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Lancet I.D. Public response to the 2009 influenza A H1N1 pandemic: a polling study in five countries

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  • Lancet I.D. Public response to the 2009 influenza A H1N1 pandemic: a polling study in five countries

    The Lancet Infectious Diseases, Early Online Publication, 5 October 2012
    doi:10.1016/S1473-3099(12)70206-2Cite or Link Using DOI
    This article can be found in the following collections: Public Health; Infectious Diseases (Anti-infective therapy, Healthcare-associated infections, Immunisation & vaccination, Respiratory tract infections); Respiratory Medicine (Respiratory tract infections)

    Public response to the 2009 influenza A H1N1 pandemic: a polling study in five countries
    Dr Gillian K SteelFisher PhD a Corresponding AuthorEmail Address, Robert J Blendon ScD a b, Johanna RM Ward MSc a, Robyn Rapoport MA c, Emily B Kahn PhD d, Katrin S Kohl MD e
    Summary

    Background
    Many important strategies to reduce the spread of pandemic influenza need public participation. To assess public receptivity to such strategies, we compared adoption of preventive behaviours in response to the 2009 H1N1 influenza pandemic among the public in five countries and examined whether certain non-pharmaceutical behaviours (such as handwashing) were deterrents to vaccination. We also assessed public support for related public health recommendations.
    Methods
    We used data from simultaneous telephone polls (mobile telephone and landline) in Argentina, Japan, Mexico, the UK, and the USA. In each country, interviews were done in a nationally representative sample of adults, who were selected by the use of random digit dial techniques. The questionnaire asked people whether or not they had adopted each of various preventive behaviours (non-pharmaceutical—such as personal protective and social distancing behaviour—or vaccinations) to protect themselves or their family from H1N1 at any point during the pandemic. Two-tailed t tests were used for statistical analysis.
    Findings
    900 people were surveyed in each country except the USA where 911 people were contacted. There were wide differences in the adoption of preventive behaviours between countries, although certain personal protective behaviours (eg, handwashing) were more commonly adopted than social distancing behaviours (eg, avoiding places where many people gather) across countries (53—89% vs 11—69%). These non-pharmaceutical behaviours did not reduce the likelihood of getting vaccinated in any country. There was also support across all countries for government recommendations related to school closure, avoiding places where many people gather, and wearing masks in public.
    Interpretation
    There is a need for country-specific approaches in pandemic policy planning that use both non-pharmaceutical approaches and vaccination.
    Funding
    US Centers for Disease Control and Prevention and the National Public Health Information Coalition.


  • #2
    Re: Lancet I.D. Public response to the 2009 influenza A H1N1 pandemic: a polling study in five countries

    The Lancet Infectious Diseases, Early Online Publication, 5 October 2012
    doi:10.1016/S1473-3099(12)70244-XCite or Link Using DOI

    Public behaviour and the response to pandemic influenza


    Enrique Castro S?nchez a, Alison Holmes aEmail Address
    Providing an effective response to emerging infectious diseases remains a pressing global health challenge; the 2009 H1N1 influenza pandemic is a salient example. 1 Governments and international organisations have to promptly implement feasible and proportionate health-protection measures, while accepting the limitations of the scientific evidence used to underpin those measures. 2 Much of the success of pandemic responses will then depend on the extent of adoption or modification of recommended beh ...

    Comment


    • #3
      Re: Lancet I.D. Public response to the 2009 influenza A H1N1 pandemic: a polling study in five countries

      The Lancet Infectious Diseases, Volume 13, Issue 7, Pages 567 - 568, July 2013

      doi:10.1016/S1473-3099(13)70097-5Cite or Link Using DOI
      Copyright © 2013 Elsevier Ltd All rights reserved.

      Behavioural research in epidemics

      Laëtitia Atlani-Duault a bEmail Address, Cécile Rousseau c, Jean-Paul Moatti a, Jean-François Delfraissy d e, Bernadette Murgue f
      Gillian SteelFisher and colleagues1 examined public adoption of preventive behaviours and public health responses to the 2009 influenza A H1N1 pandemic in five countries. The authors found wide variation across countries, and suggest that many factors might explain the variation, “including the prevalence of the illness, government responses, availability and cost of interventions, the media's portrayal of these factors, as well as each country's culture, values, and practices”.
      In our comparative study of H1N1 public communication, risk perception, and immunisation behaviour in two countries that adopted similar policies (mass vaccination offered free of charge to the general population in ad hoc vaccination centres) but ultimately reached very different H1N1 immunisation rates (France 8%, Quebec 57%), the credibility of government institutions emerged as salient.2 Using quantitative and qualitative methods, we found major differences between the countries in perceptions of who was in charge and who was credible.
      In Quebec, health professionals, experts, and politicians were united around the vaccination campaign. The non-governmental press council coordinated the dissemination of public health information, and media coverage was largely supportive. Interestingly, although H1N1 immunisation rates were high, a substantial decrease in seasonal influenza vaccination followed the H1N1 pandemic, validating Washer's concerns regarding relentless risk discourses.3
      In France, contradictory messages were rife. The media gave considerable space to experts who opposed immunisation, and family doctors—traditionally in charge of immunisation in France—were not involved in the H1N1 campaign.4 Government credibility was low; callers to H1N1 hotlines often cited the 1986 Chernobyl catastrophe, in which the French government minimised dangers associated with radiation. However, whereas H1N1 immunisation rates were low, seasonal influenza immunisation rates were not notably affected.
      Communication about pandemics such as influenza is not simply a technical challenge.5 Coordination among public health officials, governments, and the media can be effective in promoting preventive behaviour as a crisis unfolds. However, additional, more complex strategies, such as contextualising information to enhance personal agency and local identification of credible spokespeople in preparation of such events, should be explored.
      We declare that we have no conflicts of interest.

      Comment


      • #4
        Re: Lancet I.D. Public response to the 2009 influenza A H1N1 pandemic: a polling study in five countries

        The Lancet Infectious Diseases, Volume 13, Issue 7, Page 567, July 2013

        doi:10.1016/S1473-3099(13)70096-3Cite or Link Using DOI
        Copyright © 2013 Elsevier Ltd All rights reserved.

        Behavioural research in epidemics

        Qiuyan Liao aEmail Address, Richard Fielding a
        Description of basic public behavioural responses during a pandemic might improve prediction of epidemic development, but this is unlikely. An important aim of behavioural research in epidemics is to reveal the underlying determinants of individual and population behavioural responses that inform policy making for effective and practical public health intervention and risk communication. Good behavioural research should not only elucidate the effectiveness of these determinants on behaviour change, but also clarify the mechanisms underpinning these. However, Gillian SteelFisher and colleagues1 simply compared public protective behaviours across five countries and identified compliance variations among these countries, adding little to existing studies.
        International comparisons can be of interest, but although the authors suggested some underlying factors that might account for the observed variations, they did not consider the wider spectrum of existing behavioural research on influenza-epidemic and related behaviour, much of which has already addressed these questions. SteelFisher and colleagues' study results provide no information on what interventions might be implemented to improve public adoption of health protective behaviours and what could be done in future pandemics to control the spread of the diseases. Much behavioural research remains without a sound theoretical basis. Behavioural research developed and done on strong theoretical grounds is likely to provide better evidence for implementation practices.
        We declare that we have no conflicts of interest.

        Comment


        • #5
          Re: Lancet I.D. Public response to the 2009 influenza A H1N1 pandemic: a polling study in five countries

          The Lancet Infectious Diseases, Volume 13, Issue 7, Page 568, July 2013

          doi:10.1016/S1473-3099(13)70157-9Cite or Link Using DOI
          Copyright ? 2013 Elsevier Ltd All rights reserved.

          Behavioural research in epidemics ? Authors' reply

          Gillian K SteelFisher aEmail Address, Robert J Blendon a
          Liao and Fielding raise an interesting point about the usefulness of our research examining public response to the influenza A H1N1 pandemic in five countries. However, the intent of our study was somewhat different from that which they suggest; it was to address three key questions related to future global pandemic policy that require multinational comparative data for multiple behaviours.
          First, we examined whether the public's adoption of protective behaviours across countries varied or had largely similar rates. This information can help to establish whether pandemic response policies can be quite uniform at the global level or whether responses need to be more country-specific. The data clearly show great variation in the adoption of behaviours and support the need for country-specific, contextualised policies and communication approaches. We thank Atlanti-Duault and colleagues for their complementary study showing the importance of contextualisation of communications using the example of France and Quebec. Our study also shows global patterns in that the public in all countries studied were more likely to adopt personal protective behaviours compared with social distancing ones and that vaccination levels were fairly low across the board. Such information provides insights into the challenges that countries share, even as they must contextualise their responses.
          Second, we examined whether the adoption of non-pharmaceutical behaviours was a deterrent to vaccination, which can address concerns about the effect of promotion of potentially contradictory behaviours. We found no evidence that non-pharmaceutical behaviours were a deterrent to vaccination in any country studied. Thus, the data suggest it is possible to develop policies supporting both kinds of protective behaviours, which might help to maximise people's opportunities to protect themselves in future pandemics.
          Third, we examined public support for future government policies directly. We learned that all countries showed relatively high support for government policies that promote mask-wearing, school closures, and avoidance of public gathering sites like shopping centres. Such evidence can directly inform country policies in future pandemics.
          These conclusions are crucially important and need the scale of our study's design. Moreover, we could find no studies that provide such data within the H1N1 or pandemic literature. Thus, we believe this study provides a unique contribution that we hope will help inform global and country-specific responses that help to reduce the burden of illness in the case of future pandemics. We also hope it spurs additional research like that of Atlanti-Duault and colleagues.
          GKS's husband has consulted for Eli Lilly. We declare that we have no conflict of interest.

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