Abstract
BackgroundDuring the 2009-2010 A(H1N1) pandemic, many people did not seek care quickly enough, failed to take a full course of antivirals despite being authorised to receive them, and were not vaccinated. Understanding facilitators and barriers to the uptake of vaccination and antiviral medicines will help inform campaigns in future pandemic influenza outbreaks. Increasing uptake of vaccines and antiviral medicines may need to address a range of drivers of behaviour. The aim was to identify facilitators of and barriers to being vaccinated and taking antiviral medicines in uncertain and severe pandemic influenza scenarios using a theoretical model of behaviour change, COM-B.MethodsFocus groups and interviews with 71 members of the public in England who varied in their at-risk status. Participants responded to uncertain and severe scenarios, and to messages giving advice on vaccination and antiviral medicines. Data were thematically analysed using the theoretical framework provided by the COM-B model.ResultsInfluences on uptake of vaccines and antiviral medicines - capabilities, motivations and opportunities - are part of an inter-related behavioural system and different components influenced each other. An identity of being healthy and immune from infection was invoked to explain feelings of invulnerability and hence a reduced need to be vaccinated, especially during an uncertain scenario. The identity of being a ‘healthy person’ also included beliefs about avoiding medicine and allowing the body to fight disease ‘naturally’. This was given as a reason for using alternative precautionary behaviours to vaccination. This identity could be held by those not at-risk and by those who were clinically at-risk.ConclusionsPromoters and barriers to being vaccinated and taking antiviral medicines are multi-dimensional and communications to promote uptake are likely to be most effective if they address several components of behaviour. The benefit of using the COM-B model is that it is at the core of an approach that can identify effective strategies for behaviour change and communications for the future. Identity beliefs were salient for decisions about vaccination. Communications should confront identity beliefs about being a ‘healthy person’ who is immune from infection by addressing how vaccination can boost wellbeing and immunity.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1541-8) contains supplementary material, which is available to authorized users.
Highlights
During the 2009-2010 A(H1N1) pandemic, many people did not seek care quickly enough, failed to take a full course of antivirals despite being authorised to receive them, and were not vaccinated
The focus of this paper is on facilitators and barriers to uptake of pandemic influenza vaccination, because participants knew relatively little about antiviral medicines and were less able to discuss them
Responses to advice about antiviral medicine were more limited, as the participants were largely unfamiliar with these medicines, but were broadly similar to responses to advice about being vaccinated; any differences are highlighted after the responses in common are presented
Summary
During the 2009-2010 A(H1N1) pandemic, many people did not seek care quickly enough, failed to take a full course of antivirals despite being authorised to receive them, and were not vaccinated. Data from the UK National Pandemic Flu Service (NPFS) indicated that of the 1.8 m courses of antiviral medicines that were authorised, only 1.16 million were collected and many patients failed to complete a full course [7]. This suggests that there is a need to develop effective communications to improve uptake and to consider how best to advise the public on the nature of the disease, why they should seek prevention (vaccination) or treatment (antiviral medication), who should seek it and when
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