title: Australian Hajj pilgrims' infection control beliefs and practices: Insight with implications for public health approaches.
abstract: BACKGROUND
  Hajj is one of the largest annual mass gatherings around the world. Although the Saudi Arabian health authority recommends vaccination and other infection control measures, studies identified variable uptake of these measures among pilgrims, and the reasons behind this variability remain unclear. This qualitative study aimed to addresses this knowledge gap.
  
  
  METHODS
  In-depth interviews were conducted with pilgrims over 18 years of age.
  
  
  RESULTS
  A total of 10 participants took part in the study. There was low perception of the potential severity of respiratory conditions and the need for influenza vaccination during Hajj. Different attitudes were found by age group with elderly participants believing that they were under Allah's protection, and were fatalistic about the risk of illness. While younger participants described the impact infections would have on their worship. Facemask use was infrequent with discomfort; difficulty in breathing and a feeling of isolation were commonly cited barriers to use of facemasks. Participants accepted and trusted preventative health advice from travel agents and friends who had previously undertaken the Hajj more so than primary care practitioners.
  
  
  CONCLUSIONS
  This study extended our understanding of how health beliefs influence uptake of preventive measures during the Hajj, and the gaps in the provision of Hajj-specific health information to pilgrims.
authors.affiliation: National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, NSW, Australia; School of Public Health, The University of Sydney, Sydney, New South Wales, Australia. Electronic address: Amani.alqahtani@health.nsw.gov.au.
authors.forename: Amani S
authors.initials: AS
authors.lastname: Alqahtani
authors.affiliation: School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Mohamud
authors.initials: M
authors.lastname: Sheikh
authors.affiliation: National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, NSW, Australia; School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Kerrie
authors.initials: K
authors.lastname: Wiley
authors.affiliation: School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Anita E
authors.initials: AE
authors.lastname: Heywood
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017053:Infection Control / Q000379:methods; D007514:Islam; D008297:Male; D008397:Masks; D008875:Middle Aged; D033262:Narration; D011634:Public Health; D012529:Saudi Arabia / Q000208:ethnology; D014195:Travel; D014611:Vaccination; D055815:Young Adult
keywords: Facemask; Hajj; Health advice; Qualitative study; Respiratory infection