title: 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.
authors.affiliation: Department of Public Health, Östergötland County Council, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Toomas
authors.initials: T
authors.lastname: Timpka
authors.affiliation: Department of Public Health, Östergötland County Council, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Armin
authors.initials: A
authors.lastname: Spreco
authors.affiliation: National Strategies Support Directorate, ANSER/Analytic Services Inc, Arlington, Virginia, United States of America.
authors.forename: Elin
authors.initials: E
authors.lastname: Gursky
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Olle
authors.initials: O
authors.lastname: Eriksson
authors.affiliation: Linnaeus Centre HEAD, Department of Behavioural Sciences, Linköping University, Linköping, Sweden.
authors.forename: Örjan
authors.initials: Ö
authors.lastname: Dahlström
authors.affiliation: Department of Geography and Economic History, Umeå University, Umeå, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Strömgren
authors.affiliation: Department of Public Health, Östergötland County Council, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Joakim
authors.initials: J
authors.lastname: Ekberg
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Sofie
authors.initials: S
authors.lastname: Pilemalm
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: David
authors.initials: D
authors.lastname: Karlsson
authors.affiliation: Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: Jorma
authors.initials: J
authors.lastname: Hinkula
authors.affiliation: Department of Geography and Economic History, Umeå University, Umeå, Sweden.
authors.forename: Einar
authors.initials: E
authors.lastname: Holm
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003710:Demography; D004196:Disease Outbreaks; D005260:Female; D006235:Hand Disinfection; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007251:Influenza, Human / Q000453:epidemiology* / Q000517:prevention & control* / Q000523:psychology; D033182:Intention; D016015:Logistic Models; D008297:Male; D032541:Mass Vaccination; D008875:Middle Aged; D012307:Risk Factors; D057566:Self Report; D013548:Sweden / Q000453:epidemiology; D014186:Transportation; D035502:Trust