BackgroundPublic adherence to influenza vaccination recommendations has been low, particularly among younger adults and children under 2, despite the availability of safe and effective seasonal vaccine. Intention to receive 2009 pandemic influenza A (H1N1) vaccine has been estimated to be 50% in select populations. This report measures knowledge of and intention to receive pandemic vaccine in a population-based setting, including target groups for seasonal and H1N1 influenza.Methodology and Principal FindingsOn August 28–29, 2009, we conducted a population-based survey in 2 counties in North Carolina. The survey used the 30×7 two-stage cluster sampling methodology to identify 210 target households. Prevalence ratios (PR) and 95% confidence intervals (CI) were estimated. Knowledge of pandemic influenza A (H1N1) vaccine was high, with 165 (80%) aware that a vaccine was being prepared. A total of 133 (64%) respondents intended to receive pandemic vaccine, 134 (64%) intended to receive seasonal vaccine, and 109 (53%) intended to receive both. Reporting great concern about H1N1 infection (PR 1.55; 95%CI: 1.30, 1.85), receiving seasonal influenza vaccine in 2008–09 (PR 1.47; 95%CI: 1.18, 1.82), and intending to receive seasonal influenza vaccine in 2009–10 (PR 1.27; 95%CI: 1.14, 1.42) were associated with intention to receive pandemic vaccine. Not associated were knowledge of vaccine, employment, having children under age 18, gender, race/ethnicity and age. Reasons cited for not intending to get vaccinated include not being at risk for infection, concerns about vaccine side effects and belief that illness caused by pandemic H1N1 would be mild. Forty-five percent of households with children under 18 and 65% of working adults reported ability to comply with self-isolation at home for 7–10 days if recommended by authorities.Conclusions and SignificanceThis is the first report of a population based rapid assessment used to assess knowledge and intent to receive pandemic vaccine in a community sample. Intention to receive pandemic and seasonal vaccines was higher than previously published reports. To reach persons not intending to receive pandemic vaccine, public health communications should focus on the perceived risk of infection and concerns about vaccine safety.

More than a decade has passed since a conceptual framework was introduced to guide public health services and systems research (PHSSR) and elucidate the relationships associated with system performance. Since then, research has primarily focused on performance, standards, and key processes, with less emphasis on identification of measures or methods. Capacity lies at one end of the conceptual framework, although little emphasis has been placed on measuring and defining "capacity" of the public health system. This is striking, given organizational capacity is a critical determinant of performance and is necessary for understanding systematic effectiveness, sustainability, or generalizability. As a nascent field, PHSSR needs to develop a definition of organizational capacity and elucidate its relationship within a research framework. Evidence must be developed on the temporal and causal relationships between capacity, process/performance, and outcomes. The purpose of this article was to review research frameworks and capacity measures in various disciplines to expand the existing PHSSR conceptual framework.