Intentions to Perform Non-Pharmaceutical Protective Behaviors during Influenza Outbreaks in Sweden: A Cross-Sectional Study following a Mass Vaccination Campaign

Abstract

Failure to incorporate the beliefs and attitudes of the public into theoretical models of preparedness has been identified as a weakness in strategies to mitigate infectious disease outbreaks. We administered a cross-sectional telephone survey to a representative sample (n = 443) of the Swedish adult population to examine whether self-reported intentions to improve personal hygiene and increase social distancing during influenza outbreaks could be explained by trust in official information, self-reported health (SF-8), sociodemographic factors, and determinants postulated in protection motivation theory, namely threat appraisal and coping appraisal. The interviewees were asked to make their appraisals for two scenarios: a) an influenza with low case fatality and mild lifestyle impact; b) severe influenza with high case fatality and serious disturbances of societal functions. Every second respondent (50.0%) reported high trust in official information about influenza. The proportion that reported intentions to take deliberate actions to improve personal hygiene during outbreaks ranged between 45–85%, while less than 25% said that they intended to increase social distancing. Multiple logistic regression models with coping appraisal as the explanatory factor most frequently contributing to the explanation of the variance in intentions showed strong discriminatory performance for staying home while not ill (mild outbreaks: Area under the curve [AUC] 0.85 (95% confidence interval 0.82;0.89), severe outbreaks AUC 0.82 (95% CI 0.77;0.85)) and acceptable performance with regard to avoiding public transportation (AUC 0.78 (0.74;0.82), AUC 0.77 (0.72;0.82)), using handwash products (AUC 0.70 (0.65;0.75), AUC 0.76 (0.71;0.80)), and frequently washing hands (AUC 0.71 (0.66;0.76), AUC 0.75 (0.71;0.80)). We conclude that coping appraisal was the explanatory factor most frequently included in statistical models explaining self-reported intentions to carry out non-pharmaceutical health actions in the Swedish outlined context, and that variations in threat appraisal played a smaller role in these models despite scientific uncertainties surrounding a recent mass vaccination campaign.

Determinants of the public intent to receive the seasonal influenza vaccine and protective behaviors: A population-based study in Taiwan

“…Knowledge of protective behaviors against influenza was associated with perceived changes in protective behaviors and an intent to receive an influenza vaccine, which is similar to the study among lay people and nurses [34,35], but inconsistent with previous findings regarding the intent to receive the H1N1 vaccine [4,36]. Although educational level was not associated with perceived changes in protective behaviors, similar to the H1N1 outbreak in Sweden [20], this finding contrasts with those of other studies [32,34,37]. This difference may reflect underlying differences in educational level in the study populations; our study population included more highly educated respondents.…”

“…Controlling for demographic variables, perceived fear of H1N1 still existed at the time of the survey and influenced the adoption of washing hands and wearing a face mask in public places against influenza, even though the H1N1 influenza pandemic had declined over one year in a manner similar to previous outbreaks, such as SARS, H5N1 influenza and H1N1 influenza [20,[31][32][33]. Our findings indicated that knowledge was the most common predictor for these four protective behaviors.…”

“…Additionally, age was collapsed into three groups (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49), and 50 and above), and educational level was measured with four levels (primary and under, junior high school, senior high school, and college and above).…”

“…Perceived risks (i.e., susceptibility/likelihood/vulnerability and severity/seriousness), self-efficacy, response and coping were commonly associated with non-pharmaceutical protective behaviors against influenza (i.e., avoiding public transportation, using hand-wash products and frequently washing hands [20].…”

Protection motivation theory and social distancing behaviour in response to a simulated infectious disease epidemic

“…Previous research has also identified the utility of these variables in predicting behavioural responses to respiratory infectious diseases (e.g., Teasdale et al, 2012;Timpka et al, 2014).…”