Abstract
BackgroundThe outbreak of the pandemic flu, Influenza A H1N1 (Swine Flu) in early 2009, provided a major challenge to health services around the world. Previous pandemics have led to stockpiling of goods, the victimisation of particular population groups, and the cancellation of travel and the boycotting of particular foods (e.g. pork). We examined initial behavioural and attitudinal responses towards Influenza A, H1N1 ("Swine flu") in the six days following the WHO pandemic alert level 5, and regional differences in these responses.Methods328 respondents completed a cross-sectional Internet or paper-based questionnaire study in Malaysia (N = 180) or Europe (N = 148). Measures assessed changes in transport usage, purchase of preparatory goods for a pandemic, perceived risk groups, indicators of anxiety, assessed estimated mortality rates for seasonal flu, effectiveness of seasonal flu vaccination, and changes in pork consumptionResults26% of the respondents were 'very concerned' about being a flu victim (42% Malaysians, 5% Europeans, p < .001). 36% reported reduced public transport use (48% Malaysia, 22% Europe, p < .001), 39% flight cancellations (56% Malaysia, 17% Europe, p < .001). 8% had purchased preparatory materials (e.g. face masks: 8% Malaysia, 7% Europe), 41% Malaysia (15% Europe) intended to do so (p < .001). 63% of Europeans, 19% of Malaysians had discussed the pandemic with friends (p < .001). Groups seen as at 'high risk' of infection included the immune compromised (mentioned by 87% respondents), pig farmers (70%), elderly (57%), prostitutes/highly sexually active (53%), and the homeless (53%). In data collected only in Europe, 64% greatly underestimated the mortality rates of seasonal flu, 26% believed seasonal flu vaccination gave protection against swine flu. 7% had reduced/stopped eating pork. 3% had purchased anti-viral drugs for use at home, while 32% intended to do so if the pandemic worsened.ConclusionInitial responses to Influenza A show large regional differences in anxiety, with Malaysians more anxious and more likely to reduce travel and to buy masks and food. Discussions with family and friends may reinforce existing anxiety levels. Particular groups (homosexuals, prostitutes, the homeless) are perceived as at greater risk, potentially leading to increased prejudice during a pandemic. Europeans underestimated mortality of seasonal flu, and require more information about the protection given by seasonal flu inoculation.
Highlights
The outbreak of the pandemic flu, Influenza A H1N1 (Swine Flu) in early 2009, provided a major challenge to health services around the world
Behavioural change As shown in table 1 approximately a third of respondents reported they would use public transport less (116/320) or had contemplated cancelling or delaying flights (124/ 312), with this response more pronounced in Malaysia (respective x2 (1) = 21.91, 49.20, both p < .001)
Whilst around half (165/325) of our respondents reported they were at least 'somewhat concerned' about being a victim of the pandemic, this anxiety was stronger in Malaysia, where 71% (127/178) indicated they were at least 'somewhat concerned' (x2 (3) = 91.67, p < .001)
Summary
The outbreak of the pandemic flu, Influenza A H1N1 (Swine Flu) in early 2009, provided a major challenge to health services around the world. Previous pandemics have led to stockpiling of goods, the victimisation of particular population groups, and the cancellation of travel and the boycotting of particular foods (e.g. pork). 'Common sense', lay beliefs about those most likely to be at risk, and the appropriate behaviours to adopt to avoid infection, are often not taken into account by medical practitioners. Such beliefs have been shown to influence adherence and self-care behaviours [2]. During the SARS and Ebola outbreaks, association of the viruses with Chinese or African 'others' permitted Europeans to feel relatively safe from infection [3], and contributed to the victimisation of some Chinese in Toronto [4]. Faced with concerns about their mortality, individuals may turn to others for reassurance, but these social networks, by sharing their uncertainties, may sometimes contribute to greater stress [7]
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