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BMJ. 2009 Jul 2;339:b2651. doi: 10.1136/bmj.b2651.

Public perceptions, anxiety, and behaviour change in relation to the swine flu outbreak: cross sectional telephone survey.

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  • 1King's College London, Institute of Psychiatry, Department of Psychological Medicine, Weston Education Centre, London SE5 9RJ.



To assess whether perceptions of the swine flu outbreak predicted changes in behaviour among members of the public in England, Scotland, and Wales.


Cross sectional telephone survey using random digit dialling.


Interviews by telephone between 8 and 12 May.


997 adults aged 18 or more who had heard of swine flu and spoke English.


Recommended change in behaviour (increases in handwashing and surface cleaning or plans made with a "flu friend") and avoidance behaviours (engaged in one or more of six behaviours such as avoiding large crowds or public transport).


37.8% of participants (n=377) reported performing any recommended behaviour change "over the past four days . . . because of swine flu." 4.9% (n=49) had carried out any avoidance behaviour. Controlling for personal details and anxiety, recommended changes were associated with perceptions that swine flu is severe, that the risk of catching it is high risk, that the outbreak will continue for a long time, that the authorities can be trusted, that good information has been provided, that people can control their risk of catching swine flu, and that specific behaviours are effective in reducing the risk. Being uncertain about the outbreak and believing that the outbreak had been exaggerated were associated with a lower likelihood of change. The strongest predictor of behaviour change was ethnicity, with participants from ethnic minority groups being more likely to make recommended changes (odds ratio 3.2, 95% confidence interval 2.0 to 5.3) and carry out avoidance behaviours (4.1, 2.0 to 8.4).


The results support efforts to inform the public about specific actions that can reduce the risks from swine flu and to communicate about the government's plans and resources. Tackling the perception that the outbreak has been "over-hyped" may be difficult but worthwhile. Additional research is required into differing reactions to the outbreak among ethnic groups.

[PubMed - indexed for MEDLINE]
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