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PLoS One. 2010 Oct 12;5(10):e13350. doi: 10.1371/journal.pone.0013350.

Situational awareness and health protective responses to pandemic influenza A (H1N1) in Hong Kong: a cross-sectional study.

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  • 1Health Behaviour Research Group, Department of Community Medicine, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China.



Whether information sources influence health protective behaviours during influenza pandemics or other emerging infectious disease epidemics is uncertain.


Data from cross-sectional telephone interviews of 1,001 Hong Kong adults in June, 2009 were tested against theory and data-derived hypothesized associations between trust in (formal/informal) information, understanding, self-efficacy, perceived susceptibility and worry, and hand hygiene and social distancing using Structural Equation Modelling with multigroup comparisons.


Trust in formal (government/media) information about influenza was associated with greater reported understanding of A/H1N1 cause (β = 0.36) and A/H1N1 prevention self-efficacy (β = 0.25), which in turn were associated with more hand hygiene (β = 0.19 and β = 0.23, respectively). Trust in informal (interpersonal) information was negatively associated with perceived personal A/H1N1 susceptibility (β = -0.21), which was negatively associated with perceived self-efficacy (β = -0.42) but positively associated with influenza worry (β = 0.44). Trust in informal information was positively associated with influenza worry (β = 0.16) which was in turn associated with greater social distancing (β = 0.36). Multigroup comparisons showed gender differences regarding paths from trust in formal information to understanding of A/H1N1 cause, trust in informal information to understanding of A/H1N1 cause, and understanding of A/H1N1 cause to perceived self-efficacy.


Trust in government/media information was more strongly associated with greater self-efficacy and handwashing, whereas trust in informal information was strongly associated with perceived health threat and avoidance behaviour. Risk communication should consider the effect of gender differences.

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