Background
Behaviour | Definition |
---|---|
Isolation
| Staying home if symptomatic for at least 7 days (minimising contact with other household members) to reduce peak incidence of respiratory infection. |
Personal Protective Measures (PPM)
| Hygiene and distancing behaviours to reduce an individual’s chance of catching and passing on respiratory infections |
-Respiratory hygiene
| Covering/catching coughs and sneezes using disposable tissues |
-Hand hygiene
| Washing hands regularly and thoroughly with soap and water or hand gel |
-Mask wearing
| Wearing a surgical face mask |
-Personal distancing
| Keeping a distance of about 1 metre (3 feet) from people who appear symptomatic |
Social Distancing
| Actions taken by communities to reduce social contact and to literally increase the space between people |
-in children
| Temporarily closing schools and childcare facilities |
-in adults
| Postponing or cancelling large public gatherings, altering workplace environments, e.g. offering telework or remote-meeting options. |
Remote healthcare
| Accessing website or phone line advice and support, and setting up ’Flu friends’ (if ill) rather than going to local healthcare facilities to reduce spread of respiratory infection and avoid overstretching healthcare services. |
Methods
Search strategy and inclusion criteria
Inclusion criteria | Exclusion criteria | |
---|---|---|
Population of interest
| Adults ≥17years old | Health professionals, Children |
Exposure of interest
| Non-pharmaceutical respiratory infection control: | Pharmaceutical respiratory infection control: |
●Hand hygiene | ●Vaccination | |
●Respiratory hygiene | ●Antivirals | |
●Mask wearing | ||
●Isolation | ||
●Social distancing | ||
●Remote health care | ||
●Precautionary avoidance | ||
Outcome of interest
| Public perspectives of respiratory infection control (including beliefs, views, concerns, understandings and emotional and sociocultural factors) | |
Study design
| Qualitative (ethnography, grounded theory, phenomenology, focus groups, Interviews and participant observation) and mixed methods | Quantitative |
Quality appraisal and data extraction
Synthesis
Results
Study characteristics
Study (country) | Infection context (timing) | Participants (sampling) | Data collection and analysis | Behaviour type | Aims |
---|---|---|---|---|---|
SARS (During SARS, 2003-2004) | 21 adults quarantined during SARS outbreak in Toronto. (Stratified random) | Semi-structured interviews (21) Not stated (Miles & Huberman 1994) †
|
ISOLATION (Quarantine) |
To explore the experience of being on quarantine for severe acute respiratory syndrome (SARS) with a focus on the relationship between perceived risk of contracting SARS and reported compliance with the quarantine order and protocols.
| |
Janssen et al. (2006)[38]USA |
Avian Flu (Non-pandemic, 2005) | 136 members of the general public. (Purposive) | Focus groups Not stated |
PPM* (hygiene & vaccination) |
To test pandemic influenza messages with the public for understandability, believability/credibility, level of interest in the subject, perceived importance of the information, likelihood of action after being exposed to the information, and unanticipated consequences of the information.
|
Elledge et al. (2008)[39] USA |
Avian Flu (Non-pandemic, 2006) | 60 members of the general public.(Not stated) | Focus groups (12) Not stated |
PPM (hygiene) |
To determine the level of awareness of avian and pandemic flu for the county health department to develop effective communication messages
|
Jiang et al. (2009)[40]UK & Netherlands |
SARS (Post SARS, 2005-2006) | 164 European Chinese adults living in the UK & Netherlands. (Purposive) | Focus groups (23) Framework analysis (Ritchie J, Lewis J 2003) |
PPM (Mask wearing and personal distancing) |
To examine SARS-related risk perceptions and their impacts on precautionary actions and adverse consequences from the perspective of vulnerable communities living in unaffected regions.
|
Morrison & Yardley (2009)[41]UK |
Pandemic Flu (Non-pandemic, 2008) | 31 members of the general public. (Purposive) | Focus groups (8) & semi structured interview (1) Thematic analysis (Joffe H, Yardley L, 2004) |
PPM (Hygiene & personal distancing) |
To examine perceptions of infection control measures in the context of pandemic influenza.
|
Baum et al. (2009)[42]USA |
Pandemic Flu (Non-pandemic, 2008) | 37 members of the general public. (Purposive) | Focus groups (4) Thematic analysis (Creswell 2006; Krueger 1998; Weber 1990). |
DISTANCING (closure of schools, workplaces, public gatherings and quarantine) |
To characterize public perceptions about social distancing measures likely to be implemented during a pandemic.
|
Caress et al. (2010)[43]UK |
H1N1 2009 (Pandemic, 2009-2010) | 50 adults with a clinician-diagnosed chest problem & their family members(Purposive) | One to one interviews (20) & focus groups (3) Framework analysis (Ritchie & Spencer, 1994) |
ISOLATION & REMOTE CARE (Social isolation, help seeking and vaccination) |
To explore and compare information needs, worries and concerns, and health-related behaviours regarding swine flu in people with respiratory conditions and their family members.
|
Yardley et al. (2010)[44]UK |
Seasonal Flu and H1N1 2009 (Pandemic, 2009) | 28 members of the general public.(Purposive) | Semi structured -think aloud interviews Thematic analysis (Braun & Clarke, 2006; Joffe & Yardley, 2004) |
PPM (Hand washing) |
To explore attitudes towards preventive behaviours to reduce the risk of transmission of seasonal and pandemic flu in the UK in order to inform development of an intervention.
|
Sui (2010)[45] Hong Kong |
H1N1 2009 (Pandemic, 2009) | 30 chronic renal disease patients (Purposive) | Participant observation, semi-structured interviewsThematic content analysis (Liamputtong & Ezzy, 2005) |
PPM (Mask wearing and personal distancing) |
To demonstrate the knowledge perceptions of and the preventive health behaviours toward the influenza A H1N1 pandemic among the chronic renal disease patients in Hong Kong.
|
Hilton & Smith (2010)[46] UK |
H1N1 2009 (Pandemic, 2009-2010) | 73 members of the general public. (Purposive) | Focus groups (14) Not stated (Pope & Mays 2000)†
|
PPM (Hygiene & vaccination) |
To examine public understandings of the swine flu pandemic, exploring how people deciphered the threat and perceived they could control the risks.
|
Ferng et al. (2011)[47] USA |
Influenza-like illness (Non-pandemic, 2008) | 15 Hispanic females living in USA (Purposive) | Participant observation and one focus group Not stated |
PPM (Mask wearing) |
To identify barriers to mask wearing for influenza-like illness and to examine the factors associated with the willingness to wear masks among households.
|
Nizame et al. (2011)[48] Bangladesh |
Respiratory infections (Non-pandemic, 2008-2009) | 178 members of the general public. (Purposive) | Interviews (34) & Focus Groups (16) Thematic content analysis |
PPM (Hand and respiratory hygiene |
To explore community perceptions on respiratory infections, why they occur, how they are spread, and the preventive measures that people take to protect themselves and their families.
|
Teasdale & Yardley (2011)[49] UK |
H1N1 2009 (Pandemic, 2009) | 48 members of the general public. sive) | Focus groups (11) Thematic analysis (Braun & Clarke, 2006; Joffe & Yardley, 2004) |
ISOLATION & REMOTE CARE (Social isolation, remote health care & vaccination) |
To explore people’s beliefs, perceptions, reasoning, and emotional and contextual factors that may influence responses to government recommendations for managing flu pandemics.
|
Gray et al. (2012)[50] New Zealand |
H1N1 2009 (Pandemic, 2010) | 80 members of the general public. (Purposive) | Focus groups (8) Thematic analysis (Braun and Clarke, 2006) |
PPM & DISTANCING (social isolation, social distancing & vaccination) |
To provide qualitative data about community responses to key health messages in the 2009 and 2010 H1N1 campaigns, the impact of messages on behavioural change and the differential impact on vulnerable groups in New Zealand.
|
Rodriguez (2012)[51] Spain |
H1N1 2009 (Pandemic, 2010) | 51 members of the general public.(Purposive) | Focus groups (10) Not stated |
PPM (Hygiene & vaccination) |
To explore the views of the general population, the risk groups and medical personnel on the H1N1 influenza epidemic of winter 2009-2010.
|
Seale et al. (2012)[52] Australia |
Seasonal Flu and H1N1 2009 (Pandemic, 2010) | 20 university students in New South Wales. (Convenience) | Semi-structured interviews Not stated |
PPM & DISTANCING(Hygiene, social distancing and isolation) |
To examine the knowledge, attitudes, risk perceptions, practices and barriers towards influenza and infection control strategies.
|
Key themes
Theme Sub-theme | Summary definition | Study reference by infection context and study population | |||||||
---|---|---|---|---|---|---|---|---|---|
SARS | Non-pandemic | H1N1 2009 pandemic | |||||||
S1 | S2 | N1 | N2 | P1 | P2 | P3 | |||
1 | Perceived benefits of non-pharmaceutical interventions | ||||||||
a | Hand and respiratory hygiene is common sense/familiar | Hygiene behaviours are seen as familiar and acceptable in varying contexts and populations | [50] | [43] | |||||
b | Mask wearing demonstrates responsibility and reduces stigma | Mask wearing is seen as a way of visibly demonstrating one’s desire to protect self and others from infection, which can in turn reduce social stigma experienced. | [45] | ||||||
c | Social isolation and distancing are socially responsible actions | Isolation and distancing are believed to be socially responsible actions and seen as necessary for the protection of society as a whole | [36] | ||||||
2 | Perceived disadvantages of non-pharmaceutical interventions | ||||||||
a | Hand washing for respiratory infection control is irrelevant | Additional hand washing behaviours are seen as irrelevant by those who class themselves as regular hand washers | [41] | ||||||
b | Hand washing and mask wearing can attract social stigma | Hand washing and mask wearing are perceived as socially unacceptable due to the potential to attract discrimination and embarrassment | [40] | [41] | [47] | ||||
c | Non-pharmaceutical behaviours have negative personal and socioeconomic impacts | Perceived physical, practical, emotional and socioeconomic costs of isolation social distancing, mask wearing and hygiene behaviours | [47] | [50] | |||||
3 | Personal/cultural beliefs about infection transmission | ||||||||
Common beliefs about respiratory infections are caught and spread e.g. via air, from symptomatic others and in cold temperatures | [36] | [40] | [43] | ||||||
4 | Diagnostic uncertainty in emerging respiratory infections | ||||||||
Identifying symptoms of and having to diagnose infection in an emerging respiratory infection is seen as confusing and concerning and can lead to uncertainty about when to adopt infection control | [43] | ||||||||
5 | Perceived vulnerability to respiratory infections | ||||||||
a | Perceived health status | Evaluating one’s vulnerability to respiratory infection in terms of own perceived health status and the health of others | |||||||
b | Proximity to the origin of outbreak | Evaluating susceptibility to a new respiratory infection in terms of geographical proximity to the origin of the outbreak and type of living environment | [40] | ||||||
6 | Anxiety about emerging respiratory infections | ||||||||
a | Decreasing anxiety over the course of an outbreak | Initial anxiety in an outbreak decreases over the course of the outbreak as public reassess the risk/impact of a new respiratory infection according to personal experience vs. information presented in the media | [40] | [43] | |||||
b | High anxiety if perceived to be more vulnerable | Greater anxiety experienced during H1N1 by those who perceived themselves to be more vulnerable to infection. | [43] | ||||||
c | Low anxiety | Low levels of worry experienced during an emerging respiratory infection outbreak | [43] | ||||||
7 | Communications about emerging respiratory infections | ||||||||
a | Media reporting of information on new respiratory infection outbreaks is seen overhyped | People appraise the credibility of information/communications about a new respiratory outbreak in terms of consistency of information and perceived exaggeration compared to actual/previous experience | [40] | [43] | |||||
b | Official communication about new respiratory infection outbreaks is not reliable (threat is downplayed) | Some people’s evaluation of information influenced by scepticism about level of detail presented (i.e. not being given all the facts) | [50] | [43] |