title: The impact of communications about swine flu (influenza A H1N1v) on public responses to the outbreak: results from 36 national telephone surveys in the UK.
abstract: OBJECTIVE
  To assess the association between levels of worry about the possibility of catching swine flu and the volume of media reporting about it; the role of psychological factors in predicting likely uptake of the swine flu vaccine; and the role of media coverage and advertising in predicting other swine flu-related behaviours.
  
  
  METHODS
  Data from a series of random-digit-dial telephone surveys were analysed. A time series analysis tested the association between levels of worry and the volume of media reporting on the start day of each survey. Cross-sectional regression analyses assessed the relationships between likely vaccine uptake or behaviour and predictor variables.
  
  
  METHODS
  Thirty-six surveys were run at, on average, weekly intervals across the UK between 1 May 2009 and 10 January 2010. Five surveys (run between 14 August and 13 September) were used to assess likely vaccine uptake. Five surveys (1-17 May) provided data relating to other behaviours.
  
  
  METHODS
  Between 1047 and 1173 people aged 16 years or over took part in each survey: 5175 participants provided data about their likely uptake of the swine flu vaccine; 5419 participants provided data relating to other behaviours.
  
  
  METHODS
  All participants were asked to state how worried they were about the possibility of personally catching swine flu. Subsets were asked how likely they were to take up a swine flu vaccination if offered it and whether they had recently carried tissues with them, bought sanitising hand gel, avoided using public transport or had been to see a general practitioner, visited a hospital or called NHS Direct for a flu-related reason.
  
  
  RESULTS
  The percentage of 'very' or 'fairly' worried participants fluctuated between 9.6% and 32.9%. This figure was associated with the volume of media reporting, even after adjusting for the changing severity of the outbreak [chi2(1) = 6.6, p = 0.010, coefficient for log-transformed data = 2.6]. However, this effect only occurred during the UK's first summer wave of swine flu. In total, 56.1% of respondents were very or fairly likely to accept the swine flu vaccine. The strongest predictors were being very worried about the possibility of oneself [adjusted odds ratio (aOR) 4.7, 95% confidence interval (CI) 3.2 to 7.0] or one's child (aOR 8.0, 95% CI 4.6 to 13.9) catching swine flu. Overall, 33.1% of participants reporting carrying tissues with them, 9.5% had bought sanitising gel, 2.0% had avoided public transport and 1.6% had sought medical advice. Exposure to media coverage or advertising about swine flu increased tissue carrying or buying of sanitising hand gel, and reduced avoidance of public transport or consultation with health services during early May 2009. Path analyses showed that media coverage and advertising had these differential effects because they raised the perceived efficacy of hygiene behaviours but decreased the perceived efficacy of avoidance behaviours.
  
  
  CONCLUSIONS
  During the swine flu outbreak, uptake rates for protective behaviours and likely acceptance rates for vaccination were low. One reason for this may in part be explained by was the low level of public worry about the possibility of catching swine flu. When levels of worry are generally low, acting to increase the volume of mass media and advertising coverage is likely to increase the perceived efficacy of recommended behaviours, which, in turn, is likely to increase their uptake.
authors.affiliation: King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, UK.
authors.forename: G J
authors.initials: GJ
authors.lastname: Rubin
authors.forename: H W W
authors.initials: HW
authors.lastname: Potts
authors.forename: S
authors.initials: S
authors.lastname: Michie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003146:Communications Media; D054626:Consumer Health Information; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks / Q000517:prevention & control; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007252:Influenza Vaccines / Q000008:administration & dosage; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012044:Regression Analysis; D020377:Self Efficacy; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines