Beyond resistance: social factors in the general public response to pandemic influenza.
BACKGROUND
Influencing the general public response to pandemics is a public health priority. There is a prevailing view, however, that the general public is resistant to communications on pandemic influenza and that behavioural responses to the 2009/10 H1N1 pandemic were not sufficient. Using qualitative methods, this paper investigates how members of the general public respond to pandemic influenza and the hygiene, social isolation and other measures proposed by public health. Going beyond the commonly deployed notion that the general public is resistant to public health communications, this paper examines how health individualism, gender and real world constraints enable and limit individual action.


METHODS
In-depth interviews (n = 57) and focus groups (ten focus groups; 59 individuals) were conducted with community samples in Melbourne, Sydney and Glasgow. Participants were selected according to maximum variation sampling using purposive criteria, including: 1) pregnancy in 2009/2010; 2) chronic illness; 3) aged 70 years and over; 4) no disclosed health problems. Verbatim transcripts were subjected to inductive, thematic analysis.


RESULTS
Respondents did not express resistance to public health communications, but gave insight into how they interpreted and implemented guidance. An individualistic approach to pandemic risk predominated. The uptake of hygiene, social isolation and vaccine strategies was constrained by seeing oneself 'at risk' but not 'a risk' to others. Gender norms shape how members of the general public enact hygiene and social isolation. Other challenges pertained to over-reliance on perceived remoteness from risk, expectation of recovery from infection and practical constraints on the uptake of vaccination.


CONCLUSIONS
Overall, respondents were engaged with public health advice regarding pandemic influenza, indicating that the idea of public resistance has limited explanatory power. Public communications are endorsed, but challenges persist. Individualistic approaches to pandemic risk inhibit acting for the benefit of others and may deepen divisions in the community according to health status. Public communications on pandemics are mediated by gender norms that may overburden women and limit the action of men. Social research on the public response to pandemics needs to focus on the social structures and real world settings and relationships that shape the action of individuals.
School of Social Sciences, Monash University, Melbourne, Victoria, Australia. mark.davis@monash.edu.
Mark D M
MD
Davis
School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia. n.stephenson@unsw.edu.au.
Niamh
N
Stephenson
School of Social Sciences, Monash University, Melbourne, Victoria, Australia. davina.lohm@monash.edu.
Davina
D
Lohm
School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia. e.waller@unsw.edu.au.
Emily
E
Waller
School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland. P.Flowers@gcu.ac.uk.
Paul
P
Flowers
D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia; D005260:Female; D017144:Focus Groups; D058015:Health Communication; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007252:Influenza Vaccines / Q000627:therapeutic use; D007251:Influenza, Human / Q000517:prevention & control*; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D058873:Pandemics / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D011247:Pregnancy; D011634:Public Health / Q000706:statistics & numerical data*; D012606:Scotland; D017678:Sex Distribution; D055815:Young Adult
D007252:Influenza Vaccines