students' concerns were categorized at four main levels: the communicative-informative level, health-emotional level, community-social level, and academic level. All of this has created overwhelming feelings of nervousness, along with anger and emotional fatigue. These results indicate the necessity for universities to work from a holistic standpoint, not only in terms of responding to academic needs but also from psychological, communicative, social, health, and well-being perspectives.

The Role of Coping Strategies in Maintaining Well-Being During the COVID-19 Outbreak in South Korea

The COVID-19 pandemic continues to pose an unprecedented challenge for the world as people strive to cope with this significant threat to their well-being. This intensive longitudinal study of the first 94 days of the COVID-19 outbreak in South Korea (Phase 1: initial outbreak, Phase 2: intense social distancing) examined individuals’ changes in well-being, in relation to their use of coping strategies and fear of infection. A sample of 10,464 South Koreans participated in surveys during Phase 1 and Phase 2, resulting in 35,846 observations. Multilevel growth models revealed a decrease in well-being while different coping strategies moderated the individual rate of change in well-being. Although preventive measures were associated with a greater decrease in well-being, cognitive appraisal and behavioral strategies predicted stable well-being during the pandemic. Coping strategies further mediated the association between fear of infection and deterioration of well-being.

Containing COVID-19 by Matching Messages on Social Distancing to Emergent Mindsets-The Case of North America

Public compliance with social distancing is key to containing COVID-19, yet there is a lack of knowledge on which communication 'messages' drive compliance. Respondents (224 Canadians and Americans) rated combinations of messages about compliance, systematically varied by an experimental design. Independent variables were perceived risk; the agent communicating the policy; specific social distancing practices; and methods to enforce compliance. Response patterns to each message suggest three mindset segments in each country reflecting how a person thinks. Two mindsets, the same in Canada and the US, were 'tell me exactly what to do,' and 'pandemic onlookers.' The third was 'bow to authority' in Canada, and 'tell me how' in the US. Each mindset showed different messages strongly driving compliance. To effectively use messaging about compliance, policy makers may assign any person or group in the population to the appropriate mindset segment by using a Personal Viewpoint Identifier that we developed.

Social media use as a predictor of handwashing during a pandemic: evidence from COVID-19 in Malaysia

Although handwashing is an effective way to prevent infections, there is scarce evidence on predictors of handwashing during a pandemic. This paper aims to identify behavioural and demographic predictors of handwashing. The study surveyed 674 adults in Malaysia in May 2020 regarding whether the time spent on social media predicted handwashing contingent on gender and number of children. More time spent on social media was positively associated with handwashing for males with three or more children. However, for males without children, social media use was negatively associated with handwashing. The association was not significant for males with one or two children. For females, more time spent on social media was significantly linked to more handwashing only for females with one child. Gender, a traditional predictor of handwashing, was a useful predictor only for those who spent more than three hours per day on social media and had at most one child. Number of children was a novel negative predictor for males who did not use social media and who averaged one hour per day on social media, a positive predictor for males who spent lots of time on social media, but not a predictor for females. In sum, social media use predicts handwashing, and is thus a helpful variable for use in targeted health communication during a pandemic - particularly through social media. Further, more conventional predictors like gender and number of children exhibit contingency effects with social media use.

Social values, self- and collective efficacy explaining behaviours in coping with Covid-19: Self-interested consumption and physical distancing in the first 10 days of confinement in Spain

The appearance of a new coronavirus (Covid-19) and its rapid expansion throughout the world has forced all countries to establish regulations based on social confinement. In the early days of a pandemic, the adherence to regulations is crucial to be able to block its spread. This research aims to analyse the relationship between motivational variables associated with physical distancing and self-interested consumption behaviours in the first 10 days of confinement in Spain. A total of 1,324 people participated throughout the country (mean age 28.92 years). Participants answered an online survey about socio-demographic, motivational variables, which included a) risk information seeking, b) confidence in self- and collective efficacy in coping with the pandemic, and c) the four higher-order personal values ‒conservation (security, conformity, and tradition), self-transcendence (universalism and benevolence), openness (self-direction actions and stimulation), and self-improvement (hedonism and power) ‒ and the aforementioned behaviours in coping with Covid-19. Results showed a positive association between self- and collective efficacy and both coping behaviours analysed: a protective role of conservation values on normative behaviours; and a negative relationship between self-transcendence values and self-interested consumption. Additionally, risk information seeking was positively associated with the development of physical distancing behaviour.

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.

Social Distancing and Stigma: Association Between Compliance With Behavioral Recommendations, Risk Perception, and Stigmatizing Attitudes During the COVID-19 Outbreak

Introduction: Following behavioral recommendations is key to successful containment of the COVID-19 pandemic. Therefore, it is important to identify causes and patterns of non-compliance in the population to further optimize risk and health communication.

Methods: A total of 157 participants [80% female; mean age = 27.82 years (SD = 11.01)] were surveyed regarding their intention to comply with behavioral recommendations issued by the German government. Latent class analysis examined patterns of compliance, and subsequent multinomial logistic regression models tested sociodemographic (age, gender, country of origin, level of education, region, and number of persons per household) and psychosocial (knowledge about preventive behaviors, risk perception, stigmatizing attitudes) predictors.

Results: Three latent classes were identified: high compliance (25%) with all recommendations; public compliance (51%), with high compliance regarding public but not personal behaviors; and low compliance (24%) with most recommendations. Compared to high compliance, low compliance was associated with male gender [relative risk ratio (RRR) = 0.08 (0.01; 0.85)], younger age [RRR = 0.72 (0.57; 0.93)], and lower public stigma [RRR = 0.21 (0.05; 0.88)]. Low compliers were also younger than public compliers [RRR = 0.76 (0.59; 0.98)].

Discussion: With 25% of the sample reporting full compliance, and 51% differing in terms of public and personal compliance, these findings challenge the sustainability of strict regulatory measures. Moreover, young males were most likely to express low compliance, stressing the need for selective health promotion efforts. Finally, the positive association between public stigma and compliance points to potential othering effects of stigma during a pandemic, but further longitudinal research is required to examine its impact on health and social processes throughout the pandemic.

Personality Traits, Risk Perception, and Protective Behaviors of Arab Residents of Qatar During the COVID-19 Pandemic

During the 2020 COVID-19 pandemic, people in Qatar—similar to most countries globally—were instructed by health authorities to adopt protective behaviors to avoid infection. One of these behaviors is social distancing, which is influenced by diverse variables. Using data from an online survey with 405 responses, this study performed multiple regression analysis to explore effects of personality, risk perception, and personal hygiene practices on social distancing among residents of Qatar. The results showed that 87.3% of participants reported that they preferred to stay at home and not go outside unless necessary, 60.3% said that they maintain an adequate distance when communicating with others, 68.6% reported that they do not allow relatives and friends to visit them at home, 73.5% believed that COVID-19 is a dangerous disease, and 95.8% reported that they embrace personal hygiene practices and washing hands. Furthermore, multiple regression analysis showed that conscientiousness, neuroticism, risk perception, and personal hygiene practices predicted social distancing, with moderate effect sizes. Gender differences were also found in social distancing practices, indicating that women reported higher engagement in social distancing practices than men. These results highlighted the importance of individual differences in reacting to the COVID-19 pandemic and provide important information about the predictors of social distancing practices.

A study of handwashing training effects on awareness, attitude, and handwashing skills of third grade elementary school students

Background and Aims:

Hands are the first way of which many infectious diseases are transmitted. Hand hygiene is a means of infection control in schools. Close consideration of handwashing in educational units is important to control and prevent infection transmission. The present study aimed to determine the effect of handwashing education on awareness, attitude and handwashing skills of third-grade elementary school students in Tehran.

Methods:

In this study, 76 third grade students of elementary schools located at district 1 of Tehran with the mean age of 9 years were randomly divided into intervention and control groups using pre-test and post-test. Data collection for intervention and control groups was done using a researcher-made awareness- and attitude-gauging questionnaire, along with a checklist of handwashing performance which was completed in cooperation with the health instructor.

Results:

The results of this study showed that there was a significant difference between the awareness of 3^rd-grade students in intervention (69.79 ± 1.61) and control (49.03 ± 1.18) groups (P < 0.05). Moreover, students’ attitude toward handwashing improved as a result of education, and the intervention group (62.37 ± 0.65) had a more positive attitude toward hygiene and handwashing compared to the control group (48.45 ± 0.73) (P < 0.05). In the case of handwashing performance, the intervention group (56.76 ± 1.33) had better health performance compared to the control group (40.08 ± 0.67) (P < 0.05).

Conclusion:

Practical training, preparation of educational posters and videos can enhance awareness, attitude and handwashing performance.

A mixed-methods study on toilet hygiene practices among Chinese in Hong Kong

Background

Public toilets are a common transmission vector of infectious diseases due to environmental contamination. Research on Chinese people’s hygiene practices in public lavatories are lacking. This study examined Chinese people’s hygiene practices in public lavatories in Hong Kong.

Methods

We conducted qualitative interviews and a self-administered questionnaire survey with local residents from June 2016 to April 2018. Four focus group discussions and three individual interviews informed the design of the questionnaire. We recruited interviewees and survey respondents via social service centers. The interviews and questionnaire focused on the public’s daily practices and hygiene behaviors in public toilets. Content analysis of qualitative data was conducted. Multivariable logistic regressions were used to examine the association between age and toilet hygiene behaviors.

Results

Our qualitative component revealed a range of handwashing practices, from not washing at all, washing without soap, to washing for a longer time than instructions. Other toilet use practices were identified, such as not covering toilet lid before flushing and stepping on toilet seats due to dirtiness, and spitting into toilet bowls or hand basin.

Totally, 300 respondents completed the questionnaire. Among them, 212 (70.9%) were female and 246 (86.1%) were aged 65 or below. More than two thirds always washed hands with soap (68.7%) and dried hands with paper towels (68.4%). Up to 16.2% reported stepping on toilet seats and 43.9% never covered the toilet lid before flushing. Over one fourth (26.4%) spit into squat toilets/ toilet bowl. Regression analyses showed that the elderly group were less likely to report stepping on toilet seats (adjusted odds ratio, AOR = 0.17, 95%CI 0.03–0.88), flushing with the toilet lid closed (AOR = 0.40, 0.16–0.96), but more likely to spit into squat toilets/ toilet bowl (AOR = 4.20, 1.50–11.74).

Conclusions

Hong Kong Chinese’s compliance to hygiene practices in public toilets is suboptimal. Stepping on toilet seat is a unique Chinese practice due to the dirtiness of toilet seats. Spitting practices may increase the risk of airborne infectious diseases and need improvement. Measures are needed to improve toilet hygiene behaviors, including public education campaigns and keeping toilet environment clean.

The effect of training and awareness of subtle control on the frequency of hand hygiene among intensive care unit nurses

Objective

This study aimed to determine the effect of awareness of subtle control after training on the hand hygiene compliance among nurses in intensive care units (ICUs). The study was conducted in two ICUs of a trauma center in Shiraz, Iran on 48 nurses. The nurses of one ICU were randomly allocated to the intervention and the nurses of the other ICU were allocated to the control group. All nurses were trained on hand hygiene. Then a fake closed camera television (CCTV) was visibly installed in the intervention group’s ICU, while the nurses were aware of it. The degree of compliance with hand hygiene was observed in both groups before and after the intervention. Data were gathered using a checklist based on the World Health Organization hand hygiene protocol and analyzed using SPSS 16 and the Chi square, Wilcoxon, Mann–Whitney U, and Independent T-tests, were performed.

Results

The mean percentage of hand hygiene compliance in the intervention group after the intervention was significantly higher than before the intervention (p < 0.001). Additionally, the changes in the mean percentage of the intervention group was significantly higher than that for the control group (p = 0.001). The findings showed that a fake CCTV after training, installed in ICUs, can improve hand hygiene compliance.

Using an Analysis of Behavior Change to Inform Effective Digital Intervention Design: How Did the PRIMIT Website Change Hand Hygiene Behavior Across 8993 Users?

Background

In designing digital interventions for healthcare, it is important to understand not just whether interventions work but also how and for whom—including whether individual intervention components have different effects, whether a certain usage threshold is required to change behavior in each intervention and whether usage differs across population subgroups.

Purpose

We investigated these questions using data from a large trial of the digital PRimary care trial of a website based Infection control intervention to Modify Influenza-like illness and respiratory tract infection Transmission) (PRIMIT) intervention, which aimed to reduce respiratory tract infections (RTIs) by increasing hand hygiene behavior.

Method

Baseline and follow-up questionnaires measured behaviors, intentions and attitudes in hand hygiene. In conjunction with objective measures of usage of the four PRIMIT sessions, we analysed these observational data to examine mechanisms of behavior change in 8993 intervention users.

Results

We found that the PRIMIT intervention changed behavior, intentions and attitudes, and this change was associated with reduced RTIs. The largest hand hygiene change occurred after the first session, with incrementally smaller changes after each subsequent session, suggesting that engagement with the core behavior change techniques included in the first session was necessary and sufficient for behavior change. The intervention was equally effective for men and women, older and younger people and was particularly effective for those with lower levels of education.

Conclusions

Our well-powered analysis has implications for intervention development. We were able to determine a ‘minimum threshold’ of intervention engagement that is required for hand hygiene change, and we discuss the potential implications this (and other analyses of this type) may have for further intervention development. We also discuss the application of similar analyses to other interventions.

Translating concerns into action: a detailed qualitative evaluation of an interdisciplinary intervention on medical wards

OBJECTIVES

To understand how frontline reports of day-to-day care failings might be better translated into improvement.

DESIGN

Qualitative evaluation of an interdisciplinary team intervention capitalising on the frontline experience of care delivery. Prospective clinical team surveillance (PCTS) involved structured interdisciplinary briefings to capture challenges in care delivery, facilitated organisational escalation of the issues they identified, and feedback. Eighteen months of ethnography and two focus groups were conducted with staff taking part in a trial of PCTS.

RESULTS

PCTS fostered psychological safety-a confidence that the team would not embarrass or punish those who speak up. This was complemented by a hard edge of accountability, whereby team members would regulate their own behaviour in anticipation of future briefings. Frontline concerns were triaged to managers, or resolved autonomously by ward teams, reversing what had been well-established normalisations of deviance. Junior clinicians found a degree of catharsis in airing their concerns, and their teams became more proactive in addressing improvement opportunities. PCTS generated tangible organisational changes, and enabled managers to make a convincing case for investment. However, briefings were constrained by the need to preserve professional credibility, and staff found some comfort in avoiding accountability . At higher organisational levels, frontline concerns were subject to competition with other priorities, and their resolution was limited by the scale of the challenges they described.

CONCLUSIONS

Prospective safety strategies relying on staff-volunteered data produce acceptable, negotiated accounts, subject to the many interdisciplinary tensions that characterise ward work. Nonetheless, these strategies give managers access to the realities of frontline cares, and support frontline staff to make incremental changes in their daily work. These are goals for learning healthcare organisations.

TRIAL REGISTRATION

ISRCTN 34806867.

Knowledge, Attitude, and Performance of Nurses toward Hand Hygiene in Hospitals

INTRODUCTION

The proper hand hygiene is one of the foremost techniques to reduce Nosocomial infections. The hand hygiene is deemed as the simplest method for control of Nosocomial infections if it is done properly it may prevent from a lot of costs and fatalities. Due to constant relationship with patients, nurses play paramount role in proper execution of hand hygiene among clinical personnel. The current study was carried out in order to analyze knowledge, attitude, and performance of nurses regarding hand hygiene.

MATERIALS & METHODOLOGY

A cross-sectional study was conducted on 200 (of 240) nurses from three hospitals in Kerman city at east of Iran in 2015. The standardized questionnaire was the tool for data collection. These data entered in SPSS (V.22). The frequency and percentage of frequency in descriptive statistics was employed for data analysis. The confidence interval was considered as 95%.

RESULTS

The results showed that the majority of participants were male173 (86.5%), had BA degree 161 (80.5%) and were married 155 (70.5%). Most of nurses 77 (38.5%) had working experience (5-10years). The majority of nurses had good knowledge 149 (74.5%), positive attitude 141 (70.5%) and good performance 175 (87.5%).

DISCUSSION & CONCLUSION

The nurses are good level in terms of knowledge, attitude, and performance but improvement of their knowledge and knowledge seems to be more necessary by holding educational classes and courses in cases where they have less knowledge.

Future pandemics and vaccination: Public opinion and attitudes across three European countries

BACKGROUND

Understanding public opinion and attitudes regarding vaccination is crucial for successful outbreak management and effective communication at the European level.

METHODS

We explored national differences by conducting focus group discussions in The Netherlands, Poland and Sweden. Discussions were structured using concepts from behavioural models.

RESULTS

Thematic analysis revealed that participants would base their vaccination decision on trade-offs between perceived benefits and barriers of the vaccine also taking into account the seriousness of the new outbreak. Except for those having chronic diseases, participants expected a low infection risk, resulting in a low willingness to get vaccinated. Information about the health status of cases was considered important since this might change perceived susceptibility. Participants displayed concerns about vaccine safety due to the limited available time to produce and test vaccines in the acute situation of a new pandemic. Swedish participants mentioned their tendency of doing the right thing and following the rules, as well as to get vaccinated because of solidarity with other citizens and social influences. This appeared much less prominent for the Dutch and Polish participants. However, Swedish participants indicated that their negative experiences during the Influenza A/H1N1 2009 pandemic decreases their acceptance of future vaccinations. Polish participants lacked trust in their national (public) health system and government, and were therefore sceptical about the availability and quality of vaccines in Poland.

CONCLUSIONS

Although participants overall expressed similar considerations, important differences between countries stand out, such as previous vaccination experiences, the degree of adherence to social norms, and the degree of trust in health authorities.

The person-based approach to enhancing the acceptability and feasibility of interventions

Background

This paper provides three illustrations of how the “person-based approach” can be used to assess and enhance the acceptability and feasibility of an intervention during the early stages of development and evaluation. The person-based approach involves using mixed methods research to systematically investigate the beliefs, attitudes, needs and situation of the people who will be using the intervention. The in-depth understanding of users’ perspectives derived from this research then enables intervention developers to design or modify the intervention to make it more relevant, persuasive, accessible and engaging.

Methods

The first illustration describes how relevant beliefs and attitudes of people with asthma were identified from the existing qualitative and quantitative literature and then used to create guiding principles to inform the design of a web-based intervention to improve quality of life. The second illustration describes how qualitative “think-aloud” interviews and patient and public involvement (PPI) input are used to improve the acceptability of a booklet for people with asthma. In the third illustration, iterative think-aloud methods are used to create a more accurate and accessible activity planner for people with diabetes.

Results

In the first illustration of the person-based approach, we present the guiding principles we developed to summarise key design issues/objectives and key intervention features to address them. The second illustration provides evidence from interviews that positive, non-medical messages and images were preferred in booklet materials for people with asthma. The third illustration demonstrates that people with diabetes found it difficult to complete an online activity planner accurately, resulting in incorrect personalised advice being given prior to appropriate modification of the planner.

Conclusions

The person-based approach to intervention development can complement theory- and evidence-based development and participant input into intervention design, offering a systematic process for systematically investigating and incorporating the views of a wide range of users.

Electronic supplementary material

The online version of this article (doi:10.1186/s40814-015-0033-z) contains supplementary material, which is available to authorized users.

An internet-delivered handwashing intervention to modify influenza-like illness and respiratory infection transmission (PRIMIT): a primary care randomised trial

BACKGROUND

Handwashing to prevent transmission of respiratory tract infections (RTIs) has been widely advocated, especially during the H1N1 pandemic. However, the role of handwashing is debated, and no good randomised evidence exists among adults in non-deprived settings. We aimed to assess whether an internet-delivered intervention to modify handwashing would reduce the number of RTIs among adults and their household members.

METHODS

We recruited individuals sharing a household by mailed invitation through general practices in England. After consent, participants were randomised online by an automated computer-generated random number programme to receive either no access or access to a bespoke automated web-based intervention that maximised handwashing intention, monitored handwashing behaviour, provided tailored feedback, reinforced helpful attitudes and norms, and addressed negative beliefs. We enrolled participants into an additional cohort (randomised to receive intervention or no intervention) to assess whether the baseline questionnaire on handwashing would affect handwashing behaviour. Participants were not masked to intervention allocation, but statistical analysis commands were constructed masked to group. The primary outcome was number of episodes of RTIs in index participants in a modified intention-to-treat population of randomly assigned participants who completed follow-up at 16 weeks. This trial is registered with the ISRCTN registry, number ISRCTN75058295.

FINDINGS

Across three winters between Jan 17, 2011, and March 31, 2013, we enrolled 20,066 participants and randomly assigned them to receive intervention (n=10,040) or no intervention (n=10,026). 16,908 (84%) participants were followed up with the 16 week questionnaire (8241 index participants in intervention group and 8667 in control group). After 16 weeks, 4242 individuals (51%) in the intervention group reported one or more episodes of RTI compared with 5135 (59%) in the control group (multivariate risk ratio 0·86, 95% CI 0·83-0·89; p<0·0001). The intervention reduced transmission of RTIs (reported within 1 week of another household member) both to and from the index person. We noted a slight increase in minor self-reported skin irritation (231 [4%] of 5429 in intervention group vs 79 [1%] of 6087 in control group) and no reported serious adverse events.

INTERPRETATION

In non-pandemic years, an effective internet intervention designed to increase handwashing could have an important effect in reduction of infection transmission. In view of the heightened concern during a pandemic and the likely role of the internet in access to advice, the intervention also has potential for effective implementation during a pandemic.

FUNDING

Medical Research Council.

Public response to the 2014 chemical spill in West Virginia: knowledge, opinions and behaviours

Background

On January 9^th 2014, a faulty storage tank leaked 10,000 gal of an industrial coal processing liquid into the Elk River in West Virginia (WV), contaminating the drinking water of the nine counties collectively known as the Kanawha Valley. The aim of this study was to 1) explore how and when people obtained information about the water contamination and 2) understand how individual and social factors such as socio-demographic characteristics, timing of information, trust in government, and risk perception influenced compliance with recommended behaviours and the public’s views on the need for environmental regulations.

Methods

Between February 7–26, 2014, a survey was conducted of adult residents of West Virginia including geographic areas affected and non-affected by the chemical spill. The total population-based sample size was 690 and the survey was administered online. Descriptive statistics and multivariate statistical models were created to determine what factors influenced compliance and public opinions.

Results

Findings from this study show that, during the 2014 West Virginia water crisis, information about water contamination spread quickly, as 73 % of survey respondents across the state and 89 % within the affected counties reported they heard about the incident the same day it occurred. Most people received the information promptly, understood what happened, and understood what to do to prevent exposure to the contaminant. The majority of respondents living in affected counties (70 %) followed the recommended behaviours. Among participants who voiced an opinion on the role of government in environmental regulations, the majority of respondents (54 %) reported there is “too little regulation.”

Conclusion

Data from this study show that a higher perception of risk and timely receipt of information are associated with compliance with recommended behaviours, underlying the importance of releasing information to the public as quickly as possible during a crisis. This study also highlights the importance of coordinating risk communication activities beyond the area of the incident to assure public understanding of what measures are recommended, which are not and where.

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.

Factors associated with household transmission of pandemic (H1N1) 2009 among self-quarantined patients in Beijing, China

As the pandemic (H1N1) 2009 progressed, the Ministry of Health of China advised cases with mild symptoms to remain home for isolation and observation, which may have increased the risk for infection among other household members. Describing the transmission characteristics of this novel virus is indispensable to effectively controlling the spread of disease; thus, the aim of this study was to assess risk factors associated with household transmission of pandemic H1N1 from self-quarantined patients in Beijing, the capital city of China. A 1:2 case-control study with 54 case households and 108 control households was conducted between August 1 and September 30, 2009 in Beijing. Cases were households with a self-quarantined index patient and a secondary case, while controls were households with a self-quarantined index patient and a close contact. Controls were also matched to cases for sex and age of index case-patient. A structured interview guide was used to collect the data. Conditional logistical models were employed to estimate Odds Ratios (OR) with 95% confidence intervals (95% CI). Results indicated that higher education level (OR 0.42; 95% CI 0.22-0.83), sharing room with an index case-patient (OR 3.29; 95%CI 1.23-8.78), daily room ventilation (OR 0.28; 95%CI 0.08-0.93), and hand washing ≥ 3/d (OR 0.71; 95%CI 0.48-0.94) were related to the household transmission of pandemic H1N1 from self-quarantined patients. These results highlight that health education, as well as the quarantine of the index case-patient immediately after infection, frequent hand hygiene, and ventilation are critical to mitigating household spread of pandemic H1N1 virus and minimizing its impact. Household contacts should be educated to promote these in-home practices to contain transmission, particularly when household members are quarantined at home.

Understanding the school community's response to school closures during the H1N1 2009 influenza pandemic

Background

During the 2009 H1N1 influenza pandemic, Australian public health officials closed schools as a strategy to mitigate the spread of the infection. This article examines school communities’ understanding of, and participation in, school closures and the beliefs and values which underpinned school responses to the closures.

Methods

We interviewed four school principals, 25 staff, 14 parents and 13 students in five schools in one Australian city which were either fully or partially closed during the 2009 H1N1 pandemic.

Results

Drawing on Thompson et al’s ethical framework for pandemic planning, we show that considerable variation existed between and within schools in their attention to ethical processes and values. In all schools, health officials and school leaders were strongly committed to providing high quality care for members of the school community. There was variation in the extent to which information was shared openly and transparently, the degree to which school community members considered themselves participants in decision-making, and the responsiveness of decision-makers to the changing situation. Reservations were expressed about the need for closures and quarantine and there was a lack of understanding of the rationale for the closures. All schools displayed a strong duty of care toward those in need, although school communities had a broader view of care than that of the public health officials. Similarly, there was a clear understanding of and commitment to protect the public from harm and to demonstrate responsible stewardship.

Conclusions

We conclude that school closures during an influenza pandemic represent both a challenge for public health officials and a litmus test for the level of trust in public officials, government and the school as institution. In our study, trust was the foundation upon which effective responses to the school closure were built. Trust relations within the school were the basis on which different values and beliefs were used to develop and justify the practices and strategies in response to the pandemic.

The influenza A (H1N1) pandemic in Reunion Island: knowledge, perceived risk and precautionary behaviour

Background

The effectiveness of preventive measures depends on prevailing attitudes and mindsets within a population. Perceived risk is central to a shift in mindset and behaviour. The present study aims to investigate the perceived severity, vulnerability and precautionary behaviour adopted in response to the influenza A (H1N1) epidemic that broke out in 2009 on Reunion Island (Indian Ocean). As no H1N1 vaccination was available at the time, non-medical interventions appeared of crucial importance to the control of the epidemic.

Methods

A cross sectional survey was conducted in Reunion Island between November 2009 and April 2010 within 2 months of the passage of the influenza A (H1N1) epidemic wave. Individual contacts representing 725 households (one contact per household) were interviewed by telephone using validated questionnaires on perceived risks. Mean scores were calculated for perceived severity, vulnerability, efficacy of preventive measures and precautionary behaviour. Univariate analysis was applied to identify preventive measures and attitudes and multivariate analysis was used to study the determinants of precautionary behaviour.

Results

More than 95% of contacted persons accepted to participate to the survey. Eighty seven percent of respondents believed that prevention was possible. On average, three out of six preventive measures were deemed effective. Spontaneously, 57% of the respondents reported that they took one or more preventive measures. This percentage increased to 87% after the interviewer detailed possible precautions one by one. The main precautions taken were frequent hand washing (59%) and avoidance of crowded places (34%). In multivariate logistic regression analysis the following factors were significantly associated with taking one or more preventive measures: young age, previous vaccination against seasonal influenza, having had seasonal influenza in the last five years, effectiveness of the preventive measures taken and low standards of education.

Conclusion

Inhabitants of Reunion Island have expressed a preventive approach adapted to the realities of the H1N1 pandemic, a feature that likely reflects some preparedness gained after the large and severe chikungunya epidemic that hit the island in 2006. The degree of severity was well assessed despite the initial alarmist messages disseminated by national and international media. Precautions that were undertaken matched the degree of severity of the epidemic and the recommendations issued by health authorities. Further qualitative studies are needed to help adapting public messages to the social and cultural realities of diverse communities and to prevent misconceptions.

Representations of influenza and influenza-like illness in the community--a qualitative study

Background

There is little information regarding lay-people's representations of influenza and influenza-like illness in their day-to-day lives. An insight into these views may aid our understanding of community attitudes regarding official recommendations for its prevention.

Methods

This was a qualitative research. Semi-structured face-to-face interviews were conducted with 40 French participants from the community, and from five different locations. Questions elicited the participants' representations of onset of flu and influenza-like illness, as well as their views on what can/should be done to deal with symptoms and their personal experience with flu and flu-like symptoms.

Results

Thematic content analyses allowed us to identify five main themes: the presence of a clear continuum between influenza-like illness and flu; a description of flu as a very contagious disease; flu as being benign, except in "frail people", which the respondents never considered themselves to be; interruption of daily activities, which could be considered pathognomonic for influenza for most subjects; self-medication as the main current practice, and requests for healthcare mainly to confirm an auto-diagnosis.

Conclusions

There was a large homogeneity in the representation of flu. There was also a gap between people's representations (i.e., a continuum from having a "cold" to having "influenza") and scientific knowledge (i.e., a distinction between "true" influenza and influenza-like illnesses based on the existence of a confirmatory virological diagnosis). This gap raises issues for current campaigns for flu prevention, as these may not be congruent with the representation of flu being responsible for interrupting daily activities while also being seen as a non-severe disease, as well as the perception that flu is only a risk to "frail people" though no participants considered themselves to be "frail".

Reputation, relationships, risk communication, and the role of trust in the prevention and control of communicable disease: a review

Population-level compliance with health protective behavioral advice to prevent and control communicable disease is essential to optimal effectiveness. Multiple factors affect perceptions of trustworthiness, and trust in advice providers is a significant predeterminant of compliance. While competency in assessment and management of communicable disease risks is critical, communications competency may be equally important. Organizational reputation, quality of stakeholder relationships and risk information provision strategies are trust moderating factors, whose impact is strongly influenced by the content, timing and coordination of communications. This article synthesizes the findings of 2 literature reviews on trust moderating communications and communicable disease prevention and control. We find a substantial evidence base on risk communication, but limited research on other trust building communications. We note that awareness of good practice historically has been limited although interest and the availability of supporting resources is growing. Good practice and policy elements are identified: recognition that crisis and risk communications require different strategies; preemptive dialogue and planning; evidence-based approaches to media relations and messaging; and building credibility for information sources. Priority areas for future research include process and cost-effectiveness evaluation and the development of frameworks that integrate communication and biomedical disease control and prevention functions, conceptually and at scale.

Is abdominal obesity associated with the 2009 influenza A (H1N1) pandemic in Korean school-aged children?

Please cite this paper as: Kim et al. (2012) Is abdominal obesity associated with the 2009 influenza A (H1N1) pandemic in Korean school‐aged children? Influenza and Other Respiratory Viruses 6(5), 313–317.

Objective  Given their medical vulnerabilities, we investigated the epidemiological factors related to H1N1 infection in school‐aged children.

Methods  This study analyzed data collected on 7448 school‐aged children in South Korea between 18 November and 8 December 2009.

Results  We found that H1N1 infection was associated with body mass index (BMI), waist circumference (WC), the use of facemasks, contact history with H1N1‐infected persons, and overseas travel history (P < 0·05). In addition, WC quartiles were significantly associated with H1N1 infection after adjusting for BMI and other confounding variables [OR (95% CI): 1·00, 1·10 (0·72–1·45), 1·13 (0·76–1·67), and 2·71 (1·74–4·24), respectively).

Conclusions  Abdominal obesity and the use of facemasks appear to be independently associated with H1N1 infection in school‐aged children. We infer that providing education on wearing facemasks and specific planning for abdominally obese children and adolescents may be effective means of reducing the spread of the influenza pandemic in school‐aged children.

Understanding responses to government health recommendations: public perceptions of government advice for managing the H1N1 (swine flu) influenza pandemic

OBJECTIVE

To explore people's beliefs, perceptions, reasoning, and emotional and contextual factors that may influence responses to government recommendations for managing flu pandemics.

METHODS

Eleven focus groups were conducted with a purposive sample of 48 participants. Participants were invited to discuss their perceptions of the H1N1 pandemic and government advice on recommended actions for managing the H1N1 pandemic.

RESULTS

Thematic analysis showed that participants were skeptical about the feasibility and appropriateness of government recommendations for managing the H1N1 pandemic. They expressed doubts about self-diagnosis and concerns regarding the perceived effectiveness and costs of recommendations to stay home if unwell and get vaccinated.

CONCLUSIONS

Government advice is a specialized form of health communication with members of the public. People engage in an active process of evaluating government advice in terms of its credibility, feasibility and costs. To improve future pandemic preparedness, attempts should be made to elicit and address common doubts and concerns people have about following recommended advice.

PRACTICAL IMPLICATIONS

This study provides preliminary information on potential concerns and issues that could be addressed in future pandemic communications. Further research is needed to elicit and address the public perspective so that the impact of future pandemics may be reduced.

[Pandemic Influenza A (H1N1): changing population health habits in Cachoeira do Sul, Rio Grande do Sul State, Brazil, 2010]

This quantitative exploratory-descriptive study conducted from January 5 to February 26, 2010, focused on the population's health habits in Cachoeira do Sul, Rio Grande do Sul State, Brazil, before, during, and after the influenza A (H1N1) pandemic. The total population included 11,100 individuals listed in the telephone book, of which 519 (4.7%) were interviewed by telephone. Characteristics were: age range 18-90 years; 55.3% women; 22.7% with university diplomas; and 39.9% with secondary school diplomas. The following proportions of health habits were reported after the pandemic: 74% washed their hands frequently with soap and water and 39.2% cleaned their hands with alcohol gel; 94.6% covered their faces when they sneezed or coughed; 45.5% washed their hands after coughing/sneezing; 60.9% avoided touching the mucosa of their eyes, nose, and mouth; 21% avoided crowds; 85.7% attempted to keep rooms well ventilated. During the pandemic, the interviewees incorporated good habits in all the above measures, which were maintained to variable degrees even after the seven-month pandemic ended.

Factors associated with 2009 pandemic influenza A (H1N1) vaccination acceptance among university students from India during the post-pandemic phase

Background

There was a low adherence to influenza A (H1N1) vaccination program among university students and health care workers during the pandemic influenza in many parts of the world. Vaccination of high risk individuals is one of the recommendations of World Health Organization during the post-pandemic period. It is not documented about the student's knowledge, attitude and willingness to accept H1N1 vaccination during the post-pandemic period. We aimed to analyze the student's knowledge, attitude and willingness to accept H1N1 vaccination during the post-pandemic period in India.

Methods

Vaccine against H1N1 was made available to the students of Vellore Institute of Technology, India from September 2010. The data are based on a cross-sectional study conducted during October 2010 to January 2011 using a self-administered questionnaire with a representative sample of the student population (N = 802).

Results

Of the 802 respondents, only 102/802 (12.7%) had been vaccinated and 105/802 (13%) planned to do so in the future, while 595/802 (74%) would probably or definitely not get vaccinated in the future. The highest coverage was among the female (65/102, 63.7%) and non-compliance was higher among men in the group (384/595; 64.5%) (p < 0.0001). The representation of students from school of Bio-sciences and Bio-technology among vaccinees is significantly higher than that of other schools. Majority of the study population from the three groups perceived vaccine against H1N1 as the effective preventive measure when compared to other preventive measures. 250/595 (42%) of the responders argued of not being in the risk group. The risk perception was significantly higher among female (p < 0.0001). With in the study group, 453/802 (56.4%) said that they got the information, mostly from media.

Conclusions

Our study shows that the vaccination coverage among university students remains very low in the post-pandemic period and doubts about the safety and effectiveness of the vaccine are key elements in their rejection. Our results indicate a need to provide accessible information about the vaccine safety by scientific authorities and fill gaps and confusions in this regard.

Perceptions of and willingness to engage in public health precautions to prevent 2009 H1N1 influenza transmission

BACKGROUND

Recommendations about precautionary behaviors are a key part of public health responses to infectious disease threats such as the 2009 H1N1 pandemic. Individuals' interpretation of recommendations, willingness to comply, and factors predicting willingness were examined.

METHODS

A telephone survey of adult residents of New York State was conducted (N = 807). Respondents reported how they interpreted recommendations, willingness to engage in recommended actions, risk perceptions for H1N1 infection, and perceived efficacy of recommendations. Demographic characteristics were used to calculate sampling weights to obtain population-representative estimates.

RESULTS

There was substantial variability in interpretation of preventive actions. Willingness to engage in preventive actions also varied substantially; vaccination willingness was substantially lower than other preventive actions. No pattern of demographic characteristics consistently predicted willingness. Perceived efficacy was associated with willingness for all recommendations, and perceived severity was associated with willingness for some recommendations.

CONCLUSIONS

Results suggest that individual interpretation of actions differ widely. The results suggest that current recommendations are not clear to laypeople and are open to different interpretations. These varying interpretations should be considered in crafting public health messages about precautionary behaviors.

Knowledge and attitudes of healthcare workers in Chinese intensive care units regarding 2009 H1N1 influenza pandemic

BACKGROUND

To describe the knowledge and attitudes of critical care clinicians during the 2009 H1N1 influenza pandemic.

METHODS

A survey conducted in 21 intensive care units in 17 provinces in China.

RESULTS

Out of 733 questionnaires distributed, 695 were completed. Three hundred and fifty-six respondents (51.2%) reported their experience of caring for H1N1 patients. Despite the fact that 88.5% of all respondents ultimately finished an H1N1 training program, only 41.9% admitted that they had the knowledge of 2009 H1N1 influenza. A total of 572 respondents (82.3%) expressed willingness to care for H1N1 patients. Independent variables associated with increasing likelihood to care for patients in the logistic regression analysis were physicians or nurses rather than other professionals (odds ratio 4.056 and 3.235, p = 0.002 and 0.007, respectively), knowledge training prior to patient care (odds ratio 1.531, p = 0.044), and the confidence to know how to protect themselves and their patients (odds ratio 2.109, p = 0.001).

CONCLUSION

Critical care clinicians reported poor knowledge of H1N1 influenza, even though most finished a relevant knowledge training program. Implementation of appropriate education program might improve compliance to infection control measures, and willingness to work in a pandemic.

Demographic and attitudinal determinants of protective behaviours during a pandemic: a review

PURPOSE

A new strain of H1N1 influenza, also known as swine flu was confirmed in the UK in May 2009 and has spread to over 100 countries around the world causing the World Health Organization to declare a global flu pandemic. The primary objectives of this review are to identify the key demographic and attitudinal determinants of three types of protective behaviour during a pandemic: preventive, avoidant, and management of illness behaviours, in order to describe conceptual frameworks in which to better understand these behaviours and to inform future communications and interventions in the current outbreak of swine flu and subsequent influenza pandemics.

METHODS

Web of Science and PubMed databases were searched for references to papers on severe acute respiratory syndrome, avian influenza/flu, H5N1, swine influenza/flu, H1N1, and pandemics. Forward searching of the identified references was also carried out. In addition, references were gleaned from an expert panel of the Behaviour and Communications sub-group of the UK Scientific Pandemic Influenza Advisory Group. Papers were included if they reported associations between demographic factors, attitudes, and a behavioural measure (reported, intended, or actual behaviour).

RESULTS

Twenty-six papers were identified that met the study inclusion criteria. The studies were of variable quality and most lacked an explicit theoretical framework. Most were cross-sectional in design and therefore not predictive over time. The research shows that there are demographic differences in behaviour: being older, female and more educated, or non-White, is associated with a higher chance of adopting the behaviours. There is evidence that greater levels of perceived susceptibility to and perceived severity of the diseases and greater belief in the effectiveness of recommended behaviours to protect against the disease are important predictors of behaviour. There is also evidence that greater levels of state anxiety and greater trust in authorities are associated with behaviour.

CONCLUSIONS

The findings from this review can be broadly explained by theories of health behaviour. However, theoretically driven prospective studies are required to further clarify the relationship between demographic factors, attitudes, and behaviour. The findings suggest that intervention studies and communication strategies should focus on particular demographic groups and on raising levels of perceived threat of the pandemic disease and belief in the effectiveness of measures designed to protect against it.

Demographic and attitudinal determinants of protective behaviours during a pandemic: a review

PURPOSE

A new strain of H1N1 influenza, also known as swine flu was confirmed in the UK in May 2009 and has spread to over 100 countries around the world causing the World Health Organization to declare a global flu pandemic. The primary objectives of this review are to identify the key demographic and attitudinal determinants of three types of protective behaviour during a pandemic: preventive, avoidant, and management of illness behaviours, in order to describe conceptual frameworks in which to better understand these behaviours and to inform future communications and interventions in the current outbreak of swine flu and subsequent influenza pandemics.

METHODS

Web of Science and PubMed databases were searched for references to papers on severe acute respiratory syndrome, avian influenza/flu, H5N1, swine influenza/flu, H1N1, and pandemics. Forward searching of the identified references was also carried out. In addition, references were gleaned from an expert panel of the Behaviour and Communications sub-group of the UK Scientific Pandemic Influenza Advisory Group. Papers were included if they reported associations between demographic factors, attitudes, and a behavioural measure (reported, intended, or actual behaviour).

RESULTS

Twenty-six papers were identified that met the study inclusion criteria. The studies were of variable quality and most lacked an explicit theoretical framework. Most were cross-sectional in design and therefore not predictive over time. The research shows that there are demographic differences in behaviour: being older, female and more educated, or non-White, is associated with a higher chance of adopting the behaviours. There is evidence that greater levels of perceived susceptibility to and perceived severity of the diseases and greater belief in the effectiveness of recommended behaviours to protect against the disease are important predictors of behaviour. There is also evidence that greater levels of state anxiety and greater trust in authorities are associated with behaviour.

CONCLUSIONS

The findings from this review can be broadly explained by theories of health behaviour. However, theoretically driven prospective studies are required to further clarify the relationship between demographic factors, attitudes, and behaviour. The findings suggest that intervention studies and communication strategies should focus on particular demographic groups and on raising levels of perceived threat of the pandemic disease and belief in the effectiveness of measures designed to protect against it.

Using mixed methods to design a web-based behavioural intervention to reduce transmission of colds and flu

This mixed methods study informed the development of our web-based intervention to reduce the risk of transmission of respiratory infections. Two qualitative studies examined 28 users' responses to website materials, and elicited additional beliefs. A questionnaire study (N = 129) tested key intervention assumptions: that hand-washing is considered the most feasible preventive behaviour; behavioural determinants were related to behavioural intentions; beliefs related to hand-washing intentions and behaviour. Thematic analysis of the qualitative data revealed important issues, such as the belief that catching minor infections is beneficial to the immune system. The questionnaire results confirmed our assumptions, including hand-washing as the appropriate target behaviour.

Surfing the web during pandemic flu: availability of World Health Organization recommendations on prevention

Background

People often search for information on influenza A(H1N1)v prevention on the web. The extent to which information found on the Internet is consistent with recommendations issued by the World Health Organization is unknown.

Methods

We conducted a search for "swine flu" accessing 3 of the most popular search engines through different proxy servers located in 4 English-speaking countries (Australia, Canada, UK, USA). We explored each site resulting from the searches, up to 4 clicks starting from the search engine page, analyzing availability of World Health Organization recommendations for swine flu prevention.

Results

Information on hand cleaning was reported on 79% of the 147 websites analyzed; staying home when sick was reported on 77.5% of the websites; disposing tissues after sneezing on 75.5% of the websites. Availability of other recommendations was lower. The probability of finding preventative recommendations consistent with World Health Organization varied by country, type of website, and search engine.

Conclusions

Despite media coverage on H1N1 influenza, relevant information for prevention is not easily found on the web. Strategies to improve information delivery to the general public through this channel should be improved.

Perceptions and behaviors related to hand hygiene for the prevention of H1N1 influenza transmission among Korean university students during the peak pandemic period

Background

This study was performed to better assess the perceptions, motivating factors, and behaviors associated with the use of hand washing to prevent H1N1 influenza transmission during the peak pandemic period in Korea.

Methods

A cross-sectional survey questionnaire was completed by 942 students at a university campus in Suwon, Korea, between December 1 and 8, 2009. The survey included questions regarding individual perceptions, motivating factors, and behaviors associated with hand washing for the prevention of H1N1 influenza transmission.

Results

Compared to one year prior, 30.3% of participants reported increasing their hand washing frequency. Female students were more likely to practice more frequent hand washing. Women also perceived the effectiveness of hand washing to be lower, and illness severity and personal susceptibility to H1N1 infection to be higher. Study participants who were female (OR: 1.79-3.90) who perceived of hand washing to be effective (OR: 1.34-12.15) and illness severity to be greater (OR: 1.00-3.12) washed their hands more frequently.

Conclusions

Korean students increased their frequency of hand hygiene practices during the pandemic, with significant gender differences existing in the attitudes and behaviors related to the use of hand hygiene as a means of disease prevention. Here, the factors that affected hand washing behavior were similar to those identified at the beginning of the H1N1 or SARS pandemics, suggesting that public education campaigns regarding hand hygiene are effective in altering individual hand hygiene habits during the peak periods of influenza transmission.